Jeremy Watson, Medicare Insurance Broker

Answer: Trying to plan for these 2 areas can present a lot of confusion. Understanding exactly what Medicare covers and does not cover for extended care needs, what options are available for individual extended care plans, and building a plan that works best can be daunting. Working with an agent/broker that offers these coverages is ideal. They will take the time to sit down with you, dive into the concerns and needs you and your mother have, and be able to provide the solutions to meet those concerns.

Answer: Medicare Part A only covers the room and board charges for inpatient stays. It does not cover any of the services. Services are billed under Part B. Part A alone would not be sufficient for an inpatient hospital stay.

Answer: The main thing would be to sit down with a broker that offers all the coverage types. They are able to sit down and explain the pros and cons of each type. They can help you understand how they would work for you and guide you based on your situation into what would fit best. A good broker can simplify their explanations to make things easier to understand and avoid some of the confusion. They answer your questions fully and transparently. Avoid talking on the phone when possible. Finding a local agent is usually best as you can build a better relationship with them as well.

Answer: Yes, companies have the ability to decline Medigap applications based on health and/or medications outside of any guaranteed approval period. Medigap plans are optional coverage, so underwriting is within the companies rights. With that being said, companies also have different underwriting criteria. You may be able to be covered by a different company. Some are more strict while some are more laxed.

Answer: There are 3 potential reasons that an agent might do this;

1 - Medicare is easier to sell than a Medicare supplement when it comes to talking points. They are often $0 plans that offer additional benefits, whereas Medigap plans have additional premiums and no extra benefits. Advantage plans may even reduce your part B premium. So, on paper, they sound amazing and are easier to get someone to say yes to.

2 - Compensation for Medicare Advantage plans is higher than for Medigap plans. Unfortunately, there are agents who sell plans based on their best interest and not the client's.

3 - They may not be contracted to sell Medigap plans.

Generally, agents should take a neutral standpoint. They should explain the pros and cons of all coverage types and help the client choose what is best for them and their situation. Any agent who pushes one specific plan or coverage is usually doing a disservice to the client.

Answer: Life insurance can provide solutions to several different goals. It can be used for income replacement, debt liquidity, legacy planning, tax planning, and of course funeral expenses to name a few things.

The biggest issues with life insurance when you get into retirement age stem from cost and issuability. Health, age, and sex are all used to base premiums from. It can, at times, be difficult to match goals and amounts to over all affordability.

Fortunately, there are other products that can be used in place of, or along side of, life insurance that can help meet goals. Speaking with a financial professional that can provide a comprehensive review is a good starting point to seeing what is available to you. A dual licensed professional, someone who has both insurance knowledge and is a licensed financial advisor, may provide a larger portfolio of options to help you meet your goals.

Answer: The answer is that it depends on you and your personal situation. There are a lot of things to consider and understand that make original Medicare and Medicare Advantage very different. The way they operate, networks, costs, and benefits are handled differently from original Medicare and vary greatly from company to company and plan to plan. Sitting down with an agent who will thoroughly review your situation and cover the differences in depth with you so you are making a fully informed decision is important. In some situations making a change like this will limit your choices later down the road.

Answer: There are two types of seminars. One is a sales seminar and the other is educational. If you attend a sales seminar, yes, it is essentially going over a specific plan with hopes of enrollment. However, educational events do not go into specifics. They offer generalized information that help you understand Medicare coverages and differences better. Seminars are advertised as one or the other, so looking for whether it is a sales event or educational event will tell you what to expect.

Answer: Part A of Medicare only covers the Room and Board charges for a hospital stay. There is a deductible, daily copays, and a lifetime limit of covered days. Again, though, this is only for Room and Board. This does not include any services that are done. Services are covered under Part B.

With only Part A coverage, along with the deductible and potential copays for the room charge, you would also be responsible for 100% of all other billable charges since Part B would not be covering anything since you don't have it.

Answer: No, you only receive the higher of the 2 amounts. The adjustment is automatic. You can apply for a $250 amount, as well, to help with burial costs. It is a one time benefit amount.

