David Ghiorso, Medicare Insurance Agent
David Ghiorso
Ghiorso Insurance Solutions
Medicare Agent Licensed in CA, AZ, IA, MT, NV and TN
9+ Years of Experience
Contact Details
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Location
Rocklin, CA
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Phone
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Website
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LinkedIn
David Can Help With:
About Me
Ghiorso Insurance Solutions - Focus on Medicare and LTC. I support the Greater Placer/Sacramento/ El Dorado Regions. I help you navigate the Medicare Maze so you can find the right plan for your situation! Medicare Supp, Medicare Advantage, PDP. Local. Independent. Friendly. No cost to you.
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Q&A with David Ghiorso
Will private hospitals accept Medicare plans?
Answer: Most private (non‑government) hospitals in the U.S. accept Medicare, but it depends on which type of Medicare you have and whether the hospital is in a specific plan’s network.
Original Medicare vs Medicare Advantage
With Original Medicare (Part A and Part B), you can use any hospital or provider in the country that “accepts Medicare,” and the vast majority of non‑pediatric hospitals do.
With a Medicare Advantage plan (Part C), the key issue is the plan’s network, not just “Medicare.” A hospital can accept Medicare but still be out‑of‑network for a specific Advantage carrier or HMO/PPO.
“Accepts Medicare” and “accepts assignment”
Hospitals and doctors that “participate in Medicare” agree to bill Medicare and follow its payment rules.
If a hospital “accepts assignment,” it takes the Medicare‑approved amount as full payment for covered services, which gives you the lowest out‑of‑pocket costs.
Some providers are “non‑participating”; they still take Medicare but may charge up to 15% above the Medicare‑approved amount (the limiting charge).
Important exceptions
VA hospitals and active military hospitals generally do not take Medicare; they bill VA or TRICARE instead.
Some boutique or concierge practices fully opt out of Medicare, using private contracts where you pay out‑of‑pocket and Medicare pays nothing.
How to check a specific private hospital
Use Medicare’s Care Compare tool to look up a hospital; it will show whether the facility participates in Medicare.
If you have Medicare Advantage, call the hospital billing office and ask, “Are you in network for [your plan and carrier]?” because network status is what determines coverage.
What should people know about Medicare and its parts?
Answer: Medicare is a federal health insurance program mainly for people 65+ (and some under 65 with disabilities), and it’s organized into “parts” that each cover different types of care: hospital (A), medical (B), private plans that bundle A/B and often extras (C), and drug coverage (D).
Big picture: Original vs Advantage
Original Medicare is Part A + Part B, run by the federal government, and you can add optional Part D and/or a Medigap supplement on top.
Medicare Advantage (Part C) is an alternative run by private insurers that must cover at least what A and B cover and often wraps in Part D plus extras like dental or vision in one plan.
Core Medicare parts
Medicare piece What it is What it mainly covers
Part A “Hospital” insurance
Inpatient hospital, skilled nursing facility after a hospital stay, hospice, some home health
Part B “Medical” insurance
Doctor visits, outpatient care, tests, durable medical equipment, many preventive services
Part C Medicare Advantage
Combines A and B, usually adds extra benefits, often includes Part D in one plan
Part D Prescription drug coverage
Outpatient prescription drugs via private plans; formularies, tiers, and costs vary by plan
Medigap Supplement to Original Medicare
Helps pay A and B’s deductibles, copays, coinsurance; standardized plans like G, N in most states
Key things people should know
Eligibility and timing: Most people qualify at 65; you generally enroll in Parts A and B through Social Security and must have both A and B before joining a Medicare Advantage or Medigap plan.
Costs: Each part can have its own premiums, deductibles, and copays; Part A is often premium-free, but Part B, C, and D usually have monthly premiums that can vary by income and plan.
Coverage gaps: Original Medicare has no cap on annual out-of-pocket costs and does not include routine dental, vision, or hearing, which is why many people add Medigap and/or Part D or choose Medicare Advantage instead.
I'm taking a brand-name medication that doesn't have a generic version. How can I find a Medicare Part D plan that will cover it at a reasonable cost?
Answer: The best way is to use the Medicare Plan Finder to enter your exact drug name, dosage, quantity, and preferred pharmacy, then sort by total yearly cost rather than monthly premium alone. Medicare says the tool compares available plans in your area and estimates drug costs, and it’s the most direct way to see which plans actually cover a brand-name drug at the lowest overall cost.
First thing to check:
Confirm the drug is on the plan’s formulary, because each Part D plan has its own drug list and tiers. Look at the tier and any restrictions like prior authorization, quantity limits, or step therapy, since brand-name drugs often cost more when placed on higher tiers.
Compare total annual cost, not just premium, because a low-premium plan can be more expensive once co-pays and coinsurance are included.
Ask your prescriber whether a therapeutically similar lower-cost drug would work, because plans often favor generics or preferred alternatives. If the drug is not covered or is too restricted, request a formulary exception; if denied, you can appeal.
Check whether you qualify for Extra Help, state pharmaceutical assistance, or a manufacturer patient assistance program, since Medicare notes these can reduce premiums, deductibles, and cost sharing.
