Priscilla Ramos, Medicare Insurance Agent

Answer: With Original Medicare (Part B), Medicare generally covers 80% of the approved ambulance cost after you've met your Part B deductible. You would typically pay 20% of the Medicare-approved amount, with no out-of-pocket maximum, which often works out to roughly $100–$400+ out of pocket for the ambulance cost.

Answer: One of the biggest coverage gaps with a Medicare Advantage plan is that many people don’t realize they can face high out-of-pocket costs for hospital stays, chemotherapy, skilled nursing, or out-of-network care — even though the plan may have low or $0 premiums.

Answer: With Medicare, Breztri usually costs about $40–$50 per month, depending on the drug plan, deductible, and pharmacy. Some people may pay more or less based on their coverage.

Answer: Right now, CMS says Medicare claims and payments should continue during a government shutdown because Medicare is funded separately. However, if a shutdown drags on and Congress does not extend expired telehealth flexibilities, ripple effects could include:

Providers limiting certain telehealth services or requiring ABNs (Advance Beneficiary Notices) before visits

Delays in CMS support functions, enrollment processing, audits, and customer service

Slower approvals or administrative backlogs for providers and plans

Confusion for beneficiaries about coverage rules and costs

Smaller clinics or rural providers feeling financial strain if payment or operational disruptions grow

For most beneficiaries, coverage and access would likely continue normally at first, but a prolonged shutdown could gradually create delays and access issues.

Answer: Not necessarily. If you have credible employer coverage from active employment, you can usually delay Medicare Part B without a penalty.

But if you don’t have qualifying coverage and delay enrolling, you could face late enrollment penalties for Part B and Part D later.

Answer: If you’ve had oxygen equipment since 2017, Medicare usually considers you past the initial 36-month rental period, but you still must meet ongoing medical necessity requirements — including periodic doctor re-evaluations and updated documentation.

If your recertification lapsed, the supplier may temporarily bill you until updated paperwork is completed. Contact your doctor ASAP for an oxygen re-evaluation and ask the supplier if charges can be reversed once documentation is submitted retroactively.

You can also call Medicare directly or request help from your local SHIP counselor if the supplier is refusing to work with you.

Answer: If you’re still working and have credible employer coverage through your job (or your spouse’s job), you can usually delay Medicare Part B without penalty.

Most people should still enroll in Medicare Part A at 65 if it’s premium-free, but there are exceptions — especially if you contribute to an HSA.

When your employer coverage ends, you’ll get a Special Enrollment Period to sign up for Medicare.

It’s smart to review your specific situation with a licensed Medicare advisor because company size and HSA contributions can change the answer.

Answer: A Medicare agent can sell a standalone Part D (PDP) plan during valid enrollment periods:

Initial Enrollment Period (IEP) – when someone is first eligible for Medicare

Annual Election Period (AEP) (Oct 15 – Dec 7) – for anyone to enroll, switch, or drop a plan

Special Enrollment Periods (SEPs) – for qualifying events (move, loss of coverage, Medicaid/LIS, etc.)

Outside of these periods, a Part D plan generally cannot be sold or changed.

Answer: Yes. IRMAA is recalculated every year based on your income from 2 years prior (from your tax return).

If your income goes down due to a life event (retirement, divorce, etc.), you can ask Social Security Administration for a reduction.

Answer: Medicare is slowly adapting to wearable health tech. Right now, devices like smartwatches aren’t typically covered by Medicare, but:

They may be covered if classified as medically necessary equipment (like certain heart monitors prescribed by a doctor)

Data from wearables can already be used in remote patient monitoring programs, which Medicare does reimburse providers for

Future integration will likely include more coverage for FDA-approved devices and expanded use in chronic condition management (like heart rhythm tracking)

Medicare isn’t fully covering smartwatches yet, but it’s moving toward using their data more in care and may cover more advanced devices over time.

Answer: Medicare covers several cancer screenings at $0 cost (when preventive and using a Medicare-approved provider):

Breast (mammograms)

Colorectal (colonoscopy, stool tests)

Cervical (Pap/HPV tests)

Lung (low-dose CT for eligible smokers)

Prostate (PSA blood test)

Free only if routine screening

Follow-up tests may have costs

Answer: Your Medicare continues automatically, it doesn’t restart or stop when you turn 65.

