Mark Maliwauki, Medicare Insurance Broker

Answer: It will allow you to change plans if you move to another zip code that doesn't have your plan including out of state. This is particularly true for Medicare Advantage plans. Medicare Supplements will move with you so there is usually no need to change the plan unless the premium has just gotten to high and you want to reduce your monthly premium payment.

Answer: Closed network, no real value outside of your county let alone your state. However, HMO's are cheaper to operate than PPO's so they will soon dominate the market.

Answer: Your income will not affect your eligibility if you have enough work credits to go on Medicare when you turn 65 or later depending on whether you are planning to work longer.

The issue is that the more money you make while on Medicare puts you into a different income bracket and raises your Medicare payment. It is a tax that no one can avoid. It can be reduced over time but only as your income level goes down.

Answer: Part B and D not being taken when they should have been or kept active. Sadly, many people are giving the worst advice and they end up paying more because of it.

Answer: You have a 63-day guaranteed issue window for a Medicare supplement following the loss of active employer coverage, and COBRA is not considered active employment coverage for that purpose. If you already have Medicare A and B, you likely need to enroll in a Medigap plan within 63 days of when the active group coverage ended (late June), or you may lose your guaranteed issue rights, even if you continue COBRA.

Answer: Medicare brokers or agents should not be charging anyone a fee. They are paid by the Medicare carrier. Monetarily speaking, it isn't a large amount of money and every carrier pays the same amount so there should be no reason for a broker or agent to push one policy over another. This should be your choice based on your needs.

Answer: Easiest way is to go on your carrier's website and look for the tab labeled "Find a Physician or Find a Doctor".

That will tell you that they are in network with your carrier. If you type in a name and they are not listed as in network, give their office a call to confirm. The websites are not always the word of truth.

Answer: Easiest way to do this is to go on the Medicare.gov or call their number. Brokers and agents can no longer sign clients up to a Part D plan. The wonderful wisdom of the carriers.

Answer: To my knowledge, Medigap companies cannot guarantee their premiums will not increase. They can guaranteed that they will be renewable i.e. not dropped due to health issues, there isn't a single policy provider who can or would claim no future increases in premium. Nobody knows how the landscape of Medicare is going to change from year to year.

Answer: If you are currently in a Medicare Advantage plan you can change it during AEP (annual enrollment period) or OEP (open enrollment period).

AEP is Oct 15 - Dec 7 and goes effective on January 1st

OEP is Jan 1 - Mar 31 and the plan goes effective the 1st of the next month after you make the change. Change in January, your new plan is active Feb 1st.

If you move or have a change in your financial situation, get a divorce or lose your current plan, you would have a SEP (special enrollment period) and can change to a new plan within a 60 day window.

If you have a Medigap or Supplement you can change it any time but it will go through medical underwriting unless you have a Guaranteed Issue right. If you don't pass medical underwriting for the new plan, the insurance company will deny you coverage and you will have to stay on your current plan. You cannot however change your Part D plan unless you have a life change that triggers a SEP or during AEP.

Answer: We are all waiting to see what is going to happen for 2027. At this point, we have no information that would suggest that Med Advantage plans will be dropped. Typically, the Med Advantage plans that have been dropped are for many of the following reasons:

1. Pulled out of a county or even a state

2. Dropped PPO and kept HMO plans

3. Reduced Med Advantage plan benefits to make sure the plans are profitable

2025 and 2026 were driven by the Inflation Reduction Act from the Biden Administration. The elements of that Act will go through at least 2027.

Answer: Yes, Maximum Out-of-Pocket (MOOP) limits do change every year. These limits are set by Medicare and can vary based on the specific plan. For 2026, the highest a Medicare Advantage plan can set this limit for in-network care is $9,250. It's important to review your Annual Notice of Change (ANOC) each fall to stay informed about any changes to your plan's MOOP limits.

Answer: Medicare covers the Medicare Diabetes Prevention Program (MDPP), a no-cost, 2-year lifestyle change program designed to help you prevent type 2 diabetes through reduced weight and increased physical activity. The program includes over 16 weekly core sessions, followed by monthly maintenance sessions, focusing on nutrition and exercise.

Medicare.gov.

