Mark Zaruba, Medicare Insurance Agent

Answer: Part A of Medicare is an entitlement for people who have worked at least the equivalent of 10 years or 40 quarters in their lifetime and are 65 years old unless they've collected social security/disability income for 24 straight months or have ESRD with few other exceptions. Part A of Medicare usually is thought of as (the four walls) as in a hospital building. It helps with the high cost of hospital stays. I really do want to have some other insurance for hospitalization because the deductible is very high and is not even an annual deductible. The deductible runs in 60-day increments which this year's costs $1736 per benefit period. You definately want to explore your options with a Medicare Sales Agent.

Answer: Your Medicare coverage from the red, white and blue care you received with the long number and letter combination will not change. This if a federal program. If you have a Medicare Supplement in addition to the red, white and blue card, it will not change either. But if you have the red, white and blue card and a Medicare Advantage Plan with on of the offering companies, you will need to contact them and arrange to have a plan change to the service are to which you are moving to. If the company you have a plan with doesn't have a plan available in that county or service area, you will have 60 days to arrange to find a new plan with a Special Election Period, so you don't have to wait until the Annual Enrollment Period which takes place from October 115 until December 7 of the year.

Answer: If a person qualifies for SSDI (Social Security Disability Income) and receives benefits for 24 consecutive months, they will automatically qualify for Medicare, no matter what age they are. They will be automatically enrolled in Part A and Part B of Medicare; however, they may decline to be enrolled into part B because there is a premium. If they do decline Part B, they may by entering into a penalty phase for not having credible insurance and that can cause them to have a 10% increase for every 12 months without the Part B. Depending on their income, they may be eligible for Medicare Purchase plan, which will help them with the Part B payment. Social Security's "Extra Help" may, if they are income eligible, help pay for their prescription drugs and premiums for Medicare Advantage plans. Some SSDI qualifiers may also be eligible for Medicaid, which may make them eligible for DSNP (Dual Special Needs Plans). These plans may add extra supplemental benefits which are a great help for low-income recipients.

Answer: Call 1800-772-1213 or go online to your Social Security account and request a new card to be sent to you.

Answer: Medicare plans can differ substantially from one another. Some plans have no monthly premium—indeed, certain plans even provide a rebate toward the Medicare Part B premium—while others, such as Medicare Supplement (Medigap) plans, may exceed $400 per month. These variations are largely attributable to differences in the benefits offered. Many plans include additional coverage such as dental, vision, hearing, and other supplemental services that may be important depending on an individual’s circumstances.

Engaging a knowledgeable and experienced insurance agent can help ensure that the plan you select aligns with your specific needs. A qualified agent will conduct a comprehensive needs analysis and guide you through the available options. There is no direct cost to you for this service; agents are compensated exclusively through commissions paid by the insurance companies with which they are contracted.

Answer: The Medicare plan you applied for is most likely a Medicare Supplement (Medigap) plan offered through a private insurance company. Medicare Supplement plans are regulated by the state in which they are sold, not by the federal government.

When you turn 65 and enroll in Medicare, you are granted a Medicare Supplement Open Enrollment Period by CMS (Centers for Medicare & Medicaid Services). During this time, private insurance companies must accept your application regardless of your health history. This enrollment window lasts for seven months: the three months before the month you turn 65, your birthday month, and the three months after your birthday month. The one exception is for individuals born on the first day of the month; in that case, the enrollment period begins one month earlier.

Applications submitted outside of this Medicare Supplement Open Enrollment Period may be subject to medical underwriting. This means the insurance company is legally allowed to review your health history and may deny coverage based on your medical conditions.

Answer: Normally the person giving the seminar is a salesperson. We as Medicare agents need to understand that. We must be more of a teacher than a salesperson to get out the information to new to Medicare persons. They may well be helpful in some ways, but as with anything, if the person giving the seminar doesn't have their heart into in as much as getting the compensation for sales, Your Attitude is Showing (which I remember was the title of the textbook I had in college in my sales class.

