Sandra Teel, Medicare Insurance Broker

Answer: Yes, Medicare will use your yearly filed income taxes to reassess your Part B premium yearly.

One year you might pay IRMAA if you were a higher income earner that year. Be careful of adding income to your adjusted gross income even after you start Medicare.

Answer: There were some major changes to Medicare in the last few years. The biggest factor? Most of the baby boomers have now turned 65 and we have a huge influx of people coming onto Medicare. There are more people on Medicare now than ever before.

Medicare pays 80% of the cost of your medical bills. With the rising cost of everything in the medical world, that 80% plus a larger influx of Medicare beneficiaries have put a strain on Medicare's budget. Medicare pays a certain amount of money per person to the insurance companies for every beneficiary on an Advantage plan. In recent years Medicare has not increased that amount as much as needed to keep aligned with rising medical costs. This means that insurance companies that offer Medicare Advantage plans have a smaller budget to work with. Therefore, these insurance companies have had to cut out certain advantage plans that cost too much money. When a beneficiary receives a cancelation notice, they have the opportunity to make a change to another insurance. If this has happened to you, please give me a call.

Answer: If you decide to work past the age of 65, you will need to fill out the L-564 form and submit it to Social Security when you apply for your Part B. The L-564 form is filled out by your employer and shows that you've had "creditable coverage" by your employer since you turned 65. This is a very important document to submit because it will keep you from having to pay a late penalty.

Answer: As long as you continue to pay your Part B premium, you will not lose your Medicare benefits if you live outside of the United States for a period of time. However, Medicare will not cover you for health insurance while outside of the United States and U.S territories. Some Medicare Supplements and most Advantage plans will give you some foreign coverage while traveling.

Answer: In general, unless you are on the state Medicaid program with full coverage, I highly suggest you add additional coverage to Medicare Part A & B. It can be very complicated to determine what type of plan works best for your situation, so please reach out to me and we can talk more about it.

Answer: As long as your cholesterol medication is covered by your Medicare Part D insurance plan, then it will count towards your coverage gap. If any prescription is not covered by the Medicare Part D plan, then it will not count towards the coverage gap. If need more details, please feel free to give me a call.

Answer: Unfortunately, Medicare is MEDICAL coverage NOT Caregiving coverage. Much like your employer coverage which only covers medical expenses, Medicare covers medical expenses. If think you'll need help with caregiving you should contacting life insurance companies to look at long term care policy options. Employers will sometimes offer this policy separately if you want to purchase one.

Answer: Unfortunately no, UNLESS you are within the first year of being on Medicare Part B AND your choice of a Medicare Advantage plan was they only choice you made in that year.

If you are beyond that first year of being on Medicare Part B, the insurance company will look at your health history to determine if they will sell you the plan. Most serious illnesses will not allow you to be accepted.

Answer: Standalone prescription drug plans are often more expensive on specialty drugs.

1) You can ask your doctor to petition the prescription drug company and ask for a "tier reduction". If the insurance company agrees, it can help cover your specialty drug at a lower cost.

2) You can also ask your doctor to help you reach out to the manufacturer of the drug to see if you qualify for a discounted price from the manufacturer.

3) Lastly, if the prescription drug company covers your drug, then Medicare will "Cap" your out of pocket costs for ALL your prescriptions at $2,100 for the 2026 year. This means once you have paid $2,100 for your covered prescriptions, ALL your prescriptions will go to a zero cost for the rest of the year.

Answer: My go-to is to take a look at each client individually. Each person has different health needs, different doctors and different prescriptions. What's good for one member of the family or a neighbor/friend is not necessarily good for them. I really do a deep dive into these differences and look at the Medicare options in the area to help them look at plan options. Then they can choose what works best for them.

Answer: Wow, good question. If you are expecting to have health problems, I would suggest going with a Medicare Supplement plan. It will give you a structured payment every month that you can budget. However, the downfall is that as health coverage gets more expensive, your monthly payment to a Medicare supplement will also increase. On average it will increase about 10-15% a year. So, budget an increase in your healthcare costs by about 15% a year and you should be fairly close.

Answer: Good question. Television ads that talk about extra benefits like grocery money are misleading. I've had several clients call me because of these ads. Most seniors living off their social security income would LOVE to have extra money to pay for groceries. The advertisers know this, so they run ads telling Medicare beneficiaries to call them so they can get them the extra benefits they're missing. Unfortunately, unless you have a qualified chronic condition AND you are a qualified Medi-caid beneficiary, there is no money for groceries with any insurance company. These ads are misleading, and all the company really wants to do is sell someone a new policy. This can be very dangerous for a senior. Often that new policy will affect which doctors you can no longer see, or there can be a change in your prescription costs. Before you call a phone number on the television, call your agent and find out the truth.

