Ron Cronwell, Medicare Insurance Agent

Answer: Medicare part B covers dialysis. Once you satisfy the part b deductible, then Medicare pays 80% and you are responsible for 20%, no limit on coinsurance payments.

With a Medicare Advantage plan the part b deductible i covered by the plan, but a 20% coinsurance is your responsibility. A Medicare Supplement usually picks up the 20% coinsurance which reduces ;your exposure.

Speak with you facility social service coordinator. You may qualify for some stte help with costs such as Medicaid.

Answer: Medicare does not cover routine eye exams nor prescriptions for vision corrective glasses. But, Medicare covers medical issues of the eye, such as cataract surgeries. It also provides for one pair of post cataract surgery glasses.

Answer: Start with evaluation their health, no issues, a few chronic illnesses, or seriously ill at this time requiring expensive medications and procedures.

Next is general affordability. Can they afford a Medicare Supplement and Rx plan plus the part B premium, given the premium will rise 4 to 9 % per year.

Now consider a Medicare Advantage plan series.

Look at the available plans in your area. Check the top 3 companies available. Each plan benefits are arranged in the same format. Compare monthly premium if any, maximum out of pocket and so forth down the list. Compare Rx areas separately from medical. Now look at the non-medical benefits. After analysis now consider the company you may be familiar with from employment or with whom you are comfortable.

Find a trustworthy or highly recommended local agent and ask them to do thee same type of analysis. Now make your selection with confidence. Work with the local agent to enroll.

Answer: Not at all. Discount cards work outside of Medicare. All you need is a prescription from a doctor in your state to get it filled using a discount card..

Answer: if the plan covers telehealth, usually that includes specialists as well as specialists. Although you may not have access to your usual primary care doctor, there are many available through telehealth.

Answer: There are several drawbacks to going directly to a carrier. Having a local agent provides much better customer service, easier to access, have an advocate for you with the carrier, can provide easier to understand explanations o questions.

Answer: Unless you have a guarantied issue sep. then yes most plans require health questions. A few states allow a birthday sep. or an open sep. all year. states

Answer: There could be multiple reasons. A plan with a higher overall cost maybe the plan that has a persons prescriptions included in the formulary. Another reason is anticipating needing a prescription that is not included in lower premium plans.

Answer: That answer depends upon many factors. To start what is your medical situation, is the Med Adv plan widely accepted in your county,

With Original Medicare you would need to sign up for a stand along drug plan, an extra expense compared to Advantage plans.

Do all your doctors Medicare, do all your doctors take the Advantage plan you are considering.

What are the non medical benefits that come with an Advantage plan, such as dental, eye ware, hearing aids, over the counter item coverage, and more.

More than 50% of people on Medicare have a Medicare Advantage Plan. Not all, but you should sit down with a local agent to discuss the pros and cons of your specific situation and finances.

Answer: Your question needs more specificality. As to a treatment or procedure, Medicare Supplements and Medicare Advantage plans must cover all the procedures and treatments that Medicare covers.

If you men prescriptions, the each plan publishes an ANOC, Annual Notice of Change. In that document the benefits and drug coverage for the next year are listed. Italso lists of changes to the plan and benefits.

Working with a local agent or your Agent of Record can help you.

Answer: Original Medicare has 2 parts, A and B. Part B covers doctors visits, durable medical equipment, out patient surgeries, abd part B medications. There is a monthly premium for part B, an annual deductable, and copays for services.

Answer: Start with your PCP and talk about your situation. Either they will do an evaluation or your PCP will refer you to a specialist who covers your disability and they will evaluate and can issue a order/prescription for durable medical equipment. (replacement wheelchair ).

Answer: There are several methodes.

One, call the Member Services number onthe back of your medical card and ask them for several names and contact information.

A second is to call your local agent and ask for assistance.

Third is to register your online account with your insurance company. There are usually links to find in network professionals and other helpful resources.

