Angelina Watkins, Medicare Insurance Agent

Answer: Bankruptcy does not impact your Medicare coverage. They are not associated with one another. As long as you pay your Part B, you will maintain your Original Medicare coverage and should be able to enroll in a Medicare Supplement or Medicare Advantage plan.

Answer: Prior authorization requirements are sent by your Medicare Advantage carrier. Prior authorizations can vary by services and carrier. It is always best to call your carrier customer service to very requirements for your particular need.

Answer: Yes, as long as you've been on Social Security disability for 24 months and you're a US citizen or a permanent resident. Once you are on Social Security Disability for 24 months, you should be automatically enrolled into Medicare.

Answer: Inhalers are covered under Medicare Part D prescription drug plans. Nebulizers administered in a doctor's office or hospital are covered under Part B.

Answer: You have a 7 month timeframe to enroll into Medicare Parts A and B that starts 3 months before the month you turn 65, the month you turn 65, and 3 months after the month you turn 65. However, you do not have to enroll into Part B at that time if you have other creditable coverage.

Answer: If you have a Medicare Advantage plan with a private carrier, you must present your Medicare Advantage card from the carrier. If the provider does not take your carrier plan, you will need to find a provider who is in your network or look into finding a plan that your provider accepts.

You can only present your Original Medicare Card when you have Original Medicare and the government is paying your claims. If you present your Original Medicare card and the provider sends the claim to the government, the claim will be rejected because your claims are being paid through your Medicare Advantage plan.

Answer: Many times people procrastinate because they are unsure what to do. Seniors may wait until the last minute because they are scared of making the wrong decision or not sure of their options. That is where an agent becomes beneficial. They can help educate you on your options and help you make a decision on a policy that is right for your situation.

Answer: If you are unable to afford your Medicare Part B premium, you may want to contact your local state agency to see if you qualify for any assistant programs they may have available.

Answer: Doctors who accept Medicare Assignment typically do not dislike Medicare Advantage plans because they cover what Original Medicare covers plus additional benefits. Doctors do sometimes have concerns with denials of services that are medically necessary, but they just need to make sure they are providing all the proper documentation and getting the required authorizations for approval of the medically necessary service.

Answer: The change in the Part D out-of-pocket cap will benefit seniors tremendously by decreasing their maximum out-of-pocket for prescription drugs. It has been extremely high in the past but the elimination of the Coverage Gap Stage has dramatically reduced the maximum out-of-pocket.

Answer: Without knowing your exact provider and their coverage, it will be hard to give an exact answer. However, costs can increase or decrease from year to year. I suspect your Part D provider has increase the costing sharing for their plans.

Answer: Medicare Part A leaves you with significant financial gaps. So, while Medicare Part A does cover hospital stays, you will want to make sure you have supplemental insurance such as a Medicare Supplement or Medicare Advantage plan to cover the financial gaps.

Answer: If the date of service is after the effective date of your Medicare Supplemental Plan G, your policy will pay the portion not covered by Original Medicare. However, you should check with your provider to verify your specific coverage.

Answer: Original Medicare has gaps in medical coverage, large out of pocket costs for deductibles and coinsurance, and no out-of-pocket limits. Medicare Advantage helps to fill the gaps and limit your out-of-pocket costs for the year. Closing financial gaps is very critical for people on a fixed income.

Answer: The biggest red flag to look for is INDEPENDENCE. Are they an agent who is independent and can shop the best plan for you (Medicare Supplements, Medicare Advantage and Part D plans). You don't want to work with an agent who is captive and can only sell you their company's propriety plans. Length of time in the business is another good factor but not a guarantee they will give you the best service.

Answer: Your doctor can determine what your medical needs are and it is the responsibility of the doctor to be able to provide the information to the insurance company as to why something the insurance company does not cover should be covered as medically necessary.

