Donald Elliott, Medicare Insurance Broker

Answer: You should research the medical specialties in your area and ensure they are in network. Also research prescription medicine that might be required against the formulary. If anything concerns you, call your insurance company and discuss the possibility early.

Answer: From my experience the biggest mistake is making a lifetime decision based on the first advice you receive. You should carefully consider all your options rather than the recommendation of the first representative who knocks on your door. I listen carefully to your concerns and desires, ask questions to eliminate those options that simply do not fit, and my client always makes the best decision using their own understanding.

Answer: If you are 65 or older you should apply for Medicare effective the end of you group employer coverage. Carefully and thoughtfully consider all you Medicare options. If you are eligible for military or VA benefits, I recommend you utilize those programs to the maximum.

Answer: Ensure your agent covers every medication and ensures they are on the formulary. If either of you are not 100% sure it is time to call the Medicare insurance company direct and find out.

Answer: I talk to my clients extensively, getting to know them and understanding their needs and goals. There is no difference between in person on on the phone. If I do not really know them from that conversation I will not take them as a client.

Answer: Medicare deductibles always reset in January of each year. The amount of deductible also changes each year on January 1st

Answer: Talk to your primary care doctor about your concerns. There are many opportunities for counseling and treatment as needed.

Answer: Most Medicare Advantage plans require prior authorization for major medical procedures. This is generally very simple. In most cases your doctor should have submitted this prior to scheduling

Answer: There is no cut and dry answer to this question. I talk to my clients honestly and ask the questions that lead them to understand the coverage and costs, apply those costs to their budget, and finally make a wise decision. Talk to an independent broker.

Answer: When you select a Part C, or Medicare Advantage plan, you pay the plans deductible and copay. That is almost always much better than paying the Part A deductible plus 20% of the allowable charges.

Answer: The best way to select the right healthcare company and plan is to speak directly with an independent health insurance broker. A broker represents more than one company and is completely independent from outside influences. My position is very clear. I am not here to sell you something for money. I am here to ask the right questions and guide you to discover what is best for you and help you apply and receive that plan.

Answer: The only Medicare decision regret I have felt with is not asking enough questions before changing plan types. I personally will not sign a person up for a plan until they are fully aware of restrictions, especially network coverage. Make sure you know your preferred providers are in network, know the cost of going out of network, and pharmacy benefits before you make any decision.

Answer: Wow, that is easy to understand but so challenging to answer. A Medicare Agent is very limited due to HIPPA regulations. I do go as far as I can to help. That often involves submitting a service inquiry and/or an appeal.

Answer: Your primary care physician (PCP) can refer for physical therapy. I am currently in a PT program so I asked this question to my provider just last week. I can continue until all the goals set by mt PCP are met. Your out of pocket costs are determined by your specific plan. I advise you ask the PT administrator before you start

Answer: Medicare covers cataract surgery but the out of pocket cost depends on what type of procedure and where it is performed. In an outpatient setting, the cost is generally much lower than in-patient hospital. Of course the type of Medicare plan you have can vary the cost considerably. Ask your doctor these very important questions:

QUESTIONS TO ASK YOUR DOCTOR

You can ask your doctor the following questions to help determine your out-of-pocket costs for cataract surgery:

Do you accept Medicare?

Will the procedure be performed at a surgical center or at a hospital?

Will I be an inpatient or an outpatient for this surgery?

What prescription medications will I need before and after cataract surgery?

What is the Medicare code or specific name of the procedure you plan to perform? (You can use this code or name to look up costs on Medicare’s procedure price lookup tool.)

Most people get glasses to use during recovery which are also covered by Medicare.

Finally, call your insurance carrier with those medical codes from your doctor and ask them what they cover and what you will pay. You should get a very close estimate.

Please remember that not all procedures go as planned so be prepared for other costs if the procedure doesn’t go perfectly.

Answer: Medicare Advamtage combines all the required coverage of Medicare A and B, and often include prescription drug coverage and other benefits. Without a Supplement or MA plan, the user is responsible for 20% of medical care. The question I ask is simple; 20% of what? 20% of a $50 bill is $10, but 20% of a $1 million heart surgery is impossible for almost anyone. Most people pay far less with an MA plan including premium and copay. You should absolutely speak with an agent and compare all plans available in your zip code.

Answer: In my opinion, the worst choice is not doing your own homework and taking the recommendations of the first Medicare agent you talk to.

Answer: Medigap, or a Medicare Supplement, provides great advantages such as seeing any doctor who accepts Medicare with little or no out of pocket, but they can cost a lot. In comps, Medicare Advantage plans typically have low or no premium but high out of pocket costs. Do you want to pay now or pay later? Do you want to be in control of your healthcare options or do you want an insurance company to make those decisions? These are very real issues that I discuss often with my clients. There is no simple answer.

Answer: See your primary care physician early each calendar year for a consultation and review. Your doctor might recognize issues that physical therapy can help to increase strength and balance. Also many inoculations, prescription care reviews

Answer: Health insurance or prescription drug coverage that pays at least as much as Medicare. Some examples are military medical, Veterans Administration.

Answer: DO NOT ACCEPT UNSOLICITED MEDICARE PHONE CALLS, PERIOD. That is my best advice. I am on Medicare and I receive dozens of calls every day during AEP, so I understand the issue. If you need advice on Medicare, call a reputable agent or company so that you know who is on the other end of the conversation. Oh, and do not reply to an unsolicited phone number because that might be a scammer.

Answer: Wow, that is a tough question. Medicare Part A will begin automatically at 65, so the decision is for Part B. It really depends on your primary insurance coverage through your employer or an individual plan. Many employers will incentivize employees to elect Medicare so that the group coverage does not increase in price due to a higher age. Ask your employer if there is an incentive before making the decision

Answer: I do not think Medicare will privatize, but I do think private insurance might change to some sort of single payer system similar to Medicare.

Answer: A Medicare Agent can answer your questions accurately, so you make the best decisions. I never lead my clients but ask them questions they had not thought about. Most Medicare decisions are permanent so I want my clients to make the best choice for them, then I can support them with confidence.

Answer: This has always been a tough question. The amount of money received over time is about the same regardless of when you begin payments. For me, the decision was easy because I was still working and simply waited until full retirement age to avoid excess taxes. So this is not an issue that has a good general answer. One thing I do know that applies to everyone is that if you pass away before you begin payments you will get nothing at all. Talk to your tax professional about tax implications before making a decision.