Mark Boone, Medicare Insurance Agent

Answer: Switching from a Medicare Advantage plans back to original Medicare is easy, but you must enroll in a Prescription Drug Plan (Part D) and you can only do that during the Annual Enrollment Period (AEP) or during a Special Enrollment Period (SEP) otherwise you may be subject to a late enrollment penalty for each month you do not have Part D coverage

Answer: There are 5 key mistakes seniors make when enrolling in Medicare.

1. Missing Deadlines (The Top Mistake): Failing to sign up during the 7-month window (3 months before, 65th birthday month, 3 months after) leads to a 10% premium penalty for Part B for every 12-month period delayed.

2. Assuming Automatic Enrollment: If you are not collecting Social Security at least 4 months before turning 65, you must proactively sign up, as enrollment is not automatic.

3. Misunderstanding Work Coverage: Assuming you must sign up at 65 while still working with credible employer coverage, or conversely, failing to sign up when employer coverage ends.

4. Confusing Medigap and Advantage: Failing to understand that Medicare Advantage is different from Original Medicare + Medigap, which can limit doctor choices.

5. Choosing Based Only on Premiums: Picking a plan with a $0 premium but high out-of-pocket costs, or neglecting to check if doctors/drugs are covered

Answer: Create a comfortable environment for discussion by choosing a calm, private setting, and adopting a supportive, empathetic tone that emphasizes working with them rather than taking control. Focus on listening to their concerns, asking open-ended questions, and reviewing documents like the Annual Notice of Change together.

Answer: Medicare Part B covers intensive outpatient programs for seniors that require more than 9 hours of weekly therapeutic services, acting as a bridge between weekly therapy and inpatient care. Services, which include group/individual therapy and medication management, are covered at 80% of the Medicare-approved amount in hospital outpatient settings or clinics.

Answer: Neither Original Medicare nor Medicare Advantage is objectively "better"; the right choice depends on whether you prioritize lower, predictable costs and extra benefits (Advantage) or national provider flexibility (Original). Medicare Advantage often includes dental, vision, and drug coverage with a maximum out-of-pocket limit, while Original Medicare allows you to see any doctor nationwide who accepts Medicare.

Answer: Yes, you can temporarily add travel or out-of-state health coverage. Options include purchasing short-term travel medical insurance (especially for international trips) or checking if your current plan offers a "traveler/visitor benefit" for extended stays. For domestic travel, Medicare Parts A & B cover you nationwide, while Medicare Advantage/ACA plans often restrict non-emergency care to in-network providers

Answer: You will have what's called a Special Enrollment Period (SEP). You will have 1 month before and two months after you move to make a change if you have a Medicare Advantage plan. If you have Original Medicare, that moves with you regardless. You will want to make sure any new doctors are covered by your new plan and that plans covers your prescription medications. If you are receiving medical assistance, that does not move with you and you will need to apply in your new area. The sooner you take care of these things, the less likely you could encounter any gaps in coverage.

Answer: Plan G is widely considered the best value for most new Medicare beneficiaries because it offers the most comprehensive coverage available—covering all Medicare gaps except for the annual Part B deductible. It provides high predictability for healthcare costs with low out-of-pocket expenses, making it the top choice for those eligible after January 1, 2020

Answer: To manage bipolar disorder at 66, structure your Medicare with Original Medicare + Medigap + Part D, or choose a Medicare Advantage plan with low copays for specialists. Key coverage includes psychiatrist visits, therapy, and mood-stabilizing medications. Ensure providers accept Medicare assignment to minimize out-of-pocket costs

Answer: Medicare Advantage plans are offered through private health insurance companies, as alternatives to Original Medicare, often offering lower premiums and extra benefits like dental, vision, and hearing coverage, along with a yearly cap on out-of-pocket costs. However, they generally restrict you to specific networks of doctors and require prior authorization for services, unlike the nationwide flexibility of Original Medicare.

Answer: The best Medicare option for chronic kidney disease is often a Medicare Advantage Chronic Condition Special Needs Plan (C-SNP) if one is available in your area. Not only do these plans offer extra benefits like dental, vision, or transport, they usually cater care and out of pocket costs specifically to the chronic condition. Check with a certified agent in your area to see what is available to you.

Answer: Medicare Part B covers screening mammograms every 12 months for women 40+ at 100% of the Medicare-approved amount (no deductible or coinsurance) if providers accept Medicare.

Answer: You do not automatically need to change your Medicare plan, but you should review it to ensure your new prescription is covered cost-effectively. You can contact a licensed certified Medicare agent in your area that can help you compare plans and see if a new plan is right for you.

Answer: The best thing you can do is talk to a licensed Medicare certified agent in your area that can help you sort through your options and steer you in the right direction. Assuming you qualify for Medicare Part A, you will receive that automatically at age 65, then you need to apply for Part B. Once you have both Part A and Part B, you will need to decide if original Medicare is right for you or having a Medicare Supplement (Medigap) or Medicare Advantage Plan. That is where a certified agent would be able to help you most.

