Mike Alexander, Medicare Insurance Broker

Answer: Step therapy is that you must 1st yse the lower price med then move up to the more pricey brand if the cheaper version does not work.

Answer: Yes medicare will cover it. You will need to get a prescription from your doc to approve the procedure and it must be administerted

Answer: Yes many plans will pay for cologiard if you test positive then youvwill be required to see a doctor and schedule a diag procedure to determine what the issue is.o

Answer: Yes you must call and disenroll asap as your old plan runs thru 12 31. Get a copy of the disentollment letter from them. You will also need a copy of the cancellation letter from PHIP to apply for the guranteed ussue for the supplement.

We will be happy to assistt you with that and run you a spreadsheet of plan g suppkements in that area

You will also need to enroll in a part d stand aline drug plan and it will auto disenroll you.

Answer: Yes you can access benefits on jan 1st.

Make sure you Doctors have the new id card info so you wint have any issues accessing your care

Answer: You can apply with a local agent and depending on your state you may have guranteed issue rights. Youay have to answer medical questions to qualify

Answer: Yes they cover it your co pay is 20%. If you have a medigap it covers your 20% after your deductible

Answer: Yes you can also go to Husk.

They offer discounted low cost membership programs and have discounts for policy holders of insurance carriers

There are a few supplement plans that offer gym discounts thru silver and fit.

Answer: Yes, but you need to go to Hey Moe.

To find plans in your area

Answer: Yes advantage plans do go to medicare.gov to find plans in yoyr area or a standalone plan

Or go to getagreatquote.com

Answer: Sone medicare advantage plans offer otc cards

Go to medicare.gov to find a plan that has them in your area

Answer: You can go to medicare.gov and applyyou have paid in by your ssi income so you can apply for medicare do it now

Answer: You can go to medicare.gov or agent hub to find agent in your area we are working in your area i would be glad to send you to a great agent

Answer: C snps can be for certain chronic conditions

Such as Diabetes heart issues and other chronic conditions. They vary state to state

Answer: As long as the drug is a tier 1 2 or 3 level med tgen it qualifies and is in luded in you plans formulary. Ck with yourbplan to see what tier kevel your med is

Answer: If you have worked and paid taxes for 40 quarters then you qualify for medicare at age 65 and can enroll in medicare at that time

Answer: You must be on disability for two years then you will be eligible for medicare you do nothave to enroll its done automatic after the 2 years

Answer: Every year you get an Anoc letter from your carrier and you show review the changes

You have from oct 15th thru dec 7th to change plans.

Answer: Yes it is covered if denied you can have your doctor appeal it, Many times it is denied because it was not coded properly by your prrovider

Answer: You must sign up for medicare asap

As 65 plus is not eligible for the aca plansonce you are eligible for medicare

Answer: You can appeal based on retirement or change in life status. I would have your cpa fill outbthe ssa44 form and ckearly state your reduced income status.

They usually back 2 years but a change in life status could get you the appeal

Answer: You would only be able to reenroll on part b from jan 1st to march 31st of that year.

I would not recommend that you drop part b

I lived in Costa rica for a few years but did not drop part b as i had coverage when i would fly back to US from time to time.

You do not want to drop part b as you would also be assessed a penality for each year you were not enrolled

Answer: Yes you can but be sure to asl your doctor if he takes that plan United has several plans and you must be sure he takes the plan you select

Answer: Yes medicare will cover these meds you .must have a part d plan on place also

You may also qualify for Phar assist on these meds also.

Answer: You will be eligible for a medicare supplement when you turn 65, and this will be the best option for you as your only out of pocket will be $283 per year on a plan G

Or if you want a lower premium the high ded plan G would also be an option

Contact me and we can go over the options

You may also check with the american kidney foundation to see if they have any grants available

Answer: If you are unable to leave the hospital for 90 days, then your limits will start on the day you go to the facility.

Answer: The limits vary according to which plan you have; an HMO plan will usually have a $3,000 to $5,000 MOOP.

A PPO can have as much as $10,000 out of pocket.

Answer: Yes, they do, but you would need a family member to have a power of attorney or visit with someone who handles their affairs. They would not be able to do so without another person present.

Answer: You won’t lose it as long as you pay the Part B premium. However, Medicare does not cover you outside the USA. I would recommend that you take out an international medical plan if you are out of the USA.

Answer: With the IRA, your max out-of-pocket will be 2100; then the med is free. Provided it is in the plan's formulary. You may also qualify for Extra Help, which would lower the cost even more.

Answer: Yes, if the drug is on the plan's formulary, your max out-of-pocket on the meds would be 2100 plus your plan's deductible. Then the med would be free the rest of the year.

Also, you may qualify for Extra Help based on your income, and the drug would cost less.

Answer: Some generics fall into a tier 3 level drug, which will cost more. You may also have to meet a deductible or are in the co-pay stage (up to 2100).

Also, that medication may not be in the plan's formulary.

Answer: See if you qualify for extra help, which is based on income. Go to Medicare.gov and get an extra help application and send it in. They are also called Medicare savings plans.

Answer: No, it will not affect your Medicare plan, but you need to see if it is more economical to stay on your employer plan vs going in Medicare, as it may actually cost you more.

Answer: It usually involves a clinic setting where some docs may take the plan under the clinic ID but are not certified with the carrier. Another is the provider dropped out of the plan but is still listed on the provider directory. Always call your doctors before you enroll and make sure they take the plan you are enrolling in. Be sure to give the provider the plan ID code you are enrolling in, as they may not take all the plans the carrier has.

Answer: Yes, they cover them once each year unless it’s medically necessary to have more, i.e., cancer or other chronic illness. There is a code for preventative and one for medical necessity issues.

Answer: Some Advantage plans offer you gift cards for preventative visits and offer free gym memberships. Some supplement plans offer gym memberships also.

Answer: No, unless you have lost your cards. Or had a change in your status.

You may also print a card from your ssa.gov site.

Answer: Medicare will provide testing products, blood tests and Nutrition consulting to help you control it. They will also provide you with a meter for in-home testing.

Answer: Yes, if you have... You must have worked at least 10 quarters in the USA & be a citizen of the USA. Not everyone will get Medicare unless they meet the qualifications above.

You may also qualify on your spouse's earnings record.

