Steven A James, MBA, Medicare Insurance Agent

Answer: We'd first have to clarify what is meant by "large medical bills". If one has Medicare only, then yes, one can be exposed to very sizable out-of-pocket costs as Medicare Part B only pays 80%, leaving the beneficiary with a 20% cost exposure. And with no caps, there's no limit to the exposure.

Part A alone has a $1,736 deductible per 60-day benefit period. After 60 days, daily copays can rise substantially.

If one has a Medicare Supplement, Medicare pays its cost share, and the Med Supp pays most, if not all, the remaining cost share. Plan G pays all these excess costs except for the Part B deductible, which is $283. Other Med Supp plans will pay less of these cost shares. However, and unfortunately, Med Supp plans continue to increase in cost, becoming more prohibitive to purchase by many. Here in Washington, Plan G is expected to be nearly $310/mo. In addition, Medicare only pays for medical expenses and nothing else. So, one would have to purchase a separate stand-alone Prescription Drug Plan, which could add an additional $40-$110/mo.

Medicare Advantage Plans (Medicare Part C) integrate with your Medicare. These plans do have copays, which generally limit your out-of-pocket costs as compared to Medicare alone. These plans also have annual max out-of-pocket caps, so one would be limited in a catastrophic situation.

Steven A James, MBA

Contact me.

Answer: Medicare Part D prescription drug plans no longer have "catastrophic coverage". In 2025, the new rules simply had a max cap of $2,000 which is $2,100 here in 2026. The cap is after the Part D deductible is met which is $615 in 2026.

These guidelines are for stand-alone Prescription Drug Plans as well as Medicare Advantage Plans with Part D.

Steven A. James, MBA

Contact me.

Answer: Your neighbor may have some validation for his comments. Here in Washington State, Med Supp F is approximately $300/mo. Adding the preferred Prescription Drug Plan could add another $110/mo in premiums.

Thus, if one is very healthy and confident in their future health, the Medicare Advantage Plan (MAPD) is a great option as it is a full comprehensive medical plan with the necessary prescription drug plan, but at little or no monthly premium.

And oh, nothing is "free". The MAPD is funded by the insurance company receiving your Medicare $. To entice a Medicare beneficiary to enroll, the plans offer many features and benefits not available from Medicare alone, such as vision, dental, fitness membership, hearing aids, and more.

In the end, plan determination is also based upon your current "service area" or county in which you reside. If MAPD is available, great, you have that option. If no, then the Med Supp/PDP is your only option other than Medicare only.

Steven A James, MBA

Contact me.

Answer: Yes, an approved family member or person with Power of Attorney, may review and consider plan options with you or on your behalf.

Steven A James

Contact me.

Answer: Cataract surgery is Medicare medically necessary. Medicare Part B alone pays 80% and you'd have a 20% cost responsibility. If you have a Medicare Supplement, it will pay the 20%.

If you have a Medicare Advantage Plan, Outpatient Surgery would generally have a copay, which would cap/limit your out-of-pocket costs. So, regardless of the procedure, your costs are limited.

Steven A James, MBA

Contact me.

Answer: If services are "Medicare medically necessary", you'd be covered. If rehab occurs while staying in a Skilled Nursing Facility, you'd have $0 copay for the first 20 days. If rehab occurs as Physical Therapy, your plan would have associated copays.

If you have Medicare and a Medicare Supplement Plan G, all costs would be covered, other than the annual Part B deductible, which is $257 this year and $283 in 2026.

Steven A James, MBA

Contact us

Answer: The time to review your plan and consider plan options for 2026 is now, during the Medicare Annual Enrollment Period, which occurs from October 15th to December 7th. After which, no further changes may be made.

However, for those with Medicare Advantage Plans, they'll yet have another opportunity during the Medicare Advantage Plan Open Enrollment Period, which runs from January through March. Once in April, you're essentially locked into your plan for the remainder of the calendar year. Unless there's a qualifying event to be eligible for a Special Election Period.

Steven A James

Contact me

Answer: Getting married at any time while on Medicare has no effect, as your Medicare and benefits are solely yours.