Answer: You need to look at family history of illness as you come into Medicare. You have several options, some of which on a monthly basis are going to be lower cost however, the deductibles will be higher. This is the Part C or Medicare Advantage route. It includes coverage for dental, vision, hearing and Rx for no or low monthly premiums. You can only use this type of plan in your coverage area which is normally your state or a specific region of your state. There are some exceptions but not significant.

The Medigap or Medicare Supplement option costs you a monthly premium depending on the plans that are available to you in your county. Medigap plans do not come with dental, vision, hearing or Rx benefits. You would definitely need to get an Rx plan and if you need dental etc... you will pay for those separately as well. This option is more expensive due to a higher monthly premium but the deductible for Part B is under $300 (one time) and after that, you have no bills and can use it anywhere in the US that takes Medicare.

Answer: Going with the cheapest Medicare plan is an option but it depends on whether that is Original Medicare (A & B with a drug plan), a Medicare Supplement with a drug plan or a Medicare Advantage plan that includes a drug plan.

All three of these options have their benefits but they also will cost you differently. So, your objective should be to choose your Medicare plan direction strategically and based on a combination of your needs and your finances (how much you want or can pay) monthly.

You will pay more for a Medicare supplement overall each month because there are no extra benefits attached to it i.e. dental, vision, hearing and Rx. You would need to get a single plan for each of those things which adds more monthly premium.

You will pay less for a Medicare Advantage plan overall each month because it includes benefits for dental, vision, hearing and Rx.

If you were to just stay on Original Medicare A&B you would be on the hook for 20% of all major medical costs whereas with a Medicare Supplement and Medicare Advantage those costs are covered through a premium payment or a Maximum out of Pocket payment.

Answer: Medicare premiums often rise after a spouse passes away due to the "widow’s penalty," where your tax filing status changes from "married filing jointly" to "single," making it easier to exceed income thresholds. Additionally, IRMAA (Income-Related Monthly Adjustment Amount) uses income from two years prior, meaning past joint income may trigger higher premiums now.

Answer: Medicare covers wearable medical devices classified as Durable Medical Equipment (DME) under Part B, including insulin pumps, continuous glucose monitors (CGMs), and related supplies for chronic diabetes management. Coverage generally requires a doctor’s prescription and a diagnosis of medical necessity, with 20% coinsurance after the deductible

Answer: Yes, Medicare Part B covers comprehensive pulmonary rehabilitation programs for individuals with moderate to very severe chronic obstructive pulmonary disease (COPD) or those with persistent, moderate-to-very-severe symptoms following confirmed/suspected COVID-19.

Answer: Yes. In 2026, Medicare Part B covers medically necessary outpatient physical therapy with no session limit, typically requiring a 20% coinsurance payment after the deductible.

Answer: There is a calculation based on your income called IRMAA. If you make a significant income in your retirement or use your earned income from an IRA or 401k can increase your monthly Part B premium amount.

Answer: You should really add a travel policy from Blue Cross Blue Shield Global Solutions.

Your Medicare doesn't cover you outside the borders of the US, with several exceptions for border nations. I wouldn't count on it though.

Answer: If you are getting the monthly Part B premium being paid through your SS you have indeed signed up for Part B. Part A is normally just automatically granted when you turn 65 or a couple of months before as there is no premium associated with it for most people. Part B has always had a monthly premium. This year it is $202.90.

Answer: Not necessarily. You will be given Part A Medicare automatically when you turn 65. You have to elect to take Part B and it comes with a monthly premium of $202.90. You should check out a couple of things; 1. Go to Medicare.gov and find whether or not there are Medicare plans available to you in your zip code. 2. Ask Indian Health Service whether or not they will pay for your Part B premium so you can have Medicare.

Answer: Not unless you don't pay your premiums if you have a premium plan. There is nothing they can do otherwise.

Answer: Medicare covers a wide range of preventive screenings and services to detect illnesses early, generally with no out-of-pocket cost (no deductible or coinsurance) if the provider accepts assignment.

Most of these services are covered under Medicare Part B (Medical Insurance).

