Medicare Questions & Answers: Advice for Seniors
Advice for Seniors Q&A
Showing 55 questions
What is the biggest mistake seniors make when enrolling in Medicare?
It sounds cliché coming from me, but the biggest mistake seniors make is not having an independent agent acting on their behalf. When calling into insurance companies for help, their sole job is to sell you their product, whether it's the best option for you or not. You want someone who has a financial incentive to assist you in finding the right type of coverage by going over all your options and not leaving anything to chance. Imagine a doctor that only wrote you prescriptions from one pharmaceutical company; you'd have questions about their motives just as I would too.
What's one piece of advice you wish every senior knew before picking a Medicare plan?
I wish every senior knew that the 'best' Medicare plan isn’t the same for everyone...it’s the one that fits your specific needs and budget.Too many people pick a plan based on what their neighbor has or just go with the cheapest option, only to find out later that their doctor isn’t covered or their medications cost way more than expected.
Take the time to compare your options, ask questions, and make sure you’re choosing a plan that actually works for you. And if you're feeling overwhelmed, talk to an expert, because guessing your way through Medicare can be an expensive mistake!
What benefits are there to working with a Medicare Agent near me vs remote/virtual?
As Ohio Medicare Plan, I stick to Ohio’s 88 counties because I believe local agents like me bring far more value with our deep experience in local networks and plan features—details call centers or virtual agents often miss or don’t fully grasp. I’m not licensed outside Ohio, and that’s by design; it lets me stay dialed into what matters most for my clients here. Plus, some clients prefer meeting face-to-face to build trust and get that personal touch, which I’ve seen makes a real difference.What is one of the the most common misconceptions people have about Medicare?
One of the most common misconceptions about Medicare is that it covers all healthcare costs for seniors. Turns out, Medicare doesn't cover every single healthcare expense. Additionally, many assume it includes long-term care (like nursing homes) or dental, vision, and hearing services, but these items are not covered under original Medicare. People often learn this the hard way when they realize they need supplemental insurance like Medigap, Medicare Advantage, and other tertiary coverage options to fill those gaps. It’s a rude awakening for those who think Medicare = free healthcare, hence the need to fully understand your options to make the best decision for yourself.
What’s one Medicare decision that too many people regret later?
Selection of an MAPD when they could have enrolled in supplemental plan and separate PDP during their initial IEP. Too many (in my opinion) are led to the MAPD side without having the client sign-off on an affidavit saying they have in fact received a thorough discussion of the pro's and con's of both sides of the Medicare decision fence.
If a senior is turning 65 but still working, should they enroll in Medicare or delay it?
If you have employer-based health insurance through your or a spouse's current employment, where there are more than 20 employees, and you're happy with the costs, such as monthly deductions/premiums and coverage, like potential out-of-pocket costs, you can delay Medicare enrollment without accruing penalties. If this is you, it's best to schedule a quick call so we can discuss your situation. Chad
Are Medicare Advantage plans really “free,” or is that just clever marketing?
several carriers offer zero premium plans for medicare advantage plans. they can do this because they get paid by medicare to coordinate your medical care
What’s the most important question I should be asking about Medicare that I probably haven’t thought of yet?
If I am still working do I need to sign up for Medicare? How do I determine if a Medicare Advantage Plan or a Medicare Supplement is right for me?
How do discount cards and resources affect my Medicare Prescription Drug plan?
If you choose to use a discount card to pay for a prescription because it's cheaper than the Medicare Prescription Drug plan, you can use it for the cheaper price. However, it will not count towards your out-of-pocket expenses.
What’s the trade-off between a Medicare Advantage PPO and HMO when it comes to flexibility?
I usually recommend a PPO as you can go to an out of net work provider, sometimes at a higher costs depending on the plan, more providers take PPO. PPO is Preferred Provider. HMO requires referrals, and usually have very narrow networks that you MUST stay in, if you go out of network, YOU pay
Do Medicare Advantage plans really save seniors money in the long run? Why or why not?
