Sam Pak, Medicare Insurance Broker

Answer: Yes, Medicare may cover PSA blood tests more than once a year when there's a medical reason for additional testing.

Medicare Part B normally covers one routine PSA screening every 12 months for men age 50 and older, at no cost when Medicare's coverage requirements are met. However, if your PSA is elevated and your urologist wants to monitor it every three months, those additional tests may be considered diagnostic rather than routine screening.

The important difference is medical necessity. Your doctor needs to document why more frequent testing is needed, and Medicare will review coverage based on your medical condition and the applicable guidelines. Having an elevated PSA doesn't automatically guarantee that every three-month test will be covered.

As for your cost, medically necessary diagnostic laboratory tests are generally covered at no cost under Original Medicare when Medicare's requirements are met and the laboratory accepts Medicare assignment. However, separate office visits or other services may involve deductibles or coinsurance. If you have a Medicare Advantage plan, your plan's coverage rules and cost-sharing may differ.

My recommendation is to ask your urologist to make sure the tests are ordered and billed as diagnostic when appropriate, with the medical reason clearly documented. This can help avoid unnecessary denials or unexpected bills.

Answer: The good news is that if you have Medicare Parts A and B along with GEHA High Option, you may already have prescription drug coverage through GEHA, even without a separate Medicare Part D plan.

GEHA High Option includes prescription benefits administered through CVS Caremark. Eligible Medicare retirees may also have the option of GEHA's SilverScript Medicare prescription drug plan, which could provide additional savings.

Eliquis is generally a medication covered through prescription drug benefits rather than Medicare Parts A and B. What you pay at CVS will depend on your specific GEHA coverage, whether you're enrolled in the SilverScript option, and your plan's cost-sharing rules.

Before making any changes, I would recommend contacting GEHA or CVS Caremark to confirm your current Eliquis copay and whether you could save money through the GEHA Medicare prescription drug option.

One important thing to remember is that federal retiree health benefits work differently from many other Medicare arrangements. I wouldn't recommend enrolling in a separate Part D plan without first checking how it might affect your existing GEHA coverage.

My advice is to verify your current prescription benefits first. You may already have good drug coverage, and the goal should be to find the most affordable way to obtain your Eliquis without unnecessarily changing your insurance.

Answer: Yes, Medicare may cover hyperbaric oxygen therapy (HBOT) for certain serious diabetic foot ulcers that haven't responded to standard wound treatment. However, not every non-healing foot ulcer qualifies.

Under Medicare's coverage guidelines, you generally must have Type 1 or Type 2 diabetes, a diabetic wound classified as Wagner Grade 3 or higher, and no measurable improvement after at least 30 days of standard wound care. Hyperbaric oxygen therapy is used alongside regular wound treatment, not as a replacement.

As for the number of sessions, Medicare doesn't set one fixed limit for everyone. A typical treatment course may involve 30 to 40 sessions, but that doesn't mean Medicare automatically approves all of them. Your wound must be evaluated at least every 30 days, and continued coverage depends on documented healing progress and medical necessity.

If you have Original Medicare, Part B generally covers medically necessary outpatient treatment, subject to the Part B deductible and usually 20% coinsurance. If you have Medicare Advantage, your plan's cost-sharing and authorization requirements may differ.

My recommendation is to have your wound care specialist confirm that your ulcer meets Medicare's coverage criteria and verify the treatment facility and expected costs before starting therapy. This can help prevent unexpected expenses or interruptions in treatment.

Answer: Generally, no. If Social Security approved your 2026 IRMAA reduction because of retirement in 2025, you normally won't face a separate penalty simply because your 2025 income puts you above the IRMAA threshold for 2027.

IRMAA is an income-based surcharge added to Medicare Part B and Part D premiums, not a penalty. Social Security normally uses tax information from two years earlier to determine your IRMAA, so your 2025 income would generally be used for 2027.

However, retirement is considered a qualifying life-changing event. If your income has decreased significantly, you can ask Social Security to reconsider your IRMAA using more recent income information by submitting Form SSA-44.