Answer: Plan K is good for healthy people who don't mind 50% coinsurance up to a max of $8,000 annually. It will reduce your monthly premium and gives you option of freedom of choice on providers.

If 50% coinsurance is too much for you, consider Plan L, which has a 25% coinsurance.

Answer: Yes, you always will need prior authorization and/or a referral, depending on if you have an HMO or PPO plan, and will need to use a network.

Answer: The Extra Help is based on your income. You can apply at Medicare.gov to see if you qualify.

If qualified, you may get a reduction in your Part B premium and a $0 copay on many meds.

Answer: Use Medicare.gov to get a comparison on your meds and the plans that cover them. You can also call your local agent.

Answer: Yes, most Advantage plans have their own network. Call your plan, and they should be able to tell you what dentists are in their network.

Answer: Get with your agent; they should call you each year and review your options.

You should also have a Medicare.gov account set up to notify you of all changes each year.

Answer: Medicare will be primary. You should call the Cboc unit at Social Security to make sure to report the change in insurance benefits, and get a supplemental plan in place and enroll in a Part D plan.

Answer: They are lack of provider and hospital access with restrictive networks. Also, you have to deal with pre-approvals and referrals.

Also, your plans can change every year and higher out-of-pocket costs.

Answer: Yes, you can work full time; you may have to pay more for Part B based on your current income. You can find out what Part B would cost by going to Medicare.gov.

Answer: That Medicare Advantage is the best plan. NOT TRUE; every client has different needs and has to be addressed and consulted and not just enrolled.

Answer: Each year, CMS reviews and expands coverage on certain procedures. You can also see if you qualify for certain trial studies that would cover some treatments.

Answer: Most all immunizations are covered as a preventative benefit; you would have a copay in some cases. Go to Medicare.gov to find which ones are covered.

Answer: Medicare does not cover assisted living places.

You would need a long-term care plan for this type of coverage.

Answer: You will have a $283 annual deductible; then it's covered.

You would also have up to a $20 copay to the doctor.

Answer: As long as this is deemed medically necessary, then Medicare will cover this and the speech therapy.

Some Advantage plans will have limits on this; ck your plan design or go to Medicare.gov to review the coverage.

Your doctor will coordinate the benefits and the speech therapy.

Answer: If you are outside the USA, Medicare does not cover you. If you have a Med Supp policy, you are reimbursed for up to $50,000 for emergency treatments.

If you have an Advantage Plan, some of them cover you for limited amounts for emergency, usually up to $20,000. You have to pay 1st then get reimbursed.

The best thing to do is to get an International Medical policy for the duration of your trip. That way, you are covered for up to $1 million, and you don't have to pay upfront.

The International Medical plans also cover medical transport back to the USA.

They are well worth the small expense.

Answer: Yes, it does. You get 20 hours per week for medical-based care.

It does not cover custodial care, i.e., a caregiver.

Answer: Sure, there is AEP from Oct 15 to Dec 7th each year.

This is when you can change your Medicare plan or your drug plan (Part D).

Next is OEP, Jan 1 to March 31.

During OEP, you can only change from a Medicare Advantage plan to another Advantage plan or go back to Original Medicare and get a Part D plan.

You cannot change your Part D plan during this period.

There is also an SEP (Special enrollment).

If you move to a new county, lose an employer plan or are in a county that the state has declared a disaster zone, you can change plans.

If your plan leaves the market, you can get an SEP.

Some carriers have 5-Star ratings, and you can enroll in those anytime.

If you qualify for LIS or Medicaid, that will also generate an SEP.

If you are going into a nursing home, you may always qualify for an SEP.

Answer: You don't save any money, and with an agent, you have an advocate to navigate the maze of Medicare and someone to call for help with claims.

Answer: Your max out of pocket for meds is 2100 per year; then plan pays 100% on covered drugs.

So there is no donut hole.

Answer: You have a set time to enroll in Medicare Part B and D.

When you turn 65, you have 3 months before your birth month, the month of your birthday and 3 months after your birthday. Failure to enroll in Part B or D will give you a lifetime penalty, unless you are covered by an employer's plan.

When you leave employment, you have 63 days after termination to enroll or face a penalty.

Also, many people do not know that COBRA is not creditable coverage and will also generate a penalty of 10% per year for failure to enroll if over 65.

Answer: You may have a copay depending on the plan you are in. Check your outline of benefits or call your plan customer service to see if you have any out-of-pocket costs.

Answer: The MOOP is the maximum out-of-pocket for a year.

If your Advantage plan has a MOOP of 5000, then once you have paid 5000 out of pocket for the year, then 100% of your costs are paid after that.

Note this does not apply to drug costs. On the drug costs, once you have paid 2100 out of pocket on drugs, then you are covered at 100%.

Answer: Medicare A and B only cover 80% of medical costs, so you need a supplemental plan to fill the 20% gap in coverage.

Answer: People who are on Medicare disability and have certain medical conditions will qualify for Medicare under 65.

You can see these on medicare.gov.

Answer: Yes, the ANOC letters go out every year in Sept; you should always review to see what changes are in your plan for the new year.

Answer: Yes, it is covered on most all plans. You can also use some services like Advanced Diabetic Supplies, which will handle your supplies thru your carrier.

Answer: If you are on an Advantage plan, you could have dental, vision, hearing aids, gym memberships, transportation and other value-added services.

Answer: When someone turns 65, or when a client loses employer coverage, or during the Annual Enrollment Period from Oct 15 thru Dec 7 each year.

Answer: If you are covered by an employer plan, then you should delay your A & B enrollment until after you retire.

If you work for an employer with less than 20 employees, then you should enroll in A & B because Medicare will be primary.

Answer: The 2100 out-of-pocket cap will save seniors thousands of dollars; after the 2100 cost, then meds are paid at 100%.

You may also qualify for Extra Help with some of your meds, which will lower your costs even more.

Answer: Currently about 69% of Doctors take Advantage plans.

A lot depends on where you live. If you are in a large city, then you have more choices.

In small cities, choices are less.

Answer: Yes, if you prefer to go to any doctor or hospital without pre-approvals and want the lowest predictable medical costs and you can afford it, then yes, they are the best option overall.

Answer: You can apply for Extra Help at medicare.gov for meds.

You can also go to RxHelpCenters for help with medication costs.

Another place is Prescription Hope.

A lot of drug companies have assistance programs. Ask your doctor about them.

