Troy Albrecht, Medicare Insurance Broker

Answer: Go to the carrier's Find a Doctor Tool, enter the zip code and plan, then search each doctor.

You can usually get to this easily by simply Googling "[Carrier] Find a Doctor Tool" but be sure that you are selecting a link on that carrier's official website.

Answer: This a question that would be more fit to ask insurance carriers instead of agents.

From what I can tell and anecdotal statements from carrier representatives, it is a mix of a few reasons:

-The average age of enrolled members of some plans is getting higher and higher. Some plans have been around for 15+ years so there is a massive proportion in their 80's or even 90's. This makes some plans unsustainable at $0 premiums with a bunch of added benefits.

-Most insurance underwriters expected a surge in usage post-pandemic and then utilization to drop. Utilization never dropped and the plans were not set up in a way to be prepared for that.

-Hospital and medication costs continue to skyrocket.

-When Medicare funding was generous, carriers added a bunch of added benefits; large quarterly over-the-counter allowances, Part B premium givebacks, lots of dental, etc. Now we are looking at an Medicare Advantage funding increase in 2027 of only 0.09% compared to 2026's 5.06% increase and 2024's 3.7% increase.

Summary: Aging members, high utilization, hospital costs and federal funding.

Answer: No, Medicare itself does not cover any medications that you would get from a pharmacy.

Prescription coverage is through a Medicare plan such as a Prescription Drug Plan (AKA Part D plan) or most Medicare Advantage plans. These plans are issued by insurance carriers and each plan is very different.

I recommend talking with an agent/broker who will make sure you choose a Medicare plan available to you that covers Breztri well (along with any other medications).

Answer: I always insist clients consider all of the options available to them even if Medicare Advantage is a great fit because they need to consider the future as well when it comes to Medicare coverage.

In most cases, if you try to join a Medigap/Supplement policy beyond your initial eligibility, you will be required to go through medical underwriting. This generally means carriers can deny your application or can assign you a higher rate based on pre-existing conditions, weight, medications, etc.

So while Medicare Advantage may be a perfect fit *now*, will it be in 3 years? 5 years? 10 years? Sometimes overpaying in premium now to have the Medigap/Supplement policy at the lowest rate possible for down the road is a good move.

Medigap/Supplement policies are generally the highest level of coverage with the least restrictions and the benefits/network is standardized between carriers which allows you to shop around for the same plan.

Answer: In most cases, Medicare covers services deemed medically necessary.

While Medicare clearly consider restoring sight to be medically necessary, they have not yet gone the extra step of determining that having the best sight possible (eliminating the need for bifocals, reading glasses, progressive lenses or etc.) is medically necessary.

Answer: Many of the details of how Parts A and B operate by themselves become irrelevant once you enroll into an actual Medicare plan through a carrier.

In this example, it is exactly that, you would owe a copay of $350 for each day you were admitted into the hospital as an inpatient, up to a maximum of 7 days. So if you were hospitalized for 12 days, your inpatient hospitalization bill would be $2,450 ($350 x 7 day cap).

What is less known is that if you leave the hospital and return within 60 days, this benefit does not restart because you are in the same "benefit period". So if you were in the hospital for 12 days, discharged for 45 days and then hospitalized for another 12 days, the inpatient hospitalization bill would still be $2,450 ($350 x 7 day cap).

Inpatient hospitalization on a Medicare Advantage plan is one of the larger bills you can receive. This is why I will often quote clients a type of ancillary policy called a Hospital Indemnity plan along with Medicare Advantage plan options which can reimburse inpatient hospitalization copays to fill this gap in coverage.

Answer: Ideally, you would want to have an agent/broker you can call to ask this.

If you do not have an agent/broker, you can try getting as much details as you can about the procedure from the doctor's office, including "CPT Codes", and then calling the number on your Medicare Advantage ID card to have the carrier's representative provide the plan's benefits for those services.

Almost certainly, there will be a cost involved unless you have hit your plan's out-of-pocket maximum.

Unfortunately, carrier customer service tends to have long hold times and representatives can be hit-or-miss with their knowledge of plan benefits. A carrier will find the benefit in your plan documents and read it off but an agent/broker will know to also check if the Opthalmologist is in-network, ask if you are going to get post-procedure eyewear of any kind, ask if you will have a follow-up visit, look at DME benefits by implanted-lens type, etc.

