Steven Whetstine, Medicare Insurance Agent

Answer: If you have a Medicare Advantage plan, you typically do not need to carry your Medicare card with you. You will receive a card to reflect your Part C Medicare Advantage plan that will take over for original Medicare.

However, it is very important that you still retain or keep your red, white and blue Medicare card in a safe place. Should you need to change your Medicare Advantage Plan or return back to Original Medicare and add a Medicare Supplement Plan / Medigap plan and Part D Prescription Drug Plan, then you will need your red, white and blue Medicare card to be able to change plans.

Only in rare situations will medical professionals ask for your Medicare card if you have a Medicare Advantage plan. For example, if you are traveling outside of your network and have an emergency situation, you may want to have a copy of the card with you for claims processing and billing purposes.

Answer: A $0 premium Medicare Advantage Plan is an option that is often referred to as Part C. Private Insurance carriers receive payments from the federal government to provide coverage for Part A Hospital, Part B Medical and often Part D Prescriptions and will take over from original Medicare.

This type of plan operates on a network. If doctors, specialists and medical facilities are important to you, then you will want to make sure they are in the network for the plan you are looking at for the year. Please keep in mind that insurance carriers and medical professionals can make decisions as to whether or not to partner up to be in the network.

Although the monthly premium is $0 per month, you still have to pay and keep Part B Medical. As you utilize the plan, you will want to see what your various costs may include such as copays, deductibles and coinsurance and determine what your maximum out of pocket limit might be for the year. The costs associated with these plans can change from year to year so it will be important to review the annual notice of changes that typically comes out each September. Finally, you will want to be aware of prior authorizations that might be required before you utilize certain benefits of the plan such as an MRIs, certain surgeries or skilled nursing care for rehabilitation.

Answer: No.

Medicare Part A Hospital and Medicare Part B Medical do not cover smart watches or fitness trackers.

The reason for this is that Medicare covers what is medically necessary.

Now, there have been programs that have helped Medicare beneficiaries acquire wearable devices such as a Fitbit, Garmin or incentives that can help one acquire some sort of smart watch. If you have heard through the grapevine that a neighbor, friend or family member received benefits to acquire a smart watch or fitness tracker, it is possible. Likely, it would be through some value added benefit that potentially could be offered through Part C Medicare Advantage plans. Part C or Medicare Advantage plans do have the opportunity to provide added benefits that are not covered by Medicare.

Please understand that each plan may have specific benefits, guidelines, and can vary from plan to plan what benefit might be available to obtain smart watches of fitness trackers. Typically, there would be some sort of incentive to help encourage healthy behaviors.

Finally, please keep in mind benefits can change from year to year. If you do have a plan that provides fitness benefits, please review your annual notice of changes that you should receive in September that outlines these benefits. Given the volatility with Medicare Advantage or Part C Plans, insurance carriers are continuing to evaluate which benefits should remain and which benefits need to be altered or eliminated completely.

Answer: One can call the insurance carrier directly. If you absolutely know what you want and are o.k. with dealing with the insurance carrier by yourself, then it may work for you.

However, there are advantages to working with a trusted independent agent or broker. An independent agent or broker can add value because they represent multiple carriers and can help compare coverage, pricing, exclusions, and service quality. Your experienced independent agents can share carrier history and may have other tools to consider such as rate increase history and financial strength of the company. They can also act as an advocate if there’s a claims dispute, underwriting issue, or customer-service problem.

Generally, I recommend finding someone you feel comfortable with and trust to help guide you through the process as you select a company that makes sense for you and your needs.

Answer: Typically, your Medigap or Medicare Supplement plan would be the same exact coverage as the plans are standardized by the federal government. However, there are three states where the standardization rules are different. What that means is if you move to or from these states, the standardization would be different. The three states are Massachusetts, Minnesota, and Wisconsin. What you will want to know is if you current insurance carrier will continue to offer insurance in the new state that you are moving to. Also, please be aware that your premium or rate can change from state to state as you change your address.

Answer: Yes, and it would fall under Medicare Part B (Medical).

If you are unsure as to whether Medicare covers a service or not, you can always go to Medicare.gov and click on "What Original Medicare Covers" under "Providers and Services." It gives you the opportunity to search and identify whether the medical service or treatment would be covered.

As far as how often one can get a Mammogram, it is dependent on the type of Mammogram. A screening is usually offered once a year. If it is a diagnostic mammogram, it can be more frequently as long as it is medically necessary.

Answer: With Medicare Advantage plans or Part C, it is difficult when there are generalizations that the plans include dental coverage. It is really important to know what coverage is included with each of the plans. Worse yet, over the years, the high profile celebrities come in and advertise "free" benefits and may share details that licensed, appointed and certified agents cannot and many would not say that are advertised on T.V. Although there have been attempts at regulating what is advertised on T.V., it is important to identify and understand the details of the plans according to the Plan ID.

Medicare itself does not include dental coverage. It is considered to be a value added benefit. It can be added to Part C or Medicare Advantage plans. Insurance carriers can choose to offer discount coverage which many do not consider true dental coverage, or can offer just preventative or basic coverage, and some opt to include more comprehensive coverage.

The "Evidence of Coverage" will reveal the details of the coverage which can be found on the insurance carriers website, Medicare.gov, and agents should be able to provide or send the evidence of coverage or summary of benefits documents that will outline the coverage.

As legislation has changed and insurance carriers evaluate utilization and rising healthcare costs, insurance carriers have had to adjust what benefits can be offered or have had to place maximum limits for items such as dental as well as vision and hearing coverage that may be added to plans. The Value Based Insurance Designs are sunsetting at the end of 2025 that were instituted in 2017. This has prompted insurance carriers to reevaluate benefits that may be included in the plans.

