Steven Bleicher, Medicare Insurance Broker

Answer: THE most obvious knowledge as a newbie to Medicare is that the most expensive plan isn't necessarily your best choice. It has a lot to do with your potential health issues, how well you get along with your Primary Care physician (does she/he give you the bum's rush), the drugs that have been prescribed, as well as how your finances are at the time you apply for Medicare. Steve

Answer: Since I've been a Medicare expert for years and voluntarily teach Medicare at the local university for both those new to Medicare or those who are already in Medicare but wish to take a refresher course based on the new calendar year with the inevitable $$ changes. Thus, I email prospects all of the digital files that I have developed for my classes in advance of visiting them or speaking with them over the phone.

Answer: Based on the innovations in the digital world, this existential question will constantly be asked since not only will Medicare itself continually change but so will AI be teaching people in a more simplified way.

Answer: Medicare Part B covers 80% of the cost when you visit your doctors, have your blood drawn, having needed to obtain physical & speech therapy when an accident or health incident has occurred. The 20% "coinsurance" balance is then covered by a Medicare Supplement plan to its fullest extent and an Medicare Advantage plan to a decent but lesser extent. It should cover enough of the cost especially since seniors do obtain an inflation percentage increase to cover the cost of living from the prior year.

Answer: If you've been happy with the coverage since you turned age 65 and applied for Medicare, then most likely the ONLY aspect of healthcare to review each year surrounds the Rx's that have been newly prescribed OR those which are Brand Name drugs (Tiers 3, 4 and 5) for which the global economy has adversely affected its cost from one year to the next. Please remember that a Part D(rug) plan may be your best choice in one year but not necessarily as good for you in the subsequent years. NOTE: Please read your "ANOC" or the Annual Notice of Change which is mailed to your home every late October/early November. Steve

Answer: There is actually no such thing as "Regular Medicare". People know that there are two options when one turns age 65: A) a Medigap, also known as a Medicare Supplement and, B) a MAPD, a.k.a., as a Medicare Advantage Plan (with drug coverage). There is no cookie-cutter answer to choosing one over another since one's finances come into play, along with any potential health history of the applicant and her/his family history for "co-morbidities". If your parents lived a long life, that usually means you're ahead of the game, if you will. The major difference with an Advantage plan is though there is no monthly premium for this plan (since it is govt-subsidized), the give & take is that each MAPD has a steep deductible which you are responsible for which renews every single year. The dollar costs for these plans are dependent upon our global inflation. The Medigap, with a monthly premium has no deductible except for the one-time/year Part B $257.00 deductible. Each and every deductible will be likely to change at the new calendar year. Remember: an MAPD Advantage plan usually includes your drug coverage, whereas a Medicare Supplement plan has nothing whatsoever to do your prescriptions. That's what a "Stand-Alone" Part D plan is used for.

Answer: Easy one. In coming from a family of teachers and with no two Medicare-eligible prospects are totally alike, I enjoy my ability to instruct the candidate about the quirky aspects of Medicare. Plus, there is NO "cookie-cutter" answer to clients about which program is the best for them. It must be evaluated based on health issues, finances and the Rx's being taken, among other things.

Answer: If a full year has passed after turning age 65, there will be a series of health questions which must be answered in order to change your Med. Supplement plans. If you've remained healthy, the odds are good that a change will be approved. However, please note if you are still WITHIN the one year period of obtaining a Medigap/Suppmt. plan, you will have a right to change companies without having to answer any health questions. Thus, acclimating to your plans initially, no matter what they are, is paramount.

Answer: This year's out-of-pocket expense is set at a maximum of $2,000.00 (last year it was $8,050.00!). Those folks with heavy duty Brand Name drugs will be paying no more that the $2K amount for every single drug that they are prescribed. However, with some expensive drugs, be aware that though you have the right to purchase drugs from either a US or Canadian online pharmacy at discounted rates, those bought from Canada will NOT be applied toward the $2K max out of pocket amount.

Answer: Thinking that their drug costs before Medicare will resemble those same costs when joining Medicare. It is imperative to realize that Medicare drugs are priced much differently than those you enjoyed as part of an employer's healthcare plan. Brand Name drugs will be a greater challenge especially any drug in Tiers 3, 4 and 5.

Answer: Not only am I a volunteer instructor of Medicare at the U of A in Tucson but am an independent agent who teaches my peers at their homes or over the phone by sending attachments to their email addresses prior to the arranged “visit”.

Answer: Having the opportunity to teach my peers all of the quirks of Medicare has forever been my goal. I am paying it forward in that back in NYC, after moving to Tucson, my mother developed a # of major health issues. I feel that strangers came to her aid and caused her 7–8 more years of life until she passed at 92. This was my motivation to branch out into the healthcare field from scratch as the job I had back East simply didn’t exist here.

Answer: Some options in Medicare include overseas travel. For instance, with a Medicare Supplement (a.k.a., Medigap), the 1st 60 days of any trip is covered with any health ailment affected by a natural cause or by a serious accident.

Answer: Bear in mind that there are over 60,000 treatments that are covered by a government subsidized Medicare Advantage plan, being your Primary insurance at 80%. The rest of the money or 20% is paid by Medicare itself, your Secondary insurance. However, some things written in the policy may not be completely covered. Your doctor should know that! This is the “give and take” since you’re responsible for a somewhat steep deductible since you likely have no monthly premium.

Answer: Should you miss the SEVEN-MONTH window of opportunity (before the birthday month when you're about to turn age 65) to enroll into Medicare, depending upon whether you are still working and receiving healthcare coverage from your employer, there are a number of aspects that you may encounter. So, it is imperative that you've picked up at least Part A but not necessarily Part B as yet. Call 1-800-MEDICARE to investigate your specific situation. But the longer you wait to do this, the worse it could be.

Answer: When you become eligible for Medicare (usually at age 65), Part A is totally free as long as you've worked for 10 years, contributing to Social Security, taken out of your paycheck during that time. Bear in mind that Part A (inpatient hospital admittance) will pay 80% of the charges surrounding your treatments/surgery. The other 20% is normally covered by applying to either a Medicare Supplement or a Medicare Advantage plan. However, if you're still working, it's normal that your employer is paying for your healthcare unless you're working part-time.

So, to answer your question, Medicare pays for over 60,000 different procedures. As long as yours has a dollar value associated with it, it should be enough. But if you are considering an experimental treatment, Medicare does not pay for that until CMS approves it.

Answer: There is a Medicare rule that states (I am paraphrasing this): Should your Part D plan no longer offer a particular drug, they are required to sell you a one-month supply while you search the web (both US & Canadian discount websites) for a supplier who does include that (usually Brand Name drug) in their drug formulary. If you wish email me at [email protected], I'd be glad to send you my "Drug Discount Websites" digital file which I developed for the Medicare classes which I voluntarily have taught for many years at the University of AZ, here in Tucson.

Answer: Doctors have three main reasons for disliking MA plans: A) they don't want to do the paperwork involved with these types of (free of premiums, govt-subsidized) plans, B) due to that paperwork, they would be forced to hire more people to administer the plans, and

C) Advantage plans take much longer to pay the in and out of network physicians and thus want nothing to do with any Advantage plan. But they gladly take on patients with Medicare Supplements, a.k.a., Medigap plans.

Answer: The only healthcare procedures that are NOT covered are those of an experimental nature. However, once the CDC checks out these types of treatments, as long as it meets the quirky Federal guidelines, it may be declared to be covered. Be advised that there are over 60,000 treatments that are currently covered by Medicare. Your doctor was being honest with you and the odds are that most of the "uncovered" treatments are those recommended by a chiropractor since they can (via trial-and-error) attempt to develop a procedure that she/he successfully worked with "some" of their patients. Your best double-check is always to call 1-800-MEDICARE and the reps should be able to sanction a procedure unless it is brand new and has yet to be tested.

Answer: In 2025, the maximum amount of $$ that any one individual will spend on drugs is indeed a Grand Total of $2,000.00. This encompasses both Brand Name drugs as well as generic drugs which Medicare keeps track of. This also entails that though folks had the opportunity in 2024 to use Canadian online pharmacies that discounted many of one's drugs, that is no longer the case this year. So you can, in effect, save money on each drug refill purchased with a Canadian pharmacy, that amount of money will NOT be applied toward the $2K annual deductible this year. This means that you'll have to figure out yourself if buying from Canada over the course of the entire year 2025, will that be better than purchasing it from a US discount website (i.e., GoodRx, costplusdrugs.com, simplecare.com, etc.)

Answer: Marrying late in life won't have much to do with Medicare but with your Social Security entitlement. But those who are married for at least ten years will have choices upon retirement since Social Security's "formula" takes into account your 35 best earning years.

(Based on the rules today, Social Security can be opted to be picked up for those as young as age 62 and as late as age 73). However, when one turns age 65 or has been declared disabled by any governmental agency (either Federal or State), once 2 years have elapsed, no matter what age you are, there is a rule that you can become a Medicare-eligible beneficiary. I've had clients who were 47 years old who were approved to pick up Medicare due to their disability. The only limitation is that you can acquire only a Med. Advantage plan (Part C) and not a Med. Supplement plan. Though, the latter can be picked up upon turning age 65 by dropping the Advantage plan. You cannot have both an Advantage Plan - Part C, alongside a Med. Supplement, also known as a Medigap plan.

Answer: I'm sure most of you will remember this: A few years ago, there were many TV commercials featuring celebrities like Joe Namath, William Devane & Jimmie Walker which initially caused a multitude of problems for seniors who were about to become Medicare-eligible. They misinformed the public and caused many people to switch to another plan when they ALREADY had the VERY SAME plan with another insurance company in their possession.

The Center for Medicare & Medicaid Services (CMS) forced these commercials to be redone and to eliminate the misleading information but still used those same celebrities as if nothing was wrong. This was a prime example of the need for greater supervision of these overly frequent TV commercials.

Moreover, there are Medicare agents who are known as "captive agents". These folks can only sell healthcare plans for one company. Therefore, it is incumbent upon you to find 2nd and sometimes 3rd opinions from independent representatives who are affiliated with various companies who can offer both Med. Supplements, as well as Med. Advantage plans. There is a wide difference between these two plans. In my opinion, it is essential to find an honest broker who can describe the major differences between those 2 plans. Moreover, the most expensive plan is NOT always the best plan. Check out the premiums along with the value of a plan's annual deductible if you're interested in an Advantage plan.

Answer: You've been happy to learn that the donut hole has been abolished. This is a great savings for people who take a variety of different drugs. There is a $2000.00 maximum out-of-pocket through 2027 matter whether you take generic drugs or Brand Name drugs. Last year, folks paid a maximum of $8,050.00 in the donut hole and it has been replaced by the $2,000.00!! Medicare keeps track of your costs for you.

Don't forget that you have options with regard to paying for a copay for a drug. These are as follows: A) Making a copay for a prescription at your "Preferred" or in-network pharmacy when you have an Advantage plan, B) if you opted for a Medicare Supplement, along with a "Stand-Alone" Part D prescription drug plan, again going to a in-network preferred pharmacy can be your best choice, except for C) using an online discount pharmacy (like GoodRx.com, singlecare.com, costplusdrugs.com, etc., which can yield a better price than thru your Part D drug plan. That is an option; but you can only use one or the other for the same drug. Also, remember that if you've had success in the use of a Canadian online discount pharmacy, those out-of-pocket costs will no longer be applied toward that $2K deductible.

Answer: Though those seminars can be somewhat helpful, your best choice is a one-on-one visit with an independent agent/broker who will take your personal information into account and be specific toward your health issues, your family history and naturally, your pocketbook. With a seminar, it's a numbers game while a visit to your home or at a neutral site is more beneficial.

Answer: Yes, if you can prove that the modifications were needed as a direct result of a health issue, it would be covered. You just need your doctor to corroborate your "story". They can widen a door opening to accommodate a wheel chair, as well.

