Vachik Chakhbazian, Medicare Insurance Agent

Answer: f you missed your sign-up window, your options depend on the type of sign-up you missed and your circumstances, but often include qualifying for a Special Enrollment Period due to a life event, considering alternative plans like a short-term health plan, checking if you can enroll in a government program like Medi-Cal, or waiting for the next open enrollment period.

Answer: It is likely your friend received a free Annual Wellness Visit (AWV), which is covered by Medicare, while your doctor performed and billed you for a traditional annual physical exam, which is not. The two visits are often confused, but they are very different services in the eyes of Medicare.

Answer: You generally can wait to sign up for Medicare Part B if you or your spouse have a group health plan based on current employment, allowing you to avoid a late enrollment penalty, but it's essential to contact your employer's benefits administrator to confirm this eligibility. Medicare Part A (hospital insurance) may be free, so some people sign up for it at age 65 while delaying Part B. However, if your employer has fewer than 20 employees, you will need to enroll in Medicare Parts A and B at age 65 because your employer plan will be secondary

Answer: Regular Medicare, also known as Original Medicare, can be better than a Medicare Advantage plan because it offers the freedom to see any doctor or specialist who accepts Medicare nationwide, compared to Advantage plans that often require you to stay within a specific network for coverage

Answer: You and your friend likely have different types of Medicare plans; Original Medicare (Parts A and B) does not cover SilverSneakers, while Medicare Advantage (Part C) plans can offer it as a supplemental benefit. Because your friend is in a Medicare Advantage plan that includes this benefit, she gets the gym membership, whereas you, by having Original Medicare, do not.

Answer: No, that is not true. Medicare and life insurance serve two entirely different purposes. Medicare is health insurance that covers your medical expenses while you are alive, whereas life insurance provides a payout to your designated beneficiaries after you pass away.

Answer: Yes, you can have only Part A and Part B coverage, but it provides limited coverage, paying for about 80% of your costs, and leaves you responsible for the remaining 20% with no annual maximum. You'd also have no prescription drug coverage or benefits for dental, vision, or hearing.

Answer: Medicare faces demographic challenges from an aging, more diverse population and longer life expectancies, which increase the number of beneficiaries and the demand for healthcare services, leading to increased costs and potential strains on program finances

Answer: your prior authorization requirements can change because every plan has its own unique formulary and coverage rules. While it is the plan holder's responsibility to review the coverage details before enrolling, this information is not always clearly communicated and can be difficult to find.

Answer: To stay up to date on Medicare changes, read the Annual Notice of Change and Evidence of Coverage (EOC) from your current plan provider. Use the Medicare & You handbook and the Medicare.gov tool to explore plan options and costs

Answer: The gaps are not intentionally designed to cause hardship but are the result of policy choices made to balance affordability and comprehensiveness, leading to out-of-pocket costs like deductibles and coinsurance. Beneficiaries often fill these gaps by purchasing supplemental insurance, such as Medigap policies or enrolling in Medicare Advantage plans.

Answer: it provides financial protection and predictability for beneficiaries by capping their annual drug expenses. This measure offers significant cost relief for those on fixed incomes, particularly those with high-cost medications for conditions like cancer, by preventing potentially crippling debt and ensuring they can afford to take their necessary prescriptions

Answer: the ability to make a significant positive impact by simplifying a complex system for clients, helping them find the right coverage and gain peace of mind. Other motivations include building strong, trusting relationships, having a flexible work-life balance, and the opportunity to work in a growing industry with a large and often appreciative client base.

Answer: No, you're not the only one; surprise ambulance bills are a common issue because Medicare Part B covers 80% of medically necessary ambulance services after your annual deductible, leaving you responsible for the remaining 20% coinsurance. The California law that banned surprise ambulance bills in 2024 aims to prevent patients from being charged by out-of-network providers, but it doesn't cover the cost-sharing portion of the bill that Medicare itself leaves to the patient.

Answer: is nationwide provider choice and flexibility, allowing you to see any doctor, hospital, or specialist in the U.S. who accepts Medicare, without needing referrals or being restricted to an in-network plan. While Medicare Advantage plans limit you to a specific network, Original Medicare offers freedom to choose providers based on expertise and location rather than a plan's network, which can be particularly beneficial for complex care.

Answer: Medicare covers a wide range of preventive services to help you stay healthy, detect health problems early, and manage existing conditions. In most cases, if your healthcare provider accepts Medicare, these services are fully covered with no out-of-pocket costs for you.

Answer: To ensure a Medicare agent is legitimate, verify their license, confirm they're not requesting personal information over the phone, and check for a professional online presence. Legitimate agents should be licensed, work for reputable insurance companies, and not solicit business through unsolicited visits or calls.

Answer: Yes, Medicare may cover continuous glucose monitoring (CGM) technology, including devices that connect to smartphones, for individuals with diabetes who meet specific criteria. Medicare Part B covers certain therapeutic CGMs as durable medical equipment (DME). To qualify, you generally need to be prescribed the device by a Medicare-participating doctor, use it with a stand-alone receiver or insulin pump, and demonstrate proper training in its use.

Answer: Delaying Social Security until age 70 does not affect your eligibility for Medicare at age 65. You can still enroll in Medicare at 65, even if you are not yet receiving Social Security benefits. You will need to actively enroll during your Initial Enrollment Period, which starts three months before the month you turn 65 and ends three months after. If you delay enrollment in Medicare Part B beyond this period, you may face late enrollment penalties.

Answer: With a Medigap Plan F, you generally won't have a copay for emergency room visits. Plan F is designed to cover most, if not all, of the cost-sharing associated with Original Medicare, including copayments and coinsurance. This means that after Medicare pays its portion of the bill, Plan F should cover the remaining costs, including any copay for an ER visit.

Answer: Clients might ignore advice and choose less suitable Medicare plans due to a combination of factors, including the allure of $0 premiums, a preference for familiar or readily available options, or a lack of understanding about the nuances of different plans. Misinformation or conflicting information from other sources, like aggressive marketing tactics, can also contribute to this resistance.

Answer: Attending a seminar can help individuals navigate the Medicare system more confidently, understand how to use their benefits effectively, and access resources for assistance when needed.