Mail-order pharmacy Ghm

Again, many options are available.

Answer: You should be on a Medicare Supplement and not an Advantage plan, so you can go anywhere in the USA and have coverage.

Answer: Yes, it is covered at 80% of Medicare-approved charges.

Original Medicare gives you more choices on care.

Answer: It all depends on your needs.

If you want freedom to see any provider, then a stand-alone Part D may be a better choice.

With Advantage plans, the Part D is embedded into the plan.

Answer: Medicare will not pay all expenses, so that is why you need supplemental coverage to fill the gaps.

Medicare was designed to cover 80% of medical costs.

The supplemental plan will cover the 20% gap after a small deductible.

Answer: No, Medicare may or may not cover some procedures based on the type of plan you have. In most cases, Medicare is a better option.

Answer: Yes, if the drug is not on the formulary, they can deny it.

However, you can file an appeal with the carrier or ask for a formulary exception; your doctor will need to file with your carrier.

Call your carrier for an exception form.

Answer: Yes, it depends on what type of plan you are on and the benefits. Call your plan for their benefit outline.

Answer: Medicare provides a complete physical at no cost when you 1st enroll in Medicare. After that, it provides an annual wellness checkup.

Depending on what type of plan you have (Advantage or supplement), you may have a copay for the service.

Answer: In many cases, depending on the plan you have, these policies will provide benefits if you have a chronic illness or hospital stay that could benefit you in a time of need.

Answer: Medicare.gov has several online tools.

You can also use Medicare rights center.com and Medicareinteractive.com.

Answer: The best carriers are those that have an A rating with AM Best

The carriers with the lowest 5-year rating history

Customer service ratings

Claim History payments

Stay away from Low Ball price carriers that have less than 5 years in the market space

Answer: You are confined to the plan's providers

You must get prior approvals before treatments

You could have out-of-pocket costs up to $10,000

You are in a private plan and not Original Medicare

Limited coverage for chronic disease conditions and confined to their networks

Answer: Every two years, they look at your income, and IRMAA could go up or down based on your income. Go to Medicare.gov and look up your IRMAA amounts.

Answer: If you have a Medicare Advantage plan, yes, you will have out-of-pocket costs.

If you have a Med Supplement with traditional Medicare, then your max out of pocket would be $283 per year on a Plan G supplement.

Answer: In a lot of cases, many Supplement carriers give spousal discounts, and when a spouse dies, then you no longer get the discount. I would recommend that you shop for a new med supp company that has lower rates in your area.

Answer: This is a standard procedure; your doctor has to submit the request and make sure it is medically necessary. If you are on an Advantage Plan, it is required to get prior approval. If you are on traditional Medicare and a supplement, then you may not need a prior approval if your doctor requests it.

Answer: I would recommend that you go to hey moe and enter all your meds to see if they are covered.

The stand-alone Part D plans allow you to pick your own drug plan.

Answer: When you move to another state, you will have a Special Enrollment Period to change to a plan in your new home area.

Answer: Yes, it's capped at 2100 for all approved drugs. Your drug must be approved and be on your plan's formulary.

Answer: If you are on traditional Medicare, then you must 1st meet your Part B deductible of $283, then you would owe 20% of the Medicare-approved charge, and if you have a Med Supp policy, it would pick up the 20%.

If you have a Medicare Advantage, then you would be subject to a co-pay for every visit.

Answer: Some of the Medicare Advantage plans offer this service; check with your plan to see if available.

Plan to get it this year, as many of the Advantage plans will reduce these benefits in 2027.

Answer: You pay payroll taxes for Medicare Part A if working.

You do pay taxes on your SSA income but not for Medicare, except if you are still working; then it's taxed on your income.

Answer: Every year in Jan, the Part B deductible changes based on inflation and claims data.

Some years it goes up more based on medical cost increases and some years less. But every year it changes. They send out notices; also, if you have an SSA.gov account, you can see it ahead of time and budget for it.

Answer: Yes, it will cover it based on medical needs.

You also may want to get a 2nd opinion so you have the best possible outcome.

Answer: It should not affect your current plan or benefits. Based on your conditions, you could qualify for a special needs plan with the same carrier or another one with better benefits.

Thanks.

Answer: Brokers are paid by the insurance companies.

You want a broker to show you all plans, not just the ones he recommended, and let you choose the plan that meets your needs.

Answer: All Medigap plans cover up to $50,000 for foreign emergency visits.

I would, however, recommend getting an international medical plan when you travel outside the USA, as the Medigap plans require you to pay 1st and then wait for reimbursement; on the international medical, they will file the claim for you.

Answer: For at least a year; discard them once you get the new ones.

If it's a claim issue, I would keep them until the claim is settled.

Answer: When you turn 65, you have a new enrollment period and can enroll in a Medicare supplement plan without underwriting and be able to get a new Part D plan.

Answer: On an HMO-POS plan, you must select a primary doctor. You can go to any provider without a referral in the network, and you can go to a non-network provider, but you pay a higher copay.

On a standard HMO, you must pick a primary care provider, and you must have a referral.

No out-of-network benefits.

On a PPO, you don't have to pick a primary doctor, and you can freely go out of network.

PPO will give you the best choice of providers.

Answer: It is speeding up helping people get enrolled in Medicare A&B by allowing clients to do the enrollments online rather than going in to an SSA office.

Answer: ACOs: accountable care orgs that control claim costs and improve quality of care. Ask if your doctor is a member of one of them.

Answer: No, Medicare does not cover any death benefits.

Social Security has a death benefit of $255, not much.

So you may need life insurance if you don't have funds to cover your final expenses.

Answer: Advantage plans in some areas are losing money and are withdrawing from the area.

Also, some plans have too much exposure and are terminating plans to reduce their footprint and increase profits.

Answer: Yes, depending on your plan, you will have some copays and limits to the # of treatments; check your plan for details.

Answer: No, all agents are compensated by the carriers. It is illegal for an agent to charge a fee for his services.

Answer: Yes, the CPAP machine is covered under DME (durable medical equipment). The treatments are covered by Part B.

Answer: Go to ssa.gov 3 months before you turn 65 and enroll in Medicare A & B.

Then you can decide on either a supplement plan or an advantage plan depending on your budget.

Answer: In this case, you would qualify for skilled nursing benefit.

Check your plan to see what your out of pocket is.

