Edward MacConnell, Medicare Insurance Broker

Answer: it is a good idea to review your ANOC with your broker so you can both be aware of the upcoming changes in your coverage

Answer: This question asks, do maximum out-of-pocket limits change every year?

A maximum out-of-pocket is usually going to mean, on an insurance program like Medicare Advantage or a Medicare Advantage drug plan. And the answer to that is yes. The maximum out-of-pocket typically changes every year. They don't have to change, but that's why you want to review your summary of benefits and coverage if you want to make sure that you understand. It's not unusual for the maximum limits to change every year.

In Affordable Care Act plans, they almost always change. But with the Medicare Advantage plan or Medicare drug plan, which is probably what you're asking about, they often do change.

Best thing to do, make sure you meet with your Medicare health insurance professional every year to review those changes during the annual election period. And I hope that helps answer your question.

Answer: So your question is, am I eligible for a Special Enrollment Period if I lose employer coverage? The answer is generally, usually yes. It does matter if you're on employer coverage that is creditable for Part D purposes, number one, and number two, is not on COBRA.

Usually you will have a Special Enrollment Period to pick up a Medicare plan of your choosing, a guaranteed enrollment Special Enrollment Period, coming off of an employer plan. This is especially true if it's a larger 20 or more employees in many cases.

It's important to have someone who knows what they're doing take a look at your specific situation and address yours to make sure that they give you the right answers.

I hope that is helpful.

Answer: Your question is you have a Medigap Plan C, and you're curious if recent blood work is included or if you need to budget for extra costs.

My first question would be, are you sure you have a Medigap Plan C or a Medicare Advantage Plan C? The two of them are different. A Medigap Plan C is an older Medigap plan. It's not even available anymore. Generally, blood work will be covered with Medigap Plan C.

Not really sure if that's what you have. I strongly suggest that you speak to a Medicare plan expert and share your bundle up. Otherwise, you can also look up Medicare Plan C benefits right from medicare.gov. That's kind of our workaround answer, but I hope that helps.

Answer: So your question is, what is the biggest disadvantage of a Medicare Advantage plan?

I think it's important to understand Medicare Advantage plans, while being very inexpensive typically to enroll in, will come with their own slate of out-of-pocket expenses. That's going to include copays for pretty much everything: doctor visits, specialists, tests. And some of those copays go pretty high. So that's a pretty big disadvantage in my mind.

But you want to make sure that you compare all the plans and see which one works best, and I always recommend you have a specialist to do that.

Answer: The question is, with a Medicare Advantage plan, after you reach your out-of-pocket, will you have any copays or fees for the rest of the year?

I would say you really need to speak to your Medicare advisor and talk about this question, because not every plan is the same. But generally, when you reach maximum out-of-pocket, you don't have to pay any more copays and coinsurance or anything like that. If there's a premium, you do still need to pay that.

Now, if you have a Medicare Advantage plan with the prescription drug plan built into it, the prescription drug plan may have a different maximum out-of-pocket than the maximum out-of-pocket for the plan in its entirety. That's why it's important to speak to your Medicare specialist to know any Medicare Advantage plan questions specific to your established plan here.

Answer: This is a little bit of a longer question. The question is Part A inpatient hospital deductible of $1,676, but if I have a Part C Advantage plan, the hospital $350 copay for days one through seven, how does this work? I guess you're asking what the difference is between the two.

The answer is that if you've chosen a Medicare Advantage plan, you're not paying that Part A inpatient hospital deductible of $1,676, or whatever it is in the year that you enroll. What you're paying is the hospital copay of $350 per day, because that's the plan you've signed up for. And that coverage dictates your out-of-pocket expenses, your copays, and you look up the whatever for your copay answer any of that.

So if you're only on original Medicare, then you would pay that deductible. A supplement can help you not pay that much on that gap for you. And Part C, the Advantage plan, will pay that, but then in turn they turn around and charge you the appropriate copays for the plan that you've signed up for. So that's really the difference.

Some people like the deductible better, some people like the copay better. For me, I think it really depends on each person and their situation.

Answer: What's the difference between a Medicare broker and a Medicare agent? This isn't an answer that's specific to Medicare alone, but the general difference between a broker and an agent is that a broker is typically an impartial party. We work for our clients as a broker. We don't necessarily work for an insurance company. We are contracted with the insurance companies, and often they're the ones that pay us to do the work, but we're hired by our clients. It's our job to be impartial and to advise good and bad on all the different carriers and coverages that are available to you as a beneficiary or a client.