They can. Medicare Advantage typically offers additional benefits such as Dental, Vision and Hearing- the emphasis on these plans is Preventative Care. The better you take care of your health, the less costly it tends to be.If you break it down, usually a Medicare Advantage plan is about $0 monthly premium, and includes your prescription drug coverage. You will still have to pay your Part B premium (in 2025 the standard premium is $185) and any copayments associated with your plan for doctors visit, procedures, medications. This is why Medicare is considered the Pay as You Go Plan. And that suits some people just fine.
With a Medicare supplement, you are responsible for your Part B premium, your Medicare supplement premium, your prescription drug plan premium and any additional policies you may require such as a Stand-alone Dental, or bundled Dental, Vision and Hearing policy (because Medicare Supplement plans do not include coverage for these). This is why a Medicare Supplement/Medigap plan is known as a Prepaid Plan.
What additional coverage options are available for international travelers?
Medicare Supplement plans (Medigap) C, D, F, G, M, and N may offer coverage for services outside of the U.S. with up to $50,000 of lifetime coverage. Some Medicare Advantage plans may also provide some coverage, and travelers should check with their specific plan for details. Additionally, international travel plans can provide emergency medical evacuation, return of mortal remains, support for lost passports or luggage, trip cancellation protection, and even kidnap and ransom coverage for high-risk destinations.Why do some seniors end up paying lifelong penalties for Medicare Part B or Part D?
Lack of appropriate retirement planning education. One of the foundations I have built my business on is education. Medicare 101 seminars can be really useful to people to learn how to avoid these penalties.It is important to know that unless you have what is known as Creditable Coverage, delaying Part B and or Part D can carry lifelong penalties. Each situation is unique so it’s important to consult with a professional to understand if you have Creditable Coverage or not and have a plan in place, months before you turn 65. Sorting out your Medicare coverage is best done up to 3 months before you turn 65.
How does life insurance contribute to financial planning?
Life insurance contributes to financial planning in many ways: a policy that builds cash value can be borrowed against as a loan, it can be a means to pay final expenses, it can also be used as mortgage protection.
What role do annuities play in retirement planning?
Imagine having a reliable stream of income flowing in during your retirement. That's the magic of annuities! You can purchase an annuity with a lump sum or through regular payments, and it can provide a guaranteed income stream throughout your retirement. Some annuities even offer lifetime income, meaning you'll receive regular payments no matter how long you live. This can be a game-changer for supplementing Social Security and other retirement income, allowing you to live comfortably and worry-free.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.
What’s one hidden Medicare expense that people don’t think about until it’s too late?
Skilled Nursing Facility Costs. Days 1-20, Medicare pays 100%. Days 21-100, the member pays a daily co-pay. After 100 days, Medicare no longer covers expenses.
What’s the best way for seniors to protect themselves from Medicare-related scams?
Protect your information as there are many scams out there today, unfortunately. Verify Brokers/Agents licensing on the particular state those agents/brokers are inIf you had to pick just one, what’s the worst Medicare-related decision someone can make?
In my professional opinion, the worst Medicare-related decision is choosing a plan without assessing one’s individual circumstances and relying instead on unsolicited advice from others. I frequently encounter clients who select coverage based on someone else’s experience, only to discover it doesn’t align with their specific healthcare or financial needs. This misstep often leads to unnecessary complications or expenses that a tailored evaluation could prevent.What are the signs that it's time for me to switch my Medicare plan, and how often should I review my options?
There's three signs I always tell people it's time to go shopping for other options:1) Cost changes (prescriptions, copays, premiums, etc.)
2) Health changes like new meds or complications
3) Doctor changes
I'll also throw in if your benefits change on your coverage. Those are all reasons I'd want to review my coverage to see if anyone is offering better.
That being said, I will always tell people that a good time to check your coverage is at least once a year. Typically we do that review with our clients anyways.
I'm confused about when I can change my Medicare plan. Can you clarify the different enrollment periods for me?
