Don Hansford, Medicare Insurance Broker

Answer: It depends on whether you are currently covered under a Medicare Supplement or an Advantage plan. If it is a supplement, there is nothing you need to do. If it is an Advantage plan, check to see if the specialists are in network. If some are not, I would recommend you talk to your PCP and the plan. Some exceptions might be made based on some unique specialty.

Answer: If you are enrolled in a Medicare Supplement and a stand alone PDP, double check with your PDP carrier to be sure your current plan fits in your new location. Be sure and submit your address change to both.

If you are enrolled in a Medicare Advantage plan, it becomes a little more involved. Notify them of your address change and check with them to see if your current plan is available in that market. you may need to enroll in a different plan. Be sure that the provider network aligns with your choice of docs.

Answer: The question should be what is better for my situation. Everyone has unique needs and wants, both original Medicare and Medicare Advantage are good products, it boils down to which one is going to do the best job for you.

Answer: As far as indicators, if your providers have left the network or you have received new prescriptions that are not on your plan’s formulary, it might be time to look into a change. Also, if your financial circumstances have changed ( i.e. qualified for Medicaid), a change may be to your benefit.

You should review your options at a minimum once per year or whenever your circumstances have changed, such as moving to a new county.

Answer: Medicare is based on a calendar year timeline so no matter if someone is on Original Medicare or a Medicare Advantage plan, all deductibles reset on January 1st.

Answer: An SOA is a Scope of Appointment. It is required by CMS that an agent receive your permission to discuss your Medicare plan options with you. It is absolutely normal and as I said, required.

Call centers are recording your calls and you as the beneficiary are calling in to their center, therefore they do not need a written SOA. They should be asking your permission over the phone and recording it.

Answer: The key with any Medicare Advantage plan is the network of providers and your access to care. If your situation fits and you are satisfied with the network, there is no reason for the plan not to work.

Answer: Medicare is very much about preventive care so the wearable health tech fits very nicely into that model. These devices provide early warning signs of possible issues allowing providers to catch them earlier in the process and hopefully prevent a major event from occurring. They also are great reminders that as we age, we need to be sure and keep our activity levels up. Setting goals and receiving reminders are a great highlight of what these devices can do.

Answer: I don’t think worried is the right label, more that you just need to be aware that providers can drop or add networks throughout the year. If this does happen to you, you will have the option to select another provider or if the situation was deemed a major change in the network, CMS may provide a Special Enrollment Period for you to change plans.

Answer: This is a question that no longer applies as the donut hole was eliminated effective Jan. 1, 2025. This has made the Part D much easier to understand for the consumer as they now only have to deal with their deductible, Initial coverage and catastrophic coverage. No more big surprises in the middle of the year.

Answer: If someone is disabled and is receiving SS disability, after they have been disabled for 24 months they are eligible for Medicare.

Answer: Income has nothing to do with your Medicare eligibility. That is determined by the number of quarters you have worked and contributed to the Medicare fund. It takes 40 quarters/10 years to qualify for a free Part A. We all pay a premium for Part B.

Answer: Generally, your best option is to talk to the PT provider directly. They will know exactly what the process is and how to administer it with your insurance.

Answer: This occurs when someone does not enroll into either of these programs when they are first eligible and they do not have some type of creditable coverage that would wave the penalty. When they do finally enroll, the penalty is applied.

Answer: There are a couple of things you can do to alleviate any angst you may have. The easiest I believe would be to ask for a couple of references of people they have done business with. If they hesitate to do this or are reluctant to give you that info, your suspicions are confirmed and run away from that agent.

From a legality standpoint, you can go to your state insurance department website and search for the agent's licensing info. This will confirm whether they are properly licensed to do business with you. It will not tell you the things you will find out by calling some of their references.

Answer: Losing someone does not raise your Medicare premiums. Those are adjusted every year for everyone and notification goes out late in November or early December. Traditionally, the Part B premium does increase slightly every year, but that is normal.

