Medicare questions, answered straight

Nothing at all. Agents are compensated by the insurance carrier, and Medicare plan premiums are filed with and regulated by the government — the price is identical whether you enroll through me, through a national call centre, or entirely on your own.

What differs is whether somebody checked your prescription list and your doctors before you signed, and whether there is a name and a local phone number to call in February when a pharmacy tells you something is not covered.

No. I am independent and appointed with many carriers, including Aetna, Anthem, UnitedHealthcare and its AARP-branded plans, Medical Mutual, Humana, Coventry, Summa, Allwell, Medico, Cigna and Liberty Bankers. Which of those are available depends on your county and the plan year. I do not offer every plan available in your area, and where something exists that I cannot write, I will tell you it exists.

Yes, and most people prefer it. I cover twelve counties across Northeast Ohio and I am used to sitting down at kitchen tables and going through this on paper. If a phone call is easier, that works equally well — a good deal of this can be handled without anyone travelling.

Ideally: your Medicare card, a list of your prescriptions with the doses, a list of your doctors, and your current plan card if you have one. If you have Medicaid, bring that card too. None of it is required to start — call with whatever you have and we will fill in the rest together.

Neither, in the abstract. A Supplement lets you use any provider in the country that accepts Medicare, has no network to worry about, and gives very predictable costs in exchange for a higher monthly premium. You add a separate drug plan.

A Medicare Advantage plan usually has a low or $0 plan premium, often includes drug coverage plus dental, vision and other extras, but works through a network and charges copays as you use care.

The right answer depends on your doctors, how much you travel, how steady you need your monthly budget to be, and your health. Compared side by side here.

On a Medicare Supplement, yes — any provider nationwide that accepts Medicare, with no network and no referrals.

On a Medicare Advantage plan it depends on that specific plan's network, and it must be checked doctor by doctor. Networks also change from year to year, so a plan that included your specialist last year may not this year. Checking this is one of the first things I do.

Medicare Advantage and Part D plans are approved county by county, so availability genuinely differs across a short drive. On top of that, the right plan depends on prescriptions and doctors that are specific to each person. Two people in the same village can correctly end up on entirely different plans.

Not by the monthly premium, which is usually the smallest part of the cost. What matters is whether each of your drugs is on the plan's formulary, which tier it sits on, whether there are restrictions like prior authorization or step therapy, and which pharmacy you use. The correct method is to enter every medication at its actual dose and compare total projected annual cost. Bring me your bottles and we will run it properly.

No, but you should look every year. Plans re-file their networks, formularies, copays and extras annually, and the Annual Notice of Change letter you receive each autumn describes what is changing. Sometimes the right decision is to do nothing at all — but that should be a decision, not an accident.

Your Initial Enrollment Period is seven months long: the three months before your birthday month, your birthday month, and the three months after. Enrolling in the three months before is what gets your coverage active at the start of your birthday month. Waiting until your birthday month or later pushes the start date back and can leave a gap.

Full turning-65 guide →

It depends mainly on how many employees your employer has. With 20 or more employees, the group plan usually pays first and many people take premium-free Part A while delaying Part B without penalty. With fewer than 20, Medicare usually pays first and delaying Part B can leave you badly exposed.

Retiree coverage, COBRA and Marketplace plans are generally not treated as active employer coverage for this purpose, and relying on them is a common and costly mistake. Ask your HR department for written confirmation and call me before deciding to delay anything.

The Part B penalty permanently increases your Part B premium if you enroll late without qualifying employer coverage, and grows the longer you waited. The Part D penalty applies once you have gone 63 days or more without creditable drug coverage, and generally lasts as long as you have Part D.

Both are avoidable with correct timing and neither can usually be appealed away afterwards. The Part D one catches people who take no medications at 65 and skip drug coverage entirely.

Call anyway. Depending on what happened, you may qualify for a Special Enrollment Period — losing employer coverage, moving, gaining or losing Medicaid and several other events all trigger one. If none applies, there are still General Enrollment options with specific timing. The situation is usually more recoverable than people fear, but it is time-sensitive.

October 15 through December 7, for coverage starting January 1. If you are already on a Medicare Advantage plan, there is a second window from January 1 to March 31 in which you can switch once or return to Original Medicare. Dates are set nationally and can change, so confirm the current year's schedule with me.

Quite a lot, usually in your favour. You may be eligible for a Dual Eligible Special Needs Plan built specifically for that combination, with very low costs and richer benefits such as dental, transportation and over-the-counter allowances. You may also qualify for help with premiums and drug costs, and you generally have more chances to change plans during the year rather than waiting for the autumn.

More on Medicare with Medicaid →

Your Part A and Part B benefits are the same as anyone else's, and Medicare Advantage and Part D plans are available on the same terms. The difference is Medicare Supplement coverage: federal law does not require insurers to sell Medigap to people under 65, and where it is offered the premiums are frequently much higher.

In practice that often makes an Advantage plan or a dual eligible plan the workable route before 65 — and when you turn 65 you get a fresh Medigap Open Enrollment window, which is genuinely worth planning for in advance.

Yes, and it goes unclaimed constantly. Extra Help reduces or eliminates Part D premiums, deductibles and copays. Medicare Savings Programs can pay your Part B premium and sometimes more. Income and asset limits change every year, so do not rule yourself out based on a figure you heard a while ago — it costs nothing to check.

Original Medicare covers very little routine dental, vision or hearing care. Many Medicare Advantage plans include some benefit for each, though the allowances are often modest and a single crown or a pair of hearing aids can use one up. Standalone dental plans fill the gap more thoroughly, and are worth buying before you need major work because of waiting periods.

More on dental plans →

This is the most misunderstood point in the whole program. Medicare covers limited skilled nursing care after a qualifying hospital stay, for a limited number of days, with cost-sharing. It does not pay for ongoing custodial long-term care — help with bathing, dressing and daily living — which is what most people actually mean by a nursing home. Medicaid is the program that covers that for those who qualify financially.