Answer: To save on prescription drug costs, explore generic alternatives, compare prices at different pharmacies, and utilize discount programs like GoodRx. You can also consider mail-order pharmacies, seek patient assistance programs, and inquire about 90-day supplies or pill splitting when appropriate.

Answer: While Medigap benefits are standardized (meaning Plan G from one insurer offers the same core benefits as Plan G from another), premiums can vary significantly between companies. Compare prices from multiple insurers that offer the plan type you want.

Answer: You're right to be wary. While some Medicare Advantage plans genuinely offer grocery allowances as a benefit, unsolicited calls promising free groceries from someone claiming to be a "Medicare agent" are often a form of deceptive marketing or a scam.

Answer: It's frustrating to discover that your Medicare Advantage plan's dental coverage is not as comprehensive as you expected, However, the specifics of these benefits can vary significantly between plans and often have limitations

Answer: No, Medicare cannot drop you due to your health status. Medicare is a federal health insurance program, and your health conditions do not affect your eligibility or enrollment in Medicare Parts A and B.

Answer: The elimination of the donut hole and the $2,000 cap apply to all stand-alone Part D plans and prescription coverage included in Medicare Advantage plans. Some Part D plans may have deductibles (up to $590 in 2025) which must be met before coverage begins

Answer: Since Medicare is individual coverage, your spouse's passing doesn't directly impact your eligibility if you already qualify based on age, disability, or other factors. However, losing your spouse's employer coverage due to their death will likely qualify you for an SEP, allowing you to enroll in Medicare outside of the usual enrollment periods without incurring penalties.

Answer: For most seniors starting with Medicare, Plan G generally offers the best value due to its comprehensive coverage and relatively lower premiums compared to Plan F. While Plan F offers the most coverage, it's often more expensive and only available to those who became eligible for Medicare before January 1, 2020

Answer: Because marijuana remains illegal at the federal level, Medicare does not cover medical marijuana, even if it's legally available for medical purposes in your state.

Answer: Medicare Advantage plans may have lower or no monthly premiums, they often come with higher out-of-pocket costs like copays, coinsurance, and deductibles, as well as network restrictions. Medigap, on the other hand, has higher premiums but generally offers more predictable costs and the freedom to see any doctor who accepts Medicare. Ultimately, the best choice depends on individual needs and healthcare utilization patterns.

Answer: Medicare Advantage plans often overhype benefits like vision, dental, and hearing coverage, as well as fitness programs, which may not be as comprehensive or valuable as advertised. Seniors should be wary of these plans due to potential limitations on provider networks, higher out-of-pocket costs for certain services, and bureaucratic hurdles like prior authorization requirements, which can lead to delayed or denied care

Answer: due to administrative burdens, lower reimbursement rates, and restrictions on patient care. These factors can lead to increased workload, financial strain, and limitations on treatment options for both doctors and patients.

Answer: by introducing a $2,000 cap on out-of-pocket prescription drug costs. This means enrollees will not pay more than $2,000 out-of-pocket for their covered Part D drugs in 2025, including deductibles, copays, and coinsurance. The catastrophic coverage phase, where cost-sharing was previously eliminated, will now be entered once an enrollee's out-of-pocket spending reaches this $2,000 cap.

Answer: Yes, Medicare may allow for a delay in starting inpatient rehabilitation (SNF) after surgery, potentially up to 90 days, provided the patient has a qualifying three-day inpatient hospital stay and needs time to recover before beginning rehab. Medicare Part A generally covers SNF care after a qualifying hospital stay

Answer: There isn't a single "better" option between a Medicare Advantage plan and a Medigap policy. The best choice depends on individual healthcare needs and preferences. Medicare Advantage plans can offer lower monthly premiums but may have network restrictions and higher out-of-pocket costs, while Medigap plans offer broader provider choice and potentially lower out-of-pocket expenses but typically come with higher premiums.

Answer: the specific details regarding who can complete the SOA form itself prior to the agent's contact may be subject to interpretation or specific company policies within the broader regulatory framework.

Answer: Medicare is likely to cover gene therapy as it becomes more common, but with a degree of complexity and consideration for specific circumstances. Gene therapies involve complex and expensive processes for preparation and administration. While promising, there can be uncertainty surrounding the long-term durability and effectiveness of gene therapies.

Answer: Hard to tell. just remember, Your Health is their Wealth . Call me for more assistance. While income-based adjustments (IRMAA) exist for Parts B and D, current regulations focus on income rather than lifestyle choices. Implementing lifestyle-based premiums would raise significant legal, ethical, and practical challenges related to fairness and privacy

Answer: Health insurance premiums are on the rise for everyone, including those who are healthy and don't utilize their coverage much, Healthcare costs, including prescription drugs and hospital care, continue to escalate, Insurance companies adjust premiums to keep pace with the rising costs of healthcare services.

Answer: One common misconception about Medicare is that it's entirely free. While Medicare Part A (hospital insurance) is often premium-free for those who have worked the required number of years, Part B (medical insurance) requires a monthly premium, and there are also deductibles, copays, and coinsurance costs. Additionally, Original Medicare (Parts A and B) does not cover everything, such as prescription drugs, dental, vision, and hearing, requiring beneficiaries to explore additional coverage options like Medicare Advantage or Medigap plans.

Answer: It's different from both AEP and OEP, as it's specifically tied to the availability of high-quality 5-star plans and can be used only once during the specified timeframe

Answer: Increased Healthcare Costs:

Extreme heat events lead to more hospitalizations, emergency room visits, and doctor's appointments for heat-related illnesses, potentially straining Medicare's budget.

Answer: Generally, you have a guaranteed issue right to switch during your Medigap open enrollment period or in specific situations like moving out of your plan's service area. However, outside of these situations, you may be subject to medical underwriting, which could result in higher premiums or even denial of coverage.

Answer: hese plans, offered by private companies, often provide lower premiums and out-of-pocket costs compared to Original Medicare, as well as additional benefits like prescription drug coverage, vision, hearing, and dental. This trend is making healthcare more accessible and affordable for many seniors.

