Rick Boyd, Medicare Insurance Broker

Answer: When you begin drawing Social Security and you are enrolled or enrolling into Medicare part B you can request that the Part B premium is paid from your Social Security account. If you are receiving your Social Security benefit and the Medicare part B premium is not automatically withdrawn from your Social Security, you may call or log into your Myssa.gov account and change the payment method.

Answer: If your income fluctuates significantly from one year to the next and depending if the fluctuations can be managed, you should first consult with a financial professional. Managing IRMA by adjusting minimum distributions, or how you donate to charity, could help staying below IRMA thresholds. If this is not possible, you could appeal by filing form SSA-44. Insure that you completely and accurately fill out the form and submit to Social Security.

Answer: When you enrolled into a Medicare Advantage plan, you no longer can use your Medicare card for care. You may pay the cash price your out of network physician requires, but this could be costly.

Answer: You do not have to pay taxes on Medicare. If you receive social security, you will most likely have to pay federal taxes on your benefit.

Answer: A better plan may be a Medicare Supplement, if that is not possible a PPO. Some national carriers allow for you to be outside of your home location for 6 months at a time and receive covered care in the area you are wintering in. It is always a good idea to call member services before you take a trip or ask your broker if you can receive care in the location you are traveling to.

Answer: Medicare will pay for medically necessary services. If a joint replacement is medically necessary for you, then Medicare will cover it.

Answer: Once you have received Social Security for 24 months due to a

Disability, you can qualify for Medicare before you turn 65.

Answer: If you divorce and your income and or assets decrease significantly, you could be eligible for low income service. If you were the higher income earner and you are now filing income tax as a single filer, you could be subject to an increase in your part B premium due to IRMAA. Check with Medicare.gov for the current income limits.

Answer: Each year under Medicare, you can receive a no-cost Wellness visit. This is not a physical but only to update your wellness plan based on current health and any personal risk factors.

Answer: Advantage plans can save seniors money over the years. With zero premiums, low deductibles, and low maximum out of pocket expenses Advantage plans are very affordable for many seniors. What is not often addressed is the statements above are true if the individual is relatively healthy. If there are serious ongoing health issues not covered by chronic illness Advantage plans, costs increase significantly reaching the maximum out of pocket for more than a single year. Add to this nursing home cost that go beyond what is covered. Advantage plans are not perfect but offer a better option than depending on Original Medicare.

Answer: Including dental and vision would greatly increase costs for everyone. Just look at the increase in cost for part B, every year the premium increases due to costs. Adding additional coverage will increase costs for everything.

Answer: Rather than looking at the age of the advisor, consider if they have a complete knowledge of what is available and carry more than one company. If they are trying to move you into one or two particular companies, you may want to shop around. There are many companies offering Medicare coverage options, and not all companies are a good fit for you.

Answer: Original Medicare only pays 80% of the hospital and doctor visit costs, the remaining 20% is the responsibility of the consumer. There is no yearly cap on Medicare expenses, a Supplement plan (G or N ) would cover these expenses. Regardless if you have Original Medicare only or Original Medicare with a Supplement, you must also purchase a part D medication plan.

Answer: As long as you are traveling within the United States, original Medicare, or Medicare with a Supplement Plan are your best bet for receiving care anywhere in the US that takes Medicare as payment. Outside of the USA, I strongly recommend travel insurance that includes the countries you are traveling to.

Answer: Preventive services help you stay healthy, detect health problems early, determine the most effective treatments, and prevent certain diseases. Preventive services include exams, shots, lab tests, and screenings. They also include programs for health monitoring, and counseling and education to help you take care of your own health. There are approximately over 26 services and shots that are of no or little cost to the Medicare Member if your physician takes Medicare Assignment as payment. For a complete list go to Medicare.gov and search preventative services.

Answer: Medical alert systems are not covered by original Medicare as they are not considered treatment devices that would be covered by part B durable medical equipment. There are currently some Medicare Advantage plans that do offer select alert systems, and other plans that may offer a discount.

Answer: Telemedicine has allowed the opportunity for care to those who have transportation or general mobility issues, and cannot reach medical advice in a timely manner. Being an Urgent care, or Behavioral health request, the individual can talk to or in some cases video chat with a health professional. In rural areas where doctors may not be as readily available, telemedicine can connect the patient with their own primary care physician. Keep in mind to carefully check your insurance for specific coverage and costs involved by using telemedicine to access care.

Answer: Creditable coverage applies before or

after one turns 65. Creditable coverage is health coverage that is at least covers the minimum as does Medicare including prescription drug coverage.

