Jason Wisniewski, Medicare Insurance Broker

Answer: There are no "tricks". If you read the disclosures on any legitimate Medicare Health plan advertisement it is required they disclose network limitations. HMO's will state that you must use in-network providers with the exception of emergency services. PPO plans will also state that out of network providers are under no obligation to accept members.

This is why it pays to work with a broker which costs you nothing and that broker will check on your doctors to see if they are in-network or if it is a PPO that the doctor's office you wish to to use will accept the PPO out of network and bill your insurance directly. We have so many satisfied Medicare Advantage customers because they are in the appropriate plan based on the doctors they want to see. We don't blindly put them into plans.

Answer: The reason Medicare Advantage plans can afford to charge $0 monthly premium is because instead of receiving money directly from members, they are paid on a per member per month basis by the Federal Government. Medicare funds are paid each month to the Medicare Advantage plan usually around $800-$1200 per month depending on the area, star ratings and health condition of the members. Medicare Advantage plans pay all your claims instead of Medicare. Whereas when you have a Medicare Supplement plan, Medicare pays first, and the Supplement pays second, which is members who have Supplement plans pay the insurance company directly.

Answer: If you're already on Medicare, you can change your plan at least once every year during the Annual Enrollment Period (AEP) from Oct. 15-Dec. 31 each year. Your new plan starts January 1st if you make a change during this time.

If you are enrolled in a Medicare Advantage plan, you can change your plan at least 2 times per year. Once during the Annual Enrollment (AEP) from Oct. 15-Dec 31st each year, with a January 1st effective for your new plan if you make a change during the AEP and another chance from January 1st to March 31st, this is known as the Medicare Advantage Open Enrollment Period (OEP). During this period, you can change plans, and your new plan will start the 1st of the following month (for example, if you change plans in January, your new plan starts in February, etc.)

In addition to the AEP & OEP which occur annually, you may also qualify for a Special Enrollment Period (SEP) outside of these time frames which would allow you to make additional changes. Some examples of an SEP include:

Moving to a new service area (changing county or state)

Qualifying for Extra Help (LIS or Medicaid)

Qualifying for a State Pharmacy Assistance Program (SPAP)

Loss of Employer Group coverage

Moving into a Nursing Home

And many other scenarios.

Answer: If you don't have any other "Creditable coverage", yes you will absolutely be penalized. And the penalty is a lifetime penalty so if you don't have any other "creditable coverage" it's not a good idea to delay enrollment. "Creditable coverage" is the key. If you work for an employer with more than 20 employees that is considered "credible coverage" and you will not be penalized for delaying your Medicare enrollment but you will have to prove that you had this coverage before you eventually do enroll in Medicare later on ( for example you plan on retiring at 67).

If you have no other coverage, only use VA coverage or you somehow stay on an Obamacare plan past 65 or your employer has less than 20 employees and doesn't meet creditable coverage standards then you will be penalized when you join Medicare outside of the 7 month window you have to enroll.

In short, don't play games with this and make sure you get advice from a professional Medicare broker when handling this.

Answer: Some Medicare Advantage plans already cover wearable tracking devices like the Fitbit & Garmin. Original Medicare does not.

Answer: Original Medicare has no options.

Medicare Advantage plans contract with companies like MD Live, Teladoc, etc., depending on the plan.

Answer: Home modifications are covered by certain Medicare Advantage plans. Original Medicare does not.

Answer: Telehealth is only covered by Medicare Advantage plans in 2026. Original Medicare will not cover it in 2026. So you will need to enroll in a Medicare Advantage plan if you want telehealth.

Answer: With Nursing home coverage, you shouldn't rely on any type of Medicare plan, be it Medicare Advantage, Medicare Supplement or Original Medicare for long-term custodial care, but if you're talking about short-term stays for Rehab, you will get up to 100 days covered on any plan. You should either look at Long-term care insurance, or if you're below poverty level, you could apply for Medicaid.

The benefit of a Medicare Advantage plan is that they will cover those short-term stays without any prior hospital stay, whereas Original Medicare or Original Medicare plus Medicare Supplement requires a 3-day prior Inpatient Hospital stay before they cover it.

With Medicare Advantage plans, they do require Nursing facilities to submit clinical information before extending stays, which sometimes Nursing home staff are lazy to do. If your plan denies an extended stay, it's 90 percent of the time because the staff at the Nursing home hasn't given them the clinical information to support the request for extended stay. If you have a broker, your broker can help you file an appeal and also put pressure on the Nursing home staff to submit the required clinical information to get your stay extended.

I did that for my father-in-law successfully and have done it for several other clients as well.

More broadly, even Original Medicare, as well as Medicare Advantage plans, will be cracking down on Nursing homes for submitting too little clinical information and will require them to start providing more detailed diagnosis.

Answer: If you only have A and B, you will have unlimited out-of-pocket expenses because there is no out-of-pocket maximum with Original Medicare. You also have no prescription drug coverage, no dental coverage, no vision coverage and no coverage for hearing benefits.

You won't even be able to get an annual physical exam because Original Medicare only covers a physical once in your lifetime.

It is far better to get a Medicare Advantage plan (often for $0 additional premium) that includes your preferred doctors if you can't afford a Medigap policy.

Answer: Typically I find Advantage plans to have better drug coverage than stand alone plans. But to recommend the right one I would need to know where you live since plans are filed by County and State and I'd need the specific names of your medications and doctors to know which plan is the best fit

Feel free to reach out for personalized help

Answer: Once you join a Medicare Advantage plan, you no longer need to worry about any of the Part A or Part B deductibles anymore.

You're in a much better place now, though, because the Medicare Advantage co-pays include all the doctor charges whereas Original Medicare Part A does not.

For example, a 3-day hospital stay under Original Medicare would be:

$1,676 deductible plus 20% co-insurance for physician services. So if the procedure was $50,000, you would pay $10,000 (20 percent) for the procedure plus $1676 for Part A deductible facility charges.

With Medicare Advantage, there are $0 co-pays for physician services while you are an Inpatient at the hospital, so you just pay the $350 co-pay per day for the facility.

In my example, you would only pay $1,050 instead of $10,000 under Original Medicare.

Hope this clears things up and shows you the value of your Medicare Advantage plan.

Answer: For me, it is pretty easy, obviously, given that they know I am a Medicare Health Insurance broker with 18 years of experience. If you are just trying to help your parents prepare for Medicare, it is best to let them know there are plenty of ways to get information from the comfort of their home or in their local community. It is important to understand timelines as it is an important part of their retirement planning, and it is also important to understand how and when to apply to avoid costly penalties and unnecessary and easily avoidable mistakes. Working with a broker simplifies these tasks, costs nothing (we are paid by the insurance companies, not clients), and we will advise through the entire process and maintain a lifetime client relationship afterwards.

We at JW Senior Insurance offer virtual appointments via Zoom or the option to discuss over the phone or through email. Whatever works best for them. We also offer an easy-to-use Medicare Survey.

Feel free to get in touch.