Medicare Questions & Answers: The Medicare System
The Medicare System Q&A
Showing 80 questions
Are Medicare Advantage plans really "free," or is that just clever marketing?
The concept of "free" Medicare Advantage plans can be misleading. While some Medicare Advantage plans advertise $0 monthly premiums, it's crucial to understand that this doesn't mean you won't have any healthcare costs. Here's a breakdown:* $0 Premium Doesn't Mean $0 Cost:
A $0 premium means you don't pay a monthly fee to the private insurance company offering the Medicare Advantage plan. However, you'll still likely have other out-of-pocket costs, such as:
* Co-payments: Fixed amounts you pay for specific services (e.g., doctor's visits, prescriptions).
* Coinsurance: A percentage of the cost you pay for services.
* Deductibles: The amount you pay before your plan starts covering costs.
What are the reasons why I should work with a Medicare agent?
The only reason you should work with a medicare agent is because of the quality of understanding you get from quality agent. A true agents purpose is to do right by the consumer. A true agent should be able to communicate the medicare Information clearly, communicate why its important and how it affects you annually. They should be able to not only be responsive but cater to finding a plan where you dont have to change your Dr's or hospitals to use the plan. They will provide you with an annual review to make sure you are always in the best place medically. A quality agent is strong enough to put commission aside to help there consumer.
What benefits are there to working with a Medicare Agent near me vs remote/virtual?
There are many benefits to working face to face and virtually with a Medicare Agent.A local can give a more personal approach. Local agents understand the plans available in your specific area which includes doctors, hospitals, and pharmacies.
I personally find, that local agents are extremely more helpful and responsive for follow up issues, claim help, and have a personal knowledge of your needs based on the relationship that is built. A local agent also understands state specific Medicaid programs and Medicare Supplement and Medicare Advantage options in your state, since these benefits vary for each state.
In recent days, working virtually has become a favorite with my clients. Having the flexibility to meet with my clients without travel time is a plus because it gives me the option to work longer hours and across state lines in different time zones. If convenience, flexibility, and you are used to working with computers is appealing to you, working virtually may be the right choice. Everything that is done in person can be done virtually as well.
If you are looking for help, please contact me. I would be happy to review and answer questions.
What role do you think technology will play in the future of Medicare?
Advancements in technology are poised to transform Medicare in the coming years. Telemedicine, which saw explosive growth during the COVID-19 pandemic, is likely to become a permanent fixture in Medicare’s coverage. Other technological innovations, such as artificial intelligence (AI) and wearable devices, have the potential to improve care delivery and outcomes. However, integrating these technologies into Medicare will require addressing challenges such as data privacy, reimbursement policies, and ensuring equitable access for all beneficiaries.
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 don't understand how my friend pays nothing for their plan and I pay over $200-are these plans just totally random by ZIP code?
The plans are not random. If your friend pays nothing for his Medicare plan, this is highly likely to be a Medicare Advantage plan featuring deductibles, copays and coinsurance depending on the plan. Most advantage plans feature a $ 0-dollar copay to see your primary doctor but will have a $30-to-$ 50 dollar copay to see a specialist and there will be additional costs depending on what's going on. Now if you are paying over $ 200 for your plan, you may have a very high-benefit Advantage plan but it is more likely that you have a Medicare supplement plan and this is a different animal. Medicare supplement plan F pays after Medicare leaving you with no medical bills for health services for Medicare-approved services (or no bills after a 2025 $ 256 outpatient deductible if you have a supplement Plan G). Talk to your independent insurance agent about all this otherwise get your license and help me explain this stuff!
Isn't it concerning that Medicare Advantage plans are taking over the system?
Is it concerning? On the one hand the only other option is a Medicare Supplement (or high deductible Medicare Supplement) or do nothing and just have Original Medicare. Being that health costs have increased significantly and that more people are looking to not pay now and pay later (as they use their plan) it is the only option. Other factors like the cost of living have made Medicare Advantage for those eligible attractive. Whereas they would have to pay a monthly premium for a Medicare Supplement. So in that regard it’s the best option for those budgeting or trying to make ends meet. On the other hand, it does leave the fact that there are 6 major Medicare Advantage companies ( there are some regional Medicare Advantage carriers) and these 6 you could say are monopolizing the market. So in that regard they’re pockets are so deep that they can lobby for laws and regulation that benefit their stock prices at the expense of the true intention of healthcare
I've been on disability for years and am about to turn 65. Do I automatically get Medicare because I'm on Social Security, or do I need to do something?