Answer: Because you are receiving SSI, you will most likely be automatically enrolled in Medicare Parts A and B starting June 1, 2026. You most likely will be able to keep both Medicare and Medicaid, making you “dual eligible,” and Medicaid can help cover any premiums and cost-sharing. If your income and assets remain low, you will likely qualify for QMB, which pays your Part B premium and any co-pays or deductibles as well as make you eligible for a Dual Special Needs Plan (D-SNP if one is available in your area). The multiple notices are normal and come from both the Social Security Administration and your state Medicaid office as you transition to age 65.

Answer: You should review your ANOC each year for changes to premiums, deductibles, and co-pays to avoid surprises. Other key areas to check include provider network changes, formulary updates, and changes to extra benefits like dental or vision.

Answer: Medicare covers a wide range of preventive services, typically at no cost to you, to help detect illnesses early. These preventive services can include the "Welcome to Medicare" visit (within 12 months of joining), annual wellness visits, cancer screenings (mammogram, colonoscopy), vaccines (flu, pneumonia), and cardiovascular/diabetes screenings

Answer: SilverSneakers is not included in Original Medicare, it is offered as an optional extra benefit through Medicare Advantage plans. Your friend likely has a plan that includes this fitness benefit, while yours does not, as benefits vary by company, location, and plan type

Answer: You can switch to a medigap plan at any time during the year, but you will most likely be subject to underwriting and could be denied. Also you would not be able to add a prescription drug plan unless it is during the annual enrollment period or you have a special enrollment period

Answer: No, Medicare does not cover medical marijuana, even if recommended by a doctor for chronic pain, cancer, or other conditions. The federal government still classifies marijuana as a Schedule I controlled substance and it lacks FDA approval, no part of Medicare covers it

Answer: in most cases, you won’t be able to switch your Medicare Advantage plan to a Medicare Supplement policy outside your 6-month Medigap Open Enrollment Period except in specific situations when you have a guaranteed issue without having to go through underwriting. There are a few circumstances where you may be allowed a guarantee issue such as your Medicare Advantage plan is being eliminated or in some states around your birthday.

Answer: A change in health condition doesn't change your eligibility or coverage, but you should review your plan to make sure it covers new, higher costing, or specific care needs. While you can't be denied coverage for new conditions, you could have higher out-of-pocket costs if your current plan has restrictive networks or limited drug coverage.

Answer: I enjoy working with Medicare clients because it gives me the opportunity to make a meaningful difference in their lives. Medicare can be difficult to navigate and can be overwhelming. I pride myself on going over the options and clarifying any questions they may have. I thoroughly enjoy It's very rewarding seeing the relief and peace of mind that comes when seniors feel secure in their healthcare decisions. My goal is always to provide personalized service so that each client feels they have an advocate that will be with them for a long time and isn't just looking to make a sale and never help them again.

Answer: People sometimes regret choosing Medicare Advantage (MA) due to restricted doctor/hospital networks, copays/coinsurance, denials or delays for care (prior authorizations), loss of flexibility, and difficulties switching back, especially with pre-existing conditions. They often feel "trapped" by the complex rules that contrast with Original Medicare's broader access.

Answer: To avoid overpaying, review your plan during Annual Enrollment (Oct 15-Dec 7) using the official Medicare Plan Finder on medicare.gov to compare costs, benefits, and drug formularies, as well as connect a local independent Medicare certified agrent. Also check if you qualify for state/federal Medicare Savings Programs (MSPs) or other help with costs. Be aware of income-related surcharges (IRMAA) and report income changes, and use in-network providers to minimize out-of-pocket expenses

Answer: You have 2 months before the month you turn 65, the month you turn 65 and then 2 months after to enroll in a Medicare plan. If you are talking about Medicare part A and part B, as long as you have 40 credited working quarters, you will get part A automatically at age 65. Part B you need to apply through Medicare.

Answer: Your Medicare Advantage plan likely covers medically necessary eye surgery, like standard cataract surgery, but you'll still have out-of-pocket costs and must use in-network providers; costs vary, so always call your plan directly to confirm your financial responsibility before surgery, especially for advanced lenses or extra services.

Answer: Yes, if you have a Medicare Advantage plan or a prescription drug plan, you likely need to look for a new one when moving to a different county, as these plans have specific service areas.

Answer: Medicare Advantage plans can save seniors money with lower monthly premiums and extra benefits such as dental and vision but they often come with higher out-of-pocket costs for services and potential network restrictions.

