Jamie Blake, Medicare Insurance Agent

Answer: Yes, Medicare Advantage (Part C) plans are considered private insurance. They are approved by Medicare but managed by private companies (such as HMOs or PPOs) that contract with the federal government to provide all Part A and Part B benefits, often including prescription drug coverage (Part D) and extra services like dental or vision.

Answer: Medicare Advantage Plans, Part C. Max Out Of Pocket (MOOP)

MOOP may differ between different Carriers and each of their plans; in network and out of network services.

What Counts: Deductibles, copayments, and coinsurance for Part A Hospital and Part B Medical services only will count toward the limit.

What Doesn't Count:

Monthly premiums typically do not count toward the maximum out-of-pocket amount. Part D Prescription cost do not count, it has a $2100 cap on covered drug costs in 2026.

After Reaching the Limit:

Once the MOOP is reached, the plan pays for covered services for the rest of the year.

Why It Matters: These limits protect beneficiaries from catastrophic healthcare

Answer: Medicare has two components. Part A is Hospital and Part B Medical.

Part B Medical is optional with a monthly premium. Part B covers outpatient care, doctor visits, durable medical equipment, and preventive services. It helps pay for medically necessary services, including ambulance transport, mental health care, and laboratory tests. Most services require a 20% coinsurance after meeting the annual deductible.

Answer: Preventative progression would be given by the provider. They can suggest a program that may help prevent type 2 diabetes.

Answer: Yes, the guaranteed Issue is available after the Medicare Open Enrollment period ends.

This period is called The Birthday Rule.

This allows existing Medicare Supplement policyholders to have a new open enrollment period starting on the first day of their birthday month and extending for at least 60 days after.

During this time, these policyholders may purchase a new Medicare Supplement plan (with the same or lesser benefits) from their existing carrier or a new carrier without underwriting.

Carriers cannot rate up policyholders who choose to participate in the “birthday rule.”

Carriers must charge existing rates to new policyholders and cannot charge them new rates until the renewal period.

Answer: Each Provider's over-the-counter benefit can be different.

In general, the member can order by phone or online and it is shipped to them. They can also walk into the designated store(s) and purchase the OTC products to take with them.

Answer: There are different Medicare Plans. Depending on the state and county you may pay different amounts, premiums and co-pays.

It is best to speak with a Broker to find out what is available and the options that will suit you needs.

Answer: Lowering the eligibility age from 65 to a younger age, such as 60, or creating a "Medicare buy-in" option that allows younger, non-eligible individuals to purchase coverage through Medicare. While these proposals, supported by figures like President Biden, aim to expand access and lower costs.

This also present significant challenges, including shifting costs to taxpayers, potential impacts on Medicare program finances, and complex design considerations regarding benefits, premiums, cost-sharing, and provider payments.

Answer: Medicare generally does not cover health care services received on a cruise ship when the ship is more than six hours away from a U.S. port.

However, medically necessary care may be covered if the ship is docked in a U.S. port or within six hours of a U.S. port when the services are provided. The healthcare provider on the ship must also be legally allowed to provide medical services under certain laws.

Answer: To check if a doctor is in your Medicare Advantage plan's network, visit the plan's website or call their member services for a provider directory. You can also call your doctor's office directly to ask if they participate in the specific Medicare Advantage plan you're considering.

Answer: Guiding them through the maze of options available to them so they can make a wise and informed decision to best suit their needs.

Answer: No, Medicare does not cover most long-term care, particularly custodial care like help with bathing or dressing for an extended period,

Answer: Losing a spouse can raise your Medicare premiums due to how the Income-Related Monthly Adjustment Amount (IRMAA) is calculated. The income thresholds for individuals are much lower than for couples, which can push a surviving spouse into a higher premium bracket, even if their total income has decreased.

Answer: No, Medicare plans do not generally work outside of the United States; however, Original Medicare covers emergency services only in specific situations like traveling between Alaska and another U.S. state via Canada, or if a foreign hospital is closer than a U.S. hospital.

Some Medicare Advantage plans and supplemental plans may offer limited coverage for foreign travel emergencies, but you must check your specific plan details with your provider, as this is not a standard benefit.

Answer: Medicare Advantage plans are different in each state, and can even vary by county or ZIP code, because they are offered by private insurance companies and are not standardized nationally like Original Medicare. Plan availability, coverage details, costs, provider networks, and benefits can differ significantly from one state or region to another.

Answer: You can qualify for Medicare before age 65 if you have a qualifying disability, Lou Gehrig's disease (ALS), or End-Stage Renal Disease (ESRD).