Answer: Yes, you may enroll, however you will need to pay a premium for your Part A and part B if you do not have at least forty quarters (or ten years of work unless you are a spouse of a qualified recipient.

Answer: If a person, for example, decides to continue to work beyond they first month on Medicare, he or she can continue to use the employee heal care benefits which may be a savior for cost sake to them or their spouse. For this reason, because they have credible medical and drug coverage will not be subject to any late enrollment penalty. When they do decide to retire, no matter what age they are will have a 63-day window of Guaranteed Issue in a Medicare Supplement plans with no underwriting concern.

Answer: I think, personally that, since these things are all under the blanket of healthcare, they should include dental, vision, and hearing. However, a dentist for example needs to be able to cover his or her overhead and compensation that equals their ability for quality work. Same with vision and hearing.

Answer: The carrier will want you to believe that their plan and benefits are the best option for you. An independent agent is often contracted with all the popular plans in the service area and can conduct a needs analysis with the prospect to ensure they enroll with a plan that best fits their situation health and financially.

Answer: No. The patient can apply for what's referred to prior authorization for a prescription they need.

Answer: Usually, the network is the biggest disadvantage. Even if you are in a PPO plan, those plans have in and out of network costs that are often much higher if you go out of network.

Answer: The way compensation is set up with Medicare plans is usually about the same amount of money. But a good agent should know that if they do their due diligence and put clients into a plan that gives them the best chance of saving money, getting the care and doctors then need by putting them into the correct plan give the best chance to assure he or she can stay agent of record and continue to be monthly compensated for years to come.

Answer: Yes, I have walked many clients who are low income through the entire process of applying for Medicaid or any other low income or high-risk health aliments. It is my pleasure to help someone through a process that will make them a more quality living.

Answer: You will still need to pay you premium even though you may not be able to use it as for the most part Medicare does not cover foreign country medical services.

Answer: I Medicare supplement plan should cover all the medically necessary options needed to help someone if they attain heart disease symptoms. Medicare advantage plan companies often offer a CSNP (Chronic Special Needs Plan) which have focus on the specific needs of anyone with a chronic health aliment.

Answer: Mammograms are covered at 100% annually for your preventative exams. There is a list of preventative procedures in your Medicare & You catalog all Medicare recipients should receive in the mail.

Answer: The way I see it, you will pay much more if you just stick with original Medicare. Original Medicare, from the beginning, was not meant to be your entire health care option. It was set in place originally to HELP seniors to manage their healthcare costs. The fact that original Medicare does not have an MOOP (Maximum Out of Pocket) annual limit is a financial risk nobody should take especially since you can enroll in a zero-dollar Medicare plan premium which must, by federal law, be as good as original Medicare. With this you can also have a drug plan in place to keep you from the Part D late enrollment penalty.

Answer: I don't know for sure, but one can only assume it will become more expensive. Much of the reason we are going through many cost challenges is due to the fact that a higher percentage of our population is over the age of 65. The good thing is we may be reaching a peak in that percentage and hopefully the numbers will be sustainable. Supply and demand reality will always be the standard.

Answer: It is a good practice to find a Medicare sales agent from a known Agency in your area to help guide you through the process. They will want to give you the best service possible as normally they get paid the same no matter which plan you choose. You don't pay an agent as they only receive their compensation from the Medicare plan, they enroll you into. Medicare sales agents need to certify annually and are strictly disciplined by the rules and ethics of the agency they are working with.

Answer: Any medical visit, with the exception of many preventatives (not all) will need to go under the Part B deductible cost to the patient.

Answer: If you have original Medicare and a Medicare supplement plan you should be able to continue with the supplement. If you have a Medicare Advantage plan, you will need to find a new plan for the service area you are moving to.

Answer: I like to offer any financial or health assistance to anyone when I know they are getting, in most cases, better and/or cheaper than what they currently have. Especially with DSNP and their rich benefits. It makes me feel more like a social servant then a salesman. I like that the companies I work with need to compete to get the business, which makes them split hairs with the benefits and for the most part the customer is the winner in the end.