Answer: If you are already receiving Social Security, then you will automatically be enrolled into Medicare. If not, then you will need to apply for your Medicare benefits, the easiest way being online. Once you have your Medicare number, you will then need to decide which type of additional coverage you will want to enroll in, if any. Along with that,you will want to be sure to get enrolled in the Part D (prescription drug) coverage to avoid any penalties and of course, to be covered for your prescriptions.

Answer: A change in health condition doesn’t necessarily create an option to change your health coverage. There are restrictions as to when and if a change can be made. It is always a good idea to review your coverage at least once per year.

I would recommend you talk to an experienced Medicare Broker who knows all of the options available to you.

Answer: Whether any medication is covered and counts towards your maximum out of pocket, you would need to check the plan’s formulary. But your question states coverage gap, not out of pocket. As of 2024, there is no more coverage gap or donut hole.

Answer: The prior authorization process is in place to protect you and the integrity of the Medicare program. It goes a long way in preventing fraud along with reducing the number of unnecessary procedures. As long as the procedure is deemed "medically necessary", it will be covered.

Answer: This is a hard question to answer as demographic location could definitely influence the results. Just know that Medicare Supplements are standardized so that any company you purchase one through, the benefits will basically be the same when comparing like plans(i.e. Plan G to Plan G). The main difference will be the premium. Best advice is to go with a company that has been around for awhile as chances are their rates are going to be more stable year to year.

Answer: Medicare Part A is designed to cover inpatient hosptal admissions, along with some other items. Outpatient surgery would be covered under Part B.

Answer: There are several preventive screenings covered by Medicare for heart disease, all at no cost to you. And of course, if deemed appropriate, there are several drugs covered under Part D that are preventive in nature so that your risk factors can be reduced.

Answer: The benefit to you would be that you would have someone available all year long to answer questions you may have, assist you with any roadblocks you may incur, and the assurance that you will be getting expert guidance concerning your Medicare coverage.

Answer: Unless there are extenuating circumstances the general answer is no. Enrollment into a Medicare Supplement plan varies from state to state. Some states have a guaranteed enrollment feature with no health questions around someone's birthday, others require underwriting so that someone with a serious illness would not qualify.

Answer: I believe the biggest reason this occurs is a lack of understanding on how the Medicare Advantage plan works. Are their doctors in the plan's network? Do they need a referral to see a specialist? Are all of their drugs covered under the plan?

All of these questions need to be addressed before anyone enrolls into a Medicare Advantage plan so there is no regret afterwards.

Answer: A professional agent should never “push” one over the other. So yes, you should be suspicious.

Both are very good products that do exactly what they are meant to do. The job of the agent should always be to find which one best fits your situation. After you have all of the facts, it should then be your decision as to which one fits the best.

Answer: Yes, original Medicare covers you in Puerto Rico as it is a U.S. possession. If you are enrolled in a Medicare Advantage plan, you would need to check with the plan as coverage outside the U.S. could vary.

Answer: The financial risk is substantial. Along with the deductibles and coinsurance that would need to be paid out of pocket, Original Medicare has no cap on how much out of pocket you could be liable for. Both a Medigap plan and a Medicare Advantage plan protect you from having a catastrophic financial situation, limiting your annual out of pocket costs.

Answer: Yes, you can use HSA funds to pay your Medicare premiums. This includes premiums, deductibles, copays, and coinsurance amounts. The only exception is Medicare Supplement premiums, those cannot be paid with HSA monies.

Answer: Great question and a perfect scenario of why a good, qualified Broker is so valuable. They would be able to determine if a Med Supp is your best option.

Usually, affordability is going to be the driver for most people, as the premiums continue to rise. But in my opinion, you can never go wrong with a Supplement as long as you can afford the premiums.

