Marnie Applegate, Medicare Insurance Agent

Answer: Once you are over the age of 77 you are not eligible for the preventative lung cancer screening utilizing a CT however you can get a medically necessary CT scan at any age

Answer: Go to your Medicare Carriers website and choose find a provider. You will need to input your plan so I would suggest you call your agent to help you navigate the site.

Answer: Choosing a plan without understanding the downsides of Medicare Advantage plan as compared to a medicare supplement plan - for example network restrictions and pre-authorization rules

Answer: You can appeal the decision or request an exception for special circumstance. You may want to switch plans during an enrollment period - Annual 10/15 to 12/7 or Open 1/1 to 3/31. Of course if you have an emergency it is covered.

Answer: No, your eligibility shifts from disability based to age based but you maintain your Medicare coverage with the need to re-enroll. You do have a new opportunity during your initial enrollment period to re-evaluate and make any changes to your plan (part d or part C).

Answer: Late enrollment penalties for Part B and Part D. Part B penalty is an increase of 10% for each full 12 month period that you delayed enrollment or went without creditable coverage after turning 65 or if you were eligible earlier due to disability. Part D is a 1% increase (of the national average) for each month you went without creditable prescription drug coverage. Both are lifelong penalties.

Answer: There are concierge practices that will accept Medicare and will bill medicare for services that are covered, but you will still be responsible for your medicare cost-share like copayments, coinsurance and deductibles. If your are on a Medicare Advantage plan the doctor or concierge practice will need to be in network, if not then you will be responsible for all or some of the cost, depending on whether or not your Medicare advantage plan is an HMO or a PPO. You will still need to have Medicare for services not covered by the concierge membership (emergency care, hospital stays etc)

Answer: Every agent should only be looking out for what is in your best interest. With that in mind, an agent should first ask your about your current health conditions/chronic illness, and any anticipated medical services, your list of prescriptions, doctors/specialists, hospital preferences and pharmacy preference(s). They should also understand your financial considerations for any budget for premiums, copayments, deductibles and out of pocket limits. With that information they should be presenting to you the different options you have for either Med Supp and a Prescription plan or a medicare advantage plan. Not all agents get certified with every carrier, so they may only have the ability to offer you the plans for the carriers that they are authorized to write policies for.

Answer: I am making the assumption that you are already collecting benefits when answering this question. You can get the greater of yours or his but not both. Social security will compare your husband's earnings record, to what you are collecting to determine which is higher. You will need to contact Social Security Administration to report the death and apply for survivor benefits and they will adjust your benefits accordingly.

Answer: Yes Medicare will cover treatments for respiratory condition such as asthma and Part D will cover medications. Oxygen equipment or Nebulizers are typically covered under Part B.

The costs associated with treatment will depend on your individual Medicare plan and any costs associated with devices and drugs will be outlined in your plan documents.

Answer: You will automatically get Part A if you or your spouse worked 40 or more quarters over your lifetime, but if you have group medical and prescription drug coverage that is as good or better than what medicare offers, then you can stay on your employer group plan until you retire or quit and then you will have an enrollment period to opt in for Part B and sign up for a supplement and prescription plan or a medicare advantage prescription drug plan. When you are ready to do that contact an insurance agent that specializes in Medicare 3 mos before you plan to retire and they can help you with the process.

Answer: Unfortunately you missed the special enrollment period when your husband retired and no longer had group benefits. However with Open enrollment starting 10/15/25 until 12/7/25 you have an opportunity to pick up additional coverage with a medicare supplement and a prescription plan or with a Medicare Advantage Prescription Drug plan. Reach out to an agent who can help you review the 2026 plans.

Answer: Hi, this is Marnie Applegate, a Medicare agent for you, and I am here answering a question about why hospitals are not taking Medicare Advantage plans. There are several hospitals around the country, and at the beginning of 2025, I think the number was at 27 that actually stopped taking Medicare Advantage plans. That could be due to financial strain from lower reimbursement rates from the carriers. Some of the carriers are slower to pay, and some carriers have denials or extensive prior authorization processes. So that is causing some hospitals to no longer take Medicare Advantage plans.

Open enrollment, or annual enrollment, goes from October 15th to December 7th. So if you currently have a plan and a hospital that is no longer in-network, now is the time for you to make a change. Also, don't forget about the Medicare Advantage open enrollment period, which runs from January 1st through March 31st. That's also another opportunity for you to make a change should your hospital decide to no longer accept the Medicare Advantage plan that you're currently on. Thanks, and have a great day!

Answer: Hi everyone, this is Marnie Applegate with Medicare. I am here to answer a question on how you can avoid or reduce IRMAA charges on Medicare premiums. Your IRMAA adjustments, which have been around since 2007, are applied based upon your income from a two-year lookback period. So in 2025, it's currently being applied based upon your income in 2023. And those are applied to both Part B and Part D.

