Robert Barco, Medicare Insurance Broker

Answer: Medicare Plan K only pays for 50% of the costs until the out-of-pocket limit has been reached (for 2025 it is $7,220), then Plan K pays 100%. Plan G will pay 100% of the Medicare-covered charges after the yearly Part B deductible has been met.

In my county, a 65-year-old male non-smoker will pay about $94.00 less per month for Plan K than for Plan G, making it substantially cheaper than Plan G for an AARP United Healthcare Insurance Company Plan.

Answer: Yes, Medicare will cover asthma and other breathing conditions like chronic obstructive pulmonary disease with doctor visits and devices like inhalers and nebulizers. Medicare Part D will cover the prescription drugs to treat asthma and COPD.

Answer: You should qualify for assistance based on your income. Since I do not know enough about your situation, I suggest you contact Medicaid to see if you are dual eligible for both Medicare and Medicaid.

Answer: You will receive the higher payment from Social Security, either your husband's or yours, but not both.

Answer: The annual wellness visit consist of a Health Risk Assessment where your vitals are taken and reviewed. Also the doctor will review your medical history, medications, needed screenings and immunizations. Lastly the doctor will discuss fall prevention, end of life planning, legal issues, any education and referrals for any specialists.

Answer: Original Medicare will not pay for certain things, like physical exams, cosmetic surgery, dental, vision, or hearing aids. Original Medicare and Medicare Advantage plans will both require prior authorizations before any major procedures are done. These requests for prior authorizations are the responsibility of the doctor and or hospital to obtain before medical procedures start.

Answer: I do not believe you made a mistake choosing a Medigap insurance policy since you travel a lot. Unfortunately, Medigap policies do go up as you age and the insurance companies will adjust rates based on their claims history. Consult with a broker to find a different Medigap plan with lower rates. If you can pass underwriting, your policy change should be easy.

Answer: Original Medicare will cover a limited number of visits for lower back pain only under Part B. Your doctor or a qualified health care professional will supervise the procedure. It is possible that a Medicare Advantage plan may offer more acupuncture services. Check with the Medicare Advantage plan to learn more.

Answer: A Medicare agent or broker can assist you with your questions about Medicare. When I meet with someone to discuss Medicare, I do my best to explain the "maze and alphabet soup" of Medicare. It is important to get your questions answered before you select a supplement or an advantage plan.

Answer: You get a one-time six-month open enrollment when you turn 65 and first become eligible for Medicare Part B. At this time, you can sign up for a Medicare supplement without any health questions. You will not be denied coverage. If you wish to purchase a Medicare Supplement or Medigap after your 6-month open enrollment, you will need to pass underwriting, and you can be denied coverage due to health.

Answer: As of July 2025, there will be ten states that will have a "birthday rule" where existing owners of Medigap plans can change plans or change Medigap companies without underwriting. The ten states with the "birthday rule" are, California, Idaho, Illinois, Maryland, Oregon, Nevada, Louisiana, Kentucky, Utah, and Virginia.

Answer: Original Medicare does not cover your medical needs outside the United States. If you have a Medicare Advantage plan, the plan may offer emergency care outside the United States. Each plan is different when it comes to this coverage. If you have a Medicare Supplement or Medigap plan, it will have international coverage for emergencies. You will pay the first $250 provided the emergency happens during the first 60 days outside the USA. I recommend purchasing separate travel medical insurance to cover the exact time away.

Answer: Original Medicare is insurance provided by the Medicare system. This insurance is Medicare Part A, hospital coverage, and Part B, outpatient services. Additionally, you need Part D stand-alone prescription drug coverage or move to the alternative Medicare Advantage all-in-one plan. Medicare Advantage is provided by private insurance companies that have a contract with the Medicare system.

Answer: Generally, you cannot backdate Medicare enrollment. There are rare circumstances where you can enroll late due to an extreme medical emergency, but these are granted on a case-by-case basis. If by chance you qualify for a special election period, you may be able to enroll, but it most likely will not be backdated.

Answer: Medicare will cover the skilled nursing facility, but Medicare part A coverage will end once Long -Term Care starts. You will be responsible for all Long-Term Care costs unless you have Long-Term Care insurance or qualify for Medicaid.