Answer: Ues, relatives and close friends are alowed to assist you in looking at options. The final decision remains with you and how you value each option, not how it makes your kids feel.

If you feel pressured, perhaps finds a trusted local agent to assist in your understanding about the options.

Answer: One limitation could be the number of plan options avaiable in a very rural area. In addition there maybe fewer medical professionals to choose from to none at all. Hospitals maybe over an hour or more away from your location.

Answer: Yes by all means talk to your local agent about the ANOC noted changes. Also update your agent on any health changes from last year. There maybe better plans available to address any health changes. Plus he can walk you through adjustments in benefits.

Answer: Extra Help With Prescription Drugs is an income based prescription reduction cost plan from the federal government. If you fall into the income qualifications and asset qualification, the plan provides for lower prescription copays and also pays down the monthly premium for a drug plan or even some Medicare advantage plans.

On your browser in the search field type is Extra Help With Prescription Drugs. An information and application should pop up. Fill it in and submit. in a few weeks they will send you a determination.

Answer: Generally yes. But individual plans may not include all brands of inhalers or nebulizers. Each does require a prescription. In the case of nebulizers, there may be some hardware required which might be covered under part B.

Answer: Most Medicare Advantage plans cover psychologists and psychiatrist visits. Social worker visits are not medical, so no, they are not covered. Social worker by definition are not licensed in mental heath therapy, so not covered by a health care plan.

Answer: Yes. Medicare and Medicare Advantage plans cover IV chemotherapy. IV Chemotherapy is usually a Part B procedure and results in a 20% copay.

Answer: Routine prostrate blood tests are covered as needed through primary care visits. Mammograms are covered if deeded medically appropriate by your physician. Colonoscopies are covered through the Preventative Care visit and as directed due to medical diagnosis by a doctor.

Answer: Basic memory assessments are covered through the annual Preventative care visit. Neurological visits are covered as Specialist visits, usually with a copay.

Answer: Medicare covers rehabilitation and or strengthening after surgery. However, a doctor must order the treatments and monitor improvement. There is limited home visits for medical purposes after surgery. Home support such as: cooking, cleaning, toileting is not covered by Medicare Advantage plans nor Medicare.

Answer: AEP ends Dec 7th. But OEP runs from January 1 through March 31 each year. People who are already enrolled in a Medicare Advantage plan on January 1, have a one time opportunity to change plans, change insurance providers, or cancel their Medicare advantage plan and go back to original Medicare and are able to enroll in a stand along prescription drug plan, during the OEP period.

Answer: Yes, a special enrollment period is generated due to disenrollment from the C-SNP plan. But there will be at least a one month gap between the disenrollment and the effective date for the replacement plan.

As part of the program, there are notifications sent to the agent of record and the beneficiary before the actual disenrollment which also provides for a SEP to enroll in another plan if no CCV is given to the plan provider. Using that option there is not gap in insurance.

Answer: Yes an applicant can be denied enrollment in a Medicare Supplement. There are points in time such as initial enrollment period, and those triggered by a life change, such as moving from one state to another, where there are no health questions. Otherwise outside of those there are health questions that dictate price and enrollment approval. There are also several diseases that preclude signing up for a Medicare Supplement such as Kidney failure/dialysis.

Answer: Medicare does not offer incentives for healthy behaviors. But, many Medicare Advantage plans do offer rewards in actual dollars for annotating selected healthy activities. Check with your local agent or log into you r online Medicare Advantage account to find specifics.

Answer: Yes, there is a solution. Medicare Supplements provide pease of mind and support financial planning.

Medicare supplements work with original Medicare and pays most to all the copays and deductibles in original Medicare for one monthly premium. That premium does increase with time.

Answer: Domestically, look for a plan that has coverage over the whole country.

For international travel get with a local agent and sign up for international travel health insurance.

Answer: One misconception is that Medicare covers all the medical costs. But Medicare is a cost sharing program where the enrollees participates in the charges.

Another is that both parts have no premium. Part b has a monthly premium.

