David Silver, Medicare Insurance Broker

Answer: They choose plans based on extra benefits and are not focused on the health and drug coverage components.

Answer: I keep things simple and explain all options.

I asked a series of questions that insure that I make appropriate recommendations based on how the questions are answered.

Answer: You can save money with Medicare Advantage in most situations. However if you are in need of Part B drug treatment long term, Medicare Advantage can be more expensive than straight Medicare and a supplement. Also if you take expensive prescriptions you need to be careful, as well.

Answer: Sometimes. It depends on your plan. Medicare Advantage plans can cover acupuncture and other alternative therapies. Medicare Advantage offer additional benefits, such as coverage for acupuncture and other complementary therapies.

Answer: If it's an emergency or urgent care situation, your Medicare Advantage HMO and PPO and Medicare supplement will cover you.

If it's non emergency care that you need and you will probably want to have a Medicare Advantage PPO coverage, because you will be covered both in and out of network(out of network will cost more) and you will not need referrals.

Ideally, you should have Medicare Supplement coverage, because with this coverage you get get care from any provider that accepts Medicare. You never have to worry about networks and you can get care in any state.

Answer: If you take alot of prescriptions or take some expensive prescriptions, your spending will be capped at $2000.00 (this does not include your monthly premium for the drug plan) This can be a huge savings compared to what you may have paid in 2024.

Answer: Because you never have to worry about ANY network restrictions. You can use Medicare in all 50 states and US territories. So if you're a frequest traveler or have residences in multiple states, having straight Medicare and a supplement(Medi-Gap)makes getting care much easier.

Most drug plans have very large national retailers in their network. So getting prescriptions in other states is easy with a stand alone Part D drug plan or through a Medicare Advantage plan.

Answer: If you have not reached your Part B deductible it should cost you between $350.00-$400.00

If you have already met your Part B deductible than it should cost between $100-$150.00

Answer: Make sure you work with some one that will present all your options based on your needs. If the broker/agent is good they will ask you a series of questions that will determine what coverage you will need.

Answer: A client on a MAPD plan was denied coverage for a critical cancer drug her oncologist prescribed, labeled “not medically necessary.” We filed a Level 1 appeal with medical records—it was denied. We escalated to a Level 2 appeal, adding clinical studies, a peer physician letter, and a personal statement from the client. The Independent Review Entity reversed the denial, approving the drug with retroactive coverage. She began treatment within 10 days and saw improvement. This case underscored the power of persistence and strong documentation in the appeals process.

Answer: If you move into a Continuing Care Retirement Community (CCRC), you can keep Original Medicare (Parts A & B) with a Medigap plan and Part D for prescriptions, or choose a Medicare Advantage (Part C) plan that may include drug coverage and extra benefits. While some CCRCs may suggest certain plans or have preferred providers, you are free to select any Medicare option that best fits your needs. It’s important to review your coverage as your healthcare needs evolve over time.

Answer: Medicare may cover certain weight-loss services if you’re classified as obese (BMI of 30 or higher), but coverage is limited. Medicare does not cover commercial weight-loss programs or meal plans. However, it does cover obesity screening and behavioral counseling through your primary care provider, and may cover bariatric surgery (like gastric bypass or sleeve gastrectomy) if you meet specific medical criteria, such as having other health conditions like diabetes or heart disease. Prior authorization and documentation are typically required.

Answer: Enrollment Period (IEP), which is a 7-month window that includes:

3 months before your 65th birthday month

Your birthday month

3 months after

Here are the first steps you should take:

1. Determine if you need to enroll now

If you're already receiving Social Security benefits, you’ll be automatically enrolled in Medicare Part A and Part B.

If you're not receiving Social Security, you’ll need to manually enroll via the Social Security website or call them.

2. Decide if you want Original Medicare or Medicare Advantage

Original Medicare = Part A (hospital) + Part B (medical), with the option to add:

a Part D drug plan, and

a Medigap supplement (to cover costs Original Medicare doesn’t)

Medicare Advantage (Part C) = All-in-one plan offered by private insurers (includes Part A, Part B, usually Part D, and often extras like dental/vision)

3. Compare plans

Work with a licensed Medicare agent (like me!) who can help you compare plans from multiple companies — based on your doctors, prescriptions, and budget.

4. Enroll on time

Enrolling during your IEP helps you avoid:

Late enrollment penalties (especially for Part B and Part D)

Gaps in coverage

Answer: 1. Get Authorization to Speak on His Behalf

Contact Medicare and his insurance providers to get a HIPAA authorization or become an authorized representative. This allows you to call, ask questions, and manage his care legally.

If not already in place, consider a medical power of attorney or durable power of attorney for broader authority.

2. Create a Simple Filing System

Use a binder or accordion folder with labeled sections:

Medicare Summary Notices (MSNs)

Prescription drug coverage (Part D)

Medigap or Medicare Advantage plan

Medical bills

EOBs (Explanation of Benefits)

Consider going digital: scan and store documents in Google Drive or Dropbox.