The impact of marriage could occur if the combined household income surpasses certain levels, in which there could be an additional surplus charge on your Medicare Part B as well as Part C. This is known as IRMAA (Income-Related Monthly Adjustment Amount. These updated premiums are determined by Social Security, and they typically "look back" 2 yrs for income determination.

On the opposite end of the spectrum are folks who qualify for State Medicaid, in which the state may pay one's Medicare Part B as well as Part A (if necessary) monthly premiums. The state may also consider individual as well as total household income to determinethe level of assistance.

Steven A James, MBA

Contact me.

Answer: Yes, there is a one-time per occurrence Part A Deductible. So, whether you're admitted for 1 day or up to 60 days, your total out-of-pocket would be $1,570 here in 2025 and $1,600 for 2026. Medicare Part A pays for all services, including meals. It could be quite unfortunate if you're hospitalized for more than 60 days, as the daily copays become quite exurbanite, which is why you'd want a Medicare plan in place to further protect from maximum out-of-pocket exposure. $419/day for days 61-90. You also have 60 lifetime day,s which may be used for additional days, but once these are exhausted, you'd be responsible for the full costs.

If you have a Medicare Supplement (Plan G), it pays the deductible. However, you're already paying the monthly premiums for the Med Supp. It also continues to pay all your cost-sharing if you're hospitalized beyond 60 days.

With a Medicare Advantage Plan (Medicare Part C), yes, the plan typically provides for daily copays for hospital stays, typically 4-7 days, and then full coverage beyond. So, yes, technically, if you're hospitalized for more than the typical 4 days, it could result in a higher cost share than only the Part A deductible. But for shorter stays, the plan with daily copays would provide appreciable savings.

Steven A James, MBA

Contact me.

Answer: Bankruptcy would have no effect on your Medicare.

If you have a Medicare Supplement (Plan G), there'd be no out-of-pocket costs other than the Medicare Part B Deductible, which is $257 here in 2025 and $283 in 2026.

If you have a Medicare Advantage Plan (Part C), these plans do have a plan maximum out of Pocket, which may range from $5K to $8K. So, there is a limit to your exposure. However, even with this, you'd negotiate with the hospital/provider for a repayment plan. You may also inquire from the hospital if they have charity support funds to help.

If you file BK, it will simply alleviate your further payment responsibility to the hospital and/or providers.

Steven A James, MBA

Contact me.

Answer: No, nothing is "Free".

When a Medicare beneficiary enrolls in a Medicare Advantage Plan (MAPD), the insurance company receives funds from Medicare to "manage" your health insurance plan. These funds are then used to pay for all aspects defined within a particular plan. If the plan has a "$0" monthly premium, it simply implies that the plan is fully funded as is, and no additional premium is required.

For plans that do have a monthly premium, the same principle applie,s only that additional funds are required to support the plan.

To entice Medicare beneficiaries to enroll in these plans, insurance companies offer many features and benefits not available from Medicare alone, such as Vision, Dental, Hearing Aids, Fitness membership and more.

Steven A James, MBA

Contact me.

Answer: If you have Medicare and a Medicare Supplement, you needn't make any plan change. However, your monthly premium will be adjusted to reflect your new state of residence.

If you have a Medicare Advantage Plan (MAPD) or a standalone Prescription Drug Plan (PDP), you'll need to change your plan to one available in your new service area/county. This would be a Special Election Period. So, if you change before the month's end, your new plan will start on December 1st. Thus, the current Medicare Open Enrollment deadline of December 7th would not apply.

And be aware, if you currently have a MAPD, your new service area/county may not have these plans available, which means you'll be considering Medicare and Medicare Supplement.

Steven A James, MBA

Contact me

Answer: Generally, PPO plans don't require a referral to visit a Specialist whereas HMO plans do.

Here in Washington for 2025, UHC HMO plans did not require a referral, but it's been changed for 2026 again requiring a referral. So, confirm with your actual plan of choice.

I've always advised folks that although your plan may not require a referral, most Specialists will require a referral. This is to help them mitigate seemingly premature or unnecessary visits.

