Christopher Akers, Medicare Insurance Agent

Answer: You can apply for Extra Help for Low Income Subsidy, (which will assist with your Part D premium, deductibles and copays), with the Social Security Administration. You can have the application sent to the state you reside in, to apply for Medicare Savings Programs. These are state run programs, so they will vary state to state. You may qualify for QMB, SLMB, QI, or Medicaid.

Answer: When moving it is always a good idea to verify that your coverage will be accepted and is a good fit to your new zip code. If the coverage area changes, then you would have an Special

Election Period or SEP to make a plan change at that time (with Advantage plans). Medicare Supplements premiums could be affected. Prescription Drug Plans (PDP) coverage could be affected as well. Always check to insure your coverage will fit your new zip code. Better to be safe than sorry.

Answer: You can drop Part B, as Medicare typically does not cover overseas.

Keep in mind if you do not have creditable coverage (say an employer plan) you will be penalized for each month without Part B.

You will pay a penalty for each month that you do not have coverage, after you enroll back into Part B, for the lifetime of the enrollment into Part B. You also have a specific enrollment period of time that you can enroll into Part B when you return.

Answer: Do not answer calls that you do not recognize.

Do not verify your Medicare ID number.

Do not verify your Social Security number.

Do not verify your address.

Do not verify your birthdate.

Do NOT say the word 'yes' on the phone.

Scammers can buy personal information and record you verifying or supplying the word 'yes' and then put that into a pre-recorded application.

Technology can be great, but caution and suspicion need to be greater.

Medicare, Medicaid, and your insurance provider will mail you any necessary documents... scammers will call you.

Answer: Insurance agent represents: The insurance company or companies they are appointed to.

The policy options: Limited to the products offered by the insurance carrier(s) they represent.

Insurance broker represents: The client's interests when shopping for insurance.

The policy options: Has access to a wider range of products from multiple insurance carriers.

I would deal with one broker when discussing carrier plans. Multiple agents would be ok for multiple carriers. The reason I would keep the number of people involved to a minimum is you can get confused with what agent 'x' told you vs what agent 'z' told you, and mistakenly remember something. 'Too many cooks spoil the soup' concept.

Answer: You can apply for Extra Help at SSA.gov. You can use GoodRx to see if it can give you any discounts as well.

Answer: The time which you can make changes to your Medicare Advantage and Part D plans are October 15th to December 7th each year, for a January 1st effective date.

If you are diagnosed anytime during the year, you would have to wait until the Annual Enrollment Period to make those changes.

Answer: You can enroll into Medicare even if you have never paid into Social Security due to working overseas. Your eligibility and costs will depend on your residency status and work history.

Answer: You can apply for a Medigap policy at any time, but if you are outside of your guaranteed issue period, you will have to answer health questions on the application and likely face medical underwriting. This means an insurer can deny you coverage, or rate you up (or charge you more for having health conditions).

Answer: IRMAA is a surcharge added to your Medicare Part B and Part D premiums if your income exceeds certain thresholds. It’s designed to ensure that higher-income beneficiaries contribute more to the Medicare system, helping support its long-term sustainability. The surcharge is based on your modified adjusted gross income (MAGI) from two years prior. So the IRMAA you may owe in 2025 is based on your 2023 MAGI.

Answer: Restricted provider networks and limited access to care. Y

Benefits and networks can change annually.

Costs can increase as you get older and possible see more usage of the Advantage Plan.

Prior Authorization can delay or prevent coverage.

You cannot have a Medigap plan while enrolled in a Medicare Advantage Plan with Rx coverage.

You may not be able to enroll into a Medigap plan because you missed the 'guaranteed' enrollment window to enroll.

Answer: To be honest, this is really not an answerable question.

This is an opinion.

We don't have anything to firmly suggest that the treatments WILL, or will NOT be added to the coverage levels currently provided.