Key Details on Covered Services & Parts:

Part B Coverage: Covers yearly "Wellness" visits, "Welcome to Medicare" visits, cardiovascular screenings, diabetes screenings, cancer screenings (mammograms, colonoscopies, Pap tests), flu shots, and HIV screenings.

Preventive vs. Diagnostic: While preventive screenings (to prevent illness) are free, if a screening turns into a diagnostic test (to diagnose a known symptom or condition), you may owe copayments.

Requirements: Services must be deemed "medically necessary" and, in some cases, are only covered for those with specific risk factors.

Vaccines: Part B covers influenza, pneumococcal, and Hepatitis B vaccines.

Part D: Covers certain vaccines, such as the shingles shot, which are not covered by Part B.

Always ensure your doctor accepts assignment to ensure the $0 cost share.

Answer: You call Medicare.gov is you only have A&B or you call your Medicare Advantage plan carrier if you have one of those plans. If you have a Medicare Supplement and your procedure is covered by Medicare, you wont get a bill.

Answer: Yes, Medicare covers FDA-approved continuous glucose monitors (CGMs) and related supplies as durable medical equipment (DME) under Part B. If you use a smartphone for display, you must still use a, durable receiver (or receiver-compatible system) at least some of the time to qualify. Coverage requires a doctor’s prescription confirming you have diabetes, use insulin, or have a history of problematic hypoglycemia, and require frequent monitoring.

Answer: No. All medicare agents are paid a flat commission regardless of which carrier plan it is for. With the exception of United Healthcare during this last AEP. They decided to not pay a commission for any Medicare Advantage plans in specific markets.

Answer: They pay for your Part B premium. Next year, that will be $202.50 per month. Very significant savings for sure.

Answer: As a matter of fact yes, that is what the enrollment period is all about to make sure if you move or change plans that you keep your doctors if you want to. Very sorry to hear that there are agents out there who seem to care more about a puny commission than ensuring that their client is in the best most beneficial plan.

Answer: That everyone has to pay a Part B premium at all. This is a tax pure and simple and should be killed for 2026.

Answer: If you make over a certain income higher than the average in retirement and you have Medicare then yes. Otherwise, the standard is $202.50 per month for Part B in 2026.

Answer: Unless you have a guaranteed enrollment issue. Otherwise, yes, you will have to go through the underwriting questions.

Answer: Plan G or a Medicare Advantage plan that offers dental, vision, hearing and / or OTC benefits. It also comes with Rx coverage.

Answer: Yes, a 65 year old green card holder without a 5 year residency or 10 year work history might face penalties for delaying Medicare Part A (if they have to pay for it) and definitely for Part B if they don't enroll when eligible.

Answer: Yes they are. They are considered a medical procedure. Make sure you confirm this with your surgeon.

Answer: No. You have no copays at all. You have no deductibles either. Plan F is the highest coverage Medicare plan available but that is why it costs so much per month.

Answer: Let's say you have your worst possible medical year ever. $1 million bill.

The most you will pay out of pocket with a Medicare Advantage plan is your copays and some deductibles and a Maximum out of pocket of potentially 7000 which could equate to $7500 total.

Original Medicare would cost you 20% of the $1 million or $200 k. I don't know about you, but most people don't have $200 k laying around to throw at medical catastrophe's.

A Medicare Advantage plan is a much more sensible Medicare coverage option for everyone on a budget.

Answer: Some therapy is included in most Medicare plans. The amount they will approve or cover is based on the plan.

Answer: Yes, with a copay typically. You should check the medicare plan summary of benefits or Evidence of Coverage for the details.

Answer: As often as you need to. All of these are considered preventative tests and Medicare covers all preventative tests and procedures.

Answer: You most certainly can be. If you are looking to switch from a Med Supp to a new Med Supp and it is not your initial enrollment period or some other special enrollment period your application would go through underwriting. You will have to answer specific health questions which if the plan doesn't want to cover, they will deny you. Best case, they will approve the application at a higher premium.

If you have the "Birthday Rule" in your state, you can also enroll into a new Med Supp plan the month before, month of and the month after your birthday without underwriting which is called "Guaranteed Issue" special enrollment. It isn't available in all states.

Answer: What is included in the visit:

Health Risk Assessment: You will likely fill out a questionnaire to help your provider understand your current health and risk factors.