Answer: Discount cards offer separate savings but don't integrate with your Medicare Part D plan and costs from discount cards don't count toward your Part D out-of-pocket maximum

Answer: first of all you should verify if you plan covers the specialist to make sure you are covered for visits and treatments

Answer: Yes, Medicare (Part B) covers chiropractic care, but only for spinal manipulation (adjustment) to correct a subluxation (misaligned bone in your spine), not for general back pain, exams, X-rays, or maintenance therapy. You pay 20% coinsurance after your deductible, and the chiropractor must be enrolled with Medicare; other services (massage, acupuncture, extremities) and tests are usually not covered, though Medicare Advantage plans might offer more

Answer: The Income-Related Monthly Adjustment Amount (IRMAA) is an extra surcharge added to your Medicare Part B and Part D premiums if your income is above a certain threshold. The Social Security Administration (SSA) determines this based on your tax return from two years prior and will notify you by mail if it applies

Answer: yes, it's very likely that MA plans will offer more digital health tools by 2030 because of existing trends, driven by government initiatives, market demand, and technological advancements like AI.

Answer: many people are surprised by Medicare's ambulance rules, as Original Medicare (Part B) typically pays 80% of the approved amount after the deductible, leaving you with 20% (around $300 is common) unless you have Medigap or Medicare Advantage plan

Answer: yes, those medications are usually covered under your Part D plan or the prescription drug coverage of your Medicare Advantage plan.

Answer: Medicare usually doesn't cover the costs of experimental treatments or clinical trials. They may cover the cost of the doctor visits and any side effects from the treatment or trial.

Answer: If you have Original Medicare, you will be paying for eye exams and contacts and glasses on your own. If you have a Medicare Advantage plan, many times those things are covered or partially covered along with dental and hearing. The other option is to purchase a stand alone vision plan that would cover exams and many other procedures

Answer: The biggest impacts will likely be in the areas of AI and remote patient monitoring, driven by the need for more efficient and personalized care. Healthcare will see greater use of AI for decision making support and patient communication, while remote patient monitoring (RPM) will become more integrated into chronic disease management, supported by wearable devices and the expansion of virtual care

Answer: Doctors may dislike Medicare Advantage plans because of lower reimbursement rates, administrative burdens like prior authorization, and restrictions on provider networks

Answer: Medicare Part B covers remote patient monitoring (RPM) services, for managing a heart condition from home, provided they are medically necessary and prescribed by your physician.

The services fall under Medicare Part B, which covers 80% of the Medicare-approved amount after you meet your Part B deductible. Medigap or a Medicare Advantage plan can often cover the remaining 20%

Answer: When I explain the reality to clients, I highlight that these ads don't include details like provider network limitations, potential costs for treatments like dental work, and the differences between Medicare Advantage plans. I focus on the importance of reading the plan's detailed benefits, checking that their preferred doctors are in-network, and understanding that "free" doesn't mean all costs are covered.

Answer: of course. It's a good idea to discuss your plans with your family so they know what is available and what you have for coverage. If you want them to talk to Medicare or to an agent regarding what plan is best for you, you either need to be in room with them or they have some type of documentation that allows them to act on your behalf, such as a power of attorney.

Answer: You could call the Medicare insurance carrier directly, but a carrier can only tell you about their own plans, so you would have to call multiple carriers to compare options. It is often more efficient and beneficial to use a licensed independent broker

Answer: The Medigap Birthday Rule is in effect in nine states: California, Idaho, Illinois, Kentucky, Louisiana, Maryland, Nevada, Oklahoma, and Oregon. This rule allows existing Medigap policyholders to switch to a new plan of equal or lesser benefits without needing medical underwriting around their birthday

Answer: No, you don't need a form to decline Part B if you're not signing up for it, but you do need to ensure your coverage is creditable to avoid a late penalty later. You can only delay Part B without penalty if you or your spouse are currently employed and you have employer-sponsored group health coverage through that job. You should inform the Social Security Administration that you are delaying Part B because of this coverage, which can be done by contacting them

Answer: The new changes to Medicare Part D Maximum Out of Packet expenses will greatly reduce your costs. With the new rules of MOOP of $2100 for 2026 you will see your medicine costs be much lower.

Answer: Whether you should enroll or not enroll depends on the employer's size and coverage. If you have employer coverage from a company with 20 or more employees, you can likely delay Part B enrollment without penalty and enroll in premium-free Part A. If your employer has fewer than 20 employees, you should enroll in both Part A and Part B during your initial enrollment period, as Medicare will become primary and your employer's coverage secondary.

Answer: I wouldn't say it's a trick, but a tactic some agents use is to not disclose if your doctor is in network or out of network. Also not telling you its an HMO vs a PPO

Answer: Insurance companies can offer Medicare Advantage plans with a $0 monthly premium because they receive a fixed monthly payment from the federal government for each person enrolled in their plan. From an accounting standpoint the company hopes that the payment from the federal government along with the co-pays and deductibles received offsets the the cost of coverage

Answer: AI will definitely change the way Medicare claims are handled by speeding up prior authorization, identifying potential fraud, waste, and abuse, and improving efficiency. There are still concerns that AI will increase denials and have an artificial bias by taking out the human element of underwriting or handling claims.

