Ravi Natarajan, Medicare Insurance Broker

Answer: The only scenario that I can think of here would be that your income as an individual is now subject to IRMAA. Please consult with your broker to assist with the calculations.

Answer: This question is too open ended to answer. Please list the specifics such as Sign-up for Part A/B, Medicare Advantage, Prescription Drug Coverage?

Answer: The Gaps are Part A deductible, Part B deductible and 20% co-insurance and finally no coverage for Prescription Drugs that you pick up at a Pharmacy.

Answer: Medicare Part B is to cover services that are provided outside a Hospital setting. Meaning anything outside of an inpatient hospital stay.

Answer: Medicare does cover some costs associated with clinical trials, but it is not directly covered for the trials themselves. Here are the key points regarding coverage:

Routine Costs: Medicare covers routine costs for items and services in qualifying clinical trials, including necessary hospitalization and medical care for treatment-related side effects.

Part A and Part B: Coverage depends on the type of care received. Part A covers hospitalization, while Part B covers outpatient services.

Medigap Policies: If you have a Medigap policy, it must cover the same costs as Medicare for routine services in clinical trials.

Noncovered Items: Medicare does not cover noncovered items or services, such as those provided for free by the study sponsor.

For more detailed information, you can refer to the official Medicare website or consult with your healthcare provider.

Answer: As early as 3 months prior to the 1st of the month you turn 65. Make sure you enroll in Both Parts A and B if Medicare is going to be your primary insurance.

Answer: At the time of answering this question, we are already in 2026. and donut hole does not exist. But in the past, clients could have reached out to their state pharmaceutical programs for assistance. Note: One can still use this service if faced with situations where their are not in the formulary of the plan they are on.

Answer: Depends on the state. Depends on whether a product in available in a particular state. Depends on Trial Right Period that can be state specific and lastly depends on special circumstances such as the Medicare Advantage Plan that they are currently on is exiting the market. Best to work with your broker.

Answer: Unfortunately, there are several... Not making sure that their Medicare Advantage Plan accepts their Doctors. Not making sure that their drugs are in the formulary of the plan they chose. Not getting on a Prescription Drug Plan when they are required to and facing lifelong penalties. Unable to get on to a Medicare Supplement Plan down the road, as they cannot pass underwriting in states where these plans are underwritten after the initial Guaranteed Issue period.

Answer: There are some Medicare covered Dental and vision services such as dental work following an accident or vision services such as Cataract surgery. Routine Dental, Vision and Hearing are typically not covered by original Medicare. However there are several Medicare Advantage Plans that cover these services. Including these services as part of Original Medicare would likely increase the Part B Premiums.

Answer: Typically one should never use the above terminology as both are not direct representatives of Original Medicare. But both are contracted with Medicare Plans to serve clients looking to add a Medicare Supplement, Prescription Drug Plan or Medicare Advantage Plans administered by private insurers. The term "Agent" vs "Broker"...an Agent typically represents one carrier and a Broker, multiple carriers. But the terms are used loosely...

Answer: If you are eligible for Plan F, remember you should have turned 65 prior to 1/1/2020... then Plan F covers all the gaps in Original Medicare. You should not have any copays.

Answer: It is important to have it coded correctly. It is typically covered as Well Visits. Medicare Advantage plans do a better job of covering Mammograms.

Answer: Yes they are as long as they are medically necessary. Medicare may not pay for corrective lenses or crystal lenses though.

Answer: Not exactly. You get what you pay for. It is also very important that your doctors, prescriptions and Hospitals are covered by your Medicare plan.

A Medicare Plan, as a minimum has to have equal or better coverage that FFS Original Medicare.

Answer: They are 2 unrelated topics. Medicare is for Health insurance and Life insurance is for untimely death or final expenses.

consult with a trusted advisor.

Answer: Connect with your trusted advisor or choose one close to where you live using medicareagentshub.com.

Alternatively, you can shop on your own at medicare.gov

Answer: You need to confirm that your drugs are in the formulary of the Plan that you are on. You can do your own research at medicare.gov or visit a SHINE counsellor or your Agent/Broker.