Medical and Family History: A review of your past medical issues, surgical history, and any family history of disease is conducted.

Medication and Provider List: Your current prescriptions, vitamins, supplements, and a list of your current healthcare providers are reviewed and updated.

Routine Measurements: Your height, weight, body mass index (BMI), and blood pressure are checked.

Functional and Safety Evaluation: Your ability to perform daily tasks and your risk of falls may be assessed.

Cognitive Screening: Your memory and cognitive abilities may be screened for issues like dementia.

Personalized Prevention Plan: Based on the information gathered, your provider will help create a written 5-10 year screening schedule and may provide personalized health advice.

Advance Care Planning: You can discuss advance directives, like a living will or medical power of attorney, with your provider.

Referrals: You may receive referrals for other health education or preventive counseling services if needed.

What is not included:

A head-to-toe physical exam: The AWV is a preventive visit, not a comprehensive physical exam. Any specific medical issues you raise will be handled as a separate "sick" visit, for which you may be billed your regular copayment or deductible.

Answer: It is a great benefit especially if you know you are going to spend time in the hospital in the future.

The Hospital Indemnity plans will refund the cost of your days in the hospital and most do that 4x per year i.e. every 3 months.

There are some very good plans to consider from well known plan providers.

Answer: It may depend on your Medicare plan but back pain is one of the reasons Medicare plans will cover acupuncture.

Answer: Medicare Part A is hospital insurance. You could also sign up for a hospital indemnity policy.

Other than that, you would need to get a Medicare policy.

Answer: Once per year should be enough. Medicare plans don't change their benefits mid-year so once a plan goes into affect on January 1st, it will be good for that entire calendar year.

Answer: Depends on your Medicare plan. Most if not all have a copay. If you are talking a rehabilitation center that involves skilled nursing charges which are typically $0 until the 15th to 20th day.

Answer: The start of a rehab stay can be delayed by up to 90 days after a qualifying hospital stay, but it depends on insurance and medical necessity. For Original Medicare, a 3-day hospital stay is required, and the rehab stay must begin within 30 days, or longer if it's medically inappropriate to start sooner.

Medicare Advantage plans have their own guidelines and require Pre-Authorization for coverage.

Answer: Medicare Advantage give you more "advantages" than Original Medicare A&B and / or adding a Medicare Supplement or Medigap plan.

Original Medicare pays 80% of your hospital and doctor costs. You pay 20%.

Medigap plans pick up the 20% but you pay an additional premium of $100 to 300 per month depending on the plan and area you live. And you have to have a separate Part D plan for Rx which is an additional premium.

Medicare Advantage plans offer you Parts A&B and D coverage in one plan. They also give you dental, hearing and Over the counter benefits in most cases for no premium or a very low monthly premium. They are also known and Part C so you would have A, B, C and D Medicare.

Medicare Advantage plans have copays and a Maximum out of Pocket charge also known as your safety net in case of a very serious medical expense.

Answer: Medicare Part B premiums for 2026 will be $202.50 per month.

Medicare Part B is a cost associated with having Medicare Part B from the Government. It has risen in cost annually for the past several years.

The changes are driven by how much it actually costs to administer Medicare at the federal level. It is unfortunate that it isn't run more efficiently so that the premium could be capped or eliminated altogether.

Answer: Catastrophic coverage begins after you have hit the $2000 out of pocket drug max for the year.

If you go over $2000 you are covered 100 % for the remainder of the year.

Answer: Not really. A & B only cover 80% of all medical costs. You are far better off signing up for a Medicare Supplement or Medicare Advantage plan.

Answer: When you turn 65, Medicare will sign you up for Part A automatically. Part B will be signed up for as you leave your group health coverage from your employer. Make sure you give yourself at least a month prior to enroll in Part B. You have 63 days from the time you lose your employer coverage too sign up for a Medicare plan. There are a couple of different directions you can go.

Answer: No. You don’t have to do anything until you are ready to be on Medicare full time.

You will have 63 days to get into your Medicare plan so it is wise to sign up for Part B a month before your group insurance expires or is terminated and to review your plan options in advance as well.

Answer: There is no coverage gap any longer. There is a cap of $2000 for 2025 and $2100 for 2026.

