Sam Silva, Medicare Insurance Broker

Answer: Helping individuals understand their options gives them peace of mind and a sense of security.

Each client has a unique story, and being able to guide them through complex decisions makes the work meaningful.

It’s also rewarding to build trust and long-term relationships that go beyond a single enrollment.

Answer: Delaying enrollment can lead to lifelong penalties, and that’s often something they don’t find out until it’s too late.

It takes time to help clients understand that planning ahead is essential to avoid unexpected expenses.

They often assume that once they turn 65, all their healthcare costs disappear, which unfortunately is not the case.

Answer: Review Medicare Summary Notice – This document shows what Medicare has paid and what you may owe.

Check Supplement or Advantage Plan summary of benefits– If you have a Medicare Advantage plan or Medigap, coverage rules may vary.

Answer: Premiums keep your coverage active.

Deductibles are what you pay first before Medicare kicks in.

Copays/coinsurance are your share of the cost after that.

Answer: If you’re enrolled in a Medicare Advantage Plan, your costs and coverage may differ, but plans are required to offer at least the same mental health benefits as Original Medicare.

Part B covers outpatient therapy with a 20% coinsurance after you meet the deductible. Inpatient services are covered under Part A but have limits and additional costs.

Answer: No, Medicare generally does not cover acupuncture for back pain under Original Medicare.

However, Medicare Part B does cover acupuncture for chronic low back pain, but only if it meets specific criteria.

Answer: In most cases, Medicare covers cataract surgery, but it does not cover the cost of lenses if you choose premium intraocular lenses.

Standard lenses are covered by Medicare, meaning if you need a basic lens to restore vision, Medicare will usually pay for it.

Answer: ​Given the recent changes in Medicare for 2025, it's a good idea to review your current coverage to ensure it aligns with your healthcare needs.

The Trump administration has approved a significant $25 billion increase in payments to Medicare Advantage plans for 2026, providing a major financial boost to health insurers. This could lead to enhanced benefits or lower costs in some plans.

Answer: Power of Attorney gives you the legal right to make healthcare decisions on behalf of your parent, including managing Medicare benefits.

If your parent is unable to make decisions on their own and does not have a POA in place, you may need to apply for legal guardianship through the court.

Answer: Request a Reconsideration by contacting the company that handled your Medicare claim.

You can request reconsideration by calling Medicare or submitting a written appeal.

Provide any additional supporting documents that may support your case, such as your doctor’s orders or evidence of medical necessity.

you can request a review by the Medicare Appeals Council.

Answer: Annual Open Enrollment Period (October 15 - December 7)

Medicare Advantage Open Enrollment Period (January 1 - March 31)

You may qualify for a Special Enrollment Period (SEP) if you experience certain life events

Trial Period for Medicare Advantage & Medicare Supplement (Medigap)- Trial rights.

Answer: Original Medicare (Part A and Part B) covers medically necessary knee replacement surgery, including the hospital stay (Part A) and outpatient services (Part B).

Robotic-assisted surgery is generally considered a type of minimally invasive surgery, which may offer benefits like smaller incisions and faster recovery, but the coverage would be the same as traditional knee replacement if it’s medically necessary for your condition.

Answer: free : Annual Wellness Visit

If a preventive service leads to additional tests, treatments, or a diagnosis, you may have to pay.

Answer: Estimate Future Health Care Needs.

Build an Emergency Fund for Health Costs.

Consider State Assistance Programs.

Consult a Financial Advisor.

Know your premiums and out-of-pocket costs: Plan for the fixed costs of Medicare and any potential increases.

Answer: To lower your Medicare Part B premium after retirement due to income drop, contact our Medicare Specialists. They stay updated with the latest plan options and regulations.

Answer: means that the prescription drug coverage you had from another source (like an employer, union, or other group health plan) is expected to pay, on average, at least as much as standard Medicare Part D prescription drug coverage without laps in coverage till you switch to Medicare PDP or MAPD plan.

Answer: is to evaluate them side by side across the areas that matter most to your health and financial situation.

Medicare Supplement, Works with Original Medicare (Parts A and B).

Medicare Advantage. Replaces Original Medicare.

Answer: Especially those on Medicare Advantage plans—often overlook valuable benefits that could save money or improve their quality of life. eg: -  Fitness Programs,  Routine Dental, Vision & Hearing, Transportation Services, Meal Delivery,  Over-the-Counter (OTC), ect....

