Barbara Barnes, Medicare Insurance Agent
Barbara Barnes
Medicare Agent Licensed in PA
20+ Years of Experience
Contact Details
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Location
Mount Wolf, PA
Barbara Can Help With:
About Me
Hi! My name is Barbara, and I am an experienced Medicare consultant and agent, happy to help you to learn about your Medicare insurance options. My focus is specifically on Medicare, and I am committed to assisting you in finding the most suitable plan that aligns with your unique needs and budgetary constraints. My background in employee benefits and overall health insurance programs for the past 30-years allows me to understand where you've been, as well as where you want to go with your health coverage during retirement. I will get to know you so that I may advise you properly based on your needs and wishes. My services are provided at no additional cost to you, as I am compensated by the insurance company that you choose. If you are struggling with upcoming Medicare decisions and confused by the options, please reach out. I look forward to meeting you!
Q&A with Barbara Barnes
What’s the most important question I should be asking about Medicare that I probably haven’t thought of yet?
Answer: How much will it cost?
There is so much more to this question than just premiums. Of course, premiums are a part of it. Usually, Part A will be premium-free because you've already paid for it through payroll taxes, but there is a premium for Part B and Part D, and if you made more than a certain amount, the premium might be even higher than what most people pay.
Beyond Parts A and B of Medicare, you will need to choose how you want to receive those benefits. Do you want just Medicare A and B? Do you want to add a Medicare Supplement plan to Original Medicare for additional coverage? What about Prescription Drugs? Or do you want to forgo Original Medicare for a Medicare Advantage plan? Each option comes with different costs, risks and rewards. It's important to understand each option before you decide which is best for you. Then you still need to choose an insurance company!
Once you've decided on a plan and know what premiums you will pay, there are your deductibles, coinsurance, copayments and fees for the covered services you receive. Did you know that with Original Medicare, there is no out-of-pocket limit on how much your claims could cost? Usually, Medicare Advantage plans will have a maximum out-of-pocket amount, but that could be thousands of dollars. Medicare Supplements limit your out-of-pocket risk, but they often have higher premiums. Unless you have a low income and qualify for Medicaid, you will pay more than just the basic premiums for Medicare Parts A and B.
Confused yet? That certainly is not my goal, but I do want to convey to you that Medicare is complicated. This is why having an experienced Independent Insurance Agent who specializes in Medicare Insurance is so important.
Are Medicare Advantage plans really “free,” or is that just clever marketing?
Answer: You've heard that "there's no such thing as a free lunch." Well, the same is true of Medicare Advantage plans.
While it's true that there are Medicare Advantage plans that cost $0 in premium, they are not 'free' for a variety of reasons:
1. In order to qualify for a Medicare Advantage plan, you must have both Medicare Part A and Medicare Part B. There is a premium for Part B that must be paid every month.
2. You accept the terms and conditions of the Medicare Advantage plan that you choose, and that includes copayments and an out-of-pocket maximum for the services you receive. The fees you pay could add-up to thousands of dollars each year. While Medicare Advantage plans must be at least as good as Original Medicare, there will certainly be a cost to receiving medical care under Medicare Advantage.
3. Your Medicare Advantage plan is being paid by Medicare. Because they have taken-over responsibility for your medical needs, Medicare pays them a portion of what they expected to pay for your claims. The Medicare Advantage plan then decides how to spend that money in benefits. As the Medicare budget changes every year, so does the Medicare Advantage plan. It is important to review the changes in your Medicare Advantage plan every year.
4. You may end-up benefiting from Medicare Advantage by paying a little more for your medical claims, while receiving "extra" benefits like dental, vision, hearing, fitness, prescription drug and over-the-counter drug benefits at little to no cost. But in a year where you have a lot of expensive medical treatment, you could pay a lot more out of your pocket.
I'm turning 65 next month; what are the first steps I should take regarding Medicare enrollment?
Answer: You are already running a bit behind. You may start the Medicare enrollment process as soon as 90-days prior to your eligibility. Medicare benefits may begin on the first day of the month that you turn 65 (yes - even before your 65th birthday). Medicare is not simple - there are many things that you need to think about before you head to the Social Security office or website to sign-up:
1. Do you need Medicare right away? If you have coverage through an employer, you might not need or even want to sign-up for Medicare right away when you turn 65. You might be able to wait until you retire.
2. Do you contribute to an HSA? If you do and you want to continue contributing to the HSA, you cannot have Medicare.
3. Do you work for a small employer? If your employer has fewer than 20 employees, you might need to sign up for Medicare right away, even if you plan to continue working, because for small employers, Medicare is Primary and the group health plan is Secondary.
4. If you work for a large employer with more than 20 employees, you may still want to consider which benefit is better for you - Medicare or your group health plan.
5. No matter how big your employer is, you may want to compare the benefits and premiums of Medicare vs your group health plan. It is possible that Medicare will offer beter benefits with less premium than your payroll contribution.
6. Consider your dependents. If your spouse is covered under your insurance plan at work and they are younger than you, you might want to keep your group plan so that they can keep their coverage.
There are many things to consider before signing-up for Medicare. This is why it's important to work with a Medicare Insurance Agent that you trust who will point you in the right direction. I prefer to meet with my clients when they are 64 1/2 to review all of these important details and formulate a basic plan long before they turn 65.
What is the biggest mistake seniors make when enrolling in Medicare?
Answer: In my experience, the biggest mistake seniors make with Medicare is listening to their friends and choosing a plan based on what works well for someone who isn't in their shoes. Don't get me wrong - people who are already in the Medicare system can provide great insight into the things they like and dislike about their plans and experiences with Medicare, but they are not you. Only you know what is important to you. You know what your medical needs have been and what they are most likely to be in the future. You know how you feel about "managed care", prior authorizations and networks and only you know your budget.