Answer: As of 2025, the "Donut Hole" was eliminated. You would have maximum out of pocket limits each year. If you have costly medications that require you to make a major payment up front, you can consider the Medicare Prescription Payment Plan also called MP3.

The Medicare Prescription Payment Plan does not reduce the costs of your medications. Rather, it allows you to spread the costs of your medication over the calendar year which can make it easier for budgeting purposes.

Answer: This is a good question with not enough space for me to answer.

Also, I am not sure if this was a question from last year for the 2025 year. If so, there were changes to where the coverage gap or "donut hole" was eliminated with the 2025 prescription drug plans having a maximum out of pocket instituted of $2000. Also, the MP3 option was implemented which was the Medicare Prescription Payment Plan allowing Medicare Beneficiaries who may have high cost medications to spread their payments over the annual year to make it easier for budgeting purposes.

For 2026, the maximum out of pocket limit will be increased to $2100 for prescription drug plan costs.

If referencing changes from 2025 to 2026, there have been a lot of changes in the Medicare market.

Many insurance carriers (not all) have reduced their footprint in the Medicare Advantage plan market across the U.S. A small portion of insurance carriers have increased their footprint.

Also, there is a move from PPO plans being eliminated or reduced, and many of the major insurance carriers are changing their focus to HMO plans within the Medicare Advantage market.

In addition, there was a VBID or Value Based Insurance Design model that was implemented in 2017 for Medicare Advantage Plans. This will end on December 31, 2025. This decision was made by CMS (Centers for Medicare and Medicaid Services) due to substantial costs within the program. What this means is that a lot of the benefits needed to be revisited by insurance carriers. Insurance carriers may have eliminated or reduced benefits or have switched their focus to benefits that Medicare beneficiaries tend to prioritize over other benefits. Many plans with similar benefits have switched focus to Special Supplemental Benefits for the Chronically Ill or SSBCI model. With this option, Medicare beneficiaries have to qualify to be in the plans and usually have 60 days to verify the chronic condition.

Plans should be reviewed annually.

Answer: If you are in a Medicare Supplement Plan or a Medigap Plan, you can change your Medicare Supplement Plan at any time. If you are not in your initial enrollment period or in a guaranteed issue period, you may be subject to underwriting.

One can change their plans during the Annual Enrollment Period. For Medicare, any changes can be done between October 15th - December 7th. If you have a Medicare Supplement Plan and want to change to a Medicare Advantage Plan or if you have a Medicare Advantage Plan and want to switch to a Medicare Supplement plan, you can change during this time. You can change from one Medicare Advantage plan to another Medicare Advantage Plan. Plus, you can change from one Prescription Drug Plan to another Prescription Drug Plan. The last selection you make by the end of the Annual Enrollment Period will be the plan that begins on the 1st of the new calendar year.

If you are during the Open Enrollment Period from January 1st to March 31st, you can make one change during this time. You are allowed to switch from one Medicare Advantage Plan to another. Also, you are allowed to switch from a Medicare Advantage Plan to a Medicare Supplement Plan or Medigap Plan and a Prescription Drug Plan.

Finally, you can change if there is a special election period. This is typically due to a move or loss of coverage. One would have up to 2 months after the event occurred. Again, you have one opportunity to make your selection.

Answer: No. Not as of October 2025.

You have to keep in mind several things:

1.) Medicare is a federal program.

2.) If a drug is considered illegal at the federal level, then a federal program is not going to cover that drug.

If a synthetic becomes an FDA approved medication, then this may be covered by Medicare through either Part B or Part D. Many of the medications approved for chronic pain or cancer are used to address nausea or vomiting as a result of these conditions.

Answer: That is a good question, and it sounds like you already focused in on the "why!"

IRMAA stands for Income Related Monthly Adjustment Amount and what it takes into account is your tax filings from 2 years ago. It would be based on your Modified Adjusted Gross Income or (MAGI). Should you fall into higher tax brackets, it could also mean that you will contribute more to Medicare costs, and this does apply to Part B (Medical) and Part D (Prescription Drug Plan) costs which can also be applied to Part C (Medicare Advantage Prescription Drug Plans).

Each year, those amounts can change. Typically, I have found that the federal government does not release this information until November. Once the preset brackets are adjusted and determined, the Centers of Medicare and Medicaid will release the information via tables to reflect the additional amounts you will have to pay and it could also be found on Medicare.gov.

You would also be informed of the additional amounts added to your Part B (Medical) premiums and Part D (Prescription Drug Plan) or Part C (Medicare Advantage Prescription Drug Plans) via letter by the Social Security Administration.

Answer: Yes! Absolutely. Here are some things to keep in mind:

1.) Where you file your taxes or receive your benefits is where you are going to base your Medicare benefits. You need to identify a licensed agent for that state. It is not enough for the agent to be licensed in their own state with a resident license. They also have to have a non-resident insurance license and be connected with an agency that also has an insurance license within your state. Each agent has to complete certifications for each of the carriers they represent in what we call a "Ready to Sell" or "RTS" status where the carriers plans can be offered.

Bottom line: If the agent is only licensed in their state and not yours, they will not be able to help you with a plan.

2.) When you contact an agent from another state, find out if they are a captive agent where they represent one company, or if they are an independent agent where they offer two or more carriers.

3.) Medicare Supplement or Medigap Plans are standardized across the nation with the exception of three states: Massachusetts, Minnesota, and Wisconsin. What this means is that coverage will be the same according to the plans available from Plan A to Plan N. Premiums will be different from location to location.

4.) Be aware of whether or not the agents are familiar with local plans. Agents should take the time to become familiar with regional plans. However, there are a fair amount that do not always take the time to learn more about the plans and offerings that a carrier may offer in a region, state or county. Also, you may be seeking a local plan that an agent from another state may not be able to pick up. There are a small number of carriers that will only allow local agents to represent their plans. It is good to ask in advance what carriers an agent may represent before you become engaged in deep discussions about plans.