An agent typically works directly with one company. That's not to say that working directly for one company makes them a bad agent. It just means that they often can't really compare their company's programs and products to other companies who they don't work for.

I feel very strongly that if you want to have a great impartial view of all of your options, or most of your options, that you want to work with a broker as opposed to an agent. Because frankly, you want to have some impartiality involved in that process, and you don't want someone who just says, "Hey, this is great," because it may be great, but it might be the only thing that they can talk to you about. They only work for that one company.

There are people out there, agents, who work only for one company, and sometimes they even get paid only by that company. It's important, I think, that the difference being that you speak to somebody who can compare all of those different options of advice one way or another.

Answer: There are certainly some advantages to both remote or virtual and a local agent.

A local agent usually has an office or location you can stop in and meet the staff and talk to people there. We often talk to our clients about coming in, having a cup of coffee, and answering their questions. Sometimes it makes it easier for them to understand in a face to face meeting across a table as opposed to over the phone during a virtual meeting. And that's not to say that virtual is a bad thing. It's just that I think there is definitely an advantage to working with somebody near you.

The other thing is each area may have locally specific plans and doctors networks and things like that. So like where we are in Bucks County right outside Philadelphia, there are some very specific plans that somebody from outside of the area wouldn't know or understand, and wouldn't necessarily follow the idiosyncrasies of each different local plan. So that's definitely, I think, an advantage wherever you find the local agent.

The other thing is accountability. If you're working with a call center or someone who's not anywhere near you, it's difficult sometimes to get the accountability when somebody gives you an answer that you don't quite understand or you run into a problem. The broker should also be your advocate. So when you run into an issue where you get something in the mail you don't understand, it is our job to answer your questions and to help you with that kind of stuff. And who knows, if you're talking to somebody in a call center when something comes up, if you're ever going to get anybody on the phone who's going to understand what's going on. Or if they tell you something that's inaccurate and you hold them accountable, they don't even know.

So I think that there is definitely a benefit to working with somebody near you, somebody whose office you can walk into, somebody who you know is in your community. Probably a definitive advantage.

Answer: The question is, how do I get dental and vision covered with Medicare? The answer is you don't necessarily have to get it together, and oftentimes it makes some sense to take a look and see what other options are available. Medicare Advantage plans can come bundled with dental and vision coverage. Medicare supplements typically do not, so that's something to keep in mind while taking a look.

When you talk to your broker, you may want to ask them what other standalone dental and vision plans are available for me. Because oftentimes we find those have significantly better coverage, more options, and sometimes more flexibility than just getting one that's bundled with the plan.

Answer: A good thing to look for is to ask the broker or agent you're speaking to if they're only working with one carrier or multiple carriers. You might want to ask them what are the positives about the carriers we're talking about, and if there are any negatives. You may want to ask them how many insurance companies they are appointed with and how long they've been in the business.

I would say if a broker is pushy or tries to give you some pressure, any high pressure sales are not what you want. You want to talk to somebody who's an advisor, who answers your questions and asks good questions. And having some experience certainly does make a difference. The rules change every year, and your good broker will recertify, and they must recertify and retrain every year. They have to be appointed again every year. And each carrier also rolls out new training for their new programs every year. So you might want to ask some questions in that respect, and make sure that whoever you're speaking to is educated and certified and trained to handle all that stuff.

Having somebody local is probably even better because a local broker most likely knows a little bit more about your local community insurance coverage carriers and not just national ones.

Answer: That's certainly a balancing act and a challenge, because you'd like to be prepared for AEP the year that it starts. Sometimes you might think the earlier the better, as long as you go into the first week of October with all the information. That's probably the best time to be prepared for AEP, maybe the last week of September, because most of the information that you'll need for the next year isn't even available until after the beginning of October.

Sitting down with the Medicare agent or broker before then doesn't really help you a whole lot. Doing any research online, again, you might not be able to find the information from the upcoming year if you're searching before October 1st.

So I think you want to be prepared to start on October 1st, and maybe you want to gather all your information before then. If I start too early, your situation might change, your medications can change, your doctors can change, your health can change. So sometime right around October 1st is probably a great target date.

Answer: This is certainly a question I wasn't expecting. The question is, what do you like most about being a Medicare agent?

Well, I think what I like the most about it is it's one of the things I've somehow become generally good at. And I like helping people. Being able to help people with complex concepts and the confusing system that we have, it feels really good. It does feel good being able to help people and giving them some direction and answering some questions, whether they enroll through us or not. I like helping those people out.

