Jeremy Henry, Medicare Insurance Broker

Answer: I love having the ability to build relationships with people. As a Medicare broker I stay in touch with my clients year round. Some plans change every year so my clients appreciate the fact that I reach out to them and keep their best interests top of mind.

Answer: HMO's require a person has to stay within a designated network of providers. This is not as detrimental as it once was since most networks have expanded over the years. As an example, some insurance providers offer nation-wide networks now, however the provider would still need to be in the network for a HMO.

PPO's allow a person to go outside of the designated network, however usually at a higher cost. An example would be a specialist doctor... in network the copay could be $35, out of network it could be a 50% coinsurance, meaning the person would have to pay half of what the doctor charges for the visit. Definitely something to keep in mind when looking at plan options.

Answer: This is a major reduction in the (MOOP) max out of pocket versus 2024 where is was $8000. With the cost of some brand name drugs being in the thousands per month and with some copays on plans being 20% - 35% of that cost, it can be extremely expensive for Medicare members.

I have had several clients that spent over $5000 for the year on RX's in the past. This is a welcome change for them. The $2000 cap has the potential to save folks taking "brand name" prescriptions thousands of dollars for the year.

Answer: Medicare and Social Security work together to provide health coverage for people with disabilities. Folks that are eligible for Social Security Disability Insurance (SSDI) will automatically be enrolled in Medicare Part A and Part B after receiving benefits for 24 months.

Answer: To ensure that their doctors and RX's are in network and covered on the plan they are choosing. This is extremely important, especially if you have a good relationship with your doctor.

Answer: In this scenario I'm assuming the person will be working until age 70. If that is the case and they are covered under a group health plan with their employer they could possibly defer Medicare part B without penalty.

To avoid the Part B late enrollment penalties, you must have creditable coverage during the time you delay enrolling in Part B. Creditable coverage means you have coverage that meets Medicare's minimum standards. Most group health plans do.

Several other factors can play into this decision like a cost comparison of the group health plan vs. a Medicare plan, differences in coverage between the plans and if a person has an HSA-qualified high-deductible health plan (HDHP). These are just a few of the situations I would go over with my client.

Answer: This is tough because we talk with friends and family to get different perspectives which is natural, however I would tell anyone in this situation to try to look at it from a neutral perspective, at least as much as you can.

When I sit with a client we go over what I call a "Medicare 101". My goal is to educate my client on these two options by going over the pros and cons of both. That way in the end they can make an educated decision on what is best for them.

Answer: Yes, Medicare's costs are increasing. There are several reasons for this, including an aging population, rising healthcare costs, and the expansion of services offered.

There are also concerns about its long-term sustainability. Medicare hospital benefits (through the HI trust fund) are projected run out by 2026 or 2027. As costs rise there is potential for increased premiums and cost sharing for Medicare beneficiaries.

Answer: Probably not understanding the differences between Medicare Advantage plans and Medicare Supplement plans. Folks will confuse the features and benefits of these plans and then with their flawed understanding possibly sign up for a plan that was not best for them.

Another big mistake I see is signing up late and having to pay a penalty.

Answer: If you have a HMO (HMO has to stay in network vs. PPO can go outside network) you would want to figure out your next best choice as far as a hospital option.

Then when the next election period comes up you could look at plan options that would include a network with your preferred hospital. The Annual Election Period is every year from October 15 - December 7 ... that would allow a person to change plans if needed/wanted.

Answer: Good question. Dental is not covered by Original Medicare so it's considered an "additional benefit" on a Medicare Advantage plan...something that is over and above original Medicare coverage.

Since that is the case, the dental coverage on Medicare Advantage plans can vary widely depending on the plan. This is something to consider when looking at plan options for sure.