Jennifer Kalbach, Medicare Insurance Agent

Answer: Plan N charges co pays for doctors and hospital visits and can be subjected to a 15% excess billing charge from any provider. Most do not charge the 15% but they can so best to ask ahead of time if you chose an N. G has no copays and it not subject to excess billing charges.

Answer: Medicare Insurance Agents are paid commission from the carrier. You should never have to pay a local agent to help you.

Answer: All MA plans work within a network of providers whether it is PPO or HMO and PPO typically has cost sharing out of network at a reduced percentage. Medi Gap has no network any doctor who takes Medicare Insurance takes Medi Gap Insurance.

Answer: All MA plans have different MOOPS. Refer to your summary of benefit for this or contact your agent or carrier to find this out.

Answer: You pay a co pay listed on your benefits for certain services. Refer to your summary of benefits for this info.

Answer: Some Medicare Advantage plans do. Refer to your summary of benefits to get this answer or contact the agent you got the plan from and ask them or contact your carrier.

Answer: I think this question is getting ahead of yourself. None of us know what tomorrow will bring. We can only take life one day at a time in Medicare and any other facet of life.

Answer: First off the only difference between Plan F and Plan G is that plan F pays the part b deductible which is only $283 this year and often the premium is much higher. Some states have a birthday rule which then can move from a like to like plan or a like to less which in this case from Plan F to Plan G 60 days around their birthday. I recommend contacting a local agent to talk about options. If they move during AEP to a MAPD plan then then need to consider the Max out of pocket they may pay and that they will be confined to a network either in a PPO or HMO

Answer: There are many determining factors to this, like pre auth or is it medically necessary but if it is a covered procedure it will be a cost share.

Answer: If you are currently on SSI you will automatically be enrolled in both. If not, you need to go to Medicare.Gov and sign up.

Answer: Typically Medicare Part B covers 80% of this cost and you would be responsible for 20% however there are many other contributing factors as to whether they will cover it or not. I high recommend getting additional coverage to help off set some out of pocket costs associated with only having Medicare Part A and Medicare Part B

Answer: I recommend reaching out to social media to see if you can get reviews or simply go in and talk to an agent, get a feel for if they will be honest with you and provide you truthful comparisons of not only supplements to MA plans but the Summary of benefits associated with each MA plan

Answer: You would apply for Medicare by going to Medicare.gov. A good local agent should be willing to assist you with this even though there is no relationship between an agent and Medicare Part a and part b

Answer: Medicare Advantage is subsidized by the Federal Government so they pay the carriers something towards their participants coverage.

Answer: Carriers decide what formularies they are going to cover and at what tier they are not the same from plan to plan and they can drop any formulary at any time.

Answer: Giveback is a benefit that some plans offer to help with your Part B premium by depositing the money back into your Social Security check amount. They can vary in amounts but typically the MOOP (maximum out of pocket) amounts folks pay are higher with Givebacks so you can end up spending more than you would without a giveback.

Answer: If you are referring to Part B deductible, it typically changes from year to year and mostly as an increase, the Centers for Medicaid and Medicare services decides this. If you are referring to Part C, Medicare Advantage deductibles, those vary from plan to plan and some are lower than others, I would suggest to talk to a local health licensed agent on this.

Answer: IRMAA is based off of your last two years of AGI. The thresholds change each year so be sure to talk to a licensed agent to help you. It is an adjustment on your part b premium.

Answer: I highly suggest you go talk to your local social security office or a local community resource to see what is available in your community. If you have a Chronic illness as specified by CMS then you may qualify for a C-SNP which could also help with lower costs.

Answer: If you are on a Medicare Advantage plan then they may have silver sneakers but like always, you need to get a copy of your summary benefits from the agent who helped you with the plan. If you went directly through Medicare to chose your plan, then contact the plan itself. The number is on the back of your id card.

Answer: From my experience as an agent, I always like to go over plans with different MOOPS. When you say MOOP's for Medicare plans I am assuming you mean Medicare Advantage PD plans. MOOPs can range from $3000 to almost $10000 with the lower MOOPs mostly in HMO's. Even though some folks think they will not meet the MOOP there is always a chance they may and who can sustain year after year paying almost $10000 out of their pocket. The bigger question should be should I take a supplement over an MAPD plan at the time of my initial enrollment at 65 into Medicare.....