Answer: by increasing access, improving convenience, and facilitating proactive management of health conditions. It allows for remote monitoring of vital signs, personalized medication adjustments, and tailored treatment plans, ultimately leading to better patient engagement and improved health outcomes.

Answer: Yes, private hospitals generally accept Medicare plans. Most hospitals, including those in the private sector, participate with Original Medicare (Parts A and B). If you have a Medicare Advantage plan, you'll typically need to seek care within that plan's network of providers, with some exceptions for emergencies.

Answer: there are concerns about its long-term sustainability. Medicare spending is projected to grow significantly, driven by factors like the aging population and rising healthcare costs. While not facing imminent bankruptcy, the program's increasing costs are placing a strain on the federal budget and raising questions about its affordability in the future.

Answer: Many snowbirds assume their primary health insurance automatically covers them when they spend extended periods in another state, but that's not always the case.

Answer: type of Medicare Advantage plan designed for individuals with specific chronic conditions, those who are eligible for both Medicare and Medicaid, or those residing in long-term care facilities. SNPs offer tailored benefits, provider networks, and drug formularies to meet the unique needs of their enrollees.

Answer: In most situations, Medicare won't pay for health care or supplies you get outside the U.S. The term “outside the U.S.” means anywhere other than the 50 states of the U.S., the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.

Answer: A universal healthcare debate could significantly reshape Medicare in the next decade by potentially expanding its coverage to all Americans, thereby merging it with other health insurance programs like Medicaid, or by altering its structure to include a wider range of benefits and cost-sharing mechanisms. Alternatively, it could lead to the privatization of certain aspects of Medicare, with private insurers playing a larger role in providing supplemental coverage.

Answer: The biggest mistake seniors make when choosing a Medicare Part D plan is not reviewing their options annually, especially during the Annual Enrollment Period (October 15 to December 7). Many seniors stick with the same plan year after year without considering changes in their needs, plan coverage, or available options, potentially leading to higher costs or inadequate coverage.

Answer: Yes, you may still need a hospital indemnity plan even with Medicare Advantage, as it can help cover out-of-pocket costs like copays and deductibles for hospital stays. If you are hospitalized multiple times in a year, the hospital indemnity plan can help manage the cumulative financial impact, especially if your Medicare Advantage plan has cost-sharing requirements that reset with each new benefit period.

Answer: Original Medicare (Parts A and B) generally does not cover hearing aids or the exams needed for fitting them. However, some Medicare Advantage plans (Part C) may offer coverage for hearing aids, fittings, and related services.

Answer: Original Medicare (Parts A & B) generally does not cover smartwatches as they are not considered medically necessary durable medical equipment (DME). However, some Medicare Advantage plans may offer limited coverage for these devices. If a doctor deems a home heart monitor medically necessary, it may be covered under Medicare, but this typically refers to traditional Holter monitors or event monitors, not necessarily smartwatches.

Answer: determine if you have Original Medicare or a Medicare Advantage plan with dental benefits. For Original Medicare, check if the dentist is enrolled with Medicare and if the specific procedure is covered. For Medicare Advantage, use your insurer's online directory to find in-network dentists. You can also use the Medicare Plan Finder to compare plans with dental coverage in your area.

Answer: focus on accuracy and completeness, especially regarding your personal information, eligibility details, and coverage choices. Have necessary documents like your Social Security card, birth certificate, and proof of citizenship (if applicable) readily available. Carefully review the application for errors before submitting it, whether online or on paper. Pay close attention to the deadlines for enrollment periods to avoid penalties.

Answer: Yes, the cost of Medicare can be different for everyone. Several factors influence the specific costs an individual will pay, including income, enrollment choices, and healthcare utilization. Individuals with higher incomes may pay more for Medicare Part B and prescription drug coverage.

Answer: While the Medicare Extra Help program itself isn't expected to change significantly in 2026, other related Medicare changes are taking place that could impact beneficiaries. These changes, including those to the Part D benefit and the introduction of the Medicare Drug Price Negotiation Program, could affect costs and coverage for those both with and without Extra Help.

Answer: Yes, you should be concerned about potential Medicare cuts. Legislation currently under consideration proposes significant cuts to Medicare and Medicaid, which could lead to reduced benefits, higher costs, and even potential loss of coverage for some individuals. These cuts, coupled with the aging population and rising healthcare costs, could significantly impact the sustainability of the program and the quality of care for beneficiaries.

Answer: Yes, Medicare deductibles can and often do change from year to year. Both Medicare Part A and Part B deductibles are subject to annual adjustments. These changes are usually announced in the fall for the upcoming year.

Answer: most Medicare benefits are not subject to federal income tax. However, there can be exceptions, such as lump-sum payments for prior years, which may be subject to taxation.

Answer: you will be automatically enrolled in Medicare Parts A and B. You don't need to take any action to sign up for these parts of Medicare, as it's a seamless process when you're already receiving Social Security benefits.

Answer: seek personalized guidance from free, unbiased resources like SHIP counselors or local agencies on aging. These experts can help them understand their choices, compare plans, and find the best fit for their individual needs and budget.

Answer: For a low-income senior struggling with prescription costs despite Medicare Part D, the main assistance programs to explore are Medicare's Low-Income Subsidy (LIS), also known as Extra Help and State Pharmaceutical Assistance Programs (SPAPs)

Answer: No, Medicare will not cover everything your current employer plan does. While Medicare offers comprehensive coverage, it may not cover all the same benefits or have the same cost-sharing as your employer plan, especially if your employer has a larger group plan.

Answer: Medicare Part A primarily covers inpatient hospital stays, while Part B covers outpatient services, including outpatient surgery. Outpatient surgery is generally covered under Medicare Part B, not Part A

Answer: If you've been receiving Social Security disability benefits for 24 months, you'll automatically get Medicare when you turn 65, even if you're not yet receiving Social Security retirement benefits. You don't need to do anything extra to enroll in Medicare Parts A and B in this case. Your Medicare coverage will begin automatically the month you turn 65. You will receive a welcome package with your Medicare card three months before your 65th birthday

Answer: Original Medicare (Parts A & B) offers broad coverage, but may require supplemental coverage like Medigap or Part D, and has no out-of-pocket maximum. Medicare Advantage (Part C) plans are offered by private companies, often include prescription drug coverage and extra benefits like dental or vision, but can limit your choice of doctors and require prior authorization for some services.

