Medicare Questions & Answers: Coverage
Coverage Q&A
Showing 255 questions
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?
Having good, reliable doctors that you trust is really important. When looking into an Advantage plan, the first thing to consider is if a doctor is "in network". When a doctor is "in network" it means that the plan will cover those visits. If a doctor is "out of network" you will not be covered by the plan. When I meet with a person, I have a system that will narrow down plans that each doctor is covered by so that we can ensure the best coverage and benefits which is unique to each individual.
How can I get dental and vision coverage with Medicare?
Medicare does not cover dental and vision however you can get those options with some of the Medicare Advantage plans that are available.
Am I eligible for a Special Enrollment Period if I lose employer coverage?
Yes, you may be eligible for a Special Enrollment Period (SEP) if you lose your employer health coverage. This SEP typically lasts for 8 months following the loss of your coverage, allowing you to enroll in Medicare without facing penalties. It's important to inform Medicare of your loss of coverage to ensure a smooth enrollment process
I just moved to a new state. Do I need to do anything with my Medicare coverage?
Yes, you will have 60 days to make a change upon arrival into your new state. This will vary by the type of plan you are enrolled in. Consult with an agent to avoid any penalties and missing deadlines.
Is Medicare Part A enough for hospital coverage?
Part A covers hospital stays, but it is not always enough on its own. Most people need more than Part A.Consider Part B, covers Doctors, outpatient services and diagnostic testing.
Consider Medicare Supplement or Medicare Advantage, Part C.
Consider part D, prescription drugs.
I thought I was covered during my snowbird months in Florida, but apparently not. What kind of plan do I actually need for that?
You actually have several options. Sounds like you have a HMO Advantage plan where you live. One option would be to stay on original Medicare with a supplemental plan. That would allow you access to any provider that accepts Medicare across the country. Another option would be a PPO Medicare Advantage plan if its available in you area. Several national carriers have network providers across the nation and would also provide coverage out of network.
Does Medicare cover hearing aids, or do I have to pay out of pocket?
No, some advantage plans do offer this coverage though in the form of free exams and copayments for the aids themselves. Costco and Sams also offer free exams and discounted aids.
I picked a Medicare Advantage plan based on the low premium, but now I'm facing high copays. Did I make a mistake?
I'm worried about the 'donut hole' in my Part D plan. How do I manage my medication costs once I enter it?
The doughnut hole was eliminated in 2005 by the Inflation Reduction Act. The maxumum out of poket is now $2000. After you reach the $2000 limit your covered Medication will be a zero cost share. Also, you can request to make monthly payments on the $2000.
Does Medicare cover eye exams, or are seniors left paying too much?
Original Medicare (Parts A and B) doesn't cover routine eye exams for glasses or contact lenses, it does cover certain eye exams and treatments related to specific conditions like glaucoma, diabetic eye disease, and macular degeneration, as well as cataract surgery. Some Medicare Advantage plans do however give the extra benefit of eye exams and glasses.
I just moved from New York to Florida and have Original Medicare with a New York Medigap plan. Do I need to change my coverage?
No, you will simply be re-calculated at the Florida rate. You may however, want to look at the Medicare Advantage plans in Florida as they are some of the most cost effective Medicare Advantage plans in the nation.
What does Medicare Part B cover? Is it enough?
After a $257 deductible (in 2025), part b covers 80% of most medically necessary services when using a doctor or facility that accepts medicare assignment. Some places may charge 15% more, but still accept Medicare patients. You or your supplement would be responsible for the excess charges.
I picked the plan with the lowest premium, but now every doctor visit feels like a surprise bill. Should I have gone with a higher premium instead?
There are many factors to consider when choosing your plan: network available in your geography, accessibility of providers & current health conditions. It’s not as easy to evaluate a plan based off premium unload. One needs to evaluate the big picture when choosing a plan.
My Medicare Advantage plan covers dental, but I can't find a dentist who accepts it. Is this a common problem?
Yes, not all plans use the same carrier for dental, and some differ between HMO and PPO. However they all have a provider search tool that we can assist with.
My friend lives in a different city and has a much more detailed Medicare plan. Is their plan dependent on their location?
There should be little to no difference in coverage between traditional Medicare Part A and B and with a Medigap plan. Of course, some states require a few extra details in the Medigap plans, such as prevented care items.Medicare Advantage plans differ in some ways in providing requirements and services within and between states. These decisions are not Medicare decisions. They are based on the insurance carriers that provide these Advantage plans and the individual state regulations.
Which Medicare Supplement plan (Medigap) offers the best value for most seniors, and why?
Plan G is usually the best value for most seniors. It covers almost everything except the Part B deductible, making it a solid choice for predictable costs and great coverage. It’s popular because it offers the most benefits without the high premiums of Plan F. (Which is only available for those eligible for Medicare before 1/1/2020) Plus, once the deductible is paid, there are no copays or surprise bills.
I picked a PPO for the flexibility, but now every time I go out of network the bills are outrageous. What's the point of even having a PPO?
I totally understand your frustration!Having a PPO (Preferred Provider Organization) plan is supposed to give you flexibility and freedom to choose your healthcare providers, both in-network and out-of-network. But, when the out-of-network bills start piling up, it can be overwhelming.
The point of having a PPO is to have access to a wider network of providers, including specialists, without needing a referral. However, it's essential to understand that out-of-network care usually comes with higher costs.
To avoid surprise medical bills, it's crucial to:
- Carefully review your PPO plan's network and coverage
- Verify the network status of your healthcare providers
- Understand the out-of-network costs and billing procedures
If you're feeling overwhelmed or unsure about your PPO plan, I'm here to help!
As a licensed health insurance broker, I can guide you through the complexities of Medicare and health insurance. Let's work together to find a solution that fits your needs and budget.
Call me today to schedule a consultation. Let's navigate the healthcare system together and find a plan that gives you the flexibility and affordability you deserve!
Will my Medicare plan work when traveling to Europe?
Now, if you have Medicare Advantage, most Medicare Advantage plans have better coverage than the foreign travel rider you can get with a Medigap plan. Still, with an Advantage plan, typically there’s no deductible. Your plan will usually, not all plans, but most will pay 100% of your emergency care. Now, if you're admitted to the hospital following an emergency room visit, then everything changes. So, work with your agent. Consider getting a separate foreign travel plan. Even if you have Medicare Advantage, where the coverage is generally better than the Medicare supplement plans with the rider, work with your agent. A good, qualified, experienced, independent agent would be the way to go. I can think of at least one person who can help you with this.
I have multiple medications; how can I ensure my Medicare Part D plan covers them all without breaking the bank?
medicare.gov has a public website allowing you to input your Rx list including name of drug, milligrams and dosage. Then key in your pharmacy preference to see which Medicare Part D plan will give you the best bang for your buck.I just got a $300 bill for an ambulance ride I thought was covered. Am I the only one who didn't know Medicare doesn't pay for all emergency transport?
Medicare does pay for covered ambulance service but certain criteria must be met. There is a $257 Annual deductible for all medical costs that must be satisfied and a 20% coinsurance on all ambulance services. Consult with a licensed agent to find out what the criteria is that you have to meet in order for it to be a covered service. Supplement/MediGap pland and Advantage plans include coverage for Ambulance services as well.
I changed my plan during Open Enrollment and now I can't see my regular specialist. Isn't this what the whole review period is supposed to prevent?
The agent should have checked all of her doctors before they switched their policy. The client should of been aware of all of the benefits the new policy afforded her.
Is paying for a high-end Medicare Supplement plan really worth it, or is it overkill?
The answer depends on your specific situation. In general, Medicare pays for approximately 80% of your medical expenses, not including deductibles. The high-end Medicare Supplement plans pick up nearly all of the remaining 20% (in the case of the Plan G, you pay one small deductible.) Depending on the procedures or extent of care, this could still be a large financial liability. So, each person must decide if the premium for these plans is worth the potential risk of incurring even this portion of any medical bills. For many of my clients, paying this premium gives them the peace of mind that those bills will be covered, if and when they need them, even if they don't need a lot of care at this time. To balance out this premium cost, Medicare Supplement plans give you the freedom to go to any Medicare provider in the whole nation. If you reside in a different state for several months out of the year, Medicare Supplement plans suite well. The flexibility and peace of mind of Medicare Supplement plans may be worth the premium cost.
I picked a Medicare Advantage plan last year, and I'm not sure if my hearing aids are covered. How do I figure this out?
1. Call the member services phone number on the back of your card, and inquire as to how the hearing aid benefits work with your specific Advantage plan.2. or, call the Agent/Broker who helped you enroll in the Advantage plan. He or she should be able to give you the main points of the hearing aid benefits and then point you to phone numbers for third party contractors who provide the hearing aid benefits to this plan.
3. or, obtain the EOC (Evidence of Coverage) pdf document that outlines in detail how all the benefits work, for your plan.
My Medicare Advantage plan listed my doctor, but now they say he's out of network. How is that even allowed?
That can be frustrating! Medicare Advantage plans typically have contracts with specific networks of doctors, hospitals, and other healthcare providers. However, sometimes these contracts change throughout the year. Even if your doctor was in-network when you enrolled in your plan, they might have been removed from the network later due to changes in the insurance company’s agreements or policies.Unfortunately, this can happen, but you do have some options.
My friend gets SilverSneakers with her plan and I don't-how are we both paying for Medicare and getting such different stuff?
SilverSneakers and other fitness programs are benefits usually provided with the Medicare Advantage plans. Even though both of you are on Medicare, there is a difference in the plans you enrolled in.The fitness programs are not included with Medicare Supplement plans or in Original Medicare Part A & B. To receive that benefit, you would need to sign up for a Medicare Advantage plan with the fitness benefit included.
I'm on Medigap Plan G, and I'm curious how my upcoming knee replacement surgery will be billed. Does the plan cover it all after my deductible?
Yes. As long as the facility where you have the surgery accepts Medicare assignment, you will only be responsible for the Part B annual deductible ($257 for 2025). Once you pay the Part B annual deductible, Medicare will pick up 80% of the remaining bill, and your Medigap Plan G will pick up the other 20%.I've been on my employer's health plan but am retiring soon. What should I consider when moving to Medicare?
First and foremost enroll in both Part A and B if you havent already done so.Make a list your important doctors and prescriptions. Contact an independant agent that works with many if not all of the carriers and different types of plans ie Med Sups, Medicare Advantage, Prescription Drug plans to narrow down your options for you. While you can find most of this information independently, what you wont find is the detailed information that can make a difference in your coverage. Especially in 2025 with the significant changes in ALL of the prescription drug plans. You can start the rieview and application process as early as 3 months before needing it in place...
Focus on actual care thats needed now and will happen in the future.. One of those calls I get from time to time starts with "remember that plan we talked about, I should have listened to you instead of goin out on my own" There's no cost in working with an independant agent, there could be a significant cost in not doing so..
Can Medicare pay for my groceries?
Medicare itself doesn’t pay for groceries—Original Medicare sticks to medical coverage and doesn’t touch stuff like food benefits. But I’ve noticed more Medicare Advantage plans stepping up with ancillary extras, like grocery allowances, built into many options now, especially for folks with specific health needs. It’s not universal, though—depends on the plan and if you qualify, so you’d need to check what’s offered where you are.My friend said she got a free annual physical with Medicare, but my doctor billed me. What's going on?
Medicare does not provide annual physicals; these are called wellness exams. If the doctor bills it as a physical, you will most likely pay 100%. However, if you have a Medicare Advantage plan, it may be covered as an annual physical under your policy coverage. All Medicare Advantage plans are different, and their coverage for these items varies; check your policy.Under traditional Medicare Part A and B, you can receive a yearly wellness exam. Talk to your doctor about the upcoming exam and what it entails.
What should I do if I find out that my preferred hospital isn't in-network with my Medicare Advantage plan?
You can go to any doctor or hospital with Medicare Advantage. Although, there have been instances where a hospital drops the Medicare Advantage plan. You can switch plans during Medicare Advantage open enrollment. If you can't find another plan to switch to, you could return to Original Medicare and you could also pair Original Medicare with Medigap.
If I need long-term care in the future, how does Medicare fit into that plan, and what should I be doing now to prepare?
This is a great question and I am pleased to hear that you are thinking about this proactively.Unfortunately, Medicare does not cover long-term care, such as your stay in a nursing/retirement home or having someone come to your own home daily for custodial care (bathing, dressing, feeding, ect.).