Answer: No, you do not have to sign up for Medicare again. Your Medicare will roll over. However, because you are turning 65, new Medicare options are available to you. You should definitely connect with a local Medicare broker and talk about your new options.

Answer: Yes. The new Part D changes are very beneficial for someone like you. The way the old Part D plan worked, there was over an $8.000 maximum out-of-pocket amount before the insurance company picked up the complete cost of your prescription. The new change has limited the maximum out-of-pocket to $2,100 for 2026. This means that you will pay a lot less over the whole year for that expensive prescription. However, you may have a deductible to pay, but that deductible is counted towards your maximum out-of-pocket for the year.

Answer: As of September 2025, Medicare stopped paying for telehealth visits. Some Medicare insurance companies have decided to include telehealth as an additional benefit to their policies. If this is an important benefit to you, you will need to do your homework to see which Medicare plans offer telehealth.

Answer: That's an interesting question. When you compare what Medicare beneficiaries pay for healthcare to an employer or individual health insurance plan, Medicare fairs much better.

First of all, a lot of employer plans and individual plans have a very high monthly premium, and you often still have a high deductible to meet before the insurance pays anything. Then you have your co-payments when you see doctors, have surgeries etc...

Medicare has a low monthly deductible and a low or no deductible before Medicare pays. Depending on the type of Medicare plan you choose, you could have small or no co-pays when you see doctors, have surgeries etc...

Your employer plan often charges more to include dental or vision coverage. Depending on the type of Medicare plan you choose these types of benefits could be included at no extra cost.

You often can keep your same doctors when changing from an employer or individual plan, so quality of care would be similar to what you currently have.

So, does Medicare need a complete overhaul? I don't think so. Some things might need to improve, but overall Medicare insurance is really good insurance at a reasonable price.

Answer: If you have end stage renal disease, start dialysis and you qualify for Social Security, Medicare coverage usually starts on the first day of the fourth month that you start dialysis treatment. You will need to go to the local Social Security office or login to your SSA account to sign up for Medicare Part A & B because of ESRD.

If you are already on Medicare and you need dialysis, you do not get another eligibility opportunity to change Medicare insurance until the Annual Enrollment Period in the fall.

Answer: This depends on what type of Medicare plan that you have. If you have a Medicare Advantage plan you have an annual enrollment period, each year from Oct 15-Dec 7 where you can make changes to your plan. There are other special enrollment periods depending upon your circumstances, such as if you move or gain or lose Medicaid from the state.

If you have a Medicare supplement, there is an annual enrollment period for your prescription drug plan, but not your supplement plan. The annual enrollment for your prescription drug plan is the same Oct 15-Dec 7 each year.

Medicare supplement plans don't have an annual enrollment period.

Answer: In January 2023, insulin was capped at $35.00 for a 1-month supply for Part D and B prescriptions. You should pay no more than that for a covered insulin. If you insulin shot up in price, it could be that your insurance company doesn't cover that insulin any longer and you might have to change types of insulin or change your prescription drug company.

Answer: I understand your stress. Because Medicare Advantage plans are dependent upon how much money they receive from Medicare and the new regulations regarding prescription drugs, they have shifted a lot in the last couple of years. Therefore, we are seeing more out of pocket costs and less extra benefits for you the Medicare beneficiary. Medicare requires each insurance company to send you an "Annual Notice of Change" in late September. Please pay attention to this notification. It will explain the upcoming changes to your plan, so you won't be surprised by extra bills. If you need help understanding the changes, please reach out to your insurance agent or call your insurance company. Rule of thumb, if there are small reasonable changes, then you can stay with your current plan, and it will roll over into the next year. But if you see significant changes, then you should contact a license insurance agent to look at other options.

Once option is to try to get a Medicare Supplement plan, which might require you to go through underwriting. Underwriting is where they will look at your health history to determine in you qualify for a plan. The Medicare Supplement plans are stable and don't change every year like the Advantage plans do. However, they will you cost extra money each month, which can be cost prohibitive for some people.

Answer: Advantage plans have their pro's and con's. One of the reasons why people like them is because they are usually very low premiums per month and they give you extra benefits like dental, vision, hearing and OTC. These are not covered under Original Medicare, so having these benefits are a bonus.

However, advantage plans are volatile. They change every year. So, one year you may get great extra benefits and low out of pocket costs, and the next year you may pay higher for medical needs and get fewer extra benefits. Advantage plans are based on how much Medicare pays to them for each person on their plan. If Medicare reduces the amount they pay the Advantage plans, then the Advantage plans reduce your benefits. This is one reason that makes people unhappy.

