David Fiveash, Medicare Insurance Broker
David Fiveash
David Fiveash Insurance
Medicare Broker Licensed in TX, AR, LA, MS, NM and OK
29+ Years of Experience
Contact Details
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Location
Tyler, TX
About Me
I have been specializing in Medicare since 1997 and became a Certified Senior Advisor in 2006. I do enjoy helping all individuals that are and all Medicare beneficiaries receive the insurance they seek to meet their healthcare needs. Receive free advice and free quotes if you are searching for Medicare Supplements, Medicare Advantage, Medicare Drug plans and on Dental Insurance and Final Expense Life insurance. Get the answers to your questions. No obligation to enroll.
Directions to My Office
Q&A with David Fiveash
Answer:
Yes you are. This surcharge is for individuals that files income taxes in the past 2 years
that are over the average certain income that Medicare has deemed
Answer: Medicare Advantage HMO do not have any out of pocket coverage unless you get prior authorization by the plan or if have the HMO point of service do offer some out of network coverage.
Answer: For individuals that under the age 65 there certain conditions can qualify for Medicare Insurance. Usually your required to be on SSI for 2 years before qualifying for Medicare unless you have a special circumstance.
Answer: Yes, A dentist can choose not accept a Medicare Advantage plan. The dental that is on most of the these MA plan are only a benefit with limited coverage not comprehensive coverage
Answer: Not every Medicare Advantage plan is available in every county in the state so it limits your who accept these type of plans.
Answer: Medicare doesn't pay the Part A deductible( $1676.00 in 2026) and other deductible associated with Part A and Medicare doesn't pay the Part B deductible ($283.00 in 2026). After the deductible is met Medicare will pay 80% approved and the beneficiary is responsible for the 20%.
Answer:
Yes, secondary insurance are also known as Medicare supplements and Medi-gap plans
Original Medicare would primary and Medicare supplements or Medi-gap will be secondary.
Answer:
All hospitals that serve anyone on Medicare will accept Original Medicare but
but not every hospital will accept Medicare Advantage plans. Since MA plans have
annual contracts the hospital provider directory can change each year
Answer:
We do not know the answer for sure. Medicare is considering different devices every year
Keep checking with your doctor as time goes by
Answer: Most likely it will not pay for smart watch because it is not the device considered medical necessary. Medicare only pays for services when it is medically necessary
Answer: You save money in premiums but you will have out of pocket expense for many of medical services. The more you use the more you pay. It may look good on paper but you will never know what code the medical providers will use that changes the price you thought you may pay since the policies are generic in what is say it will cover.
Answer:
They think Medicare will pay mostly everything so why should I need some extra coverage.
Medicare only pays the amount it approves not what is billed. Medicare will pay 80% only.
That leaves the beneficiary all the deductible and 20% to pay. That 20% can be become very large amount in certain medical services.
Answer:
Medicare pay almost 2 times what a supplement will pay especially to everyone turning 65.
Even the renewal payments to agent are larger than supplements in comparison.
Since there are no health underwriting guideline for MA plans everyone can be insured.
Most MA plans have $0 plan premiums and $0 copays to doctors and certain medical services it easier to get interest in wanting to know more about the plan and take a chance enrolling into a plan. Everyone situation is different. What is good one may not be good for another
Answer:
The Medicare drug plans change plan premiums, copays and formularies every year.
These plans have a one year contract with Medicare and the pharmaceutical companies
Since they are year to year the plans will change.
Answer:
Yes,
usually you need to because they all have short expirations dates
Prior authorizations are made only for a certain period time.
If you change you will need new prior authorizations
Answer:
The out of pocket expense being more than they planned.
Prior authorizations
Having their medical care denied.
Answer:
Original Medicare
No doctors or hospital networks
No prior authorization
No required referral for specialist
add Medigap coverage with very little out of pocket expenses
Medicare Advantage
Doctors and hospital networks
Prior authorization
Required referrals
Extra benefits such as for dental, vision and hearing. These benefits are limited not comprehensive coverage.
Out of pocket expenses for many medical services
No, not beneficial for individuals with several issues because of out of pocket expense and prior authorizations required
No, more doctors accept Medicare vs Medicare Advantage
Your monthly premiums can be $0 on most MA plans and doctor bills can be $0 or low copay
It is always beneficial to talk to an agent that specializes in all the Medicare insurance plans
Answer:
Yes it is acceptable for Medicare supplement plans and Medicare drug plans.
I would recommend a local or nearest agent for Medicare Advantage plans