Medicare Questions & Answers: Advice for Seniors
Advice for Seniors Q&A
Showing 295 questions
What are the reasons why I should work with a Medicare agent?
I'll give you a slightly different answer than most, because after 22 years I think the standard list — "it's free, we compare plans, we help with enrollment" — is all true but misses the real point.Here it is: an agent's value isn't enrollment week. It's knowing what actually happens when you use the plan where you live.
I work in rural Utah and western Colorado. Out here, two plans can look identical on paper — same premium, same deductible — and one of them quietly assumes your cardiologist is in Salt Lake City, four hours away, while the other covers the specialist you can actually get to. The Plan Finder on medicare.gov won't tell you that. A TV ad definitely won't. Someone who has enrolled a thousand of your neighbors, and then answered the phone when their claims got denied and their doctors left networks, knows which plans hold up in your ZIP code and which ones only look good in the brochure. That's the actual product you're getting when you work with a local agent — the scar tissue.
And some honesty, since you asked for reasons: if you take no medications, love your plan, and nothing in your life changed this year, you may not need an agent this year. Where people get hurt is at the transitions — turning 65 while still working, retiring and leaving employer coverage, moving counties, a new diagnosis, a Medigap rate increase. Those are the moments a wrong move costs real money for years, sometimes with penalties that never go away. That's when having someone who does this every day, at no cost to you, stops being a convenience and starts being protection.
One tip whoever you choose: ask them how many carriers they represent, and ask them to name a plan they wouldn't put you in and why. The answer tells you whether you've found an advisor or a salesperson.
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.
My kids keep telling me to get a Medicare Advantage plan, but my friends say stick with Original Medicare. Who should I listen to?
Your kids and your friends are both right. They're just describing two different plans built for two different kinds of healthcare users, and neither one is universally better.
Your kids have probably read that Medicare Advantage plans often come with a low or $0 premium and extras like dental, vision, and hearing coverage bundled in, which preserves their inheritance. Your friends, on the other hand, are telling you what they value about Original Medicare plus a supplement. You can see any doctor in the country who takes Medicare, you're not locked into a network, and your costs stay predictable no matter what happens with your health.
Both groups are giving you real information. They're just weighing the tradeoffs differently. The right questions are: how do I use healthcare, and what am I actually trying to protect against?
If you're generally healthy, don't mind staying in network, and want lower monthly costs with built-in extras, a Medicare Advantage plan fits the way your kids expect. If you travel often, have ongoing health conditions, or you'd rather pay a bit more every month to never worry about a surprise bill, Original Medicare with a supplement is the better fit.
The honest answer is that it depends entirely on your situation, not on which group of people loves you more. And that's exactly the kind of comparison that I, or any good Medicare agent, will walk you through plan by plan before you have to make a decision either way.
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.
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 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.
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.
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 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.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.
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.
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.
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’.
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 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.
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 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.
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
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.
How do discount cards and resources affect my Medicare Prescription Drug plan?
discount cards and your Part D plan don't work together — they're an either/or choice for each prescription fill.How they interact:
You can't stack them. If you use GoodRx, SingleCare, RxSaver, or a similar card, you're paying a cash price outside your insurance entirely. Medicare never sees that transaction.
Discount card purchases don't count toward your Part D deductible or your $2,100 annual out-of-pocket cap in 2026. This is the big one. Every dollar you spend through your Part D plan moves you closer to hitting that cap — after which your plan covers 100% of costs on covered drugs for the rest of the year. Money spent on a discount card does nothing toward that progress.
Manufacturer copay cards work similarly — they're generally usable only if you pay cash and don't run the claim through Part D. Separately, income-qualifying Patient Assistance Programs (PAPs) are different and can sometimes be used alongside Medicare.
When a discount card might still make sense:
A cheap generic where your plan's copay is actually higher than the discount card price
A drug your plan doesn't cover at all
Early in the year, if you're nowhere near your deductible and a specific fill is genuinely cheaper for cash
When you're usually better off using Part D instead:
Expensive brand-name drugs, since running them through insurance gets you to that $2,100 cap faster
Any time you're already partway toward your deductible or cap for the year — using a discount card resets the "progress" on that fill
One nuance worth knowing: some insurers have been reshuffling which drug tier certain medications fall into for 2026 as they adjust to the new cap, so a drug that used to be cheaper through GoodRx might now actually be cheaper through your plan (or vice versa). It's worth comparing at the pharmacy counter rather than assuming.
The practical rule of thumb: for anyone with real ongoing prescription costs, running things through Part D tends to pay off over the year because it builds
What do I do if I cannot afford my Medicare premiums?
Medicare Savings Programs (MSPs)These state-run programs can pay your Part A and/or Part B premiums, and in some cases also cover deductibles, coinsurance, and copayments. Asset limits in 2026 are $9,950 for individuals and $14,910 for couples — though several states don’t impose asset limits at all.
Extra Help (Part D Low-Income Subsidy)
Qualifying for an MSP automatically enrolls you in Extra Help, worth an estimated $5,700/year in drug cost savings — with copays capped at $5.10 for generics and $12.65 for brand-name drugs.
Key action steps:
• Apply through your state Medicaid office (even if you’re not sure you qualify — apply anyway)
• Call SHIP (State Health Insurance Assistance Program) for free, personalized guidance
• Use NCOA’s free BenefitsCheckUp tool at benefitscheckup website.
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.
My friend gets SilverSneakers with her plan and I don't-how are we both paying for Medicare and getting such different stuff?
You and your friend are either enrolled in different Medicare insurance carriers' plans or different coverage types, i.e., Original Medicare. Paying for Medicare does not mean you will have the same type of Medicare coverage.Your friend may likely have a Part C plan, known as Medicare Advantage. These are plans offered by private insurance carriers and must include all that is covered in Original Medicare, and often add extra wellness benefits, such as SilverSneakers, to attract members and give them access to gyms/fitness facilities in their area. These "extra wellness benefits" are not standard health benefits, but are "bundled" into the plan to help encourage their members to remain active and healthy.
If enrolled in Original Medicare Parts A and B, this is considered the basic Medicare coverage, and does not offer or help pay for gym/fitness programs like SilverSneakers or any other wellness or fitness perks. You can go to any doctor or hospital in the country that accepts Medicare, but Original Medicare only covers basic health care.
There are Medicare-approved Supplement insurance plans offered by private insurance companies, known as Medigap, only available to purchase alongside Original Medicare Parts A and B, and these have an additional premium due each month on top of the Part B premium. These Medigap plans offer additional coverage to help pay deductibles, copays and coinsurance amounts, and there is also the possibility of specific private insurance companies bundling extra non-standard perks into their own unique policies. However, again there is a premium for all the extra benefits.
Check which plans in your area offer these fitness memberships and enroll during the Annual Enrollment Period (AEP) between October 15 - December 7.
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.
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.
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.
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.
The fact that you framed it as "advised, not sold to" tells me you'll do fine. Here's what I'd watch for.Watch the order of the conversation. A genuine advisor spends the first meeting learning: your doctors, your prescriptions, your health, what you can afford, how you like to use care. A salesperson spends it presenting. If a plan gets named in the first ten minutes, the conversation is backwards.
Watch how they handle both paths. There are two main ways to structure Medicare coverage, and honest agents will explain the real trade-offs of each, including the trade-offs of whatever they think fits you. If one option gets all the airtime and the other gets a dismissive wave, you're seeing their commission preferences, not your choices.
Watch how they handle money questions. Ask directly: "How do you get paid?" The right answer comes without hesitation: carriers pay us commissions, and you pay the same premium with or without an agent. Squirming at that question is disqualifying.
Watch for manufactured urgency. Medicare deadlines are set by the federal government and they're public. "You need to sign today" is never true. An advisor tells you your real deadlines and then lets you think.
Watch what they promise. If a plan sounds like all upside, free everything, no downsides mentioned, that's an ad, not advice. Real guidance always includes the words "here's the catch."
Watch their answer to one simple test question: "What do you do for me in year two?" Advisors talk about annual reviews, billing help, and being a phone call away. Salespeople change the subject.
Last thing: protect your Medicare number like a credit card. No one needs it for a get-to-know-you conversation.
Bring this list to every agent you meet, including me. A good one will be glad you did.
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?
Given how much medications can cost, there are several programs worth applying to — and it's worth applying to more than one, since some stack together. Here's where I'd start:1. Extra Help (Low-Income Subsidy / LIS) — apply first
This is the big one for Part D specifically.
The income limit is 150% of the Federal Poverty Level, which works out to roughly $1,995/month for a single person and $2,705/month for a couple in 2026 (numbers vary slightly by source, so treat this as a ballpark).
If you qualify, your Part D premium and deductible are covered, and copays are capped at around $5.10 for generics and $12.65 for brand-name drugs, with $0 owed once you hit the $2,100 yearly out-of-pocket cap.
Brevy Care
If you're already enrolled in a Medicare Savings Program like QMB, SLMB, or QI, you automatically qualify for Extra Help and don't need to apply separately.
Medicare FAQ
How to apply: online at ssa.gov/extrahelp, by calling Social Security, or at your local Social Security or Medicaid office. There's no cost to apply and no penalty for applying even if you're not sure you qualify.
Medicare FAQ
2. Medicare Savings Programs (MSPs)
These help with Part A/B premiums and cost-sharing, and as noted above, qualifying for one often triggers automatic Extra Help eligibility too. Apply through your state Medicaid office.
3. State Pharmaceutical Assistance Program (SPAP)
Many states run their own drug assistance programs in addition to Extra Help. Availability and rules vary a lot by state, so it's worth checking your state's Medicaid or aging services website.
4. Manufacturer Patient Assistance Programs (PAPs)
If you're on an expensive brand-name drug, the manufacturer often has a free or discounted supply program. Ask your pharmacist, or search which compile these by drug name.
5. Nonprofit copay assistance foundations
Organizations like the Patient Access Network
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.
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.
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.
Why do some clients ignore your advice and end up in bad Medicare plans-what makes them resistant?
Usually, it is not because someone is being difficult. Medicare decisions can bring out a lot of fear, confusion, and resistance to change.A plan may look good on the surface because it has a $0 premium, dental benefits, a grocery allowance, or some other extra benefit. Those things are easy to understand. Doctor networks, prior authorization, prescription formularies, hospital costs, and out-of-pocket exposure are harder to see until someone actually needs care.
Some people also:
Focus almost entirely on the monthly premium
Assume they are healthy now, so medical costs will stay low
Follow what a friend, neighbor, or family member chose
Get overwhelmed by too many choices and pick the simplest-looking option
Trust a television ad or phone call that highlights benefits but not limitations
Stay with a familiar company because changing feels risky
Believe they can simply switch later if the plan does not work out
That last one can be especially important. Medicare has specific enrollment periods, and changing from Medicare Advantage back to Original Medicare does not always mean someone can automatically get the Medicare Supplement they want without medical underwriting.
This is why a good Medicare conversation should not be about telling someone, “Here is the best plan.”
A licensed Medicare agent should first understand the person’s doctors, hospitals, prescriptions, travel, budget, health concerns, and how they expect to use their coverage. Then the client can see the tradeoffs and make the decision for themselves.
Sometimes people still choose differently. The goal is to make sure they understand what they are gaining, what they are giving up, and what could happen if their health changes later.
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 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.
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.
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.
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.
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)
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.
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 an income-related adjustment that can increase your Medicare Part B and Part D costs if your income is above certain limits.For 2026, Social Security generally looks at your 2024 tax return. If your modified adjusted gross income (MAGI) was above $109,000 for an individual or $218,000 for a married couple filing jointly, you may pay an additional amount on top of your regular Medicare Part B premium and/or your Part D plan premium. The amount increases on a sliding scale as income increases. (Social Security Administration)
Social Security will normally send you a notice if IRMAA applies to you. If your income has dropped because of a qualifying life-changing event—such as retirement, loss of income, divorce, or the death of a spouse—you may be able to request that Social Security reconsider or reduce your IRMAA. (Medicare)
The best way to find out if IRMAA applies to you is to review your Social Security IRMAA notice and compare your income with the current thresholds. If you have questions, you can also contact Social Security or speak with a qualified Medicare professional who can help explain how IRMAA may affect your overall Medicare costs.
Income limits and premiums can change annually, so always verify the current figures for the year in question
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 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.
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.
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.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.
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!
I've heard about Medicare fraud. What steps can I take to protect myself from scams related to Medicare?
Medicare fraud and scams are real, but you can protect yourself with a few simple habits:1. Never give out your Medicare number, Social Security number, or bank information to anyone who calls, emails, or shows up uninvited.
2. Medicare will never call you out of the blue asking for personal or financial information, or pressure you to enroll in a plan.
3. Hang up immediately on suspicious calls. If you’re unsure, call 1-800-MEDICARE yourself using the number on your Medicare card.
4. Be cautious of anyone offering “free” medical equipment, genetic tests, or gifts in exchange for your Medicare number.
5. Only discuss Medicare plans with licensed agents you trust, and always ask to see their identification.
If something feels off, trust your instincts and hang up or walk away. You can also report suspected fraud to 1-800-MEDICARE or your local Senior Medicare Patrol.
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.
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 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.
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.
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.
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'm interested in nutrition counseling to help manage my diabetes. Will Medicare cover this as preventive care?
Yes. Original Medicare (Part B) covers Medical Nutrition Therapy (MNT) and diabetes self‑management services provided by a qualified nutrition professional when ordered by your treating physician or qualified practitioner.Key points:
Covered services: MNT for diabetes (and kidney disease) and Diabetes Self‑Management Training (DSMT) when delivered by Medicare‑approved providers (typically a registered dietitian/nutritionist or other qualified clinician).
Time limits: Medicare generally pays for up to 3 hours of MNT the first year and up to 2 hours each subsequent year. Additional hours may be covered if your condition changes.
Cost sharing: Part B typically pays 80% of the Medicare‑approved amount after you meet the Part B deductible; you’re responsible for the remaining 20% and any applicable plan copay unless the provider accepts assignment or you have supplemental coverage (Medigap) or Medicare Advantage that covers more.
How to get it: Ask your physician to order/refer you for MNT/DSMT, then confirm the dietitian/RDN accepts Medicare (or is in your Medicare Advantage network) before scheduling.
Medicare Advantage: Plans may offer broader or different coverage—check your plan for specifics and prior‑authorization rules.
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'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.
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.
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.
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.
I'm planning a long trip overseas. What happens if I need medical care while I'm away from the US?
By Janix BarbosaIt depends on the type of Medicare coverage you have.
Original Medicare (Part A & Part B): In most cases, Original Medicare does not cover health care received outside the United States, except in a few limited situations.
Medicare Supplement (Medigap): Some Medigap plans include a Foreign Travel Emergency benefit. If available, it generally helps pay a portion of covered emergency medical expenses outside the U.S., subject to the plan's deductible, coinsurance, and lifetime maximum. Coverage varies by plan.
Medicare Advantage (Part C): Some Medicare Advantage plans cover emergency or urgently needed care worldwide, while others may provide limited or no coverage outside the U.S. Benefits vary by plan.
Because international coverage is often limited, many travelers choose to purchase a separate international travel medical insurance policy to help protect against unexpected medical expenses while abroad.
Disclaimer: This information is for educational purposes only and is not a guarantee of coverage. Benefits, exclusions, and limitations vary by plan. Review your plan documents or contact your insurance carrier before traveling.
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.
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.
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.
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.
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.
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!
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.
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 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
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.
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.
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.
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.
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
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Why did I receive a Medicare Summary Notice, and what should I do with it?
A Medicare Summary Notice (MSN) is a statement showing all services billed to Original Medicare. You receive it to track claims, understand your costs, and protect against fraud. It is not a bill. You can also access your notices by logging into your Medicare.gov account.Take the following steps when you receive your notice:
1. Wait for a bill: Hold onto the MSN and compare it with the actual bill you receive from your doctor or hospital. Only pay the provider after receiving their invoice.
2. Review for accuracy: Verify that you received the services, tests, or supplies listed, and check that you recognize the doctor or facility.
3. Report errors or fraud: If you spot services you never received or suspect a billing error, call your provider's billing department immediately. If you suspect fraud, call Medicare at 1-800-MEDICARE.
4. Appeal denied claims: If Medicare denied a service and you think it should be covered, you can appeal. Instructions are on the back of the MSN.
My income fluctuates significantly year to year from investment distributions. How can I avoid IRMAA surcharges when I have an unusually high-income year?
You generally cannot retroactively erase IRMAA from a high investment-income year. Pure investment fluctuations (capital gains, distributions, dividends) do not qualify as life-changing events for Form SSA-44.Effective strategies (proactive only):
-Spread large gains/distributions over multiple years to stay under IRMAA cliffs.
-Tax-loss harvest to offset gains in high years.
-If 70½+, use Qualified Charitable Distributions (QCDs) from IRAs — up to ~$111k (2026). These satisfy RMDs but are excluded from MAGI.
-Do Roth conversions in lower-income years to reduce future RMDs (conversions themselves raise MAGI that year).
-Asset location: Keep high-income assets in tax-deferred accounts when possible. Note: municipal bond interest still counts in MAGI.
