Rodney Turner, Medicare Insurance Broker

Answer: Changing Medicare Supplement (Medigap) Plans

The short answer is: not always freely — it depends on your situation and timing.

Guaranteed Issue Rights (Best Time to Switch)

You have the strongest protections during specific windows when insurers must sell you a plan at the best available rate, regardless of health:

Initial Enrollment Period — the 6-month window starting when you're 65+ and enrolled in Medicare Part B. This is the best time to buy any Medigap plan.

Special Enrollment Periods — triggered by specific life events, such as losing other coverage (employer plan, Medicare Advantage, etc.).

Outside of Guaranteed Issue Periods

Outside those windows, you can technically apply to switch plans at any time, but:

Insurers can use medical underwriting — meaning they can review your health history and deny you coverage or charge higher premiums based on pre-existing conditions.

Only exception: A few states (like New York, Connecticut, Massachusetts, and California) have stronger consumer protections that allow more open switching.

Answer: Great question! Concierge medicine and Medicare can actually work together quite well, and you're not alone in wondering how they complement each other.

Here's the basic idea: Medicare remains your primary insurance and continues to cover hospitalizations, specialist visits, lab work, and other medical services just as it always has. Concierge medicine — sometimes called a direct primary care (DPC) practice — is a separate membership arrangement you have directly with your primary care physician. You typically pay a monthly or annual fee in exchange for enhanced access and services, such as same-day appointments, longer office visits, 24/7 direct access to your doctor, and more personalized, unhurried care.

The key thing to understand is that concierge doctors generally do not bill Medicare for the primary care services covered under your membership fee. However, if your concierge doctor refers you to a specialist, orders labs, or arranges a hospital stay, Medicare can still be billed for those services as usual.

So in practice, you'd be paying the concierge membership fee out of pocket (typically $100–$300/month depending on the practice), while Medicare continues to handle the bigger-picture coverage.

If you already have a Medicare Supplement (Medigap) or Medicare Advantage plan, it's worth reviewing how those interact as well — some plans may have network restrictions that are worth considering.

Answer: A PPO (Preferred Provider Organization) plan gives you flexibility, but there are a few disadvantages seniors should consider:

* Higher monthly premiums compared to many HMO plans

* Higher out-of-pocket costs like deductibles, copays, and coinsurance

* You may pay much more when using out-of-network doctors or hospitals

* Costs can be less predictable, especially if you need frequent care

* Some PPO Medicare Advantage plans may have higher maximum out-of-pocket limits than other plan types

Answer: Annual Deductible Period: Most Medicare plans, including Original Medicare (Part A and Part B) and Medicare Advantage, use January 1 to December 31 as the coverage year.

Deductible Reset: At the start of the new year (January 1), any remaining deductible amount from the previous year does not carry over. You start fresh, meaning you’ll need to meet your deductible again before your plan starts paying for certain services.

Answer: The Social Security Administration reviews your income annually They usually base it on your tax return from two years prior Example: your 2026 IRMAA is typically based on your 2024 income.

Your IRMAA can go up, down, or disappear each year depending on your income. If your income drops, your IRMAA may be reduced the following year automatically.

If your income drops significantly due to certain events, you don’t have to wait a full year. You can request a reassessment using SSA-44 for situations like:

Retirement or reduced work hours

Divorce or death of a spouse

Loss of income-producing property

Pension loss

Answer: There is no time limit as to how long you can be outside the U.S The bigger issue is Medicare generally does not pay for care outside the U.S, except in very limited situations:

A medical emergency in the U.S. but the nearest hospital is across the border (e.g., Canada or Mexico)

You’re traveling between Alaska and another state and need emergency care in Canada

You live in the U.S. and a foreign hospital is closer than the nearest U.S. hospital.

Also If you have Part B, you must keep paying premiums to stay enrolled

If you stop paying, your coverage can be dropped—and restarting later may come with penalties.

Answer: When you are on Original Medicare, vision is generally not covered. It usually does cover

Eye exams for certain conditions like Diabetes (diabetic retinopathy screening), high risk for glaucoma

-Medically necessary treatments like Cataract surgery, glaucoma treatment, eye injuries, etc.

- Glasses after cataract surgery. Typically, one pair of standard glasses or contacts after surgery with lens implants. You still pay part of the cost (about 20% after deductible)

Medicare Advantage (Part C) plans usually include eye exams, glasses, and contacts, but coverage varies by plan and location.

Answer: Hospitals may not accept Medicare Advantage plans for a few reasons. One key factor is contracting—Medicare Advantage plans are offered by private insurance companies, and hospitals need to sign agreements with these insurers. Some hospitals may not reach an agreement due to low reimbursement rates or differences in contract terms. Additionally, certain regional networks or specific hospital systems might not participate in the networks of some Medicare Advantage plans. This can limit your options if you're enrolled in a particular plan.

Answer: If your income drops after retirement, you can request a reassessment of your Medicare Part B premium by contacting Social Security and providing proof of your lower income. If you're paying higher premiums due to past income, you may be able to appeal for a reduction based on a life-changing event, like retirement. You can also explore Medicaid or other assistance programs if your income is very low.

Answer: I would strongly recommend that you reach out to a broker to help you. There are many companies and agents that will send you mail.

When you work with a local broker, you can meet in person he/she should be knowledgeable about the local market and should be able to provide you with the best service.

Answer: Yes — your Medicare deductible can change from year to year, and it usually does. The amounts are set annually by the Centers for Medicare & Medicaid Services (CMS) and often increase slightly to keep up with inflation and rising healthcare costs.

Here’s a quick breakdown:

Medicare Part A (Hospital Insurance)

Covers inpatient hospital stays, skilled nursing, hospice, etc.

The Part A deductible typically increases each year. For example:

In 2024, it was $1,632 per benefit period.

For 2025, CMS announced it will be $1,688 per benefit period.

This deductible applies per benefit period, not annually — meaning you may owe it more than once in a year if you have multiple hospital stays separated by more than 60 days.

Medicare Part B (Medical Insurance)

Covers doctor visits, outpatient care, and other medical services.

The Part B deductible also adjusts yearly:

In 2024, it was $240.

For 2025, it’s set to rise to $257.

You pay this once per year, then Medicare typically covers 80% of approved services after that.

Medicare Advantage (Part C) and Part D (Prescription Drug Plans)

These are private plans, so their deductibles and copayments can change each year as well.

Insurers are required to notify you of changes in their Annual Notice of Change (ANOC) each fall.

Answer: The best way to handle:

Ask DR for the procedure code. With this code, you can verify coverage.

If you have original Medicare and/or a supplement:

Go to Medicare.gov, enter the procedure code to check if it is generally covered and under what conditions.

You can also call Medicare 800-MEDICARE if that is easier for you.

If you have a Medicare Advantage Plan:

Call your plan directly to check the coverage level for the procedure

Ask for Prior Authorization if needed.