Grant Hamilton, Medicare Insurance Broker

Answer: Unfortunately, you can't find Medicare coverage completely free. A person can minimize their costs. Generally, Part A will be free for most people. Part B premiums are currently $202.90 and will be automatically deducted out of Social Security each month. Part A and B also have deductibles of $1,736 per benefit period for Part A and $283 yearly for Part B

Original Medicare only covers 80 percent of the medical cost and you will cover 20 percent. The 20 percent wil be a large amount if major surgery or a long hospital stay is needed.

If you want coverage to help with your 20 percent, look at a Medicare Advantage plan. Many insurers offer Medicare Advantage plans with $0 monthly premiums. They bundle basic hospital and medical care, but require you to use specific doctor networks and obtain prior authorizations for procedures. Also, you must still continue to pay your Part B premium and the Maximum Out Of Pocket cost could range between $8-10 thousand dollars.

Supplement plans like Plan N, G, or High Deductible G deserve a mention. Based on the question it would appear the person might be on a tight budget and may feel unable to afford the premiums.

Keep in mind that these Supplement plans have less overall cost compared to Advantage plans should you need to go to the hospital. There was an old television commercial that used the phrase "Pay me now or pay me later" and it is a good way to think about Supplement plans. You're paying a monthly premium upfront, but when you reach the deductible the rest of the costs should be covered for the year.

At minimum I would suggest checking a High Deductible Plan G. If you can squeeze an extra $50-70 dollars for the premium monthly, you can save yourself thousands of dollars should you find yourself needing a hospital visit and/or surgery. The deductble of an HD G Plan is $2,950. Once the deductible is reached, this plan is covered like a standard Plan G. Supplement Plans are not tied to any networks either.

Answer: It depends on your individual situation, which feels like a bit of a cop-out. If your employer is considered a small employer (less than 20 employees) they can force you to enroll in Medicare. Smaller employers do not have to operate by the same federal rules as larger companies. Medicare Part A & B will become your primary coverage.

If your employer is over 20 people, the employer cannot legally force you to enroll into Medicare. People with larger employers have three choices for their insurance. First, just stay on your employers plan. You can delay Medicare without penalty but make sure to notify Social Security of your intent to delay. The second option is to enroll in Medicare Part A, defer Part B, and stay on your employer coverage. Last, you could drop the employer plan and enroll in Medicare Part A&B.

Make sure and review your options with your employer's HR department to verify you are taking are taking a correct action. They may even be able refer you to a Medicare agent that can review Advantage and Supplement Options.

if you defer Medicare you can visit the Social Security website at this link: https://www.ssa.gov/medicare/sign-up/part-b-only. If you don't like doing things online, you can call SSA directly for assistance at 1-800-772-1213.

Answer: For most people, you're first eligible to sign up for Part A and Part B starting 3 months before you turn 65 and ending 3 months after the month you turn 65. This is what is referred to as your Initial Enrollment Period (IEP).

One thing to consider when registering is if you are still working. If you are still working, you can delay enrollment in Part B if your are covered by a creditable emplolyer plan through you or your spouse, and the employer has 20 or more people employed. "Creditable" means your employer plan must be expected to pay out at least as well as standard Medicare.

Once you stop working, you will have an 8 month Special Enrollment Period (SEP) to enroll in Part B without facing penalties. Please note that these penalties are considered lifetime and wil; be a penalty of 10% for each full year (12 months) without enrolling in Part B.

Some companies may offer retiree health plans but generally these are not considered creditable. COBRA is not considered creditable either

Answer: Medicare Agents in a local office should have a general knowlege of the area that should be helpful. For example, where I live in Washington State, there is a Vancouver, Washington in addition to a Vancouver, British Columbia. The locations are 4 hours apart by freeway. Someone who is not local may not be aware of the differences between the two cities and send a client to a clinic in a wrong location.

Medicare Agents who are local can be met in person. Some people prefer a local office to help them with a Medicare Plan. They want to be able to look the agent and make an assessment if the agent is trustworthy. Local agents will ususally engage in the community. They will set up eductional tables and senior centers, health fairs, and other community activities. They may also reach out to doctors and clinics in order to get a better overview of plans accepted and services provided.

Remote or virtual agents may be available different hours that may work better with an individual schedule. When I had my first job as a contractor working remote I might be working until 7:00 pm or on Saturday. Many agencies that meet clients in person may work a standard Monday through Friday and end the day at 5:00 pm or 6:00 pm.