IRMAA uses a 2-year lookback (2026 premiums use 2024 MAGI). Once the high year is on your tax return, the surcharge is usually locked in. Project MAGI two years ahead and leave a buffer below thresholds. Work with a tax advisor familiar with both tax brackets and IRMAA cliffs.
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 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.
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.
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.
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.
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.
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.
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.
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.
What happens if my dad’s income changes? Can his Medicare plan or costs change too?
The short answer: income changes don't affect his coverage itself, but they can affect what he pays, in both directions.Here's how it works.
If his income goes up, his premiums can too. Medicare charges higher-income folks an extra amount on top of the standard premiums for Part B and drug coverage. Here's the part that catches people off guard: Medicare looks at his tax return from two years ago, not this year. So a spike in income, even a one-time event like selling a property or a large retirement account withdrawal, can show up as higher premiums two years later.
The good news is there's an appeal for life changes. If his income dropped because of something like retirement, the death of a spouse, or a reduction in work hours, he doesn't have to wait two years for Medicare to catch up. He can file a form with Social Security asking them to use his current, lower income instead. I've seen this save people a meaningful amount, and many folks have no idea it exists.
If his income goes down, help may open up. This is the part families miss most often. If his income is limited, two programs are worth checking. Extra Help lowers prescription drug costs significantly. Medicare Savings Programs, which run through the state, can help pay the Part B premium and sometimes more. Lots of people qualify for these and never apply, either because they don't know about them or because they assume they won't qualify. It costs nothing to check.
What income changes don't do: they don't kick him off his plan, don't change his benefits, and don't affect his eligibility for Medicare itself. Medicare isn't like some programs where earning too much gets you removed. His coverage stays. Only the price tag moves.
My suggestion: if your dad has had a real income change, up or down, that's worth a quick review. Checking whether he owes a premium surcharge he could appeal, or qualifies for help he isn't getting, is a short conversation. And it costs nothing to have it with me.
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.
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.
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.
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.
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.
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.
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."
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.
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?
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 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.
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.
Do most doctors accept Medicare Advantage plans?
It depends on the specific Medicare Advantage plan and the doctor.Unlike Original Medicare, which is accepted by most healthcare providers nationwide, Medicare Advantage plans generally use provider networks. That means a doctor may accept one Medicare Advantage plan but not another—even if both plans are offered by the same insurance company.
Before enrolling in a Medicare Advantage plan, it’s important to verify that your primary care physician, specialists, hospitals, and other preferred providers participate in the plan’s network. If you regularly see specialists or receive care from a particular health system, this step is especially important.
It’s also worth remembering that provider networks can change from year to year. Even if your doctor accepts your plan today, it’s a good idea to confirm participation during your Annual Enrollment Period or whenever you’re considering changing plans.
Choosing a Medicare plan involves much more than comparing premiums and extra benefits. Making sure your doctors, hospitals, prescriptions, and healthcare needs are all taken into account can help you avoid unexpected surprises. A personalized Medicare review can help ensure the plan you’re considering aligns with the providers and care that matter most to you.
I've been retired and on Medicare for 4 years. Why did my Part B premium increase by almost $100?
A $100 increase over 4 years almost certainly means IRMAA got triggered at some point (income crossed a threshold in a prior year’s tax return) or they moved into a higher bracket. Worth asking: any major income event in the last 2-3 years — home sale, RMDs starting, Roth conversion, pension lump sum? IRMAA uses a 2-year lookback, so a 2024 event would hit their 2026 premium.If it was a one-time event and income has normalized, Form SSA-44 (Medicare IRMAA reconsideration) can get it corrected.
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.
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?
Your parents have a few options once they cancel their Medicare Supplement (MediGap Policy) to cover the 20% Not Covered by Original Medicare.Option 1- Consider A Medicare Advantage Plan that will mitigate some of the higher costs/ risks associated with Original Medicare with their Max Out of Pocket (MOOP) design.
Option 2- Purchase a Hospital Indemnity and Cancer/Heart Attack/Stroke/Critical Illness Policy to cover the Gap with Original Medicare and avoid some of the higher cost shares (hospital admissions, ER Visits, Ambulance, etc..). Which is much cheaper than a Medicare Supplement plan and can be paired with Original Medicare and Medicare Advantage plans.
Option 3- If your parents live in state where High Deductible Plan G/ Innovative Plan G, are available, it could be a more cost effective way to reduce their monthly expenses of Medicare Supplement, without losing the coverage all together.
This is a point in their Medicare journey that it is best to speak with a licensed Medicare Agent that can help you and your family explore all options and develop a plan that is affordable, realistic, and protects your parents without compromising their access to care. I listed 3, very common options, but there are other options that are not listed that can be a consideration going forward. The good news, there are options and resources available to help your parents at this point in their Medicare Journey.
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.
I've heard Medicare Advantage plans have hidden costs. How do I know what I'm really getting?
There aren't necessarily "hidden" costs with Medicare Advantage, but there are definitely costs and plan rules that can be easy to overlook if you only look at the monthly premium.Before enrolling, I'd look at these areas:
1. Copays and coinsurance
Check what you'll pay for primary care, specialists, outpatient procedures, hospital stays, emergency care, and other services you use regularly.
2. The annual maximum out-of-pocket (MOOP)
This is one of the most important numbers to understand. It limits what you pay during the year for covered Medicare Part A and Part B services, subject to the plan's rules. A $0-premium plan can still have significant cost-sharing when you actually use healthcare.
3. Your doctors and hospitals
Make sure your preferred doctors and hospitals participate in the plan's network. Also check whether they are in-network for the specific plan, not simply whether they "accept Medicare."
4. Prior authorization and referral requirements
Some Medicare Advantage plans require prior authorization for certain services or referrals to see specialists. Understand these requirements before you need care.
5. Prescription drugs
If the plan includes Part D, check your actual medications against the plan's formulary. Look at the drug tier, quantity limits, prior authorization, and which pharmacies are preferred.
6. Supplemental benefits
Dental, vision, hearing, fitness, transportation, OTC allowances, etc. can be valuable—but don't assume a benefit is unlimited. Check the dollar limits, participating providers, frequency restrictions, and other conditions.
7. What happens if you travel
If you spend significant time outside your plan's service area, understand what emergency, urgent, and routine care will be covered and where.
The best way to compare plans is to look at the total picture, not just the premium.
Medicare Advantage can be an excellent fit for some people. The important thing is understanding the trade-offs before you enroll.
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.
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.
🎯
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.
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.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.
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.
Does Medicare offer life insurance, or is that a separate product I need to buy?
**Medicare does not provide life insurance.** Medicare is health insurance, not life insurance.### The difference is simple:
* **Medicare** helps pay for medical care, hospital services, doctor visits, prescriptions, and certain other healthcare expenses.
* **Life insurance** provides a death benefit to your beneficiaries when you die.
If you want life insurance, you generally need to **purchase a separate life insurance policy** from an insurance company.
### One important point for seniors
Being enrolled in Medicare **doesn't prevent you from buying life insurance**, but your age, health, and the type of policy can affect whether you qualify and how much you pay.
Common types include:
* **Term life insurance** — coverage for a specific period.
* **Whole life insurance** — permanent coverage that may build cash value.
* **Final expense/burial insurance** — typically a smaller policy intended to help with funeral and other final expenses.
Also, **Medicare Advantage and Medicare Supplement (Medigap) plans are not life insurance**. They are health insurance products that help with Medicare healthcare costs.
So the short answer is: **Life insurance is a separate product that you would purchase independently of Medicare.**
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.
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.
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 • 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.
How do I find a trustworthy Medicare agent in my area?
You can find local, licensed professionals using the Medicare Agents Hub or the Medicare Broker Directory to compare independent brokers in your community.The number of years experience is important. How long have they been in your area.
Where to Look for Local Help
• Online directories: Use trusted listings like Medicare Agents Hub by entering your ZIP code to see nearby licensed agents.
• Word of mouth: Ask friends, neighbors, or family members in your area for a personal recommendation.
• Official tools: Check the Medicare.gov Find Local Help tool for certified professionals in your region.
• Local storefronts: Look for dedicated regional offices like The Medicare Store if you live around Las Vegas or Henderson.
Green Flags of a Trustworthy Broker:
• Independent status: They represent multiple major insurance companies rather than pushing just one carrier.
• No fees: Their guidance and consultations are free to you because they are paid via standard commissions from insurance carriers.
• Educational focus: They take time to understand your specific doctors, prescriptions, and budget without high-pressure sales tactics.
• Year-round support: They offer ongoing assistance long after your initial enrollment period ends.
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.
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 get SilverSneakers with Original Medicare?
Original Medicare does not include a fitness benefit such as SilverSneakers.Medicare Supplement Plans or Medigap Plans are standardized by the government and do not include fitness benefits either as part of the standardized plans.
Fitness benefits like Silversneakers, Silver & Fit, Renew and One Pass to name some of the more common fitness benefits are often included in Part C or Medicare Advantage Plans. A Medicare beneficiary can identify which fitness benefit is included within the Medicare Advantage plan by reviewing the Evidence of Coverage or Summary of Benefits.
Some Medicare Supplement insurance carriers may offer a fitness benefit as an extra perk. However, this perk can vary from State to State even with the same insurance carrier. It is not very common to find a fitness benefit with a Medicare Supplement or Medigap plan. Mainly, you will find this benefit with Medicare Advantage Plans.
What are the disadvantages of a Medicare Advantage plan?
One of the largest disadvantages compared to original medicare or a medigap plan is that Medicare advantage plans are always going to have a provider network. With an HMO Health Maintenance Organization), you MUST go to an in-network doctor or you will pay full price for the service. The copayments in HMO plans are typically lower than in PPOs, however, so there’s still some benefit to this structure.With a PPO (Preferred Provider Organization), you may be able to see out of network (OON) doctors, but at a higher price than an in-network doctor. For example, an in-network primary care doctor may have a $0 copay, but an out-of-network primary care doctor may have a $25 copay. Because OON providers may charge more, the other copays (hospitalization, outpatient surgery, etc) tend to be higher in a PPO, so the flexibility comes with a price. Also, an OON provider must agree to treat you. Unless it’s an emergency or urgent care situation, an OON provider doesn’t have to see you.
The trend in the MA industry is moving toward HMOs. For people coming off of employer plans, this may not be a big change because many group plans are HMOs as well.
When you consult with an agent, they will go through your providers, medications, and other details to see if either of these types of MA plans are a good fit for your situation.
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 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.
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.
Are Medicare Supplement plans worth the cost?
There is no single right answer; the best choice depends on the beneficiary’s health and financial situation. Medicare Supplement plans must be accepted by providers that take Medicare; about 95% nationwide. These plans are indemnity insurance, not managed healthcare plans like many employer plans. Premiums vary by ZIP codes, and they cover all medically necessary, Medicare-approved services. They do not include Part D prescription drug coverage, so a separate Part D plan is required. They also typically exclude supplement benefits such as dental, vision, and hearing, though some carriers offer these benefits as add-ons. Premiums generally increase over time and may become cost-prohibitive for some beneficiaries.Medicare Supplement plans are labeled by letters. Plan G is currently the most popular and typically the most expensive. It covers all Medicare benefits except the annual Part B deductible, which is $283 in 2026. A high-deductible Plan G is also available with a lower premium; the 2026 deductible is $2,950.
In my opinion, it may not be worth it for a healthy beneficiary with a strong family history of good health. I would present the Medicare Supplement plans and available alternatives so the beneficiary can make an informed decision.
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.
Do I need to carry my Medicare card if I have a Medicare Advantage plan?
Short answer: no, day to day, your Medicare Advantage plan card is the one that belongs in your wallet.When you have an Advantage plan, that plan handles your coverage, so doctors, hospitals, and pharmacies need your plan's card, not the red, white, and blue one. Show up with only your Medicare card and the front desk will ask for the other one anyway.
So what do you do with the original Medicare card? Keep it somewhere safe at home, but don't throw it away. You'll want it if you ever change how you get your coverage down the road, and there are a couple of specific situations, like hospice care or certain clinical trials, where Original Medicare steps in even for Advantage members.
Two quick safety tips while we're on the subject. Your Medicare number is valuable to scammers, so treat that card like a credit card: don't carry it unless you need it, and never give the number to anyone who calls you out of the blue. Medicare doesn't cold-call people asking for it. And if you ever lose either card, replacements are easy: your plan can reissue its card, and your Medicare card can be reprinted through your Social Security or Medicare account online.
One last tip from experience: take a photo of both cards and keep it on your phone or with a trusted family member. When you're at an appointment and a card's gone missing, that photo saves the day more often than you'd think.
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
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.
Does Medicare cover hip replacement surgery?
Yes, Medicare generally covers hip replacement surgery when it is medically necessary and performed by Medicare-approved providers. Part A may cover an inpatient procedure, while Part B may cover outpatient surgery, doctor services, and medically necessary physical therapy.Your costs depend on whether the surgery is inpatient or outpatient, your specific coverage, and whether you have Original Medicare, Medicare Advantage, or supplemental insurance. It’s important to confirm coverage and expected costs with your doctor, hospital, and health plan before surgery.
Can I work full-time while on Medicare?
Yes, you may continue to work full or part time while on Medicare. I recommend that you meet with your personnel or Human Relations representative to discuss the cost benefits or limitations on your group coverage compared to Medicare options before making the decision to switch to Medicare. In most cases, once you switch you may not go back to your group plan.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.
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.
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 checkI'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.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.
🎯
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 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.
Does Medicare pay for eyeglasses?
Original Medicare generally does not pay for routine eyeglasses or contact lenses. However, Medicare Part B covers one pair of standard eyeglasses or contact lenses after cataract surgery in which an intraocular lens is implanted, subject to Medicare's coverage rules and cost-sharing. Many Medicare Advantage plans offer additional routine vision benefits that may include an allowance for glasses or contacts. If eyewear benefits are important to you, check your specific plan to see what's covered and which providers you can use.A DC says my late husband owed over $5,000 for 2017–2024 bills, but Medicare payments are not shown. Is this allowed, and who can review the bills?
To your first question: no, this isn't how it's supposed to work. If your husband had Medicare during those years, his providers were generally required to bill Medicare first, and there are time limits on how long a provider has to submit those claims — typically about a year from the date of service. Bills from 2017 that were never run through Medicare raise real questions, and in many cases, when a provider fails to bill Medicare on time, they're not allowed to just pass the full charge on to the patient instead.Here's what I'd do, step by step:
Don't pay anything yet, and don't agree to a payment plan. Agreeing can complicate your options later.
Send the collector a written request to validate the debt: an itemized breakdown of every charge, with dates of service, the provider's name, and proof of what was and wasn't billed to insurance. They're required to respond to this, and it's your right to ask.
Pull his Medicare records. You can call 1-800-MEDICARE and ask about claims history for those years. His Medicare Summary Notices show what was billed, what Medicare paid, and what he actually owed. Compare that against the collector's list.
Get free expert help reviewing everything. Every state has a SHIP (State Health Insurance Assistance Program) with trained counselors who help with exactly this: reviewing bills against Medicare records at no charge. Here in Texas it's called HICAP. And if anything looks fraudulent, like charges for services he never received, the Senior Medicare Patrol investigates that.
One more thing: rules about whether a surviving spouse owes a late spouse's medical debt vary by situation and state, and that's a question worth asking an attorney before assuming this debt is yours. Many legal aid organizations help seniors with this for free.
Don't let a collection letter scare you into paying $5,000 that may never have been properly billed. Get the records, get the free help, and make them prove it.
Do capital gains from selling my home affect my Medicare premiums?
Yes, selling your home can affect your Medicare premiums, but only if the sale produces a taxable capital gain that increases your Modified Adjusted Gross Income, or MAGI, above the applicable IRMAA threshold.For Medicare IRMAA purposes, MAGI generally equals your adjusted gross income plus tax-exempt interest. Therefore, the portion of a home-sale gain that is included in your adjusted gross income can affect your Medicare Part B and Part D premiums. A gain that is excluded from federal taxable income generally does not increase your MAGI.
The two-year lookback: Social Security generally uses tax-return information from two years before the Medicare premium year. For example, a taxable gain reported on your 2026 federal income-tax return could affect your Medicare premiums in 2028.
The primary-residence exclusion: The IRS generally allows qualifying homeowners to exclude up to $250,000 of gain from the sale of a primary residence, or up to $500,000 for a married couple filing jointly. To qualify, the ownership and residence requirements generally must be satisfied for at least two of the five years preceding the sale. Additional eligibility rules and exceptions may apply.
You should speak with a certified tax consultant.
Sources: IRS Publication 523, IRS Tax Topic 701, and SSA POMS HI 01101.010 and HI 01101.030.
Have a blessed day!
-Matt Maresch, NSSA®, CLTC®
Do Medicare and my UnitedHealthcare supplement cover monovision lenses with no out-of-pocket cost?
If you're referring to monovision during cataract surgery, it depends on exactly what your surgeon is recommending. Medicare Part B covers medically necessary cataract surgery and a standard conventional lens. However, any additional testing, premium lens features, or services used to correct near vision may not be covered.Your UnitedHealthcare Supplement may pay some or all of the remaining Medicare-approved costs, depending on your specific plan and whether you've met the Part B deductible. It generally won't cover charges that Medicare considers noncovered.
