Medicare Questions & Answers: Advice for Seniors
Advice for Seniors Q&A
Showing 186 questions
What are the reasons why I should work with a Medicare agent?
Working with a licensed Medicare agent offers more than just help picking a plan — it provides peace of mind. Here’s why:Trust: A good agent works in your best interest, not the insurance company’s. They build long-term relationships based on honesty, transparency, and dependability — so you always have someone in your corner.
Expertise: Medicare is complex. Between Original Medicare, Medicare Advantage, Supplements, and Part D drug plans — plus the yearly changes — a seasoned agent stays current and cuts through the confusion for you.
Personalized Guidance: Your health needs, medications, and doctors are unique. An agent takes time to understand your situation and recommends plans that fit you — not a one-size-fits-all solution.
Time-Saving: Instead of spending hours researching plans or navigating enrollment forms, your agent does the heavy lifting. That means fewer headaches and less chance of costly mistakes.
No Cost to You: Medicare agents are compensated by the insurance companies, not you. Their help is free — whether you enroll through them or not — so there’s no reason not to take advantage of the support.
Annual Reviews: Your health needs and plan options can change each year. A great agent checks in with you before the Annual Enrollment Period to ensure your coverage still works for you.
Help When You Need It: If a claim gets denied, your doctor switches networks, or you have billing issues — you’re not on your own. You have a trusted professional to call.
Local Knowledge & Carrier Access: Independent agents often represent multiple carriers, so they aren’t tied to just one company. They can compare plans across the board and help you find the best value based on what's available locally.
Are Medicare Advantage plans really "free," or is that just clever marketing?
You've heard that "there's no such thing as a free lunch." Well, the same is true of Medicare Advantage plans.While it's true that there are Medicare Advantage plans that cost $0 in premium, they are not 'free' for a variety of reasons:
1. In order to qualify for a Medicare Advantage plan, you must have both Medicare Part A and Medicare Part B. There is a premium for Part B that must be paid every month.
2. You accept the terms and conditions of the Medicare Advantage plan that you choose, and that includes copayments and an out-of-pocket maximum for the services you receive. The fees you pay could add-up to thousands of dollars each year. While Medicare Advantage plans must be at least as good as Original Medicare, there will certainly be a cost to receiving medical care under Medicare Advantage.
3. Your Medicare Advantage plan is being paid by Medicare. Because they have taken-over responsibility for your medical needs, Medicare pays them a portion of what they expected to pay for your claims. The Medicare Advantage plan then decides how to spend that money in benefits. As the Medicare budget changes every year, so does the Medicare Advantage plan. It is important to review the changes in your Medicare Advantage plan every year.
4. You may end-up benefiting from Medicare Advantage by paying a little more for your medical claims, while receiving "extra" benefits like dental, vision, hearing, fitness, prescription drug and over-the-counter drug benefits at little to no cost. But in a year where you have a lot of expensive medical treatment, you could pay a lot more out of your pocket.
What benefits are there to working with a Medicare Agent near me vs remote/virtual?
There are benefits to both but below will highlight benefits of working with Agents Near you:- Personalized Face-to-Face Interaction
* In-person meetings allow for clearer communication, especially for complex Medicare topics
* Body language and visual cues helps ensure you truly understand your options
* Easier to build trust and rapport though face-to-face interactions
- Local Market Knowledge
* Familiarity with local healthcare providers, hospitals, and specialists in your network
* Understanding of regional Medicare Advantage plans that might be specific to your area
* Knowledge of local community resources and support services
- Immediate Assistance
* Ability to meet on short notice when urgent issues arise
* Can help with physical paperwork and documentation in person
* No technology barriers or internet connection issues
- Community Connection
* Often involved in local senior events and educational seminars
* May have established relationships with local healthcare providers
* Can provide references from other clients in your community
What is the biggest mistake seniors make when enrolling in Medicare?
There are 5 key mistakes seniors make when enrolling in Medicare.1. Missing Deadlines (The Top Mistake): Failing to sign up during the 7-month window (3 months before, 65th birthday month, 3 months after) leads to a 10% premium penalty for Part B for every 12-month period delayed.
2. Assuming Automatic Enrollment: If you are not collecting Social Security at least 4 months before turning 65, you must proactively sign up, as enrollment is not automatic.
3. Misunderstanding Work Coverage: Assuming you must sign up at 65 while still working with credible employer coverage, or conversely, failing to sign up when employer coverage ends.
4. Confusing Medigap and Advantage: Failing to understand that Medicare Advantage is different from Original Medicare + Medigap, which can limit doctor choices.
5. Choosing Based Only on Premiums: Picking a plan with a $0 premium but high out-of-pocket costs, or neglecting to check if doctors/drugs are covered
What's one piece of advice you wish every senior knew before picking a Medicare plan?
The single most important piece of advice:Don’t miss your initial enrollment window—timing matters more than anything.
When you first become eligible (typically around age 65), you get a 7-month Initial Enrollment Period—3 months before your birthday month, your birthday month, and 3 months after. If you miss this window:
• You could face lifetime late enrollment penalties (especially for Part B and Part D)
• You may have gaps in coverage
• You might be limited to enrolling only during certain times of the year
Just as important—during this window, you often have guaranteed issue rights for supplemental coverage (Medigap). Miss that, and you could be subject to underwriting later, meaning higher costs or even denial.
What is one of the the most common misconceptions people have about Medicare?
One of the most common misconceptions about Medicare is that it’s entirely free once you’re enrolled. Many people assume that because they’ve paid into the system through payroll taxes during their working years, all Medicare services will come at no additional cost. In reality, while Part A (hospital insurance) is typically premium-free for those who’ve worked long enough, it still has deductibles and coinsurance. Part B (medical insurance) requires a monthly premium——and covers only 80% of outpatient costs after a deductible, leaving beneficiaries responsible for the rest. Add in Part D for prescriptions or extra services like dental and vision (which aren’t covered under Original Medicare), and the out-of-pocket expenses can pile up quickly if you’re not prepared. This misunderstanding often leads to sticker shock when the bills start rolling in.
What's the most important question I should be asking about Medicare that I probably haven't thought of yet?
The most critical question most people overlook isn’t about what Medicare costs today, but how your choices today limit your options 10 years from now: "How will my choice today affect my ability to change coverage if my health fails in the future?"Most people focus on monthly premiums and current doctors. However, the "hidden" logic of Medicare centers on Medical Underwriting. Why this question is the most important: The Medigap "One-Time" Window: When you first join Medicare, you have a six-month Medigap Open Enrollment Period. During this window, insurance companies must sell you a Supplement (Medigap) plan regardless of your health history. The Trap: If you choose a Medicare Advantage plan now because it's cheaper, and five years later you develop a chronic illness and want to switch to a Medigap plan (which has more predictable costs and no networks), you may be denied. In most states, after that initial window, insurers can use "medical underwriting" to charge you significantly more or refuse to cover you entirely based on your health. The Long-Term Impact: Approximately 80% of healthcare usage occurs after age 60. A plan that looks great while you are healthy might become a financial burden if you lose the "guaranteed issue" right to switch to a more comprehensive supplement later. Other "Missed" Questions to Consider: The Question Why It Matters: "What is my Total Out-of-Pocket (MOOP) in a 'Bad Year'?"Many focus on $0 premiums but forget that a single major surgery or hospital stay could hit a $5,000–$9,000 "Maximum Out-of-Pocket" limit."Does my plan require 'Prior Authorization' for specialists?"Original Medicare doesn't care if you see a specialist. Many Advantage plans require your primary doctor to "ok" it first, which can delay care."Are my drugs on the 'Formulary' and what tier are they?"A drug can be "covered" but placed in a Tier 4 or 5 category, costing you thousands more than if it were Tier 1 or 2."Will this plan cover me if I travel or move?"Original Medic
If a senior is turning 65 but still working, should they enroll in Medicare or delay it?
Whether a senior turning 65 should enroll in Medicare or delay it while still working depends on their job situation—specifically, their employer’s size and health plan. Here’s how it breaks down:If the employer has 20+ employees: The company’s group health plan is usually "primary" (pays first), and Medicare is "secondary." In this case, they don’t have to enroll in Medicare right away. They can stick with the work plan and delay Medicare Parts A and B without penalties, as long as the job coverage is “creditable” (meets Medicare standards). Part A (hospital coverage) is free, though, so some sign up for it as a backup since it can coordinate with the work plan. Part B (doctor visits, outpatient care) has a monthly premium, so delaying it often makes sense to avoid double costs.
If the employer has fewer than 20 employees: Medicare typically becomes primary, and the work plan secondary. Here, they should enroll in Medicare Parts A and B at 65, because the work insurance might not cover much unless Medicare kicks in first. Skipping it could mean gaps in coverage or higher out-of-pocket costs.
Other Factors: If their work plan is pricey or skimpy (high deductibles, limited drug coverage), switching to Medicare might save money or improve care, even with a big employer. They’d need to compare premiums, copays, and drug formularies. Also, if they have an HSA, signing up for Medicare stops HSA contributions—something to weigh if they’re still saving there.
How to Delay: If they skip Medicare Part B (the part that costs a monthly premium) at 65 because of a solid work plan, they will get a Special Enrollment Period (SEP) later to turn on Part B and enroll in a plan in short order at that time.
What's one Medicare decision that too many people regret later?
One common Medicare decision that many people regret later is not enrolling in Medicare Part B when they first become eligible. Here are some reasons why this decision can lead to regret:1. Late Enrollment Penalties
◦ If you do not enroll in Part B during your Initial Enrollment Period (IEP) and do not qualify for a Special Enrollment Period (SEP), you may face a 10% penalty on your monthly premium for each full 12-month period you delay enrollment. This penalty can add up significantly over time and can be a financial burden.
2. Coverage Gaps
◦ Without Part B, you will not have coverage for outpatient services, such as doctor visits, preventive services, and certain medical supplies. This can lead to high out-of-pocket costs if you need these services and are not covered.
3. Limited Enrollment Opportunities
◦ After your IEP, the only time you can enroll in Part B is during the General Enrollment Period (GEP), which runs from January 1 to March 31 each year. However, coverage will not begin until July 1, which can leave you without necessary coverage for several months.
4. Difficulty Accessing Care
◦ Some individuals may assume they can rely on other health insurance (such as employer-sponsored plans) indefinitely. However, if that coverage ends or changes, they may find themselves without adequate coverage and facing delays in obtaining necessary medical care.
5. Misunderstanding of Coverage Needs
◦ Many people underestimate their healthcare needs as they age. They may believe they can manage without Part B, only to realize later that they require more medical services than anticipated, leading to regret over not having enrolled.
Conclusion
To avoid this common regret, it’s essential to carefully consider your healthcare needs and options as you approach your 65th birthday. If you are unsure about whether to enroll in Part B, it may be helpful to consult with a Medicare counselor or a licensed insurance agent who can provide personalized guidan
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?
Here’s how you and your mom can check if her doctors are covered before switching:Step 1: Get a List of Her Current Providers
Write down every primary care doctor, specialist, hospital, and clinic she wants to keep.
Include her pharmacy too, since some MA plans restrict those.
Step 2: Check Each Plan’s Provider Directory
Every Medicare Advantage plan has an online provider search tool.
Go to the insurance company’s website, search by doctor’s name or facility, and confirm they’re “in-network.”
Call the doctor’s office directly and ask: “Do you accept [Plan Name Medicare Advantage] for the coming year?” (sometimes the websites are outdated).
Step 3: Check Prescription Coverage (Important!)
Use Medicare’s Plan Finder tool at Medicare.gov
to enter her medications.
This shows which plans cover them, and at what cost.
Step 4: Compare Out-of-Network Rules
Some MA plans are HMO (only in-network, very restrictive).
Others are PPO (can see out-of-network doctors, but at higher cost).
If her doctors aren’t in-network, she could face much higher bills — or be unable to see them at all.
Step 5: Talk to a Licensed Medicare Agent
An agent can screen all the local Advantage plans at once, instead of you checking each one individually.
They’ll tell you up front if a doctor or hospital drops out of a plan (which sometimes happens mid-year).
Key Caution:
Once she switches to Medicare Advantage, if she later wants to go back to Original Medicare with a Medigap supplement, she may face medical underwriting and be denied supplemental coverage in most states (unless she qualifies for a special trial right).
My advice: Confirm her doctors and meds before signing anything. Don’t rely only on what friends say, because the best plan for one person may not fit another.
My neighbor says I'm crazy for paying for a Medigap plan when Medicare Advantage is "free." What should I tell him?
When choosing between a Medicare Advantage Plan and a Medicare Supplement Plan (Medigap), there are no right or wrong answers. The best choice depends on each individual's financial and health needs.Medicare Advantage Plans (also known as Part C) replace Original Medicare (Part A and Part B). Many of these plans offer additional benefits, such as coverage for prescription drugs, dental, vision, and hearing services. While some Medicare Advantage Plans have no extra monthly premium, individuals must continue to pay their Part B premium, which is $185 in 2025. These plans also feature a maximum out-of-pocket limit, which helps protect you from high costs if you are hospitalized or require expensive medical procedures. Most Medicare Advantage Plans are available as either PPOs (Preferred Provider Organizations) or HMOs (Health Maintenance Organizations). If you choose a Medicare Advantage Plan, you will need to use in-network providers. Be aware that there are copayments and coinsurance costs associated with these plans.
Medicare Supplements (or Medigap plans) work alongside Original Medicare (Parts A and B). Original Medicare typically covers 80% of medical expenses, while a Medicare Supplement plan covers the remaining 20%. When you choose a Medigap plan, you still need to pay your monthly Part B premium of $185 (in 2025), in addition to the monthly premium for the Medicare Supplement plan. Although the total of these premiums can add up, the only out-of-pocket expense is the one-time Part B deductible of $257 (for 2025). All other copayments and coinsurance are covered by your Medicare Supplement plan.
In summary:
- A Medicare Advantage Plan generally costs less each month, but you will incur copayments or coinsurance whenever you visit a doctor or undergo a procedure. This means you are paying for care as you receive it.
- A Medicare Supplement Plan has a higher monthly premium, but your medical expenses are known. This means you are paying for care in advance.
What's the trade-off between a Medicare Advantage PPO and HMO when it comes to flexibility?
The differences between PPO's and HMO's are considerable. Both have advantages and disadvantages:Medicare Advantage PPO – More Flexibility
• See out-of-network providers: You can see doctors and specialists outside the plan’s network without a referral, though it will usually cost more than staying in-network.
• No need for referrals: You do not need a referral to see a specialist.
• Good for frequent travelers: More ideal if you travel often or split time between states/seasons, as you have coverage outside of your primary area (at higher cost).
• Higher premiums and/or out-of-pocket costs: You typically pay more for the added flexibility. It's also important to note that additional benefits such as dental are often richer with HMO's.
Medicare Advantage HMO – Less Flexibility, Lower Cost
• Must use network providers: You must get care from in-network doctors and facilities (except for emergencies or urgent care).
• Referrals required: You usually (but not always) need a referral from your primary care doctor to see a specialist.
• Lower premiums and copays: These plans generally cost less out of pocket, which can be a big draw for those who stay local.
• Often greater ancillary benefits such as dental, transportation, etc.
• Limited travel coverage: Not ideal if you travel a lot or live in multiple states seasonally.
In short, the important thing is to match your priorities with the plan. Please don't hesitate to contact me with any questions or need for assistance!
What's the financial risk of sticking with Original Medicare without a Medigap plan?
Sticking with Original Medicare (Parts A and B) without a Medigap (Medicare Supplement) plan can expose you to significant out-of-pocket costs because Medicare doesn’t have an annual limit on what you might pay for covered services. You’re responsible for 20% of all Part B expenses — including doctor visits, outpatient care, surgeries, and medical equipment — after meeting your deductible. If you face a serious illness or require frequent treatments such as chemotherapy, dialysis, or hospital stays, those 20% coinsurance payments can add up quickly and create major financial strain.In addition, Original Medicare doesn’t cover many common healthcare needs such as prescription drugs, routine dental or vision care, or extended stays in skilled nursing facilities beyond the limited covered period. Without a Medigap plan to help fill those coverage gaps, beneficiaries are essentially “self-insuring” against potentially high medical bills, making them financially vulnerable in the event of unexpected or chronic health issues.
What advice would you give to seniors who are feeling overwhelmed by all the Medicare options available?
It’s completely normal for seniors to feel overwhelmed by Medicare. The best advice is to take it one step at a time and remember that you don’t have to figure it all out on your own. Medicare isn’t a one-size-fits-all program, and the right choice really depends on your doctors, prescriptions, budget, and lifestyle.One of the most helpful things you can do is talk with an independent Medicare agent who represents multiple insurance companies. They can break everything down in plain English, compare your options side-by-side, and help you understand what fits your situation — not just what one company is trying to sell. It takes a lot of the stress out of the process and makes sure you don’t overlook something important like drug costs, networks, or enrollment deadlines.
The bottom line: you don’t have to become a Medicare expert. Just get someone trustworthy in your corner who can guide you through it.
My kids keep telling me to get a Medicare Advantage plan, but my friends say stick with Original Medicare. Who should I listen to?
Everyone’s situation is different so to speak exactly as to your individual situation is hard to do.Generally, if you have the means to do so, and afford a Supplemental carrier plan, there is no better coverage then Original Medicare with a top Supplement offered in your state. This allows you to control your health, and have access to the best doctors, hospitals, facilities, and professionals within the medical community anywhere in the country at any time. For that you will have your Part A, B (which is $185/mo. and can be paid through your SSI) and the premium for your Supplement. You will also have a Part D Prescription plan that can be a $0-180 Premium per month. For the G plan here in Florida (the best plan) you are looking on average between $200-$230/ month. Unless it is a concierge doctor, 98% of Doctors accept this payment across the country.
For MA plans, you will have either a PPO, HMO, or PFFS plan, and will be limited as to your choices as you will generally have to stay in their networks. Your major specialty hospitals will not accept MA plans - examples: John’s Hopkins, Mayo Clinic, Cleveland Clinic, etc. Most plans require you to pick up the Part B still, and you may still have Co-pays, Co-Insurance, and deductibles. You will also have a MOOP and then the policy can apply. So be careful here. They may offer “gifts” and “freebies”, which make it front loaded for benefits, but where you really may need them is the backend, and we can’t be sure when that is for any of us!
Remember: Price is what you pay, Value is what you get, and Cost is what it is when paid the wrong price to get the wrong value! - so be careful as this is the ONLY TIME you will choose with no Underwriting involvement, and you can be sure that your health with age cannot ultimately improve, but have more challenges! Good luck!!!
Is it better to get Medicare Part D or Medicare Advantage?
It depends on your priorities — they serve different purposes, and sometimes people even combine coverage strategies. Here’s the short comparison:Medicare Part D (Prescription Drug Plan)
Purpose: Covers medications only.
Works with Original Medicare (Parts A & B).
Can be added to Original Medicare at any time (with enrollment periods).
Pros:
Keeps Original Medicare freedom to see any doctor or hospital that accepts Medicare
Multiple plan options for prescriptions
Cons:
Does not cover extra benefits like dental, vision, or hearing
You still pay deductibles, coinsurance, and premiums for Part A/B
Medicare Advantage (Part C)
Purpose: Combines Part A, Part B, and usually Part D into one plan.
Often includes extra benefits like dental, vision, hearing, fitness programs, and sometimes OTC allowances.
Pros:
One plan, one card, simpler management
Extra perks not in Original Medicare
Cons:
Usually network restrictions (HMO/PPO rules)
Travel and specialist access can be limited
Out-of-pocket costs can vary widely
Bottom line
If you value provider choice and broad access: Original Medicare + Part D + Medigap may be better.
If you want lower premiums and extra benefits: Medicare Advantage may make sense — but check the networks and coverage for your doctors and prescriptions carefully.
I'm turning 65 next month and the amount of Medicare mail I'm getting is overwhelming. How do I sort through all this?
Totally normal—and you’re not alone. Turning 65 triggers a marketing avalanche, and most people feel buried under it. Let’s make it manageable instead of maddening.First: know why you’re getting all that mail
When you turn 65, your name goes on a public Medicare eligibility list. Insurance companies and agents are allowed to market to you, which is why it suddenly feels nonstop.
How to sort through it without losing your mind
1. Separate education from advertising
Official Medicare info
“Medicare & You” handbook
Mail from Social Security or CMS
👉 These are worth keeping.
Everything else = ads
“You may be missing benefits”
“Extra money back”
“No cost plan”
👉 These are marketing pieces, not personalized offers.
2. Don’t call the 800 numbers on random postcards
Those usually go to:
Large call centers
Agents who can only sell one company’s plan
They don’t know your doctors, meds, or situation—and they’re paid to push their plan.
3. Focus on what actually matters
Ignore the flashy promises and ask these questions instead:
Do my doctors accept this plan?
Are my prescriptions covered and affordable?
What are the max out-of-pocket costs?
Can I see specialists easily?
Do I want Medicare Advantage or Original Medicare + supplement?
If a mailer doesn’t clearly help answer those questions, it’s not important.
4. Pick one trusted source (not 20)
Instead of reacting to every piece of mail:
Choose one knowledgeable, independent Medicare agent
Or use Medicare.gov as your baseline
Once you have a plan, the rest of the mail becomes noise.
5. You can reduce the junk
Opt out at OptOutPrescreen.com (cuts down insurance/credit offers)
Write “Refused” and return mail you don’t want
Register your number on the Do Not Call Registry
One last reassuring truth
There is no prize for choosing fast and no penalty for ignoring the mail.
You have a 7-month Initial Enrollment Period—you don’t need to decide based on fear or pressure.
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?
I love this question because it shows something really important about Medicare and how it actually works, and that is that it's not one size fits all.
The short answer is no, it's not random. There's always an answer to why someone's paying nothing and you're paying a lot more. Here's just a few of them.
Your friend might be on a Medicare Advantage plan and you might have a Medicare Supplement. Medicare Advantage plans have little to no premium, and you pay as you go. For Medicare Supplement, you're paying a high monthly premium, usually over $200 a month, and it gives you basically 100% coverage. So even if they're paying nothing, they may end up paying more than you if they have to use their insurance a lot.
They also may not know how much they're even paying. I've met a ton of people who thought they weren't paying for Medicare, but it turns out they're drawing $202.90 a month out of their Social Security check before they even get it.
But the most common reason I see is because they have Medicaid, which is a state program that's income based, and it can pay for all their premiums and all their health coverage. Not everybody qualifies. You have to be below a certain income.
So many people assume they can't qualify for things based off their zip code because that's what the commercials tell you. That just shows you what plans are available in your area or your county. Your income is what determines a lot of times what things you can qualify for.
But regardless, no two situations are alike. Don't make your decision based on what your friend has. Make sure to reach out to a broker who can help you determine what plan is going to be best for your specific situation.
Why not just call the insurance carrier directly?
It seems like the obvious thing to do—just call the insurance company and ask about their plans. And you can do that. But if you’re trying to figure out which Medicare Supplement or Medicare Advantage plan is actually the best fit for you, here’s why it might not be your best first step:1. They Only Sell Their Own Plans
When you call an insurance company, you’re only going to hear about their products. They’re not going to tell you if another company has a better rate, lower out-of-pocket costs, or a bigger provider network.
It’s kind of like walking into a Verizon store and asking if AT&T has better coverage in your area—you’re only getting one side of the story.
2. You Don’t Get the Full Picture
Each company has its own premiums, copays, networks, and drug coverage. If you’re calling around to different carriers, you’re left trying to sort it all out yourself—and it can get overwhelming fast.
You may not even know what questions to ask unless you’ve done this before.
3. They’re Not Focused on You—They’re Focused on Their Plan
The person you talk to is there to sell their company’s plan. That doesn’t mean they’re dishonest—it just means they’re not going to spend time walking through all your options or helping you compare other plans that might suit your needs better.
For example, they may not check if your doctor is in-network, or if your prescriptions are covered affordably, or how well their plan works if you travel.
4. You Could Miss Out on Better Options
Some of the best Medicare plans—especially local or regional ones—don’t advertise heavily. If you’re only calling the big-name insurance companies, you might never even hear about those options.
So What Should You Do Instead?
Talk to someone who isn’t tied to just one company. That is:
An independent Medicare broker (licensed to represent multiple insurance companies)
Serving ALL of Texas, California & Florida
Contact me.
I picked a Medicare Advantage plan based on the low premium, but now I'm facing high copays. Did I make a mistake?