Answer: Make sure all your doctors are in network. Also, ensure your prescriptions are covered and determine the copay or coinsurance.

Answer: Yes, as long as they are deemed medically necessary by your physician. You can verify with the staff to ensure they are covered. Some procedures may require pre approval.

Answer: Once a year during AEP. Also review yor ANOC which you receive in late September for the next year.

You should also verify with your therapist to ensure they remain in network.

Answer: Medicare covers medically necessary Mammograms as needed, usually once per year. However, in consultation with your doctor and family history the frequency may be adjusted.

Medicare follows the federal health guidelines for Mammograms.

Answer: Both Medicare and Medicare Advantage plans of coverage for breast cancer. Extra coverage is available through ancillary insurance policies, such as cancer plans.

Check with a trusted local agent to investigate different ancillary insurance options.

Answer: There are several mood and environment enhancers to consider when addressing such issues with parents. One is recognizing you are switching places with them, going from

daughter or son to adult to adult. So set up a professional setting, away from their usual place where they are the parent. Dress accordingly, if you are an agent, where a logoed shirt/blouse and nice pants/skirt. (adult cloths).

Create a check list or outline of the presentation you want to have with them, educational and informative. Gather materials ahead of time and become familiar with them. Create a folder for the materials for each of them ahead of time. There are good information materials available form providers or from Medicare. Into to Medicare, basics of Medicare Advantage planes, basics or Medicare Supplement, outlines of Prescription drug plans.

find a location away from where they hold "court," such as the dinning room table, or at a quiet coffee shop where you can offer them a cup of coffee, tea, or beverage.

Use graphics to demonstrate your major points. ask if they have questions along the way.

Make sure you reiterate they have decisions to make. You can offer to help, but they are the deciders. The bottom line is what gives them the best peace of mind at an affordable amount, that still provides good coverage for their needs.

allow time for them to absorb the information. If there is time, give them a chance to mull over or think about the information before circling back for a decision.

Answer: Very few. Medicare will reimburse costs for a visit the an emergency room near us borders.

Better to purchase travel medi al insurance through a local agent.

Answer: Part D describes stand alone prescription drug plans offered through private insurance providers under contract with Medicare.

From my experience Repatha is covered by most PDP Prescription drug plans. It is, however, considered a specialty drug in most plans and therefore has a larger cost-sharing or tier value.

Check with specific plans and verify coverage and what their tier level assigned.

Answer: There could be several reasons your Part B premium has increased after your husband passed.

But, I suggest you contact Medicare directly and ask them why your premium increased. When an increase is coming, Medicare usually issues a latter informing the person of the increase and explains the WHY.

Answer: Original Medicare does not include dental or vision coverage. There are ancillary policies that offer varius levels of dental and vision coverage.

Check with a local agent to review your several combination options that meet your specific needs or requirements.

Answer: if you were covered by employer health insurance you in effect deferred your sign up time frame.

Usually your employer insurance require you sign up for part A, but defer signing up for part B until your employer insurance ends.

When your decide to retire and stop your employer insurance, call Medicare and activate your part b so it starts when your employer insurance ends.

Answer: There are several ways to save on prescription drugs.

One is to sign up for a plan with a prescription drug plan embedded in the health care plan. The copays are usually much lower than the full price.

A second method is to check several of the discount drug plans available from the place where you get your prescriptions filled.

A third way is to check several of the private discount plans. GoodRx, Costplus, and Singlecare are a few.

Finally, check with your doctor or pharmacist about using generic rather than brand-name prescription drugs.

Answer: The tier levels relate to the amount of copy or coinsurance out of pocket cost of a particular prescription. Tier levels may change be different between different plans.

Answer: Work with your primary care provider to get a referral to the appropriate specialist to refine the diagnosis and develop a treatment plan. Depending on your plan, there may be a copay for the specialist visit.

Answer: When you go to the emergency room, give them your Medicare card and your Medicare Supplement (medigap) card. Between both cards there should not be any additional charges for you to pay.

