Otisha Newton, Medicare Insurance Agent

Answer: Yes — if you’ve been receiving Social Security disability benefits for at least 24 months, you automatically become eligible for Medicare when you turn 65. You usually don’t need to sign up manually; your Medicare card should arrive in the mail about three months before your birthday.

A few things to keep in mind:

You can still choose your coverage: Original Medicare, Medicare Advantage, Part D, or a Medigap plan.

If you want a different start date or are thinking about a Medicare Advantage plan, you may need to take some action to enroll.

Even though it’s automatic, it’s a good idea to review your plan options to make sure your current doctors, prescriptions, and preferred hospital are covered.

Here’s the important part: your Medicare coverage should kick in automatically, but reviewing your options now can save you headaches and money later. If you want, I can walk you through your choices and make sure your coverage is set up the way you want — just reach out, and we’ll go over it together.

Answer: The important thing to know is that Medicare can cover robotic knee replacement, but your costs and coverage depend on your plan and the facility. The best way to be sure is to check your specific plan and confirm with your surgeon. If you want, I can help you review your plan, figure out costs, and make sure everything is set before your surgery—reach out to me anytime, and I’ll walk you through it.

Answer: Medicare costs vary based on a few key factors:

Which parts you have – Original Medicare (Part A & B), Part D (prescription drugs), Medicare Advantage (Part C), or Medigap. Each part has different premiums, deductibles, and copays.

Your income – Higher earners may pay income-related monthly adjustment amounts (IRMAA) for Part B and Part D.

Your plan choices – Even within Part D or Medicare Advantage, each plan sets its own copays, coinsurance, and deductibles.

Where you live – Some plans are only available in certain areas, and costs can vary regionally.

Bottom line: Everyone’s Medicare costs are a little different. It’s worth reviewing your coverage options each year to make sure you’re getting the best plan for your needs and budget.

Answer: Changes to Expect for Medicare in 2026

Some changes are coming to both costs and plan rules:

Premiums and deductibles for Part A and Part B will increase.

Part D out-of-pocket and deductible limits will go up.

Medicare Advantage plans may adjust extra benefits and out-of-pocket limits.

Certain services in Original Medicare may require more prior authorization.

Bottom line: Costs and plan rules are changing, so it’s a great idea to review your coverage and options for 2026. If you have any questions or want help understanding what’s best for you, don’t hesitate to reach out—I’m here to guide you.

Answer: Yes, there are some important guidelines you want to follow when filling out your Medicare application to make sure it goes smoothly and you get the coverage you need.

Know your enrollment period – Make sure you’re applying during the Initial Enrollment Period, or if you missed that, during the General or Special Enrollment Periods.

Have your personal information ready – Social Security number, birth date, current insurance info, and employment info if you’re delaying Part B.

Decide what coverage you want – Original Medicare, Medicare Advantage, Part D, or a Medigap plan. Know which combination works best for your situation.

Fill it out carefully – Use your full legal name, answer all questions honestly, and double-check for errors.

Verify key items – Confirm your mailing address, coverage start dates, and any extra forms or premiums required.

Keep copies – Save a copy of your application and any confirmation notices.

Ask for help if needed – A Medicare broker or Social Security rep can review your application to make sure everything is correct.

Answer: Yes — many Medicare Part D and Medicare Advantage plans do cover Breztri.

Coverage and cost depend entirely on the plan’s formulary tier, so your copay can vary a lot.

It’s usually a Part D drug.

Some plans put it on a higher tier, which means a higher copay.

Most plans don’t require prior authorization, but some may have limits (quantity limits, step therapy).

AstraZeneca’s $35 cap does NOT apply to Medicare, but you may qualify for their AZ&Me assistance program.

Bottom line: Breztri is generally covered, but what you pay depends on your specific plan. I can check your ZIP code to see which plans in your area cover it the best.

Answer: That’s a great question — and it’s one a lot of people ask when they first get on Medicare.

Technically, yes — you can have just Medicare Parts A and B and choose not to enroll in anything else. However, it’s usually not enough coverage for most people. Here’s why:

Part A covers hospital stays, skilled nursing care, hospice, and some home health care — but you’ll still face a large deductible per hospital stay and daily coinsurance costs if your stay is extended.

Part B covers doctor visits, outpatient care, preventive services, and medical supplies — but it only pays 80% of approved costs, leaving you responsible for the other 20% with no cap on how high those bills can go.

That means if you have a serious illness, surgery, or long hospital stay, your out-of-pocket costs could be thousands of dollars.

That’s why most people add either:

A Medigap (Supplement) plan to cover the leftover 20% and hospital costs, or

A Medicare Advantage (Part C) plan, which combines A and B and often adds prescription, dental, and vision benefits.

