Wade Shiu, Medicare Insurance Broker

Answer: It comes down to the type of inhaler.

Medicare Part B covers inhalation medications used with a nebulizer — the machine that turns liquid medicine into a mist (for example, albuterol or budesonide respules). When medically necessary, Part B covers both the equipment and the medication; you typically pay 20% coinsurance after your Part B deductible.

Medicare Part D covers handheld inhalers you use on your own — metered-dose and dry powder inhalers like albuterol HFA, Advair, Symbicort, Spiriva, Breo, or Trelegy.

Albuterol can be via nebulizer or by inhaler, so don’t just look at drug names!

Answer: Mostly NO!! The one exception is if someone has FULL Dual Special Needs (Medicare + Medicaid). Apart from that, the premium may be $0, but that's just the monthly cost to have the insurance.

You could still pay deductibles, copays when you see doctors, and there's still a yearly max out-of-pocket. There is no 1 size fits all. $0 premium plans can be a fit for some people.

Don't confuse $0 premium with $0 healthcare!!

Answer: If your doctor drops your Medicare Advantage plan mid-year, that can trigger a Special Enrollment Period.

Contact your agent or 1-800-MEDICARE as quickly as possible to check. You can also always switch during fall enrollment (Oct 15–Dec 7) if you can/want to wait.

Also, Medicare Advantage members get a second window Jan 1–Mar 31. This is mostly a Medicare Advantage problem because with Original Medicare plus a supplement, any doctor who takes Medicare would take yours.

Answer: First, you can start with the Annual Notice of Change letter. Usually every September they are sent and lists exactly what's changing in her plan next year, including the drug list. During enrollment season (Oct 15–Dec 7), you can:

Plug all prescription medications into the Plan Finder at Medicare.gov.

An agent can also look for/with you.

You should do it every year, even if her medications stay the same. Plans can change even if your medications don't.

Answer: First of all, THANK YOU for your service.

Secondly, VA and Medicare don't work together like primary and secondary insurance. You would pick one per visit.

If you go to a VA facility, the VA covers it.

If you go to a civilian doctor, Medicare covers it under its normal rules. Also, you can't bill both for the same service, and one doesn't cover the other's copays.

Veterans can keep both. VA usually for prescriptions and service-connected care, and usually Medicare for everything else.

Answer: This is the price Medicare sets for a service. Accepting Medicare Assignment means the doctor agrees to take that price as full payment. The best way I have found to know if they accept is to ask the office, "Do you accept Medicare assignment?" Another way is to look them up on Medicare's Care Compare at Medicare.gov.

Answer: The emergency room visit itself is handled by Part B. If, after the ER visit, they admit you, it changes to Part A.

Answer: It is normal, and the 80/20 rule is the confusion. That split applies to Part B (doctor and outpatient services), not hospital stays. Original Medicare generally does not pay a percentage of a hospital’s billed charges for an inpatient stay. It typically pays the hospital a predetermined amount based on the diagnosis group; some adjustments apply. You generally should not expect Medicare’s payment to equal 80%. If you have Medicare Advantage, your costs are determined by your plan’s copays, coinsurance, deductible, etc.

Answer: That answer can vary. TV ads, mailers, and Facebook quizzes promising "free grocery cards" are lead generators. If you call the number or fill in your info, your number gets sold to call centers. Data brokers sell lists too.

To stop it: register at donotcall.gov, and tell every caller to put you on their do-not-call list — they legally have to.

Also, Medicare rules actually ban cold-calling you. A call center calling you without written permission is breaking the rules. Report them to the FTC.

Answer: In my experience as a pharmacist and as a Medicare agent...

The biggest red flags are when:

1. a provider bills for visits or tests you never had

2. offers "free" services but asks for your Medicare number first

3. pressures you to sign blank forms

4. or goes door-to-door pushing freebies for your card info.

Protect yourself like this: treat your Medicare number LIKE your Social Security number — don't hand it out for free gifts. Read your Medicare Summary Notices and flag anything you don't recognize. If something seems off, call 1-800-MEDICARE or your state's Senior Medicare Patrol. They investigate this stuff for a living.

Answer: Those benefit cards come with certain Medicare Advantage plans, usually Special Needs Plans for people on both Medicare and Medicaid, or with certain chronic conditions. I have seen anywhere from $25 to a couple hundred a month depending on the plan and your zip code. Original Medicare doesn't offer them.

My honest advice...

There's a lot of noise out there. Don't pick a plan just for the benefit card. Make sure it covers your doctors, facilities and meds first. The grocery money is a bonus, not the reason.

An agent can check what your zip code actually qualifies for.

Answer: That depends, and this one confuses people every fall.

Fall enrollment (Oct 15–Dec 7) covers Advantage plans and drug plans. Medigap has its own rules.

For Medigap, you get window(s) with no health questions when:

1. the six months after you turn 65 and enroll in Part B.

2. the Medicare Advantage plan you are on is discontinued in your zip code.

Apart from that, switching Medigap in most states — including SC and NC, means a health questionnaire.

Talk to an agent or your state's SHIP program before you change things; the wrong change is hard to undo.

Answer: Honestly, because Medicare is confusing, and getting it wrong or not exactly right costs real money.

I'm also a licensed Pharmacist. What I tell people is working with an agent doesn't cost you anything extra; your premium is the same either way.

Medicare also has a lot of moving parts - hospital coverage, doctors, drug plans, networks or Advantage vs Supplement. What I have seen a lot of people miss is that plans can change every year; even if your treatment remains the same. Lots of people deal with billing problems, claims headaches and insurance jargon. People who don't have an agent deal with these on their own. I'm actually someone's agent year-round, not just during their enrollment.