If you already have Medicare benefits due to disability, you just continue to have your Medicare benefit. If you like to change your plan such as the Medicare supplement plan, you are eligible to an open enrollment period that begins three months before your 65th birthday and ends three months after your 65th birthday. Please ask your Medicare insurance agent.If you don't have Medicare benefits now and have enough Medicare credit, you will automatically receive your medicare benefit.
I prefer to access to Social Security Administration on WEBSITE.
https://www.ssa.gov/medicare/sign-up
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.
Why am I paying more for Medicare Part B and D than my friends? What is IRMAA and how is it calculated?
If you’re paying more for Medicare Part B (medical insurance) and Part D (prescription drug coverage) than other people you know, it’s likely due to something called IRMAA – the Income-Related Monthly Adjustment Amount.IRMAA is an additional amount that people with higher incomes must pay on top of their standard Medicare premiums. It affects Medicare Part B and Part D. The Social Security Administration (SSA) determines if you owe IRMAA based on your reported income.
Your friends might have a lower reported MAGI, different filing statuses, or different income sources. Even similar incomes can result in different IRMAA outcomes depending on deductions, tax-exempt interest, or capital gains.
What do I do if I cannot afford my Medicare premiums?
You can inquire on a reduction to your Medicare Part B premium by calling Medicare at 1800MEDICARE. When you call Medicare please note the date of the call & the Medicare representative's name. If you call Medicare back, you will most likely not get the same representative on that call.You can also apply for Medicaid in your State of residence. Please call your State's Medicaid Office. Thank you.
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.
Who can help me figure out this Medicare "maze and alphabet soup" it's so confusing.
Always try to find a licensed Medicare Broker or Agent when looking at enrolling, changing plans, or for more information on copays/benefits. Meeting with them and possibly becoming their client does not cost you anything, we are paid directly by the companies. If you decide to enroll with one they will become your agent and you may contact them with future questions about your plan.
Every year I stress over picking a plan and still end up surprised by the bills. Is there any way to just get peace of mind with Medicare?
Change from medicare advantage to Medigap. You will pay a monthly premium but never get a bill. You can keep the plan forever and have peace of mind knowing your exact cost upfront
Are Medicare plans and requirements different for every state?
Medicare plans are different in regions even, so within a state, there will be multiple carriers offering multiple plans, sometimes differing zip code to zip code. Working with an independent broker, like myself, can help to widen your options and explore what will be best for you.
What should I do if I miss the Medicare Open Enrollment period, and I want to change my plan?
If you have a Medicare Advantage plan and you have missed your opportunity to make a change in the Open Enrollment Period, then perhaps you might have the ability to make a change using one of the several Special Enrollment Periods (SEP) that are allowed by Medicare.Some of the SEP's include things like the following:
1) Have you moved to another county or state? Have you recently moved back to the United States after living abroad? Have you moved into or out of a skilled nursing facility?
2) Have you lost Medicaid? Or lost the Extra Help for prescription drugs? Did you lose the PACE program?
3) Have you recently been granted Medicaid or Extra Help with prescriptions? Do you have a Chronic condition like diabetes or heart disease?
4) You could join a 5-star rated plan
5) Were you affected by a FEMA disaster?
There are many other SEP's that you might possibly qualify for. So, talk to a local Medicare Insurance Broker to know all your options.
Should there be stricter regulations on Medicare Advantage marketing and sales practices?
Short answer - yes and long answer it's complicated. Deceptive marketing is a problem with some marketers using confusing and misleading messages. Not to forget the people turning 65 that get a overwhelming amount of marketing calls, emails, and letters. To the point that a person feels as if they are underseige. While most agents are ethical who actually care about clients, there are definitely bad actors out there who game the system and chase commissions. People then get put into a plan that does not meet their needs.The intent of stricter regulations is good but it could also hinder the good agents but adding more red tape to do the right thing. Not every agent is going to be deceptive. Most agents have good intentions and want to do right by the client.