Steven A James, MBA

Contact me

Answer: Yes, this would fall under SEP for Involuntary Disenrollment. The SEP would start once you're notified as such and can last up to a couple of months.

It is, of course, advisable to reenroll in a plan immediately to preempt any lapse in full medical and prescription drug coverage.

Steven A James, MBA

Contact us.

Answer: One can't make a blanket statement as different companies offer varying plans nationwide. Plans are available in various "service areas" or counties. Generally, the more rural areas will have limited or no plans available. Plans are generally available in more urban areas, as a viable network of hospitals/doctors is necessary to keep the plan viable.

And yes, plans offered in some service areas may have substantially more robust features and benefits. Most folks are also captivated by ads promoting Dual plans with "unbelievable" features and benefits, but although this may be true, these are strictly for Medicare beneficiaries who also have Medicaid.

Regarding Medicare Supplement plans, these are standardized plans and are useful everywhere Medicare is accepted. Although the plans are identical, Plan G is Plan G. The only difference w/b the price, based upon the State of residence and the particular insurance company's pricing structure.

Steven A James, MBA

Contact us.

Answer: Firstly, the "Donut Hole"/Coverage Gap was eliminated for 2025 as there is now an annual cap of $2,000 for qualified prescription drugs. The cap will be $2,100 in 2026.

These caps pertain to standalone prescription drug plans as well as those included in a Medicare Advantage plan.

Steven A James, MBA

Contact us.

Answer: Medicare itself only provides coverage within the US and its territories.

If you have a Med Supp, depending on plan, a set amount ($50K) is first covered in full and then a typically an 80/20 cost share for the balance.

If you have a Medicare Advantage Plan, you're covered worldwide for Urgent Care and Emergency for a nominal copay. See specific plans for details.

Steven A James, MBA

Contact us.

Answer: Yes, the current Medicare Annual Enrollment Period (AEP) enables folks to review and consider their plan options for the following year. Changes may be made from October 15th to December 7th.

However, if one misses this opportunity and is currently enrolled in a Medicare Advantage Plan (MAPD), they may yet make one final plan change during the Medicare Advantage Open Enrollment Period (OEP), which occurs from January through March. If a plan is selected during this period, the new plan would simply begin on the 1st of the following month. Whatever your coverage is in April, will be your coverage for the remainder of the year.

Additionally, the MAPD member may also opt out of their plan and revert to Medicare only and then enroll in a standalone prescription drug plan (PDP).

If you currently have Medicare only, this AEP is your only option.

Steven A James

Contact me

Answer: A couple of years ago, Medicare required that insulin not have more than a $35 copay for Part D as well as Medicare Advantage Plans with Part D coverage.

In regard to other medications, in the future, Medicare will now have the ability to negotiate prescription drug pricing, so stay tuned for further developments.

Steven A James

Contact me.

Answer: Your bill of $300 is very reasonable.

Medicare alone may pay for ambulance services, but after the Part B deductible, it pays 80% of the authorized cost, and you'd pay the outstanding 20%.

If you have a Medicare Supplement, after the Part B deductible is met, the Supplement will pay the 20% after Medicare's 80%.

If you have a Medicare Advantage Plan (Medicare Part C), these plans typically have copays ranging from $200 to $300.

Steven A James, MBA

Contact me.

Answer: You actually have several options.

1) Medicare is valid through the US and its territories. So, w/Medicare only or with a Medicare Supplement, you'd be covered.

2) Medicare Advantage PPO plan which would provide coverage whether in or out of network

3) Medicare Advantage HMO plan which also provides access to a national network. UnitedHealthcare has such plans but specifically by individual States.

Steven A James, MBA

Answer: Because Medicare is only valid in the US and its territories, location is key as ship must be in a US port or no longer than 6 hours away. Services must be Medicare medically necessary and provided by a license MD authorized to provide such services while on board the ship.

If you enroll in a Medicare Advantage Plan, you'd have coverage worldwide for Urgent Care and Emergency.

Otherwise, if overly concerned, buy appropriate travel insurance for the trip.