Answer: Just because a PPO allows you to go both in & out of your Advantage plan's network has nothing to do with referrals. You're confusing two different principles here. Also, bear in mind that I know the State of Arizona backwards & forwards. That means that there are likely some states where the answer given above may be different. It would make sense to check with your Medicare insurance company or your agent.

Answer: The first thing that comes to mind is that you probably did not meet with a long-time Medicare professional agent who knows the ins & outs of its very quirky rules. In my opinion, enrolling with Medicare yourself online means that you may be bypassing the rules concerning the different periods during the year when one can enroll AND make changes.

The only thing for you to do at this point is to enroll with a Medicare Advantage plan temporarily (you HAVE the right to do this at anytime since you've never enrolled before by picking up Medicare Part B with a monthly premium). Then, when the Open Enrollment begins on October 15th thru Dec. 7th (to become effective on Jan. 1st of the following year), you have what is known as "a trial right", meaning since you have your very 1st Medicare plan for less that 12 months, you will be able to apply for a Medigap (a.k.a., Med. Supp.) without having to answer any medical questions concerning pre-existing conditions.

Using any online information only yields the more well-known tenets of Medicare. The best advice I could ever give anyone regarding THE most important aspect of your life: HEALTH, is to be certain to get a 2nd & even 3rd opinion from an independent rep who is also known as a broker. However, in using a "Captive Agent": one who only has allegiance to one insurance firm, is foolhardy since all companies who offer Medicare-compliant Advantage plans can vary the rules to a certain extent. Though I truly hope that most agents are honest/reliable and can cover the gamut of the regulations, as an instructor myself, I will deliberately "over"-emphasize the more important areas/rules to all of my clients. Good luck and if needed, call 1-800-MEDICARE so that the person on the other end who's trained for this, confirms what a trial right means.

Answer: Wherever you got that idea, please cross that person’s name off your advisor list! That is totally NOT true. The only aspect of Medicare that pays anything are for routine Dental, Vision and Hearing. The reason is that when Medicare was established in 1965, the Feds wanted to only be responsible for the inexpensive healthcare treatments. For example, in the Dental area, Medicare pays for x-rays cleanings and fluoride treatment. But, if you are seeking an umbrella policy that covers the more expensive procedures, buy a “DVH” (Dental, Vision & Hearing) individual policy that covers “some” aspects of implants, root canal, partial dentures extractions, etc. Your best option is one that can cost about $65.00 per person depending on your state.

Answer: My succinct answer is NO! Don’t listen to those “scare tactics”. I recently saw that there is enough until around 2040.

Answer: All things come in cycles. That’s the key point relevant to this question. When that happens, I don’t know but it won’t be too long until people turn to a Medigap policy (a.k.a., Medicare Supplement).

Answer: Yes. “DME” stands for Durable Medical Equipment. A glucose monitor is paid for by most Medicare Supplements (aka, a Medigap plan). Go to medicare.gov and put DME in the horizontal search box. You will find that a Medigap covers over 60,000 treatments while an Advantage has a high deductible which, depending on the company, will potentially provide partial coverage for the monitor.

Answer: Depending on your chosen company and if you opted for a Supplement or an Advantage plan, there are 2 code #’s that a billing department person will code the treatment that was provided. If you made the appointment due to some pain you are feeling, then that is to be coded as “diagnostic” while a visit without pain is coded as “preventive”. Though, if during an annual checkup, the doctor discovers a “problem”, then the visit will change to a diagnostic code, even though it began as a preventive code. All doctor visits are covered by Medicare Part B at an 80% rate. The remainder of 20% is paid partially by the secondary insurance you have. If a new procedure has been done in a hospital, then Medicare Part A pays the 80% and the secondary again does the 20% in the same manner as above.

Answer: No, it does not. Medicare only covers the 1st 100 days at a Nursing Home, Assisted Living and Alzheimer's facilities. To be more specific, within the first twenty days, there is no cost at all to you. Then, on days 21 - 100, it reverts to a daily rate which is $204.00 per day. If you've enrolled in a Med. Suppmt., depending upon the "letter" of the Suppmt., that is also fully paid for. But when you've reached the 100th day, Medicare drops out. The Medicare Advantage plan is different from a Suppmt. and each insurance company will vary those and its hospital benefits. If you've previously enrolled into a Long-term care policy, that should kick in on Day 101 and also will be dependent upon what benefits you had opted for within either a LTC or "Recovery Care" policy (which used to be known as Short-term care). Always remember that some states dictate their own regulations with specialty care; I can only generalize the above.

Answer: Mental health is covered but it is up to you to review different company policies since they could vary widely from state to state. There is a limited number of days that should be covered. It is incumbent upon you to fully understand those limitations. This is why it is imperative to go over with a knowledgeable agent who can easily differentiate between what an Advantage plan covers vs. what a Med. Suppmt. (Medigap) covers in this extremely important area.

Answer: This question may be a bit "iffy" as there are psychiatrists who may also serve as a therapist. Be cautious when you enroll into Medicare since there are widely different benefits between a Medicare Supplement plan and a Medicare Advantage in regard to this topic. The main thing to concentrate on would be the meds that are prescribed since there are differing types of anti-depressants with widely different copay costs. Naturally, with an Advantage plan with a network, you are forced to use those specialists within an HMO network. However, the better option likely is an Advantage plan which is a PPO since this allows you to go BOTH in and out of the plan's network. When going out of network, the costs for that option would also be higher $$. Plus, this wouldn't happen with a Supplement since it is a "non-network" plan for any type of treatment. And you won't need referrals from your Primary Care doctor.

Answer: Sure. If you are already qualified for Medicaid and are about to enroll with Medicare, you're going to qualify for a "SNP" or Special Needs Plan. This means that you are not going to pay for ANYTHING at all since your status (financially speaking) has been approved. Not every insurance firm offers a SNP plan. You will have to do a little searching but it should be fairly easy to do. By the way, if you've been granted Medicaid status by either a State or Federal agency and two years have elapsed, no matter what your age, you can enroll with Medicare! There are clients who are in their 50's who were approved for Medicaid and then 24 months later, they were able to only enroll into an Advantage plan with drug coverage. But, when you are Medicare-eligible at age 65, you can transition to a Medicare Supplement and a Part D(rug) plan, each with a monthly premium, if that is your preference.

Answer: Differences occur from state to state with respect to the Medicare Advantage plans. However, since a Medicare Supplement follows all CMS rules, those are sacrosanct and cannot vary without Congress agreeing to a new set of rules. This is why it is imperative to carefully review the variables between insurance companies. This also means that you should consider whether your agent is a “captive agent” (only works for one firm) and therefore cannot compare the HMO, the PPO and the SNP’s (Special Needs Plans for those with Medicaid & who are close to being eligible for Medicare), all of which are types of Advantage plans.

Answer: These situations likely mean that you have a Medicare Advantage plan. If so, companies have the right to vary the regulations and in your case, cataracts are common and they are saving you money for the surgery, done weeks apart on both eyes. Not to be punny, but you have to treat your initial Medicare Agent interview with both eyes open. Don’t forget that the Supplement plan provides specific differences that you are going to need a number of years later than when you 1st turn 65! Do consider everything!

Answer: I'm going to use the choices that doctors make concerning a quicker

recovery due to a new prescription. The most frustrating problem

today is the "over-use" of "PRIOR AUTHORIZATION" specifically by

your insurance company. This is NOT your doctor's fault. This is

extremely prevalent due to greater dollar restrictions nowadays.

When being interviewed by a competent Medicare agent, it is an

essential topic to discuss "P.A."! This is not something that any

agent can anticipate since it has become an overwhelming cause

for complaints specific to "MAPD" (in-Network) Advantage plans.

Be sure to recall that you have two choices with the RX copays

that are a part of Medicare: A) you can use your Advantage plan

as a means for the purchase of a drug at a "preferred" pharmacy,

or, B) you can use any US online discount website (the most

common is www.goodRx.com, singlecare.com, etc. ) which will

feature better copays for certain drugs. Moreover, their cheapest

copay also may be at a pharmacy which you don't usually use.

Thus, if it is a much better price, you must notify your doctor to

re-send this new Rx to the "other" local drug store. It is a quick

double-check with these discount online websites to fill in the

long horizontal search box on the landing page. Be certain that

you use their drop-down menus to specify the dosage and the

frequency of the drug's (usual) 90-day use.

Answer: Greatly!! The passage of the Inflation Reduction Act last year means that the most you will spend on known Rx’s (not ones of an experimental nature) is going to be $2,000.00 which Medicare will keep track of. Bear in mind that the $6K is preposterous! This could also mean that as long as you know that a “bio similar” drug is not recommended by your doctor as a substitute, in the very 1st month, you have already surpassed the maximum out of pocket! This is going to be a boon to your expenses this year.

Answer: This is among the many reasons why people who are still within their first year of having enrolled into Medicare that spending for a Medicare Supplement ought to be considered. Being within those 1st 12 months exempts you from having to answer the medical questions. You are entitled to a guarantee issued Supplement and the G plan, the N plan and the high deductible G plan should have been considered. Check them out now if you’re new to Medicare.

Answer: Yes. The most obvious means toward doing that is to ask your agent what is covered in your policy in the area of mental health and those medications that are prescribed to treat that malady. If you want to compare your current plan with other companies, it is going to be essential for you to realize that mental health is covered by Medicare but only so much. This depends upon the State you live in, unfortunately. You need to call both Supplement firms as well as those who offer Advantage plans. Based on a "side-by-side" comparison, you should have enough ammunition to make a determination. It would have been better had you come to this conclusion before a full 12-months had elapsed after turning age 65. This means that now you will be subject to underwriting though you won't be declined just for a bipolar disorder but an accumulation of health issues that you might also have.

Answer: Prior authorization! This has nothing to do with your doctor or your agent but with your insurance company. There have been a greater # of insurance firms that now will question whether a less expensive treatment for your malady may be used instead of the first one prescribed by your Primary Doctor. Moreover, you likely know that an Advantage plan has no monthly premium as it is subsidized by the Federal Govt. As a tradeoff to that, it does contain a fairly steep deductible which again, depending upon the State you live in and the policy of your insurance company, can be a burden for those with not much money. This is why it is essential to fully understand the differences between a Med. Supplement (with a premium) and a Med. Advantage plan. The cheapest premium does not always offer the best benefits!

Remember this: at 65, you're likely to be healthier than you will be in 5 or 10 years. So, just because you may run 3 miles a day, doesn't mean that you can keep that up when you're 75!

Answer: This sounds like whoever you dealt with when you were about to become Medicare-eligible DID NOT TEACH you "the system" properly. Hopefully, you did use an experienced agent who was not a neophyte in the Medicare arena. IRMAA is the manner in which Medicare determines how much each Medicare member will pay for Part B (Part A is usually free). This has everything to do with your 2-year old tax return in the area of your "Adjusted Gross Income". Go to the Medicare website and put in the letters "IRMAA". This will take you to the part of the Medicare.gov site which shows you a chart.

But, first look at your 2023 AGI and if you file individually, check that column vs. if you file with your partner, look at the column called "joint" filer. That indicates how much you'll pay in the New Year. It is also based upon the global inflation factor too, of course. As far as your Part D prescription drug plan, be sure that your agent isn't a "captive agent" since that means that she/he only works for one insurance company (ergo, a conflict of interest?).

Dealing with an independent rep/broker is much better since she/he will note the drugs you take, the dosage and the frequency and use the Medicare.gov website to see which of the various drug plans in your State (Part D) are the best for you. Having been prescribed Brand Name Rx's (more expensive) means you'll be paying a higher monthly premium.