Answer: Yes, this is normal. Most Medicare advantage plans will cover preventive dental care and either none or very limited on comprehensive coverage. If you know you need additional dental coverage, it is best to ask what is covered by your MA plan or purchase additional coverage that will cover your needs

Answer: The donut hole was eliminated before 2025 thus there is no longer a gap in coverage. Once you reach $2100 you no longer will pay anything for your prescription medications in 2026.

Answer: You haven't missed anything yet, you have until December 7th to make any changes for a January 1st effective date. If you have a Medicare Advantage plan and miss that enrollment period you will be able to make another change from January 1-March 31, if you have a Medicare Advantage plans. Sometimes you may qualify for a Special Enrollment Period that would allow you to make a change outside of those periods

Answer: Every Part D plan has its own specific formulary drug list, and different rules. A drug that didn't require PA under your old plan might have different coverage rules under a new one thus the need for a prior authorization

Answer: To some it is concerning that Medicare Advantage plans are increasing their enrollment because of issues like potential denials of care, network restrictions, and higher costs to the Medicare program, though supporters point to the added benefits like vision and dental coverage as reasons for a Medicare Advantage plan

Answer: Medicare Advantage plans are a form of managed care, and prior authorization is used to manage costs by ensuring services are medically necessary before they are approved

Answer: Yes, you may still have guaranteed issue after the general Medicare Open Enrollment period ends, but only in specific qualifying situations, such as losing other health coverage or moving out of your Medicare Advantage plan's service area. These rights are separate from the initial six-month Medigap Open Enrollment Period and allow you to purchase a Medigap policy without medical underwriting during these events

Answer: Following up with parents after discussing Medicare is crucial for ensuring they understand their options, feel supported, and avoid costly mistakes

Answer: You are not eligible yet as you need to reside in the US for 5 continuous years as a permanent resident

Answer: No, Original Medicare generally does not cover supplements, herbs, homeopathy, or most natural/alternative medicine, as it typically requires FDA approval and scientific evidence for coverage. Some Medicare Advantage plans may offer limited coverage for certain services like acupuncture or provide benefits for specific supplements, so it's crucial to check your specific plan's details.

Answer: Most likely you have a Medicare Advantage plan and prior authorizations are common. The insurance company just wants to make sure its medically necessary and that all other options have been reviewed. Getting a prior authorization shouldn't be that difficult. The surgeon just needs to submit a request that it's a medically necessary operation and it's usually granted. Just because you are being asked to get prior authorization does not mean your plan is bad.

Answer: Original Medicare with a Part D plan is often better for frequent travelers because it offers nationwide coverage without geographic limitations, unlike most Medicare Advantage plans which restrict you to a specific provider network and service area

Answer: The most common Medicare penalties are the Late Enrollment Penalties for Part B and Part D, which apply if you don't sign up when you're first eligible and don't have other creditable coverage

Answer: No, you do not have to sign up for Medicare again if you are already receiving it due to a disability, as you will be automatically enrolled in Medicare Parts A and B when you turn 65. Your Medicare coverage will continue uninterrupted. You will receive a new Medicare card about three months before your birthday in October.

Answer: Original Medicare does not offer incentives or rewards for maintaining a healthy lifestyle, but many private Medicare Advantage (Part C) plans and some Medicare Supplement (Medigap) plans offer such benefits.

Answer: Plan K has lower monthly premiums but higher out-of-pocket costs, whereas Plan G has higher premiums but lower, more predictable out-of-pocket expenses. Plan K covers a percentage of costs (50% for many services) until you meet an annual out-of-pocket limit, after which it pays 100%. Plan G typically covers 100% of most Medicare-approved costs after you pay the Part B deductible.

Answer: Original Medicare (Parts A and B) can cover some in-home care for dementia if it is medically necessary and ordered by a doctor, including skilled nursing care, physical or occupational therapy, and medical social services, as long as your mom is homebound. For potentially broader coverage, including help with daily activities, consider a Chronic Special Needs Plan (C-SNP) (a type of Medicare Advantage plan) or the Program of All-Inclusive Care for the Elderly (PACE), especially if your mom qualifies for both Medicare and Medicaid. Care must be provided by a certified home healthcare agency.

Answer: If you need cataract surgery, Medicare may cover most of the cost. However, you may pay deductibles and other out-of-pocket fees depending on if you have Original Medicare, a Medicare supplement or a Medicare Advantage plan. Medicare will cover the standard surgery but choosing a premium lens like a multifocal or toric lens will likely result in additional costs for the lens and any related tests

Answer: Yes, significant changes to Medicare in 2026, including a $2,100 annual cap on out-of-pocket prescription drug costs and the start of negotiated prices for some high-cost drugs. Other changes include an increase in the Part B premium, an increase to the maximum Part D deductible to $615, and changes to some Medicare Advantage plans, including stricter rules on certain benefits and potential shrinking doctor networks as well as some plans being eliminated and some carriers no longer writing Medicare Advantage plans.