Steven A. James, (MBA)

Answer: These ads are for Medicare Advantage plans (Part C) Dual Complete Plans, which are for Medicare beneficiaries who also qualify for Medicaid benefits. These plans will provide more robust benefits than standard plans and would typically include:

1) Higher dental benefit allowance, and depending on the state, could be as high as several thousand dollars.

2) Monthly Over the Counter (OTC) benefits which may be as high as a few hundred dollars/month and may be used to purchase OTC products, healthy meals, and payment towards utilities.

3) Transportation, typically 24 or 4,8, which can be used for doctor and dental appointments as well as going to the pharmacy to pick up prescriptions.

So yes, the ads do catch people's attention, but they are valid.

Steven A James, MBA

Contact me.

Answer: Medicare is only valid in the US and its territories. If traveling abroad, or even venturing into Canada or Mexico, Medicare is not valid.

If you enroll in a Medicare Advantage Plan (Part C), the plan will provide coverage worldwide for Urgent Care & Emergency. If concerned, I advise folks to purchase travel insurance, either annually for frequent travelers or per trip.

If you purchase a Medicare Supplement, such as Plan G, the plan may pay the first $50K and then an 80%/20% cost share thereafter. Confirm with your plan benefits.

Steven A. James, MBA

Contact me.

Answer: Medicare alone does not pay for prescription drugs. Prescription drug coverage is attainable either by purchasing a standalone Prescription Drug Plan (PDP) or a Medicare Advantage Plan with Prescription Drug Plan included (MAPD).

You'd then simply review the plan's drug formulary to determine if a prescription is covered.

Steven A. James, MBA

Answer: Call Medicare 1-800-MEDICARE and request a replacement card.

Once you've received, I've always advised making a copy to carry with you if necessary and leave the original card in safe keeping.

Steven A. James, MBA

Answer: Medicare does not cover vision care. Which essentially is seeing an eye doctor or optometrist for vision care and obtaining prescriptions for glasses and/or contacts.

If the services is for a Medicare medically necessary such as treatment for glaucoma or cataract surgery, this would be covered by Medicare.

If you enroll in a Medicare Advantage Plan (Medicare Part C), these plans typically include vision care as well as a defined $ allowance for purchase of lenses/glasses/contacts.

Steven A James, MBA

Answer: Social Security expects a new Medicare beneficiary to enroll in their Part B as well as a Part D prescription drug plan (PDP).

When turning 65, you'll have a 7-month window (3mo ahead before your birth month, your birth month, and 3 months thereafter) to enroll in your Medicare Part B. If not, a Late Enrollment Penalty (LEP) would apply. If one goes longer term without having enrolled in their Part B, they'll eventually pay an additional 10% for each year without coverage above the current standard rate at the time of issue.

If one is retiring and losing employer/group coverage, they'll have the opportunity to enroll in their Part B without penalty, so long as creditable coverage has been verified.

Social Security also "expects" one to have a qualified PDP. If one doesn't enroll in a PDP plan, nothing happens until there is enrollment into a plan; either a standalone PDP or a Medicare Advantage Plan w/PDP. The LEP here is a % of the current standard rate for a PDP at the time of issue, multiplied by a % factor to establish the LEP.

Unfortunately, in either circumstance where an LEP is applied, this penalty is for life. Thus, it's always wise to make sure there's adequate research before becoming Medicare eligible or simply contact a credible agent.

Steven A James, MBD

Contact me.

Answer: Medicare does not pay for any dental unless it's for medically necessary procedures, such as TMJ, etc.

Medicare Advantage Plans (Part C) generally provide for dental coverage with as little as coverage for preventative services only to providing a dollar amount of dental benefit allowance, which typically covers most dental procedures except implants. These plan dental benefit allowances may range from $500 to $5000.

Steven A James, MBA

Contact me.

Answer: Social Security "expects" a Medicare Beneficiary to enroll in their Part B within the 7-month window of their Medicare Initial Enrollment Period (IEP) (3mo before birth month, birth month, and then three months after birth month). If not, a Late Enrollment Penalty (LEP) shall apply.