Answer: So this question is an interesting one. The question is, can I show my original Medicare card instead of my Medicare Advantage card if the provider doesn't take my Medicare Advantage insurance? The answer is really no.

If you have selected a Medicare Advantage plan, you have generally replaced original Medicare with that private Medicare Advantage plan coverage. You can go back to original Medicare if you choose to, but you can't just choose at the point of service whether you want to use the original Medicare or Medicare Advantage. Once you move into Medicare Advantage, that generally will replace the original Medicare with that Medicare Advantage plan.

That's why it's important to understand that coverage when you're signing up for it. You also may want to know when you can go back to the original deal here. That's why it's also a great idea to speak to a Medicare specialist before getting enrolled, and not just someone who works for that company. An independent person is great to speak to.

Answer: Your question is what is Medicare Part A, what does it cover, and is it really free?

The first half of your question asks about the coverage from Medicare Part A. Part A generally covers your inpatient hospital services. It usually covers it after a deductible, and it covers some things like rehab and a nursing home or skilled nursing facility for a short period of time.

What is interesting is that the deductible in Part A, you have to be careful about because it's not an annual deductible like we're used to. It's a benefit period deductible. So anyone who only has Part A, is on Medicare, and doesn't have any other coverage can pay that deductible multiple times in a calendar year. And that's important. That's why supplemental coverage is really important.

The second part of your question is, is it really free? Medicare Part A does not charge a premium if you've always paid into Medicare for at least 40 quarters, which works out to be 10 years. If you have not paid in for 40 quarters, there is a premium, and for many people who paid that premium to get their Medicare Part A.

Answer: Should I enroll in Medicare if I already have VA benefits for veterans benefits? The answer is you don't have to enroll in Medicare, but you probably should.

The major difference is that the VA is a healthcare system. It's not insurance. If you only have the VA coverage, then you can only use the VA doctors and hospitals and so on. But when you enroll in Medicare, at least in Part A, you're going to have more choices. You can go to other doctors and other facilities, and you don't have to get your medications from the VA. You can get them right through your Medicare Part D rule on that.

So I think it will be recommended that you still get Medicare, at least Part A, but probably also Part B, even though you have VA coverage, because then you can have the best of both worlds. You can get your coverage at the VA, the care at the VA, you can do it there. Or if you want to use your coverage to get care somewhere else, you can use it somewhere else.

You don't have to. That's your question only. But the answer is you probably should.

Answer: Your question is which vaccines Medicare covers for free, for no cost. Basically all of the recommended vaccines are typically covered now at no cost. The difference is just where it gets billed. Some are covered by Part B, some are covered by your Part D drug plan. That's where it depends on where you're going to go and how it gets billed.

But generally all of your recommended vaccines are covered. If you want to ask about a specific one, you should talk to a professional and they can look up specific ones for free. I hope that helps.

Answer: Too many factors to say. Itd different for each person's situation. Best advice is to work with a professional

Answer: The question is, can I keep seeing my current doctors if I switch to a Medicare Advantage plan, or do I have to find new ones?

The answer is that depends on if your doctors are in network with the new Medicare Advantage plan. The best thing you can do is search the doctors before switching.

Answer: Hi. Your question asks if you can stay on employer coverage even though you're turning eligible for Medicare. The answer is you can stay on as long as you want.

You'll want to make sure that you talk with your employer about how many employees they have and whether your Medicare will be your primary or secondary coverage.

After that, I suggest you talk to a professional who handles Medicare Advantage and Supplement plans. Let them know where you fall in with that as far as your employer coverage and if you're going to continue working or not. They'll help you find the right answers to all those questions that are specific to you.

Answer: So your question is, can you change Medicare Supplement plans at any time? I'm assuming you mean any time of the year.

The answer is you can apply to change Medicare Supplement plans at any time. However, you have to keep in mind when you do this that the new Medicare Supplement company you are applying to outside of your open enrollment or special election periods will have the ability to ask you a number of medical questions. We'll call this medical underwriting, and they can deny you or change the price based upon your preexisting conditions or your current health situations.

That's not the same as Medicare Advantage plans, which have an open enrollment period every year. But that's the price of changing a Medicare Supplement plan. Good news is, if you're in great health, you can change Medicare Supplement plans at any time.

I hope that answers your question.

Answer: So your question is, does Medicare cover hospital observation stays, and how is it different from being admitted?

An observation stay is very different from being admitted from a Medicare point of view, because an observation stay is typically covered under Medicare Part B and is not the same as an inpatient stay. It's also important to note that the hospital needs to notify you if you are staying under the observation stay rules, and those days do not count towards your lifetime hospital or inpatient days, or your skilled nursing benefit.

