Medicare Questions & Answers: The Medicare System
The Medicare System Q&A
Showing 150 questions
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.
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 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.
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.
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!
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.
Should I keep original Medicare or go with an Part C, Medicare Advantage plan? What is better?
What is better for one Medicare beneficiary, could be the biggest mistake for you. Unfortunately, there is no 'better' or 'best' when it comes to choosing your Medicare path. It is important that you work with a trusted broker to clarify your options.Original Medicare only should not be a consideration for most people. The financial gaps within Original Medicare will be catastrophic to most people. However, Original Medicare + a Medicare Supplement plan is what you will want to compare to a Medicare Advantage Plan.
Most of our Medicare clients come down to the conclusion that it's Freedom VS Cost. The Medicare Supplement provides freedom of choice for a Medicare beneficiary, but typically at a higher monthly cost. The Medicare Advantage plan often has a $0 monthly premium for the plan itself, but you are often bargaining with some of your freedom of choice, such as what doctors you can see.
Regarding the cost of a Medicare Supplement or Medicare Advantage plan, we are referencing what Medicare Supplements & Medicare Advantage plans cost in the state of Florida, as costs can vary across the USA.
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
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.
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.
I lost my Medicare Card. What do I do?
Hello,You can go to SSA.org, create an account or login, and request a replacement card.
You can also make an appointment to visit your local SSA office in person to request a replacement card.
You should receive it within 5 to 14 business days.
Thank you!
Nydia Flores
Rogala Benefits-36 years l Quote all plans, Licensed, Non-Licensed and Non-Commissionable • Northville, MI
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
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.
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.
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.
Can I show my Original Medicare Card instead of my Medicare Advantage card, if my provider doesn't take my advantage insurance?
No, you cannot use your Original Medicare card if you're enrolled in a Medicare Advantage plan.When You’re on a Medicare Advantage Plan (Part C):
Your Medicare Advantage plan takes the place of Original Medicare for your medical and hospital coverage.
You must show your Medicare Advantage card when receiving care, not your red, white, and blue Medicare card.
Original Medicare will not pay for your services while you're enrolled in a Medicare Advantage plan.
If a Provider Doesn’t Accept Your Advantage Plan:
You cannot use your Original Medicare benefits to bypass the Advantage plan’s network or billing rules.
You would either need to:
Pay out of pocket, or Find a provider who is in-network or accepts your Advantage plan, or
Switch plans during an eligible enrollment period (like the Annual Enrollment Period or Special Enrollment Period if applicable).
Bottom line: If you have Medicare Advantage, that plan is your primary coverage. Your red, white, and blue card no longer applies unless you disenroll from the Advantage plan and return to Original Medicare.
How 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.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.
An agent asked me to sign a scope of appointment for before we could discuss my Medicare insurance or part D plan. What is an SOA? Is this normal? Are call centers exempt from this practice?
The Scope of Appointment (SOA) form is required to be signed 48 hours prior to any scheduled appointment where Medicare Prescription Drug (Part D) plans or Medicare Advantage (Part C) plans benefits are being discussed. The SOA lays out what will be discussed during your appointment with the agent/broker. Only plan types selected on the SOA can be discussed during your meeting. It must be signed by both the Medicare beneficiary and the Medicare agent/broker. The form is a Medicare requirement and all agents, included call center agents, are required to comply with the regulation.There are three exceptions to the 48 hour rule:
1) Walk in without prior appointment
2) Inbound call initiated by the beneficiary
3) Within 4 days of the end of a valid election period
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.
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.
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 healthcareCan you just have A and B and not enroll in anything else and still have good coverage?
Yes, you can have just Medicare Part A (hospital insurance) and Part B (medical insurance), but it does not provide the full coverage most people need.Original Medicare (A & B) covers about 80% of approved medical costs, which means you’re responsible for the remaining 20%—with no cap on out-of-pocket costs. It also doesn’t include things like prescription drug coverage (Part D), dental, vision, or hearing.