Answer: Those on original Medicare for the first time may not realize they are responsible for 20% of the bill that Medicare does not pay. There are is a deductible of $1736 per benefit period of 60 days. If you have to receive care after being "well" for the same issue after the 60 day benefit period, you will have to pay the $1736 deductible again.

Answer: There are some advertisers that do not disclose doctor choices. Any HMO restricts choice of doctors to their particular organization. PPO's have a wider choice of doctors at normally, a higher cost to the consumer. Medicare HMO's are often very regional, but cover out of area emergency care. It is up to the consumer to carefully read their evidence of coverage to be informed what is covered and where they can receive such care. Do not depend on marketing ads when making choices for health coverage.

Answer: Medicare normally covers mental health therapy with a telehealth option regardless if you live in a rural area or not. For other non behavioral health telehealth options after January 31 2026, the rules will change to require persons to be in a medical facility and a rural area. Check with Medicare.gov for a full description of the changes.

Answer: If you are the type of individual that thrives on freedom of choice, and no year to year changes, a Medicare Advantage plan would not work for you. Medicare Advantage plans may change some benefits and or copays each new year. doctors can go in and out of network at anytime during the year. If you are someone who does not do well with change, an Advantage plan my not be the plan of choice for you.

Answer: I Start off with the basics of Medicare explaining the costs and requirements, then move to the differences between Supplement, and Advantage plans. If there is a short up to date carrier approved video, I may also show it to the client. Asking what their needs and longer term goals for their care is also important. This all occurs before a Scope of Appointment, Providers, Medications, and specific care is discussed.

Answer: In general if occupational therapy is deemed medically necessary by your doctor, then Medicare and Medicare Advantage plans will cover your care under part B. Have your primary care physician always seek authorization by your plan, and submit documentation that this care is medically necessary

Answer: Providers can move out of network any time during the year, and you should receive a 30 day notice at the minimum. If it is a critical provider, call your broker or member services to determine if there is another provider in-network that will meet the same need. If there is not a provider within the network, you may have a special election period in which you can choose another plan. PPO Advantage plans do allow for out of network providers who take Medicare but at a higher cost to the consumer.

Answer: Will a true and honest audit cause change? That is a question I don't have a definitive answer for. Change is needed, along with improved accountability, to ensure that seniors with Advantage plans receive the full number of days allowed for recovery. How this is measured needs to be carefully thought through before the implementation of any new rules.

Answer: Brokers are paid by the carriers they sell for. When a client is enrolled by the broker, the broker is paid. Commissions are how we make an income, but along with other good agents, I focus on what best meets the client’s needs.

Answer: Medicare covers many if not most, standard tests. If your Doctor deems the genetic testing medically necessary, Medicare will cover certain tests. Always check first if the specific test your Doctor requests is covered under Medicare.

Answer: The agent will represent more than one company and be willing to share their license number. They will have a valid phone number you can call back, a mailing and an email address. Even after checking these basic items, if the agent does not ask for a Scope of Appointment before any specifics on plans, benefits, or personal information such as your Medicare Number. Kindly thank them and hang up. You may be dealing with a potential scam artist.

Answer: If you have group employer supplied health insurance, that will be sufficient to meet the requirement. Always check with your employers HR department if there is any doubt.

Answer: Like many agencies, Medicare does not have sufficient employees to answer calls in a timely and efficient manner as we would desire. I have found the best way to receive answers to my questions is to first go to medicare.gov. You may use their chat feature if you do not yet have an account. If you have an account which is highly recommended, log on and then go to the live chat feature. Be very specific with your question(s), ask if you need to download and complete certain forms, or provide any supporting documents.

Answer: After you reach your out of pocket max, which for 2026 is $2100.00. Your insurance will pay the full amount of medications covered by your plans formulary.

Answer: PPO plans will allow you to see doctors that are out of network if they accept your insurance for payment. PPO Advantage plans do not act like Original Medicare or Supplement plans which do not require prior authorization.

Answer: If you are on Original Medicare, you may seek care any where within the US from any doctor that accepts Medicare without referral. If you are traveling outside of the US, obtaining Medical travel insurance from your travel agent, or insurance broker is a prudent option. Original Medicare does not provide coverage outside of the US.

Answer: Medicare Advantage plans are in fact private insurance. Medicare Advantage plans replace Original Medicare as primary payer. By doing so, receive much of the money earmarked for the Medicare recipient and must cover at least what Medicare covers. In many cases Advantage Plans cover certain benefits like dental and vision that Original Medicare does not.

