Donnie Vermillion, Medicare Insurance Broker

Answer: Yes, maximum out of pocket limits for Medicare Advantage plans change yearly. Another good reason to have your plan reviewed every September when you receive your ANOC annual notice of change in the mail.

Answer: After Part B deductible you pay 20 % , if you are eligible. If you have diabetes Medicare may cover a continuous glucose monitor and supplies if your doctor prescribes them for you.

If you take insulin or have a history of problems with Hypoglycemia low blood sugar. Also if your healthcare provider has decided that you or your caregiver have enough training to use a continuous glucose monitor as prescribed.

Answer: As long you maintain credible coverage through your wife's employer sponsored group health plan. She works for a large employer of 20 employees or more. You will not owe a part B penalty when she retires and you sign up for Part B.

Answer: If you sign up for an Medicare Advantage HMO plan you will have to stay in network. If your current doctors are in that plans network then yes you can still see your doctors.

If you sign up for a Medicare Advantage PPO plan you can go out of network but it will cost you more.

Its important to get with an Independent Broker and have them verify that your doctors are in network and prescriptions covered for the plan you are thinking of signing up for.

Your plan needs to be reviewed yearly because the plans change every year. Whats right for this year may no be the right plan for you next year.

Answer: You have to stay in network, referrals to see specialist, and prior authorization could delay your healthcare.

Answer: You need to review your summary of benefits and evidence of coverage for your plan. Each plan is different its important to review these before you purchase the plan so you know what you are getting into.

Answer: The downside to staying with original medicare Parts A and B is the risk of having to pay the 2026 Part A deductible of $1736 more than once. It is based off of benefit periods and not a calendar year. Meaning that if you have a bad year you could pay this more than once.

At least with an advantage plan you may have the opportunity to get a plan with a set max out of pocket for the year. Advantage plans have referral and pre-authorization requirements. These plans can feel restrictive.

A Medigap / Medicare Supplement plan offers predictable cost and freedom to see any provider that accepts Medicare.

Answer: Go to the website for your insurance carrier and search using the provider look up tool. You may need to enter the name of your current plan as well.

Answer: Your initial enrollment period is a 7 month period revolving around your birthday month when you turn 65. The 3 months before your birthday month, your birthday month and the 3 months after your birthday month.

You should go ahead and start a my social security account now at my ssa.gov to make the process smoother. Even if you are not planning on drawing social security right away.

Answer: I believe brokers and agents should educate their clients on the pro's and con's of staying on original Medicare, Medicare Advantage plans and Medigap plans.

You should base your choice off of your individual health care needs and financial situation.

Answer: Yes, it is always a good idea to shop around until you have found a broker you trust. Independent brokers will be contracted with multiple carriers in your area, but that doesn't mean they are contracted with every carrier / plan available in your area.

Answer: Plan F covers your Part A deductible and 20% coinsurance. So you should not expect to pay a copay for hospital visit.

Plan F also covers your Part B deductible.

Answer: If you are already on Medicare do to age or disability starting dialysis does not change your eligibility or coverage.

If you are only eligible for Medicare do to end stage renal disease, there is a waiting period for coverage to start. Coverage would start the 1st day of the fourth month of your continuous dialysis treatment.

If you choose a home dialysis training program before your 3rd month of the dialysis the 3 month waiting period can be waived.

Answer: The government pays these companies about $1000 a month to cover you on an Advantage Plan. The government does this because they know if you get say a cancer diagnosis for example while you are on original medicare, they are going to be on the hook for 80% of your health coverage. So for the government its less expensive to pay private healthcare companies to cover you on an Advantage plan.

Answer: It depends on your current situation. With original medicare Part A Hospital and Part B Medical you have a Part A deductible of $1,736 for 2026 and Part B deductible of $283 for 2026.

With original medicare there is no "cap" on how much you could pay for the year. If you have a bad year this could get really expensive. You could end up having to pay that $1,736 Part A deductible more than once if your hospital stays are far apart and not related to each other.

At least with an advantage plan there is a "MOOP" maximum out of pocket that you will not go over.

Medicare advantage plans can feel really restrictive with networks, copays and coinsurance.

I you are turning 65 soon or are older and healthy enough to pass underwriting a Medicare Supplement plan is the most comprehensive coverage and you have the freedom to see any doctor that accepts Medicare.

You would also get a stand alone drug card "Part D" make sure you avoid that Part D penalty, sign up when you first get the chance at 65. You would also purchase a separate plan for dental, vision and hearing.

Answer: The decision to not go with a Medicare Supplement plan during your guaranteed issue period, the six month period that starts the month you turn 65.

Or the decision to not go with a Medicare Supplement when you are younger and healthy enough to pass underwriting may be a decision that could be regrettable.

Answer: With a Medicare Advantage Plan if you have a stay in the hospital, you will have a hospital copay usually days 1-5. These copays can be very costly as much as $350 a day depending on the plan.

A hospital indemnity plan can help mitigate some of the risk by cutting you a check for your hospital stay. You can get a high plan or a low plan depending on your desired benefit amount. High plan around $50 a month and low plan around $30 a month.

Depending on the plan there may be a 60 day requirement before the plan will pay twice. This means staying out of the hospital for at least 60 days.

But, if its been a bad year health wise and you have already met your "MOOP" maximum out of pocket for your advantage plan. You are going to pocket that indemnity plan check, and actually make a profit.

Answer: Yes, you can use your accumulated funds to pay for Medicare Parts A,B,C and D. You cannot use an HSA to pay for your Medicare Supplement plan.

Also, you aren't eligible to make contributions to an HSA once you have Medicare.

Answer: If you are under 65 years of age and have a disability you will automatically be enrolled in Medicare Part A and Part B, after you have received disability benefits for 24 months.