There's a lot of details regarding this question, but you should definitely speak to a specialist when it comes to this question. It's an important one.

Answer: Your question is, can Medicare drop your coverage or cancel your plan? The answer is that they certainly can drop the Medicare Part B if you don't pay your premium.

Individual private health insurance like Part D also has a premium, and you do need to pay that. It can also drop it if you refuse to pay any of the additional charges like IRMAA.

They cannot drop your Medicare coverage because of a health

Answer: Your question is, what is the difference between Medicare and Medicaid? There is a big difference between Medicare and Medicaid, although they also work together.

Medicare is a federal health insurance program for the sick and aged. Medicaid is usually a federal and state cooperative plan, mostly state, that is provided for people who are disabled or low income.

Sometimes they can work together. Most of the time they do not. I hope that answers your question. Medicare and Medicaid are not the same.

Answer: The question is, does Medicare still cover telehealth visits and services in the year 2026? The answer is definitely yes, it includes telehealth visits. In fact, they have expanded some of the flexibility, including some audio only options, and they have extended some provider eligibility, so many more providers can get into the Medicare telehealth services.

You certainly can find that out, and you'll find that in your Medicare and You booklet. If you have not downloaded that, I suggest you do.

Answer: So the question is, does Medicare cover assisted living? The simple answer is no. It doesn't cover assisted living. It doesn't cover what they call custodial care. Medicare does not cover the living facility costs, room, meals, housekeeping, those kinds of things, or your ADLs, your activities of daily living. Long term care covers something like that, or in many cases, Medicaid.

But if you are in assisted living, Medicare does cover some things like doctor visits and lab work, physical therapy, durable medical equipment. If you have a prescription drug plan, it would usually cover that. So it doesn't specifically pay for an assisted living facility or any custodial care, but does cover some of those other options.

A lot of people think that because they pay into Medicare, that it's going to cover them in a nursing home or assisted living facility. The answer is that it really does not. Sometimes in a rehab, like after a hospital stay, you'll get some coverage. But that's about it.

Answer: Your question is, what are special needs plans in Medicare Advantage?

Special needs plans are typically targeted to help people with certain special needs. For example, an eligible or dual eligible person who gets Medicare and Medicaid is considered a special needs prime. You can also have a special needs plan with a chronic illness, diabetes for example, or a cardiac issue.

Different Medicare Advantage providers have designed these types of benefits to specifically and directly target and be more helpful to people in those types of demographics. So these special needs plans can be very helpful for those who really need the extra help.

Answer: Your question is, what are the disadvantages of a PPO? I guess disadvantage as compared to what? The Medicare supplement compared to a Medicare Advantage PPO maybe? I'll take a shot in the dark here that that's what you're asking about.

A Medicare supplement has no network to worry about, so as long as you're going to providers that accept Medicare assignment, you're in good shape. A PPO typically refers to, for example, a Medicare Advantage plan, and Medicare Advantage plans are much different than supplements. A PPO is going to have a network of contracted providers, and sometimes that network is going to be very geographically specific in nature. Some plans offer a national network, so on their PPOs, but many plans don't. And that PPO is usually restricted to giving coverage in their network.

Some plans subdivide where you divide that network down into smaller specific networks, like preferred and non-preferred providers, that you use for benefits and network. A PPO is usually less restrictive than, say, an HMO.

I hope that answers your question, what are the disadvantages of a PPO?

Answer: The question is, what is the main benefit of Medicare Part D? I guess the answer to that question is pretty simple. Medicare Part D provides coverage for your prescription drugs, outpatient prescription drugs, drugs that you pick up at the pharmacy, drugs that you order through mail. That's what you're talking about. It's about retail or mail order prescription drugs.

That is the main benefit. Of course there's certainly other benefits, but I'm not a physician or a pharmacist, so I can't really answer to that. But the coverage of a Medicare Part D plan is prescription drug coverage. D for drugs.

Answer: Your question is, who will make medical decisions as to what is necessary to me, my doctor or the insurance company?

It's important to note that medical decisions are made by doctors. Payment and coverage decisions are often made by insurance companies. So a doctor may prescribe a therapy or a treatment, but the insurance, Medicare for example, will often have to make a decision as to whether it's covered or not based on the doctor's diagnosis and suggestion, and also the coverage that you have.

Answer: There are many differences from every angke, premium, coverage and so much more. The best advice is to find an independent professional to assist you in the process.