One of the beauties of working with an agent in another state is convenience.

Answer: Since this question is for a very broad audience to review and not really with specific information, I am going to provide multiple answers in such a way that it may help multiple beneficiaries. By the nature of the question, it could be assumed that the person already has had a wheelchair, is needing it long term, and is looking for a wheelchair replacement.

First things first! Wheelchairs are Durable Medical Equipment or (DME).

How long do you need a wheelchair? What makes sense for you? Are you going to need more than a wheelchair? Do you need a bath / shower transfer chair too?

Your doctor or medical professional would work up an order to obtain the wheelchair. Then, you would get with the Medicare approved supplier to make arrangements for the wheelchair.

One approach can be to visit a lending closet for medical equipment. This equipment can be used to bridge the gap for people with temporary or permanent disabilities. It can be a means of accessing essential equipment without the burden of purchasing the equipment outright. Sometimes, lending closets provide equipment for free or for a very low cost or for a donation. It can also help with transition while you wait for the durable medical equipment to arrive specific to your needs.

If just using Original Medicare, this would fall under Part B (Medical). Medicare pays 80% of the cost, and you would be responsible for the remaining 20%. If you have a Medicare Supplement Plan or Medigap plan, the plan will kick in and you would be subject to the expenses according to the terms of the standardized plan. For example, if you had Plan G, your plan would cover the rest subject to the Part B deductible for the year.

If you are using a Medicare Advantage Plan or Part C, then you would have to look at the Explanation of Benefits or you can take a glance at the Summary of Benefits to see how durable medical equipment is covered under the plan.

Answer: Before I answer this question, the key term I am pointing out to this question is "Original Medicare." This is very important!

If one chooses a Part C Medicare Advantage plan, then this is no longer "original Medicare" as it combines Part A Hospital and Part B Medical. Often, it will include Part D Prescription Drug Coverage. Medicare Advantage plans are sold by private insurance carriers as an alternative to original Medicare.

With that being said, the underrated benefit of Original Medicare that many people overlook is the flexibility and ability to see any doctor or specialist or use any medical facility as long as the providers accept Medicare. One does not have to worry about networks. One does not have to worry about losing a medical professional. If traveling, one does not have to worry about getting back home due to being outside of a network. With original Medicare, there is no network.

Answer: I am receiving this question in August of 2025. With that being said, I hope you have an agent or a broker that informed you that there is no donut hole in 2025.

Also, if you find that you cannot afford your medications, there are a number of ways to tackle this scenario.

Every year, it is good to review your plan and see what your total estimated cost would be with premiums and copayments.

Also, you can see if it is better to use your plan or look at other programs such as GoodRx, Clever Rx, Well RX, and other prescription discount plans.

You can check to see if Medicare Savings Programs may be of assistance, Extra Help for Part D, or State Pharmaceutical Assistance Programs.

Some manufacturers do offer financial assistance with formularies of prescriptions.

Finally, if all of your costs are more at the beginning of the year, you may want to check into the Medicare Prescription Payment Plan with your insurance carrier or MP3. This allows you to budget your expenses over the course of the annual year rather than pay so much up front which makes it easier for beneficiaries for budgeting purposes.

Answer: The short answer is that it depends on if you have expensive medications similar to your friend.

All Prescription Drug Plans and Medicare Advantage Prescription Drug Plans have to offer this option as of 2025. It is voluntary. If you have expensive medications, it will make it easier for budgeting for the year as it will divide the balance by the number of months in the year. You still have to pay any plan premium if applicable. You would pay the plan rather than the pharmacy.

To know if it would be beneficial for you, Medicare does also offer on their website a way to determine if it makes sense for you at: https://www.medicare.gov/prescription-payment-plan

If you would be expected to hit the maximum out of pocket expense cost early to mid-year, it would likely make sense for you. If September or any month thereafter, it would likely not make sense for you.

Answer: When you move to a rural area, it does limit your Medicare Advantage options as Health Insurance Carriers do not find it profitable to operate in these areas due to limited resources and healthcare provider networks. As a result, there may be fewer plan types such as HMOs only or very few other options to include PPO options. Lower population densities mean also less doctors, specialists and medical facilities in the area which makes it more challenging to have more Medicare Advantage Options due to the limited networks. For example, it will be easier to find Medicare Advantage plans in more populated states such as Florida, Texas, California, Arizona, etc. with larger metropolitan areas than those states that do not have high density populations such as Wyoming. Less populated areas generally mean higher costs to serve the health insurance needs of those populations.

Answer: Long-Term Care!

Medicare does not cover long-term care needs specifically. It may cover for shorter term care needs such as skilled nursing care for rehabilitation or hospice.

Long term care expenses can be catastrophic financially.

Also, Long term care costs can also vary according to geographic location.

Many assume Medicare will cover these costs, children will take care of them, or it will not happen to them. However, children often have to work or have children of their own to care for or may be separated by distance and relocation expenses may be involved. Perhaps, assistive devices need to be installed such as grab bars, ramps, non-slip devices, etc. Also, a child or a Medicare beneficiary may not feel comfortable helping or receiving help with some activities of daily living such as toileting.

Long-term care can also vary by need and be provided in a number of different ways. A Medicare Beneficiary may need partial long-term care to assist or may need full-time care. It can be provided in various settings to include at home, in assisted living facilities or in nursing homes which can vary greatly in cost.

The bottom line is that Medicare does not provide coverage for chronic conditions that impact one cognitively or impact someone to where they cannot perform two or more activities of daily living such as eating, bathing, dressing, transferring, toileting, or continence.