The best time to enroll is when you first become eligible for Medicare, as you are guaranteed coverage with no health questions and your premiums will be the lowest they will ever be.

Answer: The best advice I could give is for you to remain diligent at all times. Most mistakes are made when someone lets their guard down. Never give out any private info to someone over the phone who you don’t personally know, such as your Medicare number, Social Security number, etc. This is especially true if they called you.

Also, do not open any emails that you do not recognize the sender and NEVER click on any links unless you are 100% sure it is legitimate.

Answer: If you are receiving a bill for Part B, then that means you are enrolled in Part B. What does your red, white, and blue card show? Not sure why your Part B premium is not being deducted from your Social Security, you need to contact them to find out. In the meantime I would recommend that you pay the premium they have billed you for.

Answer: The plans can vary. A Medicare Supplement plan is good anywhere in the U.S., you can see any doctor that accepts Medicare. For Medicare Advantage plans, either an HMO or a PPO, some plans are set up to allow you to travel and still be able to access providers who participate in the network. You would need to check with your broker or directly with the carrier to verify which plans allow this.

Answer: Unfortunately, no. health changes do not trigger an SEP. This is why you want to be sure you are enrolled in the correct plan for your situation. Be sure you are prepared to financially handle the worst scenario your coverage allows.

Answer: For the majority of beneficiaries they should go ahead and enroll in Part A, because they pay nothing as far as premiums. If they are still covered under the employer group program, then they can defer enrolling in Part B until such time that they stop working and will lose the group coverage.

Answer: The Annual Enrollment Period (AEP) begins on 10/15 and ends on 12/7. During this time you can make changes to your Medicare Advantage plan or Prescription Drug plan.

Answer: Medicare does cover this. Traditional Medicare would have a 20% coinsurance. If you have a Medicare Supplement, it would cover this 20% after you have satisfied the Part B deductible. If you are covered on a Medicare Advantage plan, check with the carrier as to the copay and whether the procedure might need to be pre-approved.

Answer: If you are outside your enrollment window, Medicare has an General enrollment period beginning Jan. 1st. You can enroll then but be aware that you may have a late enrollment penalty added on to your premiums.

Answer: Medicare and health insurance in general seems to get more complicated year after year. The majority of time when this occurs, it is strictly a financial issue. What the hospitals receive is much lower under Medicare vs Commercial plans, and on top of that each insurance carrier negotiates their contracts with the hospital systems. If they get to the point that they don’t feel their compensation is sufficient, they will leave the network.

Answer: I can’t specifically say what the status is of the government systems but I do believe that there is ongoing work being done to update some systems and processes.

Answer: Special Needs Plans (SNP) are designed for individuals with specific maladies such as diabetes or heart disease. You must be diagnosed with the specific condition to qualify. There are also plans available for those with both Medicare and Medicaid.

Answer: It does cover ongoing care but only covers the manual manipulation of the spine. Any other services like heat therapy, etc. would be out of pocket.

Answer: Yes, but it only will cover the manual manipulation of the spine. Anything else would be out of pocket.

Answer: Not enrolling in a Part D plan when first eligible. Besides not having coverage when it might be needed, penalties will be added should they decide to join at a later date. These penalties are for a lifetime.

Answer: Medicare itself does not offer any incentives for a healthy lifestyle but most insurance companies who provide either supplements or advantage plans will have incentives.

Answer: A simple and straightforward answer. No, not at this time. It may be something that they consider in the future.

Answer: The answer is neither one. Both are great products, what matters is which one fits your particular situation the best. They are different in how they cover your care, so it is important for you to sit down with a professional, have them go through a complete needs assessment, and once you have the complete picture, decide which program best fits your needs.

Answer: The biggest reason I would give you is that whoever you manage to talk to will not have any knowledge of your local market. This is vital when dealing with Provider networks and Hospital systems. The question I always pose to clients is " If you needed legal help or advice, would you seek out someone who does not live locally and has no idea about the local judicial system?"