I went to a free Medicare seminar and it felt like a timeshare pitch. Are any of those events actually helpful?
Though those seminars can be somewhat helpful, your best choice is a one-on-one visit with an independent agent/broker who will take your personal information into account and be specific toward your health issues, your family history and naturally, your pocketbook. With a seminar, it's a numbers game while a visit to your home or at a neutral site is more beneficial.
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.
I've heard about IRMAA affecting my Medicare premiums. How can I find out if it applies to me, and how does it work?
IRMAA (Income-Related Monthly Adjustment Amount) affects Medicare Part B and D premiums for those with higher incomes, and it's determined by the Social Security Administration based on your income from two years prior. You'll receive an "Initial Determination" if IRMAA applies to you.
I live in California but might move to another state next year. How will my Medicare coverage change if I relocate?
When you move outside of your current coverage, you have a special enrollment period. Allows you 3 months after your move to select a plan Example: Move in June you have July 1, August 1 and September 1
So with all these 2025 Medicare changes, should I be switching plans or staying put?
That’s really on an individual basis. If you have a Medicare Supplement, those don’t change from year to year, so the only thing you need to review with your agent is your Prescription Drug Plan.Medicare Advantage plans DO change from year to year. The two questions you should ask your agent:
1) Are there any negative changes to my plan, and
2) Any positive changes, or better options for me?
The one thing you should NOT do is assume that staying in the same Medicare Advantage or Prescription Drug Plan will give you the exact same coverage from one year to the next. They can change - even if you don’t.
Shouldn't Medicare do more to address health disparities among minority seniors?
That seems to be more of a question to ask your representative. There are many gaps that could be addressed by Medicare and our representatives need to hear from you to seek ways and means to make Medicare better for all.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.
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….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.Won't Medicare run out of money before I can benefit from it?
Medicare and Social Security are two different government accounts and departments. Medicare is funded by Congress each year out of the same bucket from which our federal military receives its money.On the other hand, our Social Security accounts are sovereign from other Government activities. That means that what goes into the Social Security account is only paid out to Social Security benefits.
The Social Security account is fully funded until around 2035, and after that, Congress will have to subsidize Social Security payments. It has been stated that after 2035, not enough money is being paid into the Social Security account as Social Security is paid out.
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 penalty
Does IRMAA go away automatically if my income drops, or do I need to report it to Social Security?
Completing your income tax return should change your recorded income for calculating IRMAA. Even with that being said, it makes sense to go ahead and attach your income tax form with an appeal to insure your surcharge is removed.
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.
How do I report a suspicious Medicare billing error without getting in trouble myself?
Don't let the fear of retaliation prevent you from exposing the possible wrongdoing of someone in a position of trust over you. The False Claims Act protects you.Fraud, waste, and abuse hurts us all. It takes courage to report something you think is wrong, but it's the right thing to do. We all must do our part to expose corruption in the system because, in the end, it's our money being misused.
To report something you think is wrong, you have several options. You can call your provider's office and inquire about the charge. They may be able to explain it. If you feel uncomfortable or sense your concern was brushed off, call your plan's member services number and speak with a supervisor about the billing error. You may also call Medicare to voice your concerns. These actions take time, but after you call, you'll feel better knowing you did the right thing.
If you could change one thing about the Medicare system, what would it be and why?
Medicare is very complex. The cost of prescription drugs are high and it's difficult for some clients to fill their prescriptions due to the cost. It would be great if pricing was adjusted for Medicare clientsWhat demographic challenges will Medicare face in the coming years?
The aging population also brings a higher prevalence of chronic conditions such as diabetes, heart disease, and Alzheimer’s, which require costly long-term care and management. Medicare must adapt to meet the growing demand for services while ensuring the program remains financially sustainable.Can you help me understand Maximum Out-of-Pocket (MOOP) limits in Medicare plans, from your experience as an agent?
There are two maximums out of pocket limits to consider.The first one is on prescription drugs.