Answer: It would depend on so many things. How much do you mean when you say younger? 5 years, 10, 20? It would be met with mixed results. You would have young healthy people contributing to a system that is designed for the senior market. It may steer health care to a prevention model instead of a pill treatment model, but would the younger generation be willing to contribute the income required? Especially when the have heard for years, how Medicare and Social Security are not secure programs. We may be able to lower the age, but I don't think more than 5 years would be realistic without seeing some in depth info.

Answer: Financial concerns. They can have lower reimbursement rates compared to traditional Medicare, delayed payments and possibly administrative burdens. MA plans can be more restrictive with more claim denials and possibly require prior authorizations for many services. This can increase administrative costs, and cause delays or denials.

Answer: As we face an aging population, we face more health conditions, some being chronic. This will drive up costs and demand for services. The size of the Baby Boomer generation, and longer life expectancy will cause greater stress to an already burdened system.

Answer: The coverage gap for Medicare Part D plans has been eliminated beginning in 2025. There will be a new cap ($2,000 for 2025, and $2100 for 2026) for your annual out-of-pocket drug costs.

Answer: An agent or broker can search in their quoting portal or go to the carriers portal directly to verify. You can also verify by checking the doctors website, calling the doctors billing department and calling the insurance carrier direct.

Answer: If you have Medicare Part A, the Hospital benefit and Part B the Medical benefit, there could be significant gaps because they do not provide comprehensive coverage. A&B covers about 80% of the approved claim, leaving the patient responsible for the remaining 20%. This does not address the lack of Part D Prescription Drug coverage.

Answer: If you are getting Social Security disability, you get Medicare after getting disability benefits for 24 months. If you have ALS (commonly referred as Lou Gehrig's disease) you will get Medicare automatically as soon as you start getting the disability benefits. If you have been on disability for years, you may already qualify for your Medicare benefits.

Answer: No. Medicare does not cover all blood tests. It covers medically necessary diagnostic blood tests and certain preventative blood tests. Your doctor can discuss why a blood test is being recommended for you and you can ask if it is medically necessary by Medicare.

Answer: Agents can host two types of meetings:

Educational-this means they are to educate you to the choices you have available (original Medicare, Medicare Supplements, Medicare Advantage plans, and Prescription Drug Plans…no sales are to take place at these meetings and no plan specific conversations are to take place, and enrollments are prohibited during these meetings.

Sales-this is where a sales person can talk to you about plan specific information and they are usually hosted by the specific company they represent. Enrollments can take place at these meetings.

Answer: Yes, it is required to be mailed to you if you are on an Medicare Advantage Plan. Original Medicare and the supplement benefits do not change year to year like a Medicare Advantage Plan or Medicare Advantage Plan with Prescription Drug coverage can.

Answer: If you chose original Medicare and are drowning in bills, it sounds like you have ONLY original Medicare, where Medicare pays roughly, 80% of the Part A hospital and Part B medical expenses. You could have went with a Medicare Supplement with a guaranteed issue the first year of turning 65, and paid a monthly premium (how much would depend on which Supplement Plan you chose, they start with the letter A and go to the letter N (some are no longer available)), or you could have chosen a Medicare Advantage Plan. If reviewed correctly, and you consider everything from networks, copays, etc., then you can make a well informed decision. October 15 to December 7 is the window to consider a Medicare Advantage plan. If you are still in your 65th year of age, you can get a Medicare supplement without any health questions. If you are drowning in bills, and are over 65, it could have a higher premium, or you may no longer be eligible for a supplement, it would need to be reviewed to be certain (did you delay enrolling into Part B for example). Reach out to a broker in your area to see how they can get you into a better position moving forward. We cannot change the past but we can try and help you make well informed decisions for the future.

Answer: Had a client get burned on their farm and was flew out to a burn center. The carrier did not want to pay because another burn center was closer 'as the crow flies'. We filed an appeal with the carrier, stating that they were unable to make the decision as to where to be flown to because they were unconscious, and they nor any family member had signed off on it.