Answer: safeguard your Medicare number like a credit card, carefully review your statements, and be wary of unsolicited calls or emails requesting personal information. Medicare will not call you asking for your information unless you've initiated the contact. Report any suspicious activity to the appropriate authorities.

Answer: some private Medicare Advantage (Part C) plans may offer a grocery allowance, also known as a healthy food allowance. This benefit is often included in Special Needs Plans (SNPs) designed for individuals with specific health conditions or those eligible for both Medicare and Medicaid, such as Chronic Condition Special Needs Plans (C-SNPs) and Dual Eligible Special Needs Plans (D-SNPs).

Answer: A Medigap (Medicare Supplement Insurance) policy can be a good choice if you want more predictable healthcare costs and the freedom to see any doctor who accepts Medicare. The best time to buy one is during your Medigap Open Enrollment Period, which starts when you're 65 or older and enrolled in Medicare Part B. During this six-month period, you can buy any Medigap policy available in your state, even if you have pre-existing health conditions,

Answer: contact your specific Medicare plan (either Part D or Medicare Advantage) directly. You can also consult with your doctor or call me and i will check it for you

Answer: Yes, the 2025 Medicare Part D changes, specifically the $2,000 out-of-pocket spending cap, will likely help individuals taking expensive specialty medications. This cap limits the total amount you pay for covered drugs, meaning you won't pay more than $2,000 out-of-pocket for the year.

Answer: A person might choose a Medicare Part D plan with a higher total cost (premium plus out-of-pocket costs) if it provides better coverage for their specific medications, especially if they take expensive prescriptions. This could mean lower costs for those medications within that plan's formulary, even with a higher overall premium, compared to a cheaper plan with less favorable drug coverage.

Answer: Yes, Medicare Part B covers medical nutrition therapy (MNT) as a preventive service for individuals with diabetes. This coverage includes an initial assessment, individual or group therapy, and follow-up visits to help manage lifestyle factors related to diabetes. There is typically no cost to the beneficiary for these services if they qualify, meaning they won't have to meet a deductible or pay a copayment.

Answer: Medicare Part A generally covers inpatient hospital stays after you meet the deductible, but coverage for extended stays may involve coinsurance costs. you need to understand what constitutes an inpatient stay and the associated costs

Answer: due to confusion about deadlines, the vast array of plan options, or assumptions about automatic enrollment or employer coverage. Medicare agents can help prevent these issues by providing early education, simplifying choices, sending timely reminders, and offering personalized guidance to avoid penalties and poor coverage decisions,

Answer: you should apply for Medicare about three months before your 65th birthday. This is because you have a seven-month initial enrollment period that starts three months before your 65th birthday, includes the month of your birthday, and ends three months after. If you miss this initial period, you may face late enrollment penalties and have to wait to enroll.

Answer: they offer the same level of freedom and benefits as Original Medicare with Medigap (supplemental insurance), while also suggesting they provide extra benefits like dental, vision, and hearing coverage. The reality is that Medicare Advantage plans often have limited provider networks, requiring you to see doctors within the plan's network to receive full coverage. Additionally, while they may offer extra benefits, the quality and coverage of those benefits can vary significantly.

Answer: Several assistance programs can help with Medicare costs for those with limited income, particularly those receiving only Social Security. Medicare Savings Programs (MSPs) can help pay for Part A and/or Part B premiums, deductibles, and copayments. The "Extra Help" program can assist with Part D (prescription drug coverage) costs. Additionally, Medi-Cal (California's Medicaid program) may offer further assistance with medical costs.

Answer: crucial legal document that designates someone to make medical decisions on your behalf if you become unable to do so yourself. It can significantly impact your life and the lives of your loved ones in various situations, Preventing Family Conflicts, Ensuring Your Wishes are Respected, Avoiding Court Intervention, Providing Peace of Mind, Enabling Timely Decision-Making.

Answer: Medicare can work alongside other insurance types like VA benefits and employer-sponsored plans, but coordination rules vary. VA benefits are separate, and you choose which to use for each service. Medicare and VA benefits generally don't pay for the same services, with the VA covering care at VA facilities and Medicare covering care elsewhere. Medicare pays second to employer plans if you're working past 65

Answer: is the potential limitation of healthcare providers and the need for prior authorization. Unlike Original Medicare, MA plans typically have restricted networks of doctors and hospitals, meaning you might not have access to your preferred providers.

Answer: Medicare does not allow backdating of enrollment past the initial enrollment period due to a medical emergency. However, you may qualify for a Special Enrollment Period (SEP). If you qualify for an SEP, you can enroll without penalty during that time.

Answer: While Medicare does cover some short-term skilled nursing care after a hospital stay, it doesn't pay for ongoing care for chronic conditions or disabilities.

Answer: to look beyond just the monthly premium and carefully consider all potential out-of-pocket costs. A plan with a low monthly premium might have higher deductibles or copays, which could result in greater overall expenses if you need to use healthcare services frequently.

Answer: Yes, Medicare may cover certain weight-loss treatments if you are classified as obese, but coverage for specific programs and surgeries depends on meeting certain criteria.

Answer: is now, in June, even though the official period doesn't begin until October 15th. This allows for ample time to complete certifications, organize your business, and develop a strong marketing strategy.

Answer: while offering flexibility in provider choice, have several disadvantages. These include higher monthly premiums, potentially higher out-of-pocket costs, and the risk of fragmented care due to less coordination between providers.

Answer: have some significant drawbacks, primarily related to limited provider choices and the need for referrals. Specifically, HMOs restrict members to in-network providers, meaning you'll need a referral from your primary care physician (PCP) to see a specialist, and out-of-network care is generally not covered except in emergencies.

Answer: There are several types of Medicare Advantage plans, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) plans, and Special Needs Plans (SNPs)

Answer: If your doctor leaves your plan's network, you may need to find a new in-network provider, which could involve searching for doctors and potentially disrupting your care, especially if you have a chronic condition. Seeing a doctor outside of your plan's network might result in significantly higher out-of-pocket costs or even no coverage at all, depending on your specific plan. Medicare Advantage plans can have complex prior authorization processes and sometimes delay payments to providers, making it difficult for them to manage their practices.

