Medicare Questions & Answers: Advice for Seniors
Advice for Seniors Q&A
Showing 104 questions
Are Medicare Advantage plans really "free," or is that just clever marketing?
The concept of "free" Medicare Advantage plans can be misleading. While some Medicare Advantage plans advertise $0 monthly premiums, it's crucial to understand that this doesn't mean you won't have any healthcare costs. Here's a breakdown:* $0 Premium Doesn't Mean $0 Cost:
A $0 premium means you don't pay a monthly fee to the private insurance company offering the Medicare Advantage plan. However, you'll still likely have other out-of-pocket costs, such as:
* Co-payments: Fixed amounts you pay for specific services (e.g., doctor's visits, prescriptions).
* Coinsurance: A percentage of the cost you pay for services.
* Deductibles: The amount you pay before your plan starts covering costs.
Contact at 859-309-5033 if you would help with your Medicare Planning
What is the biggest mistake seniors make when enrolling in Medicare?
It sounds cliché coming from me, but the biggest mistake seniors make is not having an independent agent acting on their behalf. When calling into insurance companies for help, their sole job is to sell you their product, whether it's the best option for you or not. You want someone who has a financial incentive to assist you in finding the right type of coverage by going over all your options and not leaving anything to chance. Imagine a doctor that only wrote you prescriptions from one pharmaceutical company; you'd have questions about their motives just as I would too.
What benefits are there to working with a Medicare Agent near me vs remote/virtual?
Medicare agents are not supposed to solicit customers without their permission. Therefore, it is essential that you feel comfortable with your agent and trust his knowledge and efforts to provide you with the best plan, for your future, not necessarily for the moment.
What's one piece of advice you wish every senior knew before picking a Medicare plan?
I wish every senior knew that the 'best' Medicare plan isn’t the same for everyone...it’s the one that fits your specific needs and budget.Too many people pick a plan based on what their neighbor has or just go with the cheapest option, only to find out later that their doctor isn’t covered or their medications cost way more than expected.
Take the time to compare your options, ask questions, and make sure you’re choosing a plan that actually works for you. And if you're feeling overwhelmed, talk to an expert, because guessing your way through Medicare can be an expensive mistake!
What is one of the the most common misconceptions people have about Medicare?
One of the most common misconceptions about Medicare is that it covers all healthcare costs for seniors. Turns out, Medicare doesn't cover every single healthcare expense. Additionally, many assume it includes long-term care (like nursing homes) or dental, vision, and hearing services, but these items are not covered under original Medicare. People often learn this the hard way when they realize they need supplemental insurance like Medigap, Medicare Advantage, and other tertiary coverage options to fill those gaps. It’s a rude awakening for those who think Medicare = free healthcare, hence the need to fully understand your options to make the best decision for yourself.What's the trade-off between a Medicare Advantage PPO and HMO when it comes to flexibility?
An HMO limits your services to a closed network of physicians and caregivers. HMOs require members to choose one of their in-network primary care physicians to manage your healthcare, and require a referral approval to use other in-network services. HMOs generally do not allow any out-of-network services unless it's an emergency.PPOs are more flexible with their network of services and do not necessarily require a primary caregiver. You can use services outside of their network of treatment services, and you will still be covered. However, PPOs generally have higher prices, deductibles, copays, and coinsurance when you use services outside of their network.
What's one Medicare decision that too many people regret later?
Selection of an MAPD when they could have enrolled in supplemental plan and separate PDP during their initial IEP. Too many (in my opinion) are led to the MAPD side without having the client sign-off on an affidavit saying they have in fact received a thorough discussion of the pro's and con's of both sides of the Medicare decision fence.
If a senior is turning 65 but still working, should they enroll in Medicare or delay it?
If you have employer-based health insurance through your or a spouse's current employment, where there are more than 20 employees, and you're happy with the costs, such as monthly deductions/premiums and coverage, like potential out-of-pocket costs, you can delay Medicare enrollment without accruing penalties. If this is you, it's best to schedule a quick call so we can discuss your situation. Chad
How can I make sure I'm not overpaying for my Medicare plan, and are there any tools or resources you recommend?
Find a local trusted insurance broker whom can answer your questions and explain things in easy to understand terms. If you are more of a do-it-yourself person I would highly encourage you to read through the Medicare and you book and also use the tools available on medicare.gov websiteWhat's the most frustrating misconception you have to clear up with clients about Medicare every year?
First, It’s essential to clearly understand the differences between Traditional Medicare with a Medigap plan vs Medicare Advantage.Second item is the mistakenly think that starting with a low-cost plan is the best option; however, this isn’t always the case with insurance companies under the Medigap program. After the first four to five years, premiums can increase significantly, making it difficult for those with health issues to switch to a more affordable plan. Often, individuals are left at point in life with no choice but to transition to an Advantage plan a more affordable monthly rate and giving up their freedom of choice. Being informed about these options can lead to better long-term decisions regarding healthcare coverage.