Finally, there are multiple ways to address long-term care that are non-insurance and insurance based outside spending down assets. Some of the insurance plans can include long term care insurance, life insurance policies with long term care riders, and some annuities may have options to assist with long term care costs such as fixed indexed annuities.

Answer: Centers of Medicare and Medicaid Services or CMS may be prompted by legislative or executive action to create strategies in response to health issues. For example, when COVID-19 impacted the United States, telehealth was implemented to allow Medicare Beneficiaries to still connect with a medical professional without possible exposure to COVID-19.

Medicare could use costs and utilization data to monitor geographical areas to see if there are needed adjustments or potentially adjustments in reimbursement models. If it is due to heat stroke, maybe there is a potentially higher reimbursement to address health conditions during summer months.

It is also possible there may be a look at ways to implement more preventative care measures to keep medical costs low.

Chronic special needs plans may become more prevalent in Medicare Advantage Plans (Part C) as various climate conditions could cause serious or chronic conditions to intensify such as cardiovascular issues or respiratory illnesses.

Answer: Maximum Out of Pocket limits are just like it sounds. It protects you from catastrophic medical benefits.

Mainly, Medicare Beneficiaries would be concerned about Maximum Out of Pocket (MOOP) limits in Medicare Advantage Plans (Part C) or now Prescription Drug Plans (Part D) options (starting in 2025).

Maximum Out of Pocket limits can change each year, and your insurance carrier will typically communicate that through the Annual Notice of Changes (ANOC) that typically would be sent out in September.

It is important to know what counts and does not count towards the Maximum Out of Pocket Expenses. It is also important to note if there is a single Maximum Out of Pocket limit or in the case of PPO plans, there may be a combined in and out of network limit.

What counts toward maximum out of pocket expenses? This would be your co-pays, coinsurance, and if there are any applicable deductibles. This is also important to note the specifics of any deductibles on any Part C or Part D plan.

What does not count towards maximum out of pocket expenses? Services not covered under the plan, monthly premiums, and prescription drug costs that would be under a separate Maximum out of Pocket category. Balance billing or out-of-network surprise hospital visits also may not count towards maximum out of pocket expenses either.

One final special note: If there is a concern about maximum out of pocket expenses with prescription drug plans, there is now an option as of 2025 (subject to change with legislation). There is no cost to this option and is completely voluntary. In my experience, some Medicare Beneficiaries find it difficult to pay for the costs of their prescriptions all at the beginning of the year. It is called M3P or MP3 with the various insurance carriers. It is short for Medicare Prescription Payment Plan, and it allows the Medicare Beneficiary to spread their prescription costs over the annual year which makes it easier for budgeting purposes.

Answer: The good thing is that I do a good job explaining to my clients how their insurance works and they know how to reach out to me if they are unsure about anything.

On the other end, those that are not my clients! Perhaps leads or those seeking truth and trying to get information from the general public. There are several frustrating misconceptions out there even when I see Medicare Beneficiaries interact with one another on social media. Knowing the difference between a Medicare Supplement Plan and a Medicare Advantage Plan is a big one! There are many Medicare Beneficiaries who have Medicare Advantage Plans that say they have a Medicare Supplement plan and spread disinformation. It makes me cringe when I read the posts on social media and people spread incorrect information. Picking a plan is important and can have consequences if you choose the incorrect plan for you. That is why it is important to seek guidance from a licensed and certified agent that can assist you.

On that note, it is also important to know your agent and develop a relationship with them. There are many businesses out there that have similar names, and it is important to verify which agent and business you are dealing with when choosing your Medicare options. There are ways to verify if an agent and business is licensed within the state. Personally, I have received complaints from individuals that are not my clients only to gather more information and identify the bad actors and have those agents and their entities become compliant with the state. If a person has their own business, many times they have to have both an active individual and entity license. It is important to do your homework.

Answer: One of the biggest priorities is going to be identifying what makes sense for you. The biggest mistake that people make when choosing plans is choosing a plan based on what is the lowest premium. Sometimes, this does work, but you typically need to get an idea of what total estimated annual costs may be and utilization (premiums and out of pocket costs factored together).

Personalization is very important when considering Medicare options. You will need to evaluate whether or not your medical professionals will accept the plan or are in the network. If a medical professional accepts Medicare, then a Medicare Supplement or Medigap plan will make sense without being dependent on a network. With a Medicare Advantage plan, you have to check to see which Medical professionals are in the network and whether or not the plan will cover costs out of network.

No monthly premiums may be enticing on a Medicare Advantage plan, but you will have to consider deductibles, copays and sometimes coinsurance as well as potential maximum out of pocket costs within the year. Medicare Supplement plans tend to have a premium each month and tend to take care of more out of pocket costs. Out of pocket expenses would be dependent on which plan is chosen.

For prescription drug plans, you will want to consider which pharmacy or pharmacies that you may use, the exact formulary or prescription that you take (Brand versus generic, tablet versus capsule, and dose), and the frequency that you take the prescription(s). While your prescriptions can change in time, it is a good indicator of what plan makes sense for the upcoming year and the prescription drug plans can be evaluated each year to ensure that the plan still makes sense the following year.

Answer: Recently, I had the opportunity to earn the trust of a client living with a cognitive condition. Her Power of Attorney and Medical Power of Attorney shared with me the challenges they faced in navigating her insurance coverage and accessing the care she desperately needed. She had low income and there was a disconnect in the copayments for her prescription drugs. They lived in a remote rural area, where finding the right doctors and specialists was already a major obstacle.

Several critical issues were on the line. The client had not seen a doctor or specialist for months, despite the clear need for continued care. On top of that, her prescriptions were running low, and there was an urgent need to switch from a local pharmacy to a mail-order pharmacy to simplify and ensure ongoing medication access. The pharmacy was stating that the prescriptions would be at a higher amount which sent the medical power of attorney into a panic due to their limited resources.