You should consider discussing a Long-Term Care policy with your agent/broker.
One thing to note is that as you age, these policies become more expensive. In many cases, people faced with the situation to enter Long-Term care may have to apply for Medicaid in order to receive any financial assistance or cover their costs. In some cases, extended family members may be able to contribute, however it can end up being a hefty financial burden.
My Medicare Advantage plan advertised dental coverage, but it barely covers anything. Is this normal?
While many Advantage plans vary between networks and carriers, it's important to note that some can offer substantial coverage, and I’ve seen some reaching up to $1,700 per year for dental services. The type of coverage depends on whether it’s root canals or plain fillings, and that needs to be considered. However, it's essential to recognize that these plans may not be as comprehensive as standalone dental plans. Verify that your dental clinic is within the plan’s PPO or HMO network to maximize your benefits. This ensures you receive maximum benefits.
Why might Original Medicare with a Part D plan be better than a Medicare Advantage plan for frequent travelers?
Original Medicare combined with a Part D prescription drug plan offers flexibility, nationwide access, and consistent coverage, making it an excellent choice for frequent travelers. Unlike Medicare Advantage plans, which are often geographically limited and depend on specific provider networks, Original Medicare with Part D ensures you can access care and prescriptions anywhere in the United States without restrictions.
I'm on Original Medicare with no supplement, and I'm wondering how much I'd pay if I need an ambulance ride to the hospital tomorrow.
You will have a charge of the Part B deductible first which as of 2025 will be $257 and then 20% of the charge of the ambulance company charge in your area (state/city) you live.
What's an underrated benefit of Original Medicare that many people overlook?
The most underrated benefit of Original Medicare is freedom of choice. With Original Medicare you can see any provider as long as they take Medicare. no referrals are needed and it travels well. The coverage is Nation wide.
I picked a Medicare Advantage plan because of the dental and now I found out it only covers cleanings. Why didn't anyone tell me this upfront?
Most Medicare advantages cover more than cleanings. If you worked with a broker you needed to ask them how the dental works and what they will Cover. You can also call me and I can adviseIf Medicare Supplement (Medigap) plans are better for long-term coverage, why don't more people choose them?
What we do here is explain to our clients both the advantages and disadvantages of Medicare Supplement and Medicare Advantage. Whatever makes better sense for the client, we help them with that. So, work with someone who can offer you both Medicare Supplement and Medicare Advantage. More importantly, work with someone who's dealt with it for years and knows the good and bad about both plans. We would love to help you. Please, these decisions are way too important to take by chance or wait until the last minute. Let us help you. We'd be glad to.
I need a hearing aid but I've heard Medicare doesn't cover them. Is there any way around this?
Original Medicare does not cover hearing aids. However, most Medicare Advantage plans cover hearing aids and offer them at a discount or copay through their approved Vendor. Check with your local Broker if you are enrolled in a Medicare Advantage Plan.
Why do doctors not like Medicare Advantage plans?
For Medical services and procedures, doctors need to bill the Insurance company you have your Medicare Advantage plan with. For certain services/procedures, pre-authorization is needed which takes longer with dealing with an insurance company.If you have a Medicare Supplement Plan (also called a Medigap plan) such as Plan F, G, or N then the billing and medical services pre-authorization request goes to Medicare direct, which is a simpler process.
Both billing and pre-authorization might just be simpler and quicker for the doctors to deal with. The administration with a Medicare Advantage insurance company might be more work for the doctors' administrative office.
Hope this helps ...
I just started on Medicare Part D, and I'm confused about whether my new cholesterol medication counts toward my coverage gap. Can you explain?
Figuring out how your new cholesterol medication fits into Medicare Part D’s coverage gap can be confusing—it does count toward that limit, depending on your plan’s formulary and annual drug spending. In 2025, once your total costs hit the gap, you’ll reach catastrophic coverage after $2,000 out-of-pocket, lowering your costs to zero for covered meds, and Medicare now sends a statement detailing these expenses to keep you informed. Check that statement or your plan’s formulary for a clear snapshot of your progress!
Do I need a Hospital Indemnity Plan if I have Medicare Advantage? What if I am hospitalized twice in the same year?
A hospital indemnity plan to work with your Medicare Advantage plan is a good idea. Your Medicare Advantage plan will have daily copays (or at least per-stay copays) and the hospital indemnity plan can pay those for you. Most policies will pay more than once in a year as long as you have been out of the hospital for a set amount of days (differs per policy) before needing to go back in the hospital. Hospital indemnity policy premiums are usually inexpensive.
I'm on Medicare but recently declared bankruptcy due to medical bills. How will this affect my coverage and options going forward?
I’m sorry to hear that. And good luck.Medicare itself has no credit rating or change in coverage due to BK. But as long as you continue to to make your Part B payments your Medicare will continue to on.
My suggestion is to try to find at least a High Deductible Supplement plan that allows you to keep your Doctor choices and limit the amount of responsibility that can come back to you. If you hadn’t accepted a Medicare Advantage Plan, do not worsen your situation financially with a plan that will control you and your health moving forward.
You can work through Bankruptcy. You can’t work through not allowing yourself the control and freedom that you would then give up on your health by taking an Advantage plan.
I just got Medicare Part A, and I'm worried about hospital stays. How do I know if my overnight stay will be covered fully?
Overnight stay in hospital can be classified into two statuses (Inpatient and outpatient admission). If your doctor ordered that you need to be admitted to the hospital as an inpatient for medical care overnight, Medicare Part A will cover the cost of your hospital stay, including drugs, accomodation and meals for the first 60 days after you meet your Part A deductible which is $1,676.00 in 2025, for each benefit period. You will also pay coinsurance for days 61-90 of each benefit period.If your doctor ordered that you be admitted as an outpatient for observation only, overnight, Medicare Part B will cover the costs, not Part A.
How do I compare Part D plans to minimize costs for a mix of generic and specialty drugs?
You can always reach out to a professional broker for help in comparing Part D plans. Or, you can go directly to Medicare.gov and click on Health and Drug Plans in the upper right hand corner of the homepage. Then click on compare health and drug plans and enter your zip code. It will allow you to enter all of your prescriptions drugs and compare all available plans in your zip code. The comparison will also show what your monthly costs will be for each prescription. Don't hesitate to call for additional help!Does Medicare fully cover nursing home care, and are there alternatives?
Medicare does not fully cover nursing home care. It only provides limited coverage for skilled nursing facility care under certain conditions, such as after a qualifying hospital stay of at least three days. Even then, Medicare typically covers only the first 20 days fully, with beneficiaries responsible for a daily copayment for days 21 to 100.For long-term care in nursing homes, Medicare does not provide coverage. Alternatives for covering these costs include Medicaid for those who qualify based on income and assets, long-term care insurance, or personal savings. It's important to explore different options well in advance to ensure a comprehensive plan for potential long-term care needs.
I called to ask about a knee replacement and suddenly they said I need prior authorization. I thought my plan was supposed to be good-what's going on?
If you have a Medicare Advantage plan thy could ask for a prior authorization. It also could depend on the healthcare provider, or weather it is an HMO or a PPO.I'm on a supplemental Plan N, and I'm curious if my recent MRI is covered or if I'll get stuck with a big bill.
With your Medicare Supplement Plan N, your recent MRI is covered under Medicare Part B as long as it’s deemed medically necessary, but you’ll need to meet the 2025 Part B deductible of $257 first, and then Plan N picks up the 20% coinsurance—though you might face a small copay, up to $20, if it’s done in a doctor’s office. Unlike Plan G, which also covers the Part B coinsurance but skips those copays and fully handles excess charges if a provider bills above Medicare’s rate, Plan N leaves you responsible for any excess, though that’s rare with MRIs since most imaging centers stick to Medicare-approved amounts. I’ve seen beneficiaries caught off guard by these details, so double-check your provider’s billing with your Explanation of Benefits to avoid surprises—either way, your bill should stay manageable compared to having no supplement at all.
How well does Medicare support seniors who need assisted living, or does it fall short?
Medicare does NOT cover Assisted Living facilities at all, You will need a long-term Care policy to cover that expense.
Is it true that Medicare pays for dental implants?
Who told you that? It does not! A few Medicare Advantage plans MAY have dental coverage that includes implants, but Original Medicare itself does not.
Will Medicare cover everything my current employer plan does?
In general, most people on Medicare who receive employer health insurance will delay Medicare Part B enrollment. In this case Medicare Part A (in-patient services) is billed first. I would contact your employer health insurance plan to find out what your cost sharing would be for specific services.If I need hospice care in the future, can my Medicare plan cover it?
Yes, under Original Medicare Part A, you are eligible for hospice benefits if a doctor certifies that you are terminal illness. These benefits cover your cost, even if you are enrolled in a Medicare Advantage plan. However, you will still need Medicare Part B and pay the monthly premiums. Depending on your Medigap plan or Medicare Advantage coverage, you may have some out-of-pocket expenses.
What's the cheapest way to get Medicare coverage if I only need basic hospital care?
I would never advise someone to ONLY enroll in Part A (Hospital)If you skip Part B (outpatient care) to avoid its monthly premium - here’s the catch: if you delay Part B and later decide you need it, YOU'LL FACE A LATE ENROLLMENT PENALTY —10% added to the premium for each year you could’ve enrolled but didn’t—unless you have other creditable coverage (like an employer plan). Also, Part A alone won’t cover doctor visits, labs, or outpatient procedures, so if “basic hospital care” might stretch beyond inpatient stays, you’d be paying those extras fully out-of-pocket. For pure cost minimization with a hospital-only focus, Part A solo is your leanest option—just be sure your needs won’t creep into Part B territory later.
How does the Part D "catastrophic coverage" phase work once I hit the out-of-pocket max?
Once you hit the 2,000 max out of pocket everything is Covered 100%There is no Catastrophic phase anymore No donut hole
I'm on Medicare Part B, and I'm wondering how my physical therapy visits are covered. Do I have to hit my deductible first?
I am assuming you are on Original Medicare Part B and not an Advantage plan.Yes, you have to meet your Part B deductible then you would have copayments for those services. The deductible this year is $257.
What if I missed my window to sign up?
If you missed your window to sign-up for Medicare you could qualify for a Special Enrollment Period (SEP) , such as when you loose employers insurance (or other reasons). If you do not qualify for a Special Enrollment Period, you can sign up for Medicare Part A and/or Part B during the Open Enrollment Period which runs from January 1 through March 31 each year. Check the medicare.gov website or talk to a Medicare Insurance agent to find out what applies for you and how to go about the application process.
My Advantage plan says I need a referral just to see a dermatologist. I thought PPOs didn't require that - was I wrong?
You are correct. PPOs do not require referrals. But there are "office policies" that require one. The insurance company can't force the practice to not require one.
I've been paying into Medicare for years, and I'm not sure why my specialist visits still cost me so much. What am I missing here?
That’s a great question, and one we hear a lot. Even though you’ve paid into Medicare through payroll taxes, that mainly covers Part A, which is hospital insurance—not everything. Part B, which covers outpatient care like specialist visits, has its own monthly premium and usually only covers 80% of the cost after you meet the deductible. That means you’re responsible for the remaining 20%, and there’s no out-of-pocket max unless you have additional coverage. This is where a Medicare Advantage or Supplement plan can help reduce or cap those costs. It’s frustrating, but you're not alone—Medicare can feel like a maze, and that's why it's worth reviewing your options to see what might lower your expenses moving forward.My friend got her cataract surgery covered by Medicare, but they didn't cover the lens she wanted. How does that work?
Medicare does cover cataract surgery, and I have personally undergone the procedure. However, they only cover standard lenses, and you will need to pay extra if you want to purchase a premium lens or any other special types. These are considered luxury items or cosmetic options by Medicare and are not deemed absolutely necessary. Nonetheless, Medicare does cover the cost of the surgery as well as the standard lenses.
How does Medicare Part B handle coverage for preventative screenings like mammograms?
Medicare Part B covers preventive screenings like mammograms as part of its focus on early detection and health maintenance, with specific rules on frequency, cost, and eligibility. Here’s how it works:Screening Mammograms: These are covered for women aged 40 and older to detect breast cancer early, before symptoms appear.
Frequency: Part B fully covers one screening mammogram every 12 months (anytime after 11 months from your last one). If you’re new to Medicare, you also get a baseline mammogram covered between ages 35–39.