Even if you listen to your friends and choose Medicare Advantage over Original Medicare, only you know what doctors you want to see and what medications you need to have covered on the formulary. And if your life experience is different and you already have a chronic condition, only you can decide if you would sleep better at night with Original Medicare and a Supplement plan than you would with Medicare Advantage.
When you choose your first Medicare plan, it could be the last health insurance plan that you choose for the rest of your life. This decision is too important to make on a whim or because a plan worked great for your pickle ball buddies. Give it the time and consideration that it deserves.
Will I be penalized if I do not enroll in Medicare when I turn 65?
Answer: Maybe. It depends on WHY you choose to delay your enrollment.
If you delay your Medicare enrollment because your have coverage at work, possibly including a Health Savings Account that you contribute to for the tax benefits, you will likely be able to delay enrollment in Part A, Part B or both A and B, and then enroll for those benefits at a later date, when the employee benefits expire - usually due to retirement in some form. But don't delay when that coverage ends - you will have a limited amount of time to enroll without a penalty.
However, if you work for a small employer with fewer than 20 employees, you should not delay your Medicare benefits because your group health plan will be secondary to Medicare and you will need Medicare Parts A and B as your primary insurance, even if you continue with the group plan at work.
If you choose not to enroll for Medicare Parts A and B simply because you don't want it, or you don't think you need it, or you don't want to pay for it, then you will owe a penalty if you sign-up for it later, and you can only sign-up at a certain time of the year. That will be bad if you get a cancer diagnosis and then must wait another 10-months to get Medicare coverage.
Every situation is different, so it is important to consult with a Medicare professional to get answers to your questions and help you decide what option is best in your particular situation.
What do you enjoy most about working with Medicare clients?
Answer: I enjoy helping my clients to make good decisions. It's as simple as that! I've worked in health insurance for 30-years and I've had the privilege of touching thousands of lives over that time. I love when I meet with a client and they reaffirm that they made the right decision for their needs, even if it was a different decision than their friends made. My job is to educate my clients so they can make the best decision possible based on what they need and want.
Is Original Medicare or Medicare Advantage better? Why do you recommend one over the other?
Answer: This is a trick question.
Neither option is better in every situation or for every client. They both have an important place in our healthcare payor system. It is important for each person to understand both options so that they can choose which is best for themselves. Beware of insurance agents who approach clients with a one-size-fits-all mentality on either side of this argument.
The best decision is one that is measured and educated and based on the individual needs, wants and priorities of the client.
Can I change my Supplemental/Medigap plan at any time?
Answer: Technically, yes. Medicare Supplement plans are not locked-in to an annual cycle like Medicare Advantage and Medicare Part D plans. This means that you can make changes to them at any time of the year.
BUT outside of the Initial Enrollment Period (when you're new to Medicare Part B), or a Special Enrollment Period, you will need to qualify through Medical Underwriting to make a change in Medicare Supplement insurance plans or companies. If you've recently been in the hospital, have medical tests or treatment pending or you have a chronic condition or use a lot of medications, you can be denied coverage. This is why it's important that you never cancel one policy without first having the new policy that you're replacing it with in place. Many clients have questioned this because the Affordable Care Act eliminated pre-existing conditions and made it so that people with pre-existing conditions could get insurance, but that law does not specifically apply to Medicare programs. It is possible that this could change in the future, but for now, Supplement plans are still medically underwritten and can be denied.
I’m retiring next year—do I need to do anything with my Medicare?
Answer: Maybe. It depends on what you've already done.
If you already chose your Medicare plans in lieu of a group plan at work, then you may be set and ready to roll. But if you delayed your full Medicare enrollment because you had coverage at work, you will need to enroll in Medicare Parts A and B before you may choose any other plan options, like Medicare Advantage or Medicare Supplement. It would also be a good idea to review any notices that you've received from your group plan to know where that plan stands in comparison to Medicare Part D and to see if you may owe a late enrollment penalty if the group plan was not as good as Medicare Part D.
Can I switch from a Medicare Advantage plan to a Supplemental/Medigap plan during the Annual Enrollment Period without answering health questions?
Answer: Maybe. How long did you have a Medicare Advantage plan?
If you are still in your first year of Medicare Advantage coverage and you previously had a Medicare Supplement plan that you dropped to join the Medicare Advantage plan, you may exercise your 'Trial Right' Special Enrollment Period to return to your Medicare Supplement plan with no medical questions. If that plan is no longer available, you may choose another Medicare Supplement insurance company and enroll without Medical Underwriting, within certain guidelines.
If you enrolled directly into a Medicare Advantage plan during your Initial Enrollment Period and are leaving that plan within the first 12-months of coverage, you may also choose to return to Original Medicare and enroll with a Medicare Supplement plan without Medical Underwriting, again, subject to certain guidelines.
This process can be a bit tricky because you must first drop the Medicare Advantage plan and return to Original Medicare before you may enroll for a Medicare Supplement plan, and this can take some time. The Annual Enrollment Period is from October 15 - December 7 each year, and it is a very busy time of year for Social Security and Medicare, as most Medicare beneficiaries need to review and make changes to their plans during that time of year. It is possible that you could leave your Medicare Advantage plan and go back to Original Medicare only to have your Special Enrollment denied by the insurance company and find yourself without a Supplement plan while also outside of the Annual Enrollment Period, so also unable to re-enroll in your Medicare Advantage plan. If you want to do this, be prepared to start the process in October to allow enough time for the disenrollment and re-enrollment. You do not want to wait until the end of November or beginning of December to start this process.