Don Golding, Medicare Insurance Broker

Answer: Local agents, especially independent brokers, have in-depth knowledge of plans and networks in your area. Additionally, face-to-face communication is the most complete form of communication. This combination of "presence" and local knowledge helps beneficiaries find a plan suited to their specific needs.

Answer: Broadly speaking, Part A covers Hospitalization, skilled nursing confinement, and Hospice. There is a Part A deductible, and copays may apply as well. Part B also has a deductible and covers roughly 80% of covered expenses. Additionally, there are no maximum out-of-pocket limits. Neither Part A nor Part B covers prescription drugs - Part D.

I recommend looking at either a Supplemental (Medigap) Plan with a separate Part D prescription plan or an Advantage Care plan with drug coverage built in to cover the "gaps" in original Medicare.

Answer: Premiums are payments for a policy; they do not count towards a deductible or a maximum out-of-pocket expense. Most people will pay the Medicare Part B premium. There may be additional premiums based on the type of additional policies a beneficiary has enrolled in.

Deductibles are the money you pay before a plan pays for services. Generally, these payments count towards your maximum out-of-pocket.

Copays (and co-insurances) are the costs of your services and count toward your maximum out-of-pocket.

You can find specific amounts in your plan's summary of benefits document.

Answer: To minimize IRMAA (Income-Related Monthly Adjustment Amount) surcharges on your Medicare Part B and Part D premiums when income changes, focus on strategies to reduce your Modified Adjusted Gross Income during years of high income. This includes making tax-deductible contributions to retirement accounts, donating appreciated assets to charity, and potentially delaying or timing Roth conversions to avoid unexpected income spikes.

Answer: There's no one question. Everyone's situation is unique. A better approach to your situation is to understand how your plan works for you. What are the premiums? Copays and coinsurance? Is there a deductible? Are my medications covered? What's NOT covered? I recommend a comprehensive analysis of current circumstances and future needs. I would suggest this be done with an independent broker to maximize your choices.

Answer: Hospitals negotiate with insurance companies and plans for payments. Depending on the plan's payment structure, a hospital (or any care provider) makes a business decision to accept the plan(s). Hospitals generally sign multi-year agreements with the insurance carriers.

Answer: The type of coverage, Supplemental (Medigap) vs. Advantage, costs, and your value system are very personal decisions. Everyone's circumstances are different. If the cost of your Medigap plan is becoming a burden or it no longer fits your lifestyle, I recommend a review with a local, licensed broker in your area. If appropriate, you can switch to an Advantage Care plan during the next annual enrollment period.

Answer: For many people, Medicare and associated Medigap or Advantage plans can have significant savings for your parents, whether or not they have retired. I would enlist the assistance of an independent broker, representing a variety of options, to help explain how Medicare and the various plans work. The discussions can take place in-home, at an office, via Zoom, or by phone. Having a local expert on board to compare and contrast opinions will help your parents feel at ease when making Medicare decisions.

Answer: I would be skeptical of any agent who "pushes" clients into either category - Advantage or Supplemental plans. One type does not fit all health and financial situations. By conducting a thorough needs analysis, an agent can determine the type of plan to recommend to a client. The client should always have the final say and should never feel pressured into a decision.

Answer: Supplemental (Medigap) plans do not have open enrollment periods, so it is possible to change plans anytime; however, if you are outside a guaranteed issue period, you may have to go through medical underwriting. The results of the underwriting could be higher rates or denial. The underwriting process will vary by state, carrier, and plan. It is recommended that you discuss your specific needs with a licensed, independent agent before making any changes.

Answer: I do not recommend Medicare ONLY (A & B) as a solution. The roughly 20% coinsurance and the fact that there is no Part D coverage in original Medicare makes it unsuitable for most beneficiaries.

A better question might be, "Is Original Medicare, plus a Part D plan, and a Supplemental (Medigap) plan, or an Advantage plan better?" - The answer to that question depends on you. One option is not "better" than the other; there are many factors involved. I recommend you discuss all your options with a licensed agent who represents both Supplemental and Advantage plans, and represents multiple carriers. One solution is not right for everyone.

Answer: No, neither Advantage nor Original Medicare (with a supplemental plan and prescription plan) is the correct fit for everyone. Both types of coverage have their advantages and their downsides. Medicare Advantage plans are gaining popularity due to their low or no monthly premiums and the rich benefits. Each person has their unique situation. Consult with an independent broker to determine the type of plan that best suits your needs.

Answer: Advantage plans can be a cost-effective alternative to regular Medicare. They are private insurance companies with a Medicare contract to cover your health. Many have additional, ancillary benefits not offered in original Medicare. No plan is perfect, whether original Medicare, Medicare plus a supplemental plan (with a stand-alone drug plan), or an Advantage Care plan. All the options have benefits and drawbacks. Over 34 million beneficiaries are currently enrolled in Advantage plans. As always, I recommend a thorough review of your individual needs to find a plan that fits your unique circumstances.