Charles Calvin, Medicare Insurance Broker

Answer: You will still want to opt in for Medicare A & B within the 3 months preceding the month you turn 65. This will guarantee that you don’t incur penalties for late enrollment. Instead of having the Part B premium deducted from Social Security, they will bill you quarterly, until such a time that you activate Social Security and it transitions to monthly deduction.

Answer: You cannot be denied a Medicare Advantage plan based on your health. However, you do have to have a valid enrollment/election period to be able to enroll, as well as having both Parts A & B of Medicare.

Answer: Currently, they do not. If marijuana was ever legalized on the Federal level (currently it’s only on the State level), then it would be possible that Medicare might cover it. Until then, it is not covered.

Answer: You’re missing the nuances that go into it. Medicare is not a one-size-fits-all, and what works best for one person may not make any sense at all for another. I have couples that don’t even have the same type of plan because their needs are very different. Always make your choice with proper guidance, from someone who’s licensed and can speak knowledgeably on the subject to point you in the right direction for your specific needs.

Answer: The very first thing we do is sit down and assess their health care needs and wants. From there, I walk them through Medicare Advantage vs. Medicare Supplement, with pros and cons for each. Once they choose which path they prefer, then we narrow down further based on various factors. If we’re doing an Advantage plan, we base our plan choice on who has the lowest drug costs while also having all of their doctors in the network. If we’re doing a Supplement, we find the one that is the most benefit for the lowest cost (typically a G or N); since Supplements are standardized, we can compare strictly on cost since benefits are identical across same-letter plans, no matter which company you’re getting it from. Then we find a Part D plan that will minimize costs, as formularies and deductibles can vary wildly across companies/plans. Once we settle on a plan, we submit the application(s), and then we review each year to account for any changes that have occurred.

Answer: Plans can change their formulary year-to-year, as well as their copays/coinsurance on each drug tier. Sometimes generics can move from Tier 1 to Tier 2, which can result in a cost change, and sometimes they’re even moved into the name-brand tier or removed altogether, resulting in a significant cost jump. And now that more plans are charging deductibles on Tiers 3 & 4 (and some even on Tier 1 & 2), it can cause surprises if you’re not reviewing your drug plan each year. It’s always best to run a cost comparison for your current prescriptions each year during the Annual Enrollment Period from October 15-December 7.

Answer: Medicare is not a one-size-fits-all; it’s a starting point only, and there are many options from there, with many variables to consider. Too many seniors get caught in the trap of “Oh, my friend has this plan, so it must be great”, or “Oh, my friend said this plan is awful, so it must be bad”. Everyone’s experience will be different, and for different reasons. You have to choose a plan that makes the most sense for your health needs and goals, as well as ways to minimize expenses over time. I frequently tell my clients that health care is a pay now or pay later system, there’s no third option. You’re either going to pay upfront and have little to no expense when you get to the problem, or you’re going to pay nothing upfront, and pay for the problem when you get to it. There’s no free lunch, but you can at least have some control over how much of your money gets spent. It’s not my place to tell someone that they can’t spend their life savings on medical care if that’s what they really want to do, but I can help them avoid that situation altogether.

Answer: The only disadvantage of an HMO is if you want to see a provider that is not in the network. Otherwise, an HMO is perfectly fine, and costs are cheaper than on a PPO. If you have doctors that are out of network, or if you travel frequently, then an HMO may not be a best fit. Which type of plan is most suitable for your needs can be determined by a licensed broker, as we can compare and contrast across multiple carriers to find that best fit.

Answer: The main thing to know is that Medicare Advantage, by law, has to offer coverage as good as or better than Medicare; meaning you won’t lose out on anything by having a Medicare Advantage plan. Beyond that, it comes down to how you want services covered, and how much you want them to cost, as well as what benefits are important to you. There are too many nuances to cover here, but Advantage plans often give you extra benefits that Medicare doesn’t, as well as including Part D prescription coverage. Original Medicare with a Supplement (also known as Medigap) will cover nearly everything, but will not give you the extras of an Advantage plan, nor does it include Part D, which has to be gotten separately for (in most cases) an additional cost. Which direction to go is best determined by a careful analysis of each individual’s situation, which we as brokers are equipped to do.

Answer: Both methods have their advantages. It all depends on the level of service that the client wants. I have clients that want face-to-face appointments, so if they’re local, they can come to our office, or I can come to their home. For my out-of-state clients, we do everything over the phone, and they’re comfortable with that. The key is to find someone you can trust, and who knows the industry well.

Answer: As long as the provider accepts Medicare, and as long as Medicare approves the charges, then the procedure is covered. If the MRI is performed in a doctor’s office or ER, there is the possibility of a copay for the service. If any or all of the Part B deductible hasn’t been met yet, then you would be responsible for that amount.

Answer: If you are currently receiving Social Security benefits, you should be automatically enrolled into Medicare A & B sometime in March. Not only can you have both Medicare and Medicaid, in some cases, the combination of the two will allow you to enroll in a Dual Special Needs Plan. Your level of Medicaid will dictate eligibility for such a plan, and that can be determined by either calling your Medicaid case worker, or sometimes we have software programs that can retrieve that information.

Answer: First, it should be noted that there are big differences between an agent and a broker. While all of us on here are licensed insurance agents, some of us are brokers. The main difference is that agents are generally captive to one company, and thus can only offer that one company’s products. Brokers, on the other hand, contract with multiple companies to be able to offer a broader portfolio of products to our clients, which results in more precise customization.

The reason you want to work with an agent/broker is because we see things that you don’t. And what I mean by that is that we are trained to know the nuances of coverage and how everything interacts together. We also know exactly what to look for when there are specific needs and concerns that have to be accounted for. People can spend hours upon hours on the internet doing their own “research”, and they’re welcome to do so, but we can streamline that and have a proper solution in a small fraction of the time. Additionally, when you have questions or concerns, you have a consistent point of contact instead of a random customer service person that may or may not know how to help you.

Answer: Screenings are covered at no cost under Medicare Part B. Further diagnostics (such as if results are abnormal and require additional testing) are then billed at the current deductible rate ($283/yr for ‘26) and/or 20% of contracted cost.