Many agents step away once a policy is signed—but for me, that’s just the beginning. I believe in advocating for my clients every step of the way. I knew it wouldn’t be easy, but I listened carefully, asked the right questions, and committed myself to finding a path forward.

The results speak for themselves. She was successfully scheduled for vital diagnostic testing to assess the stage of her cognitive condition and got appointments with the necessary specialists. Additionally, the mail-order pharmacy responded immediately, ensuring she received the life-saving medications she needed—without interruption. Plus, there was an investigation into the copayments and the formularies of the prescriptions which resulted in an outcome in the client's favor.

This experience reminded me why I do what I do. It's not just about policies or paperwork. It is about people, and doing what’s right for them when they need it most.

Answer: Yes! Medicare Supplements operate differently than Medicare Advantage plans (Part C) and Prescription Drug Plans (Part D)>

However, you may be subject to medical underwriting. If you proceed with an application, do not cancel your current Medicare Supplement or Medigap coverage until you are approved and the policy is issued with the new insurance carrier.

There are many reasons for changing a Medicare Supplement plan. Many insurance carriers can choose to increase a premium on the anniversary date and some may even increase your premium twice a year corresponding to their fiscal year and your anniversary date.

Some carriers may choose to close out a certain block of business at any time which prevents new beneficiaries from entering the same plan. When this happens, a combination of factors happens such as beneficiaries exiting the plan, some beneficiaries become deceased, and those beneficiaries still alive tend to have more claims with age which could require that insurance carrier to increase premiums even further.

Answer: It is a very good question and there are various timelines to follow.

Periodically, you can check mainstream media to identify what changes are happening in the healthcare industry. Mainstream media may leak information or make announcements based on what insurance carriers may release on their own news releases.

If you have a Medicare Supplement or Medigap plan, you can get ahead of the curve. Medicare Beneficiaries have anniversaries at different times of the year. You do not have to wait for annual enrollment period to change a Medicare Supplement or Medigap plan.

Agents usually can only start certifying in late June and it can take independent agents several months to certify for the new annual enrollment period as insurance carriers have different release dates for agents to complete certification requirements for that carrier.

Annual Notice of Changes (The Insurance Industry calls it ANOC for short) usually comes out in September. Please make note of all of the changes that will take place January 1st should you decide to keep your current plan.

One thing that is important is making sure all of your information such you keep a list updated of you current doctors and specialists, as well as all of your medications (Make sure to make note of exact name of prescription as it could be a brand name or generic), the dose, and frequency you take your prescriptions as well as preferred pharmacy or pharmacies. Some agents have different resources that can share with you to update this information and some even update the information on Medicare.gov.

From October 1st - October 14th, Medicare agents or brokers can review the upcoming year's plans with you. However, please note that Medicare agents or brokers cannot make any changes until the official Annual Enrollment Period begins. Annual Enrollment Period is from October 15th - December 7th of each year. Any changes will take place on January 1st.

Answer: First, please note this question highlights Medigap Plan C and not Medicare Part C! There is a clear difference between the two options. If you have Medicare Part C (also known as a Medicare Advantage Plans), then you would have to look at the plan details to see if bloodwork is included.

Since the question is specific to Medigap Plan C or Medicare Supplement Plan C, original Medicare would take care of the first 80%. The Medigap Plan C would take care of the remaining amount for Part B (Medical) coinsurance and the Part B deductible.

Really, the only thing that would not be covered under Part B would be any Part B excess charges. While excess charges are not always charged, they can be! Medicare Part B excess charges are extra fees charged by a doctor, provider or supplier that does not accept Medicare assignment. These out-of-pocket costs can be up to 15% more than the Medicare-approved amount for the service provided. One way to avoid excess charges would be to receive care from Medicare-approved providers who accept assignment. If you choose not to receive care from Medicare-approved providers who accept assignment, then you would need to budget for the costs due to excess charges.

Answer: Original Medicare with a Part D is better than a Medicare Advantage plan for frequent travelers as doctors, specialists, and medical facilities that accept Medicare will accept Original Medicare. It is important to consider a Medicare Supplement Plan or Medigap Plan to address some of the other 20% of costs that original Medicare does not cover. If you travel outside your geographic area, chances are you are going to travel outside of your network which means that costs could be more expensive or may not be covered. If you travel outside of the network, you are mostly covered in the event of an emergency situation.

Part D Prescription Drug Plans offer a nationwide network. In many cases, there are more than one preferred pharmacy within the network for fulfilling prescription drugs, but many also will allow you to fulfill it at other pharmacies at the standard pharmacy rates which could mean higher copays or coinsurance.

The bottom line is if you travel frequently and may become ill on the trip, you have more flexibility and can see a doctor or specialist immediately without having to wait until you get back home to get back to your network. There are no network restrictions with original Medicare and Medicare Supplement or Medigap plans. You also do not need referrals.

Answer: Take the time to understand the difference between Part A (Hospital), Part B (Medical), Part C (Medicare Advantage) and Part D (Prescription Drug Coverage) along with the Medicare Supplement or Medigap plans.

Know your Medicare timeframes and when you can choose your plans.

Do not wait until the last minute as it can add to the stress of feeling overwhelmed.

Medicare.gov has a lot of free resources and 1-800-Medicare can answer general questions about Medicare.

State Health Insurance Programs or SHIP is a free resource that is available in every state. This gives people an opportunity to ask questions to help navigate the complexities of Medicare and they provide insurance counseling.

Consider whether or not your preferred doctors, specialists, and medical facilities will accept your plan. Identify which plans will minimize your out-of-pocket expenses for prescriptions with the pharmacy of your choice. Evaluate your situation carefully to consider not just premiums, but copays, coinsurance, and deductibles. You want to evaluate your total out-of-pocket expenses when you consider your options.