You did not necessarily make a mistake. Low-premium Medicare Advantage plans are common, but they operate as a "pay-as-you-go" system. They trade low monthly premiums for higher copays when you actually receive care. Here is what you need to know:Your Protection: Your plan likely has a mandatory Maximum Out-of-Pocket (MOOP) limit. Once you hit this cap, the plan covers 100% of your medical costs for the rest of the year.
When It Works: Low premiums save money if you rarely visit the doctor.
When It May Not Be a Good Fit: Frequent specialist visits, scans, or hospital stays can quickly outpace your premium savings.
How to Fix It:
You can switch to a plan with higher premiums but lower copays during the next Medicare Annual Enrollment Period (October 15 – December 7).
Or, if you are interested in a Medicare Supplement/Medigap Plan, you may have options for enrolling sooner.
I recommend you reach out to a local Medicare Broker to help you find a plan that works for your healthcare needs.
I lost my Medicare Card. What do I do?
Don’t panic because losing your Medicare card is more common than you might think and it can be replaced.If you have an online My Social Security account, you can log in at ssa.gov to request a replacement card or print an official copy right away. If you don’t have an account yet, you can create one in just a few minutes.
You can also call Social Security directly at 1-800-772-1213 (TTY: 1-800-325-0778) to request a new card by mail.
While you’re waiting for your replacement, most doctors and pharmacies can still look up your Medicare coverage using your Social Security number. If you’re enrolled in a Medicare Advantage or Part D plan, you can continue using your plan’s member ID card.
To protect yourself, avoid carrying your Medicare card unless you need it and never share your Medicare number with unsolicited callers.
If you need help accessing your information or have questions about your coverage, a licensed, independent agent can help guide you every step of the way.
I went to a free Medicare seminar and it felt like a timeshare pitch. Are any of those events actually helpful?
Some are helpful, but a lot of them are really lead-generation events dressed up as education. The useful ones focus on explaining Medicare basics, enrollment timelines, penalties, Medigap vs. Medicare Advantage, Part D, and how to compare options; the less useful ones spend most of the time steering people toward one plan, one carrier, or setting a one-on-one appointment. A good rule is this: if the event feels balanced and educational, it may be worth attending, but if it relies on pressure, fear, “limited-time” language, or pushes you to enroll before you’ve had time to compare your choices, treat it like a sales pitch.
So my friend told me I should just go with the cheapest Medicare plan. That sounds too simple - what am I missing?
So the question is, my friend told me I should just go with the cheapest Medicare plan. That sounds too simple. What am I missing? I believe you're missing a couple of things. One is, if you're looking at Medicare Advantage plans, those plans typically work with networks of providers. So you want to make sure that the doctors and hospitals you see are included in the network of that plan. Or you could be in a situation where those doctors or hospitals might not be covered.
Additionally, all of the Medicare Advantage plans have different formularies and cover prescription drugs differently. So based on the prescription drugs that you happen to take, one Advantage plan might not work at all for you, while another one will, just based on those two things.
So first and foremost, if you're looking at Medicare Advantage, you really want to make sure doctors and hospitals are in-network and that it's doing the best job of covering your prescription drugs. On the other hand, if you are looking at Medicare supplement plans, or what people call Medigap, those plans are standardized. So the same plan works the same way from company to company. There's not variance in what the benefits are or how they are covered.
In that case, many times choosing the least expensive Medicare supplement plan might work best. On the prescription drug side of things, though, when you then look at prescription drug plans, again, you want to make sure that the drugs you happen to take fit in the formulary of the prescription drug plan that you're choosing. And that it's offering the best value for you.
If you had to pick just one, what's the worst Medicare-related decision someone can make?
The worst Medicare decision somebody can make is selecting a Medicare Advantage plan just based on the extra benefits it provides, instead of looking at whether all your doctors are in-network and all your medicines are covered affordably. You should also consider whether you want to deal with referrals or not. These are the things that a lot of people don't look at when they really should. The extra benefits are really just gravy, but the biggest mistake I see with people selecting Medicare Advantage plans is that they are just chasing those extra benefits, which is a really bad idea.
When it comes to Medicare supplement coverage, the worst mistake people can make is overpaying for their Medicare supplements. Your Medicare supplements here in Florida are standardized coverages based on the Medicare supplement plan letter. If you don't believe what I just said, you can look at the Medicare and You book, which is put out by the Department of Health and Human Services, and it simply states the same thing.
For example, if you want to go with a Plan G in Florida, every company that offers a Plan G in Florida provides the same exact coverage. The only difference is the monthly premium. So why would you want to overspend when you're really not getting anything in return? I would say that 90% of the people who call me and already have coverage in place are either with a Medicare Advantage plan that they could do better with or have a Medicare supplement and could save money by switching to another plan without giving up any benefits at all.
The last part is the drug coverage. This year, 14 out of the drug plans are non-commissionable, one is almost close to being non-commissionable, and that's a problem because a lot of times agents are only focusing on putting people in plans that they get commissions on. The folks here at Dave Silver Insurance will put you in the plan that is the most affordable for you when you factor in the premium plus the cost of medicine. So if it's not commissionable to us, we're still going to let you know which plan to sign up with, and you can just do that on your own.
What's the best way for seniors to protect themselves from Medicare-related scams?
The Senior Medicare Patrol (SMP)—a national volunteer-led program—recommends a three-step approach: Protect, Detect, and Report.1. Protect: Guard Your Information
Treat your Medicare number like a credit card or your Social Security number.
The "No-Call" Rule: Medicare will never call you uninvited to ask for your Medicare number or Social Security number. If someone calls claiming to be from Medicare to offer you a "new plastic card" or "2026 benefits update," hang up immediately.
The Mail First Rule: Official Medicare communications almost always arrive by U.S. Mail first.
Avoid "Free" Offers: Be skeptical of anyone offering free medical equipment (like knee braces), genetic testing, or "wellness packages" in exchange for your Medicare number. These are often "kickback" schemes to bill Medicare for services you don't need.
2. Detect: Review Your Statements
Scammers often rely on the fact that many people don't read their paperwork.
Check your MSN/EOB: Every three months, you receive a Medicare Summary Notice (MSN) or an Explanation of Benefits (EOB) from your Advantage plan.
Look for "Phantom Billing": Look for charges for doctor visits you didn't attend, medical supplies you never received, or dates of service when you were at home.
Keep a Health Calendar: Jot down your doctor appointments and tests so you can easily cross-reference them with your statements later.
3. Report: Use Trusted Resources
If you suspect you’ve been targeted or see a suspicious charge, don't wait.
Call 1-800-MEDICARE: This is the primary line for reporting suspicious activity.
Contact your local SMP: The Senior Medicare Patrol (SMP) provides free, confidential help to seniors to help identify and report fraud.
Slam the Scam: If you receive a call from someone posing as a Social Security or Medicare official, you can also report it to the SSA Office of the Inspector General.
I've heard that once you're on Medicare, you might not need life insurance as much. Is that true?
This is a very interesting question. It reads, "I've heard that once you're on Medicare, you might not need life insurance as much. Is that true?" Well, if life insurance is needed before we turn 65, why would we not need it the day after we turn 65? Life insurance isn't health insurance. Life insurance is designed to pay for items that we can't be here to pay for, such as probate fees, taxes on the properties that we still own, paying our executor something, filing our taxes, paying off your credit card debts. Dying costs money. Life insurance is a tool that's intended to be used for a couple of reasons. Number one is liquidity. When you die, your money basically freezes. It can't be accessed until your estate is cleared. So if we have a small amount—I'm talking ten, twenty, or thirty thousand dollars in life insurance, which is easy to get for hardly any money—I'm talking $30 a month for a 64-year-old forever. That's how much it costs. You give your entire family or the people that love you and are responsible for getting you in the ground, so to speak, some money to work with. It's not tied up in probate. Dying is not a clean and easy thing to do. We don't just kind of expire and everything magically gets done. It leaves the people around you with a ton of work to do that costs money. So I do believe that there is a need. I also believe that you may want to provide something for your heirs if you haven't already done so. It's probably a little bit late. But if you have a half-million or a million-dollar permanent life insurance policy and you think, "Oh, I don't need this; I've got Medicare now," stop right there. Your heirs could use it, or your spouse could use it, or your grandchildren. So there are no hard and fast rules here. But if you have life insurance and you can afford to keep it, do so. It's a wise financial planning choice. You will not regret it.
I'm getting conflicting information about whether Medicare covers my specific medication. How can I get a definitive answer?
The only truly definitive answer comes at the pharmacy when you pick up your medication. Accurate answers before you pick up your medication may come from your insurance company. You may call their customer service line to discuss your medication questions and coverage provisions. They will help you to know if the medication is on-formulary and if any extra approval is required through prior-authorization or step therapy. You can also ask them if there are similar medications that would be covered at a lower cost so that you may discuss those options with your doctor or pharmacist. If they are telling you something different than you expect, you can ask to speak to a supervisor to figure out why you’re getting a different price quote or coverage determination from your pharmacy or from their online formulary tool.Every detail matters with Part D coverage - drug, dosage, formulation, quantity, diagnosis, pharmacy, specific plan, how much you’ve anlready spent toward your MOOP and prior-authorizations. Only when all of these factors align correctly can you rely on the quoted price as ‘definitive’.
My friend lives in a different city and has a much more detailed Medicare plan. Is their plan dependent on their location?
Hi there. It depends. If your friend has Original Medicare and a Medicare Supplement (Medigap), then she can go anywhere in the U.S. that accepts Medicare. If however, your friend has "detailed plan", it sounds like an Advantage plan. If it an HMO, she must stay in her local organization of doctors. Many of the PPO Advantage plans will now allow you to go to another doctor in a different city, as long as it is still in that insurance carriers network. If she has Aetna PPO, for example, she can often find in network Drs away from home.With that said, all Advantage plans cover emergency care out of network.
If your friend is traveling and has an emergency, her insurance will usually cover out of network, but if she is moving... she will either want Medigap plan G/ N or change Advantage plans to her new location.
I hope this helps.
I'm confused about when I can change my Medicare plan. Can you clarify the different enrollment periods for me?
1. Annual Enrollment Period (AEP)October 15 – December 7
This is the “big one” each year.
During AEP, you can:
Switch Medicare Advantage plans
Switch Prescription Drug Plans (Part D)
Move from Original Medicare + a supplement to Medicare Advantage
Move from Medicare Advantage back to Original Medicare
Changes take effect January 1.
2. Medicare Advantage Open Enrollment Period (MA OEP)
January 1 – March 31
Only for people already enrolled in a Medicare Advantage plan.
You can:
Switch to a different Medicare Advantage plan
Drop your MA plan and go back to Original Medicare + add a Part D plan
You cannot switch from one Part D drug plan to another during this time.
3. Initial Enrollment Period (IEP)
This is when you first turn 65.
It’s a 7-month window:
Starts 3 months before your 65th birthday month
Includes your birthday month
Ends 3 months after
You can enroll in:
Part A
Part B
Medicare Advantage
Part D
4. Special Enrollment Periods (SEPs)
These happen when life changes give you the right to switch your plan outside the regular windows.
Common SEPs include:
Losing employer coverage
Moving to a new county or state
Your plan reduces its service area
Becoming eligible for Medicaid or LIS
Your plan receives a 5-Star rating
Each SEP has its own rules and timing, but most give you 60 days to make a change.
Why do some seniors end up paying lifelong penalties for Medicare Part B or Part D?
Late Enrollment penalties (LEP's) are a result of not having creditable coverage through an employer or spouse and not being enrolled in Medicare Part B or Part D after age 65. Part B and Part D (drug) penalties are calculated based on how my many months you went without being enrolled in Medicare Part B and Part D past age 65. Medicare Part B penalties may go away after a certain amount of time, Part D penalties never go away. LEP's are avoidable by enrolling in Medicare Part B and Part D at age 65 if you do not have "creditable" coverage. Medicare considers most group employer plans creditable, but it a good idea to check with your HR dept ahead of your 65th birthday to verify.
Can I use a health savings account (HSA) to pay Medicare premiums after I retire?
After you retire, you can use funds from a Health Savings Account (HSA) to pay for certain Medicare premiums, offering significant tax advantages. Specifically, HSA funds can be used tax-free to cover Medicare Part B (medical insurance), Part D (prescription drug coverage), and Medicare Advantage (Part C) premiums. These withdrawals are not subject to income tax if used for these qualified medical expenses, making the HSA a powerful tool for managing healthcare costs in retirement. However, you cannot use HSA funds tax-free for Medigap (Medicare Supplement) premiums—doing so would result in a taxable distribution, and if you're under 65, a 20% penalty would also apply. One key benefit of an HSA is that once you turn 65, you can withdraw funds for any purpose without incurring the 20% penalty, though non-medical withdrawals will still be taxed as income. Additionally, while you can no longer contribute to an HSA once enrolled in Medicare, the account remains available for tax-free withdrawals on qualified medical expenses, making it an excellent long-term savings and tax planning tool.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?
You're definitely not alone—Medicare can feel overwhelming, and it’s incredibly frustrating to try to make the “right” choice each year only to be hit with surprise bills anyway. The good news is: yes, there is a way to get peace of mind, but it depends on what peace of mind looks like for you.Ask Yourself: What Does Peace of Mind Mean?
Predictable costs?
Freedom to see any doctor?
No need to switch plans every year.
Extra benefits like dental and vision?
Once you define what matters most, you can build your Medicare around that.
Here Are 3 Paths to Peace of Mind with Medicare:
1. Original Medicare + Medigap Plan G
Fixed, predictable costs: Only pay the Part B deductible ($240 in 2024), then Plan G covers the rest
See any doctor in the U.S. who takes Medicare—no networks, no referrals
Doesn’t change year to year like Medicare Advantage plans
Best for people who want stability and maximum coverage with no surprises
2. A Strong Medicare Advantage PPO Plan
Includes medical, hospital, and usually drug coverage in one plan
Often $0 premium with added benefits (dental, vision, hearing, gym)
Some offer nationwide access (PPO), but you may pay more out-of-network
Best if you’re healthy, want extras, and prefer simplicity in one plan
3. Work with a Trusted Medicare Agent Every Year
Instead of trying to do it alone, a good agent will:
Compare all available plans in your ZIP code
Make sure your doctors and prescriptions are covered
Help you avoid hidden costs and coverage gaps
Best if you want expert help and hate doing all the research yourself
Bottom Line:
Yes, peace of mind is possible—you just need a strategy that matches your lifestyle, and ideally, a guide you trust to help you through it each year.
Would you like help reviewing your current setup and seeing if there’s a more stable, lower-stress option for you?
Contact us for help
What do I do if I cannot afford my Medicare premiums?
💙 1. Medicare Savings Programs (MSPs)These state-run programs can help pay for:
• Part B premiums
• Sometimes Part A premiums
• Deductibles and coinsurance (depending on the program)
The main programs include:
• QMB (Qualified Medicare Beneficiary)
• SLMB (Specified Low-Income Medicare Beneficiary)
• QI (Qualifying Individual)
Eligibility is based on income and limited assets.
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💊 2. Extra Help (Part D Low-Income Subsidy)
The Extra Help program helps pay for:
• Prescription drug plan premiums
• Deductibles
• Copays
You apply through the Social Security Administration, and many people qualify without realizing it.
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🏥 3. Medicaid
If your income is very limited, you may qualify for both Medicare and Medicaid (often called “dual eligible”). Medicaid can help cover premiums and additional medical costs.
You apply through your state Medicaid office.
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📌 4. Contact Social Security
If you’re having trouble paying premiums that are being deducted from your Social Security check — or you’re being billed directly — contact the Social Security Administration right away to avoid losing coverage.
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✅ Key Takeaway
If you cannot afford your Medicare premiums, do not ignore the bills. Help is available — and many assistance programs are income-based, not credit-based.
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?
I'm Cody Brown, a senior benefits services agent. Today's question is, "I'm living solely on Social Security of $1,400 monthly and can't afford my Medicare premiums and co-pays. What assistance programs might help someone in my situation?"
There are many assistance programs out there for people on Medicare who have a limited income. The two most common ones are Medicare Savings Programs and Extra Help with prescription drugs. The Medicare Savings Programs are funded and administered locally through your state Medicaid office. That can help pay for things like your Medicare premium and your health co-pays, or both. You can reach out to your local Medicaid office to see what you might qualify for.
There's also Extra Help with prescription drugs. That's the actual name of the program, and it is run through Social Security. So if you qualify for this program, you could get drastically reduced costs on your prescriptions. Someone who does not qualify for that program typically pays around $100 a month or so for a brand-name prescription on most prescription plans.
This assistance program would limit the amount that you pay for any brand-name prescription to $12.65 and any generic prescription to $5.10. So, there are lots of savings on the table out there for you. If you qualify for some of those programs, just make sure to reach out and see what's available for you.
I'm worried about choosing the wrong plan and being stuck with it. How often can I change my Medicare coverage?
You may have more opportunities to change your Medicare coverage than you realize, depending on the type of coverage you have and your situation.If You Have Medicare Advantage (Part C):
You can usually make changes during these periods:
* Annual Enrollment Period (October 15 – December 7):
You can join, switch, or leave a Medicare Advantage plan or change your prescription drug coverage. Changes generally take effect January 1.
* Medicare Advantage Open Enrollment (January 1 – March 31):
If you already have a Medicare Advantage plan, you can switch to another Medicare Advantage plan or return to Original Medicare (and possibly add a prescription drug plan).
If You Have Original Medicare:
* You can generally join, switch, or drop a prescription drug plan during the Annual Enrollment Period.
* You may also have opportunities to change coverage if you qualify for certain special circumstances.
Special Enrollment Periods (SEPs)
You may qualify for additional enrollment opportunities if certain life events happen, such as:
* Moving to a new area
* Losing employer coverage
* Qualifying for Extra Help or Medicaid
* Moving into or out of a nursing facility
* Other qualifying circumstances
Important Note About Medicare Supplement (Medigap):
If you want to switch your Medicare Supplement plan later, you may have to answer health questions depending on your state and situation, so timing can matter.
Simple Answer:
You are usually not permanently “stuck” with a Medicare plan, but when and how you can change depends on your current coverage and circumstances.
How do discount cards and resources affect my Medicare Prescription Drug plan?
How Discount Cards & Resources Impact Your Medicare Drug Plan?They Can’t Be Combined at the Pharmacy
Medicare Part D doesn’t allow you to use a discount card (like GoodRx, GlicRx, etc.) at the same time as your Medicare coverage for the same prescription. You have to choose one at the pharmacy counter:
Use your Part D plan (counts toward your deductible and out-of-pocket costs), or
Use a discount card (may be cheaper, but won’t count toward Medicare costs)
Discount Cards Might Be Cheaper for Some Drugs
Sometimes, a discount card price is actually lower than what your Medicare plan would charge, especially for generics.
But remember:
The purchase won’t count toward your plan’s deductible or coverage gap.
You’ll need to track what you spend separately if you use both in the same year.
Manufacturer Assistance Programs
Some drug companies offer patient assistance or copay programs, but most can’t be used with Medicare. These are usually for people without insurance or in very specific hardship situations.
The Extra Help Program
If you have limited income, you may qualify for Extra Help, a Medicare program that:
Lowers your copays for medications
Eliminates or reduces your deductible
Covers the “donut hole” coverage gap
Talk to Your Medicare Broker or Agent
A trusted agent can:
Help you compare retail and plan prices
Find the most cost-effective pharmacy or plan
See if a Supplemental plan or changing your Part D plan is a better fit
Always ask the pharmacist which option is cheaper, your Medicare plan or a discount card, and choose what saves you the most without missing long-term benefits from your plan.
What are the signs that it's time for me to switch my Medicare plan, and how often should I review my options?
Signs that it’s time to switch your Medicare plan include:Rising Costs: If your out-of-pocket expenses—like premiums, deductibles, or copays—are creeping up beyond what’s comfortable, a different plan might save you money. For example, a Medicare Advantage plan could cap your annual spending, unlike Original Medicare.
Changing Health Needs: If your doctor says you need new treatments, specialists, or meds that your current plan doesn’t cover well (or at all—like dental or vision in Original Medicare), it’s a red flag. A plan that once fit might not anymore.
Provider Network Issues: If your preferred doctors or hospitals drop out of your plan’s network (common with Medicare Advantage), or you move to a new area, you might need to switch to keep care seamless.
Poor Coverage Fit: Maybe you’re overinsured—paying for bells and whistles you don’t use—or underinsured, scrambling to cover gaps. A plan tweak could align better with your reality.
Plan Changes: Every year, plans adjust. Your Medicare Advantage or Part D plan might hike premiums, cut benefits, or alter drug formularies in ways that hit you hard. The Annual Notice of Change letter (sent by September 30) will tip you off.
As for how often to review your options: once a year is the sweet spot. The Annual Enrollment Period (AEP)—October 15 to December 7—lets you switch Part D or Medicare Advantage plans, or jump between Advantage and Original Medicare, with changes kicking in January 1. Even if you’re happy, skimming your plan’s updates during this window keeps you from getting blindsided. Life shifts—like a new diagnosis or move—might warrant an extra look, and Special Enrollment Periods (SEPs) can pop up for those (e.g., losing employer coverage). Medicare’s website or a quick call to 1-800-MEDICARE can help you compare. Don’t sleep on it—plans evolve, and so do you.
How does life insurance contribute to financial planning?
Life insurance plays a crucial role in financial planning for several reasons:Income Replacement: In the event of the policyholder's death, life insurance provides a death benefit to beneficiaries, which can replace lost income and help maintain their standard of living.
Debt Coverage: Life insurance can cover outstanding debts, such as mortgages, car loans, or personal loans, ensuring that the burden doesn't fall on family members.
Education Funding: Parents can use life insurance proceeds to fund their children's education, ensuring that their educational aspirations are not jeopardized by the loss of a parent.
Estate Planning: Life insurance can be an effective tool in estate planning. It can provide liquidity to pay estate taxes or cover other expenses, preventing the forced sale of assets.
Business Continuity: For business owners, life insurance can fund buy-sell agreements, ensuring that the business can continue operating smoothly after the death of a key stakeholder.
Cash Value Accumulation: Certain types of life insurance, like whole life or universal life, accumulate cash value over time, which can be borrowed against or withdrawn for various financial needs.
Peace of Mind: Knowing that loved ones will be financially protected in the event of an unexpected death provides peace of mind, allowing individuals to focus on their current financial goals.
Tax Benefits: In many jurisdictions, life insurance death benefits are paid out tax-free to beneficiaries, making it an efficient way to transfer wealth.
Supplementing Retirement Income: Some life insurance policies allow for withdrawals or loans against the cash value, which can be used to supplement retirement income.
So with all these 2025 Medicare changes, should I be switching plans or staying put?
This is a good question with not enough space for me to answer.Also, I am not sure if this was a question from last year for the 2025 year. If so, there were changes to where the coverage gap or "donut hole" was eliminated with the 2025 prescription drug plans having a maximum out of pocket instituted of $2000. Also, the MP3 option was implemented which was the Medicare Prescription Payment Plan allowing Medicare Beneficiaries who may have high cost medications to spread their payments over the annual year to make it easier for budgeting purposes.
For 2026, the maximum out of pocket limit will be increased to $2100 for prescription drug plan costs.
If referencing changes from 2025 to 2026, there have been a lot of changes in the Medicare market.
Many insurance carriers (not all) have reduced their footprint in the Medicare Advantage plan market across the U.S. A small portion of insurance carriers have increased their footprint.
Also, there is a move from PPO plans being eliminated or reduced, and many of the major insurance carriers are changing their focus to HMO plans within the Medicare Advantage market.
In addition, there was a VBID or Value Based Insurance Design model that was implemented in 2017 for Medicare Advantage Plans. This will end on December 31, 2025. This decision was made by CMS (Centers for Medicare and Medicaid Services) due to substantial costs within the program. What this means is that a lot of the benefits needed to be revisited by insurance carriers. Insurance carriers may have eliminated or reduced benefits or have switched their focus to benefits that Medicare beneficiaries tend to prioritize over other benefits. Many plans with similar benefits have switched focus to Special Supplemental Benefits for the Chronically Ill or SSBCI model. With this option, Medicare beneficiaries have to qualify to be in the plans and usually have 60 days to verify the chronic condition.
Plans should be reviewed annually.
My friend gets SilverSneakers with her plan and I don't-how are we both paying for Medicare and getting such different stuff?