To help fill those gaps, most people choose one of the following:
Medicare Supplement + Part D: Covers the 20% and helps reduce unexpected medical costs.
Medicare Advantage (Part C): All-in-one plans that include A, B, often D, and extras like dental or vision.
So while A & B alone is technically “enough” to get by, it can leave you financially vulnerable. Most beneficiaries find better protection by adding coverage.
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.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.
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'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'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.
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.
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. When you call that number make sure to say representative until they actually get someone on the phone.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.
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.
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
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.
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.
Is my Medicare deductible supposed change from year to year?
Yep, your Medicare deductible can change each year! It's set by the government and usually goes up just a bit to keep up with inflation. I always keep an eye on it during Annual Enrollment Period which is October 15th to Dec 7th of each year.
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 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.
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.
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.
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
Will I get an Annual Notice of Change (ANOC) every year?
Yes, each insurance company will send or email you an ANOC each year in the fall, usually the end of September or first week of October. This provides you with a comparison of this years benefits and price to what is offered for the next year. So you have the opportunity to review and compare before speaking with your agent with questions and advice.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.
I signed up for part A. I'm still on my husband's insurance so I didn't sign up for part B. is there a form I need to fill out stating I'm still on my husbands insurance?
Once you’re ready to re-enroll in Medicare Part B, you’ll need to complete form CMS-40B. This form allows you to show proof of prior creditable coverage, which helps you avoid a late enrollment penalty.
I’ve talked to a few Medicare agents near me already, and everyone seems to push something different. How do I know you’re genuinely looking out for me and not just trying to make a sale?
I ALWAYS DO A NEEDS ASSESMENT WITH YOU, TO DETERMINE WHAT PLAN WILL WORK BEST FOR YOU, I DONT WORK FOR AN INSURANCE COMPANY, I WORK FOR YOU,WE ALWAYS REVIEW YOUR INDIVIDUAL NEEDS, AND EVEN IF THE PLAN YOU CHOOSE IS NOT ONE WE REPRESENT, WE WILL STILL HELP YOU GET ENROLLED IN THAT PLAN, IF IT FITS YOUR CRITERIA FROM THE NEEDS ASSESMENT. I WILL ALWAYS DO WHAT IS RIGHT FOR NEEDS, WE OBJECTIVELY REVIEW AND DO NOT STEER YOU TO A PARTICULAR PLAN
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.
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 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.What should people know about Medicare and its parts?
Should I review my ANOC with my Medicare agent?
Absolutely! Your agent can help confirm that your doctors are still in-network... your prescriptions are still in-formulary.If you've been happy with the plan and all of those things are still in-network/formulary... they can help clarify the plan changes and then help you determine if that is STILL the best policy for the incoming year.
Blessings-
Mike Cooper
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.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 clients
How do you get paid, and does it affect the plan you recommend?
So Medicare has already thought this through, and it actually makes a lot of sense. Great question! The way that we get paid is from the insurance company that we enroll you into. But Medicare has flat fees, and they basically level the playing field. All the fees are the same, typically for the carriers. So it doesn't matter if you're getting enrolled into a Blue Cross plan, Humana, or United; they all pay the same fees to brokers when you're enrolled.
And the same goes for the renewal. So that's just how it works. It makes it pretty easy because there are some agents out there that might steer you to a plan depending on what the compensation is.
Can my daughter work with a Medicare agent or broker on my behalf?
Your daughter or anyone with written authorization can represent the person on Medicare to help with Medicare enrollment.
What are the different benefits of Medicare Advantage from Medicare? Is Medicare Advantage more beneficial for someone with several health issues? Do more doctors accept Medicare Advantage? Do you pay more out of pocket for Medicare Advantage-premiums and doctor’s bills. Should I talk with an insurance agent?