What changes (and what doesn’t):

Parts A & B: Stay in place, no gap in coverage

You get a new Initial Enrollment Period (IEP) at 65 → chance to change plans without penalty

You can switch to a Medicare Advantage plan or Part D if you want

You also gain guaranteed issue rights for a Medicare Supplement (Medigap) in most states

Good to know:

If you already have a plan, it usually continues, but turning 65 is a great time to review and possibly improve your coverage.

Answer: No, your Medicare hospital days do NOT reset every year.

How it actually works:

Medicare uses a benefit period, not a calendar year

A benefit period starts the day you’re admitted and ends after 60 days in a row without inpatient care

What that means:

You get up to 90 hospital days per benefit period

If you go back in after 60 days out, your days reset

If not, you continue using the same benefit period.

Answer: Medicare brokers are paid by the insurance company after you enroll, not by you, and it shouldn’t affect their recommendation.

How they get paid:

A set commission (regulated by Centers for Medicare & Medicaid Services)

Typically the same amount across plans in the same category (Medicare Advantage or Part D)

Paid whether you enroll directly or through a broker

Does it affect recommendations?

It shouldn’t, rules require brokers to recommend plans based on your needs

But: brokers can only offer plans from companies they’re contracted with.

Answer: An HMO-POS (Point-of-Service) Medicare Advantage plan is basically an HMO with a little flexibility.

How it compares:

HMO:

Must use in-network doctors, need referrals, lowest cost, least flexibility

HMO-POS:

Primarily in-network but can go out-of-network for some services (higher cost), middle ground

PPO:

Can use in or out-of-network anytime, no referrals, most flexibility, higher cost

Answer: Keep your Medicare Summary Notices (MSNs) for at least 1 year, up to 3 years is better.

Why keep them:

Check for billing errors or fraud

Compare with provider bills

Use for tax or appeal purposes

Answer: No, Medicare does NOT cover long-term memory care (like Alzheimer’s or dementia facilities).

What Medicare does cover:

Short-term skilled nursing care (after a hospital stay)

Medical care inside a facility (doctor visits, medications, therapies)

Hospice care if eligible

Answer: Medicare will cover medical-grade heart monitors (like Holter monitors or prescribed patches) if your doctor says it’s medically necessary.

Bottom line:

Consumer wearables, not covered

Doctor-prescribed cardiac monitoring devices, often covered

Some newer pilot programs may start integrating wearables with medical care, but that’s still limited and not standard coverage yet.

Answer: It’s not a bill, it’s a summary of your services.

A Medicare Summary Notice shows what Medicare was charged, paid, and what you may owe. What to do: Review it for accuracy. Check for services you didn’t receive. Keep it for your records If something looks wrong, report it right away.

Answer: Not required, but it can help with out-of-pocket costs. Medicare Advantage plans have daily hospital copays, so a Hospital Indemnity plan can pay you cash to offset those. If you’re hospitalized twice: Most indemnity plans pay benefits for each separate stay (based on the policy limits).

Answer: Compare plans based on your exact medications. Check each drug’s tier (generic vs. specialty) Look at total yearly cost (premium + copays), not just the premium. Make sure your pharmacy is preferred/in-network

The cheapest plan monthly isn’t always the cheapest overall.

Answer: Yes, but very limited. Medicare only covers spinal adjustments to correct a subluxation. It does NOT cover exams, X-rays, or other services.

Answer: Sometimes, but not always.

They can save money with low premiums and extra benefits, but costs can add up later with copays, networks, and higher out-of-pocket if you get sick. Best for healthy users; less predictable for frequent care.

Answer: Yes, you can enroll in Medicare, but you may have to pay for it. Part B: You can enroll and pay the monthly premium. Part A: If you didn’t pay into Social Security, you may have to pay a premium to get it.

Some people qualify through a spouse’s work history instead

Answer: Original Medicare isn’t always “better”, it depends on your needs.

Why some people prefer it:

See any doctor nationwide (no networks)

No referrals needed

More predictable coverage with a supplement

Trade-off: higher monthly costs vs. Medicare Advantage’s lower premiums but more restrictions.

Answer: Yes, Medicare will still pay, if the care was medically necessary. Leaving against medical advice does not automatically mean you pay the full bill, but you’re still responsible for your normal share (deductibles, coinsurance).

Answer: Usually no. They can’t drop your medication mid-year, but they can change costs or add restrictions, or remove it for safety reasons.