However, you also have the right to use any US online pharmacy (like GoodRx.com, singlecare.com, costplusdrugs.com, etc. ) and see if their cost for the exact same drug may be less expensive for you. But, you can use ONE or the OTHER (NOT BOTH) for the same Rx): A) your Part D(rug) plan or, B) any online discount pharmacy. Note: Be aware if you use a Canadian discount pharmacy, please consider that any drug provided by that cheaper pharmacy will NOT count toward the maximum $2,000.00/year which is the most that any Medicare-eligible person will be spending for drugs in 2025 & 2026.

Answer: I do agree. The dilemma here is that due to the scarcity of Primary doctors in the US, focusing on prevention rather than treatment (in the long run) will be less expensive to Medicare. In our global economy, this is "the formula" that healthcare has adopted. Moreover, there are two specific kinds of "codes" that are placed in your record after a visit: A) "Preventive", and, B) "Diagnostic", the latter of which will come out of either Part A (in-patient) and Part B (out-patient) Medicare, therein costing the Feds the extra money. However, when a person sees her/his doctor without complaining of any type of pain, that visit is automatically coded as Preventive, thus costing the patient more $$ rather than the Federal government. The exception to that is, for example, if you're having a colonoscopy and the surgeon removes some polyps which have to be analyzed, if it has been found to be cancerous, it will change codes from a preventive visit to one that needs further discussion and thus is now diagnostic.

Answer: I suggest you go to Medicare.gov and put in the search box "SEP's". This stands for Special Election periods. These represent "odd" times when certain circumstances occur which allow you to use an SEP and change your initial plan. There are numerous SEP's that folks can utilize at their discretion. The most obvious one is when you have moved your domicile to another location be it within your State OR outside your current State.

Most of the time however, "GI" or guaranteed issue are for those newly eligible Medicare folks who are within that 7-months' window of eligibility. That is: 3 months before your birthday month, your actual birthday month and 3 months after your birthday month for a grand total of 7 months.

However, folks are usually not aware of what is called a "trial right". This means that if they are inside one year of having joined Medicare at age 65, they can exercise a trial right, dropping what they initially thought was better, in favor of an alternate plan (whether it is a free Advantage or a monthly Medigap (or Med. Supplement) premium plan).

Answer: There can be a wide variety of answers to this question due to the various symptoms that folks can have. There are tools that can be used to "remotely" signal to an outside location that your heart is working properly (or not). You will be beholden to your cardiologist who is your expert and will write up "A PLAN OF CARE" specifically for you. It might entail a number of hours a day where the doctor feels that a registered nurse ought to see you daily or every other day, depending upon the cardiologist's discretion. The other side of this coin is that I can only presume that an operation to remedy your dilemma is out of the question. It can sometimes have a lot to do with which plan you picked up at age 65 between a Medigap or Supplement vs. a Med. Advantage plan both of which demonstrate differing benefits.

Answer: Due to your work history, when you become Medicare-eligible, you have the same rights as those who did not work for the Federal Govt. Most folks like you have enjoyed excellent healthcare benefits during your career. You will be tasked with comparing what benefits you have retained as a veteran of the govt., vs. what you "might" gain as a Medicare person in your particular State.

The real dilemma with folks like you is that you likely did not contribute to Social Security and rather will get a pension. You also have the right to speak with a counselor or a Human Resources person with whom you can question about how most govt-veterans go about using Medicare throughout your lifetime.

Answer: Someone has not brought you up to speed. You always have choices. First of all, please do not forget to read your "ANOC" or Annual Notice of Change which is mailed to you every October which compares the current year costs to the following one. My guess is that you are paying much more premium per month since you don't have the means of checking other plans in your particular State. What is elusive is that a Part D plan can delete a drug that you take and you'd not know that this has occurred. Therefore, it is ESSENTIAL for you to call your company's customer service department, asking for a supervisor and determine which of your drugs are not a part of their drug formulary for the next year.

Insulin Price Cap: If you use insulin, Medicare capped monthly insulin costs at $35.00 apiece which began in 2023. Don't let a drug store clerk tell you that it is not $35.00 since they know nothing about Medicare and the Inflation Reduction Act. Furthermore, No-Cost Adult Vaccines: since 2023, vaccines under Medicare Part D are available at no cost to adults which can keep you protected without unexpected expenses. However, we cannot predict if insulin may be on the rise in the future due to our global economy.

However, NEVER simply retain the original Part D plan that you started with, since the volatility of pharmaceuticals is rampant at this time. Always use Medicare.gov and investigate if from one year to the next, not just insulin but all of your Rx's may have changed "TIERS". There are five drug tiers: Tier 1 is Preferred Generic, Tier 2 is Non-Preferred Generic, Tier 3 is Preferred Brand Name, Tier 4 is Non-Preferred Brand Name, and Tier 5 is a Specialty drug which is very expensive. The lower the tier, the cheaper the copay. Plus, be sure to use your plan's "Preferred" pharmacy & not the closest one to your home or the one with a drive-in window. That could cost you a lot of $$ over a 1 year time!!

Answer: .Believe it or not, there ARE some plans that offer you free groceries and free over-the-counter products if you join their plan. This is an enticing offer and sometimes that very benefit overwhelms someone since anything free is a boon (supposedly) to your finances. You must look at the overall benefits of the plan & not just a "niche" benefits. The crackdown on enticements like that have already taken place a few years ago when Joe Namath, Jimmie Walker and actor William Devane talked about a plan that many people already had in place but didn't know it. The Centers for Medicare & Medicaid Services (CMS) forced this company to re-shoot those TV commercials to eliminate the misleading parts of their plan.

Answer: That's an easy one: Those veterans of the Medicare wars had better been explained at age 65 all of the ins & outs of Medicare since it is so very quirky. If I question these veterans and they simply don't recall having been taught what I consider to be "properly", I will treat those seniors just as I would with those first entering Medicare. As a longtime agent, I tell folks that there simply is no "cookie-cutter" means of teaching & advising Medicare. "Simply the rules, madam, simply the rules".

I teach Medicare at the local university every year for the past decade right before the Annual Open Enrollment period which should be close enough for everybody to "get the gist" of the 80% - 20% rule. That is: if you're having a procedure in a hospital (In-patient) that comes under the heading of Medicare's Part A (no cost/month usually), then Part A pays the 80% and your secondary pays most or all of the remaining 20%. BUT, if you're receiving treatment in a doctor's free-standing surgical center (Out-patient), the 80% is paid for by Medicare's Part B (has a monthly premium) with the remainder coming from your secondary insurance.

Constantly, I remind folks that there are basically THREE aspects of Medicare that you'll be paying for: A) your monthly Part B "Premium Payment" which is predicated on your 2-year old tax return on the line that is called your "Adjusted Gross Income". There is an "IRMAA" Income chart on Medicare.gov showing the most common (= the least amount in 2025 at $185.00 per month). This can be withdrawn from your Social Security Direct Deposit if you've begun to collect your SS entitlement., B) there is a one-time per year Part B "Deductible" which is $257.00 in 2025, and C) whether you've chosen a Medicare Supplement (which has a monthly premium) or a Medicare Advantage plan (the latter of which is free since it is government-subsidized). Then, depending upon which of the many plans are chosen, that will dictate your entire monthly money outlay.

Answer: Most Part D plans exhibit 5 tiers of drugs: 1) Preferred Generic, 2) Non-Preferred Generic, 3) Preferred Brand Name, 4) Non-Preferred Brand Name, and 5) Specialty Drugs. The lowest the tier, the cheaper the copay.

Tiers are determined by Medicare (CMS) and are based upon the costs of bringing the drug to market (research & development, plus the ingredients). There are some categories of drugs that don't fit into that rule like Insulin ($35.00 apiece) and the ever-escalating costs of various inhalers.

My tip on paying the least amount of money is to always check with the online discount websites like GoodRx.com, costplusdrugs.com, simplecare.com, etc. There are also a number of Canadian online discount pharmacies that are available in order to check their cost to you. Please remember that should you decide to use a Canadian pharmacy, the drug cost will NOT be applied toward the 2025 annual drug deductible (max: $2,000.00).

Be advised that in 2025, you have 2 options: A) Using your Part D(rug) plan or in checking the drug formulary within your Advantage plan, vs. B) using an online pharmacy which you've investigated and contains a less expensive amount by printing a coupon from your PC. BUT, you cannot use both for the same drug. You CAN use either A or B for the various drugs you take, some of which might point you to your favorite local drug store, while others might dictate that you drive further away from your home to a "different" pharmacy which has better pricing for your drug. The only inconvenience is that you must check that your doctor knows which pharmacy to fax to with each individual drug/Rx.

Answer: Whether you've ever been prescribed drugs or not, once you become Medicare-eligible, usually at age 65, if you either have NOT picked up an Advantage plan WITH drugs or a "Stand-Alone" Part D(rug) plan, you will have a Lifetime penalty imposed depending upon how many months you failed to enroll with any drug plan.

This penalty will be added on top of your monthly Part D plan. So, though your answer is obvious, I have had many clients who claim to be healthy and lucky enough not to need any prescriptions. Once they tell me that, I do mention everything that I've stated above and they will usually abide by my recommendation as there currently are drug plans with a zero monthly premium. Bear in mind also that you may be as healthy as a horse but once you're in a car accident, you're no longer healthy and will require some meds as part of your recovery process, even if they're just painkillers.

Answer: IRMAA (or Income-Related-Monthly-Adjustment-Amount) which is based upon your 2-year old tax return under the category of "Adjusted Gross Income" or AGI. There is a chart on the Medicare.gov website which you can find by putting those 5 letters into the search box and print out the chart. The least amount for 2025 is $185.00/month (predicated on a joint return of $206K or less). Then, regarding the higher AGI's, it can reach a maximum of $594.00 per month (is an AGI of over a half million $$ or greater when filing as an individual or $750K when filing jointly with your partner).

I would recommend that you "remind" Medicare of your lower income since at times, they will not necessarily "catch up" as quickly as you'd like them to (call 1-800-MEDICARE). Remember that chart contains SIX categories of AGI's so if you have a new lower income, it may not make any difference. You don't need to specifically report that since both the Medicare and the IRS computers usually communicate this info directly within 3 months (hopefully) after filing.

Answer: The fact that you included the above word "heard" is kind of ironic. You've heard wrong! Thus, I'd agree that you actually DO need a hearing aid. In fact, two of them! LOL. Medicare doesn't pay for the entire amount. But it will give you an allowance (this depends of which insurance company you've chosen when you turned age 65) toward the purchase of hearing aids. Some will permit that every year or two though there shouldn't be the need that quickly if they're fitted properly. Go to Costco (one of the least expensive places to buy a pair) and the cost (in AZ) is around $1, 699.00 and it can work with your iPhone.

Answer: There are rules in this area which are found on Medicare.gov. For example, if you attend an educational event, whomever is the host cannot specify names of ANY insurance companies that she/he is appointed with. AND by the same token, a gift card cannot be handed out as THAT IS ILLEGAL since that is considered to be "cash"! BUT, she/he can have light snacks available at a single event as long as it does not cost more than $15.00 per attendee. Anything valued more than that can cause a fine to be levied and a refresher course to be given to the agent.

Answer: This can be complicated. It has to do with you & your husband's "Adjusted Gross Income" or "AGI" which is taken from your 2-yr. old tax return. If you've earned more than your husband during your respective careers, once he is out of the picture, Medicare only looks at your new and "individual" tax return. The least amount in 2025 for the Part B premium is $185.00 (as an individual filer, that means the "AGI" is $103,000.00 or less; but it can be as much as $594.00 per month if your AGI is $500K or greater). My best advice for you would be to make an appointment with a counselor at your nearest Social Security office to verify that the above example happened to be your case, or not.

Answer: You are always a "GI" or a guaranteed issue person when you first become eligible for Medicare, usually at age 65 (you have a 7-month window to apply; 3 months before your birthday month; your actual birthday month and then 3 months after your birthday month for a grand total of 7 months). If an entire year elapses and you're now 66 years old, if you wanted to possibly change your 1st plan to another company's Supplement, you would have to go thru Underwriting to verify that you have NO pre-existing health conditions.