On Advantage plans, you will have more out of pocket for these services.

In a supplement, like a Plan G or N, you will have much less out of pocket.

Answer: Divorce has no effect on eligibility, but if your income is now less after the divorce, you may be able to save on your Part B premiums.

File an SSA-44 after your divorce.

Answer: Part B excess charges are applied when you go to a doctor who does not take Medicare assignment. The excess charge is 15%.

You can avoid this by making sure your doctor takes Medicare by asking them.

Answer: Agents who have been in the field for at least 5 years or more are the ones to look for.

Experience, trends and knowing what to do for everyone, as everyone is different and experience is needed in the Medicare field more than ever.

Answer: Yes, HSAs can pay for Medicare premiums and Part D copays and Dr. out-of-pocket expenses.

Your deductibles and max out-of-pocket expenses can also be covered.

Answer: All plans change their benefits in Jan of each year. Check your plan benefits for 2026; you should have received an ANOC letter in Oct with changes to your current plan.

Answer: No, you are not in Original Medicare; Advantage plans are Part C of Medicare and not Original Medicare.

Answer: No. In an HMO, you must go to their contracted providers, or it's 100% out of pocket.

Get your PCP to get you a referral to a doc in their network.

Also, ask the cardio doctor what plans he takes, as you may be able to change to a different plan with a chronic SEP enrollment.

Answer: You should apply for LIS (Low Income Subsidy) or, depending on the state you live in, apply for Medicaid.

Answer: Yes, they can help. You will need to request that they be available when you call and ask for permission to be on the line with you.

I would also recommend that you get a power of attorney to save time in the future.

Answer: Most all preventative services are covered annually; some services, such as colonoscopies, have time schedules as to how often Medicare will approve them unless your doctor files an exception.

Answer: With just A & B only, you will be responsible for 20% out of pocket with no cap on costs.

We recommend getting a Medigap or a Part C plan to reduce your out of pocket and protect you from financial burden.

Answer: Yes, as long as the doctor has it approved and it is necessary and the medications are in the plan's formulary. You can also appeal to have the meds covered.

Answer: 1. Look at what you want, such as freedom to see doctors you want.

2. If you travel for extended periods outside of your city or state.

3. Can you afford a monthly premium for supplements?

4. Do you have chronic conditions?

5. Use a professional to help you do a needs assessment.

6. Everyone is different; find the plan N that meets your needs.

Answer: Many issues as providers leaving due to compensation adjustments, poor client service, not being able to see specialists they want, and many plans are leaving certain areas.

Answer: They look back every two years and will automatically adjust your IRMAA. If you have a change in life status or income, you should submit an SSA-44 form to have your IRMAA adjusted.

Answer: Sometimes either the doctor's practice drops certain plans, or they have a dispute with the carrier and lose their contract.

Answer: Medicare only covers spinal manipulation adjustments; it does not cover routine chiropractic care and is limited to # of visits.

Answer: Yes, urgent care is covered by Medicare and all insurers who write Medicare plans, as well as all Part C plans.

Answer: Most all preventative care is covered at 100%, as long as it is coded as preventative care.

Make sure your doctor's office codes it correctly, so you won't have any issues.

Answer: You can go to Medicare.gov and look up covered procedures. Also, you can have your doctor request an appeal to see if Medicare will cover it. You can also call 1-800-MEDICARE to speak with a live person.

Answer: Always be sure your medications are in the formulary, make sure your pharmacy is a preferred pharmacy, and use Medicare.gov to get an independent view before you enroll.

Answer: A good agent should not push either product. They should do a Needs Analysis to determine the best plan for each client. When agents tend to push one plan over the other, they do not have the best interests of the client. Every person has different needs, and pushing one plan over another for commission is not keeping the best interests of the client in mind.

Answer: 1. Restricted list of providers

2. Must get a referral to see a specialist

3. Travel outside of your right home area

4. Dealing with managed care issues

5. Not having ability to see specialists you want if not in network

Answer: Yes, you should look at all changes, especially your prescription benefits, copays and what your value-added benefits will look like for the new year.

Always make sure that your plan will be in the area and if there is a plan change.

Answer: Medicare does not cover caregivers; you would need a home care policy or an LTC policy to cover these services.

Answer: You can go to an Advantage plan, as many have hearing aid benefits, or you can purchase a stand-alone plan that includes dental, vision and hearing, but you may have a waiting period.

Answer: In rural areas, provider networks are limited; you should consider going back to Original Medicare, as doctors are limited in rural areas.

Answer: Due to reservation status, most Native Americans prefer to be treated in their home, and the reservations provide home care.

Answer: When you call, tell them the reason you are calling.

If it's to check on your insurance status, call the COBC unit.

Sometimes you can go to the website at SSA.gov or Medicare.gov and find your answers.

Answer: Yes, all plans have different plans; it goes by your county and ZIP codes.

If you relocate, be sure to check and see if your current plan is in your new ZIP code.

Answer: They do, but plans vary, so be sure to read your outline of benefits from your plan to see what changes occur.

You should get your ANOC letter in Oct of each year stating any changes.

Answer: If you have both Medicare and Medicaid, Medicare pays 1st and then Medicaid picks up 100% of what Medicare does not pay, but you must use doctors who accept Medicaid.

You can enroll in a dual eligible plan thru a Medicare Advantage plan to get the most benefits.

Answer: SSA does a two-year lookback, so if you had the withdrawal in 2024, you should file the SSA-44 in 2026 or 2027 depending on when the funds were disbursed.

Answer: TRICARE is for retired career military and is a part of their military benefits. It acts as secondary coverage to Medicare.

VA care is for veterans who have served in the military but are not career military. They get use of VA facility for medical care. It acts alone, and they can also have Medicare and an Advantage plan also.

Answer: What she needs to do is sell her car to a relative for one dollar, then the relative can sell the car and not deposit this to her account.

Make sure you change the title to a relative.

Or she can gift the car to a friend, relative or charity.

Answer: Only for spinal manipulation adjustments.

Medicare will not pay for extensive chiro treatments.

Medicare will only pay a fixed fee for adjustments.

And some providers will not bill Medicare.

Answer: It will depend on the state you live in.

Some states allow guaranteed issue, while some require underwriting.

An exception is if the MAPD plan exited the market.

If so, then you may have a GI option.

Answer: 1st, make sure all your doctors and hospitals take the Advantage plan you prefer.