In 2024, Medicare changed the way prescription drug plans work. Out with the old and in with the new $2,000 maximum amount you will pay for your covered prescription drugs. Our prescription drug plan insurance company keeps track of how much you've paid for your prescriptions and when you have reached your maximum, your covered prescriptions will drop to zero amount for the rest of the year.
The second maximum out of pocket to know about is with the Medicare Advantage plans.
If you have a Medicare Advantage Plan, commonly known as a Part C, the insurance company keeps track of how much you pay for co-pays and co-insurance through the year. Once you reach the plans maximum out of pocket amount, then the insurance company pays the remaining co-pays and co-insurance for the rest of the year. Each plan has a different Maximum out of pocket amount, so knowing what that amount is important.
Make note that if you only have original Medicare, there is no maximum out of pocket amount for your 20% co-insurance.
Isn't it suspicious that Medicare Advantage plans offer gift cards and incentives to enroll?
I do not feel it is suspicious, but it is against regulations. Offering such gift cards to entice a beneficiary to enroll is not permitted.Offering gift cards to beneficiaries for completing health assessments is permitted, but not for enrollment.
Why does Medicare allow insurance companies to bombard seniors with confusing mail and TV ads?
I wouldn't say Medicare allows it; however, private insurers aggressively market Medicare Advantage plans to gain enrollment and sometimes use tactics that can be confusing.Some ads or mailings can be misleading, such as promising benefits at a specified amount that isn't correct.
Medicare beneficiaries are more vulnerable. That's why I recommend working with a broker you trust to handle your insurance needs. I tell all of my clients to call me with any questions they have about anything they see on TV or receive in the mail. This is my way of protecting them from being enrolled in a plan that isn't a good fit for their situation.
Most of the time, the people on the phone you reach to go over your benefits, don't discuss all aspect of your needs such as medications, doctors, etc.
Isn't Medicare headed for a crisis with so many baby boomers aging into the system?
This is known very well by the Medicare market and it is pretty much going to hit its peak by 2030. This is not a surprise as it’s been known for a very long time. There may be changes and adjustments made but it isn’t going to blindside the industry.Don't you think Medicare will eventually be privatized completely?
This is a considerable debate among Medicare beneficiaries and our government. The possibility of prioritizing Medicare is happening through the Medicare Part C Advantage plans, known as managed care under the supervision of major insurance companies. However, it is in the individual's choice to choose which direction they're going with Medicare. As Medicare Advantage plans continue to improve their services and networks of managed care, we will see more and more individuals moving in that direction.Suppose traditional Medicare Part A and Part B, with a Medigap plan, offered similar services like dental, hearing, and vision coverage to Medicare Part C advantage plans. In that case, they may not be as attractive. Traditional Medicare does not have in-network services, so you can use your benefits anywhere that they will take Medicare.
Don't you think Medicare's technology systems are outdated and inefficient?
Based on my experience with helping individuals and families, yes. Medicare's systems needed an update 5 years ago!
How do Medicare Savings Programs help with Medicare costs?
Medicare Savings Programs (MSP) can help people with limited income cover their Medicare premiums, deductibles and other costs like co-insurance. This is also known as a Medicare Buy-In program.Eligibility can be vary by state. Extra help with Medicare Part D drug costs can by applied for simultaneously with the MSP. Income and resources can also vary by state, however most states use income and resource limits based on the Federal Poverty Level (FPL).
Types of MSPs include:
Qualified Medicare Beneficiary (QMB) which helps pay for Part A and B premiums, and covers cost- sharing for Medicare-covered services.
Specified Low-Income Medicare Beneficiary (SLMB) which helps pay for Part B premiums.
Qualified Individual (QI) which helps pay for Part B premiums.
Qualified Disabled Working Individual (QDWI) which helps part Part A premiums for individuals under age 65 who a disabled and have returned to work recently.
You can apply through your State Medical Assistance office (Medicaid).
I worked for the federal government for 30 years and took early retirement. How does my federal retirement affect my Medicare options?
Well that depends on a lot of factors. If you are not 65 then you don't have an option to get on medicare unless you are diagnosed with a disability.If you are 65 and the your coverage will stop at 65 then you need to get on medicare part A and
B.