“Paying for Medicare” does not mean you have the same type of Medicare coverage. Most people pay the standard Part B premium, but what you get beyond basic Medicare depends on whether you are in Original Medicare (Part A and Part B) with a Part D and/or Medigap policy, or in a Medicare Advantage (Part C) plan.SilverSneakers is not a standard Medicare benefit. Original Medicare generally does not include gym memberships. SilverSneakers (or a similar fitness benefit) is typically an extra perk that some Medicare Advantage plans (and a few retiree/Medigap policies) choose to include.
Plans can be very different even if premiums look similar. Medicare Advantage plans can bundle extras like fitness programs, dental/vision/hearing, transportation, etc., but they may also have networks, copays, and prior authorization rules that differ from Original Medicare + Medigap.
Benefits vary by plan, company, and county. Even two people in Medicare Advantage can have different extras because benefits can change by zip code/county and by plan design.
Do Medicare Advantage plans really save seniors money in the long run? Why or why not?
It depends, and "in the long run" is really the key phrase in that question. I could ask you how well do you predict the future?For a lot of seniors — especially people who are generally healthy and don't see many specialists — Medicare Advantage genuinely does save money in a given year. Premiums are often low or $0, and you're getting dental, vision, and other extras bundled in that you'd otherwise pay for separately.
But that math can flip in a bad health year, because your maximum out-of-pocket cost resets every January, and that number has been climbing. The national median out-of-pocket cap on Medicare Advantage plans went from $5,400 in 2025 to $5,900 in 2026 — nearly a 10% jump in one year — and some plans allow as much as $9,250.
So the "long run" question really comes down to whether your health stays the same as it is today, and it rarely does. Someone who's healthy for five years and then has a rough sixth year with a hospital stay or a new diagnosis can end up paying more cumulatively on Medicare Advantage than they would have with a Supplement plan's steady, predictable premium the whole time.
Neither answer is universally correct — it depends on how much your health changes and how much certainty is worth to you. That's not a question you or anyone can answer, but it is one that I, or any excellent independent Medicare agent, will spend time with you to make the right decision.
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?
There are multiple ways to address prescription drug costs.First, you can see if you qualify for "Extra Help." You can visit Medicare.gov/extra help to learn more about the program or call 1-800-MEDICARE.
If you qualify, this can reduce or eliminate your Part D premiums, deductibles, copays, and coinsurance.
You can use prescription discount cards. This includes Clever Rx and Good Rx, and many retail areas offer programs such as Kroger and Walmart with their own savings programs.
State Pharmaceutical Assistance Programs can also help with reducing premiums or copays. You can contact your local SHIP (State Health Insurance Program) and talk to a counselor or Medicaid office to check on eligibility and also possible receive enrollment assistance.
Drug Manufacturers sometimes have programs of their own to provide assistance. You can see if the drug manufacturer offers a patient assistance program to help cover the costs of the medications.
You can check the Health Resources and Services Administration website. You can check to see if there is a Federally Qualified Health Center near you. Federal Qualified Health Center pharmacies offer medications at reduced prices under the federal 340B program.
In addition, there are foundation grants available in some cases. PAN Foundation, Health Well, Patient Services Inc, Cancer Care, NORD, Patient Advocate Foundation, Good Days, LLS and more offer grants for disease specific conditions. There are often chronic illness funds within these nonprofit and charitable foundations that can assist with prescription costs, and some may help with premiums and potentially travel costs.
Finally, one thing to consider is checking into the Medicare Prescription Payment Plan with your prescription drug coverage. The insurance industry also calls it MP3, and it allows you to spread your costs over the year with capped costs instead of all at once.
Aren't those Medicare seminars just sales pitches in disguise?
Agents who choose to help people with Medicare have many rules we have to follow. One of these, is that we can conduct one of two different kinds of events at a time: educational or marketing.If a seminar is about a generic topic like Medicare, it is likely an educational event. The advertisements for these events should specifically include the word "educational". We are prohibited from selling anything during these events, so there will not be any sales pitches. We offer educational events to help the community better understand Medicare-related topics and reach people who don't currently work with a trusted agent.
Marketing events are events about a specific kind of product (e.g. a specific Medicare Advantage plan). Since we are breaking down plan details, this is considered selling even if it feels educational. These events are highly regulated, and we must register each of them with the insurance companies we're representing. We can even be "secret shopped" by the government to make sure we're following the rules. If you've ever seen an agent in a grocery store around a table with insurance company branding, you've seen one kind of marketing event. Remember, we're just there to help you and you will never be obligated to enroll in a plan because you attend a marketing event. You are in control of what the agent does at every step of the process.
I personally love conducting educational events because they're purely academic. It's our chance to show off and use the knowledge we've gained through the many hours we spend learning - so you don't have to! It's also your chance to ask questions and explore the topic in a neutral environment free of sales.
What's the most frustrating misconception you have to clear up with clients about Medicare every year?
This is a great question! There are a few misconceptions that I have encountered in my career both as a top performing captive agent at one of the largest Medicare carriers in the country, as well as now as an independent broker licensed in all 50 states + DC.Here are a few common ones, for example:
1. Medicare is "free." - No it is not. Part A coverage is generally premium-free for people who have worked and paid taxes for at least 40 quarters (10 years) in their lifetime, or whose spouse has done so. Part B has a premium, and it is set by CMS yearly. In 2025, it is $185 per month. That premium is the beneficiary's responsibility unless their state's Medicaid organization is paying the premium on their behalf due to income-qualification.
2. Medicare covers "everything." No, it does not. Original Medicare (Medicare parts A&B only) does not cover prescription drugs, vaccinations, dental, vision, hearing or the cost of custodial care or long term care. That is why supplemental coverage exists - to cover the gaps left where traditional Medicare leaves off.
3. Medicare prescription drug coverage is optional for people who don't take medications - Incorrect. Creditable Part D (prescription drug) coverage is required by Medicare, either through an employer, Veterans Administration/Tricare, or a Part D plan through a Part D insurance company (PDP or MAPD) is required. If someone goes without creditable coverage while on Medicare, they are penalized for each month they go uncovered for the rest of their lives if they enroll into Part D coverage in their future. Penalties apply for delayed enrollment into all parts of Medicare without other creditable coverage, but the Part D coverage is the most commonly overlooked.
Medicare is complex and complicated, and it's important to navigate it with a thorough, compliant, certified advisor and advocate who can align with your unique, individual needs, so you can cut through the noise to make informed decisions.
What's the biggest mistake seniors make when choosing a Medicare Part D plan?
With continual changes in Carrier Plans, Formularies, and Deductibles, choosing the right Medicare Part D plan is getting more challenging each year. Below is a quick summary of the four biggest mistakes seniors make when choosing a Medicare Part D plan.1) Not comparing plans: The biggest mistake is not comparing plans. This is critical to ensuring you are on the right plan to start out with, and each year during the annual enrollment period (AEP), because plans change annually. You must not assume that your plan will remain the same year to year. This goes for both Medicare Part D and Medicare Part C plans.
2) Not considering your prescriptions: Some plans may have a low premium, but your prescriptions may not be covered in that carriers formulary. Carriers may change their formularies each year, so this comparison should also be done during initial enrollment as well as each year during the AEP.
3) Not considering deductibles, copayments, and in network pharmacies: In 2026, several carriers added or increased their drug deductible and copays. In addition to considering these elements you should also ensure that you are using an in-network pharmacy. Not doing so could cost you several hundred dollars per prescription. All of these costs vary from carrier to carrier and many of these costs will change annually.
4) Missing enrollment periods: Missing your initial enrollment period in Medicare Part D or missing the annual enrollment period are key mistakes that seniors make. Seniors that are turning 65 or currently on a Medicare Plan, should work with a local broker at least 3 months in advance of their 65th birthday and each year during the AEP, which is October 15th-December 7th.
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.
That’s a great question—and honestly, you should interview your Medicare agent just like you would any professional advisor.Here are some red flags to watch for:
• They pressure you to enroll immediately — A good agent educates first. If someone says, “You need to sign today or else,” be cautious.
• They only talk about one company or one plan type — Ask: “How many carriers do you represent?” If they only push one option repeatedly without discussing alternatives, that’s a concern.
• They avoid discussing disadvantages — Every Medicare plan has pros and cons. If everything sounds perfect, you’re probably hearing a sales pitch rather than advice.
• They don’t ask questions about your doctors, medications, budget, travel habits, or healthcare needs — Medicare should be personalized. An agent who doesn’t ask questions may be matching you to a commission—not your needs.
• They cannot clearly explain costs — You should understand premiums, deductibles, copays, maximum out-of-pocket costs, and provider networks before enrolling.
• They discourage you from comparing options — A trustworthy agent welcomes questions and comparisons.
• They ask for sensitive information too early — Be cautious if someone immediately asks for banking information, Social Security numbers, or Medicare numbers before explaining why.
• They disappear after enrollment — Ask: “Will you help me after I enroll if I have questions or problems?” Service after the sale matters.
Questions you should ask an agent:
✓ How many insurance companies do you represent?
✓ How are you compensated?
✓ What happens if my doctors leave the network?
✓ What are the biggest downsides of this plan?
✓ Will you help me during Annual Enrollment or if I need changes later?
A good Medicare agent should make you feel more informed—not more confused or pressured.
Can Medicare drop me for health reasons?
No, Medicare cannot drop you because of your health. If you have Medicare, your coverage continues even if you have health problems or develop a new illness.Original Medicare (Parts A and B) is a government health insurance program, so once you’re enrolled, you’re guaranteed coverage (assuming you remain eligible, such as by age or disability status).
The following are a few details to know:
Original Medicare (Parts A & B): You cannot be denied or dropped based on your health.
Medicare Advantage (Part C): These are private insurance plans, but they must accept anyone who’s eligible for Medicare and who lives in their service area, regardless of health. The only exception is for people with end-stage renal disease (ESRD) — until recently, plans did not have to accept those patients, but this has now changed, and nearly all plans accept ESRD.
Medicare Supplement (Medigap): When you first become eligible (your 6-month Medigap Open Enrollment Period), you’re guaranteed acceptance regardless of health. Outside that window, insurance companies in most states can ask health questions, but once they accept you, they cannot drop you as long as you pay your premiums.
In summary, while your plan options may vary based on when and how you apply, once you have Medicare coverage, the program cannot drop you for health reasons.
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?
Really glad you didn’t fall for it — and you’re right to be frustrated. Here’s the honest answer on why this keeps happening:It’s not really “allowed” — it’s a gray area being actively abused.
CMS has rules prohibiting misleading Medicare marketing. Agents and plans cannot:
• Make false benefit promises
• Use high-pressure tactics
• Promise benefits not included in the actual plan
But enforcement is slow and complaints are high. The sheer volume of bad actors — many operating as third-party lead generators, not licensed agents — makes it hard to police in real time.
Why it’s so common right now:
The VBID program termination in 2026 (which we discussed earlier) actually reduced grocery benefits significantly — but the TV ads and phone scripts haven’t caught up. Many callers are still pitching benefits that no longer exist at the scale they’re implying.
Red flags you can share with clients:
• Unsolicited calls promising specific dollar amounts (”$900 in free groceries!”)
• Pressure to decide immediately
• Asking for Medicare or Social Security numbers upfront
• “I’m calling from Medicare” — Medicare does not call you
What to do if it happens:
• Hang up
• Report it to 1-800-MEDICARE or the FTC at reportfraud.ftc.gov
• Contact your State Health Insurance Assistance Program (SHIP)
If Medicare Supplement (Medigap) plans are better for long-term coverage, why don't more people choose them?
First, one has to define “better”. What is “better”?• No networks.
• Less prior authorizations.
• More financial protection if something serious happens.
• Standardized...A Plan G is a Plan G no matter where you live. They don’t change from year-to-year.
After that, the main reasons why more people don’t choose them are as follows:
1. The 800# TV ads from the corrupt, publicly traded e-brokers. The ads and agents that represent these companies do not give full disclosure about ALL the options and pros and cons of each option that a Medicare beneficiary has. Unfortunately many people that have enrolled into Medicare Advantage over the last 5 years or so have little to no clue what they have and the pros and cons that go along with it.
2. Almost 20% of Medicare beneficiaries also receive Medicaid, therefore they have no need for a Medicare Supplement.
3. Many people can’t afford the escalating premiums. For those that can’t, they need to seriously consider a High-Deductible Plan G. It is “The Best Alternative To Medicare Advantage.”
4. Then you have a large percentage of Medicare beneficiaries that have group retiree coverage in place of or in addition to their regular Medicare. These would include those who have retired from federal, state, and local government, as well as those in the military that have Tricare for Life.
5. Lastly, there are people that have truly weighed their options and prefer Medicare Advantage over a Medicare Supplement because of the $0 to low premiums and the extra benefits (dental, vision, etc.). And they are willing to deal with copays, networks, and annual changes. From my experience and research, the vast majority of people that have a Medicare Advantage plan are satisfied to very satisfied with their plans.
So, “better" depends on each Medicare beneficiary's specific needs, philosophy, and budget.
I hope that helps.
Regards,
Chris
What's the most cost-effective way for a healthy 65-year-old to structure their Medicare coverage?
Great question! For a healthy 65-year-old looking for cost-effective Medicare coverage, the goal is balancing affordable premiums with enough protection to avoid big surprise bills.Here’s a common, cost-effective approach:
1. Original Medicare (Part A & B)
Part A is usually premium-free if you’ve worked enough
Part B has a standard monthly premium ($170.10 in 2024)
2. A High-Value Medigap Plan (Like Plan G)
Covers nearly all out-of-pocket costs except the Part B deductible
Predictable costs—usually a higher monthly premium but no surprise bills
Great for peace of mind against unexpected hospital or doctor costs
3. A Standalone Part D Prescription Drug Plan
Choose a plan with good coverage for your medications
Premiums vary, but you can shop annually for better deals
4. Skip Extras You Don’t Need Yet
Since you’re healthy, you may not need dental, vision, or hearing coverage right away
You can add these later if needed via standalone plans or Medicare Advantage
Why This Works:
You avoid high out-of-pocket costs with Medigap’s broad coverage
You keep monthly premiums manageable
You maintain freedom to see any doctor who accepts Medicare
You can tailor drug coverage to your needs and budget
Would you like help comparing Medigap and Part D plans available in your area to find the best value? Contact us.
Why do some clients ignore your advice and end up in bad Medicare plans-what makes them resistant?
Some clients ignore good Medicare advice for a variety of reasons:1. Information Overload – Medicare is complex. With so many commercials, mailers, and opinions from friends or family, it’s easy for people to feel overwhelmed and make quick decisions without fully understanding the consequences.
2. Trust Issues – Some may have had bad experiences with salespeople in the past, making them hesitant to believe an agent has their best interest at heart.
3. Influence of Advertising – National TV ads and celebrity endorsements can be persuasive, even when the plans being pushed don’t fit someone’s specific needs.
4. Fear of Change – Seniors often stick with what feels comfortable, even if it’s not the best option financially or medically. Change can feel risky.
5. Focus on “Perks” Over Coverage – Many get attracted to extra benefits (like dental, vision, or gym memberships) without realizing that provider networks, drug coverage, and out-of-pocket costs matter more in the long run.
6. Misinformation From Friends/Family – Well-meaning loved ones often give advice based on their own plan or situation, which may not apply at all.
How can I select the right healthcare company and representative to work with?
1. How to Evaluate and Select a Healthcare CompanyWhen looking at insurance carriers, it is easy to just look at the monthly premium. However, a company's overall reliability, network size, and financial stability matter just as much. Look for the following indicators:
Network Adequacy: Ensure your preferred doctors, specialists, and local hospitals are "in-network." Out-of-network care can result in massive, unexpected out-of-pocket expenses.
Plan Variety: A strong healthcare company should offer a diverse portfolio of products (such as HMOs, PPOs, Medicare Advantage, or Medigap plans) so you can find a structure that fits your specific lifestyle and budget.
Financial Strength Ratings: Check independent rating agencies like A.M. Best, S&P, or Moody’s. Companies with high ratings (e.g., A or A+) have a proven track record of financial stability and the ability to pay out claims.
Customer Service & Claims Reputation: Look into the company's track record for processing claims efficiently and resolving customer disputes fairly. For Medicare plans, you can easily check the CMS Star Ratings (ranging from 1 to 5 stars) to see how existing members rate their quality and performance.
2. How to Choose the Right Insurance Representative
The representative you work with is your advocate. They interpret complex policy language and build a plan tailored to your life.
Captive Agents vs. Independent Brokers
First, understand the two primary types of representatives:
Captive Agents: Work exclusively for one healthcare company. They know their specific products inside and out, but they can only offer you plans from that single carrier.
Independent Brokers / Agents: Partner with multiple insurance companies. They can shop the entire market on your behalf, compare rates across competing brands, and provide an unbiased recommendation based purely on your needs.
I need a hearing aid but I've heard Medicare doesn't cover them. Is there any way around this?
You’re right — Original Medicare (Parts A & B) does not cover routine hearing exams or hearing aids.But there are several practical ways people get hearing aid coverage or lower the cost. Here are your best options, clearly laid out:
1. Medicare Advantage plans (Part C) — most common workaround
Many Medicare Advantage (MA) plans include hearing benefits, such as:
Hearing exams
Allowances for hearing aids (often $1,000–$3,000 per ear every 1–3 years)
Access to large networks (UnitedHealthcare, Humana, Anthem, etc.)
⚠️ Important:
Benefits vary by plan and county
Usually must use in-network providers
Often requires prior authorization
➡️ This is the only Medicare path that routinely includes hearing aids.
2. VA benefits (if applicable)
If you’re a veteran:
The VA often covers hearing exams and hearing aids at low or no cost
Even partial service-connected hearing loss can qualify
3. Medicaid or Medicare Savings Programs (income-based)
If you qualify for Medicaid or a Medicare Savings Program:
Some states cover hearing aids
Coverage varies by state and medical necessity rules
4. Costco, Sam’s Club, and direct-to-consumer options
If coverage isn’t available:
Costco hearing aids: often $1,500–$2,000 per pair
OTC FDA-approved hearing aids (for mild to moderate loss): $300–$1,000
Direct-to-consumer audiology programs with remote fitting
💡 These are often cheaper than using insurance.
5. Flex cards, OTC cards, or supplemental benefits
Some Medicare Advantage plans offer:
OTC allowances
Flex cards
These sometimes can be used toward hearing-related costs (plan-specific).
6. Timing strategy (important)
If you currently have:
Original Medicare + Medigap → no hearing aid coverage
You can switch to a Medicare Advantage plan during Annual Enrollment (Oct 15–Dec 7)
Or during Medicare Advantage Open Enrollment (Jan 1–Mar 31) if already on MA
Coverage would start the month your MA plan is effective.
Are Medicare Supplement plans the same thing as "Medicare Secondary Insurance"?
Yes, “Medicare Supplement” and “Medicare Secondary Insurance” usually mean the same thing.Both refer to insurance that pays after Medicare — helping cover costs like deductibles, copays, and coinsurance that Medicare doesn’t fully pay. The official name is Medicare Supplement Insurance (or Medigap), but a lot of people casually call it “secondary insurance” because it acts after Medicare pays first.
Quick tip: Not all “secondary insurance” is a Medigap plan — some people might have secondary coverage through a retiree plan, Medicaid, or an employer too. But if you’re buying it yourself specifically to fill Medicare’s gaps, it’s a Medicare Supplement.
What should I look for in a Medicare plan if I travel frequently both domestically and internationally?
If you travel domestically, Original Medicare with a Medigap policy is hard to beat because it works with any doctor or hospital in the country that accepts Medicare, giving you true nationwide access without network restrictions. Medicare Advantage plans are network based, which means if you travel outside your plan's service area you are generally only covered for emergency or urgent care, not routine services. For international travel, Original Medicare provides virtually no coverage outside the United States, so your Medigap plan becomes especially important. Plans G and N both include a foreign travel emergency benefit that covers 80 percent of emergency care costs outside the US after a small deductible, up to a lifetime maximum of $50,000. If you travel internationally often or for extended periods, a standalone travel insurance policy on top of your Medigap coverage is worth considering for added protection. The bottom line is that frequent travelers are usually best served by Original Medicare paired with a strong Medigap policy rather than a Medicare Advantage plan.
How to know if a Medicare agent is legitimate?
Check for Licensing and CertificationThe first step in verifying the legitimacy of a Medicare agent is to ensure they are properly licensed and certified. All Medicare agents must be licensed in the state where they operate. You can verify their license through your state’s Department of Insurance website. Additionally, agents must be certified by Medicare to sell Medicare Advantage and Prescription Drug Plans. Ask the agent for their National Producer Number (NPN) and verify it on the Centers for Medicare & Medicaid Services (CMS) website.
Verify Company Affiliation
Legitimate Medicare agents usually work for reputable insurance companies or agencies. Confirm the agent’s affiliation with the company they claim to represent. You can contact the insurance company directly to verify if the agent is authorized to sell their Medicare plans. Be cautious of agents who are vague or hesitant to provide this information.
Be Wary of High-Pressure Tactics
Legitimate Medicare agents will provide you with all the necessary information and allow you time to make an informed decision. Be cautious of agents who use high-pressure sales tactics or who insist on making a quick decision. This can be a red flag indicating that the agent may not have your best interests in mind.
Be on the lookout for red flags that may indicate an agent is not legitimate:
• The agent asks for your personal information, such as Social Security number or bank details, over the phone or online without a secure connection.
• The agent offers a plan that seems too good to be true or promises unrealistic benefits.
• The agent is unwilling to provide written materials or documentation about the plans they offer.
Schedule a Face-to-Face Meeting
If possible, arrange a face-to-face meeting with the agent. This will give you the opportunity to ask questions, review materials, and get a sense of their professionalism. A legitimate agent will be willing to meet in person.
I'm on Medicare but recently declared bankruptcy due to medical bills. How will this affect my coverage and options going forward?
Filing bankruptcy does not take away your Medicare coverage. You will still keep Parts A and B, and you can still enroll in Medicare Advantage or Part D plans.What bankruptcy can affect:
Medicare Advantage or Part D premiums — if you were behind on payments, a plan could disenroll you, but you can usually join another plan during the next enrollment period.
Medigap plans — if you already have one, you keep it. If you try to buy a new one after bankruptcy, the company may use underwriting and could deny you.
Medical bills going forward — Medicare will continue covering care the same as before; bankruptcy only clears past qualifying debts.
Bottom line: Your Medicare stays intact, and you still have plan options — just be mindful of premium payments and Medigap underwriting rules if you switch.
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 is always (NOT) a fun surprise and many folks don’t see it coming. It stands for Income-Related Monthly Adjustment Amount, but really, it just means Medicare is charging you more because you “made too much” two years ago. Yay, right?Medicare looks at your income from two years back - so in 2025, they’re using your 2023 tax return. If your income was over a certain amount, you’ll pay extra for Part B and Part D. And no, it’s not always a small bump - it can be a few hundred bucks more per month depending on your income level.
You’ll get a letter from Social Security if IRMAA applies. The timing of that letter? Let’s just say it's government issued and doesn’t always conveniently show up BEFORE you’ve already picked your plans and thought you had your costs locked in.
If you’re not working with someone who brings this up ahead of time, that Social Security letter is not a fun one to open. That’s why it helps to trust your advisor who’s actually looking ahead - not just plugging in plan info or letting you go at it alone.
The good news? If your income has gone down if you just retired, sold a business, or lost a spouse - you can appeal it using form SSA-44 to get those premiums adjusted.
If your 2023 income was over $103,000 (single) or $206,000 (married filing jointly), it’s worth looking into. If not, you’re probably good. Either way, the key is catching it before you’re stuck wondering why your Medicare bill just jumped.
What's a red flag in a phone call that it might be a Medicare scam targeting my personal info?
A big red flag is when someone asks for your personal info out of nowhere.• If a caller asks for your Medicare number, Social Security number, bank info, or credit card, that is a warning sign.
• If they say you must “act now” or you will lose your benefits, that is a scare tactic.
• If they say they are “from Medicare” and try to sign you up for a plan, that is a scam. Medicare does not call people to sell plans.
• If the caller refuses to tell you the company name, hang up.
• If the caller gets angry or pushy when you ask questions, that is another warning sign.
• If the call sounds too good to be true, like offering gifts or money for signing up, it is not real.
A safe rule is simple. If the call feels strange or makes you uncomfortable, hang up and call your trusted agent instead.
Every licensed Medicare agent has an NPN number.
• You can look up that number on the NIPR website (see below) to make sure they are licensed in your state.
• A real agent will give it to you without hesitation.
