Edward MacConnell, Medicare Insurance Broker

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.