Answer: Seniors have been surveyed and THE most worrisome question from those who are about to become eligible for Medicare usually at age 65 is: Did I make the right decision? Since there is absolutely no "cookie-cutter" plan which is perfect for everybody, there are many considerations to be aware of in making this extremely important decision. Here are many of the aspects of that decision: A) How is my current health and what is my family's health history?, B) What is my financial status?, C) Do I take multiple drugs and if so, are they mostly generic or Brand Name drugs?, D) Should I consider coverage for the more expensive aspects of Dental, Vision & Hearing which Medicare only covers the "routine aspects" of those 3 topics?

So, since the Advantage plan should have been totally free since it is subsidized by the

Federal Government/Medicare, there is always a give & take with a free plan. Yes, there should have been a zero premium. But, in return the "take" is that every single Advantage plan contains a deductible. The average one in my State of AZ is around $3,000.00 or less. That means that if you were hospitalized, depending upon the rules of YOUR Advantage plan, there will be some out-of-pocket costs that you will have to bear. Then in the next calendar year, the deductible will start all over again.

However, if you are within the first 12 months of having joined Medicare, you should consider exercising "your Trial Right"! This means that as long as you have yet to turn age 66, you can drop the Advantage plan in favor of the alternative or a Medicare Supplement plan which has a monthly premium but NO deductible (except for the 1-time per year Part B Ded'l.) whatsoever! If you used a "Captive Agent" who can only offer an Advantage plan, that's where your error was, in not getting a 2nd & even 3rd opinion on your plan options.

Answer: Since there is NOW a special kind of (all-in-one) lens that can take into account both nearsightedness & farsightedness (a.k.a., like a regular progressive lens) in one set of lenses, that option is NOT a part of Original Medicare. In this case, the ophthalmologist was wrong in not telling her that this is not covered by Medicare since she/he should know this. Your friend can, if she wishes, file a Medicare grievance against that doctor but it likely won't do YOU any good but should help other folks in the future.

Answer: Absolutely not! Though there are a small amount of rules that can vary from one State to another, it usually happens with a Medicare Advantage plan though it is rare to see that.

Depending upon the individual insurance company, if they are well-known, they will do everything possible to broach all Medicare topics with a fine tooth comb. It could be that your individual agent is fairly new to the business and has yet to acquire all of the digital files available to forward to their customers.

This is a sin as the upper managers need to instruct the neophytes about how to get their numerous messages across. So, when you became Medicare-eligible, I hope that you realized that you need to obtain 2nd and even 3rd opinions from multiple-aged agents. That is why many clients appreciate that old expression about someone like me: "There may be snow on the mountain but there is still fire in the furnace!". If you're not fully understanding about any Medicare-related rule, try searching on the Medicare.gov website in the open horizontal box. You may be surprised at what you can find.

Answer: Yes, a nutritionist is available but please bear in mind that since there is a dearth of specialists like nutritionists. So, if you are in an Advantage plan network, hopefully there will be choices of specialists that you can depend on. At times, a Medicare Advantage plan will insist upon a "Prior Authorization" which is also known as "Step Therapy". This means that since you may already have a cardiologist (who usually hands out menus for those with a high cholesterol condition), they may not wish to also pay for a nutritionist except in extraordinary circumstances.

That won't happen with a Medicare Supplement plan (with no network) since any specialist would be glad to accept what "letter" of supplement plan with what company you have enrolled with and you'll be able to be treated for your high cholesterol.

Answer: Since it would make no sense to pick up an added cost for a plan with Medicare, you are not expected to pick up the costly Part B monthly premium. However, ask your Indian Health Service if they know that picking up the TOTALLY FREE Part A (in-patient hospital) is a wise decision since a full-fledged hospital has much more equipment to be used to save your life.

Answer: Last year, before the Inflation Reduction Act kicked in, the most anyone would spend for their annual prescription drug cost was $8,050.00.

Now that 2025 has arrived, with the elimination of the "donut hole", the most anyone will be spending for either their cumulative generic or the brand name drugs they're prescribed is a maximum of $2,000.00. This is tracked by Medicare and the approx. $6K savings is going to be a boon to those without secure finances.

Answer: I seriously doubt that since that would take a lot of time for the Senate and the House to come to an agreement. Don’t expect it anytime soon!

Answer: There is a law that protects folks from intimidation when it comes to a health care or Medicare-related incident or grievance. It is the “Whistleblower” regulation. No worries!

Answer: Apparently, you may not recall that Medicare DOES cover anything that is considered to be “routine dental”, like x-rays, cleanings & fluoride treatment. But depending upon when this policy was written, it is imperative that you look in your new updated manual to locate all of the benefits of your policy.

However, you are also remiss if thinking that dental cleaning should take precedence over so many other health benefits that Original Medicare and a Med. Supplemt. can provide you.

Plus, you should insist on having an assigned agent to help you or call 1-800-Medicare.

Answer: Every single State uses the birthday rule. That means that there is a 7-month window when you are about to turn age 65, when you can enroll with Medicare. First of all, you are eligible on the first day of your birthday month. Ergo, if your birthday is June 29th, then June 1st is your date of eligibility. So, the window is: 3-months before your birthday month, your actual birthday month and then three-months after your birthday month for a grand total of seven months!

Answer: There are “captive agents” who work exclusively for only one insurance company. Therefore, they push the Advantage plan since it is the only one for that agent to earn a commission! Thus, what I have said before many times in this column, it is essential to be interviewed by 2-3 different agents, preferably an independent agent who may also be known as “a broker” who is affiliated with a variety of different firms and can tailor his advice to specifically YOU! Don't be afraid to ask the question as to whether she/he is a broker and have the agent name a minimum of five different national insurance firms for whom an application can be written! Remember: there is no “cookie-cutter” plan recommendation for everyone!

Answer: In my opinion, critical illness should only be considered if you are from a family history of maladies with parents and/or siblings. Medicare has put a dollar value on over 60,000 procedures for which they pay for. It would be somewhat rare for you to require that coverage as a separate rider.

Answer: Easy. A broker, a.k.a., an independent rep is affiliated with various Medicare- compliant insurance companies while an agent “could” be a captive agent who can only offer you the plans of the one firm that she/he works for. It is important to get 2-3 “diagnoses” from various agents or you could miss out on better as well as cheaper premium plans.

Answer: Yup. If you don't speak to an experienced and honest agent, you won't know what your monthly payments will be. For example, there is a premium for the Part B, for the Part B one-time per year deductible, possibly a Medigap plan along with a Part D(rug) plan. If you want better coverage for the more expensive Dental, Vision & Hearing procedures, that can also be an extra cost per month. Sounds like you tried to get around using an agent whereas YOU are not paying for the agent's commission since the firm you chose pay the agents!

Answer: Should any of your current doctors be registered in the Advantage plan of your choice (during the next Annual Open Enrollment period in the fall for a 1/1/26 effective date), they are yours to retain. Though I have found that, for example, if a client has 5 doctors that they want to keep, 2 will be in one network and the rest will be in another one. At that point, you must decide which of those doctors are more important to you, whether it is the 3-doc network or the 2-doc network.

Answer: Of course. Medicare has covered over 60,000 treatments and as long as it is not an experimental procedure, it is to be covered as many times as your oncologist deems it to be necessary.

Answer: Naturally, the answer to this question will be different for every family. However, I will attempt to set the stage for a calm (and maybe distasteful topic) as those in my age category have gone through this both with my widowed mother when she was alive, as well as with my own grown children who now have their own kids.

Probably the most likely setting would be when all children have gathered together for a special event, either an anniversary or if a few birthdays that are close to each other and one child possibly lives far away and flies into your town for the grand celebration.

Once everyone has eaten (a barbecue?), they will be more likely to want to "rest". This is the time when you can modulate your voice to mention in a tactful way what your estate planner or close friend has suggested this session as the best means of declaring your wishes. It should be a soft-spoken voice which enunciates clearly and definitively exactly what you've signed as your last will and testament/estate plan. Setting this stage should not cause anyone to raise their voices in order to make a point. Tell them that your wishes have already been reduced to writing in a loose leaf book of pages consisting of all of the legalities which are a part of this extremely important and noteworthy event.

Answer: The only aspect of the Star rating system that can be helpful is if a company's plan has received a 5 Star rating (this is rare), it creates a new SEP or Special Election Period where changing to that plan can occur whenever there is no other valid period to use.

Answer: Yes. A half year out of the country does not allow you to stop paying for Medicare. A longer period depending on its length can be considered.

Answer: Hospice care means that you likely have less than 6 months to live which Medicare pays for while palliative care is something where a doctor writes up “a plan of care” of a determinate length based on her/his diagnosis of a serious illness. This will require the use of various equipment (& physical therapy) usually found in a Nursing home or possibly in an assisted living facility.

Answer: Since the doctor whose specialty is treating your malady, she/he will write up “a plan of care” which Medicare accepts. Then based on your progress, that same doctor can increase the number of days of treatment and therapy or release you to your home. The out-of-pocket cost is impossible to determine since you may have a Medigap or an advantage plan with differing benefits. Always rely on the social worker working at your facility who should know the differences between those 2 options chosen when you became Medicare-eligible.

Answer: Any US territory like those mentioned do retain all Medicare privileges as though you lived on the mainland. No problem!

Answer: This is a case which happened around the pandemic. I have a female client who went to her specialist who prescribed a drug for her malady. The doctor ordered it for her and it went directly to the specialist's office for dispensing. However, once the Covid 19 crisis became a major problem for the entire country, my client discovered that the medication would NOT be advisable and was "contra"-indicated due to the pandemic which by then was running rampant. The specialist sent a large invoice to the client who by the way, was not even aware that the specialist had ordered it from the pharmaceutical manufacturer. Since the client didn't want to make waves, she was kind enough to pay for the drug which now couldn't be used by anyone.

Subsequently, the client related this story to me, as her agent. Since she had a unique Medicare Supplement policy which pays for anything that is coded as "Preventive" and had not been paid for by Medicare.

My response to her was: "Put in a claim. It will only cost you a stamp to mail a copy of the paid invoice to the insurance company's claims dept. Nothing ventured, nothing gained". We talked further and the more I thought about it, the more upset I became with this entire incident. I also reiterated one of my favorite expressions which I give everyone reading this my permission to use: "If you don't ask the question, the answer is always NO!.

The result of the claim was that my client received a check about 2 weeks later from the Medicare Supplement company for over $2,000.00! Needless to say: when my client notified me of this windfall, it made my day, my week and my month!!

Answer: Due to stricter rules governing “Prior Authorization”, also known as Step Therapy, it is a delaying tactic used by Advantage plans to pay a cheaper price for a supposedly equivalent drug. The practice has gained popularity and causes consternation with doctors who are referring to the best prescription drug based on the malady you have.

Answer: You will be better off acquiring a “DVH” individual policy since Original Medicare in 1965 only wanted to be responsible for the routine procedures related to those 3 major topics.

Answer: Considering the current state of the spat between the two political parties, that is not going to happen anytime soon. Sorry.

Answer: Find out the difference in the coverages between you and your friend and you will have your answer. Doctors actually could not care any less about Medicare costs. So, since true physicals are covered, it comes down to how the visit was “coded” by the doctor's billing department. If they mis-code the visit, they are no longer permitted to fix their error.

Answer: This one is too easy! You must meet with at least 2-3 agents who will hopefully present a comprehensive review of the tricky and quirky Medicare system. I will tell you that most agents are trustworthy but since we don't know anyone's upbringing, there "could" be crooks among us. Also, you want to be certain that an agent is NOT a "Captive Agent" who only works for one insurance company and therefore, can only concentrate on THAT firm's policies. Moreover, some folks don't trust strangers in their home. Thus, there are times when I do sense that caution and will arrange to meet at a local fast food place where nobody bothers you.

