Daniel Fraser, Medicare Insurance Broker

Answer: I wouldn't tell you to be worried but absolutely you should be concerned which is why you need to verify that any provider you plan on seeing accepts your insurance. Not just the carrier but the product you have (PPO/HMO).

This is also a main reason why you need to work with a Medicare Specialist. The advisor can keep you up to date on providers no longer participating with your plan.

Answer: When it comes to Referrals, Medicare does not require referrals to see a specialist, however there are a few things to keep in mind. First, you need to make sure the provider you see accept Medicare and the second is that you don't want to confuse Referrals with Authorizations. There are times when you may need prior authorization for certain procedures. (For example, you can't just get an MRI if you have a headache). Speak with your provider and they should be able to guide you for specifics

Answer: That is a great question. In the past, Medicare Advantage plans were growing every year because the government subsidized the insurance carriers, however, this reimbursement has been lowered and now insurance carriers are either lowering their benefits or exiting the marketplace all together depending on where you live. Certain areas in Florida (Specifically, South Florida) has seen PPO plans exiting the marketplace everywhere.

To answer your question, we will have to wait and see each year as these plans change annually. This also brings up the point that it is essential to work an advisor/broker who can help guide you and keep this information in front of you so you can make an informed decision

Answer: Contracts are signed between providers and the insurance carriers that are allowed to sell Medicare Health Plans (Medicare Advantage) in your area. When these contracting periods occur, it is the decision between the hospital and the insurance company on if they want to participate with each other. Normally this is financial matter but other reasons may come into play.

This is another example as to why it is imperative to work with an agent/broker that can determine if your providers are in-network with the Advantage plan you choose.

Answer: As an independent broker that represents most carriers in the state of Florida, I can not and will not answer this question. As long as the carriers are licensed to sell in the state of Florida, you will see their financial ratings, reviews, rate history, etc... and determine with the help of you agent/broker what plan is best for you

Answer: This depends on your Part D carrier but typically Repatha is a Tier 3 Brand Name drug. Here in Florida, there are carriers that do not cover Repatha so as always, have your Agent/Broker shop your drug plan during the Annual Election Period (10/15 - 12/7).

Answer: The rule is if your current Medicare Advantage plan does not cover your new area, then most likely yes, you will not need to answer medical questions.

Also, there is a time limit as to when you can do this. Typically, you need to apply within 2 months (63 days) after your Medicare Advantage plan ends in order to have guaranteed issue rights.

Speak to your agent/broker about the details

Answer: This could vary based on carrier but normally, if it an inhaler that you can pick up at a pharmacy, it most likely will be billed under Part D. If it is a machine and you have to get a liquid vile, or dispensed in a doctors office, it normally is billed under Part B.

Your Insurance agent/broker can help you determine this by calling the insurance carrier/provider to clarify this

Answer: Medicare Part D has three phases. The deductible phase, the initial coverage phase and the catastrophic phase. During the deductible phase, a Medicare beneficiary is responsible for meeting a deductible for Brand Name drugs (normally Tier 3-5) Generic drugs (Tiers 1,2) normally do not have to meet the deductible. During the Initial phase, you will pay either a copay or coinsurance based on the tier your prescription falls into. The drug tiers which are typically Tiers 1-5 with the lower tiers being the least expensive.

This is why it is important to work an agent/broker. Prescription Drugs can change tiers each year so your plan must be "Shopped"

Answer: there are a few options so it would take a deep dive into your parents situation. This is a difficult question to answer without a thorough interview.

However, remember that Medicare still pays first. This means Part A and B pays and the 20% is based on the Medicare allowed amount.

Also, there may be a possibility to 'downgrade" their Plan F to a less expensive plan, however, certain carriers have implemented changes to the ability to do this so it would depend on the carrier they currently have.

And lastly, there is always a Medicare Advantage plan as an option during the Annual Election Period.

Answer: Absolutely, but do not solely rely on this. There is one company that has been around since Medicare began, and they are an A+ rated carrier by S&P, but because they do not advertise everywhere, many Medicare beneficiaries haven't heard of them. On the same note, many "Popular" carriers are inconsistent with their rates and have large increases every few years or so.

Again, look at carrier ratings, time in the business, financials, and overall performance as determining factors

Answer: Medical loss ratio determines the percentage of money that goes back to the Medicare beneficiary in the form of medical care and overall care. By law, only 15% can go to the carriers admin costs & profit.

A carrier with a higher medical loss ratio is essentially giving more money back to the Medicare Beneficiary so this would be an important part to the decision of what plan to go with

Answer: I would start off by looking at how long a carrier has been in the business. UHC, Humana, Aetna, Blue have been doing this a long time even though they have withdrawn their PPO plans from some counties in the past couple of years, they still have quality products available. Ultimately, you will want to look at carriers with high star ratings and quality reviews on-line

Answer: I believe that these are a big part of the Medicare Insurance company and plan overall quality. There are many factors that come in to play but having the ability to see doctors when it comes to transportation, the ability to pay for your utilities, Over the counter benefits, etc... have an impact on your overall health. Therefore, I believe a carrier with higher star ratings ultimately will be subsidized by the government more which will provide better benefits to the Medicare Beneficiary

Answer: I believe it is imperative to work with a licensed Medicare agent/broker. Especially when it comes to Medicare Advantage plans that change on an Annual Basis and Providers enter in and leave networks throughout the year. Also, a licensed broker works for you and is carrier neutral and product neutral .. meaning a broker should educate the Medicare Beneficiary and guide them to the insurance that best fits their needs