Once you hit 2000 for this year, you will pay no more for your Rx through the end of the year.

Any Rx you buy in 2025 goes toward that $2000 cap.

Answer: There are several ways you can change your Medigap plan during the year but beware of what is required. If you choose to switch plans outside of annual enrollment, you could be subject to underwriting in which the insurer will decide if you qualify or will receive a higher rating = higher premium because of a pre-existing condition.

If you move to another state that will trigger an SEP "special enrollment period" and if your plan were to be terminated or canceled by your insurer you would have the same right. And the best part of those events is that it is also considered a guaranteed issue ie no underwriting.

Lastly, many states have or are enacting a "Birthday Rule" whereby you can change to another less expensive plan during your birth month for a 30 to 63 window.

Answer: Any Medicare agent and pull plan comparisons and load all of your medications into those comparisons so you can see what plan has most or all of your medications in their formulary and what the prices are if you bought them at various local pharmacies or through a mail order option.

Answer: If you just turned 65 or are still within 6 months of turning 65 you can move to a Medicare Supplement plan that would cover all of your bills after a small deductible. If you have passed this period of time, a Medicare Advantage plan could definitely save you money and give you more benefits like dental, vision, hearing OTC and medications that are built into these types of plans in most cases. Things are changing a little for 2026 you would just need to compare plans for your county and see what all is available. You do have much better options than sticking with Original Medicare.

Answer: The Donut Hole cost you 8800 per year as a Rx deductible. Now, you have a maximum of 2000 going to 2100 for 2026 and then your Rx are paid 100%. That was and is a tremendous savings for anyone who takes expensive medication.

Answer: In cataract surgery, Medicare covers the medically necessary procedure and a standard intraocular lens (IOL), but not the cost of "premium" lenses. Your friend's out-of-pocket expense was for the difference in cost between the standard lens and the upgraded one she chose.

Answer: Yes, bone density screenings (AKA bone mass measurements) are considered preventative. Medicare Part B coverings these tests once every 24 months.

Answer: Everyone who turns 65 and is retiring meaning they will not have group insurance any longer, has to go on Medicare. It is a hard discussion. It is necessary that they understand what all is involved, how to apply and how to choose the right Medicare plan path for them. If they don't sign up within the appropriate time frames required, there are penalties and potential lost benefits that cannot be claimed again. The smart move is to understand their healthcare situation and meet with a licensed Medicare agent who can help you strategize and pick the best future path for coverage.

Answer: Its very well known. It is all over Medicare.gov and internet searches. If you search Initial Medicare Supplement or Medigap Enrollment Period it explains it all very well. It is a pretty long period at 6 months after you enroll in Part B. If Medigap is what you know you are going to need because of chronic or other potentially deniable conditions, you need to hit the window of guaranteed issue rights.

Answer: Nothing to do with healthcare regardless of what plan it is, is truly zero anything.

Zero premium plans come with deductibles for several things including Rx, hospital stays, procedures etc... you are going to still have to pay something to use the plan.

MA plans, however, have generally been a good alternative to a Medicare Supplement for healthier individuals because if you don't take Rx, don't see a Dr., have no health issues, you don't have to cover the Medicare Supplement and Rx plan premiums which are both going up again on average 30% every year.

Answer: Original Medicare will cost you 20% of any major medical incident / occurrence. A Medigap plan has a $244 deductible but all expenses would be covered. Of course, there is a $100 + per month premium in addition to your Part B premium of $185 in 2025.

Answer: It doesn't. You don't have to pay your Medicare premium with SS money, you can if you want or switch when you are ready to use your SS.

Answer: Essentially a broker usually owns their own agency but both represent Medicare companies and help clients with their Medicare needs

Answer: Your plan should cover 80% of the cost to rent a wheel chair. It is defined as DME or Durable Medical Equipment.

Answer: Absolutely. Many Medicare Advantage carrier plans are built with healthy minded and focused individuals in mind. They give additional rewards $s for staying active, visiting your Dr once per year for a check up, being social and getting out and about.

Answer: There is no donut hole any longer.

