Edward Smith, ChFC, CRPS, AIF, Medicare Insurance Broker

Answer: I just love seeing them have that ah ha moment. It makes me feel good knowing that they have peace of mind because of something I have had a small part in.

Answer: I was able to explain to a person who wanted to enroll into a Medicare Advantage plan, that since he had very expensive infusions every 3 months, he would max out his out-of-pocket expenses with the MAPD plan due to the infusions being given in the medical facility. They would have been covered under Part B (20% co-insurance). Instead, I enrolled him in a Medicare supplement that covers all part B except the small part B deductible each year. It has saved him approximately $5,000 every year.

Answer: Because there are many seniors that have extremely high-cost drugs. The lower out of pocket maximum could very well be the difference in life or death for some people.

Answer: Being involved in the decision-making process. Offering support but giving them the power to decide.

Answer: Not necessarily. It covers a large percentage (80%) of covered expenses but the 20% the Medicare beneficiary is responsible for has not cap and medical expenses can add up quickley.

Answer: There are several things to consider. #1 You could be opening yourself up to multiple deductibles due to the fact that a new Part A deductible could be assessed each benefit period (60) days. #2 there is no maximum out of pocket expense on the 20% you would be responsible for. Original Medicare only covers 80%, you are responsible for the 20% with no cap, each and every year.

Answer: I walk them through a presentation that explains original Medicare basics, what is covered and what is not. Then, I explain how to cover what original Medicare does not and the pros and cons of each solution. This allows the client to make an informed decision as to what they think works best for them. I educate and the client decides.

Answer: It is always good to have an advocate. If you work with an independent agent, you have a small business owner that needs and wants your business. If that person is worth their salt, they will always put your interest before their own. The thing that benefits the independent agent more than anything, is what I call shelf-life. The longer you stay with an independent agent the more they make and are able to grow their business. Also, buying from an independent agent doesn't cost you anything. The price and benefits are the same. However, as your needs change, or benefits change from year to year and from company to company, that agent can always steer you to the plan and company that best fits your needs through the years. Relations matter, 800 numbers can't do that.

Answer: Yes, but there are stipulations. If you have been enrolled for more than a year in the Medicare Advantage plan, you may have to qualify health wise by answering a few underwriting questions. If you have been enrolled in your Medicare Advantage plan less that 12 months, you can use an SEP called, the Trial Right SEP any month during that first year of MAPD enrollment. This is a once in a lifetime SEP.

Answer: You can use a discount card to use toward prescriptions not covered by your plan. You have to remember though, that these purchases will not count towards your deductible or your out of pocket maximum.

Answer: The OTC benefits may be used to cover things like, minerals, vitamins and other needs. Not all plans other these benefits and the amount allotted is different from plan to plan.

Answer: As an agent, I do both but I always offer in-home consultations. I think people appreciate being able to put a face to a name. It is comforting to know your agent cares enough to meet with you from time to time to help you.

Answer: Annuities can provide a dependable income that can not be outlived. They also can allow you to take money that has taxable interest income and move it into a tax deferred account. This could possibly lower your income enough to reduce part B premiums and more. There are also, no-load fee-only annuities which do not have surrender penalties or fees.

Answer: There are resources for folks that have limited resources. Medicaid and local support services. Low income subsidies as well as dual-eligible plans.

Answer: You will have 60 days from the time you come off your group coverage to enroll in a supplement or Medicare Advantage plan. The Social Security Administration will tell you that you have 8 months to enroll in part B from your last day of coverage. While this is true for part B, it is not true for a supplement or a Medicare Advantage. If you miss this deadline, you may have to wait until the next Open Enrollment to enroll in a plan.

Answer: You have a guarantee issue enrollment period when you first become eligible, due to turning 65 or coming off of a group health plan after age 65. Once you pass this initial enrollment period and want to change plans you may be required to go through underwriting to see if the insurance company deems you insurable. The only exception I know of is, if you enroll in a Medicare Advantage plan and then decide you want to go to a Medigap (Supplement plan), You can, during the first year of coverage. This is called a Special Enrollment Period ( SEP). It is called your Trial right SEP. You can always go back to a Medicare Advantage plan, as there is no underwriting with these products. However, if you want to change from one company Medigap to another you would be subject to underwriting.

Answer: Are my doctors in network, How are my prescriptions covered by the insurance companies formulary list, will I be traveling a lot, Does the plan I am considering pay for charges outside of their primary network.

Answer: Not necessarily. I think you must look at, what is the chance I am going to have ongoing health issues? Are you going to have to pay these co-pays every year? And also, even if you do, Will these copays equal more than the monthly premium, I would have paid for a Medicare supplement and a standalone PDP plan? You may consider buying a hospital indemnity plan. These policies help with out-of-pocket copays and still cost less than Medicare supplements. You can use them in conjunction with your Medicare Advantage plan.

Answer: Yes, once your initial enrollment period is past you will have to go through underwriting. The only exception to this I know of is, if you enroll in a Medicare Advantage plan and then change your mind, you can change to a Medicare supplement within the first 12 months of enrolling in your Medicare Advantage plan. This is an SEP call Trial Right SEP.

Answer: It should cover everything that is considered medically necessary. You have your part B deductible, and it should cover the 20% that original Medicare doesn't cover. Check and see if your state allows for balance billing. My state does not. Balance billing is when the doctor or facility charges more than is allowed by Medicare.

Answer: Yes, they can deny coverage. However, there is an appeal process you can use to see if the insurance company will make an exception. It may require an explanation from your physician as well as supporting documentation, but it can be done. I hope this helps.

Answer: Since Medicare Advantage plans use networks, this can happen. If you are concerned about this, you could do one of two things. You could make sure you go with a PPO plan, so that even if the facility were to drop out of the carrier's network, there would still be some out of network coverage. Secondly, you could consider purchasing a Medicare Supplement plan. These plans do not use network and allow you to see any doctor or go to any facility that accepts original Medicare. I hope this helps.

Answer: There are Medicare Advantage plans that use PPO Networks and HMO networks. PPO networks are larger and offer in and out of network coverage, although you will incur a higher out of pocket cost for out of network services. HMO plans offer in network coverage only except in the case of emergency care and some other limited situations. In some states there are PFFS (Private Fee for Service) plans. These plans allow you to go to any doctor that accepts original Medicare and is willing to accept the PFFS plans terms and conditions. I hope this helps.

Answer: Mostly the limitations of only having coverage for in network services, except for emergencies and some offer limited situations.

Answer: Start reading and preparing late September or early October. Agents are allowed to tell you about the new plans coming for the next year starting 10/01 but cannot submit an application until 10/15. I hope this helps.

Answer: Most of the time, all I see is slightly higher co-pays and slightly less extra benefits than HMO plans. The biggest reason to go with a PPO is if you are planning on traveling a lot or have a plethora of medical professionals you see for several different reasons. I hope this helps.