Cost: There’s no out-of-pocket cost—no coinsurance, copayment, or Part B deductible—as long as the provider accepts Medicare assignment (agrees to Medicare’s payment rates). This applies to 2D and 3D (tomosynthesis) screenings, though 3D coverage was clarified in updates around 2018 to match evolving standards.
Diagnostic Mammograms: If a screening finds something abnormal or you have symptoms (like a lump), Part B covers diagnostic mammograms to investigate further.
Frequency: No strict limit—covered as medically necessary, which could mean multiple in a year if your doctor orders them.
Cost: After meeting the Part B deductible ($240 in 2025), you pay 20% of the Medicare-approved amount. There’s no cap on how many are covered, but each one triggers that 20% coinsurance unless you have a Medigap plan to offset it.
Key Details: The mammogram must be done at a Medicare-approved facility (like a radiology center or hospital outpatient department). If it’s bundled with other services (e.g., a biopsy), additional costs might apply under Part B’s standard rules. Preventive coverage assumes you’re symptom-free—once it’s diagnostic, it shifts to a treatment framework.
This setup reflects Part B’s broader approach to preventive care: full coverage for annual screenings to catch issues early, with cost-sharing kicking in when it’s about diagnosis or follow-up. It’s a balance between encouraging checkups and managing expenses when care escalates.
What should I do with my Medicare plan if I'm diagnosed with a rare disease requiring specialists?
Your actions depend on what kind of plan you're on. If you have Medicare Supplement, you may go to any doctor in the US who accepts original Medicare as payment.If you have a Medicare Advantage plan, you may have a PPO, an HMO, or a similar plan. If your plan is a PPO, you have a choice of going to a specialist in or out of network. In-network doctors have lower co-payments than out-of-network. You can check your Evidence of Coverage for your share-of-cost.
If you have an HMO, you will need a referral from your primary care physician to see a specialist. When your doctor writes the referral, ask him/her to mark it as urgent. This will speed up the processing time. Remember that Medicare Advantage is required to provide care at least as good as Original Medicare. Hold your health plan to that standard. Remember that you are your own best advocate. Best wishes to you and please contact me if you have questions.
Does Medicare cover Ozempic and other drugs prescribed for weight loss?
Part d will cover some of these meds if you Doc gets it approved due to a medical issue. Not everyone will get it approved
What are the 6 things Medicare doesn't cover?
Original Medicare does NOT typically cover: Please see pages 55-56 in your 2025 Medicare and you Handbook. If you want a digital copy, contact me and I will be happy to forward by email.1. Cosmetic Surgery
2. Massage Therapy
3. Hearing Aids and Exams
4. Routine Dental Care
5. Concierge Care
6. Eye Exams (for Prescription Glasses)
Good news is that some of these are covered in a Medicare Advantage plan. Dental/Vision can be covered in a Standalone Dental/Vision plan.
Contact a local broker to confirm these coverages in your local plan.
What's the process for signing up for Medicare if I'm already on disability benefits?
After being on Disability for 2 years you are automatically enrolled in Medicare even if you have not reached 65 yet.Does Medicare Advantage cover acupuncture or alternative therapies in some plans?
Yes Some Medicare Advantage plans may cover Acupuncture. Always check your Summary of Benefits. The Acupuncture benefit could be covered for chronic low back pain only. Not all providers could be included.also See page 30 in your Medicare and You Handbook 2025
I'm interested in nutrition counseling to help manage my diabetes. Will Medicare cover this as preventive care?
Medicare part B does cover with a referral from a doctor to a regestiered dietitan or specialist. But it all starts with your doctor.
My Medicare Advantage plan denied coverage for a specialist I need to see. What are my options now?
Your primary care physician may need to make the referral before its approved by your plan, especially if you have a HMO plan vs a PPO or HMO-POS plan where you can select specialists on your own instead of through your primary care provider. The other situation is the specialist you selected may not be in network. Again with HMO plans you always need to stay in network. With a PPO plan, you can choose a specialist who is not in network, but you will pay significantly more if you do. Check either with your agent or the customer service to find out what your options are to resolve this issue.
My doctor recommended a bone density test. Is this considered preventive care under Medicare?
Yes, bone density screenings are considered preventive under Medicare Part B. They are typically covered every 24 months, however they can be approved more frequently if medically necessary.
Will Medicare cover asthma and other breathing conditions?
Yes, Medicare will cover different inhalers and meds associated with asthma. It can be covered through Part B and/or Part D Medicare. Some equipment will be covered as durable medical equipment.
I've had a change in my health condition. How does this affect my current Medicare plan, and should I reconsider my coverage?
If you have a severe or disabling condition that recently occurred and are enrolled in a Medicare Advantage plan you may qualify a (SEP) Special Enrollment Period.If you have a Medigap plan most likely no changes will be needed.
In what situations will Medicare pay for medical services in a foreign hospital?
Medicare covers services in a foreign hospital in three situations. First, if you have a medical emergency in the U.S. and the foreign hospital is closer than the nearest U.S. hospital that can treat you. Second, if you are traveling through Canada without unreasonable delay between Alaska and another state and a medical emergency occurs, and the Canadian hospital is closer than a U.S. hospital. Third, if you live in the U.S. and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat your condition, regardless of whether it is an emergency.I exercise regularly and maintain a healthy lifestyle. Does Medicare offer any incentives or additional benefits for preventive health behaviors?
A few Medicare Supplements and some Medicare Advantage plans have a benefit for gym memberships. Some Medicare Advantage plans will pay you a specific dollar amount for preventative visits. I would not choose a plan based on these benefits. Focus on the quality of the medical coverage. Please contact your local agent for more information about the plans in your area.
Can you explain what "creditable coverage" means and when it applies?
Credible coverage refers to health insurance that is considered as good as or better than Medicare, particularly for part B and part D. It’s most commonly relevant when someone is delaying Medicare because they’re still working and have an employer sponsored coverage. As long as that coverage is deemed credible, you can delay enrolling in Medicare without facing late enrollment penalties. When you do retire or lose that coverage, you’ll get a special enrollment period to sign up for Medicare without penaltyCan Medicare Part D deny coverage for a brand-name drug if a generic isn't available?
Medicare Part D can’t deny coverage for a brand-name drug just because a generic isn’t available—plans must cover it if it’s on their formulary and medically necessary, based on your doctor’s prescription, though they might require prior authorization or step therapy to justify it over other options. Upon enrollment, I always encourage my clients to call me if their medication regimen changes during the year so we can verify coverage details with the carrier and avoid surprises. I’ve dealt with this plenty, and as long as the drug’s listed and no generic exists, your plan has to honor it under CMS rules, but check your formulary or call your provider to confirm it’s not excluded or restricted. If it’s off-formulary, you’d need an exception, which can be a hassle but doable with your doctor’s help.What additional coverage options are available for international travelers?
Medicare Supplement plans (Medigap) C, D, F, G, M, and N may offer coverage for services outside of the U.S. with up to $50,000 of lifetime coverage. Some Medicare Advantage plans may also provide some coverage, and travelers should check with their specific plan for details. Additionally, international travel plans can provide emergency medical evacuation, return of mortal remains, support for lost passports or luggage, trip cancellation protection, and even kidnap and ransom coverage for high-risk destinations.I want to get a shingles vaccine. Will Medicare cover this preventive service?
The Shingles vaccine is covered by your Part D Prescription plan. It is not covered by Part A or B. Medicare Part D covers all the recommended vaccines by the Advisory Committee on Immunization Practices (ACIP). This includes Shingles, RSV, whooping cough, etc. The plan will not charge you a copayment or credit towards a deductible for doing so.
What do seniors often misunderstand about Medicare's coverage for long-term care?
Some seniors think that Original Medicare covers all aspects of post hospital care. That is not the case. Original Medicare only covers "Skilled Nursing Care" and only for a certain period of time. Occupational and speech therapy is post-hospital care most people need but is only covered under Long-Term and Short-Term care plans.
What happens to my Medicare coverage if I enter a skilled nursing facility for rehab but then need long-term care?
When you enter a skilled nursing facility (SNF) for rehab, Medicare Part A typically covers up to 100 days per benefit period, provided you meet eligibility requirements (e.g., a qualifying 3-day hospital stay, skilled care needs, and admission within 30 days of hospital discharge). Here’s how it breaks down:Days 1–20: Medicare covers the full cost of SNF care (assuming the facility is Medicare-certified and care is medically necessary).
Days 21–100: You pay a daily coinsurance ($204 in 2025), and Medicare covers the rest. Supplemental insurance (like Medigap) may cover this coinsurance.
After 100 days: Medicare Part A stops covering SNF care, regardless of whether you still need rehab or have transitioned to long-term care.
Do I need extra protection like Critical Illness Insurance if I am on Medicare?
Critical illness, heart attack, stroke and cancer plans are optional indemnity plans that can be purchased separately. The plans pay you directly upon a certain diagnosis and are designed to cover non medical and out of pocket costs such as travel, lodging, missed time from work, experimental, treatments, etc. In short, you receive a cash payout that can be used at your discretion regardless of the type of medical coverage because there is no coordination of benefits with insurance companies.My doctor mentioned something about Medicare not covering my procedure. How do I find out for sure before I get stuck with a bill?
Suppose you're under Medicare Part A and Part B with a Medicare supplemental insurance, and the physician sees a need for a diagnosis due to your health circumstances. In that case, the procedure should be covered, less any amounts for Medicare Part B premium or deductibles, and this is based on the type of supplemental plan you have. If you're on Medicare Part A and B with a Medicare Part C - Advantage plan, then your coverage could only be determined with the prior approval procedure through the insurance carrier of your Advantage plan. Most likely, there will be additional deductibles, co-pays, or out-of-network charges under these plans.I'm confused about all these different Medicare costs - premiums, deductibles, copays. How do they all work together?
All parts of Medicare have some cost associated, whether it be a premium, deductibles, copays for services, or even a max out-of-pocket.Premiums are the payments you make for the coverage. Deductibles are the amount you must pay out-of-pocket before your coverage will pay anything. Copays are the amount you pay for specific services after meeting your deductible.
Medicare Part A is free once you retire if you or your spouse worked for the last 40 quarters (10 years) before you signed up, because you paid taxes while working. Medicare Part A:
* Has a deductible for each benefit period (every 60 days) for inpatient hospital stays.
* Has copays for hospital stays longer than 60 days.
* Has daily coinsurance for days 61-90 and 91-150.
Medicare Part B has a premium that comes out of your Social Security check before it is dispersed to you. If you are not receiving Social Security, you must pay the premium for Part B out-of-pocket until you start drawing your Social Security. Medicare Part B:
* Has an annual deductible.
* Does not have copays for most services.
* Has a 20% coinsurance for most services after the deductible is met.
Medicare Supplements (Medigap) provide benefits to help cover out-of-pocket costs like deductibles, coinsurance, & copays. Each Med Sup has a premium, & each one has different benefits. Medigaps:
* Help pay the 20% coinsurance for services covered by Original Medicare Part B (medical insurance).
* Many cover the Medicare Part A (hospital insurance) deductible.
* May cover additional days in the hospital after Medicare benefits are used up.
* Some may cover costs for skilled nursing facilities, hospice care, excess charges from non-participating providers, & foreign travel health care emergencies.
Medicare Advantage usually does not have premiums, but may have a deductible(s), has copays for services, & an annual max out-of-pocket.
I've heard Medicare covers home health care, but what exactly does that include?
Medicare generally covers part-time or intermittent home health care services when medically necessary, especially after a hospital stay or skilled nursing facility stay. This includes skilled nursing, physical therapy, occupational therapy, and speech-language pathology services, as well as medical social services and some home health aide care if it's related to skilled care. Medicare, however, does not cover 24-hour care, meal delivery, or personal care when it's the sole need. You can find more extensive break down online if you search or sit down with an agent sometime to go over all of it.
I was already scheduled for total knee replacement when I took out my policy, will my supplemental plan G still pay?
Yes. Once the policy is issued it will pay secondary to any claims paid by medicare. If you enrolled in Plan G during your Medigap Open Enrollment Period (the 6 months after enrolling in Part B at 65+), no pre-existing condition limitations apply—your surgery would be covered.I need a new wheelchair, and I'm not sure if Medicare will cover it. What's the process for getting durable medical equipment?
Original Medicare pays for DME, unless noted anywhere within its policy Medicare Advantage plans do not.You will have the 20% Co-pay responsibility, unless you have a Supplement plan that covers those charges.