The Medicare Part D donut hole (coverage gap) was eliminated as of December 31, 2024. In 2025, there are only three phases of Part D coverage: a deductible phase, an initial coverage phase, and a catastrophic coverage phase. Beneficiaries will now have a $2,000 out-of-pocket spending limit before entering the catastrophic coverage phase.

Once you hit $2k in out of pocket deductible, your Rx are covered for the rest of the year.

You can sign up for the Medicare Prescription Payment Plan where you can even out the cost of your Rx to a monthly payment amount for the year so you don't have to pay it all in the first few months.

That is a great option.

Answer: All Big Pharma companies have programs where they actually give you your medication for free. It is a year to year type of thing but it is definitely worth checking out. Outside of that, you want to make sure that your pharmacy choice is always in network and more importantly a preferred pharmacy in their network to ensure you are getting the lowest price on your meds.

Lastly, depending on which medication it is, every year Medicare and Medicaid services (CMS) will add 15+ Rx to a list of capped pricing. This is what they did with insulin last year.

Answer: Apply for State Medicaid.

Partial Medicaid also known as Medicare Savings Program can help pay your Medicare Part A&B premiums, other plan premiums (if you have a Medicare Advantage plan), copays and coinsurance. This particular MSP is also called QMB or Qualified Medicare Beneficiary.

Answer: There is no such thing as a perfect Medicare plan. There is no such thing as a free lunch.

Medical services cost money and from year to year sometimes month to month the needs of people change and the only thing you can do is match your current and / or short term needs with the best plan to meet those needs that is available right now.

You will always have to put some skin in the game. I firmly believe the future of Medicare and Medicaid is going to include more cost share from the member. Premiums, copays et al will have to go up.

Answer: Medicare.gov is the source of truth (or should be) for these types of inquiries:

https://www.medicare.gov/coverage/mammograms

Answer: If you already have a Red White and Blue Medicare card with Part A and Part B, you do not need to sign up for Medicare again when you reach 65. You will have been awarded Medicare early because of your disability most likely.

Answer: If you are 65 you will have to go on Medicare. You have 63 days to get on Original Medicare A&B or chose a Medicare Supplement or Medicare Advantage plan.

Answer: Original Medicare has no Rx, dental, vision, hearing or OTC benefits. You would need separate policies to have them and the Part D or Rx plan is mandatory or your will be fined for life.

It also doesn't pay for copays and deductibles. And, of any expenses you incur, you will owe 20%.

A Part C or MAP+D plan comes with all of the benefits or 90% of the benefits above (depending on the plan and service area) and has a MOOP (Maximum out of pocket) so you know that the most you will ever pay vs the 20% of Original Medicare is a set amount. Then, you are covered 100% for the remainder of the year.

That safety net and the fact that MAP+D (Part C) plans are very affordable is really what you have to consider.

Answer: Doctors often disapprove of Medicare Advantage plans due to issues with pre-authorization requirements, frequent claim denials, complex administrative processes, and reduced reimbursement rates. These challenges can lead to increased administrative burdens for doctors, impacting patient care and potentially leading to burnout.

There are explanations for all of these that would counter the Doctors dislike. A big one is PA and claim denials. Both of these have been around long before MA plans. PAs are helpful for all involved. Claim denials more often than not are the result of a miscoded procedure at the provider (doctor, hospital) level.

Answer: This is a very good explanation from the source of truth ie; Medicare.gov on what Medicare's role is in covering long term care.

https://www.medicare.gov/coverage/long-term-care

Answer: Yes, Medicare will cover home healthcare assistance under certain conditions. Both Original Medicare (Parts A and B) and Medicare Advantage (Part C) can provide coverage for home health services. However, it's crucial to understand that not all home healthcare is covered, and there are specific requirements and exclusions. 

Here's a breakdown of how Medicare and home health care work:

1. Medicare Parts A and B Coverage:

    •    Part A:

Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care. 

    •    Part B:

Covers certain doctors' services, outpatient care, medical supplies, and preventive services. It also covers eligible home health services. 

    •    Home health under Part B:

Requires you to be "homebound" and need skilled care (e.g., nursing, therapy). A doctor must certify that you are homebound and that you need these services. 

    •    Home health under Part A:

May be covered after a hospital stay or skilled nursing facility stay, but only for a limited period. 