Find an Independent Agent or Broker you can partner with whom you can trust and can be an advocate for you. Independent Agents or Brokers can simplify the process, and can identify what makes sense for your particular situation. Also, Independent agents use resources that will help identify what makes sense financially, and tend to keep informed of changes within the industry.

Answer: When choosing Medicare options, it is important to know what is important to the Medicare Beneficiary and Healthcare needs.

Some factors may include health risks and needs, financial concerns, lifestyle preferences and how one chooses to receive treatment or care.

For example, if your preference is to receive care through the Mayo Clinic, the Mayo Clinic only accepts original Medicare and Medicare Supplement or Medigap Plans. They do not accept Medicare Advantage Plans.

If you like to travel or reside in more than one state in the year, then Medicare Supplement or Medigap plans typically make more sense. You are not limited to a network and can receive your medical care anywhere. With a Medicare Advantage plan, you typically have to wait until you get back to your local area within your network unless it is a medical emergency.

If someone has a chronic or severe condition, I evaluate their situation. Is it during their initial enrollment period? That has to be considered as there are no underwriting questions for a Medicare Supplement Plan or Medigap Plan and factor high utilization. Otherwise, a chronic special needs plan may be appropriate for the person if they meet the criteria for the plan.

If one would like more flexibility in their care, a Medicare Supplement or Medigap plan may make sense because you do not have to get a referral and you can see any medical professional or visit any facility as long as they accept Medicare whereas you have to verify that your medical professionals and facilities are within the network with a Medicare Advantage plan.

Would you prefer to pay a higher premium with less out of pocket expenses, or would you rather have no premium or much smaller premium and pay the out-of-pocket expenses as you utilize the plan?

There are many things to consider when choosing the appropriate Medicare plan for you!

Answer: In Medicare, there are three major types of Special Needs Plans with Medicare. They are specific to Medicare Advantage plans. It is important to review which plans are available in your geographic area.

Institutional Special Needs Plans are very specific to a nursing home level of care or in a nursing or assisted living setting.

Dual Special Needs plans are specific to Medicare Beneficiaries who have both Medicare and Medicaid.

Chronic Special Needs Plans are for people with chronic or severe conditions. This can include individuals with chronic heart conditions, cardiovascular disease, diabetes, autoimmune diseases, and certain neurological diseases. These plans offer benefits specific to the chronic and severe conditions and offer an enhanced coordination of care for Medicare Beneficiaries who have this plan.

Answer: Medicare can be very complex with Parts A, B, C, and D and if choosing a Medicare Supplement or Medigap Plan, there can be Plans A through Plan N.

Medicare plans can change from year to year. It is important to make sure that the options continue to make sense for health and financial needs. Sometimes, rates can go up astronomically, and it may make sense to shop around to ensure that the plan continues to make sense from a financial standpoint.

Following up can provide more peace of mind, and boost confidence that the proper decision was made that is specific to health and financial needs. It can help reinforce key topics on the Medicare discussion. It allows time for processing thoughts on Medicare, and address any further questions or concerns about the Medicare options.

Answer: It is good that you are skeptical with going with the cheapest Medicare plan. It is important to identify which plan makes sense for you.

The cheapest month to month plans are typically Medicare Advantage plans. While this may not be a bad thing for your situation, you do want to make sure that you choose the plan that makes sense for you.

Choosing the cheapest plan will usually mean less coverage and a limited network. When you choose that option, you will want to make sure your preferred doctors, specialists and medical facilities are in the network. In addition, you will want to make sure your prescriptions are covered and identify the preferred pharmacies in the plan to make sure it makes sense for you. Less coverage can mean more copays. deductibles and coinsurance as you utilize the plan. Often, there is a maximum out of pocket annually for these plans. Choosing a Medicare Advantage plan can mean that there is no out of network coverage in many cases, and the service would be limited to your geographic area unless it is considered an emergency situation.

Cheaper plans can elect to change their coverage annually. Often, you will receive the annual notice of changes in September prior to the Annual Enrollment Period. Cheaper plans tend to mean less stability and can mean cuts to benefits or higher copays, deductibles and coinsurance over time. It is important to evaluate if a cheaper plan makes sense for you if you have a chronic condition as expenses can really add up as you utilize the services. Some people opt to add coverage through an indemnity plan to address the gaps in coverage and out of pocket expenses.

Answer: If you feel like a Medicare seminar is like a timeshare pitch, it may be important to trust your gut feeling.

Unfortunately, there are bad actors out there that will hold Medicare seminars to push certain Medicare products because it will give them the most commissions. Often, this is a person that is holding seminars to push Medicare Advantage plans.

While Medicare Advantage plans are not a bad option for some people, it is a good idea to go to an Educational seminar or ask an agent the pros and cons for both Medicare Advantage plans and Medicare Supplement plans. You would want an unbiased perspective to identify what option makes sense for you.

A licensed and ethical agent will ask you questions to identify what Medicare options make sense for you and your specific situation.

If you ever feel any pressure to sign up now, it also can be a warning sign. The only time where you may ever need to sign up immediately is if you waited until the last minute for your election period and may be forced to make a decision as soon as possible. Identify an agent you can trust that can guide you through the process.

Answer: There are several major mistakes that Seniors or Medicare beneficiaries make when enrolling in Medicare, but the biggest mistake is missing the initial enrollment period or guaranteed issue period when it first becomes available. If you have health concerns and miss your enrollment period, you could be subject to health underwriting if you miss the initial enrollment period or guaranteed issue period.

Some Medicare beneficiaries assume that Medicare is free. Most Medicare beneficiaries do not have to pay Part A (Hospital) if they or a spouse or former spouse worked at least 10 years or 40 quarters and paid Medicare taxes. Most people have to pay a premium for Part B (Medical).

