Melanie Blackston, Medicare Insurance Broker

Answer: The Inflation Reduction Act (IRA) brings major financial relief and structural changes to Medicare Part D. The most significant updates include:$2,000 Out-of-Pocket Cap: Enrollees' out-of-pocket costs for covered prescription drugs are capped at $2,000 annually. Once this limit is reached, there is no more cost-sharing for the rest of the year. Elimination of the Donut Hole: The "coverage gap" (donut hole) phase was eliminated, simplifying Part D into only 3 stages: deductible, initial coverage, and catastrophic coverage. Monthly Payment Option: A new Medicare Prescription Payment Plan allows enrollees to spread their annual out-of-pocket prescription costs into smaller, monthly payments rather than paying high upfront costs at the pharmacy. While these updates offer significant financial relief for beneficiaries, they also shifted the financial liability onto insurance plans and drug manufacturers. To compensate, some standalone drug plans may have adjusted their deductibles or premiums.

Answer: It is absolutely okay to work with a younger Medicare advisor. Age is not a determining factor; you should base your decision on their knowledge, industry credentials, and how well they can clearly explain your coverage options. A younger, highly educated agent can be just as competent and dedicated as a seasoned veteran.

Answer: Social Determinants of Health (SDOH)—such as housing, food security, and transportation—drive up to 80% of health outcomes. In Medicare, plans increasingly incorporate SDOH screening and support to reduce costly hospitalizations, advance health equity, and boost their official quality and star ratings.

Answer: If your specialist leaves your insurance network mid-year, your care is not immediately disrupted. You generally have options to apply for a temporary "continuation of care" extension or switch providers to continue receiving coverage at your in-network cost-sharing rates.

Answer: Yes, the influx of baby boomers is fundamentally changing Medicare. The system is navigating a significant collision between surging enrollment and the resources required to support it. However, this situation is not an overnight "collapse," but rather a long-term sustainability and systemic pressure issue.

Answer: Yes, you have sixty (60) days to contact social security and Medicare to change your address and look at new plans in your area.

Answer: Moving to a new state will start a 60-day Special Enrollment Period, allowing you to change Medicare Advantage or Part D plans because your current plan's service area has changed. You must update your address with Social Security and Medicare to avoid coverage gaps, as plans are regional and usually do not cover out-of-state, non-emergency care.

Answer: Patients can reduce Medicare medication costs by applying for the Extra Help program-LIS which is for limited incomes, you can also try switching to generic alternatives, using preferred in-network or mail-order pharmacies, and utilizing manufacturer assistance programs. In 2026, a $2,100 out-of-pocket cap on Part D drugs will further limit expenses.

Answer: Medicare Advantage plans are often avoided due to restrictive networks. The requirement for prior authorization for services, and potential for high out-of-pocket costs, particularly for chronic illnesses. Medicare advantage plans often limit your doctor choices to local areas, lack national coverage, and can deny care.

Answer: A Scope of Appointment (SOA) is a form required by the Centers for Medicare & Medicaid Services, that you must sign before a Medicare agent can discuss specific private insurance plans with you, and is required 48 hours before the meeting.

This is to protect you from high pressure sales tactics and ensures the agent only talks about the types of plans you are interested in, which helps in preventing call centers or unethical agents from pushing unnecessary products.

Answer: Medicare Advantage plans can save seniors money through lower monthly premiums and mandatory out-of-pocket maximums. They also can provide extra benefits like dental and vision.

Answer: Seniors often face permanent Medicare Part B and Part D penalties because they miss their Initial Enrollment Period (IEP)—a seven-month window around their 65th birthday—and fail to qualify for a Special Enrollment Period (SEP). These penalties are not one-time fees but, in most cases, permanent surcharges added to monthly premiums for life.

