Brent Minter, Medicare Insurance Broker

Answer: Every Medicare Advantage plan has a service area that is based on counties. Sometimes the service area for a plan can be as small as one county, and other times a service area may span counties in multiple states.

When you move, it is always a good idea to make sure your new county is in your plan's service area. If it is not, you will need to change your Medicare plan to a plan that is available in your new county.

Even if your current plan is available in your new county, it is still a good idea to review your coverage as additional plans may be available that fit your needs better.

When you move counties, you are granted a Special Election Period that allows you to change plans mid-year. This helps ensure you are able to be enrolled in the plan that is best for you.

Answer: Original Medicare Part A & B focus on helping pay your hospital and doctor bills; however, Medicare plans that fall under Part C of Medicare, also known as Medicare Advantage plans, go far beyond just helping pay your healthcare costs. They can play a key role in helping their members access assistance programs that are in place to address issues around social determinants of health.

Social determinants of health are the non-medical factors—such as financial health, nutrition, housing, and transportation—that impact individuals’ health outcomes. Unmet social needs can exacerbate health conditions, prevent people from accessing needed health care in timely fashion, and increase reliance on more costly hospital and emergency services.

Helping Medicare beneficiaries address social needs by connecting them to government and community-based programs that provide services like financial support, meal delivery, housing assistance, and ride sharing can improve health outcomes, enrollees’ quality of life, and support effective use of the health care system. Health plans and providers, community-based social service organizations, and government agencies each have a role to play in

addressing social determinants of health.

Medicare Advantage (MA), which covers about half of all Medicare beneficiaries, is well-positioned to play a leadership role. Unlike Medicare fee-for-service, the integrated MA model can wrap a wholistic medical and social support model around Medicare enrollees.

Answer: Everyone who is enrolled in a Medicare Advantage plan will receive an ANOC each year before the Annual Enrollment Period (AEP) opens up. The ANOC, aka Annual Notice of Change, is sent to members either by mail or email, and it details the changes to their plan for the upcoming year.

It is important to review this document to understand how your plan is changing and to ensure it is still the best plan for your needs. However, like most insurance documents, ANOCs can be hard to understand sometimes. Reviewing the ANOC with your agent is a very wise decision. Your agent can help you better understand the changes and how they might impact you. The agent can also help make recommendations as to whether you should remain enrolled in your plan or explore other options for the coming year.

It's always best to work with a local independent agent to help make sure your plan is right for you.

Answer: As we age, the need for both dental and vision coverage increases. Unfortunately, Original Medicare does not cover routine, comprehensive dental and vision benefits.

It is true that Original Medicare will cover some dental and vision benefits if they are medically-necessary and related to another health condition, but your routine exams, teeth cleanings, extractions, crowns, eyeglasses (except after cataract surgery) are not covered.

If these benefits are important to you, you can get them in one of two ways.

1. If you are enrolled in Original Medicare Part A & B, you have the option to purchase a separate dental and vision plan that best meets your needs. There are many insurance companies that sell these plans, and they are quite affordable when you compare them to the cost of care.

2. If you are enrolled in a Medicare Advantage plan, it is very likely your plan offers dental and vision coverage as additional benefits.

To make sure you have the benefits that best suit your needs, it is always a good idea to work with a local independent insurance agent who can work with multiple companies to find the plan that is best for you.

Answer: Healthcare is a rapidly changing industry when it comes to how you can receive care. Telemedicine is playing a large role in this change.

Telemedicine has eliminated the need to go sit in a busy waiting room anxiously waiting to hear your name called. It has also eliminated that long wait in the exam room while your doctor finishes up with their previous patient. In other words, telemedicine has made receiving healthcare more convenient for you, the patient.

Telemedicine may not be appropriate for all types of visits to your doctor, but it can be a game-changer for certain non-emergent needs or even follow-up visits.

Work with a local independent agent to make sure your plan covers telemedicine and how it works. It could save you both time and money.

Answer: One of the unique things that set Medicare Advantage plans apart from Medicare Supplements is that they usually offer additional benefits beyond what Original Medicare provides. These additional benefits generally do include dental coverage.

Not all dental benefits are created equal when it comes to Medicare Advantage plans. When shopping for a plan be sure you understand how the dental benefit works and what it covers. You should also review the dental network and confirm if you can use the benefit at a dentist office who is not in-network.

A knowledgeable local independent agent will be able to help answer these questions and many more to make sure you are enrolling in the plan that best fits your needs.

Answer: Medicare Supplements will automatically renew each year as long as you continue to pay the premium.

Medicare Supplements differ from Medicare Advantage and Part D plans in that the Annual Enrollment Period (AEP) does not apply.

Answer: Moving to a new state or even just a new zip code can be very daunting considering all the things you have to update with new addresses and mailing information, and yes, your Medicare coverage will need to be updated too. This especially applies if you are enrolled in a Medicare Advantage plan or a Part D plan.

Generally, when you move, you will need to select a plan that is offered in your new state. You will have access to a special election period related to your move. You can exercise this special election period one month prior to your move and up to two months after your move.