Remote agents may be licensed in more states. If you move to a new state, you may still retain the agent if they have a license in the new state. However, do not automatically write off a local agent. They may have licenses for multiple states as well. Remote agents *may* also have acess to more products than a local agent. (Please note the emphasis on the word *may*.)

Overall, it comes down to client preference when meeting the agent. I think the local agents still have the advantage because of the ability to meet in person. Local agents can meet by phone or by video conferencing. Remote agents do not have the ability to meet in person.

Answer: Routine dental and vision coverage is not covered by Original Medicare (Part A & B). Dental and vision coverage is available with most Medicare Advantage Plans or as a stanalone purchase.

Advantage plans will cover preventative services like cleanings, exams and x-rays for dental patients. Advantage plans may have allowances for dental work such as root canals, fillings, and other comprehensive work. Vision and hearing may also be covered by Advantage plans,.

Standalone Vision plans may offer an allowance for glasses. They may offer yearly visit coverage and allowances for contacts and frames. Be sure and review the plan's Summary of Benefits and Plan Details to verify specific coverage.

Answer: Medicare Part A covers 100% hospice related services. Some of these services include nursing care, medical equipment (such as oxygen, hospital beds and wheelchairs), hospice aide services, counseling, and respite care.

The only exceptions that are not covered by Medicare are co-pays for prescription medication dealing with pain management. These co-pays are limited to a $5 charge. If respite care is used, there is a 5% co-insurance.

Respite care is where relief is provided for primary caregivers. This allows a break for caregivers while making sure their person is still safe. Respite care is covered up to 5 days at a time.

Whether or not you should get on Part B depends on your prognosis from your doctor. Hospice care is designed to support individuals with a life expectancy of six months or less if their illness follows its natural course. Hospice can be extended as long as the patien continues to meet eligibility standards. Recently, former President Carter was in hospice for 22 months before he passed away in December 2024.

Overall statics show the median length of hospice care in the US is 18 days. 50% of patients pass away in the first three weeks. Up to 15% of patients survive longer than 6 months. With those statistics in mind, I would suggest to someone that they go through the Part B process only if they have a complete understanding of their remaining life expectancy from their doctor.

Some people will stay enrolled in Part B and Advantage or Supplement Plans if they need medical care or prescriptions unrelated to the hospice diagnosis. Obviously you want to have coverage if you have needs for non-medical care or prescriptions. Conversely, I suspect someone on hospice is not going to have a need to see an orthopedic surgeon. My best advice is use common sense based on your current condition.

Answer: There are no dedicated Medicare offices. You can resigster for Medicare at your local Social Security office of online at www.ssa.gov. You can alo contact your local office of the State Health Insurance Program (SHIBA) which provides free counseling and will help you understand the complexity of Medicare rules and processes.

Medicare also offers support through a toll-free numbner at 1-800-MEDICARE or use their live chat feature. This office will be able to assist you with general questions, penalties, checking eligibility, or submitting a complaint.

You can also use a local, indepoendent Medicare broker. Many brokers will offer an educational seminar introducing Medicare to people ready to enroll. Brokers work with multiple insurance carriers and should be able to suggest plans based on your needs.

Answer: Medicare Parts A and B do not pay for dental implants. For that matter, they do not cover dental items like routine cleanings at all. You may get dental coverage through Medicare Advantage Plans or stand-alone dental plans.

Exceptions for dental coverage on Part A for Medicare would be if the procedure is medically necessary. However, the process for covering dental procedures or implants would be linking the dental procedure to another procedure such as jaw reconstruction or removing a tumor.

Advantage Plans or stand-alone dental plans generally do not cover the full cost of implants. Check your plans Summary of Benefits to see your coverage limits and maximum benefits. You may have high copays as well.

Answer: Most, but not all, Medicare Advantage Plans offer dental coverage. When you are signing up for a plan make sure to ask if dental coverage is included and ask for the coverage amount. This will be available to you in the plan's Summary of Benefits.

Keep in mind that since Advantage Plans are run by private companies, the dental benefits will not be the same. Some may have different coverage dollar amounts. Some plans may offer preventative services like two cleanings per year, x-rays, orl exams and flouride treatments. Others may offer additional coverage through a dental rider. This means that for an additional fee you can purchase more coverage for dental work.

Answer: My employer offers what we call a "Medicare 101" webinar introduction two times each month up to the time when the Annual Enrollment Period (AEP) starts in October. These webinars are designed to have many clients watching the presentation.

We also offer individual meeetings in our local offices, by phone or by Zoom. Based on feedback, most clients appreciate the breakdown of terms and options between Supplement and Advantage Plans. We give them a nice full color brochure to take home for reference.