Another mistake Medicare beneficiaries is not taking the time to understand their options. If an option is not affordable, it is important to look at what makes sense to according to finances and looking at ways to receive "Extra Help" to address the financial concerns.

Even if you are healthy or do not take any prescriptions, it is important to make sure that you have coverage. A person's health can change at any time. If you miss an election period, then you can face lifetime penalties on both Part B (Medical) and Part D (Prescription Drug Coverage). Also, you may have to wait until those timeframes become available.

It is a good idea to get Medicare through a licensed agent you can trust. They can be an advocate for you in the event you experiences any challenges with Medicare or with your plan to include claim issues. If you enroll directly with the plan itself, you may not have that free benefit that is available to you.

Answer: The biggest disadvantage to a Medicare Advantage plan is the limited network of doctors and hospitals and care access. If you choose to see a doctor or visit a hospital, out of network expenses can be very expensive and the plan may not cover out of network expenses at all. Medicare advantage plans may only allow you to use certain durable medical equipment within the plan.

Sometimes, plans may require that you get a referral or prior authorization. For example, the HMO plans may require that you see the primary care physician who is the gatekeeper to get a referral to see a specialist.

Medicare Advantage plans are typically restricted to the local area. If you travel, it is important to consider that you may not be able to see a doctor or specialist unless it is an emergency situation.

Medicare Advantage costs can be unpredictable. You will want to check all of the details of the plan to include copays, coinsurance and deductibles as well as the maximum out of pocket amount for the calendar year. Medicare beneficiaries who choose a Medicare Advantage plan need to consider utilization which factors into the unpredictability of costs.

Answer: It is important to review doctors, specialists and medical facilities within a Medicare Advantage plan as Medicare Advantage Plans operate under a network. Networks can change each year, so it is important to review your plan each year to make sure the specific plan covered doctors, specialists and medical facilities that are important.

Each Medicare Advantage plan will be different, so you will have to check the zip code where you file your taxes each year to verify the doctors are within the network. Each plan will have something along the lines of a "Find a Doctor" or "Provider Directory" option on their website to verify the doctors within the network.

Also, you can contact the doctor's office directly. However, it is important to not only check if they accept the insurance carrier, but also if they accept the plan or are within the plan's network. Some doctors may accept some plans but not others under the same insurance carrier. Perhaps, the doctors will accept HMO plans, but not PPO plans or PPO plans and not HMO plans.

Out of network costs can be costly. Some plans may cover out of network costs while others do not cover out of network costs at all.

Answer: One of the biggest mistakes is choosing a plan based solely on the premium and not factoring the out of pocket costs and pharmacy or pharmacies that will be used.

A Medicare beneficiary will want to check to see if their preferred pharmacy is in the network for the Part D Prescription Drug Plan. Each insurance carrier will have different preferred pharmacies within their network.

It is important that one identifies the correct prescription that will be taken when reviewing the formulary under the plan. It can make a difference if reviewing tablets versus capsules or brand name versus the generic option.

It is important to review the Part D plan annually as your needs may change with prescriptions, and the plans change annually. Premiums, deductibles and copays can shift each year. Also, prescription formularies can change tiers from year to year.

Also, it is a great idea to have a discussion with the medical professionals who prescribe prescriptions to identify which medications would work well to treat you and what options could potentially save you money.

It is always good to look at the bottom line. You always want to look at the total estimated costs rather than which plans offer you the lowest premium.

Answer: There are multiple ways to address prescription drug costs.

First, you can see if you qualify for "Extra Help." You can visit Medicare.gov/extra help to learn more about the program or call 1-800-MEDICARE.

If you qualify, this can reduce or eliminate your Part D premiums, deductibles, copays, and coinsurance.

You can use prescription discount cards. This includes Clever Rx and Good Rx, and many retail areas offer programs such as Kroger and Walmart with their own savings programs.

State Pharmaceutical Assistance Programs can also help with reducing premiums or copays. You can contact your local SHIP (State Health Insurance Program) and talk to a counselor or Medicaid office to check on eligibility and also possible receive enrollment assistance.

Drug Manufacturers sometimes have programs of their own to provide assistance. You can see if the drug manufacturer offers a patient assistance program to help cover the costs of the medications.

You can check the Health Resources and Services Administration website. You can check to see if there is a Federally Qualified Health Center near you. Federal Qualified Health Center pharmacies offer medications at reduced prices under the federal 340B program.

In addition, there are foundation grants available in some cases. PAN Foundation, Health Well, Patient Services Inc, Cancer Care, NORD, Patient Advocate Foundation, Good Days, LLS and more offer grants for disease specific conditions. There are often chronic illness funds within these nonprofit and charitable foundations that can assist with prescription costs, and some may help with premiums and potentially travel costs.

Finally, one thing to consider is checking into the Medicare Prescription Payment Plan with your prescription drug coverage. The insurance industry also calls it MP3, and it allows you to spread your costs over the year with capped costs instead of all at once.

Answer: It depends on your scenario.

If you had already scheduled your knee replacement prior to taking out your policy and you enrolled during open enrollment or a guaranteed issue period, then there was no underwriting and no wait for preexisting conditions. After original Medicare pays for Part A (Hospital) and Part B (Medical), the Plan G would pick up the remaining costs except for the Part B deductible.

If you took out the policy and it was not the open enrollment or a guaranteed issue period, medical underwriting would have applied. Original Medicare will still cover its share. As far as the Medicare Supplement Plan G, there would have been some disclosures included within the policy. Many insurance carriers would not have covered the knee replacement. Generally, they ask for you to keep coverage and contact them after the knee replacement. Some insurance carriers may impose a preexisting condition waiting period and may not cover the costs associated with the knee replacement. Some insurance carriers may not have issued a policy had the knee replacement been disclosed prior to taking out the policy.