Answer: yes you can change your Medigap policy at any time but you may be subject to underwriting unless you have a guaranteed issue enrollment period or another reason that qualifies for guaranteed issue

Answer: Your experience can be frustrating because many Medicare Advantage plans include dental benefits as a key selling point. It's hard for me to comment if you had been told the plan includes dental by your agent or they may not have fully explained the specific limitations. In other cases, the restrictions might have been in the plan materials, but were not obvious. If you did not use an agent, you may not have seen what was covered under dental and what wasn't. In any event, since it is the Annual Enrollment Period right now you can make a change and find a plan that fits your needs.

Answer: Yes, with Medicare Part B, you must first meet your annual deductible before coverage for physical therapy begins. After the deductible is met, Medicare Part B pays 80% of the approved amount for outpatient physical therapy services, and you are responsible for the remaining 20%.

Answer: Your Medicare Advantage (Part C) plan replaces Original Medicare, so the deductible is not what you see listed for Original Medicare Part A. Instead, you will be responsible for the $350 copay per day for the first 7 days of a hospital stay, and then your plan will cover costs according to your specific Part C plan's rules for subsequent days. You must pay the $350 copay for each benefit period, and your out-of-pocket costs will depend on your plan's maximum out-of-pocket limit

Answer: Medicare Parts A and B can cover home health care if a doctor certifies you are homebound and need skilled nursing care. Coverage includes skilled nursing, physical therapy, and occupational therapy. Home health aides are covered only when they also provide skilled care, such as help with bathing or walking, as part of a larger care plan. Personal care and 24-hour care are not covered. Most Medicare Advantage plans also cover home health care.

Answer: As long as the facility where you have the surgery accepts Medicare, you will only be responsible for the Part B annual deductible ($257 for 2025). Once you pay the Part B annual deductible, Medicare will pick up 80% of the remaining bill, and your Medigap Plan G will pick up the other 20%. Most knee replacements also require a hospital stay, so you may need to meet your Part A deductible also. After that you should not have any additional expenses.

Answer: The benefit of using an agent is that you are getting an ally that is trained and certified in all the different plans that are available in your area. We can also at a glance have access to all the plans and be able to compare them for you. Most independent agents are able to help you make an unbiased decision that best suits your needs

Answer: Original Medicare (Part A and B)

Covers hospital stays and medical services like doctor visits and outpatient care.

You can see any doctor or specialist who accepts Medicare.

Includes deductibles, copayments, and coinsurance, and there is no annual out-of-pocket maximum limit.

Does not include prescription drug coverage; you must purchase a separate Part D plan.

Does not cover extra benefits like routine vision, dental, or hearing care.

Medicare Advantage (Part C)

Bundles Part A, Part B, and often Part D (prescription drugs) into a single plan, plus additional benefits.

You typically must use doctors and hospitals within the plan's network.

May include a monthly premium in addition to the Part B premium. Has an out-of-pocket maximum for Part A and B services, which limits your yearly spending on those costs.

Usually includes prescription drug coverage (known as an MAPD plan).

Often includes coverage for things like routine vision, hearing, and dental care, fitness programs, and transportation to appointments.

Answer: The Annual Notice of Change was sent prior to October 1st. You should have received around that time. If you didn't you can call your provider and see if they can send it again.

Answer: It's ok. If you choose a Medicare Advantage Plan during Annual Enrollment, you have a chance to change it during Open Enrollment. Annual Enrollment Period (AEP) runs from October 15-December 7. Open Enrollment Period (OEP) runs from January 1-March 31

Everyone can make a change during AEP and only those that have a Medicare Advantage Plan can change during OEP. Sometimes under certain conditions a person may be eligible for a Special Enrollment Period (SEP) and can make a change during that time.

Answer: There could be many reasons. Your best bet is to contact the Social Security Administration and find out. It could be that you signed up late and you are being assessed a late enrollment penalty, it could be that SSA hasn't gotten the paperwork finished yet to take from your social security check or many other reasons. Again, the best thing to do is call SSA and they can provide the definite answer,

Answer: I feel the best way to build rapport is to be honest and knowledgeable and for the beneficiary to truly believe you have their best interest at heart.I don't think it's any different if it's on the phone or ii-person. Either way you still need to build that level of trust and respect. The most important thing to do is to listen

Answer: The best way to compare Medicare plans for your parents is to start by understanding their current healthcare needs, doctors, and prescriptions and then either doing the research yourself on Medicare.gov or contact a licensed broker in your area that can narrow down the options to the ones that would work for your parents

Answer: I get paid from the insurance company after they get paid from Medicare (CMS). For me personally it does not affect the plan I recommend. I recommend the plan that is right for the client and will give them the best coverage to meet most or all of their needs. Commission should never be the driving force on which plan to recommend to a client

Answer: To avoid surprise lab bills under Medicare Advantage, stay in-network for all tests, verify coverage with your plan before the service, and ask your doctor if the tests are medically necessary and covered. It is also helpful to confirm with your plan if prior authorization is needed and to get the Current Procedural Terminology (CPT) code to check pricing.