Medicare Advantage (Part C) offers some different benefits compared to Original Medicare. It often includes additional services like dental, vision, hearing, and prescription drug coverage, which Original Medicare does not cover unless you buy separate plans. Medicare Advantage plans also have an annual out-of-pocket maximum, which can provide financial protection if you have high medical costs—something Original Medicare lacks. However, Advantage plans typically require you to use a network of doctors and hospitals, meaning fewer doctors accept them compared to Original Medicare, which is accepted by most providers nationwide. This can be a drawback, especially if you see many specialists or need care from providers outside the plan's network. While premiums for Medicare Advantage plans are often lower, you may pay more out of pocket through copays and coinsurance when you actually use services. In contrast, Original Medicare combined with a Medigap plan and Part D drug coverage usually costs more per month but offers broader access to care and more predictable costs. For people with multiple or serious health issues, the choice depends on whether they value flexibility and access (Original Medicare) or lower premiums and extra benefits (Medicare Advantage). It's wise to speak with a licensed, independent insurance agent who can compare multiple plans.
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.
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.Should I sign my parents up for Medicare?
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.
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.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 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).
Should I worry about Medicare cuts?
While I don't think worry or panic is necessary, being prepared for the fact that changes are going to come to the 2026 benefits due to those cuts. Pay careful attention to your "ANNUAL NOTICE OF CHANGE for 2026" that should come in the first couple of weeks in October. It will compare last years coverage to this year and you should be able to clearly see the differences that your plan has made.Should I worry about my income effecting my Medicare eligibility?
Your income will not affect your Medicare eligibility. What it could affect is how much your part B premium would be. That is based on your annual income and the standard is $185 a month , but if your income is over a certain amount that premium can go up and also if your income is low enough, you can also get extra help to help pay for that premium. But your income loan will not affect your eligibility for Medicare that is based on age, and if you have paid in enough over the years to qualify for it
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 to answer questions that will help you better understand what to expect.
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.
Why does Medicare have so many coverage gaps, and is it designed that way on purpose?
Isn't Medicare Advantage just private health insurance? What is the difference?
Pretty much correct! The only thing is that it will cover what would be allowed by Medicare for these services. As a Private Company, they can change coverages and accepted charges or not. They can limit the services they offer you or keep you in a Network, where there is none in Original Medicare. And because the Doctors and facilities are paid from a Private entity, they may not be paid as much or as fast as Original Medicare pays. Therefore, you need to ask yourself if a better professional would then accept being paid less and later than those who will not accept it! When you accept the lower frontal costs of MA plans, what is it really costing you? This is why it is so important to do this right when you first come into your Medicare Open Enrollment!With a Medicare Advantage plan after I reach the max out of pocket, $3,000 or more, will I have any copays or fees the rest of the year?
Once you reach your maximum out-of-pocket (MOOP) limit on a Medicare Advantage plan, you will not pay any more copays, coinsurance, or other out-of-pocket costs for Medicare-covered services for the rest of the calendar year. That means:No more copays for doctor visits, hospital stays, or outpatient services
No coinsurance for procedures, labs, or diagnostic tests
Your plan covers 100% of covered medical services after you hit the MOOP
Do I have to pay taxes on Medicare?
If you mean pay taxes on receiving Medicare benefits, the simple answer is NO. However, if a person receives payments that are may more than the out of pocket cost of the medical expense, that may be taxable. Best to check with an accountant or tax attorney.I am moving to a new state in a few months. What's a good Medicare check list to make sure I am not missing anything in my new state?
First, you have a lot going on for the move to another state. I would highly suggest working with someone (Medicare Broker or Specialist) to help you with it.As for your Medicare, it depends if you have Original Medicare with a supplemental or a Medicare Advantage plan. Your actual Medicare card will not change and will move with you across the country, but you should notify Medicare and/or Social Security of your new address.
