Dutch VanHoesen, Medicare Insurance Broker

Answer: Part C is Medicare Advantage which takes the place of part A and B. You remain a Medicare beneficiary, however your care is being coordinated through the private insurance carrier. There are typically no deductibles with Medicare Advantage-just copays and possibly some coinsurance. You would not be subject to the Part A $1736 or Part B $283.

Answer: As with any insurance, a deductible is what you pay before the plan kicks in. A copay is a standard fee for a procedure, a doctor visit for example.

Answer: I had a client who was using the Medicare "trial right" the carrier did not know anything about the process, which held up the enrollment. After listening to the carrier's representative be rate me and tell me I needed to read manuals and go back and redo certifications. Once I got her supervisor on the phone, everything was resolved. The biggest objections I have to overcome are the disinformation or misinformation people hear from their friends, family, other agents, TV and radio, social media, and even the insurance companies themselves.

Answer: Original Medicare covers vision if medically necessary- for example, cataract surgery. Routine vision is not covered through Original Medicare, however most Medicare Advantage plans have some coverage towards exams, lenses, frames and contacts. Some supplements may offer some vision care discounts.

Answer: Medicare advantage plans cover everything Medicare covers and usually offer extra benefits such as gym membership, dental, vision, hearing, otc, etc. Medicare advantage prescription drug plans offer prescription drugs obviously.

Some Medicare advantage plans may cater to your specific health problems such as Chronic Special Needs Plans and social security benefits for the chronically ill.

For your last three questions no, maybe and yes.

Answer: Helping people! What else is there in life? Many clients become friends. You simply cannot be in a better place to bring good news to people every day!

Answer: There is a form (SSA-44) to waive or appeal. Once the IRS reports your income under the IRMAA limit, your premiums will drop.

Answer: Be careful whom you are listening/reading to-it may be a dubious or disreputable source. 95% for Medicare Advantage and 90% overall for Medicare beneficiaries overall report satisfied with their plan. My biggest obstacles to overcome are what people hear from their neighbors, friends, family, medical providers, radio, TV, other agents/brokers and of course anything on the internet.

Answer: Evaluation of your health history, current needs and requirements. ie: how often are Dr visits, medication costs, regular treatments, upcoming procedures, etc. Then determine exactly what your priorities are: Keeping your preferred providers, cost, freedom or autonomy over your healthcare decisions.

Ask questions and follow up with the advice from an independent broker NOT a captive agent.

Answer: Medicare Part B costs $185 in 2025. If you are a high earner, for example, single making over one hundred and six thousand dollars a year, you pay more and it increases as you earn more. If you are low income, you can take advantage of Medicare extra help, to help pay for prescriptions. If you are very low income, you may qualify, for Medicaid which waives your Part B premium entirely.

Answer: Medicaid eligibility starts at $1761/mo with a limit of $9660 in assets. There is also a $20 standard disregard for coverage. If you are under these figures in earning/assets, you are eligible for medicaid, which pays your part B $185 premium among other benefits. Typically, dual eligible Medicare, medicaid HMO special needs plans have no copays. Many offer monthly credit card benefits to use on housing, utility and grocery expenses.

Answer: Medicare advantage plans pay doctors and other providers less than original Medicare pays. Also Medicare Advantage has authorizations and referrals that a provider may feel gets in the way of their prescribed method of care.

Answer: Medicare part D is a program comprised of private insurance carriers offering prescription drug coverage. A Prescription Drug Plan (PDP) is not mandatory but highly recommended. Fines may be imposed on those whom previously had not participated in the program but apply for coverage at a later date. Standard fines are 1% of the national average cost of a PDP which was around $36/mo=$0.36/mo penalty. No coverage for 1 yr? $3.60/mo penalty.

No coverage for 10 yrs? $36/mo penalty.

Answer: I would say it depends on what you mean by eventually. Certainly not if you are close to retirement age. Every single lawmaker that has reached retirement age is on a Medicare supplement. Until there are more lawmakers that went to privatize Medicare I do not believe this will happen anytime soon.

Answer: This information is required to be in the enrollment materials. If you enrolled yourself you're on your own. If you used an agent or a broker they are required to give you this information. This is precisely the reason why you should use a broker who's not affiliated with any carrier and who doesn't cost you anything to use their expert recommendations.

Answer: There really is no way to know for sure until you talk to a professional broker or agent. There is just so much information and thought that needs to go into a decision like this. Typically the best time to get into a Medigap plan is within 6 months of your Medicare Part B effective date. After that they will underwrite you and may deny you coverage based on your answers to medical questions.