2. Medicare Advantage (Part C) and Home Health:

    •    Medicare Advantage plans are private health plans that offer the same benefits as Original Medicare, plus extra benefits, such as home health care.

    •    Some plans may offer more comprehensive coverage for home health than Original Medicare. 

3. Covered Services:

    •    Skilled nursing care (e.g., medication management, wound care).

    •    Physical, occupational, and speech therapy.

    •    Medical social services.

    •    Home health aides (if receiving skilled nursing or therapy).

    •    Durable medical equipment (DME) and medical supplies. 

4. Services Excluded from Coverage:

    •    Custodial care: Generally, Medicare does not cover services that are not medically necessary, such as help with personal care or homemaker services.

    •    Home meal delivery: Medicare typically does not cover home meal delivery services.

    •    Skilled nursing is limited

Answer: According to Medicare.gov the "source of truth" for all things Medicare:

Medicare Part A (Hospital Insurance) usually covers inpatient hospital care if you meet both of these conditions:

You’re admitted to the hospital as an inpatient after an official doctor’s order, which says you need inpatient hospital care to treat your illness or injury.

The hospital accepts Medicare.

It does not cover hospital submissions that are for emergency needs.

Answer: I look forward to breaking things down so the information is understandable and helping my clients choose the best option for them at the present and immediate future time. I enjoy helping them solve the challenges associated with Medicare plans and coverages so that they know what they have and how their plan truly benefits them.

Answer: It needs a serious look. You can't have an organization that big and not have regular reviews of performance and outcomes. It should have a major review at the end of every Medicare enrollment year.

Answer: Medicare provides 60 lifetime reserve days of inpatient hospital coverage, which can be used after a beneficiary has exhausted their standard 90 days of coverage within a benefit period. These reserve days are used only once and can be used at any point during a beneficiary's lifetime to extend their hospital stay.

Answer: It all depends on your needs and financial situation. Med Supps definitely have a place in the Medicare plan space and you need to consider all plans available so you choose the best option for you.

Answer: I wouldn't necessarily say they are over hyped but many people never even use the OTC or Over the Counter dollars each quarter. It is a nice benefit but depending on the plan you have, the items could be more expensive than they would be if you were able to just pick them up at the pharmacy or grocery store.

Outside of that, there are benefits for vision, hearing and dental that are included in the plan coverage which if they weren't, you would have to have a separate policy for or pay out of pocket anyway. Some coverage is better than no coverage.

Answer: Once your income reduces, get with SSA and let them know so the IRMAA premium or "tax" can be reduced or eliminated

Answer: Ask them to get in-network, find out what your out of network charges will be compared to in network charges, negotiate with the hospital for a cash price, enroll into a different plan that is in network when you are able to do so.

Answer: Any Medicare agent (including myself) is equipped and trained to help you navigate the maze and breakdown the acronyms that make up Medicare. Contact me.

Answer: When the client doesn't have their Medicare Card or VA Benefits cards with them to enroll. It would be much better if all Medicare agents had access to a system that contains this information and is available to get via username and password security.

Answer: Anything outside of seeing your Primary Care doctor i.e. a specialist of any kind is going to cost you a copay.

Answer: Yes. Colonoscopies are preventative and therefore covered at 100%.

You could always check on Medicare.gov as a back up to confirm.

Answer: Original Medicare is a 20% out of pocket for all services.

A Medicare Advantage or Part C plan has an inpatient hospital deductible of $x per day for 1-6 days typically. That is your responsibility with your Medicare Advantage plan.

To summarize:

You would not pay both of these charges. If you have Part A only would you pay the $1676 deductible (or 20%) and with the Medicare Advantage Part C plan you would pay the $350 per days 1-5 deductible and after that, you would not have any additional inpatient hospital charges.

Answer: Mental health services usually have a copay depending on the plan so you would want to do a plan comparison to see which one is the least expensive. It can be up to $40-50.

Since the Covid-19 plandemic, telehealth services have been covered 100%

Answer: Contact SSA.gov to get enrolled in Medicare. If you will not be staying on group coverage you will need to sign up for both Medicare A & B.

You have until 3 months after your birth month to get enrolled without a penalty.