Answer: When a spouse passes away, your Medicare premiums can increase due to changes in your tax filing status, which affects the income-related monthly adjustment amount (IRMAA). Another possible reason is the loss of a household discount if you had a supplemental Medicare plan. The first year after your spouse's death, your IRMAA is likely still being calculated using your old, higher joint income. The Medicare system then applies that income against the new, lower threshold for individuals, which can put you in a higher premium bracket.

Answer: To compare a Medicare supplement (Medigap) plan with a Medicare Advantage plan, evaluate costs (premiums, copays, and out-of-pocket maximums), coverage (including prescription drugs and supplemental benefits like dental and vision), and network restrictions for doctors and pharmacies. Consider doctor and hospital choice, cost, coverage, and foreign travel when deciding between a Medicare supplement and a Medicare Advantage plan

Answer: No, Original Medicare typically does not cover routine eye exams, eyeglasses, or contact lenses. However, Medicare Part B does cover medically necessary eye exams and services, such as annual diabetic eye exams and glaucoma screenings for high-risk individuals, and one pair of eyeglasses or contacts after cataract surgery with an intraocular lens implant

Answer: Yes, you should expect out-of-pocket costs after surgery, which can include costs for the surgeon, facility, anesthesia, labs, and medications, depending on your health insurance plan's deductibles, copayments, and coinsurance. Your final financial responsibility will also depend on whether the providers are in-network, if you've met your out-of-pocket maximum, and if you qualify for any financial assistance from the hospital. You should contact your insurance provider and the hospital to get an accurate estimate of your costs before and after the procedure

Answer: The best way to protect yourself is to only work with reputable agents in your area. You can find agents by doing a online search of agents and then checking with CMS or the state insurance department. In my opinion if an agent is reputable they will not be concerned about you doing your due diligence on them and making sure they have your best interests in hand.

Answer: To save money on your Medicare Supplement (Medigap) plan, shop for a new policy with a different insurance company as plans with the same letter (e.g., Plan G) offer identical coverage and vary only in price, check if you qualify for state-run Medicare Savings Programs, and ask the Social Security Administration to lower your Medicare Part B and Part D IRMAA (Income-Related Monthly Adjustment Amount) if you have a life-changing event that reduced your income. It's a good idea to shop your Supplement plan annually because premiums do change.

Answer: Yes, you will likely face a Medicare Part B late enrollment penalty if you don't enroll at age 65 unless you have other creditable coverage, such as through a current employer. This penalty is a permanent 10% increase to your monthly Part B premium for each 12-month period you delay enrollment. You may also face a Part D penalty if you delay prescription drug coverage without creditable alternative coverage. You have 3 months before you turn 65, the month you turn 65 and 3 months after you turn 65 to enroll in Part B without penalty.

Answer: Medicare Part B covers medical services, including doctor visits, outpatient care, preventive services, durable medical equipment, and home health care. However, it is often not enough on its own, as you will still be responsible for the annual deductible and a 20% coinsurance on many services. Many people also need additional coverage for prescription drugs and to help with these out-of-pocket costs, often through Medicare Supplement (Medigap) or a Medicare Advantage plan.

Answer: If you have a Medicare Advantage plans you will need to find new coverage in your area. You will also need to notify Medicare and the Social Security Administration of your move. If you don't change plans, many coverages will be considered out of network and you will be responsible for higher co-pays or no coverage at all.

Answer: yes if you lose your employer coverage you are eligible for a special enrollment period. You have a 60 day window in which to apply once you lose your coverage

Answer: In 2025, hitting the "donut hole" is eliminated, and your costs are capped at $2,000 in out-of-pocket spending for covered drugs. After you spend $2,000, you enter the catastrophic coverage phase and pay nothing for your medications for the rest of the year. Additionally, you can now enroll in a Medicare Prescription Payment Plan to spread your high-cost drug expenses over the year in smaller monthly installments.

Answer: To afford your Medicare costs on a Social Security income of $1,400/month, you can apply for the Extra Help program (also known as the Low-Income Subsidy or LIS), which helps with prescription drug costs, and the Medicare Savings Programs (MSPs), which help pay for Original Medicare premiums, deductibles, and coinsurance. You may also be eligible for Medicaid, which can cover additional costs like dental care and long-term care, depending on your state's rules. To apply for these programs, contact your state's Medicaid office or visit the Social Security Administration's website.

Answer: Nothing is "free". There are many "no-cost" or no premium Medicare Advantage plans available in many areas. Most MA plans do have co-pays and possibly deductibles for services. Medicare does not allow a broker to use the word free since that word can be misleading.