Answer: Medicare Part B generally covers telehealth services, including virtual visits, for beneficiaries in rural areas like yours, especially when accessed from designated facilities or when certain conditions are met. You may have to pay a deductible and coinsurance, similar to in-person visits.

Answer: Yes, if you are retiring next year and are either already 65 or will turn 65 during your retirement, you likely need to enroll in Medicare or take action regarding your existing Medicare coverage. If you are already receiving Social Security benefits, you'll likely be enrolled automatically.

Answer: Medicare Part A covers inpatient hospital stays. Hospital beds, Surgery, Diagnostic tests, Medications administered during hospitalization, and Skilled nursing care after hospitalization.

Answer: With Original Medicare, you can see any doctor or visit any hospital in the U.S. that accepts Medicare, while Medicare Advantage plans typically restrict you to their specific provider networks, which can be regionally limited. This makes it easier to maintain your healthcare coverage while traveling, especially if you frequently change locations.

Answer: a surcharge added to your premiums if your income is above a certain threshold. IRMAA is calculated based on your Modified Adjusted Gross Income

Answer: Annuities play a crucial role in retirement planning by providing a predictable and potentially lifelong income stream, helping manage risks like outliving savings and market volatility. They can act as a pension substitute, offering a guaranteed payment that can cover essential expenses like housing and food.

Answer: You can sign in to your MyMedicare account and print a copy of your card or request a replacement to be mailed to you. Alternatively, you can call 1-800-MEDICARE to order a replacement.

Answer: Adding dental, vision, and hearing coverage to traditional Medicare would likely increase costs for some beneficiaries, but it could also improve overall health outcomes and potentially reduce healthcare spending in the long run by addressing preventative issues early. Currently, Original Medicare doesn't cover routine dental, vision, or hearing care, leading to high out-of-pocket costs for many beneficiaries and potentially delaying or forgoing necessary care.

Answer: Generally, U.S. health insurance plans do not cover medical care received outside the United States. This means you may need to pay out-of-pocket for medical services or file for reimbursement upon returning home

Answer: gaps include prescription drugs, routine dental, vision, and hearing care, and long-term care. To address these, you can enroll in Medicare Advantage (Part C) or Medicare Supplement Insurance (Medigap).

Answer: not reviewing their Medicare plans, particularly drug coverage, annually during the Annual Enrollment Period. Drug manufacturers can change their prices and how they are covered by plans, and this can significantly impact out-of-pocket costs.

Answer: consider exploring these options: switching to a different Part D plan, seeking manufacturer assistance programs, or investigating state-run programs. If you have limited income and resources, Extra Help or Medicaid may also be available to further reduce costs.

Answer: can be used instead of your Medicare Part D plan for prescription costs if the discounted price is lower. However, you cannot combine these discounts with your Medicare coverage for a single prescription. If you choose to use a discount card, the cost doesn't count towards your Medicare deductible or out-of-pocket maximum.

Answer: you can still enroll, but you may face late enrollment penalties. You can enroll during the General Enrollment Period, which runs from January 1 to March 31 each year. You may also qualify for a Special Enrollment Period (SEP) if you had other coverage when you turned 65 and are now retiring.

Answer: Yes, there are penalties for delaying enrollment in Medicare Part B, The penalty is a 10% increase to your monthly premium for each 12-month period you delay enrolling, and you'll pay this penalty for as long as you have Part B.

Answer: Carefully review the specifics of any Medicare plan you're considering, particularly its coverage for travel. A licensed insurance agent, specially me, can help you compare plans and choose the one that best suits your travel habits and healthcare needs.

Answer: Ensure traditional Medicare is comprehensive, simple to navigate, and affordable.

Add oral health, audiology, and vision coverage for all beneficiaries in traditional Medicare.

Increase low-income protections and reduce cost-sharing.

Add coverage for long-term care.

Answer: Each Medicare Part D plan has a formulary, which is a list of covered drugs. Utilize the Medicare Plan Finder tool to see if your medications are on a plan's formulary. After entering your medications, you can compare estimated costs for each plan. The covered drugs list and associated rules might change, so review your plan's latest information online.

Answer: depends on whether Medicare itself considers the tests medically necessary. Medicare Part B typically covers blood tests and other diagnostic tests that are medically necessary to diagnose or treat a health condition, or if your doctor orders them for that purpose.

Answer: Yes, Medicare may cover acupuncture for chronic lower back pain, but with some limitations. Medicare Part B covers a maximum of 12 acupuncture sessions in a 90-day period, and potentially an additional 8 if the pain is improving, for a total of 20 treatments per year. However, the pain must be chronic (lasting 12 weeks or longer) and not due to other specific causes like surgery, pregnancy, or systemic diseases.

Answer: While Original Medicare covers medically necessary specialist visits, you'll generally be responsible for the Part B deductible and 20% coinsurance for the Medicare-approved amount of the service.

Answer: A zero-premium Medicare Advantage plan means there's no monthly fee for the plan itself, but it's not necessarily "free" overall. You'll still have to pay your Medicare Part B premium, and you may also have out-of-pocket costs for services, medications, or other plan-specific expenses.

Answer: Yes, when switching from one Medigap (Supplemental) plan to another, you may have to answer health questions and go through a medical underwriting process in most states. However, there are exceptions, including your first Medigap open enrollment period and guaranteed issue rights.

Answer: To check if your mom can keep her doctors with a Medicare Advantage plan, you need to verify if they are in the plan's network. You can do this by contacting the plan directly, checking their website, or using Medicare's online tool. If they are not in-network, you'll need to consider whether the plan allows out-of-network care and what the costs would be.

Answer: Medicare Part B, which covers ambulance services, has a yearly deductible that you must meet before Medicare starts to pay.

For 2025, the Part B deductible is $257. You will be responsible for this amount if you haven't already met it.

After you meet your Part B deductible, you'll generally pay 20% of the Medicare-approved amount for the ambulance ride.

Medicare will pay the remaining 80%.

Answer: Medicare now offers a range of preventive services, and the shift towards Medicare Advantage plans and value-based care emphasizes a more proactive approach.