Changing your Medicare plan depends on specific enrollment periods, and knowing them can save you headaches down the line. Your Initial Enrollment Period (IEP) spans seven months around your 65th birthday to join Parts A, B, D, or Medicare Advantage; miss it without other coverage, and penalties loom—10% per year for Part B and 1% per month for Part D, both lifelong. The Annual Enrollment Period (AEP), October 15 to December 7, lets you switch between Original Medicare, Advantage plans, or Part D options for the next year, while the Medicare Advantage Open Enrollment (January 1 to March 31) offers one tweak if you’re already in Advantage. Special Enrollment Periods (SEPs) kick in for life events like losing a job’s coverage, typically giving you two months to adjust penalty-free, and the General Enrollment Period (January 1 to March 31) is for late Part A or B sign-ups if you missed IEP. For Medigap, you get a six-month window starting when you’re 65 and on Part B to enroll without health-based denials—outside that, it’s possible but trickier—something I’ve watched folks overlook until it’s urgent over my years in this field.Why do some clients ignore your advice and end up in bad Medicare plans—what makes them resistant?
Some clients hesitate to follow my advice because of a common misconception that Medicare advisors like me drive up their premiums or costs due to commissions, when in reality, our guidance doesn’t change what you pay—plans and pricing are set by insurers and Medicare, not us. There’s also a false narrative that we can push you into specific plans for higher payouts, but the truth is, we earn the same regardless of the provider or product, so my focus is purely on what fits your needs best. Ignoring tailored advice can lead to picking the wrong plan, missing out on key benefits, and facing unexpected costs that hit both your health and wallet hard.
Are there any tax benefits tied to paying Medicare premiums as a retiree?
Possibly. Medicare premiums can sometimes be deducted as a medical expense if you itemize — but it depends on your overall situation. Best to run it by a CPA to see what applies to you.
I got a call from a “Medicare agent” promising me free groceries and I almost fell for it. Why is this kind of marketing allowed?
Medicare is trying to stop these unwanted calls. Even if your name is on the Do Not Call list, they still reach out to you. Most of these calls are made offshore and then transferred to an agent in the U.S. upon you answering the phone, this is what I have been told. I am 65 and have blocked over 600 numbers on my phone.Regarding the information about the free grocery card, it is partially correct and depends on your qualifications, including your location, the type of plans, your health, and on Medicaid. These plans are available through some Medicare Advantage plans.
How does moving to a new state affect my Medicare enrollment timeline?
If you currently have a Medicare Advantage plan and you move to a new state, you will fall into a Special Election Period you will have 60-days to enroll into a new plan.If you are enrolled in a Medigap plan, in most cases you do not need to change. However, you may decide to do so if you can get a lower premium.
What are some lesser-known benefits or services that my Medicare plan might cover that I could be missing out on?
This is a perfect question, and a great one especially in today’s time, as Medicare Advantage plans are introducing more creative and innovative benefits to differentiate themselves. You might find lesser-known Medicare Advantage perks like quarterly allowances for rent, utilities, groceries, over-the-counter items like pain relievers, or even transportation to medical appointments and gym memberships for wellness programs. Meanwhile, Medicare Supplement plans, such as G or N, often include a valuable international travel benefit for emergency care abroad, which can be crucial if you’re overseas and need treatment unexpectedly.I've had a change in my health condition. How does this affect my current Medicare plan, and should I reconsider my coverage?
on Medicare Advantage Plans there is NO underwriting, so regardless of the health of someone, everyone can get a Medicare Advantage Plan is long is their Part A & B are in effect. Medicare Supplements require medical under writing and based on results could require much higher monthly premiums
I've heard about IRMAA affecting my Medicare premiums. How can I find out if it applies to me, and how does it work?
IRMAA (Income-Related Monthly Adjustment Amount) affects Medicare Part B and D premiums for those with higher incomes, and it's determined by the Social Security Administration based on your income from two years prior. You'll receive an "Initial Determination" if IRMAA applies to you.
How can I select the right healthcare company and representative to work with?