Answer: Medicare covers various cancer screenings, primarily through Part B, and the frequency of these screenings depends on the type of cancer and individual risk factors. Generally, screenings can be covered every 12-48 months, depending on the specific cancer and the patient's risk level. For example, breast cancer screenings are covered annually for those 40 and older, while colorectal cancer screenings may be covered every 24 months under certain conditions. It's important to check with your healthcare provider for specific coverage details and to understand any additional costs that may apply.

Answer: Medicare Special Needs Plans (SNPs) are a type of Medicare Advantage plan for people with specific chronic conditions, disabilities, or those who are eligible for both Medicare and Medicaid.

These plans tailor benefits to meet the specific healthcare needs of their members, such as including prescription drug coverage and potentially offering additional services like dental, vision, and care coordination.

SNPs are divided into three main categories: Chronic Condition (C-SNP), Dual Eligible (D-SNP), and Institutional (I-SNP).

Answer: "Zero-premium" means you don't pay a monthly fee for the plan itself, but you will still have other out-of-pocket costs like copayments, coinsurance, deductibles, and the mandatory Part B premium. These costs are what the plan uses instead of a monthly premium to cover your medical services when you use them. It's crucial to compare these variable costs across plans, not just the monthly premium, to find the best fit for your budget and health needs.

Answer: The Centers for Medicare & Medicaid Services (CMS) approves all Medicare Advantage advertisements and commercials to ensure they are clear, accurate, and not misleading. The CMS has specific marketing guidelines and a review process that private insurance companies must follow before they can distribute their marketing materials.

If the agent misrepresented the plan you can file a complaint against the agent.

Answer: Offering gift cards or incentives to enroll in a specific Medicare Advantage (MA) plan is illegal and a red flag for potential fraud or a scam. Federal regulations strictly prohibit offering any form of remuneration to induce a beneficiary to enroll in a particular plan.

However, some MA plans can offer legitimate rewards after enrollment for completing specific health-related activities, such as getting a preventive screening or a health risk assessment (HRA).

Answer: Typically, once you reach your maximum out of pocket (MOOP) limit, your plan will cover 100% of the costs for covered services for the remainder of the year. The MOOP includes deductibles, copayments, and coinsurance for eligible services. Be sure to check you specific plan benefits for your coverage to verify.

Answer: Seniors often misunderstand that Medicare primarily covers only short-term skilled care after a hospital stay, not the ongoing custodial care (assistance with daily activities like bathing, dressing, and eating) that constitutes most long-term care. This misunderstanding leads them to believe Medicare will cover extended stays in assisted living or nursing homes, which is incorrect, leaving them financially unprepared for costs that can run into tens or hundreds of thousands of dollars annually.

Answer: Since his employer-sponsored coverage ended in 2024, you missed the Special Enrollment Period (SEP) to sign up for supplemental insurance. However, you can enroll or switch your plan every year during the Annual Enrollment Period (AEP) which is Oct 15 thru Dec 7. You should explore options like enrolling in a Medicare Supplement Plan (or Medigap Plan), Medicare Advantage Plan (Part C), or a Part D prescription drug plan to add more coverage.

Please be aware that if you did not sign up for a Part D plan when eligible, you may have a late enrollment penalty.

Answer: You do not have to change your Original Medicare coverage, as it is federal and follows you to Florida. However, you must notify your Medigap insurer of your new address, and while you can likely keep your current New York plan, you may want to explore new options in Florida because your premium may change and Florida offers different insurance carriers and prices.

Answer: Medicare will continue to cover medically necessary skilled services like physical or occupational therapy in a skilled nursing facility (SNF) for up to 100 days per benefit period. However, Medicare does not cover long-term custodial care, which includes help with daily living activities like bathing, dressing, or eating, so you will be responsible for 100% of the cost for this care once it is deemed the only care you need.

Answer: There is a Part B monthly premium you would pay. The cost is dependent on your income. I can't be 100% sure without seeing the bills you are referring to, but more than likely that is the Part B premium almost everyone has to pay.