• A scammer will avoid the question or hang up.
If you ever feel unsure, ask for the NPN, check it on NIPR, and call your trusted agent before giving any personal info.
What role do annuities play in retirement planning?
Annuities can play a significant role in retirement planning by providing a reliable income stream and offering various benefits that help retirees manage their finances. Here are several key roles that annuities serve in retirement planning:Guaranteed Income: Annuities can provide a steady, guaranteed income for a specified period or for the lifetime of the annuitant, helping retirees cover essential living expenses and maintain their standard of living.
Longevity Risk Mitigation: Annuities help protect against the risk of outliving one’s savings. By offering lifetime income options, they ensure that retirees receive payments for as long as they live, regardless of how long that may be.
Tax-Deferred Growth: The funds in an annuity grow tax-deferred until they are withdrawn. This can be beneficial for retirement planning, as it allows the investment to compound without the immediate impact of taxes.
Investment Options: Many annuities offer various investment options, including fixed, variable, and indexed accounts. This allows individuals to tailor their investment strategy based on their risk tolerance and retirement goals.
Inflation Protection: Some annuities offer options for inflation protection, such as increasing payment amounts over time. This can help maintain purchasing power in retirement as the cost of living rises.
Estate Planning Benefits: Annuities can have death benefit provisions that allow the remaining balance to be passed on to beneficiaries, providing a financial legacy.
Flexibility in Withdrawals: Many annuities offer flexible withdrawal options, allowing retirees to access funds as needed. Some may also allow penalty-free withdrawals under certain conditions.
Diversification: Including annuities in a retirement portfolio can enhance diversification, as they can behave differently than other investment vehicles like stocks or bonds.
Peace of Mind: The predictability of income from annuities can provide retirees with peace of mind.
I'm worried about affording my medications even with the 2025 changes. Are there additional assistance programs I should know about?
It's understandable to be concerned about medication costs. Fortunately, there are several assistance programs that may help you:1. **Medicare Extra Help**: This program assists with paying for your Medicare prescription drug plan costs. Eligibility depends on your income and resources.
2. **State Pharmaceutical Assistance Programs (SPAPs)**: Some states offer programs to help residents pay for prescription drugs. Check if your state has an SPAP and what the eligibility requirements are.
3. **Patient Assistance Programs (PAPs)**: Many pharmaceutical companies offer PAPs to provide free or low-cost medications to those who qualify. You can often find information on the company's website or through resources like NeedyMeds or RxAssist.
4. **Medicare Savings Programs**: These programs help pay for Medicare Part A and Part B premiums, and in some cases, may also cover deductibles, coinsurance, and copayments.
5. **Nonprofit Organizations**: Organizations such as the National Council on Aging and the Partnership for Prescription Assistance can help you find resources and programs to assist with medication costs.
6. **Discount Cards**: Prescription discount cards, like GoodRx, can sometimes offer lower prices than insurance copays.
It's a good idea to review these options and see which ones you may qualify for. Additionally, speaking with a Medicare counselor or a social worker can provide more personalized guidance.
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?
The "Extra Help" program, also known as the Low-Income Subsidy, is a federal program to help people with Medicare Part D pay for prescription drug costs like premiums, deductibles, and copayments. Eligibility is based on your income and financial resources, such as savings and assets. You can apply online at ssa.gov/extrahelp or contact your State Health Insurance Assistance Program (SHIP) for free counseling and help with the application.Eligibility requirements (for 2025)
Income: Your annual income must be below \(23,475\) for an individual or \(31,725\) for a married couple living together. These limits are higher in Alaska and Hawaii.
Resources: Your total resources (like bank accounts, stocks, and bonds) must be at or below \(17,600\) for an individual or \(35,130\) for a married couple.
Automatic qualification: You automatically qualify if you are enrolled in both Medicaid and Medicare ("dual-eligible") or receive Supplemental Security Income (SSI).
How to apply
Online: The quickest way is to apply online through the Social Security Administration at ssa.gov/extrahelp.
Through SHIP: You can also contact your local State Health Insurance Assistance Program (SHIP) for free, unbiased counseling and help with the application process
What's the cheapest way to get Medicare coverage if I only need basic hospital care?
Unfortunately, you can't find Medicare coverage completely free. A person can minimize their costs. Generally, Part A will be free for most people. Part B premiums are currently $202.90 and will be automatically deducted out of Social Security each month. Part A and B also have deductibles of $1,736 per benefit period for Part A and $283 yearly for Part BOriginal Medicare only covers 80 percent of the medical cost and you will cover 20 percent. The 20 percent wil be a large amount if major surgery or a long hospital stay is needed.
If you want coverage to help with your 20 percent, look at a Medicare Advantage plan. Many insurers offer Medicare Advantage plans with $0 monthly premiums. They bundle basic hospital and medical care, but require you to use specific doctor networks and obtain prior authorizations for procedures. Also, you must still continue to pay your Part B premium and the Maximum Out Of Pocket cost could range between $8-10 thousand dollars.
Supplement plans like Plan N, G, or High Deductible G deserve a mention. Based on the question it would appear the person might be on a tight budget and may feel unable to afford the premiums.
Keep in mind that these Supplement plans have less overall cost compared to Advantage plans should you need to go to the hospital. There was an old television commercial that used the phrase "Pay me now or pay me later" and it is a good way to think about Supplement plans. You're paying a monthly premium upfront, but when you reach the deductible the rest of the costs should be covered for the year.
At minimum I would suggest checking a High Deductible Plan G. If you can squeeze an extra $50-70 dollars for the premium monthly, you can save yourself thousands of dollars should you find yourself needing a hospital visit and/or surgery. The deductble of an HD G Plan is $2,950. Once the deductible is reached, this plan is covered like a standard Plan G. Supplement Plans are not tied to any networks either.
When will my provider send my Annual Notice of Change?
Medicare Advantage plans can change every year on January 1st. Insurers of Medicare Advantage Plans are required to provide a notice to the Medicare beneficiaries on their plans that contains information about the changes to the plan benefits by September 30th each year. The notice is called the Annual Notice of Change. Many companies send the Annual Notice of Change well in advance of the September 30th deadline. If you are on a Medicare Advantage plan, you should receive your Annual Notice of Change (or ANOC) sometime during the month of September.The Annual Election Period (which runs from October 15th to December 7th) provides you the opportunity to make changes to your coverage for the upcoming year. Plan changes made using the Annual Election Period will be effective on January 1st.
Your Annual Notice of Change letter is important. When you receive it, review it right away to help you decide whether or not you want to make an Annual Election Period change. Even better, look to your local broker who will help you understand the changes you are seeing in the context of the local and national markets. That information will help you decide whether or not you want to pursue a change. Sometimes it is better to stay put because the grass is not always greener on the other side of the fence!
Isn't it suspicious that Medicare Advantage plans offer gift cards and incentives to enroll?
That’s a great question, and this is going to be a bit of a long answer because there’s a lot to think about with it.I’m guessing you’re talking about the over the counter cards or the healthy foods benefit cards. The grocery cards you’ve heard about are not incentives to enroll, they’re actually benefits included in certain Medicare Advantage plans. These cards are typically part of what’s called an ‘over-the-counter (OTC) or healthy foods benefit,’ and they’re meant to help members afford nutritious food, which supports better health outcomes.
As far as gift cards, Medicare has strict rules that prohibit offering gifts over a certain value to influence enrollment decisions. What you typically see are small, government-approved tokens, usually under $15, used to encourage people to attend educational events or complete health assessments after they’re already enrolled. These are designed to promote preventive care and overall wellness, not to sway anyone’s plan choice.
The grocery cards or Flex Cards you see advertised, especially with dual-eligible Medicare Advantage plans, are not sign-up incentives. They’re actually approved supplemental benefits offered to people who qualify for both Medicare and Medicaid.
These benefits are designed to support low-income individuals with things like groceries, over-the-counter items, or utilities, depending on the plan. The government allows Medicare Advantage plans to provide these extra benefits to improve health outcomes and help members manage chronic conditions.
So, it’s not about getting a gift for enrolling, it’s about providing real, ongoing support to those who qualify.
Providing the best healthcare plan for each individual should be the focus of any agent when helping a client with a healthcare plan.
How does moving to a new state affect my Medicare enrollment timeline?
When you move to a new state, your Medicare coverage may need to change, especially if you have a Medicare Advantage or Part D drug plan, since these plans are limited to specific service areas. Moving out of your plan’s area triggers a Special Enrollment Period (SEP) that lets you switch to a new plan in your new state. If you tell your plan before you move, your SEP starts the month before and lasts two months after your move; if you tell them afterward, it starts when you report it and lasts two months. Original Medicare (Parts A and B) travels with you nationwide, but you’ll want to review Medigap and Part D options available in your new ZIP code and update your address with Social Security.I'm in the donut hole and can't afford my medications. What are my options right now before the 2025 changes?
I am receiving this question in August of 2025. With that being said, I hope you have an agent or a broker that informed you that there is no donut hole in 2025.Also, if you find that you cannot afford your medications, there are a number of ways to tackle this scenario.
Every year, it is good to review your plan and see what your total estimated cost would be with premiums and copayments.
Also, you can see if it is better to use your plan or look at other programs such as GoodRx, Clever Rx, Well RX, and other prescription discount plans.
You can check to see if Medicare Savings Programs may be of assistance, Extra Help for Part D, or State Pharmaceutical Assistance Programs.
Some manufacturers do offer financial assistance with formularies of prescriptions.
Finally, if all of your costs are more at the beginning of the year, you may want to check into the Medicare Prescription Payment Plan with your insurance carrier or MP3. This allows you to budget your expenses over the course of the annual year rather than pay so much up front which makes it easier for beneficiaries for budgeting purposes.
My husband passed away and now my Medicare premiums went up. Why does losing someone raise your costs?
It's understandable to feel frustrated & confused when your Medicare premiums increase after the passing of your husband. Here's why this might happen:Income-Related Monthly Adjustment Amount (IRMAA): Your Medicare Part B and Part D premiums are determined, in part, by your income. After your husband's death, your income may change, potentially shifting you into a different income bracket & affecting your Income-Related Monthly Adjustment Amount (IRMAA).
Change in Tax Filing Status: When your husband passed away, your tax filing status changed from "married filing jointly" to "single" in the year following his death. This can impact your Modified Adjusted Gross Income (MAGI), which is used to calculate your IRMAA.
Income Thresholds: There are different income thresholds for single filers versus those married filing jointly, & the loss of your husband's income might put you above the threshold for the higher IRMAA, even if your income decreased overall.
Loss of Spousal Discounts: If you had a Medicare Supplement plan & were receiving a spousal discount, this discount would no longer apply after your husband's passing, leading to an increase in your premium.
Increased Healthcare Needs: A study published in the National Institutes of Health (NIH) indicates that spousal death can lead to increased healthcare costs & usage for the surviving spouse, which may influence your Medicare premiums in some ways.
What you can do:
Contact Social Security: You can contact the Social Security Administration to discuss your situation & see if your new income level might qualify you for a reduced IRMAA.
Appeal IRMAA: You can appeal your IRMAA determination if you believe it is incorrect.
Review Your Medicare Plan: It's important to review your current Medicare coverage & consider your options.
Consult a Financial Advisor: A financial advisor specializing in retirement planning can help you understand how losing your husband might impact your Medicare costs & guide you.
How do you approach educating clients who are new to Medicare versus those who are considering switching plans?
The approach is a little different depending on where someone is in their Medicare journey, but the goal is always to make things clear, simple, and personalized.1. For Clients New to Medicare
Start with the basics: I explain what Medicare is, the difference between Parts A, B, C, and D.
Focus on timelines: We go over the Initial Enrollment Period, penalties to avoid, and what steps they need to take first (like enrolling in Parts A & B).
Use plain language: Instead of jargon, I break it down into real-life examples, like how a hospital stay or prescription would be covered.
Decision framework: I walk them through their two main paths—Original Medicare with a supplement + Part D versus a Medicare Advantage plan—and explain the pros and cons of each.
Cost comparison: I often make side-by-side charts showing them what the cost would be with a Medicare Supplement vs a Medicare Advantage plan so they can see the numbers clearly.
2. For Clients Considering Switching Plans
Focus on what’s changing: Instead of reviewing the entire Medicare system again, I look at their current coverage, what they like about it, and where the pain points are (costs, doctors, prescriptions, extra benefits).
Review updates: I highlight new plan options, changes in drug formularies, or network differences for the upcoming year.
Cost comparison: I often make side-by-side charts showing their current plan versus alternatives, so they can see the numbers clearly.
Reassurance: I remind them that it’s normal to re-evaluate each year during Annual Enrollment, and that my role is to make sure they’re not paying more than they need to or missing out on coverage they value.
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?
Navigating brand-name drugs without generics can be tricky, but it’s all about finding the right "fit" in the plan's list. Here is a short and simple breakdown you can use:1. Use the Medicare Plan Finder
The most effective tool is the Medicare.gov Plan Finder. By entering the specific drug name, exact dosage, and preferred pharmacies, the system will rank all available plans based on the total annual cost (monthly premiums + co-pays) rather than just the premium.
2. Review the "Formulary" Tiers
Every Part D plan has a "Formulary" (drug list). Since this is a brand-name medication, it will likely be in Tier 3 or Tier 4.
* Compare different plans to see which one places that specific drug in the lowest possible tier.
* Watch out for "utilization management" rules like "Prior Authorization" which might require a doctor's note before they cover it.
3. Look for Financial Assistance
* Extra Help (LIS): Check if you qualify for the Social Security "Extra Help" program. It is designed specifically to lower drug costs for seniors with limited income.
* Manufacturer Programs: Many pharmaceutical companies offer "Patient Assistance Programs (PAPs)" for brand-name drugs that have no generic equivalent. These can often provide the medication at a very low cost or even for free.
Tip: Always check if your pharmacy is "Preferred" within the plan. Using a preferred pharmacy instead of a "standard" one can significantly lower the co-pay for expensive brand-name medications.
I've heard about Medicare fraud. What steps can I take to protect myself from scams related to Medicare?
It’s very important to understand some basics that will allow you to spot scams and help differentiate them from legitimate calls. Medicare and social security will never call you. They will send letter, however when someone calls asking for you to provide personal private info or stating that they are calling for a legitimate reason you should in my opinion be skeptical. Here are a few tips to help.1. Always get a name and phone number and ask for a license number from the people who are calling. Ask what company they are with. If they are not a scammer they should have a number where they can be reached directly.
2. Don’t give private information out over the phone. This information is what scammers are hoping to get. Guard your info and if your concerned that you may be speaking to a scammer simply hang up.
3. Know some basic rules that apply to medicare sales. Agents are not allowed to solicit medicare beneficiaries without expressed permission. An agent has to have a permission to contact form or a scope of appointment in order to call
you for sales purposes. You can call them directly but the rules protect you from being solicited and knowing that can help you spot scammers or even agents who don’t play by the rules.
4. Lastly if you have a local agent that you know and trust reach out to them for guidance. They can help educate you on the rules and be used as a resource to help you spot scammers.
What should I do with my Medicare plan if I'm diagnosed with a rare disease requiring specialists?
1. Understand Your Current Coverage: Original Medicare (Part A & B): This typically covers medically necessary treatments, including hospitalization and outpatient care, even for chronic conditions.Medicare Advantage (Part C): If you have a Medicare Advantage plan, review its specifics. Some plans, called Special Needs Plans (SNPs), may be tailored for people with certain chronic diseases, offering benefits like specialized formularies, provider networks, and care coordination services.
Medicare Part D (Prescription Drug Coverage): This covers the cost of medications. Rare disease drugs, also known as orphan drugs, are generally covered, but often subject to prior authorization and placement on higher cost tiers.
2. Explore Special Enrollment Periods (SEPs): A rare disease diagnosis may qualify you for an SEP, allowing you to change your Medicare Advantage or Part D plan outside of the usual enrollment periods. Contact Medicare (1-800-MEDICARE) or your State Health Insurance Assistance Program (SHIP) to understand your SEP options.
3. Consider Medicare Advantage Special Needs Plans (SNPs): If your rare disease is a chronic condition, consider whether a Chronic Condition Special Needs Plan (C-SNP) may benefit you. C-SNPs can offer tailored benefits, provider networks, and care coordination specifically for your condition.
4. Check Prescription Drug Coverage: Confirm your plan's formulary (drug list) includes any required medications. Be aware that prior authorization may be required for some rare disease drugs. If you face high out-of-pocket costs, explore patient assistance programs (PAPs) from the drug manufacturer, or the Medicare Extra Help program.
5. Seek Expert Advice: Consult your healthcare provider and/or a Medicare specialist (like a SHIP counselor) to understand your options and choose the best plan for your needs.
Review your coverage annually during the Annual Enrollment Period
I'm interested in nutrition counseling to help manage my diabetes. Will Medicare cover this as preventive care?
Yes, Medicare will cover nutrition counseling, specifically medical nutrition therapy (MNT), for individuals with diabetes as part of preventive care. Medicare Part B covers 100% of the cost of MNT for those with diabetes, as long as they meet specific criteria and use a doctor who accepts Medicare assignment.Elaboration:
Coverage for Diabetes:
Medicare provides coverage for MNT when a doctor refers a beneficiary with diabetes for these services.
Preventive Care:
MNT is considered a preventive health service, meaning Medicare covers the full cost, and you won't have to pay any copay or deductible.
Other Conditions:
Medicare also covers MNT for individuals with kidney disease or who have had a kidney transplant within the last 36 months.
Diabetes Self-Management Training:
Medicare also covers diabetes self-management training, which is an important part of managing diabetes.
Importance of MNT:
MNT is an effective way to help individuals with diabetes manage their condition and reduce the risk of complications.
Limited Coverage Hours:
While Medicare covers MNT, there are limits on the number of hours covered each year. For example, Medicare typically covers 3 hours of MNT in the first year and 2 hours in subsequent years.
My Medicare Advantage plan denied coverage for a specialist I need to see. What are my options now?
Options:1. First- ask your Primary Care Provider if they were able to submit the prior authorization, supporting notes and documentation required for the request; if yes and still denied;
2. Consider asking the Primary Care Provider to do a Peer to Peer call with the plan Medical Director for further discussion and insight around the plan's decision;
3. Appeal the decision through the carrier specific appeal process and be prepared to present all supporting documentation and address the reason for the denial specifically as part of the strategy;
4. If still denied and deemed necessary by your primary care provider/treatment team; escalate the appeal through the carrier to the next level of review and appeal;
5. If no resolution and the treatment team deems the referral as absolutely necessary and there is peer reviewed, evidence based, clinical support and medical necessity, you can escalate the appeal to CMS through their appeal process.
Typically, the denial is related to lack of prior authorization being filed, lack of supporting documentation and/or clinical evidence of medical necessity, or failure to comply with step therapy and conservative treatment options first. In fact, most of the denials are overturned when they have the supporting information and there is medical necessity to support the request.
You can always reach out member service of the plan or contact your local, trusted, Licensed Medicare Agent for support and guidance around the how to appeal and navigate the process.
I exercise regularly and maintain a healthy lifestyle. Does Medicare offer any incentives or additional benefits for preventive health behaviors?
While Original Medicare doesn't offer direct financial incentives or rewards for maintaining a healthy lifestyle, it does provide coverage for preventive services that can help you stay healthy and potentially avoid future health issues.Medicare-covered preventive services that support a healthy lifestyle:
Annual Wellness Visit: This visit allows you to develop or update a personalized prevention plan with your doctor, including discussing healthy lifestyle choices.
Screenings: Medicare covers various screenings like mammograms, colorectal cancer screenings, and cardiovascular screenings, which can help detect potential problems early.
Counseling: Medicare covers counseling services for things like obesity, alcohol misuse, and tobacco use, which can help you make healthier choices.
Vaccinations: Medicare covers vaccines for the flu, pneumonia, and hepatitis B, which can help protect you from illness.
Medicare Diabetes Prevention Program: If you have prediabetes, Medicare covers a program to help you prevent type 2 diabetes through lifestyle changes.
Medicare Advantage plans and additional benefits:
Many Medicare Advantage plans (Part C) offer additional benefits that can support a healthy lifestyle, such as:
Fitness programs: Some plans may include gym memberships or fitness programs like SilverSneakers or Renew Active.
Wellness programs: These may include services like vision, hearing, and dental care, or even virtual check-ups.
Rewards programs: Some Medicare Advantage plans have started to offer rewards or incentives for completing healthy activities, like getting a flu shot. However, these programs and the specific incentives offered can vary by plan, so it's important to check the details of any plan you're considering.
Key takeaway:
While Original Medicare focuses on covering preventive services, You can check with your specific Medicare plan to see what Medicare Advantage plans often offer additional benefits that can support a healthy lifestyle.
I've had a change in my health condition. How does this affect my current Medicare plan, and should I reconsider my coverage?
1️⃣ If You Have Original Medicare (Part A & B) + SupplementGood news:
Your coverage itself does not change because your health changes. Medicare covers medically necessary services regardless of new diagnoses.
However, you may want to review:
Do you now see more specialists?
Are you traveling for care?
Has your prescription list grown?
Is your current Part D plan still covering your medications well?
👉 If you already have a Medicare Supplement, you generally don’t need to worry about network restrictions or referrals.
⚠️ But switching Supplements later may require medical underwriting in most states.
2️⃣ If You Have Medicare Advantage (Part C)
This is where changes in health can matter more.
You’ll want to review:
Are your doctors still in-network?
Do you now need specialists frequently?
Are prior authorizations slowing care?
Are your copays adding up?
Are your medications covered affordably?
If your health needs increase, out-of-pocket costs can increase too (up to the plan’s annual maximum).
3️⃣ Should You Reconsider Your Coverage?
You may want to review your plan if:
You’ve been diagnosed with a chronic condition
You need regular specialist care
You’ve had a major hospitalization
Your medications have changed significantly
But timing matters:
You can change plans during Annual Enrollment (Oct 15–Dec 7)
There may be Special Enrollment Periods depending on your situation
Switching from Advantage to a Supplement may require underwriting unless you have a guaranteed issue right
The Bottom Line
A change in health doesn’t automatically mean you must switch —
but it’s absolutely a good reason to review your coverage.
What additional coverage options are available for international travelers?
Original Medicare: Almost no international coverage.Original Medicare only covers you in the U.S. and its territories (Puerto Rico, Guam, etc.) with very few exceptions — like emergencies on a cruise ship close to a U.S. port, or if a foreign hospital is closer than a U.S. one in an emergency near the border.
Your main options:
1. Medigap (Medicare Supplement)
Some Medigap plans include foreign travel emergency coverage. Plans C, D, G, M, and N cover 80% of emergency care abroad after a $250 deductible, up to a $50,000 lifetime limit. This is the most reliable Medicare-connected option for international travelers.
2. Medicare Advantage
Most MA plans follow Original Medicare rules — no international coverage. Some PPO plans may offer limited emergency coverage abroad, but it varies widely by plan. Don’t count on it.
3. Standalone Travel Insurance
The most comprehensive option. Policies can include:
• Emergency medical and evacuation (which can cost $50,000–$100,000+)
• Trip cancellation/interruption
• No lifetime dollar caps like Medigap
Recommended for anyone traveling internationally more than once or twice a year, or going to remote destinations.
4. Medical Evacuation Insurance (MedJet, etc.)
Specifically covers transport back to a U.S. hospital of your choice — not just the nearest facility. Often purchased separately or bundled with travel insurance.
Do I really need help in figuring out what's best for me as for as Medicare Planning?
I’m going to say yes. Medicare isn’t just one decisionIt’s a stack of permanent and time-sensitive choices:
• Original Medicare vs Medicare Advantage
• Medigap Plan G vs Plan N (and when you’re allowed to enroll without underwriting)
• Part D drug plans that change every year
• Provider networks, prior authorizations, and out-of-pocket exposure
• Penalties that last for life if you miss something.
As an agent, I/we have to go thru annual training and certifications to assist you correctly. It’s not to say that you can’t search out the information for yourself and even get things right but I don’t know why one would if they found a good agent to work with them, and the help comes at no cost to them.
Is it ok to work with a Medicare Agent from another state?
Yes! Absolutely. Here are some things to keep in mind:1.) Where you file your taxes or receive your benefits is where you are going to base your Medicare benefits. You need to identify a licensed agent for that state. It is not enough for the agent to be licensed in their own state with a resident license. They also have to have a non-resident insurance license and be connected with an agency that also has an insurance license within your state. Each agent has to complete certifications for each of the carriers they represent in what we call a "Ready to Sell" or "RTS" status where the carriers plans can be offered.
