Tory Blain, Medicare Insurance Broker

Answer: The most common Medicare penalties are for enrolling in Part B or Part D late when you don’t have other creditable coverage. Those penalties can increase your monthly premium and, in many cases, last for as long as you have Medicare.

Answer: Medicare can cover physical therapy when it’s medically necessary, but the cost and rules can depend on your plan. Talking with me can make it easier so you know what to expect before you go.

Answer: Medicare does not have a set yearly limit on physical therapy visits as long as they’re medically necessary. This is where talking with me can make it easier, because I can help you understand what your plan covers and what your costs may look like.

Answer: The Medicare “donut hole” is gone. In 2026, once you’ve paid $2,100 out of pocket for covered prescriptions, you’ll pay $0 for covered drugs the rest of the year, making Medicare prescription costs much simpler to understand.

Answer: The worst Medicare-related decision someone can make is not enrolling on time when they are first eligible and do not have other creditable coverage. Missing the right enrollment window can lead to late enrollment penalties, delayed coverage, and expensive gaps in care that could have been avoided.

It is important to understand when you need Medicare Part A, Part B, and Part D, especially if you are still working, have employer coverage, are on COBRA, or have retiree coverage. Before delaying Medicare, make sure your current coverage allows you to postpone enrollment without penalties or problems later.

Answer: If you are diagnosed with a rare disease that requires specialists, you should review your Medicare plan carefully to make sure your doctors, specialists, hospitals, medications, and treatment centers are covered. Some Medicare Advantage plans have provider networks, referral rules, and prior authorization requirements, so it is important to confirm that the specialists and facilities you need are in-network before making any plan decisions.

Before changing plans, it is best to compare your options with your doctors, treatment needs, prescriptions, and budget in mind.

Answer: What I like most about being a Medicare agent is helping people feel less confused and more confident about their Medicare choices. Medicare can feel overwhelming, so I enjoy being able to explain things in a simple way and help people compare options based on their doctors, prescriptions, budget, and benefits that matter to them.

I also like building relationships with people in my community and being someone they can call when they have Medicare questions or need help reviewing their coverage.

Answer: Yes, this can happen. Medicare Advantage dental benefits often sound good in the summary, but the actual coverage may have limits, networks, waiting periods, copays, annual maximums, or restrictions on what procedures are covered.

Before choosing a plan, it is important to look beyond the advertised dental amount and review what services are actually covered, which dentists accept the plan, and how much you may still have to pay out of pocket.

Answer: Yes, in most cases, if you receive Social Security Disability Insurance, you are automatically enrolled in Medicare after receiving disability benefits for 24 months. Your Medicare card is usually mailed before your coverage starts, and you will typically get Medicare Part A and Part B unless you choose to decline Part B.

There are some exceptions. If you have ALS, Medicare can start sooner, and if you have End-Stage Renal Disease, the rules are different, so it is important to review your specific situation.

Answer: Medicare does not usually have local “Medicare offices” the same way Social Security does, but you can get in-person help through your local Social Security office, your State Health Insurance Assistance Program, or a licensed Medicare agent. I help people locally review their Medicare options, compare plans, and understand how Medicare Advantage, Medicare Supplement, and Part D prescription drug coverage work.

Answer: If someone already has Medicare Part A and is receiving hospice care, hospice is generally covered under Medicare Part A, so they usually do not need to enroll in Part B, a Medicare Advantage plan, or a Medicare Supplement just for hospice coverage. However, Part B, MAPD, or Medigap may still matter for medical care that is unrelated to the terminal illness, so the person should review their situation with Medicare, the hospice provider, or a licensed agent before making a decision.

Answer: Working with a Medicare agent can make Medicare easier to understand by helping you compare Medicare Advantage, Medicare Supplement, and Part D prescription drug plans. A licensed agent can review your doctors, prescriptions, pharmacies, budget, and benefits you care about so you can better understand which options may fit your needs.