One important distinction is that if your original 2026 reduction was based on estimated income that turned out to be higher than reported, Social Security could reassess that earlier determination and require repayment of any underpaid premiums. That would be an adjustment, not an additional penalty for retirement.

My recommendation is to review your 2027 IRMAA notice carefully and compare the income Social Security used with your actual or expected income. If your retirement has resulted in lower income, you may qualify for another reduction rather than automatically paying the higher surcharge.

Answer: There are several reasons why Moda may cost more than UnitedHealthcare through PERS, but a higher premium doesn't necessarily mean better coverage.

The difference may come down to how each plan is priced, the provider network, prescription drug coverage, deductibles, copays, and how much PERS contributes toward the premium. Even when two plans are offered through the same retirement system, the monthly cost and benefits can be quite different.

I would recommend comparing the total cost of coverage rather than looking at the monthly premium alone. That includes checking whether your doctors and hospitals are in the network, how your medications are covered, and what you could pay out of pocket if you need medical care.

The best choice isn't always the least expensive plan. It's the one that provides the right balance of coverage, access to your preferred doctors, and overall cost based on your healthcare needs.

Answer: The good news is that you generally don't have to renew or re-enroll in Medicare every year. Once you're enrolled in Original Medicare (Parts A and B), your coverage normally continues automatically as long as you remain eligible and keep up with any required premiums.

If you have a Medicare Advantage plan or a Part D prescription drug plan, your coverage will also generally renew automatically each year, provided the plan continues to be offered in your area and you remain eligible.

However, here's something important I always remind people: just because your plan renews automatically doesn't mean your benefits will stay the same. Insurance companies can change their premiums, copays, deductibles, prescription drug coverage, and provider networks from year to year.

That's why I strongly recommend reviewing your plan's Annual Notice of Change (ANOC), which is typically sent by September 30, and comparing your options during Medicare's Annual Enrollment Period, October 15 through December 7.

If your current plan still meets your healthcare needs and budget, you generally don't need to do anything. But if your doctors are no longer in the network, your medications become more expensive, or your benefits change, you may want to consider switching plans.

My advice is simple: You don't necessarily need to change your Medicare plan every year, but you should review it every year. A little time spent reviewing your coverage can help you avoid unexpected healthcare expenses and make sure your plan continues to meet your needs.

Answer: Yes, Medicare Part B generally covers blood glucose meters, test strips, lancets, and control solution for people with diabetes when prescribed by their doctor and Medicare's coverage requirements are met.

The number of test strips Medicare normally covers depends on whether you use insulin. If you use insulin, Medicare typically covers up to 300 test strips and 300 lancets every three months, which averages about 100 per month. If you don't use insulin, the standard allowance is 100 test strips and 100 lancets every three months, or about 33 per month.

Since your doctor wants you to check your blood sugar three times a day, you'll need approximately 90 test strips per month. If you don't use insulin, that exceeds Medicare's standard allowance. However, Medicare can cover additional strips when your doctor documents why more frequent testing is medically necessary and the additional coverage requirements are met. You may also need to keep a record of your daily blood sugar readings.

Under Original Medicare, you generally pay 20% of the Medicare-approved amount after meeting your Part B deductible. If you have a Medicare Advantage plan, your cost-sharing and supplier requirements may differ.

My recommendation is to have your doctor write a prescription specifying how often you need to test and make sure your pharmacy or medical equipment supplier accepts your Medicare coverage. This can help avoid unexpected costs or delays in getting your supplies.

Answer: Yes, Medicare may cover PRRT (Peptide Receptor Radionuclide Therapy) using Lutathera for certain types of neuroendocrine tumors, provided the treatment meets Medicare's medical necessity and coverage requirements. Lutathera is a targeted radioactive treatment generally used for specific tumors that have somatostatin receptors.

What you pay out of pocket depends on your Medicare coverage. Under Original Medicare, Lutathera is generally covered under Part B when administered as an outpatient treatment. After meeting the Part B deductible, you typically pay 20% of the Medicare-approved amount, unless you have supplemental coverage that helps pay those costs.

