Alexander Lehn, Medicare Insurance Agent

Answer: I love being a Medicare agent because I get to help people improve their lives and solve problems that go unaddressed by so many others. Every day I have the opportunity to make a difference in someone's life by helping them get better access to healthcare, planning their legacy, preparing for or navigating retirement, and so much more. It is a rewarding career that is built on a foundation of service and I would choose it over and over again.

Answer: The trade-off between an HMO and PPO come down to an individual's circumstances and preferences. A PPO provides access to care outside of the "preferred network" of your insurance carrier, this can be helpful for some people who may travel or live in rural areas or even have a specialist that they prefer but is out of the "network". Their are many circumstances that a PPO can be beneficial in. The HMO plans typically have a lower cost of care and work great for people who stay in their care network most of the time. These plans can have lower out of pocket costs and may offer stronger supplemental benefits. HMO networks may be more strict about requiring referrals to see a specialist than a PPO would, but there are exceptions to that as well. At the end of the day, this decision comes down to your lifestyle and healthcare needs. A Licensed Medicare Agent can ask the right questions to assess your situation to help you make an informed decision.

Answer: This will depend completely on the Medicare plan that you have. If you are on original Medicare or have a supplement, only "medically necessary" things are covered. If you see a Primary Care Physician for the issue, there's a possibility that certain mental health support could be covered. If you are on an Advantage plan, most have built-in access to mental health support in their supplemental wellness benefits. This can vary from carrier to carrier though and I would recommend having your coverage reviewed by a licensed Medicare agent to determine what you may have access to.

Answer: A hospital indemnity plan is not required if you have a Medicare Advantage plan, but many people choose to have one. These types of plans pay a fixed amount to you if you are hospitalized so you can have any co-pays covered without worry. A cost-benefit analysis can be done to determine if the cost of coverage over 12 months is worth having to offset the potential costs associated with being hospitalized. Many people on a fixed income prefer to have this coverage so the costs are built into their budget and they don't have unexpected large bills associated with their healthcare, just a low monthly cost for the indemnity coverage.

Answer: Most Medicare seminars are not sales pitches because they are governed by the Center For Medicare Services. Most seminars are meant to be educational events to teach people how Medicare works and about the different options that Seniors have. These seminars can be listed as "Sales Events" with CMS which allows agents to do enrollments at the event, but most people are not ready or able to even sign up then and there. They are a tool for agents to build relationships in the community.

The benefit for the agent or broker putting on the event is that they often build trust with folks in the room and many may go to the agent/broker for help with their Medicare needs. At these events you are not required to sign in or provide any information if you choose not too. There can be no "high pressure" sales tactics used to force you to work with the agent/broker putting on the seminar.

Answer: This is a hard question to answer without the opportunity to sit down with you for a presentation, but I'll give you my best breakdown. Original Medicare covers 80% of most of your healthcare costs and it carries a few different deductibles and out of pocket costs. You are required to maintain prescription drug coverage while on original Medicare and you are responsible for the 20% cost share on any approved services. Medicare does not include preventative care and requires all services to be "Medically Necessary" i.e. routine bloodwork would not be covered but if you had kidney failure and needed blood labs done, they would cover that.

In comparison, Medicare Advantage plans are more like traditional health insurance. They have a network of Doctors and Hospitals they work with and require you to use. They may have copays but they include preventative care and can offer supplemental benefits. These are the plans that people talk about which may include dental, vision, hearing, or other benefits that original Medicare doesn't. These plans can have as low as a $0 monthly premium and most of them include prescription drug coverage.

Choosing between the two requires an in-depth look at your individual health, financial situation and lifestyle preferences. If you travel a lot, staying on original Medicare and purchasing a Supplement plan may be best for the flexibility of no mandated network. If you stay close to home and prefer having some supplemental benefits or are lower income and need a $0 monthly premium, the Advantage plan may be a great option. It comes down to talking with a licensed agent who can understand your needs to provide the right options so you can make an informed decision.