Answer: If you are only on Part A and Part B you have limited coverages. If you have Medicare Advantage Prescription Drug Plan (Part C) which is a combined A and B with a Prescription Drug Plan component then there are covered formularies for each carrier which you would check with the carrier on. I highly recommend you do not just keep Part A and B without any other coverage without speaking to an agent to make sure you have the best coverage for your particular situation.

Answer: I believe you are talking about Medicare Advantage and not Medicare Insurance (Part A and B). Each year your Medicare Advantage plan will send out a Annual Notice of Change which will list the items they are changing (if any) such as your doctor is leaving the network or a particular formulary is no longer going to be covered, or a change in benefits. This letter comes out in September typically so watch for it and be sure to read it, some people just toss it thinking it is junk mail but this letter is very important so you know what is changing in your plan.

Answer: Hospitals can chose what carriers they want to contract with. I do not think it is a case if they are taking MA or not rather are they contracted with the carrier. These are for profit organizations.

Answer: It is important that you chose the right plan for you when you are originally going into Medicare. You can chose a Supplement or a MAPD plan and you are not underwritten at that time. During AEP you would need to first return to original Medicare then you would apply and be underwritten. This will always be the case once you chose an MA over a Supp. If you chose a Supp at the time you get your Medicare, some states have birthday rules which allows you to change around your birthday without be underwritten. Speak to an agent before turning 65 to find out all options in your state.

Answer: Medicare Part B is the medical component to Original Medicare and Part A is hospitalization component.

Answer: IRMAA is based off of Modified Adjusted Gross income and there is a threshold for single and joint tax returns which have a 2 year look back.

Answer: Most dental plans cover preventative procedures such cleanings and xrays (usually every 6 mo or 1 time a year). Some have higher limits that they cover for other procedures. I would suggest if that is important to you to seek out a MA plan that has higher limits for the areas you are interested in.

Answer: Medicare Advantage plans are a pay as you go plan with a network of doctors both in the HMO and PPO plans. Your doctor may chose to leave a network so that could be an issue. Also there is pre authorizations required in MA plans but with a Supplement such as N or G you can see any doctor that takes Original Medicare without a pre auth.

Answer: Medicare Insurance can not drop you for health reasons but what could happen is that you chose a supplement and you want to change plans then you would be underwritten if it is not during a period which you can change without underwriting. Talk to a local agent for more info.

Answer: There are different types of life insurance such as Term, Universal, Whole Life. I highly recommend you speak to an insurance agent to discuss your personal financial goals to make sure you are getting the right policy for your situation.

Answer: The donut hole is no longer an issue, they covered that gap (this only applies for covered drugs as non covered formularies do not count towards the out of pocket cost).

Answer: You have an opportunity to get a Medicare Supplement without being underwritten when you first get Medicare Health Insurance or come off a group plan. I highly suggest you talk to an agent prior to turning 65 to see what your options are.

Answer: I think the process can be more streamlined and folks need proper information to make an educated decision when they are turning 65. So many people do not even know about supplements vs MA and are left with choosing a plan that is not best for them.

Answer: You should be applying for a DSNP (dual eligibility) first you need to get with your local Medicaid office to see if you qualify and they will enroll you in Medicaid. Once you are enrolled, you would qualify for extra help. You can also check with your local resources to see if they have additional help to provide you.

Answer: No, when you get Medicare Advantage that is the coverage that you have and your red, white and blue card is no longer active rather combined with MA to create what they call Part C.

Answer: Yes if the patient is homebound all Medicare Advantage plans are required to provide Medicare approved home health care services.

Answer: Do the math on it. Look at what your out of pocket costs may potentially be for all scenarios. Go see an agent in person to help you make the right decision.

Answer: Depends, do you work for an employer with at least 20 people in the group plan? If so then you can stay on their coverage for now until you leave then you have a window to join MA. Taking Part A costs you nothing but Part B has a premium. I suggest you look at the costs involved. Talk to an agent in person for more info.

Answer: Everyone who has Part B has the same premium across the board unless they have a MAPD DSNP (dual eligible) and Medicaid is helping to cover part of the Part B premium. Perhaps your income went up (SSI or other retirement benefits) and that knocked you out of DSNP eligibility.

