Mark Murphy, Medicare Insurance Agent

Answer: Yes, but the doctor must accept Medicare and it must be a Medicare approved procedure. My suggestion would be to call the doctors office to see if they accept Medicare.

Answer: Life insurance is a separate purchase. There are a lot of different life insurance companies out there from which to choose. Life insurance prices are based on age, sex, and physical health.

Answer: There are a number of ways. The first is to talk to your friends that have moved into Medicare and ask if they would recommend their agent. You could also do an internet search. If you have Siri or Alexa you can ask them for a list of Medicare agents in your area as a lot of us are on google search engines. You can also go to www.medicare.gov and search their site by zip code.

Answer: To answer your question, yes and no. If you work for a company with more than 20 employees and your prescription coverage meets Medicare's minimum requirement, you do not have to register for Medicare. In this situation your group plan would pay before Medicare paid.

If you work for a company with under 20 employees you must enroll in Medicare Parts A&B. In this situation Medicare is the primary payer and the group plan would be 2nd.

It is always wise to speak with an agent 3 months before you turn 65 to look at your options and the costs of making such a move. Sometimes it's best to move to Medicare, other times it's better to stay on the group plan until you retire.

Answer: In my opinion it falls short. Original Medicare and Part D do a good job covering medical issues and Rx issues but offers little to nothing for assisted living or nursing home members. Always check with your county social services office to see if they offer any help. Many do.

Answer: The rule with Part B is:

If you work for a company with more than 20 employees, you do not have to sign up for Part B unless your work plan doesn't have creditable Rx coverage. They should notify you of that every year at renewal.

If you work for a company with under 20 employees you must sign up for Part B. In this case Medicare pays first and company insurance (if you keep it) pays second. If you don't sign on for Part B in this scenario, your work plan can refuse to cover all Part B services.

Hope that clears it up for you.

Answer: I don't know why you weren't aware of this before buying the plan. There is a lot of information discussed by your agent, perhaps you or they missed it. He should have left you a book with the plan details of your new plan. Always go through that before purchasing any plan and ask about the details line by line. I'm sorry if you were not informed.

Answer: You have 60 days from the time of the move to buy a plan in your new area. If you're sure of your moving date, you can notify them 30 days before and buy a plan in that area within 30 days before moving.

Answer: Medicare doesn't pay anything towards foreign hospitals. Certain Medigap plans and Medicare Advantage Plans will cover overseas in emergency or urgently needed situations.

With Medigap Plan G or Plan N you would have a $250 deductible and they'll cover 80% up to a lifetime maximum of $50,000 for foreign travel.

With Medicare Advantage plans you are covered anywhere in the world in an emergency or urgently needed situation. There could be lifetime limits, depending on the plan.

There is a catch. Foreign doctors and hospitals don't accept US insurance so you'll have to pay cash or credit for the bill while you're there and get reimbursed up to your copay or coinsurance when you get back.

My suggestion, when traveling, is to buy travel health insurance for your trip. The cost is very reasonable and it will cover you anywhere in the world and help you find doctors and hospitals in other countries. You can get unlimited coverage for about $100/person for the week you are away.

The company is GeoBlue. You can buy it online or through an agent that works with them.

Answer: No, you don't need help. I would recommend that you do get help. Agents like me don't charge fees and are trained every year on the new plans available in the area and are usually up to date on other programs for which you might be eligible.

In my experience, people who have done the work themselves end up spending more money or making mistakes that can't be fixed until the annual open enrollment. There are a lot of moving parts with Medicare so if you're going to do this yourself, please read up on everything and shop the market.

Answer: I'm not really clear on your question but I'll try to answer.

If you didn't sign up for Medicare at age 65 because you were still working, you worked for an employer with more than 20 employees, and you had creditable Rx coverage through them, the only thing you'll need to do is go to your local Social Security office and register for Medicare Parts A&B. You can also register online at: www.ssa.gov

You will also need a Certificate of Creditable Coverage from your work plan stating that you had creditable Rx coverage from the time you turned 65 until you started your Medicare.

