Medicare questions & answers

Medicare has a few different times when you can change your plan. The main one is the Annual Enrollment Period, October 15 – December 7, when you can review and change your Medicare Advantage or prescription drug plan for the following year.

There is also a Medicare Advantage Open Enrollment Period, January 1 – March 31, for people already enrolled in Medicare Advantage.

You may also qualify to make changes during the year with a Special Enrollment Period, such as moving, losing coverage, or qualifying for certain assistance programs. If you are not sure whether you can make a change, a Medicare agent can check your situation and explain your options.

— Christian Martin del Campo, licensed agent

I recommend working with an experienced agent, because it is a multi-step process: it starts with a needs analysis (doctors, medications and budget) and, if it applies, includes properly cancelling any supplement you currently have so you are not left without coverage or paying twice.

I am happy to help you through the whole process. Book an appointment and we will review it together.

— Christian Martin del Campo, licensed agent

Yes. Start by updating your address with Social Security. Then review your coverage: plans and benefits change by ZIP code, and if you have Medicare Advantage or a drug plan you may need to switch to one available in your new area. Moving usually gives you a Special Enrollment Period to do it.

You can call us, or contact Medicare.gov or 1-800-MEDICARE.

— Christian Martin del Campo, licensed agent

Yes. What you pay can depend on your income, work history, when you enroll, the plan you choose, your prescriptions, and whether you qualify for programs that help with Medicare costs.

Some people may have a $0 monthly premium Medicare Advantage plan, while others may pay additional premiums depending on their coverage. It is important to compare your individual options, because the lowest-premium plan is not always the lowest-cost plan overall.

— Christian Martin del Campo, licensed agent

The Maximum Out-of-Pocket (MOOP) is the most you would have to pay during the year for covered medical services under a Medicare Advantage plan.

For example, if your plan has a $5,000 MOOP and your copays and coinsurance for covered medical care reach $5,000, the plan generally pays 100% of covered medical services for the rest of that year. Your monthly premium and prescription drug costs generally do not count toward the plan’s medical MOOP.

This is why it is important to look beyond a $0 premium and compare the MOOP, copays, network, medications and benefits when choosing a Medicare plan.

— Christian Martin del Campo, licensed agent

Medicare Advantage plans are paid by the federal government (CMS) to manage members’ care. Instead of Medicare paying hospitals and doctors directly under Original Medicare, CMS pays a fixed monthly amount (capitation) to the insurance company for each enrollee.

This amount is risk-adjusted: plans get more for members with chronic conditions and less for healthier members. A $0 premium does not mean the plan has no costs — always review copays, deductibles and the maximum out-of-pocket.

— Christian Martin del Campo, licensed agent

Verify coverage before having the test done. Ask your doctor which laboratory they are sending your test to, and confirm that the lab is in your plan’s network. Also check whether the test requires prior authorization and what your copay or coinsurance may be.

Don’t assume that because your doctor is in-network, the laboratory they use is also in-network. A quick call to your plan or your agent before the test can help prevent unexpected costs.

— Christian Martin del Campo, licensed agent

That’s a great question, and one many people wrestle with. Whether Medicare Advantage or Original Medicare is better depends on your personal health needs, budget and lifestyle: your doctors, your medications, whether you travel, and what you can afford if you get sick.

The best step is to have a professional review your situation and explain the differences so you can make the decision.

— Christian Martin del Campo, licensed agent

Yes, you can, but you will be missing out on many additional benefits like dental, vision and hearing aids, which Original Medicare mostly does not cover. You also would not have drug coverage without a Part D plan, and Original Medicare has no annual out-of-pocket limit.

— Christian Martin del Campo, licensed agent

Yes. If traveling around the U.S. is important to you, Original Medicare paired with certain Medicare Supplement (Medigap) plans generally allows you to see any provider nationwide who accepts Medicare, without being limited to a network.

Some Medicare Advantage PPO plans also provide out-of-network coverage, but costs and rules vary by plan. Emergency and urgently needed care are generally covered within the U.S. under Medicare Advantage plans.

For international travel, coverage is more limited, although some Medigap plans and certain Medicare Advantage plans may provide emergency coverage outside the U.S. The best option depends on how often and where you travel, your doctors, medications and budget.

— Christian Martin del Campo, licensed agent

Yes. Your friend’s plan likely has more benefits because their city or ZIP code has different plans available, or their area has other insurers and more competition.

You can compare plans by ZIP code with the Plan Finder at Medicare.gov, or ask us to review the options in your area.

— Christian Martin del Campo, licensed agent

1. Review the denial notice. It should include the reason, how to appeal, and the deadline.

2. Request a redetermination/reconsideration (first level). With Original Medicare, fill out the Redetermination Request Form or write a letter and send it to the address on the notice within 120 days. With Medicare Advantage or a Part D plan, you or your doctor can request a reconsideration from the plan; for urgent cases, request an expedited appeal.

3. Add supporting documentation. A letter from your doctor explaining medical necessity, relevant medical records, and any prior approvals.

4. If denied again, continue through the 5 levels: plan or Medicare contractor reconsideration, Qualified Independent Contractor review, Administrative Law Judge hearing, Medicare Appeals Council review, and Federal District Court review. Each level has deadlines.

If you need help with an appeal, give us a call.

— Christian Martin del Campo, licensed agent

Generally, you do not receive both benefits in full. If you qualify for survivor benefits, Social Security will generally pay your own retirement benefit first and then add enough survivor benefit to bring your total up to the higher amount you qualify for.

For example, if your benefit is $1,200/month and your eligible survivor benefit based on your husband’s record is $2,000/month, you would generally receive a total of $2,000/month — not $3,200.

The exact amount depends on your age when you claim the survivor benefit, whether you have reached survivor full retirement age, and your husband’s record. Survivor benefits can start as early as age 60 (or 50 if disabled), but claiming before full retirement age can reduce the amount. For your specific case, check with Social Security.

— Christian Martin del Campo, licensed agent

A local agent gives you personalized, face-to-face support and understands the doctors, hospitals, pharmacies and Medicare plans in your area. They can help you compare options, check your doctors and prescriptions, assist with enrollment, and most importantly, keep helping you throughout the year when questions or problems come up.

Virtual agents can be convenient, but with a local agent you have a trusted person in your community you can call or meet with. Medicare can be complicated — you don’t have to navigate it alone.

— Christian Martin del Campo, licensed agent

One of my clients, a 72-year-old gentleman with diabetes, was struggling to afford his insulin under his Medicare coverage. He was paying hundreds of dollars each month and wasn’t aware of plans and programs like Extra Help that could significantly reduce his costs.

We sat down and reviewed his medications, his doctors, and his eligibility for savings programs. We compared several plans in his county with strong insulin coverage, and I helped him apply for Extra Help through Social Security.

The result was life-changing: his insulin dropped to $35 a month, and he also gained dental and vision benefits he never had before. What mattered most to him wasn’t just the savings, but that someone took the time to explain his options in simple terms and guide him step by step. That is why I love this work.

— Christian Martin del Campo, licensed agent