If you are 65 and the government is giving you lifetime coverage then you need to see if it is worth paying the medicare part B premium and adding medicare or just staying on your current coverage.
I tried calling Medicare and got transferred five times. Is there any way to get straight answers from them?
I would first say make sure you called the right number for Medicare which is 1 (800) 633-4227. When you call that number make sure to say representative until they actually get someone on the phone.
Is Guaranteed Issue available after the Medicare Open Enrollment period ends?
Guaranteed Issue is available for up to 6 months after your Part B becomes effective, and it doesn't have to coincide with with the Medicare Open Enrollment Period. There are also other situations in which Guaranteed Issue applies, but consult with a local independent health broker to determine if your situation applies.
How do I budget for Medicare costs if I expect my health to decline in the next decade?
If you expect your health to decline over the next decade, it’s smart to plan ahead for higher medical expenses. Start by choosing a Medicare plan that offers good coverage for frequent doctor visits, specialists, and prescriptions. Consider a Medicare Advantage PPO if you want flexibility, or Medigap with Original Medicare if you prefer predictability and nationwide access.Also, budget for the “hidden” costs like copays, coinsurance, dental, vision, and long-term care, which Medicare doesn’t usually cover. If you can, set aside a health savings cushion or look into plans that offer extra benefits, like an Advantage plan with a spending card or over-the-counter allowance.
Lastly, review your coverage every year during open enrollment. Your health needs will change, and so should your plan.
What's a common trick in Medicare marketing that hides restrictions on doctor choices?
You must check if your doctor accepts either a PPO or HMO with a specific plan. All plans do not have to accept all doctors.
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.
Would expanding Medicare to younger Americans improve or hurt the program?
People pay into Medicare all their working life. If Medicare added younger Americans, who have not contributed for as long as others, would likely increase the cost for existing and new Medicare beneficiaries. I am sure you can get a different answer from who ever you ask, so this is my opinion. Many economists debate your big question.
Why did I receive a Medicare Summary Notice, and what should I do with it?
A Medicare Summary Notice (MSN) is a quarterly statement sent to individuals with Original Medicare (Parts A and B) that summarizes their claims for services and supplies billed to Medicare during that period. It details what Medicare paid, what you owe, and if the service was approved. MSNs are not bills; they are a record of claims and payments. There is nothing you need to do with the statement.Can you explain how Medicare works with other types of insurance like Veterans Affairs benefits or employer plans?
Veteran Affairs benefits and separate from Medicare. If a Senior is using the VA, Medicare is not responsible for any coverage. If the Senior also has a Medicare plan and sees a doctor outside of the VA they Medicare may pay.In the case where a Senior has an employer plan and Medicare. Typically, the employer plan pays first and then it goes to Medicare as a secondary. But employee plans vary and coverage could work differently.
Can Medicare drop me for health reasons?
Medicare can NOT drop you because of health reasons. If you have a Medicare supplemental plan and drop the plan because you want to change to a Medicare Advantage and you are on the Medicare Advantage for more than 12 months you will be asked health questions to go back to a Medicare Supplemental plan and some people can not qualify. Or if you missed a monthly premium and have a lapse of coverage, you may have to answer health questions to get back and you may not qualify.
What states have the Medigap "birthday rule" and what is it?
As of July 2025, there will be ten states that will have a "birthday rule" where existing owners of Medigap plans can change plans or change Medigap companies without underwriting. The ten states with the "birthday rule" are, California, Idaho, Illinois, Maryland, Oregon, Nevada, Louisiana, Kentucky, Utah, and Virginia.Isn't it time for Medicare to completely overhaul how it approaches senior care?
This is a long-time debate. Some feel we need to privatize Medicare, and others feel we need to let the government control it under a one-plan-for-all. Health decisions are very private, and with that being said, many areas in the Medicare system need to be adjusted or approved, along with the idea of using newer technology.Can you explain Special Needs Plans in Medicare?