Answer: Yes. you can gather information and options. But unless you have their Power of Attorney, they will need to be involved in the decision making and signature process.

Fortunately, signatures may be obtained through several means. Remote signature, inspersion, or voice authorization.

contact a trusted local agent to help with options and methods.

Answer: Good news. The Annual Enrollment Period has just started. October 15 thru December 7th.

This is a time Medicare enrollees can enroll in Medicare Advantage plans which include prescription drug plans.

Contact a local agent through Agents Hub and discuss your options.

Answer: There are many hurdles to overcome. One is technical ability and how comfortable individual's are with using a cell phone or tablet.

Another is high speed internet connectivity or availability.

Another is the availability of qualified and educated agent assistance.

and finally, increasing general confidence in the information being disseminated. Currently there is far to much misinformation from national telephone centers who lie, beguile, misinform and abuse communications with clients.

Find a trustworthy local agent to build a relationship with over time.

Answer: Usually yes. Your have roughly 63 days from the last day of coverage under an employer plan to utilize a special enrollment option. But to make the change, you must have activated both part A and Part B.

Answer: The Annual Enrollment Period AEP, begins October 15 and runs through December 7th. Contact a local agent and review your available options for Medicare Advantage or Presription drug plans.

Answer: Beginning with January 1, 2025, the donut whole was eliminated as a stage of medicare prescription plans. Currently the stages are: Deductible stage, Co-pay stage, and Catastrophic coverage stage.

Additionally, there is now a $2000 maximum out of pocket limit on out o pocket payments for prescriptions under the plan.

Answer: If you have SSDI, then there is a 24 month waiting period before you are eligible for Medicare. up to three months ahead of your 24 month waiting period you may contact Medicare and sign up for A and B of Medicare. There is a monthly premium for Part B. Currently that amount is about $185. Your Medicare should start the first day of the 25th month.

If you have SSI, then you are not eligible for Medicare until you turn 65, but you qualify for Medicaid from the effective date of your disability award.

Answer: based on my experience, none of the Medicare based plans covers in-home dementia care. It sounds like she requires Nursing Home care.

One possible route is through Medicaid. If she qualifies for Medicaid, depending upon her condition, Medicaid may provide some in-home alternative to going in a nursing home.

Check with your county Office On Aging or state Medicaid office.

Answer: The time window is fully described in the New to Medicare booklet you received along with your Medicare card. There is a 6 month open enrollment window following the month of your part B effective date, where there are no health questions. Working with a local agent gets you information on your several options, including time windows for enrolling in Medigap, Prescription Drug, and or Medicare Advantage plans.

Answer: There is no specific trap. Each type of Medicare insurance has its specific rules and requirements. They differ so a person should know the differences or work with a local agent who can explain the differences and and consider each persons specific set of needs and equipment's. Such as health, finances, region, and availability of medical services.

Answer: AEP and OEP. Annual Enrollment Period is October 15 thru December 8th each year with an effective date of January 1. Sign up for the first time or make a change in plans. OEP runs January 1 thru March 31. OEP is for those who have a Medicare Advantage Plan, they get a one time opportunity during that time to cancel out of their MAPD or to change MAPD plans.

There are other times during the year that trigger a special enrollment period, such as moving from one plan area into another plan are. Another other is for people who enroll in Part B for the first time.

Answer: Annual Enrollment Period (AEP), October 15th through December 7th each year a Medicare enrollee may sign up for a Medicare Advantage or a prescription drug plan. During the same period, a person with a Prescription drug plan or a Medicare Advantage plan may change plans or go back to original Medicare.

OEP, Open Enrollment Period, is January 1 through March 31 each year. An enrollee with a Medicare Advantage Plan may change plans or go back to Original Medicare.

Answer: Sign up for Medicare Part A. But, when enrolling, delay enrolling in Part B until your employer insurance ends.