A good representative Will usually be very easy to spot ( Medicare agents hub ). If you End up finding someone that you trust then the carrier that you go with becomes Not as important. I have several clients and I can speak from experience in saying that putting them all on the same“good” plan Is not the right thing to do. Every individual is different, And a good representative should match up your needs with a plan that’s best for you.
How can I avoid or reduce IRMAA charges on my Medicare premiums?
The fact is IRMAA charges are calculated based on your AGI (Adjusted Gross Income) from 2 years ago. Know this may give you and your tax accountant time to do some financial planning that will help you pay less IRMAA charges when the time comes. You can do a Google search to see the levels of additional IRMAA charges that will be added to your base Medicare premium.I'm an independent agent and am compensated for my services by the insurance companies. I never charge you additional fees for my services. I'm asked this question (IRMAA charges) quite often by higher income earners. You can contact me at 801-550-1800 to answer questions that will help you better understand what to expect.
Can I use a health savings account (HSA) to pay Medicare premiums after I retire?
Yes, absolutely. In addition to paying Medicare Part B, Part D, and Medicare Advantage (Part C) premiums, you can also use your HSA funds tax-free to cover out-of-pocket costs like copays, coinsurance, and deductibles for those plans. That includes copays at the pharmacy under Part D or doctor visit copays under a Medicare Advantage plan. HSA funds can also be used for dental, vision, and hearing expenses—even if Medicare doesn't cover them. Just remember, once you're enrolled in any part of Medicare, you can no longer contribute to your HSA, but you can continue to spend what you've already saved. It's a great preplanning tool for managing healthcare costs in retirement with tax advantages.
What’s the financial risk of sticking with Original Medicare without a Medigap plan?
I have a client who if she had went with her first choice of a Medigap plan her annual cost would be around $2,400. She decided to take a less expensive route and enrolled in a Medicare Advantage plan. She was diagnosed with a health issue requiring a doctor to administer shots in her eye every quarter for the remainder of her life. This cost is reaching her out of pocket maximum of $5,500 which is more than twice the annual cost of her supplement. In this particular case it would have been more cost effective for her to have been on the Medigap plan costing her $2,400 per year.How do I know if a Medigap policy is right for me, and what's the best time to buy one?
This question cannot be answered without knowing all your circumstances, but there are just as many different answers to this question as there are agents in the field, as to why you should or should not. Again, a trustworthy agent can explain this in detail.
If Medicare Supplement (Medigap) plans are better for long-term coverage, why don’t more people choose them?
Advertising often misleads people to assume they know things they don't. The privatized companies that offer MA plans televise 9500 commercials per day! Have you seen many, if any, commercials regarding supplement plans? So many people don't have the information about them and the difference they make. In today's world, many seniors fear that they will be "Taken for a ride", so trusting a company or an agent is difficult.MA companies make it seem so easy! They lay out the positives, but don't show what is missing from the policies, such as the choice of practitioners, specialists, or travel benefits. It doesn't show that the highest quality choices very often do not accept the MA product. It doesn't show what Out-of-Pocket costs are if you do not choose a Network Provider. It doesn't clarify that in giving your Original Medicare back for the MA plan that you lose coverage for your Durable Medical Equipment needs. Those plans need to be changed every year, and the policy you have today may not be in place next year, or your Doctor may not even participate in that plan any longer. You rarely have that issue with Medigap plans.
And we cannot leave out that the premiums for the Medigap plans may be out of reach for some. Unfortunately, some find out too late that they chose "Easy" instead of "Thorough", and what they saved in premiums cost them hugely later on when they needed more quality coverage.
Why did I receive a Medicare Summary Notice, and what should I do with it?
The notice is used to Notify beneficiaries of decisions on a claim made for Medicare.I would open it and see what claim they are talking about. If you have questions I would call them.
I've heard about Medicare fraud. What steps can I take to protect myself from scams related to Medicare?
Never give out your Medicare # to anyone over the phone unless it's your doctors office or agent during Annual Enrollment 10/15-12/7 as long as you are requesting a update/change of insurance.
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.