Answer: One of the benefits of regular Medicare is that you don't have any restrictions on the network that you can go to for healthcare. Original Medicare has the most flexibility in where can get healthcare in the US, but it has drawbacks as well. Original Medicare typically covers 80% of the medical bills and has certain deductibles and copays to fulfill. Advantage plans are usually designed to keep out-of-pocket costs lower while providing a coordinated network for healthcare. One way that can be competed with while being on original Medicare, is to buy a "Supplement" that compliments Medicare and picks up the 20% cost share and various other charges. This decision hinges more on your health, personal finances and lifestyle than anything as one choice may be better for you but neither are better than the other for every single person.

Answer: In general, the answer is yes. A major illness diagnosis would typically be considered a "qualifying life event" that would allow for a change like this. This kind of change would come at a cost and may not be approved by a Medigap carrier. They can require medical underwriting and deny coverage coverage under circumstances like this. It is best to be approved for a Medicap plan before cancelling your advantage plan.

Answer: If someone is classified as obese, Medicare may approve a weight loss surgery when the BMI is above 35 and if there is another compounding health issue like diabetes or high blood pressure. Medicare does not pay for general weight loss programs or weight-loss medication.

Answer: I had a client who lost her part B because she was out of work and in the hospital. No one tried to help her get her social security set up to maintain the premiums so she lost all coverage. She ended up moving states to where I live and got healthy enough to fight through the process of getting her social security set up and reinstating her part B. The process took so long but that by the time she got her new Medicare card with an updated Part B affective date, she missed her new enrollment windows and Medicare denied her enrollment. At this point she was spending over $400 per month on prescription drugs with no coverage and had been in and out of the Hospital, incurring significant financial burdens. I found a loophole due to her chronic health conditions and got her coverage with a carrier that specializes in managing care for her conditions. Medicare told us that she would have to wait until next year, but they were wrong and she now has the coverage and care she needs along with her prescription cost being lowered to less than $50/mo. That was a win.

Answer: Home modifications, like stairlifts, are not covered by Medicare. There are Medicare advantage plans that may include some coverage or money that can be used for DME like home-safety improvements. These funds are pretty limited and not every Advantage plan has that type of supplemental benefit. The important factor is that original Medicare does not pay for these things and therefore any benefits provided by an Advantage plan or not guaranteed and are subject to many factors like location and possibly event company approval.

Answer: Most healthcare companies are pretty good and are competitive on their offerings. Some things to consider would be the company's financial stability and their rates of coverage denial as well as their preferred network of doctors and hospitals. The more important side of the question is finding a good representative to work with. I advise you to contact a broker or two to get a sense of if you like them and communicate well together. Having a broker is important because they can work with whatever carrier suits you best rather than pushing you into a single option or limited offering.

Answer: If you are on original Medicare, there is no way around the fact that they do not pay for hearing aids. There are options to look into if you need help covering their costs, but you will be looking outside of original Medicare coverage. Some Medicare Advantage and supplement plans will help with hearing aid costs, but they are not required to. There are also discount programs or other supplemental insurance programs that can lower the cost of hearing aids. The best route to go down is to evaluate your current Medicare coverage and finances with a Medicare Broker to determine if changing your coverage or adding supplemental insurance will help you get the devices you need or if there is an off-the-shelf alternative that could work without having to make a change.

Answer: One of the worst Medicare-related decisions someone could make is to choose their coverage completely on their own or through a captive agent. The guidance and help from an independent broker is free to Seniors and does not cost them anything beyond the regular premiums they would already be paying. Brokers are compensated evenly by the insurance companies so they are not beholden to pressure folks into a plan that doesn't suit their needs. Brokers can analyze finances, health, needs, geography, and more to help make sure the choice for coverage fits each client on an individual basis without sacrificing something essential that a captive agent or individual would not even realize was a factor.

Many people try to figure it out on their own and end up incurring penalties or delays/gaps in coverage. They can also get contacted by tele-sales teams that don't understand local markets which can leave them vulnerable or without guidance due to the nature of health networks and the other intricacies of Medicare coverage.

At the end of the day, seek professional and honest help. It doesn't cost a dime and you'll be in the best position for your future if you do.