Answer: No, unfortunately. Original Medicare does not cover dental services. The one exception is where as a result of an accident dental reconstruction is medically required.

Answer: There are several programs which may help with your premiums and copays.

(LIS) Extra Help With Prescription Drugs is an income qualified Medicare program that reduces the part d monthly premium and limits the copays for qualified medications.

Check with your states Medicaid program to determine if you qualify. Medicaid can pay the part B monthly premium and reduce the copays for medical costs for those who qualify.

Check with a local agent who can help you apply for LIS. Call your local Medicaid office for assistance applying for Medicaid.

Answer: Many Medicare Advantage plans have a zero monthly premium, which is not the same a free. Part of your part b premium goes to the Medicare Advantage provider to pay for the plan along with other monies from Medicare. So it is not free, but may have a zero monthly premium.

Answer: Perhaps. If you have Part D, check your plan's formulary ensuring the drug is in the formulary.

Check the tier level and the copay associated. There may be a deductible for expensive drugs. Then combine the copay and deductible for each month.

The donut whole was eliminated for 2025 and the maximum out of pocket is $2000.

So perhaps your out of pocket expense is less under the 2025 plan.

Contact your agent of record or speak with a local agent they should be able to help you with the calcualtions.

Answer: Medicare is a federal program, so the policies are the same is all the states. If you are looking at more than original Medicare, the each state has varying policies. Such as Medicare Advantage plans and Part D plans. Also, Medicare Supplements are state controlled as to price.

So much of the analysis boils down to the individuals situation.

Answer: Generally yes. But first check the formulary of each plan you are considering to make sure it is in the formulary. Second determine the copay for that tier value. Third, if you have not been on a Part D for more than 63 days since you were first eligible, there may be a penalty that has accrued.

Check with a local agent about these questions to determine the overall cost, premium, copays, potential penalty, before moving ahead with enrollment.

In 2025 there is a maximum out of pocket limit of $2000 annually. So a very expensive drug may be more affordable with a Part D plan.

One other item, check to determine if the person qualifies for what is called Extra Help With Prescription Drugs.

Answer: Burial contracts where the owner is the funeral home do not count into assets.

Another option is to have her give the car to a underage grandchild, then the parent can dispose of the auto and use the funds to help out the mother as needed. Talk to a qualified tax professional to determine the actual process and implications.

Answer: yes. As long as the qualifying condition of income continues the IRMAA surcharge will continue to be added to your monthly premium.

Answer: Not completely. There are deductibles and copays for transactions under part A and part B. In addition there is a monthly premium for part B of at least $185 per month.

Answer: Generally NO. There are two exceptions. One is being diagnosed with Kidney failure. The other is being diagnosed with ALS.

A third is being diagnosed with Diabetes, Chronic heart failure or Cardio Vascular Disease.

Answer: Selecting a plan only based on a monthly premium. A person should consider personal situation, health, premium, deductible, and current prescriptions.

Answer: The largest mistake is usually not taking the time to get help in understanding the pros and cons of Medicare and the options when first enrolling. Find a local agent to work with to become an informed buyer.

Consider the several steps and considerations, personal health, plans available, financial situation, prescription requirements.

Answer: Most Medicare Advantage plans list in the benefit summary what the lab work copays are. Usually they are a zero copay. But check with the benefit summary to make sure.

Answer: Generally there are only a few typical costs for a chronic condition like diabetes.

1) 2 to 4 PCP visits per year.

2) If on Insulin, a $35 copay per prescription. 12 times 35.

3) Blood sugar monitoring supplies. Test strip, lancets, and meter. Many Medicare Advantage plans provide for those supplies at a zero copay.

4) If taking a prescription drug instead of insulin to control blood sugar, Then look to the RX plan and what the copay is for the script and calculate the annual cost.

Work with a local agent to help estimate the annual costs.

Answer: Under most Medicare plans, the annual Preventative Care visit has a zero copay. But the visit is not what we used to identify as the annual physical. So, if the patient request tests beyond the scope of the Preventative Care visit, there may be a charge.

