Andrew Kramer, Medicare Insurance Agent

Answer: If you like to travel, especially outside the US, your question would be, "Do I have any coverage outside the US and how would it coordinate with my Medicare plan?"

Answer: Hospice comes under Medicare Part A, regardless of whether a person is on original Medicare, or an Advantage plan. In both cases, Hospice is free. It's typically offered when end-of-life is determined to be less than 6 months by the PCP. The service varies according to the needs of the person. Palliative care is not free, but follows the co-pays or co-insurance of their plan.

Answer: That depends. If there is a similar generic medication for that illness, then Medicare can require "step-therapy" meaning the patient will need to try the generic to see if it works. If it does not work, or the patient exhibits a drug side effect to the generic, then the Dr can seek an authorization for the brand name. But if there are no other generic medications for that illness, then Medicare cannot deny the brand name.

Answer: Simple answer... Plan F has no co-pays for any Medicare allowable service of any kind. An ER visit is Medicare allowable, assuming that the accident or illness could not have been handled by an urgent care.

Answer: There is no "pat" answer to this questions. The variables are: #1 Where do you live, in a rural or urban area? Urban areas typically have more Dr's who take Advantage plans. #2 Did you or an agent, research your current Dr's to see which Advantage plans they accept? #3 Do you live in one place, or do you have a home in another state that you frequent? #4 Can you afford a Medicare supplement plan?

Answer: That depends. If you have an ACA plan (Affordable Care Act), then you must sign up for Medicare at age 65. But if you are on employer health insurance, the rule from Medicare is that you can keep your group health insurance, and not be penalized later for not taking Part B, if 20 or more employees are on the group plan. Not just employed, but on the group health plan. Second rule, does the drug plan of your group health meet Medicare's minimum requirements of Part D? If not, you will need to sign up for a Medicare Part D plan. Lastly, it's important to compare the cost of your group health plan, including the premium, deductible, co-pays and max out-of-pocket, to paying for Medicare Part B and either choosing an Advantage plan, or a supplement.

Answer: If you are on original Medicare with a supplement to Medicare, you can typically keep that supplement. Call the company to check. End of story. If you are on an Advantage Plan, you are given an SEP (Special Enrollment Period) of 3 months to change your plan to a plan in the state or county where you will move to: consisting of the month that you move + the following 2 months, to make the change. I always advise my clients who move out of state, to find a Dr in your new location from friends, relatives or neighbors, then ask that Dr for an independent agent who can advise on the local Advantage plans. Most Dr's know agents who they can refer the patients to. Until you make the change, if you need medical care, you can go to any urgent care, or the ER of any hospital. If you have a PPO Advantage plan, you can also see any Dr, either in or out of your network.

Answer: An experienced Medicare broker should be asking you many questions on the phone, so he/she can prepare ahead of time which plan most suits you. Also, you want an independent agent who represents multiple Advantage plans in your county, 5 or more, and also supplements. Lastly, some who has at least 5 years experience and over 200 clients, or more. You can ask! Also, it's probably best to get a referral from friends, relatives or neighbors, of a broker they used and how often that broker communicates with them, either by phone, or email.

Answer: HMO Advantage plans require Dr's to follow "metrics of care." They need staff to do that. But the outcome for a patient is much better! Actually, Dr's who are on "risk" Advantage plans make a lot of money, but they need to have a large client base on risk plans and the staff to support the documentation and referrals. A risk plan means the Dr is responsible to share the cost of care outside of his/her office, meaning specialist visits, ER, hospital, advanced imaging, etc. A practice that has a large Advantage plan client base can handle that and still make a lot of money.

Answer: The question is, where was that listing? If it was in a printed book that your plan sent you, that is notoriously inaccurate due to when it was printed! The best way to look up a Dr is on the plan's provider website, and then call the Dr to double check. But it is possible that during the year, a Dr can go off network. That was either done by the Dr or the plan, for reasons unknown to you and it is allowed.

Answer: MOOP's on Medicare Advantage plans are the total of annual co-pays and co-insurance on the plan. Rx drug costs are excluded from the MOOP because they have a separate MOOP of $2,000/yr from the 2024 Inflation Reduction act. From my experience, it's very rare to reach the MOOP from just the co-pays. The rare exception from my clients have been those on chemo therapy infusions, because those are always 20% co-insurance of the Medicare allowable cost for the medication, which adds up.