Answer: That is a great question. However, since there are States that do change some things every year which is allowable with those insurance companies who offer Medicare Advantage plans. However, moving to a new state qualifies you for an "SEP", a Special Election Period. What this means is that you can choose ANYTHING you wish without any medical questions being asked of you on an application. So, if you found out that a Supplement (or Medigap) seems to be a better plan for you as opposed to the Advantage plan that you may have, that SEP is going to be vital to transition to, due to the more comprehensive medical benefits.

However, if you already have a Medigap, there will be a difference in the cost per month once you enlighten them of your new address. Depending upon your current State, it could be less OR it may be more expensive/month. Contact your current agent if you have the Medigap to ask her/him which State is going to have a higher premium?

Answer: Mental health coverage is one of the lesser known benefits of Medicare. Yet, there

are folks who don't realize that there is coverage. When one sees a psychologist, it would be advisable to ask her/him if there is anything they can add to their visits that would complement them through the Medicare system at no added costs? Depending on the plan they picked up at age 65, additional counseling can be very helpful.

Answer: If you are first turning age 65, there are no pre-existing conditions that will yield a decline for your enrollment into a Med. Supp, aka, Medigap plan. However, once you turn age 66, if you do exhibit some serious conditions, you would not be able to move in the future to another Supplement if you so desired. So, be sure to get 2-3 agents advise you, making sure that they are independent reps or brokers since you don't want to be interviewed by a "captive agent" who can only offer you one company's plans. Remember: an Advantage plan has NO monthly premium (since it's govt-subsidized) but a steep deductible which is a potential cost factor for you if you were ever "officially" admitted (don't be under observation!) to a hospital.

Answer: There is no way of giving you a guaranteed reply! There are pros and cons of both the Med. Suppmts. and an MAPD plan. It has to do with your health and family history, your finances, the Rx's you have been prescribed and luck. Just be sure to meet with 2-3 agents, making sure that none of them are “captive” agents! Those are reps who can only offer one company's plans. Ask if they are independent reps or brokers? Those folks have affiliations with many firms and can tailor the presentation toward some of your vital needs.

Answer: Be sure to be aware that you have a lot of choicess before choosing a drug plan. Since last year, you can join Advantage plans that contains drug coverage or not. You can pick up a “Stand-alone” Part D prescription drug plan (PDP) and you can use an online US/Canadian discount website like GoodRx, costplusdrugs.com or simplecare.com. Bear in mind though that should any Canadian website be significantly reduced, that buy will NOT be applied to the maximum of $2,000.00 per year for ALL of your Rx's as only US purchases will apply. Remember that if you prefer to pay for a Med. Supp., it does NOT pay for drugs at all! This is why folks who purchase a Med. Suppmt. must pay a small monthly premium for their Part D plan.

Answer: Believe it or not, you have 4 appeals as a member of the Medicare system. The pattern is that you will be declined on your 1st appeal. But on the 2nd one, now they know that you mean business. Once the appeals has been exhausted, you can now file a grievance thru the Medicare website.

Answer: THE absolutely worst decision someone new to Medicare can make is if you have previously qualified for Medicaid and are now close to becoming Medicare-eligible and you are not aware of a “SNP” aka, (Special Needs Plan) Advantage plan. The reason is that everything is totally free! Free hospitalizations, free doctor and specialist visits, free prescription drugs, free in-home care, free dental, vision and hearing products/treatments and more! The only apparent problem is that it CAN depend on the county that you live in. How can you beat that??

Answer: The one glaring thing that I, as an agent would love to change is that the Free Special Needs (Advantage) Plan or SNP plan isn't: A) available in every county in the US &, B) has a much larger network of doctors/specialists/psychologists who are more compassionate towards the poor folks who truly require a greater assistance due to the conditions that they have suffered through all of their previous life!

Answer: Supplement premiums will vary from company to company. It can be based upon the past history of a “block of business” and past claims in any age category. Each insurance company has chosen their own “cycle month” when the usual once a year price increase takes place. Some choose July while others pick September. Plus, depending on the state you live in, their cost of living has a lot to do with the payment. Those living on the East Coast and states like Illinois & Ohio always have higher premiums than those in the Midwest & South. Please understand that this naturally has to do with the global economy, too. Do yourself a big favor by interviewing 2-3 agents, making sure that they are NOT “captive agents” who can only offer one company's plans!

Answer: I fully understand how you feel. The overwhelming dilemma facing seniors who are about to enter the Medicare world is: "Am I doing the right thing?". This is very common. As long as you interview 2-3 agents (asking them for references, if need be), making sure that none of them are called "captive agents" who can only review those plans with the ONE insurance firm that they are appointed with, you will do fine.

Ask your friends, relatives and neighbors about their comfort zone (does the agent return your phone calls/emails in an expeditious manner?) with their agents and your hesitation should disappear. During the 3 agents' interview process, is she/he looking directly at you when they answer your questions? Does the referred agent have the years of experience necessary in covering some of the more quirky parts of Medicare? Are the companies she/he represents among the largest in the country? Google those companies and check as to how well they are rated in YOUR STATE! Don't forget that you may be surprised that the largest insurance firm in the US may not necessarily be among the highest rated. This should be enough ammunition.

Answer: If you are willing to pay the steep price for a concierge doctor, be aware that some of them do NOT accept Medicare for payment. The trade-off is that the doctor is beholden to you 24/7. This means that you will get his cell phone number and thus, you can reach out to him/her at 3 am, if need be. The added responsibility on your part is that though you are paying upwards of $2,500.00 per year to become their patient, you will still be billed at his menu of pricing for any treatment provided. Since these doctors abhor the Medicare paperwork, this is one of their motivations to transition to a “CD”. Just be careful that his “bedside manner” jives with your own personality!

Answer: I hope that you have not been declared disabled for a long time. The rule has always been that if a governmental agency (Federal or State) approved you as being disabled, once 24 months has elapsed, no matter what age you are, you are qualified for Medicare! Though you can only acquire a Med. Advantage plan with drug coverage, when you turn age 65, you will be able to switch over to a Med. Supplement, if you wish. Don't forget that at age 65, pre-existing conditions are eliminated and you can pick anything that your finances dictate.

Answer: Plan G is the most popular Medigap plan you can acquire. Remember that the ratio of 80/20% ALWAYS comes into play. Part A is for IN-patient hospital services. That's your Primary insurance, paying 80% while the balance of 20% will be paid by your Med. Supplement. Thus, here are your two theoretical examples: A) like the above, the knee surgery is performed in a hospital. Part A pays the 80% of all surgical charges while the Supplement picks up all the rest except for the one-time per year (!) Part B deductible of $257.00. If you already have met that amount, no additional funds are your responsibility. B) Though rare, if this same operation is done in an outside surgical center, (outpatient!) the 80% is paid by Part B and the remainder is again paid by the Medigap plan.

Answer: One of the nice perks of an Advantage plan is the ordering of OTC products from the company's catalog each quarter at no cost to you. They will deliver it to your door by either the USPS or UPS. The allowance varies from company to company. If you don't use the entire amount by the end of the quarter, you lose it but the new quarter starts all over again with the same initial amount. The products are anything from toothpaste, baby powder, aspirin, mops, etc. If you have stocked up on all items needed, you can order for your relatives, neighbors and friends. Why not use this benefit?

Answer: You likely decided to acquire a Med. Supplement (Medigap) at a monthly premium. Your friend applied for a free Advantage plan which is subsidized by the Federal Govt. The trade-off is that your friend is responsible for a steep deductible (anywhere from $2,600.00 per year thru as much as $10,000.00!). Choosing among those options are not easy. It had to do with your health issues if any, your family history of longevity, the Rx's you have been prescribed and naturally, your finances. If you interview only one agent, he/she may have been a “captive agent”, meaning that they only represent one company. But if you see the requisite 2-3 agents when turning age 65, you will have a variety of plans to pick from. Your zip code only matters if you chose an Advantage plan whereas the Supplement is universally accepted in every State of the Union.

Answer: It depends on how the doctor codes the visit. However, the odds are that this decision is based on your own choice with nothing having to do with any health issues that you posed to your doctors.

Answer: They have realized that a Medigap plan aka, Med. Supplement does not have those “Prior Authorization” (PA) issues which will delay an immediate visit with a doctor. This means that your company wants to determine if a less expensive drug works just as well as the one originally written by your doctor. This process is also called “Step Therapy”. With the scarcity of doctors now in our society, it is rare if you are very sick to be able to see your Primary Care physician right away. So, that together with “PA” can be very frustrating when you don't feel well.

Answer: It is handled very well by both Part A (Hospital Inpatient) or through Part B (Outpatient). 80% is covered by Medicare & ALL the rest by a Medigap.

Answer: If you are covered by an employer plan, you only need Medicare Part A for hospital coverage which is FREE. Once you retire, you will need to pick up Part B (outpatient) with a monthly premium. However, once you join Medicare, you will have to acquire a Part D(rug) plan immediately or a penalty will ensue!

Answer: Nope. But you need to contact your agent who can explain what you bought at age 65. You also have a “Trial Right” before you turn age 66. This gives you the one-time chance to move over to an Medicare Supplement plan, at your discretion without having to answer any medical questions.

Answer: The real deal is that if you have a low financial picture when turning age 65, the Advantage plan is right for you. The reason is that it has no monthly premium since it is subsidized by the Federal government. But the tradeoff is that each Advantage plan will contain a fairly high deductible. Each insurance firm does have the right to choose that amount at their own discretion. The importance of that is if you exhibit poor health and have to be hospitalized, the approximately $3,000.00 becomes your responsibility! Plus, every new calendar year, it starts all over again, potentially at a higher cost due to the global economy. The better choice in my professional opinion is the Medicare Supplement, if you can afford its monthly payment. Furthermore, the steep deductible does not exist with it.

Answer: Please understand that you are a Guaranteed Issue person upon becoming Medicare-eligible. So, if a monthly premium paid towards a Medigap, aka a Medicare Supplement is your best friend. So, if you have a poor family history of longevity, that will be best. Moreover, there are over 60,000+ procedures that Medicare has placed a dollar value on. So, as long as your issues are common, Medicare will be a boon to you!

Answer: Since cataracts are indeed covered by Medicare, depending on the policy that you applied for at age 65, most of the costs are currently covered. In addition, after the 2 cataracts are removed, you need to find an eyewear store who knows how to submit the paperwork to Medicare so that the very next pair of glasses & frames won't cost you at all!

Answer: Yes! Part A covers up to 6 months of hospice care. You have the right to make your home to be your hospice OR an outside facility who specializes in this benefit. Most folks will choose the latter due to the equipment they have.

Answer: Easy. A few years ago, Joe Namath, Jimmie Walker and actor Wm. Devane hosted a TV ad that the Centers for Medicare & Medicaid Services (CMS) forced them to do over. It explained some Medicare benefits in a roundabout way. It turned out that those folks who called the toll-free # on the screen already had those perks in place but did not know it. This was just an enticement to try to convince you to switch to their plan. Once the uproar began, a number of months later, this practice came to a halt and to a certain extent, besmirched their “careers”.

Answer: Most Medicare members presume that a car accident would automatically be covered. Not necessarily! Depending on the severity of the health issues, for example, whiplash is not covered since a neck brace is given and no admittance to a hospital would occur. But naturally, if you have broken any body part, the ambulance driver normally brings you to the nearest hospital.

Answer: Basically,,all Vax are covered. However, the CDC/CMS will determine whether a booster will be needed based on the age of the patient. Of course, the childhood shots are still covered but be careful as the controversy surrounding some older inoculations do vary from state to state.

Answer: Yes. You know the expression: “You get what you pay for”. In the case of plans covering your health, the same thing applies. But, If you are still in the 1st year of Medicare, you are entitled to a benefit known as a “trial right”. This means that as long as you have yet to turn age 66, you can exercise that right (with no medical questions being asked) and acquire a Medicare Supplement or a Medigap plan with a monthly premium. When you were about to enter Medicare, I doubt that you spoke with more than one agent. If you had, you would have received lessons from 2 to 3 different agents, giving you a variety of rules which demonstrate the quirkiness of our illustrious healthcare system!