A lot of Advantage plans have dental coverage, and you should check to see which ones have the best dental coverage.

Answer: Yes, if you are 65 or older, you should apply for Medicare online at www.ssa.gov.

You should do this 3 months before your retirement date.

Once you have applied, then you can look at a Supplement or Advantage plan.

Answer: Go to Medicare.gov.

Type in all your meds, and it will give you the best options.

Medicare.gov is free.

Answer: This won't affect you at all. What will affect you is the IRMAA penalty if you have a higher income. Go to Medicare.gov and look up IRMAA costs for Part B and Part D costs.

Answer: Never answer telemarketing calls; hang up.

Never give out any personal info if you don't know who the person is.

Always report any high-pressure tactics to Medicare.

Answer: Annual physicals, all screenings and immunizations.

Annual cancer screenings.

Blood work and labs.

Always check with your doctor to see what options he recommends each year.

Answer: Insurance companies must underwrite the risk and make sure they have a balance of healthy individuals in order to be able to pay claims.

Note: all insurance carriers have different underwriting guidelines, so if you are denied by one, apply with another as you may be approved.

Answer: The insurance companies pay the agents for enrolling you in certain plans. Almost all agents are paid a commission on each enrollment.

Answer: On Traditional Medicare, you can go to any hospital or doctor that takes Medicare.

On Advantage plans, you must use network providers in order to have the lowest cost.

Answer: The only one better is which one gives you the benefits you want.

If you can afford a supplement, then Traditional Medicare is best.

Some people like the Extra benefits that Advantage has, like dental & vision, whereas some people like the freedom of Traditional Medicare and not have the network restrictions of Advantage plans.

Answer: I agree, it should not be allowed. They use this to get your personal info.

Never speak with any of these telemarketing salespeople; ask a local agent or call Medicare at 1-800-MEDICARE to find out if you qualify.

Answer: It depends on the state you live in; some states have GI rules, and others require underwriting.

Check with your state Insurance Dept.

Answer: Medicare fraud affects all of us. If you see fraud or notice questionable practices, call 1-800-MEDICARE and report it.

Answer: There is a list of all preventative procedures covered on Medicare.gov.

You can also look at your plan's outline to see what is covered.

Answer: Yes, Medicare will cover all Preventative care exams.

Most all are covered at 100%, and you are encouraged to get all preventative screenings.

Answer: If you just only have A & B, then you have a hospital admission deductible and a Part B deductible.

Medicare will pay 80%, and you pay 20% of charges.

If you have a Medigap plan, then it will pick up the 20% after a $280 ded.

Answer: The IV chemo is covered under Part B of Medicare.

After your deductible, Medicare will pay 80% and you pay 20%; if you have a supplement, it will pick up to 20%.

If you have a Medicare Advantage plan, then you would pay the 20% up to your MOOP.

Answer: I try to do a needs assessment to see what is important to you.

Medicare is confusing, and I try to educate you on how Medicare works, the different parts, when to enroll to avoid any penalty, and to educate you on the different plans Medicare has and which are best suited for you.

If you are a client who is switching plans, I look at carriers' 5-year rate history, client service reputation, carriers' AM Best rating, and, of course, current rates.

Answer: What you need to look at is:

1) Their 5-year rate history

2) AM Best rating; you want an A or B rating

3) Client service

4) How long have they been in business

That is what will determine the value.

Answer: Medicare does not pay for dental, but some Part C Advantage covers some dental, and some may cover 1 implant, depending upon the plan and the area.

You can, however, buy a standalone dental plan, but you may have a waiting period before it is covered.

If you have a DMO (like an HMO), you may have immediate coverage.

Also, there are dental discount plans that offer immediate coverage if you use their dentists.

Answer: No, but you may qualify for a special enrollment period in your area, or you can change a plan during OEP from Jan 1st thru Mar 31st.

Answer: COBRA is not considered creditable coverage for Medicare, and you will be subject to a penalty.

You should enroll in Part B within 63 days in order to have guaranteed issue.

Answer: The person who enrolled you should have gone over all the benefits with you in detail; you still may be able to change plans before March 31st and get a plan that covers more dental.

Answer: You must 1st have your doctor write a prescription for it, and Medicare will cover it. You must also use an approved Medicare vendor.

Answer: There is no disadvantage; the broker services are free and do not cost you.

You have an advocate that is there for you to assist so you are not alone.

Answer: Medicare will only pay for a standard lens; if you want expanded lens coverage, you must pay out of pocket.

Answer: Dental, eyeglasses, long-term care, caregiver care or home care, hearing aids, medical care outside the USA.

Answer: I would change the IRMAA penalty for Part B and Part D.

People who have made more income should not be subject to IRMAA fines.

Reality is, yes, you made more in income, but you have also paid more in taxes. IRMAA is like double taxation.

Answer: Yes, you will have to show proof of employer coverage and get an L564 form from your employer verifying your dates of coverage.

Answer: Cheapest is not always the best.

Several factors to consider:

1) How long has the carrier been in business?

2) What is the carrier's AM Best rating?

3) What is the carrier's 5-year rate history?

4) What is the carrier's claim history?

5) Customer service: Make a service call; see how they handle your call.

As far as plans, all Medigap plans are standard benefits, so all carriers have the same benefits regardless of rates.

Do your research and make sure the cheapest one meets all the above.

Answer: You should follow up to be sure that they have met their enrollment timelines and are not being subject to enrollment penalty.

Also, make sure they have enrolled in a plan that is right for them and not being pressured into an Advantage plan they don't need.

Follow up just to be sure.

Answer: Medicare does not cover you outside of the USA.

Some Part C plans cover you for a limited amount for emergency, and some Medigap plans will pay up to $50,000 for urgent and emergency care.

If you travel outside the USA, you should consider international medical for the duration of your trip.

Answer: 1st, you have to be sure to notify your insurance company of your move, as well as Medicare.

Since you have relocated, you have a special enrollment period to enroll in a plan that is in your new area.

Many of the carriers are in multiple states, and you could stay with the same carrier.

Answer: This is considered Durable Medical Equipment, and you must have a prescription for the equipment before you can use it.

Answer: Special Needs Plans are for people that have certain health conditions or you are on Medicaid and Medicare in force.

There are also some plans for people on disability and have SSDI.