Answer: Medicare looks at your tax return from 2 years ago, if your income went up (even temporarily), your Part B premium can increase significantly.

Other possibilities:

Annual Medicare premium increase

Late enrollment penalty (if applicable)

Answer: Will this plan truly work with my doctors, medications, and lifestyle all year?

Most people focus on price, but this question uncovers the real costs, coverage, and surprises.

Answer: Here’s a very simple way to explain it:

Don’t give your Medicare number to anyone who calls you

Hang up on random calls about Medicare

Be careful with “free” offers, they’re often scams

Only talk to people you trust (like your agent)

Check your statements for anything you don’t recognize

Easy rule: If you didn’t call them first, don’t share your information

Answer: You can keep your doctors only if they’re in the plan’s network.

HMO: must use in-network doctors (except emergencies)

PPO: can go out-of-network, but costs more

Always check your doctors before enrolling.

Answer: Honestly, it’s the peace of mind you bring to people.

Most Medicare clients feel overwhelmed, confused, or even stressed, and being able to simplify everything and help them feel confident in their decision is the most rewarding part.

It’s also the relationships. You’re not just enrolling them, you become their go to person year after year, helping with questions, changes, and even life events.

And for many, especially in bilingual communities, it’s about trust and understanding, making sure they truly get their benefits and don’t feel taken advantage of.

In short, helping people feel secure, informed, and cared for.

Answer: You generally can’t drop Medicare Part A by itself. To disenroll, you must withdraw your entire Medicare enrollment (Part A & B) and if you were receiving Social Security, you’d have to repay any benefits (doesn’t apply to you since you haven’t claimed).

Answer: Stay in-network, get tests pre-approved when needed, and always verify coverage before the lab work is done.

Answer: Life insurance provides financial protection for loved ones, helps cover debts, funeral costs, and can support long term goals like education or estate planning.

Answer: Medicare home health care covers skilled nursing, therapy (PT/OT/ST), home health aides for medical needs, social services, and some medical equipment, but not full-time personal care or chores.

Answer: To lower high specialty drug costs with Original Medicare, Medigap G, and Part D:

Compare Part D plans for better coverage

Apply for Extra Help to reduce copays

Check state or manufacturer assistance programs

Ask your doctor about alternatives or formulary exceptions

Answer: When retiring, consider:

Timing your Medicare enrollment to avoid penalties

How your current employer coverage coordinates with Medicare

Whether you want Original Medicare or Medicare Advantage

Prescription drug coverage (Part D) and extra benefits like dental or vision

Answer: You can enroll in Medicare 3 months before your 65th birthday, the month you turn 65, and 3 months after, this 7 month window is your Initial Enrollment Period.

Answer: Yes, Part D costs can change year to year. Your plan may have:

Changed its formulary (which drugs are preferred)

Moved your generics to a higher tier

Updated copays or coinsurance

It’s a good idea to check your plan’s annual notice or call your pharmacy to see the exact reason.

Answer: Disadvantages of a PPO include:

Higher premiums than HMO or Original Medicare alone

Out of network care can be very expensive

More complex billing and paperwork

Costs can add up quickly if you frequently see specialists or multiple providers

Answer: Yes, Original Medicare may cover certain wearable medical devices like insulin pumps or seizure monitors if they’re medically necessary and prescribed by your doctor. Coverage depends on the device type, your plan, and supplier requirements.

Answer: Many “free Medicare seminars” are mostly sales pitches, not education. Only attend ones labeled “Medicare 101” or go one on one with an independent agent to get real, personalized help without pressure.

Answer: The old Medicare Part D “donut hole” (coverage gap) no longer exists under the current rules starting in 2025. Instead of a gap where costs suddenly jump, Part D now has a simpler structure with an annual out of pocket cap (about $2,100 in 2026), after which you pay nothing for covered prescriptions for the rest of the year.

Answer: My most successful strategy remotely is actively listening and asking clear, simple questions, showing empathy and patience.

Compared to in person, I rely more on tone, pacing, and verbal cues rather than body language to build trust and make the conversation feel personal.

Answer: A common hidden expense is the 20% coinsurance under Original Medicare Part B for things like doctor visits, outpatient therapy, or durable medical equipment. Many seniors don’t realize this adds up until they get bills, especially if they don’t have a Medigap or supplemental plan.

Answer: You can check by:

Looking at the plan’s provider directory, see if your mom’s doctors are listed.

