Steven Kirsch, Medicare Insurance Agent

Answer: There is no catch. Medicare Advantage plans receive payments from the Federal government. Because of the money insurance carriers receive, they can offer a plan with zero cost.

Answer: Yes. Most Medicare Advantage plans offer Flex cards, which allow you to purchase over-the-counter items such as vitamins and first aid supplies. The amount of money deposited in the prepaid debit cards varies from company to company

Answer: I have not heard of any planned Medicare cuts. However, if there are cuts, it typically impacts providers, not patients.

Answer: Divorce will not affect your Medicare eligibility or benefits. However, your Medicare Part B cost could be reduced depending on your household income.

Answer: Part D plans vary from company to company. However, typically, you have 5 tiers of coverage. Tier 1 Preferred generic

Tier 2 Generic

Tier 3 Preferred Brand

Tier 4 Brand

Tier 5 Speciality

Depending on the medication you are currently taking, the cost would be based on the tier the medication falls into. That is why it is important to shop around with various companies to see if you can get a lower copay for your prescription.

Answer: Medicare can be overwhelming to individuals turning 65 after having employer coverage for the last 40+ years.

I enjoy working with seniors, and unlike individuals under age 65, the elderly really appreciate my help.

Answer: If you file a joint tax return, Medicare Part B is based on the household income from the prior 2-year tax return. Part B could cost you more than if you were single.

Answer: Original Medicare is not necessarily better; it is simply different. A Medicare Supplement plan provides coverage with a minimal deductible and small co-pays, if any, and it does not require you to use a provider network.

By contrast, Medicare Advantage plans are often less expensive and may include additional benefits, but they typically require the use of a provider network and may involve deductibles, co-pays, or other out-of-pocket costs for services.

Answer: You will have to wait until open enrollment in October unless you have a qualifying event. If you have a 5 star plan in your area, you may be able to enroll anytime during the year.

Answer: It's hard to say without all the information. However, typically, you will pay a co-pay for outpatient surgery and a in-patient copay if you are admitted.

Answer: Don't give out your Medicare claim number to anyone over the phone if you do not know who they are. Check your explanation of benefits each month to make sure you are being billed correctly.

Answer: If a family history of colon cancer has been documented, Medicare will most likely allow for more frequent colonoscopies than the usual every 10 years

Answer: I apologize that the agent did not clearly explain that some Medicare Advantage plans only cover dental cleanings.

Since open enrollment is still available, you do have the option to change your Medicare Advantage plan to another company that may offer additional dental services.

Answer: If you enroll in a Medicare supplement, you would have minimal costs after your Medicare Part B deductible. With an Advantage plan, you have inpatient and outpatient copays.

Answer: You can have a mammogram once a year as part of your annual physical. However, if a physician is concerned about something he sees, they could order additional mammograms.

Answer: Some insurance plans for 2026 do cover Breztri with a copay. To confirm coverage, you’ll need to review the insurance carrier’s formulary list to see which tier the medication is listed under.

Answer: Individuals living in a Continuing Care Retirement Community have the same Medicare options as any other Medicare-eligible person. You have the option to enroll in a Medicare Supplement (Gap Plan) with a prescription drug plan (Part D) or a Medicare Advantage (Part C) plan, which may even have a $0 cost.

Answer: In 2026, the maximum you’ll have to pay out-of-pocket for covered Part D drugs is set at $2,100.

That means once you reach that amount in cost-sharing (deductibles, copays, coinsurance) on covered drugs, your plan covers 100% of the cost for the rest of the plan year.

Because RA meds can be very expensive, having a hard cap is a big plus.

Under the Inflation Reduction Act, starting January 1, 2026, some high-cost drugs will have lower negotiated prices for Medicare beneficiaries. Importantly for you: one of the drugs listed is Enbrel, which is used for rheumatoid arthritis. So if you take Enbrel (or a similar biologic) this could directly reduce your cost.