If one goes without enrolling in Part B, the penalty is a 10% increase above the current Medicare Part B premium. One would then be restricted to enroll in Part B during the General Enrollment Period (Jan - Mar). In the past, Part B would then start that July 1st, but I believe that's been updated, so it may start on the 1st after enrollment.

Social Security also "expects" a Medicare Beneficiary to be enrolled in a qualified Prescription Drug Plan (PDP). If not enrolled in a PDP, no penalty. The penalty occurs once the beneficiary enrolls in either a standalone PDP or a Medicare Advantage Plan with PDP included.

The PDP (LEP). There's a calculation of 1% x the national rate of an average PDP. If the national average is $30 and one goes 5 years without coverage, the penalty w/b $1.50. Unfortunately, this penalty is for life or until one is no longer enrolled with prescription drug coverage.

So, enrolling in Part B and prescription drug coverage during IEP is the soundest advice. There are circumstances that are special circumstances which help to avert an LEP, such as retiring and/or losing group coverage. Those who qualify for Low Income Subsidy ("Extra Help") from Social Security would also be eligible for a PDP LEP.

Steven A. James

Contact me.

Answer: You can search the Medicare website as well.

Medicare alone is only accepted anywhere in the US and its territories. There are generally 3 situations in which coverage is available for reimbursement.

1) In the US, with an emergency situation, but the nearest hospital happens to be across the border, generally Canada or even Mexico.

2) Also, in the US, but not an emergency if the nearest hospital happens to be across the border.

3) Traveling through Canada to and from Alaska, but considered to be a direct travel route.

However, if you have a Medicare Advantage Plan, you'd have coverage worldwide for Urgent Care & Emergency for a nominal copay.

With a Medicare Supplement, the plan may pay up to $50K and then a scaled cost share thereafter.

I happen to travel internationally frequently and also advise folks to consider travel insurance while traveling abroad.

Steven A James, MBA

Contact me.

Answer: ANOCs are in the process of being mailed out. If you haven't yet received a copy, simply contact your agent/insurance carrier and request a copy.

You may also simply go online and review any of the following: Benefit Highlights, Summary of Benefits and/or Evidence of Coverage.

Steven A James, MBA

Contact me.

Answer: Your insurance carrier should have an online search available to confirm if your desired providers are in network. As well, you may contact the providers directly.

I represent UnitedHealthcare here in the Seattle area. UHC contracts with all the major hospitals/clinics along the I-5 corridor except Kaiser which is its own entity. So, all the providers within those contracted hospitals/clinics are covered.

Steven A James, MBA

Contact me.

Answer: You plan should cover but nearly all surgeries require PA. Doctors/hospitals are going to confirm it's in place before any procedures to ensure follow up payment. Even Medicare requires PA as procedures must be deemed "Medicare medically necessary" to be covered.

Steven A James, MBA

Contact me.

Answer: If you have a Medicare Advantage Plan (MAPD) HMO plan, it simply means if you seek provider service in network you're covered. If you go out of network, you'd have no coverage and would self-pay. Essentially all MAPD plans provide worldwide coverage for Urgent Care and Emergency.

If a PPO is offered, covered in and out of network but at a higher cost share than in network. I'd suggest if you do go to an out of network provider, try to seek a referral from your PCP and have all or as much as possible testing service at an in-network provider.

Steven James

Contact me.

Answer: From my experience, the two don't actually work together. Most doctors who decide to provide concierge services do so to avoid dealing with insurance companies altogether. Here in the Seattle area, providers are typically charging from $2K to $5K. And this is regardless of the number of visits, if at all.

If you're on Medicare alone or have a Medicare Advantage Plan, these won't help directly ,but would if referred out to providers who would accept billing Medicare and/or the insurance company.

Steven James

Contact me.

Answer: Medicare is increasingly covering virtual therapy platforms through telehealth and digital mental health platforms. This would be covered under Medicare Part B as well as part of Medicare Advantage Plans (Medicare Part C) and would generally have the same cost-sharing/copay requirements as in-person visits. To have the mental health app covered, it would need to be FDA approved, a prescription would be necessary from a healthcare provider, and be deemed medically necessary to help with a qualified condition.

Steven A James

Contact me.