Answer: Ask your broker to review your plans summary of benefits and coverage with you. Hearing aids are often an add on benefit and not baked into the medical coverage directly.

Answer: While a Medicare Advantage plan may save you PREMIUM dollars it all comes down to a couple of facors:

1. how much do you use the coverage? A MA plan will usually have copays and deductibles on most services including a max out of pocket in the thousands whereas a supplement usually does not. If you need to see physicians, specialists and get tests on a regular basis a Medicare advnatga ewill not nexessarily save you money overall because what you save in premium may beexceeded by what you spend on the cost of care services.

2. How much geographic flexibility do you need? An MA plan is typically geographically limited in network scope so you may pay for more expenses out of pocket. MAPD plans may alsohave nedtwork restrictions forcing you again to pay more out of pockey for providers you want to see who are not in network.

Answer: The CMS-L564 is important to show that you had credible employer coverage. This permits you to enroll on Part B at a later date without having to pay a late entrant penalty on your Part B premium

Answer: Medicare does not cover Silver Sneakers. Some Medicare advantage plans include Silver Sneakers or other fitness memberships. It's best to talk to your independent broker to find out which ones include fitness memberships and their accompanying benefits.

Answer: It depends. Are you currently on Medicare advantage, a supplement a drug card? How about an employer plan? The answer is not the same for everyone your circumstances will dictate what your choices are. Speak with an independent professional who can review your full situation and give you a correct and proper answer to this and any other questions you might have.

Answer: The answers are not the same for everyone. You may have to pay for Medicare if it isn't free for you. The answer is usually yes but it may not be free. I would make an appointment with an independent broker who can review your specific circumstances and give you a complete and correct answer.

Answer: So your question is what happens to your Medicare when you turn 65 if you are already on Medicare due to disability? The answer is really nothing, unless you want it to. Turning 65, you'll still remain eligible for Medicare, but you're transitioning from disability to Medicare retirement.

This is a really good opportunity for you to take a look and see what your other options may be. If you want to change your coverage, this might be a good time to do it. I would talk to your broker, or just give us a call.

Answer: It shouldn't matter directly at all but what may matter when you choose a plan. Each client has specific needs to consider. Your finances and health concerns will all figure into what best works for you.

Answer: Any Medicare Advantage plan will provide a list of network doctors and hspitals. Usually this is done online these days as opposed to a printed directory. Your broker should be able to guide you though the process of confirming participation.

Answer: You should never have to pay a licensed, qualified and certified Medicare broker, local or not. A local one will be more familiar with plans and importantly care choices where you lve than one who is not local.

Answer: A great agent or broker will have the experience to get the job done correctly so you are enrolled on the proper plan, on time and on budget. Long time clientswill usually express their satisfaction through reviews providing verifiable third party experiences. An independent broker will shows clients everything that is available good and bad and not use high pressure sales tactics.

Answer: Yes you can be denied a Medicare Advantage plan if you do not have a valid election period or you do not live in the advantage plans geographic area.

Answer: If you have met Medicare eligibility requirements you can simply enroll on Medicare part A and B through your local Social Security office or online at Medicare.gov.

Answer: You can get Medicare through a spouses benefits. But how much it costs depends on your situation, especially your (or a spouse’s) work history.

Answer: Medicare covers sleep studies (either in-lab or approved home sleep tests) when ordered by a Medicare‑enrolled provider to diagnose obstructive sleep apnea and durable medical equipment covers a CPAP Machine under Medicare part B when precribed.

Answer: Medicare part B eccess charges are balance billed over and above the Medicare allownce. Goint o providers who accept Medicare as payment in full will avoid these charges. Also a quality Medigap plan can help avoid them.

Answer: Stroke recovery and rehab are covered by Medicare. Medicare Part A covers an inpatient services. A quality Medigap plan will cover 100% of the inpatient deductible

Answer: Divoce can affect your Medicare costs which can be increased based on your household income. Additionally any household discounts may no longer apply to your coverage. Further, moving can create be a special election period to select and enroll on a new plan.

Answer: Because we have the experience to advise properly based on your own personal situation, in the Medicare world, a mistake can cost you significantly in lost money and opportunity and may not be resolved easily or at all. Unlike an agent who gets paid by the insurance company we work for, we are independent brokers who represent the best interests of our clients.

Answer: We are paid by the insurer if we do help you enroll. We do not have any allegiance to any carrier/insurer we represent our clients directly. Most pay us the same amount if at all. We are a non commission driven firm.