If you don't change your plans, your current coverage will be cancelled and you will be returned to original Medicare and subject to the deductibles, co-insurance and copayments that apply to Part A and B of Medicare. You will also risk losing your Part D coverage. If this happens, you may not be able to enroll in a Part D plan until the next Annual Election Period, and your coverage will not start until January 1 of the following year. You could also be subject to penalties if this occurs.

It is always best to work with a local independent insurance agent to help you review all of your plan options to find a plan that works best for your needs.

Answer: As you know, biologic medications are very expensive and your share of the cost is determined by how the medication is classified. These medications can be classified under your Part D benefits as prescription medication that you purchase from a pharmacy, or they can be classified as a Part B medication that is usually administered in a clinical setting such as a doctor's office or infusion clinic.

If the medication is classified as a Part D prescription and is covered by your Part D plan, your overall out-of-pocket costs are limited to $2,000 for 2025. Most Part D plans will have a $590 deductible and then you will owe 25% of the cost of the drug. In the case of a $6,000 prescription, you can expect to pay the deductible plus 25% of the cost until you have spent $2,000. At that point, your prescription will be covered 100% for the rest of the plan year.

If your medication is classified as a Part B drug, it is subject to the Part B deductible if it has not been met, and then you will pay 20% of the cost of the drug. Part B does not have a maximum out-of-pocket limit.

If you have a Medicare Supplement (aka Medigap plan) or if you are enrolled in a Medicare Advantage plan, your costs for Part B drugs could vary.

It is always best to speak with a local licensed independent insurance agent to better understand the costs of your drugs and other benefits.

Answer: Many people believe that Medicare Advantage plans are "too good to be true" because they often provide coverage for a $0 premium and/or offer benefits above and beyond what original Medicare offers.

Medicare Advantage plans are a part of Medicare known as Part C. Unlike Part A and B, Part C plans are offered by private insurance companies who have a contract with Medicare to offer the plans. In simple terms, Medicare pays the private company to administer the Medicare benefits for the individuals who enroll in the Medicare Advantage plan. In return, the private company agrees to provide all the benefits and services of original Medicare and oftentimes provides additional benefits.

These private companies use certain "tools" such as provider networks, prior authorization, referrals to specialists and programs to help improve the overall health of their members to reduce medical costs. They then pass some of these savings on to members in the form of additional benefits.

You also have certain protections when you enroll in a Medicare Advantage plan in case you find out you are not happy with the plan.

To conclude, there are no traps in Medicare Advantage plans. To learn more about Medicare Advantage and if it is a good choice for you, please speak with a local licensed independent insurance agent.

Answer: Enrollment periods can be one of the most confusing aspects of Medicare. Below is information on the most common enrollment periods:

Initial Election Period - occurs three months before the month of your 65th birthday and continues for three months past the month of your 65th birthday, seven months in total. During this time you can enroll in both Part A and/or B of Original Medicare. You can also enroll in a Medicare Advantage (Part C) plan or a Part D prescription plan.

Annual Election Period - occurs each year starting on October 15 and continues through December 7. During this time you may enroll in, change or cancel a Medicare Advantage or Part D prescription plan

Open Enrollment Period - occurs each year starting on January 1 and continues through March 31. During this time you may make one change to your Medicare Advantage (Part C) coverage only.

Special Election Periods - occur throughout the year and are usually tied to some change in circumstances such as moving, becoming eligible for financial assistance, being diagnosed with certain chronic conditions or losing creditable coverage such as employer-sponsored coverage.

Generally, Medicare enrollment periods do not apply to Medicare Supplements, also known as Medigap policies. If you are interested in purchasing a Medicare Supplement, you do have an open enrollment period during the first 6 months that you are eligible for both Part A & B of Medicare. During this time, you have the right to purchase any Medicare Supplement available to you based on where you live without having to answer health questions.

For more information on enrollment periods, it is always best to consult a local independent licensed insurance agent who can help guide you through the maze of enrollment periods.

Answer: It is a common belief that Original Medicare covers an annual physical exam; however, it does not.

When you first become eligible for Original Medicare, you have the opportunity to have a "Welcome to Medicare" preventive visit. This is not a physical exam. It is simply a review of your medical and social history related to your health. Each year after that, Original Medicare also provides a yearly "Wellness" visit to update your personalized healthcare plan with your doctor.

Many Medicare Advantage plans, also known as Part C of Medicare, do offer Annual Physical Exams as part of their preventive health coverage. If your friend is enrolled in a Medicare Advantage plan, then it is probable that her annual physical was completed at no cost to her.

To better understand what is provided by your specific coverage, it is always best to consult with a local independent licensed insurance agent. Local independent agents must complete annual certification requirements to ensure they understand Medicare and the plan options available to you.

Answer: Working with a local independent insurance agent provides many benefits to you. Local agents are generally more knowledgeable about the plans available in your area. Plans change each year, new plans are introduced, old plans may be discontinued and there may be major network changes for certain plans. A local Medicare agent will likely be better informed about the plans in your area and be better positioned to help you navigate these changes.

Another thing to consider is the local independent agent works for you not the insurance companies they represent. Therefore, it is in the agent's best interest to make sure they are advising you based on what is best for you and your needs. The local independent agent wants you to be a long-term client and that requires trust by doing what is right for you.