William Gray, Medicare Insurance Broker

Answer: So that's not really a fair question, the answer is it doesn't stop.

At age 77, Medicare stops paying for some screenings.

If you have a medical "NEED," Medicare still covers those CT scans.

William Gray

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Answer: The short answer is no you won't lose your Medicare coverage and anything done up to that point would be paid.

As it normally would. You would still have your deductible and co pays.

The long answer is a little more difficult if you have Medicare Advantage it may affect utilization review they may trigger some things within the advantage company to make decisions on their care.

Answer: Great question, I have a full page of my website devoted to you directly. https://themedicaredude.com/fehb-medicare , The quick answer is it depends on what branch of the government.

If you are FEHB then you do not have to enroll in Medicare Part B. Do not need a supplement and can continue doing what your doing.

However if you decide to "suspend your coverage - not cancel" you would need to have part B and a Part D drug plan and chose a Medicare Supplement or Medicare Advantage plan.

It is best to speak with a specialist in your case there are a few moving parts.

William Gray

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Answer: I would have to say the most common misconception for Medicare is that the open enrollment period at the end of the year applies to Medicare Supplements.

It is very shocking to some that they may not get to choose another carrier "EVER" because of their health issues.

William Gray

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Answer: Honestly,

I start from the assumption that there is little or no education on Medicare and go through a process of explaining the basic parts of Medicare, then in broad strokes how the supplemental and advantage plans work.

I give honest feedback on good and bad on both programs. And let the client steer the boat. If they are comfortable with Medicare Supplement We go down that path. The same for Medicare advantage.

It really depends on the client

Answer: Medicare Part A is a very good hospital policy. In fact, after you meet your deductible in 2026 of $1736, you are covered for 60 days under that one cost.

If, however, you go into the hospital for a broken hip and have surgery, and they release you 15 hours later. You did not have a Medicare Part A event.

Hospital, in its strict definition by Medicare, is any "hospitalization," meaning you have to be admitted to the hospital for more than 24 hours.

If you do not meet that requirement, then that visit falls under Medicare Part B or outpatient care.

In this case, you would owe the entire amount without Part B.

William Gray

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Answer: That's a great question,

Predominatly people use Medicare Supplements, to cover them when they travel. It could be any of the available supplements starting with the G plan , N plan, Hdg, just to name a few. These plans are P.O.S. Plans (point of service) meaning anywhere that accepts Medicare will be paid by your supplement plan.

A little in the weeds but what supplement depends on what you need for coverage. The current plan with the most coverage is the PLan G. These plans are standardized by the government so what one plan has to offfer is the same as any other plan.

What does change is the financial stability of the company, the premium, and the rate increase history.

If you stay on a Medicare Advantage you will need to pick a plan with a nationwide network or you risk having no coverage or coverage at a much higher rate.

William Gray

The Medicare Dude

Answer: Credible coverage means that the coverage you have is at least as good as what Medicare offers.

Why does it matter: Medicare says if you don't take Medicare when offered and you don't have "Creditable Coverage," then you will be assessed penalties for all the time you did not.

This assessed penalty will stay with you for life.

William Gray

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Answer: The easy answer is profit. The longer answer is that the insurance company is compensated by Medicare.

There have been changes that have impacted the cost associated with operating these plans.

This could be because of changes to Medicare Part D or just the cost of care associated with these plans.

Medicare Advantage plans are not guaranteed and can withdraw from any market at any time.

William Gray

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Answer: Ao Medicare as a primary coverage and a secondary could mean you have a group major medical policy through your employer.

Or it could mean you have Medicare A&B and a Medicare supplement.

Medicare Advantage plans are Medicare replacement plans not secondary policies.

Answer: IRMAA is income-based and uses the numbers from 24 months ago to determine your cost adjustment.

While not necessarily permanent, if your income does not change, you will continue to pay the higher IRMAA charges.

Additionally, you do not necessarily have to wait the 24 months either; if you are retiring and your income drops substantially, you can ask for consideration. There are forms to submit to request this adjustment.

William Gray

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Answer: The answer is NO.

But:

What do you mean by lose coverage? Medicare A&B are both benefits you have from working and are entitled to, so you have them as long as you want them. Part B premium will have to be paid.

If you cancel part B, you will have to wait for the general enrollment period to reapply, and you will be given penalties for the period of time you did not have coverage.

If you keep both A&B in force, generally speaking, there is no coverage abroad.

William Gray

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Answer: There are three thing to make sure that you are looking at and these are the minimum. Look at all doctors and hospitals and make sure they are in the network, 2. make sure all of your prescriptions are in the formulary, 3. make sure that the MOOT or maximum out of pocket cost is something that you can afford.

Secondary to that you want to make sure you are aware of the type of plan HMO, PPO, POS .

And then consider if you want an Advantage plan or a Medi gap plan. and then what plan he would

Answer: Well, we must first distinguish what we mean by help. If they are acting on your behalf without your authorization and independently of you being there, then the answer is not without a durable power of attorney.

If by help you mean going over plans and helping you make decisions while you are there and in full agreement with the decision, and you are the one signing the application, then yes, they are allowed to help you.