Bottom line: If the agent is only licensed in their state and not yours, they will not be able to help you with a plan.
2.) When you contact an agent from another state, find out if they are a captive agent where they represent one company, or if they are an independent agent where they offer two or more carriers.
3.) Medicare Supplement or Medigap Plans are standardized across the nation with the exception of three states: Massachusetts, Minnesota, and Wisconsin. What this means is that coverage will be the same according to the plans available from Plan A to Plan N. Premiums will be different from location to location.
4.) Be aware of whether or not the agents are familiar with local plans. Agents should take the time to become familiar with regional plans. However, there are a fair amount that do not always take the time to learn more about the plans and offerings that a carrier may offer in a region, state or county. Also, you may be seeking a local plan that an agent from another state may not be able to pick up. There are a small number of carriers that will only allow local agents to represent their plans. It is good to ask in advance what carriers an agent may represent before you become engaged in deep discussions about plans.
One of the beauties of working with an agent in another state is convenience.
My doctor mentioned something about Medicare not covering my procedure. How do I find out for sure before I get stuck with a bill?
It's wise to check on Medicare coverage before a procedure, especially if your doctor has raised concerns.Here's how you can verify if Medicare will cover your upcoming procedure:
1. Check Medicare's Website:
Go to Medicare.gov's "What's Covered" tool and search for your specific procedure.
You can also download the "What's Covered" mobile app for easy access on the go.
2. Talk to your Doctor or their Billing Department:
Your doctor's office might have experience with similar procedures and can offer insights.
They can also clarify the medical coding for the procedure, which affects coverage.
3. Contact Medicare Directly:
Call 1-800-MEDICARE and explain your situation.
They can provide information on Medicare coverage and your potential out-of-pocket costs.
4. Review your Medicare Summary Notice (MSN):
If the procedure is similar to something you've had in the past, look at your past MSNs.
This can give you an idea of how similar procedures were covered previously.
5. Consider a Pre-Authorization:
In some cases, you can request a pre-authorization from Medicare to confirm coverage before the procedure.
This can provide peace of mind and avoid unexpected bills later.
Important Note:
Keep records of all your inquiries, including names of representatives you spoke with and dates of contact.
If your doctor suggests that Medicare might not cover the procedure, they may ask you to sign an Advance Beneficiary Notice of Noncoverage (ABN), acknowledging that you'll be responsible for the cost if Medicare denies the claim.
If you have a Medicare Advantage plan, consult your plan materials or contact your plan directly to confirm coverage and cost-sharing details.
How does getting married late in life affect my Medicare coverage or costs?
Medicare itself is individually based - your eligibility for part A, B, C, and D, Medigap, etc, are not affected by getting married early or late in life.However, getting married and combining incomes COULD put your MAGI (modified adjusted gross income) over the limit resulting in higher premiums for both of you when only one would have paid them previously. For example, if a single man has a MAGI of $108,000 he will pay $202.50 for medicare in 2026. But if he gets married and her income takes their combined MAGI to $220,000 they will both pay $284.10 per month, when singly only she would pay the higher amount.
At the other end of the spectrum, Medicaid, Medicare Saving Programs, SNAP, or Federal Extra Help for lower income individuals may be affected, especially eligibility or the level of support from those programs. So if you’re eligible for a Medicare DSNP plan individually, you may lose access to it after getting married if your combined MAGI causes you to lose your eligibility for Medicaid.
But marriage itself will not affect your individual eligibility for Medicare. Since eligibility is based on your age or disability status, there’s no change to when you can get Medicare regardless of when you get married.
Since many considerations are more likely to be triggered by combining incomes and assets, I would recommend you consult a financial planner or tax professional to ensure you have survivor planning in place, and speak to your health insurance agent about your specific situation to see what cost impacts you may face.
Is my son or daughter allowed to help me with my Medicare plan?
Your son or daughter can help you, but what they are allowed to do depends on the situation.- They can help you shop and understand options. They can compare plans, look up doctors/drugs in networks and formularies, and help you gather information and paperwork.
- They can usually help during calls if you are present. If you call Medicare or your plan and your child is on the line with you, you can typically give verbal permission for the representative to speak with them during that call.
- To speak to Medicare or the plan without you, they usually need authorization. You can file an authorization (often called an “Authorization to Disclose Personal Health Information”) with Medicare and/or complete your plan’s “authorized representative” form so your child can talk to them on your behalf.
- To enroll you or change your plan, you generally must authorize it. In most cases you must complete the enrollment yourself (or sign), unless your child has legal authority (such as power of attorney/guardianship) and the organization accepts it.
What's one hidden Medicare expense that people don't think about until it's too late?
Long-Term Care!Medicare does not cover long-term care needs specifically. It may cover for shorter term care needs such as skilled nursing care for rehabilitation or hospice.
Long term care expenses can be catastrophic financially.
Also, Long term care costs can also vary according to geographic location.
Many assume Medicare will cover these costs, children will take care of them, or it will not happen to them. However, children often have to work or have children of their own to care for or may be separated by distance and relocation expenses may be involved. Perhaps, assistive devices need to be installed such as grab bars, ramps, non-slip devices, etc. Also, a child or a Medicare beneficiary may not feel comfortable helping or receiving help with some activities of daily living such as toileting.
Long-term care can also vary by need and be provided in a number of different ways. A Medicare Beneficiary may need partial long-term care to assist or may need full-time care. It can be provided in various settings to include at home, in assisted living facilities or in nursing homes which can vary greatly in cost.
The bottom line is that Medicare does not provide coverage for chronic conditions that impact one cognitively or impact someone to where they cannot perform two or more activities of daily living such as eating, bathing, dressing, transferring, toileting, or continence.
Finally, there are multiple ways to address long-term care that are non-insurance and insurance based outside spending down assets. Some of the insurance plans can include long term care insurance, life insurance policies with long term care riders, and some annuities may have options to assist with long term care costs such as fixed indexed annuities.
I'm planning a long trip overseas. What happens if I need medical care while I'm away from the US?
Medical coverage outside of the US is dependent on what type of Medicare insurance you have. Original Medicare does not usually cover outside of the US, except for a few exceptions.There are some Medicare Advantage Plans that do offer limited urgent or emergency coverage outside of the US, but most do not. It's very important to read your Evidence of Coverage prior to planning your travel.
There are some Medicare Supplement plans do cover 80% of emergency medical expenses but there is a $250 deductible that you must pay first, and there is a lifetime cap of $50,000.
If planning a trip outside of the US, I always advise my clients to purchase Short-term Travel Medical insurance because it covers hospitalization if needed, doctor visits and most important if you need to be evacuated back to the states, it's covered.
Does Medicare cover health care services on a cruise ship?
Medicare may cover medically necessary health care services on a cruise ship if (1) the doctor is allowed under certain laws to provide Medicare services, (2) the ship is in a U.S. port or no more than six hours away from a U.S. port when services are provided. However, Medicare does not cover health care services when the ship is more than six hours away from a U.S. port.
Should I review my ANOC with my Medicare agent?
The first thing you should do when you receive your Annual Notice of Change is simply review it. It will be a side by side comparison of your current coverage versus the coverage you will have the following year should you decide to remain in the plan. It's the single best way to stay informed about changes in your policy from year to year. If you see anything that concerns or confuses you then reach out to your agent. If you're okay with the changes you see then just do nothing and the policy will be rolled over to the following year automatically.NOTE: If a plan is not renewing, or is exiting your market entirely, the plan does not send a standard ANOC because there are no "changes" to describe for a plan that won't exist next year. Instead, the plan is required to send a separate non-renewal or termination notice to affected enrollees. This notice informs you that the plan is ending, explains what happens next (e.g., whether you'll be automatically enrolled/"mapped" into another plan offered by the same company, or if you'll be disenrolled). If you receive one of these notices you should immediately set up an appointment with your agent during the Annual Enrollment Period (Dates: 10/15–12/7) or a Special Enrollment Period if applicable.
How can I make sure I'm not overpaying for my Medicare plan, and are there any tools or resources you recommend?
1. Compare Plans AnnuallyMedicare plans change every year, including premiums, copays, and covered services. What was a good deal last year may no longer be the best option. The Medicare Annual Enrollment Period (Oct 15 - Dec 7) is the best time to review your plan.
2. Check for Extra Benefits
Many Medicare Advantage plans offer dental, vision, hearing, and even over-the-counter allowances at no extra cost. If you’re paying out-of-pocket for these, you may be able to switch to a plan that covers them.
3. Review Prescription Drug Costs
If you have a Medicare Part D or Medicare Advantage plan with drug coverage, make sure your medications are still covered affordably. Use Medicare’s Plan Finder tool (Medicare.gov) to compare drug costs.
4. Look for Assistance Programs
Depending on your income, you may qualify for Medicare Savings Programs, Extra Help for prescriptions, or Medicaid assistance, which could reduce your costs significantly. Many people don’t realize they qualify!
5. Work with a Licensed Medicare Agent
As a Medicare professional with 20 years of experience, I can compare plans for you, ensure you’re not paying for coverage you don’t need, and find ways to lower your costs—all at no charge to you.
Would you like a free plan review to see if you’re overpaying? Let’s connect and make sure you’re getting the most out of your Medicare benefits!
I'm a smoker trying to quit. What smoking cessation benefits does Medicare offer for someone in my situation?
Medicare covers up to eight face-to-face counseling sessions for smoking cessation per year, provided by a Medicare-recognized practitioner, and can also cover prescription medications for quitting. You may be eligible for counseling and other services through Medicare Part B, and prescription medications are often covered by Part D or a Medicare Advantage plan. Counseling sessions are typically provided at no out-of-pocket cost if your provider accepts Medicare assignment.What Medicare Covers
Counseling Services:
Medicare Part B covers up to eight individual or group counseling sessions over a 12-month period, for up to two separate quit attempts. These sessions are considered preventive care and are available for regular tobacco users.
Prescription Medications:
You may be covered for certain prescription drugs that aid in quitting smoking, such as bupropion (Wellbutrin) or varenicline (Chantix), under your Medicare Part D plan or a Medicare Advantage plan with drug coverage.
Over-the-Counter (OTC) Products:
Medicare generally does not cover over-the-counter smoking cessation products like nicotine patches or gum, but this may vary with your specific Part D or Medicare Advantage plan.
How to Access These Benefits
Contact your Doctor: Start by talking to your primary care physician or other Medicare-recognized healthcare provider.
Check Your Plan Details: Review your specific Medicare Part D or Medicare Advantage plan's drug formulary to see which prescription medications are covered and what your out-of-pocket costs will be.
Use the Medicare Plan Finder: You can also use the Medicare Plan Finder tool on the Medicare.gov website to find out how Part D and Medicare Advantage plans in your area cover specific medications.
Important Considerations
Accepts Assignment:
To receive counseling sessions at no cost, your healthcare provider must accept Medicare assignment, meaning they agree to be paid directly by Medicare and not bill you for more than the approved amo
I'm caring for my elderly parent with dementia. How can I get legal authority to manage their Medicare?
1. Determine Their CapacityIf your parent still has legal capacity (can understand what they're signing), they can give you permission via paperwork. If not, you'll need to go through the courts.
2. Appoint a Medicare Authorized Representative
This allows you to talk to Medicare and make decisions on their behalf.
Form to use: CMS-10106: Authorization to Disclose Personal Health Information
This form gives you permission to access info but does not give full control to manage benefits.
3. Get a Durable Power of Attorney (POA)
This gives you legal authority to manage your parent’s Medicare and other affairs.
Must be durable (remains in effect after mental decline).
Ideally drafted and signed while your parent still has legal capacity.
Take it to a lawyer or use your state’s legal aid or elder law services.
4. If Capacity Is Lost: Petition for Legal Guardianship
If your parent no longer understands or can’t consent, you’ll need to go through probate court in your state.
This is a formal court process.
You’ll be appointed a guardian or conservator.
Involves a court hearing and possibly an evaluation by a doctor.
5. Register the POA with Medicare or Other Agencies
Once you have POA or guardianship:
Call Medicare
Submit documentation as requested.
If you're also managing other benefits (like Social Security or Medicaid), contact those agencies separately — each has its own process.
I'm confused by all the star ratings for Medicare plans. Do they actually mean anything for the care I'll receive?
Medicare gives plans a 1 to 5-star rating (5 is best) based on several factors, including:• Member satisfaction (from surveys)
• Customer service
• Managing chronic conditions
• Preventive services (like screenings and vaccines)
• Drug safety and accuracy (for Part D)
Higher-rated plans usually have better customer service, fewer complaints, and do a better job helping members stay healthy.
• Plans with 4 stars or more are generally considered high quality.
• Bonus payments go to plans with 4+ stars, which can mean more money for extra benefits (like dental, vision, or OTC allowances).
Use star ratings as a starting point, but not the only factor. Always also check:
• Your doctors’ network participation
• Your prescriptions and their cost tiers
• Maximum out-of-pocket limits
• Extra benefits that matter to you (like travel coverage)
If you travel a lot or have specific health needs, sometimes a lower-rated plan might actually serve you better than a 5-star plan.
I need help at home after my surgery. Will Medicare cover a home health aide or am I on my own?
Yes, Medicare can cover a home health aide after surgery, but only if you also need part-time skilled nursing or therapy, are homebound, and get care from a Medicare-certified agency, as aides assist with personal care only when skilled care is part of the plan. If you just need help with daily activities like bathing or dressing (unskilled care) and no skilled services, Medicare won't pay for the aide, and you'd need other options like long-term care insurance or private pay, notes Homewatch Caregivers.Key Medicare Requirements for Home Health Aides:
Doctor's Order: A doctor must certify you need home health care.
Homebound: You must be mostly confined to your home.
Skilled Care Need: You must need intermittent skilled nursing, physical therapy, or speech-language pathology.
Medicare-Certified Agency: Care must come from an approved agency.
What Medicare Covers (If You Qualify):
Home Health Aide: Assistance with personal care (bathing, dressing, toileting) if you're also receiving skilled nursing or therapy.
Skilled Nursing: Care that only a licensed nurse can provide (wound care, medication education).
Therapy: Physical, occupational, or speech therapy.
What Medicare Doesn't Cover (If That's Your Only Need):
24/7 care.
Help with daily living (bathing, dressing) if that's the only care you need.
Homemaking (cleaning, laundry, shopping) if it's the only help you need.
Next Steps:
Talk to Your Doctor: Discuss your needs with your doctor or hospital discharge planner.
Check Your Plan: If you have Medicare Advantage (Part C), you might need to use their network of agencies.
Find an Agency: Use the Medicare.gov Care Compare tool to find a Medicare-certified agency in your area.
What is the best way to compare Medicare plans for my parents?
Start with what actually matters to them. Not what sounds good in a commercial, not what their neighbor has, and definitely not what was pitched at a "free" dinner seminar.You want to look at three main things:
1. Doctors and hospitals they want to keep.
2. Prescription drugs they take.
3. Budget: including both monthly premiums and total out-of-pocket costs when they actually use the plan.
From there, the best way to compare plans is by using real tools, not guesswork. Medicare.gov has a plan finder that can help, but honestly, it is only as good as the info you put in. Our tools are a lot more in-depth and easier to compare.
If you're not familiar with how Medicare works, it can get confusing fast. Comparing Supplements to Advantage plans, figuring out provider networks, and trying to read between the lines of what is actually covered can wear anyone out. Even people who do this every day get overwhelmed, so we get it.
When I helped my own mom, the key was starting with her doctors and medications, then working backward to find what fit. We didn’t just sort by lowest cost and hope for the best.
The best approach is to work with someone who knows the system and is willing to take the time to get it right. And if you are doing it yourself, do not rush. Look at multiple options.
Medicare mistakes are expensive and long-term. Fixing them later is a lot harder than doing it right the first time, so ask questions and ask them early.
How can I find new doctors in my network?
If you are on Traditional Medicare Part B and a Medigap plan, there are no provider networks. If you are on a Medicare Advantage (Part C) plan, the insurance company that you are signed up with will have a provider directory on their website where you can search for doctors by name or specialty.If you're looking at plans for 2026 and thinking of changing insurance companies, you can search provider directories as a guest user (no login required) so you can make sure that all of your current providers are in-network with any plan that you are considering switching to.
If you use a broker or agent, we can also help you with this task and make sure that your current providers are in-network with your plan options for 2026.
How do I appeal a decision by Medicare or my plan if they deny coverage for a procedure or medication I need?
Step 1: Review the Denial NoticeYou will receive a denial letter or Notice of Denial of Medical Coverage (for Medicare Advantage) or a Part D Explanation of Benefits. This notice should include:
• The reason for the denial
• Instructions on how to file an appeal
• Deadlines for submitting your appeal
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Step 2: Request a Redetermination (First Level of Appeal)
Original Medicare
• Fill out a “Redetermination Request Form” (optional— you can also write a letter).
• Send it to the address listed in the denial notice.
• You must file within 120 days of the date you received the denial.
• A Medicare Administrative Contractor (MAC) will review your case.
Medicare Advantage (Part C) or Part D Drug Plan
• You (or your doctor) can request a reconsideration.
• Call your plan or submit a written request.
• For urgent cases, request an expedited (fast) appeal if waiting could seriously harm your health.
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Step 3: Add Supporting Documentation
It’s helpful to include:
• A letter from your doctor explaining why the procedure or medication is medically necessary
• Relevant medical records
• Any prior approvals or evidence of similar cases being approved
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Step 4: Follow the Appeals Process Through the 5 Levels (If needed)
If your first appeal is denied, you can continue through these levels:
1. Redetermination/Reconsideration by the plan or Medicare contractor
2. Review by a Qualified Independent Contractor (QIC)
3. Hearing before an Administrative Law Judge (ALJ)
4. Review by the Medicare Appeals Council
5. Federal District Court Review
Each level has deadlines and procedures, and you’ll be notified how to proceed to the next step if necessary.
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Need Help?
• 1-800-MEDICARE — for guidance on appeals
• State Health Insurance Assistance Program (SHIP) — free, local help
• Your doctor or medical provider — can assist with medical justification
• Medicare.gov — has forms and additional details
Sample Medicare Appeal Letter
[Your F
I have a family history of colon cancer. Will Medicare cover more frequent colonoscopies for someone in my situation?
Medicare does cover more frequent colonoscopies if you have a family history of colorectal cancer, because that places you in the high‑risk category.For high‑risk beneficiaries, Medicare allows a screening colonoscopy every 24 months instead of the standard 10‑year interval for average‑risk individuals
If you have a first‑degree relative (parent, sibling, or child) with colon cancer or advanced polyps, Medicare classifies you as high risk.
-Under this classification: Screening colonoscopy is covered every 24 months.
-Diagnostic colonoscopy is covered whenever medically necessary (e.g., symptoms, positive stool test, follow‑up on polyps).
The cost for screening: $0 out‑of‑pocket. If polyps are removed (procedure becomes diagnostic), you may owe 20% coinsurance under Part B.
Why did I receive a Medicare Summary Notice, and what should I do with it?
A Medicare Summary Notice (MSN) is a statement you receive every 3 months if you have Original Medicare. It’s not a bill—it shows the medical services you received, what Medicare paid, and what you may owe. Review it carefully to make sure the information is correct, compare it with your doctor’s bills, and keep it for your records. If you notice any mistakes or charges for services you didn’t receive, report them to Medicare at 1-800-MEDICARE.Does Medicare cover vision care?
No, Original Medicare (Parts A and B) does not cover routine vision exams, eyeglasses, or contact lenses, but it does cover certain medical eye exams and treatments for conditions like glaucoma, diabetic retinopathy, and macular degeneration. For routine vision care, you can get coverage through a Medicare Advantage (Part C) plan, which often includes exams, glasses, and contacts, or you can purchase a private vision plan to supplement your Medicare coverage.What Original Medicare covers:
Medical eye exams: Covers annual eye exams for people with diabetes to check for diabetic retinopathy and annual eye exams for those at high risk of glaucoma.
Diagnostic tests and treatments: Covers diagnostic tests and treatments for conditions like macular degeneration.
Cataract surgery: Covers the surgery to remove a cloudy lens and one pair of corrective eyeglasses or contact lenses after surgery.
What Original Medicare does not cover
Routine eye exams: For the purpose of fitting eyeglasses or contacts.
Eyeglasses and contact lenses: The cost of the frames, lenses, or contacts themselves.
How can I plan for Medicare costs if I expect to need long-term custodial care in a nursing home or assisted living facility?
Medicare doesn't cover the costs of long-term custodial care in nursing homes or assisted living facilities. To plan for these costs, you'll need to consider options like LTC insurance, savings & potentially qualifying for Medicaid.Here are options on how to plan for these costs:
Long-Term Care Insurance:
This type of insurance can help cover the costs of custodial care in a nursing home or assisted living facility, or for in-home care. You'll typically need to qualify for a payout, often requiring assistance with at least two activities of daily living or evidence of cognitive impairment.
Private Pay:
Many individuals and families pay for long-term care out of pocket, using savings, investments, or even selling assets like property. Be aware that using up these resources may eventually make Medicaid an option.
Medicaid:
This program, funded by the federal government but administered by individual states, provides coverage for long-term care, including nursing home care, for people with low incomes & limited assets. Eligibility requirements vary by state but typically involve strict income & asset limits.
Savings & Investments:
Building a dedicated fund for LTC expenses through consistent saving & strategic investing can help offset future costs.
Health Savings Accounts (HSAs):
If you have a high-deductible health insurance plan, funding a HSA can be a way to save for long-term care expenses & potentially minimize the tax bite.
Consider Alternate LTC Options:.
The National Council on Aging (NCOA) suggests exploring options like community-based care services, subsidized senior housing, & Continuing Care Retirement Communities (CCRCs).
Important Considerations:
Medicare Supplement: While Med Supp plans (Medigap) can help cover some costs associated with Original Medicare they don't cover LTC or care lasting more than 100 days.
Medicare Advantage: Medicare Advantage plans may help cover some LTC costs but coverage costs can vary significantly between plans.
My income fluctuates significantly year to year from investment distributions. How can I avoid IRMAA surcharges when I have an unusually high-income year?
Avoiding IRMAA (Income-Related Monthly Adjustment Amount) surcharges can be challenging, especially with fluctuating income. Here are some strategies you might consider:1. **Income Management:** Plan your investment distributions carefully. If possible, spread out distributions over multiple years to avoid spiking your income in any single year.
2. **Tax-Advantaged Accounts:** Maximize contributions to tax-advantaged accounts like IRAs or 401(k)s, which can reduce your taxable income.
3. **Roth Conversions:** Consider converting traditional IRA funds to a Roth IRA in years when your income is lower, which can help manage taxable income in future years.
4. **Charitable Contributions:** Make charitable contributions, which can be deducted from your taxable income if you itemize deductions.
5. **Harvesting Losses:** Use tax-loss harvesting to offset gains with losses, potentially reducing your taxable income.
6. **Filing an Appeal:** If your income has decreased due to a life-changing event (like retirement, divorce, or loss of income-producing property), you can file an appeal with the Social Security Administration using form SSA-44 to request a reduction in your IRMAA.
7. **Consult a Professional:** Consider working with a financial advisor or tax professional who can help you strategize and manage your income effectively.
Let me know if you have any more questions!
I'm considering concierge medicine but already have Medicare. How would these work together?
Concierge medicine is separate from Medicare. You pay a membership fee for better access—longer visits, same-day appointments, direct communication—and Medicare does not cover that fee.Here’s how concierge works with Medicare:
Original Medicare (especially with a supplement):
This is where concierge usually works best. If the doctor accepts Medicare, they bill Medicare for covered services, and your supplement applies as normal.
Most of my clients who use concierge care are on Original Medicare with a High Deductible Plan G—it keeps premiums lower while still giving strong protection for bigger expenses.
Medicare Advantage plans:
This can be more difficult. These plans use networks, and many concierge doctors are out-of-network or don’t participate. That means you could be paying the membership fee and out-of-pocket for care.
If the doctor opts out of Medicare:
Medicare won’t pay at all—you’re fully private pay.
Bottom line:
Concierge care can complement Medicare, but it usually works much better with Original Medicare (often paired with a High Deductible Plan G) than with Medicare Advantage.
Call our office if you still have questions or concerns about Medicare.
Why does Medicare allow insurance companies to bombard seniors with confusing mail and TV ads?