Answer: Not covered by Original Medicare (Parts A & B). Eyeglasses and Contact Lenses: Not covered unless you recently had cataract surgery.

Medically Necessary Eye Exams:

Covered by Original Medicare if related to a medical condition, such as: Diabetes (diabetic retinopathy screening: once per year), Glaucoma (high-risk patients: once per year), Age-related macular degeneration, Eye injuries or infections.

Answer: Original Medicare (Parts A & B) does not pay for groceries. However, some Medicare Advantage (Part C) plans may help with groceries under certain conditions.

Answer: IRMAA does not go away automatically.

If your income drops, you must report it to Social Security to request a reduction.

Answer: The best way to ensure you're not overpaying—or under-covered—is to work directly with a licensed, ethical, and experienced insurance broker.

Think of a broker as your Medicare attorney.

You wouldn’t represent yourself in court without a lawyer.

Likewise, you shouldn’t navigate Medicare alone when there’s so much at stake financially and medically.

As licensed brokers accredited by CMS and active in this field for over a decade, we are trained to do more than just enroll you in a plan. 8336000669

We take a full, analytical approach that includes:

- A personalized financial and needs assessment

- Side-by-side plan comparisons

- Review of your prescriptions, doctors, and demographics

- Evaluation of all costs: premiums, deductibles, copays, and hidden out-of-pocket expenses

- Ongoing support beyond enrollment

We do this ethically, transparently, and with your best interest at heart.

 Don't take plan advice from doctors, pharmacists, or friends who aren’t licensed.

Even well-meaning advice can be misleading if it's not rooted in proper Medicare training and compliance.

The right broker is your healthcare advocate—your insurance attorney—making sure you know exactly what you’re signing up for.

If you’d like, I can run a full benefits and cost analysis based on your current plan and what’s available in your ZIP code or state. Just say the word.

Answer: To ensure you get the mental health care you need, consider Medicare Advantage or Supplement Plans. Contact our Medicare Specialists for tailored advice.

Answer: Yes, Medicare plans can vary by location. Different cities may offer different plan options and benefits. Contact our consultants to learn more about specific plans in your area.

Answer: In 2025, there’s no more coverage gap ("donut hole").

Medicare Part D has a \$2,000 out-of-pocket cap for the year.

Once you pay \$2,000 total out-of-pocket, you pay \$0 for covered drugs the rest of the year.

Your cholesterol medication costs do count toward that cap.

Check your Explanation of Benefits (EOB) to see how much you’ve spent so far.

Need help reviewing your medication or plan? Call us.

Answer: If you move to a U.S. territory, Original Medicare still covers you.

Medicare Advantage and Part D plans may not be available, so you could lose those.

Territorial programs may offer limited drug coverage instead.

Answer: * You can keep Original Medicare (A & B).

* Medicare Advantage depends on plan network—check local coverage.

* You can keep Part D, but CCRCs may offer their own drug plan.

* Medigap can stay, but some CCRCs may not accept it for billing.

Check with the CCRC on how they coordinate with Medicare.

Answer: Yes, Medicare may cover certain obesity-related treatments:

* Bariatric surgery is covered if you meet medical criteria (BMI ≥35 with related conditions like diabetes) and the surgery is done at a Medicare-approved facility.

Answer: No, Medicare does not cover medical marijuana, even if it is prescribed for chronic pain, cancer, or other conditions.

Federal law classifies marijuana as a controlled substance, which prevents Medicare from covering it.

Answer: Yes, Medicare can cover wearable medical devices for chronic conditions, such as:

Insulin pumps: Covered under Part B if medically necessary for managing diabetes.

Seizure monitors: May be covered if prescribed by a doctor and deemed medically necessary for managing epilepsy or seizures.

You may need to meet specific criteria, and coverage might depend on the device's use and how it's prescribed.

Answer: Medicare does not generally cover mental health apps or virtual therapy platforms unless they are part of an approved treatment plan or offered by a licensed provider.

However, Medicare covers:

Mental health services like therapy sessions (individual or group) under Part B, including telehealth therapy with a licensed provider.

Depression screening under Part B, typically during annual wellness visits.

Answer: If your preferred hospital isn't in-network, contact our consultants to explore other plan options or find a suitable alternative. We're here to help you navigate your choices.

Answer: Medicare Part D can deny coverage for a brand-name drug if a generic isn't available. Contact our consultants to explore your options and find the best solution for your needs.