Answer: My strategy is to educate my client about the positives and negatives of an Advantage Plan , Medigap plan or staying with just original medicare.

Answer: Sometimes advantage plans can feel a little more restrictive, possibly having to stay in network and get referrals to see specialist. You pay for what you use which could be a really good thing if you are healthy. But if you have a bad year you may pay more than what you would have paid with a supplement / medigap plan.

Answer: If you continue to work and are covered by a group health plan by your employer then no you just need to maintain credible coverage, your HR department can verify that for you.

If you miss your initial enrollment period when you turn 65 you could face late enrollment penalties if you are not working / maintaining credible coverage through your employer.

Answer: Ask them if they have thought about the future and how they will get their healthcare after they retire. An independent broker can help them with their options and get them coverage thats at least as good as what they had while working.

Answer: This depends on your financial situation. Medicare may cover some of the treatments for critical illness. But it will not cover the cost of travel, lodging, food or your caregiver or spouse missing work.

Answer: If you are close to turning 65 and not receiving Social Security benefits you will need to sign up for Medicare at SSA.GOV/MEDICARE

You can also contact social security 3 months before you turn 65.

Answer: Yes, to avoid a lapse in coverage and possible penalties, you must still pay your Medicare Part B premium if you live abroad for part of the year.

Answer: Set up your my social security account online. You do not have to collect benefits yet but it will ensure you are enrolled in Medicare on time. It may make sense to delay Part B enrollment if you are still working and have "credible coverage". You want to avoid signing up late for Part B, there are lifetime penalties if you do not enroll in time.

Credible coverage is coverage that is at least as good as what Original Medicare offers, discuss this with your Human Resources department, and contact an Independent Insurance broker.

Medicare.gov and the medicare and you handbook are also good resources.

Answer: Expanding Medicare benefits to cover dental, vision, and hearing would more than likely increase the cost of Medicare.

Answer: If you have had Part B for at least a year, Medicare will cover an annual wellness visit. The purpose of this visit to to create a personalized plan for to prevent disease or disability based on your current health and risk factors.

Answer: Yes, attending a free educational medicare 101 seminar is a great way to learn the basics of medicare. If it is titled an educational event it should not be plan specific. You will learn how to enroll in medicare. You will learn about the basics of Part A and B , what they cover.

You can get your medicare coverage in different ways. Whether that be just using Original Medicare A/B, a Medicare Supplement / Medigap plan or a Medicare advantage plan.

Answer: I explain that it's a good idea to go ahead and set up your my social security account online. Even if you are not ready to receive benefits you can set it up now so that when you turn 65 you will be automatically enrolled in medicare.

Part A = Hospital Stay - Part A is free for most

Part B = Medical - Part B everyone pays a premium - for most $185 - but based off income, your

tax return from 2 years back

Part C - Combines Part A/B with coverage from private insurance companies, could include

prescription drug coverage.

Part D - Prescription Drug Coverage

Answer: If you are collecting Social Security when you turn 65 you will automatically be enrolled in Part A (Hospital Care) and Part B (Medical Care) You do not need to do anything to enroll in Medicare and the part B premium of $185 will automatically be deducted from your social security check.

$185 for 2025

Answer: You will pay 20% of the "medicare approved amount" - the amount that original medicare sets for a service or item. When your provider accepts assignment medicare pays their share and you pay your share.

Answer: A medicare supplement plan can help cover many of the expenses original medicare does not cover. Just going with original medicare can leave you exposed to a high deductible $1676 for 2025 and 20% coinsurance.

An advantage plan offers services not covered by original medicare such as dental, vision, hearing and part D prescription drug coverage.

Answer: Review your summary of benefits for your HMO plan. Out of network usually requires a referral from your primary care physician to see a specialist. Out of network will usually require greater out of pocket expense.

Answer: If you have what medicare considers to be "credible coverage" from your employers group health plan or your spouses group health plan , it may make sense to delay enrollment in Part B to save on the monthly premium. You must maintain credible coverage from an employer with at least 20 employees.

Setting up your my social security account is the first step.

Answer: Talk with your doctor about alternate dosages or generic drug options.

Talk with your pharmacy about discount programs.

You may qualify for "extra help " if your income is below a certain level.

You can also request a tier exception on your medications, this requires doctor support.

Answer: I would advise seniors that are feeling overwhelmed by all of their medicare options, to number one talk to a trusted independent insurance broker / agent.

Independent brokers are not beholden to any specific insurance provider and can help you find the right plan to meet your needs and budget.

When shopping for a health plan remember that its exactly that a health plan. The goal should be at the very least to have comparable coverage to what you had during your working years.

If there are extra perks with the plan like gym memberships or groceries thats great but the focus should be on selecting the right health coverage for you.

An independent agent can review the summary of benefits, deductibles, copayments, coinsurance and verify that your doctors and prescriptions are covered by plan you select.

Answer: Medicare does not cover around the clock supervision or personal care. Long Term Care insurance helps with ADL's "activities of daily living" and dementia specific needs. Depending on the policy it may help cover personal home care.

Answer: Yes, it is considered a preventive service.

Medicare Part B (Medical Insurance) covers this test once every 24 months (or more often if medically necessary) if you meet one or more of these conditions:

You’re a woman whose doctor determines you’re estrogen-deficient and at risk for osteoporosis, based on your medical history and other findings.

Your X-rays show possible osteoporosis, osteopenia, or vertebral fractures.

You’re taking prednisone or steroid-type drugs or are planning to begin this treatment.

You’ve been diagnosed with primary hyperparathyroidism.

You’re being monitored to see if your osteoporosis drug therapy is working.

You pay nothing for this test if the doctor or other health care provider accepts assignment.