Christopher Garcia, Medicare Insurance Broker

Answer: I believe that the biggest mistake seniors make when enrolling in Medicare is not taking the time to gather important information and understand their options fully. The other mistake I see often is choosing a health insurance plan without fully understanding their options. The decision to go with the Medicare supplement versus a Medicare advantage plan is one of the most important decisions you’ll have to make. Fully understanding that decision is extraordinary important. Speaking with an experienced professional who can ensure that you fully understand your right and options is highly recommended.

Answer: I would say the most common misconception about Medicare is that it works the same as other health insurance plans. Medicare is unique and there are many differences between Medicare and the health insurance people are used to having.

Answer: The biggest imbalance that I see is the overall cost of medications. Whether that cost is passed down to the consumer or the health insurance company. Lower medication costs mean both the consumer at the health insurance company keep money in their pockets. It’s obvious why this is important to the consumer. For the health insurance company, it means that money could be spent on other benefits and keeping plan copays low.

Answer: It’s very important to understand some basics that will allow you to spot scams and help differentiate them from legitimate calls. Medicare and social security will never call you. They will send letter, however when someone calls asking for you to provide personal private info or stating that they are calling for a legitimate reason you should in my opinion be skeptical. Here are a few tips to help.

1. Always get a name and phone number and ask for a license number from the people who are calling. Ask what company they are with. If they are not a scammer they should have a number where they can be reached directly.

2. Don’t give private information out over the phone. This information is what scammers are hoping to get. Guard your info and if your concerned that you may be speaking to a scammer simply hang up.

3. Know some basic rules that apply to medicare sales. Agents are not allowed to solicit medicare beneficiaries without expressed permission. An agent has to have a permission to contact form or a scope of appointment in order to call

you for sales purposes. You can call them directly but the rules protect you from being solicited and knowing that can help you spot scammers or even agents who don’t play by the rules.

4. Lastly if you have a local agent that you know and trust reach out to them for guidance. They can help educate you on the rules and be used as a resource to help you spot scammers.

Answer: To put it simply these gaps are either costs that are passed on to you such as deductibles or copays. They can also be services that are simply not covered by original medicare such as Dental, Vision, and Hearing Aid coverage. A good medicare agent can help explain these gaps in more detail and show you solutions to help get them covered if need be.

Answer: This is a common occurrence. While your plan may include dental coverage it’s also important to check to see which procedures are covered under that benefit. Medicare Advantage plans change benefits every year. Along with the annual coverage limit there will also be a list of procedures that are covered and not all procedures may be covered 100% Its important to know what percentage of those procedures are covered. The coverage info will be summarized in your summary of benefits and expanded coverage info will be available on your Evidence of Coverage document. If you’re working with an agent or broker, they should be able to explain the benefits in great detail. I hope this information helps.

Answer: medicare has a standardized list of preventive services that are covered as well as as a standard frequency when you should be getting these screenings. Your summary of benefits should have a list of these in your preventive services section. Sometimes the frequency can vary based on medical history and necessity. It’s important to work with your doctor to determine if your screening should be done more frequently than the standard.

Answer: while Medicare does cover emergency transport, it does not cover it at 100%. If you have original Medicare, they typically cover 80% after you meet your deductible. If you have a Medigap plan and there should be no cost but that can vary based on which medigap plan you own and whether you have met your annual deductible. If you have a Medicare advantage plan then the co-pay will vary based on the plan you are on. You can refer to your summary of benefits to see what your co-pay is for ambulatory transport.

Answer: Medicare part B has a monthly premium of $185 a month. If you’re collecting Social Security benefits, you can have this withheld directly from your Social Security check on a monthly basis. If you’re being billed for Medicare part B you are typically billed for three months at a time. The bill you receive will state the amount you owe as well as the period you are being billed for. you can contact them directly using the number on your bill if you have questions. I hope this information helps.

Answer: The CMS star rating combines several factors to rate the plan so that consumers can get an idea of how well the plan performs. The plan is rated 1-5 stars. A higher star rating indicates how well the plan performs and the rating affects how much funding the insurance company gets to provide the plans benefits and services. As an example an 3 star rating is an average rating. All plans are required to provide the plans rating and agents and brokers are required to inform the consumer of the rating when the plans are presented to a consumer. You can also fine the plans star rating on the insurance companies web site when looking up plans.

Answer: Original Medicare ( Parts A and B) does not cover hearing aids or the evaluations and fittings for them. However, many Medicare advantage plans do provide coverage for hearing aid services. Medicare supplements may also offer some discounts on hearing aid services. It’s important to properly evaluate the differences between a Medicare advantage plan and Medicare supplement before making a decision. There are major differences between the two and it is a very important decision. Make sure you speak to your agent or Broker and properly evaluate all your options.