How do discount cards and resources affect my Medicare Prescription Drug plan?
Normally Discount Cards (Good RX and others) may discount your Prescription cost at certain pharmacies. This may be a way to save on Prescriptions when there is a higher copay. These companies may gather your information and market Medicare plans.There are State Resources available to help with Prescription costs. There are many generic medications that could be $0 copay in Medicare Advantage or Standalone RX plan. Brand Medications can have copays.
State programs have an application and can take up to 2 weeks to 4 months to be approved. These programs have income guidelines to qualify. Most do not consider assets.
NJ PAAD
PA PACE
If you have questions on the state resources, please contact me for more information.
Do Medicare Advantage plans really save seniors money in the long run? Why or why not?
Medicare Advantage plans can potentially save seniors money in the long run, but the impact varies by individual circumstances. They often have lower premiums and may include additional benefits not covered by Original Medicare, such as vision and dental care. However, these plans might have higher out-of-pocket costs for certain services and often require members to use a specific network of providers. It’s important for you to evaluate their healthcare needs and compare costs before choosing a plan.
What additional coverage options are available for international travelers?
Medicare Supplement plans (Medigap) C, D, F, G, M, and N may offer coverage for services outside of the U.S. with up to $50,000 of lifetime coverage. Some Medicare Advantage plans may also provide some coverage, and travelers should check with their specific plan for details. Additionally, international travel plans can provide emergency medical evacuation, return of mortal remains, support for lost passports or luggage, trip cancellation protection, and even kidnap and ransom coverage for high-risk destinations.
Why do some seniors end up paying lifelong penalties for Medicare Part B or Part D?
Lack of appropriate retirement planning education. One of the foundations I have built my business on is education. Medicare 101 seminars can be really useful to people to learn how to avoid these penalties.It is important to know that unless you have what is known as Creditable Coverage, delaying Part B and or Part D can carry lifelong penalties. Each situation is unique so it’s important to consult with a professional to understand if you have Creditable Coverage or not and have a plan in place, months before you turn 65. Sorting out your Medicare coverage is best done up to 3 months before you turn 65.
How does life insurance contribute to financial planning?
Life insurance can be very crucial to financial planning. Life insurance is something that should be in investigated sooner rather than later. A good benefit Rich policy May offset Some costs in the case of a passing that incurred medical debt.
What role do annuities play in retirement planning?
Imagine having a reliable stream of income flowing in during your retirement. That's the magic of annuities! You can purchase an annuity with a lump sum or through regular payments, and it can provide a guaranteed income stream throughout your retirement. Some annuities even offer lifetime income, meaning you'll receive regular payments no matter how long you live. This can be a game-changer for supplementing Social Security and other retirement income, allowing you to live comfortably and worry-free.So my friend told me I should just go with the cheapest Medicare plan. That sounds too simple - what am I missing?
Medicare comes in different parts (A, B, C, and D), and your choices determine your cost. Choosing a cheap or simple plan during your initial enrollment could jeopardize your ability to choose other plans later in life that could benefit you the most regarding health coverage.An independent health insurance agent should be able to show you the difference in these areas. If you choose this cheaper plan today, ask your agent lots of questions about your long-term goals, coverage, and premium costs five, ten, or fifteen years from now.
If you had to pick just one, what's the worst Medicare-related decision someone can make?
People fail to analyze their options at the beginning of their Medicare journey, making hasty decisions or following their friends' or families' decisions. These first decisions could affect their Medicare coverage throughout their retirement years, especially their pocketbooks. You should know all the facts or have an agent that you can trust to guide you through the Medicare process when signing up for Medicare.
Does Medicare cover health care services on a cruise ship?
Once you cross into International waters, your Medicare will not cover you. There are very specialized situations while traveling abroad where it does. Always take the travel insurance.However, adding a proper supplemental plan to your original Medicare can provide a $50,000 lifetime reimbursement benefit to augment your billing.
My mom is considering switching to a Medicare Advantage plan because her friends say it's better. She's scared of losing her current doctors. How can we check?
One, no one should ever pick a plan because their "friends" say it's better. I cannot tell you how many people made that mistake. Medicare insurance needs are different for everyone.Two, she should be concerned about her doctors accepting the insurance because Medicare Advantage plans are network plans. But that is why you have me as a broker to check all the networks to make sure your doctors accept the plan you may be switching to.
I'm confused about when I can change my Medicare plan. Can you clarify the different enrollment periods for me?
1. A Medicare supplemental plan may be changed to another Medicare supplement plan at any time of the year.2. A Medicare supplemental plan can be changed to a Medicare Advantage plan between October 15 and December 7. However, this change will not take effect until January 1 of the following year.
3. Medicare Advantage plans can be changed to another Medicare Advantage plan once during open enrollment, which runs from January 1 to March 31.