Answer: Medicare Supplement plans are identical regardless of carrier. The differences are with the preferred company from which to purchase, the price, and the insurance agent.

Med Supps come in different forms of the alphabet, with Plan G being the most comprehensive, as it essentially pays everything after Medicare except the Part B deductible, which will be $288 in 2026. Pricing is established based on the service area. For appreciably lower premiums, Plan N and then K may offer a more affordable solution and still provide substantive coverage after Medicare's payments.

If a Medicare beneficiary is also on Medicaid, they're ineligible to purchase a Med Supp. I also come across situations where a Med Supp may be the more appropriate plan, but is unaffordable. If you live in a service area where Medicare Advantage Plans (MAPD) aren't available, the only choice is Medicare/Supplement and Prescription Drug Plan (PDP). If one can't afford a Med Supp, then Medicare and a PDP would be considered the minimal level of coverage.

Steven James

Contact me.

Answer: Great question,

Again, Medicare is a federal medical insurance program for those who turn 65 or before 65 due to permanent disability.

Although you're not required to enroll, it's generally medical insurance for the remainder of your years. If you have more involved and/or complicated surgeries or necessary hospital stays, the tribal health service may not be fully adequate

If you've worked 10 years/40 quarters, you're fully "vested" and thus would pay no premium for Part A, which covers hospitalizations. Medicare Part B is the medical insurance for doctor and specialist visits, outpatient surgery, and more. However, Part B does have a monthly premium, which will be $206.50. If this is a challenge, one would typically contact State Medicaid for further guidance and assistance. I'd also consult with the tribal health benefits office to inquire if they provide any similar support.

Much of this also depends on where you live. I happen to live in the Seattle area, and there are multiple noteworthy tribes. Members may visit tribal clinics ,but because they're so close within the greater metro area, they'd also have access to the same hospitals and clinics as the general population.

Steven James

Contact me.

Answer: Before you make any changes, you do need to notify/confirm with all your providers if they would accept the proposed Medicare Advantage Plan (MAPD).

Depending on where you reside, the MAPD network may be more than adequate to meet your needs. If any or all your providers aren't in the network, you may simply decide to remain in your current coverage.

Steven James

Contact me.

Answer: Firstly, Medicare Part A, which covers hospitalization, Skill Nursing Care/rehab post in-patient hospitalization, and Hospice. If you've worked the requisite 10yrs/40credit, you'll have no monthly premium as you'd be fully vested.

Medicare Part B is your medical insurance for the remainder of your years. Alone, it covers services such as doctor/specialist visits, outpatient surgery, lab test, etc. at an 80/20% cost share. Medicare pays 80%, you'd have a 20% cost share after you've met the annual Part B deductible which increases from the current $233 to $288.

Social Security "expects" you to enroll in your Medicare Part B or it will result in a late enrollment penalty (LEP) which is permanent. SS also expects you to enroll in a qualified Medicare Prescription Drug Plan (PDP) or again, permanent late enrollment penalties may apply.

If you're looking to mitigate your coverage premiums, then a Medicare Advantage Plan would work best as these plans are full comprehensive medical plans and generally do include the prescription drug coverage as well as other benefits not available from Medicare, like vision, dental, fitness memberships and more.

These plans generally can be obtained for $0 monthly premium. You'll need to confirm if any plans are available in your Service Area/County. However, you must have both Medicare Part A & B. If none are available, your only option is Medicare alone with a PDP plan or Medicare Supplement with PDP.

Steven James

Contact me.

Answer: Again, to confirm, Medicare alone doesn't pay for prescription drugs. However, Medicare Part D does have a deductible, which increases from $595 this year to $615 next year.

If you have a standalone Part D prescription plan (PDP), the company doesn't have access to your Medicare $ and thus it's a true insurance plan that the consumer must pay for alone. This results in more exposure to the Part D deductible and higher cost share than compared to Medicare Advantage Plans (MAPD).

Most MAPD plans include the Part D prescription drug coverage, and often for a $0 monthly premium. Because the insurance company is receiving your Medicare $ to help fund the plan, they can better manage costs, resulting in your out-of-pocket cost share being appreciably less. Many MAPD plans only charge a lower Part D deductible for Tiers 3, 4 & 5 prescriptions.