Answer: There is no medical rule that prevents you from getting a CT scan simply because you turn 78. The decision to order a CT scan for an older patient is not based on a specific age cutoff, but rather on a careful consideration of the potential benefits versus the risks for that individual.

For seniors, especially those over 78, doctors consider a variety of factors before ordering a CT scan.

Potential risks and challenges for older patients

Medical conditions (comorbidities): Older individuals are more likely to have coexisting conditions such as chronic kidney disease, diabetes, or heart problems. These conditions can make it more dangerous to use the contrast dye often required for optimal image quality.

Diagnostic accuracy: Age-related changes in the body can sometimes make CT scans less useful. For instance, the buildup of calcium in heart arteries is common by age 80, so a CT scan to identify this specific finding is of limited use.

Physical limitations: Mobility issues or chronic pain from conditions like arthritis can make it difficult for elderly patients to lie still in the correct position for the duration of the scan. Patient movement can lead to blurry or poor-quality images.

Cognitive issues: For older patients with dementia or severe anxiety, the confinement and noise of a CT scan can be disorienting and distressing, offering little clinical benefit.

Radiation exposure: While the lifetime risk of cancer from CT radiation is a concern for everyone, the cumulative exposure from multiple scans over a long life should be weighed against the diagnostic need.

Answer: Yes, Medicare may cover a home health aide after surgery, but only if you meet specific conditions, such as a doctor certifying that it's medically necessary, the need for skilled nursing or therapy services, being homebound, and receiving care from a Medicare-certified agency. The home health aide's services are limited to helping with skilled care, not just daily activities like bathing or dressing

Answer: To ensure your parents feel supported during their Medicare decisions, break down complex information into digestible parts, focus on their needs and preferences, and involve them in the decision-making process. Gather information about their health and financial situation, double-check that their preferred doctors and pharmacies are covered, and be prepared for the annual enrollment period. (AEP)

Answer: Yes, Medicare seminars are helpful for understanding the complex Medicare program, explaining coverage options (Parts A, B, C, and D, plus Medigap and drug plans), clarifying enrollment periods and deadlines, and providing insight into costs. If it's an educational seminar the speaker should be talking in general terms and not specific to any one company. If what they speak about is of further interest to you, then the next step would be to schedule an appointment to discuss your specific needs.

Answer: When selecting the right healthcare company and representative, you should first assess your specific needs and then research providers and representatives who meet your criteria. Working with an independent broker allows them to find a company that meets most if not all of your needs by shopping a selection of companies available in your region, thus saving you the time searching yourself. Also an independent agent is certified on an annual basis and has also passed training with each of the companies they represent.

Answer: Medicare Part B covers up to eight sessions of smoking cessation counseling within a 12-month period.

Part D (prescription drug plans) or Part C (Medicare Advantage plans) cover prescription medications, such as nicotine replacement therapy and drugs like bupropion (Zyban) or varenicline (Chantix), though costs depend on your specific plan's formulary pricing.

Answer: Generic prescription costs might be rising because Part D plans update their formularies, premiums, and copays each year

Answer: The IRMAA surcharge is added if your modified adjusted gross income is above a certain level. The Social Security Administration determines if you are subject to IRMAA based on your income from two years ago. For example, your 2025 IRMAA is based on your 2023 income. You can ask the SSA to reassess if you’ve had a major life-changing event.

Answer: Yes, Medicare Advantage plans and Prescription Drug Plans can vary from zip code to zip code. The insurance companies choose which counties they want to service based on available resources and such. For example, I live on the northern edge of my county and if I go 1/2 mile north to the next county, the plans in my county aren’t available in that county.

Answer: Annuities can play a very important role if used properly. There are many options of annuities available and some are currently paying very nice bonuses. Annuities are not necessarily a short term investment so if you are looking for short term annuities are usually not the way to go. Many have longer surrender charge periods but they also can allow you to withdraw up to 10% of the value yearly without a charge. I’ve used annuities with many of my clients, especially indexed annuities and they have been very happy. They participate in the upside of the market but not the downside, so the risk is minimal.

Answer: In my opinion, the best way is to meet with a licensed agent and review your coverages and needs on a regular basis. Whether you have original Medicare, a Medicare supplement or a Medicare advantage plan it is always best to work with an experienced licensed agent that help you make the right decisions. Also there are many of supplemental products that can help cover any gaps that your Medicare policies don’t cover such as cancer policies or hospital indemnity policies and such that reimburse and help cover the expenses you may incur with you health needs.

Answer: yes you can, but you may have to pay a premium for Medicare Part A if you have not accumulated 40 working quarters in the US during your lifetime. You also may have to pay a penalty if you do not enroll in Part B during your initial eligibility and you do not have an exception.