Insurance carriers are for-profit companies. Their Medicare Advantage plans make money by spending less on a member's healthcare than the government payments they receive from Medicare. So, the more people they enroll, the more money they make.The Centers for Medicare & Medicaid Services (CMS) has strict restrictions and guidelines on what insurance companies, agencies, and agents/brokers can and cannot advertise.
Unfortunately, many agencies and marketing firms slip in phrases like, "if eligible", and, "qualified members" with their ads. This is especially true when pushing Over the Counter (OTC) cards that can be used to pay for groceries.
I personally have had dozens of calls from seniors asking how they get their $[insert 4-digit number] check? I've had to explain that some ads walk the fine line using phrases that make it seem like people are entitled to big dollar checks, rebates, and even free dental coverage.
Bottom line is the are legal, provided they don't flat out say something that is definitely untrue (which is why they qualify with those phrases like "if eligible" and "qualified members" to enroll as many people as possible.
This is why it's wise to use a licensed health insurance broker who is certified to sell Medicare Advantage plans (like me) instead of going through Medicare.gov or an insurance agency where you talk to an agent in a call center who has quotas to meet.
How do I know if a Medigap policy is right for me, and what's the best time to buy one?
Medigap (a Medicare Supplement) is often a good fit if you want:- Predictable costs: fewer surprise bills when you have tests, procedures, or hospital stays.
- Freedom to choose doctors: you can generally see any provider nationwide who accepts Medicare (no plan networks).
- Less hassle with referrals/prior authorizations than many Medicare Advantage plans.
- Travel flexibility: helpful if you travel often or live in more than one state.
- Peace of mind if your health changes: you’re less exposed to per-visit copays and plan changes.
Medigap may be less ideal if:
- You’re comfortable with networks and copays to keep monthly premiums lower, or
- You mainly want extra benefits like routine dental/vision (more common with Medicare Advantage).
Best time to buy one:
- The best time is your Medigap Open Enrollment Period: the 6 months that start when you’re 65+ and enrolled in Medicare Part B. During this window:
- You can buy any Medigap plan sold in your state with no health questions, and
- You can’t be charged more due to medical conditions.
After that window, you can still apply, but in many states you may face medical underwriting (possible higher premiums or denial), unless you qualify for a special guaranteed-issue right.
Also, some states have a “birthday rule” (or similar annual window) that lets you switch Medigap plans around your birthday with reduced or no underwriting (rules vary by state).
Isn't Medicare headed for a crisis with so many baby boomers aging into the system?
As more baby boomers age into Medicare, the system is under pressure, especially the Hospital Insurance (Part A) trust fund.Experts do project that this part of Medicare could face funding shortfalls in the coming years, possibly as soon as the 2030s. That doesn’t mean Medicare is going away, but it does mean changes may be needed to keep the program strong for future generations.
It is important to note that if you’re already on Medicare or close to enrolling, your benefits are not in immediate danger. The Medical & Drug Insurance (Part B and Part D), which covers doctor visits and prescriptions, is funded differently and isn’t at risk of running out of money in the same way. Lawmakers are consistently exploring solutions.
Bottom line: it is not a crisis, it just might be an adaptation and change in the future years.
How can I avoid or reduce IRMAA charges on my Medicare premiums?
Great question—IRMAA catches a lot of people off guard, especially around retirement.First, quick refresher (in plain English)
IRMAA = Income-Related Monthly Adjustment Amount
It’s an extra charge added to your Medicare Part B and Part D premiums if your income is above certain limits.
Important (and annoying) detail:
Medicare looks at your income from TWO YEARS AGO.
So in 2026, they’re usually using 2024 tax data.
How to avoid or reduce IRMAA (the practical stuff)
1. Watch your “MAGI” like a hawk
IRMAA is based on Modified Adjusted Gross Income (MAGI), not just your paycheck.
Common things that push people over the line:
Large IRA or 401(k) withdrawals
Roth conversions
Capital gains from selling property or investments
One-time bonuses or severance
Required Minimum Distributions (RMDs)
💡 Strategy: Spread income over multiple years when possible instead of taking a big hit in one year.
2. Use Roth accounts strategically
Roth IRA withdrawals do not count toward MAGI
Partial Roth conversions done before age 65 can reduce future IRMAA exposure
This is one of the most powerful long-term planning tools.
3. Time big financial moves carefully
If you can control when income hits:
Delay selling investments until a lower-income year
Spread withdrawals across December/January to straddle tax years
Avoid stacking multiple income events in the same year
Sometimes staying $1 over the limit can cost thousands in extra premiums.
4. File an IRMAA appeal if your income dropped
This is HUGE—and underused.
If your income went down due to a life-changing event, you can ask Social Security to reduce or remove IRMAA.
Qualifying events include:
Retirement or work reduction
Loss of income-producing property
Divorce or death of a spouse
Employer settlement ending
You do this using SSA Form 44.
👉 This can lower your premiums immediately, not years later.
5. Coordinate Medicare decisions with tax planning
This is where people get burned:
Medicare choices
What are some lesser-known benefits or services that my Medicare plan might cover that I could be missing out on?
Some Medicare plans — especially Medicare Advantage plans — include benefits people never use because they don’t know they’re there. Original Medicare generally does not cover routine dental, vision, hearing, and many lifestyle benefits, but Medicare Advantage plans may offer extra benefits beyond Original Medicare.Here are benefits worth checking:
Commonly missed Medicare Advantage benefits
1. Dental allowance
Cleanings, X-rays, fillings, extractions, dentures, or a yearly dental dollar allowance.
2. Vision benefits
Routine eye exams, glasses, contact lenses, or an eyewear allowance.
3. Hearing benefits
Hearing exams and hearing aid discounts or allowances.
4. Over-the-counter allowance
Many plans give a quarterly or monthly allowance for items like pain relievers, vitamins, toothpaste, bandages, allergy medicine, and first-aid supplies.
5. Fitness membership
Programs like SilverSneakers, Renew Active, gym memberships, online fitness classes, or at-home exercise kits.
6. Transportation
Rides to doctor visits, pharmacies, dialysis, or other approved medical appointments.
7. Meal delivery after a hospital stay
Some plans cover prepared meals after discharge from the hospital or skilled nursing facility.
8. Telehealth or virtual visits
Medicare currently covers many telehealth services, and Medicare Advantage plans may have additional virtual care options.
9. Nurse hotline or care coordination
Some plans include 24/7 nurse lines, medication reviews, chronic condition support, or help coordinating specialists.
10. Part D vaccine savings
Medicare drug coverage generally covers ACIP-recommended adult vaccines, such as shingles, RSV, and Tdap, with no out-of-pocket cost. Part B covers certain vaccines like flu, COVID-19, pneumococcal, and hepatitis B.
11. Preventive services
People often miss the yearly Medicare wellness visit, cancer screenings, diabetes screenings, depression screenings, obesity counseling, tobacco-use counseling, and other preventive service
I want to be proactive about my health. What preventive services should I be taking advantage of with Medicare?
Covered Preventive Services with Medicare Part B:1. "Welcome to Medicare" Visit (First 12 Months)
One-time check-up to review your health, risk factors, and future screenings.
2. Annual Wellness Visit (Yearly)
A personalized prevention plan to update screenings and manage health goals.
3. Screenings (Usually Once a Year or as Recommended):
Mammogram (Breast cancer)
Colorectal cancer screening (includes colonoscopy and stool tests)
Lung cancer screening (for high-risk individuals)
Prostate cancer screening
Cardiovascular disease screening
Diabetes screening
Depression screening
Bone density test (osteoporosis)
4. Vaccinations:
Flu shot (yearly)
Pneumonia shot
Hepatitis B (for those at higher risk)
COVID-19 vaccines and boosters (as recommended)
5. Additional Services:
Smoking cessation counseling
Obesity counseling
Nutrition therapy (for diabetes or kidney disease)
Glaucoma tests (for high-risk individuals)
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Most of these are free if your provider accepts Medicare. Staying up to date on these can make a big difference in staying independent and active.
How do Medicare Savings Programs help with Medicare costs?
Medicare Savings Programs (MSPs) are essentially a "financial bridge" provided by your state to help cover some of the costs that Medicare doesn't.Depending on your income and savings, these programs help in three main ways:
Paying your Part B Premium: For most people in 2026, this saves you about $202.90 every single month. Instead of this being deducted from your Social Security check, the state pays it for you.
Lowering Out-of-Pocket Costs: The most helpful level (called QMB) acts like a secondary insurance, covering your Medicare deductibles, coinsurance, and copayments so you don't get hit with big bills after a doctor's visit.
Automatic Prescription Savings: If you get into an MSP, you automatically get "Extra Help." This is a federal program that lowers your prescription drug costs, usually capping your copays at a few dollars.
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?
Here is how to structure your 2026 coverage for maximum support:1. The Outpatient Strategy: Therapy & Psychiatry
Bipolar disorder typically requires regular visits with a psychiatrist (for medication management) and a therapist.
The Original Medicare + Medigap Route (Highly Recommended): If you choose Original Medicare with a Medigap Plan G, you pay your Part B deductible ($283 in 2026), and after that, your therapy and psychiatry visits are generally $0 out-of-pocket. This is ideal because there is no limit on the number of sessions as long as they are medically necessary.
The Medicare Advantage Route: These plans often have lower monthly premiums but require copays for every mental health visit (often $25–$50). If you see a therapist weekly, these costs can add up to more than a Medigap premium. Also, check that your preferred mental health providers are "in-network," as many therapists do not join Advantage networks.
2. The Medication Strategy: Part D
Medicare Part D (Drug Plans) must follow "protected class" rules. This means every plan is legally required to cover substantially all antipsychotic and antidepressant medications.
2026 Drug Cap: Starting this year, there is a $2,100 annual out-of-pocket cap on all Part D drugs. If you are prescribed expensive brand-name mood stabilizers, you will never pay more than $2,100 in a year for your prescriptions.
The "Medicare Prescription Payment Plan": In 2026, you can opt into a program that allows you to spread that $2,100 out over the year in monthly installments rather than paying a large amount at the pharmacy counter all at once.
3. Inpatient "Lifetime Limit" Warning
It is important to be aware of a specific Medicare quirk regarding inpatient psychiatric care:
The 190-Day Limit: Medicare Part A covers inpatient mental health care, but if you are treated in a specialized psychiatric hospital (rather than a psychiatric unit within a general hospital), there is a 190-day lifetime limit.
I've been diagnosed with prediabetes. What preventive services does Medicare cover to help prevent progression to type 2 diabetes?
So the question is, I've been diagnosed with pre-diabetes. What preventative services does Medicare cover to help prevent progression to type 2 diabetes? Here’s the information I found, and I hope you find it useful.
Diabetes screening is covered under Medicare Part B. Eligibility includes having risk factors such as high blood pressure, obesity, or a history of high blood sugar. The frequency is up to two screenings per year, depending on your risk level, and the cost is free. That covers diabetes screening.
Then there’s the Medicare Diabetes Prevention Program. This is a structured program for a proven lifestyle change to help prevent type 2 diabetes. It includes 12 months of group sessions focusing on weight loss, healthy eating, and physical activity, along with ongoing maintenance sessions for eligible participants.
Eligibility includes being diagnosed with pre-diabetes, having a BMI of 25 or higher (23 or higher for Asian individuals), never having had type 1 or type 2 diabetes before, and never having participated in the Medicare Diabetes Prevention Program before. The cost is free for eligible beneficiaries.
There’s also something called Medical Nutrition Therapy (MNT), which is covered under Medicare Part B. Eligibility includes being diagnosed with diabetes or kidney disease, or having had a kidney transplant in the last 36 months. If you progress from diabetes to diabetes, services include nutrition assessment, diet counseling, and follow-up visits with a registered dietitian. The cost is free if the provider accepts Medicare assignments.
Obesity screening and behavioral counseling are also covered under Medicare Part B. Eligibility requires a BMI of 30 or higher. Services include one face-to-face visit every week for the first month, every other week for months two through six, and monthly sessions for months seven through twelve if you meet weight loss goals. The cost is free.
I hope you found this information useful. If you have any other questions about pre-diabetes or any other Medicare coverage options, feel free to reach out. I look forward to hearing from you.
Are there any tax benefits tied to paying Medicare premiums as a retiree?
Yes, Medicare premiums (Parts A if premium-paying, B, D, Medicare Advantage, and Medigap) qualify as medical expenses with tax advantages, depending on your situation.1. Self-Employed Health Insurance Deduction (Best for Many)
If you or your spouse have net self-employment profit, deduct 100% of premiums for yourself and spouse as an above-the-line deduction on Schedule 1 (Form 1040). This lowers your Adjusted Gross Income (AGI) even if you take the standard deduction. Limited to your net earnings. Available since 2012.
2. Itemized Medical Expense Deduction (Schedule A)
For most retirees: Deduct premiums + other medical costs (copays, dental, vision, etc.) only if you itemize. Total medical expenses must exceed 7.5% of AGI. Premiums withheld from Social Security count. IRMAA surcharges are also deductible.
Key Limits
*Cannot double-dip if paid with HSA funds.
*Most standard retirees benefit only if medical expenses clear the 7.5% floor.
Bottom line: Self-employed retirees often get the strongest break via the above-the-line deduction. Consult a tax professional or CPA for your situation, especially with high medical costs or self-employment income.
I am moving to a new state in a few months. What's a good Medicare check list to make sure I am not missing anything in my new state?
Moving to another state can affect your Medicare coverage more than many people realize. Here’s a Medicare Relocation Checklist to keep you organized:-Notify Social Security and Medicare: Call Social Security (1-800-772-1213) or log in at ssa.gov/myaccount to update your address and mailing info.
This ensures you keep receiving important Medicare correspondence and premium notices (especially if you pay your Part B directly).
- Original Medicare (Parts A & B): Your Original Medicare coverage travels with you anywhere in the U.S. You can continue to use any provider who accepts Medicare nationwide. Just confirm your new doctors accept Medicare assignment to avoid surprise bills.
- Prescription Drug Plan (Part D): Part D plans are state-specific, so when you move you’ll likely need to select a new plan available in your new ZIP code. You’ll qualify for a Special Enrollment Period (SEP) to switch plans. Compare plans at Medicare.gov/plan-compare or contact an agent to receive help.
- Medicare Advantage (Part C): MA plans are tied to service areas; moving out of state almost always requires a plan change. You’ll have a 2-month SEP starting from your move date to join a new plan in your new state.
-Dental, Vision, and Other Add-Ons: If your current MA plan includes extra benefits (dental, vision, OTC, transportation, etc.), check whether equivalent options exist in your new state — many carriers differ by region.
-Supplemental (Medigap) Policy: Medigap policies are state-regulated. Some states require new underwriting when you move; others have guaranteed issue protections.
-Medicaid or Extra Help (if applicable): If you receive Medicaid or LIS/Extra Help, you’ll need to reapply in your new state, since eligibility rules vary.
Don't you think Medicare should ban all those celebrity Medicare Advantage commercials?
Many people, including government officials, think Medicare should ban or heavily regulate celebrity-driven Medicare Advantage commercials due to concerns about their misleading nature & potential to confuse seniors. These ads often promote the idea that seniors are missing out on benefits by not enrolling in Medicare Advantage & some have been found to use deceptive tactics to get people to sign up. Here's why there's a push for tighter regulation:Deceptive & Misleading Claims: Ads often claim that seniors are missing out on benefits, including higher Social Security payments, to encourage them to call broker hotlines.
Misleading Information: Some ads don't fully disclose that Medicare Advantage plans have limited networks of doctors & hospitals, potentially leading seniors to switch plans only to find they can't see their preferred providers.
Predatory Sales Tactics: Brokers & agents using hotlines have been accused of using "bait-and-switch" tactics & other misleading techniques to enroll seniors in plans.
Confusion for Seniors: The sheer volume of these ads, combined with their misleading claims, can make it difficult for seniors to understand their Medicare options.
Financial Incentives for Brokers: Brokers receive higher commissions for enrolling seniors in Medicare Advantage plans than for Medigap or Part D plans, creating a financial incentive to promote Advantage plans.
Government Actions: The Centers for Medicare & Medicaid Services (CMS) is working to crack down on misleading Medicare marketing practices. Congress is also investigating Medicare Advantage plan broker pitches on TV & has proposed regulations to address deceptive advertising. Some states have seen an increase in complaints about deceptive marketing leading to further investigations & proposals for stricter regulations.
In essence, the concern is that these ads are not providing seniors with accurate & unbiased information, making it difficult for them to make informed decisions.
Is it better to update your Medicare plan often, or to get a plan that will work long term?
The answer to this question lies in the middle. It depends on the types of plan you have and your personal situation. If you have a Medicare Supplement, your coverage doesn't change so changing for that reason isn't necessary. If your premium has become cost prohibitive, you can look for a less expensive supplement, but remember you will need to pass underwriting if you are outside of your guaranteed issue period.If you are on a Medicare Advantage plan then you may want to check your plan annually, but not necessarily change it. When the MAPDs come out in the Fall, you are sent a letter that explains how your plan will change. If there is something significant that is changing, then you may want to shop around to see if another plan can be a better fit. If there isn't much change, I don't suggest moving. If your plan has worked fine for you and your providers, then stay with it.
In general having a plan for the long run creates fewer issues when it comes to getting care. However it doesn't hurt to look at the new MAPDs each year as they can change significantly and you don't want to be surprised later in the year.
Won't Medicare run out of money before I can benefit from it?
Medicare isn’t expected to “disappear,” even though you may hear it’s “running out of money.”- The warning you hear is mainly about Medicare Part A (hospital insurance). The Part A Trust Fund is projected to face a shortfall in the mid‑2030s. If Congress did nothing, Part A could still pay a large share of benefits—just not 100%—so it would mean reduced payments, not Medicare ending.
- Medicare Part B (doctor/outpatient) and Part D (prescriptions) don’t work the same way. They’re funded largely by monthly premiums and general tax revenue, so they aren’t set up to “run out” in the same way.
- Historically, Congress has stepped in when deadlines approach (through tax changes, payment changes, etc.). The fixes can change costs or rules, but beneficiaries typically continue to have coverage.
Bottom line: People on Medicare today still use it every day, and it’s very likely to be there for you. It’s usually a good idea to choose coverage based on your health needs and budget now, rather than trying to time political headlines.
How do I budget for Medicare costs if I expect my health to decline in the next decade?
As health declines, you may require more frequent medical visits, higher prescription drug costs, and possibly long-term care.Make sure to:
• Review Medicare coverage: Ensure you understand what parts of Medicare will cover your anticipated needs.
• Consider supplemental insurance: Evaluate Medigap policies or Medicare Advantage plans offering additional coverage.
• Explore Medicaid eligibility: If you have limited income and assets, you might qualify for Medicaid, which can help cover costs not covered by Medicare.
Creating Your Budget:
• Calculate monthly premiums: Include premiums for Medicare Part B, Part D, and any supplemental insurance.
• Account for out-of-pocket costs: Factor in copayments, deductibles, and coinsurance for medical services and medications.
• Prepare for unexpected expenses: Set aside funds for emergencies or unplanned health interventions.
Long-Term Care Planning:
• Investigate long-term care insurance: Consider policies that cover nursing home care, assisted living, or home healthcare.
• Plan for home modifications: Budget for adjustments to your living environment to accommodate changing physical needs.
Additional Resources and Support:
• Financial advisors: Professionals can help create a personalized budget and explore investment options for covering healthcare costs.
• Licensed Agents Offering Medicare Plans: Licensed Agents can review your current plans and compare them with other plans in your area to ensure you have a plan that suits your needs.
• Medicare counselors: State Health Insurance Assistance Programs (SHIP) offer free counseling for Medicare beneficiaries.
Monitoring and Adjusting Your Budget:
• Review your budget: Assess expenses and adjust your financial plan based on changing health and economic conditions.
• Update your insurance coverage: Ensure your plan continues to meet your needs as they evolve.
Shouldn't Medicare do more to address health disparities among minority seniors?
Yes, there is a strong argument that Medicare should do more to address health disparities among minority seniors. Research suggests that expanding Medicare, particularly for those under 65, could significantly reduce these disparities. Additionally, Medicare's significant influence as a major purchaser & regulator of healthcare provides opportunities for systemic change to improve access & quality of care for minority beneficiaries.Why Addressing Disparities is Important:
Unequal Outcomes: Minority seniors often experience higher rates of chronic diseases, poorer health status, & lower rates of preventative care compared to their white counterparts.
Structural Factors: These disparities are often linked to social determinants of health like poverty, discrimination, & limited access to quality healthcare, education, & resources.
Financial Strain: Many minority seniors are more likely to rely on Medicaid or less adequate supplemental coverage, putting a greater financial strain on their health care.
Increased Costs: Health disparities lead to higher overall healthcare costs, including those associated with emergency room visits & chronic disease management.
How Medicare Can Help:
Expanded Coverage: Lowering the eligibility age for Medicare could significantly expand access to healthcare for minority seniors, particularly in areas with high rates of disparity.
Targeted Programs: Medicare can create specific programs and initiatives to address the unique needs of minority seniors, such as:
Language access: Ensuring healthcare providers have the ability to communicate effectively with beneficiaries who speak languages other than English.
Cultural competency training: Educating healthcare professionals on the specific cultural & social factors that may affect health outcomes for minority seniors.
Transportation & childcare: Providing assistance with transportation to appointments & childcare services, which can be significant barriers to care.
What's one tip for balancing affordability and personalization when finding the best Medicare options?
One of the biggest priorities is going to be identifying what makes sense for you. The biggest mistake that people make when choosing plans is choosing a plan based on what is the lowest premium. Sometimes, this does work, but you typically need to get an idea of what total estimated annual costs may be and utilization (premiums and out of pocket costs factored together).Personalization is very important when considering Medicare options. You will need to evaluate whether or not your medical professionals will accept the plan or are in the network. If a medical professional accepts Medicare, then a Medicare Supplement or Medigap plan will make sense without being dependent on a network. With a Medicare Advantage plan, you have to check to see which Medical professionals are in the network and whether or not the plan will cover costs out of network.
No monthly premiums may be enticing on a Medicare Advantage plan, but you will have to consider deductibles, copays and sometimes coinsurance as well as potential maximum out of pocket costs within the year. Medicare Supplement plans tend to have a premium each month and tend to take care of more out of pocket costs. Out of pocket expenses would be dependent on which plan is chosen.
For prescription drug plans, you will want to consider which pharmacy or pharmacies that you may use, the exact formulary or prescription that you take (Brand versus generic, tablet versus capsule, and dose), and the frequency that you take the prescription(s). While your prescriptions can change in time, it is a good indicator of what plan makes sense for the upcoming year and the prescription drug plans can be evaluated each year to ensure that the plan still makes sense the following year.
Don't you think Medicare's focus on treatment rather than prevention is backwards?
In my opinion, I believe Medicare does focus on prevention, and my reasons are these:1. Medicare's preventative annual physicals are extremely comprehensive, and are covered at $0 copay to the beneficiary. They cover over 35 health screenings for every part of the body, cancer screenings, mental health screenings, tobacco cessation, and many more.
2. Routine colonoscopies, mammograms & PSA screenings are also covered at $0 copay.
3. Vaccinations as recommended by the Advisory Committee on Immunization Practices (ACIP) are covered by Part D at $0 copay. These include the flu shot, pneumonia, COVID, tetanus and other routine immunizations. About 3 years ago, the instructions even encompassed the shingles vaccine at $0, which I believe to be extremely proactive in preventative health measures.
4. Primary Care Physicians and practices are subject to rigorous CMS standards that require alignment with strict protocols in preventative health.
What happens if my dad’s income changes? Can his Medicare plan or costs change too?
Yes, both Medicare plan and costs could change based on someone’s income. If your dad’s income goes up and he was on a Dual Special needs plan, he could lose his Medicaid and eventually lose his qualification for his DSNP plan. During the deeming period he could be held responsible for higher copays or coinsurance as defined by his plan. After his “deeming period” he could be disenrolled from his current plan and lose coverage all together unless he chooses another plan before the end of his deeming period.If your dad’s income goes down, and he now qualifies for Low Income Subsidy (extra help paying for prescription drugs) or even Medicaid, then a whole new set of plans may become available to him now (DSNP) depending on the are he lives.
In either case, whether losing or gaining Medicaid qualification, your dad qualifies for a special election period to choose a new plan that meets his current needs.
On the other hand, if your dad’s income goes up from under $100,000 a year to over $106,000 as a single individual, he may be imposed an IRMAA, which can significantly raise his Medicare part B premium, and his Medicare part D Premiums. The higher the income-the higher the Income Related Monthly Adjustment. If the income goes down again he could then request a reconsideration by filling out the proper form with SS.