So while you can stay with just A and B, it’s not recommended long-term if you want full protection and predictable costs.

Would you like me to explain how much you’d typically pay out of pocket if you kept only A and B?

Answer: That’s a great question — and you’re not alone. The tiers in Medicare Part D plans can definitely be confusing, but once you understand how they work, it makes your prescription costs much easier to predict.

Here’s the breakdown:

Every Medicare Part D plan has a formulary — basically a list of covered drugs — and those drugs are divided into tiers. Each tier has a different cost level (copay or coinsurance). The lower the tier, the less you pay.

Here’s a general idea of how most plans structure it:

Tier 1: Preferred generics — lowest copay (often $0 to $5)

Tier 2: Non-preferred generics — slightly higher copay

Tier 3: Preferred brand-name drugs — moderate cost

Tier 4: Non-preferred brand-name drugs — higher cost

Tier 5 (or Specialty Tier): Very high-cost or specialty medications — you’ll usually pay a percentage (coinsurance) rather than a flat copay

The main thing to remember is that the same drug can be on different tiers in different plans, so what you pay depends on your plan’s specific formulary.

When helping clients, I always review their current prescriptions and compare how each plan covers them — because the tier placement can make a huge difference in what you pay at the pharmacy each month.

Would you like me to show you how to check what tier your medications are on in your current plan?

Answer: Yes — Medicare premiums can offer tax benefits for retirees. If you itemize deductions, you may be able to deduct your Medicare premiums and other medical expenses that exceed 7.5% of your adjusted gross income. And if you’re self-employed, you can often deduct 100% of your Medicare premiums without itemizing.

Answer: Medicare now covers most vaccines at no cost when you get them from a provider or pharmacy that accepts Medicare. Part B covers the flu, pneumonia, COVID-19, and certain Hepatitis B vaccines, while Part D (your drug plan) covers shingles, RSV, Tdap, and other routine vaccines — all now free with no copay or deductible. If you’re unsure which ones you qualify for or how to get them covered, I can help you review your Medicare plan and make sure you’re fully protected.

Answer: Got it — since we’re now in October 2025, your situation changes a bit, but there are still options.

Here’s what’s happening:

Because your husband retired back in April 2024, your Special Enrollment Period (SEP) for losing employer coverage has already expired. (That SEP lasts 8 months after losing group coverage — so it would’ve ended around December 2024.)

But the good news is — you’re now in Medicare’s Annual Enrollment Period (AEP), which runs October 15 through December 7 every year. During this time, you can:

Enroll in a Medicare Advantage (Part C) plan, which combines hospital, medical, and often prescription coverage.

Or enroll in a standalone Part D (prescription drug) plan if you want to stay on Original Medicare.

Your new coverage would start January 1, 2026.

Since you mentioned you only have Parts A and B right now, you should definitely look into adding at least a Part D plan — otherwise, you could face a late enrollment penalty later on. You might also qualify for Extra Help or a Medicare Savings Program depending on your income, especially since your SSI changed to standard Social Security. Those programs can help lower your premiums and copays.

So right now, you’re in the perfect window to fix this — just make sure you act before December 7, 2025.

Would you like me to help you figure out what type of plan (Advantage or Supplement + Part D) might work best for your health needs and budget?

Answer: Medicare Part A does cover hospital stays, skilled nursing care, hospice, and some home health care — but it’s not enough on its own. You’re still responsible for deductibles and coinsurance, and it doesn’t cover doctor visits, outpatient care, or prescriptions. To have full protection from high medical bills, you’ll need Part B and possibly a Medigap or Medicare Advantage plan.

Answer: You can tell your neighbor this:

“Medigap and Medicare Advantage aren’t the same thing at all. With my Medigap plan, I can see any doctor in the country that takes Medicare, and I don’t have to worry about networks, referrals, or surprise medical bills. Sure, I pay a monthly premium — but it gives me peace of mind knowing most of my costs are covered.

Those $0 Medicare Advantage plans might sound ‘free,’ but they usually come with copays, network limits, and prior authorizations. You still pay your Part B premium either way. So for me, paying a little more each month is worth it to have the freedom and predictability I want in my coverage.”

It’s not about being crazy — it’s about choosing what works best for your peace of mind and healthcare needs.

Answer: What I love most about being a Medicare agent is genuinely being able to help people — to guide them with the same care and honesty I’d give my own parents if they were still here. Every client I meet, I treat like family. If I wouldn’t have put my own mom or dad in a certain plan, I’m not going to put you in it either. This job isn’t just about insurance for me — it’s about making sure people feel protected, understood, and cared for during one of the most important stages of their lives.