If a person has 2 PCP visits a year, the second would have a charge or copay.

Answer: The changes changes in plans will be finalized and published by October 1, 2025 for the 2026 plan year. Each year in late September or early October, each plan provider sends out to current enrollee an Annual Notice Of Change document. In the document is a comparison of the current year benefits to the new year benefits.

Another way to obtain the same information is to contact a local agent and have them review your plan and your situation, help you determine if a change in plans is warranted. Some agents host Medicare seminars or host resource walk in locations, stating the October 15th, where you can obtain new year plan information.

Answer: Medicare Part D are prescription drug plans. The plans are offered through private companies and approved by Medicare and the state. The drugs covered are for chronic illnesses. Many of the drugs are available for a copay that is lower than the street price of the drug.

Answer: Usually a change in medical health condition does not impact your plan. The exception might be chronic kidney failure or ALS.

In terms of reconsideration of your plan, each year, in the fall, people with Medicare Advantage plans are able to compare plans and make changes if they wish.

Contact your local agent and discus the changes to determine how your plan covers your new situation.

Answer: Being obese in itself does not qualify as medical necessity for Medicare to cover surgery. Many Medicare Advantage plans offer free or greatly reduced exercise memberships where there are employees to help with weight loss planning exercise and meal programs. Original Medicare does not offer weight loss programming.

Work with your doctor on weight loss regimens.

Answer: That is a good question and the answer lies in a proper analysis of a persons health, financial situation, and life style. Medicare Supplements can provide significant peace of mind around medical costs. But at the same time, a solid financial evaluation of the increasing premiums due to changes in age and inflation, with affordability across time.

Also adding in the with the Supplement, a standalone prescription drug plan is needed at an additional premium.

Both Medicare Supplements and Medicare Advantage plans are positive methods to help offset the costs of medical coverage. But each has pluses and minuses that then need to be factored in with person health history adn finances.

Answer: When evaluating plans there are several points to consider. One is the monthly premium. Two is looking at the copays for various benefits. Three is weighting the possible use volume for each benefit.

An example is a low premium might include a zero copay for a Primary care visit, but have a $30 copay for specialists. So if there are two primary care visits each year that represents a zero copay. If there are three specialists involved and each is visited twice per year that represents $180 in copays.

This should not be a surprise if your agent reviewed your personal medical situation and ran a few what if scenarios to help you understand how each plan works and that is one of the strengths of having a local agent over just some call center.

Answer: If your income dropped low enough you might qualify for Medicaid or a level of Medicare Savings Program where the state would pay your Part B premium. Contact your state Medicaid office to get more information.

While investigating Medicaid, ask a local insurance agent to help you apply for Extra Help With Prescription Drugs. LIS is a income limited program through Social Security.

Answer: There are two primary types of Medicare Advantage Plans. 1) HMO and 2) PPO.

For the HMO type, those plans have a list of in-network doctors and medical facilities. Under the HMO style an enrollee is required to use an in-network doctor or facility to get coverage. Going to an out 0f network providers mostly results in the enrollee paying out of pocket for the services. For HMO's the service area can be nation wide, or reduced down to a county or few. Check with each plan for specifics.

For the PPO style of plan, it has both an in-network provider list and an out of network copay list. Using the in-network providers generally have a much lower copy than going to an out of network provider. The areas of coverage also can be different. Usually one can go to any provider that takes Medicare and they will take a PPO as out of network. Again, check with the individual plan to determine specifics.

To get the best help, find a local agent you are comfortable with and have them address your individual situation.

Answer: The would be nice, but Medicare law does not consider DVH a health related mater. CMS has been encouraging Medicare Advantage plans to offer DVH and many plans do offer DVH as non medical benefits.

Answer: The answer is no. As Medicare is a federal plan and Marijuana continues to be restricted under federal law, Medicare does not cover it.

However, one can always appeal and ask for an exception through a physician.