4. Medicare Advantage plans can revert back to traditional Medicare with a supplement plan between January 1 and March 31. However, you may be without a drug plan for the remaining of the year.
5. Medicare Part D stand long prescription drug plans can only be changed between October 15 to December 7 and do not take affect until the following year of January one.
6. There are other special enrollment periods allow for case by case situations.
I've heard about IRMAA affecting my Medicare premiums. How can I find out if it applies to me, and how does it work?
IRMAA (Income-Related Monthly Adjustment Amount) affects Medicare Part B and D premiums for those with higher incomes, and it's determined by the Social Security Administration based on your income from two years prior. You'll receive an "Initial Determination" if IRMAA applies to you.
What's the best way for seniors to protect themselves from Medicare-related scams?
Protect your information as there are many scams out there today, unfortunately. Verify Brokers/Agents licensing on the particular state those agents/brokers are in
I'm a low-income senior who can't afford my prescription drugs even with Medicare Part D. What specific assistance programs should I apply for?
I loved the short answer to this question Apply for LIS/Extra Help! Its easy to do, it doesn't take long and if you are not eligible "NO BIG DEAL"! You don't need to go to any government office and set a future appointment. Just APPLY! You won't regret it!
I need a hearing aid but I've heard Medicare doesn't cover them. Is there any way around this?
Original Medicare (Parts A and B) does not include Hearing Aid Coverage. Medicare Advantage often times does but not all plans so check closely on the plan if you are enrolled into Advantage. Supplement plans typically do not include Hearing Aid coverage but may include a discount plan or a rider for purchase with certain carriers (in certain states only).
My neighbor says I'm crazy for paying for a Medigap plan when Medicare Advantage is "free." What should I tell him?
I help folks in Michigan and after your initial enrollment into medicare here, you will have to health qualify for medigap(supplemental) plans. With our health you never know what is around the corner. If serious health issues wiping out your savings is a concern...and it should be. Medigap plans are the safest option.I've been diagnosed with prediabetes. What preventive services does Medicare cover to help prevent progression to type 2 diabetes?
Its always a tough when you hear about any diagnosis from a Health Care professional regarding Diabetes. If you watch the news at all, you know that any Diabetes related health condition is serious and effects a large part of our population. Medicare provides several "Preventive Services'" that come at low or no Out of Pockets costs. Medicare Diabetes Prevention Program (MDPP) is a comprehensive One Time health behavior change program is available to help you prevent Type II diabetes. Common services like Diabetes Screening and monitoring, Medical Nutrition, foot exams and Hemoglobin A1C, Glaucoma Screenings as well as "Welcome to Medicare" preventive visits are design to address your diagnosis and prevent it from getting worse! Your Medicare agent can educate you on what is available to you! If you are new to Medicare you will love it!
Every year I stress over picking a plan and still end up surprised by the bills. Is there any way to just get peace of mind with Medicare?
Change from medicare advantage to Medigap. You will pay a monthly premium but never get a bill. You can keep the plan forever and have peace of mind knowing your exact cost upfront
I don't understand how my friend pays nothing for their plan and I pay over $200-are these plans just totally random by ZIP code?
The plans are not random. If your friend pays nothing for his Medicare plan, this is highly likely to be a Medicare Advantage plan featuring deductibles, copays and coinsurance depending on the plan. Most advantage plans feature a $ 0-dollar copay to see your primary doctor but will have a $30-to-$ 50 dollar copay to see a specialist and there will be additional costs depending on what's going on. Now if you are paying over $ 200 for your plan, you may have a very high-benefit Advantage plan but it is more likely that you have a Medicare supplement plan and this is a different animal. Medicare supplement plan F pays after Medicare leaving you with no medical bills for health services for Medicare-approved services (or no bills after a 2025 $ 256 outpatient deductible if you have a supplement Plan G). Talk to your independent insurance agent about all this otherwise get your license and help me explain this stuff!
What's one hidden Medicare expense that people don't think about until it's too late?
Skilled Nursing Facility Costs. Days 1-20, Medicare pays 100%. Days 21-100, the member pays a daily co-pay. After 100 days, Medicare no longer covers expenses.What are the red flags I should look for when interviewing agents? I want to make sure I'm not just getting sold to but genuinely advised.
Experience matters. Ask your agent how long they've been in business? What percent of their business is Medicare (important!). Have your agent provide you with the names of the states where they're licensed and list the Medicare plans they are licensed / appointed to sell in your resident zip code.I've heard that once you're on Medicare, you might not need life insurance as much. Is that true?
The United States formed Medicare in 1965 to help seniors with their healthcare. Medicare and life insurance serve two different purposes. Medicare doesn’t replace life insurance, or offer death benefits, or cover expenses after death.However, Medicare will pay a lump sum of $255 to help with your barrel arrangements.
I went to a free Medicare seminar and it felt like a timeshare pitch. Are any of those events actually helpful?