Answer: Yes, Medicare star ratings do matter — but they measure how well the plan performs, not your individual doctor. The Centers for Medicare & Medicaid Services (CMS) rates each Medicare Advantage and Part D plan from 1 to 5 stars based on things like customer service, member satisfaction, preventive care, and how well the plan supports people with chronic conditions. In general, higher-rated plans tend to provide better service, fewer billing headaches, and stronger care coordination, so it’s a good idea to look for a plan with 4 stars or higher when you can.

Answer: The best way to verify if a Medicare Advantage plan’s advertised benefits are legitimate is to go straight to the official sources. Here’s what I always recommend:

Check the plan on Medicare.gov

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You can use the Plan Finder tool to look up the exact plan name and see what benefits it truly offers. If it’s listed there, it’s an approved plan regulated by CMS (Centers for Medicare & Medicaid Services).

Contact the insurance company directly.

Call the number on the insurer’s official website — not one you saw in an ad — and ask them to confirm the benefits and the plan’s service area.

Watch out for misleading ads.

Some ads make broad or exaggerated claims, like “Get $900 back every month” or “All seniors qualify for free dental and vision.” Those statements are usually not true for everyone — benefits depend on your ZIP code, county, and eligibility.

Talk to a licensed Medicare broker or agent.

An independent broker (like me) can verify plans for your area, check CMS-approved details, and make sure the plan really includes what it advertises.

So in short: if it’s not listed on Medicare.gov or confirmed directly by the insurance carrier, take it with a grain of salt. Always double-check — because if it sounds too good to be true, it probably is.

Answer: That’s a great question, and it’s something a lot of people notice when comparing plans with friends or family in other areas.

Yes — location absolutely matters when it comes to Medicare Advantage plans. If your friend lives in a different county, even within the same state, their plan options and benefits can be completely different from yours. The plans might even have the same name or carrier, but the benefits, copays, provider networks, and drug coverage can vary depending on the county.

That’s because Medicare Advantage plans are approved and priced by county, not by state or nationally. Insurance companies design their plans around local healthcare networks and costs, so what’s available (and affordable) in one area might look very different in another.

So yes — if your friend’s city is in a different county, it’s very possible they have a more detailed or richer plan, even if it’s technically the same plan name. Always review what’s available in your specific ZIP code each year to make sure you’re getting the best option for your area.

Answer: That’s a great question — and honestly, it’s one of the smartest things a healthy 65-year-old can ask before enrolling in Medicare.

From my experience as a Medicare broker, the most cost-effective setup really depends on how often you see the doctor and what kind of flexibility you want. But generally, here’s the breakdown:

If you’re healthy and don’t see the doctor often, a Medicare Advantage (Part C) plan can be the most affordable route. Many Advantage plans have $0 or very low monthly premiums and include extras like prescription drug coverage, dental, vision, hearing, and even gym benefits. You’ll just want to make sure your doctors and hospitals are in the plan’s network, and that you understand any copays or out-of-pocket maximums.

If you prefer more freedom to choose any doctor and want to avoid networks, you can stick with Original Medicare (Parts A and B) and add a Medicare Supplement (Medigap) plan along with a Part D prescription plan. This costs more each month but can save you big if unexpected medical needs come up — it’s essentially “pay more upfront, less later.”

So, for a healthy 65-year-old, the most cost-effective option is usually a Medicare Advantage plan with low premiums and solid coverage benefits — but it’s always worth comparing local plan options each year, since benefits and networks can change.

Answer: That’s a really good question, and one I hear often from seniors trying to plan their health costs.

Here’s the truth: Original Medicare (Parts A and B) doesn’t cover routine eye exams, glasses, or contact lenses. It only helps with medically necessary eye care, like exams or treatments for conditions such as glaucoma, macular degeneration, or cataract surgery. So if you only have Original Medicare, you’d be paying out of pocket for routine vision care and eyewear.

However, this is where a Medicare Advantage (Part C) plan can make a big difference. Depending on the plan, vision coverage may be included at little to no cost — and that can cover annual eye exams, eyeglasses, contact lenses, and even allowances toward frames. The details vary by plan, but many Medicare Advantage options include vision benefits to help reduce those out-of-pocket expenses.

So in short, without a Medicare Advantage plan, seniors are usually stuck paying for vision care on their own. But with the right Advantage plan, you can often get routine eye exams and glasses covered at a low — or sometimes zero — cost.

Answer: That’s a great question — and as a Medicare broker with over four years of experience, I get asked this one a lot.

