James Stang, Medicare Insurance Agent

Answer: It depends on the policy you enrolled in but normally out of network doctors will not be covered by an HMO. There are exceptions based on someone’s individual situation and you should ask your carrier if you could get one.

Answer: Explaining the different parts of Medicare, how they differ and the costs. Then ask questions about their health, if they have any issues they are currently treating and then explain how the different options would look moving forward.

Answer: That everyone should be in one type of plan. Different people might get more benefits from different plans, no Medicare plan is one size fits all.

Answer: Co tact Socisl Security to enroll in Part A and Part B. That is the first step for everyone! Once you have your MBI number you can contact an agent to enroll in a plan that fits you!

Answer: I absolutely think it should but that is a question for Congress. I'm sure any of the carriers would support alternative treatments that are proven to be effective.

Answer: I agree, the different lettered parts and plans can be confusing. I host Medicare education events for UnitedHealthcare and would be happy to help you understand the different parts of Medicare to find the option that suits your individual situation.

Answer: That depends on your plan and your provider. If you enroll in a HMO, your provider would need to be in network in most cases. A PPO plan would allow you to see non-network providers if they are willing to bill the carrier and there is sometimes a higher cost.

Answer: Medigap plans offer the ability to see any doctor that accepts Medicare without any networks. You also have no co-pays when you access services. Medigap plans might not be right for everyone but they do have advantages.

Answer: You need to be covered by a MA plan with a national network or by Medicare A & B with a Supplement. It sounds like you are covered by a Medicare Advantage plan with a local network.

Answer: You need to be enrolled in Medicare when eligible or have credible coverage to not be penalized. Credible coverage is normally an employer plan or other group health plan.

Answer: A scope of appointment is a government required document. It is designed to make sure unscrupulous sales agents don't use Medicare as a way to get their foot in the door to pressure you into buying other products. I am not familiar with the regulations for call centers, but it is absolutely normal for field agents.

Answer: There are different types of events a Medicare agent can run. .What you are talking about is probably a formal sales event, where an agent/broker can discuss plan specific information. I frequently offer Medicare Made Clear educational events to people interested in the nuts and bolts of Medicare coverage. By law, we are not allowed to discuss plan-specific information at an educational meeting.

Answer: It depends. A Medicare Supplement gives you freedom to go to any provider that accepts Medicare with no networks but can be a lot more expensive than a Medicare Advantage plan. You should talk to a licensed agent to see how each would work for you specifically before making a decision.

Answer: Guarantee Issue means there is no medical underwriting when applying. For Medicare Supplement plans, the most popular time to enroll with Guarantee Issue is three months before your 65th birthday, the month of your 65th birthday and the three months after your 65th birthday. If you delay enrolling in Medicare Part B, you have another window around the start date of your Plan B.

Answer: Medicare is based on paying in via working for 40 quarters. Unless you can qualify through a spouse, you need to speak with someone at Social Security to check on qualification.

Answer: Medicare Advantage Plans have a network you have to use where Original Medicare with a Medicare Supplement do not. The MOOP (max out of pocket) could also be higher than the annual premium for a Medicare Supplement, meaning in a year where you have multiple hospital stays a Medicare Advantage could cost more.

Answer: You need to go through a cost analysis with a licensed agent. That will help you understand the costs of the different types of Medicare coverage in relation to your health. The best time to buy is when you are in your Guarantee Issue period.

Answer: In most cases I would say no. However, there are times when those types of policies can help. It's a personal choice as to if the premium for those types of plans gives you enough benefit to make them worth it.

Answer: The costs of Medicare coverage are pretty straight forward. I always explain all the costs, from Part B premiums to plan premiums and copays. I would rather my clients be prepared for the worst and be surprised by not paying that amount.

Answer: I won't say it's impossible but to change from a MA plan to a Medicare Supplement would necessitate going through medical underwriting unless you are in a Guarantee Issue period, which is rare outside of your Initial Election period. If you are diagnosed with a serious illness it would be difficult to pass through medical underwriting.

Answer: You can apply for Low Income Subsidy assistance (LIS), also called Extra Help, from the Social Security website. LIS gives you assistance with co-pays for medications.

Answer: Medicare eliminated the coverage gap in 2025, capping the max out of pocket at $2000. If you are taking expensive medications you could hit the max in the first part of the year and pay nothing for the rest of the year.

Answer: You would have to be more specific. Medicare Part B premiums can change annually but are individual so that would not be effected by losing your spouse. If you were covered by a Medicare Supplement policy that had a discount for two people in the household being covered, you would lose the discount when your spouse passes.

Answer: Medicare Parts A and B only cover 80% of your medical costs. You can purchase a Medicare Supplement or enroll in a Medicare Advantage Plan to mitigate the risk of having to pay 20% of your medical bills.

Medicare does not provide for prescriptions, dental vision or hearing issues. All can be covered by buying additional coverage if you choose.

Answer: There are a few different types of special needs plans in Medicare coverage, Dual Special Needs Plans, or DSNP's, that include some level of Medicaid coverage, and Chronic Special Needs Plans, or CSNP's. CSNP's do not require Medicaid enrollment but do require verification from your provider of one of the conditions of the plan. You may qualify for a CSNP if you are diabetic or have cardiovascular or heart issues. These plans offer benefits tailored to the needs of the condition.

Answer: You shouldn't be too worried. It can happen under certain circumstances but the carriers will usually find a way to retain the providers in the network until the end of the year so their clients can find other policies that would allow them to continue to see their preferred providers.

Answer: No, as long as you have credible coverage after you are eligible for Medicare you do not have to enroll. But you may want to enroll in Part A anyway. In most cases it does not have a premium, you have already paid for it by working 40 quarters and paying payroll tax, and it could help reduce your costs if you have a inpatient hospital stay.

You can apply for Part B when you are ready to drop your Employer Group Health Plan.

Answer: Yes. You can apply for Extra Help, called LIS (low-income subsidy) on the Social Security website. If you are accepted into the program, you will have your Rx costs reduced to nominal amounts.

Answer: If you did, the Annual Open Enrollment period starts in October. The policies I represent have $0 copay for primary care visits and the copays for specialists vary by $10 to $20. If you see multiple specialists each month the extra cost could certainly add up.