If you have a Medicare Advantage plan, your costs will depend on the plan's medical benefits, copays or coinsurance, and annual out-of-pocket maximum. The plan may also require prior authorization, so it's important to verify coverage before beginning treatment.

Because PRRT is a specialized and potentially expensive cancer treatment, I would recommend confirming that both the treatment and the medical facility are covered, along with any additional costs for imaging, laboratory tests, and related services.

As a Medicare agent, I believe it's important to look beyond monthly premiums and extra benefits, especially when someone is dealing with a serious medical condition. Understanding the coverage details and potential out-of-pocket expenses can make a significant difference when choosing a Medicare plan.

Answer: If your Medicare Advantage plan is discontinued or no longer offered in your area, don't panic. You won't lose your Medicare eligibility, and you'll have an opportunity to choose new coverage.

When this happens, you generally qualify for a Special Enrollment Period (SEP), which allows you to enroll in another Medicare Advantage plan outside the regular enrollment period. You can also choose to return to Original Medicare.

One important benefit many people aren't aware of is that you may have guaranteed issue rights to purchase a Medicare Supplement (Medigap) policy if you return to Original Medicare. This means you may be able to obtain certain Medigap plans without being denied coverage because of pre-existing health conditions. However, specific eligibility requirements and deadlines apply.

If you don't select another Medicare Advantage plan before your current coverage ends, you'll generally return to Original Medicare automatically. Since Original Medicare doesn't include most prescription drug coverage, you should also consider enrolling in a separate Part D prescription drug plan.

My advice is not to wait until the last minute. Review your options carefully, especially your doctors, hospitals, medications, and out-of-pocket costs. As a Medicare agent, I believe it's important to help people understand their options and enrollment deadlines so they can make informed decisions and avoid unnecessary gaps in coverage.

Answer: Step therapy is a requirement used by some Medicare prescription drug plans. It means the plan may ask you to try a lower-cost medication first before it will cover a more expensive medication prescribed by your doctor. The idea is to see whether the lower-cost medication works effectively for your condition.

If you switch Medicare drug plans, you don't necessarily have to start over. However, each plan has its own drug formulary and coverage rules, so an approval from your previous plan may not automatically carry over.

If you've already tried other medications without success, or you've been doing well on your current medication, your doctor can provide that medical history and request an exception from the new plan. If approved, you may be able to continue your medication without repeating the step therapy process.

In some cases, the new plan may also provide a temporary supply of your medication while the coverage requirements are being resolved.

This is why I always encourage people to review more than just premiums and copays when comparing Medicare plans. It's important to check whether your medications are covered and whether they have restrictions such as step therapy, prior authorization, or quantity limits. My goal is to help people understand these details before switching plans so they can avoid unexpected costs or interruptions in treatment.

Answer: Choosing the right Medicare coverage can be confusing, especially with so many plans and options available. Working with a knowledgeable Medicare agent can make the process much easier.

A good Medicare agent does more than just compare premiums and benefits. They take the time to understand your healthcare needs, including your doctors, specialists, preferred hospitals, prescription medications, and budget. For example, a plan offering a $0 monthly premium, generous dental benefits, or other attractive extras may not be the best choice if your doctors aren't in the network or your medications aren't covered.

An agent can also explain the differences between Original Medicare, Medicare Advantage, Medicare Supplement, and prescription drug plans, help you understand enrollment periods and potential penalties, and guide you through the enrollment process.

Another important benefit is having someone you can turn to after enrollment. Medicare plans and personal healthcare needs can change from year to year, and having an agent who can help you review your coverage and answer questions can make a real difference.

Personally, I believe being a good Medicare agent is about educating people, listening to their concerns, and helping them make informed decisions rather than simply selling a plan. My goal is to help people find coverage that truly fits their healthcare needs and budget.

And best of all, there's generally no additional cost to you for working with a Medicare agent.