Seminars can be helpful - up to a point. But one of the problems is that because Medicare has many different parts and options, a person is best served with a one-on-one consultation.
My friend gets SilverSneakers with her plan and I don't-how are we both paying for Medicare and getting such different stuff?
A Silver Sneakers gym membership may be included in some Medicare Supplement plans, and it can also be part of some Medicare Advantage plans. But that benefit is not uniformly offered by ALL plans. If this is important to you, be sure to ask if Silver Sneakers or other gym membership is offered as a benefit under the plan you are evaluating.
How does moving to a new state affect my Medicare enrollment timeline?
When you move out of a service area, whether from one county to another, or a different state, you must change plans if you have a Medicare Advantage (MA) or Prescription drug plan (PDP). The ability to change plans after a move falls under a Special Enrollment Period (SEP).If you don't notify your plan before you move, you have the month you move and 2 months after (3 months total) to change plans. If you notify your plan before you move, you have the month before, the month of, and 2 months after (4 months total) to make a change.
Plans vary greatly by service area, so don't be surprised if you have different benefits, including maximum out-of-pocket, deductibles, co-pays, and co-insurance. Extra benefits may also differ from area to area.
Be advised that some counties with low populations don't have MA plans, so adding a supplement and a PDP may be your only option. Medicare Supplement SEPs are similar but exclude the month before a move. You can join a Medicare Supplement plan the month you move and up to 2 months after. Guaranteed issue is available ONLY if there is no MA plan available in your new service area.
Sound complicated? Contact me and I'll walk you through it.
How do I know if a Medigap policy is right for me, and what's the best time to buy one?
A Medigap policy is right for you for a number of reasons:1. You are in the younger market like age 65 and that gives you a low premium.
2. You're health is not great, many doc visits, maybe a few chronic conditions requiring on going services.
3. Medigap policies follow Medicare's lead, and Medicare patients are treated everywhere. In other words, Medigap clients don't hear "no" when or if they want to go to a specialist locally or anywhere in the country.
If Medicare Supplement (Medigap) plans are better for long-term coverage, why don't more people choose them?
Medicare supplement plans are generally much lower cost for people age 65 - to - 70 but after that, things change. I have customers who started paying $ 125 monthly for their supplements but their plans closed for new business and increased premiums on current grandfathered members to $ 500 monthly (and higher).
Why do some clients ignore your advice and end up in bad Medicare plans-what makes them resistant?
Some clients hesitate to follow my advice because of a common misconception that Medicare advisors like me drive up their premiums or costs due to commissions, when in reality, our guidance doesn’t change what you pay—plans and pricing are set by insurers and Medicare, not us. There’s also a false narrative that we can push you into specific plans for higher payouts, but the truth is, we earn the same regardless of the provider or product, so my focus is purely on what fits your needs best. Ignoring tailored advice can lead to picking the wrong plan, missing out on key benefits, and facing unexpected costs that hit both your health and wallet hard.I'm turning 65 next month and the amount of Medicare mail I'm getting is overwhelming. How do I sort through all this?
Throw all of it in a bag for recycling! Work with a Professional who's been helping folks for decades with Medicare Planning! Work with someone who can offer BOTH Medicare Supplement/Medigap AND Medicare Advantage and make sense of the "Medicare Alphabet Soup" for you! WE do that! WE make is simple and understandable! You got this!I'm considering concierge medicine but already have Medicare. How would these work together?
Concierge Care will work with Medicare, but doctors may still charge you for some items that Medicare will not cover but may be covered under Concierge Care. Concierge services are not reimbursed by Medicare.This is good for having an extra layer of coverage. The premium for this coverage is not covered under Medicare, so this is one way to get extra insurance coverage and your Medicare. Medicare Advantage networks also work with Concierge.
Medicare does not reimburse concierge services, which provide this enhanced care.
I need home health care after my surgery, but Medicare denied coverage. What are my appeal rights?
You can always appeal. According to the Medicare Rights Center, 80 percent of Medicare Part A appeals and 92 percent of Part B appeals result in coverage for the beneficiary.
I'm worried about affording my medications even with the 2025 changes. Are there additional assistance programs I should know about?
Even with the coverage gap being eliminated and a max of $2000 out-of-pocket being set, medications can still be costly.Medicare Beneficiaries can:
1) Apply for the Low-income Subsidy (extra help) through Social Security
2) Apply for the state-based program called the Medicare Savings Program
3) Apply for patient assistance programs offered by the drug manufacturers or non-profit organizations.
I'm taking a brand-name medication that doesn't have a generic version. How can I find a Medicare Part D plan that will cover it at a reasonable cost?
Work with an independant agent that has access to all the plans..The changes in 2025 to Part D has caused every plan to review and adjust coverage. Not every plan covers every drug in their forumulary. This was the area I spent the most time on this year for my clients to help them get the coverage needed...