Answer: Part D plans can have various factors that lead to changes in drug costs, including plan-specific formulary, manufacturer price changes, and the coverage gap or donut hole.

Answer: ou can request a reconsideration of your Income-Related Monthly Adjustment Amount (IRMAA) by filing Form SSA-44 with the Social Security Administration (SSA). This form reports a life-changing event like retirement, which can significantly impact your income.

Answer: Yes, Medicare covers the shingles vaccine through Medicare Part D or a Medicare Advantage plan with drug coverage.

Answer: The MOOP is the limit on annual out-of-pocket expenses that you'll pay for medical services that are covered by your Medicare plan. Once you reach this limit, your insurance pays 100% of the covered costs for the rest of the policy year. This limit helps protect you from excessive healthcare expenses.

Answer: Yes, you are generally eligible for a Special Enrollment Period (SEP) if you lose your employer-sponsored health insurance coverage.

Answer: focus on their knowledge, experience, and approach. Experienced brokers will have a deep understanding of Medicare, its various plans, and how they work together. They will also be able to explain the benefits, restrictions, and complexities of Medicare, including recent changes and updates. Inexperienced brokers may lack this detailed knowledge and may be less helpful in navigating the intricacies of Medicare.

Answer: they offer personalized guidance, local knowledge, and can help you compare different plan options, ensuring you choose the right coverage for your specific needs. They can also provide ongoing support and connect you with relevant community resources.

Answer: start by building trust and understanding their individual needs. Explain the basics of Medicare, including the different parts (A, B, C, D) and their coverage, then tailor your explanation to their specific circumstances. Use plain language, avoid jargon, and be patient as they learn the system.

Answer: Yes, the changes to Medicare Part D for 2025 are designed to potentially lower your out-of-pocket prescription drug costs. The main change is the removal of the "donut hole" and a cap on annual out-of-pocket spending at $2,000. This cap means that once you reach $2,000 in out-of-pocket drug costs for the year, you won't have to pay anything for covered drugs for the rest of the calendar year.

Answer: No, Medicare generally does not fully cover nursing home care, but it does cover short-term, medically necessary care in a skilled nursing facility. Alternatives to paying for nursing home care include Medicaid, long-term care insurance, and private pay. Medicare Part A covers up to 100 days. The first 20 days are fully covered, and then a daily coinsurance applies for days 21-100.

Answer: Medicare Part B covers preventive services, including screening mammograms. Diagnostic mammograms are also covered when medically necessary, with the beneficiary paying 20% of the Medicare-approved amount after meeting their Part B deductible.

Answer: Medicare generally doesn't cover 24/7 in-home care for dementia patients who wander or need constant supervision, but it can cover part-time, intermittent care for those who are "homebound" and need skilled nursing or therapy. Medicare may cover home health services, including skilled nursing, physical therapy, and speech therapy, if a doctor deems these services medically necessary and the person is "homebound". However, Medicare doesn't cover personal care like bathing or dressing, or homemaker services like laundry and shopping

Answer: Yes, some Medicare Advantage plans may cover acupuncture and other alternative therapies, Original Medicare covers acupuncture for chronic low back pain, Medicare Advantage plans can offer broader coverage for acupuncture and other alternative therapies, including massage therapy, chiropractic care, and biofeedback,

Answer: The main difference is that Medigap (Medicare Supplement) plans allow you to see any doctor or specialist who accepts Medicare, regardless of whether they're in-network or out-of-network. Medicare Advantage plans generally require you to stay within a network of providers, and may charge more or not cover services if you go out-of-network.

Answer: The best time to start researching Medicare options is three months before you turn 65, during your Initial Enrollment Period. This seven-month window includes the month you turn 65 and ends three months after.

Answer: I've heard about IRMAA affecting my Medicare premiums. How can I find out if it applies to me, and how does it work?

Answer: For your expensive diabetes medication, both standalone Part D and Medicare Advantage plans can offer drug coverage, but the best choice depends on your specific needs and situation.

Answer: help people with limited income and resources pay for some or all of their Medicare costs, including premiums, deductibles, and coinsurance. are designed to ease the financial burden of Medicare for low-income beneficiaries.

Answer: Medicare Advantage plans set their own cost-sharing terms and may or may not charge deductibles for hospital stays. After meeting the deductible, your Medicare Advantage plan may have a copay for the initial days of your stay.

Answer: dialysis doesn't automatically change Medicare eligibility, but it triggers Medicare coverage for dialysis after a waiting period, typically the fourth month of treatment. If you're already eligible for Medicare, your coverage begins right away. If you're only eligible because of ESRD (End-Stage Renal Disease), the waiting period applies.

Answer: Taking it early at 62 results in a reduced monthly payment, while waiting until 70 guarantees the highest possible monthly payout. The best approach depends on individual circumstances, including health, financial situation, and life expectancy

Answer: Medicare may cover specific services like physician care and hospitalization within a CCRC. Medicare doesn't typically cover the cost of living in a CCRC itself, but it can be used for related medical expenses.

Answer: Original Medicare offers greater freedom in choosing providers, while Medicare Advantage often includes extra benefits like dental, vision, and fitness coverage, and may have lower out-of-pocket costs.

Answer: helps cover the cost of prescription drugs, a benefit not included in the original Medicare plan (Part A and Part B). This coverage is provided through private insurance companies approved by the federal government.

Answer: You will receive either his survivor benefit (which is based on his work history) or your own retirement benefit, whichever is higher. Social Security only pays one benefit at a time.

Answer: Individuals under 65 can qualify for Medicare coverage if they have a disability, End-Stage Renal Disease (ESRD), or ALS (Amyotrophic Lateral Sclerosis). If they are receiving Social Security Disability Insurance (SSDI) benefits, they are automatically enrolled in Medicare Parts A and B after receiving benefits for 24 months. If they have ESRD or ALS, they are also eligible for Medicare.

Answer: No, routine eye exams for glasses or contacts are generally not covered by Original Medicare. However, Medicare does cover certain eye exams related to the diagnosis and treatment of eye diseases, such as glaucoma and cataracts.