That is an important feature in keeping your Original Medicare pays- it handles your DME, Medicare Advantage is typically handled Out-of-pocket by the insured.
Why are hospitals not taking Medicare Advantage plans?
Hospitals negotiate with insurance companies and plans for payments. Depending on the plan's payment structure, a hospital (or any care provider) makes a business decision to accept the plan(s). Hospitals generally sign multi-year agreements with the insurance carriers.
Does Medicare cover emergency care if I'm traveling in a U.S. territory like Puerto Rico?
Yes(Si), you have coverage anywhere in the US and its territiories with Medicare and Medicare Plans, including Puerto Rico.How can I estimate my total Medicare costs if I have a chronic condition like diabetes?
Estimating your total Medicare costs will depend on how many doctor visits you have and the cost of any diabetic medicine you take which can be outlined in your Part D drug plan. I can provide you with a PDF outline of your costs.
If I start dialysis, how does that change my Medicare eligibility or coverage?
Most people on dialysys are covered on their plan. A member on Medicaid-Medicare, all cost would be covered, depending on their plan & cost shareHow does losing a spouse impact my Medicare plan if I was on their employer coverage?
When a client loses a spouse and was on their employer coverage, I explain they have 63 days to enroll in Medicare or adjust their plan without facing a penalty. It’s a qualifying event, so they’d need to switch to their own Part B if they’re 65, and I’d urge them to do it promptly to avoid any cost hikes or coverage lapses. The rules give them a clear path forward, but timing is critical.Is Medicare's coverage for cataract surgery enough, or do seniors still face high out-of-pocket costs?
Original Medicare covers 80% of a variety of services including cataract surgery. Depending on how you subsidize original medicare your costs will vary. Medicare is a very individual choice and one to not take lightly. My job is to educate you on your choices to supplement and ensure you understand the pros and cons of each.I'm considering genetic testing to assess my cancer risk based on family history. Will Medicare cover this preventive approach in my situation?
Under traditional Medicare Part A and B with a Medigap plan, Medicare generally does not cover pre-symptomatic genetic testing for cancer risk assessment. However, with a doctor's order for the testing, it will most likely be approved for certain types of cancer testing. Some Medigap plans come with a rider that covers 100 percent of preventive care testing.Under the Medicare Advantage plan, these tests most likely will require prior approval from the insurance company.
My doctor wants me to get several preventive screenings. Will Medicare cover all of these at once?
There is a long list of preventive screenings that are covered by Medicare, including an annual Wellness visit.Does Medicare Advantage cover home health care?
Yes, if your doctor orders it. However, Medicare does not cover 24-hour-a-day care at your home, home meal delivery, homemaker services (like shopping and cleaning) unrelated to your care plan, or custodial or personal care that helps you with daily living activities (like bathing, dressing, or using the bathroom), when this is the only care you need. Some Medicare Advantage plans include some homemaker services when returning home from the hospital, so ask your broker.
If I live part of the year abroad, do I still have to pay for Medicare if I don’t use it?
Yes. A half year out of the country does not allow you to stop paying for Medicare. A longer period depending on its length can be considered.My doctor wants me to try acupuncture for my back pain. Will Medicare cover any of this?
I'm considering a smartwatch that monitors my heart rhythm for atrial fibrillation. Will Medicare help cover this type of wearable technology?
No, Original Medicare Parts ( A and B) do not cover Fitness Smartwatches that track heart rhythm or other vitals. Also Original Medicare does not cover Medical Alert Devices. If you are interested in getting either and having it covered by Insurance, some Medicare Advantage Plans offer coverage for these devices.Does Medicare cover health care services on a cruise ship?
Once you cross into International waters, your Medicare will not cover you. There are very specialized situations while traveling abroad where it does. Always take the travel insurance.However, adding a proper supplemental plan to your original Medicare can provide a $50,000 lifetime reimbursement benefit to augment your billing.
I'm a smoker trying to quit. What smoking cessation benefits does Medicare offer for someone in my situation?
Medicare provides some support to help beneficiaries who are trying to quit.Medicare Part B covers a variety of preventive services, and smoking cessation counseling is included.
Medicare Part D (prescription drug) plans may cover prescription medications or nicotine inhalers and nasal sprays that require a prescription.
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 home health aide services after your surgery, but certain conditions must be met.Eligibility Criteria:
To qualify for Medicare-covered home health services, you must:
Be under the care of a doctor who certifies that you need intermittent skilled nursing care, physical therapy, speech-language pathology, or continued occupational therapy.
Be homebound, meaning it's difficult for you to leave your home without assistance due to your medical condition.
Boost Home Healthcare
Receive services from a Medicare-certified home health agency.
Services Covered:
If you meet these criteria, Medicare may cover:
Part-time or intermittent skilled nursing care (e.g., wound care, injections).
Therapy services, such as physical, occupational, or speech-language therapy.
Home health aide services, which provide personal care like bathing and dressing, but only if you're also receiving skilled care as mentioned above.
Medical social services to help with social and emotional concerns related to your illness.
Certain medical supplies and durable medical equipment (e.g., walkers, wheelchairs).
Limitations:
Medicare does not cover:
24-hour-a-day care at home.
Meals delivered to your home.
Homemaker services like shopping, cleaning, and laundry when these are the only services you need.
Custodial or personal care that helps you with daily living activities (like bathing, dressing, or using the bathroom), when this is the only care you need.
I use a continuous glucose monitor for my diabetes that connects to my smartphone. Will Medicare cover this technology for someone with my condition?
Yes. “DME” stands for Durable Medical Equipment. A glucose monitor is paid for by most Medicare Supplements (aka, a Medigap plan). Go to medicare.gov and put DME in the horizontal search box. You will find that a Medigap covers over 60,000 treatments while an Advantage has a high deductible which, depending on the company, will potentially provide partial coverage for the monitor.
I live in a rural area with limited specialists and am interested in telehealth options. How does Medicare cover virtual visits for someone in my location?
Original Medicare does cover telehealth visits and I will cut and paste information regarding telehealth visits as it relates to original Medicare hereHowever…
I want to bring to your attention the importance of comparing original Medicare, Medicare Supplement or Medigap and then Medicare Advantage plans, if you live in a rural area and need to access telehealth options.
Original Medicare, as mentioned above, does include telehealth, however it is limited in its scope, therefore because Medigap or Medicare Supplements simply work WITH Original Medicare…Medicare supplements or Medigap policies are also limited in their scope.
You can think about Medigap or Medicare Supplement and original Medicare like puzzle pieces. They work together, so if original Medicare cover something, Medicare supplement is required to come in and pick up what original Medicare does not cover at whatever benefit level you have on your plan.
Medicare advantage plans, however, provide enhanced benefits for telehealth so…oddly…if you’re living in a rural area, a Medicare advantage plan may offer you more options for telehealth that you would otherwise not have access to if you were simply on original Medicare and Medigap.
The reason I say “oddly” is because Medigap and original Medicare are often said to give you the most freedom and flexibility however, where you live and the network access that you have has a larger impact on the concept of freedom and flexibility as it relates to telehealth in this case.
This is why it’s so important to work with a broker because your broker can take a look at, not only, what is the “best option” for most people, but what really is the “best option for you.”
I hope you guys are having a great experience with your Medicare broker and if you’re not simply reach out!
I'm caring for my dad who has Alzheimer's with lots of medications and I keep getting bills I don't understand. Any tips for not drowning in paperwork?
I will assume that you have power of attorney.First, you will need to understand the details of your father's prescription drug insurance (Part D) and the types(tier) and numbers of medications he is taking.
Next, you will need to confirm where the bill came from and contact the insurance company to find out if the claim is valid.
(I also recommend making a bullet point list.)
Finally, many insurance companies allow you to check the medication status online.
We recommend that you speak to your agent for more information.
My plan covered my cataract surgery but not the lenses I actually needed-how do they get away with that?
Insurance plans, including Medicare, typically cover the cost of standard monofocal intraocular lenses (IOLs) for cataract surgery, but they often don't cover the extra cost of more advanced lens options like toric, multifocal, or extended depth-of-focus (EDOF) lenses. This is because these advanced lenses offer additional features beyond basic vision correction and are considered "premium" upgrades.
Should Medicare cover dental, vision, and hearing, or would that just make it more expensive for everyone?
If Medicare covered dental, vision and hearing it would increase the cost to tax payers no doubt. These services are provided by independent practices so it is most cost effective for them to be offered through private companies such as Humana, Aetna, Manhattan life etc….
How can I find new doctors in my network?
Most carriers have online member sites that you can search for specific doctors and specialties within your plans network. Other sources you can call are your broker or member services for your current plan.
Are preventative screenings covered by Medicare?
Most preventative services and procedures are covered under Medicare. Refer to your benefits explanation guide for specifics. There are other preventative procedures that must be medically necessary to be covered.I'm interested in a robotic knee replacement surgery that my surgeon recommends for my specific anatomy. How does Medicare coverage work for this advanced procedure?
Original Medicare: Medicare premium $185/mo, $257 deductible + (20% of $20,000 to $40,000 + post care costs)$5-10K no max out of pocket.
Medigap Plan G: $200-225/mo+
Medicare premium $185/mo, $257 deductible is your max out of pocket for the year
Medicare Advantage: Medicare premium $185/mo (may be reduced by up to $174,70/mo) specialist copay $10-$45+ outpatient hospital copay $100-$300 + post op rehab $20-$40/visit maximum out of pocket could be less than $500. Max out of pocket $1000-$6700.
I'm planning a long trip overseas. What happens if I need medical care while I'm away from the US?
No, in most cases, Medicare does not cover medical care received outside the United States However there are some exceptions and some Medicare Supplements may cover some emergency coverage for travel abroad. It’s important to know what your plan offers.How do I appeal a decision by Medicare or my plan if they deny coverage for a procedure or medication I need?
To appeal a decision by original Medicare, contact Medicare. If your Part D plan is denying prescription drug coverage, have will need to request that your doctor file for a "formulary exception" with your insurance. If the insurance company decision is to deny the requested exception, you need to feel an appeal with your insurance. The recommended plan of action for an insurance company's denial of coverage for a specific procedure is you need to contact your insurance company and file an appeal of the denial. Your independent Medicare health insurance agent (who sold you the plan) most assuredly should be able to help you.
Does Medicare cover vision care?
Original Medicare doesn’t cover routine eye exams, glasses, or contacts. It only helps with eye care related to medical issues, like cataract surgery or glaucoma. For routine vision benefits, you’d need a Medicare Advantage plan or separate vision insurance.
Will private hospitals accept Medicare plans?
Most private hospitals accept original Medicare and Medicare Advantage Plans. But hospitals sign contracts with each provider company and list which Medicare Advantage plans are included. Toward the end of the contract period, if a new contract is not signed hospitals and providers are required to notify users of the hospital that the hospital may not be in network for the next period... usually the next year. Most of the time contract negotiations are completed and the hospital remains in network. But it is up to the individual to double check, before surgery or a procedure, that the hospital is in network.How can I plan for Medicare costs if I expect to need long-term custodial care in a nursing home or assisted living facility?
Since the doctor whose specialty is treating your malady, she/he will write up “a plan of care” which Medicare accepts. Then based on your progress, that same doctor can increase the number of days of treatment and therapy or release you to your home. The out-of-pocket cost is impossible to determine since you may have a Medigap or an advantage plan with differing benefits. Always rely on the social worker working at your facility who should know the differences between those 2 options chosen when you became Medicare-eligible.
Are all types of blood tests covered by Medicare?
No, not all types of blood tests are covered by Medicare. What is covered is medically necessary diagnostic blood tests which are ordered by a physician, but it may not cover routine or preventative blood work that is not medically justified.I'm considering concierge medicine but already have Medicare. How would these work together?
I have met with a local concierge Dr and she requested that if working with Medicare advantage, PPO plans would be a good fit since they are not in-network with the Medicare advantage plans. As of recently, one of the local health plans told me their HMO plan does work with concierge. So it sounds like they are more flexible now, don't need a PPO is what I've been told!My doctor prescribed physical therapy, but I'm not sure how many visits Medicare will cover. How do I find out?
The number of physical therapy visits you get depends on what your doctor says. If the therapy is deemed medically necessary, Original Medicare will pay.However, if you have a Medicare Advantage plan and they deny the therapy, appeal the decision. MA coverage is required to be at least as good as Original Medicare so make sure your plan pays for what your doctor says you need.