3. Review Medication Coverage

If he's on many medications, make sure he's enrolled in a Part D plan (or Medicare Advantage with drug coverage) that covers his current list at the best cost.

A Medicare agent can help you run a drug comparison to minimize out-of-pocket costs.

4. Understand the Bills

Medicare Summary Notices (MSNs) arrive quarterly and are not bills — they show what Medicare paid and what you may owe.

Actual bills come from providers. Cross-check them with the MSNs or Explanation of Benefits (EOBs) from the insurance company.

If something looks off, call the provider or insurance — billing errors are common.

5. Get Help — You Don’t Have to Do This Alone

Talk to a local Medicare advisor (I can help) to review his coverage and make sure he’s in the right plan.

Consider contacting a State Health Insurance Assistance Program (SHIP) — they offer free help.

Keep a log of calls and notes from each billing issue.

Answer: 1. More Red Tape & Prior Authorizations

MA plans often require prior approval for tests, procedures, and even some medications.

This creates extra administrative work for doctors and delays care for patients.

2. Lower and Delayed Reimbursement

Compared to Original Medicare, MA plans may:

Pay lower rates

Take longer to reimburse

Dispute more claims

This can strain smaller or independent practices financially.

3. Limited Networks

Many MA plans have narrow networks, meaning:

Doctors must contract with the plan to see patients

Some patients can't continue with their preferred doctor unless they switch plans

Doctors may choose not to participate in some MA networks to avoid the hassles.

4. Complex Plan Variability

Every MA plan is different — even within the same insurance company.

This creates confusion for both patients and providers when trying to determine what’s covered and how much the patient owes.

5. Care Delays That Affect Patients

Delays from denials or prior auths can negatively affect patient outcomes.

Doctors may feel these plans interfere with clinical decision-making.

To be fair, Medicare Advantage can offer good value for some patients — especially those looking for lower premiums and extra benefits like dental or vision — but from a doctor’s point of view, it can feel like a bureaucratic burden.

Answer: Original Medicare does not cover hearing aids or routine hearing exams. That means:

You’ll typically need to pay out of pocket for hearing aids, exams, fittings, and maintenance.

This can cost anywhere from $1,000 to $6,000+ per pair, depending on the brand and technology.

Answer: Medicare does not directly pay for groceries, but some Medicare Advantage (Part C) plans may offer grocery-related benefits — especially for individuals with certain health conditions or financial needs.

Answer: 1. Colorectal Cancer Screenings

Fecal Occult Blood Test: Once every 12 months (age 50+)

Flexible Sigmoidoscopy: Every 4 years

Colonoscopy:

Every 10 years (or 4 years after a sigmoidoscopy)

Every 2 years if you're at high risk

Stool DNA test (e.g., Cologuard): Every 3 years (age 50–85, average risk)

2. Breast Cancer Screening (Mammogram)

Screening mammogram: Once every 12 months (for women age 40+)

Diagnostic mammogram: Covered as needed, with coinsurance

3. Cervical & Vaginal Cancer Screening

Pap test and pelvic exam: Every 2 years

Every 12 months if high-risk or had an abnormal Pap in the last 3 years

4. Lung Cancer Screening

Low-dose CT scan: Once per year if:

Age 50–77

History of smoking (20 pack-years)

Currently smoke or quit within the past 15 years

5. Prostate Cancer Screening (for men)

PSA (Prostate-Specific Antigen) blood test: Once every 12 months (age 50+)

Digital Rectal Exam: Covered, but you may pay part of the cost

No Cost If:

You meet age/risk criteria

You go to a provider that accepts Medicare assignment

Answer: What I enjoy most about working with Medicare clients is the opportunity to make a real difference in someone’s life at a time when clarity and trust really matter. Medicare can be confusing, and many people feel overwhelmed or worried about making the wrong choice. I get to step in, simplify things, and help people feel confident and secure about their coverage.

I especially value:

Building long-term relationships — not just helping with enrollment, but being there year after year

Hearing stories and learning from clients — many have lived rich, fascinating lives

Knowing I’ve helped someone save money or find a plan that fits their health needs better.

Answer: Why Seniors Delay Enrollment:

1. Lack of Awareness or Understanding

Many seniors aren’t fully aware of their Medicare Initial Enrollment Period (IEP), the penalties for late enrollment, or the options they have. They might assume they’ll automatically be enrolled or think they don’t need to worry until a later time.

2. Fear or Overwhelm

The Medicare system can feel overwhelming with its various parts (A, B, C, D, Medigap). The fear of making the wrong choice often leads to procrastination.

3. Health or Work Factors

If seniors are still working or have employer-provided health insurance, they may think they can delay Medicare enrollment without consequences. However, this can be risky if their employer insurance isn’t considered "creditable" (as good as Medicare).

4. Waiting for a "Perfect" Plan

Some seniors wait until they are sure about which plan is best, hoping to get more information or thinking they’ll figure it out later. However, waiting can often result in missed opportunities or more limited choices.