Anthony Castelluccio, Medicare Insurance Agent

Answer: There are so many great questions, it's hard to narrow it down to the most important question. Is your Agent sitting down face to face with you to review all of your questions either at your kitchen table or their office? I am a visual learner myself and I know I would prefer to sit down to review all of the many different options people have. This process can be overwhelming and I simplify the full process and walk through the timeline you need to be aware of!

Answer: There are a few different reasons why people regret going with a Medicare Advantage plan vs Original Medicare. They don't realize the full cost of what they could pay year after year on a Medicare Advantage plan. The Maximum Out Of Pocket (MOOP) on most plans are over $7000 and if you are dealing with some major health concerns you could pay that for multiple years. The other reason is on a Medicare Advantage plan, you have to make sure your Dr's are in network and the Dr's can drop in and out of network year after year.

Answer: Normally there are 5 tiers with most prescription plans. Tier 1 is preferred generic, Tier 2 is generic, Tier 3 preferred Brand name prescriptions, Tier 4 Nonpreferred And Tier 5 is speciality drugs. Most cases. The lower the Tier, the lower your co-pay. But that's not true all the time, it depends on your prescriptions that you take, your zip code you live in, and what Pharmacy you like to use. I will show you how you can check to see which prescription plan is the best for you and it could change annually!

Answer: Let them know there has many changes and updates to Medicare through the years. I meet with many people turning 65 and help them with the transition to Medicare and offer my services to help family members with the same service. We all know most people don't like change, and the 65 year old that i met with parents are probably 85-95 and I offer to sit with them all together to review they're parents situation. Sometimes they are in the best position they could be, but sometimes they could have similar or same coverage for much less money.

Answer: I really don't have a strategy to help someone decide Medicare Advantage vs Original Medicare. I always explain all of the details about both options. The 2 big differences are Medicare Advantage you should stay in network and if you have some chronic conditions then you could pay a lot more out of pocket then Original Medicare plus a supplement. Also if you are on a Medicare Advantage for more than 12 months you may not be able to qualify to get into a Medicare Supplemental plan. Many people i meet don't know that and are stuck paying a lot for their health care.

Answer: I don't think Medicare will go fully privatized. Over the past few years more and more people are moving to the Medicare Advantage plans, which are through private insurance companies. Every year the plans will change some and I feel the changes are related to how much the government will subsidize these plans.

Answer: Basically that is correct. Any Part B service which will include a knee replacement or PT afterwards should be covered by your G plan, but the big piece here is if Medicare approves the service. If it's done experimental knee replacement, Medicare most likely will not approve that service and your G plan will not cover it. But for the most part, you really should not see any bills after your deductible for a knee replacement.

Answer: Most cases a bone density test is considered preventive care. Just be careful if you are on a Medicare Advantage, you should stay in network.

Answer: If you are on a Medicare Supplemental plan like a G or an N plan, you shouldn't be to concerned about the out of pocket cost that you will pay. If you are on a Medicare Advantage plan, just make sure your Specialist is in network.

Answer: I am not a Doctor, so I can only assume that they might not like Medicare Advantage plans too much because they may not get paid as much for certain services. Medicare Advantage plans are considered managed care plans, so many time the Dr and patient have to get prior authorizations for certain procedures, this could delay the patients care and take administrators time and energy.

Answer: Your Medicare Summary Notice usually is automatically generated and mailed to you quarterly. This notice is not a bill. It will show you all of the Medicare claims for the last quarter and weather the services are Medicare approved or not. This notice could also show other services that are fraudulent. Over the past few years, we have been seeing more and more services submitted under a Medicare beneficiaries number and it's really not from them, it's fraudulent.

Most people I work with will review and keep their Medicare Summary Notices on file.

Answer: It really depends on which way you go Medicare Advantage or Medicare Supplemental. On the Medicare Advantage plans, one of the main reasons that people hit their MOOP (max out of pocket), is because they are dealing with a Critical Illness. If you have a Medicare Supplemental, depending on the plan, you may see very little out of pocket costs for critical illnesses, except for your prescriptions. But now with the Inflation Reduction Act in full effect, if your prescription is approved by Medicare and on formulary, then the most you will pay in a year for your prescriptions will be $2000. So going back to the original question, I would recommend a Critical Illness policy to go with your Medicare Advantage plan if you go the Advantage route. If I was going into Medicare right now, I would go with a Medicare Supplemental plan. This way I will limit my exposure to any large medical bills, and that's a good feeling when people are on a fixed income!

Answer: Medicare can NOT drop you because of health reasons. If you have a Medicare supplemental plan and drop the plan because you want to change to a Medicare Advantage and you are on the Medicare Advantage for more than 12 months you will be asked health questions to go back to a Medicare Supplemental plan and some people can not qualify. Or if you missed a monthly premium and have a lapse of coverage, you may have to answer health questions to get back and you may not qualify.

Answer: The Over The Counter (OTC) benefits are pretty nice and most of the people I work with will use them. All of the different plans vary some on how to use them. Some plans will give you a card to use at different locations and some you can log in or phone in your order of OTC items and they are mailed to you at no additional cost. All of the plans also vary on how much they will give you in extra OTC benefits. This past year, most of the plans cut the OTC benefits down 30-50% from last year. I feel this is a direct result in how much the government will subsidize these plans and my thought process is that the next couple years, I could easily see the government continue to cut the amount of money given back to these plans. Again, just my thoughts.

Answer: Most people try to wait until full retirement age to collect their social security. There are certain circumstances that would sway me to take it earlier than full retirement age. If I really need the money to live or to help cover the essentials, then I'm starting earlier. The other reason would be if my health is not the best and I know that most likely I will not live past 80, then I would start collecting social security sooner than later.

Answer: First, you have a lot going on for the move to another state. I would highly suggest working with someone (Medicare Broker or Specialist) to help you with it.

As for your Medicare, it depends if you have Original Medicare with a supplemental or a Medicare Advantage plan. Your actual Medicare card will not change and will move with you across the country, but you should notify Medicare and/or Social Security of your new address.

If you have a Medicare supplemental plan plus stand alone prescription plan than you should check with your insurance carrier as rules vary from state to state. You may have to reapply for coverage or you should qualify for "guaranteed issue" plans, depending on your health. Either way you will have options. Then you should check to see if your prescription plan is available in your new state. Then you should also check the formulary on that plan to see if that's still the best plan for you based on your new state and zip code. You will have a (SEP) Special Enrollment Period to switch prescription plans anytime of the year. You have a 60 day window to switch.

As for Medicare Advantage plans, you should see what plans are available in that state or zip code. You also will have a (SEP) Special Enrollment Period. You can switch plans 1 month before the move or 2 months after your move to make the change. Keep in mind when you switch plans, they always start the first of the month. Most of the Medicare Advantage plans have networks to deal with, so make sure your Dr's will be in network. Also, if you are switching doctors, make sure to request your records be sent to your new providers.

Lastly, make sure to check in with the State Health Insurance Assistance Program (SHIP). They will be a great resource.

Answer: I would suggest talking with a couple different Insurance Agents or Brokers as you start looking for Medicare help. Some Agents or Brokers only work with one carrier for supplemental plans. Some are too pushy, some may have the knowledge but can't communicate that well to transfer that knowledge to the people they are helping. Many different reasons to talk to a couple different people.