Roger Werking, Medicare Insurance Agent

Answer: Generally, Medicare Part D plans can cover generic prescription sleep medications (such as generic zolpidem, the active ingredient in Ambien), but coverage varies significantly depending on the specific plan's formulary, brand versus generic status, and utilization management rules. Key details to keep in mind regarding Medicare Part D coverage for these medications include:

Answer: Original Medicare (Parts A and B) generally does not cover birth control pills (such as Portia, Nikki, or Yasmin) when they are used solely for the purpose of pregnancy prevention.

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However, coverage depends on the specific type of Medicare plan and the medical reason for the prescription:

Medicare Part D (Prescription Drug Plans): Many Part D plans and Medicare Advantage (Part C) plans with prescription drug coverage will cover oral contraceptives if they are prescribed for a medically necessary condition other than contraception. This commonly includes managing conditions such as endometriosis, polycystic ovarian syndrome (PCOS), ovarian cysts, or severe hormonal imbalances.

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Formulary Check: Because coverage is determined at the plan level, specific pills like Portia, Nikki, or Yasmin (or their generic equivalents) must be listed on a particular plan’s formulary. Copays and tier levels will vary depending on the exact Medicare prescription drug plan chosen.

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Answer: 1. Medigap is Sold by

Private Insurance Companies

Unlike Original Medicare (Parts A and B), which is administered federally and cannot deny you or charge you more based on your health history, Medigap policies are sold by private insurance companies. Because they are private companies, federal rules permit them to evaluate risk.

2. Medical Underwriting Outside of Open Enrollment

Federal law protects consumers during specific windows—most notably your 6-month Medigap Open Enrollment Period, which starts the month you are 65 or older and enrolled in Medicare Part B. During that specific window, insurance companies are legally prohibited from using medical underwriting; they must accept you regardless of your health history and charge you the same standard rate as someone in perfect health.

However, if someone applies outside of their initial open enrollment window and does not qualify for a "Guaranteed Issue Right" (such as losing employer coverage or certain changes involving Medicare Advantage), private insurers in most states are legally allowed to use medical underwriting. This means they can review health history, ask medical questions, and legally deny coverage or charge higher rates to applicants with pre-existing conditions.

3. State-Specific Protections

While federal rules allow medical underwriting after open enrollment, a few states (such as New York, California, Connecticut, Massachusetts, Maine, Oregon, and Washington) have enacted stricter state laws that provide continuous open enrollment or annual guaranteed-issue rights regardless of health history. Depending on the state where the senior lives, alternative rules might apply.

Answer: Yes. You can cancel your Part B if you move to another country. Make sure you have adequate health insurance in your new location.

Answer: Most companies send out the Annual notice of change no later than September.

Please review the document, since it contains important changes about your current Medicare plan.

Answer: Creditable coverage is any type of health insurance that covers you after your initial enrollment period (IEP) is over. Your IEP is the 3-month window before and 3 months after you turn 65. As an example, if you are 67 years old and still on a group health plan at work, you do not have to go on Medicare until your group plan expires. You will not be penalized for missing your IEP.

Answer: If you have a Medicare Advantage Plan, there are two times per year you can change.

October 15th through December 7th, or January 1st through the end of March.

Answer: Medicare does not cover SilverSneakers, but if you purchase a Medicare Advantage Plan to go with your regular Medicare, most Medicare Advantage Plans cover/offer SilverSneakers.

Answer: Yes. You can apply and get Medicare if you are not drawing Medicare.

Contact me.

Answer: Yes, Medicare covers Breztri, but it depends on what drug plan you have, or what Advantage Plan you have. Some plans cover it; some do not. You need to check each plan to see if it is covered.

Answer: If you were taken to the Emergency Room for a stroke, the average copay would be around $150.00 for a Medicare Advantage plan.

If you were admitted, your room rate could be anywhere from $175.00 per day up to $400 per day, depending on the specific plan you for a Medicare Advantage plan.

Then rehabilitation could be $30 to $40 per treatment until you recovered.

Answer: In 2026, Part B of Medicare, which covers doctors, costs $202.90 month. Whereas in 2025 Part B was $185.00. This represents a 9.7% increase from 2025.

Answer: You can stay on your group plan if you like; you do not have to leave it. But, if your group plan costs more than Medicare, you would probably save some money by moving to Medicare.

Answer: If this is the first time this year you have been to the ER, then you would have a one-time $283.00 deductible, but no copay.

Answer: You need to decide if you want a Medicare Supplement Plan or a Medicare Advantage plan. Make sure you know your correct dates to sign up.

Answer: Your annual wellness visit with your PCP has a ZERO copay with most companies. Some Advantage plans might cost more.

Answer: In 2026, most people will pay $202.90 per month for Part B of Medicare. In most cases, Part A is free.

However, if you have a high income, your Part B cost might be higher.

Or, you might qualify for a Part B reduction if you pick one of the Part B giveback plans.

Answer: They assume that the 20-day coverage for nursing home after a short stay in the hospital is part of the long-term care coverage. LTC is a different type of coverage that can pay for assisted living expenses for 3 to 5 years, or longer.

LTC is completely different than the short-term coverage in a nursing home and can cost $5000 to $8000 per month, which is paid by the occupant.

Answer: HMOs do not have as many doctors to choose from as a PPO would.

You have to have referrals to see a specialist. With a PPO, you do not need referrals.

Answer: Medicare provides preventative services and programs that can help delay or reduce progression from prediabetes to type 2.

MDPP = Medicare Diabetes Prevention Program.

Answer: A solid tip would be to prioritize plans based on actual usage, not just monthly premium.

Make sure your current providers are in the network, and your medications are covered.

Answer: I like to meet new people and hear their story. I also want to make sure people have the necessary coverage for the future.

Answer: Knee replacement is very expensive, so the insurance company wants to confirm that the replacement is really necessary, and that conservative treatments were tried first.

Answer: If you have opted out of Medicare, you cannot bill Medicare Advantage Plans.

Once opted out, you may not be paid by Medicare or Medicare Advantage plan for services under Part B.

Answer: Long term care, most dental care, routine vision care, hearing aids, cosmetic surgery, prescription drugs.

Answer: If you are not on a company group health plan, then you need to get your Medicare Card and apply for a Medicare Supplement or Advantage plan.

Answer: You can change plans during the Annual Enrollment Period: October 15th - Dec 7th.

Or during the Open Enrollment Period: Jan 1st to the end of March.

Answer: As an example, if you have a Medicare Advantage plan, you can rent a wheelchair or crutches around 3%, which is what my Humana Plan offers.

Answer: Yes, as long as you are in your Initial Enrollment Period.

Which is 3 months before you turn 65 and 3 months after age 65.

Answer: Take your time and look at several plans before you invest your money. There are several different plans to choose from. Make sure the plan meets all your needs.