Before the surgery, ask the surgeon for the exactly lens name and a written breakdown of covered and noncovered charges. You can also have a local independent Medicare broker review your Supplement benefits, but the surgeon and UnitedHealthcare should confirm the final billing details.
My husband passed away, and we had Medicare and health insurance through his employer. Medicare was primary. What happens to my coverage now?
I would first check with your husbands employer and find out your options if any. In most cases the cost to carry a spouse can be expensive so you may get your coverage terminated. If this is the case you will have a SEP for loss of employer coverage and you will be able to sign up for either a Medigap plan and add a PDP for drug coverage, you can also enroll in an MAPD (Medicare Advantage Prescription Drug Plan) or you can use Orginal Medicare and just add a PDP (Prescription Drug Plan). You generally will have 63 days to enroll after your coverage ends.
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.
My income is limited. Are there programs that can help pay my Medicare premiums?
Yes, there are various Federal & State programs that are available to help. The key is taking the time and effort to see if you qualify for any of the programs. The most common one on the Federal side is the Exta Help (Low-Income Subsidy), which you apply directly through S.S Administration. I know in PA, there is the Medicare Savings Program, in which you apply through the PA Dept. of Aging. PA also has PACE and PACE-NET, which is a state-funded prescription assistance program that helps lower out-of-pocket medication costs.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.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.
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
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 biggest coverage gap most people don't know about with a Medicare Advantage plan?
One of the biggest gaps I see people overlook with Medicare Advantage plans is their out-of-pocket responsibility when something serious happens, especially a hospital stay or a cancer diagnosis.Many plans may have daily hospital copays that can add up quickly, and certain cancer treatments and other Part B services may have coinsurance that can be as high as 20%. This is why I always encourage my clients to look beyond just the monthly premium and routine copays and understand what their costs could look like during a major health event.
Depending on the plan and the individual's needs, supplemental coverage such as hospital indemnity or cancer coverage may be worth considering to help protect against some of those unexpected out-of-pocket expenses.
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.
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'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.
I have a Humana Medicare Advantage plan in Illinois. How do I know if my plan will still be available next year?
By September 30 you would have received a letter from Humana, called an ANOC (Annual Notice of Change), about what changes that would be taking place with your coverage. You could also receive a letter by October 2 called a Plan Non-Renewal Notice. If your specific plan is not continuing into the next year, and you received an ANOC, it is possible that you're being transferred into a similar plan automatically. If you get the Plan Non-Renewal Notice, you will auto-revert to Original Medicare if no action is taken.If you do not remember receiving or accidentally threw out those letters, there are four ways to check if your plan is available for the next year. The Medicare Plan Finder will list non-renewed plans as "Not Available" on the website. The call center at 1-800-Medicare could look it up for you. Your Carrier's Member Portal will have all mandatory correspondence available for view online, including the ANOC or Plan Non-Renewal Notice. You can also call the customer service on your member ID card.
Why do people say Medicare Advantage plans are bad?
A lot of the negativity around Medicare Advantage comes from the fact that it isn’t the right fit for everyone—and, like anything in insurance, people tend to talk more about the bad experiences than the good ones.The biggest criticism is that Medicare Advantage plans have networks and managed-care rules. Depending on the plan, you may need to stay within a network of doctors and hospitals, get referrals, or have certain procedures approved through prior authorization. That can be frustrating, especially for someone with serious or complicated medical conditions who wants maximum flexibility in where they receive care.
On the other hand, Medicare Advantage can be an excellent fit for the right person. Many plans have low or $0 monthly premiums, set maximum out-of-pocket limits, and may include benefits like dental, vision, hearing, fitness, and prescription drug coverage.
Medicare Supplements give you much more freedom to see providers that accept Medicare nationwide and generally involve fewer managed-care restrictions, but you pay additional premiums for that flexibility and still need separate Part D coverage.
That’s why I don’t believe Medicare Advantage plans are “bad,” and I also don’t believe they’re right for everybody. My job is to look at your doctors, prescriptions, health needs, budget, and how much flexibility you want, then determine which route makes the most sense for you. There isn’t one Medicare option that is best for everyone.
How long should you keep Medicare statements?
This is one of those questions almost nobody asks until the drawer is full. Here is the simple system I teach my clients:Keep your Medicare Summary Notices for at least one year. These are the statements Medicare sends every three months showing what was billed, what Medicare paid, and what you may owe. Before you put one away, do one thing: compare it against the bills you actually received. If everything matches and your providers have been paid, that statement has done its job.
Keep anything tax related for at least three years. If you deduct medical expenses on your taxes, those statements become part of your tax records. Three years is the general rule; some accountants prefer up to seven. When in doubt, ask your tax preparer. In my office we do both, insurance and taxes, so my clients get one answer instead of two.
Keep statements longer if something has not been solved. An appeal, a billing dispute, a claim you have questions about, or treatment for an ongoing condition: hold those papers until the matter is fully closed, no matter how old they are.
When you let go of them, shred them. Medicare statements carry information identity thieves love. Never throw them in the trash whole. If you don't have a shredder, many banks and community centers hold free shredding days.
And one more thing that gives my clients peace of mind: Medicare keeps your claims history online at Medicare.gov, so even if a paper is gone, the record is not. If a statement ever confuses you, don't file it away worried. Call your agent. That's what we are for.
Does Medicare now require a doctor or PA evaluation for shoulder surgery, and what is the timeframe?
Here's the short version: if you have Original Medicare, there is no new rule requiring special approval before shoulder surgery. Starting in January 2026, Medicare did launch a pilot program in six states, including here in Texas, that requires prior approval for certain procedures. But shoulder surgery is not one of them. That list covers things like certain knee procedures, skin substitutes for wounds, and implanted nerve stimulators. So if your surgeon recommends shoulder surgery and you're on Original Medicare, this new program doesn't stand in your way.Now, if you have a Medicare Advantage plan, that's a different story, and it always has been. Most Advantage plans do require prior authorization for shoulder surgeries, and your surgeon's office handles that paperwork. The plan then has a set window to respond, generally about a week for a standard request and faster if your doctor says it's urgent. Your surgeon's office deals with this all the time, so ask them where your approval stands.
One more thing that might be behind your question: yes, your surgeon will evaluate you before any surgery, and you'll typically have a pre-operative exam shortly before the procedure. That's standard medical practice, not a new Medicare requirement.
If you're not sure which type of Medicare you have, or you want to understand how your coverage handles a surgery like this, that's exactly the kind of thing I help people sort through. No cost, no pressure, just answers.
Do both spouses need to submit Form CMS-L564 to prove coverage through one spouse’s employer?
No, both spouses do not always need to submit a CMS-L564. Each person who delayed Medicare Part B because of employer coverage must provide proof of that coverage when applying for their own Part B Special Enrollment Period. If both spouses are Medicare-eligible and covered through one spouse’s active employer, each spouse generally needs documentation showing they had qualifying coverage based on that employment. The employer completes the employment verification section of the CMS-L564 form, which is submitted with the Part B enrollment request.Does Medicare cover SilverSneakers gym memberships?
Original Medicare does not include SilverSneakers as a standard benefit. However, many Medicare Advantage plans and some Medicare Supplement plans include SilverSneakers or a similar fitness benefit, such as Renew Active or Silver&Fit. Availability depends on your specific insurance carrier and plan. An independent Medicare agent can help you compare plans that include gym membership benefits if staying active is important to you.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.
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.
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.
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.
I want to switch to a different Medicare Advantage plan, How do I do that?
You can switch Medicare Advantage plans, but first make sure you are in an enrollment period that allows a change.The most common times are:
October 15–December 7: You can switch to another Medicare Advantage plan for January 1.
January 1–March 31: If you are already enrolled in Medicare Advantage, you can make one change to another Medicare Advantage plan. The new plan generally starts the first of the following month.
Special Enrollment Period: Certain events such as moving, losing other coverage, gaining Medicaid or Extra Help, or other qualifying circumstances may let you change at another time.
Before switching, compare more than the premium or extra benefits. Check your doctors, specialists, hospitals, prescriptions, pharmacy, copays, coinsurance, and maximum out-of-pocket cost.
Once you have chosen the new plan, you can enroll through Medicare, the insurance company, or a licensed Medicare agent. You will need your Medicare number and Part A and Part B effective dates.
Do not cancel your current Medicare Advantage plan first. When you properly enroll in the new Medicare Advantage plan during an allowed enrollment period, your old coverage generally ends when the new coverage begins.
The goal is a clean switch: verify the new plan first, enroll in it, confirm the effective date, and then let the Medicare enrollment process replace the old plan.
Does the 20-employee rule count non-contractor employees who live and work outside the U.S.?
Yes. For Medicare’s 20-employee rule, employees who live and work outside the United States can count toward the employer’s total.CMS — the Centers for Medicare & Medicaid Services — specifically instructs employers to count employees worldwide when determining employer size for Medicare Secondary Payer rules. CMS even gives an example of a U.S. subsidiary with 12 employees and its Swedish parent company with 18,000 employees; for Medicare purposes, the employer count is 18,012.
Both full-time and part-time employees count. Independent contractors and self-employed individuals are not counted as employees for this test.
The employer generally meets the rule when it has 20 or more employees for each working day in at least 20 calendar weeks during the current or previous year. The 20 weeks do not have to be consecutive.
Why does this matter? If you are 65 or older and covered through current employment, an employer that meets the 20-employee test generally has its group health plan pay first, with Medicare paying second.
So if a company has only 10 or 15 U.S. employees but also has employees working overseas, do not assume it is a “small employer” for Medicare. The worldwide employee count needs to be checked.
I hear about special Medicare Advantage plans for Chronic Conditions. How do I qualify for the plans? What is the benefit of enrolling in a special needs plan?
These plans are called Chronic Condition Special Needs Plans, or C-SNPs. They are Medicare Advantage plans designed for people with certain serious or disabling health conditions.To qualify, you generally need to:
Have Medicare Parts A and B
Live in the plan’s service area
Have one of the chronic conditions that the particular plan is designed to serve
Have the diagnosis verified by your healthcare provider
Qualifying conditions can include things such as diabetes, chronic heart failure, certain cardiovascular or lung conditions, cancer, dementia, stroke, kidney failure requiring dialysis and several others. Not every C-SNP covers every condition. The plan has to specifically serve your diagnosis.
The advantage is that the plan is built around the needs of people with that condition. That can mean a provider network with doctors who commonly treat it, prescription coverage designed around medications those members frequently use, and more care coordination between doctors, specialists and the plan. All Special Needs Plans also include Part D prescription coverage.
There can also be an important enrollment advantage. If you develop or already have a qualifying condition and a C-SNP serving that condition is available where you live, Medicare provides a Special Enrollment Period that can allow you to join the plan outside the normal fall enrollment period.
But qualifying does not automatically mean the C-SNP is your best choice. I would still check your doctors, hospitals, prescriptions, copays and maximum out-of-pocket costs before enrolling.
The real benefit is not simply that the plan has “extra benefits.” It is that the medical coverage, drug coverage and care coordination are designed around the health condition you are actually managing.
Does the Medicare Prescription Payment Plan lower my drug costs?
No. It spreads eligible out-of-pocket Part D costs into monthly bills over the remaining calendar year; it does not reduce the total cost. Your health or drug plan administers the option. It can help with cash flow when costs arrive early, but you still owe the charges and must keep paying your plan premium separately.
What is the Part D out-of-pocket limit for 2026?
Hi there,For 2026, the Medicare Part D out‑of‑pocket limit is $2,100. Once you’ve spent that amount on covered prescriptions — including your deductible, copays, and coinsurance — your plan pays 100% of your covered medications for the rest of the year. Premiums don’t count toward that limit, but everything you pay out of pocket for covered drugs does.
Does fall Medicare Open Enrollment let me switch Medigap without health questions?
That Depends, and this one confuses people every fall.Fall enrollment (Oct 15–Dec 7) covers Advantage plans and drug plans. Medigap has its own rules.
For Medigap, you get window(s) with no health questions when:
1. the six months after you turn 65 and enroll in Part B.
2. the Medicare Advantage plan you are on is discontinued in your zip code.
Apart from that, switching Medigap in most states — including SC and NC means a health questionnaire.
Talk to an agent or your state's SHIP program before you change things, the wrong change is hard to undo.
What is the Annual Notice of Change, and why should I read it?
The Annual Notice of Change is a document specific to the plan that you have, either a Medicare Advantage plan or a stand-alone Part D prescription drug plan. The importance of this document is that it will notate changes in premiums, benefits, coverage levels, co-pays, co-insurance, or medication changes within the plan. It's important for you to review this so you're not surprised by unexpected costs or coverage levels that may have changed. This is a document that I encourage my clients to review, as well as having a review with me about their plan benefits and changes, to see if there is a more optimal plan for them for the next plan year. Some clients have not done this, specifically related to the Part D prescription drug plans. They did not do a review, did not pay attention to their Annual Notice of Change, and assumed that their plan would operate the same in the next plan year. That was not the case. Certain drugs were not covered, and others were not covered to what had been covered before, which led to very high costs for them, and they were not able to make a change until the following plan year. So, it's really up to you whether you pay attention to this notice or not. Just know that if you do not, you could have higher costs in the next plan year, and depending on the plan type you have, you may or may not be able to make the change.I live in the UK and visit the U.S. for one month a year. Will Medicare Part A cover me, and are there top-up travel policies for costs Part A doesn’t cover?
Part A will cover you, but only for part of what you might need while you're here.What Part A covers: If you're entitled to Part A, it works anywhere in the U.S. no matter where you live. It covers inpatient care when you're formally admitted to a hospital. You'd pay the Part A deductible ($1,736 per benefit period in 2026), plus daily coinsurance if the stay runs past 60 days. It generally doesn't cover care outside the U.S., so it won't help you in the UK.
What Part A doesn't cover:
- An ER visit where you aren't admitted
- Urgent care and doctor visits
- Doctors' bills during a hospital stay (those are billed separately)
- Ambulance rides and outpatient tests
- Prescriptions
Most of that falls under Part B, and in the U.S. even a short ER visit can easily cost thousands of dollars. If you don't have Part B, keep in mind that dropping it or signing up late can mean a lifelong late penalty. Weigh that before deciding.
Top-up options: The usual Medicare add-ons aren't available to you. Medigap, Medicare Advantage, and Part D all require you to live in the U.S., so you can't buy them while you're based in the UK.
Your best option is likely travel medical insurance bought in the UK that covers U.S. trips. When you shop for it:
- Tell the insurer you have Medicare Part A, and ask how they handle claims Medicare pays first.
- Make sure the medical limits are high. U.S. costs are steep, so many people look for cover in the millions.
- Check for pre-existing condition exclusions and any age limits.
- Confirm there's a 24/7 emergency assistance line and coverage for getting you home if needed.
Since this is a cross-border setup, talk to both a UK travel insurance broker and someone familiar with Medicare enrollment rules before you make any changes to Part B.
I’m retiring and losing my health insurance through work. When do I need to enroll in Medicare in Louisiana?
Employer with 20+ employees: You get an 8-month Special Enrollment Period starting the month after employment or coverage ends, whichever comes first. No late penalty during this window.Employer with fewer than 20 employees: Medicare is already primary at 65, so enroll right at 65 rather than waiting for retirement — the group plan likely won't cover much without Medicare in place.
Best timing: File for Part B a month or two before coverage ends, so Medicare starts the day after, with no gap. You'll need Form CMS-L564 (employer completes) plus CMS-40B, filed with Social Security.
Watch for: COBRA doesn't count as coverage that delays Medicare — enrolling in COBRA instead is a common costly mistake.
I see doctors through Novant Health. Will I have to change doctors if I switch Medicare Advantage plans?
As of September 22, 2026, Novant Health participates with a number of Medicare Advantage plans, but not every Novant doctor, hospital, or location participates with every plan.Switching Medicare Advantage plans does not automatically mean you have to change doctors.
Start with the Novant doctors you want to keep. For each one:
Search the exact Medicare Advantage plan’s provider directory using the doctor’s full name and office location.
Call the doctor’s office and ask, “Are you in-network with this exact Medicare Advantage plan?”
If you use a Novant hospital or specialist, verify those separately too.
Do not simply ask, “Do you take this insurance company?” One plan from that company may include your doctor while another does not.
If keeping your Novant doctors is important, make that the first filter. Then compare the plans that include them for prescriptions, copays, hospital costs, and maximum out-of-pocket limits.
The goal is simple: verify the exact doctor, exact location, and exact plan before you switch.
I live in Cook County. How do I know which Medicare Advantage plan covers my doctors and prescriptions?
If you already work with a licensed Medicare agent, start there. Ask them to review your doctors, hospitals, prescriptions, and pharmacies against the Medicare Advantage plans available in your part of Cook County.If you are comparing plans yourself, start with your doctors and prescriptions, not with the plan advertisements.
Use your ZIP code at Medicare Plan Finder to see which plans are available where you live. Enter every prescription you take, the dosage, how often you take it, and the pharmacies you prefer.
Then make a list of the doctors and hospitals you want to keep — your primary doctor, specialists, and preferred hospital or health system.
For each plan you are considering, verify those providers in the exact plan's provider directory and confirm with the doctor's office as well. Don't simply ask whether they take the insurance company. Ask whether they are in-network with that specific Medicare Advantage plan.
Then narrow the choices to plans that work with both your providers and your prescriptions.
