Sandra (Sandy) Steffy, Medicare Insurance Agent

Answer: Free counseling

• Up to 8 smoking‑cessation counseling sessions every 12 months

• $0 cost to you when the provider accepts Medicare

• Covers two quit attempts per year (4 sessions each).

Medication coverage

• Quit‑smoking medications (patches, gum, lozenges, bupropion, varenicline) are covered under Part D or Medicare Advantage

• Your cost depends on your plan’s drug copays

Answer: Original Medicare (Part A & B) does not require a doctor’s referral for therapy, but Medicare Advantage plans often do. However, all Medicare-covered therapy must be certified as medically necessary by a qualified provider, even if you didn’t need a referral to start.

Answer: Your Initial Enrollment Period (IEP) lasts 7 months:

• 3 months before your birthday month

• Your birthday month

• 3 months after your birthday month

Answer: I love this work because it’s personal. Every client has a story, a family, and unique needs. Building trust and helping them find the right coverage is incredibly rewarding

Answer: Here’s the clearest way to think about it: concierge medicine and Medicare can work together, but they operate in completely separate lanes. Medicare continues to cover Medicare‑approved services, while the concierge membership fee is always 100% out‑of‑pocket. The key is understanding what your concierge doctor bills to Medicare versus what your membership fee actually buys you.

Answer: Yes — a bone density test is considered a Medicare preventive service when you meet Medicare’s risk‑based criteria, and in those cases you pay $0 as long as your provider accepts assignment. Medicare covers the test once every 24 months (or more often if medically necessary).

Answer: Medicare Part A pays for a wide range of hospice services, including:

• Nursing care and physician services, Pain relief and symptom‑management medications

• Medical equipment (hospital bed, oxygen, etc.), Medical supplies (dressings, catheters, etc.)

• Hospice aides & homemaker services, Physical, occupational, and speech therapy

• Social work services, Spiritual and grief counseling for you and your family

• Short‑term inpatient care for pain/symptom management, Inpatient respite care (Medicare covers 95% of the cost)

Answer: Medicare spending has shifted heavily toward Medicare Advantage (MA). MA now accounts for over half of all Medicare spending, up from about 39% in 2019. This jump is driven by rapid enrollment growth and higher per‑person payments to MA plans compared with traditional Medicare.

Answer: Yes — Medicare does cover nutrition counseling for diabetes as a preventive service under Part B, and you pay nothing if you qualify. Medicare calls this benefit Medical Nutrition Therapy (MNT), and it’s specifically available to people with diabetes when referred by a doctor.

Answer: It covers expensive or specialty medications.

It could lower out‑of‑pocket costs overall.

Maybe better formulary match for chronic conditions.

Brand loyalty or familiarity.

The new $2,100 out‑of‑pocket cap changes the math.

Answer: 1) Start by understanding what your current Medicare plan actually covers.

2) So, the key question becomes: Does your current plan let you access the specialists you need without huge barriers or costs?

3) Ask your specialists which plans they accept.

4) Check whether you need out-of-network flexibility.

5) Review your drug coverage.

6) Consider switching plans during an enrollment period

You can change plans during:

• Annual Open Enrollment (Oct 15–Dec 7)

• Medicare Advantage Open Enrollment (Jan 1–Mar 31)

• Special Enrollment Periods (sometimes triggered by major life changes)

7) Talk to a State Health Insurance Assistance Program (SHIP) and sign up with you local agent.

Answer: Yes! You will have an Special Enrollment period(SEP) to change your Medicare plan after moving. The SEP will last 2 full months form the time you report the move. If you report the move before you move your SEP begins the month before you move and continues for 2 full months after.

Answer: You should always check your plans during annual open enrollment. The dates are October 15 through December 7 every year. During that time, you can switch your plan any way you would like.

Answer: That is an excellent and important question. Navigating prescription costs on Medicare can be complex, but there are several major strategies and programs people can use to significantly reduce their out-of-pocket expenses.

​Here are the most effective ways to reduce medicine costs while on Medicare:

​1. Enroll in "Extra Help" (Low-Income Subsidy - LIS)

​This is the single most impactful program for people with limited income and resources.

​What it is: A Medicare program (also called the Low-Income Subsidy, or LIS) that helps pay for Part D prescription drug plan costs, including premiums, deductibles, and co-pays.

​Benefits: If you qualify, your costs will be capped at very low amounts for both generic and brand-name drugs, and your Part D deductible is eliminated or greatly reduced.