Answer: If your current prescription coverage is not covering a new medication well, it is certainly worth comparing your options during Open Enrollment (October 15th-December 7th annually) to see if a switch makes sense for the following year.

If the drug is not being covered by the current plan, you can work with your doctor to request a formulary exception from the carrier if it is medically necessary. You can contact your current carrier to determine if the denial is due to needing prior authorization, needing to try an alternative first, it is not on the formulary or etc.

Answer: Based on feedback during Open Enrollment plan reviews with current clients, it seems like the vast majority of my clients who have Medicare Advantage plans do utilize their over-the-counter (OTC) benefits.

OTC benefits vary a bit by carrier but generally the carrier will issue members a payment card automatically loaded quarterly with an allowance to spend for health goods such as vitamins, bandages, OTC medicine, etc. This generally can be used like a debit card at participating stores, the OTC portal or placing an order over the phone. Some plans will also allow you to spend these funds on select groceries if you are diagnosed with qualified chronic conditions.

Coming into 2026, we saw many plans make drastic cuts to this benefit. When carriers scale back benefits, this is usually one of the first ones to go. I would caution anyone not to let this benefit exclusively convince you to choose one plan over another as it becomes a minimal amount of money (that changes often) when compared against actual medical benefits.

Answer: No, unlike just having Original Medicare or even with a Medigap/Supplement policy, Medicare Advantage plans become the entirety of your coverage. Therefore, you have to follow any network rules that carrier's Medicare Advantage plan may have.

To get coverage for that doctor, you might want to consider an open-network PPO Medicare Advantage plan or even seeing if going through medical underwriting for a Medigap/Supplement policy might make sense during Open Enrollment (October 15th-December 7th annually) for the following year.

Answer: Applying for Original Medicare (AKA Parts A and B) last minute.

The majority of the steps required to transition to Medicare coverages can be completed quickly if necessary. However, there is very little that can be done to make the Social Security Administration move faster.

The only rare times I see clients unable to get Medicare policies set up for the date they want is when they apply for Original Medicare too late and are still waiting on their red/white/blue Medicare card when the deadline passes.

A close second would be when seniors choose Medicare Advantage without understanding (or often were not even told) about Medigap/Supplement plans and cannot switch into one later without underwriting.

Answer: There are many reasons it is advisable to get assistance from a Medicare agent, especially in regards to the various deadlines, knowing your options and filing everything correctly.

However, let's say someone turning 65 or over 65 planning to retire soon does their research, knows when and how to enroll in Parts A and B and knows the types of carrier Medicare plans available. I would ask yourself the following:

1. Think of the most important and most costly health service you have utilized in the last 2 years. This could be a brand-name prescription, a knee replacement, Durable Medical Equipment, regular physical therapy visits or many others.

2. Which type of Medicare plans covers that type of service best? For that plan type, which plan with which carrier covers that type of service best?

If you cannot answer those questions, a Medicare agent can.

There is no difference in the plans or costs whether you set things up yourself or with an agent.

Answer: In my experience, the common explanation of the coverages of Medicare as lettered "Parts" actually causes more confusion. I find that seniors often misunderstand what Parts A, B, C and D are and get hyper-focused on fulfilling the Parts instead of focusing on understanding their options.

Some aggressive advertisers use scare tactics that often only use the terminology "Part C plans" and the "Part D Late Enrollment Penalty." These are both important things to understand and go over but leads to confusion in practice.

Ex/ the sentence "you must have Parts A and B to get Part C, which usually includes Part D" is accurate but wildly confusing.

If a client seems to be mixing up the Parts terms, I quickly insist we change the terminology:

-"Drug/prescription coverage" instead of "Part D": the "D" in Part D stands for "Drugs" - usually regardless of where you get that drug coverage.

-"Original Medicare" instead of "Part A" and "Part B"

-"Medicare Advantage" instead of "Part C"

Ex/ now we can say "you must have Original Medicare to enroll in a Medicare Advantage plan, which usually cover prescriptions."