Finally, compare the remaining plans for premiums, prescription costs, hospital and specialist copays, pharmacy pricing, and maximum out-of-pocket costs.
If none of the Medicare Advantage plans include the doctors and hospitals most important to you, that is worth knowing before you enroll. It may also be a reason to compare Original Medicare with a Medicare Supplement.
The best order is simple: agent review → doctors and hospitals → prescriptions and pharmacies → costs and benefits → choose the plan.
I moved to a different county in Illinois. Will I still have the same Medicare Advantage plan choices?
Not necessarily. Medicare Advantage plans are offered by specific service areas, which often vary by county. When you move to a different county, some of your current plan choices may no longer be available, while new plans may become available at your new address. A permanent move that changes your available coverage can also qualify you for a Special Enrollment Period (SEP) to select a new plan. Before moving or changing coverage, compare the Medicare Advantage plans available in your new ZIP code and confirm that your doctors and prescriptions are covered.I spend part of the year outside Illinois. Will my Medicare Advantage plan still cover me when I’m away?
Yes, but what is covered depends on your exact Medicare Advantage plan.Emergency and urgent care are covered when you are away from home, even if you are outside your plan’s normal network.
Routine care is where you need to be more careful.
If you have an HMO, you generally must use the plan’s network for regular doctor visits, specialists, and hospital care. Routine out-of-area care may not be covered unless your plan has a special travel or visitor benefit.
If you have a PPO, you generally have more flexibility to use out-of-network doctors, but you may pay more. Before seeing a doctor while you are away, make sure the provider will accept your plan and ask the plan what your out-of-network cost will be.
If you spend several months each year outside Illinois, also ask whether your plan has a visitor or traveler program or a broader national network.
How long you are away matters too. Medicare Advantage plans require you to maintain your permanent residence in the plan’s service area. If you live outside that area for more than six consecutive months, the plan may have to disenroll you unless it offers a qualifying visitor/traveler program that allows a longer absence.
So before spending part of the year somewhere else, call your plan and ask:
Will my routine doctors and hospitals be covered where I’m staying, what will I pay, and how long can I remain outside the service area without affecting my enrollment?
If you regularly receive healthcare in more than one state, that should be considered when choosing your Medicare coverage — not just when you leave Illinois.
If I’m not taking any medications, do I still need to enroll in a Part D plan?
No, you are not legally required to enroll in a Medicare Part D plan if you do not take any medications. However, if you choose to skip it and do not have other creditable coverage such as insurance through a current employer, the VA, or a retiree plan that is at least as good as Medicare Part D, you will face a permanent Part D late enrollment penalty if you decide to join a plan later in life.If you go without creditable prescription drug coverage for 63 days or more in a row after your initial Medicare eligibility period, Medicare will penalize you when you sign up.
The penalty is calculated as 1% of the "national base beneficiary premium" for every full month you went without coverage. This penalty is not a one-time fine. It is added to your monthly Part D premium for as long as you have Medicare prescription drug coverage.
How many hours of home health care does Medicare cover, and how long can it last?
Medicare does not set a simple limit like “30 days” or “100 days” for home health care.If you qualify for Medicare-covered home health services, skilled nursing and home health aide services are generally considered “part-time or intermittent” when they total less than 8 hours per day and no more than 28 hours per week combined. In certain limited situations, Medicare may cover up to 35 hours per week for a short period.
As for how long it can last, Medicare can continue covering home health care as long as you continue to meet the eligibility requirements and your doctor or other authorized provider continues to certify that the services are medically necessary. Eligibility is generally reviewed and recertified every 60 days, and Medicare does not set a limit on the number of consecutive 60-day certification periods.
There is an important distinction, though: Medicare does not cover 24-hour care at home or long-term custodial care simply because someone needs help with bathing, dressing, meals, cleaning, or other daily activities. Home health aide services are generally covered only when you're also receiving qualifying skilled nursing or therapy services.
So someone who needs a nurse or therapist at home may qualify for ongoing Medicare home health coverage, but someone who mainly needs a caregiver to stay with them several hours every day may need a different type of long-term-care assistance.
Why can't I see a doctor of my choice?
It depends on how you receive your Medicare coverage.With Original Medicare, you can generally see any doctor or hospital in the U.S. that accepts Medicare. You usually do not need a referral to see a specialist.
With a Medicare Advantage plan, your choices can be more limited because the plan may use a provider network.
If you have an HMO, you generally need to use doctors and hospitals in the plan’s network for routine care. If you go outside the network, you may have to pay the full cost except for situations such as emergency or urgent care.
A PPO usually gives you more flexibility to see out-of-network providers, but you may pay more, and the provider still has to be willing to treat you under that plan.
So if you are being told you cannot see a particular doctor, find out why. Is the doctor outside your plan’s network? Does the doctor no longer participate with the plan? Does your plan require a referral? Or is the doctor simply not accepting new patients?
If keeping certain doctors is important to you, those doctors should be checked before choosing or changing Medicare coverage.
The important distinction is this: Original Medicare generally gives you broader provider choice, while Medicare Advantage may limit that choice based on the plan’s network.
What is a Medicare OTC card, and how do I find out if my plan includes over-the-counter benefits?
A Medicare OTC (over-the-counter) benefit is an extra benefit offered by many Medicare Advantage plans that provides an allowance for eligible nonprescription health and wellness items. Depending on the plan, it may cover items such as pain relievers, vitamins, first-aid supplies, cold medications, and other approved products. The amount, eligible items, participating retailers, and how often the allowance is provided vary by plan, and unused funds may expire. Check your plan’s Evidence of Coverage, member portal, or OTC benefit catalog—or call Member Services—to confirm exactly what your plan includes.Can a Medicare Part D plan be reinstated after termination for unpaid premiums if the missed payments were caused by the member’s dementia?
Yes, it may be possible.Medicare allows a Part D plan to reinstate someone who was dropped for unpaid premiums when there is “good cause” for the missed payments. Dementia can support a good-cause request if the cognitive impairment prevented the member from understanding the bills, managing finances, or arranging for the premiums to be paid.
But the diagnosis by itself does not automatically restore coverage. The plan reviews the circumstances individually.
Act quickly. The member or an authorized representative generally must request reinstatement within 60 days of the disenrollment effective date and explain how the dementia caused the missed payments. The plan may ask for a credible statement or other information supporting what happened.
If good cause is approved, all premiums that were owed when the coverage ended must be paid in full within three months of the disenrollment date. The reinstatement can then restore the Part D coverage without a break.
So I would contact the Part D plan immediately and specifically say: “We are requesting reinstatement for good cause because the member’s dementia prevented the premiums from being paid.”
Have the disenrollment notice, dates of the missed payments, information about the dementia, and details about who was handling the member’s finances available.
The important thing is not to assume the termination is final. There is a Medicare reinstatement process specifically for situations where circumstances outside the member’s control caused the nonpayment.
I don’t pay the $202 Medicare premium because of my SSDI income. Will I have to pay it when I turn 65?
Yes, you may have to pay the Medicare Part B premium when you turn 65, but it depends on why you currently pay $0.In 2026, the standard Part B premium is $202.90/month.
If your Part B premium is currently being paid through a Medicare Savings Program or another state assistance program, that assistance may continue after 65 if you still qualify based on your income and resources. Your SSDI status itself does not automatically make Part B free. Part B normally has a premium.
Importantly, when someone receiving SSDI reaches 65, they generally don't face a Part B late-enrollment penalty simply because they were on SSDI. So the key question is: Who is currently paying your $202.90 Part B premium? If you tell me whether it's Medicaid, a Medicare Savings Program, or something else, I can explain what is likely to happen at 65.
What is the difference between a Medical Savings Account (MSA) and a Health Savings Account (HSA)?
A Health Savings Account, or HSA, is typically paired with a qualifying high-deductible employer or individual health plan before Medicare. You, your employer, or both can contribute money to it, and the money can grow and roll over from year to year.Once you enroll in Medicare, however, you can no longer contribute to an HSA. You can keep the money already in the account and continue using it for qualified medical expenses. (irs.gov)
A Medicare Medical Savings Account, or MSA, is different. It is actually a type of Medicare Advantage plan that combines a high-deductible health plan with a savings account.
With an MSA, you do not contribute money to the account yourself. Medicare provides money to the MSA plan, and the plan deposits a set amount into your account each year. You can use those funds toward healthcare expenses, and unused money can roll over. (medicare.gov)
Another important difference is prescription coverage. Medicare MSA plans do not include Part D, so if you want prescription coverage, you generally enroll in a separate Part D plan. (medicare.gov)
The simplest way to remember it is:
HSA: your healthcare savings account before Medicare, with contributions from you or an employer.
Medicare MSA: a Medicare Advantage plan where the plan deposits Medicare-funded money into an account to help you manage a high deductible.
They sound similar, but they work very differently.
What is the best supplement plan to have that will pay for prescriptions?
Medicare Supplement (Medigap) plans do not provide outpatient prescription drug coverage.However, they can help with your share of Medicare-covered medications when those drugs are covered under Part A or Part B.
For example:
• Part A: Medications administered while you are a covered inpatient in the hospital are generally included in the hospital services covered by Part A. Your Medigap plan may help with applicable Part A deductibles and coinsurance.
• Part B: Certain medications are covered by Medicare Part B, such as many physician-administered injections or infusions, some chemotherapy drugs, and certain immunosuppressive drugs. After Medicare pays its share, a Medigap plan may cover some or all of the remaining Medicare-approved cost, depending on the Medigap plan.
For the prescriptions you normally pick up at the pharmacy, you generally need a Medicare Part D prescription drug plan or drug coverage through a Medicare Advantage plan.
Can my employer reimburse my Medicare premiums?
Yes, an employer can reimburse Medicare premiums, but it generally needs to be done through a properly structured arrangement rather than simply paying an employee’s Medicare premium informally.For example, an Individual Coverage HRA (ICHRA) can be designed to reimburse an employee for Medicare Part A (if a premium applies), Part B, Medicare Advantage (Part C), Part D, and even Medicare Supplement premiums. Medicare Part B and Part D premiums are recognized as medical expenses under the tax code.
There are some important rules, particularly if the employer also offers a traditional group health plan. An employer generally cannot single out Medicare-eligible employees and simply pay them to leave the group plan and enroll in Medicare, because Medicare Secondary Payer and other benefit rules can come into play. Also, an Excepted Benefit HRA cannot reimburse Medicare Part A, B, C, or D premiums.
So if you’re asking this for an employer/client situation, tell me how many employees the company has and what coverage they currently offer, and I can tell you which reimbursement structure would likely work.
How likely am I to qualify for Medigap at 73 after the six-month enrollment period? I have some medical history and a possible cancer workup, but no diagnosis, hospitalizations, or treatment.
This comes up a lot, and the honest answer is: it depends on your state and on timing more than on your age. Outside your six-month Medigap Open Enrollment window, most states let carriers ask health questions, and they can approve, rate you up, or decline.Here's the part that matters in your situation: Medigap applications don't just ask about diagnoses — they ask about pending tests, recommended treatment, and symptoms under investigation. A "possible cancer workup" with no diagnosis usually isn't a decline for being sick; it's a postpone for being unresolved. Most carriers won't approve while a workup is open, because they can't underwrite an unknown. Once the workup closes with a clean result, your odds improve dramatically — no hospitalizations, no diagnosis, and no treatment history is actually a decent underwriting profile at 73.
So the practical path is usually: (1) let the workup resolve first, (2) answer every application question truthfully — a misstatement can void the policy later, and (3) check your state's rules before assuming you'll be underwritten at all. A handful of states have birthday rules or year-round guaranteed-issue windows, and there are federal guaranteed-issue situations (like losing certain coverage) where health questions can't be asked. An independent agent who works with several Medigap carriers can pre-screen you against each carrier's health questions before you ever submit an application, so a decline never hits your record.
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.
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 coverageMy 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.
What life events qualify me for a Medicare Special Enrollment Period?
A Special Enrollment Period, or SEP, is an opportunity to change Medicare coverage outside the normal annual enrollment periods because something in your life changed.Some of the most common situations include:
Retiring or losing employer or union coverage
Moving to a new address where your current plan is not available or where different plans become available
Losing Medicaid or Extra Help, or having a change in that assistance
Moving into or out of a nursing home, rehabilitation facility or other qualifying institution
Moving back to the United States after living overseas
Developing a serious chronic condition that qualifies you for a Chronic Condition Special Needs Plan
Your Medicare plan leaving your area or ending its Medicare contract
Certain other changes involving employer coverage, prescription coverage or special circumstances
The important thing is that there is not one universal Special Enrollment Period. What you are allowed to change and how long you have to do it depend on what actually happened. For example, moving may give you a different window than losing employer coverage or Medicaid.
So if something in your life changes, don't assume you have to wait until October. Ask: What changed, when did it happen, and does that event give me an opportunity to change my Medicare coverage now?
And don't wait too long to ask. Many Special Enrollment Periods only last a few months.
What does it mean if a Medicare agent is 'independent,' and why does that matter for me?
An independent Medicare agent is not tied to just one insurance company.Instead, the agent may be contracted with several Medicare insurance companies and can compare the plans they are authorized to represent. That gives you a broader look at your options instead of starting with one company and trying to make its plans fit your situation.
That matters because Medicare coverage should be built around you — your doctors, prescriptions, hospitals, budget, travel and the amount of financial risk you are comfortable taking.
There is one important distinction: independent does not automatically mean the agent represents every Medicare plan available in your area. It is fair to ask which companies and plans the agent can compare for you.
CMS — the Centers for Medicare & Medicaid Services, the federal agency that oversees Medicare — requires agents to disclose when they do not represent every available plan in your area.
A good independent agent should do more than show you a list of premiums and extra benefits. The real value is helping you compare the whole picture, make a recommendation based on your needs, and then remain available when questions or problems come up later.
The advantage of independence is simple: the conversation can start with what you need instead of with the insurance company the agent works for.
Can I leave Medicare Advantage and automatically get a supplement?
Not necessarily. You can leave a Medicare Advantage plan and return to Original Medicare, but that doesn't always mean you can automatically enroll in a Medicare Supplement (Medigap) plan.Whether you can enroll in a Medicare Supplement without medical underwriting depends on your individual situation. You may have a guaranteed issue right in certain circumstances. If you do not have a guaranteed issue right, the insurance company may ask health questions and could deny your application or charge more, depending on the state and the plan.
Before leaving your Medicare Advantage plan, I recommend checking your Medicare Supplement eligibility first. You don't want to cancel your current coverage and then find out you cannot get the Supplement coverage you expected.
I am a licensed insurance agent and am not affiliated with or endorsed by Medicare or any government agency. We do not offer every plan available in your area. Currently, we represent multiple organizations that offer Medicare products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Assistance Program (SHIP) to get information on all your options.
What can I change during the October 15 through December 7 enrollment period?
Pretty much anything. You can change from one Advantage plan to another. You can disenroll from your Advantage plan and switch to Medigap insurance along with a Part D prescription drug plan. You can disenroll from Medigap and go into an Advantage plan. Etc. You even can revert to just traditional Medicare - although that would subject you to considerable financial exposure.
Should I review Medicare coverage even when I like my current plan?
If you love your current plan, you’re "likely" in good shape to stay where you are.HOWEVER, just keep two quick things in mind each fall:
- Check your ANOC: Your carrier sends an Annual Notice of Change every September detailing any price or benefit updates. If a plan is terminating, they are required by law to let you know.
- Check your medications: Drug formularies change every year. Even if your plan stays the same, the tier or cost of your specific medications could shift.
Taking five minutes to review your drug list and ANOC packet ensures complete peace of mind and zero surprises on January 1st or to see if there is a better plan fit for you.
Does Medicare cover acupuncture, naturopathic doctors, or other alternative medicine?
Sometimes, but Medicare's coverage of alternative medicine is pretty limited.Acupuncture is a good example. Original Medicare Part B covers acupuncture for **chronic low back pain**, but not simply for any condition. Medicare currently allows up to 12 treatments in 90 days, with up to 8 additional treatments if you are improving.
Chiropractic care is also limited. Medicare covers manual manipulation of the spine when it is medically necessary to correct a specific spinal problem. It does not automatically cover the X-rays, massage therapy, acupuncture or other services a chiropractor may provide.
Routine visits to a naturopathic doctor and many other alternative treatments generally are not covered by Original Medicare. Massage therapy, for example, is specifically excluded.
Medicare Advantage plans can be different. Some plans may offer additional benefits beyond Original Medicare, so don't assume a service is covered—or excluded—without checking the exact plan.
If you regularly use acupuncture, naturopathic care or another alternative treatment, I would ask a few questions before choosing Medicare coverage: What exact treatment do you receive? How often? Who provides it? And what does your specific plan say it will cover?
That matters because a provider may offer several services, but Medicare may pay for only one of them. Knowing that ahead of time can prevent a surprise bill.
I’m new to Medicare in North Carolina. How do I decide between Medicare Advantage and a Medicare Supplement plan?
Start with how you actually want to use your healthcare.With Medicare Advantage, you receive your Medicare benefits through a private insurance plan. Many plans have low or $0 additional premiums and may include prescription coverage, dental, vision, hearing, and other benefits. But you may need to use a provider network, get prior approval for certain services, and pay copays or coinsurance as you receive care. Every Medicare Advantage plan also has an annual maximum on what you can pay for covered medical services.