Isn't it suspicious that Medicare Advantage plans offer gift cards and incentives to enroll?
They are not allowed to offer incentives to induce enrollments. I advise prospects and clients to be wary of offers like this.
Don't you think Medicare's focus on treatment rather than prevention is backwards?
This is a complicated answer, how I look at it is Medicare is Based on Western Medicine that that focuses on treatment of conditions, so Medicare follow that process. However in my many years of doing this I have seen a lot of folks find out they have major health conditions because of the regular screenings that are at no cost to you on your policies. The plans do encourage you to use them and take advantage of no cost screenings and some doctor visits. So know that you are well covered. Now some plans do include no cost to you benefits, like gym memberships, access to over-the-counter products like vitamins and supplements, and other benefits that take aim at getting you and keeping you healthy! Make sure you choose a plan that fits your needs and lifestyle.
I'm interested in nutrition counseling to help manage my diabetes. Will Medicare cover this as preventive care?
Medicare part B does cover with a referral from a doctor to a regestiered dietitan or specialist. But it all starts with your doctor.
I want to be proactive about my health. What preventive services should I be taking advantage of with Medicare?
There is a list of preventative services on Medicare.gov. Of course your annual physical, exercise and diet.
I'm a smoker trying to quit. What smoking cessation benefits does Medicare offer for someone in my situation?
Some Medicare Advantage Plans provide Smoking and Tobacco cessation counseling to stop smoking or tobacco use in the Medical Benefits. Some provide counseling visits over a 12 month period at no cost to you.
I'm living solely on Social Security of $1,400 monthly and can't afford my Medicare premiums and copays. What assistance programs might help someone in my situation?
Low-income subsidy by the state you live in or apply for state Medicaid at that income. You can apply for this online at SSA.gov under the Medicare tab dropdown that says Low-income part D extra helpI'm on Medicare but recently declared bankruptcy due to medical bills. How will this affect my coverage and options going forward?
I’m sorry to hear that. And good luck.Medicare itself has no credit rating or change in coverage due to BK. But as long as you continue to to make your Part B payments your Medicare will continue to on.
My suggestion is to try to find at least a High Deductible Supplement plan that allows you to keep your Doctor choices and limit the amount of responsibility that can come back to you. If you hadn’t accepted a Medicare Advantage Plan, do not worsen your situation financially with a plan that will control you and your health moving forward.
You can work through Bankruptcy. You can’t work through not allowing yourself the control and freedom that you would then give up on your health by taking an Advantage plan.
I'm confused by all the star ratings for Medicare plans. Do they actually mean anything for the care I'll receive?
The star ratings are real and based on customer feedback and experience with the different plans. As an agent, my focus is more toward plan benefits than star ratings but the star ratings are worth noting.My kids keep telling me to get a Medicare Advantage plan, but my friends say stick with Original Medicare. Who should I listen to?
Someone who deals with helping clients with Medicare planning every day! Get the facts-not the hype! Work with someone who can explain the "medicare alphabet soup" so it's easily understandable and who also sells both: Medicare Supplement/Medigap AND Medicare Advantage! We can go over all the Pros and Cons of each plan and with staying with Original Medicare!I'm caring for my elderly parent with dementia. How can I get legal authority to manage their Medicare?
This is a difficult decision in a person's life when they're making their care decisions for someone else. To legally manage your elder parent, you'll need to see an attorney or get the attorney's advice on whether to use a power of attorney or have the court appoint you as a guardian. There are some other online procedures that you could use to obtain legal authority to manage Medicare..
How do Medicare Savings Programs help with Medicare costs?
Medicare Savings Programs (MSP) can help people with limited income cover their Medicare premiums, deductibles and other costs like co-insurance. This is also known as a Medicare Buy-In program.Eligibility can be vary by state. Extra help with Medicare Part D drug costs can by applied for simultaneously with the MSP. Income and resources can also vary by state, however most states use income and resource limits based on the Federal Poverty Level (FPL).
Types of MSPs include:
Qualified Medicare Beneficiary (QMB) which helps pay for Part A and B premiums, and covers cost- sharing for Medicare-covered services.
Specified Low-Income Medicare Beneficiary (SLMB) which helps pay for Part B premiums.
Qualified Individual (QI) which helps pay for Part B premiums.
Qualified Disabled Working Individual (QDWI) which helps part Part A premiums for individuals under age 65 who a disabled and have returned to work recently.
You can apply through your State Medical Assistance office (Medicaid).
How can I select the right healthcare company and representative to work with?
A good representative Will usually be very easy to spot ( Medicare agents hub ). If you End up finding someone that you trust then the carrier that you go with becomes Not as important. I have several clients and I can speak from experience in saying that putting them all on the same“good” plan Is not the right thing to do. Every individual is different, And a good representative should match up your needs with a plan that’s best for you.I got a call from a "Medicare agent" promising me free groceries and I almost fell for it. Why is this kind of marketing allowed?
