Christopher DiBiase, Medicare Insurance Broker

Answer: Short answer: They don't consult with an experienced professional. Long answer: Medicare is different from health insurance, since it is government-sponsored, and there are more rules, regulations, and guidelines to follow. There are generous time frames to enrolling and many think they can get it if and when it is needed. Those errors are unforgiving; the government fines people for the remainder of their lives.

Answer: Your preventative services are a yearly exam, screenings, HIV testing, mammograms, and vaccines. There is no cost; in some rare cases, there can be costs for office visits if you require specialized testing.

Answer: Medicare Advantage Plans have 2 main networks: HMO and PPO. HMO is a smaller, trusted network for which the carrier has set pricing for the services and benefits. Depending on the carrier and the location, these can be restrictive. They will have all types of specialists, hospitals, dentists, urgent care etc. It may not be your favorite or the one next to your location. Your primary care provider will refer you to other in-network providers to keep your costs lower. In some cases, you can ask for another provider, but they will have to be within the network.

With a PPO, you can choose to go to out-of-network providers but there is usually a higher cost with the premium and/or copays and max out-of-pocket. If lower costs mean the most to you, an HMO will work. If to restrictive or controlling and you want the freedom of choice of your provider, then you should look for PPO plans.

Answer: There are many factors that can fluctuate what the carriers can and will do to change the benefits. Most of it goes around what the government does with their payments and the amount of fraud that affects costs. (Believe what you will, it will always be for profit) 2024 saw a highlight of additional benefits nationally; now we have seen a slimming of those benefits. Many were not even given just a short 7 years ago, like dental. It started as preventative only then evolved into $1000, $2000, $3000 max out of pocket for some plans. Consumers want more in an all-for-one package, but are they willing to pay a little more for it? The majority of Medicare Advantage plans are under $25 a month, and many are $0. I have seen the changes the last 12 years and when talking to regional managers, expect to see Medicare Advantage plans become more inclusive with benefits but with smaller networks to provide it at a low cost.

Answer: Yearly, there is testing to make sure we pass to keep selling Medicare from the government. Each carrier for Medicare has its own additional quizzes and tests that you must pass to sell their particular plans. Most carriers have a meeting online or in person to highlight their plan changes for the upcoming year, where we have a first look at the differences. If that isn't enough, your company may have more quizzes and information, not just on the rules and regulations, but on what to look for in clients for certain plans. Most brokers are well-tested, and experience matters, because 60% are standard enrollments. 20% are difficult because research is needed or issues with Social Security, billing or penalties. The last 20% might qualify for special enrollments based upon health and/or finances, where you need special training, knowledge, and patience to handle these enrollments. Many brokers and agents skip these or tell people they cannot help them due to a lack of experience or are scared of dealing with them. I was that way until my 5th year. I had a relative who had these needs, and I decided to learn and understand the options, rules, and regulations that are required to know how to help people.

Answer: Costs can vary on a few different factors. For your Part B & Part D year-to-year, there are increases, and those who have higher earnings will pay a higher IRMMA fee, depending on the income and if married. With Supplemental plans, it can vary depending on the plan selected, age at which you join, and the state in which you live. When it comes to Medicare Advantage plans, depending on the plan and, more so, your zip code factor in. Nationally, plans are under $25 per month, with many at $0. This is why working with an experienced broker gives you multiple options to see what fits not just your budget, but your coverage concerns.

Answer: This is the 6th months after accepting Part B and turning 65 where you can skip underwriting for supplemental plans. This is the basic right nationally but some states have additional time frames which your Agent/Broker should be aware of. This can also apply if you lose Medicaid, lose your Medicare Advantage plan, Move to a new area where your Med Advantage plan does not cover as well as your 2nd trial period if you leave an Supplemental plan to a MA plan and move back within 12 months. Now, which plan suits your needs?

Answer: Travel insurance is what is needed abroad as most health insurance and Medicare Advantage do not give you coverage beyond US border and it's territories. Original Medicare and supplemental plans will have limitations on coverage and is only health coverage. If you are looking for lost baggage, trip interruption or flying home severely injured that would be covered by TI. I always tell people, know before you go, check your plan exclusions and talk to customer service if it is not clear. It's not the cost that is key, it's the what if your car has you missing a flight or boat?

Answer: This depends on what your current coverage is. If you are turning 65 or leaving group coverage you would have to apply for Medicare Part B and go over your needs to see what Medicare advantage plan suits your needs. you may do this anytime of the year.

If you are on a supplement plan you would want to talk to a professional about the differences in how the coverage and costs work so you are informed if moving is right for you. If you are on a current Medicare Advantage Plan you can do so by checking which plan(s) your doctors take and where you would spend less for your prescriptions then compare it to your current plan factoring in max out of pocket deductibles and additional benefits. These last two should be done during open enrollment Oct 15th-Dec 7th but there are a few exceptions through the year.

Answer: Plan N will cover your MRI at $0 cost. You will have a $20 copay for the doctors office and pay the deductible($257-2025) if it has not been satisfied at that point.

Answer: You would want a broker over an agent as as broker has more carriers to offer where an agent has just one they can work with. With a broker we are trained directly from the carriers yearly on their plan changes from pricing to coverage and prescriptions.