So if you’ve had anything like marriage, divorce, annulment, death of your spouse, work stoppage or reduction, loss of income due to property loss, or loss of pension income, or maybe you just retired, you can go to Medicare.gov or cms.gov and pull up SSA-44. You can complete that form, attach the required documents, and send it into Social Security. They will review it, and if they agree, they will either reduce or eliminate your IRMAA adjustment.

If you're wondering how they determine what those adjustments are, feel free to go to cms.gov and type in IRMAA. It will take you to the tables and show you how they are applying those adjustments to your Part B and your Part D premiums. Hope that helps answer the question, and if you have anything else, please feel free to reach out and contact me. Thanks!

Answer: No, you generally can’t switch during AEP without answering health questions unless you have a guaranteed issue right or you live in a state with the birthday rule that allows for an annual Medicare supplement/Medigap switch to a plan with equal or lesser benefits without medical underwriting, pre-existing conditions or a new waiting. Period. If your state has the birthday rule, the guaranteed issue. Is typically anywhere from 30 to 60 days. But to answer the question, can you switch from a Medicare advantage plan to a Medicare supplement/Medigap during AEP yes you can but it typically requires medical underwriting.

Answer: If the agent doesn’t start off by asking you about your doctors, your medications and what you can afford that could be a concern. You ideally want an agent that offers several different companies plans and that definitely doesn’t pressure you to make any decisions on the spot. You also want an agent that make sure you understand what they’re explaining, and it goes through the coverage details thoroughly

Answer: Medicare pays each of the private insurance companies that offer MAPD plans a set amount for each person that is enrolled in their MAPD plan. In addition to this insurance companies manage costs well and they also supplement those set amounts that are paid by Medicare with things like Higher co-pays, deductibles and helping to make sure it’s members stay healthy.

Answer: it is important to make sure that your parents understand the plan that they chose, and that it meets all of their needs for coverage as well as financially

Answer: It will depend on the provider whom you have your prescription plan with or if you have a Medicare advantage plan with prescription coverage it will depend on whether or not it is a covered drug on your insurance providers formulary. If it is a covered drug, your cost will then depend on what tier it is ranked. However, the the limit for what you and your insurance company will pay is $2000 in 2025 and then you will go catastrophic for covered drugs.

Answer: Again this question depends on whether or not you have a Medicare supplement/Medigap policy or you have a Medicare advantage policy. You should look at your plan documents to see what responsibility you have for any deductibles co-pays or coinsurance that is on your plan.

Answer: Part B covers medically necessary, durable medical equipment so long as your doctor/provider prescribes it for you. Medicare does cover different kinds of durable medical equipment in different ways. Meaning you might have to rent it. You might have to buy it sometimes you own it after you make a certain number of payments. Your best bet is to call the number on the back of your card and talk to customer service and see what your particular plan covers And how they cover it.

Answer: Assisted living cost is not a benefit that is covered by Medicare. You should reach out to an insurance agent to see what options you have in obtaining a standalone policy that would help with your costs Should you need assisted living

Answer: Every insurance provider has their own set of roles as it relates to obtaining a referral to see a specialist. You should make sure that is one of the questions that you are talking to your insurance agent about during your annual enrollment. Since there have been some changes going into 2026 for some of the carriers in regards to referral requirements.

Answer: Irma has a two year look back. So for 2025 Social Security is looking at your modified adjusted gross income that you claimed on your tax returns in 2023. If you’ve had a significant life event, you are allowed to submit SSA form 44 requesting that Social Security look at your current income versus the two year look back, which could either lower or even eliminate the IRMAA.

Answer: if you are surprised by the bills, you may want to consider a Medicare supplement/Medigap plan specifically plan G as it is the only one that covers excess charges. Plan an F also covers excess charges, but you would’ve had to have turned 65 before January 1 of 2020. Plan G also doesn’t have any part ARB coinsurance or copayment, but it does have a part B deductible and that changes annually. This way you know exactly what you’re paying for your premiumand the Medigap plan picks up the 20% that part an and B don’t cover. And the Medigap plan picks up the 20% that part a and B don’t cover then you’ll just have to consider getting a prescription plan

Answer: There really is not an answer to this question because it absolutely depends on your circumstances and what your needs are for coverage. I often tell my clients if you don’t want to adhere to a network and you want to see any doctor anywhere in the United States then a Medicare supplement/Medigap plan is something to consider. Of course these types of plans have a higher cost upfront in your premium and you have to pick up a prescription plan if needed however with that said there are a couple carriers that do have nationwide networks so it is to your benefit to meet with an insurance agent to review your specific situation and your needs to determine which could be the best path for you to take either a supplement and a prescription plan or a Medicare advantage plan