Answer: You can change your Advantage plan during the annual enrollment period October 15 through December 7. If your plan is not working for you such as your doctor is no longer in network or

due a medication change for example, you may change your Advantage plan once only, during open enrollment from January 1 through March 31

Answer: When working with a Medicare broker, you have access to quotes from multiple companies and a mix of coverages. If you are working with a specific company that offers Medicare insurance, it is most likely a single company and can only offer a limited number of policies which that company sells. There are rarely a one size fits all coverage options, so it is best to seek the guidance of a licensed broker who may use your criteria to find the coverage that is a best fit for you.

Answer: What many seniors look for in a Medicare plan in order are, Monthly costs, benefits, then what Doctors, hospitals, and medications are covered. Cost is always a consideration, but Medications, Doctors, and Hospitals that are included should be of primary concern. Do not be misled by low cost or nice but not essential additional benefits. Focus on what your long term needs are while looking at each plans’ benefits.

Answer: Most carriers have online member sites that you can search for specific doctors and specialties within your plans network. Other sources you can call are your broker or member services for your current plan.

Answer: For a client that is new to medicare, I first explain what original Medicare A and B covers, and what it does not cover, along with the costs involved. After the potential client understands the basics of Original Medicare, I explain the various coverage options and general costs including adding part D only, Supplement plans plus part D, and Advantage plans, along with asking them what they are looking for in a healthcare plan. If they choose to explore further, after securing a SCOPE of appointment, I ask more specific questions to find a plan(s) that best meet their needs.

Answer: Medicare Advantage plans may have zero monthly premiums, yet they are not free. There are copays for some doctors and most specialists, copays or coinsurance for some procedures, hospital stays, and or nursing home stays to name a few.

Answer: Being able to see any doctor that takes Medicare, anywhere in the country with no referral. This benefit makes some of the best doctors for certain conditions available to Medicare patients.

Answer: Medicare may pay for more frequent colonoscopies with a medicare approved provider if you are at high risk of colon cancer. Medicare may make exceptions due to previous test results and or symptoms that indicate further examination is necessary.

Answer: What the real question is how long and frequent are your hospital stays? For short one or two days maybe twice a year, I would say an Advantage plan zero premium, $200- $300 per day co-pay and a maximum out of pocket of $5000/year, will be less than the 20% cost of original medicare, unless you live in a state where hospital costs are well below the national average of $3000/day. If your potential hospital stays are anticipated to be longer or more frequent, then original medicare with a G or N supplement plan would be cheaper overall.

Answer: Medicare Advantage plans are administered by private insurance companies. The federal government gives the private companies funds that would normally go to paying your Original Medicare insurance claims. Where as Medicare pays 80% of covered claims and the insured pays the remaining 20%, Advantage plans after a copay plus deductible, and in some cases a daily fee if involving a hospital stay for example, pay the balance of a covered service. Many Advantage plans include services that Original Medicare does not such as prescription medications, dental, vision and hearing coverage. If you choose to stay with Original Medicare, combining it with a supplement plan that covers the 20% Medicare does not, is often a good option instead of an Advantage plan.

Answer: For many Medicare Advantage plans they come with a zero monthly premium, yet you still have to pay your Medicare part B premium. Advantage plans are a “pay as you go “ type plan wheee you pay co-pays or coinsurance for many if not most of the services. In essence, the more services you use in your Advantage plan, the more you pay.

Answer: The part B premium is set by CMS which oversees Medicare. For 2025 the part B base premium is $185.00/mo, and will most likely increase for 2026. If you have filed over the last two years as Single, and have an AGI of $106,000/year or less, or filed Married and have an AGI of $212,000 or less, you pay the base premium. Above these limits for 2025 you will pay more for your part B premium. There are some Advantage Plans that offer a Part B "give back" of a certain amount that reflects as a lower Part B premium. The amount of the give back is dependent on the carrier and plan you enroll in.

Answer: If you are within your 12 month Advantage plan trial period, your Advantage plan is terminated, or you have moved out of the service area, you may qualified for guaranteed issue rights. If you moved to a different state, you may have a 60 day period guaranteed issue window. Check with your new state's insurance commissioner.

Answer: Your part B may cover medication, but insure that your part D plan covers the medications you need in their formulary. As far as coordination, you must give your permission for both providers to share health information, but inform them of the treatment plan along with any changes. You can help keep the channels of communication open.

Answer: If your particular medication is included in your plans formulary, you must first meet the plans deductible. After paying the deductible, you will pay the full copay of the medication as directed for the tier (1-5) the medication is placed in, including any of your other medications until you reach, for 2025 the $2000.00 TrOOP cap. The TrOOP is calculated by your deductible, plus the cost you pay for all medications, plus the cost your plan pays, plus any manufacturers reduction (if any). When you reach the $2000.00 TrOOP you are in the catastrophic phase of your coverage and will pay $0.00.