Ideally, we want the potential client to do a seminar during their initial enrollment period. We want to bulld upon the knowledge and schedule an appointment after they have received their Mediare card.

Answer: There are no co-payments on Plan F. As long as your premiums are paid, all of the Medicare gaps are covered. The covered costs include:

Part A coinsurance and hospital costs (including an additional 365 days after Medicare benefits are exhausted).

Part B coinsurance or copayments (generally the 20% gap)Blood (the first 3 pints each year).

Part A & Part B deductibles

Part B excess charges (covers the extra 15% a provider can charge above the Medicare-approved amount).

Skilled nursing facility coinsurance.

Foreign travel emergency medical care (up to plan limits)

Plan F is only available to people who were eligible for Medicare before January 1, 2020. If you were eligible on or after that date, you cannot enroll in Plan F. If you already have it, you can keep it as long as you continue to pay your premiums.

Answer: Yes Medicare has deductibles for both Part A and B. Part A i(Hospital) is not a standard yearly deductible, but a deductible for a benefit period of $1,736 if you have an inpatient hospital stay. A benefit period begins when you are admitted to a hospital and ends when you haven't received inpatient care for 60 days in a row. You can have multiple benefit periods in a single year. If you have multiple benefit periods, your Part A deductible will reset.

Part B (Medical) has a standard yearly deductible of $283. Once the deductible has been met, Medicare pays 80% and you pay 20%. If you add an Advantage Plan, deductibles wil vary by plan. If you add a Prescription Drug Plan, deductibles will vary but are capped at $615 per year by the government.

Part A has no premium, Part B has a premium of $202.90. If you decide to add other sevices, like a Supplement Plan and a Prescription Drug Plan (Part D) you will still need to pay your Part B premium and whatever premium you have for a supplement or drug plan.

Answer: Moving to a new state opens a Special Enrollment Period (SEP) for your move where you can switch with what's called . The moving process is a bit involved. First, you will need to stop your Advantage Plan and go back to Original Medicare. Once you are back in Original Medicare, you can apply for a Medigap Plan.

Keep in mind that moving from Medicare Advantage to Medigap does not cover prescriptions. You will need to add a separate Prescription Drug Plan (Part D) with your Medigap Policy. Don't forget to check and see if your medications are covered.

You’ll have up to two months to get a Part D prescription plan, and you’ll qualify for a Medigap guaranteed issue period that lasts up to 63 days after your Medicare Advantage coverage ends. During this time, you can purchase most Medigap plans regardless of existing health problems.

Although the Medigap Plans offer the same coverage, premiums are not the same price. Also, different sates have their own rules for Medigap policies. For instance, New York, Connecticut, and Massachusetts offer enrollment at anytime, without the need for a Special Enrollment Period. Check with a licensed Medicare Broker in your new home town to help you with the specific rules in your new hometown.

Answer: Generally, you are not able to switch a plan once the Annual Enrollment Period ends December 7. There are some exceptions where you can change an Advantage or Prescription Drug Plan outside of the Annual Enrollment Period. Before you make changes, I'd suggest reviewing your prescription prices in this example for the remaining medications. It's possible you still have a competitive price for your other prescriptions and may not benefit from switching plans.

Assuming you still want to switch plans and use a Medicare Advantage plan, you can make a one-time change during the Medicare Advantage Plan Open Enrollment Period from January 1 to March 31. Individuals can switch can switch from their current Medicare Advantage plan to another Medicare Advantage plan or go back to Original Medicare.

It's possible you may qualify for a Special Enrollment period if you experience a "qualifying life event," Unfortunately prescription changes mentioned in the question do not count as a qualifying event. Qualifying events include the following:

Moving out of your plan's service area.

Losing Medicaid eligibility or gaining "Extra Help."

Moving into or out of a nursing home.

Your plan leaving the Medicare program.

A full list of Special Enrollment Periods can be found on Medicare.gov. I wouid encourage people to visit the website since there is lots of helpful information available. Thank you.

Answer: Hello!

Medicare Part B offers coverage for counseling programs that help people quit smoking. Part B will cover up to 8 sessions every 12 months. You may also pay nothing in the provider accepts the assignment from Medicare.

Your doctor may choose to prescribe medications or over the counter nicotine replacements like patches, gum or lozenges. The prescriptions may come in the form of nasal sprays, inhalers or pills. One of the common names for a medication is Chantix. It's a good idea to check with your plan to confirm coverage and cost. If you are on an Advantage Plan, your carrier may offer additional incentives.

Note: Assignment is an agreement by your doctor, provider, or supplier to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance.