David Treadway, Medicare Insurance Agent
About Me
Hi! My name is David, and I am your dedicated Medicare consultant and agent. My focus is on Medicare, and I am committed to assisting you in finding the most suitable plan that aligns with your unique needs and budgetary constraints. I will tackle the challenge of sifting through plans from nationally and locally recognized companies, so you don't have to. What's more, my services are entirely free! Reach out to me today to explore your Medicare insurance options and be sure to mention that you discovered me on Medicare Agents Hub!
Q&A with David Treadway
What are the reasons why I should work with a Medicare agent?
Answer: There are too many mistakes that you can make doing it on your own. Most people have trouble understanding insurance and the differences between coverages. We know that information well and can help you avoid costly mistakes. We are trained and certified every year in Medicare rules and then trained on local plans. There is no cost for our assistance so there is no reason not to use a broker. We have helped thousands of clients navigate the complexities of Medicare and would love to help you understand your options better: now, and each and every year.
Are Medicare Advantage plans really "free," or is that just clever marketing?
Answer: You always have to pay the part B premium (unless you receive state assistance) so they are not free. There are many $0 premium plans that cost nothing additional above the part B premium but some advantage plans have additional premiums because they provide benefits that some clients want. Currently there are a lot of excellent $0 premium plans but that does not mean they are “free.”
I just enrolled in Medicare, and I've got my Part A and B, but I'm hearing there are gaps in coverage. What are these gaps exactly?
Answer: Here is a condensed listing of the gaps if you were to utilize only original Medicare: https://www.medicare.gov/basics/costs/medicare-costs. You’ll want to manage those costs with either a supplement or an advantage plan.
Does Medicare Advantage cover acupuncture or alternative therapies in some plans?
Answer: Every plan has a detailed outline of coverage called a Summary of Benefits ("SOB"), which may list that type of service. If you can't find that service in the SOB, then you would need to look in the Evidence of Coverage to see if that particular service is covered. That is the long answer, the short answer is that some plans do and some plans don't cover acupuncture or alternatives to it. Find a qualified independent broker in your area to help you find the specific answer to that question. I hope this was helpful. Good luck!
What are disadvantages of PPO?
Answer: The disadvantage of a PPO is that it is an advantage plan and subject to change each and every year. Advantage plans are 1 year contracts that run Jan 1 - Dec 31. The plans change each year and some non-renew, meaning discontinue altogether. They also require prior authorization and the use of networks or acceptance by a provider outside of the network. Supplements don't do that. Those would be disadvantages.
On the flipside there are many advantages to a PPO including a low premium and the ability to go outside of a defined network. They also typically include coverage for RX, vision, dental and more; however, you asked for the disadvantages so I'll leave it at that. I hope this was helpful to you and others.
What are the types of Medicare Advantage plans?
Answer: There are many types of Medicare Advantage plans so hang in there and I'll try to give you the main categories.
First, there are dual plans and non-dual plans, meaning those that also require a certain level of Medicaid and those that are available without.
Second, there are chronic condition advantage plans which require certain diagnoses to enroll in them (for example, diabetes or COPD).
There area also MA only advantage plans, which mean they do not including Rx or PDP (prescription drug coverage).
Finally, there a categories of advantage plans based on what kind of network they adhere to (for example, HMO- must use the network unless an emergency, PPO- you pay the lowest cost in network but you can go anywhere so long as the provider accepts it, PFFS- private fee for service, also network based but flexible, POS- point of sale, allow for some out of network coverage.
Some of these can be combined (for example, you could have an MA only PPO or a dual PPO (also known as DSNP). The dual plans and chronic plans are also known as SNPs or Special Needs Plans.
Great questions because knowing how your plan may limit your access or enable flexibility is important to know, especially in an environment where we are seeing a bit of tightening in the network acceptance of the most restrictive plans (HMOs).
I hope this response is useful to your and others. Good luck in your Medicare years!