Answer: Medicare offers one free one-time "Welcome to Medicare" preventive visit and a free Annual Wellness Visit (AWV) for most beneficiaries enrolled in Part B.

Answer: Insurance factors into financial planning by providing financial security against unexpected events like illness, accidents, disability, or death, thereby protecting assets and income, ensuring debt repayment, and supporting legacy goals. It serves as a risk management tool, absorbing the financial impact of potential losses through various policies such as life, health, disability, and property insurance. Additionally, some insurance policies offer tax benefits and contribute to wealth transfer, making them a strategic component of a comprehensive financial plan.

Answer: Original Medicare consists of Part A (hospital insurance) and Part B (medical insurance) only. Medicare does not cover prescription drugs.

Medicare Advantage, also known as Part C. Medicare Advantage plans combine Part A and Part B benefits and may also include prescription drug (Part D) coverage, routine vision, dental, and hearing services. In addition to extra benefits such as over the counter allowances (OTC), transportation, gym memberships and more.

Answer: Allows individuals to spread their out-of-pocket prescription drug costs across the calendar year. It doesn't lower your costs but helps manage them by letting you pay in monthly installments instead of one large sum, especially beneficial for those with high costs early in the year.

The MPPP helps you pay your out-of-pocket prescription costs over the entire year by breaking them into smaller, monthly payments.

This plan doesn't save you money or lower the total amount you pay for your drugs; it only changes when and how you pay them.

Your monthly payment can change as you fill prescriptions, and your bill will increase if you add new, expensive drugs because there are fewer remaining months in the year to spread the costs over.

The MPPP is most helpful for people who have high prescription costs earlier in the year and struggle with large upfront payments.

Answer: Recent Decade (2010-2020)

Medicare spending grew at a slower rate, both overall and per beneficiary, compared to prior decades.

Future Projections (2020-2030):

Slower growth in the prior decade is expected to reverse, with higher per capita spending projected, comparable to private health insurance growth.

Answer: Work with a licensed and certified Broker. I began my career in 1998, and over the years my true passion and commitment has been to educate Medicare beneficiaries. Guiding them through the maze of options available to them so they can make a wise and informed decision to best suit their needs.

Answer: Thanks to the Inflation Reduction Act, the donut hole was completely eliminated as of January 1, 2025.

Answer: To verify advertised Medicare Advantage plan benefits, check your provider's network, carefully read the official Evidence of Coverage (EOC) and Summary of Benefits, contact your State Health Insurance Assistance Program (SHIP) for unbiased guidance, and review the official www.medicare.gov website for plan details and potential scams.

Answer: Medicare Part A, also known as Hospital Insurance, primarily covers costs associated with inpatient care in facilities like hospitals, skilled nursing facilities, and hospice care, along with some home health care services.

Part A covers care received in a hospital, including the cost of a semi-private room, meals, nursing services (not private duty), and other hospital services.

Answer: The Guaranteed Issue allows eligible Medicare beneficiaries to purchase supplemental health insurance without medical underwriting. This means that insurance companies cannot deny coverage or charge higher premiums based on your health status.

Guaranteed issue applies when:

You are enrolled in Medicare Parts A and B

You have not had a Medicare Advantage or Part D prescription drug plan in the past six months

You are within a specific time window after a qualifying event, such as:

Turning 65 and enrolling in Medicare

Losing employer health insurance coverage

Disenrolling from a Medicare Advantage plan

Answer: Beneficiaries with Medicare drug coverage won't pay more than $2,000 (in 2025) for their prescription medications over the calendar year, after which they will pay $0 for covered drugs for the remainder of the year.

Answer: Discount cards and other resources available may lower your Rx costs.

These programs allow you to pay a lower "cash" price for medications by acting as a coupon, but you cannot combine them with insurance coverage. The savings come from the difference between the pharmacy's negotiated price and the higher "cash" price.

Answer: Not all Insurance agents are the same. Choosing the right one can make a big difference.

I have over 20 years of knowledge and expertise with Medicare. I understand the complexity of Medicare with the compliant rules and regulations in all areas related to Medicare, Medicaid, and Social Services. I am a native of Las Vegas which has given me the knowledge of all other services available to Medicare beneficiaries here in Nevada. I began my career in 1998, and over the years my true passion and commitment has been to educate Medicare beneficiaries. Guiding them through the maze of options available to them so they can make a wise and informed decision to best suit their needs.

I represent several different insurance companies, and can compare coverage and prices to find the best possible value for your individual circumstances. I am your consultant, working with you as you determine your needs. With an independent Broker, like myself, you get choices.