No, you can’t use your Original Medicare card if you’re enrolled in a Medicare Advantage plan (Part C). When you join a Medicare Advantage plan, that plan becomes your primary coverage — meaning Medicare pays the plan, not your doctor directly. So if your provider doesn’t accept your Advantage plan, showing your red, white, and blue Original Medicare card won’t change that. The provider would still have to bill your Advantage plan.

If your doctor doesn’t take your Medicare Advantage plan, you have a couple of options:

You can see if there’s another provider in your plan’s network who does.

Or, if you prefer to keep your current doctor, you can switch back to Original Medicare during the Annual Enrollment Period (Oct 15–Dec 7) or another eligible time.

In short, once you’re on a Medicare Advantage plan, that card is the one you have to use for coverage — your Original Medicare card won’t work for billing purposes.

Answer: When someone is approved for Social Security Disability Insurance (SSDI), they start receiving a monthly check to help cover their expenses while they’re unable to work. After receiving SSDI for two years (24 months), they automatically qualify for Medicare — even if they haven’t worked during that time. That means they’ll get coverage for hospital care under Part A, doctor visits and medical services under Part B, and they can choose to add Part D for prescriptions or go with a Medicare Advantage plan that includes everything in one.

There are a few exceptions to the waiting period. For example, if someone has Amyotrophic Lateral Sclerosis (ALS) — also known as Lou Gehrig’s disease — they get Medicare right away as soon as their SSDI benefits begin, without having to wait the two years.

So in simple terms, Social Security provides income support, and Medicare provides the health coverage, working together to make sure people with disabilities are taken care of both financially and medically.

Answer: If you’re struggling to afford your Medicare premiums, there are several ways to get help. You can apply for a Medicare Savings Program through your state to help cover your Part A and B premiums or other costs, and you may also qualify for Extra Help through Social Security to lower your prescription drug expenses. If your income is very limited, you could be eligible for Medicaid, which can cover even more of your medical costs. Another option is to explore $0 premium Medicare Advantage plans, which often reduce monthly expenses. Finally, you can contact your local SHIP office for free, personalized help finding and applying for these programs.

Answer: Yes, you can still enroll in Medicare, but the difference is you may have to pay a premium. Normally, people who’ve worked and paid into Social Security for at least 10 years get Medicare Part A with no monthly cost. If you haven’t, you can still get Part A, but you’ll pay a monthly premium for it. Part B also always comes with a premium, regardless of your work history. So, even without U.S. work credits, you’re still eligible it just may cost more.

Answer: Medicare does a good job covering medical needs like hospital stays, doctor visits, rehab, and prescriptions. But assisted living — things like daily help with meals, bathing, or dressing — isn’t covered under traditional Medicare because it’s considered custodial care. That said, some carriers do offer plans that can help with certain assisted living costs, so it’s always worth looking at the options available. Families also often turn to Medicaid, long-term care insurance, or personal funds to fill in the gap.

Answer: Yes, that’s already in place. Medicare Part D now caps your out-of-pocket drug costs at $2,000 a year. Once you reach that amount, you don’t pay anything more for covered prescriptions for the rest of the year. There’s also a new option where you can spread your costs into monthly payments instead of paying large amounts all at once.

Answer: Starting in 2025, Medicare is capping what you pay out of pocket for prescriptions at $2,000 a year. There’s also a new option to spread those costs out in monthly payments instead of paying a big chunk all at once. So if you have Medicare drug coverage, this should help you too.

Answer: The best way to know if your hearing aids are covered is to check the details of your Medicare Advantage plan, since coverage is different depending on the company and the plan you chose. Not every plan includes hearing aids, but many of them do offer some kind of allowance or discount. You can look in your plan’s Evidence of Coverage or Summary of Benefits, or call the member services number on the back of your card and they’ll tell you exactly what’s included.

Answer: Medicare does cover a lot of preventive screenings, but not all at once. Each one has its own schedule. For example, a mammogram is usually once a year, a colonoscopy is every few years, and diabetes screenings can be twice a year. So yes, they’re covered, it just depends on the test and how often Medicare allows it.

Answer: Working with a Medicare agent or broker can really take the stress off your shoulders. Instead of trying to figure everything out on your own, you’ve got someone who knows the ins and outs and can explain it in plain language. We look at your doctors, prescriptions, and budget to make sure the plan actually works for you, and it doesn’t cost you anything extra. In the end it can save you a lot of time and stress.

Answer: Medicare actually gives some good preventive help if you’ve got prediabetes. They’ll cover up to two screenings a year at no cost, and they also have the Medicare Diabetes Prevention Program. That’s a one-time, year-long program where you get support and coaching on things like eating better, staying active, and losing a little weight to help lower your chances of developing type 2 diabetes. You can do it in person or online, and if you qualify, it’s fully covered.