Building trust starts at the first call. Let the Broker know your concerns then sit back and listen. The Broker should share their background…show their License when requested…offer references if necessary. The “rede flags” are failing to produce their License, failure to explain how the process works to obtain Medicare and then ask the appropriate questions of the client.A key “red flag” is if the Broker only works with one or two Insurance Carriers…the key to getting the best Plan for yourself is to work with a Broker Licensed and Certified by all of the Major Carriers in your area so you are not pushed into a Plan not right for you. And a Broker should never ask for or accept any fee for helping you as the Carriers will pay his or her fee.
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?
Her friends may endanger your mother. Medicare Advantage may have authorizations, Dr networks, service areas, referrals, Etc. It's easy for any Medicare broker to check her current doctors and see if they are in network for various Medicare Advantage plans.
How do you approach educating clients who are new to Medicare versus those who are considering switching plans?
If not sure you have the best plan, I would verify the current plan vs some new options. I would explain that some plans may not have wide network, while other plan may better cover your needs. Should you keep it is your decision.
What’s the cheapest way to get Medicare coverage if I only need basic hospital care?
I would never advise someone to ONLY enroll in Part A (Hospital)If you skip Part B (outpatient care) to avoid its monthly premium - here’s the catch: if you delay Part B and later decide you need it, YOU'LL FACE A LATE ENROLLMENT PENALTY —10% added to the premium for each year you could’ve enrolled but didn’t—unless you have other creditable coverage (like an employer plan). Also, Part A alone won’t cover doctor visits, labs, or outpatient procedures, so if “basic hospital care” might stretch beyond inpatient stays, you’d be paying those extras fully out-of-pocket. For pure cost minimization with a hospital-only focus, Part A solo is your leanest option—just be sure your needs won’t creep into Part B territory later.
How can I make sure I'm not overpaying for my Medicare plan, and are there any tools or resources you recommend?
I would strongly recommend that you speak with a licensed, independent Medicare agent with access to all of the major plans in your zip code. An experienced Medicare agent will easily be able to help you and there should be no cost or obligation.How do I appeal a decision by Medicare or my plan if they deny coverage for a procedure or medication I need?
Under traditional Medicare, you will appeal directly to Medicare, and Medicare supplemental/Medigap coverage must follow Medicare's lead in paying your coverage cost. With Medicare Advantage, you will deal directly with the insurance companies that write those plans.
How do Medicare Savings Programs help with Medicare costs?
Medicare Savings Programs (MSP) can help people with limited income cover their Medicare premiums, deductibles and other costs like co-insurance. This is also known as a Medicare Buy-In program.Eligibility can be vary by state. Extra help with Medicare Part D drug costs can by applied for simultaneously with the MSP. Income and resources can also vary by state, however most states use income and resource limits based on the Federal Poverty Level (FPL).
Types of MSPs include:
Qualified Medicare Beneficiary (QMB) which helps pay for Part A and B premiums, and covers cost- sharing for Medicare-covered services.
Specified Low-Income Medicare Beneficiary (SLMB) which helps pay for Part B premiums.
Qualified Individual (QI) which helps pay for Part B premiums.
Qualified Disabled Working Individual (QDWI) which helps part Part A premiums for individuals under age 65 who a disabled and have returned to work recently.
You can apply through your State Medical Assistance office (Medicaid).
Every year I stress over picking a plan and still end up surprised by the bills. Is there any way to just get peace of mind with Medicare?
Change from medicare advantage to Medigap. You will pay a monthly premium but never get a bill. You can keep the plan forever and have peace of mind knowing your exact cost upfront
I went to a free Medicare seminar and it felt like a timeshare pitch. Are any of those events actually helpful?
Only if you want a free piece of pie. If you want detailed answers on Medicare it's best to talk to a broker that represents a number of different companies. If you have any questions please call me at 239-848-8893.
My husband passed away and now my Medicare premiums went up. Why does losing someone raise your costs?
It is possible you lost a spouse discount if you had a Medicare Supplement plan.
What advice would you give to seniors who are feeling overwhelmed by all the Medicare options available?