How do I find local Dentists that take my Medicare coverage?
Medicare does not cover dental services. They are usually included as an add-on in Medicare Advantage plans, but these are typically HMO dental plans, which may have a smaller network. If you see a specific dentist, I recommend asking your dentist which dental plans they accept and purchasing the plan with which your dentist is contracted.I have a family history of colon cancer. Will Medicare cover more frequent colonoscopies for someone in my situation?
If someone is deemed to be at high risk for colon cancer, Medicare will cover frequent colonoscopies every 2 years. Your doctor or other health care provider may recommend you get services more often than Medicare covers. An additional plan such as a Medicare Supplement or a Medicare Advantage can provide such additional coverage.I've heard Medicare covers an annual wellness visit. What exactly is included in this visit?
A Medicare Annual Wellness Visit focuses on preventative care and health planning, including a health risk assessment, review of medical history, and creation of a personalized prevention plan, but it's not a full physicalAre mental health services like therapy fully covered under Original Medicare?
Mental health is covered but it is up to you to review different company policies since they could vary widely from state to state. There is a limited number of days that should be covered. It is incumbent upon you to fully understand those limitations. This is why it is imperative to go over with a knowledgeable agent who can easily differentiate between what an Advantage plan covers vs. what a Med. Suppmt. (Medigap) covers in this extremely important area.
What's the deal with Medicare covering medical equipment like wheelchairs- do I need a special approval?
Most items that are covered under durable medical equipment by Medicare Will have a 20% copay to the member. Certain items such as a wheelchair with customizations may require a doctor's prescription and others, for example a shower chair, would not require a prescription. If you are enrolled in a Medicare Advantage plan you will want to check with the plan to ensure that you are using an in-network supplier to keep your cost at the lowest possible rate. And oftentimes places like senior centers will have received donations for things like transport chairs, walkers, shower chairs that you can borrow.What are some lesser-known benefits or services that my Medicare plan might cover that I could be missing out on?
This is a perfect question, and a great one especially in today’s time, as Medicare Advantage plans are introducing more creative and innovative benefits to differentiate themselves. You might find lesser-known Medicare Advantage perks like quarterly allowances for rent, utilities, groceries, over-the-counter items like pain relievers, or even transportation to medical appointments and gym memberships for wellness programs. Meanwhile, Medicare Supplement plans, such as G or N, often include a valuable international travel benefit for emergency care abroad, which can be crucial if you’re overseas and need treatment unexpectedly.
I've got Medigap Plan C, and I'm curious if my recent bloodwork is included or if I need to budget for extra costs.
If you’ve got Medigap Plan C, that’s actually one of the more solid plans. Since it works alongside Original Medicare, most of the time your bloodwork, if it’s medically necessary and ordered by your doctor should be covered by Medicare Part B, and then Plan C usually picks up the leftover costs like the deductible and coinsurance. So chances are, you’re not paying much, if anything. But it’s always good to double-check with your provider just in case something’s considered non-routine.
Are there plans that allow me to continue to travel anywhere and be covered?
If you are going to be traveling quite a bit then I would recommend that you do a medicare supplement to utilize the lack of networks. A supplement G or N would be a great option (along with an appropriate drug plan) to get you coverage while traveling the United States. There are some PPO plans with good networks that allow you to utilize In/Out of network benefits (you will pay higher copays when out of network). I have several "snow birds" that use their plan both in Indiana and in Florida just the same. It is very important if you are going to go this route to verify that your primary doctors are in-network in both locations (such as snow birds).
How do I know if a Medigap policy is right for me, and what's the best time to buy one?
A Medigap policy is right for you for a number of reasons:1. You are in the younger market like age 65 and that gives you a low premium.
2. You're health is not great, many doc visits, maybe a few chronic conditions requiring on going services.
3. Medigap policies follow Medicare's lead, and Medicare patients are treated everywhere. In other words, Medigap clients don't hear "no" when or if they want to go to a specialist locally or anywhere in the country.
Does Medicare cover chiropractic appointments?
Only for spinal maniulation adjustmentsMedicare will not pay for extensive Chro treatments
Medicare will only pay a fixed fee for adjustments
And some providers will not bill medicare
Can Medicare help cover in-home care for dementia patients who wander or need supervision 24/7?
Unfortunately Medicare does not provide coverage for in home custodial care or supervision. Medicare does provide some home health care but it will not help activities of daily living or companion care.I'm caring for my spouse with dementia and experiencing caregiver burnout. Will Medicare cover any mental health support for me?
If you’re on Medicare mental health is supported by Medicare as for your spouse with dementia Medicare will provide health care services. But you’d have to look into local caregivers to be able to help you as far as with with that, but not Medicare.
I want to be proactive about my health. What preventive services should I be taking advantage of with Medicare?
medicare has a standardized list of preventive services that are covered as well as as a standard frequency when you should be getting these screenings. Your summary of benefits should have a list of these in your preventive services section. Sometimes the frequency can vary based on medical history and necessity. It’s important to work with your doctor to determine if your screening should be done more frequently than the standard.
Are home modifications (like stairlifts) ever covered by Medicare for safety reasons?
That's an interesting question. I just had this come up recently. With typical DME, Durable Medicare Equipment, like wheelchairs, hospital beds, etc., is usually covered under Medicare Part B. Stair lifts, in particular, would fall under Part A coverage and are generally not covered under Medicare. There is an actual exclusion for that type of Home Modification need.Does Medicare pay for telehealth visits with specialists, or is it limited to primary care?
Yes many do. It’s important to know the limitations involved for your specific plan, so be sure to ask questions and check those situations before you make a choice on your plan if that’s an important issue for you.Does Medicare cover medical marijuana if it's prescribed for chronic pain or cancer?
Marijuana or marijuana treatments are not recognized by federal law, even though states may recognize it as a form of treatment. Since federal laws govern Medicare, it does not acknowledge marijuana as a legal treatment, regardless of whether it is legal in your state for medical purposes.Why does Medicare have so many coverage gaps, and is it designed that way on purpose?
Is occupational therapy covered by Medicare Advantage with UnitedHealth?
Yes, occupational therapy is generally covered by UnitedHealthcare Medicare Advantage plans, provided it is deemed medically necessary by a doctor. All Medicare Advantage plans are required to cover at least the same services as Original Medicare Part B, which includes outpatient occupational therapy. Check for prior authorization also!I've been diagnosed with prediabetes. What preventive services does Medicare cover to help prevent progression to type 2 diabetes?
Preventive care is not done on the bases of your medicare but on the quality of care from your doctor. A good doctor will provide good care and education to prevent progression of illness. Depending on your insurance and dietary needs set by your physiscian, you can utilize benefits like nutrition health as well as gym memberships to support a good healthy habit which are typically included with your coverage.I'm participating in a clinical trial for a new cancer treatment that uses personalized medicine based on my genetic profile. How does Medicare coverage work in this situation?
Medicare covers specific genetic tests if they are medically necessary and meet particular criteria. The cost of these procedures will be handled through expected Medicare benefits in payment. However, specialized clinics and procedures should always be verified for Medicare coverage before using them, and the medical necessity of such procedures must be demonstrated.
Medicare Plan Solutions serving NY & CT offering multicarrier plans • Poughkeepsie, NY
How does Medicare handle coverage for experimental treatments or clinical trials?
Routine services that would normally be covered under Medicare may be covered for participation in a clinical trial. But, clinical trial services and experimental treatment will not be covered. Any covered services would most likely be subject to prior approval. Likewise, your OOP responsibility would apply for covered services. Your provider should work with Medicare or other Medicare plan coverage carrier regarding specific criteria to actually participate. I also recommend the patient discuss with a carrier nurse to determine any patient responsibilities.
Does Medicare cover weight-loss programs or bariatric surgery if I’m classified as obese?
Medicare may cover certain weight-loss services if you’re classified as obese (BMI of 30 or higher), but coverage is limited. Medicare does not cover commercial weight-loss programs or meal plans. However, it does cover obesity screening and behavioral counseling through your primary care provider, and may cover bariatric surgery (like gastric bypass or sleeve gastrectomy) if you meet specific medical criteria, such as having other health conditions like diabetes or heart disease. Prior authorization and documentation are typically required.
I keep hearing about free preventive services with Medicare. What exactly is free and what will I still pay for?
Medicare covers preventive services that per the Medicare.gov website are identified as exams, shots, lab tests, and screenings. They key benefit that Medicare does not specifically cover are Routine Physical Exams. The majority of Medicare Advantage plans do cover a routine annual exam and typically they are a $0 copay.It is really important when setting up a routine physical exam with your doctor or provider that you have a good understanding of what services will be provided. For example, lets say your Medicare Advantage plan covers the routine physical exam which would include all of the $0 copay screenings, shots, and lab tests covered by Medicare. Those items would be a $0 copay. I never use the word free and Medicare does not allow a broker to ever use the word free.
It is common though that a good provider will ask you if there are other things you would like to discuss during your visit. Those items could be outside of the routine exam and you might have a copay for that portion of your visit. Lets say for example that you wish to discuss shoulder or knee pain you have been having. Those discussions are generally beyond your preventive $0 copay services and could trigger a copay for you.
In conclusion, its important to know that Medicare encourages all consumers to stay healthy and obtain the preventive services that have a $0 copay. It would only be services beyond or outside of the routine physical exam, tests, labs, screening that you might see additional costs.
What happens to my Medicare coverage if I move to a U.S. territory like Guam or the Virgin Islands?
Original Medicare will work in U.S. territories. If you have a Medicare Advantage plan, you will likely need to change plans when you move. Medicare allows a Special Election Period when you move to a new area.
Can Medicare cover wearable medical devices like insulin pumps or seizure monitors for chronic conditions?
Yes, Medicare CAN cover these devices. Sometimes a patient will need to pay a co-pay to cover a percentage (at times 20 percent) in order to take delivery of these devices. Check with your plan or a qualified agent to ensure that you are following the correct steps to have your device covered if applicable.I use several prescription apps and digital therapeutics for my chronic conditions. Does Medicare provide any coverage for digital health tools in cases like mine?
Medicare’s coverage for prescription apps and digital therapeutics (DTx) is limited but evolving, particularly for chronic conditions. Original Medicare (Parts A and B) typically does not cover DTx, as these tools often fall outside defined benefit categories. However, recent developments show some progress; so the answer would depend on what your currently using.Don't you think Medicare's focus on treatment rather than prevention is backwards?
I do agree. The dilemma here is that due to the scarcity of Primary doctors in the US, focusing on prevention rather than treatment (in the long run) will be less expensive to Medicare. In our global economy, this is "the formula" that healthcare has adopted. Moreover, there are two specific kinds of "codes" that are placed in your record after a visit: A) "Preventive", and, B) "Diagnostic", the latter of which will come out of either Part A (in-patient) and Part B (out-patient) Medicare, therein costing the Feds the extra money. However, when a person sees her/his doctor without complaining of any type of pain, that visit is automatically coded as Preventive, thus costing the patient more $$ rather than the Federal government. The exception to that is, for example, if you're having a colonoscopy and the surgeon removes some polyps which have to be analyzed, if it has been found to be cancerous, it will change codes from a preventive visit to one that needs further discussion and thus is now diagnostic.If my parent needs care at a hospital out of state, will their coverage still work?
If they are on a Medigap, they wont have any issues.If on an Hmo, they can only use the hospital if its for urgent care or emergency care.
Why, when you turn 78, are you no longer able to get a CT scan?
Medicare will pay for a ct scan, but it has to be preapproved by medicare doctor and be deemed necessaryWho will make medical decisions as to what is necessary to me: my Doctor or the insurance company?
Your doctor is the primary decision-maker for your medical care, making recommendations based on their expertise and what they believe is best for your health and well-being.Insurance companies determine what tests, drugs, and services they will cover based on their understanding of the types of medical care most patients need.
What are my Medicare options if I move into a Continuing Care Retirement Community (CCRC)?
If you move into a Continuing Care Retirement Community (CCRC), you can keep Original Medicare (Parts A & B) with a Medigap plan and Part D for prescriptions, or choose a Medicare Advantage (Part C) plan that may include drug coverage and extra benefits. While some CCRCs may suggest certain plans or have preferred providers, you are free to select any Medicare option that best fits your needs. It’s important to review your coverage as your healthcare needs evolve over time.I'm confused about preventive services under Medicare. Which screenings are actually free?
