Rick Boyd, Medicare Insurance Broker

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.