You'll readily find that lower premium PDPs will require you to pay the full Part D deductible regardless of Tier level. Higher premium PDPs may better reduce your Part D deductible. And for many plans, if you use Mail Order, Tier 1 & 2 drugs can be obtained for $0.

Steven James

Contact me.

Answer: The 3-midnight rule gets its name from how Medicare counts days. For a person to meet the requirements of this rule, they need to have 3 consecutive days of inpatient hospital care — not counting observation — before admission to an SNF. This can occur in one or more hospital facilities.

The three days must be full inpatient days. The "clock" starts at midnight and ends 24 hours later. Time spent in the ER and Observation is excluded.

Medicare Part A covers Inpatient hospital care, Skilled Nursing Care post-inpatient hospital stay, and Hospice. The rule is to ensure beneficiaries have adequate inpatient care before dbeing ischarged to a SNF. Medicare itself will then pay for the first 20 days in SNF.

Steven James

Contact me.

Answer: Medicare and Social Security aren't affected because these are congressionally mandated expenditures. The current shutdown relates to debate over future budgetary spending for federal employees and programs.

In the background, because its employees are somewhat affected, claims processing and payments to providers may be affected by delays and not refusal of payments.

Steven James

Contact me.

Answer: Medicare is a Federal Medical Insurance program for eligible beneficiaries upon reaching age 65. There are no preexisting conditions that would preempt eligibility. Unfortunately, there are those under 65 who become eligible duo to permanent disability.

To be eligible, you must be a US citizen or Legal Resident having lived in the US for 5 continuous years. I've had numerous situations where someone or a family member returned home for an extended period of time and thus weren't eligible until they eventually would/could meet the continuous requirement.

Steven James

Contact me.

Answer: Generally, I advise that if you have numerous medical service needs, the Medicare Supplement G will ensure that your medical costs are covered and at a known cost; typically, simply the cost of your monthly premiums less the Medicare Part B annual deductible will increase from $257 this year to $288 in 2026.

However, Medicare Part D will have a $615 annual deductible, so depending on your plan, some or all may be mitigated. Typically, separate standalone prescription drug plans (PDP) will require payment of this deductible. If you consider a Medicare Advantage Plan (MAPD), you'd save paying the monthly premium of your Med Supp while also having a drug plan included. For some, this could be an annual savings of =/- $4K alone.

Keep in mind that MAPD plans are only available in certain service areas/counties. So even if this is the most desired/appropriate option, it may not be available.

The next consideration would be if your drug plan requires copays or coinsurance. Copays will cap your out-of-pocket cost per medication where coinsurance would require more. However, for 2021, the annual cap for your out-of-pocket exposure is $2,100.

Steven James

Contact me.

Answer: Medicare alone does not provide coverage outside the US. Generally, almost all Medicare Advantage plans provide coverage worldwide for both Emergency and Urgent Care for a very small copay. If you have a Medicare Supplement, it may pay up to a certain amount (i.e. $50K) and then a cost share for the remaining balance (i.e. 80/20).

Answer: The Medicare deductibles can change annually. For 2026, the Part B deductible increases from $257 to $288. The Part D prescription drug deductible also increased from $590 to $615.

The Part B deductible can be mitigated as for most Medicare Advantage plans this isn't required. However, the Part D deductible applies to MAPD as well as individual standalone drug plans but at varying rates.

Answer: Yes, Medicare does cover wearable medical devices. This would be considered Durable Medical Equipment and is covered under Part B. If you're a direct Medicare beneficiary, the provider would bill Medicare for its 80% and you (or a Medicare Supplement) would pay the remaining 20%. Further savings can be had with a Medicare Advantage Plan as the associated copays my help to further mitigate one's out of pocket costs.

You'd simply first confirm Medicare, or your plan accepts the provider/supplier for payment.

Answer: Yes, all preventative screenings are covered at $0 copays. This includes services such as pap smears, mammograms, pelvic exams, heart and stress screening.