When it comes to Medicare, with Medicare Part A and B and the additional purchase of a Medicare supplement, or some call it Medigap, you can receive several preventive screenings and services at no cost. Diabetes, colon cancer, depression, hepatitis B, hepatitis C, HIV, cholesterol, and mammograms can all be covered without cost, if you have a Medicare supplement plan added to your traditional Medicare Part A and B.Does Medicare cover cancer screenings, and how often can I get them?
Cancer screenings are typically covered as a preventative service. How often depends on the carrier. Refer to the explanation of benefits for specific details as the amount may be different per carrier.
Does Medicare cover mammograms, and how often can I get them?
Medicare Part B has a very concise list of Preventive Services such as annual mammogram, cervical pap smear, and every other year bone density scan, etc. These are listed on the Medicare.gov websiteHow 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 homebound and need remote monitoring for my heart condition. What Medicare benefits might apply to someone in my situation?
There can be a wide variety of answers to this question due to the various symptoms that folks can have. There are tools that can be used to "remotely" signal to an outside location that your heart is working properly (or not). You will be beholden to your cardiologist who is your expert and will write up "A PLAN OF CARE" specifically for you. It might entail a number of hours a day where the doctor feels that a registered nurse ought to see you daily or every other day, depending upon the cardiologist's discretion. The other side of this coin is that I can only presume that an operation to remedy your dilemma is out of the question. It can sometimes have a lot to do with which plan you picked up at age 65 between a Medigap or Supplement vs. a Med. Advantage plan both of which demonstrate differing benefits.
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?
Based on family history of heart disease, you may consider a Medicare Supplemental Plan, to go along with your original Medicare, this would give you the best coverage if you encountered major issues so your medical expenses would have the best coverage available to you.What’s the best Medicare plan for someone with chronic kidney disease?
And most times, their formularies are set up to where they cover the drugs associated with that chronic illness a lot better and a lot cheaper than most other plans. So I've said it 100 times, find yourself an independent broker that only does Medicare and have them help you with that. Because the plans are pretty good, and the benefits are really super good too.
After a surgery, should I expect out-of-pocket costs?
That is vague question because it would be different depending on which plan you are utilizing. If you have Medicare Supplement (G or N) and have not satisfied your $257 deductible then you will owe up to that deductible. If you have already satisfied your deductible then you should not have any out of pocket costs accrued. However, if you are on a Medicare Advantage plan then you will be billed the set copayment for that procedure based upon which plan you are on with which carrier.Are there any guidelines I should follow when filling out my Medicare application?
The guideline for completing an application to enroll in a Medicare plan is pretty simple. The question should be: do you understand what you are signing up for and how your Medicare plan will work for you today and in the future as your healthcare needs change? I would recommend working with a knowledgeable agent or broker who can help you choose the right plan.
How can I use Medicare to cover occupational therapy for arthritis or mobility issues, and what are the limits?
Medicare Part B covers occupational therapy as long as it is considered to be medically necessary and your provider recommends it. There are no limits to the number of occupational therapy sessions Medicare will cover, but you will pay 20% of the Medicare-approved rate after you have met your Part B deducible.If you are an inpatient in a hospital or skilled nursing facility, occupational therapy is covered under Medicare Part A.
What's the likelihood of Medicare covering gene therapy as it becomes more common?
Yes - I am sure the likelihood is good of coverage to become more common.Medicare sometimes offers coverage for certain high cost treatments through specialized programs.
Medicare is likely to expand coverage for gene therapy as more evidence supporting its benefits and effectiveness emerges and as the treatments become more common and potentially more affordable.
Also have your Doctor submit an authorization for treatment to confirm coverages.
My dad’s back pain is getting worse. Can Medicare cover ongoing chiropractic care, or is it just short-term treatment?
Medicare only covers spinal manipulation adjustments it does not cover routine Chiropractic care and is limited to # of visits.
How will the recent attention & auditing around Medicare Advantage plans effect nursing home coverage?
The recent attention and increased auditing of Medicare Advantage plans is focused on ensuring these plans are following the rules and putting patients’ needs first. One area under scrutiny is how these plans manage care in nursing homes—particularly the use of prior authorizations and decisions around how long someone can stay in a facility.What this means for nursing home coverage is that we may see improvements. Audits are likely to reduce practices that led to early discharges or delays in care. The goal is to make sure that if someone truly needs skilled nursing care, they can access it without unnecessary barriers.
That said, it’s more important than ever to have an advocate who understands how each Medicare Advantage plan handles post-acute and long-term care. Plans vary, and being on the right one can make a real difference in what care you or your loved one receives.
How does Medicare cover outpatient mental health intensive programs for seniors with severe conditions?
Intensive Outpatient Program (IOP) services are covered under Medicare Part B and include intensive psychiatric care, counseling, and therapy. These services are provided in hospitals, Community Mental Health Centers, Federally Qualified Health Centers, Rural Health Clinics, and Opioid Treatment Programs (when services are for the treatment of Opioid Use Disorder).The beneficiary will pay 20% of the Medicare-approved amount after the Part B deducible has been met.
I need home health care after my surgery, but Medicare denied coverage. What are my appeal rights?
My concern would be why did they deny it.Home Health Care is a Skilled Nursing Code.
Doctor has to certify that you are home bound and that you need a nurse to come in and do basic MEDICAL needs for you. Example is wound care or Medicine care and PT.
They don't stay very long. They come in and do the medical care needed and leave.
They would have to have a reason why you can come to them to get approved.
It is also only approved for 30 days and can be extended if the doctor approves it. It has to be recertified every 60 days. It is meant for short term and that you are healing and getting better.
If you need it all the time and your not getting better then that will be under Long Term Care. That is a separate policy and not covered by Medicare.
If you want to file an appeal here is the link:
https://www.medicare.gov/providers-services/claims-appeals-complaints/appeals
How might climate change-related health issues (like heat stroke) influence Medicare policies?
In my 25 years working with Medicare, climate change-related health issues like heat stroke have never come up in discussions or policy updates—not once. Honestly, it’s not something I’ve ever thought about either, but I’d assume it wouldn’t shift Medicare coverage much since conditions tied to it are already baked into what’s covered. Any impact would likely stay minor, handled within existing frameworks.Can my Medicare Advantage plan offer extra coverage for breast cancer services?
Some plans have value added services for chronic iillness. check what is called C Snp plans in yoyr area or go to medicare.govI am a resident in another country outside of America, will I still be covered living abroad?
Original Medicare generally doesn’t cover you outside the United States, except in very limited situations—like certain emergencies close to the U.S. border. Some Medicare Advantage plans or Medicare Supplement (Medigap) policies may offer emergency coverage abroad, but it’s usually for a limited time and amount. If you plan to live outside the U.S., it’s important to look into private international health insurance or a plan in your country of residence so you’re protected wherever you are.Does Medicare cover nutrition counseling for high cholesterol?
Yes it does.It covers it through a program called Medicare Nutritional Therapy Services.
Medicare Part B (Medical Insurance) covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
If you have diabetes or kidney disease, or you’ve had a kidney transplant in the last 36 months, you qualify got this service and a doctor must refer you for services.
What type of Medicare coverage do I need to cover in-home caregivers?
Medicare does not cover caregivers, you would need a home care policy or a ltc policy to cover these servicies
How has telemedicine enhanced personalized healthcare?
Telemedicine has been a great tool for people in remote areas or those who do not have a mean of transportation. These video conferencing sessions offer convenience and fast resolution to a health problem from the comfort of your own home. It enhances personalized service because it's still face to face (even though it's through videoconference) with your doctor.I need both a psychiatrist for medication and a therapist for talk therapy. How does Medicare coordinate coverage for these different providers?
Medicare provides coverage for both psychiatric medication management and talk therapy through its Part B (Medical Insurance) and Part D (Prescription Drug Coverage) plans.Psychiatric Medication Management
Medicare Part B covers outpatient mental health services, including visits with psychiatrists or other qualified healthcare providers for psychiatric evaluations and medication management. After meeting the Part B deductible, you typically pay 20% of the Medicare-approved amount for these services if your provider accepts assignment. Provider Acceptance: Not all mental health providers accept Medicare. It's important to confirm with your psychiatrist and therapist that they accept Medicare assignment to ensure coverage. Medicare Advantage Plans: If you're enrolled in a Medicare Advantage Plan (Part C), your plan may offer additional mental health benefits beyond Original Medicare. However, provider networks can be more limited, so verify that your preferred providers are in-network
How can I make sure my Medicare plan will cover future treatments for my illness?
Treatment for illness is generally covered. Most are illness and accidents are covered. If it is covered by Medicare A&B. It will be covered by supplement programs or Medicare Advantage programsTell me about a time you had to fight through the appeals process to secure coverage for a client—what was on the line and how did it resolve?
A client on a MAPD plan was denied coverage for a critical cancer drug her oncologist prescribed, labeled “not medically necessary.” We filed a Level 1 appeal with medical records—it was denied. We escalated to a Level 2 appeal, adding clinical studies, a peer physician letter, and a personal statement from the client. The Independent Review Entity reversed the denial, approving the drug with retroactive coverage. She began treatment within 10 days and saw improvement. This case underscored the power of persistence and strong documentation in the appeals process.How does Medicare cover palliative care for serious illnesses, and what’s the difference between palliative care and hospice care?
Hospice care means that you likely have less than 6 months to live which Medicare pays for while palliative care is something where a doctor writes up “a plan of care” of a determinate length based on her/his diagnosis of a serious illness. This will require the use of various equipment (& physical therapy) usually found in a Nursing home or possibly in an assisted living facility.Shouldn't Medicare expand to cover more alternative treatments that actually help seniors?
I've heard about new AI-powered diagnostic tools for early disease detection. Does Medicare cover any of these cutting-edge technologies?
Yes, Medicare is increasingly covering AI diagnostic tools and services. AI is becoming a major player in all aspects of our lives and continues to grow in knowledge every day. It is being used to help diagnose people’s healthcare problems. However, it’s in its early stage and still needs to have the oversight of humans' approval before it can be accepted as a proper diagnosis.How often should I review my plan to make sure my therapy is still covered?
It depends. As an agent I call or try to everyone my clients to answer any questions. I am always at phone call to help. However, there will be somethingThat I cannot control and you will have to call the Insurance company
Can I temporarily add travel or out-of-state coverage options?
Most certainly. Your Medicare programs and supplements will cover you for any emergency in the USA. In addition there is 50000 dollars with supplements and with Medicare Advantage programs.Will Medicare cover the cost of Medicare treatment?
Not completely. There are deductibles and copays for transactions under part A and part B. In addition there is a monthly premium for part B of at least $185 per month.
What are Medicare’s coverage options for mental health apps or virtual therapy platforms for seniors with depression or anxiety?
One's coverage will depend on whether they are on the Original Medicare (Parts A & B), or a Medicare Advantage Plan (Part C). Both options will offer mental health coverage. However, the MA plans will include other options like the telehealth apps, group or single therapy sessions or other supplemental mental health services. These services can vary between plans.Are imaging tests like MRI or ultrasound for breast cancer covered?
Medicare does cover both of those. Your Dr will give you all of your options. Both supplements and Advantage plans cover all of that and some Medicare Advantage plans will help with transportation to take you back and fourthHow much will I have to pay out-of-pocket for therapy?
Does Medicare cover supplements, herbs, homeopathy or other natural / alternative-medicine treatments?
Medicare and supplement programs do not these supplements you have ask about. Medicare Advantage sometimes do cover them in the over the county programs.My mom has dementia and needs in-home dementia care. What Medicare plan will cover this?
MEDICARE HAS HOME HEALTH CARE SERVICES, FOR MEDICAL ISSUES, FOR 20 HOURS A WEEK. IF YOU NEED CAREGIVER SERVICES, THEN YOU WOULD NEED A LONG TERM CARE OR HOME HEALTH CARE POLICY.IF SHE IS ON MEDICAID AND MEDICARE, SOME ADVANTAGE PROVIDE SOME CARE IN THE HOME, BUT IT IS LIMITED.
THERE ARE SOME HOME CARE POLICIES THAT HAVE GURANTEE ISSUE, SO SHE MAY BE ABLE TO APPLY FOR ONE OF THEM FOR ADDITIONAL HOME CARE.
What role might private insurers play if Medicare expands to cover more preventive care?