Answer: If you are enrolled in the Medigap Plan F, you generally do not pay for any Medicare covered services in the United States. After Part A (Hospital) and Part B (Medical) are covered by original Medicare, the Plan F would pick up the remaining costs as long as it is covered by Medicare.

When you go to the ER and it’s a Medicare-covered visit, you should not expect to pay any copays, coinsurance, or deductibles.

Answer: You will sign up for Part A (Hospital) and Part B (Medical). If you worked long enough, you will not have to pay for Part A. For Part B (Medical), you will have to pay the premium each month.

To start, you will need a letter of creditable coverage through your employer which you can get through your Human Resources or Benefits Administrator. You would need this to complete the CMS-L564 form through social security to reflect proof of employment and that you had employer coverage. Most people sign up through the social security website at ssa.gov which is the gatekeeper for Medicare whether you are taking social security or not. You can also call or visit the local social security office.

Once you get your Part A (Hospital) and Part B (Medical) set up, you will be granted a special election period to identify the options that make sense for you.

Answer: It depends on your situation.

If you are in the initial enrollment period, it may be good to get an idea 3-6 months in advance. Part of this would also depend on which Medicare option you choose.

If you have a life event, it is important to look into your options as soon as possible and determine how much time you have in what is considered a special election period. A life event could include events such as a move or loss of employer coverage to name a few.

If you have a Medicare Supplement or Medigap plan, you can change insurance carriers at any time. There is not a specific timeframe. Please be aware that underwriting may be involved. Many people will review their plan when they receive a notification of a change in premium which tends to happen on the anniversary of the policy.

For Medicare Advantage and Prescription Drug plans, Medicare beneficiaries will receive an annual notice of change notice in September as to all changes that will take place for the upcoming year. For discussions on other plans options, you can start checking into plan options on October 1st. However, you would not be able to make any changes to these plans until the official Annual Enrollment Period which runs from October 15th - December 7th.

If you make an election and are not satisfied with the plan during the new year, you have from January 1st through March 31st to make one change which is called an Open Enrollment Period, and it could be effective as early as the 1st of the following month.

Answer: It is important that an agent get to know your situation or needs before offering any product or service.

If an agent automatically offers a product without asking you any questions, it may be a good idea to part ways with that agent as they are not looking out for your interests. There is a good chance that the agent may be steering you to a plan that is going to give them the most commissions.

If an agent seems overly aggressive or pushy, that would be a concern. It is important to know key dates and important deadlines as it relates to making Medicare decisions.

Also, it is important that an agent takes the time to answer all of your questions.

If the agent is not willing to answer your questions, then they are also not likely going to advocate for you when you enroll in a plan with them should you need service or assistance in the future.

Answer: In most cases, Medicare does not cover dental services like routine cleanings, fillings, tooth extractions (removals), or items like dentures and implants. Medicare also does not typically cover eye exams for glasses or contacts. However, Medicare does cover certain eye care services if you have a chronic eye condition, such as cataracts or glaucoma. Medicare covers: Surgical procedures to help repair the function of the eye due to chronic eye conditions.

Sometimes, Medicare advantage plans or Part C, will include dental and vision coverage. However, it is important to know what is covered and excluded in the plan with the insurance carrier. Each plan is going to be different as some only provide discounts on dental and vision, some only allow for basic or preventative services, and some have specific coverage limits with various benefits and exclusions.

Medicare Supplement Plans or Medigap Plans do not typically include dental or vision coverage, but insurance carriers may opt to add a rider for dental coverage.

In many cases, it is important to identify your needs. You can purchase stand alone dental and /or vision coverage or sometimes there are Dental, Vision and Hearing plans (DVH plans) that can also provide coverage for the areas where Medicare does not provide coverage.

Answer: Yes!

You want to find a Medicare agent that is going to be a good fit for you. Identifying what makes sense for you is an important decision to make as you consider your Medicare options.

Some agents are captive agents meaning they represent one company. Some call themselves an independent agent or independent broker. In these instances, you need to have an idea or understanding of what insurance carriers the agent is contracted and appointed with. An independent agent is not limited to how many insurance carriers they are contracted, appointed and certified with. Some call themselves an independent agent or broker with only a few contracts and some have may contracts with many insurance carriers. Personally, I attempt to gain as many contracts as possible and have hybrid contracts as I know not everyone has the same needs.

You will need to make sure that the agent has a license for the state that you file your taxes in. Where you will file your taxes is where your plan is going to be based.

It is good to get an idea if an agent has certain biases. Some agents may influence your decisions to give them the most commissions. Some agents, like myself, will listen to your situation and identify what options make sense.

Answer: I chose to become an Independent Medicare Agent because I wanted to make a meaningful difference in the lives of Medicare beneficiaries. My journey began with a deeply personal motivation. It began helping my parents as they navigated the complex Medicare system while supporting my grandparents.

Over time, I changed my career path from the property and casualty insurance so I could learn the intricacies of Medicare and be able to assist more of my family. Little did I know at the time that I would eventually leave as a captive agent and branch out as an independent agent with my own business.

As I grew more experienced in this field, my passion for helping others only deepened as I continued within the industry. I provided assistance to insurance carriers within the industry to help facilitate more options for Medicare beneficiaries within the market.

Unfortunately, I also witnessed firsthand how some agents exploited seniors, even going so far as to use my business name unethically to boost their commissions. These experiences only strengthened my resolve to operate with integrity and advocate fiercely for those I serve.

Being an independent broker allows me the freedom to get to know my customers, understand their unique needs and provide appropriate solutions tailored to their needs. I am intentional in picking up as many contracts as possible with insurance carriers to facilitate those needs. I receive a lot of referrals because my clients know that I am one who can be trusted. I operate with integrity to the extent that I will enroll clients in products that may not offer commissions. I started with my family. Now, I am here for yours!