David Wiley, Medicare Insurance Broker

Answer: The primary differences are the monthly premium, copays and deductible. G has a higher monthly premium, no deductible or copays. Plan N has all three of them.

Answer: With original Medicare Parts A & B with a supplement plan, you only get a complete physical at $0 cost every 3 years. In between you pay. With a Medicare Advantage plan you do indeed get a FREE physical every year.

Answer: no, because the government (Medicare) cannot budget for paying medical claims at 80% with no stop loss. They can budget for the set price they pay an insurance company annually to pay your claims.

Answer: It isn't in my opinion and experience. You almost always will pay less out of pocket with an Advantage plan . Most Advantage plans have a $0 premium and include prescription coverage. Original Medicare with a Medicare supplement has a monthly premium and you also have to have a stand alone Part D (prescription drug) plan with it, which also has a monthly premium. In both cases they are now both increasing 10-15% a year. Advantage plans also have many extra benefits such as dental, vision, hearing, OTC monthly allowances, and food cards.

Answer: Yes, beginning in 2025 most, if not all, Part D plans have a deductible to meet 1st. That means you will be paying the negotiated price for all your drugs until you reach that deductible. The deductible for most plans in 2026 is $615. When your total cost out of your pocket reaches $2100 for the year (including your deductible) then all your prescriptions will have a $0 cost to you.

Answer: You will automatically be enrolled in both Medicare Parts A & B since you are already drawing Social Security benefits, however, A & B only cover 80% of your medical bills and you will have no drug coverage (Part D). You will need to contact an agent to help you enroll in a plan that covers 100% of your medical and to add Part D. You may do both 3 months prior to the month in which you turn 65. An agent charges you $0, but their knowledge of which plans best serve your needs is invaluable.

Answer: You have one opportunity only to apply for a MediGap plan with no underwriting( guaranteed issue) and that is when you are turning 65. After that it will be underwritten; however, you may always get a Medicare Advantage plan with guaranteed issue no matter your age or medical conditions. The Annual Election Period (AEP) is 10/15-12/07 every year and that coverage takes effect on 1/1 of the following year. Outside of AEP, you may get a Medicare Advantage Plan (MAPD) if you have a Special Election Period (SEP) with guaranteed issue. Your prescription coverage is also included in a MAPD plan and the premium can be as low as $0/month.

Answer: STAR ratings are very important as it rates how well a plan performs in every category. It also determines how much money the government gives them to work with and that determines the benefits they are able to provide you as their insured. All companies aspire to receive a 5 STAR rating as that is the highestt possible.

Answer: This is a question you should address to Social Security. I can tell you my understanding, but I do not want to take that responsibility as the definitive authority on your question is Social Security. My advice is to contact them directly.

Answer: You may, but not really as you need to work with one that represents most carriers, if not all, and has been successfully in the business for years. You want to establish a trusting relationship and shopping around doesn’t do that.

Answer: Travel medical insurance for the specific dates you are traveling or to cover you for multiple trips in a year. Rates are VERY reasonable and have deductibles of $0 up to $500 and coverage up to $1million.

Answer: Yes, but only for up to 30 days after being discharged from a hospital or skilled nursing facility preceded by a hospital stay. It does NOT cover Long Term Care.

Answer: It takes Medicare anywhere from a week to two weeks to make a decision on an appeal.

I wish the process was quicker, but the volume of appeals is quite large.

Answer: If someone is disabled and receiving Social Security Disability Benefits for 24 months then they can be given Medicare. However, a Medicare Advantage plan is the best option as it can be as little as $0 premium whereas a Medigap plan is well over $1000/mo. if you are under age 65 and qualify for Medicare.

Answer: Not really. They will cover them if prescribed for Type II Diabetes, but not for weight loss. The reason given is weight loss is more cosmetic than for health reasons. Also, insurance companies cover different drugs in this category. One company will cover Ozempic and not Mounjuro and another will do just the opposite.

Currently, both Zepbound and Wegovy are only approved for weight loss and are not covered by Medicare plans of which I am aware.