The second reason has to do with the fact that insurance companies are the "primary" insurance. They have the ability to request additional treatments, deny treatments, or require your doctor to try other methods before they will approve certain treatments that Original Medicare wouldn't necessarily have required.

Answer: The answer to this question will depend on what type of insurance you have along with Medicare.

If you have Original Medicare with a Medicare supplement, there is no limit on "medically necessary" physical therapy. Your doctor, or health provider must certify that you need it.

If you have an Advantage plan, the insurance company will still need your doctor or health provider to certify that it is medically necessary. They may also put a limit on how many times you can see a physical therapist or may need continued pre-authorization prior to extending any physical therapy.

Answer: There are several "windows" of opportunity to sign up for Medicare. The 65 birthday opportunity is a 7-month window. 3 months prior to your birth month, the month of your birthday, and 3 months after your birth month. If you miss this window, you could face a lifetime penalty. However, if you are still working for a large employer (20 or more employees) and they give you "creditable" coverage and you want to stay on your employer plan, there will be another "window" for you to sign up for Medicare once you stop working. You will have additional paperwork to fill out that proves you've been on employers' creditable insurance.

The bottom line: You have to know which window you need to sign up in. If you miss that window, it could cost you a penalty.

Answer: The answer to this question will depend upon the following.

1) Whether Medicare approves of the robotic knee replacement surgery. If Medicare does NOT approve the surgery, they will not pay for it.

2) If Medicare approves the surgery, then the type of insurance you have along with Medicare will determine the price you will pay for the surgery.

Answer: Medicare Advantage plans are run by insurance companies. Medicare pays the insurance companies to manage the plans. Each insurance company negotiates with the Medicare providers, like hospitals, doctors and labatories to decide how much they will pay for services.

Often these negotiations don't favor the Medicare providers so many providers are opting out of accepting Medicare Advantage plans.

Answer: Yes and No. Every insurance company goes through "contracting" with local medical groups.

This is usually done every few years. Most of the time the insurance company and the medical groups come to an agreement and there is no interruption to your service. Sometimes however, they do not come to an agreement by a specific time frame and that medical group is "out" of the insurance companies' network.

If you have an HMO plan this will affect you greatly, as you will no longer be able to see your doctors in that medical group. The HMO insurance company will reassign you to another in network medical group. This can be very distressing. It doesn't happen often, but it does happen.

If you had an Advantage PPO plan, you might still be able to see your "out" of network doctor at the out of network price.

This is something you should consider when you are choosing an Advantage plan

Answer: Good Question. Health changes happen as we get older. How your health change can affect your Medicare plan will depend upon the type of Medicare plan you have. For instance:

1) If you have a Medicare Advantage plan, it would be wise to take a look at your plan in the Annual Enrollment Period (Oct 15- Dec 7th) to see if there is another Medicare Advantage plan that will cover your health condition better. Some Medicare Advantage plans have "Chronic" condition plans that would help with certain chronic conditions like diabetes, and heart disease.

If you have a qualifying chronic condition, you might be able to make a change to the new plan sooner that the Annual Enrollment period. Be sure to call a Medicare Insurance Broker to find out if you qualify to make a change.

2) If you have a Medicare Supplemental Plan (Metsup) then you do not have to make any changes. You can choose to see any Medicare specialist doctor for your health condition.

If you are confused, please be sure to reach out and get help from a Medicare Insurance professional that works with both types of plans.

Answer: Very good question. Be aware of agents that can only sell one type of Medicare plan or an agent that only works for one insurance company. You don't want to get railroaded into something that might not be your best option.

When you are looking into Medicare insurance options, you need a Broker. Brokers are contracted with several different insurance agencies and can offer information on all types of Medicare insurance options.

A Medicare Broker who offers all the Medicare options has more training with Medicare and is able to explain the differences between the different types of plans available in your area.

There are pros and cons to each type of plan. A good Broker will take the time to explain each one to you, so you can make the choice of what works best for your situation.

If you have questions, please feel free to reach out to me.

Answer: Even if you are under the age of 65 and you have been on Social Security Disability (SSDI) for 24 months or more, you most likely are already on Medicare. Once you turn 65, then you have another opportunity to use a "Special Enrollment Period" to change your Medicare plan if you'd like.

You do not automatically get Medicare because you are on Social Security unless you have been on SSDI for 24+ months. Most people who are not on SSDI have to sign up for and start Medicare at the age of 65.

Answer: Things like wheels chairs, walkers, canes, sleep apnea machines, insulin pump etc. are considered durable medical equipment or DME. If you are only covered by original Medicare, (meaning that you do not have any additional Medicare coverage like an Advantage Plan or Medicare Supplement Plan), DME is covered by Part B and you will pay 20% of your DME costs.