William Gray

The Medicare Dude

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Answer: The easiest way is to call Medicare directly at 1800 Medicare. Other options are to go to the Medicare and You guidebook that printed each year. Or simply call and ask your broker/agent for assistance. After all, that is why we are here.

William Gray

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Answer: Outside of special circumstances, the answer is no. The issue is in the question itself, whether you have a serious illness diagnosis. The diagnosis itself may very well make you uninsurable for any Medicare Supplement in the future.

Those circumstances could be that you have a Medicare Advantage plan for the first time and are within your first 12 months, you have a Medicare Advantage through an employer "group" and have a right to pick a plan if you leave. These are just a couple of the special circumstances, but for the vast majority, the answer is no.

William Gray

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Answer: You have a bunch of variables.

Do you have Original Medicare A&B?

Do you have Orginal Medicare and a Supplement?

* No, then yes you can expect to pay 20% of the entire amount approved by medicare and the part B deductible assuming you were not hospitalized overnight.

* Yes, What supplement do you Have?

A, B, D, G, J, K, L, M, N ( some or no longer available.

* Does your plan have a deductible? HDG/ HDF

Are you on a Medicare Advantage?

If so forget everything i just said and look at your ANOC. There will definatley be out of pocket costs.

Honestly it's best to speak to a Medicare Speciliast usually the Broker who sold you your plan.

William Gray

"The Medicare Dude" Daytona Beach Fl, 32117

Answer: It is a good practice to review your plan yearly. Many things change from the drugs you take, the formulary, the doctor networks, and even the hospitals that accept your coverage.

That is, if you have Medicare Advantage, it is equally important to look at the costs of premium increases on Medicare supplement insurance policies. All policies are equal; they are standardized.

So the premium is the only real difference.

Answer: No and yes. So they cannot terminate your policy because of claims or experience.

But if you fail to make your premium payments then yes they can it's important to have a third party to be notified if you are sick they can make sure your premium is paid.

Answer: No, you get the larger of the two.

Spousal benefit is 50% of what your husband earns. If that is greater than yours then you get the larger not both.

If you have been married then years or more. You don't have to wait until he dies to can find out if it's greater now.

Answer: Yes, I mean technically speaking, when you do a seminar it's supposed to be "educational," but the agent is spending his/her time on the event with the idea of making sales.

It would be naive to think they were not. The real problem can arise when that agent is a sales agent for one insurance company; therefore, you are not getting the full picture of what is available to you in the market.

Look at it like this: if you go to the Chevy dealer, he's probably not going to tell you how the Ford has better towing capacity and better rebates.

William.

Answer: This is a very loaded question.

Here is what I tell my clients, when choosing a Medicare plan. It is important to realize that while I can move you from one Medicare Advantage plan to another year to year.

You many not have this option with Medicare supplement once in you cannot be cancelled but the company is not required to accept new clients without underwriting them based on health.

Answer: Medicare covers up to 12 treatments for accupunture for " low back pain that has lasted 12 weeks or longer) it is covered only in this situation.

A Medicare Advantage plan has to offer at least what Medicare offers and can offer extra coverage.

So while all Medicare advantage plans have to offers "accupunture" in this situation it is up to the plan whether they offer additional coverage outside of the Original Medicare Benefit.

Answer: Medicare is an entitlement benefit.

As an entitlement benefit you cannot be canceled unless you don't pay for your premium.

Answer: Medicare plan G is the most comprehensive Medicare Supplement available today.

Once you meet the 257$ deductible for part B your medicare supplement will cover your remaining cost of care at 100%.

This is assuming you are on the G and not the HDG (the HDG has a 2870) then its 100% covered.

Answer: There is really no advantage or dissadvantage of a local agent vs a remote agent. Let me explain there are tools that make the world a lot smaller now.

If you have the proper license and contracts you may find that a VERY EXPERIENCED Broker will likely do most of their work remote.

I will see most of my clients remote after 28 years of bellying up to the table I am at a point in my career where my phone rings and I don't chase new clients. I am able to offer my clients the experience of nearly 30 years of work.

You may find a local agent who Is brand new who will drive hours to meet people at the table. This doesn't make them better it doesn't make them worse. It simply is a different model.

Answer: You have not provided enough information.

If you have original Medicare and chose a plan like the HDG - or the N plan or K / L there will be copays and deductibles. Medicare will pay after the deductible of 257$ 80/20. These plans all have different variations of copays so it will likely cost you different copays when you go to the dr.

If you chose a Medicare Advantage plan you have replaced original Medicare with this plan and therefore you will have to read that plans summary of benefits to determine your copays and out of pocket costs.

You can reach out to me if you need help understanding what you have and what costs you can expect.

Answer: The Part A deductible applies to those in original Medicare.

If you have a Medicare Part C plan you would love pay according to the terms of your plan.

Answer: The Biggest mistake that people make with part D is not reviewing it annually.

Cost per company and Formulary teirs change every year.

You may be paying for more than you need to without an annual review.

