Rukshini Sandrasegaran, Medicare Insurance Broker

Answer: If you are a US citizen or a lawful permanent resident and have lived in the United States for at least five continuous years, you are generally eligible to enroll in Medicare at age 65.

However, eligibility for premium-free Medicare Part A (hospital insurance) depends on your work history. In most cases, you (or your spouse) must have earned at least 40 Social Security credits (about 10 years of work). If you do not meet this requirement, you can still enroll in Medicare, but you will likely need to pay a monthly premium for Part A.

If you worked overseas for the US. government or the US. -Based employer, your wages were generally subject to Social Security and Medicare (FICA) taxes under US. law. As a result, you likely earned credits toward Medicare eligibility just as if you had worked in the United States.

To determine your exact eligibility. Especially if you qualify for premium‑free Part A, your best course of action is to contact the Social Security Administration. They can review your work record and confirm your eligibility for Medicare Parts A, B, and D, as well as any premiums that may apply.

Answer: You can switch from a Medicare Advantage plan back to Original Medicare during the Annual Enrollment Period (Oct 15–Dec 7) or the Medicare Advantage Open Enrollment Period (Jan 1–Mar 31). Special Enrollment Periods may also apply in certain situations.

There is no penalty for switching back. However, you may face a Part D late enrollment penalty if you go more than 63 days without creditable drug coverage.

Be aware of potential coverage gaps, particularly with Medigap (supplement) plans—depending on your situation, you may not have guaranteed acceptance and could be subject to medical underwriting.

Answer: Medicare drug coverage can vary depending on whether the medication falls under Part D or Part B and the specifics of your plan.

Part D generally covers self-administered medications, subject to the plan’s formulary, tier placement, and requirements like prior authorization or step therapy.

Part B typically covers medications administered in a clinical setting, such as injections or infusions.

Because each plan has different coverage rules, it’s common to receive conflicting information.

Recommended next steps:

1. Confirm details with your doctor

2. Contact your insurance plan to verify coverage

If not covered, request a formulary exception, consider alternatives, or explore manufacturer assistance programs

Answer: Yes, you can be denied a Medicare Supplemental Plan, unless you are in the Guaranteed Issue period. It is important you discuss your situation with a Mediare Agent Professional. Contact me.

Answer: Depends on type of surgery and Medicare Advantage Plan one is enrolled in. Other factors that impact are in and out of network, whether one got prior authorization, place of service, whether it is in and out patience procedure. It is important to talk to the hospital/doctor who is performing the service as well one's insurance company to understand any out-of-pocket cost prior to surgery.

Answer: As Independent Broker, I enjoy helping my client choose the plan that suits their needs. I also enjoy talking to them and understanding their needs. I become their go to person when it comes to Health Insurance Questions.

Answer: Medicare Advantage plans require members to receive care from primary care physicians, specialists, hospitals, and other providers that are contracted as in‑network with the insurance company. Services received out of network can result in significantly higher copays, deductibles, and out‑of‑pocket costs. Most Medicare Advantage plans also require prior authorization (pre‑approval) for many services.

Medigap (Medicare Supplement) policies do not require prior authorization, and policyholders can generally see any provider who accepts Medicare. However, Medigap plans charge a monthly premium that must be paid regardless of whether medical services are used.

There is no one‑size‑fits‑all Medicare plan. Coverage needs and costs vary from person to person.

An independent insurance broker can review an individual’s specific situation, explain available options, and recommend the plan that best fits their healthcare needs and financial goals.

Answer: Most of the lab test should have zero copay under Medigap and Medicare Advantage plan. However, if the lab is out of network there could be co-pay.

Ask your doctor what lab the doctor uses and check with the insurance company that that lab is in-network.

Also ask following questions with the insurance company.

Is the Lab covered in-network?

Is the lab test doctor is asking covered in the insurance plan?

Does the lab test require prior authorization?

If it is hospital- ask the doctor, is this covered in-network by my insurance company?

Answer: The IRMAA for Part D and Part B premium based on your last two years of income. Managing this income and spreading it over one's life. I do Medicare 101 online seminars where I go through these details.

Answer: Medigap is run by private insurance companies. Federal laws allow these companies to assess health risks outside of the specific protected period.

Answer: The insurance company the doctors are contracted with dictates whether doctor can accept Medicare Advantage or Medigap Insurance.

Answer: The government gives certain amount of money to Heath Insurance companies and value care providers. They are responsible for managing the patience's health and the money given to them by the government to provide best health service.

Answer: Either the patience or the health care provider will contact the Health Insurance Company to get pre-authorization.

Answer: Medicare Agent is an Independent Broker who looks at all plans across the board matches the plan that is suitable to one's lifestyle, needs and budget.

Answer: Most of the time, the statement will come from the doctor's office, ask them for details, and break down the statement. At the same time, contact your insurance company that provided either Medicare Advantage or Supplemental. If there's something on the Medicare card. Then you would need to reach out to the Social Security Benefit government.

I would need to understand your situation more in order for me to provide further information.