With Original Medicare and a Medicare Supplement, Original Medicare gives you access to any doctor or hospital in the country that accepts Medicare. The Supplement helps pay some or most of the deductibles and coinsurance Original Medicare leaves behind, depending on which Supplement you choose. You will generally pay a higher monthly premium, but your medical expenses can be more predictable. You would also normally add a separate Part D prescription plan.
So I would ask:
Which doctors and hospitals are important to you?
Do you travel or spend time outside North Carolina?
What prescriptions do you take?
Would you rather pay more each month for more predictable medical costs, or pay less in premiums and share more of the cost as you use healthcare?
There is one especially important consideration when you are new to Medicare.
When your Medicare Part B first begins, you generally have a 6-month Medigap enrollment period when you can buy any Medicare Supplement available to you without being turned down because of your health. In North Carolina, once that period ends, an insurance company can generally use medical underwriting if you apply later unless you have another protected enrollment right.
That does not mean a Medicare Supplement is automatically the better choice. It means your first Medicare decision deserves a careful look, because changing from Medicare Advantage to a Supplement later may not be as simple as changing plans in the fall.
I have an Aetna Medicare Advantage plan in Illinois. How can I check if my hospital will still be in network next year?
As of September 22, 2026, Aetna says its Medicare provider directory will show 2027 network information after October 1.Start with the exact Aetna Medicare Advantage plan name and plan number on your ID card. Then:
Review your Annual Notice of Change (ANOC) for changes taking effect January 1.
After October 1, use Aetna’s Medicare provider directory and search for your exact hospital and location.
Call Aetna Member Services and ask, “Will this hospital be in-network with my exact plan for 2027?”
Then call the hospital’s insurance or billing office and confirm the same thing from their side.
Do not simply ask whether the hospital “takes Aetna.” A hospital may participate with one Aetna Medicare Advantage plan but not another.
Aetna also notes that provider networks can change, so this is something worth checking every fall.
If that hospital is important to you, verify it before the October 15–December 7 Medicare enrollment period ends, so you still have time to compare other coverage if necessary.
My prescriptions got more expensive this year. Can I switch to an Illinois Medicare Advantage plan that covers them better?
Maybe, but the first thing I would want to know is why the prescription got more expensive.Did the price change in January? Did you change pharmacies? Did the drug move to a different tier? Are you paying a deductible now? Did your doctor change the dosage or prescribe a different version of the medication? Did you lose Extra Help or another assistance program?
Those details matter because changing Medicare Advantage plans may not be the first or best answer.
Sometimes simply moving a prescription to a preferred pharmacy can lower the cost. If a medication changed tiers or is no longer covered the same way, it may also be worth asking the plan about an exception. Medicare drug costs can vary based on the plan, the drug's tier, the pharmacy you use, and where you are in the plan's drug coverage for the year.
If a different Illinois Medicare Advantage plan really does cover your prescriptions better, the next question is whether you can change plans now.
Everyone gets an opportunity to review and change Medicare coverage from October 15 through December 7 for the following year. If you are already in a Medicare Advantage plan, you also get one opportunity between January 1 and March 31 to change to another Medicare Advantage plan or return to Original Medicare.
Outside of those periods, a higher prescription cost by itself normally does not give you the right to change plans. But there are quite a few situations that can.
For example, you may have another opportunity if you moved, recently lost other coverage, receive Medicaid or Extra Help, moved into or out of a nursing or rehabilitation facility, qualify for a plan designed for a serious chronic condition, or meet one of Medicare's other special circumstances. There are also limited opportunities involving certain 5-star or consistently low-performing plans.
So I would not start by shopping for a new plan. I would start with the prescription.
What changed? What are you taking? What pharmacy are you using?
My prescriptions got more expensive this year. Can I switch to an Illinois Medicare Advantage plan that covers them better?
Possibly, but before changing plans I would want to know why your prescriptions got more expensive.Did the price change at the beginning of the year, or did it happen suddenly? Are you taking the same medication and dose? Did you change pharmacies? Are you using one of your plan's preferred pharmacies? Are you paying a deductible? Did the medication move to a different level on the plan's drug list? Did you lose Extra Help? Did the plan add a requirement such as getting approval first or trying another medication?
Those questions can point us toward the real problem.
Sometimes the fix is surprisingly simple. Another pharmacy may have a lower cost. Your doctor may be comfortable prescribing a generic or another covered medication. Mail order may be less expensive. If the medication isn't being covered properly, your doctor may also be able to ask the plan for an exception.
I would also compare what the prescription costs through your Medicare plan with the cash price. Programs such as GoodRx or other pharmacy discount programs can sometimes offer a lower price, particularly on certain generic medications.
There is an important catch. You don't use GoodRx together with Medicare. You are choosing to pay outside your Medicare drug coverage for that prescription. If you do that, what you pay generally will not count toward your Part D deductible or your yearly out-of-pocket limit.
So don't automatically choose the lowest price at the pharmacy counter. If GoodRx saves you $20 today but you take several expensive medications during the year, using your Part D coverage could still make more sense when you look at the entire year.
Then I would look at whether you actually have an opportunity to change plans.
If you are already enrolled in Medicare Advantage, you generally have one opportunity to make a change between January 1 and March 31. Everyone also gets the annual October 15 through December 7 period to review coverage for the following year.
There are other
I’m turning 65 in Illinois and still working. Do I need to sign up for Medicare right away?
Not necessarily.If you are still working at 65 and covered by an employer group health plan through your or your spouse’s current employment, you may be able to delay Medicare Part B without a late-enrollment penalty.
The first thing to check is the employer size.
If the employer has 20 or more employees, the employer plan generally continues to pay first, and many people can delay Part B while that coverage remains active.
If the employer has fewer than 20 employees, Medicare generally becomes primary at 65. In that situation, delaying Parts A and B can create unpaid claims because the employer plan may expect Medicare to pay first.
Also ask whether you contribute to an HSA. Once Medicare begins, you can no longer contribute to an HSA, so that needs to be planned before enrolling in Part A or Part B.
COBRA, retiree coverage and VA benefits are also different from coverage based on current employment and should not automatically be treated as reasons to delay Part B.
So about six months before you turn 65, have the employer benefits reviewed. Confirm the employer size, whether the coverage is based on current employment, how it works with Medicare, and whether you are contributing to an HSA.
Then you can decide whether enrolling at 65 or delaying Medicare is the better path for your situation.
What is a SHIP counselor, and how is that different from working with a Medicare broker?
A SHIP counselor works through the State Health Insurance Assistance Program. SHIP is federally funded and provides free Medicare counseling. SHIP counselors are not connected to an insurance company or health plan, and they can help explain Medicare, compare plans, understand bills, work through coverage questions and find assistance programs.A Medicare broker is a licensed insurance professional. A broker can help you compare Medicare plans they are authorized to represent, make a recommendation based on your situation, and help you actually enroll. Independent brokers may represent several insurance companies rather than just one. Medicare agents and brokers must be state licensed and complete Medicare training each year.
The other big difference is what happens after enrollment.
A good broker should continue helping you when plans change, prescriptions get expensive, a doctor leaves a network, or you have a coverage problem. That ongoing relationship can be valuable because the broker already knows your doctors, prescriptions and what mattered when the coverage was originally selected.
SHIP can be especially helpful if you want a free, non-sales Medicare resource, need help understanding your rights, or are working through a billing or assistance issue.
You do not necessarily have to choose one or the other. The important thing is understanding the role each one plays and getting help from someone who will look at your whole Medicare situation rather than simply pointing you toward a plan.
What does Medicare cover?
Medicare covers a lot, but it does not cover everything.Part A is mainly hospital insurance. It helps cover inpatient hospital stays, skilled nursing facility care, hospice, and some home health care.
Part B is medical insurance. It helps cover doctor visits, outpatient care, testing, durable medical equipment, mental health care, and many preventive services.
Part D helps pay for prescription drugs. You can get Part D through a separate drug plan or through many Medicare Advantage plans.
If you choose Medicare Advantage, the plan must cover almost all medically necessary services Original Medicare covers and may add benefits such as dental, vision, hearing, or other extras.
What Medicare generally does not cover includes long-term custodial care, most routine dental care, routine eye exams for glasses, hearing aids, and several other services.
And remember, Medicare coverage does not mean Medicare pays 100% of the bill. Deductibles, copays, and coinsurance can still leave you with meaningful out-of-pocket costs.
That is why the better question is often not just, “Does Medicare cover it?” but also, “What part will Medicare pay, what could I owe, and do I have additional coverage for the gaps?”
What should I do if I receive a letter from my doctor or Medicare and don't understand it?
First, don’t throw it away and don’t assume it is just informational.Look for a few things right away:
Who sent the letter?
What are they asking you to do?
Is there a deadline?
Does it mention a denial, change in coverage, prior authorization, payment, appeal, or termination of coverage?
If the letter came from your doctor, call the office and ask them to explain exactly what it means and whether you need to take any action.
If it came from Medicare or your Medicare Advantage or Part D plan, call the number on the letter and ask them to walk you through it in plain English.
And if you work with a Medicare agent, this is a good time to use them. Send them a copy of the letter. A good agent should help you understand what it means, what questions to ask, and whether a deadline or appeal needs immediate attention.
The biggest mistake is setting an unfamiliar Medicare letter aside until later. Some notices have short deadlines, and waiting can make the problem harder to fix.
When in doubt, ask before you act — and especially before cancelling coverage, paying a large bill, or ignoring a deadline.
When do I get the ANOC(Annual Notice of Change) and what should I do if I have questions about my ANOC?
The Annual Notice of Change (ANOC) has to be mailed no later than September 30th each year and prior to Annual Enrollment Period(AEP).VERY IMPORTANT INFORMATION RE: Annual Notice of Change
1- Be On Look Out (BOLO) for it in the mail.
2- Keep It
3- Review It and Understand what is changes are happening with your current cover plan (Medicare Advantage and Part D-Prescription Drug Plan).
Here are a list of key items to review:
- Is Your Plan Available in 2027, or will you need to identify a new plan
- Cost Shares (Co Pays, Coinsurance, and Deductibles (Medical and Prescription)
- Max Out of Pocket (MOOP) Costs
- Network Changes (doctors, specialists, hospitals enter or leaving your plan network)
- Extra Benefits Changes (Dental, Vision, Hearing, Over The Counter (OTC), Fitness/Gym)
- Optional Supplemental Benefits (OSP)- What's available for your plan and costs of them
- Review your Medications / Plan Formulary / Co Pays / Coinsurance, Deductibles, Tiers (Preferred Generic, Generic, Preferred Brand, Brand, Specialty, Non Formulary)
- Preferred Pharmacy vs In-Network Pharmacy (Additional Savings Available)
- Plan Vendor Partners (this can change from year to year as well ) like EyeMed, DentaMax, LIbertyDental, Carreigton, TruHearing, etc..
Industry Hack:
If you work with a broker, they will do all of the above for you and highlight the differences, best options, and help you navigate any changes you may see with you plan from one year to the next. There is no additional costs to work with a broker and there is no fees charged for their services.
I retired in August 2026 and want to take a large retirement-account withdrawal this year, which would push my 2026 MAGI above the IRMAA threshold. Since my income will be lower in 2027 due to retirement, could I use the work-stoppage life-changing event to have my 2028 IRMAA based on my lower 2027 income instead?
Yes.Your 2028 IRMAA would normally be based on your 2026 tax return. That means a large taxable retirement-account withdrawal in 2026 could cause higher Medicare Part B and Part D premiums in 2028.
But you retired in August 2026. Social Security considers stopping work a qualifying life-changing event. If your retirement causes your 2027 income to be significantly lower, you can ask Social Security to use your 2027 income instead of your 2026 income when calculating your 2028 IRMAA.
Here is what you do:
When you receive the 2028 IRMAA notice, complete Form SSA-44.
Select Work Stoppage and enter your August 2026 retirement date. Provide proof that you stopped working and give Social Security your expected 2027 MAGI and married-filing-jointly status. If your 2027 tax return is not yet filed, Social Security can use your estimate and later verify it against IRS records.
The large 2026 withdrawal still counts as 2026 income. You are not asking Social Security to remove it. You are asking them to use the more recent 2027 income because your retirement caused a significant reduction in income.
If both spouses are on Medicare and the IRMAA reduction needs to apply to both, each spouse should contact Social Security about their own IRMAA determination.
So the planning opportunity is clear: the 2026 withdrawal may raise the income reported for that year, but your August 2026 retirement can allow Social Security to use your lower 2027 income when setting 2028 Medicare premiums.
Can green card holders get Medicare?
Yes. Lawful permanent residents, commonly called green card holders, can qualify for Medicare.For someone age 65 or older, there are two important pieces to look at.
First is work history. If you or your spouse worked and paid Medicare taxes long enough — generally about 10 years — you may qualify for premium-free Medicare Part A, just like a U.S. citizen.
If you do not have enough work history for premium-free Part A, there is another rule to consider. A lawful permanent resident who is at least 65 and has lived continuously in the United States for the five years immediately before applying can generally enroll in Medicare Part B and may be able to purchase Part A.
So the important questions are:
How old are you?
How long have you been a lawful permanent resident living in the United States?
How many years did you or your spouse work and pay Medicare taxes?
Someone under 65 may also qualify for Medicare because of disability or certain medical conditions, but those eligibility rules are different.
The key point is: a green card can make Medicare eligibility possible, but citizenship status alone does not determine whether Medicare is free or when you can enroll. Work history and residency matter too.
What are the pros and cons of a Medicare Medical Savings Account?
A Medicare Medical Savings Account, or MSA, is a special type of Medicare Advantage plan that combines a high-deductible health plan with a medical savings account.Medicare provides money to the plan, and the plan deposits a set amount into your MSA each year. You can use that money toward healthcare expenses. If money is left at the end of the year, it stays in the account and can roll over for future years.
There are some attractive benefits:
MSA plans generally have no additional monthly plan premium, although you still pay your Part B premium.
They usually do not have traditional provider networks, so you can generally use Medicare-approved providers who agree to treat you.
You do not need a primary care doctor or referrals to specialists.
The plan deposits money into your account, and unused money can accumulate from year to year.
Once you reach the plan's deductible, the plan pays for your Medicare-covered Part A and Part B services.
The tradeoff is the high deductible. The amount deposited into your MSA is usually less than the deductible. If you use all of the account money and still have medical expenses, you may have to pay the difference yourself before the plan begins paying.
MSA plans also do not include Part D prescription coverage. If you want Medicare drug coverage, you need to enroll separately in a Part D plan.
There are also restrictions on who can enroll. For example, people with Medicaid, TRICARE, VA benefits, certain retiree coverage, or other insurance that would pay toward the MSA deductible generally cannot join one.
So an MSA can be attractive for someone who wants provider flexibility, is comfortable managing healthcare dollars, and can financially handle the gap between the account deposit and the deductible.
The number I would look at most closely is not just how much the plan deposits into the account. Compare that deposit with the deductible and ask, “How much of my own money could I realistically have to spend in a bad year?"
What happens when my doctor stops taking my insurance?
It depends on what kind of Medicare coverage you have.On a Medicare Advantage plan: Your doctor leaving the network is the most common version of this. After that:
- HMO: Visits with that doctor usually aren't covered anymore, except in an emergency.
- PPO: You can still see the doctor, but you'll pay higher out-of-network costs.
- Mid-treatment: Your plan should let you know ahead of time. If you're in the middle of treatment, ask the plan about continuity of care, since some will cover you for a transition period.
- Your options: Pick a new in-network doctor, or switch plans. Annual Enrollment runs October 15 to December 7, and Advantage members get another chance from January 1 to March 31. If a lot of doctors leave your plan's network at once, Medicare may give you a Special Enrollment Period to change plans sooner.
On Original Medicare (with or without a Supplement): There are no networks, so you can see any doctor in the country who accepts Medicare. If your doctor stops taking Medicare entirely, though, you'd have to pay out of pocket under a private contract, and Medicare won't reimburse you. Some doctors still see Medicare patients but don't "accept assignment." They can charge up to 15% more than Medicare's approved amount, and Plan G covers that extra charge.
If keeping a specific doctor matters to you, make it the first thing you check when you're choosing or renewing a plan. With Annual Enrollment starting soon, now's a great time to confirm your doctors are still in network for next year.
A man has Medicare Parts A and B through SSDI and turns 65 on September 28, 2026. When does his new Medicare Supplement Open Enrollment Period begin and end?
It starts September 1, 2026, and ends February 28, 2027.People who get Medicare early because of a disability receive a new six-month Medigap Open Enrollment Period when they turn 65, even though they already have Part B. The window opens on the first day of the month he is both 65 and enrolled in Part B. Since his birthday falls in September, that's September 1. Six full months (September through February) puts the end date at February 28, 2027.
During this window, he can buy any Medicare Supplement plan sold in his area without medical underwriting, and the carrier can't decline him or charge more for health conditions. Because he's already on Part B, he can't postpone the window, and he only gets it once.
Do Medicare Advantage plans pay my Part B premium? How much do they pay, and how do I qualify?