It’s unfortunate but there are a few loopholes in Medicare marketing guidelines that allow agents to discuss benefits associated with “DSNP’s” (Dual Special needs plans) on cold calls. These types of plans require that you have both Medicare and Medicaid, if you have both of these then there may be a DSNP plan available in your area that includes a”healthy food and produce” benefit that gives you a monthly allowance towards OTC items and groceries. Unfortunately I think a commonly used tactic is the “bait and switch”. Agents/brokers have to be a little more transparent if you were to physically meet them and go over your plan options. Be a good practice To ask these individuals “how are these benefits available to me” or simply just hang up. This sure isn’t a way to conduct good business but some brokers do engage in this.
What advice would you give to seniors who are feeling overwhelmed by all the Medicare options available?
It's easy to get caught in the weeds! Please work with a local agent who has access to a variety of companies. They can work with you to explain the options in your area and find a plan that fits your needs. There is never a fee to work with an agent.
How do you approach educating clients who are new to Medicare versus those who are considering switching plans?
If not sure you have the best plan, I would verify the current plan vs some new options. I would explain that some plans may not have wide network, while other plan may better cover your needs. Should you keep it is your decision.My friend lives in a different city and has a much more detailed Medicare plan. Is their location dependent on their plan?
There should be little to no difference in coverage between traditional Medicare Part A and B and with a Medigap plan. Of course, some states require a few extra details in the Medigap plans, such as prevented care items.Medicare Advantage plans differ in some ways in providing requirements and services within and between states. These decisions are not Medicare decisions. They are based on the insurance carriers that provide these Advantage plans and the individual state regulations.
Can I use a health savings account (HSA) to pay Medicare premiums after I retire?
Yes, absolutely. In addition to paying Medicare Part B, Part D, and Medicare Advantage (Part C) premiums, you can also use your HSA funds tax-free to cover out-of-pocket costs like copays, coinsurance, and deductibles for those plans. That includes copays at the pharmacy under Part D or doctor visit copays under a Medicare Advantage plan. HSA funds can also be used for dental, vision, and hearing expenses—even if Medicare doesn't cover them. Just remember, once you're enrolled in any part of Medicare, you can no longer contribute to your HSA, but you can continue to spend what you've already saved. It's a great preplanning tool for managing healthcare costs in retirement with tax advantages.
Are there any tax benefits tied to paying Medicare premiums as a retiree?
Ultimately that is a question for a tax professional. It depends on many factors such as income, tax brackets, and state of residence. I would ask a qualified tax professional.
What's a red flag in a phone call that it might be a Medicare scam targeting my personal info?
The major red flag is if the caller asks for your Medicare number fairly quickly into the call. The first questions should be about your doctors and prescriptions as well as questions about the coverage you are seeking. Working with a local broker in your community is always a great option.
What should I do with my Medicare plan if I'm diagnosed with a rare disease requiring specialists?
If you are on a Medicare Supplemental plan like a G or an N plan, you shouldn't be to concerned about the out of pocket cost that you will pay. If you are on a Medicare Advantage plan, just make sure your Specialist is in network.What are some lesser-known benefits or services that my Medicare plan might cover that I could be missing out on?
This is a perfect question, and a great one especially in today’s time, as Medicare Advantage plans are introducing more creative and innovative benefits to differentiate themselves. You might find lesser-known Medicare Advantage perks like quarterly allowances for rent, utilities, groceries, over-the-counter items like pain relievers, or even transportation to medical appointments and gym memberships for wellness programs. Meanwhile, Medicare Supplement plans, such as G or N, often include a valuable international travel benefit for emergency care abroad, which can be crucial if you’re overseas and need treatment unexpectedly.
What should I look for in a Medicare plan if I travel frequently both domestically and internationally?
This can be very complicated. Out of network coverage is unique to each plan and carrier. Some plans say "go anywhere in our national network" and other plans can say "go anywhere Medicare works." It's best to ask us (or your broker) which plans have the best out-of-area coverage. In terms of international, most will cover for international emergency, but there can be limits. I always recommend my customers to get international travel coverage, which I help them with. It's very inexpensive and gives peace of mind should you have a problem while traveling abroad.What's the biggest mistake seniors make when choosing a Medicare Part D plan?
With the changes made in 2025 to the drug formulas and tears, it is wise to analyze all the plans. Cheaper premiums could cost you more in the long run at the pharmacy. I would always investigate the drug plans each year.Why did I receive a Medicare Summary Notice, and what should I do with it?
Your plan changes every year. That is why you need to make sure and have your agent quote even if your plan is currently working for you.I've heard about Medicare fraud. What steps can I take to protect myself from scams related to Medicare?
Fraud generally comes in the form of waste, fraud and abuse such as providers billing for services not done, or unnecessary tests being preformed, pharmacy meds and others. Deal with licensed agents and brokers providing plans. If you suspect something call the Medicare Hot Line.What are the signs that it's time for me to switch my Medicare plan, and how often should I review my options?