Answer: During the next Annual Open Enrollment period in the fall (October 15th through December 7th) for an effective date of January 1st of the next year, you have the right to switch to another company's Advantage plan which now includes your favorite hospital. BUT be aware that in the process, you could lose a favorite doctor or two who might be a part of your current network! It sounds likely that if you used an agent to “show you the ropes” of Medicare, that she/he failed to check on the doctors AND the hospital that you preferred! So, if I were you, I’d consider changing agents!

Answer: This question has more to do with your educational background than a full comprehension of Medicare. There can be a variety of premiums that are an integral part of a healthcare system. In effect, a premium is usually a monthly payment for a service provided. It can be a payment for a Medicare Supplement, or one for the Part D(rug) plan or one for a Hospital Indemnity plan. But “costs” are another entity. A cost could be a true “copay” at the pharmacy for an Rx prescribed by your doctor or a fee for a laboratory who will draw your blood based on an upcoming appointment with the doctor. So, costs are “indeterminate”, depending on any health checks/issues while premiums are definite costs that are common in the Medicare system.

Answer: Not having chosen the best plan “for your health” rather than the least expensive healthcare program. Skimping on your health is foolish. You have only one life to live and if you prefer that it continues for as long as possible, then the above principle must always apply!

Answer: The “Inflation Reduction Act” of 2023/24 put forth a maximum out of pocket (for Medicare members) for all Prescription drugs (both generic & brand name) at no greater than $2,000.00 per year. Prior to that law, it used to be $8,050/year! What a difference for folks who are prescribed a variety of Rx's!

Answer: One aspect of this question has to do with your decision as to how many months are you staying at each location. If it the same 6 months, you must decide which is your true home domicile? Once you have committed to your home state, the Medicare Supplement is universal in every state. It moves with you, whereas the Advantage plan only works in the county you live in! Even if you were to move within your home state, a change of county at any time of the year causes an “SEP”, or Special Election Period. This ensures that a switch to the best plan in your new county is necessary! It can be with your current insurance company or with a new one with a possible smaller deductible. Exception: should you have an Advantage plan in a larger FL town, you can check with your Customer Service department, asking for a doctor who is is willing to take you on. So, doing some investigation on your part will be essential.

Answer: There are professional Medicare agents who are trained to teach prospects about our quirky healthcare system. I will never understand how folks who are about to become Medicare-eligible seemingly refusing to speak with a minimum of 2-3 experienced agents?!? With that # of interviews, you should receive a well-rounded review! Moreover, you will have established a relationship with an expert with whom you continue to work with as you age. He/she is going to be vital cog for all of your future health needs! Please be sure not to talk to a “captive agent” who is affiliated with only one insurance company as that agent can only offer 1 firm's options! That means that only an independent agent, a.k.a., a broker can write a wide range of Medicare-compliant plans.

Answer: The Inflation Reduction Act of 2023/24 has fully eliminated the coverage gap which also used to be called “the donut hole”. Thus with that legislation, the maximum out of pocket costs in 2025 are $2,000.00 tops! This will be tracked by Medicare and includes both generic and brand name drugs, including your cholesterol meds. Your Primary doctor or cardiologist should know which Rx's are the most expensive (with higher copays at your “preferred” pharmacy) and which are more reasonably priced.

Answer: By having an agent nearby (presumably in your county), she/he will inevitably be more knowledgeable with the programs in their own zip code. If however you live in a remote county, the choices of plans are much more limited. Anyone in that position should more seriously consider a Medicare Supplement or Medigap plan. This will also make it easier to travel while on vacation as this plan moves with you wherever you go & also covers you for emergencies outside the US!

Answer: When your agent chooses a Part D(rug) plan, one of her/his responsibilities is to verify that as many Rx's as possible are in your chosen plan's drug "formulary". This means both generic drugs as well as Brand Name drugs. In addition, you have alternatives in paying for a drug. You have a secondary means of determining if any of the online US Discount websites like GoodRx.com, simplecare.com, costplusdrugs.com, etc., show a savings on the exact name/dosage. Becoming a member of these websites is free. Once the online membership has been completed, all you need to do is to place your prescription drug in the horizontal search box & ensure that you use their drop-down menus to verify the right dosage and amount (90 days). Then, print out the economical coupon that you see on your monitor. The only caveat is that you MUST go to the pharmacy that is printed on the coupon. It may not be your favorite. Don't worry about that since the added blocks to drive to an "unfamiliar" pharmacy more than makes up for the savings.

Answer: The Part A (IN-patient hospital) copay per day will vary among Advantage plan companies. However, the $1,676.00 has been determined by Medicare itself every new year. Since that figure is the maximum that you'll pay for that one specific hospital visit, the daily rate will be applied toward that amount. Thus, if you're in the hospital for the typical 3 days, $1,050.00 ($350.00 times 3) will be applied toward the $1,676.00. That means that you have yet to arrive at the annual deductible in that example. Since Medicare keeps track of your Inpatient hospital stays, there will be the leftover amount of $626.00 that will remain as your responsibility should you be officially admitted to a hospital within that same calendar year.

Answer: People who know virtually nothing about Medicare's benefits presume that a specific health issue is NOT covered! Why is that? That is the farthest from the truth! In actuality, there are over 60,000+ procedures and treatments that ARE definitely covered. You need to ask an experienced agent or go to Medicare's website and put a question in the search box. You would be surprised to have really found an answer.

Answer: Most folks ought to know that Medicare Part A is completely Free (no premium). This is the part for In-Patient hospital treatment. Many employee plans do NOT cover this benefit. So, if your Human Resources professional doesn't tell you that, if you are ever hospitalized, all bills are coming out of your own pocket! So, those about to turn age 65 need to just acquire the totally free Part A only. Then, when you separate from the employer plan, whether by being let go or by choosing retirement, you must pick up Part B with a monthly premium (for medical visits that are not related to a hospital visit = Outpatient services) three months before leaving the company. You will choose between a Medigap = a Medicare Supplement, a Medicare Advantage plan and/or a Part D prescription Rx plan (small premium).

Answer: The simple way to do that is to ask your nurse or doctor: “Have I been “officially”admitted to the hospital”? You can trust them to tell the truth. However, if you have not been placed in a semi-private room and only had occupied a gurney outside of a room, your answer might be “NO”, as you are “under observation”. This means that you WILL be responsible for the first night of your stay. Ask them to find a legal way to officially admit you.

Answer: This is a loaded question. Many folks “claim” that an emergency prevented them from joining Medicare. You may have to show proof of your claim to be granted an exception. I trust you know that there is a 7-month window to enroll into Medicare. This is based on your Date of Birth. For example, if you were born on July 23rd, your eligibility for Medicare is always the 1st day of your birthday month or in this case July 1st. Then, there is a 7 month window to join: 3 months before your birthday month, your actual b/day month and 3 months after the birthday month. That's a grand total of seven months!

Answer: An agent must be licensed by the state that YOU live in. Calling the state license department will confirm that. Since an agent must know comprehensive information about Medicare, a more compelling reason to check on this is - Has the agent lost his license in your state due to unscrupulous or illegal prior actions?

Answer: Since I only have an Arizona insurance license, I can only tell you about my state. Therefore, you are currently making too much to qualify for Medicaid. You can also contact “SHIP” or the State Health Insurance Program (Google it) to see if you may qualify for other types of assistance? There are also non-profit organizations to whom you can appeal. If you know of a social worker, that is yet another source of information to help you, too. See if there is an organization of social workers who can recommend someone who is willing to advise you. Lastly, if you can't afford the Medicare premiums, you may have signed up for a Medigap or Medicare Supplement plan, all of which have a monthly premium. So, during the upcoming fall Annual Open Enrollment period: October 15 - Dec. 7, pick up a (free of premium) Medicare Advantage plan which is government- subsidized. That becomes effective on January 1st of the following year.

Answer: Yes. Losing a job occurs at any time of the year. Therefore, you can acquire another healthcare plan depending on your age. If you are too young to enroll with Medicare, you can apply to the Affordable Care Act. Often times, you can qualify for an ACA subsidy when you have submitted your financial picture. Then when you find a new job, the new employer will include their medical plan once you have worked there for a minimum of 3 to 6 months.

Answer: Creditable coverage means that whatever your current medical plan consists of (this is usually an employer plan), it is equal to or better than that of Medicare's rules. These rules have to do with inpatient hospital coverage, out- patient medical coverage (ie: labs) and your prescription drug plan benefits.

Answer: As a senior myself, I frankly don't answer my phone if it's an unrecognizable phone number since Medicare scams are more rampant on a phone call, along with the Internet. Remember that your bank will NEVER call you on the phone if you are ever scammed since they reach out to you via an email. Moreover, I'll also use my face as a means for ensuring that I am entering my commonly used websites perfectly. It's this double-verification process that will work every time. All you need to do is: A) using your phone's camera, shoot the online barcode to set up the process, B) hit the word “continue” and it automatically knows that it is you! Ergo: a new 2-step verification process and no scam!!

Answer: I am sorry to say that this year, some plans eliminated telehealth visits since nobody was using them. Please check your own plan by calling the toll-free number on the back of your plastic card.

Answer: I would love to tell you in a positive way but I would be lying to you. Due to the current administration, things are going to be more topsy-turvy than ever before. You should not have to stress on this every year unless you you have a (free of premium) Med. Advantage plan whose benefits can radically be altered from one year to the next. Had you chosen a Medigap or Supplement plan, the perks are defined by Medicare itself and won't be changed without legislation. However it is the government subsidized MA plans with a private Medicare-compliant insurance company who has the right to switch or delete the benefits at their own discretion but with the approval of CMS. It is likely that you won't qualify for a Medigap due to health reasons, I am so sorry to say. The only consideration I can think of, if you should move your official domicile to another state, you will be able to pick up the better Medigap plan because you are entitled to a “Special Election period” or SEP due to the move!

Answer: You are always covered for a one-way ambulance trip but maybe you failed to show them your 2 medicare cards when they picked you up. Therefore, make a copy of the bill and show the means that it was already paid. Send it in to the claims department of the primary plan & a refund check should be forthcoming in a month or so.

Answer: Yes. There is a premium for those who are in your situation or those with only a green card. It is somewhere around $475.00/month. Call 1-800-Medicare and they will set you up.

Answer: You just described one of the major reasons why you chose a Medigap. Overseas emergencies happen all the time and your plan will reimburse you up to $50,000.00 lifetime for any out of pocket expenses that you incur overseas within the 1st 3 months of that trip. Moreover, the Medigap is a great choice besides that since it is a much more predictable plan for your budget. But check with your insurance company to see if they have an “Internal Conversion” program which lowers the premium since they don't want to lose your business and can place you into a new “book of business” by the submission of a new Medigap online application. This also does not entail you having to answer any questions about your current health.

Answer: Human nature is such that nobody wants to ever admit that they have made a mistake. Their personality is simply resistant to finger-pointing. In other words, they refuse to say that they are just not perfect after all!

Answer: Things mainly change each calendar year: from the Part B premium, to the Part B one-time per year deductible, to the daily rate in a hospital or nursing home, etc. This all has to do with the global economy which used to only include the US inflation rate but as we all know, it has permanently been altered.

Answer: There used to be a gap called the “doughnut hole” regarding drugs. With the Inflation Reduction Act of 2023/24, this has changed. That gap has been fully eliminated in favor of a maximum out of pocket cost of $2,000.00 per year for all of your drugs, both generic and brand name. The next new year, it will begin all over again.

