Ricardo Sanches, Medicare Insurance Broker

Answer: Yes, in the long run a Medicare Advantage plan can save seniors for cost of care. However, the best way to save in a Medicare Advantage plan is to make sure you have chosen the correct health plan. Not all Medicare Advantage plans are created equal.

Answer: Agents should not be pushing anyone toward one plan or another. An ethical agent will present you with options and you determine which one will be best for you. If you need help with this decision, I always encourage my prospective clients to bring with them a family member they trust to help them make that decision. There are many reasons why an agent would "push" for a Medicare Advantage plan, but in the end, it up to the beneficiary to decide between a Medi-gap or Medicare Advantage plan.

Answer: The best way to determine which dentists to see, is to look at the network providers with your dental insurance plan.

Answer: The biggest disadvantages to Medicare Advantage plans are limits in seeing providers withing a network, referrals, and prior authorizations.

Answer: It is likely you chose a plan that is Fee for Service or a PPO plan. This is where HMO plans have a slight advantage because HMO plans have contracted and negotiated costs of care. The only want to help you determine the best plan for you is to meet with a licensed Medicare Broker to assess your personal situation.

Answer: If you are in a Medicare Advantage plan, then the original Medicare Part A and B do not apply to you. Each Medicare Advantage carrier has their own benefits and coverages for their specific Medicare Advantage plan. In your case, the $350/day for days 1-7, would equal $2,450. If your Medicare Advantage plan has a Maximum out of pocket of say...$1,500 then you will not be responsible for the $2,450 because your MOOP protects you from spending any more for your care. Once you spend $1,500, you're done and the insurance will pay the rest.

Answer: There are many factors that may dictate why some beneficiaries pay very little or nothing at all. The best way to find out what your options are, is to meet with a Medicare agent or Broker who can assess your individual situation. It is likely that your "friend" is on Medicaid or perhaps enrolled in a Medicare Advantage plan with no premium.

Answer: Biggest mistake seniors make is not understanding their options. It is imperative to know how Medicare works and what the pros and cons are between those options.

Answer: Yes, generally speaking Medicare may cover durable medical equipment, but this will need referral from your medical providers and authorizations from medical group or insurance.

Answer: Generally speaking, there are two types of Medicare presentations or seminars. One is an educational presentation and the other a sales presentation. The former is strictly used to inform Medicare beneficiaries on how Medicare works. The latter is strictly used to sell a carrier service or product. Make sure that you attend an educational seminar if you do not want to pitched a sale. If you sign a contact form or card at an educational event, then expect a call from a Medicare sales agent or Broker. This is all done in good faith. If you do not wish any calls for sales do not give permission to contact.

Answer: A Maximum out of pocket value is the amount of costs you will have to pay for your care in a given year. Look at it as a financial protection limit. In other words, you will not have to worry about the total cost of care beyond this MOOP. It is also important to note that this is not an annual deductible. All of your deductibles, co-payments or coinsurance, count towards that MOOP.

Answer: One step to take us to make certain your prescribed drugs are on formulary with your health plan. Call your Medicare Broker who can guide you in this. If they are not on formulary, there should be like-drugs on formulary. Many times your provider's do not know what medications are on formulary with every health plan but I have helped Providers find alternative prescriptions for their patients that are covered under formulary. If, however, neither of those are good options, the new Medicare Prescription Payment Plan may be a good option to spread the cost of your drugs over a year.

If you need more guidance reach me.

Ricardo Sanches

Answer: One of the biggest benefits of working with a licensed agent and Broker, is the value proposition we bring to our clients. In my practice, I value the Broker/Client relationship. I am not just with my clients at the time of enrollment, but I am with them when they need me most. Whether that is navigating the complexities of Medicare, medical groups, referrals, pharmacy etc....I am there to guide my clients through it all. This is an added value that is inherent to working with a good Medicare Broker. Reach me for more guidance.

Ricardo Sanches

Answer: The changes that came in 2025 were the out of pocket costs for prescription medication set to a maximum of $2,000. This was also a year where the metaphorical "donut hole" or gap in coverage was removed, meaning a beneficiary could hit the catastrophic stage much sooner. And one last major change that came with 2025 was the inclusion of a payment plan for prescriptions, called Medicare Prescription Payment Plan. This payment plan is arranged through your insurance carrier and it spreads out your co-payment or coinsurance throughout the year. This is beneficial for those who rely on high cost drugs like tier 4 or 5. In 2026, the maximum out of pocket will increase to $2,100. And the deductible is also going to increase to $615.

It is important for you to read your Annual Notice of Change (ANOC) letter to learn about all the changes coming in the new year regarding your current health plan. If you need assistance with your Medicare, please reach out to me.

Ricardo Sanches