Answer: If you have not done so, the first step is actually enrolling into Medicare Part B. This can be done by calling the Social Security office and setting up an appointment or on the SSA.gov website. Many agents will assist in this process. Once you have your Medicare ID card, you can choose the type of coverage you want. This is ideally done with an agent, also. We can help you understand the pros and cons of the different types of coverages available, compare plans and benefits, and help guide you to the best option for your specific circumstances.

Answer: There is a lot of information that goes along with Medicare. Agents and brokers have to go through a certification process every year to maintain their license to offer these plans. So, yes, it can be confusing if you are trying to figure it out alone. Often times talking to an experienced agent will be the easiest way to get the answers you need. In this case, if you are still working, your work coverage is considered creditable, the premium is similar to what Medicare coverage may be, and/or the benefits are comparable, then you do not need Part B. You would not face any late enrollment penalty. If you aren't sure what the better option would be, sitting down with an agent that can do a side-by-side comparison of your group coverage verse Medicare would clear up a lot of questions and confusion.

Answer: Medicare Advantage Plan companies are not allowed to incentive any enrollment. This would be a direct violation of CMS codes. The additional benefits they offer, such as dental/vision/hearing, over the counter cards, etc., are included as extras. These are things that Medicare generally doesn't cover, still offer medical benefit, and still need approved by CMS to be included. The plans themselves should be chosen by the medical and prescription coverage needs of the individual. This may mean the "best plan" for you doesn't include the extra benefits, or maybe not as robust of benefits. Agents and brokers should not be using the extra benefits as enrollment incentives either.

Answer: An ambulance ride in this scenario would be billed like so: You would have any of the Part B deductible that hasn't been met so far initially, and then 20% of any remaining billable charges. The exact amount would be dependent on how much the ambulance service in your area charges.

Answer: You may qualify for the Medicare Savings Program based on your income and asset levels. The programs that can save you money as based on both of those factors. You can apply through your state for the Medicare Savings Program. There is also a program called Extra Help that can help on medication costs. This is provided through Social Security and a link to apply can be found on Medicare.gov.

Answer: Free is not exactly accurate. The term zero additional premium is a much more fitting term. You will still need to pay the part B premium so there is still a "premium" cost. They have some $0 co-pay services, but you will still likely run into costs during the year for services. However, the coverage itself may have no additional premium.

Answer: There are a few ways to do this. Most of the company websites will have a "physician finder" tool that lets you look up networks based on your plan. These may be a little bit tricky to navigate at first because they aren't very intuitive. The next option would be calling the customer service number for your plan. They are able to assist you as well. You could also contact the agent you work with and have them assist you. They should be more familiar with the finder tools or local networks in your area.

Answer: Medicare and Medicare Advantage Plans do cover ambulance rides, but not 100%. If you have just Medicare A&B, you would have the Part B deductible and then 20% of the billable charge to pay. If you have Medicare A&B and a Medigap plan, you would likely just have the Medicare Part B deductible to meet. If you have a Medicare Advantage plan, the co-pay amount is specific to the plan you are enrolled in and can vary from company to company as well as plan to plan.

Answer: Yes, you can apply for a different supplement anytime during the year and change it assuming you can health qualify for the company you're applying with.

Answer: There is absolutely nothing wrong with meeting with several agents or brokers. I generally suggest it. It gives you different inputs, perspectives, and also let's you see who you can build a relationship with. Trust is important to have with who you decide to work with. I would also add that if you do plan on meeting with several different agents, be honest about that initially, and let the ones you aren't going to work with know once you make your decision.

Answer: There are several things over the years I have ran across. I could probably mention several different things. If I had to choose one that is the most commonly misconception, it would involve Medicare Advantage plans. The biggest thing I run into is clients thinking they plans will cover all services, at any provider, and medications, at $0 costs I always explain networks, billing copays, annual changes, medication tiers, and how maximum out of pockets work, along with answering any questions they may have when I sit down with clients. I just tend to hear quite often "oh, I thought Medicare covered that for me".

Answer: There are two ways to approach this question.

If you look at it purely from a premium standpoint, then a Medicare Advantage program would be the best option. Many carriers have $0 additional premium plans (you still must pay your Part B cost), so your monthly cost is really just the Part B premium. With prescription plans included with most plans, there is no additional premium there. Due to Medicare Advantage plans being a co-pay based system, you also are only paying for services rendered. Some may have a small deductible that may need met, but they are very reasonable. And with value added services, like dental and vision, they can provide a lot of overall value with a fairly low outlay. If you do have a bad medical year, though, it could cost you up to the maximum out of pocket on your plan.