Answer: I had someone come in my office talking about another line of insurance when they mentioned that they were going to change from Medi Gap Plan g to a a MAPD. I took lots of my time to explain to him the differences and why he should consider to stay on the Medi Gap plan and not move to a MAPD plan. Unfortunately, the other agent he spoke with that talked him into the MAPD plan did not have his best interests at heart as there are significant differences between the coverages.

Answer: Currently, they have done away with the donut hole with regards to PDP's. The max out of pocket for Medicare Covered drugs is $2100 a year at which point you enter catastrophic coverage and have no more out of pocket costs. I think you should look yearly at what PDP plans cover the most cost sharing for the scripts you are on even though any carrier can change that at any time.

Answer: You can meet with as many Medicare Health Insurance agents that you want to. You can also go to Medicare.gov and do it all yourself without even speaking to an agent. The bigger question for yourself should be what do you want to look at Medicare Advantage Prescription Drug plans or Standalone PDP with a Medicare Supplement. If I were you I would educate myself on the differences between those plans.

Answer: I think it would be hard for anyone to respond to this as we do not even know what Medicare Insurance will look like come 2030. I would say focus on today and use the tools the digital tools they already have in place if that is something that motivates you.

Answer: Part B covers medically necessary surgeries that are covered under Medicare. You will have a cost sharing and I would not recommend that you have only Part A and Part B without finding out what your options are especially at the Guaranteed issue period around your 65th birthday.

Answer: On Medicare, at this time insulin is capped at $35.00 for everyone on Medicare. Part D standalone or a Medicare Advantage Prescription Drug doesn't necessarily matter what does is are your scripts covered and if so what is the price for them (tier 1, 2, 3 , 4 ,5 6) . A good agent will run your scripts to let you know what plan pays the most but keep in mind they can change what drugs they cover at anytime. These are for profit organizations.

Answer: There are a lot of gaps in having Medicare Part A and Part B only. I highly recommend that you speak with an agent in your area face to face to discuss what your options are at your Guaranteed Issue period which is 3 months before your 65 birthday, the month of your 65th birthday and the three months following.

Answer: Medicare cuts with regards to Part A and Part B, regarding services? Need some more info to properly answer for you. :-)

Answer: I do not have enough information to properly answer this question. Call me and we can discuss it or call a local agent licensed and contracted to sell Medicare Health Insurance so they can have a discussion with you.

Answer: If your mom is in KY contact me as I would like to take a comprehensive look into the plan she is on versus moving to a MA plan. With a supplement, there is no network so you can see any doctor that takes Medicare insurance. With MA there is a network and quite frankly, a doctor can chose to leave the network so there is no promise or guarantee on that.

Answer: I personally lay it all out and explain and read the summary of benefits to them and highlight the costs that they will be responsible for and most importantly the MOOP.

Answer: The point of having a PPO over an HMO would be that there is some cost sharing for you with a PPO for out of network. On a straight HMO there is no cost sharing out of network and you would be responsible for the entire amount.

Answer: You should compare plans and costs to in order to make an informed decision. You can stay on group coverage as long as it is an employer plan with over 19 employees (at least 20).

Answer: You will be automatically enrolled in Medicare Part A and Part B if you are currently getting disability benefits once you turn 65.

Answer: HMO's are network cost share only and typically limited coverage for any out of area cost. PPO's offer cost sharing for out of network providers.

Answer: I would suggest that you ask for a summary of benefits to review prior to signing up for a MAPD plan. In this you will see what cost sharing you are responsible for. All MA plans are pay as you go you.

Answer: Unless you have a POA or legal rights to be involved in your parents health care then they will be the ones to speak with the Medicare Health Insurance agent. If they are only taking Part A and Part B then they won't have an agent just Medicare to speak with. Your parents can make an appointment and go in and talk with a local agent and if they agree, you can go with them and listen that way you can take notes if they have questions afterwards.

Answer: If you only have Original Medicare, your typical out of pocket expenses for cataract surgery would be around $600-$900 give or take but you can contact the provider to run an estimate for you first off so you have no surprises.