If you have a Medicare supplemental plan plus stand alone prescription plan than you should check with your insurance carrier as rules vary from state to state. You may have to reapply for coverage or you should qualify for "guaranteed issue" plans, depending on your health. Either way you will have options. Then you should check to see if your prescription plan is available in your new state. Then you should also check the formulary on that plan to see if that's still the best plan for you based on your new state and zip code. You will have a (SEP) Special Enrollment Period to switch prescription plans anytime of the year. You have a 60 day window to switch.
As for Medicare Advantage plans, you should see what plans are available in that state or zip code. You also will have a (SEP) Special Enrollment Period. You can switch plans 1 month before the move or 2 months after your move to make the change. Keep in mind when you switch plans, they always start the first of the month. Most of the Medicare Advantage plans have networks to deal with, so make sure your Dr's will be in network. Also, if you are switching doctors, make sure to request your records be sent to your new providers.
Lastly, make sure to check in with the State Health Insurance Assistance Program (SHIP). They will be a great resource.
A Medicare supplement broker told me something about "extra lifetime reserve hospital days". What are those and how do they work?
So, simply put, with Medicare Part A, that's your hospital coverage from day zero through 60. You just pay your deductible for the benefit period, which is about $1,600; it's a little more this year. Once you hit day 61, while you're in the hospital, from day 61 through 90, you're paying about $400 a day.
Once you hit day 91, you get into what's called your lifetime reserve days. Basically, you have 60 days that will give you hospital coverage. You are going to pay a little more than $800 a day, and if you use all those days, they are gone for your lifetime.
So, say for instance you're in the hospital and you end up being there for 150 days. You've already used your 60-day benefit or lifetime reserve days, and then five years later you go back to the hospital. The most that you can get Medicare coverage for would be 90 days, 'cause you've already eaten into your lifetime reserve days.
Thank you for listening, hope this helps!
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.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 how Medicare works with other types of insurance like Veterans Affairs benefits or employer plans?
Veteran Affairs benefits are 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.
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.
Are Medicare agents paid by specific insurance to sign up clients to their plans only
The insurance companies pay the agents for enrolling you in certain plans. Almost all agents are paid a commission on each enrollmentIs it better to update your Medicare plan often, or to get a plan that will work long term?
SINCE YOUR NEEDS CHANGE , IF YOU HAVE A PART D OR AN ADVANTAGE ITS GOOD TO DO A REVIEW EVERY YEAR BETWEEN OCT 15 TO DEC 7TH. THESE TWO PLANS CHANGE EACH YEAR AND ITS IMPORTANT YOU REVIEW THE PLANS YOU HAVE AND MAKE SURE THAT THEY ARE THE BEST FOR YOU IN THE COMING YEAR, BENEFITS ON PART D AND PART C (ADVANTAGE PLANS) ARE ONLY GOOD FOR ONE YEAR AND EACH YEAR , THEY CAN CHANGE.ON MEDI GAP PLANS , THEY RENEW EVERY YEAR AND THEY AUTO ADJUST TO ANY MEDICARE CHANGES, SO ON A MEDI GAP , PLANS F, G OR N, YOU DONT HAVE TO DO ANYTHING , AS THEY AUTO RENEW.
Are there any changes I should expect for Medicare in 2026?
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.Can a Medicare broker help us find a plan that includes broader chiropractic coverage?
Am I responsible for an IRMAA surcharge?
Yes. The IRMMA surcharge began in 2007 and focuses on higher income enrollees. They go back the past two years of income.Once One retires that income can decrease since the two year window will continually be changing.
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 basis
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.
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.
What's the difference in copays vs deductibles?
Yes, its confusing! Basically, a deductible is a higher amount (usually $500 on the low end and up to $5000 or more) that you need to meet before your Insurance Company starts paying for your medical costs.A copay on the other hand is usually a set amount (usually around $10 and up to $500) that you pay for a certain appointment or procedure. For ex: a Primary Care appointment might cost a $20 copay, while with your deductible you might pay over $100 for that same appointment. That said, deductible plans usually have a lower monthly premium and Plans with copays are usually more expensive per month.