Sure. If you are already qualified for Medicaid and are about to enroll with Medicare, you're going to qualify for a "SNP" or Special Needs Plan. This means that you are not going to pay for ANYTHING at all since your status (financially speaking) has been approved. Not every insurance firm offers a SNP plan. You will have to do a little searching but it should be fairly easy to do. By the way, if you've been granted Medicaid status by either a State or Federal agency and two years have elapsed, no matter what your age, you can enroll with Medicare! There are clients who are in their 50's who were approved for Medicaid and then 24 months later, they were able to only enroll into an Advantage plan with drug coverage. But, when you are Medicare-eligible at age 65, you can transition to a Medicare Supplement and a Part D(rug) plan, each with a monthly premium, if that is your preference.
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 husband passed away and now my Medicare premiums went up. Why does losing someone raise your costs?
This can be complicated. It has to do with you & your husband's "Adjusted Gross Income" or "AGI" which is taken from your 2-yr. old tax return. If you've earned more than your husband during your respective careers, once he is out of the picture, Medicare only looks at your new and "individual" tax return. The least amount in 2025 for the Part B premium is $185.00 (as an individual filer, that means the "AGI" is $103,000.00 or less; but it can be as much as $594.00 per month if your AGI is $500K or greater). My best advice for you would be to make an appointment with a counselor at your nearest Social Security office to verify that the above example happened to be your case, or not.
I'm healthy and barely use my coverage, but I'm still paying more every year. Why isn't there a discount for people like me?
Everyone has options to help with cost. We can evaluate your current cost and do a comparison to see what are the best options.
How can I avoid or reduce IRMAA charges on my Medicare premiums?
The fact is IRMAA charges are calculated based on your AGI (Adjusted Gross Income) from 2 years ago. Know this may give you and your tax accountant time to do some financial planning that will help you pay less IRMAA charges when the time comes. You can do a Google search to see the levels of additional IRMAA charges that will be added to your base Medicare premium.I'm an independent agent and am compensated for my services by the insurance companies. I never charge you additional fees for my services. I'm asked this question (IRMAA charges) quite often by higher income earners. You can contact me at 801-550-1800 to answer questions that will help you better understand what to expect.
Can I enroll in Medicare if I've never paid into Social Security due to working overseas?
Yes, you can enroll in Medicare even if you've never paid into Social Security due to working overseas. However, your eligibility and costs will depend on your residency status and work history.Medicare Eligibility Without U.S. Work History
To qualify for Medicare, you must be either a U.S. citizen or a lawful permanent resident who has lived in the U.S. for at least five continuous years before applying.
While most people receive Medicare Part A (hospital insurance) premium-free by earning 40 work credits (approximately 10 years of work paying into Social Security), you can still enroll in Medicare by paying premiums if you haven't met this requirement
Costs Without Work Credits
Part A (Hospital Insurance): If you have fewer than 30 work credits, you'll pay the full premium for Part A. For 2025, this premium is up to $505 per month.
Social Security
Part B (Medical Insurance): Part B requires a monthly premium for all enrollees, regardless of work history. In 2025, the standard Part B premium is $185 per month
How might artificial intelligence change how Medicare approves claims in the future?
AI will definitely be a part of claims decisions in the future, but it will not be the end all as you will always have the ability to appeal to a real person.
What's the projected impact of an aging population on Medicare Part A hospital funds?
I just searched online and the second article listed was written in 2008 and stated that Medicare Part A will have insufficient funds by 2019. Be careful of the information you read online. It's good to be informed but don't get caught in the weeds or buy into fear-based articles. If you called Medicare I would guess they would not be able to answer that question, other than Part A funds must be increased every year.Could Medicare ever adopt a tiered premium system based on lifestyle factors?
This question is a very vague question and difficult to answer without understanding the individual circumstances.Medicare has tiers of cost in their Part B and part D premiums and are based on your income. This does not affect the average Medicare beneficiary unless you’re in those high-income brackets.
Insurance companies operate on different levels, and their cost structure includes high and low deductibles, that can affect your cost.
How could a universal healthcare debate shift Medicare's structure in the next decade?
Despite the stories hard in the US, Universal Healthcare has not been an effective solution in any of the countries that use it.The continuously skyrocketing rise in costs are not stopped by that method. Politicians keep thinking they can mandate a solution that may sound good but is actually impractical.