Make a complete medication list with exact names, strengths, and how often you take each drug.
Use Plan Finder to compare plans in your ZIP code and enter your pharmacy choice.
Open the top few plans and verify formulary placement, tier, and restrictions for your brand-name drug.
Pick the plan with the lowest total yearly cost that still covers the drug in a manageable way.
One important caveat
If your brand-name drug is excluded from a plan’s formulary, that plan is usually not a good fit unless an exception is approved. A plan with a slightly higher premium can still be cheaper overall if it places your medication on a better tier or has a lower deductible.
Can I be turned down for a Medicare Advantage plan because of my health?
Answer: You generally cannot be turned down for a Medicare Advantage plan because of your health, as long as you’re eligible for Medicare Parts A and B and live in the plan’s service area.
Enrollment and health conditions
Medicare Advantage plans (Part C) are required to accept you regardless of pre‑existing conditions; they must follow the same “no health underwriting” rule as Original Medicare for eligibility.
Since 2021, people with End‑Stage Renal Disease (ESRD) can also enroll in most Medicare Advantage plans, which used to be a major exception.
Plans also cannot drop you from coverage later just because your health gets worse, as long as you keep paying premiums and meet basic plan rules.
When a plan can say “no”
A Medicare Advantage plan can’t deny you based on health, but it can deny enrollment for non‑medical reasons such as:
You don’t have both Part A and Part B.
You don’t live in the plan’s service area or network county.
You try to enroll outside of an allowed enrollment period (Initial Coverage Election Period, Annual Enrollment Period, or a qualifying Special Enrollment Period).
You are enrolled in certain types of other coverage that are incompatible with that plan (for example, another Medicare Advantage plan at the same time).
Coverage limits vs enrollment denial
Even though you can’t be turned down for health reasons, the plan can have rules about which doctors you can see (network), which drugs are covered (formulary), and when you need prior authorization or step therapy.
A plan must cover all services that Original Medicare covers and cannot refuse medically necessary care, but it may deny particular services if it decides they are not medically necessary under Medicare rules, in which case you have appeal rights.
Medicare Advantage vs Medigap (important distinction)
Medicare Supplement (Medigap) plans are different: outside of your first Medigap open‑enrollment or certain guaranteed‑issue situations, a Medigap insurer can use medical underwr
What's the process for signing up for Medicare if I'm already on disability benefits?
Answer: f you’re already getting monthly Social Security disability (SSDI) or Railroad Retirement disability benefits, you usually don’t have to “sign up” for Medicare—Medicare enrolls you automatically after a waiting period, and you only need to decide what to do with Part B, Part D, and any Medicare Advantage or Supplement options.
When Medicare starts on disability
If you have SSDI (most disabilities): Medicare starts after you’ve received 24 months of disability benefits; coverage generally begins the first day of the 25th month of SSDI entitlement.
ALS (Lou Gehrig’s disease): Medicare starts the same month your disability benefits start—no 24‑month wait.
End‑Stage Renal Disease (ESRD): Medicare usually starts after 3 months of dialysis or right away if you get a kidney transplant, as long as you apply.
Social Security (or the Railroad Retirement Board) mails you a welcome package with your Medicare card about 3 months before your coverage begins.
What happens automatically
Automatic Parts A and B: If you’re getting SSDI or RRB disability, you’re normally auto‑enrolled in Medicare Part A (hospital) and Part B (medical) when you become eligible (either after 24 months, or immediately for ALS/ESRD exceptions).
Card and start date: Your red‑white‑and‑blue Medicare card shows your Part A and Part B effective dates, which are usually the first of the month your eligibility kicks in.
Puerto Rico/outside U.S.: If you live in Puerto Rico or outside the U.S., you generally get Part A automatically but must actively sign up for Part B if you want it.
If you do nothing and keep the card, you’ll keep both Part A and Part B and start paying the Part B premium out of your disability check unless you qualify for help.
What you may need to actively do
Decide about Part B (and avoid penalties)
If you don’t want Part B (for example, you’re covered by certain employer insurance), you can follow the instructions in your Medicare welcome packet to decline it before it starts.
I picked a Medicare Advantage plan last year, and I'm not sure if my hearing aids are covered. How do I figure this out?
Answer: 1. Call the member services phone number on the back of your card, and inquire as to how the hearing aid benefits work with your specific Advantage plan.
2. or, call the Agent/Broker who helped you enroll in the Advantage plan. He or she should be able to give you the main points of the hearing aid benefits and then point you to phone numbers for third party contractors who provide the hearing aid benefits to this plan.
3. or, obtain the EOC (Evidence of Coverage) pdf document that outlines in detail how all the benefits work, for your plan.
Can you describe a time when you helped a client navigate a complex Medicare issue?
Answer: I can think of multiple times when a client was facing complex Medicare issues, which really means, they were having to compare the two different Medicare Pathways. More complex situations can arise when one has, employer retiree health insurance and has too look at price and coverage when comparing that to outside Medicare plans.
What's one Medicare decision that too many people regret later?
Answer: They choose price (saving a few pennies) over the medical group they want to actually received medicare through. They get caught up in "shiny object" benefits instead of quality of care, via the medical group.