Some Medicare Advantage plans can help pay part or even all of your Medicare Part B premium. Medicare calls this a Part B premium reduction, although you may hear it advertised as a “Part B giveback.”For 2026, the standard Part B premium is $202.90 per month. A plan might reduce that by $25, $50, $100 or another amount. The exact benefit depends on the plan available where you live.
You generally do not qualify based on income. You need Medicare Parts A and B, must live in the plan’s service area, and enroll in a Medicare Advantage plan that offers the benefit.
You also still have to stay enrolled in Medicare Part B. The plan is helping reduce the premium — it is not replacing Part B.
The most important step is to read the entire Summary of Benefits and compare it with a more traditional Medicare Advantage plan in your area.
Look at hospital copays, specialist visits, outpatient surgery, diagnostic testing, skilled nursing, prescription costs and the plan’s maximum out-of-pocket limit. A larger Part B giveback may come with higher costs somewhere else.
For example, saving $100 a month gives you $1,200 a year back. But if the plan’s copays and coinsurance could cost you several thousand dollars more during a year when you need care, the giveback may not actually save you money.
So don’t compare Part B givebacks by themselves. Compare the whole plan and what you could realistically pay over the entire year.
I hear about these Food Benefit cards all the time. How much are they worth and how do I get one?
Those “food benefit” or “grocery” cards you see advertised are not a standard Medicare benefit.They are usually extra benefits offered by certain Medicare Advantage plans. Some plans may provide an allowance for approved groceries or healthy foods, often through a debit-style card. The amount varies widely by plan, where you live, and whether you qualify. There is no one Medicare amount that everyone receives.
Eligibility is important. Some food benefits are available only to members who meet certain health requirements, such as having a qualifying chronic condition. CMS — the Centers for Medicare & Medicaid Services, the federal agency that oversees Medicare — allows some Medicare Advantage plans to provide food and produce benefits to eligible chronically ill members.
Be careful with advertisements that promote a large dollar amount. Sometimes that number represents a yearly total, or combines several benefits such as groceries, over-the-counter items or other allowances. It does not necessarily mean you will receive that amount in cash to spend however you want.
You also don't apply to Medicare for a universal “food card.” You have to be enrolled in a Medicare Advantage plan that offers the benefit and meet that plan's eligibility requirements.
Most importantly, don't choose a Medicare plan because of the grocery card alone. Check your doctors, prescriptions, hospitals, copays and maximum out-of-pocket costs first.
A few hundred dollars in grocery benefits can disappear pretty quickly if the plan creates a much larger healthcare expense somewhere else.
I have a SCAN Medicare Advantage plan and turn 66 in November. Can I switch back to Original Medicare during this enrollment period?
Yes. If you mean the October 15 through December 7 Medicare Open Enrollment period, you can leave your SCAN Medicare Advantage plan and return to Original Medicare. The change would generally take effect January 1.But before you drop SCAN, there are two important things to work through.
First, how will you cover the costs Original Medicare leaves behind? Many people look at a Medicare Supplement. Since you are turning 66, your original six-month Medigap enrollment period may already be ending or over. If SCAN was the Medicare Advantage plan you joined when you first became eligible for Medicare at 65, you may have a special 12-month trial right that gives you additional Medigap protections. The exact dates matter, so check that before making the change.
Second, if your SCAN plan includes prescription coverage, you will normally need a separate Part D plan when you return to Original Medicare.
There are important exceptions. If you also have TRICARE For Life, CHAMPVA, VA benefits, retiree coverage or another form of secondary coverage, that can change whether you need a Medicare Supplement, Part D plan, or both. Those benefits should be reviewed before changing anything.
So yes, you can switch. But do not cancel your current Medicare Advantage coverage until you know exactly what will replace it and the new coverage has been approved with the correct effective dates.
The goal is a clean handoff from one set of coverage to the next — not a gap while you are waiting for something to be approved.
What Medicare drug-cost changes are already confirmed for 2027?
What Medicare drug-cost changes are already confirmed for 2027?Several important changes to Medicare Part D prescription drug coverage have already been confirmed for 2027.
1. Maximum Part D deductible increases to $700
The maximum standard Part D deductible increases from $615 in 2026 to $700 in 2027. However, individual plans may offer lower deductibles or exempt certain medications from the deductible.
2. Annual prescription drug out-of-pocket cap increases to $2,400
The Part D annual out-of-pocket threshold increases from $2,100 in 2026 to $2,400 in 2027.
Once a beneficiary reaches this threshold through qualifying spending on covered Part D medications, they generally pay $0 for covered Part D drugs for the remainder of the calendar year.
3. Additional prescription drugs receive Medicare-negotiated prices
Beginning January 1, 2027, negotiated Medicare prices take effect for 15 additional high-cost Part D medications, bringing the total number of drugs with negotiated prices to 25.
These negotiated prices may help reduce costs, although individual savings depend on the drug, insurance plan, and benefit structure.
4. The Medicare Prescription Payment Plan continues
Beneficiaries can continue using this program to spread their out-of-pocket prescription drug expenses throughout the calendar year instead of paying large amounts at the pharmacy all at once.
This program does not reduce the total amount owed, but it can make expenses easier to manage.
5. Individual Part D plans may change significantly
Although CMS projects the national average standalone Part D premium will remain relatively stable in 2027, individual plans may have substantial changes in premiums, deductibles, formularies, pharmacy networks, and copayments.
My recommendation: Don't evaluate your 2027 prescription drug plan based on its monthly premium alone. Compare your specific medications, preferred pharmacies, deductible, and estimated total annual cos
My Medicare PPO Blue plan in Massachusetts has lapsed. What options do I have for getting new coverage?
If the Plan Was Discontinued or Non-Renewed by the Insurer• Return to Original Medicare: If you take no action, you are automatically enrolled in Original Medicare (Parts A and B). You will need to add a stand-alone Part D plan for prescription drug coverage.
• Enroll in a New Medicare Advantage Plan: A plan termination triggers a Special Enrollment Period (SEP). If it ended at year's end, this window runs from December 8 through the last day of February.
• Add a Massachusetts Medigap Policy: Massachusetts features continuous open enrollment for Medicare Supplement (Medigap) plans. You can switch to a Medigap policy from Original Medicare without waiting for a specific annual window.
If the Plan Lapsed Due to Non-Payment
• Contact the Insurer Immediately: Call Blue Cross Blue Shield of Massachusetts right away. Ask if they allow reinstatement for "good cause" if you can show an emergency or unexpected situation prevented timely payment.
• Pay Past-Due Balances: If you are within the grace period (typically up to two months), paying the overdue premium restores your active status.
• Wait for an Enrollment Window: If your disenrollment is final and good cause is denied, you generally must wait for the next Annual Enrollment Period running from October 15 to December 7
From your experience working with Medicare beneficiaries, what are the biggest warning signs that a doctor or healthcare provider may be involved in Medicare fraud, and what should beneficiaries do to protect themselves?
Most of the fraud I see doesn't start in a doctor's office. It starts with a phone call or a "free" offer. Here are the red flags I tell my clients to watch for:Warning signs:
Free things in exchange for your Medicare number. Free braces, diabetic supplies, genetic tests, COVID tests, gift cards. If something is "free with Medicare," be suspicious.
Unsolicited calls, texts, or visits from anyone saying they're "from Medicare." Medicare won't call you out of the blue to ask for your number or sell you something.
Cheek swabs or screenings at health fairs, senior centers, or your front door, especially genetic or cancer tests your own doctor didn't order.
Supplies or equipment showing up that you never asked for.
Pressure to get tests or services you don't think you need, or being told Medicare "requires" them.
A provider who routinely waives your copays or says you'll never owe anything.
Charges on your statements for things you didn't get: visits that didn't happen, equipment you never received, or doctors you've never seen.
How to protect yourself:
Guard your Medicare number like a credit card. Only give it to doctors, pharmacies, and plans you trust.
Read your Medicare Summary Notice or Explanation of Benefits every time. You can also check claims anytime with a free Medicare.gov account.
Keep a simple log of appointments, tests, and supplies so you have something to compare against.
Hang up on anyone pressuring you. Call your doctor, your plan, or your agent directly to check before you agree to anything.
Don't accept anything you didn't order. Refuse the delivery or send it back, and report it.
Where to report it:
1-800-MEDICARE (1-800-633-4227)
HHS Office of Inspector General: 1-800-HHS-TIPS (1-800-447-8477) or oig.hhs.gov
Senior Medicare Patrol: 1-877-808-2468. They're free, local, and very good at helping people work through suspicious charges.
Reporting doesn't cost you your coverage. It protects you, and it protects Medicare for everyone else too.
I’m new to Medicare in Louisiana. Is Medicare Advantage or a Medicare Supplement plan a better choice if I want to keep my current doctors?
If keeping your current doctors is one of your biggest priorities, I would start by finding out how each of them works with Medicare before choosing a plan.Ask your primary doctor, specialists and preferred hospital two separate questions:
Do you accept Original Medicare?
And if you are considering Medicare Advantage, are you in the network for this exact Medicare Advantage plan?
Those are very different questions.
With Original Medicare, you can generally see any doctor or hospital in the country that accepts Medicare. A Medicare Supplement plan can then help pay many of the costs that Original Medicare leaves behind. The Supplement itself does not create the doctor network — Original Medicare gives you that broader access.
Medicare Advantage works differently. These plans often have networks, so your doctor may accept Medicare but not participate in the particular Medicare Advantage plan you are considering. Some PPO plans give you more flexibility outside the network, while HMOs are generally more restrictive.
That does not automatically make Medicare Advantage a bad choice. If your doctors, specialists and hospitals are all in the plan's network, and the plan fits your prescriptions and budget, it may work very well.
But there is one more reason to think carefully when you are brand new to Medicare.
When you first start Medicare Part B at age 65 or older, you get a six-month period when you can buy a Medicare Supplement plan without being turned down because of your health. That opportunity does not simply start over every year. After that period, a Louisiana insurance company may be able to ask health questions before approving you for a Supplement unless you have a special right to enroll.
So I would not make this decision based only on which option has the lowest monthly premium today.
How important is keeping your doctors? Do you travel? Do you want the flexibility to see specialists without worrying as much about networks? What prescriptions do
I use LCMC Health doctors and hospitals. Will I still be able to see them if I switch Medicare Advantage plans?
LCMC Health is a large New Orleans-area hospital and physician system, so if those are the doctors and hospitals you use, they need to be checked carefully before you switch Medicare Advantage plans.Do not assume that because LCMC works with an insurance company, every LCMC doctor and hospital is in every Medicare Advantage plan that company offers.
Start with the doctors you actually see. Who is your primary care doctor? What specialists do you use? Which LCMC hospital would you want to use if you needed surgery or were admitted?
Then check each one against the exact Medicare Advantage plan you are considering.
I would verify it two ways: check the plan’s provider directory, then call the doctor’s office and ask if they participate with that specific Medicare Advantage plan.
If keeping your LCMC doctors and hospitals is important, check that first. A lower premium or better extra benefits do not help much if you lose access to the doctors you want to keep.
I’m turning 65 in Louisiana. How early should I start looking at Medicare plans?
I would start learning about Medicare about six months before you turn 65.That may sound early, but there is more to look at than just finding a plan. You want time to understand how Medicare works, decide between Medicare Advantage and Original Medicare with a Medicare Supplement, check your doctors and hospitals, review your prescriptions, and think about what you could pay out of pocket.
About three months before you turn 65, you can begin the actual Medicare enrollment process. Medicare generally gives you a seven-month sign-up window that starts three months before your 65th birthday month and continues for three months afterward.
Starting earlier means you can learn first and make decisions second instead of trying to figure everything out while you're also completing enrollment paperwork.
If you are still working and have employer health insurance, start the conversation about six months ahead anyway. Whether you should enroll in Medicare at 65 can depend on how that employer coverage works, so don't assume you should automatically enroll or automatically delay it.
A good rule of thumb is simple: start planning about six months before 65, and be ready to begin the enrollment work about three months before your birthday.
I live in Charlotte. How do I know which Medicare Advantage plans my doctors accept?
Start with your doctors, not with the Medicare Advantage plans.Make a list of your primary doctor, specialists and the hospital system you want to use. In Charlotte, that may include doctors with Atrium Health, Novant Health, or independent practices.
Then ask each office which specific Medicare Advantage plans they participate with. If most of your doctors are part of one health system, check that system's Medicare page as a starting point. Atrium and Novant both publish information about Medicare Advantage plans that include their providers.
The goal is to find the plans that overlap across all of your important doctors.
Once you have that shorter list, verify each doctor again in the exact plan's provider directory. Don't stop at the insurance company name because one plan from a company may include your doctor while another does not.
Then compare the plans themselves — prescriptions, hospital costs, specialist copays, maximum out-of-pocket costs and other benefits.
That is the safest order: doctors first, find the plans they have in common, then compare the plans.
I’m turning 65 in Illinois. When should I start the Medicare enrollment process?
Ideally, start learning about Medicare about six months before you turn 65.That may sound early, but there are several decisions to make. You want time to understand how Medicare works, look at your current health coverage, compare your options, and think through things like doctors, prescriptions and what you could pay out of pocket.
About three months before you turn 65, you can begin enrolling in Medicare. By starting the conversation earlier, you are not trying to learn everything and make all of your decisions at the same time.
If you plan to keep working after 65, start early anyway. Your employer coverage should be reviewed before deciding whether enrolling in Medicare at 65 makes sense for you.
The goal is pretty simple: learn first, make a plan, and then enroll when the time is right.
Where can I get local help understanding Medicare in Melbourne or Brevard County?
If you live in Melbourne or Brevard County and need help understanding Medicare, there are a few good places to start.Florida has a state Medicare counseling program called SHINE — Serving Health Insurance Needs of Elders. It is part of Florida’s State Health Insurance Assistance Program and offers free, unbiased Medicare counseling. SHINE counselors can help explain Medicare, prescription drug coverage, Medicare Advantage, Medicare Supplements, appeals, and programs that may help with Medicare costs.
You can also use Medicare.gov for official Medicare information and plan-comparison tools.
If you want help comparing coverage based on your doctors, prescriptions, hospitals, travel, and budget, a licensed Medicare agent can also be a helpful resource.
The best place to start depends on what kind of help you need — general Medicare education, help understanding benefits, or a review of coverage options based on your individual situation.
What are the potential issues for someone under 65 on SSDI who has Medigap Plan N in New York and wants to move to a lower-cost state?
There can be a significant issue here because New York has much stronger Medicare Supplement protections for people under 65 than many other states do.If you have Medicare because of SSDI and already own a Medigap Plan N in New York, you can generally keep your existing Medigap policy when you move to another state, as long as you remain on Original Medicare.
But there are two things I would check before moving.
First, don't assume moving to a lower-cost state automatically means your existing Plan N premium will become cheaper. A Medigap policy originally issued in New York can continue to be governed by New York's rating rules even after you move. In other words, changing your address does not necessarily turn your New York policy into a policy priced for the new state.
Second, be very careful about replacing that policy while you are still under 65.
New York allows Medicare beneficiaries to apply for Medigap throughout the year without being denied or charged more because of their health, and those protections also apply to people under 65 who have Medicare because of a disability.
That is not true everywhere.
Federal law generally does not require insurance companies to sell Medicare Supplement policies to people under 65. Depending on the state you move to, you may find that:
Plan N is not available to you while you are under 65.
Only certain Medigap plans are available to people under 65.
The available premiums are substantially higher.
Medical underwriting may apply if you try to change policies.
Simply moving to another state may not give you a federal guaranteed-issue right to buy the replacement Medigap policy you want.
I work for a church with 40 employees, but only 7 are full-time and eligible for employer health insurance. Does Medicare’s 20-employee rule still apply?
Yes — if those 40 people are employees of your church, Medicare's 20-employee rule would generally apply even though only 7 qualify for the employer health plan.Medicare counts full-time and part-time employees, not just the employees who are eligible for or enrolled in the health insurance.
The employer generally meets the rule if it has at least 20 employees for 20 or more calendar weeks in the current or previous year. The weeks do not have to be consecutive.
There is one additional question for churches: Who is considered the employer? Medicare does not automatically combine employees from every church in a denomination, diocese, or church organization. If your coverage is through a church-wide or multi-employer health plan, those rules need to be checked separately.
So in this example, don't count only the 7 people who receive health benefits. First confirm that the 40 workers are employees of the same employer and whether the church participates in a larger multi-employer plan.
If the 20-employee rule applies and your coverage is based on current employment, the employer health plan generally pays first and Medicare pays second.
Does Medicare cover transportation to doctor appointments?
Original Medicare only covers ambulance emergency transportation, Part B Medicare could cover some non emergency transportation only of deemed necessary by a medical doctor.There are some Medicare Advantage plans that do assist in non emergency transport to doctors visits etc.
I have Medicare Parts A and B and drug coverage through my wife’s employer plan. Could I face a Part D late-enrollment penalty later?
If you have Medicare Parts A and B but receive prescription drug coverage through your wife’s employer, you can generally delay Part D without a late-enrollment penalty as long as the employer drug coverage is considered creditable. Creditable coverage means it is expected to pay, on average, at least as much as Medicare’s standard Part D coverage. Your employer or health plan should provide a notice each year confirming whether the drug coverage is creditable - keep those notices for your records. If that coverage ends, be careful not to go 63 consecutive days or more without creditable drug coverage, or you could face a Part D late-enrollment penalty later.My hospital bill shows Medicare credited less than 80%. Is that normal?