Answer: Since you are receiving Social Security payments, you qualify for an automatic enrollment in part A and Part B of Medicare. You should receive your Medicare card about 2 months before your birthday month. The effective date should be the first day of the month in which you turn 65. The exception is if your birthday falls on the first of the month, then your Medicare effective date is the month before.

If on disability you already have a Medicare card with A and B, the you have a special enrollment option begin again.

Answer: The coverage gap was eliminated beginning with the 2025 plan year. But in answer to your question for last year's plan, yes, Part D copays counted towards the gap dollar limit.

Answer: There are many factors that should be considered before making the selection decision. A person's health, cost, available medical services in the area, the formulary with the plan, the in-network list of the plan.

Also consider the short term financial impact and the long term impact. Do premiums rise over time?

It is a best practice to find a local agent you are comfortable with and work with that person to review your situation and look at available options. Cheap is not always the best option.

Answer: Slowly. Until CMS determines such devices are reliable and have a high degree of accuracy, and are more than nice to have, the extra cost to Medicare will probably not be approved. If, such devices can demonstrate a cost reduction to Medicare approval is unlikely. Also, the communication vehicles will need to be more universal and not vendor specific.

Answer: Nothing. But most employer plans require a member to sign up for Part A when eligible. There is no additional cost or premium to the member for enrolling in Part A. But during the enrollment in Medicare select to defer Part B. Part B is the one that has a monthly premium.

When losing employer insurance, contact Medicare and enroll in Part B. There is no penalty since you have had compliant employer insurance.

Answer: Speak with a licensed and knowledgeable local insurance agent who will you take into account your specific situation and coverage needs. The decision is not only a financial one. Family health history, your health history, peace of mind, financial, availability of medical services in you area are a few of the consideration that go into making a educated decision. What is great for another person in a different location may not be the same for you.

Answer: Medicare is a national or federal program. The cost structure is set nationally. The Part B and Part D surcharge is income based. If you have Medicare Part B and/or Medicare Part D prescription drug coverage, you could owe a monthly surcharge based on an income-related monthly adjustment amount or (IRMAA). These surcharges apply to enrollees in Original Medicare and Medicare Advantage plans.

The 2025 IRMAA income brackets and Parts B and D surcharges have been announced. This year, 2025, Medicare beneficiaries with income over $106,000 (for single tax filers), $212,000 for joint filers and $106,000 (for married people who file separately) will pay the surcharge. For these beneficiaries, total Monthly Part B premiums will range from $259.00 to $628.90.

Social Security makes the surcharge calculation based on your Modified Adjusted Gross Income (MAGI) from two years ago.

Answer: The Part A and Part B annual deductibles are set by CMS. So, they may change each year. CMS annouces what the adjustments are around mid year, for the next year.

Answer: Yes, as long as they are licensed and appointed in your state. But a local agent may be more familiar with local doctors and services available to you.

Answer: Check with the Customer Service for your provider. Another method is to check with your local insurance agent. They usually have access to a list. You may also have access to an online insurance account. Many or these provider accounts have links to dentists, doctors, and other medical services.

Answer: If you mean pay taxes on receiving Medicare benefits, the simple answer is NO. However, if a person receives payments that are may more than the out of pocket cost of the medical expense, that may be taxable. Best to check with an accountant or tax attorney.

Answer: Just follow the application questions. They are clear and precise. Do not overthink the questions. If you have significant questions, contact Medicare to clarify or visit a local Medicare office, where they can assist with the application.

Answer: Stay informed. Each year Medicare sends out a Medicare and Me booklet which explains Medicare coverage, review your copy. Also, each year providers issue a NOAC or Notice of Annual Change in their plans. Review your copy and take note of the year to year comparison.

Finally, speak with a trusted local agent about your situation and insurance needs.

Answer: So far, I am not aware of significant changes to the (LIS) Extra Help With Prescription Drugs program, other than the annual or inflationary increases in premium coverage adn copays for drugs.

