Mary Rivera, Medicare Insurance Agent

Answer: Your federal retirement gives you the option to keep FEHB into retirement, which works hand-in-hand with Medicare when you turn 65. The big decision is whether or not to take Part B, based on your health needs and budget.

Answer: Lower tiers, like generics, usually have lower copays, while higher tiers, like brand name or specialty drugs, cost more.

The tier your medication is in determines your share of the cost, so checking the plan’s formulary is very important.

Answer: Social Security provides monthly income to people with disabilities, and after a waiting period, those on SSDI also qualify for Medicare, which covers their healthcare.

Together, Social Security supports costs of living while Medicare provides medical and drug coverage

Answer: In 2025, Medicare Part D has a new out-of-pocket cap of $2,000, meaning once you reach that limit, your plan will cover 100% of your drug costs for the rest of the year. This can significantly help people with expensive medications like biologics, reducing the financial burden even if your medication costs $6,000 per month.

Answer: Some Medicare seminars can be helpful if they’re run by trusted, unbiased sources, like local SHIP programs or community centers, because they explain your options clearly. Be cautious of events that push specific plans or incentives, since those are often more about sales than education.

Answer: A licensed Medicare agent can help you navigate the “maze” and explain all the parts—A, B, C, and D—so it makes sense for your situation. You can also get free, unbiased guidance from your local SHIP counselors or Medicare.gov.

Answer: It is a law in some states that lets people switch Medigap (Medicare Supplement) plans around their birthday without medical underwriting (no health questions). This helps beneficiaries change to a plan that may have lower premiums or better benefits without being denied for pre-existing conditions.

CA, ID, IL, NV, LO

Answer: The best way is to make sure the lab is in network with your MA plan before getting tests, and confirm that the doctor has submitted a prior authorization or referral if the plan requires it. Always ask both the provider and the plan directly to avoid unexpected charges.

Answer: You can check if your mom’s doctors are in network by calling the doctor’s office directly or using the plan’s online provider search tool. It’s important to confirm before switching, since Medicare Advantage plans usually require staying within their provider network.

Answer: No, unfortunately, a sudden change in health does not qualify someone for a Special Enrollment Period (SEP) under Medicare

Answer: I enjoy being a Medicare agent because it gives me the chance to guide people through an important part of their lives.

Medicare can be overwhelming, and I love being able to explain it in a way that’s clear and simple. Most of all, it’s rewarding to know I’m helping families feel secure and confident about their health coverage