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?
1. Cardiovascular Disease Screenings: Medicare Part B covers these screenings once every 5 years. This includes blood tests to check your cholesterol, lipid, and triglyceride levels, which can indicate conditions that may lead to a heart attack or stroke. If your provider accepts assignment, you won't have to pay anything for these screenings.2. Cardiovascular Behavioral Therapy: Medicare Part B covers one session each year with your primary care physician or practitioner. This therapy helps you lower your risk for cardiovascular disease and may include a blood pressure check and healthy diet advice. You pay nothing if your provider accepts assignment.
3. Abdominal Aorta Aneurysm Screening: If you have a family history of abdominal aorta aneurysm, Medicare covers a one-time screening. This screening involves a one-time ultrasound to check for a ballooning of the main blood vessel transporting blood to the legs.
4. Intensive Behavioral Therapy (IBT) for Obesity: Medicare covers IBT for obesity, especially relevant if being overweight contributes to your heart disease risk. This counseling is typically done by a doctor or other healthcare professional in a primary care setting. If the provider accepts Medicare assignment, there are no out-of-pocket costs for the counseling and assessments.
5. Other Related Preventive Services: Tobacco Cessation Counseling: If you use tobacco, Medicare Part B covers counseling to help you quit.
Medical Nutrition Therapy: Medicare covers medical nutrition therapy if your doctor determines it is medically necessary.
Intensive Behavioral Therapy for Cardiovascular Disease: This therapy is specifically designed to reduce CVD risk through counseling on diet, exercise, and aspirin use.
Annual Wellness Visit: This annual visit provides an opportunity to discuss preventive care and establish a personalized screening schedule.
How can my Medicare plan still meet my needs if my health changes?
The different plans do not change in accordance with changes in your health. The option that may be available is possibly changing your plan based on your health. However, there are limitations to this. Advantage plans and PDPs have enrollment periods and Medicare Supplements require underwriting once you are no longer in your guarantee issue period.The most common ways to switch an Advantage plan is during the Annual Enrollment Period, Oct. 15- Dec. 7th. These changes take affect on January first of the next year. If you are diagnosed with a chronic condition, you may be able to switch into a Chronic Special Needs plan at anytime. The conditions that qualify for a C-SNP can differ by location and plan so be sure to check with a local broker in your area.
Medicare supplements can be changed whenever you like. However, if you are outside of your GI period you will need to complete underwriting, If your health has deteriorated, the chances of passing the underwriting go down. Keep in mind that your agent will ask you all of the questions but they do not make the decision. That is 100% in the hands of the carrier.
Isn't it time for Medicare to completely overhaul how it approaches senior care?
Yes, many experts and advocates believe it is time for Medicare to undergo a significant overhaul in how it approaches senior care. While Medicare has been a lifeline for millions of older Americans, several critical issues point to the need for reform.Fragmentation of Care
Medicare often treats conditions and services in silos—hospital care, physician services, home care, etc.—with poor coordination between them. Seniors with chronic or multiple conditions can experience disjointed care and repetitive services.
Solution: Move toward integrated, value-based care models like Medicare Advantage (MA) plans or Accountable Care Organizations (ACOs), but with stronger oversight and transparenc
Inadequate Long-Term Care Coverage
Medicare does not cover most long-term care services, such as help with bathing, dressing, or eating—support that’s vital for many seniors.
Result: Seniors often deplete their savings and turn to Medicaid for long-term care, creating both personal and systemic financial strain.
Solution: Incorporate long-term support services into Medicare—either through new benefits or a hybrid public-private solution.
Underinvestment in Preventive and Home-Based Care
While preventive services are covered, Medicare still leans heavily toward reactive, acute care. Seniors would benefit from stronger support for preventive, home-based, and palliative care.
Solution: Expand coverage and reimbursement for home-based primary care, telehealth, and geriatric care teams.
Mental Health & Social Isolation
Medicare has limited mental health coverage, and many seniors suffer from depression, dementia, and loneliness, which can worsen physical health.
Solution: Increase access to mental health professionals, community-based support, and addrss social determinants of health
Medicare Advantage Oversight
MA plans are growing fast, but some prioritize profi
I need home health care after my surgery, but Medicare denied coverage. What are my appeal rights?
The notice you receive from Medicare, which includes details on why home health care was denied, will also include information regarding your appeal rights and the steps to take.First, you must file an internal appeal (redetermination) with the Medicare Administrative Contractor, which involves submitting a request form with supporting documents.
If the Medicare Administrative Contractor denies your coverage after reviewing, you may request reconsideration by a Qualified Independent Contractor.
If denied again, you can request an Administrative Law Judge hearing. This involves a formal hearing in front of the Judge, and you will present evidence and argue your case.
If the Judge denies your claim, you can appeal to the Medicare Appeals Council.
If you are still unsatisfied, you may have the right to seek judicial review in the Federal District Court.
How often should I review my plan to make sure my therapy is still covered?
Good rule for them: once a year, during the Annual Enrollment Period (Oct 15 – Dec 7) — that's when plans can change formularies, networks, and cost-sharing for the next year.Two other checkpoints worth considering:
Right after they get their Annual Notice of Change (ANOC) in September — it spells out what's changing for the coming year, including therapy/rehab benefit changes.
Anytime their therapy needs change (new diagnosis, more visits needed, new provider) — don't wait for AEP if something shifts mid-year.
If it's Medicare Advantage, also flag that prior authorization rules for therapy services can change plan to plan, so a review isn't just "is it covered" but "how many visits before I need auth again."
Shouldn't Medicare expand to cover more alternative treatments that actually help seniors?
That’s a question a lot of people are asking right now.Medicare’s coverage decisions are usually based on whether a treatment is considered “medically necessary” and supported by strong clinical evidence. Some alternative treatments don’t get covered because Medicare requires large-scale studies showing safety and effectiveness.
That said, Medicare has expanded certain benefits over time — for example, it now covers some acupuncture for chronic low back pain and certain preventive services that weren’t included years ago.
If there’s a specific treatment you’re wondering about, I can help you check whether Medicare covers it, whether a Medicare Advantage plan offers it as an extra benefit, or what other options might help reduce the cost.
What treatment were you thinking about?
Do I have to pay extra to use a local Medicare Licensed Insurance agent?
You do not have to pay anything at all to work with a local, Medicare-licensed insurance agent.Here’s why it’s free:
Medicare rules do not allow licensed agents to charge you a fee for helping with Medicare Advantage, Medigap, or Part D plans. The insurance companies pay the agent directly (through commissions set by Medicare). Your monthly premium and the benefits you receive stay exactly the same whether you enroll directly with the insurance company or through an agent.
Using a good local agent is often the smartest and easiest way to compare plans and enroll. They can explain your options in plain English, answer your questions, and help you choose the plan that fits your needs, all at no cost to you.
How to enroll in Part D plan for RX coverage?
You can enroll in a Medicare Part D plan through the Medicare.gov website. You will want to be careful and make sure you verify that all of your medications are covered and compare your out-of-pocket costs between plans as they will vary. Also make sure your preferred Pharmacy is in network as well. Even though the insurance carriers no longer compensate Medicare Health Insurance Agents to enroll Medicare beneficiaries into their Part D Plans, some agents may be willing to offer their time and expertise in finding a plan that fits your needs. This process can be time consuming if you have a lot of prescriptions, so start early and be sure to have an organized list of your prescriptions and the dosages ready to enter when you do your research. Remember, not signing up for Medicare Part D when you are eligible even if you don’t have any prescriptions will result in a late penalty when you sign up later on down the road.I will turn 65 in June 2026 and currently receive SSI and Medicaid. Will I automatically get Medicare, can I keep both Medicare and Medicaid, do I qualify for QMB due to low income, and why am I receiving so many application notices?
1. Automatic Enrollment in MedicareBecause you receive Supplemental Security Income (SSI), your enrollment in Medicare is generally automatic when you turn 65.
When it starts: Your Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) will begin on the first day of the month you turn 65 (June 1, 2026).
What to expect: The Social Security Administration (SSA) will automatically enroll you, and you should receive your red, white, and blue Medicare card in the mail about 3 months before your 65th birthday.
2. Keeping Both Medicare and Medicaid (Dual Eligibility)
Yes, you can absolutely keep both. Individuals who qualify for both programs are known as "dual eligibles." * How they work together: Medicare will become your primary insurance (paying first for your medical care), and Medicaid will act as your secondary insurance, covering costs that Medicare leaves behind, such as deductibles, copays, and coinsurance.
Prescription Drugs: Once you have Medicare, your prescription drug coverage will shift from Medicaid to a Medicare Part D plan. Because you have SSI and Medicaid, you will automatically qualify for Extra Help, a federal program that helps pay for your Part D premiums, deductibles, and lowers your medication copays.
3. Qualifying for the Qualified Medicare Beneficiary (QMB) Program
Since you are already receiving SSI and Medicaid, it is highly likely that you will automatically qualify for a Medicare Savings Program (MSP), specifically the Qualified Medicare Beneficiary (QMB) program.
What QMB does: The QMB program is a state Medicaid program that pays for your Medicare Part B monthly premiums. It also legally prohibits doctors and providers who accept Medicare from billing you for Medicare-covered deductibles, copayments, and coinsurance.
The Process: In many states, if you already have full Medicaid and SSI, you are automatically transitioned into the QMB category when Medicare starts.
How do Medicare brokers get paid, and does it affect the plan they recommend?
Fair question. Medicare brokers are usually paid commissions by insurance companies, not directly by clients.For Medicare Advantage plans, CMS — the federal agency that oversees Medicare — sets commission limits. That means an agent often does not earn more by recommending one Advantage plan over another in the same area. However, agents may only offer plans from companies with which they’re contracted, and some plans may not pay commissions at all.
Medicare Supplement plans, also called Medigap, work differently. Their commissions are set by the insurance companies and can vary.
The bigger issue is often not one Advantage plan versus another — it’s Medicare Advantage versus Medigap. Agents can be paid significantly more to place someone on an Advantage plan.
Consequently, Medicare Advantage plans are heavily marketed, and agents or call centers may have a financial incentive to focus on them. That helps explain why seniors hear so much about “zero-premium” Advantage plans and far less about Medigap. Unfortunately, many people never get a clear, balanced explanation of the differences.
I've been retired and on Medicare for 4 years. Why did my Part B premium increase by almost $100?
Your part B premium is based on your income from 2 years prior. Most often, a large increase in your Part B premium, after being on it for several years, is due to an IRMAA surcharge you incur due to a large influx of income. The most common causes of this include a large IRA withdrawal, the sale of a business, the sale of real estate, or a ROTH conversion. The proceeds from all these transactions are counted as income. This increase could trigger an IRMAA charge that will last for a year.Can I use my Medicare when I travel to another state?
Yes. If you travel to another state within the U.S., Original Medicare covers you anywhere in all 50 states and U.S. territories, as long as the provider accepts Medicare. If you have a Medicare Advantage plan, emergency and urgent care are covered anywhere in the U.S., but routine care may be limited to your plan’s service area.
If I don't have a primary physician will my new carrier assign me to one?
Yes — in many cases, if you enroll into certain Medicare plans, especially HMO plans, the insurance carrier may automatically assign you a Primary Care Physician (PCP) if you do not select one during enrollment.However, you usually still have the ability to change your assigned doctor afterward if you would prefer someone else who is in-network and accepting new patients. I always recommend reviewing the provider network carefully to make sure the doctor, specialists, hospitals, and medical groups are a good fit for your healthcare needs and location.
I also partner with senior-focused healthcare networks and medical groups that offer strong support for Medicare beneficiaries, including access to quality primary care physicians, quicker new-patient appointments, coordinated specialist care, wellness resources, and senior activities. My goal is not only to help clients select a plan, but also help connect them with healthcare resources and support systems that can improve their overall experience and quality of care.
How many physical therapy visits does Medicare cover per year?
Medicare does not limit the number of physical therapy visits per year. Coverage depends on medical necessity, not a fixed number of sessions.As of 2026 here is no hard cap on outpatient physical therapy under Medicare Part B.
Once your total Medicare-approved charges reach $2,480 (for PT and speech therapy combined), your therapist must add a KX modifier to claims. This simply confirms the services are still medically necessary.
A higher targeted medical review threshold of $3,000 applies. Claims above this amount may receive extra review.
You pay 20% coinsurance after your Part B deductible.
Your therapist must document why continued therapy is needed. Medicare can deny visits if they’re not considered medically necessary.
Summary: You can receive as much physical therapy as medically necessary, but good documentation becomes especially important once you pass the $2,480 threshold.
Do most doctors accept Medicare Advantage plans?
Throughout the US, about 46% of doctors who are contracted with Medicare, accept some Medicare advantage plans; unlike original Medicare, which is accepted by over 90% of physicians. The best way to find out if all your doctors take a specific plan is based on a one-on-one consultation with an independent insurance agent who can help verify and go over your concerns.
How do I find a Medicare broker in my area?
Here is a clear and easy 1‑2‑3 strategy for locating a licensed Medicare broker or agent in your area.1. Medicare Agents Hub
This national directory lists licensed, independent Medicare brokers. It’s simple for seniors to use for obtaining...
Broker profiles
States they serve
Experience and specialties
Contact information
Just visit Medicare Agents Hub, https://medicareagentshub.com/
Enter your ZIP code and browse brokers who can help you compare plan options.
2. Medicare.gov – “Find Local Help” Tool
Medicare’s official website also offers a reliable way to find licensed professionals.
Go to Medicare.gov
Type Find Local Help in the search bar
Enter your ZIP code
Select Medicare Brokers / Agents
This tool lists brokers who are registered with Medicare and meet federal standards.
3. Local Medicare Agencies in Your Community
Many seniors prefer someone nearby who can meet in person. You can search for:
“Medicare agency near me”
“Medicare insurance office”
“Medicare broker [your city]”
Local agencies may offer walk‑in support with familiar, community‑based service.
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Does Medicare offer life insurance, or is that a separate product I need to buy?
Life insurance is a separate product not covered by Medicare... Medicare is health insurance not life. Medicare will cover hospice care, which is an end-of-life benefit: nursing care, pain management, medical equipment, but not a cash death benefit like life insurance.Social security does have a one-time $255 death benefit, but best to connect with them for the details... It's not through Medicare.
Does Medicare ever call you at home, or is every call a scam?
Generally speaking, Medicare will never call you unprompted. They will only call if you explicitly requested a callback or if you recently reported fraud. If you receive an unexpected call from someone claiming to be from Medicare, simply hang up and call Medicare directly at 1-800-MEDICARE to verify. Scammers can easily fake caller ID numbers, so even if the incoming call appears to be official, ignore it and manually dial the number yourself.
Are the Medicare flex cards and grocery allowance cards I see on TV legit?
Yes, they're legitimate, but the advertising can sometimes be misleading. Some Medicare Advantage plans offer benefits such as flex cards, grocery allowances, utility assistance, or over-the-counter spending cards, but these benefits are not available in every plan or every area. The amount available, eligible purchases, and qualification requirements vary significantly by plan.It's important to understand that these benefits are offered by specific Medicare Advantage plans—not by Medicare itself. Before enrolling based on a TV commercial, make sure the plan's doctors, hospitals, prescription coverage, costs, and overall benefits fit your needs, not just the extra perks being advertised.
How do you avoid IRMAA surcharges on Medicare premiums?
You can’t always avoid IRMAA, but you can often reduce or minimize it through income planning. IRMAA is based on your Modified Adjusted Gross Income (MAGI) from two years ago, so large IRA withdrawals, Roth conversions, capital gains, and other taxable income can push you into a higher premium bracket.Strategies may include spreading withdrawals over multiple years, using Roth assets strategically, and working with a tax professional to manage taxable income. If your income drops because of a life-changing event such as retirement, you can request an IRMAA reconsideration through the Social Security Administration using Form SSA-44.
Planning ahead is often the best way to keep Medicare premiums lower.
Do I need to notify Medicare or Social Security if I move to a new address?
Yes, you will want to notify both Medicare and Social Security when you move. This not only helps ensure you continue receiving important communications regarding your Medicare coverage, premiums, Social Security benefits, and annual plan information, but it may also qualify you for a Special Enrollment Period (SEP) if you need to change your Medicare plan based on your new location.In many cases, updating your address with Social Security will also update your Medicare records automatically.
You can update your address:
✔️ Online through your SSA.gov account
✔️ By calling Social Security
✔️ Or by visiting your local Social Security office
If you are moving, it’s always a good idea to contact a local Medicare broker who can help you review whether your current plan still fits your needs in your new area.
If you have questions, I’m always happy to help!
Barson Financial / Kellogg Insurance Group/ Integrity Insurance Company/ Kellogg Insurance Group • Las Vegas, NV
Does life insurance affect my Medicare eligibility or premiums?
The short answer — No.Life insurance has absolutely no effect on your Medicare eligibility or your monthly premiums. The two are completely separate and do not interact with each other in any way.
Here's what actually determines your Medicare premiums:
Part A (Hospital Insurance)
Most people pay $0 for Part A if they or their spouse worked and paid Medicare taxes for at least 10 years.
Part B (Medical Insurance)
Your Part B premium is based on your income — specifically your Modified Adjusted Gross Income (MAGI) from two years prior.
For 2026, the standard premium is $202.90/month. Higher earners pay more through what's called IRMAA.
Part C (Medicare Advantage) & Part D (Drug Plans)
Premiums vary by plan, carrier, and your location — not by your life insurance coverage.
My parents, ages 90 and 91, can no longer afford their Medicare Supplement Plan F and do not qualify for Medicaid. What happens if they cannot pay the 20% not covered by Medicare after cancelling the supplement?
Since they do not qualify for Medicaid, dropping all supplemental coverage is highly dangerous. Instead, the best path forward is looking into Medicare Advantage.Many Medicare Advantage plans have $0 monthly premiums. Your parents will have to pay copays as they use the plan, but the plans have Maximum Out-of-Pocket (MOOP) limits. Once they hit that limit in a calendar year, the plan covers 100% of their medical costs, giving them the exact financial safety net they need without the heavy monthly premium of a Plan F.
They can enroll during the Annual Enrollment Period with no underwriting.
Beyond costs and benefits, should I consider an insurance company’s reputation, values, or social responsibility when choosing a Medicare plan?
Yes, but I recommend making it a secondary consideration after evaluating the plan’s coverage, provider network, prescription drug coverage, and total out-of-pocket costs.A company’s reputation can provide insight into areas such as customer service, claims handling, member satisfaction, and how responsive they are when issues arise. Some seniors also prefer to support companies whose values align with their own, whether that’s community involvement, environmental initiatives, veteran support, or charitable giving.
However, the “best” Medicare plan is usually the one that best fits your personal healthcare needs. A highly respected company may not necessarily offer the strongest provider network in your area or the lowest costs for your medications.
What are the worst Medicare Supplement insurance companies to avoid?
There usually isn’t a “worst” Medicare Supplement company in terms of coverage, because the plans themselves are standardized by Medicare. A Plan G is a Plan G no matter which company you buy it from, and Medicare is the one approving claims, not the supplement company. What really matters is picking a carrier that’s more likely to keep rate increases reasonable over time, even if they aren’t the absolute cheapest upfront. A good local broker should have enough experience with the various plans to let you know which ones to avoid.
Can a drug plan drop one of my medications during the middle of the year?
Yes, Medicare prescription drug plans ( Part D) can remove drugs from their formulary or changed their coverage rules through out the year. The plan can drop a medication or move it to a higher, more expensive tier. They must provide the consumer a 30 day notice. Plans may also add restrictions like prior authorization or quantity limited.There are protected drug classes that drug plans must cover medications, Those six protected classes are immunosuppressants, antidepressants, antipsychotics, anticancer, anticonvulsants and HIV/Aids treatments.
If a plan stops covering your medication, you can appeal the decision or request an exception through your plan's formal process.
What Medicare-related items commonly get missed or misunderstood when doing taxes?
Deducting Premiums: Medicare Part B, C, D, and Medigap premiums are all tax-deductible medical expenses if you itemize.• The SSA-1099 Trap: Many forget to look at their Social Security statement (Form SSA-1099) to find the premiums that were automatically deducted from their checks.
• Self-Employed Deduction: If you’re self-employed, you can often deduct 100% of Medicare premiums "above the line," meaning you don't have to itemize to get the benefit.
• IRMAA Surcharges: If you pay high-income surcharges, those extra costs are also fully deductible as medical expenses.
• HSA Conflicts: Once you enroll in Medicare, you must stop contributing to an HSA. Many people accidentally keep contributing and face tax penalties.
• Life-Changing Events: If your income dropped (e.g., you retired) since your last tax return, you can appeal your premium costs using Form SSA-44 rather than paying the higher rate.
If I already have part A and am already terminal on hospice care, do I need to get on part B and go through the MAPD/MedSup enrollment process?
Medicare Part A covers 100% hospice related services. Some of these services include nursing care, medical equipment (such as oxygen, hospital beds and wheelchairs), hospice aide services, counseling, and respite care.The only exceptions that are not covered by Medicare are co-pays for prescription medication dealing with pain management. These co-pays are limited to a $5 charge. If respite care is used, there is a 5% co-insurance.
Respite care is where relief is provided for primary caregivers. This allows a break for caregivers while making sure their person is still safe. Respite care is covered up to 5 days at a time.
Whether or not you should get on Part B depends on your prognosis from your doctor. Hospice care is designed to support individuals with a life expectancy of six months or less if their illness follows its natural course. Hospice can be extended as long as the patien continues to meet eligibility standards. Recently, former President Carter was in hospice for 22 months before he passed away in December 2024.
Overall statics show the median length of hospice care in the US is 18 days. 50% of patients pass away in the first three weeks. Up to 15% of patients survive longer than 6 months. With those statistics in mind, I would suggest to someone that they go through the Part B process only if they have a complete understanding of their remaining life expectancy from their doctor.
Some people will stay enrolled in Part B and Advantage or Supplement Plans if they need medical care or prescriptions unrelated to the hospice diagnosis. Obviously you want to have coverage if you have needs for non-medical care or prescriptions. Conversely, I suspect someone on hospice is not going to have a need to see an orthopedic surgeon. My best advice is use common sense based on your current condition.
Do I need to carry my Medicare card if I have a Medicare Advantage plan?
If you have a Medicare Advantage plan, you typically do not need to carry your Medicare card with you. You will receive a card to reflect your Part C Medicare Advantage plan that will take over for original Medicare.However, it is very important that you still retain or keep your red, white and blue Medicare card in a safe place. Should you need to change your Medicare Advantage Plan or return back to Original Medicare and add a Medicare Supplement Plan / Medigap plan and Part D Prescription Drug Plan, then you will need your red, white and blue Medicare card to be able to change plans.
Only in rare situations will medical professionals ask for your Medicare card if you have a Medicare Advantage plan. For example, if you are traveling outside of your network and have an emergency situation, you may want to have a copy of the card with you for claims processing and billing purposes.
Can Medicare drop your coverage or cancel your plan?
Yes — but it depends on what type of Medicare coverage you have.Original Medicare itself generally does not “cancel” you as long as you continue paying any required premiums, such as your Part B premium. However, Medicare Advantage and Part D prescription drug plans can end or change coverage under certain situations.
Some common reasons coverage could be affected include:
• Not paying your monthly premiums
• Moving outside your plan’s service area
• Giving incorrect information on an application
• Losing Medicaid or Extra Help status if your plan depends on it
• A plan leaving the market or discontinuing coverage in your county
• Medicare terminating its contract with a carrier
Every year, insurance companies can also change:
• Provider networks
• Prescription drug formularies
• Copays and deductibles
• Extra benefits
• Plan availability
That’s why reviewing your Medicare coverage annually is extremely important — even if you’ve had the same plan for years.
I’ve met many seniors who assumed everything stayed the same, only to later discover their doctor was no longer in network, medications changed tiers, or benefits were reduced.
The good news is that in many situations, if a plan ends or coverage changes, you may qualify for a Special Enrollment Period to choose new coverage.
This is exactly why I spend so much time educating seniors and families so they understand how Medicare actually works and what protections they may have available.
If you ever have questions about your plan or want a second set of eyes on your coverage, I’m always happy to help at no cost.
Chuck Winslow
US Marine Veteran 🇺🇸
Retirement & Legacy Planner
Contact me.
How to sign up for A & B?