Answer: A copay is a fixed amount you pay for a specific service (like a doctor's visit) at the time of service. A deductible is the amount you pay for covered healthcare services before your insurance plan starts to pay its share. A copay is the amount you pay and your insurance pays the remainder. A deductible is the amount you pay for services before your insurance pays anything. Copays are what you will pay each time you have a specific service performed. A deductible is what you will pay until you exceed that amount and then you probably won't have any other payments due for the remainder of the year

Answer: Medicare typically will not cover routine dental, vision and hearing aids and related exams. They also will not cover long term care, cosmetic surgery and most chiropractic care. It also won’t cover some routine foot care or acupuncture.

Answer: What medication are you on? Most insulin medications are capped at $35 per month. If you are on another medication you can check with your doctor and pharmacist to see if there is a less expensive alternative. You can also see if the manufacturer can help with the cost. You can also check with the Social Security Administration to see if you qualify for low income assistance. Lastly you can have an agent shop the market for you to see if there is a better MAPD plan or stand alone PDP plan that meets your needs.

Answer: The "Extra Help" program, also known as the Low-Income Subsidy (LIS), is a Medicare program that helps people with limited income and resources pay for their Medicare Part D prescription drug costs. If you qualify, it can significantly reduce or even eliminate your drug costs, including premiums, deductibles, and copayments.

You can apply for Extra Help through the Social Security Administration (SSA).

You can apply online at the Social Security website, or you can get a paper application from your local SSA office.

You can also get help with the application process from your local State Health Insurance Assistance Program (SHIP).

You can apply for Extra Help and Medicare Savings Programs (MSPs) at the same time.

MSP's can provide additional assistance with other Medicare costs.

Answer: It’s hard to answer that question based on the limited info you provided. There are a lot more factors that go into choosing the right plan for you. The zip code you live in and the plans available in your area are the first criteria. Then unless you are willing to switch doctors, you want a plan that your doctor is in network. Also another factor is prescription drug costs. Another factor is the supplemental benefits that come with the plan, such as dental, vision and hearing and also over the counter benefits. The best thing to do is talk to a licensed agent and see what plans are available to you and make that decision.

Answer: Yes it is normal and is a requirement to be signed at least 48 hours prior to meeting with a prospect to discuss any Medicare plans and then the agent is only allowed to discuss the products checked. If anything is to be discussed a new scope of appointment is required. The requirement was relaxed during Covid but was put back in place last year. There are a few exceptions such as a prospect walking into an agents office or if it’s the last few days of an enrollment period. Call center rules are slightly different because you are agreeing to the terms prior to be connected to an agent or you called them yourself and that’s treated similar to a walk-in.

Answer: You can obtain a replacement by requesting it online through your My Social Security account or by calling Medicare.

Answer: There is no requirement that you work with an agent for Medicare planning but it is always best to work with someone that deals with Medicare on a daily basis. It’s like working on your car. You could probably do the work yourself but wouldn’t you rather have someone trained and knows all the benefits and pitfalls of the system working with you to help you make your decisions? There is no out of pocket expense to the beneficiary to work with a Medicare certified agent

Answer: If you are still working and covered by an employer plan you are not required to sign up for Medicare Part B. As long as you qualify, Part A will be automatic at age 65. As long as you have credible coverage through the employer plan there should not be a Part B or Part D penalty for delaying coverage.

Answer: You are not able to backdate your enrollment as all enrollments are forward dated. You might be able to enroll if you are eligible for a special enrollment period (SEP). Talk to an agent and they can see if you qualify.

Answer: Plans and doctors and clinics are allowed to leave for a variety of reasons usually related to administrative and financial burdens. Sometimes doctors leave because of slow Medicare and insurance reimbursements rates. It is always a good idea to review your Medicare advantage plan each year during annual enrollment period to make sure the plan is meeting your needs and that your doctor is still in that plan.

Answer: Over $5 trillion per year is spent on health care each year in the US and that equates to over $15,000 per person

Answer: That’s a great question. Many insurance companies do provide rewards for clients that are proactive and complete healthy living activities such as annual wellness visits, cancer screenings and being active. So not a direct discount but money back or gift cards for taking care of yourself and choosing wellness.

Answer: It doesn’t affect it at all unless you are receiving Medicaid or extra help from the government. Medicare is an individual coverage and getting married late in life will have no affect on your Medicare coverage.

Answer: It’s not a straight yes or no answer. It depends if it’s original Medicare or a Medicare supplement or a Medicare advantage plan. You would need to check with your plan and see what coverage you have when traveling and in what countries. Most of the time if traveling in Mexico or Canada they will work with you and your coverage but some overseas countries will not and you will have to pay for services and then see if you can get reimbursed from your provider.

Answer: I enjoy working with seniors and others that qualify for Medicare services. I enjoy making a difference in the lives I touch on a daily basis and making sure that seniors and Medicare qualifiers are taken care of with the best coverage available in their area.

Answer: I assume you have a Medicare Advantage plan otherwise you would need to have a stand alone dental plan. If you do have a Medicare Advantage plan you can contact your insurance company or look on their website