There's three signs I always tell people it's time to go shopping for other options:1) Cost changes (prescriptions, copays, premiums, etc.)
2) Health changes like new meds or complications
3) Doctor changes
I'll also throw in if your benefits change on your coverage. Those are all reasons I'd want to review my coverage to see if anyone is offering better.
That being said, I will always tell people that a good time to check your coverage is at least once a year. Typically we do that review with our clients anyways.
My income fluctuates significantly year to year from investment distributions. How can I avoid IRMAA surcharges when I have an unusually high-income year?
They use taxes from two years ago (so 2023's taxes for 2025), so you have time to prepare. The brackets change every year and they are tiered so if you just go over a little the penalty is is about $1,200 for the year. Work with your tax advisor if you will be near the current year's levels to reduce you income through things like charitable giving and other tax deductions. Balance the deduction spending against the expected penalty. To be honest, it's a great problem to have. Good work on the savings.I need help at home after my surgery. Will Medicare cover a home health aide or am I on my own?
Yes, under traditional Medicare A & B with a Medigap plan, Medicare will cover some home health services after surgery. Under Medicare Advantage plans, this will require prior approval by the insurance companies that carry the plan.
I'm getting conflicting information about whether Medicare covers my specific medication. How can I get a definitive answer?
This is why it is so important to actually meet with an agent in person who has several carriers they write for. The agent can put the members in the carrier's formulary to make sure the medication is coveredI have a family history of colon cancer. Will Medicare cover more frequent colonoscopies for someone in my situation?
Yes, under Medicare A & B, you may find that Medicare will cover your screening potentially every two years, under a doctor's order. Preventive care testing is offered as a separate rider with your Medigap programs, with some insurance carriers. These additional rider programs generally cover one hundred percent of the cost if classified as preventive care screening.My doctor mentioned something about Medicare not covering my procedure. How do I find out for sure before I get stuck with a bill?
Suppose you're under Medicare Part A and Part B with a Medicare supplemental insurance, and the physician sees a need for a diagnosis due to your health circumstances. In that case, the procedure should be covered, less any amounts for Medicare Part B premium or deductibles, and this is based on the type of supplemental plan you have. If you're on Medicare Part A and B with a Medicare Part C - Advantage plan, then your coverage could only be determined with the prior approval procedure through the insurance carrier of your Advantage plan. Most likely, there will be additional deductibles, co-pays, or out-of-network charges under these plans.Why does Medicare allow insurance companies to bombard seniors with confusing mail and TV ads?
Medicare agents can solicit customers through marketing advertisements and mail, but cannot make unwanted phone calls if you are on the do-not-call list. These calls are not legal! The marketing of Medicare Advantage plans is often very aggressive, and it is recommended that you do not act in haste when dealing with these plans. Medicare Advantage plans can be a very accessible and rewarding substitute for traditional Medicare with a Medigap plan. However, these plans must be carefully considered in conjunction with your in-network physicians and other healthcare providers you may be using in your area.Aren't those Medicare seminars just sales pitches in disguise?
Mostly, yes they are. They benefit you as you can meet the agent, ask questions and gather information. They are not supposed to have a sales pitch attached, or even any obligation for follow up contact. However, as polite human beings, many feel obligated to follow through and set up a meeting. To be fair, most presenters are salespeople, and we can't help but sell.As an agent with 30 years behind me, I always have preferred one on one meetings. I have always felt they are far more personal and efficient for the customer. Skip the seminar and go see an agent.
My husband passed away and now my Medicare premiums went up. Why does losing someone raise your costs?
This can be complicated. It has to do with you & your husband's "Adjusted Gross Income" or "AGI" which is taken from your 2-yr. old tax return. If you've earned more than your husband during your respective careers, once he is out of the picture, Medicare only looks at your new and "individual" tax return. The least amount in 2025 for the Part B premium is $185.00 (as an individual filer, that means the "AGI" is $103,000.00 or less; but it can be as much as $594.00 per month if your AGI is $500K or greater). My best advice for you would be to make an appointment with a counselor at your nearest Social Security office to verify that the above example happened to be your case, or not.
How can I avoid or reduce IRMAA charges on my Medicare premiums?
The fact is IRMAA charges are calculated based on your AGI (Adjusted Gross Income) from 2 years ago. Know this may give you and your tax accountant time to do some financial planning that will help you pay less IRMAA charges when the time comes. You can do a Google search to see the levels of additional IRMAA charges that will be added to your base Medicare premium.I'm an independent agent and am compensated for my services by the insurance companies. I never charge you additional fees for my services. I'm asked this question (IRMAA charges) quite often by higher income earners. You can contact me at 801-550-1800 to answer questions that will help you better understand what to expect.
How do I budget for Medicare costs if I expect my health to decline in the next decade?
