Sam Silva, Medicare Insurance Broker

Answer: Yes, in many cases you can. However, the right timing depends on the size of your employer and your current coverage.

Answer: Yes. Medicare Part B generally covers heart monitors, such as Holter monitors or EKG/ECG tests, when they are medically necessary and ordered by your doctor.

Answer: No. Life insurance does not affect your Medicare eligibility.

Most life insurance policies also do not affect your Medicare premiums.

However, if a life insurance policy builds cash value and you apply for certain low-income assistance programs such as Medicaid or Medicare Savings Programs, the cash value could sometimes be counted as an asset depending on the situation and the state guidelines.

Answer: I’m compensated by the insurance company when someone enrolls in a Medicare plan, and CMS regulates how agents are paid.

Using an agent does not increase your premium or cost you extra.

My recommendation is based on your doctors, medications, budget, and healthcare needs — not compensation.

Answer: You can still enroll in Medicare Part A now since it’s usually premium-free if you’ve worked enough years, but confirm with your HR or benefits department first—especially if you have a Health Savings Account (HSA). Once you enroll in any part of Medicare, you can no longer contribute to an HSA.

Answer: When you have Medicare, IHS can bill Medicare for covered services, which helps stretch the IHS budget and allows them to provide more care to the community.

If you ever need to see a doctor or go to a hospital that isn’t part of IHS, Medicare will cover those costs, while IHS generally will not. Without Medicare, you could be responsible for the full cost of any non-IHS care.

Answer: Working with a local Medicare agent offers personal, face-to-face guidance, local plan knowledge, and a trusted relationship for ongoing support. A nearby agent understands your community’s providers and can assist with in-person enrollment and reviews. On the other hand, a remote or virtual Medicare agent provides greater convenience, broader plan access across multiple states, and fast digital enrollment from the comfort of your home. Both offer valuable benefits, and many agencies—like EZ Access Insurance—combine in-person and virtual options to give clients flexibility and personalized care.

Answer: Since you are already receiving Social Security, you will be automatically enrolled in Medicare Part A and Part B at age 65.

Your Medicare card will typically arrive by mail about 3 months before your 65th birthday.

Answer: Medicare does not cover routine chiropractic care or adjustments for wellness or maintenance. Medicare Part B covers manual manipulation of the spine by a chiropractor, but only when medically necessary to correct a subluxation (a misalignment of the spine).

Answer: Yes, its covered.

The service must be prescribed / certified by a doctor (or equivalent provider) as medically necessary.

Answer: Yes, your Medicare deductible is supposed to change from year to year. The federal government reviews and may adjust Medicare costs annually, including deductibles, premiums, and coinsurance. These adjustments are usually based on inflation, healthcare costs, and other related factors.

Answer: Yes, Medicare covers a bone density test as preventive care once every 24 months if you meet certain risk factors, such as being at risk for osteoporosis or having a history of fractures. If your doctor orders the test for medical reasons beyond routine screening, it may be covered more frequently. It’s important to check with your provider and Medicare to confirm coverage details and avoid unexpected costs.

Answer: You can tell your neighbor that while Medicare Advantage plans may have low or zero premiums, they are not truly free. They often come with copays, deductibles, and network restrictions that can add up over time, especially if you get sick or need specialized care. A Medigap plan may cost more upfront, but it gives you the freedom to see any doctor nationwide who accepts Medicare, fewer out-of-pocket expenses, and more predictable costs overall. It's not about paying more—it's about having better coverage, fewer surprises, and peace of mind.

Answer: Some of the most overhyped benefits of Medicare Advantage plans that seniors should be cautious about include dental, vision, hearing, and gym memberships. These benefits are often advertised heavily but may be limited in coverage, have caps on services, or only cover basic care. For example, dental may only include cleanings and x-rays, not crowns or dentures. Vision might cover an exam and one pair of glasses with restrictions. Hearing benefits may not fully cover hearing aids or fittings. Gym memberships like SilverSneakers are a nice perk but not a replacement for comprehensive healthcare. Seniors should focus on the plan's core medical coverage, provider networks, and out-of-pocket costs, not just the extras.

Answer: Whether Medicare Part D or Medicare Advantage is better depends on your health needs and preferences. Part D is a stand-alone drug plan that works with Original Medicare and a Supplement, giving you broad provider access and more predictable costs. Medicare Advantage includes hospital, medical, and usually drug coverage in one plan, along with extra benefits like dental and vision, but it has network restrictions and may require referrals. If you value provider flexibility and lower out-of-pocket costs for serious care, Part D with a Supplement may be better. If you want convenience, low premiums, and added benefits, Advantage could be a good fit.

Answer: Original Medicare is often preferred because it allows you to see any doctor or hospital in the U.S. that accepts Medicare, without network restrictions. It also works with Medicare Supplement plans to help reduce out-of-pocket costs and typically does not require referrals or prior authorizations for care. While Advantage plans may offer lower premiums and extra benefits, they often come with limited networks and more rules. For those who value flexibility and nationwide access to care, Original Medicare with a Supplement plan is often a better choice.

Answer: As you retire and transition off your employer health plan, it’s important to enroll in Medicare Part B during your Special Enrollment Period to avoid penalties or gaps in coverage. Be sure to align your Medicare start date with the end of your employer coverage. In addition to Original Medicare (Parts A and B), you can choose to add a Medicare Supplement plan for more predictable costs, or enroll in a Medicare Advantage plan, which often includes extra benefits like dental, vision, and prescription drug coverage. Supplement or Advantage options are always available depending on your preferences, budget, and healthcare needs.

Answer: Yes, Medicare Parts A and B have gaps in coverage. They do not cover prescription drugs, dental, vision, hearing, long-term care, or care outside the U.S. You’re also responsible for deductibles, copays, and 20% coinsurance for most services. To fill these gaps, many people choose either a Medicare Supplement plan or a Medicare Advantage plan with extra benefits.

Answer: You may be penalized if you don’t enroll in Medicare when you turn 65, unless you have creditable coverage through an employer or union. Part A is usually premium-free, so there’s no penalty for delaying if you qualify. However, delaying Part B without creditable coverage can result in a 10% penalty for each 12-month period you delay, and that penalty lasts for life. Part D (prescription coverage) also carries a lifetime penalty of 1% of the national base premium for every month you go without creditable drug coverage. To avoid penalties, enroll during your Initial Enrollment Period or qualify for a Special Enrollment Period.

Answer: Agents may push Medicare Advantage plans due to higher commissions. Always compare both options to see which best fits your needs.

Answer: Medicare Advantage plans often highlight extra benefits like gym memberships and dental care. However, these plans may have network restrictions and higher out-of-pocket costs.

Answer: Social Security and Medicare work together by providing disability benefits and health coverage. Social Security determines eligibility, and after 24 months of benefits, Medicare coverage begins.

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.

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

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.

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: IRMAA does not go away automatically.

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

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: 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: 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: 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: 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: 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: 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: free : Annual Wellness Visit

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

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: 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: 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: 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: ​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: 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: 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: 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: 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: 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: 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: 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.