Answer: 2 ways to reduce cost. 1) Getting a Medicare Supplement and a stand-alone Prescription Drug Plan or a Medicare Advantage Plan. A Medicare Advantage Plan will help lower out of pocket costs compared to Just Original Medicare...

Answer: A lot of things are changing with Part D formularies, It is best to have a trusted broker to review your prescriptions will be covered on your current plan for 2026. Note: If your prescription is not in the formulary, it will not be subjected to the max out-of pocket. The max out-of pocket if increasing from $2000 to $2100 for 2026.

Answer: Yes, Absolutely.

Plans are County specific especially when it comes to Medicare Advantage Plans. So it does pay dividends...

Answer: Absolutely. This helps the Broker assist you better. But stay away from call centers and deal only with Licensed Professionals...

Answer: That is not a simple answer.... Original Medicare has a wider network of Hospitals and Doctors in the Network as opposed to a Medicare Advantage Plan. However, the Medicare Advantage Plan may offer additional benefits, reduce out-of-pocket costs, and provide prescription drug coverage as well. Consult with a professional...

Answer: Freedom of choice could be the issue. But to a large extent a PPO could take care of it if one is available.

Answer: If your employer has 20+ employees (size or enrolled in a plan), this varies from state to state, then you need not enroll in Part B. You can enroll in Part A only. But may also choose to Delay Part A if you are on a High-Deductible Health Plan and are making contributions to an HSA. The Part B can be enrolled in any time after but before 8 months of losing Employer coverage, to avoid Part B Late Enrollment Penalty. If you work for a small employer, then you will have to enroll in Parts A and B so the group plan can coordinate benefits with Medicare, unless you do not have enough work history and are not Eligible for premium free Part A.

Answer: Remote meetings can be wither held as Zoom calls or similar. That is what I prefer. This way you can see the client and they, you. PH calls are a secondary option. Disclose your contact information to build trust. If necessary, share your License# as well...

Answer: Most of the information can be completed by an administrative staff. But the client needs to choose what plans they want to discuss and sign the document at least 48 hours prior to the appointment. The only exception are, walk-ins and the last 4 days of the Annual Enrollment Period. The Agent then needs to document when the appointment was held and sign the document for that date.

Answer: Medicaid eligibility requirements. At present, a multi-millionaire, NOT on Medicare, meaning under the age of 65, can qualify for Medicaid through Affordable Care Act as long as their earned income is low. Assets don't count towards determining eligibility for a subsidy. That is not the case for a senior...

Answer: I take the time to explain "How Medicare Works" by going into the different Parts and the pathways to cover the gaps in coverage and get Prescription Drug Coverage, for those clients who are new to Medicare.

Complete your profile so I can assist you

After that, schedule an Appointment.

Regards,

Ravi

Answer: As long as it is medically necessary, your service provider should be able to get a prior authorization to help pay for this procedure.

Complete your profile so I can assist you

After that, schedule an Appointment.

Regards,

Ravi

Answer: For 2025 a Medicare Member will not pay anything more than $2000 for their prescription drugs. For 2026 the amount is $2100

Answer: It depends. A lot of changes are happening for 2026. Plans are changing, terminating, and in some cases, carriers are exiting the market. Please pay close attention to your Annual Notice of Change Letter (ANOC).

Please complete your profile so I can assist you.

You can also schedule an appointment.

Regards,

Ravi

Answer: Original Medicare covers anywhere in the US and so do Medigap Policies. Medicare Advantage Policies will cover outside of the state if its an emergency, even if the Hospital is not in the network. PPO policies will cover as in-network or out-of-network, even if it's not an emergency situation.

If you need further assistance, please reach out to me.

Regards,

Ravi

Answer: A Licensed Medicare Plan Broker/Agent can look at all the plans available to you, on one screen, and guide you through the process of enrolling you in a Plan that will be a good fit.

If you need further assistance, you can contact me.

Ravi

Answer: Drugs are placed in different Tiers based on cost, primarily. The best way to determine what your cost would be is to complete your profile and schedule an appointment with me 48 hours after completing your profile

Regards,

Ravi