​How to Qualify: Eligibility is based on income and assets. You automatically qualify if you have full Medicaid, are in a Medicare Savings Program, or receive Supplemental Security Income (SSI). Otherwise, you can apply through the Social Security Administration (SSA).

​2. Compare and Switch Part D Plans Annually

​Your current Part D plan might no longer be the most cost-effective option for your specific medications.

​Annual Enrollment: Every year (October 15 – December 7), you should use the official Medicare Plan Finder tool on Medicare.gov to compare all available plans.

​Check the Formulary: Always check a plan's formulary (its list of covered drugs) to ensure your specific medications are covered and which tier they fall into (lower tiers mean lower out-of-pocket costs).

​Lower Premiums vs. Lower Drug Costs: A plan with a lower monthly premium might have a higher deductible or higher co-pays for your specific drugs, making it more expensive overall. Focus on the lowest total annual cost for your medications.

​3. Talk to Your Doctor and Pharmacist

​Simple conversations can often lead to immediate savings.

​Switch to Generics: Ask your doctor if a generic version.

Answer: That is incredibly frustrating, and you're right to be confused. The key is that the $35 cap on insulin under the Inflation Reduction Act (IRA) only applies to people enrolled in Medicare (Part D and Part B). If you have private insurance or are uninsured, you are not covered by the federal cap, and your costs may still rise based on your specific plan's formulary or deductible changes.

​However, major manufacturers like Eli Lilly, Novo Nordisk, and Sanofi have since voluntarily capped their insulin copays at $35 for most commercially insured and uninsured individuals—so you may still have options to lower the cost by checking those manufacturer programs.

Answer: Yes, medicare normally pays for the cataract surgery and the standard lens. This lens is a single distance normally covering faraway vision. The patients still will need reading glasses for close up.

If someone would like to have the premium lens, they would have to pay the difference in full. This lens would cover multifocal, toric, and other technology lenses the correct a wider range of vision problems.

Answer: Thank you for the question. Yes and No. The basic cost is the same; what varies are the plans. The biggest difference would be your financial status. If you had Medicaid of any kind to help offset the cost.

Answer: Utilizing hospital indemnity policies in conjunction with Medicare Advantage plans can help mitigate rising healthcare costs. Here are some key points:

1. **Financial Protection:** These policies provide cash benefits for each day spent in the hospital, covering out-of-pocket expenses.

2. **Supplemental Coverage:** They fill gaps in Medicare Advantage plans, especially for those anticipating frequent hospitalizations.

3. **Predictable Costs:** Benefits are clear, helping you budget for healthcare expenses.

4. **Flexibility:** Cash benefits can be used for medical bills or other expenses incurred during hospitalization.

5. **Cost Consideration:** Weigh the premiums against the benefits to ensure they align with your needs.

Answer: Yes, when switching from one Medigap plan to another, you may have to answer health questions or undergo medical underwriting, depending on your circumstances:

1. **Open Enrollment Period:** If you're within your Medigap Open Enrollment Period (which lasts for 6 months after you enroll in Medicare Part B), you can switch plans without answering health questions or facing underwriting.

2. **Guaranteed Issue Rights:** In certain situations, such as losing your current plan, moving out of your plan's service area, or your insurer going bankrupt, you may have guaranteed issue rights, allowing you to switch plans without answering health questions.

3. **Outside Open Enrollment:** If you're switching plans outside of these periods or circumstances, insurers may require health underwriting, which could affect your acceptance into the new plan based on your health status.

Answer: Following up with your parents after discussing Medicare is helpful for several reasons:

1. **Reinforcement:** It ensures they understand their options clearly.

2. **Addressing Questions:** They can seek clarification on any lingering questions.

3. **Support in Decision-Making:** Regular check-ins provide emotional support as they navigate their choices.

4. **Encourage Action:** It helps motivate them to take necessary actions before deadlines.

5. **Monitoring Changes:** Conversations can reassess their situation if their health or circumstances change.

6. **Building Trust:** It fosters open communication for future discussions about their healthcare.

These follow-ups enhance their understanding and confidence in managing Medicare coverage.

Answer: To find peace of mind with Medicare, consider these steps:

1. **Educate Yourself:** Understand the different parts of Medicare, including coverage and costs.

2. **Get Expert Help:** Work with a Medicare broker or agent for personalized guidance on your options.