Yes, it can be normal.The commonly quoted “Medicare pays 80%” rule generally applies to covered Part B services after the deductible, such as doctor services and many outpatient services. It does not mean Medicare pays 80% of every amount shown on a hospital bill.
If you were formally admitted as an inpatient, Medicare Part A usually pays the hospital under a different system. You may owe the Part A deductible and, for a longer stay, daily coinsurance. Part A is not based on a simple 80/20 split.
If you were an outpatient or under observation, Part B generally applies. You may owe 20% of the Medicare-approved amount for certain services, but the hospital can also have separate outpatient copays. Even spending the night in the hospital does not automatically mean you were admitted as an inpatient.
Also, don't compare Medicare's payment with the hospital's original billed charge. Medicare uses a lower Medicare-approved amount, and the difference may show on the statement as an adjustment rather than a Medicare payment.
The best way to check the bill is to compare it with your Medicare Summary Notice (MSN). Look at what Medicare approved, what Medicare paid, what was adjusted off, and what Medicare says you actually owe.
If those numbers do not match the hospital bill, call the hospital billing office before paying and ask them to explain the difference.
If Medicare skilled nursing facility coverage runs out before discharge, can you self-pay to stay in the same facility another month? Would that affect when Medicare coverage can restart?
Yes. If Medicare stops paying for your skilled nursing stay, you may be able to remain in the same facility and pay privately.But self-paying does not automatically reset your Medicare skilled nursing benefit.
Medicare allows up to 100 covered skilled nursing days in a benefit period. To earn a new benefit period, you generally must go 60 consecutive days without receiving skilled nursing facility care or inpatient hospital care.
The important question is what kind of care you receive while self-paying.
If you remain in the facility but no longer need skilled nursing or skilled therapy and are receiving only custodial or long-term care, the 60-day clock can generally begin even though you are still living there.
But if you are self-paying and continue to receive a skilled level of care, simply paying the bill yourself does not create a new 60-day break.
And one month is not enough. You generally need 60 consecutive days without skilled care for the old benefit period to end. If you later need Medicare-covered skilled nursing again, you would also need to meet Medicare's qualification requirements for a new stay, which will generally include a new qualifying inpatient hospital stay.
So before deciding to self-pay, ask the facility a very specific question: “If Medicare stops paying, will I still be considered to be receiving skilled care, or will I be staying here at a custodial level of care?”
That answer can make a big difference in when a new Medicare benefit period can begin.
We’re selling our primary residence with 3-year owner financing, a balloon payment, and about $200,000 in gain. How would the monthly payments affect our Medicare premiums if we file jointly?
For a lot of couples, the answer is "probably not much," but it depends on a couple of details.The gain itself may not count at all. When you sell your primary home, married couples filing jointly can usually exclude up to $500,000 of gain from taxable income. You generally qualify if you owned and lived in the home for at least 2 of the last 5 years. If your $200,000 gain qualifies, it never shows up in your income, so it won't affect your Medicare premiums. Owner financing doesn't change that.
The interest you collect does count. The interest part of each monthly payment is taxable income. Medicare looks at your modified adjusted gross income from two years back to decide whether you owe the income surcharge (IRMAA) on Part B and Part D. Your 2026 premiums are based on your 2024 tax return. For joint filers, the surcharge starts above $218,000 (2026). Interest from the note pushes your income up a little each year. That only matters if you're already close to that line.
Where it could matter more:
If part of the gain isn't excluded. That can happen if you didn't meet the 2-of-5-year test, the home was partly a rental or business, or you claimed depreciation. With installment reporting, the taxable gain is spread across the years you get paid, and a balloon payment can bunch a big piece into one year. Two years later, that could mean a one-year jump in your premiums.
If you're right at a threshold. IRMAA is a cliff. Going $1 over a tier puts you at the higher premium for the full year.
One heads-up: Selling a home doesn't count as a "life-changing event" for appealing IRMAA. If a balloon year bumps you into a higher bracket, you generally can't get it waived on that basis.
Before closing, run the numbers with your CPA or a financial planner, including how the sale is structured and when the balloon payment lands. A little planning up front can keep you under a threshold.
My Medicare PPO Blue plan in Texas has lapsed. What options do I have for getting new coverage?
A few different situations fall under "lapsed," so the right move depends on why:If the plan was cancelled for non-payment of premium:
Most MA plans have a grace period (typically 2-3 months) — check if reinstatement is still possible by paying the past-due premium.
If reinstatement window has passed, you're generally locked out until the next enrollment period (Medicare Advantage Open Enrollment, Jan 1–Mar 31, or the Annual Election Period, Oct 15–Dec 7) — unless a Special Enrollment Period applies (see below).
If the plan was terminated by the insurer or left the market (not your fault):
This creates an involuntary-loss SEP — you can enroll in a new MA plan or Original Medicare + Part D starting 2 months before the loss and up to 3 months after.
This does NOT require waiting for AEP.
If you moved out of the plan's service area:
Also triggers an SEP, similar window as above.
Coverage options once eligible to enroll:
Another Medicare Advantage plan available in the area, or
Original Medicare (Part A + B) + a standalone Part D drug plan, with the option to also add a Medigap policy — though Medigap underwriting may apply outside guaranteed-issue windows in Texas.
I hear about these OTC cards all the time. How much are they worth and how do I get one?
You’ve probably seen a lot of advertisements for “Medicare OTC cards,” but there isn’t one standard Medicare card or dollar amount that everyone receives.An OTC allowance is an extra benefit offered by some Medicare Advantage plans. Medicare.gov confirms that some Medicare Advantage plans cover over-the-counter items that Original Medicare doesn’t cover.
How much is it worth?
There is no universal amount. The allowance depends on the specific Medicare Advantage plan available where you live. Some plans provide an allowance monthly, while others provide it quarterly. The amount, the products you can purchase, where you can use the benefit, and whether unused funds carry over are all determined by the individual plan.
Depending on the plan, covered items might include things such as pain relievers, first-aid supplies, vitamins, cold medicines, dental-care products, and other approved health-related items.
How do you get one?
You generally get the benefit by enrolling in a Medicare Advantage plan that includes an OTC allowance. It is not a separate benefit that you apply for through Social Security or Medicare.
Some Special Needs Plans may also provide additional supplemental benefits to people who meet certain eligibility requirements.
One caution: I would never recommend choosing a Medicare Advantage plan just because it advertises a large OTC allowance. Your doctors, hospitals, prescriptions, copays, maximum out-of-pocket amount, pharmacy network, and other benefits are much more important.
The OTC benefit can be helpful, but it should be looked at as one piece of the plan... not the reason you choose it. I can help you compare the plans available in your area and see which ones include an OTC benefit while still making sure your doctors, prescriptions, and overall costs fit your needs.
How is January through March Medicare Advantage Open Enrollment different from the October through December Enrollment period?
October 15–December 7 is Open Enrollment.You can:
- Switch from Original Medicare to Medicare Advantage.
- Switch from Medicare Advantage back to Original Medicare.
- Change Medicare Advantage plans.
- Join, change or drop a Part D prescription-drug plan.
Changes generally begin January 1.
January 1–March 31 is Medicare Advantage Open Enrollment.
This period is only for people already enrolled in Medicare Advantage. You can make one change:
- Switch to another Medicare Advantage plan, or
- Return to Original Medicare and, if needed, join a Part D plan.
You cannot use this period to move from Original Medicare into Medicare Advantage or change a stand-alone Part D plan while remaining in Original Medicare. Changes generally begin the first day of the following month.
How can I find out what a test or procedure will cost me before I have it done?
If you have Medicare, you can often get a good idea of your cost before a test or procedure — but you need to know exactly what is being ordered.Start by asking the doctor’s office for the name of the procedure and the billing code, usually called a CPT or HCPCS code. Also ask where it will be performed and whether it will be considered inpatient or outpatient. Those details can change what you pay.
If you have Original Medicare, use Medicare’s Procedure Price Lookup to see estimated costs for many outpatient procedures: Medicare Procedure Price Lookup. You can search by the procedure name or billing code.
If you also have a Medicare Supplement, it may pay some or most of what Original Medicare leaves behind.
If you have a Medicare Advantage plan, call the plan with the procedure code, doctor’s name and facility. Ask what your copay or coinsurance will be, whether everyone involved is in-network, and whether prior approval is required.
One more important question: Will there be separate bills? A procedure can involve the facility, surgeon, anesthesiologist, radiologist or pathology lab.
The goal is to know the procedure, the providers involved, and your expected out-of-pocket cost before the procedure is done.
I live near New Orleans and see doctors at Ochsner Health. How do I know which Medicare Advantage plans they accept?
Start with Ochsner Health’s list of Medicare Advantage plans it accepts. Ochsner publishes this information for Louisiana, which gives you a good starting point.Then make a list of the Ochsner doctors and facilities you actually use — your primary doctor, specialists, and the hospital you would want if you needed surgery or were admitted.
That second step matters because Ochsner specifically notes that not every facility accepts the same insurance plans.
Once you know which Medicare Advantage plans are available at your home address, look for the plans that also include all of those Ochsner providers.
Then verify it both ways: check the exact plan’s provider directory and confirm with the Ochsner doctor’s office that they participate with that specific Medicare Advantage plan.
Don’t stop at “Ochsner accepts this insurance company.” The exact plan, doctor and facility all need to line up.
The goal is to find a plan available where you live that keeps the Ochsner doctors and hospitals that matter to you.
My doctor is with Atrium Health. How can I find out which Medicare Advantage plans they take?
Start with the exact Atrium Health doctor and location you want to keep.Atrium Health participates with a number of Medicare Advantage plans, but not every doctor, hospital or plan is necessarily included in every network. Plan availability can also vary by county.
I would verify it two ways.
First, check the Medicare Advantage plan’s provider directory or call the plan and ask whether your specific doctor and preferred Atrium hospital are in-network.
Then call the doctor’s office and confirm the same thing from their side. Don’t simply ask, “Do you take Medicare Advantage?” Give them the exact plan name you are considering. Atrium Health recommends checking both the health plan and the doctor’s office before enrolling.
If you see specialists, check them too. A plan is not a good fit just because your primary care doctor is in-network if the cardiologist, surgeon or hospital you rely on is not.
The safest approach is to verify the doctors and hospitals that matter to you before choosing the plan, not after the coverage starts.
I’m a retired Illinois state employee. How does my state retiree Medicare Advantage coverage work?
If you are a Medicare-eligible retired Illinois state employee, your retiree coverage is generally provided through TRAIL — Total Retiree Advantage Illinois.TRAIL is a state-sponsored Medicare Advantage Prescription Drug PPO plan. To participate, you must be enrolled in Medicare Parts A and B, and you continue paying your Medicare Part B premium.
Once TRAIL begins, the plan handles your hospital, doctor and prescription claims instead of Original Medicare. It combines your Part A, Part B and Part D prescription coverage into one retiree plan. Vision coverage is also included, with dental available separately.
The PPO is somewhat different from many traditional Medicare Advantage networks. You may generally see any provider who participates in Medicare and accepts the TRAIL plan, and the 2026 plan uses the same member cost-sharing whether that provider is in or out of the plan’s network.
Your share of the retiree premium depends in part on your years of state service. For 2026, retirees with 20 or more years of qualifying service receive the medical, prescription and vision portion without a retiree premium, while retirees with fewer years contribute toward the cost.
The simplest way to think about it is: you keep Medicare Parts A and B, but TRAIL becomes the plan you use for your medical and prescription coverage.
Where can I attend a free Medicare education workshop near me?
There are several good places to start. Medicare.gov is a great resource for general Medicare information and comparing plans available in your area.For information that may be more specific to where you live, such as Fresno or Madera, I also recommend looking for local community Medicare education events. Many independent Medicare agents host events, especially during this annual enrollment period (AEP). Eventbrite is an easy place to start — search for “Medicare Education,” “Welcome to Medicare,” or “Medicare 101” along with your city.
Local workshops can be especially helpful because Medicare Advantage plans, provider networks, and available benefits can vary by county and service area.
Just be sure to check whether the event is an educational Medicare workshop or a sales presentation for a specific insurance carrier. I recommend starting with an education event.
Can I have a Medicare Advantage plan if my doctor is with United Health Centers in Fresno?
As of September 22, 2026, United Health Centers of the San Joaquin Valley states that it accepts Medicare and most insurance plans. However, that does not mean every United Health Centers doctor or Fresno location participates with every Medicare Advantage plan.Start with the United Health Centers doctor and location you want to keep and ask which specific Medicare Advantage plans they currently participate with.
Then look at which of those plans are available at your home address.
Once you have that shorter list, verify your doctor again in the exact plan’s provider directory. If you use specialists or have a preferred hospital, check those too.
Do not stop at “United Health Centers accepts Medicare” or “they take this insurance company.” With Medicare Advantage, the exact plan, doctor and location all need to match.
The best order is: keep the doctors you want, find the plans that include them, then compare those plans for prescriptions, costs and benefits.
What happens to my Covered California plan when I turn 65?
When you become eligible for Medicare at 65, your Covered California plan does not automatically turn into Medicare or automatically cancel. You need to coordinate the transition.If you qualify for premium-free Medicare Part A, you generally will no longer qualify for the financial help or premium tax credits that were lowering the cost of your Covered California plan.
The most important rule is: do not cancel your Covered California coverage until your Medicare enrollment has been approved and you have confirmed your Medicare effective date.
Once that date is confirmed, contact Covered California and have them schedule the Marketplace coverage to end so it transitions directly into Medicare without a gap in coverage.
Covered California recommends reporting your Medicare eligibility promptly and giving them advance notice when ending the plan.
If your spouse or other family members are younger than 65, they may be able to remain on Covered California even though you are moving to Medicare.
The goal is simple: confirm Medicare first, then coordinate the Covered California end date carefully so one coverage hands off to the other without leaving you uninsured.
I have PERS Providence Medicare through year-end and must choose between UnitedHealthcare and Moda Connexus. Which do you recommend?
I cannot recommend one over the other without first knowing more about certain key variables unique to you. I want to ensure my recommended plan covers all your needed prescription medications. I'd also want to verify that your most-needed doctors and preferred hospitals were participating providers in the recommended plan. Then, and only then, would I recommend a particular plan.
My Medicare Advantage plan with UHC has been closed and will not be available next year. Can I switch to enrolling in a Medicare Supplemental plan for 2027 without having to pre-qualify
It’s called a plan exit, and yes, you can get a guaranteed issue Medicare Supplement without having to qualify medically. Generally, when your Medicare Advantage plan is discontinued in your area, you have the right to enroll in certain Medicare Supplement plans without answering health questions. You’ll need to return to Original Medicare, and there are specific deadlines to take advantage of this opportunity.I’m 68 with Medicare and a HealthSpring supplement, and my new employer offers company-paid insurance. Can I keep all three to cover gaps or doctors outside one plan’s network?
To begin with HealthSpring is a Medigap plan. Both Medicare, itself, and Medigap plans have no networks, per se. You can visit any provider who accepts Medicare. That said, you should begin by examining whether, or to what extent, your providers lie outside of the network for your company plan. If that is minimal, then it may not be worth continuing to pay both Part B and Medigap premiums - which could easily exceed any higher copays you might encounter. However, the other issue - which I woujd need to research further - is whether you can have coverage by the group plan, Medicare and Medigap. You can have Medicare as the secondary payer behind your group plan, but that may be all.
A corrected 1099 and amended tax return moved my inherited IRA income from 2023 to 2024, when I actually received the funds. How can I get my Medicare premiums reduced after paying over $700 a month since 2024?
Yes. If the corrected 1099 and amended tax return establish that the inherited IRA distribution was reported in the wrong tax year, you may have a strong basis for asking Social Security to recalculate your Medicare IRMAA premiums—and potentially make the correction retroactive.The key is to distinguish an IRS correction/amended return from simply saying that your income was lower. Social Security has specific procedures for amended and corrected tax information.
My Medicaid ends when I’m outside the U.S. for over 30 days, leaving me to pay Medicare Part B premiums on Social Security retirement income alone. Is there a plan that covers those premiums while I’m abroad?
Yes—but not usually through a Medicare Supplement (Medigap) policy. The key distinction is between a plan that pays your Part B premium and a plan that covers medical care while you’re abroad.Medigap generally does not pay your monthly Part B premium. You must continue paying Part B to keep the Medigap policy.
Certain Medicare Advantage plans may offer a Part B premium reduction (“giveback”), but you generally must live in the plan’s service area and remain enrolled according to the plan’s rules. Simply being abroad doesn’t make the plan pay your premium.
If your income and resources are limited, the Medicare Savings Programs may be a better solution. Programs such as SLMB and QI can pay the Part B premium. Eligibility is determined by your state.
For the medical expenses you incur overseas, Original Medicare generally provides very limited coverage outside the U.S. Some Medigap policies—particularly Plans C, D, F, G, M and N—include foreign-travel emergency coverage, subject to limitations.
So, if your primary concern is “How can I keep my Social Security check from being reduced by the Part B premium while I live/travel abroad?” the first thing to investigate is a Medicare Savings Program or, depending on where you live and your eligibility, a Medicare Advantage plan with a Part B giveback.