I’ve always stated that you should plan with good health coverage, but budget for today. It is difficult to project the future outcome of your health, but getting the right coverage in Medicare today can help alleviate expensive costs in coverage for tomorrow.I've had a change in my health condition. How does this affect my current Medicare plan, and should I reconsider my coverage?
on Medicare Advantage Plans there is NO underwriting, so regardless of the health of someone, everyone can get a Medicare Advantage Plan is long is their Part A & B are in effect. Medicare Supplements require medical under writing and based on results could require much higher monthly premiums
What's the most cost-effective way for a healthy 65-year-old to structure their Medicare coverage?
Enroll in a Medicare Advantage plan that has prescription drug coverage, vision, dental and hearing coverage for a low or no monthly premium. There is a maximum-out-of-pocket (MOOP) per year which differs with each plan.I'm on a fixed income and struggling to afford my medications. What's this Extra Help program I've heard about for Medicare Part D?
In 2025, single tax filers making up to $ 1,976 monthly gross income with no more than $ 17,600 in assets (couples: $ 2,665 / $ 35,130) should qualify for Extra Help for Medicare Part D also referred to as LIS (Low Income Subsidy). To apply for help, go to ssa.gov/extra help, call Social Security at 800.772.1213, or call your local SS office. Walk in traffic is not recommended.I'm in the donut hole and can't afford my medications. What are my options right now before the 2025 changes?
This year of 2025 there are no known holes in the prescription drug plans. All drug plans are mandatory with this feeling of $2000 out-of-pocket expenses for the beneficiary. However, it is important to make sure that your drug plan includes your prescription drugs in their formulary so that you get full benefit of the out-of-pocket expenses.All part D prescription drug plans should be reviewed annually
I've been diagnosed with bipolar disorder at age 66. How should I structure my Medicare coverage to ensure I get the mental health care I need?
Yes. The most obvious means toward doing that is to ask your agent what is covered in your policy in the area of mental health and those medications that are prescribed to treat that malady. If you want to compare your current plan with other companies, it is going to be essential for you to realize that mental health is covered by Medicare but only so much. This depends upon the State you live in, unfortunately. You need to call both Supplement firms as well as those who offer Advantage plans. Based on a "side-by-side" comparison, you should have enough ammunition to make a determination. It would have been better had you come to this conclusion before a full 12-months had elapsed after turning age 65. This means that now you will be subject to underwriting though you won't be declined just for a bipolar disorder but an accumulation of health issues that you might also have.Won't Medicare run out of money before I can benefit from it?
My succinct answer is NO! Don’t listen to those “scare tactics”. I recently saw that there is enough until around 2040.
Isn't Medicare headed for a crisis with so many baby boomers aging into the system?
This is known very well by the Medicare market and it is pretty much going to hit its peak by 2030. This is not a surprise as it’s been known for a very long time. There may be changes and adjustments made but it isn’t going to blindside the industry.What's the cheapest way to get Medicare coverage if I only need basic hospital care?
The cheapest way to get hospital coverage is with Part A. Part A covers hospital charges at a 80/20 coinsurance rate. Medicare pays 80%, you pay 20%. Be aware, there is NO CAP on your 20%.How does getting married late in life affect my Medicare coverage or costs?
Getting married later in life may affect your Medicare coverage and costs in a variety of ways. If you file a joint tax return with your spouse, higher income may affect your Medicare part B and part D premiums. Medicare charges beneficiaries more in part B and part D premiums if they are in higher income brackets. Marriage may also affect your assets which may affect your ability to get some sort of aid such as extra help and or Medicaid. I recommend speaking to a Medicare expert and a financial advisor as to your specific situation.
My Medicare Advantage plan denied coverage for a specialist I need to see. What are my options now?
Your primary care physician may need to make the referral before its approved by your plan, especially if you have a HMO plan vs a PPO or HMO-POS plan where you can select specialists on your own instead of through your primary care provider. The other situation is the specialist you selected may not be in network. Again with HMO plans you always need to stay in network. With a PPO plan, you can choose a specialist who is not in network, but you will pay significantly more if you do. Check either with your agent or the customer service to find out what your options are to resolve this issue.Don't you think Medicare should ban all those celebrity Medicare Advantage commercials?
I think it's their right to make commercials. If they are giving false information and misleading people to think that all plans come with $1,800 in grocery benefits every year, they need to make those things clear. I just make simple commercials and educational videos, which seem to work!
I'm at high risk for heart disease based on my family history. What additional preventive services might Medicare cover for someone with my risk factors?
If you’re at high risk for heart disease, Medicare DOES cover some extra preventive services that can really help.They’ll cover things like a cardiovascular screening every 5 years, that checks your cholesterol and other key levels. And you also get a yearly visit with your doctor to talk about heart health and how to stay on track with things like diet and exercise.
If your doctor sees any other red flags, there may be more services Medicare can cover, too, but it depends on your situation.