Answer: Depending on when you enroll: if you are in the open enrollment period, then you can't be denied; after that, depending on the state you reside in, you may have to be medically underwritten.

Some states have annual open enrollments based on either your birthday or policy renewal.

So in some states, you can be denied if you don't meet the underwriting.

If you are losing employer coverage, you have GI on med supps as long as you apply in a limited window.

Answer: You will need a power of attorney in order to act in their behalf.

Make sure your POA has specified the POA includes Medicare and Social Security issues, as it must be stated as such.

Answer: Yes, most do because it saves costs, but I would check with your plan to be sure it is covered.

Not all plans may approve it.

Answer: Yes, all the plans support this, as it lowers costs to the Medicare trust funds, to the health plans and providers.

Answer: If you have opted out of Medicare, the plan will no longer pay. Unless you are in the Medicare payment system, the patient will need to pay you, as Medicare will not.

Answer: Yes, all Medicare Part B premiums are based on your income, and you have a 2-year lookback.

Go to Medicare.gov and look at the IRMAA chart.

Answer: As long as you are working for an employer of 20+ employees, you do not have to sign up for Medicare.

Your group plan would be primary.

If under 20 employees, then you need to sign up for A&B,

as Medicare would be primary.

If you have an HSA plan, do not sign up for Medicare until you retire.

I recommend that when you decide to retire to sign up for Medicare 3 months prior to retirement.

Answer: No, you will get the higher of the two benefits or widow's benefit.

I would recommend a visit at your local SSA office to speak to a counselor to make sure you are getting the most benefit.

Answer: There is no one best plan.

What to look for:

1) Are all your doctors in the plan?

2) What is the plan star rating? Stay away from a plan that has less than a 3-star rating.

3) Make sure the hospital you want takes the plan.

4) Look at your max out-of-pocket (MOOP).

5) Make sure it covers your meds.

6) Check customer service ratings.

7) Make sure the carrier has been in your market for at least 3 years or more.

The best plan is the one that meets all your needs.

Answer: You should have your doctor file the appeal with both Medicare and your secondary insurance co.

Make sure they ask for an expedited appeal.

Answer: In some cases, this may be approved; if it's approved by Medicare, it would be covered at 80%.

You should ask your doctor to get pre-approval from Medicare, as these procedures can be pricey.

Answer: Part B is the outpatient benefit of Medicare. It pays your benefits outside the hospital. You will pay a premium amount each month based on your income.

You must have Part B in order to get a Medigap plan or an Advantage plan.

Answer: You should call the Doctor's office and ask their billing dept what Medicare Advantage plans they accept; make sure you give them the Plan code on your ID card.

If your mom wants to switch back to the Medigap she had before, she can call Medicare and ask them to disenroll from the Advantage plan.

Be wary of trusting the salespeople; before you sign up, always call your doctors to make sure they accept that particular plan.

Traditional Medicare and a Medigap is always the best option.

The Advantage plans are going thru Market turmoil now and are not as stable as traditional Medicare.

Answer: 1st, set up an online account at www.ssa.gov.

You can apply online for Medicare.

Then you will need either a Medigap or Advantage plan.

On LTC, Medicare does not cover that, so you need a special type policy that will cover LTC.

I would consult with an advisor on this issue.

Answer: No, as long as you maintain creditable coverage, you will not have a penalty.

When she does retire, you will need two forms to apply for Part B: form 40-B and L564. I would do this 3 months before she retires.

You can go to SSA.gov and print out the forms and have them ready.

Answer: Medicare will cover at 80%.

If you have an Advantage plan, many of them offer telehealth at a $0 copay; you may want to check for plans in your area.

If you have a supplement like a Plan G, some of the supplemental carriers offer telehealth.

You can also enroll in services like Teladoc for an additional premium.

Answer: You will automatically be enrolled in A & B if you are on disability, and not have employer coverage.

Answer: You have to be careful and not be swayed into enrolling in a plan that is not right for you.

I agree it's a marketing tactic to steer you into a certain plan, so beware.

Answer: If it's done in the hospital on an overnight stay, then yes; otherwise, it would be covered under Part B.

Answer: For medical and hospital, once you reach the MOOP for that year, then you would not have any out-of-pocket except for Pres drugs.

Answer: Medicare only covers 100 days of skilled nursing care.

For long-term care, you would need a long-term care policy, which is a separate plan.

If you can't afford it, you should get with an estate attorney and set up a Miller trust to protect your assets and qualify for Medicaid, which will pay for LTC.

Note your Miller trust has to be in place for 5 yrs before you go into the nursing home.

Be sure to plan for it.

Answer: If you have an SSA.gov online account, you can go online and print a card and order a new one.

You can also go to a local SSA office, but be sure to bring a picture ID with you.

Answer: You will have a copay; look under outpatient surgery benefits on your plan or call the member service # on your ID card to get your copay amount.

Answer: You must file an SSA-44 form; it's available on SSA.gov.

Then you have to mail it to your local SSA office in your ZIP code.

Be sure to send by certified mail.

You should contact your CPA, as they know how to fill out this form.

SSA approves about 70% of SSA-44 forms that are filed properly.

Answer: As long as the blood test is medically necessary, it is covered. In some cases, if it's denied, you can appeal it.

Make sure your doctor codes the test as preventative, and it's usually covered.

Answer: This is important because it limits your cost each year on covered drugs to a total of 2100.

Some meds can be expensive, and this limits your annual cost.

Bear in mind that this total only applies to covered drugs in your plan formulary.

If you have drugs not covered by Medicare, you would need to look for other sources to help pay for non-covered drugs.

Places like the copay assistance programs you can find on Google.

Just type in the drug name and type coupons or copay assistance.

Answer: Medicare will pay for a CT scan, but it has to be preapproved by a Medicare doctor and be deemed necessary.

Answer: No, but you will need to check and see if your plan will cover that drug or use an alternative like GoodRx.

Answer: In most cases, you would lose that employer coverage. And you will need to enroll in Medicare A and B and either a Medigap or Advantage plan.

Answer: Part D will cover some of these meds if your doc gets it approved due to a medical issue. Not everyone will get it approved.

Answer: Medicare does not give any discounts; the amount you pay for Medicare is based on your income.

On Medigap policies, some give discounts based on family status and other factors.

If you are on Medicaid also, you may get your Part B premium waived.

Answer: People think Medicare will cover you for caregiver care; it does not.