Answer: Empathize with their concerns, and be mindful of potential feelings of loss of independence or fear. Ensure you have their consent to discuss their medical information with Medicare. Use plain language, explain options in detail,

Answer: Original Medicare offers more flexibility in choosing doctors and hospitals, while Medicare Advantage plans often provide extra benefits and lower costs,

Answer: I provided clear and concise explanations of the Medicare regulations and plan's coverage rules, helped the client gather necessary documentation, and filed an appeal on their behalf.

Answer: begin by contacting the healthcare provider or billing department first to inquire about the error and seek resolution. If the issue persists, you can then report the error to the Medicare Administrative Contractor (MAC) or the Senior Medicare Patrol (SMP) for further investigation. You can also submit a complaint through Medicare.gov.

Answer: Agents are often financially incentivized to enroll beneficiaries in Medicare Advantage due to higher commissions, potentially influencing their recommendations.

Answer: generally won't directly impact your Medicare coverage, but it can affect how you handle pre-existing medical debt and future medical expenses. Medicare benefits typically remain unchanged during and after bankruptcy, and you'll continue to receive the same coverage. However, you are still responsible for new medical bills incurred after filing for bankruptcy.

Answer: While it's possible to call your health insurance carrier directly for some inquiries, it's often more efficient and effective to use online resources or contact your doctor's office for health-related questions. Calling the insurance company might be best for issues like policy changes or claim status checks. However, for medical advice or questions about your health, it's generally recommended to consult with a healthcare professional or your doctor's office.

Answer: No, not all types of blood tests are covered by Medicare. Medicare covers blood tests that are ordered by a doctor to help diagnose or treat a medical condition.

Answer: Medicare generally covers palliative care through Part A and Part B, often as part of broader care during a serious illness, and may also cover palliative care during hospice. Hospice care, however, is a specialized type of palliative care specifically for those with a terminal illness and a life expectancy of six months or less, where curative treatments are no longer pursued.

Answer: In 2025, once your out-of-pocket prescription drug costs reach $2,000, you enter the catastrophic coverage phase of Medicare Part D. At this point, you won't have to pay anything for covered Part D drugs for the rest of the year

Answer: Your SSI will continue as long as you meet the financial requirements (income and resource limits). It can continue for life unless your income, assets, or living situation change.

Answer: These cards allow you to purchase eligible health and wellness products at participating retailers.

Answer: Yes, it's possible to be denied a Medicare Supplement (Medigap) plan, but it depends on the circumstances and when you're applying. Generally, you can't be denied for pre-existing conditions if you are in your 6-month Medigap open enrollment period or during other guaranteed issue periods.

Answer: the top five companies for Medicare Supplement plans for 2025.

Best for Medigap plan options: AARP/UnitedHealthcare.

Best for premium discounts: Mutual of Omaha.

Best for member satisfaction: State Farm.

Best for low premiums: Cigna.

Best for extra benefits: Anthem.

Answer: No, you do not need to sign up for Medicare again when you turn 65 if you are already receiving it based on disability benefits. Your Medicare coverage will continue without interruption.

Answer: include changes in your health status, changes in your medication list, concerns about plan costs, or changes in your plan's benefits.

Answer: No, Medicare Supplement plans and "Medicare Secondary Insurance" are not exactly the same, though they are related. Medicare Supplement plans, also known as Medigap, are specific types of secondary insurance designed to cover the costs that Original Medicare doesn't cover.

Answer: you have the right to appeal. The first step is a redetermination, where you submit a written request within 120 days of the initial denial. If that's denied, you can move on to a reconsideration, a level two appeal with a Qualified Independent Contractor.

Answer: your first step is to understand why the denial occurred and whether it's due to a network issue, lack of prior authorization, or other coverage limitations. Then, you can appeal the denial through the formal Medicare appeal process, you can consider switching to a different Medicare Advantage plan or exploring Original Medicare with a Medigap policy

Answer: one of them is the missing the initial enrollment period. 2nd is listening to some one other than their agent. each policy is tailored to specific needs.

Answer: can cover a range of home health care services, including skilled nursing care, therapy, and medical supplies. Skilled Nursing Care, Therapy, home health aides, social services, telehealth,.

Answer: as of 2025, the Medicare Part D coverage gap is eliminated. Beginning January 1, 2025, there are now three phases of part D coverage: deductible phase, initial coverage period, and catastrophic coverage.

Answer: Yes, you may be wrong. some PPOs, may require referrals, even for specialists. rules can vary between different insurance companies and even between different plans offered by the same company. You might be required to use specialists within the plan's network, and some plans may require referrals to use in-network specialists.

Answer: With a PPO, you have the flexibility to visit providers outside of your network. However, visiting an out-of-network provider will include a higher fee and a separate deductible. HMOs don't offer coverage for care from out-of-network healthcare providers.

Answer: Yes, it can be suspicious While legitimate Medicare Advantage plans may offer some extra benefits, such as flex cards for certain expenses, it's crucial to be aware of potential scams and misleading marketing tactics.

Answer: Yes, Medigap Plan G will help cover your knee replacement surgery costs after you meet your Part B deductible. Once you've met the deductible, Plan G will cover the remaining out-of-pocket costs, including copayments and coinsurance

Answer: You have up to four months to enroll in new Medicare coverage insurance following your move, if you let your Medicare provider know before you leave. In this situation, you can enroll a month prior to the move date, and up to two months after the moving month.

Answer: spending on these plans significantly increasing as a percentage of total Medicare spending. ith Medicare Advantage enrollment growing rapidly and representing a larger portion of Medicare spending than traditional Medicare. Furthermore, Medicare Advantage plans are, on average, paid more per beneficiary than traditional Medicare.

Answer: faster approvals, reduced errors, and more efficient use of resources. AI can also enhance the accuracy of claims documentation and streamline the overall process.

Answer: can help ensure they fully understand their coverage and make informed decisions, as well as provide ongoing support and address any questions or concerns that may arise.

Answer: Yes, Medicare covers emergency care in U.S. territories like Puerto Rico. This includes both Original Medicare and Medicare Advantage plans.

Answer: they can work together. but Medicare doesn't cover the membership fees for concierge care. You'll need to pay the membership fee out-of-pocket, but your Medicare Part B may cover services provided by a concierge physician that would normally be covered under Part B.

