Jake Dalton, Medicare Insurance Broker
Jake Dalton
Dalton Insurance Agency of the Carolinas, LLC
Medicare Broker Licensed in NC, FL, GA, SC, TN and VA
31+ Years of Experience
Contact Details
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Location
Brevard, NC
Jake Can Help With:
About Me
Hello, I'm Jake, your neighborhood Medicare insurance advisor. My expertise lies in the realm of Medicare, and my mission is to assist you in identifying the perfect plan tailored to your unique requirements and financial capacity. Allow me to navigate the array of plans available from both nationally and locally esteemed companies on your behalf. And don't worry, my services are provided free of charge! Contact me to discover your Medicare insurance alternatives and don't forget to mention that you discovered me on Medicare Agents Hub!
Directions to My Office
Q&A with Jake Dalton
What's your go-to strategy for helping someone decide between Medicare Advantage and Medigap?
Answer: Education. Then they make their choice. We educate our clients first. Then help them with their decision get enrolled. Simple as that.
What's the trade-off between a Medicare Advantage PPO and HMO when it comes to flexibility?
Answer: Many HMO's are nationwide now, except for your state-based Blue Cross plans. However, you MUST use a provider in-network to facilitate coverage; otherwise, you self-pay (no coverage).
The PPO's link up to other PPO's in other states too, but if you do use a provider out-of-network, then you still have coverage; just pay a different copay (or co-insurance) up to the maximum limit (plan specific).
But always remember, in the event of an Emergency, it is considered in-network no matter where you obtain care. This applies to HMO or PPO plans. Emergency coverage is applied as in-network.
Does original Medicare require referrals before visits to specialists?
Answer: Not yet, but they are in around two dozen markets trial testing pre-approvals for certain procedures. Most likely this will go Nationwide soon with these trials.
I applied for a Medigap plan and got denied because of my health history-how is that even legal when I've paid into Medicare for years?
Answer: Medi-gap plans (otherwise known as Medicare Supplements) are not governed by Medicare. They are underwritten by insurance companies. The risk has to be acceptable for the insurance company to assume the liability. Has nothing to do with Medicare, or what you've paid into the system.
Whereas Part C or Medicare Advantage plans are highly governed by CMS (Center for Medicare Services) and do NOT ask any health questions.
What's the best way for seniors to protect themselves from Medicare-related scams?
Answer: Don't call 1-800 numbers off tv/radio ads.
Don't answer calls that you don't recognize the number.
Find a local, experienced and trusted agent to call with questions, to review mailers, and to guide with the important Medicare decisions.
My clients bring by their mail for me to review because they are so inundated with mail that they are not sure what is legit, and what is not.
Do I need a Hospital Indemnity Plan if I have Medicare Advantage? What if I am hospitalized twice in the same year?
Answer: HI plans are a great way to cover those most expensive copayments that are in Advantage plans. From Hospitalization, ER, Ambulance, PT Therapy visits, cancer diagnosis and so on. It reduces that maximum out of pocket for the client to a very low, reasonable amount. The company I use for these plans, has an automatic 'replenishing' of the benefit for hospitalization to full benefit, after a 60 day time-lapse after a hospitalization.
If Medicare Supplement (Medigap) plans are better for long-term coverage, why don't more people choose them?
Answer: 1. Increasing costs each year with premiums.
2. Prescription formulary's are more expansive on the Advantage plans than they are on stand-alone PDPs.
3. Some people just cannot afford the premiums of a Medi-gap plan, plus the Part B premiums (Both of which increase annually).
4. Under 65 persons on Medicare due to Disability can pay upwards of $500 a month or more for a Medicare Supplement; not including a Part D plan too.
5. Many Advantage plan's maximum out-of-pocket is sometimes less than what is paid annually for premiums on Medigap plans.
6. Some people are most interested in Dental or Hearing, or Vision coverage that cannot be obtained under OE Medicare and Med-Supplement plans.
Just a few quick thoughts this busy AEP season.
I missed my Medigap window by a few months and now no one will cover me without underwriting. Why isn't this rule more well known?
Answer: This is why it is recommended that one works with a competent Medicare broker! As a broker, there can be workarounds for situations such as this, too. In NC, some companies will allow you to enroll in a Medicare Advantage plan, and then move over to a Medicare Supplement plan (Medigap) at a later date. My next question would be... Did you get enrolled in a Part D plan to avoid that late penalty?
Like I said, in the Medicare Broker world, these deadlines are common knowledge, and is one of the main reasons for working with someone that does this day-in & day-out (Over 30+ years of experience myself).
What do you like most about being a Medicare agent?
Answer: Helping people make informed choices related to their coverage and care. Also, developing relationships that last (have lasted) for over 30 years. It is very rewarding.
How can I plan for Medicare costs if I expect to need long-term custodial care in a nursing home or assisted living facility?
Answer: Medicare does not cover custodial care in a Nursing Home. You would need to purchase a LTC policy while healthy. There are options with Annuities, Life/LTC hybrids, and traditional LTC policies.