Answer: Turning 65 soon means you are in your 7-month Initial Enrollment Period (3 months before, the month of, and 3 months after your birthday). If not automatically enrolled (via Social Security), sign up at SSA.gov to avoid late penalties. Key steps include deciding between Original Medicare or Medicare Advantage and, if working, checking if your employer coverage allows you to delay Part B.

Answer: Yes, Medicare Part B covers wearable medical devices like insulin pumps and continuous glucose monitors as Durable Medical Equipment (DME) for diabetes, provided they are deemed medically necessary, prescribed by a doctor, and obtained from a participating supplier. Coverage typically includes 80% of the cost after the deductible is met.

Answer: I have a passion to help people. They need one on one direction with a person that can fully explain their questions and needs. Medicare can be very confusing so it is best to rely on a professional trained and educated Medicare advocate to help you make the bet decision of what's best for you!

Answer: With Original Medicare-Parts A and B, you generally do not need a doctor's referral or PCP visit to see a therapist for mental health or physical therapy services, provided the therapist accepts Medicare assignment. However, if you have a Medicare Advantage plan, you may need a referral from your primary doctor.

Answer: Yes, a disenrolled from a Medicare Advantage Chronic Special Needs Plan (C-SNP) for failing to submit the Chronic Condition Verification (CCV) form within the required timeframe normally 60 days of effective date qualifies for a Special Enrollment Period (SEP). This SEP allows you to enroll in another Medicare Advantage plan or return to Original Medicare.

Answer: Yes, Guaranteed Issue rights for Medigap policies are available after the initial 6-month Open Enrollment period, but only during specific qualifying situations. These rights allow you to buy certain Medigap plans without medical underwriting or pre-existing condition exclusions.

Answer: Medicare Part B your medical insurance covers: stress tests, EKGs, and echocardiograms when ordered by a doctor and deemed medically necessary for diagnosing or treating heart conditions. Costs generally include a 20% coinsurance after the deductible is met, plus any applicable hospital copayments.

Answer: You can look at cost-effective Medicare Part D plans for a brand-name medication, by using the Medicare Plan Finder on Medicare.gov to compare plan. You can enter your specific medication, dosage, and preferred pharmacies to see your options.

Answer: When thinking of a "ZERO premium" means no monthly plan fee, but costs are still associated to copays/coinsurance, deductibles, prescription tiers, and you still pay your Part B premium monthly.

Answer: Do not give out any personal information and do not even confirm your information. Never say yes to any question. Call your local broker for their assistance to make sure you stay safe and not scammed.

Answer: No, you normally don't get both your own Social Security check and your husband's, the Social Security Administration will pay you the higher amount, either your full retirement benefit or the survivor benefit (up to 100% of his benefit if you're at full retirement age), but not both combined. You'll receive your own benefit first, and if his survivor amount is higher, they'll "top it up" to that higher amount, ensuring you get the most generous payment available to you.

Answer: Meet with a local broker to review and show you all the available plans in your area. That way you can do comparisons with them, take notes and ask questions.

Answer: Contact a local broker that can help you with all available plans in your area. Annual enrollment is October 15-December 7.

Answer: Sometimes it can be a problem to struggle to find a dentist who accepts your Medicare Advantage plan. However, most plans offer preventative dental benefits, because dental coverage details vary significantly, and most plans require you to use a network dentist to get your benefits.

Answer: Yes, the insurance companies now offer a prescription payment plan program. You will need to reach out to the customer service department on the back of your insurance card to inquire about your options and more detailed information.

Answer: First, I would recommend looking at their company website and check their personal google reviews.

Red flags would be calling outside of the USA, and having a language barrier as well. If they do not take the time to get your doctors information to check in network's or prescription's to check cost with the plan they are recommending to you, I would be careful.

Answer: You need to look at your plans summary of benefits, it will give you the information on what is accepted and how many visits are allowed.

Answer: Yes, plans are specific to your area and zip code. You can go online or call your broker for more information on your areas plans available.