Answer: The basic items that A and B do not cover (gaps) are: Dental care, Eye exams, Cosmetic surgery, Chiropractic/Massage therapy, Routine physical exams, Hearing exams /hearing aids, Concierge care, Covered care from a provider who has opted out from Medicare, Long term care. It is important to note that Medicare does not cover all prescribed medications. To have what is called "creditable coverage", purchase a part D medication plan from a private insurance company as soon as you start Medicare. You could be subject to paying a life-time penalty of 1% for each month you do not have medication coverage.

Answer: Moving to another state, you will have a special enrollment period,( 1 month before and 2 months after your move) you will most likely have to change your coverage. Keep in mind that even if you have a Supplement plan, you may have to change companies, your coverage will not change, but you may have a change in premium. For those with Medicare Advantage plans your coverage and company may have to change.

Answer: Read through your summary of benefits that were included with your enrollment. If you cannot find them or understand what is written. Call your plans member services, or your broker giving the exact name of the test. They should be able to help determine if the test has a certain co-pay or co-insurance.

Answer: Original Medicare normally does not cover health care while traveling outside of the US. There are instances where Medicare may cover medically necessary ambulance transportation with a Hospital admission, only for necessary covered inpatient hospital services. You will still pay for the 20% that Medicare does not cover. Some Medigap plans (F,G,M,N) will pay 20% of costs due to an emergency. When traveling internationally, I highly recommend travel medical insurance often available through your travel company or home owners insurance. Many Medicare Advantage plans have included international travel insurance. Look at the coverage limits and read any conditions carefully. Never assume imbedded coverage will meet your unique needs.

Answer: Clients want information, yet do not take the brokers advice, and end up self enrolling into a plan that is not a good fit for them. When their actions do not work out and they come back for help, it's often too late to help them.

Answer: As of 2025 there are 9 states that have some form of the Medigap Birthday Rule. The states are California, idaho, Illinois, Kentucky, Louisiana, Maryland, Nevada, Oklahoma, and Oregon. Each state has differences in the amount of time around your birthday, to apply with a different company. While most allow you to move to the same or a lower coverage, and change companies, other states allow only like coverage to like coverage with a different company. All of these scenarios come with no medical underwriting.

The best advice is before your birthday, speak with a licensed Medicare insurance specialist to see what your options are in your specific state.

Answer: Deciding that part A and B are all they need and do not need to enroll into a part D medication plan. This exposes the senior to 20% of the costs that Original Medicare does not pay. The second biggest mistake is for the senior to only consider cost of coverage. What may look attractive when only considering initial/monthly cost, could prove to be physically or financially disastrous. As brokers we help prospective clients make informed choices.

Answer: With the introduction of the reduced out of pocket cap, there has been an increase in the medication deductible. Max deductible currently is set at $590.00, although yours may be less. Once the deductible is met along with the $2000.00 maximum out of pocket, you pay zero for your in formulary medications for the rest of the year. Individuals who need expensive medications can realize a significant savings over the course of the year. Those who do not require expensive medications, may see their cost for medications increase due to higher deductibles and increased part D premiums.

Answer: Doctors can move in or out of network often depending upon if they change groups or move out of the area. Doctors and facilities moving out of network is one of the many reasons I recommend an Advantage PPO over an HMO if one is available.

Answer: By not checking if your medications are on the plans formulary. Or deciding that you do not need a part D plan because you don’t currently take medications.

Answer: Unless you qualify for a guaranteed issue enrollment if your state has a supplement birthday rule. You will have to answer health questions.

Answer: Stay with standard Medicare A, and not enrolling into Medicare part B, and a part D medication plan.

Answer: If your provider certifies that you need physical therapy, after your part B deductible, Medicare pays 80%, you pay the remaining 20%

Answer: Often changing carriers while maintaining the same level of coverage can save you money on your premiums.

Answer: Medicare brokers work with multiple carriers and can better advise using your needs what plans could work best for you.

Answer: If you are referring to your initial deductible. If your medication is in your plans formulary, it will count for the deductible.

Answer: Medicare does not pay for assisted living. You will need to look towards long term care insurance, or other types of additional care coverage.

Answer: Medicare does not cover:

Dental Care

Eye Exams

Hearing Aids

Long-term care

Cosmetic Surgery

Massage Therapy

Concierge Care

Covered Items/Services you receive from an "opt-out" Doctor except in an emergency or urgent case

Answer: Enroll into Medicare if 65 or older 3 months before the month you retire making the effective date your retirement month. Email me for more detailed information.