You can sign up for Medicare Part A and Part B online through the Social Security Administration (SSA) website during your 7-month Initial Enrollment Period (3 months before to 3 months after your 65th birthday). The process takes about 10 minutes, and you will need to create a login.gov account.Several ways to Enroll:
- Online, visit SSA.gov and click "Sign up for Medicare".
- Phone: Call Social Security at 1-800-772-1213
- In-Person: Visit your local Social Security office.
Does Medicare cover Alzheimer's disease treatment?
In short, yes. Medicare focuses on medical treatment and diagnostic support of Alzheimer's disease. It does not provide daily living assistance ultimately required in advanced stages of the disease.In brief, Medicare Part B will cover:
• Cognitive Assessments: Included in an "Annual Wellness Visit" to track memory loss.
• Specialist Visits: Covers appointments with neurologists and geriatricians.
• Diagnostic Imaging: Covers MRI, CT, and certain PET scans (used to confirm a diagnosis).
• Care Planning: A dedicated visit to create a roadmap for treatment and support.
• Mental Health: Psychotherapy and counseling for the patient.
Medicare Part D (Prescription Drugs)
• Symptom Management: Covers standard drugs used to treat Alzheimer's disease
• Disease-Modifying Drugs: Covers newer infusion drug therapies if the prescribing doctor participates in a registry to track outcomes.
• 2026 Benefit: Total drug costs will be capped at $2,100 for the year.
Facility & Home Care (Part A & B)
• Home Health: Covers medically necessary part-time skilled nursing or physical therapy if the patient is "homebound". It is important to remember, Medicare does not cover 24/7 care, it does not cover custodial care (e.g. activities of daily living, bathing, dressing, eating).
• Skilled Nursing: Covers up to 100 days of rehab in a facility following a 3-day hospital stay.
• Durable Medical Equipment: Pays 80% for hospital beds, walkers, and wheelchairs used at home.
• Hospice: Fully covers end-of-life care, including pain management and grief support.
How long should I keep my Medicare Summary Notices?
A good rule of thumb is to keep your Medicare Summary Notices for at least one year, longer if a bill, claim, appeal, or tax question is still unresolved.Your Medicare Summary Notice, often called an MSN, is not a bill. It is a record of Medicare Part A and Part B claims, including services or supplies billed to Medicare, what Medicare paid, and the maximum amount you may owe.
These notices can help you check for billing errors, compare them with provider bills, and review claim decisions.
You may want to keep them longer if:
• You are disputing a claim
• You are appealing a denial
• You need them for tax records
• You have ongoing medical treatment
• The notice relates to a bill that has not been fully resolved
If everything matches your bills and there are no open questions, many people keep Medicare Summary Notices for about a year and then safely shred the paper copies.
You can also view Medicare claims online through your Medicare.gov account, which may reduce the amount of paper you need to keep.
Are caregivers or home health aides included for dementia care?
Medicare does not cover long-term caregivers or home health aides for dementia if the care is mainly custodial—meaning help with bathing, dressing, meals, or supervision.Medicare only covers short-term home health when it’s skilled care ordered by a doctor (like nursing or therapy). It won’t pay for full-time in-home caregivers or long-term dementia support.
Most people use Medicaid, long-term care insurance, or private pay for that type of help.
Can I have both Medicare and Medicaid at the same time?
Yes. You can have both Medicare and Medicaid at the same time. Individuals who qualify for both are called dual-eligible beneficiaries.* Medicare is your primary health insurance.
* Medicaid helps pay Medicare costs, such as premiums, deductibles, copays, and coinsurance, and may also cover services like dental, vision, hearing, transportation, and long-term care.
Many dual-eligible individuals enroll in a Dual Eligible Special Needs Plan (D-SNP), which combines Medicare benefits with extra services such as prescription drug coverage, dental, vision, hearing, OTC allowances, transportation, care coordination, and, on some plans, grocery or utility benefits.
To qualify, you must:
1. Be eligible for Medicare, and
2. Meet your state’s Medicaid income and eligibility requirements.
Medicaid assistance may include Full Medicaid or a Medicare Savings Program (QMB, SLMB, QI, or QDWI), depending on your eligibility.
Are stair lifts covered by Medicare?
Medicare generally doesn’t pay for stair lifts because they’re viewed more like home upgrades similar to ramps or wider doorways, rather than medical equipment. In most situations, Original Medicare may not cover them, though some Medicare Advantage plans may offer limited assistance depending on the plan.You can always double‑check by visiting Medicare.gov or calling Medicare’s toll‑free number at 1‑800‑MEDICARE for official guidance. You can also check with your state’s Home‑ and Community‑Based Services (HCBS) programs; each state has its own HCBS office and toll‑free number, and they can explain whether any programs might help with a stair lift or other home‑safety needs.
If you’re a veteran or assisting one, the VA can provide information about benefits that may be available.
Contact me.
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How do Medicare Advantage plans make money if many have $0 premiums?
Medicare Advantage plans receive a monthly payment from Medicare for each enrolled member, regardless of whether the plan charges a premium. They also collect any copays, coinsurance, and deductibles required under the plan.Plans manage costs through provider networks, negotiated rates, care management programs, and utilization controls such as prior authorization. In addition, plans that earn high quality ratings from the Centers for Medicare & Medicaid Services may receive bonus payments.
That’s why a plan can offer a $0 premium and still operate profitably.
Is there a Medicare office near me where I can get help in person?
There are no dedicated Medicare offices. You can resigster for Medicare at your local Social Security office of online at www.ssa.gov. You can alo contact your local office of the State Health Insurance Program (SHIBA) which provides free counseling and will help you understand the complexity of Medicare rules and processes.Medicare also offers support through a toll-free numbner at 1-800-MEDICARE or use their live chat feature. This office will be able to assist you with general questions, penalties, checking eligibility, or submitting a complaint.
You can also use a local, indepoendent Medicare broker. Many brokers will offer an educational seminar introducing Medicare to people ready to enroll. Brokers work with multiple insurance carriers and should be able to suggest plans based on your needs.
Does Medicare cover assisted living?
Generally, no—Original Medicare does not pay for assisted-living room, meals, or ongoing personal care. Those expenses are considered custodial, or long-term care, such as help bathing, dressing, eating, or using the bathroom.Medicare may still cover medically necessary healthcare received while someone lives in assisted living, including: Doctor visits and outpatient treatment under Part B
Prescription drugs through Part D or a Medicare Advantage plan
Physical or occupational therapy when eligibility requirements are met
Certain home-health or hospice services
Short-term skilled nursing or rehabilitation following a qualifying medical event—not permanent assisted living
Possible ways to help pay for assisted living include Medicaid programs or state waiver services, long-term-care insurance, veterans’ benefits, personal savings, or certain life-insurance benefits. Medicaid assistance varies by state and may cover supportive services but not necessarily the facility’s entire room-and-board c
How do I find a trustworthy Medicare agent in my area?
A good Medicare agent should focus on education first, not pressure.Look for someone who asks about your doctors, prescriptions, and budget, explains your options in plain language, and is available year‑round, not just during enrollment season.
You can check online reviews, ask friends or your pharmacy for referrals, and make sure the agent is licensed in your state and represents multiple plan options, not just one company.”
Do Medicare brokers charge seniors a fee, or is their help free?
Let me clear this up, because there’s a lot of misinformation out there.No—Medicare brokers do NOT charge seniors a fee for their help.
If you sit down with me, call me, text me, ask a hundred questions… you’re not getting a bill. Period.
So how does that work?
We’re paid by the insurance companies, not by you. When you enroll in a plan, the carrier pays the agent a commission that’s already built into the plan. It does not increase your premium, and it’s the same whether you use an agent or go direct.
Now here’s the part people don’t always think about…
If you go online and enroll yourself… or call a 1-800 number…
you’re still paying for that commission—you’re just not getting the guidance that comes with it.
You can do this alone…
or you can have someone walk it with you, answer your questions, fix problems, and make sure you’re actually in the right plan…for the exact same cost.
And I don’t disappear after you enroll.
When something looks off, when a bill doesn’t make sense, when you get one of those “Medicare letters” that makes your head spin… that’s when you call me.
At the end of the day, you’re not paying for a broker…
but you absolutely benefit from having one on your side.
Does moving to a new state let me switch from Medicare Advantage to Medigap without health questions?
Moving to a new state opens a Special Enrollment Period (SEP) for your move where you can switch with what's called . The moving process is a bit involved. First, you will need to stop your Advantage Plan and go back to Original Medicare. Once you are back in Original Medicare, you can apply for a Medigap Plan.Keep in mind that moving from Medicare Advantage to Medigap does not cover prescriptions. You will need to add a separate Prescription Drug Plan (Part D) with your Medigap Policy. Don't forget to check and see if your medications are covered.
You’ll have up to two months to get a Part D prescription plan, and you’ll qualify for a Medigap guaranteed issue period that lasts up to 63 days after your Medicare Advantage coverage ends. During this time, you can purchase most Medigap plans regardless of existing health problems.
Although the Medigap Plans offer the same coverage, premiums are not the same price. Also, different sates have their own rules for Medigap policies. For instance, New York, Connecticut, and Massachusetts offer enrollment at anytime, without the need for a Special Enrollment Period. Check with a licensed Medicare Broker in your new home town to help you with the specific rules in your new hometown.
I've heard Medicare Advantage plans have hidden costs. How do I know what I'm really getting?
No, there should not be any hidden costs in your Medicare Advantage plan. All copays, coinsurance, deductibles, and other cost-sharing are outlined in the plan's Summary of Benefits (SOB), which every plan is required to provide.To fully understand what you're getting, it's also important to review the plan's Evidence of Coverage (EOC), which provides detailed information about your benefits, coverage rules, and out-of-pocket costs.
Where confusion sometimes arises is with the cost-sharing of the supplemental benefits such as dental, vision, and hearing coverage. While these benefits are included in many plans, they often have coverage limits, copays, coinsurance, or annual maximums that aren't always understood.
If my spouse dies, do I get his Social Security and mine?
Good question! You cannot collect both Social Security benefits in full, but you receive the higher of the two amounts. Social Security combines your earned retirement benefit and your survivor benefit into a single, maximum monthly payment.I’m on Humana Medicare. Customer service pre-approved a nuclear stress test, but I just got a $780 bill. They escalated it over a week ago and never called back. Do I have to pay? How do I file a complaint?
Call the Customer Care number on the back of the Humana member ID card. Or, you may file an appeal online at HUMANA. Make sure you have the following information.Humana ID card
Provider bill
Humana EOB
Date of service
Claim number
Provider name and NPI, if available
Amount billed
What the client believes is wrong
Any notes from calls with Humana or the provider
Make sure to indicate that it is an appeal of payment or a coverage decision.
If HUMANA can't resolve the issue, you can call 1-800-MEDICARE. Tell Medicare you have already filed the billing complaint with HUMANA, it has not been resolved to your satisfaction, and you would like to know what your next steps are.
I'm over 65, not enrolled in Part A or B, and leaving active coverage through an employer with 20+ employees for six months of COBRA.
No, once your active employer coverage ends, your 8-month Special Enrollment Period starts immediately, and COBRA doesn't extend or pause it. So even if you elect 6 months of COBRA, you still need to enroll in Part A and B within 8 months of your active coverage ending, not 8 months from when COBRA runs out. Waiting until COBRA ends would put you outside the SEP window and risk a late enrollment penalty plus a potential gap in coverage.
Do you lose Medicare if you move out of the country?
No. What happens when you move out depends which parts of Medicare you have and whether you expect to return to the USA.You can generally keep your Medicare part an even if you live abroad. Understand that original Medicare generally does not pay for healthcare received outside the United States. You can generally keep your Medicare part A even if you live abroad. Understand that original Medicare generally does not pay for healthcare received outside the United States with a very few narrow exceptions.
Part B. You may keep part B, even though you cannot use it abroad. If you later return and you already have part B and drop it you may have to wait for an enrollment period to re-enroll and could owe a late enrollment penalty unless you qualify for a special enrollment.
Part D if you leave the service area, which, if you’re living outside the USA, your plan will generally disenroll you because you no longer reside in the Service area. If you later return, you will usually qualify for a special enrollment. To enroll in a new part D plan.
Part C same answer as above for parts C
Are Medicare Supplement plans worth the cost?
The true value of a Medicare Supplement plan, regardless of the carrier someone may elect to have their plan with, is the freedom to be treated anywhere in the United States that accepts Medicare. Someone would never have to deal with a service being "out of network". As long as the Dr. or Facility accepts Medicare, then they will accept the Medicare Supplement. It will fill in the 20% gap after Medicare pays 80% and that is why they are also called Medigaps. Many people value that freedom more than others.Although there are many zero premium Medicare Advantage plans, they will be a little more restrictive on Dr's and Specialists that can be seen and will usually have copays associated with the different services the plan covers. Great question!
Can I have Marketplace and Medicare coverage at the same time
No. Once you are enrolled in Medicare Part A or Part B, you are not eligible for premium tax credits (subsidies) on a Marketplace plan. It is against the law for an agent or insurer to knowingly sell you a new Marketplace plan if you have Medicare. You can technically keep an existing Marketplace plan after enrolling in Medicare, but:*You will pay the full premium (no subsidies).
*The insurer may not renew the plan at the end of the year.
*It is almost always a waste of money because Medicare duplicates much of the coverage.
Rare Exceptions:
*If you pay premiums for Part A (not premium-free) and choose not to enroll in Medicare, you may keep subsidized Marketplace coverage.
*ESRD (End-Stage Renal Disease): Limited flexibility to keep or enroll in Marketplace with subsidies in some cases.
How do I find out if Medicare covers a specific procedure before I have it done?
You have a several options to learn if a specific procedure is covered by original Medicare and if there will be any co pays , coinsurance, and /or deductible requirements triggered with having the procedure done.1- Contact your Local, Licensed, Medicare Agent- They can quickly answer your question.
2- Visit www.Medicare.gov and look up covered procedures.
3- If you downloaded the Medicare App, What's Covered, you can look up the procedure on the app.
4- Call Medicare Directly at 800-Medicare
5- Ask the Provider's Office/Ordering Provider if the procedure will be covered
* Some procedures may be covered as part of the preventative/screening benefits as part of your Medicare benefits. Things like a mammogram, colonoscopy, etc...There are limitations and frequency requirements with included preventative and screening benefits.
* * Keep in mind, depending on where you have the procedure (inpatient / at the hospital) vs outpatient (freestanding Ambulatory Care Center/ Surgery Center) may have different cost shares. Also, there are typically costs associated with the procedure/services, and then there are professional fees (provider fees).
What is the difference between Plan G and Plan N of Medicare?
There are a couple of difference between these two plans. First Plan G is the more comprehensive plan and typically more expensive. Plan G has very minimal out of pocket , you simply pay your monthly premium and the Medicare part B deductible and than you will be 100% covered for all Part A&B covered services.Plan N still a good plan covers 100% of Part A deductible and you still have to pay the Part B deductible each year and once you do Plan N allows a maximum of $20 at a doctors office & a $50 copay at the emergency room. Lastly Plan N does not cover provider excess charges. This means if a doctor has not opted into Medicare's rates meaning they do not accept Medicare's usual an customary for payment they can bill up to 15% on top. Currently less than 5% of all doctors have opted out nationwide.
Does Medicare cover hospital observation stays, and how is that different from being admitted as an inpatient?
Yes — Medicare does cover hospital observation stays, but this is one of the most misunderstood areas of Medicare and it can create major unexpected costs for seniors.Many people think if they stay overnight in a hospital, they’ve automatically been admitted as an inpatient. That is NOT always the case.
Under Medicare, “observation status” is considered outpatient care — even if you stay in a hospital bed for several days.
Here’s why that matters:
• Observation stays are generally covered under Medicare Part B
• Inpatient admissions are covered under Medicare Part A
• Your costs, deductibles, copays, and coverage can be very different depending on how the hospital classifies you
One of the biggest issues involves Skilled Nursing Facility coverage.
Medicare typically requires a qualifying 3-day inpatient hospital admission before it will help cover rehabilitation or skilled nursing care afterward. Observation days usually do NOT count toward that requirement.
So someone could spend multiple nights in the hospital thinking they qualify for rehab coverage — only to later discover they were never officially admitted as an inpatient.
This is why I always encourage seniors and families to ask the hospital directly:
“Am I admitted as an inpatient or am I under observation status?”
That one question can make a huge financial difference.
I help seniors understand these gaps and how different Medicare plans may help protect them from unexpected costs and confusion — always at no cost.
Chuck Winslow
US Marine Veteran 🇺🇸
Retirement & Legacy Planner
Contact me.
How can I find out if Medicare will cover a specific procedure or treatment?
To find out if Medicare will cover a specific procedure or treatment:• If you have Original Medicare – use the coverage tool on Medicare.gov to check.
• If you have a Medicare Advantage plan – check your plan’s benefits list, or call the plan’s member services number.
I have Medicare through Mutual of Omaha but I have no Medicare cards. How do I get my part A and B cards.
Your Medicare card (Parts A & B) comes from the federal government, not from Mutual of Omaha. What you have through Mutual of Omaha is likely a Medicare Supplement (Medigap) plan, which is separate from your actual Medicare coverage.Here's how to get your red, white, and blue Medicare card:
Online (fastest):
- Go to mymedicare.gov
- Create or log into your account
- Request a replacement card directly through the portal
By Phone:
-Call 1-800-MEDICARE
In Person:
- Visit your local Social Security Administration office
- Bring a valid photo ID
Things to know:
- Replacement cards are free
- It typically arrives within 30 days
Are there churches or community organizations in my area that help with Medicare questions?
Yes, in PA there are 3 main sources and organizations that offer free and unbiased Medicare counseling. These are, You Local Area Agency on Aging, PA MEDI Helpline, and Senior Community Centers. These places have counselors that are specially trained to assist with plan comparisons, enrollments and appeals.
I'm hesitant to share personal or financial information with an insurance agent. Is my information safe with you?
Insurance agents are required to follow privacy laws and protect your personal information. Only necessary information such as your ZIP code, age, preferred doctors, prescriptions, and Medicare eligibility date are needed to compare plans. Financial information should only be shared if you are choosing to enroll in a plan and that insurer requires the information. Don't hesitate to ask why a piece of information is needed, how it will be used, and who will have access to it.Are there Medicare plans that also help with chronic conditions like diabetes or high blood pressure that run in my family?
Yes. Many Medicare Advantage plans offer care management programs for chronic conditions such as diabetes, heart disease, and high blood pressure. If you already have certain qualifying conditions, you may also be eligible for a Chronic Condition Special Needs Plan (C-SNP), which provides more specialized care coordination and benefits.If these conditions only run in your family and you haven't been diagnosed, you won't qualify for a C-SNP based on family history alone. However, Medicare covers preventive services like diabetes screenings for people at increased risk, and many Medicare Advantage plans offer wellness programs to help you stay healthy.
My income is limited. Are there programs that can help pay my Medicare premiums?
Yes, depending on your income and assets, you may qualify for programs that help pay Medicare costs. These include Medicare Savings Programs (MSPs), which can help pay your Part B premium and, in some cases, deductibles, coinsurance, and copayments. You may also qualify for Extra Help (Low-Income Subsidy), which helps lower the cost of Medicare Part D prescription drug coverage. If you qualify for Medicaid, you may also be eligible for a Dual Eligible Special Needs Plan (D-SNP) that provides additional benefits.
Is help available in Spanish when choosing or using my Medicare plan?
Yes — absolutely, and you have a legal right to it. As your broker, I make sure all my clients know about this, whether they need it for themselves or for a family member.Official Medicare - Free, in Spanish
Medicare.gov/es - The entire Medicare website is in Spanish
1-800-MEDICARE - Say "Español" or press 2 for Spanish. They have Spanish-speaking reps 24/7.
Your Medicare & You handbook - Available in Spanish every year
You are allowed to have a family member or interpreter on the call with Medicare, HICAP, or with me. Medicare will just do a quick permission check. I also have access to a free interpreter line, so I can do a three-way call in Spanish if you need me to explain your options to a family member.
Will my prescription drugs be covered under any plan I choose?
No. Every Medicare Part D and Medicare Advantage prescription drug plan has its own formulary, which is a list of covered medications. A drug may be covered by one plan but not another, or it may be placed in a different tier with different copays.Before enrolling, always check that your medications, dosage, and preferred pharmacy are covered. The best plan isn't necessarily the one with the lowest premium—it's the one with the lowest total annual cost for your specific prescriptions.
What is the donut hole, and does it still exist?
Let's not confuse you with the "Donut Hole" as it no longer exists today. This was part of the Inflation Reduction Act. Medicare Part D - Prescription Drug coverage now operates in 3 phases. 1. Deductible Phase, where you pay 100% of the drug cost until your deductible is met. 2. Initial Coverage Phase, where you typically pay a copay or percentage (%) of the cost, and the plan pays the rest, until out-of-pocket spending reaches an annual cap limit. 3. Catastrophic Coverage Phase, once your out-of-pocket prescription costs reach the annual limit (e.g., $2,100 in 2026), you pay nothing for covered medications for the rest of the year.
Did you know you can receive money back each month from your part B premium?
That benefit is called the Part B Giveback or Part B reimbursement. It will return some of the premium to you monthly for whatever you may need it for. It works somewhat like a discount. As an example, if you enroll in a plan with a $150 giveback benefit, it means each month you will receive $150 of your $202 monthly Part B premium returned to you through your SS check
Do you have to renew your Medicare Supplement plan every year?
No, you do not have to renew your Medicare Supplement plan every year. Medicare Supplement plans are desinged to automatically renew each year as long as you continue to pay your premiums on time. You do not need to reapply or renew your policy annually.I do, however, suggest reviewing your coverage each year to ensure it still meets your healthcare needs and budget. Your premium and plan costs can change over time, and depending on your situation, you may have other coverage options worth considering.
Also, you can change your Medicare Supplement plan anytime during the year, you don't have to wait until your anniversary date. Some states have Birthday or Anniversary Rules allowing you to change without answering health questions.
In NC, I’m on my husband’s active employer plan with 20+ employees. Since it’s credible coverage, can I delay Medicare, including Part D?
Yes, since your husband's employer plan covers 20+ employees, it counts as creditable coverage for both Medicare and Part D. So you can delay enrolling in Part A, Part B, and Part D without a late enrollment penalty as long as that coverage stays in place. Once the employer coverage ends, you'll get an 8-month Special Enrollment Period to sign up for Part A and B, and a separate 2-month window to enroll in a Part D or Medicare Advantage plan with drug coverage
What is the biggest coverage gap most people don't know about with a Medicare Advantage plan?
The biggest coverage gap in Medicare Advantage plans is the costs for a hospital stay. Though there is a maximum out of pocket on what one will pay in a year, many Medicare beneficiaries are not prepared for the per day costs they would incur if they were hospitalized or the post-release care if they need additional institutional care. Having a hospital indemnity plan can help cover costs for the hospital stay; long term care coverage or tapping into the living benefits of a life insurance policy (if the policy has them) can help with post-release institutional care.My oxygen provider says I need yearly re-evaluations for oxygen coverage, but my last one lapsed and now they are charging me. I’ve been with them since 2017. Please help.
Medicare does require periodic documentation and recertification for oxygen coverage, especially continued proof that the oxygen remains medically necessary. If the required yearly re-evaluation or physician documentation was missed, the supplier may temporarily stop billing Medicare and charge you directly until updated records are provided.Since you’ve had oxygen since 2017, you may already be beyond Medicare’s standard 36-month rental period, but documentation requirements can still apply for continued service and supplies. Contact your doctor immediately to schedule the re-evaluation and have updated chart notes and oxygen testing sent to the supplier.
You should also ask the supplier for a detailed explanation of the charges and whether they can rebill Medicare once the updated documentation is received.
I'm confused about when I can change my Medicare plan. Can you clarify the different enrollment periods for me?
There are several Medicare enrollment periods, each with a different purpose. Your Initial Enrollment Period (IEP) is when you first become eligible for Medicare, starting 3 months before your 65th birthday month, including your birthday month, and ending 3 months after. The Annual Enrollment Period (AEP) runs October 15 through December 7 each year and allows you to change Medicare Advantage or Part D plans. The Medicare Advantage Open Enrollment Period (OEP) runs January 1 through March 31 and allows people already enrolled in a Medicare Advantage plan to make one plan change or return to Original Medicare. You may also qualify for a Special Enrollment Period (SEP) if you experience certain life events, such as moving, losing other coverage, or becoming eligible for Medicaid.Browse Other Questions & Answers
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