Calling her doctors’ offices to confirm they accept that plan.

Reviewing the Summary of Benefits for in network vs. out of network rules.

This ensures she can keep her doctors while understanding what extra benefits the plan offers.

Answer: What I love most is helping people feel confident and secure about their healthcare. Many seniors feel overwhelmed by Medicare’s complexity, and I enjoy guiding them through the choices, answering questions, and making sure they get coverage that truly fits their needs, all while giving peace of mind.

Answer: A PPO gives flexibility to go out of network, but out of network care often costs much more. The main benefit is still lower cost if you stay in network, the flexibility is there, but it comes with higher risks and bills.

Answer: That’s a common situation. Low-premium plans often have higher out of pocket costs, copays, coinsurance, and deductibles, which can make routine visits expensive.

Sometimes, a higher premium plan with lower cost-sharing ends up saving money if you see doctors or need prescriptions regularly. It’s all about matching the plan to your healthcare needs, not just the monthly cost.

Answer: That happens more often than you’d think. Many people assume “dental coverage” means everything, but most Medicare Advantage dental benefits are limited, often just preventive care like cleanings, exams, and X-rays.

Agents or plan materials should disclose this, but sometimes the details are easy to miss in brochures or summaries. It’s always a good idea to check the Summary of Benefits or ask specifically about restorative or major services before enrolling.

Answer: For the U.S. Virgin Islands, the Scope of Appointment (SOA) must be completed by a licensed insurance agent. Administrative staff cannot fill it out on the agent’s behalf before contacting the client.

CMS guidance requires that the agent personally obtains the client’s agreement to discuss Medicare Advantage and/or Part D plans, to ensure compliance and documentation accuracy.

Answer: If you miss Open Enrollment, you can still change plans during a Special Enrollment Period if you have a qualifying event (like moving, losing other coverage, or getting Medicaid). Otherwise, you usually must wait until the next annual enrollment.

Answer: Medicare doesn’t cover most care outside the U.S., but you can get:

Medicare Advantage plans with limited foreign coverage

Travel or supplemental insurance for medical emergencies abroad

Short-term travel insurance to cover hospitals, doctors, and medical evacuation

Answer: No, Original Medicare generally does not cover dental implants. Some Medicare Advantage plans may offer limited coverage or discounts, but you usually pay out of pocket.

Answer: If universal healthcare passes, Medicare could expand to cover more people and services, possibly merging with other public programs, changing benefits, costs, and eligibility over the next decade.

Answer: People under 65 qualify for Medicare if they:

Receive Social Security Disability benefits for 24+ months

Have End-Stage Renal Disease (ESRD)

Have ALS (Lou Gehrig’s disease)

Answer: Yes, when you retire, you should:

Check your current coverage and see if it fits your new situation

Decide if you want Original Medicare or a Medicare Advantage plan

Consider adding a Part D (prescription) plan if needed

Enroll or update during your Special Enrollment Period to avoid penalties

It’s a good idea to review your doctors, prescriptions, and budget before your retirement date.

Answer: Yes, with Part B, you must meet your yearly deductible first. After that, Medicare typically pays 80% of approved costs for medically necessary outpatient therapy, and you pay the remaining 20%.

Answer: With Original Medicare (Part B) for physical therapy:

You must first meet your Part B deductible for the year.

After that, Medicare usually pays 80% of the Medicare approved amount for medically necessary outpatient therapy, and you pay the remaining 20% coinsurance.

So out of pocket costs can add up depending on how many sessions you need and what your therapist charges, unless you have a Medigap plan or a Medicare Advantage plan that changes your cost‑sharing.

If you want a quick estimate for your specific situation, let me know your plan type!

Answer: You can say:

Medicare Advantage may have low or $0 premiums, but Medigap gives more predictable costs and lets me see any doctor. It’s about the coverage that works best for me, not just the monthly price.

Answer: For most people, not immediately. Medicare changes happen, but core benefits usually stay. It’s smart to stay informed each year, especially during enrollment, to make sure your plan still fits your needs.

Answer: Explain options clearly in simple language

Include them in every step of the decision

Compare plans together based on their doctors and prescriptions

Encourage questions and listen to concerns

Offer help with enrollment and paperwork

Answer: In rural areas, Medicare Advantage plans are often limited because:

Fewer insurance companies offer plans there

Networks of doctors and hospitals may be smaller

Some extra benefits like Silver Sneakers or dental might not be included

You can still get Original Medicare anywhere, but your Advantage plan choices and convenience could be more restricted.