3. **Create a Checklist:** Identify your healthcare needs to choose a plan that fits.

4. **Review Annually:** Compare plans during the Medicare Open Enrollment Period to avoid surprises.

5. **Consider Medigap:** A Medigap plan may provide more comprehensive coverage and predictable costs.

6. **Stay Organized:** Keep all Medicare documents and medical records in one place for easy access.

7. **Join Support Groups:** Connect with others for shared experiences and advice.

Taking these steps can help simplify your Medicare experience and reduce stress.

Answer: People may be unhappy with Medicare Advantage plans for several reasons:

1. **Network Limitations:** Many plans restrict members to specific providers, limiting their choices.

2. **Referral Requirements:** Some plans require referrals to see specialists, which can complicate access to care.

3. **Out-of-Pocket Costs:** While premiums may be lower, costs like deductibles and copayments can be high.

4. **Limited Coverage:** Some services or treatments may not be covered, leading to frustrations.

5. **Variable Quality:** The quality of plans can differ, with some offering poor customer service and support.

6. **Annual Changes:** Plans can change benefits and networks each year, which can be confusing.

7. **Prior Authorization:** Some services or medications may require prior authorization, delaying care.

Carefully reviewing options can help beneficiaries find a plan that better meets their needs.

Answer: Yes, it's perfectly fine to meet with multiple Medicare brokers and agents as you begin your search for assistance. In fact, doing so can be quite beneficial for several reasons:

1. **Diverse Perspectives:** Different agents may have varying insights and recommendations based on your specific needs, allowing you to gather a wider array of options.

2. **Comparative Analysis:** Meeting with multiple agents can help you compare different plans, costs, and coverage options. This will give you a better understanding of what is available to you.

3. **Finding the Right Fit:** Each agent may have different styles in how they communicate and provide information. Speaking with several people can help you find someone with whom you feel comfortable working.

4. **No Obligation:** There's usually no obligation to choose a plan or agent after meeting with them. This allows you to explore your options thoroughly before making a decision.

5. **Additional Resources:** Some agents may offer services or tools that others do not, so you may find valuable resources that can assist you in making an informed decision.

Be sure to clearly communicate your needs and preferences to each agent so they can provide the best possible advice tailored to you. Gathering information from multiple sources can empower you to make informed decisions about your healthcare coverage.

Answer: Choosing a Medigap plan for your travels can offer advantages, such as coverage for out-of-pocket costs and the ability to see any doctor that accepts Medicare. However, if you're finding the premiums are too high, it’s worth reassessing your situation:

1. **Evaluate Your Needs:** Consider how much you're actually using your Medigap benefits compared to the premiums you're paying. If you’re not using many healthcare services while traveling, it might be worth exploring other options.

2. **Plan Comparison:** Look into whether there are different Medigap plans available that might provide adequate coverage at a lower premium. Some plans cover basic needs while others may offer additional features that might not be necessary for everyone.

3. **Annual Enrollment Period:** If you're considering a different plan, you typically have the opportunity to change during the Medicare Open Enrollment Period. However, be aware that switching plans might involve medical underwriting and could affect your coverage options, depending on your health status.

4. **Consider Alternative Coverage:** If Medigap premiums are becoming unmanageable, consider whether a Medicare Advantage plan (Part C) might better suit your needs, particularly if it includes travel coverage. However, make sure to review the network of providers and costs associated with these plans.

5. **Consult an Agent:** Speaking with a Medicare broker or agent can help clarify your options, and they can assist you in finding a plan that balances coverage with affordability.

Re-evaluating your healthcare needs and costs is a smart move, and ensuring you have the right coverage for your lifestyle is important. It’s never too late to reassess your options!

Answer: Medicare coverage for Ozempic and other weight loss medications can be somewhat complex. Here are the key points to consider:

1. **Medicare Part D:** Ozempic, which is primarily used to manage diabetes but may also aid in weight loss, may be covered under Medicare Part D, depending on the specific plan. It's essential to check the formulary of the Medicare Part D plan to see if Ozempic is included and what the associated costs would be.

2. **Medically Necessary:** For Medicare to cover weight loss medications, they typically must be deemed medically necessary. This often means that the medication is prescribed due to a related health condition (like obesity or diabetes), and the doctor provides proper documentation.

3. **Weight Loss Drugs:** Other weight loss drugs may not be covered, as some plans may exclude weight loss medications altogether unless they have a specific health indication.