Answer: if you did not take medicare at 65 you will be penalized at 1% per month for each month that you did not have coverage under the Medicare program.

If you had qaulifying coverage you will need to submit Form CMS L564/R297 (09/23) to get the penalty removed before you apply for Part A, B, and D.

William

Answer: Originial Medicare does not have a Network, you can use your red white and blue Medicare card at any Dr. or Hospital that accepts Medicare.

Medicare Advantage replaces Originial Medicare and has in most cases a network of Dr. and Hospitals that you must use to ge the best rates avaialble.

Answer: To can go to Medicare.gov and compare part d drugs.

When you put them into the plan finder you will be given the lowest prices plan and lowest cost.

Answer: Medicare Parts A and B will not be affected.

If you have a Medicare Supplement you will not need to do anything other than inform your provider of the address change.

You will have a Two month open enrollment to choose a new Medicare Advantage or Part D plan.

Answer: Medicare does not include dental and vision

Many companies offer stand alone plans I offer coverage that includes dentures and implants.

Answer: Medicare Advantage Plans are different in almost every county in the country.. some plans cover multiple counties.

Medicare Supplement Plans are standardized by CMS and cannot be different based on state or county.

Answer: In your summary of benefits and your annual plan book there will be a list of costs associated with lab tests

You should not be getting surprised billing you should only have to pay your co pay.

Answer: If you are getting bills for part B it means you are not taking social security benefits.

Medicare will bill you quarterly if they cannot deduct it from social security payments.

Part B is $186 a month in 2025.

Answer: Medicare does NOT cover dental implants. There are some Med on care Advantage programs that might but there are limits.

There are stand alone Dental plans that do cover implants.

Answer: Puerto Rico is a US territory so there would be coverage. If you are travelling outside the country to a non terrritory then no.

Some Medigap plans (C, D, F, G, M, and N) offer foreign travel emergency coverage, but these plans often have limitations, such as a $250 deductible, a 80% coverage rate, and a lifetime maximum benefit of $50,000.

Answer: It's not necessary but you could face pretty high out of pocket costs.

Advantage plans have deductibles and copays. The indemnity plan pays you a set amount by plan

Answer: You can still enroll at 65. You will need to do this from the SSA website or by visitin your SSA office.

If you don't enroll at 65 and don't have coverage through a group plan you will be penalized 1% per month for each month you don't have coverage.

You will be billed by Medicare for your part B premium 3 months at a time.

Answer: Medicare Advantage plans have netwrork restrictions and can cost more out of pocket for deductibles and copays. Your doctor who is in network now may not be next year and the plans change annually.

If you are on a Medicare Advantage plan and exceed your first 12 months and have health problems you may never be able to apply for a Medicare Supplement in the future.

Answer: Plan K will likely cost less than a plan G in upfront premiums.

However, in plan benefits it is substantially higher out of pocket expense on a major health condition.

It would consider a Plan N or a Plan HDG to get the most bang for your buck.

Answer: There are people who have special circumstances that CMS has determined qualify for extra help and benefits.

There are several different categories.

Dual Special Needs - Medicare / Medicaid eligible.

Chronic Special Needs - Those with listed health conditions

SNP - facility plasn - Those who are confined to a facility.

each case is different it is best to talk with a professional

Answer: If you are over the age of 65 in order to avoid the penalties imposed you will need to submit the CMS-L564 form

If you have income from 24 months ago that will put you in a high income earner you will need to fill out the form SSA-44 for an IRRMA reduction.

Answer: Medicare supplements have multiple options. But one of the easiest way to reduce cost of coverage is to consier one of the plans with a deductible.

Medicar plan G is considered the cadillac policy it covers 100% after the $257 par B deductible but it also has the highest price tag.

The Medicare plan G has an option to add a deductible of $2,885 this works more like an out of pocket maximum.

Think about it like this, you have a $257 part B deductible then Medicare pays 80% of your bills until you reach an out of pocket of $2885 then it's 100% coverage.

Answer: Original Medicare is a point of service plan you do not have to choose a network provider and can go to any doctor who accepts Medicare.

With a supplement to Medicare you can reduce your liability to a few hundred dollars per year.

These plans will have a premium.

Medicare part C "Advantage" plans are Medicare replacement plans.

You will likely need to use network doctors to receive the best rates or to be covered at all.

There are more significant copays and out of pocket limits. But many plans have zero additional premium.

Answer: , Medicare premiums are tax deductible as a medical expense as long as you meet two requirements.

First, you must itemize your deductions on your tax return to deduct them from your taxable income.

Second, only medical expenses that exceed 7.5% of your adjusted gross income (AGI) are deductible.

Answer: You should not be receiving unsolicited calls from an insurance agent it is not allowed regarding Medicare Advantage plans.

The benefit that is being discussed is available under certain plans but should not in my opinion be the main reason to choose a plan.

I think the primary concern is that there are people who willfully violate marketing rules and this is one of them if not solicited by you.

Answer: I enjoy helping provide solutions that they may not have known were available. I have made many life long friends who started as clients.

Since, all I do is Medicare I am able to do a deep dive into their situation and help them get the most out of their benefits.