Answer: Yes, it can be a problem. Most plans are a PPO which means you have in and out of network benefits. If that's the case and they are out of network, it may only pay a percentage of the cost, like 70-80%. If the dentist won't bill you'll most likely pay out of pocket and have to file a claim form to your plan to get reimbursed. This may also happen if you have vision benefits.

In my opinion, most dentists are hard to work with and don't want to accept any dental insurances. I hope you don't run into that problem. Call the member services number on the back of your MAPD card and ask them to find you a dentist in your zip code that accepts their plan.

Answer: My suggestion is to contact an insurance professional that can guide you through the alphabet soup. There is a lot of information that you must know when entering Medicare. An independent broker/agent can shop the market for you and get you the plan that best fits your needs.

Answer: it does happen from time to time. In most cases, if you're in a PPO plan, you'll still be able to use your provider until you can make your annual change in October. it shouldn't be a big worry but be aware that it can happen.

Answer: I've been doing Medicare for over 20 years and have never seen a plan that didn't increase every year. I have clients in Blue Cross/Blue Shield and their rates increase every year. Good luck in your pursuit.

Answer: No, it's not true that Medicare pays for dental implants. Original Medicare doesn't cover dental, hearing aids or eye glasses. Some Medicare Advantage plans will cover them, but not all.

Most stand-alone dental plans will give some type of discount towards implants. Usualy in the 15-20% range.

Answer: If you're healthy enough to pass the underwriting for a Medicare Supplement Plan G. I would suggest that type of plan. It has a monthly premium and the Part B deductible that would be your cost. After the deductible you should have very little, if any, medical costs. The procedure must be a Medicare covered procedure for the Supplement to cover it. A prescription plan is a separate cost.

Answer: The cheapest Medicare plan may not work for you. A lot of detail goes into which plan is right for you. Doctors, prescriptions and benefits factor into your decision. I suggest finding a qualified broker to walk you through the process. It is important to make the right decision out of the gate as it may cost you a lot of money down the line. In my opinion, as a broker, it's not to your advantage to listen to your friends. Talk to an expert.

Answer: Yes, Medicare Advantage plans offer anywhere in the world coverage for an emergency or urgently needed care. If you are traveling abroad they most likely won't honor American insurance but you'll be reimbursed up to your copays or coinsurance when you return home.

A couple of Medicare Supplemental plans like Plan G or Plan N offer limited coverage abroad. Usually they'll cover 80% of the bill, after a $250 deductible up to a maximum lifetime amount of $50000. Check with your agent to see which plan works for you.

Answer: I wouldn't say that regular Medicare is better than an advantage plan. They both have their pros and cons. Regular Medicare allows you to go to any doctor, hospital or facility that accepts Medicare throughout the country, so it's very easy to use. Medicare Advantage plans are managed care programs so sometimes finding doctors can be challenging but advantage plans cover a lot of benefits that original Medicare doesn't cover like dental, eye, hearing aids, etc.

It's just a personal preference and a budgetary consideration.

Answer: Medicare does not cover nursing home care unless it's being used as a rehab unit. If you have a Medicare Supplemental plan it will cover up to 100 days. If you have a Medicare advantage plan usually the first 20 days are covered at no cost. Days 21-100 usually have a copay of around $218/day. For either type of plan there is no coverage after day 100.

Most people will purchase Long-term Care policies or some other homecare policies to help cover those costs.

Answer: Hospice services are covered under Medicare Part A. If you should need those services, it would happen automatically.

Answer: Those medications would have to be on the formulary of your current Rx program or your current Medicare Advantage plan Rx formulary.

Medicare Rx programs do cover many antidepressants and anti-anxiety medications. Check with your prescription plan. Call the number on the back of your current Rx card or MAPD card..

Answer: Yes, for 2026 the deductible is $283. After the deductible Medicare Part B will cover 80% of your visit.

