Nadia Ponce Simbron, Medicare Insurance Broker

Answer: Our expert help and guidance are completely free of charge. Reach out to us. We're here to help you!

Answer: You're correct! Medicare typically only covers 80% of the approved amount for emergency ambulance services, leaving a 20% balance to pay out-of-pocket. The $300 bill you received might have been the 20% that Medicare did not cover.

Answer: A great option is to speak with a licensed insurance broker, as they can run a comprehensive search across multiple carriers and confirm network coverage for her!

Answer: I love being a community resource that turns a confusing process into something simple so my clients can feel confident and secure about their healthcare.

Answer: Original Medicare generally does not cover hearing aids or routine exams, so you would typically pay 100% of the cost out of pocket unless you have a Medicare Advantage plan that includes those benefits.

Answer: Since you'll lose that employer coverage, you get a Special Enrollment Period to sign up for your own Medicare plan without late penalties. You'll need to pick a new plan so your doctor visits and prescriptions stay covered.

Answer: You can self enroll through Medicare.gov or 1-800-MEDICARE to pick a plan yourself, or you can contact a local broker who will evaluate the costs of your meds and handle all the paperwork for you.

Answer: A copay is a fixed fee you pay at the time you receive a specific service and a deductible is a set annual amount you pay out-of-pocket for covered medical services before your insurance kicks in.

Answer: While Original Medicare (Part A and Part B) does not cover hearing aids, you can bypass this by switching to a Medicare Advantage (Part C) plan, which typically includes hearing benefits such as exams and allowances.

Answer: If you qualify for both, you are considered Dual Eligible. Medicare and Medicaid work together to cover almost all of your healthcare costs!

Medicare pays for your doctor visits and hospital stays first, while Medicaid steps in to pay for your premiums, deductibles, and things Medicare doesn't cover, like long-term care and dental.

Answer: Yes, Maximum Out-of-Pocket (MOOP) limits can change every year.

These limits depend on your specific plan; Medicare Advantage plans can adjust their limits annually as long as they stay below the federal limit. For 2026, the highest a Medicare Advantage plan can set this limit for in-network care is $9,250.

Similarly, Part D plans have their own mandatory out-of-pocket cap, $2,100 for 2026. This means that once you reach these limits, the plan pays 100% of your covered costs for the rest of the year.

Answer: Yes, Medicare Advantage plans are strictly tied to your zip code and county. While the government’s "Original Medicare" works the same nationwide, Medicare Advantage plans are offered by private companies and are restricted to specific service areas.

Answer: Working with a Medicare Agent is beneficial; they act as a free personal guide to help you find a plan that fits your budget and health needs!

They also handle the confusing paperwork and deadlines for you, ensuring you avoid penalties that could last a lifetime.