Medicare already provides a pretty significant list of preventative service covered under Medicare. If there is a plan you are looking at in specific, refer to your explanation of benefits for reference to specific preventative services you would like to see or know are covered.Will Medicare pay for heart medications or implantable devices like pacemakers?
Yes as long as the doctor has it approved and it is necessary and the medications are in the plans formulary, you can also appeal to have the meds covered
What’s the difference between what Original Medicare covers and what a Medicare Advantage plan might include for holistic care?
Its been my experience that holistic care, by and large is not covered with the exception of some Medicare advantage plans covering acupuncture. Vitamins can be a covered expense on some over the counter plans with Medicare advantage plans as well.
If a patient had surgery with more than a 3 day stay in the hospital and needed to recover from the surgery before starting rehab, can the rehab stay be delayed by up to 90 days pending recovery?
Yes with a couple of caveats. Medicare will pay for inpatient rehab in a skilled nursing as long as the rehab stay is preceded by a 3 day stay in a hospital. This is called the "Medicare 3-day rule." And it is true that beginning the rehab stay can be delayed by up to 90 days after the hospital stay, pending recovery from the surgery. However, if the delay is longer than 30 days, it must be medically inappropriate to begin rehab sooner to remain covered. Also, the above rules apply to Original Medicare. If someone is enrolled in a Medicare Advantage plan, they will have to follow the guidelines set forth by their particular plan. Medicare Advantage members are not subject to the 3-day rule, but their plan will still have to approve any inpatient rehab stay based on medical necessity.Can I drop my employer health insurance and switch to Medicare instead?
Many 65+ers keep their employer plan but not all. Medicare is usually a better deal featuring an annual outpatient deductible of $ 283 in year 2026. Can your employer plan do that? It's doubtful. OK but the cost of Medicare must be factored in. Medicare Part A is typically $ 0 monthly but the standard Part B (outpatient) monthly cost is $ 202.90. Compare that with your employer plan's cost and see where you will come out ahead. There's more to it because original Medicare generally is not enough. Medicare members should consider a Medigap / supplment plan or Medicare Advantage insurance in addition to Medicare A and B. Age 65 Medicare supplement premiums can run close to $ 200 monthly depending on your zip code and plan design. Many Medicare Advantage plans typically have $ 0 monthly plan premium with the full understanding that there will be copays and / or coinsurance depending on unitilization. Now getting back to your question, "can you drop your employer health plan?" Check with the employer. Most of them don't want you on their plan. But if you stay, there might be considerable monthly plan premium costs, possibly higher than when you were a sprightly age 64. Your primary considerations should be, what are the coverages and benefits? Check with a licensed Medicare agent who should be able to review your employer plan and compare it with private insurance costs plus the cost of Medicare A and B. I don't know of any employer that will not allow you to drop their insurance. They really don't want you!Does Medicare pay for pulmonary rehab sessions?
Yes Medicare will cover Pulmonary Rehab sessions. The level of coverage will depend on what type of plan you have. An Advantage plan will have a specific copay while a Medicare supplement will have your annual deductible to meet and then it will cover the visits.
Does Medicare cover stress tests, EKGs, or echocardiograms?
Yes, with a copay typically. You should check the medicare plan summary of benefits or Evidence of Coverage for the details.
Will Medicare cover my recovery after surgery?
Yes — in most cases, Medicare does help cover recovery after surgery, but what’s covered depends on the type of care you need.Here’s how it typically works:
Hospital Recovery (Inpatient)
If your surgery requires you to stay in the hospital, Medicare Part A usually covers your inpatient stay, including:
Your room
Nursing care
Medications
Medically necessary therapies
Skilled Nursing Facility (SNF) Care
If your doctor says you need extra recovery time in a skilled nursing facility, Part A may cover it after a qualifying inpatient hospital stay, which means:
You were admitted as an inpatient (not just under observation), and
You stayed at least 3 consecutive inpatient days
If those requirements are met, Medicare generally covers:
Up to 20 days at no cost
Days 21–100 with a daily copay
Beyond 100 days you pay out-of-pocket
Home Health Care
Many seniors prefer to recover at home — and Medicare often covers that too.
If your doctor orders it and it’s medically necessary, Medicare can cover:
Skilled nursing
Physical therapy
Occupational therapy
Speech therapy
And there’s no cost for covered home health services.
Outpatient Recovery
If your recovery happens mostly at home but you need follow-up care such as:
Physical therapy
Wound care
Follow-up visits
These are typically covered under Medicare Part B, with your usual copays/coinsurance.
Medicare covers a wide range of post-surgery recovery services — in the hospital, in a skilled nursing facility, or at home — as long as they are medically necessary and ordered by your doctor.
Are inhalers and nebulizers covered by Medicare?
Medicare under Part B covers a nebulizer. Inhalers fall under Part D of the drug plan. Be sure to check which drug plan has the best coverage.Are x-rays, exams, or therapies done by chiropractors covered under Medicare?
Yes these procedures are covered under your Part B coverage. There can be limitations and exclusions, so be sure to refer to your evidence of coverage document.My mother is in a Georgia nursing home with asset limits. If she sells her car for its listed value, her bank balance will exceed the limit. Can the extra go into a burial account? The nursing home says yes, but online sources say no. Please help! Or do I need to hire an elder care lawyer?
I always recommend a Certified Elder Law Attorney. Most states allow the purchase of a pre-paid Irrevocable Funeral Trust, this will be Medicaid exempt. The Elder Law Attorney knows the options for Medicaid eligibility. If a person has whole life insurance, it is often possible to change the ownership of the policy to a family member before the Medicaid application to allow the family member to control the policy as not to lose the accumulated cash value and use that money for the future funeral. Proceeds from life insurance are generally tax free when going to a family member, but not when going to an estate, in most states. Again, consult the certified Elder Law Attorney.Is telehealth still covered under Medicare in 2026?
In 2026, medicare will limit some Tele Doc services as a lot of the covid era enhancements are not available in the fitute.Does Medicare handle coverage for telemedicine mental health therapy?
If you meet certain conditions and are unable to drive to the Drs office, telemedicine will be coveredWhich Medicare plans offer support for arthritis or chronic pain management?
All Advantage plans have forms of a pain management & Chronic care management. Some Advantage plans have Special needs plans , called SNF, & C-SNP plans that cater to these individuals.Check n Medicare.gov to fibd plans in your state.
Does Medicare cover SilverSneakers gym memberships?
Original Medicare does not cover SilverSneakers or gym memberships. However, many Medicare Advantage plans and some Medigap plans include SilverSneakers as an extra fitness benefit at no additional cost.If your plan includes it, you can access participating gyms, fitness classes, and online workouts using your SilverSneakers membership ID. Coverage varies by carrier and ZIP code, so you should check your specific plan benefits or use the official SilverSneakers eligibility tool.
Are visits with psychologists, social workers, or psychiatrists included in Medicare coverage?
Yes, they are. Medicare pays 80% of the approved amount. Patient pays 20% coinsurance unless they have Medigap/Supplement in which case it usually reduces to $0. A Medicare Advantage plan varies by plan, but typically $0-$40.Are there any exceptions for medical nutrition therapy or therapeutic supplements under Medicare?
Depending on health conditions some may be approved, it also depends on the type of plan you have, as some advantage plans havevthus coverageHow does Medicare cover COPD treatment and oxygen therapy?
COPD and oxygen treatment are covered at 20%. If you have a supplemental program. If you have a Medicare Advantage plan you will have a 20% copay until you reach a cap.Danny Brechin
Will I lose my Medicare benefits if I get married?
You will not lose your Medicare benefits just because you get married, but marriage can affect your premiums, eligibility for certain low-income programs, and a few special situations. Medicare is individual coverage, not a family policy, so your own Medicare eligibility and basic coverage do not stop when you marry.
If I have Medigap or secondary insurance, does it cover my Medicare Part A and Part B deductibles?
This will depend on which Medigap plan you have. If you have a plan F, yes they will be covered. If you have a plan G, the Part B deductible will not be covered but Part A will be. Other plans vary as well.Does Medicare cover CPAP machines and sleep apnea treatment?
Yes the c pap machine is covered unfer DME durable medical equipmenthe trearments are covered by part b
Does Medicare cover shoulder replacement surgery?
Yes it will cover it based on medical needsYou also may want to get a 2nd opinon so you have the best posdible outcome
What role do Social Determinants of Health play in Medicare plan quality?
Social Determinants of Health are the everyday things that affect someone’s health outside of the doctor’s office, like transportation, housing, food access, and social support. Medicare plans are paying more attention to these because they can directly impact whether someone takes medications, gets to appointments, or manages chronic conditions well. A good Medicare agent can help you look beyond just premiums and benefits to see which plans actually offer support that fits your situation.How can I find out if Medicare will cover a specific procedure or treatment before I schedule it?
Are genetic tests or screenings covered?
Yes, generic tests are covered by Medicare if they are deemed medically necessary.Medicare covers most blood tests ordered by a doctor to diagnose or monitor a medical condition, typically with no out-of-pocket costs for you.
Coverage may vary based on the type of test and whether it is part of a preventive service or routine screening.
It's important to check with your healthcare provider and Medicare to understand the specific tests covered and any potential costs.
For more information, you can consult with your healthcare provider or check the Medicare.gov website.
I hope this helps.
Do most doctors accept Medicare Advantage plans?
Currenty about 69% of Doctors take Advantage plans.A lot depends on where you live. If you are in a large city then you have more choices
In small cities choices are less
Can my Medicare Advantage plan drop me, and what happens if it does?
There are circumstances where a Medicare Advantage plan can you drop you as a member, but it is regulated and can't be due to your health or increased utilization. Typically it is due to non-payment of premium, moving outside of covered service area, you become no longer eligible and enrolled in Part A and Part B as required, or the plan exits the market that you are living in, or the plan no longer meets the requirements to offer the plan through Medicare.If you are dropped it will trigger a Special Enrollment Period (SEP) and you will be able to enroll in a new plan without waiting for Annual Enrollment Period (AEP) or Open Enrollment Period (OEP).
Do Medicare Advantage plans include dental coverage?
Some Medicare Advantage("MA") plans have a limited amount of dental coverage. Speak to a licensed and trained Medicare Insurance Agent to help you find the best plan for your needs.Can I use my Medicare when I travel to another state?
You can use your Medicare when you travel to another state. However, you may be limited on your options depending on whether you have a Medicare supplement or a Medicare Advantage plan.Medicare supplements offer great flexibility. You can use your supplement at any provider that accepts Medicare. Medicare Advantage plans on the other hand usually require network adherence. This often limits you to just emergency care and ambulance services. Each plan will have its own rules for out of network coverage. Be sure to know what your plan will cover.
How much does Breztri cost with Medicare?
The cost of Breztri with Medicare can vary quite a bit, but here’s a realistic range:With Medicare Part D or MAPD, many people pay about $45–$50 per month on average.
In fact, about 80% of Medicare users pay $50 or less monthly for Breztri.
Without insurance, the price can be $400–$600+ per month, which is why Part D coverage is important.
Your exact cost depends on your plan’s formulary tier, deductible, pharmacy, and whether you’ve hit the $2,000 drug cap. The best way to know your real price is to run it through your specific plan or Medicare Plan Finder with your pharmacy selected.
Which inhalers are covered by Medicare Part B vs Part D?
The best way to answer this is to give a list of inhalers you like to an agent or put them into a medicare rx calculator. Every insurance company is different.What does Medicare cover for stroke recovery and rehabilitation?
In this case you would qualify for skilled nurding benefit.Check you plan to see what your out of pocket is.
On Advantage plans you will have more out of pocket for these services.
In a supplement , like a plan G or N, you will have mych less out if pocket
What is the cost and value of a supplemental plan, and what plans are available?
The value of a Medicare supplement is outstanding. They allow you to see any provider that accepts Medicare without regard for network adherence. They also have a low annual deductible before the benefits kick in.The cost for Medicare supplements vary based on your zip code, your gender and your age as well as the carrier. Carriers charge different amounts for the same plans.
There are many plans available. Different locations may have different carriers available. You will see different costs for the same plan name from different carriers. The biggest carriers may not be worth the cost increase compared to a smaller carrier. The best thing to do is to find a local broker that represents multiple carriers. They can quote the different carriers and different costs in your area.
Do you have to renew your Medicare Supplement plan every year?
