Bill Holland, Medicare Insurance Broker

Answer: Generally You can switch to a Medicare Advantage plan during the Annual Enrollment Period (AEP) which runs from October 15th - December 7th each year. There are some Special Election Periods (SEPs) such as qualifying for Medicaid which will allow for Mid Year enrollments.

Answer: If YOU qualify and enroll in Medicare YOU have Medicare. Medicare benefits apply to YOU only.

I have Medicare and I got Married. I still have Medicare A & B & D even though my wife has Group Medical coverage thru her employer. If I decide to go on my wife's Group Medical coverage I still have Medicare Coverage.

Answer: Special Needs Plans are designed for Medicaid Eligible Clients or for Clients with specific Health Issues ie. Cardiac issues, Diabetes etc. These plans have benefits specifically designed to meet

the needs of Certain Populations.

Answer: Hospital Indemnity Policies are a Must to be combined with all "Zero Premium" Medicare Advantage Plans .

The "Zero Premium" plans have a per day Co-Pay for the first 5 or 6 days in Hospital.

These Co-Pays can be as much as $300.00, $400.00 , $500.00 per day.

Also If a Medicine is a Part B drug ie. Chemo, the Patient is responsible for

20% of the cost of the Drugs.

"NON Zero Premium Plans" also have the same issues.

Medicare Advantage plans can save lots of premiums but there are holes that a Hospital Indemnity Plan will cover.

Answer: There is a BIG IF. The If has to do with If and When you sign up for Medicare Part B.

You have a Guaranteed Issue window based on the EFFECTIVE DATE of your Medicare Part B.

You have a 2 Windows to sign up for Medicare Part B.

Window # 1 You are turning 65- you have a 7 month window

3 months before your Birth Month, your Birth Month , 3 months following your Birth Month.

Part B coverage starts the 1st day of your Birth Month.

Window # 2 Enrolling In Medicare Part B when losing Employer Coverage.

You have 8 months from Termination of Employer Coverage

to signup for Medicare Part B without a Penalty.

Part B coverage starts the 1st day of the Month.

These 2 windows Medicare Part B Enrollment Windows

will get you a Guaranteed Issue Medicare Supplement Plan.

These windows close 3 months after the Effective Date of Your Medicare Part B

Answer: You can always appeal a Medicare Denial of Coverage. You can generally find out how to appeal on pages 97-102 of the 2026 Medicare & You book.

If you do not have a copy, go to your local Social Security office. There is a form CMS-20027. You can download that form.

Or call 1-800-MEDICARE to get a copy mailed to you.

If you have a Medicare Advantage Plan or Medicare Prescription Plan, check the "Evidence of Coverage" you received from your Insurance Company

A Medical Professional must request Home Health Benefits.

A lot of the time, the denial is a matter of what the Doctor/provider said,

or what was not said, or what was not said clearly.

I had a personal problem getting some Durable Medical Equipment approved because of forms/prescriptions not being filled out correctly for the DME Provider and Medicare.

Finally, if you think the Denial is wrong, go to work quickly and find out why.

Answer: The Free Groceries thing is sort of in a grey area.

1) The Food /Grocery benefits are in addition to the Primary Medical benefits. Medicare agent/brokers are not allowed to discuss specific plan medical benefits until you have signed what is called a "Scope of the Appointment" form. Also You must qualify for the Food/Grocery Benefits , not everyone can get them. To qualify you must have a specific Health Condition or be below a certain income level etc .

2) Medicare Agent/Brokers CAN NOT make unsolicited contact with Medicare Beneficiaries. You may have answered one of those online surveys that ask all sorts of question. Buried in those Questions is a note that you are giving a Medicare agent/broker permission to call you. Same con as free windows in your zip code and you get calls from every New Window seller in 50 miles.

I am hoping that CMS? Medicare will Tighten up and Stop these type of phone calls.

WHEN IN DOUBT CONTACT A LOCAL AGENT/BROKER OR CMS !

2)

Answer: The United Healthcare AARP Medicare Advantage Plans do cover Occupational Therapy IF your Doctor, or Health care Provider certifies that you need this type of Care .

Answer: Stay active outside of your house / apartment. Go for walks , go to church, go shopping , go to Library , get involved in community events , go out and do something.

Answer: The Short answer is NO . Medicare/ CMS is also in the process of removing all cannabis type products from the Medicare Part D Formularies.

If you can Your Doctor to approve you for the use of "Medical Marijuana" , You will have to pay for it.

Also remember Marijuana laws vary by State, Just because you are approved in your home state Marijuana use in another might get you arrested

Answer: Medicare does not provide any Life Insurance type benefits.

If you need Final Expense benefits or something to cover your Debts you will need to have aLife Insurance Plan of some sort.

Answer: NO ! Absolutely Not . Coverage will start the 1st of the month following the enrollment. Special Enrollment/Election Period allow for Non-AEP enrollments on the 1st of the following month but never backdate Effective Dates

Answer: Medicare Advantage plans are no free. The Federal Government uses your tax dollars to pay Insurance companies to provide benefits to their clients. There is a standard rate per insured paid by the Feds modified by Star Ratings and specific health conditions (CSNPs).

BTW The Feds do not allow Brokers to call a plan "free" ,

Brokers are to call these plans "Zero Premium ".

Answer: Generally the enrollment Numbers do not show people leaving.

However if they do leave it is because the plans were not fully explained to them

or they did not receive good customer service

or their enrolling broker was no where to be found when a problem arose.

My job is to put my clients first.

So when my Knoxville Tennessee Client falls and breaks her Hip in Texas, I worked with the Insurance company and Client to get the Medical benefits covered in Network.

OR

Pointing my Clients to Special Programs like Special Veterans programs or Hotlines .

I am Medicare Broker all the time 7 days a week 365

Answer: Medicare Brokers work with but are not employed by Insurance Companies.

Medicare Brokers work for YOU our Clients.

Medicare Brokers generally work with a number of Medicare Insurance Companies.

Medicare Brokers are able to better match a clients needs to a Carrier. We can look into a number of different Hospital and Doctor Networks.

Some clients require Special Hospitals and/or Doctors

We can match your Pharmacy needs with Plan Formularies and explain Tier Levels etc.

Medicare Brokers will know about Special Medicare assistance programs for Clients.

D-SNP , CSNP , LIS (Extra Help), Medicare Prescription Payment Plan, etc.

Answer: Covered Members should start preparing August/ September when they receive their (ANOC) Annual Notice of Change Letters from their Current Carrier.

Your Current Broker can only address any questions about your ANOC Letter prior to October 1st.

Another good Tool is to pick up the new "Medicare and You Book" for the coming year. Current Medicare enrollees will have this book mailed to them.

Your local Social Security Office will also have copies of these Books.

If you be a first time enroller, Find a broker and start asking general questions about how Medicare Advantage Plans and Medicare Part D plans work. Brokers cannot get into the New Plan Specifics until October 1st

Remember AEP enrollments are for plans with an effective for January 1 of the Coming Year

not the current Year