Medicare will cover skilled nursing care for 100 days, if deemed medically necessary.

Answer: Once you are on disability for 2 years, you are auto-enrolled in Medicare.

In some cases, you can be fast-tracked in Medicare A & B.

Answer: You should get an estate attorney and set up a trust to have income flow into a trust so as not to go into personal income to minimize your IRMAA penalty.

And also consult with a tax advisor.

Answer: Life insurance is simply risk management to protect your family and provide funds for your estate obligations.

A good rule of thumb is 5 to 8 times your income in face amount. EXAMPLE:

If your income is 100,000, you should have 500 to 800,000 in life insurance in place to protect your family and estate.

Answer: Medicare Part A covers SN at 100% for 1st 20 days; for days 21 to 100, you have a copay of $217 per day for up to 100 days.

Medicare does not cover Long term care; you would need an LTC policy in place to cover a nursing home.

Answer: Medicare does not cover nursing home care; it will only cover skilled nursing facility care for a limited # of days. Review your Medicare and You Handbook for complete details.

Answer: Income won't affect your eligibility, but it can subject you to an income penalty on your Part D; you can check the income chart on Medicare.gov for your penalty.

Answer: No, you must work at least 10 years to be eligible for Medicare. You can check with your state for Medicaid, as you will not qualify for Medicare.

Answer: Medicare will cover medically necessary Home Health Care for 20 hours each week.

You should also look into Long-Term Care for more benefits also.

Answer: Once you are eligible for SSDI, then you must wait for two years, and then you will get Medicare. However, depending on the date of your disability, they may fast-track your SSDI app and make you eligible for Medicare at an earlier date.

Answer: Yes, but plans can add or drop doctors at any time during the year; in some cases, you will have an SEP to change plans. One of the new proposals is that if a provider leaves a plan, it will give you an SEP to change plans.

Answer: You may be able to enroll in another plan if you have a special enrollment in your state. You can also change plans during the OEP from Jan 1st to March 31st.

Answer: For some, Advantage works best; for others, Traditional Medicare is best. Each person has their own needs; a good advisor will show you both.

Answer: Some Medicare Advantage & Supplement plans offer limited international coverage for accidents and urgent care.

I always recommend an international medical plan when you travel outside the USA.

Answer: Do a full needs assessment to be sure that you are picking the right plan at the right time. Contact a professional; avoid answering the phone from telemarketing.

It's against the law for people to call you randomly.

Be aware; do your research 1st.

Answer: Home health care is covered by Medicare; caregivers are not.

Some SNF Medicare provide a small amount of caregivers aide; you would need to check with your current plan.

Answer: All Advantage plans have forms of pain management & chronic care management. Some Advantage plans have Special Needs Plans, called SNP & C-SNP plans, that cater to these individuals.

Check on Medicare.gov to find plans in your state.

Answer: Some plans have value-added services for chronic illness. Check what is called C-SNP plans in your area or go to Medicare.gov.

Answer: Acupuncture is covered by some Medicare Advantage plans with a small copay.

It has been quite effective for some people with chronic pain management.

Answer: On some of the chronic special needs plans, they have some additional benefits if you have certain chronic conditions.

Also, some of the plans have expanded drug formularies.

Ask the agent if any of the plans are in your area.

Answer: Every year they adjust the income amounts based on the inflation index. So if you were denied one year before, you may want to reapply, as you may now be eligible.

Answer: Medicare will cover 80% of approved Medicare charges, as long as the provider will accept Medicare assignment.

Answer: You are subject to 20% coinsurance with no cap on expenses.

You should have a Medigap or an Advantage plan to reduce your financial risk.

Answer: If you have a Medigap, you can change every month. On Advantage plans, you can change during AEP and OEP.

Answer: You can ask for an appeal or exception for that med.

In some cases, ask your doctor if there is a trial program for that med.

Answer: You have an open enrollment due to loss in coverage; you should look into both an Advantage plan and a supplement, depending on your current state.

Answer: Yes, make sure the plan you have is in your new state.

Also be sure to change your address with SSA and Medicare.

Answer: You should interview several agents. Look for how long they have been in the business, if they can look at all plans for you and not steer you into a plan they want to push.

Answer: Depending on health conditions, some may be approved. It also depends on the type of plan you have, as some Advantage plans have this coverage.

Answer: In 2026, Medicare will limit some Tele Doc services, as a lot of the COVID-era enhancements are not available in the future.

Answer: If you meet certain conditions and are unable to drive to the Dr.'s office, telemedicine will be covered.

Answer: You should review every year, before Dec 7th.

You should also make sure all your doctors take that plan.

Answer: Yes, it is covered by Part D; you need to see if your plan has it in their formulary, and what tier level it falls in.

Answer: Always ask for generics 1st.

Get a larger dose of the drug and use a pill cutter to cut it in half; you will save 50%.

Ask your pharmacy if they have coupons you can use.

Use mail order more.

Answer: Yes, some drug formularies cover it. You would need to review your drug plan formulary with your carrier.

Answer: The best way is to go to your Carrier's website and check provider search.

It will give you the most accurate information.

Answer: IRMAA, late enrollment penalties for Part B & D are common, but you can appeal them if you have had a change in life status.

Answer: No, Medigap is your best choice. You can shop carriers to get a better rate if you can qualify, or consider a high-deductible Plan G or a Plan N to save premium dollars.

Answer: The strain on costs will impact premiums, and Congress will need to raise the age for eligibility and increase the Medicare taxes to sustain the increase in the aging population.

Answer: With concierge medicine, most doctors don't take Medicare assignment, so you would pay 100% out of pocket. Make sure the doctor also takes Medicare, and if he does, you will have to file the claim, as most concierge docs won't file claims.

Answer: If you are on an Advantage plan, you should check with them to be sure they are in your new county.

If not, you will need to change plans; also, be sure to notify SSA with your new address.

Answer: Access to certain doctors and having to deal with managed care restrictions.

Also, Advantage plans change every year and may terminate your plan.

Answer: You should look at Traditional Medicare and a Medigap plan; you pay a monthly premium, but your only out-of-pocket is a $288 annual deductible. You pay a premium, but you have predictable costs and no surprises.

Answer: Regular Medicare allows you to see any doctor or hospital that takes Medicare, and you don't have to deal with networks.