Answer: Depending on your health condition. it's a complex decision that depends on individual circumstances. may have lower premiums or offer extra benefits, they often come with trade-offs like network restrictions and potential higher costs for out-of-network care.

Answer: you can delay enrolling in Part B and may not need it until you retire. if your employer has fewer than 20 employees, you'll likely need Part B to avoid gaps in coverage.

Answer: Medigap plans can be more expensive than Medicare Advantage plans, but Medigap policies cover all the areas where Medicare has limitations, which is beneficial for travelers. Medigap might not always be the best choice for everyone.

Answer: There are legit plans with strong benefits, but verifying them is key so you’re not misled by marketing fluff. Go to Medicare.gov/plan-compare or call me and i will be more than happy to help you.

Answer: If you’re at high risk for heart disease, Medicare actually offers a pretty solid range of preventive services designed to catch issues early and manage your risk.

Answer: Yes, Medicare provides comprehensive coverage for hospice care through Medicare Part A (Hospital Insurance). To qualify, you must meet the criterias.

Answer: ​Yes, Medicare has begun covering several AI-powered diagnostic tools that aid in early disease detection, particularly in areas like cardiovascular health and cancer surveillance.

Answer: Yeah, you're definitely not alone in thinking that. A lot of people—especially those working within or alongside Medicare—have raised concerns about how outdated and clunky some of their systems are. These outdated systems can make data sharing between providers real headache.

Answer: Medicare generally covers the routine costs of clinical trials and may cover certain experimental treatments or services, especially those that are part of a "Coverage with Evidence Development" (CED) study. Routine costs include services that would normally be covered by Medicare if not part of a clinical trial.

Answer: Medicare Part B covers certain outpatient mental health services, there are still out-of-pocket costs like copayments or coinsurance. Original Medicare, which includes Part A and Part B, provides coverage for both inpatient and outpatient mental health services, but it's important to understand that not all mental health treatments are covered without any conditions.

Answer: virtual agents can provide convenience and potentially broader coverage options, allowing you to compare plans from multiple companies.

Answer: No, you likely do not need to change your Medicare coverage when moving from New York to Florida, as long as you have Original Medicare and a Medigap plan. Original Medicare coverage remains the same regardless of your location, and most Medigap plans are transferable if you remain within the US. However, you should notify your Medigap insurance company of your new address.

Answer: focus on strategies to lower your Modified Adjusted Gross Income (MAGI), which is used to calculate IRMAA. This can include shifting from traditional to Roth IRAs, maximizing tax-deductible retirement account contributions, and utilizing tax-efficient withdrawal strategies. You can also consider appealing the surcharge if you have a life-changing event that significantly impacts your income

Answer: Traditional Medicare and even Medicare Advantage may not fully meet the diverse and evolving needs of all seniors, particularly those with chronic conditions or significant health needs.

The current system can be confusing and difficult to navigate, leading to errors and potential financial losses for beneficiaries.

Reforms to Medicare are likely to face political opposition and may require significant compromise.

Answer: Medicare Part B covers outpatient mental health services from various providers, including psychiatrists and therapists. However, it doesn't cover all mental health services. Medicare Part D covers mental health medications. To get medication, you'll likely need a prescription from a psychiatrist, and the medication itself is covered under Part D.

Answer: Medicare will reimburse for remote patient monitoring. home heart monitor is deemed medically necessary by your doctor then it will be covered by Medicare

Answer: To ensure your procedure is covered by Medicare before incurring unexpected costs, you should first ask your doctor or the facility if they accept Medicare and if they will accept assignment. You can also verify coverage on the Medicare.gov website . If coverage is uncertain, inquire about potential out-of-pocket costs and ask if the provider will file a claim with Medicare, even if they anticipate a denial.

Answer: If you need medical care while traveling abroad, it's crucial to know that the U.S. government does not provide insurance coverage or pay for medical bills overseas. You are responsible for all costs. Before your trip, it's essential to purchase travel insurance and to know how to access healthcare abroad.

Answer: could significantly strain Medicare funding within the next 20 years due to reduced payroll tax revenue, the primary source of Medicare funding.

Answer: With Original Medicare (Parts A & B) and Medicare Advantage plans, many preventive services are covered at no cost to you. These include screenings, vaccines, and counseling services aimed at preventing or detecting health problems early.

Answer: Medicare provides support for quitting smoking through Part B, Part D, and Medicare Advantage plans. Part B covers counseling, while Part D and some Advantage plans may cover prescription smoking cessation medications.

Answer: Medicare will typically pay for the full cost of these services if a Medicare-certified home health agency provides them.

Answer: Yes, stricter regulations on Medicare Advantage marketing and sales practices are needed. More oversight is needed

Answer: which is allowed because these plans are contracted by commercial insurance companies, not the government.

Answer: Yes, Medicare covers mental health services, including treatment for bipolar disorder, through both Original Medicare (Parts A and B) and Medicare Advantage plans, covering both inpatient and outpatient services, as well as prescription medications.

Answer: you'll need a prescription from your doctor stating the medical necessity and then find a Medicare-approved supplier.

Answer: Medicare covers knee replacement surgery, including robotic-assisted procedures, if your doctor determines it's medically necessary.

Answer: You need to call me as your agent to review your Medicare SOB and let you know your options. coverage is based on medical necessity, not a set number of visits, and there is no longer a therapy cap for Original Medicare.

Answer: Yes. You can withdraw money from your HSA to reimburse yourself for Medicare premiums that are automatically deducted from your Social Security benefits check.

Answer: Medicare does not cover drugs solely for weight loss, but it may cover drugs like Ozempic and Wegovy when prescribed for other conditions like type 2 diabetes or cardiovascular disease

Answer: Treasury is good at printing money out of thin air, you will be OK. With the number of Baby Boomers entering retirement every day, the demand for Medicare guidance is escalating.

Answer: While some Medicare Advantage plans advertise zero monthly premiums, they aren't truly "free." You'll still need to pay your Medicare Part B premium and may incur costs like deductibles, coinsurance, and copayments for medical services.

Answer: How will my current and anticipated healthcare needs align with the coverage and flexibility of different Medicare plans.