I turn 65 in January 2027, have disability Medicare with an ESKD C-SNP in Indiana (47331), and am awaiting a kidney transplant. I need coverage for out-of-pocket costs and post-transplant medications, including immunosuppressants, plus an O+ or O- kidney donor.
Turning 65 is your golden opportunity to get the best coverage available through a Medicare Supplement Plan G without any medical underwriting. (Your health problems won’t keep you from getting the best plan available at the preferred rate!) Enrollment is available now for a supplement. You can also enroll in any drug plan that will cover the medications you need; however, you can also get your provider to write a pre-authorization letter if necessary for drugs Medicare may not initially cover. You can enroll in your drug plan 90 days before your 65th birthday. A qualified Medicare agent can help you with the options, enrollment process, timing, and may even help you with future plan changes. Call me if you need someone in your corner!
Do I need long-term care insurance if I already have Medicare, and what age should I buy it?
Medicare is not a replacement for long-term care in a nursing home. Medicare will pay a portion of the cost in a NH for a short time of 21 days. This is rehab or care to return to normal daily living after surgery. Yes, if you want protection for the cost of LTC, indeed the purchase of a policy will help to cover some or all of LTC expenses.Does Medicare cover podiatrist visits and routine foot care like toenail trimming?
Original Medicare does not cover routine foot care. For any foot care to be covered by Original Medicare, it would need to be classified as medically necessary like an injury or infection. If you have a high-risk systemic condition, that, too, would be considered medically necessary. If this is something that you are looking for in your health coverage, some Medicare Advantage plans offer this extra coverage.Humana covered six months of Spravato treatment in 2026 at no cost because of my low income. Will it sharply increase my Plan G premium even though I no longer need treatment?
I have good news for you: no. You can breathe easy on this one.Medicare Supplement (Medigap) plans like Plan G cannot raise your individual premium because of the care you used. Your claims history, whether it was Spravato treatment, a surgery, or anything else, does not get priced into your personal premium, and the company cannot single you out for a rate increase or cancel your policy because you needed treatment. That's true regardless of the condition treated.
Medigap premiums do go up over time, but those increases apply to everyone in the same plan class in your area (based on things like overall claims across the whole pool, inflation, and in some pricing structures, age). If your premium rises next year, it will rise the same way for every Plan G member in your group, not because of your six months of treatment.
One more reassurance: using your benefits is exactly what they're for. You paid your premiums; the coverage did its job.
And since you mention qualifying for help due to low income: make sure whatever assistance you receive (like a Medicare Savings Program or Extra Help) stays active by completing any renewal paperwork your state sends. Those programs renew periodically, and keeping them current protects your costs going forward.
I'm glad the treatment is behind you and that it was covered. If you ever want a free review of how all your pieces fit together, that's what agents like us are here for.
Are $0 premium Medicare Advantage plans really free?
No. A $0 premium Medicare Advantage plan does not mean your healthcare is free.You generally still pay your Medicare Part B premium — $202.90 per month in 2026 — and you may have copays and coinsurance when you use medical care.
Here is an example.
Suppose someone is diagnosed with cancer in October and has a $0-premium Medicare Advantage plan with a $7,000 in-network maximum out-of-pocket limit. Chemotherapy can involve significant cost-sharing, including 20% coinsurance in some situations.
If that person reaches the $7,000 out-of-pocket limit by the end of December, the plan generally pays 100% of covered in-network medical costs for the rest of that calendar year.
But on January 1, the out-of-pocket limit resets.
If chemotherapy continues and the person reaches another $7,000 in the new year, that is $14,000 in medical out-of-pocket costs across two calendar years.
Now compare that with this illustration:
Plan G: $200 per month
Part D: $50 per month
Part B: $202.90 per month
Over 24 months:
Plan G: $200 × 24 = $4,800
Part D: $50 × 24 = $1,200
Part B: $202.90 × 24 = $4,869.60
Total: $10,869.60
The $0-premium Medicare Advantage example:
Plan premium: $0
Part B: $4,869.60
Medical out-of-pocket costs: $14,000
Total: $18,869.60
These numbers are for illustration only. Actual Medicare Advantage cost-sharing, Medigap premiums, drug-plan premiums, prescriptions, and other costs vary.
The point is simple: $0 premium does not mean $0 cost. A Medicare Advantage plan may have no additional monthly premium, but it definitely is not free.
What are the five biggest differences between my former BC/BS JY Plan and my current HealthSpring Medicare Advantage plan?
Great question, though I'll be upfront: the honest answer depends on the exact documents of both plans, and those details deserve a one-on-one review rather than a public post. What I can give you are the five biggest structural differences people typically find when they move from an employer or retiree group plan from their working years to a Medicare Advantage plan:1. Networks. Group retiree plans often let you see almost any provider. Medicare Advantage plans work with a network, and staying in it is what keeps your costs low, so the first thing to verify is that your doctors and hospitals are in-network.
2. How you pay. Group plans often use deductibles and coinsurance; Advantage plans typically use fixed copays per service, plus an annual maximum out-of-pocket limit that caps your worst-case year, something Original Medicare alone doesn't have.
3. Prior authorization. Advantage plans more often require approval in advance for certain services, procedures, or equipment. It's manageable, but it's a change in how things flow.
4. What's bundled in. Most Medicare Advantage plans combine medical and drug coverage in one card, and many include extras like dental, vision, hearing, or fitness benefits. Check your own plan's materials to see exactly what yours includes.
5. Who runs the rules. Your old plan answered to your former employer's contract; Medicare Advantage plans operate under Medicare's rules, which means annual changes arrive every fall in the plan's Annual Notice of Change: always read it, because benefits and costs can shift each year.
If you'd like, I can sit down with both plans' documents and map the differences line by line for your specific situation; that review is free, and it's the only way to answer your question with real numbers instead of generalities.
How do I find a Medicare agent licensed in both Colorado and Florida who can help snowbirds choose a Medicare Supplement plan?
You do not necessarily need an agent who physically lives in both Colorado and Florida. You want an independent Medicare agent who is licensed in both states and understands snowbird Medicare planning.Here are a few good places to look:
Medicare Agents Hub: Search by your ZIP code or state and review agent profiles. Profiles can show the states an agent serves, which makes it easier to look for someone licensed in both Colorado and Florida.
NABIP Find an Agent: The National Association of Benefits and Insurance Professionals has a directory where you can search by ZIP code and select Medicare as the agent’s practice area.
Google: Try searches such as “independent Medicare broker licensed in Colorado and Florida” or “snowbird Medicare Supplement agent Colorado Florida.” Look beyond the advertisements and read the agent’s website, reviews, and biography to see whether they regularly work with people who live in two states.
Ask for referrals: Friends who are snowbirds, financial advisors, CPAs, retirement planners, or other professionals who work with retirees may know an agent who already handles this type of situation.
Once you find two or three candidates, ask:
Are you currently licensed in both Colorado and Florida?
Do you regularly work with snowbirds?
How many Medicare Supplement companies can you compare?
Will you also review my Part D coverage and pharmacies in both states?
If I later change my permanent residence from one state to the other, can you help me understand what changes?
Then verify the licenses yourself. Colorado provides an insurance-producer license lookup through Sircon, and Florida provides a Licensee Search through its Department of Financial Services.
Finally, remember that your Medicare Supplement is generally based on your primary residence. You do not need separate Supplement policies for Colorado and Florida. With Original Medicare, you can generally use Medicare-participating doctors nationwide.
Can I lose my Medicare coverage if I fall behind on my premiums?
Yes, you can. How fast it happens depends on which part of your coverage you fall behind on.Part A and Part B: If your premiums come out of your Social Security check, you don't have to worry about this. If you pay Medicare directly by bill, you'll get a second bill and then a delinquency notice. If you still haven't paid by the date on that notice, your coverage ends. Getting it back usually means waiting for the General Enrollment Period (January 1 to March 31). You could have a gap in coverage and might owe a late enrollment penalty too. If you had a good reason for missing the payments, like a serious illness, you can ask Medicare to reinstate you.
Medicare Advantage and Part D plans: Plans must give you a grace period before they drop you, so read any letters from your plan carefully. If you're dropped from an Advantage plan, you go back to Original Medicare, but you could lose your drug coverage. Being without drug coverage can lead to a Part D late penalty. You usually can't join another plan until the next enrollment period.
Medigap: Most policies have a short grace period of about a month. After that, the policy can be canceled. Getting a new one later may mean answering health questions, and you could be turned down.
If money is tight: Look into a Medicare Savings Program before you miss a payment. If you qualify, your state may pay your Part B premium. Extra Help can lower your Part D costs. Even if you don't qualify, call your plan or Medicare as soon as you know you'll be late. It's much easier to fix before the coverage ends than after.
How do the Medicare Advantage plan call centers get my number? How can I stop them from calling me?
You're far from the only one dealing with this, especially if you're turning 65 or it's enrollment season.How they get your number:
You responded to an ad. TV commercials, online quote forms, and "see what benefits you qualify for" websites are often run by lead-generation companies. When you call or fill out the form, the fine print usually lets them share your information. Then it gets passed or sold to call centers and agents.
Mailers and surveys. Return cards, sweepstakes, "free" offers, and health surveys can collect your number for marketing.
Data brokers. Companies build "turning 65" lists from public records and consumer data and sell them to marketers.
The call isn't coming from Medicare. Medicare won't call you out of the blue to sell you a plan, and legitimate plans and agents aren't allowed to cold call you about Medicare Advantage or Part D.
How to stop the calls:
Join the National Do Not Call Registry at donotcall.gov or 1-888-382-1222. Legitimate companies honor it, but scammers won't.
Ask each caller to put you on their company's do-not-call list. They're required to honor that request. Write down the company name and date.
Don't press 1 to "opt out" on robocalls. That usually just confirms your number is active.
Be careful with ads and online forms that ask for your phone number to "check your benefits."
Turn on call blocking through your phone carrier or a call-blocking app.
Report persistent or shady callers to the FTC at reportfraud.ftc.gov, and to 1-800-MEDICARE if they claim to represent Medicare.
The best protection: Never give your Medicare number, Social Security number, or banking information to someone who called you. If you want help with your coverage, reach out yourself to an agent or plan you've chosen and trust.
I moved to a different parish in Louisiana. Can I keep my Medicare Advantage plan, or do I need to choose a new one?
Maybe. The first thing to find out is whether your current Medicare Advantage plan is offered in your new Louisiana parish.Medicare Advantage plans have specific service areas. Moving to another parish does not automatically mean you have to change plans, but you should not assume your current plan follows you either.
Start with a few questions:
Is your exact Medicare Advantage plan available at your new address?
Are your current doctors and hospitals still in the plan's network from your new location?
Did the move give you different Medicare Advantage or prescription drug plan choices?
And are you planning to keep the same doctors, or will you be establishing care closer to your new home?
If your current plan is available in the new parish, you may be able to keep it. I would still review the provider network and prescriptions before deciding to stay.
If your current plan is not available at your new address, the move gives you a special opportunity to choose new coverage. You can generally select another Medicare Advantage plan available in your new area, or you can return to Original Medicare. If you tell your plan before you move, that opportunity can begin the month before the move and continue for two full months afterward. If you have already moved, it generally continues for two full months after the move.
There is another option that is easy to overlook.
If you move outside your Medicare Advantage plan's service area and decide to return to Original Medicare instead of joining another Medicare Advantage plan, you may have a special federal right to buy certain Medicare Supplement plans without being turned down because of your health. There are time limits on that protection, so it is worth looking at before automatically choosing another Advantage plan.
If you return to Original Medicare, remember that you will also need to think about prescription drug coverage because a Medicare Supplement does not include Part D.
I live in Jefferson Parish but see doctors in Orleans Parish. Can I choose a Medicare Advantage plan that covers providers in both areas?
Yes. You can live in Jefferson Parish and choose a Medicare Advantage plan that includes doctors and hospitals in Orleans Parish.Your home address determines which Medicare Advantage plans you are eligible to enroll in. But a plan's provider network can extend beyond the parish where you live.
Start with the doctors and hospitals you want to keep in Orleans Parish. Then look for Medicare Advantage plans available at your Jefferson Parish address that include those providers in-network.
If you are considering an HMO, this is especially important because routine care generally needs to stay within the plan's network. A PPO may give you more flexibility to use out-of-network providers, but you will usually pay more.
Before enrolling, verify your primary doctor, specialists and preferred hospital with the exact plan. Do not assume that because a plan includes one doctor in Orleans Parish, it includes the entire health system.
The goal is to find a plan available where you live that also works where you actually receive your care.
I’m turning 65 in North Carolina. When should I start looking at my Medicare options?
I would start learning about Medicare about six months before you turn 65.That may sound early, but there is more to look at than just finding a plan. You want time to understand how Medicare works, decide between Medicare Advantage and Original Medicare with a Medicare Supplement, check your doctors and hospitals, review your prescriptions, and think about what you could pay out of pocket.
About three months before you turn 65, you can begin the actual Medicare enrollment process. Starting earlier gives you time to learn first and make decisions second instead of trying to do everything at once.
If you are still working and have employer health insurance, start the conversation about six months ahead anyway. Whether you should enroll in Medicare at 65 can depend on how that employer coverage works, so don't assume you should automatically enroll — or automatically delay it.
A good rule of thumb is simple: start planning about six months before 65, and be ready to begin the enrollment work about three months before your birthday.
I spend part of the year in Illinois and part of the year in Florida. Should I choose an Illinois HMO or PPO?
If you spend several months each year in Florida, I would be very careful about choosing an Illinois HMO.With most HMOs, routine care needs to stay inside the plan's network. Emergency and urgent care while you are in Florida would generally be covered, but regular doctor visits and follow-up care may not be.
A PPO usually gives you more flexibility because you can go outside the network, although you may pay more. But don't assume that every doctor in Florida will accept your Illinois PPO. That needs to be checked before choosing the plan.
If you regularly see doctors in both Illinois and Florida, I would also compare the PPO to Original Medicare with a Medicare Supplement. That combination can give you much more freedom to use doctors who accept Medicare across the country.
One other thing to watch is how long you are away from your permanent Illinois home. Some Medicare Advantage plans can have problems if you live outside their service area for more than six months at a time.
If you are spending about half the year in Florida, your coverage needs to be built around that reality from the beginning.
I live in Illinois and have a Medicare Supplement plan. Can I switch to another Medigap plan without going through medical underwriting?
Answering with current data as of September 11, 2026, Illinois gives some Medicare Supplement policyholders a special opportunity to change plans without medical underwriting.If you are between ages 65 and 75, you have a 45-day window beginning on your birthday each year. During that time, you may be able to move to a plan with the same insurance company, or an affiliated company, as long as the new plan has the same or lesser benefits.
The pitfall is thinking this gives you the freedom to switch to any Medicare Supplement company or any plan without health questions. It does not.
Outside of that birthday window, medical underwriting may still apply unless you have another guaranteed-issue right.
Before making a change, make sure you understand exactly what you qualify for. And never cancel your current Medicare Supplement until the new coverage has been approved.
My cardiologist wants me to start cardiac rehab after my heart attack. Does Medicare cover it, and how many sessions do I get?
Before receiving treatment you should always ask your doctor about Medicare coverage and what is included. According to Medicare.gov website "Medicare Part B (Medical Insurance) covers regular and intensive cardiac rehabilitation programs if you're eligible." A heart attack in the last 12 months is one of the eligible conditions, so you qualify as long as you start within that window. Your cardiologist’s referral is the key piece. Make sure to ask your doctor how many sessions will be covered by Medicare to avoid any surprises.I had Medicare Part B for one year, then dropped it when I took a job and re-enrolled a year later. Why was I charged three months of back premiums and a lifetime penalty that I’ve been paying since 2020?
I can’t see your specific records, but a Part B late enrollment penalty applies when you were eligible for Part B and went without it, and without group health coverage based on current employment (yours or your spouse’s), for 12 months or more. Other coverage, like COBRA, retiree plans, or marketplace plans, doesn’t count. If you had qualifying job-based coverage during the gap, those months shouldn’t count toward the penalty, but you’ll need to prove it. Ask your employer’s HR to complete their part of the CMS-L564 form, and submit it to Social Security along with a request to review the penalty. Employer size can matter, so ask SSA whether it affects your situation. The appeal deadline is 60 days from receiving the penalty letter. If that’s passed, you can still ask whether a late request will be accepted for good cause, especially if documentation was missing or you were given wrong information.Can Medicare be taken away once I have it, or is my coverage guaranteed for life?
Once you qualify for Medicare and enroll, you can generally keep it for life as long as you continue to meet eligibility and enrollment requirements. Unpaid premiums, voluntary cancellation, or loss of eligibility can affect your Part A or Part B coverage. Original Medicare is the federal program. Part C (Medicare Advantage), Part D, and Medigap are offered by private insurers. Part C and Part D plans can change or leave an area, and you can generally switch during enrollment periods. Part C plans must cover at least everything Original Medicare covers, though costs, networks, and rules can differ. If you have Medigap with Original Medicare and pay your premiums, you generally have the right to keep it unless you made a material misrepresentation when applying. As always, check Medicare.gov to stay up to date on any changes to the program.Browse Other Questions & Answers
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