Answer: Yes, they sure do. Some insurance plans allow the card benefits for only over the counter items which are pharmacy items, other plans allow not only OTC (over-the-counter) in the pharmacy but also for healthy foods and fruits, and some plans allow you to use your card benefits to help with utilities and rent. You would need to check your plan benefits for exact usage of your OTC.

Answer: When you are looking into a Medicare Advantage Plan versus Original Medicare, it's normal to receive conflicting advice from many different sources. Both plans have their own advantages and disadvantages, but the best choice for you will depend on your individual needs and preferences.

Answer: Medicare agents bring a lot of one on one and face to face to the table to help Seniors. They are very familiar with the local hospital systems, doctors networks as well as pharmacies. You don't have to call a 1-800 call center as you have your personal dedicated agent to take care of you.

Answer: Seniors often think that Medicare covers all long-term care costs, mainly nursing home care and assisted living. However, Medicare mainly focuses on acute care and short-term skilled nursing care after their hospital stay. It generally does not cover the long-term, custodial care needed for activities of daily living, such as bathing, dressing, and eating.

Answer: The biggest mistake seniors make when enrolling in Medicare is they miss the initial enrollment period and incur late enrollment penalties. Many seniors also fail to properly research their options in plans and benefits, which can lead to choosing plans that don't fully cover their needs or cost more than necessary.

Answer: When you move you have up to 4 months to notify Medicare, the month before you move and up to 2 months after your move, however the sooner the better. Not only do you notify Medicare, you update Social Security and your Insurance Company. Look into new plans in your new area with your current broker as they also may be licensed in the state you have moved to. Get enrolled into the plan quickly and find new doctors and medical facilities in the networks. Also do not forget to request a transfer on your medical records.

Answer: Medicare Part C your out-of-pocket costs for inpatient hospital care are different from Original Medicare Part A. Part A has a deductible of $1,676 for each benefit period. Advantage Plans usually have a copay of $300-350 per day for the first 5-7 days, and then a different cost for additional days, which could be zero The exact cost-sharing for MA plans vary by plan. Make sure to check your plan's specific coverage and cost information.

Answer: Medicare supplement plans like Plan G, offer more comprehensive coverage. It can include coverage for Part B excess charges and possibly lower premiums compared to traditional plans. Med Supp plans have higher premiums and increase annually with your age.

Answer: You will need to call your insurance companies customer service and check the specific deductible, co-pays and benefits of your plan for your procedure.

Answer: Having life insurance can take a burden away when you pass. It provides a death benefit that can be used to cover financial needs of the beneficiaries. It is mainly used for funeral expenses, but is also used for debt and everyday living expenses.

Answer: Yes, Loss of your employer health insurance is considered a qualifying life event that will trigger a Special Enrollment Period, allowing you to enroll in a new health insurance plan outside of the regular Open Enrollment Period.

Answer: You can, but generally only under special circumstances that qualify you for a Special Enrollment Period-SEP.

Answer: Yes, If you sign up for a Medicare advantage plan most do offer some type of annual hearing benefit in your plan at no cost.

Answer: When they ask for your Medicare number or to tell you they need to confirm your Medicare number but ask you to give it to them. When they tell you about big extra benefits you can get with nothing to back it up in regards to your health, medication or doctors.

Answer: It is unlikely Medicare would implement a system based on lifestyle as many factors would have to be considered. In the current form due to potential inequities and practical challenges the current Medicare system largely bases premiums on income.

Answer: It's a set time period when you can apply that guarantees you'll get coverage and you may get a better price on your Medicare supplement plan. You are generally eligible to enroll in Medicare Part B within a 7-month period, starting 3 months before and ending 3 months after the month you turn 65.

Answer: No, you will just need to delay your Part B and you will need to make sure you have credible medical coverage with prescription benefits as well.

Answer: As a broker, I have the ability to truly dig into Medicare plans that best fits my clients needs. I have a passion to be an advocate for the Senior Community.