Answer: With Medigap there really isn't any out-of-network providers. If they accept Medicare and it's a Medicare covered procedure, the gap plan pays. If it's not a Medicare covered procedure, the gap plan doesn't pay for it. Pretty simple.

Medicare Advantage plans with out-of-network benefits usually charge higher copays or coinsurances for any out-of-network benefits. There is also, usually, a higher maximum out-of-pocket for out-of-network medical.

Answer: Call Medicare directly. They'll replace it for you. It usually takes about 2 weeks.

Answer: This is a question for your accountant or tax preparer. We, as insurance agents, aren't allowed to give financial advice.

Answer: The first step is to talk to a qualified Medicare agent to see if enrolling in Medicare makes sense for you. Some people save money staying in their group plan from work, others don't. It all comes down to cost and benefits and whether you can keep coverage for a spouse that doesn't qualify for Medicare yet. If Medicare is your best step, that leads to...

The second step is to go to the social security site and enroll for Medicare Parts A&B. The website is: www.ssa.gov.

Sometimes, if you're needing coverage quickly, it's better to make an appointment at your local Social Security office. Online services can take 6-8 weeks.

Answer: You may have. Lower premiums don't always mean higher copays and higher premiums don't always mean lower copays. It all depends on the county in which you live as to what plans and rates are available to you.

Take heart, if you aren't happy with your Medicare Advantage plan there is an Open Enrollment period from January 1st - March 31st each year where you can make one change to your Medicare Advantage plan. You can choose another Medicare Advantage plan or go back to original Medicare and choose an Rx plan. Your new plan would start on the 1st of the following month.

I suggest you call your agent to discuss your options going forward.

Answer: The Medicare insurance practice is highly regulated by the Centers for Medicare and Medicaid Services (CMS). They require all agents to have a signed Scope of Appointment for every appointment that we do. The scope obligates you to nothing but does limit the agent from talking with you about anything but Medicare. If you'd like to talk about life insurance or annuities, he has to wait 48 hours before he can come back and discuss those issues with you. As agents, we must keep that scope in your file, whether you work with us or not, for 10 years. If our files get audited and that scope is not in there, we can be fined heavily or, in some cases, lose our license to sell Medicare products.

As for call centers, they are held to the same standard, but every call is recorded and reviewed randomly to make sure they are following CMS rules.

Congratulations to your agent for following the rules.

Answer: I'm so sorry to hear that. Medicare Part A will pay for a physical therapist or nurse to come to your home after surgery but will not pay for home health care. Unfortunately, you'll have to bear those costs.

Some counties have programs where, if you qualify income wise, will pay for a nurse or family member to take care of you. Contact your local social services office in your county.

Best of luck.

Answer: To be a Medicare insurance agent there are a lot of hoops to jump through each and every year to maintain our ability to present Medicare plans.

Each year we have a 5 hour training through AHIP. They give a final exam that we must pass with a 90 or above to be able to sell. We also must take certification classes and tests with each carrier that we represent each year. This includes ethics courses, fraud, waste and abuse courses and proper marketing courses. We also meet with each carrier representative in person or via zoom to learn their plans each year.

The average Medicare agent spends most of his summer taking classes and tests to qualify for the coming year.

Answer: Original Medicare doesn't offer dental at all. If you're currently on a Medigap plan you can pick up a separate dental plan at any time. It is also true that a lot of Medicare Advantage plans offer dental plans as part of the package. Some only offer preventative dental. It really comes down to your specific needs medically and orally.

I recommend you speak to a local Medicare insurance agent and have him help you determine what works best for your situation.

Answer: I love that I'm not a salesperson but an educator. It's not about sale, it's about helping people. I teach seniors about Medicare and help them chose the right plan for their needs. As a Medicare insurance agent, we get paid the same for every plan so it avoids the need to upsell the client but to do what's right. I also enjoy getting to know them and listening to their stories and adventures. I've become very good friends with a lot of my clients.