Answer: This has to do with the free of premium Medicare Advantage plans. Since each private insurance company has the right to determine its maximum deductible amount, if yours is $2,900.00 per calendar year, the MOOP for you is that same figure. Bear in mind that it starts all over again next year. I presume you know that these have little or no premiums due to the Federal government subsidy.

Answer: The prior year used to cost people $8,050.00! Isn't that a great savings all due to the Inflation Reduction Act from 2023/2024?

Answer: Depending on your health issues if any, it may have been a great decision or if you suffered thru many health downturns with a lot of hospitalizations, a Medigap might have been the better choice in the long run.

Answer: Since plan G has been the most popular plan for many years and some insurance firms don't even offer Plan K (I have never written up a K application!) I’d suggest that you ought to pay more attention to the health benefits of G, rather than the saving of money. You only have one life to live!

Answer: You will always have two options when you purchase a prescription drug: A) buy it through the Part D(rug) plan that was chosen during the Annual Enrollment period in the fall OR, B) purchase the Rx via the various online discount websites like pharmacychecker.com, GoodRx.com, simplecare.com, & costplusdrugs.com. + There are more than that! Whichever of those sources show the best copay price is the one to use. If you print a coupon, be sure to see if the pharmacy on that coupon is your usual pharmacy. At times, it pays to drive a few blocks further down the street if you want to save $$! Be sure to inform your doctor that for that one drug, he needs to fax a new Rx to the alternative pharmacy for you!

Answer: The Part B deductible in 2025 is $257.00. Once you go over that threshold, your PT is indeed covered by your Part B. This is determined by your doctor's “Plan of Care” which can be of any duration he sees fit. This can be increased if in the doctor’s assessment, you have not made as much progress as he initially thought. Medicare grants the doctor's opinions.

Answer: By definition, a Medigap (aka, Med. Supplement) is a totally Non-network program. As long as you verify that the doctor whom you are about to visit for the first time accepts Medicare for his being reimbursed, there's no worry whatsoever, anywhere in the US.

However, that being said: If you have enrolled with a "concierge doctor" who despises the paperwork that Medicare imposes upon all doctors, she/he may NOT accept any Medicare patient, at their discretion. The truth is that this type of doctor just does not want to hire a big staff which will adversely affect his/her profit margins.

In contrast, a Med. Advantage plan can be an HMO (a definite In-Network plan only) or a PPO (this is called a Preferred Provider Organization, with the chance to visit an In-Network as well as an Out-of-Network doctor, at your convenience). Though the copays with the out of network doctors will be a greater $$ copay amount than with an In-Network PPO practice.

Answer: This answer comes down to your crystal ball. If you maintain good health throughout your lifetime, then the Supplement may have been overkill. But if you and your family history of longevity is unfavorable, the Supplement would have been well worth it.

Answer: You always must remember to interview at least 2-3 different agents in order to hear their differing opinions regarding their company's benefits/premiums. Be careful NOT to utilize a "Captive Agent" who only works for 1 Medicare-compliant company. This means that she/he is beholden only to them, while an independent rep can have multiple affiliations with a variety of company benefits.

This kind of agent is also called "a broker" who can elaborate on the wide variety of quirks of Medicare. This person can offer solutions that can cover those oddball situations. You may have heard negative references toward a broker but that has been attributed to a person who usually sells car and homeowner insurance (property & casualty) But it is the Medicare brokers who will attend multiple company events & have a greater knowledge of the complexities of Medicare.

You also want to ensure that among the possible 3 companies, the one with a history of as low a percentage of premium increase each new calendar year is possibly the one "to lean on".

Please remember that we are now at an unusual time in our history when inflation is world-wide and is not just reflecting the US economy.

Moreover, the rapport that you establish with an agent is an important consideration, too! So, when you have posed a question, if you feel that the agent hasn't properly conveyed the Medicare principle/answer (or seems to be double-talking), that is not the right agent for you.

Answer: When you turned age 65, you had a true open enrollment (you are called a "GUARANTEED ISSUE person) since no medical questions will be asked of you. Plus, all pre-existing conditions are fully eliminated from disclosure.

Thus, you chose a free Medicare Advantage plan as the alternative. That plan has always been totally free of monthly premiums because it is subsidized by the Federal government. However, the "give & take" with those plans is that every one of them will contain a fairly steep deductible each year. If you have had multiple hospitalizations, the # of days spent in a semi-private room will be applied toward that deductible. It will be charged based upon the discretionary rules of the firm's policy that you have joined. These daily hospital rates vary from firm to firm. Should you go over that threshold (for example, $2,900.00/year) including other Part B medical treatments, that is your Maximum Out-of-Pocket expense (or MOOP). Subsequently every brand new year, that amount begins all over again, potentially at a higher price based on our global economy.

Answer: Go online to the private insurance firm's website to verify that the rules have been copied properly. Please bear in mind that as long as you prefer to join the Advantage plan, by interviewing a minimum of 2-3 “experienced” agents, you will be able to corroborate that the annual deductible as well as the number of days that you are responsible for in a hospital setting are absolutely correct.

Answer: The more important question is: Since you are going to receive only the higher dollar value of your respective Social Security deposits, by LOSING the smaller amount, how will that loss affect the paying of your expenses? Since you are entitled to a Special Election Period (SEP) in losing the employee plan, you will be able to choose any plan you desire (without answering any medical questions), between the Medicare Supplement, aka a Medigap plan, or a Med. Advantage plan. If you have health issues, the Medigap is the better choice, even though it contains a monthly premium.

Answer: Nope. Based on your DOB, the F plan only has a monthly premium with no deductibles. A visit to the ER is totally covered and therefore, don't fall for the claim that you owe something for that visit! Just because it is not available for t

newbies to Medicare does not mean that those perks are no longer pertinent!

Answer: Tough question to answer at this time due to the current administration’s attitude. Once the lawsuits have been adjudicated by the Supreme Court, we all will know a lot better surrounding your excellent question.

Answer: Yes. Depending on whether you signed up with a Supplement or an Advantage plan, call the Customer Service # on the back of that plastic card. The Customer Rep will enumerate those benefits for a spouse who is suffering from burnout. Good luck!

Answer: Firstly, applying for a State or Federal disability is the way to begin the process. This can happen at any age, not just for seniors who are already enrolled with Medicare.

Here's the key: Once approved by either agency, 24 months must first elapse where at that point, you CAN become Medicare-eligible, no matter what age. However, if you have not attained age 65, you can only acquire an Advantage plan with drug coverage. Though, when you are close to being Medicare-eligible, you have the right to switch over to a Med. Supplement, at your discretion. Since you are in a special category, it is imperative at that time to thoroughly review those 2 plans to see which plan makes the most sense for your household. The Supplement (aka, a Medigap plan) has a monthly premium while the Med. Advantage (MA) plan has no monthly premium due to being Govt-subsidized. But the "give and take" there is that each MA plan contains a deductible every year. If you were hospitalized for example, you'd be responsible for upwards of $3,000.00 every year instead of paying the premium.

Answer: This will depend upon the State you live in. There are some companies who have picked up acupuncture over the years while others did not. You will have to check by calling your state department of insurance to determine that. Moreover, naturalpaths are not covered by Medicare so if you enjoy using natural substances, until legislation is ever passed, those costs for the supplements/vitamins you take will not be paid for.

Answer: Every Advantage plan and every Part D plan has a drug formulary containing all the drugs that the plan covers. However, in our current global economy, that list will be very unreliable, I'm sorry to say! That is why you must check with the wide variety of online US and Canadian discount websites which can save you the copay money. The most popular of which is GoodRx.com. The maximum out of pocket cost for ALL of the drugs you take is $2,000 this year. Medicare keeps track of this. But if you use a Canadian pharmacy, the expense in using them won't be applied toward that deductible. Then in each calendar year, it begins all over again.

Answer: Hesitation is the dead giveaway. Not to sound crass but a younger agent simply has not experienced the wide variety of questions that an agent of over, let's say 7 years has. I am glad that you used the word broker since that definition will be more appropriate for a Medicare expert!

Answer: Please don't presume that a parent is not cognitive enough to make the right healthcare choice. I am sorry to say that this is how I interpreted your question, whether true or not. In your being a part of the agent interview process gives parents the confidence that they require for THE most important decision when they turn age 65. Plus, don't forget to see 2-3 agents in order to gain multiple opinions based on the health, the family history and the financial wherewithal of the patient!! Very Important!

Answer: Absolutely! Medicare has placed a dollar value (for doctor reimbursements) on over 60,000+ procedures! COPD and other respiratory issues are certainly covered. No worries.

Answer: One of the misconceptions about the above question is that there is a choice when applying for an “MA” or Medicare Advantage plan. You have the right to choose an “MAPD”, the PD standing for Prescription Drugs or an MA that does not include drug coverage. If you prefer the latter for whatever reason, you must pick up a Part D(rug) plan as the alternative. If you don't, there will be a lifetime penalty added to a drug plan’s premium for every month that you did not acquire drug coverage at age 65.

Answer: Both of these options can be equally problematic, I am sorry to say! The main dilemmas are the Brand Name drugs especially those advertised on TV. You will need to do some extra homework since you face a choice of using your Part D program OR using an online US or Canadian discount website like to GoodRx.com, pharmacychecker.com, simplecare.com, costplusdrugs.com and many others. Just be sure that you use the drop-down menus on these sites to ensure the correct dosage, frequency of use and how many times a day you must take them. This will show you the least expensive copay for the Rx. Don't forget that the maximum $$ that you will spend this year on ALL your Rx's is $2,000.00, tops! Every new calendar year that will begin all over again.

Answer: You have to explore how you can save by reaching out to the drug's manufacturer online for a possible subsidy as well as checking the US and Canadian discount websites like the Canadian Medstore, costplusdrugs.com, GoodRx.com, pharmacychecker.com, simplecare.com, and many more! You have the 2 options of using your Part D plan OR the above suggestions; but not both for the same Rx, though. There also are foundations to apply to and they can be Googled.

Answer: Since Medicare Supplements’ benefits are defined by the Center for Medicare & Medicaid Services (CMS), one of the major rules of ALL Supps which appeal to travelers going all over the globe, is that if you incur an emergency within the first 60 days of an overseas trip, you will likely have to pre-pay but save the paid invoice, make a copy of it and send it to the claims department of the Supplement company whom you joined. They will mail you a reimbursement check in around 4-5 weeks.

Answer: The most popular Medigap policy has been the “G” Supplement for many, many years. It's the easiest to understand and covers the most since you are only responsible for the monthly premium and the one-time/yr. Part B deductible which is $257.00 in 2025. Both these figures are going to increase every new calendar year due to the global inflation.

Answer: Be careful by interviewing 2-3 agents before deciding on the best plan for you. There is absolutely no “cookie-cutter” answer with Medicare! It has to do with your health, your family longevity and your pocketbook. In this way, you will obtain varying opinions and get a “feel” for the lack of any hesitation when you are asking pertinent questions.

Answer: Prior Authorization, also called ‘Step Therapy” is when your Advantage plan company delays accepting a new and fairly expensive Rx, in their hope of finding a cheaper Rx for the same health issue. The delay can be ridiculously long, depriving you of the immediate medication that your doctor knows is your best choice. Moreover, the drug formulary of acceptable drugs can be changed at the drop of a hat during anytime of the year. Some will call that ‘bait and switch”!!

Answer: Dental, vision and hearing are issues that Medicare will only cover those of a routine nature; example in dental: x-rays, cleanings & fluoride treatment. Acquiring an individual DVH plan is the way to go since the expensive problems in those 3 areas of health are partially reimbursed.

Answer: Only if you are in the first year of Medicare! After age 66, medical questions are asked and if you have a health issue, you can only move to a different company's MA plan. This is known as using a “Trial Right”.

Answer: Please ,dump the mailings sent to you as they only cover a small part of Medicare. It is better to interview 2-3 agents so that they together would reveal most of the rules and the “quirks” of the system.