Until recently, most Advantage Plans did not have a deductible, only copays. Because of the Inflation Reduction Act, more Advantage Plans are now adding deductibles to their Plans.
What is one Medicare trend that you believe is having a positive impact on Medicare affordability? How is it making a difference?
The newest change for 2025 is No Donut Hole in the Medicare Part D patient maximum. The new limit for out of pocket prescription costs are $2000 limit. Basically, is the medication you require is covered by your Part D plan or MAPD, the new guidelines limit your maximum costs per year. Additionally, there is a new monthly payment plan option to cover high cost Brand Name medications.Is Medicare fraud an issue I should be worried about?
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.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'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.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.What 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.What is the best MAPD plan in South Carolina?
There is no such thing as the "best" MAPD in any zip code. Many factors such as hospital and provider networks and prescription drug coverage must be taken into account. Additionally in and out of network maximum out of pocket (MOOP) varies significantly among plans: HMO's, PFFS's & PPO's. For example, there may be six HMO's available in a zip code and the MOOP can vary by $1000's per year. As well as the requirement for pre-authorizations and referral approvals before care can begin.
Who 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'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 do agents charge to help clients to enroll
Medicare agents get paid by the application I turn in. There is no charge to answer all of the questions you want to ask
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.
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!Does Medicare cover Breztri?
Yes it is covered by Part D, you need to see if your plan has it in their formulary, and what tier level it fallsCan I meet with a Medicare advisor on behalf of my mom and dad?
So, the question we're looking at is, "Can I meet with a Medicare advisor on behalf of my mom and dad?" Well, the simple answer is yes. You can meet with us, and you can talk to us in general terms. But when it comes to enrollment or actually giving specific advice to people, it has to be the Medicare beneficiary. Unless you've got a power of attorney over mom or dad, or both, then we can speak to you directly, and you can help them enroll with us.
What are Special Needs Plans (SNPs) in Medicare Advantage?
SNP plan under Medicare Advantage plans is available to individuals with certain health issues, such as diabetes, heart disease, and stroke patients, etc.
What is the benefit to me if I use your Medicare Referral phone number?
Well the benefit would be the same if you found us by getting referred by another client- having an agent that you can trust, that you can talk with, hopefully that you appreciate their time and attention to your needs. Not everyone appreciates the time licensed agents put into their training on Medicare every year. Personally, I put in over 100 hours of training and certifications every year to be able to direct my clients to plans that will help them. It is a difficult task and it’s not for everyone. Some people just use Medicare.gov and have no idea what the nuances of plans are. I assist my clients annually and are there throughout the year for problems they may encounter with new issues or medicines.Are some Medicare Advantage providers better than others?
That depends on where you live. If you live in a large metropolitan area, you'll have more choices. Living in a rural area, you'll have limited choices or no choice at all. Medicare Advantage plans do have a Star rating. You can call Medicare to ask about some of the 4 and 5 Star plans. Work with a licensed Medicare agent to review the plans available in your area.Does everyone over the age of 65 qualify for Medicare?
Why did my Medicare deductible reset in January?
Every year in Jan the part b deductible changes based on inflation and claims data.Some years it goes up more based on medical cost increases and some years less. But every year it changes. They send out notices also if you have a ssa.gov account you can see it ahead of time and budget for it
Does Medicare pay for medical alert systems?
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.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.
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 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.
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 it is 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.Is there a Medigap Plan company with a non-increasing premium? I heard Blue Cross/Blue Shield Offers this. If so, how expensive is it?
No all mefi gap plans increase d ue to medical claims and age. Some plans have rate guarantees for limited times, but ask will increase over timeWhat Medicare penalties are most common?
