Victoria Shiu, Medicare Insurance Broker

Answer: It is not a mistake, it is more of a learning curve. You need to make sure you have a Medicare Advocate that is looking out for your best interests. Here is what to look for in a Medicare advocate:

1. Licensed professional you can trust

2. Asks your needs in a health plan

3. Reviews your doctors, medications, and pharmacy to make sure you are in the appropriate network.

4. Reviews your plan's Summary of Benefits

5. Compares your total costs

6. Gives you their email and direct phone number

7. Offers to do an annual review

Answer: Reporting suspicious Medicare billing is an important step in protecting the integrity of the healthcare system. Here are 5 steps to ensure you report correctly and anonymously.

1. Know What You're Reporting:

Being billed for services you never received

Duplicate charges

Upcoding (billing for a more expensive service than was performed)

Unbundling services (charging separately for things that should be grouped together)

2. You Are Protected by Law:

There are laws to protect individuals who report Medicare fraud. You can report anonymously, and you are legally protected from retaliation.

3. Reporting Suspicious Billing:

Medicare (U.S. Department of Health and Human Services - OIG)

You can report fraud directly to the Office of Inspector General (OIG):

By Phone: 1-800-HHS-TIPS

**You can remain anonymous if you choose.

4. Keep Records:

Make sure you do the following to protect yourself:

Write down dates, providers, charges, and a summary of what happened.

Keep copies of any bills or correspondence.

Document when and where you submitted the report.

5. Want to Stay Completely Anonymous?

Do not provide identifying information when submitting the report. OIG accepts anonymous reports—know they won’t be able to follow up with you for more details.

Answer: That’s a great question and one many seniors have! It depends on what type of Medicare plan you have. If you have traditional Medicare or traditional Medicare with a Medicare Supplement plan; you just need to notify your insurer and update your address with Social Security. However, if you are on a Medicare Advantage plan you will have to change plans as that is specific to the zip code you live in.

Answer: I know Medicare can feel overwhelming, but you don’t have to figure it out on your own. As a pharmacist, I understand both the insurance side and the medication side, so I can help you sort through your options, make sure your prescriptions are covered affordably, and keep everything simple. We’ll take it one step at a time.

Answer: With a chronic condition like diabetes, your Medicare costs include more than just premiums: you’ll want to account for doctor visits (primary care and specialists), medications, and supplies.

If you are working with a Medicare Advocate, they can help calculate all of your costs depending on the plan you choose.

Answer: This is one of the most confusing questions I receive as a Medicare Advocate. The answer depends on your situation when you turn 65.

If you have creditable coverage when you turn 65, you can delay Medicare without penalty. Creditable coverage, in the context of Medicare, refers to health insurance coverage, particularly prescription drug coverage, that is at least as good as Medicare Part D. Examples include an employer with 20 or more employees, Tricare, VA, or union coverage.

You will face penalties if you don’t have creditable coverage and skip enrollment at 65.

Answer: What I enjoy most is helping people feel less stressed about Medicare. It can be confusing, but I like being able to explain things simply and make sure patients can get the medicines they need without breaking the bank. With my pharmacist background, I can also connect the dots between their coverage and their medications, which gives them continuity of care and peace of mind.

Answer: That’s a really important question — and the answer depends on timing and underwriting rules for your Medigap Plan G.

If you bought Plan G during your 6-month open enrollment at age 65 (or when you first got Part B): Your Medigap must pay its share, even if the surgery was already scheduled.

If you bought outside that window: Whether Plan G pays depends on your prior coverage history and whether the insurer applied a pre-existing condition waiting period.

Answer: Medicare covers wheelchairs if they’re medically necessary, but you’ll need a doctor’s order and must go through a Medicare-approved supplier. You’ll owe 20% unless you have Medigap or a Medicare Advantage plan with different cost rules. The process to make sure you follow the appropriate rules with your plan is as follows: Talk with your doctor, get documentation from you doctor, choose a Medicare-approved supplier, confirm coverage and costs. This is a great example of why a Medicare advocate is so important! I will help you navigate these authorization processes with ease!

Answer: Cataracts are one of the most common surgeries for Medicare beneficiaries, and the costs can be confusing. Traditional Medicare, traditional Medicare with Medigap, and Medicare Advantage all cover the surgery, but at different copays or coinsurance. If you have Traditional Medicare, you will typically pay a 20% coinsuance. Adding a Medigap plan will help lower the high out-of-pocket costs.

Answer: You can save by shopping around, choosing a lower-premium plan design, or taking advantage of state-specific switching rights and discounts. Here are some steps that will help guide you: Shop around the same letter plan, Consider Plan N or a High-Deductible Plan G, Use Household or Spousal Discounts, Check Issue Age vs. Attained Age Policies, etc. It is good practice to talk with your Medicare Advocate regularly to ensure you are saving the maximum amount of money.

Answer: Medicare rules are “one size fits all” — but employers’ insurance rules aren’t. The tricky part is figuring out how your job’s insurance interacts with Medicare. That’s why the answer is different for a 67-year-old at a 3-person law office versus a 67-year-old at IBM. Make sure you have a Medicare Advocate that will help you navigate these complexities.

Answer: Sticking with Original Medicare alone exposes you to unlimited financial risk. For someone with significant health issues, this could be financially devastating. A Medigap plan or Medicare Advantage plan adds protection by capping or covering those out-of-pocket costs. Do NOT get into medical debt when I can make sure you are covered!

Answer: Medicare doesn’t set a hard cap on PT visits — as long as therapy is medically necessary and properly documented, it’s covered. The number of visits you get may depend on your medical need and, if you’re in Medicare Advantage, your plan’s rules (Evidence of Coverage). The best way to ensure you are covered is to call your plan directly.

Answer: With an HMO Medicare Advantage plan, you’ll almost always need to stay in-network (with referrals) for coverage. Out-of-network cardiology visits are usually not covered, unless it’s an emergency.

Answer: “Each year, it’s important to review your income to see if it might trigger higher Medicare premiums (called IRMAA). Even things like investment gains, IRA withdrawals, or tax-free interest can count toward your income. By planning ahead—such as spreading out withdrawals, using Roth accounts, or giving to charity directly from your IRA—you may be able to stay below the thresholds. And if your income has dropped since a high-income year, you can often appeal the surcharge.”

Answer: “As a pharmacist and Medicare advocate, what I value most is helping patients navigate the often confusing world of Medicare and medication coverage. I enjoy being able to simplify complex options, connect people with affordable solutions, and ensure they have access to the medications they need. For me, the most rewarding part is building trust—knowing that patients see me not only as their pharmacist, but also as a partner who advocates for their health and financial well-being.”