Answer: You can go to Medicare.gov, type in your zip code to find the available plans in your county and then type in the Rx you are looking to source.

Answer: You would simply need to call your HMO and find out. It is likely that you will pay out of network charges if you choose to get care outside of your HMO network although there can be exceptions made if you are specifically referred to a Dr outside of the network.

Answer: They certainly can be. Medicare plans are based on the county you live in and the benefits associated with the plan are normally driven around the # of members or potential members in that county.

Answer: It is the doctor's choice to go out of network. There are various reasons for it but unfortunately, it seems to always come at the time you really need their services and you are no longer covered as they are out of network.

Answer: Medicare Part D will cost you an extra premium and it would be paired with a Medicare Supplement as they don't come with an Rx plan.

Medicare Advantage plans with the exception of specific veteran's plans come with Rx built in and there is no additional cost for the coverage.

Answer: No. But a good Medicare agent always goes through the various options and why they are different. That way you are educated on exactly what the differences are why a Supplement makes more sense for you vs a Medicare Advantage plan or vice versa,

Answer: The increased scrutiny and auditing of Medicare Advantage (MA) plans, especially through Risk-Adjustment Data Validation (RADV) audits, is likely to impact nursing home coverage in several ways. Specifically, tighter scrutiny and potential cost containment efforts within MA plans could lead to:

Reduced Payments:

MA plans may reduce payments to nursing homes to offset potential overpayments identified during audits or to balance budgets.

More Denials and Appeals:

As MA plans face pressure to control costs and maintain compliance, they may be more likely to deny or delay coverage for nursing home stays, leading to increased appeals from beneficiaries and providers.

Pressure on Nursing Home Contracts:

Contract negotiations between MA plans and nursing homes may become more challenging, with nursing homes potentially facing unfavorable terms to ensure continued coverage.

Shifting of Costs:

To manage their budgets, MA plans may increase premiums or reduce other benefits, potentially shifting the burden of care to beneficiaries.

Potential Impact on Access:

The combination of reduced payments, more denials, and potential cost-shifting could lead to reduced access to quality nursing home care for some beneficiaries, particularly in rural areas or those with complex medical needs.

Answer: The latest information we have comes from 2023. It states that the United States spent $4.9 trillion on healthcare, which translates to $14,570 per person. This amount represents a significant portion of the nation's Gross Domestic Product (GDP), accounting for 17.6%

Answer: Original Medicare Part A and Part B would be very costly in the event of a serious or catastrophic accident or injury. You would pay 20% out of pocket for all expenses incurred. A Medicare Advantage plan has a Maximum Out of Pocket that limits your liability and caps your costs.

Answer: Yes. Losing employer coverage qualifies as a special enrollment period. You have 63 days to get your new coverage in place.

Answer: They can supplement depending on the availability of your Rx and a plan in a given plan area. Discount cards are another option when regular Rx plan options are not available.

Answer: It will save some Seniors who are paying a lot for Rx. The challenge is that it is unfair to assume Medicare carriers can pick up the slack. Drug prices must come down so significant pressure must be put on all Rx companies.

Answer: It has the opportunity to change it dramatically. AI integration, getting rid of fraud and waste once and for all will allow Medicare benefits to truly change lives.

Answer: You will have 63 days from your last coverage date to enroll in a qualified Medicare plan. This can be a Medicare Supplement or Medicare Advantage plan or Original Medicare with a drug plan.

Answer: You certainly could be. You must be able to either prove you have medical and prescription drug coverage or get bothPart A and B and a drug plan Part D

Answer: Because it is a cap on all prescriptions for a given year. Once the $2000 cap is achieved, all prescriptions are $0 for the remainder of the year.

Answer: Planning for the unknown is what insurance is all about. Risk should be considered and addressed. Financial futures are severely impacted when the right amount of insurance is not taken out.

Answer: They mix up Medicare with Social Security. These are separate. Medicare is only health insurance and although most qualify, there is a standard number of hours worked or “credits” that must be achieved to get Medicare.

Answer: You can sign up for Medicare 3 months before your birth month.

I encourage my clients to sign up for both Part A & Part B to avoid future penalties for enrolling late.