Answer: This seems to be the way healthcare and many other services are headed. Telehealth, for example, is an option doctors really seem to like and it's often much more convenient and cheaper than in person. I'm sure we'll see other options like the telehealth popping up in our healthcare.

Answer: Although the cost of insulin goes up annually just as all medication, your cost while on Medicare is $35/mo and the maximum annual cost for all medication costs is $2100 for 2026.

Answer: I like to make an appointment, either in their home or, if they prefer, stop into our office around four months before their 65th birthday and give them an easy, short booklet put out by my home office or of the many Medicare companies which I am contracted with and go through the booklet slowly so they can understand, or at least get a good idea of what to do next. It is very important for them to know they must apply for Medicare at least three menthe before their 65th birthday (or 24 months after receiving Disability income from social security) If they are turning 65 and choose to collect Social Security during this time, they automatically will be enrolled into part B of Medicare, which will take the annual premium of just over $200/mo for 2026. In a case where they want to continue working and want to continue on the employee insurance, they may want to call Social Security and ask to decline to have the Part B premium taken out of your social security check each month. I then make sure they understand all their options with Medicare plans. If they don't have a company plan ,it is highly recommended to combine their original Medicare (Part A and B). They must be told that they will need a credible prescription drug plan in place, even if they have no medications. They must understand that if they don't have credible prescription coverage, they risk a penalty, increased each month if they don't have one within 63 days of receiving part B. Communicate with them once a week or so by phone to make sure they grasp the sometimes-complex Medicare options. Generally, they will understand and be competent and educated enough to make the more detailed decisions about their Health and costs during their Medicare years.

Answer: Often the reason for and elder person on Medicare will need these options to sustain a good quality of life due to a chronic illness or maybe an accident. If this is the case, be sure to find the phone number of the Department of Aging in your county and state. They may send out an evaluator to help them be sure they have any necessary help needed. After an assessment has been conducted, the county may review the Health Risk Assessment (HRA) and that information will be passed on to the Medicare Plan they work with and they may receive specific help. I would also contact the county consortium in your state to see what level you need help for.

Answer: I’m very sorry to hear about what your father is facing with Alzheimer’s. It’s an incredibly difficult condition for families to navigate, and managing medications on someone else’s behalf can feel both emotional and overwhelming. Many caregivers find the costs and coordination challenging, so it’s completely understandable that you’re looking for clarity.

Beginning in 2026, Medicare has an annual limit of $2,100 for prescription drug spending. This includes deductibles, copays, and coinsurance. Once that amount is reached, your father will not have any additional out‑of‑pocket costs for covered medications for the remainder of the year. I recommend keeping a simple record of all prescription-related expenses so you’ll know when that limit has been met.

There is also a new option available called the Medicare Prescription Payment Plan, which allows beneficiaries to spread their prescription drug costs into equal monthly payments rather than paying larger amounts upfront. Many caregivers find this especially helpful for budgeting and planning throughout the year.

It may also be worthwhile to check whether your father qualifies for Extra Help, a federal program that can significantly reduce prescription drug costs for individuals with limited income or resources. You can contact Social Security at 1‑800‑772‑1213 to determine whether he may be eligible.

If you’d like, I can also help you estimate what his monthly costs might look like under the new payment plan or review his current coverage to make sure he’s getting the most support available.

Answer: Absolutely!

Depending on which kind of recovery you need, Medicare does cover up to 20 days of skilled nursing care at 100% for all approved amounts. For day 21-100, Medicare covers all but $209.50 per day.

After 100 days you would need an additional insurance plan that covers recovery care or a long term care policy.

Answer: Ever since the Inflation Reduction Act was passed, Part D plan recipients will pay a maximum of $2100 Out-of-pocket cost annually for their Part D plan deductible, co-pays and co-insurance. If the deductible phase causes budget unease, with the Medicare Prescription Payment Plan Part D payments can be evened out so you pay the same amount every month.