An example is the Inflation Act & the Infrustructure Act that mandated healthcare changes, as did the Affordable Care Act that solved some problems, but priced to finding to do what was required.
That is why the countries with so-called Universal Healthcare have extreme waiting periods for serious procedures like hip replacement, and heart by-pass operations, etc; causing those that can afford to go to countries like the USA, India, etc; where they can pay to have the procedures done.
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.Is Medicare becoming more expensive over time, and will it ever be unsustainable?
Medicare is the 2nd or 3rd largest budget in the United States. It’s a very important part of our sustainability as a country, so I don’t believe it’s going anywhere anytime soon - the efforts, time and money dedicated to it.With that said, the government is trying to crack down on fraud and waste, as they should, so this should extend the budget and help it go further. Over time, there might be more costs passed off to the Medicare beneficiaries, but the entire purpose of Medicare was to off-set high medical costs for the 65 and older population, so I’m sure there will always be a push to sustain its purpose.
What's a common Medicare myth that even some agents still believe?
I'd say that some agents still think they have to take additional tests in order to get a non-resident license.What's a Medicare rule or regulation that's outdated or unfair to seniors?
Medicare raises costs for seniors who miss their Part B or Part D signup deadline, even if they didn’t know about it.
How much is spent on healthcare per year the U.S., and what does this amount represent per person?
The 2023 CMS Healthcare Expenditure Report revealed an eye-opening total of $4.9 trillion spent on healthcare, averaging about $14,570 per person.
What shift has been observed in Medicare spending, particularly regarding Medicare Advantage plans?
Some plans which were in place in 2023 and 2024 have had their Maximum Out Of Pocket (MOOP) increase in 2025.
I am on ssi Disability. I turn 65 in June. I also just got Humana health. So does it be change to SSI?? Or does my SSI -Disabiliy just go on til death.
If you are on SSDI (Social Security Disability Insurance):SSDI is an insurance program you earn by working and paying Social Security taxes.
When you reach full retirement age (currently 66–67, depending on your birth year), your SSDI automatically converts to Social Security retirement benefits.
You don't need to do anything — the switch happens automatically.
The amount of your monthly check usually stays exactly the same — it just becomes classified as "retirement" instead of "disability."
This change can sometimes affect things like work incentives or how other benefits are calculated, but it does not reduce your payment.
I am a member of a federally recognized tribe here in Arizona. I receive all my medical needs through the Indian Health Service at no cost. Do I still have to have Medicare?
IHS, Indian Health Services, is not health insurance, and it is only available at tribal clinics throughout their nations. Working with many Native Americans in Oklahoma, I have seen that having Medicare alongside the IHS can help provide healthcare providers and specialists outside their IHS clinics and hospitals. Some may find that having this dual coverage will give them the best Healthcare anywhere in the USA.
Don't you think Medicare should ban all those celebrity Medicare Advantage commercials?
In my opinion, yes. They are misleading and cause a lot of confusion with Medicare beneficiaries. I usually have to address misinformation caused by those commercials on a daily basisHow do you stay up to date with changes in Medicare policies and plan options each year?
I listen to a weekly podcast that does a deep dive on the news and notes of the industry. I just got back from an insurance conference in Las Vegas to keep me up to date and make connections. Because of the way the industry is constantly changing you have to keep up to date of you will be left behind.
How could a shrinking workforce affect Medicare funding in the next 20 years?
Medicare is funded through the workforce for future generations which is why its very important that every person working is contributing to this program. We have many workers in the US who are either self-employed or undocumented who are not contributing, that gap needs to be fixed by having a legal path to citizenship for those workers who will also benefit from Medicare when they retire.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.How will advancements in wearable health tech (like smartwatches) integrate with Medicare?
Advancements in wearable health technology are poised to significantly enhance patient care and facilitate faster diagnoses. By continuously monitoring vital metrics such as heart rate, blood pressure, glucose levels, oxygen saturation, and sleep patterns, these devices provide valuable data that can be shared with healthcare providers. This allows for more efficient coordination of care and timely follow-up.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.Browse Other Questions & Answers
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