Answer: Absolutely a perfect plan!! Good for you! I wish more Medicare newbies use your idea. Good luck with your decision.

Answer: Different plans use differing gym memberships. They all are basically the same, whether you have an Advantage or a Supplement plan. It is usually a free benefit but since I live in AZ, I can not really speak for some other states. For example, there is another mirror-image of Sneakers called "Silver & Fit". There are situations where you go online to see which of S & F's gyms are located closer to home. The distance should not be a dilemma as there usually are many to choose from near your zip code.

Answer: Everyone is entitled to 100 days of hospital service. However, if some folks are not as healthy as most, you are granted additional reserve days up to a total of 150 in your lifetime.

Answer: One of the quirky things about Medicare is that you can change your Supplement all year round! Many people forget that. Thus, the different periods are mostly used for the Advantage and Part D(rug) plans with the latter being the most common change. This can be due to a new Rx being prescribed. This change becomes effective on January 1st of the next calendar year. Moreover, if you are changing your home residence to a totally new state, you have a Special Election Period (SEP) which allows you to switch your healthcare plan to anything that you want with no medical questions being asked of you! That is a guarantee!

Answer: Due to the rate of inflation that is being predicted, Medicare insurance firms are cracking down on expensive procedures. This means that their underwriting dept wants to review the doctor's notes as to the severity of pain before agreeing to the operation. This mostly occurs with Advantage plans rather than a Medigap.

Answer: I doubt that. Anything new like a smartwatch, must go through rigorous reviews before both the CDC & CMS will sanction it for all Medicare-eligibles.

Answer: Any territories like Puerto Rico, Guam, the US Virgin Islands, etc. is considered to be in the US, according to the rules of Medicare. So anything that occurs there as an emergency IS covered!

Answer: Once you have qualified for Medicare, it is permanent health insurance. Since we never know what the future holds for us, this is THE main reason for Medicare. Please don't forget that this system has placed a dollar value on over 60,000 treatments and procedures. Dialysis is indeed one of the 60,000 and you are entitled to receive this treatment!

Answer: Rural areas bear the brunt of lesser benefits than those who are big city dwellers. This means that there is a limited number of plans available as well as a limited doctor network. If this seems unfair, it certainly is!! So, depending on your health issues if serious, moving to a remote area of your state is, in my honest opinion, not a good idea, sorry!

Answer: Medicare Parts A and B pay 80% of the value of any sanctioned procedure. By not picking up a Med. Supplement, the remaining 20% is coming out of your own pocket. If it is a big expense, why would you NOT wish to have it paid for??

Answer: Each of us have the discretion in picking up their SS entitlement up thru age 73 now. When you register online through SSA.gov, you are asked if you want both Parts A and B. Most of us say yes. Then, you are asked if you want to collect your SS entitlement? You can decline this question without any penalty. When you are getting close to age 70, three months before that, you call 1-800-Medicare to explain your wish to begin its collection.

Answer: No, you are confused. Since Part A is totally Free, if you or your wife pitched in and contributed toward Social Security for at least 10 years, you do pick up Part A but decline Part B as THAT is the part with a monthly payment. Once your wife retires, both of you need to get both Parts A and B, about 3 months before her separation from the employer plan.

Answer: Nope. The Medicare card only confirms your having acquired Parts A & B. The Advantage plan is Part C. So, if your provider does not take your MA plan, if you insist upon seeing that doctor, you are going to pay the retail price for the treatments from that visit! What should have happened when you turned age 65, was in finding what insurance company network that preferred doctor was in?That would have eliminated the tough predicament you now find yourself in!

Answer: After that frustrating situation, you should be calling 2-3 experienced agents (brokers) who can intelligently answer your questions. That type of individual has been “around the block” awhile and should be able to reply truthfully to you. It is this philosophy that I profess when one is close to Medicare-eligibility. Two to three agents to review with & the one with the most rapport is now YOUR own agent!

Answer: There is a 7-month window to enroll. It is as follows: A) Three months before your birthday month, B) Your actual b-day month, and C) 3 months after the b-day month. This is a grand total of 7 months! Remember, the birthday month is always the first day of that month! So, if you were born on June 22, you are eligible for Medicare on June 1st! Good luck.

Answer: You will have to pay out of pocket for anything of an experimental nature. However, should the CDC or the Center for Medicare and Medicaid Services (CMS) approve that treatment in the future, it would then be paid for.

Answer: Very tough situation here. I would first check with the drug mfr to see if their online site may have an available subsidy? Then, consider using either a US or Canadian discount website if the Part D plan shows an excessive copay. Moreover, Google foundations who offer reimbursements for a brand name drug.

Answer: Not knowing that a Part D drug formulary can be changed to eliminate your drug anytime during the year. Naturally, this is outrageous! It will happen with brand name drugs due to the volatility of all Rx's nowadays. I feel that this is THE biggest challenge facing seniors today.

Answer: Your own doctor will put in place "a plan of care". This decision depends upon the severity of your needs. For example. once "a 4 week plan" ends, if you still require more therapy, that same doctor can write added weeks so that in her/his opinion, you are very close to a recovery. So, your answer is AS MANY AS YOUR CONDITION REQUIRES.

Answer: Absolutely. All 365 days per year. Just bear in mind that if you have already become age 66, you will have to declare to any health conditions that exist, along with the Rx's that you have been prescribed. But, if you are within that 12 months when you first enrolled into Medicare, you can exercise a rule known as "a trial right". This means no medical questions will be asked of you!

Answer: As a long-time Medicare expert, there are a number of things that I would hope could be changed as some rules are totally illogical. A panel of experts should convene and hack it out for the betterment of Medicare folks. In addition since currently, only 4 parts of Medicare exist. But since a Medigap policy (a.k.a., a Med. Supplement), is a MAJOR choice, CMS must invoke that it becomes Part E, in my honest opinion. That just makes a whole lot of sense!

Answer: First of all, in order to answer that query, everyone needs to ensure that they use a "Certified Financial Planner" for their will or their trust. This person is a trusted "fiduciary" who is usually paid on the initial consultation and will not participate in the financial gains of the program that will be established. Since life insurance is for your family's protection due to a sudden loss of your income, that option automatically is a part of the conversation in the overall scheme of things that are looked upon a being existential.

Answer: If you work for a major corporation, due to their buying power with so many employees being covered for healthcare, it is incumbent upon you to do a comparison study as to which insurance covers more ground: your employer's plan or Medicare? Though, if you work for a smaller company, now it likely becomes more clear that Medicare will be the better choice. The main topics to review are: the # of days covered with an official admittance to a hospital, what the copays are with a visit to specialists or labs, if there is a free gym membership included, what drugs are covered especially those brand name drugs that can afford to advertise on TV, etc., etc.

Answer: As long as your financial picture is in order, I am prejudiced in this regard. I've always been fond of the Medigap, a.k.a., the Medicare Supplement "G" plan. The rules of the G plan are developed by Medicare & cannot vary from state to state like the Advantage plan. So, you can budget for A) the Part B premium, B) the Part B $257.00 deductible, C) the Part D(rug) plan and D) the Medigap policy easily. They are simply more predictable and it covers emergencies which occur out of the country (within the 1st 60 days) when you are on vacation, up to $50.000.00 lifetime.

Answer: If there is one main regulation to memorize it is that: an 80/20 ratio is the main rule of Medicare. Thus, if you are operated on in a hospital, Part A will pay the 80% and your alternate plan will pick up all or most of the remaining 20%. However, if that same operation takes place in a free-standing surgical center outside of a hospital, yes, only Part B will pay the 80% and the same 20% exists as above-mentioned. Just recall that anything of an experimental nature will NOT be paid for until the CDC & CMS combine to approve that treatment.

Answer: Once the IRS’ data checks in with the Medicare data, if the Adjusted Gross Income has lowered significantly, the Part B monthly premium will change. You have the right to call 1-800-Medicare to notify them of this major income change and your obligation will be decreased.

Answer: One of the great benefits of a Medigap plan is that emergencies occurring in the first 60 days of your trip are covered, up to $50K lifetime. All you need to do is to pre-pay the bill, save a copy and send it to the claims department. Since my interpretation of the trip seems to be more than two months, taking out travel insurance is certainly indicated! What you may want to bring up is does this insurance cover a helicopter evacuation and is a Covid diagnosis also a benefit?

Answer: Medicare basically only covers routine problems with Dental, Vision & Hearing. For example, fluoride treatment, x-rays, and cleanings are reimbursable in the area of Dental. However, there are some excellent “DVH” plans that will partially pay for a root canal, a cap, a crown, etc., that are reasonably priced. Anyone can buy this policy at any age; it is not just for seniors! Check into it.

Answer: It is different though very rare. Should a plan be evaluated by the Center for Medicare and Medicaid Services (CMS) based upon customer surveys and their own evaluation, a 5-Star rating can be granted. This means that whenever this rating is published, the very next month, you are able to switch over from your current Advantage plan to the 5-Star. It will not count if you have a Medigap plan.

Answer: An SOA is a form for your protection as it “tells” Medicare that you understand what the benefits of either an Advantage or a Part D(rug) plan are. It can only be exercised by a licensed agent. It ought to be signed 48 hours in advance of the new plan being processed. A call center is mainly involved with taking a prospect's personal data for distribution to an agent. However, some agents may be a part of a call center so that variance has more to do with an individual state’s rules. This is a customary practice.

Answer: With all the publicity surrounding the volatility of prescription drugs and that every country in the world is affected by the global economy, even generic Rx's will increase its pharmacy copay at any time, not just each new calendar year. You MUST evaluate your drug plan every single year! If you initially used an agent to enroll you in a drug plan, if you are not comfortable in using the Medicare.gov website, that agent should acknowledge her/his duty to find you a competitive plan for the next year. Just because one plan was your best choice when you turned age 65 does not mean that it will remain as the best plan. It has to do with the combination of generics and brand name Rx's. You also must check the US & Canadian discount websites like GoodRx, costplusdrugs.com, simplecare.com, pharmacychecker.com and many more! Everyone has a choice: A) using your Part D plan, OR, B) using the discount sites above. You cannot use both for the same drug since that's illegal. Good luck.

Answer: As long as you ask an agent if she/he is a “captive agent” & immediately gives you an answer, you may trust that agent due to the lack of hesitation. Though now you must be “on guard” since if the reply is yes, they only work for one company! This signals you to interact with at least two more agents who are not captive. In this way, you should get a well-rounded synopsis of the Medicare system. In effect, a broker or independent rep is a better bet since there is “no cookie-cutter” answer to your top choices. It has to do with your own health, your family history of longevity, your finances and surely NOT the least expensive premium!

Answer: When you were approved for a disability and 24 months elapsed, no matter your age, you became entitled to Medicare with the card showing the dates of when Part A (In-patient hospital) and Part B, (Outpatient) became effective with a random series of letters & numbers known as an MBI number or your “Medicare Beneficiary Identifier”. Though you may not have known this, you were only permitted to acquire the free (govt-subsidized) Advantage plan (Part C) with drug coverage with a steep deductible. But 3 months before you are about to turn age 65, you are then entitled to get the better Medicare Supplement (with a monthly premium), aka, a Medigap, along with a Part D(rug) plan usually with a small premium. S, since you already have the red, white and blue Medicare card, there is no need to sign up again. You now must carry the Medicare card, your Supplement card and the Part D card in your wallet wherever you go, especially for emergency purposes.

Answer: I would not count on anything AI in the near future until they are thoroughly reviewed by Medicare and legislation which has been passed by the Senate and the House of Representatives. In these cloudy times, nobody can answer this question with any certainty, I am very sorry to say!

Answer: Since fraud, waste and abuse is top of mind nowadays, a MSN informs you that charges have been processed and await Medicare's approval as a legitimate test or screening. With rampant identity theft, if something seems awry, report it asap so you can stop the fraud/abuse in its tracks! You can file it away with the yearly tax returns in case you are ever audited by the IRS.