Edward Wooten, Medicare Insurance Broker

Answer: Reading your Annual Notice of Change (ANOC) from your insurance company is a great way to stay on top of any changes to your plan for the upcoming year. This is where having an agent comes in handy, as they can keep you updated on plan changes and explain how those changes might affect you moving forward.

Answer: You can buy a Medigap (supplement) plan without medical underwriting when you first become eligible for Medicare at age 65 or if you delayed Part B while still working. A Medigap policy can also be guaranteed issue if you’re enrolled in a Medicare Advantage plan and that plan makes significant changes, stops covering your area, or leaves Medicare altogether.

Answer: Usually, you’ll cover all costs upfront and then submit an itemized bill to Medicare for reimbursement. Since Medicare offers limited travel medical coverage outside the U.S., you might want to consider getting a travel insurance policy for extra protection.

Answer: Original Medicare lets you see any doctor who accepts Medicare, giving you the freedom to choose your physician. Just remember, it doesn’t cover all costs, so adding a Medigap (supplement) plan can help provide extra coverage and protection.

Answer: Medicare can be tricky, but taking the time to learn about it is worth it. A major life change might shift your needs, and having a licensed Medicare agent by your side can help keep you informed and guide you through the process.

Answer: Max out of pocket (MOOP) limits can change each year. Review your Annual Notice of Change (ANOC) for policy adjustments and or work with a licensed Medicare agent/broker to stay informed.

Answer: The Open Enrollment Period (OEP), which ends on March 31st, gives anyone currently enrolled in a Medicare Advantage plan the chance to switch to another Advantage plan or move to Original Medicare. You can only make one change, so once you decide, you’ll need to stay with your new plan for the rest of the year.

Answer: If you’re working past 65, depending on your company size and work history, you might not need to apply right away. Still, signing up for Part A can give you extra protection when paired with active job or union coverage. If you’re getting Social Security or railroad retirement benefits, you’ll be enrolled automatically! You can delay enrollment if you keep working, but you’ll need proof of credible health coverage when you sign up for Part B. Once you do enroll in Part B, your monthly rate will be based on your income from two years earlier.

Answer: Part B covers part-time and intermittent home health for specific services once your doctor certifies it is medically necessary.

Medicare will NOT cover: caregivers, 24hr care, meal delivery, and personal or custodial care.

Answer: Always be cautious of fraud and scams. Treat your Medicare number just like your Social Security number. Social Security and Medicare will never call you first, and if something feels off, trust your instincts. Working with your broker or agent can help keep you protected.

Answer: I got a call from a business owner whose wife had been diagnosed with cancer. She had opted out of Part B since she was covered under their company’s group plan. During her treatment, they began receiving unexpected bills and couldn’t understand why insurance wasn’t covering them. After meeting with them, I was able to pinpoint the gaps and secure the best coverage for her. Now she can focus on getting healthy and enjoying life without the stress of mounting medical bills.

Answer: If you are under 65 and have a disability you could qualify for Medicare coverage. If you are covered under a group health plan, the number of employees determines if the plan will pay primary or secondary.

Answer: After the death of a spouse, the surviving partner receives only the higher of the two Social Security benefits, not both. When a spouse passes away, the surviving spouse may inherit the higher benefit as a survivor’s benefit if it exceeds their own retirement benefit. Social Security only pays one benefit, either survivor or retirement. If a person qualifies for both, they will receive the higher amount only.

Answer: One is not better than the other. Find the best plan for you, your lifestyle, and your wallet. Generics are always cheaper than brand name and some plans will give you a better rate than others. Contact an agent to see what prescription plan is best for you.

Answer: Yes, there is a specific time during the year you can change. If you choose Original Medicare and are thinking about adding a supplement (Medigap) policy, it is best to do so within 180 days after enrolling in Part B.

Answer: Yes, Medicare will cover medically necessary screenings under your Part B coverage. Services and tests are covered to diagnose or treat a condition. When your doctor recommends a screening, depending on your plan you may be responsible for a small copay, but what's a couple dollars to get or staying healthy!