Medicare can be very complex and confusing, you can be new to Medicare and feel overwhelmed by all the terms, but even people on Medicare for years can still find themselves overwhelmed when looking at switching plans. This is why it is so important to work with a local Medicare agent or broker that is licensed and able to explain plan benefits and copays. Having a Medicare broker or agent should never cost you anything to be their client. If you decide to switch or enroll with one you may contact them with any questions you have on your plan, instead of calling a carrier yourself. ALLOW ONE INITIAL APPOINTMENT with an agent before contacting them with questions or concerns.
Is it better to get Medicare Part D or Medicare Advantage?
There really isn't a perfect answer to this question. It is based on what each person's needs and the how they want to be covered. The best choice really is an individual choice and how they look at their insurance needs and money they want to have to spend monthly on their insurance.More often Part D plans will have a higher Deductible and copay costs over a Medicare Advantage, so looking at each person's medications is a must when deciding on these plans.
My friend lives in a different city and has a much more detailed Medicare plan. Is their location dependent on their plan?
Yes. You must enroll in a plan available in the service area that matches your legal address. My friends and family members give advice to and mention specific plan benefits. Plan specifics differ across the country. If there is a benefit that you are interested in, please ask. If you don't mention something, your advisor may never know that it was important to you. We ask as many questions as we can to start a conversation, to determine what is most important for each potential client.How does getting married late in life affect my Medicare coverage or costs?
Getting married later in life may affect your Medicare coverage and costs in a variety of ways. If you file a joint tax return with your spouse, higher income may affect your Medicare part B and part D premiums. Medicare charges beneficiaries more in part B and part D premiums if they are in higher income brackets. Marriage may also affect your assets which may affect your ability to get some sort of aid such as extra help and or Medicaid. I recommend speaking to a Medicare expert and a financial advisor as to your specific situation.What should I do with my Medicare plan if I’m diagnosed with a rare disease requiring specialists?
Great question.if that rare disease is going to lead to expensive complications down the road, it may be a good idea to look into a supplement plan like a “G” or “N”. The tough part would be passing underwriting since you’ve recently been diagnosed. If you’re unable to pass underwriting Then you may just try to get familiar with your advantage plan costs and if possible, get familiar with all of your lesser expensive “in-network” options. It may be a good idea to utilize your broker or contact the Member Services number for your insurance and get a list of providers in your area.
What should I look for in a Medicare plan if I travel frequently both domestically and internationally?
If you travel within the US - reviewing plan choices that offer a Nationwide network is key.If you travel internationally - Travel insurance is available based on your dates of travel.
Review with a local Medicare Broker, contact me for specific questions.
What’s the biggest mistake seniors make when choosing a Medicare Part D plan?
Hello ,On the Part D, (Prescription drug coverage).
I get a list of your prescriptions you are currently taking, then I go to the Medicare.gov
I check what plans cover the drugs and the pharmacies at the lowest cost, so you can get the best prices and control the budget for your cost for the year!
It is best to check all your cost at the pharmacy you use, (it might be costing you a lot, or it might be the best, the Medicare.gov site lets you know, call me, I can help!
Thx!
What’s the most cost-effective way for a healthy 65-year-old to structure their Medicare coverage?
It all depends on your situation and needs. Most senior beneficiaries save money by enrolling in a Medicare Advantage Plan in their area but that may or may not be what is best for them specifically.What’s the most frustrating misconception you have to clear up with clients about Medicare every year?
First, It’s essential to clearly understand the differences between Traditional Medicare with a Medigap plan vs Medicare Advantage.Second item is the mistakenly think that starting with a low-cost plan is the best option; however, this isn’t always the case with insurance companies under the Medigap program. After the first four to five years, premiums can increase significantly, making it difficult for those with health issues to switch to a more affordable plan. Often, individuals are left at point in life with no choice but to transition to an Advantage plan a more affordable monthly rate and giving up their freedom of choice. Being informed about these options can lead to better long-term decisions regarding healthcare coverage.