Answer: Digital Therapeutics may be covered under original Medicare, but on a case by case basis. Medicare Advantage Plans also on a case by case basis.

According to "HealthCare Brew" A history of challenges

This latest development is a long time coming.

The FDA cleared the first DMHT for market, Pear Therapeutics’s reSET, in 2017. But in April 2023, Pear declared bankruptcy and reSET, plus its opioid use disorder program reSET-O, were sold to digital treatment provider PursueCare. In a LinkedIn post, Pear’s former CEO partly blamed its collapse on payer denials.

In September 2023, Akili Interactive—a digital medicine company that created an FDA-authorized prescription video game to treat ADHD—abandoned the prescription model after hitting roadblocks from payers, and offered its video game-based treatment over the counter.

These new codes may get more payers on board, Andy Molnar, SVP of industry affairs at trade group American Telemedicine Association (ATA) and head of digital health at advocacy arm ATA Action, told Healthcare Brew.

“We’re in such a better place now in 2025 than we have ever been before,” he said, explaining that now it’s possible to “actually start to show real-world evidence and cost data” to convince Congress to further expand coverage.

The Medicare test

So far, seven apps qualify for CMS’s HCPCS codes, according to the DTA:

Big Health’s SleepioRx for insomnia and Daylight for anxiety

Otsuka Precision Health and Click Therapeutics’s Rejoyn for depression

PursueCare’s reSET for substance use disorder and reSET-O for opioid use disorder

Nox Health’s Somryst for chronic insomnia

Curio’s MamaLift Plus for maternal mental health

But even with Medicare coverage, challenges remain.

Check with your professional and the insurance provider.

Answer: Under Original Medicare much of the cost is covered by Medicare. If the surgery is done in a private outpatient setting the Part B annual premium, plus a 20% coinsurance for the balance.

The person getting the surgery is also eligable for a zero cost pair of glasses after the surgery.

Answer: Here are three ways to help with an answer:

1) Call the customer service number on the back of your prescription drug card or Medicare Advantage plan card.

2) Each provider has a web sight where a client can lookup the drug to determine coverage and copay.

3) Contact your agent for assistance.

This assumes the drug is for a chronic condition and administered my you and listed under Part D.

If the drug is administered by the doctor or in the hospital, that is probably a pert B drug. Call your provider for clarification.

Answer: Medigap policies are by design and contract automatically renew each year, as long as the monthly premiums are paid on time. premiums may change form time to time. Most increase at least yearly. A provider may decide to exit an region or state, if that occurs, that notice activates a Special Enrollment Period of time during which impacted clients may sign up with another provider using a guarantied issue right, meaning no health questions. The price may be different, but no health questions and no pre-existing condition exclusions. This may happen during the year or at year end.

Answer: Most private hospitals accept original Medicare and Medicare Advantage Plans. But hospitals sign contracts with each provider company and list which Medicare Advantage plans are included. Toward the end of the contract period, if a new contract is not signed hospitals and providers are required to notify users of the hospital that the hospital may not be in network for the next period... usually the next year. Most of the time contract negotiations are completed and the hospital remains in network. But it is up to the individual to double check, before surgery or a procedure, that the hospital is in network.

Answer: The Annual Notice of Change booklets start arriving in the fall, late September through the first week of October. They usually are printed on thin newsprint paper and Have ANOC on the cover or first page. For Medicare part C and D, each person receives their own. For Marketplace (ACA) insurance, one copy is sent to the primary name on the policy.

Answer: Yes, each insurance company will send or email you an ANOC each year in the fall, usually the end of September or first week of October. This provides you with a comparison of this years benefits and price to what is offered for the next year. So you have the opportunity to review and compare before speaking with your agent with questions and advice.

Answer: I enjoy translating Medicare language into everyday understandable terms. Being an agent, I have the opportunity to help fellow seniors with insurance solutions to their health care needs. As an agent it is more than the initial sale, it is also how available I am to provide customer service and for questions.