Edward Givens, Medicare Insurance Broker
Edward Givens
HealthMarkets
Medicare Broker Licensed in AZ, CA, CO, CT, DC, FL, GA, IL, MD, NC, NM, NV, OR, SC, TX and VA
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Tempe, AZ
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Edward Can Help With:
About Me
I'm a United States Military Academy graduate with 15+ years of experience in the healthcare industry. I have developed a consultative style that educates people about the healthcare options they have available to them. Most people find health insurance selections confusing and frustrating. My process allows you to examine your current situation, helps you identify your desired situation, and then as a team, we will work the plan you select to ensure it fits your budget and meets your needs at every step. If this process sounds good to you, please reach out. I'd love to have a conversation with you.
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Q&A with Edward Givens
What is the biggest mistake seniors make when enrolling in Medicare?
Answer: Medicare plans can change yearly. Not reviewing coverage during the Annual Enrollment Period (Oct 15–Dec 7) can mean staying in a plan that no longer fits your needs or budget. Some people who continue to work past 65 assume their employer coverage is sufficient and delay Medicare enrollment, not realizing this could lead to penalties or coordination of benefits issues.
What is one of the the most common misconceptions people have about Medicare?
Answer: Medicare covers everything.”
People are often surprised to learn that Medicare doesn't cover dental, vision, hearing aids, or long-term care. These gaps can lead to major out-of-pocket expenses if not planned for. “Medicare is free.”
Many believe that once they turn 65, Medicare won’t cost anything. While Part A is usually premium-free, Parts B, D, and supplemental plans come with monthly premiums, deductibles, and co-pays.
What is the biggest disadvantage of Medicare Advantage?
Answer: Limited Provider Networks
Unlike Original Medicare, many Medicare Advantage plans have restrictive networks. You may not be able to see your preferred doctors or go to certain hospitals unless they’re in-network.
Prior Authorization Requirements
Many Advantage plans require prior approval for services or procedures, which can delay care and add extra administrative hassle.
Unexpected Out-of-Pocket Costs
While premiums may be lower, Medicare Advantage plans often have higher copays and coinsurance for certain services, and the cost can add up—especially if you have chronic conditions.
I need both a psychiatrist for medication and a therapist for talk therapy. How does Medicare coordinate coverage for these different providers?
Answer: Medicare provides coverage for both psychiatric medication management and talk therapy through its Part B (Medical Insurance) and Part D (Prescription Drug Coverage) plans.
Psychiatric Medication Management
Medicare Part B covers outpatient mental health services, including visits with psychiatrists or other qualified healthcare providers for psychiatric evaluations and medication management. After meeting the Part B deductible, you typically pay 20% of the Medicare-approved amount for these services if your provider accepts assignment. Provider Acceptance: Not all mental health providers accept Medicare. It's important to confirm with your psychiatrist and therapist that they accept Medicare assignment to ensure coverage. Medicare Advantage Plans: If you're enrolled in a Medicare Advantage Plan (Part C), your plan may offer additional mental health benefits beyond Original Medicare. However, provider networks can be more limited, so verify that your preferred providers are in-network
I want to be proactive about my health. What preventive services should I be taking advantage of with Medicare?
Answer: Key Preventive Services Covered by Medicare:
“Welcome to Medicare” Visit: A one-time preventive visit within the first 12 months of enrolling in Part B.
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Annual Wellness Visit: Yearly appointments to develop or update a personalized prevention plan.
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Screenings: Including but not limited to colorectal cancer, mammograms, prostate cancer, cardiovascular disease, and diabetes.
Vaccinations: Coverage for flu, pneumococcal, hepatitis B, and COVID-19 vaccines.
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Counseling Services: Such as smoking cessation and alcohol misuse counseling.
Bone Mass Measurements: For individuals at risk of osteoporosis.
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Depression Screenings: Annual screenings to detect depression early.
What should I do if I miss the Medicare Open Enrollment period, and I want to change my plan?
Answer: If you've missed the Medicare Open Enrollment period (October 15 to December 7) and wish to change your plan, you may still have options through Special Enrollment Periods (SEPs).
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Special Enrollment Periods (SEPs): SEPs allow you to make changes to your Medicare Advantage or Part D prescription drug coverage outside the standard enrollment periods if you experience certain life events. Qualifying events include:
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Moving out of your plan's service area.
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Losing other credible health coverage.
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Gaining or losing eligibility for Medicaid or Extra Help.
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Your plan changes its contract with Medicare.
I need help at home after my surgery. Will Medicare cover a home health aide or am I on my own?
Answer: Yes, Medicare can cover home health aide services after your surgery, but certain conditions must be met.
Eligibility Criteria:
To qualify for Medicare-covered home health services, you must:
Be under the care of a doctor who certifies that you need intermittent skilled nursing care, physical therapy, speech-language pathology, or continued occupational therapy.
Be homebound, meaning it's difficult for you to leave your home without assistance due to your medical condition.
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Receive services from a Medicare-certified home health agency.
Services Covered:
If you meet these criteria, Medicare may cover:
Part-time or intermittent skilled nursing care (e.g., wound care, injections).
Therapy services, such as physical, occupational, or speech-language therapy.
Home health aide services, which provide personal care like bathing and dressing, but only if you're also receiving skilled care as mentioned above.
Medical social services to help with social and emotional concerns related to your illness.
Certain medical supplies and durable medical equipment (e.g., walkers, wheelchairs).
Limitations:
Medicare does not cover:
24-hour-a-day care at home.
Meals delivered to your home.
Homemaker services like shopping, cleaning, and laundry when these are the only services you need.
Custodial or personal care that helps you with daily living activities (like bathing, dressing, or using the bathroom), when this is the only care you need.