4. **Doctor’s Recommendation:** Always consult with your healthcare provider to discuss options and obtain necessary prescriptions. They can help navigate the coverage and appeal process if a medication is initially denied.

5. **Regularly Review Plans:** As Medicare coverage can change, it's a good idea to review your Part D plan annually during open enrollment to ensure it still aligns with your medication needs.

If you're considering a specific medication, it’s best to reach out to your Medicare plan provider for detailed information about what is covered under your plan.

Answer: If a senior is turning 65 but is still working, whether to enroll in Medicare or delay it depends on several factors:

1. **Group Health Insurance:** If the senior has health insurance through their employer (or their spouse’s employer), they may choose to delay Medicare enrollment. It's essential to verify if the employer has 20 or more employees, as this typically indicates that the group health plan is primary. In this case, they can postpone enrolling in Medicare without penalty.

2. **Special Enrollment Period (SEP):** If they delay enrollment due to having employer coverage, they will qualify for a Special Enrollment Period when they eventually retire or lose their coverage. This allows them to enroll in Medicare later without facing late enrollment penalties.

3. **Costs and Coverage:** It’s essential to compare the employer’s health plan benefits with Medicare. Sometimes, Medicare can provide better coverage or lower out-of-pocket costs, depending on an individual's health needs.

4. **Parts A and B:** Seniors should consider enrolling in Medicare Part A (hospital insurance) when they turn 65, as it is usually premium-free. However, they can choose to delay Part B (medical insurance) if their employer's plan covers them.

5. **Consulting with HR or a Medicare Agent:** It may be beneficial to speak with the employer’s HR department or a Medicare agent for personalized advice based on their situation and to ensure they understand the rules and options.

Overall, the decision should be based on individual circumstances, and careful consideration is key to making the right choice.

Answer: Deciding whether to switch Medicare plans or stay put in light of the 2025 changes depends on a few factors:

1. **Changes to Benefits:** Review the details of the changes for the plan you're currently on. If your current plan is reducing benefits or increasing costs, it may be worth considering a switch.

2. **Personal Health Needs:** Assess your health needs and how well your current plan meets them. If you anticipate needing more coverage or have new healthcare needs, switching to a new plan could be beneficial.

3. **Plan Comparisons:** Take the time to compare other available plans. Compare premiums, out-of-pocket costs, and networks to see if there is a plan that offers better value or services tailored to your needs.

4. **Enrollment Periods:** Be mindful of the enrollment periods. Changes typically need to be made during the annual open enrollment period, so timing is crucial.

5. **Expert Guidance:** Consulting with a Medicare agent can be helpful to understand the implications of the changes and to receive personalized advice based on your situation.

Ultimately, it's essential to carefully evaluate your options to ensure you have the best coverage for your healthcare needs and budget moving forward.

Answer: The worst Medicare-related decision someone can make is not reviewing and comparing their Medicare options during the enrollment period. Many people mistakenly assume that their current plan will always meet their needs, but health circumstances and plan benefits can change over time. Failing to explore different plans can result in higher out-of-pocket costs, inadequate coverage, or missing out on needed benefits. This decision can significantly impact both health and financial well-being, making it essential to reassess options annually.

Answer: There are several reasons to consider working with a Medicare agent when navigating your health insurance options:

1. **Expert Guidance:** Medicare can be complex, with different plans and coverage options. Agents have specialized knowledge and training that can help simplify the process and clarify your options.

2. **Personalized Assistance:** A Medicare agent can provide personalized recommendations based on your specific health needs, financial situation, and preferences.

3. **Plan Comparison:** Agents can help you compare different Medicare plans side by side, highlighting the benefits, costs, and coverage differences to help you make an informed decision.

4. **Enrollment Support:** They can guide you through the enrollment process, ensuring you meet deadlines and understand your rights and responsibilities under Medicare.

5. **Updates on Changes:** Medicare rules and plans can change frequently. A knowledgeable agent can keep you informed about any changes that may impact your coverage or options.

6. **No Cost to You:** Most Medicare agents are compensated by the insurance companies, meaning their services are typically free to you as the beneficiary.

7. **Advocacy:** If you encounter issues with your Medicare coverage or need assistance with claims, an agent can act as your advocate to help resolve problems.

8. **Continuous Support:** Many agents provide ongoing support even after enrollment, so that you can reach out to them with questions or changes in your situation.

By working with a Medicare agent, you can feel more confident and well-informed about your healthcare choices.