Answer: Most have a $0 monthly premium, but you must have Part A & B of Medicare to have an Advantage plan & Part B has a monthly premium to be paid to Medicare. The government subsidizes Medicare Advantage plans and the money paid to an insurance company is then applied to providing you, the insured, benefits.

Answer: Cancer coverage needs to be added to any Medicare plan as the only drugs covered are those already approved by the FDA and the only treatments covered are those sanctioned by the American Medical Assn. Additional cancer coverage provided you the money to seek and have other options to treat your cancer.

Answer: Yes, as long as she has your medical power of attorney. If she has that you do not need to be present, but if she does not then she still can if you are present, but you would need to be the person signing any application.

Answer: With a Medigap plan F you should pay $0. You have no medical deductible and no copay. All you pay is your monthly premium.

Answer: You pay the same whether you use an agent or deal directly with the insurance carrier. An agent charges you no fee, but brings a lot of knowledge as to how each plan works in your area, whereas an insurance company is only interested in selling you one of their products.

Also, if you need assistance in dealing with any insurance company an agent will be on your side.

Answer: Social Security looks at your tax return 1 years back to determine what you pay for your Part B, however. If your income will be a permanent drop from that tax return you may contact Social Security and file an appeal have your Part B reduced in the current year.

Answer: Yes, Medicare is designed to have some cost sharing. There is no such thing as a free lunch. The good news is that Medicare does cover most things.

Answer: It really depends on the type of lense you wish to have. Medicare covers the basic lense, but upgrades can cost more.

Answer: Doctors and insurance companies have the right to remove themselves or be removed at any point. It is usually either financial or bad reviews. Unfortunately,the insured will never know the reason.

Answer: Some Medicare Advantage plans cover more than just cleanings. You chose the wrong one, but your agent should have told you its limitations. The ones that cover more do not cover implants or teeth whitening, but they do cover everything else to their dollar limit for the year.

Answer: No, absolutely not! Premiums for med supps go up 8-16% a year and you. Also have to have a stand alone Part D as well. What you save in not paying premiums more than covers your copays!

Answer: In my opinion, there are no surprises with a Medicare Advantage plan if you stay in Network. With original Medicare and a med supp you sometimes encounter balance billing, which means you pay more.

Answer: Yes, all Medicare Advantage plan benefits are based on where you physically live (zip code and county). Medicare Supplements are not, however, you must keep the carrier informed as to your current address.

Medicare Advantage plans are loaded with extra benefits over Medicare A & B with a Medicare supplement, but all Medicare Advantage plans are based upon where you live.

Answer: Original Medicare only covers a complete physical every 3 years (due to Affordable Care Act), whereas Medicare Advantage plans provide them every year.

What’s included is annual female exams as well as internal medicine checkups, which can include an EKG. Men get their internal medical exams, including PSA screening and EKG’s. Periodic Colonoscopies are also covered as are bone density exams for women.

Answer: All preventative vaccines are covered at no charge. Flu, Shingles, Pneumonia, and Covid are covered by Medicare. In short, all immunizations are covered.

Answer: AI is already playing a role in claims, but the human element will always be available as the answer may sometimes fall into a grey area rather than black & white. That said, AI will continue to play a part in Medicare decisions and of course in the enrollment process.

Answer: You have 60 days before and 60 days after your move to change your plan. If you have a Medicare supplement, such as Plan N or G, then it should not be effected at all.

Answer: Protects your assets from market declines. If your goal is to eliminate risk ( growth and decline in the investment market) then annuities provide safety. However, the tradeoff is lower returns than what the investment markets have historically yielded.

Answer: It does as it counts not only what you pay but counts the total negotiated cost that your insurance company pays as well.

Answer: They don’t. They are as if they didn’t exist as it does not count toward meeting your prescription deductible or your maximum out of pocket. Their cost is totally on you.

Answer: AI will definitely be a part of claims decisions in the future, but it will not be the end all as you will always have the ability to appeal to a real person.

Answer: Not utilizing an agent in making their decision in selecting their Medicare coverage. This can be an extremely costly mistake. Agents charge no fees but offer a wealth of experience and knowledge about plans meeting a client’s needs.