Dominic Colonero, Medicare Insurance Broker

Answer: It is strictly covered under Medicare Part B. You will still be responsible for the Part B deductible and the 20% coinsurance for the Medicare-approved amount.

Answer: I would say not speaking with a Medicare broker to go over your options and help answer any questions you may have. There is a lot of misinformation out there especially on when to enroll to enroll in Medicare and avoiding penalties. A trusted expert can guide you through the process.

Answer: The agent that helped signed you up should have gone through that information to help you make a wise decision if that Medicare Advantage plan would meet your needs. There are a few options, you can possibly switch to a different Medicare Advantage plan and a broker should be able to help you see if that is an option. You can get a stand alone dental plan and sign up for those anytime of year. That is an option to you can have comprehensive dental, but it would cost a premium to have one of those.

Answer: When you hit the maximum out of pocket or the catastrophic coverage for Part D, you will pay NOTHING for your covered medications for the rest of that year!

Answer: Absolutely! Its always go to review it with your agent as they can go over any major changes.

Plans change year to year and it is better to be prepared than surprised. Also your agent can see if that plan is still a good option for you or if there is something better to move to. A good agent will then double check that your doctors and prescriptions are covered as well.

Answer: Unfortunately you do not qualify for a special election period (SEP) if your health dramatically gets worse.

There are certain conditions that do qualify someone for an SEP, those are chronic conditions such as diabetes, Congestive Heart Failure, and certain Cardiovascular disorders. This would only allow you to move into a Chronic Special Needs Plan (C-SNP).

Feel free to contact a broker who can help you navigate your situation.

Answer: If you have a Medicare supplement plan, then yes you will have coverage.

If you have a Medicare advantage plan, you will only have coverage if it is in the network of the plan. Some Medicare advantage plans do have a nationwide network or a travel benefit, so check to see if that is an option.

If this is an emergency situation, you are covered in a Medicare advantage plan throughout America, but you may still have some costs.

Answer: I would always do your yearly wellness exam. There are other preventive services such as screenings for various cancers and conditions, immunizations, and counseling on topics like tobacco use. I would go to the medicare.gov website for a full list of preventive services. https://www.medicare.gov/coverage/preventive-screening-services

Answer: In order to make Medicare decisions for your family you will need to obtain either a Power of Attorney (POA) or a court-appointed guardianship or conservatorship.

Answer: Medicare Advantage plans are based on the county you live in within your state. Rural areas tend to have less plan options compared to urban areas. Before you move, you can always go to the Medicare website and put in your zip code to see what plan options would be available to you in that rural area.

Answer: The absolute first program you should apply for is Medicare's Extra Help program, also known as the Low-Income Subsidy (LIS). This is a federal program that significantly lowers or eliminates your Part D prescription costs, including premiums, deductibles, and co-pays. You can apply through the Social Security Administration (SSA) online or by phone.

Another option can be to apply for State Pharmaceutical Assistance Programs (SPAPs), which offer further help with drug costs in many states, and Patient Assistance Programs (PAPs). Most major drug manufacturers have PAPs that provide their specific, expensive brand-name medications for free or at a deep discount to people with very limited income.

Answer: There are 3 SNPs types.

Dual special need plans that are for individuals with both Medicare and Medicaid. They help coordinate benefits between both.

Chronic special need plans that are for individuals with specific conditions. These can be plan specific and can include diabetes, congestive heart failure, and cardiovascular disorders. This plan provides coordinated care and helps manage the condition.

Institutional special need plans that are for individuals who live in a long term care facility and nursing home.

Answer: Yes they can work in rural areas. When you sign up for a Medicare Advantage plan it all depends on what county you are in, within your state. You will usually have to stay in a network of doctors, unless your plan has out of network coverage.

If the concern is emergency coverage in rural areas, you are covered nation wide for emergencies.

Answer: Yes it will. You will have to pay for the deductible (if you have not already) , but afterwards your supplement will pay the rest. Make sure the supplement plan is effective before the surgery.

Answer: It really depends on what plan you have. If you have a supplement plan than most likely you will not have out-of-pocket costs after the deductible, unless they are prescription drugs from after the surgery. If you have a Medicare Advantage plan, you probably had that copay for the surgery then if you have additional care needed like physical therapy or follow ups there are copays for that.

A broker can help you know your costs beforehand so there are no surprises.

Answer: Higher star rating plans can correlate with better member satisfaction, higher quality of care and more benefits. A higher star rating plan receives more funding from CMS which allows for those higher benefits and quality of care.

That being said, it is not the only thing to look at when picking a plan as you still want it to meet your individual needs. A slightly lower star rating plan can still provide quality care and be a good plan option. That's why it's best to work with an insurance broker to help!

Answer: First I want to acknowledge how frustrating that can be. I'm not sure if you changed your plan on your own or with an agent, but it is the agent/brokers job to let you know if your specialist is in network or not.

If you changed plans during Open Enrollment Jan-Mar, then you are not able to change plans again unless you have what is called a valid election period which would be if you loss employer coverage, lost or gained Medicaid or LIS, or moved out of the county, to name just a few.

If this change was done during Annual Enrollment Period then you are able to change your Medicare advantage plan 1 time during Jan-Mar.

I recommend calling your insurance company to see if they can do anything for you especially if you are receiving ongoing treatment from your specialist. I would also call the specialist to see if they can offer any kind of discount/aid if you have to pay out of pocket.

Last option could be to call CMS/Medicare and let them know the situation to see if they are able to change your plan back to your previous one.

Answer: The best thing to do would be to talk with an insurance broker and we can help you find a a prescription drug plan that would cover your medication. We would go over any copays you would have go pay and find you the best option for your individual needs.

Answer: Great question and I wish that did exist. The technical answer is because Medicare insurance is risk pooling model where everyone pays in and shares the risk of illness.

That being said there are different plan options available to people. Some supplement plans have lower premiums, Medicare advantage plans are usually low premiums and some Medicare advantage plans can give money back on your part b premium!

It's best to talk with a broker (like myself) and see what is best for you and your individual needs.

Answer: Medicare will cover 8 counseling sessions within a 12 month period at no cost. If you have a Medicare advantage plan, it will offer the same benefits if you use an in network provider.

Also your prescription drug plan may cover certain smoking cessation drugs, but make sure to check with your plan first.

Answer: The Maximum Out of Pocket (MOOP) is the a safety net. It is the most you will pay for covered medical expenses for the year and then your plan pays 100% of the rest. This includes any deductibles, copays, and coinsurance you have to pay. When that total hits your MOOP then you pay 0 dollars for covered medical expenses and your plan will pay 100% for the rest of that year.

Premium payments DO NOT count toward your MOOP.