Answer: Being informed can deter the regret. Similar to car and house insurance you really do not know how great your coverage is until you have a claim. With a supplement/Medigap you're covered for the remaining 20% on covered health services and supplies. You do pay a monthly premium for the supplement/Medigap plan as it does provide consistency and flexibility. With an Advantage plan, you pay as you go and are subject to changes every year in coverage and out of pocket expenses. There are plans that cover specific conditions at a relatively low cost that can help mitigate big bills.

Answer: You will have coverage wherever you travel to in the country. If you are traveling for months at a time there are companies and plans that may accommodate you better. If you are traveling out of the country adding trip insurance is a good idea.

Answer: Your premiums are based on your TAXABLE income from two years prior. 2027 premiums will be based on income from this year so speak to your tax accountant and or financial advisor to help you prepare for future premiums that most likely will be more than they are now.

Answer: Your part B covers equipment that is medically necessary. Make sure your doctor and suppliers accept your plan, so you won't be hit with paying for all of it. If you purchase equipment hoping to be reimbursed you may be disappointed.

Answer: Yes! Part B will cover those with diabetes, kidney disease, or if a kidney transplant was done within 3 years. In order for Medicare to cover, your physician must recommend the service and only a registered dietitian or professional nutritionist will be approved.

Answer: I would recommend sitting down with a Medicare professional and work together selecting a plan that works best for you! Many factors come into play so ask questions to know how that plan will fit your needs. Ask your family and friends why they suggest one over the other and discuss those concerns when speaking to your agent. They all love and care for you but select the option that is in your best interest!

Answer: Majority of advantage plans are similar to plans you may have through an employer. Including major medical coverage you may have also received vision, dental, hearing. Advantage plans will have a network of doctors you may choose from, coverages and the max out of pocket may be adjusted from year to year, and flexibility to choose a different plan each year.

Answer: There are many options to help get the costs of your prescriptions lowered. Ask your physician if there is a generic or alternative option for you. There are many online sites offering help with certain prescriptions. You may also contact the drug manufacturer, your insurance company, and or speak to your pharmacist to see if there is another option or payment plan.

Answer: Majority of Advantage plans include hearing coverage. There are a few ways to verify:

1. Contact your agent (fastest)

2. Review your plan booklet or documents

3. Create an online account, which is a great way to stay informed about your plan including any perks your plan may offer.

4. Call the company you are insured with

Answer: Enrolling in Medicare when you are first eligible is crucial to avoid being penalized, however, if you continue to work past your IEP (initial enrollment period) you may be able to delay your enrollment by having creditable coverage. The two main reasons you would be penalized is not enrolling during your window and/or not having creditable coverage.

Answer: Most plans will and do cover medically necessary lab tests and preventive screenings that your physician orders. Engage in conversation with your physician and nurse so you understand why the tests are being ordered and performed. You and your doctor being on the same page leads to a healthier you!

Answer: If you are still working, deciding to join or delaying Medicare can be a big decision. There are a few factors that can come in to play if you are thinking about delaying. Be proactive and contact an agent to help you avoid making a costly mistake.

Answer: Once you are approaching 65 or contemplating retirement if you're working past 65 is a good time to start researching. Prior to the beginning of your first 3 months of the seven-month window (IEP-Initial Enrollment Period) is worthwhile. Any changes to existing Advantage plans are released mid-October so contacting an agent can make it easier to decide if your current plan will continue to fit your needs.

Answer: If your employment or health coverage ended within the past 8 months, whichever happened first, you may qualify for Special Enrollment. You might also be eligible if you're currently covered under a group health plan or have an exceptional situation. If neither of these situations apply, you can enroll during the General Enrollment Period, which runs from January 1 to March 31.

Answer: Your part B covers many preventative services. Medicare may cover some services and tests more often if those services are needed to diagnose or treat a condition. Majority of services are covered if administered by a doctor or other qualified health care provider that accepts your plan, however, you could be responsible for your deductible.