Adam Ashby, Medicare Insurance Broker

Answer: The most important question that most individuals spend almost no time thinking about is - What is most important to me today? The differences between Medicare Supplement and Medicare Advantage are significant - both serve a very important purpose. You need to be able to talk through your current needs and establish what value does each one bring to me and then decide for yourself what is better. So many of us are used to being told by our employer what our benefits are going to look like and then we have to adapt. You have the opportunity to choose what you need and work with a Broker who will fill that need. As a bonus, ask your broker how many carriers they represent - make sure that you are not working with someone who has limited your options by only working with one carrier.

Answer: The confusion that people run into is the process. Remember, you have paid for Medicare Part A through employment deductions you working life and you then pay for Medicare Part B as you start to enjoy Medicare coverage. That money is given to Insurance Carriers to then find a way to manage care in a way that they can be profitable. It is a different experience from Medicare Supplement - but based on choosing a plan that meets your needs can be exactly what you need.

Answer: Depending on the Carrier you choose there are some benefits that are available that some individuals do not think of. Some companies are offering food benefits, gym membership, shuttle services and even companionship benefits providing one on one social care. It is important that you allow a Medicare Broker review your needs and your available benefits to maximize the areas of help you need.

Answer: When you have Original Medicare you are exposing your risk to no out of pocket maximum with your responsibility for expenses that occur. My suggestion would be to ensure that you are reviewing Medicare Advantage plans that have a large network range if you are a frequent traveler. A Medicare Supplement may be the best option as the benefits of your Medicare Supplement are accepted by any doctor who accepts Medicare giving you the most flexibility.

Answer: Higher premiums are not necessarily the answer. You have to work with a Medicare Broker who is willing to deep dive into your specific needs and doctors. The different Plans offered through carriers for Medicare Advantage have different benefits. They will often soften some benefits in one area to make them more robust in another. The key is for you to communicate what your primary needs and concerns are and EXPECT your Broker to do the research to find the plan best for you.

Answer: Although it is talked about by everyone - networks is one thing that can create hidden expenses. For example, knowing that your Primary Care Provider is in network and able to meet your needs is great, but if you have a dental provider who is not a part of the network and you have significant needs for dental that can become a huge setback. Another issue we see is individuals not understanding deductibles, whether Medical or Prescription can cause an unexpected bill especially at the first of the year.

Answer: The biggest risk is Out of Pocket Maximum. Original Medicare does not have a ceiling. Should you be faced with an unfortunate diagnosis - the sky is the limit as far as your responsibility. Even if you simply want the protection of an Out of Pocket Maximum a Medicare Advantage is a way to protect yourself financially.

Answer: You need to think about a lot of things and you should start considering these things 90 days prior to losing your employer's health plan. First of all, you get the gift of Guaranteed Issue for a Medicare Supplement, this is your once in a lifetime opportunity to be protected by amazing coverage without the need to answer health questions - should you take advantage of that? Another thing you need to consider is your budget, for some moving from an employer plan to a Medicare Advantage plan is easier as they are already used to copays, networks and limitations. A full review of your NEEDS and WANTS in regards to your health is important. An agent cannot answer those questions in 5 minutes - if they do they are putting you where they want you, not where you necessarily should be. Find a Broker that will ask you about you and will help you be ready for the future.

Answer: Let's answer the second question first - you should review your options every year. EVERY YEAR. Medicare is changing and you need to stay informed. You will receive an Annual Notice Of Change from your provider - let an expert review that with you. Some of the signs that you may need to switch plans is your health. With health changes comes the need to ensure your coverage puts your main needs as you main protection.

Answer: There are some plans that do allow for coverage with acupuncture and alternative therapies. Most of the carriers that allow that will have it as a specific dollar amount of coverage that you have to pay for the service and then get reimbursed. Most carriers that allow for this are smaller organizations who are trying to carve out a niche. It is important to review what carriers and plans are in your area to determine this availability.

Answer: There are a lot more details needed. ESRD is a qualifying event which allows individuals who have not obtained age 65 to qualify for Medicare. If you are already on Medicare, Dialysis may qualify you for C-SNP or Chronic Plans that may be available in your area. In either situation, it is best to connect with a Medicare Agent/Broker - someone who will be able to represent many carriers and find the best solution for you.

Answer: Depending on the plan that you are on your carrier may have steps that you must complete to ensure that a knee replacement is required and the best possible solution for your needs. Requiring prior authorization does not automatically mean that the procedure will be denied, only that the carrier you have chosen can verify best practices have taken place. The fact that different carriers have different requirements is exactly why you want to visit with a Medicare Broker who represents several different carriers each and every year. Make sure that you and your doctors have the capability to make the best decisions for you.

Answer: Everyone has one guaranteed issue opportunity for Medicare Supplement when they go onto Medicare. There will be no questions asked at that time. After that initial opportunity you will generally have to go through underwriting if you ever want to change carriers. There are exceptions, one exception is that if your current carrier were to exit your area that opens up an opportunity for a guaranteed issue again. If you are wanting to make a change, reach out to a Medicare Broker who represents several different carriers. Have them review what you need and seek out specific and personal advice.