Answer: Medicare Advantage plans are a yearly plan as where Medicare Supplements are a life time plan. Most always, each carrier announces changes annually to their Medicare Advantage plans and sometimes that means your doctor may leave the network so be sure to always ready your annual notice of change that is mailed to you usually in September or early October.

Answer: If you filed bankruptcy, if I were you I would check with your local Medicaid office to see if you qualify for any extra help due to your financial situation.

Answer: Well hopefully you were on a group plan with at least 19 employees or more which means you will not be penalized for taking it late. You have 63 days to get coverage once leaving a qualified group plan.

Answer: The most underrated benefit is that Original Medicare covers some expenses for Medicare related emergencies when travelling abroad.

Answer: My recommendation would be to focus on getting set up with Medicare Part A and Part B and reach out to a local agent you can sit down with face to face to go over options. There are a lot of scams out there, face to face with a local agent may be a better choice.

Answer: Medicare Annual Enrollment is from 10-15 to 12-7. If you miss that period, you will have from 1/1 to 3/31 (open enrollment) to change from one MA plan to another. Outside of that, there is a SEP (Special Enrollment Period) if you fit into one of the certain events to be able to make the change.

Answer: Generally speaking, if your wife's Group Plan is for 19 or more employees then you will not have a penalty to wait as long as that remains in place. Once she retires or leaves the company (group plan coverage of 19 or more) then you will have 63 days to join another plan or you will have penalties.

Answer: How much you pay out of pocket for therapy depends on the coverage you have. You can review your summary of benefits for your specific plan to review this.

Answer: Everyone needs to make the best decision for themselves. Medicare Advantage may not have a premium but the do have costs associated with services where as a Medi Gap Plan G, for example, only has the cost for the deductible for Part B as an out of pocket cost. MA plans are a pay as you go plan where a Medicare Supplement is more comprehensive.

Answer: There are income limits to the premium paid for Part B and Part D and if you go over that limit (2 year prior tax return) then you will be assessed a surcharge. These are in increment brackets based off of income and are paid directly to Medicare.

Answer: The number 1 thing I like about being a Medicare Health Insurance agent is helping people make informed decisions about what coverage is best for them by presenting options to them. Some agents do not always do that because they are focused on commission as where I am not at all, I am focused on presenting facts to people and making sure they fully understand each option they have.

Answer: Original Medicare with a Part D plan offers more flexibility for frequent travelers as it provides nationwide access to any doctor or hospital that accepts Medicare as Medicare Advantage plans limit you to a specific network and service area and if you go outside of it then you will have higher costs or no coverage at all. Maybe consider getting a Medicare Supplement Plan such as an N or G to help cover some gaps in costs instead of a Medicare Advantage Plan.

Answer: Are your parents turning 65? Do they have a group health care plan currently? Your best bet is to speak with a local insurance agent who sells Medicare Health Insurance plans.

Answer: Co Pays are are a set amount of money, fixed fee, that is attached to service covered services while a deductible is a set amount of money you pay out of pocket for covered services per plan year which is before your insurance will start sharing in the costs. Co pays do not always count toward your deductible.

Answer: Medicare open enrollment is January 1st to March 31st at which time you can switch to another MA plan, or change from Medicare Advantage to original Medicare and join a Part D plan during MA open enrollment.

Answer: Part B covers 80% of eligible Medicare covered costs then the insured is responsible for the 20% remaining and the Part B deductible which would be paid prior to the 80% covered costs.

Answer: I think sometimes people are afraid of change of any sort even if the change will be better for them. In addition, I think they have had bad experiences or have been inundated in calls and direct mail that it all gets very confusing for them. I am local and deal with local people where we can meet face to face and I can answer all their questions. I with at a local agency so this is a perfect fit.

Answer: If your formularies are covered on your current PD plan then they are counted towards your maximum out of pocket that you can pay for prescriptions and once you meet the $2100 max then you will have no more to pay towards them.

Answer: Original Medicare refers to Part A & B only. A Medi Gap Plan G covers 100% of Part A coinsurance and hospital costs up to 365 days, part B coinsurance or copays, First 3 pints of blood, Part A hospice care coinsurance or co pay, skilled nursey facility care coinsurance and Part a Deductible, Medicare Part B excess charges, and co pays for doctors and ER room.