Answer: The bankruptcy by itself has no effect on your Medicare coverage. However, you may want to explore as to whether you may qualify for some financial help based on your income and assets. The Medicare Savings Program (thru your state Medicaid) would pay your Part B premium for you if qualified and the Low Income Subsidy (thru the Social Security Administration) would provide savings on your prescription drug costs.

Answer: Not necessarily guidelines but certainly some suggestions. Take your time and double check all of your info; you want to be sure what you are submitting is 100% correct. Errors can be difficult to correct once they are submitted.

Save copies of everything you submit, it may come in handy down the road.

Answer: The answer is that this type of marketing is not allowed. It is strictly forbidden for an agent to call you without first obtaining your permission. Ask them for their personal contact info along with their NPN (National Producer Number). They will not give it to you and will probably hang up. If they somehow do give it to you, hang up and call Medicare to report them.

Answer: Yes it is. It is one of the screenings that Medicare recommends as we age. It is a simple, no cost scan so I would highly recommend it.

Answer: We should all be concerned about Medicare fraud, as it costs us, the taxpayer, millions of dollars every year. Be diligent by reviewing all charges on your EOB (explanation of benefits) to be sure nothing looks out of place.

Answer: A loaded question for sure. Depending where you live and what your current coverage is, the changes could be minimal or they could be substantial. All of the normal things like Part B premiums and deductibles will go up. If you currently are covered under a standalone Part D plan, expect to see your premiums increase.

Answer: Depending on your current coverage, you may have to change plans to one that the onsite providers accept. As there are different levels of care available at these type of facilities, not all services would be covered by Medicare.

Answer: The most important reason is familarity of the local market. Every market is unique when it comes to the doctors and hospitals, they all have their quirks. Having someone local who understands those quirks can be invaluable.

Answer: This situation is a tough one. My first recommendation would be to obtain a Medical Power of Attorney so that you will be able to conduct his healthcare business for him. Along with that, find a professional Medicare Broker/Agency that can guide you through the process of making sure he is in the right coverage for his situation and assist you with understanding the paperwork.

Answer: The satisfaction I get from assisting someone who really needs the help is the most rewarding feeling ever. To see a smile and a level of understanding that was not there before is irreplaceable.

Answer: Brokers and agencies are not allowed to call you concerning Medicare plans unless you have given them permission to do so ahead of time. So if it is a call TO you, be very suspicious. And NEVER provided any personal info over the phone unless you know who you are giving it to.

Answer: Two recommendations:

1) Find an experienced and reliable Medicare Broker in your market who will be able to answer any questions you may have.

2) Log in to Medicare.Gov to compare plans and review benefits.

Answer: If you are enrolled in coverage through your employer and it is deemed creditable coverage (most are), then you do not need to enroll in Part B. The same holds true for Part D. You are guaranteed to be able to enroll when you leave your employer coverage.

Answer: If you are drawing Social Security disability benefits, you will automatically be enrolled after 24 months. If you are not drawing SS benefits, then you will need to sign up 3 months prior to your 65th birthday.

Answer: Long term custodial care is not something that Medicare covers. For Medicare covered items, you can know your set costs by enrolling in a Medicare Supplement. For long term care costs, you would need to look into Lobg Term Care coverage.

Answer: It is possible that the carrier has decided to either terminate the plan they are on or may be exiting that particular market. Also, if someone loses eligibility ( loses Part B), they would no longer qualify for an Advantage plan. There should be other options available to them should this occur.

Answer: You can enroll up to 3 months prior to your birthday. Highly recommended that you apply as early as possible to assure all will be processed for your eligibility date.

Answer: A professional Medicare agent who is local knows the nuances of the market and gives you a valuable resource when questions come up. They may also have relationships with providers that may make your decisions easier.

Answer: You will need to get a Medical Power of Attorney set up which will allow you to make medical decisions which includes their Medicare.