Duane Everding, Medicare Insurance Broker

Answer: Assisted living is not covered by Medicare. You will still have coverage for things like physical therapy, dr visits, etc but the assisted living itself is not covered. Medicare does cover 100 days of skilled nursing care during your lifetime, but you are required to show continuous improvement in order to actually use all 100 days. When the cost or a potentially nursing home stay is concerning to our customers, we recommend an additional policy. My favorite being policy that covers skilled level of care, but you get to decide if that care is received in a facility or at home. Coverage is available up to 7 years and has a return of premium feature in the event the coverage isn't needed, then your heirs will at least get the premiums you paid returned.

Answer: When I evaluate Medicare Supplement companies, I look at the past rate increases, and AM Best ratings. I also look at the number of enrollees in each of the plans. Statistically, more enrollees spread out the financial risk increasing the likelihood of better price stability.

Answer: Yes, you're not required to take your social security right away when you first enroll in Medicare. You will, however, need to pay via alternate payment method for your Part B premiums.

Answer: Medicare does not, however, some Medicare Advantage plans offer a Personal Emergency Response button at no cost. You will need to call the company to request they send yours.

Answer: This depends on which Medigap or Medicare Supplement plan you enrolled in. For example, Plan G requires you to pay your Part B deductible.

Answer: Not reviewing doctors or medications. This should be step 1 when selecting which Medicare option is best for you.

Answer: Your annual wellness visit should be covered at 100%. If you also have other medical problems reviewed at the same visit, you may need to pay something out of pocket.

Answer: You need to review the plans network participation by talking to your agent or looking at the insurance company website online. A word of caution, doctor networks can change with Medicare Advantage plans mid-year with as little as a 30-day notice should the insurance company and doctor disagree on contract rates. Just because a doctor chooses to no longer participate with a certain carrier, this doesn't mean you will have a special enrollment period to switch plans. You will generally need to wait until open enrollment Oct 15-Dec 7 for enrollment starting January 1.

Answer: The word I've seen used with for Medicare supplements is "luxury". If you cannot afford a supplement plan, then you should consider a Part C Medicare Advantage plan. Original Medicare has a high coinsurance, no maximum out of pocket, and no dental/vision/hearing coverage.

Answer: Medicare Advantage really falls into 2 main categories. Those that include drug coverage and those that do not. From there, you have network differences and special needs plans for people with low incomes or chronic health conditions.

Answer: This depends on many factors. Do your specialists participate with the plan you have selected, how much are you being charged, what other services is your specialist billing for. This could be as simple as the specialist office not knowing that you have a supplement or advantage plan.

Answer: You need to review your plan specific formulary. This can be found on the insurance company's website or give your agent a call to help you research to see if its covered and also how much you should expect to pay at the pharmacy of your choice.

Answer: I always tell my clients that it depends on your comfort level with an unplanned out of pocket expense for a hospital stay. Review your inpatient copay amount and add up to see how much a one-week hospital stay will cost out of pocket. If this cost is higher than your budget or savings can support, it's a good idea to enroll in an indemnity plan. Hospital indemnity plans generally reset after 60 days, so it's possible to collect on an indemnity policy more multiple times per year. This can be used to cover out of pocket expenses for yourself, a family member or friend that's helping you.

Answer: I've seen many people overlook the hospital copay and maximum out of pocket. Giveback plans notoriously increase the amounts for these copays, while giving a little back in your Social Security check each months. These aren't exciting benefits and most people don't anticipate they will become hospitalized over the next year or become ill with a critical illness. This can cost the member thousands of dollars they weren't anticipating if something does happen and you need those services.

Answer: This depends on what the doctor billed. To know for sure, you will need to compare your explanation of benefits with the bill from your doctor. Call your agent, your plan or Medicare once you have this information and ask questions.

Answer: Complete a Medicare review with a licensed and certified insurance agent. Everyone's situation is specific to them and Medicare is not a one-size fits all. The doctors you see, medications you take or may take in the future, and budget are very important steps in the process of selecting the best plan for you.

Answer: I may need a little more information to understand what happened in your specific situation. Most snowbirds will enroll in a Medicare supplement plan, so they don't have to worry about the ability to see doctors in multiple parts of the country. If a supplement plan is unaffordable, you may enroll in a Medicare advantage plan and use the plans travel benefit (if available) by calling the company directly. Sometimes it is necessary to change your Medicare advantage plan each time you "move" to a new area even if only for a few months.

Answer: A Medicare agent will be able to provide how Medicare works and all the options available to you including original Medicare, Medicare supplement, or Medicare advantage plans. An agent will also help you asses if you will need additional coverage such as long-term care (nursing home), or hospital insurance to cover rising hospital copays. Of course, calling directly to CMS or federal Medicare is also an option, but often the call centers don't always understand the local dynamics of healthcare providers and network issues specific to your area.

Answer: You might consider enrolling in a Medicare Supplement, depending on your age and the state you live in. This option provides an open network of doctors. The other option would be to evaluate special enrollment options for a Medicare Advantage or Part C plan. Certain chronic conditions, moving to a new service area, or natural disasters can all provide ways to enroll after open enrollment if you qualify. Contact me, and we can review your specific situation.