Other people will say, "I don't take medications, I don't need a drug plan." Well, you're required to have a drug plan, and a care only covers Part B hospital and your medical services. So if you don't have a drug plan, you are going to get a penalty.
And the other thing is changing your plans. It's important that you understand what you need to do either when you're aging into Medicare at 65 or when you actually have to do your roaming, and also when you're leaving your employer. It's very, very important that when you're leaving your employer, you sit down with a licensed Medicare agent. Don't try to do it on your own unless you know what you're doing. It's important to know when you have a qualifying event. So hopefully that answers your question.
When should my plan be reviewed?
You should review every year, before Dec 7th.You should also make sure all your doctors take that plan
What are some ways patients can reduce medication costs while on Medicare?
Always ask for generics 1st,Get a larger dose of the drug and use a pill cutter to cut it in half, you will save 50%
Ask your pharmacy if they have coupons you can use.
Use mail order more
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.
Are there any pointers or suggestions when looking over my ANOC (Annual Notice of Change)?
Yes you should look at all changes especially your Prescription benefits, co pays and what your value added benefits will look like for the new year.Always make sure that your plan will be in the area and if thete is a plan change
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.
Do Medicare Advantage plans work in rural areas?
Folks in rural areas will have a difficult time utilizing Medicare Advantage plans. Because MAPDs are focused on a provider network and rural areas have fewer providers it is difficult for a carrier to establish a sustainable network in less populated areas. PPOs were once an option however they are not profitable for the carriers so they are becoming less available.
Does the SOA need to be completed by a licensed agent, or can administrative staff complete it on the agent’s behalf before the agent contacts the client? This question specifically refers to clients in the USVI.
An administrative assistant could fill out the scope of appointment, but both the licensed agent and the client need to sign it. It is a short form and the licensed agent should be able to complete it without assistance from an administrator.Do Maximum Out-of-Pocket (MOOP) limits change every year?
They do but Plans vary so be sure to read your outline of benefits from your plan to see what changes occur.You should get your Anoc letter in Oct if each year stating any changes
What is Medicare Part B?
Part b is the outpatient benefit of medicare. Its pays your benefits outside the hospital you will pay a premium amount each month based on your income,You must have part b in order to get a medigap plan or an Advantage plan.
Does Medicare pay for hip, knee, or shoulder replacement surgery?
Yes, most on a same day surgery. It is covered by supplement and Medicare Advantage plans. Recovery is also covered for rehab a joint or procedurer.Shouldn't Medicare expand to cover more alternative treatments that actually help seniors?
Does original Medicare require referrals before visits to specialists?
No, Original Medicare generally does not require referrals to see a specialist. As long as the doctor accepts Medicare patients, you can schedule an appointment directly. However, the specialist must accept Medicare assignment for the lowest out-of-pocket costs. Some services may still require prior authorization depending on the procedure. Referral requirements are more common with Medicare Advantage plans, especially HMOs.
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.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.Are cataract surgeries covered by Medicare?
Cataract surgery is covered by all Medicare programs. Medicare will cover additional glasses or lensesDoes Medicare pay for IV chemotherapy?
The Iv chemo is coveted under Part B of Medicare.After your Deductible medicare will pay 80% and you pay 20%, if you have a supplement it will pick up to 20%.
If you have a Medicare Advantage plan, then you would pay the 20% up to your MOOP.
How much will the monthly premium for Medicare Part B be in 2026, and what drives those changes?
Medicare Part B premiums for 2026 will be $202.50 per month.Medicare Part B is a cost associated with having Medicare Part B from the Government. It has risen in cost annually for the past several years.
The changes are driven by how much it actually costs to administer Medicare at the federal level. It is unfortunate that it isn't run more efficiently so that the premium could be capped or eliminated altogether.
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 programsHow do I handle billing issues if something is wrong on a Medicare statement?
So I've said this before, I'll say it again. First of all, you should have an independent Medicare advisor help you with this. That's why we get paid. We get paid not just to enroll you, but to help you with issues that come up, whatever those issues are. You need to lean on your agent to help you with any billing issues.