No. Medicare Supplement (Medigap) plans are generally guaranteed renewable, which means you do not need to reapply or renew your coverage each year as long as you continue paying your premium. The insurance company cannot cancel your policy because of your health or because you've had claims.Your premium may change over time, and the plan's benefits remain standardized by Medicare. While it's a good idea to review your coverage periodically, you can keep your Medicare Supplement plan year after year without annual renewal.
Does Medicare cover Alzheimer's disease treatment?
This is a two part answer:1. Medicare covers physician office visits, and Part D covers standard medications for Dementia's.
2. Any Long Term Care: in home caregiver, Assisted Living, Nursing Home, etc IS NOT covered by Medicare and requires a Long term care insurance policy.
Does Medicare cover smart watches or fitness trackers?
Medicare itself doesn't cover any of these but some medicare advantage companies do. I would check with a local agent to find the companies that do.Why have millions of seniors suddenly lost their Medicare Advantage coverage?
Because of the reduction in payments to medicare and medicare advantage companies there has been a pull back in especially rural areas with respect to these plans.What happens to my Medicare coverage when I turn 65 if I'm already on Medicare due to disability?
When you turn 65 you have a new enrollment period and can enroll in a medicare supplement plan with out underwriting and be able to get a new Part d plan .Does Medicare cover memory care facilities?
Does Medicare cover extended care and memory impaired patients. The answer is no. Medicare will cover medical treatment, But does not cover room and. BoardWhich Medigap plans cover foreign travel emergencies, and how much do they pay?
All medigap plans cover up to 50,000 for foreign emergency visitsI would however recommend getting an international medical plan when you travel outside usa as the medigap plans require you to pay 1st and then wait for reimbursement, on the international medical they will file claim for you
Do my Medicare hospital days reset every year?
They reset every benefit period. Medicare benefit periods under part A starts upon becoming an inpatient in the hospital and ends when you have been out of the hospital or skilled nursing facility for 60 days in a row.You also have extra lifetime days to use if you run out of days that Medicare will cover. These 60 lifetime days can only be used one time in your life.
Medicare advantage and Medigap plans are figured differently and provide you with more days.
Does Medicare cover memory assessments or neurologist visits?
Yes Medicare covers neurologist visits and cognitive testing requested by those physicians. Neurologists are specialists so they are covered based on the type of plan you have, a Supplement or an Advantage plan.Keep in mind that Medicare DOES NOT pay for memory care, or Long Term Care.
Does Medicare offer life insurance, or is that a separate product I need to buy?
Life insurance is a separate product not covered by Medicare... Medicare is health insurance not life. Medicare will cover hospice care, which is an end-of-life benefit: nursing care, pain management, medical equipment, but not a cash death benefit like life insurance.Social security does have a one-time $255 death benefit, but best to connect with them for the details... It's not through Medicare.
Can I have Marketplace and Medicare coverage at the same time
No. Once you become eligible for Medicare and enroll in it, you generally cannot receive Marketplace premium subsidies, and it usually doesn't make financial sense to keep a Marketplace plan. Medicare and Marketplace coverage do not coordinate benefits the way other insurance can.If you have Medicare, you should typically transition to Medicare-based coverage rather than paying for both. Delaying Medicare and staying on a Marketplace plan when you're eligible for Medicare can also expose you to late enrollment penalties for Part B and Part D.
How do I find out if Medicare covers a specific procedure before I have it done?
Your provider or you carrier should be able to tell you if a procedure is covered by Medicare. If you want to check for yourself you can check the Medicare Coverage Databasehttps://www.cms.gov/medicare-coverage-database?utm_source=chatgpt.com
You can check by Procedure name, CPT/HCPCS code or Diagnosis.
You can also check for certain procedures on Medicare.gov
If you have an Advantage plan you will also want to check to see if your procedure requires prior authorization and if the provider you're using is in network.
What is a $0 premium Medicare Advantage plan, and what's the catch?
Many Medicare Advantage plans have a $0 premium. This means there is no monthly charge to have the plan. These plans will have copayments and coinsurance applied when you receive medical care. These plan make having health coverage more affordable for millions of people. In addition to a $0 premium these plans also offer an Annual Max Out of Pocket Limit. This MOOP protects people from catastrophic medical bills and is perhaps of of the most overlooked benefits of an Advantage plan.
What is the difference between Plan G and Plan N of Medicare?
Medicare supplement plan G and plan N have the same deductible, however, on plan G after the deductible is satisfied, you do not have to pay anything for doctor visits or emergency room visits and on plan N you have to pay $20 for doctor visits and $50 for emergency room visits.Does Medicare cover hospital observation stays, and how is that different from being admitted as an inpatient?
Observation stays are covered by Medicare Part B. This means you are subject to the Part B deductible if you have not already met it. Then Medicare pays 80% of the cost, leaving you 20%. There will also be copays for any services performed or medications given during the stay.Does Medicare cover assisted living?
Unfortunately Medicare does not cover assisted living and will not pay room and board or custodial care.In order to get those services you will need either a long term care policy, or a separate policy that will help you pay for those services.
What is the maximum out-of-pocket limit for Medicare Advantage plans?
The federal government sets mandatory caps on out-of-pocket expenses for Medicare Advantage (Part C) plans. Once you reach this limit, your plan pays 100% of covered medical costs for the remainder of the year.Specific limits vary by plan, but federal guidelines enforce the following thresholds:
* IN-NETWORK SERVICES: The maximum limit is $9,250.
* COMBINED IN-NETWORK AND OUT OF NETWORK SERVICES: The maximum limit is $13,900.
Keep in mind these important details about the maximum out-of-pocket (MOOP) limit:
* LOWER LIMITS ARE COMMON: While $9,250 is the maximum allowed by the government, many individual plans voluntarily set much lower caps.
* AVERAGES: The average out-of-pocket cap is $5,421 for in-network services, and $9,825 for combined in-network and out-of-network services.
* WHAT COUNTS: Deductibles, copayments, and coinsurance for Part A and Part B covered services count towards this limit.
* WHAT DOES NOT COUNT: Your monthly plan premiums, prescription drug (Part D) costs, and extra supplemental benefits (such as dental, vision, or hearing) do not count toward your medical MOOP.
* PRESCRIPTION DRUGS: Part D prescription drug costs have a separate, dedicated annual out-of-pocket cap of $2,100.
To find out the specific MOOP limit for a plan you are considering, you can review its Summary of Benefits or compare options using the Medicare Plan Finder.
How do Medicare copays work?
A copay is a fixed dollar amount you pay for a covered medical service or prescription drug. Copays are most common in Medicare Advantage and Part D plans, such as paying $20 for a primary care visit or a set amount for medications.Original Medicare usually uses coinsurance instead of copays, meaning you pay a percentage of the cost rather than a flat fee. Copay amounts vary by plan, service, and drug tier.
These costs typically count toward your plan’s Maximum Out-of-Pocket (MOOP) in Medicare Advantage plans.
Does Medicare cover MRI scans?
If the MRI is medically necessary, they will cover it. Most times it is based on the diagnosis utilized for the client..
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.
If I leave the hospital against medical advice, will Medicare still pay the bill?
Yes, Medicare will still pay its portion of the bill up to the point that you leave the hospital. Any costs that were medically necessary and approved will still be covered. However, follow-up care, skilled nursing care, and any readmissions may present issues. Readmissions and follow-up care may be closely examined. For Part A to cover skilled nursing care, you must have been an inpatient for 3 days and have been properly discharged.Do I need Medicare Part B if I have VA benefits?
No, you are not required to enroll in Medicare Part B if you have VA benefits. However, VA healthcare and Medicare are separate systems, and VA coverage generally only pays for care received at VA facilities or VA-authorized providers.Part B gives you access to non-VA doctors, specialists, hospitals, and outpatient services outside the VA system. If you decline Part B when first eligible and later decide you want it, you may face a late enrollment penalty and have to wait for an enrollment period.
Many veterans enroll in Part B as a backup, even if they primarily use the VA, because it provides greater flexibility and access to care when needed.
Does my Medicare Advantage plan cover me when I travel to another state?
Your Medicare Advantage plan covers you for emergencies and urgent care anywhere in the United States — even if the hospital is out-of-network.Important limitations:
Routine care (regular doctor visits, specialists, elective procedures) is usually only covered inside your plan’s local service area (often just Georgia). Out-of-area routine care may cost more or not be covered at all.
Tips for snowbirds & travelers:
*Many plans offer temporary out-of-area coverage (check your Evidence of Coverage).
*Prescription drugs are usually covered nationwide at network pharmacies.
*For frequent or long-term travel, a plan with strong travel benefits, or pairing with a Medigap Plan G, gives you the most freedom.
Bottom line:
*Emergencies = covered nationwide.
*Routine Care = stick close to home or choose your plan carefully.
What is the biggest coverage gap most people don't know about with a Medicare Advantage plan?
There are many: in/out of network costs, inpatient admissions costs, chemotherapy, skilled nursing costs and network restrictions, possible travel/network restrictions, just to name a few. Each plan has a lengthy summary of benefits which is required to list required co-pays/cost of care within the parameters of the plan.Does Medicare cover heart monitors?
Typically Medicare does cover heart monitors when it is a medical necessity. A physicians order and documented symptoms are required. Heart monitors are considered Durable Medical Equipment, so once the Part B deductible is met Medicare pays 80% and the beneficiary pays 20%.Medicare does not cover devices like Apple Watch or a Fitbit. These are considered consumer electronics.
My oxygen provider says I need yearly re-evaluations for oxygen coverage, but my last one lapsed and now they are charging me. I’ve been with them since 2017. Please help.
Ask “Am I being billed because Medicare denied medical necessity, or because paperwork simply expired?” If the paperwork has expired, ask the supplier exactly what they need. Then, contact your physician to get the required prescription or testing that is being requested. If it is just paperwork, that issue can usually be solved fairly quickly. If it is a Medicare denial, you may have more testing and documentation necessary.How does a Medicare insurer's Medical Loss Ratio affect the quality of my coverage?
The insurer's Medical Loss Ratio should not affect the quality of your healthcare. More likely you would see a change in any extra benefits offered by the carrier. When evaluating a carrier MLR can be useful but it should NOT be the primary factor when choosing coverage. The things that you should evaluate more are the providers available, the drug formulary, Star Ratings, the max out of pocket limit and the carriers customer service reputation.How long can I stay abroad without losing my Medicare benefits?
You can stay abroad indefinitely without losing your Medicare eligibility or benefits. Medicare enrollment itself is not terminated by extended time outside the U.S., but coverage for health care services received abroad is extremely limited, and there are important considerations for maintaining your coverage.Does Medicare cover Life Alert or medical alert systems?
No Medicare will not cover these things. Some medicare advantage plans MAY cover these as a plan benefit but many do not.Does Medicare cover cataract surgery with monovision (1 standard IOL for near and 1 for distance)? My eye center says it’s considered premium and would cost $2,500 per eye.
Here is the current Medicare guidance for standard lenses for Cataract Surgery. Always feel free to call 1 (800) Medicare with specific questions or procedures prior to surgery.Cataract surgery
Medicare Part B (Medical Insurance) may cover cataract surgery that implants conventional intraocular lenses, depending on where you live.
Covered by Part B
Cataract surgery removes a cloudy natural lens from your eye and, in most cases, replaces it with a clear artificial lens.
Coverage details
Medicare doesn’t usually cover eyeglasses or contact lenses. However, Medicare Part B (Medical Insurance) covers one pair of eyeglasses with standard frames (or one set of contact lenses) after each cataract surgery that implants an intraocular lens.
Costs
For covered cataract surgery in a hospital outpatient setting or ambulatory surgical center: After you meet the Part B deductible, you pay 20% of the Medicare-approved amount to both the facility and the doctor who performs your surgery.
For covered cataract surgery you get in a doctor’s office: After you meet the Part B deductible, you pay 20% of the Medicare-approved amount for both the intraocular lens and the surgery to implant it.
Will Medicare cover Zepbound and other weight loss drugs in 2026?
Medicare GLP1's.Beginning July 1, 2026, Medicare will make certain Glp-1 medications available to eligible Medicare Part D policyholders for the treatment of obesity and weight loss under the Bridge Program. This is a temporary in that will run through December 31, 2027.
Medicare will manage this program. This is separate from the Medicare Beneficiary’s Medicare Part D coverage.
Source: Anthem BC/BS Medicare.
Plans are insured or covered by a Medicare Advantage (HMO, PPO and PFFS) organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare to get information on all of your options.
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