Elliot Andrews, Medicare Insurance Agent

Answer: First step is to gather all of her pertinent medical information, Medicare ID, doctors, medications, conditions, medical history. Next would be to call a licensed Medicare agent who works with multiple providers and plan types. This allows them to be able to discuss several options and how they all work. Medicare is by no means a “one size fits all” system.

This should all be discussed further with an agent, but Medicare Supplement plans have limited care included and often require multiple different plans (prescription, dental, vision, hearing, non-Medicare) to get a full scope of insurance coverage. Medicare Advantage plans simplify the process but can have various levels of co-pays/co-insurances to keep in mind.

Again, nothing is perfect for every single person, and each person has differing circumstances. Speaking to a licensed professional who works with more than one provider is the best option to get things set up properly and achieve peace of mind.

Answer: Original Medicare consists of parts A & B. Part A covers Hospital and Part B covers Medical (doctors visits). These both have deductibles that change every year before kicking in with a 20% coinsurance for all related claims. With no additional coverage outside of A & B you are responsible for that 20% with no maximum limit. Part A has no premium and Part B carries a premium (currently right around $204/month)

You would typically want to consider Prescription drug coverage (even minimal amounts to avoid a penalty in the future), a supplement plan to cover the 20% co-insurance, and possibly a Dental, Vision, Hearing plan to cover non-medical costs. All of these typically carry a premium and their own deductibles.

Medicare Advantage combines your A and B, and typically, dental, vision, hearing, and prescription drug coverage all into one single plan. These plans are usually $0 premium (you only pay the Part B premium that Medicare requires - though some Medicare Advantage plans help reduce that cost). These plans have various co-pays or co-insurance for different claim types. They also have a Maximum Out of Pocket amount that caps your total costs per year (useful in the event of a major medical procedure).

As for which option is best, it is highly recommended to speak to an agent about the differences and take your personal medical and financial situation into account before deciding.

Answer: Most Medicare Advantage plans will help cover chiropractic care at low or $0 copays. You would want to make sure your provider accepted that particular coverage.

There are also other benefits in Medicare Advantage plans to help with home health products that can make navigating bad back pain easier. Reach out to an agent to discuss potential options.

Answer: Whenever you are written a new prescription you should check with your insurance provider to make sure it is covered. With Medicare insurance you may find that a certain prescription is not covered and may need to look into changing carriers to cover that specific drug if needed. If the prescription is already covered you do not need to make any changes.

Answer: Original Medicare A/B does provide some help for vision care. Typically a Medicare Covered Eye Exam would be $40.

However there is not much coverage beyond this exam unless you are dealing with cataracts.

Medicare Part C (Medicare Advantage) Plans often provide significantly more for vision. This can include lower co-pays for exams, coverage for surgeries, and coverage for lenses/frames/contacts.

Answer: This depends, if you travel to multiple places for “vacation” type travel, then it is possible that a Medicare Advantage would be a better option and would save you money in premiums. If you live in multiple places (say in one state for half the year, and a different state for the other half) AND have doctors that you REGULARLY see in both places a Medigap plan is your best option despite the higher premiums.

If you absolutely must be on a Medigap plan it is highly encouraged to regularly check premiums from multiple carriers.

Answer: You do not need to enroll in Medicare while you are still working, but it would be advantageous to compare the cost and coverage difference. For MOST (not all) Medicare coverage would save money and often times also provide better coverage than an employee group plan.

Answer: You aren’t required to change your MediGap plan (though there may be less expensive option available in your new area), but if you also have a Prescription Drug Plan you do need to have that changed for a local plan.

Contact a licensed Florida agent for assistance.

Answer: The most misleading is food benefit cards. The reality is that most seniors are eligible for some sort of assistance for over the counter health and wellness items, but it is a smaller group that qualifies for assistance with groceries. Those that do also often are not eligible for the extremely high amounts that are advertised.

Often times those that qualify aren’t able to receive those very high amounts because those plans are not actually available in their area, or there are other factors that contribute.

As always, the best option is to speak to a qualified, licensed agent who can explain all your available options from multiple carriers.

Answer: A licensed Medicare agent who is contracted with multiple insurance carriers is your best bet. Financial planners or other consultants often help advise on Medicare due to its connection to retirement, but they often don’t have the required expertise or may have a financial incentive to direct beneficiaries a certain way.

You can search the NIPR database, or even google for licensed agents in your area/state.

Answer: This is not a problem specific to Medicare, but rather to the overall US health care system. However, there are several options available through Medicare Advantage plans that allow beneficiaries to take a much more preventative approach to their health. These plans often include incentives for healthy lifestyle activities, coverage/reimbursement for gym memberships, and benefits to cover supplements, vitamins, and healthy foods.

Answer: No, Medicare is not required for anyone. If someone is eligible for Medicare it is always worth considering as a healthcare option, but it is not required.

Answer: Typically yes. It can depend on what type of coverage you have in place, but normally you do want to review your coverage anytime you move. Especially if you move to a new state. Contact an agent to review available options in your new zip code.

Answer: There is no restriction based on age for getting a CT scan. Though as your age increases your doctor may take more precautions with other health factors when deciding to order a CT scan. If you have been told you cannot get one the reason is not age based.

Answer: The short answer is yes. The difference for a beneficiary in this situation would be the premium cost.

For a typical enrollee who worked in the US and paid into Medicare they would receive Part A for no cost. They would need to only pay their Part B premium. For someone in the situation (or something similar) that is asked here they would need to pay premiums for both Part A and Part B.

Answer: You should primarily review your plan yearly during the Annual Enrollment Period. This window is from October 15th to December 7th. Agents can begin discussing the upcoming plan year on October 1st, but no applications for this period can be submitted until October 15th.

If you are on a MediGap (Supplement) plan, it is also advised to review your coverage during this window OR during your birth month. Many states have rules allowing you to make easy changes during that month.

You should also review your plan immediately if you move, have a significant health event, or become enrolled/disenrolled with state Medicaid or Federal Extra Help (LIS).

Answer: The Medicare Advantage Open Enrollment period is different than the Medicare Annual Enrollment Period.

It is for beneficiaries enrolled into a Medicare Advantage plan that started on January 1st of the current year or older, and the window runs from January 1st to March 31st. This enrollment period allows beneficiaries to change to a different Advantage plan, or disenroll from Part C altogether and re-enroll into a stand alone Prescription Plan with Original Medicare.

Answer: The answer to this question is largely individual. Several factors can come into play. Do they have a spouse who isn’t eligible for Medicare yet that relies on their employer’s group insurance plan? What kind of premiums are they currently paying for the employer group plan? Is the group health plan closed to them forever if they decide to enroll into Medicare?

There are many things to take into account with this scenario and it will be different for every beneficiary. Often it is the case that Medicare would be a less expensive option for them, but the route to get there is often different for each person.

Speaking to an agent who can help compare the various options and associated costs, or their employer plan coordinator is the best route.

Answer: The determination for which vaccines are covered is decided based on what type of coverage you have. Most vaccines will be covered under Part B, so with Original Medicare only you would be responsible for 20% of the cost. With a Medicare Advantage plan most vaccines are a $0 copay, and with a Medicare Supplement it would depend on the plan and specific coverage outlined in the Summary of Benefits. You should discuss specific vaccines with your insurance provider. They will be able to tell you exactly which ones are covered under your plan.