Answer: Possibly, if you are collecting social security disability, you will qualify for Medicare after 24 months. You will receive your Medicare card in the mail and then it's up to you to pick up a Medicare health plan to go with Medicare Parts A&B. I recommend that you use a Medicare qualified insurance agent to help you as it can be quite complicated finding the right plan for your needs.

Answer: No, you do not have to sign up for Medicare again. You will, however, get a 60 day open enrollment window starting in October through November. This will allow you to enroll into any Medicare supplemental plan that you would like with no underwriting.

Answer: Not usually. To move up to a Medicare Supplemental plan from an advantage plan requires the medical questionnaire if you are 6 months past your Part B start date.

Answer: Hi,

The best way to sort through all of the mail is to find yourself a local broker who can guide you through your Medicare enrollment. The broker will be licensed with a number of plans in your area and can help you decide on the best plan that fits your medical and prescription needs. It would be easier for you to have a knowledgeable professional that can answer all of your questions than talking to a voice on the phone.

Answer: All Medicare Supplements and Advantage plans must cover everything that Medicare covers. If it's a Medicare covered procedure, the plans will pay for it.

Medigap plans are the easiest to work with in this situation. No networks, no referrals, and possibly no deductibles. If Medicare covers the procedure, the gap plan will cover it.

Medicare Advantage plans are a little more difficult to use. Sometimes they require a prior authorization before a procedure can be done. Think of it like your group plan from work.

I hope that helps you.

Thanks,

Mark Murphy

Senior Medical Solutions

Answer: Unfortunately, no, you can’t switch mid-year to a Medigap plan. Those plans are medically underwritten and if you get sick, they won’t even consider your application. It’s best to buy them when you’re aging into Medicare or are still very healthy. Everyone is eligible for Medicare Advantage. It makes it easy to switch to when the Medigap plans become too expensive.

Hope that helps.

Take care,

Mark B Murphy

Broker

Answer: There are a couple of ways to do that. First, many of the Medicare Advantage Plans come with dental plans attached. They can offer anything from just preventative to a full, comprehensive dental plan.

Second, there are many stand-alone dental and vision programs available on the open market. They can be purchased anytime during the year.

Answer: Early retirement should not affect your Medicare eligibility. You can apply for Medicare 3 months before the month of your 65th birthday

Answer: No, some types of blood tests are not covered by Medicare. Ask your doctor to verify which test are covered so there are no surprises.

Answer: Most likely. Before 2025 the catastrophic level on the Rx plans was $8000 out of your pocket before your drug prices dropped to $0 for the rest of the year. Starting in January of 2025 the catastrophic level is now $2000. Once you've spent $2000 in copays your drug costs drop to $0 until January 1, 2026.

I say most likely because most seniors have low-cost generic drugs. On most Rx plans those copays can run from $0 copay to about a $15 copay. The $2000 catastrophic level will help seniors that take drugs that have no generic brand available and are paying the higher coinsurances or copays.

Answer: A lot of states offer Senior Prescription Assistance programs (SPAPs) to help with prescription costs. In NJ we call that program PAAD (Prescription Assistance for the Aged and Disabled). It is a state program where your qualification is based on your yearly income. The income levels increase just about every year so it's always good to continue to check the site for updates.

Answer: I've found that if you go to www.medicare.gov site you can use the chat box to get your answers quickly and with no hassles or long hold times.

Answer: Free is not a term we are allowed to use to describe Medicare Advantage plans, but, yes, there are a number of $0 premium plans out there that may fit your needs. Plan choices vary by the county you live in.

Answer: What I like most about being a Medicare agent is that I get to help the seniors navigate a very confusing time for them. Most people draw a blank when talking about medical plans. I try to explain everything in very simple terms, and I walk them through the whole process. I explain things thoroughly, but I keep it short and sweet and very understandable. Most seniors appreciate the hand holding through the process.