Answer: Maximum out-of-pocket, a.k.a. MOOP, is the highest amount that you will pay for your covered healthcare services in a Medicare Advantage plan during the calendar year. Once you reach that limit, your plan covers 100% of eligible cost for the remainder of the year. You do have to keep in mind that MOOP applies only to covered services. You still have to pay for any out-of-network care that you receive or non-covered services, and monthly premiums. It is beneficial to meet with an agent to review the different insurance providers plans, as typically your lower premium plans will have higher MOOP limits

Answer: Yes your provider will send you your annual notice of change by September 30 of each year. The notice explains what the changes are to your coverage your network and your costs that will take affect on January 1 of the following year if you did not receive your annual notice of change by the end of September, you should contact your Insurance provider to request it

Answer: There are now three phases for prescriptions and that is going to be your deductible phase your initial coverage phase and catastrophic phase. What that means is if your plan has a deductible you will meet that deductible first and then you will roll into the initial coverage phase at which point once what you pay and the insurance company pays reaches $2000 in 2025 you go into catastrophic and you won’t pay anything further for covered drugs. What that means is the drugs have to be on your prescription carriers formulary in 2026. It will be $2100

Answer: I am not sure what type of plan you have, but there are many options out there and it would be best for you to meet with an insurance agent so they can go through your specific needs and situation to determine what other options are available for you at a lower cost

Answer: I don’t know your overall needs that you have but many people Get a Medicare supplement/Medigap plan because they are traveling and they don’t want to have to adhere to a specific network of doctors. There are a couple carriers that do offer nationwide networks for Medicare advantage plans which means you can see any doctor in their nationwide network as long as you validate that they are a current network provider for that carrier you could always meet with a Medicare agent who can look up your doctors and your prescriptions and let you know which carriers have networks that cover those doctors

Answer: Your friend may have a Medicare advantage plan with a $0 monthly premium but will have higher co-pays for specialist and other services and more than likely a much higher maximum out of pocket. I’m not sure if you’re in a Medicare advantage plan with a higher premium, but lower max out-of-pocket costor if you’re on a Medicare supplement plan as those typically have higher monthly premiums than Medicare advantage plans due to the coverage/cost paid on your behalf

Answer: Original Medicare, which is parts an and B offers nationwide coverage and Medicare supplement. Also known as Medigap plans are an excellent choice to pick up that other 20% and they work with any provider that agrees to accept and bill Medicare so there are no geographic limitations on Medicare supplement/Medigap policies. If you have a Medicare advantage plan, they typically have geographical restrictions, but there are some plans that have visitor or snowbird benefits, which allows for temporary coverage in another state, but you would have to contact your Medicare advantage carrier to ask them whether or not you have coverage and your prescriptions will be covered while you’re away from your primary Residence

Answer: Life insurance can help support several financial goals, such as ensuring, long-term, financial security and stability upon death orpaying for education or retirement life insurance can help you cover funeral costs any significant bills or debts that are left behind as well as help with living expenses going forward. You can structure life insurance proceeds to provide a stream of income in case of the policyholder’s death. It also offers other tax benefits, like tax-free, death benefits for your beneficiaries or even tax deductions for premiums that are paid. You can also integrate life insurance into investment plans so that you can grow the value of the policy while still providing insurance coverage.

Answer: I’m not sure if you’re looking for a specific answer for a coverage gap on Medicare supplement or Medicare advantage plan so I’ll try to be general and answering. Each type of plan has out-of-pocket expenses for services not covered deductibles and coinsurance. Original Medicare has 20% responsibility for the beneficiary. You can pick up a Medicare supplement also known as a Medigap plan to cover that 20% but you’ll still have depending on which letter plan you pick a deductible and excess charges. You’ll also have the cost of a prescription plan the cost of the drugs and any deductible. However, with the elimination of the donut hole or coverage gap, the max out-of-pocket spending for cover drugs is capped at $2000 in 2025 and it will increase to $2100 in 2026. If you have a Medicare advantage plan also known as part C there are specific coverages that vary between plans and those have different premiums, max out-of-pocket and co-pays and they are all developed based upon each carrier and the plans that they choose to offer. It is really important that you sit down with a knowledgeable agent that can explain the differences between original Medicare, Medicare supplement plans, prescription plans, and Medicare advantage plans and review not just the premium cost but what your overall cost could be as a result of coverage gaps. I hope that helps

Answer: It really depends on whether or not you want to adhere to a network of doctors or be able to see any doctor you wish. With Medicare advantage plans you also have to adhere to preapprovals of procedures by the carrier and potentially referrals to see specialists with some carriers There are some good reasons to consider a Medicare advantage plan because you have ancillary benefits like dental vision hearing over-the-counter benefits. It really is something that you need to review with an agent so that agent can show you all of the benefits that a Medigap plan offers a Medicare advantage plan.