Answer: Typically you would be eligible for survivor benefits depending on many different variables. You'd be eligible for the $255 death benefit once again providing you meet certain requirements.

Answer: People that are new to Medicare require much more time and explanation regarding how Medicare works and what their options are. People who already have Medicare and are just switching plans usually know what they want however people switching plans do require occasional updates and re-education about how things work.

Answer: No, you will simply be re-calculated at the Florida rate. You may however, want to look at the Medicare Advantage plans in Florida as they are some of the most cost effective Medicare Advantage plans in the nation.

Answer: Yes. You must have missed the cost of Part B. If you are receiving benefits it is automatically deducted. If not, billed quarterly.

Answer: Original Medicare: Medicare premium $185/mo, $257 deductible + (20% of $20,000 to $40,000 + post care costs)

$5-10K no max out of pocket.

Medigap Plan G: $200-225/mo+

Medicare premium $185/mo, $257 deductible is your max out of pocket for the year

Medicare Advantage: Medicare premium $185/mo (may be reduced by up to $174,70/mo) specialist copay $10-$45+ outpatient hospital copay $100-$300 + post op rehab $20-$40/visit maximum out of pocket could be less than $500. Max out of pocket $1000-$6700.

Answer: A local broker can help you on an annual basis. He should be able to keep most of your information on a secure file in order to familiarize himself with your needs. Many people change their plans for coverage through the years. Local Brokers are more knowledgeable than someone not from the area. Many plans offer different benefits or cover niches that are not typically published.

Answer: Medicare does not cover dental vision or hearing unless medically necessary. Medicare Advantage plans have some coverage for dental, vision and hearing. They typically are not comprehensive benefits but offer mostly preventive coverage. Some plans offer more than others.

Answer: Her friends may endanger your mother. Medicare Advantage may have authorizations, Dr networks, service areas, referrals, Etc. It's easy for any Medicare broker to check her current doctors and see if they are in network for various Medicare Advantage plans.

Answer: Yes there is an 8-month period between losing your employer coverage to get into a Medicare Advantage plan or prescription drug plan. Cobra coverage does not count as it is not creditable coverage according to Medicare.

Answer: 1. Extra help: if you are low income, you may qualify for the Medicare extra help program. Contact Social Security.

2. Medicare prescription payment program: this is a new Medicare option to spread your drug payments over the course of a year.

3. Generic medication alternatives to your brand name drugs.

4. Patient Assistance programs: most drug manufacturers offer some sort of assistance to help pay for your drugs.

5. Mail Order: this may save you money and may not it all depends on your medications and your prescription drug plan carrier.

Answer: I have a client who if she had went with her first choice of a Medigap plan her annual cost would be around $2,400. She decided to take a less expensive route and enrolled in a Medicare Advantage plan. She was diagnosed with a health issue requiring a doctor to administer shots in her eye every quarter for the remainder of her life. This cost is reaching her out of pocket maximum of $5,500 which is more than twice the annual cost of her supplement. In this particular case it would have been more cost effective for her to have been on the Medigap plan costing her $2,400 per year.

Answer: The annual enrollment period is Oct 15-Dec 7th. The open enrollment period for those on existing Medicare Advantage plans is Jan 1-Mar 31st.

Answer: Medicare Advantage plans may be less expensive when you are healthy. Medicare supplements or Medigap may be less expensive if the worst of the worst happens to you. However I can give you examples directly from my clients who have ended up paying more on a Medicare Advantage plan. While you may feel healthy now 85% of our Medical Care comes after age 65.

Answer: You may utilize a Special Election Period which includes:

Moving to a new plan area.

Enrollment in a 5 star plan.

Losing health insurance.

Weather related disasters.

Annual enrollment. Is October 15th through December 7th. If you miss that enrollment period and you are a current Medicare Advantage member, You have 1 more opportunity to change plans January 1st through March 31st.

So from April 1st through December 31st you are locked into your plan unless you meet a special election period requirement.

Answer: Medicare will have an historic 80 million beneficiaries by 2030. With fewer paying into the system Medicare will have to make some changes along with Social Security in the coming years.

Answer: Medicare covers vision only when medically necessary such as cataracts. Routine vision, hearing and dental is not covered by Medicare. However many Medicare Advantage plans do include some coverage for vision. There are also ancillary vision discount or savings plans available.

Answer: I would say the most common misconceptions about Medicare are the costs involved and when to enroll. There are fines and penalties for late enrollment. Costs may decrease significantly if you qualify for a low income subsidy or Medicaid. Costs increase for high earners.

Answer: There is an overwhelming amount of disinformation or misinformation regarding Medicare. Make sure you deal with a broker who has most if not all of the plans available in your area.