If you are on a Medicare Advantage Plan or Medicare Supplement Plan you will likely pay less for your DME depending on the type of plan you have.

Your doctor must write you a prescription for the DME. You then take that prescription to a durable medical equipment place to fill it. Be careful filling it at a pharmacy, they often will bill it incorrectly to the Part D of Medicare and not Part B.

Answer: Yes. If you are losing your employers insurance, whether you are retiring or losing your coverage for other reasons, it opens up a Special Enrollment Period (SEP) of time for you to get onto Medicare.

Please note that COBRA coverage is not considered credible coverage by Medicare, so you will still need to apply for Medicare if you are offered Cobra.

Once your employer coverage ends, or your COBRA coverage begins there is a limited time you have to get your Medicare coverage before you will be penalized.

Please reach out to a professional Medicare Broker so they can help navigate you through the process.

Answer: Medicare can be very confusing. There are so many rules and penalties that scare people. It makes me happy to help people understand what applies to them, and what does not apply. Because I am a broker, I'm able to help them all the way through the process so they feel confident in the choice they make with their insurance option. My clients become my friends, and I'm available when they have questions.

Answer: If you have incurred a higher Part B premium because you were considered a high-income earner, you can ask Medicare for a reconsideration if your income has dropped significantly.

Every year Medicare looks at your Adjusted Gross Income from 2 years previously to determine what you will pay for Part B. If you were a high-income earner, then you received a letter letting you know that your Part B premium would be adjusted. In that letter there is an explanation of how to apply for a reconsideration.

If your income has decreased significantly and takes you to a lower premium bracket, Medicare will automatically decrease your Part B premium to match the new lower premium level when they look at your filed income taxes.

Answer: If you have a Medicare Advantage plan and you have missed your opportunity to make a change in the Open Enrollment Period, then perhaps you might have the ability to make a change using one of the several Special Enrollment Periods (SEP) that are allowed by Medicare.

Some of the SEP's include things like the following:

1) Have you moved to another county or state? Have you recently moved back to the United States after living abroad? Have you moved into or out of a skilled nursing facility?

2) Have you lost Medicaid? Or lost the Extra Help for prescription drugs? Did you lose the PACE program?

3) Have you recently been granted Medicaid or Extra Help with prescriptions? Do you have a Chronic condition like diabetes or heart disease?

4) You could join a 5-star rated plan

5) Were you affected by a FEMA disaster?

There are many other SEP's that you might possibly qualify for. So, talk to a local Medicare Insurance Broker to know all your options.

Answer: Possibly. The only time I recommend anyone to stay on original Medicare is if they are also on the State Medicaid program that will pay for your 20% co-insurance.

 

There is no maximum out of pocket amount with original Medicare. That means you will continue to pay your 20% with no limit.

If you chose a Medicare Advantage plan there would be a maximum out of pocket amount to help keep your costs under control. Choosing the right Advantage plan is very important. Getting help from a professional Medicare Insurance broker will help you see if your doctors accept Advantage Plans along with which ones they accept. It would also help cover your prescriptions premium because most Advantage plans include prescription drugs.

If keeping your doctors are the most important thing, and they don't accept Advantage plans, you might possibly qualify for a Medicare Supplement plan (Medigap) to help cover your costs.

Answer: There are two maximums out of pocket limits to consider.

The first one is on prescription drugs.

In 2024, Medicare changed the way prescription drug plans work. Out with the old and in with the new $2,000 maximum amount you will pay for your covered prescription drugs. Our prescription drug plan insurance company keeps track of how much you've paid for your prescriptions and when you have reached your maximum, your covered prescriptions will drop to zero amount for the rest of the year.

The second maximum out of pocket to know about is with the Medicare Advantage plans.

If you have a Medicare Advantage Plan, commonly known as a Part C, the insurance company keeps track of how much you pay for co-pays and co-insurance through the year. Once you reach the plans maximum out of pocket amount, then the insurance company pays the remaining co-pays and co-insurance for the rest of the year. Each plan has a different Maximum out of pocket amount, so knowing what that amount is important.

Make note that if you only have original Medicare, there is no maximum out of pocket amount for your 20% co-insurance.

Answer: I take the time to start at the beginning and walk them through the whole process. Once they get their Medicare card, then we sit down and look at all the options available to them. One size does not fit all, every situation is different, so I personalize what options best suit their needs.

Answer: It's okay that you don't understand. Medicare is complicated. There are so many options, and every state and county are different So what works for your friend in another state or county may not work for you. Don't just talk to your financial advisor or call one insurance company that can only tell you about their plan. Talk to a professional Medicare Broker who can tell you about all your options.