If you don't have an agent, you need to find one at the next enrollment. Time and again, look for someone that's independent, that doesn't work for a specific insurance company. Someone that's local and hopefully not a snowbird, because the claims that come in are going to be in the middle of summer, where they're probably somewhere else, and you need to find someone.
Most importantly, find someone that only does Medicare, because I learned a long time ago, you can't be an expert at everything. You have to pick one thing and get really good at it.
How long do Medicare appeals take?
Which states have the best Medicare policies?
Being licensed in Florida, I see many really great plans pop up every year largely due to the large population of Medicare beneficiaries in Florida. Plans vary not only state to state but also county to county so it is hard to say one state or another has the "best" policies for Medicare Advantage and Part D. Medicare supplements do not vary in their coverage, but they do vary in the premiums. Where you live determines the premiums and what plans are available to you.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.Why do my copays or premiums look different in January?
All plqns change tgeir benefits in Jan of each year ckeck you plan benefits for 2026, you should have received an Anoc letter in Oct with changes to your current plan.If I switch plans to cover a brand-name eye drop my current plan won’t cover, but my new doctor later takes me off that medication after open enrollment ends, do I have any way to change my plan again?
Yes you may change AEP decision in Jan, Feb and March. During oep. It runs from Jan 1-Mar 31. Might want to ck with your Dr as to why he took you off that Medicine.What’s the best time of year to change my Medicare plan if I develop a new diagnosis?
Those changes depend. The only time to make changes for the upcoming year is during AEP, from October 15 through December 7. There may be other opportunities to change. I recommend meeting with a licensed Medicare agent to review your options.What happens if my specialist leaves the network in the middle of the year?
That will depend on which Medicare plan you have. If you're on a Medicare Advantage plan, you'll need to find another specialist that's in network with your current plan.
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 to enroll in Part D plan for RX coverage?
Unfortunately, the carriers have removed the ability for agents and brokers to help individuals determine and enroll in their PDPs. So now the best way to compare plans is to use the Medicare.gov site.This site allows you to enter your medications and compare plans in your area. You can then enroll in the plan you select, or you can contact the carrier directly.
I start Medicare in 2026 and a one-time 401(k) withdrawal in 2024 placed me in the second IRMAA tier for part of that year. When should I file Form SSA-44 so my 2027 premium returns to the lowest tier?
Ssa does a two year lookback so if you had the withdrawal in 2024 you should file the ssa44 in 2026 or 2027 depending in when tge funds were dispersedDo I need a doctor’s referral for Medicare to cover therapy?
Some therapy is included in most Medicare plans. The amount they will approve or cover is based on the plan.How often can I get mammograms, colonoscopies, or prostate tests?
Most all Preventative services are covered annually, some services such as Colonoscopies have time schedules as to how often medicare will approve them unless your doctor files an exceptionHow has the push for healthcare price transparency affected your work as a Medicare Agent? What's one unexpected outcome you've observed?
I really have not found this has affected my work as a Medicare Agent. I do believe the Medicare Advantage plans have adjusted and set copays for procedures and tests based on hospitals charging more than stand alone facilities and physician group facilities.How is automation improving efficiency and compliance in Medicare processes?
Switching from paper applications to online applications has greatly streamlined processes for signing beneficiaries up on plans, but it has also increase agents misleading clients as well and opened the door for non-compliance. Now a signature is not required on most electronic applications, all the agent has to do is check a box which in my opinion is not a good practice or secure. It has also increased the illegal cold calling for Medicare Advantage and allows these call centers to break many laws including lying to the beneficiary simply to make a sale and move on. I myself have recently gone on Medicare and the 40 to 50 illegal daily cold calls are actually harassment and needs to be stopped. I advise clients to never ever talk to these people and to simply hand up.Browse Other Questions & Answers
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