Answer: Even if your plan covers it, many insurers require prior authorization to confirm the surgery is necessary, with an approved provider, and costs will be covered. It’s a standard step, not a problem with your plan.

Answer: Yes! It’s completely okay, and smart to meet with multiple Medicare agents or brokers. Comparing their advice helps you:

Understand different plan options in your area

See who explains things clearly

Make sure you choose a plan that fits your needs and budget

You’re not locked in until you enroll, so talking to a few agents is normal and encouraged. Just make sure they also service their customers, some may enroll you and forget you.

Answer: There’s no one size fits all “better” it depends on your needs:

Original Medicare gives flexibility to see any doctor but usually doesn’t cover extras.

Medicare Advantage (Part C) bundles Medicare with extra benefits like dental, vision, or fitness, often with lower out of pocket costs, but may limit your doctor network.

Choosing the right plan depends on your doctors, prescriptions, and the benefits you want.

Answer: Even though you both pay for Medicare, your benefits depend on the plan. Medicare Advantage plans often include extras like Silver Sneakers, while Original Medicare usually does not.

Answer: A client turning 65 was confused about whether to stay on Original Medicare or switch to Medicare Advantage. I reviewed her doctors, prescriptions, and costs, then helped her choose a plan that kept her doctors and lowered her medication expenses, all at no cost to her. Happy client.

Answer: No, you generally don’t need to sign up again. If you’re already on Medicare due to disability, your coverage continues automatically at 65.

Answer: The Medicare Part B late enrollment penalty makes seniors pay 10% more for every year they delay signing up. It’s permanent, even if they had good reasons for waiting, which can be unfair for those on fixed incomes.

Answer: No, Medicare doesn’t cost the same for everyone. It depends on your income, your work history and the plan you choose. I can help you find a plan that would work for you.

Answer: If you call a specific insurance carrier, they will only offer plans from that specific carrier. If you were to call me, I have access to different carriers which may have better plans that will work better for your needs.

Answer: “The benefit of using my Medicare referral number is that you have an advocate. Instead of speaking with a random call center each time, you have one licensed specialist who knows your situation, can explain your options clearly, and can help if you have problems later with billing, benefits, or plan questions.”

Answer: Original Medicare

• You can see any doctor that takes Medicare

• No networks, no referrals

• Higher monthly cost, but fewer surprise bills

• Good if you travel or want freedom to choose doctors

Medicare Advantage

• You use a network of doctors

• Often low or $0 monthly premium

• Includes extras like dental and vision (limited)

• You pay copays when you use care

If you have Medicaid as well, that will make a difference because then you will be eligible for a Medicare advantage dual plan which can cover a lot more depending on the level of Medicaid you have.

Answer: IRMAA is an extra charge added to your Medicare costs if your income is high.

It can increase what you pay for Part B (doctor visits) and Part D (prescriptions).

It’s not a penalty and not a separate plan—it’s just an income-based surcharge. IRMAA can apply if your income is over $103,000 (single) or $206,000 (married).

The more you earn above that, the more you’ll pay.

Answer: It all depends on the insurance plan. There are some plans that offer better dental coverage than others, that's why you should always have an agent that represents more than just a couple of insurance companies, they will be able to show you which plan is better for what you are looking for.

Answer: Yes, sometimes. It depends when you apply and why you are applying. If you apply during your Medicare Supplement Open Enrollment Period, insurance companies must accept you. If you are applying outside the open enrollment period, the insurance companies will require medical underwriting, and you may be denied. For certain life events or guaranteed issue situations you will not be denied.

Answer: Yes, Medicare does cover dialysis both at a dialysis center and at home if you have End Stage Renal Disease.

Answer: Medicare can be complicated, we simplify it. We compare multiple plans, not just one. Plans change every year; we review it annually. There’s no cost to work with an agent and you have help beyond enrollment when and if issues come up. Local, licensed and bilingual support.

Answer: If you're turning 65 and new to medicare, the best time would be 3 to 6 months before your birthday.

If you already have medicare, the best time to review your options would be during the annual enrollment period which starts October 15th thru December 7th.

If you miss the annual enrollment period, then you can make any changes during open enrollment period which begins January 1st thru March 31st.