Answer: Medicare Part D providers have a list of formularies that are tiered. They can't deny coverage of a brand name if the formulary is one they cover if a generic is not available.

Answer: What I would consider to be a big disadvantage to an HMO is the limitations to a network of doctors under a Health Maintenance Organization. This is not a good plan for someone who may be seasonal in one location or travels outside of their immediate network as there is no coverage outside of your network of providers and can become costly.

Answer: The best part of working with Medicare clients is that I have their best interest at heart. If I can't help them find the best product for themselves then I will let them know that. I want to educate them so they can best the best health care decisions for themselves. It is a cumbersome process and confusing enough I want to help ease that and spend the time they need to make their decision.

Answer: No that is not how it works. When your husband dies you get to draw on the social security amount that is higher, so if his is higher than you can draw on that otherwise you would want to stay on your own benefits plan.

Answer: It is always a good practice to do business with local agents. You can go to their office and sit down with them and to discuss your needs and they are members of the community just like you.

Answer: Medicare Advantage is a pay as you go plan. They are either HMO or PPO's which operate with a network of doctors. Medicare advantage often requires pre authorizations to see specialist or to get procedures done. Medicare Supplements are more comprehensive and your health care is between you and your doctor not your doctor and an insurance company.

Answer: Some Medicare Advantage plans have meals, or an OTC card that is for healthy foods. Be sure to ask for a summary of benefits to see what those are.

Answer: Perhaps down the road it will like recording health data, or exercise, maybe monitor heart rate. In the future more should come out about this.

Answer: Agents are paid by the carriers (in my case the carrier pays my agency who then shares a portion of the commission with me). For me, I only care about what is the best plan for the customer and that is what we should be doing but unfortunately, some agents try and sway people toward Medicare Advantage plans as those pay out more commission that Medicare Supplement plans. I present all facts and provide information so my clients can make the best decision for themselves. Medicare Advantage is a pay as you go plan with little to no premiums while Medicare Supplements are more comprehensive and have a premium. Most Medicare Advantage plans have annual MOOP's higher than what their annual premium would be on a Medicare Supplement plan.

Answer: Some Medicare Advantage plans have a giveback which helps lower your Part B premium by providing money back into your SSI account (you pay the premium and they give you back) another way is if you qualify for a DSNP plan (dual eligible with Medicaid) these plans offer help in paying for your Part B premium.

Answer: Typically this would be covered under your Prescription drug plan (Part D stand alone or a Medicare Advantage Plan with a prescription drug plan).

Answer: I would recommend taking your denial letter to your insurance agent and asking them to assist you.

Answer: Go to SSA.Gov to enroll in Medicare Part A & B unless you are already on SSI then you will be automatically enrolled.

Answer: Do you have Medicare Advantage or a Medicare Supplement policy in addition to Part A & Part B? I highly recommend you speak to your carrier to ask them about possible out of pocket costs that you can incur.

Answer: Medicare is not a long term care policy. It does not cover room and board or basic custodial care for chronic conditions. Medicare Part A MAY cover some long term care for up to 100 days in a skilled nursing facility but not custodial care.

Answer: First off, a Scope of Appointment and a Health Risk Assessment would need to be done. Then I would go over with clients what their options are so they can make the best possible decision for their health.

Answer: If you have chronic lower back pain, Medicare may cover up to a certain amount of treatments. As always, contact your Medicare provider for the details of what your plan pays.

Answer: I would suggest to get with a Medicare Health Insurance agent to let them walk you through this and also they can help you with Medicare Advantage plans or Medicare Supplement plans.

Answer: Medicare covers folks under 65 if you have received SSI for a disability for at least 24 months then you are generally enrolled in Medicare Part A and B. End Stage Renal Disease at an age if you have permanent kidney failure requiring dialysis or a transplant. Then Lou Gehrig's Disease otherwise known as ALS, if diagnosed then you are immediately eligible upon receiving SSI Disability benefits. As always, speak to a agent directly about your own personal situation.

Answer: The short answer is yes but there are other factors that may affect your enrollment.  Contact a Medical Insurance Plan agent to get a quote on this.  

Answer: Yes — concierge medicine can work with Medicare. But it depends on the practice. Medicare Advantage plans may be more limited. Always check whether your specific plan is accepted.

Most are not compatible with Medicaid.