Answer: Yes, in most cases, they save in premium cost, but all Advantage plans have out-of-pocket costs you must pay that vary with HMO and PPO plans.

Answer: You must have them present or have legal POA. You can also have them request with the agent that they have given you the right to listen on their behalf.

Answer: The fact that with Traditional Medicare, you can go to any Dr or hospital in the USA that takes Medicare; you are not subject to a network or prior approvals.

Also, if you need access to major specialty hospitals, like MD Anderson, the Mayo Clinic or Johns Hopkins, you have that with Traditional Medicare.

Answer: Yes, every year the deductible changes, along with your Part B premiums and the cost-of-living adjustment.

Answer: A trusted advisor in your community who will do a Medicare one-on-one with you, and not someone who is just selling you a product.

Answer: A local agent can come to your home for a face-to-face meeting. A local agent is invaluable and builds a relationship with you, not an AI call center.

A local agent is important to your community and builds a trustworthy relationship as a real person, not a call center agent.

Answer: Sales seminars are, yes. I recommend only going to an educational event and not a sales seminar, so you don't get a hard sell on one product.

Answer: Doing a needs assessment to determine their needs.

Asking questions about what they need and what is important to them as an individual.

Answer: With a 5 star plan, you can enroll any time during the year and are not limited by AEP or OEP.

So you have year-round enrollments.

Answer: No, Medicare is for life as long as you pay your Part B premiums.

That is the only way you could lose Medicare.

Answer: Providing value-added services and educating people to make the right choices, both with Medicare and retirement benefits.

Answer: Not being able to change plans mid-year and being stuck in a plan that does not work for them with doctors.

Answer: Not picking the right plan at the time of enrollment, and losing the guaranteed issue right for a Medigap plan.

Answer: If you have had creditable employer coverage, you need to apply for Medicare A & B.

Use an advisor who will help you with the application, to avoid any penalty.

Answer: 1) Always use an independent agent who represents you and not an insurance company.

2) Never use a captive agent who only represents one company.

3) Never use a call center agent.

4) Use a local agent who is nearby who you can reach when needed.

5) A good agent will do a needs assessment before he talks with you.

Answer: Apply for Extra Help and LIS (low income subsidy) thru SSA or Medicare.gov. A good advisor will assist you.

Answer: In some cases, but it must be pre-approved. It has to be medically necessary, but is not easy to get covered.

Answer: No, that's a political terminology. Medicare is easy to fix and control thru payroll taxes, but both political parties use it as a campaign issue.

Answer: That Medicare is free and it covers everything. Medicare is an 80% plan, and you must find additional coverage to cover the 20%.

Answer: Yes, this is a preventative procedure; however, if you are on an Advantage plan, it must be pre-approved, and you would need to use the in-network provider.

Answer: I never say 0 premium; I always say no additional premium, other than your Part B premium.

You will always have to pay your Part B cost, unless you are very low income.

Answer: No, all Medigap plans increase due to medical claims and age. Some plans have rate guarantees for limited times, but all will increase over time.

Answer: You should consider Traditional Medicare and a Medigap plan, to be sure you can go to the doctors you want and need. I would avoid an Advantage plan, which could restrict your choices.

Answer: You may want to consider an MA-only Advantage plan; many of these work well with VA coverage, and some even give you a Part B giveback.

Answer: I do a Medicare one-on-one with them, showing how Medicare works. I never try to sell them on a product; education is the key.

Answer: The experienced broker will always do a needs assessment, so he can determine your needs and be able to show you all the plans.

Answer: Many states have this rule with more added each year; check the states you are in for details.

States that have this rule tend to have more costly premiums.

Answer: They can inform you of that plan, but you should use Medicare.gov to search all the plans in your area. I would only attend educational events and not sales events that tend to pressure you.

Answer: Faster processing of claims, and less wait time for the doctors and insurance company.

It will take some time, but it should be a more efficient method.

Answer: No, Medicare secondary insurance is an employer plan that pays second to Medicare, depending on how many employees are in your company.

Answer: 3 months before your birthday, the month of your birthday and 3 months after you turn 65.

Failure to do so could cost you a late enrollment penalty.

Answer: Helping educate them about Medicare and assisting with their plan and enrollments.

We help enroll them with Medicare and SSA retirement benefits, saving them time and money.

Answer: Your time limits and when is the right time to enroll, in order to avoid a late enrollment penalty, which can be costly.

Answer: Yes, you are able to get an SEP, but you should enroll within 63 days of your coverage termination.

Answer: No, they are not free. When you elect enrollment in an Advantage plan, Medicare sends your Medicare money to the Advantage plans, who are then responsible to pay all your bills, not Medicare.

Carriers get from $800 to $3,000 per month for each person who elects an Advantage plan, and Medicare is not responsible for your treatment; the carrier is.

Answer: If it's approved by Medicare, then it's covered; if not, there may be some other programs that can assist with the cost.

Answer: You should contact your insurer and sign up for the M3P program (Medicare Prescription Payment Plan). Also look at Canadian pharmacies and discount programs out there, and ask your doctor to see if he has samples or knows of a discount plan.

Answer: Yes, because it limits consumer choice. Advantage plans appeal because of premium cost, but that is not the full story.

Answer: Make sure you read your Medicare & You handbook each year, and review your plan's benefits.

You should have been made aware of the ambulance copays.

Answer: Several things to consider:

On the health plan, you should look at many factors:

1) Look at the star ratings of the plan. I would pick a plan that has less than 3 stars with CMS. The star ratings tell you if the plan has adequate benefits and provides good client service.

2) Make sure you know the difference between an Advantage plan and traditional Medicare with a Medigap plan. There is a huge positive to traditional Medicare.

3) How long has the plan been in business in your area? Stay away from new plans with less than 3 years in the market you are in.

4) Never answer a telemarketing call about Medicare; only call a trusted advisor.

5) On an Advantage plan, make sure you call your doctors and ask them what HMO & PPO plans they accept, and check on the plan's formulary.

6) Only use an independent advisor, who works for you and not the insurance company; that way, you get the plan that will work for you.

7) Make sure your advisor does a needs assessment and not just pitch you plans he wants to sell.

8) Make sure you are dealing with a seasoned advisor who has at least 5+ years in the business.

9) Ask the advisor for references from their clients.

10) Do not answer random calls; it's illegal for someone to call you without you 1st requesting the call.