If you look at it from a way to minimize total out of pocket bills, a traditional Medigap plan may be a better option. You would have an additional monthly premium, and would need a separate prescription plan that may premium as well, so up front costs may be higher than a Medicare Advantage plan. However, you would likely have a very low deductible that acts as a maximum out of pocket from a billable charge. A "G-Supplement" only has the Medicare part B deductible, then all approved services are 100% covered. An "N supplement" acts like a "G supplement", but adds an up to $20 co-pay for doctors or specialists, and up to $50 for the emergency room. Even though up front costs are higher than a Medicare Advantage plan, you may be several thousands ahead in bills if you have a catastrophic event.

Answer: That depends on the individual and what their situation. Here are some of the things to consider when deciding if it is worth it.

1 - Affordability: Does the premium being paid fit within your budget? Are the annual increases staying within your budget also?

2 - Current and Past Health History: How is your current state of health? Are you seeing several doctors? Do you have chronic conditions that require a lot of monitoring? Have you had health issues in the past such as cancer, heart attacks, or strokes? Are you able to requalify for a Medigap (Medicare Supplement) plan based on your health if you were to cancel it?

3 - Peace of Mind: Does having a Medigap plan offer you peace of mind with your health care? Do you like knowing that you have very low out of pocket costs throughout the year?

If you can afford the cost and it gives you peace of mind, it is absolutely worth it. If you see several doctors, have chronic health conditions, have had major health issues in the past, or are in a current state where you may not be able to requalify, it may very well be worth having the plan in place.

There is not a right or wrong answer in coverage. There is only what is right for you and your specific situation!

Answer: There may be a couple reasons for this.

It sounds like you have a Medigap plan with an additional monthly premium on top of your Part B coverage. That is where your over $200 cost is. As well as an additional premium for a stand-alone prescription plan.

Your friend likely has a $0 premium Medicare Advantage plan. They are zip code based, but most areas offer them. It may or may not be beneficial for you.

The other option would be that your friend qualifies for the Medicare Savings Program, or more easily explained, Medicaid. In this case the state is paying their premiums.

It is entirely possible that you could save premiums on your Medigap plan just by shopping around for a new one. You could also take a look into Medicare Advantage Plans and see if they might be beneficial for you.

Answer: Part B covers the Medical services of Medicare. This means doctors, specialists, emergency room, lab work, and other services are billed through Part B. There is an annua deductible and then it becomes an 80/20 coverage where Medicare covers 80% on you have a 20% liability.

The issue with Medicare Part B is there is no maximum out of pocket. The 20% liability is based on total allowable charges. If you had a situation and incurred thousands in charges, you are responsible for the 20%, regardless of how high it is. This is where Medigap or Medicare Advantage plans help to limit exposure.

Answer: Medicare does cover out of country emergencies with a lifetime benefit amount. In general, you will have to pay for the services at the time they are rendered. Once you get back home, you will need to submit them through Medicare. There are specific forms that would need to be filled out and you will also need to have copies of the bills from the provider.

Answer: The Extra Help program is a prescription help program offered through Social Security. It is income and asset based, but has higher thresholds than the Medicare Savings Program.

Those individuals who qualify for Extra Help have their Part D premiums paid for and their cost of medications greatly reduced.

You can find a link through Medicare.gov under the Basics tab. Give to Medicare Costs and click the "Get help with costs" link. Scroll down until you see the "apply for Extra help" link.

Answer: Based on the wording of the question, I will assume you have a Medicare Advantage Plan. These plans are network based, and some companies only provide local networks. You would need to do one of two things to know you are covered when you are staying in Florida over the winter.

Your first option would be to see if you can qualify for a Medicare Supplement (Medigap) plan. This puts Medicare as your primary coverage and thusly means anyone in the Medicare network would see you.

If you have a Medicare Advantage plan you would need to make sure that you have a plan that offers nationwide networks. Several carriers have them. You can also look into a PPO plan, however, out of network services are generally more expensive and other aspects of the plan may have higher limits, such as higher maximum out of pockets.

Answer: If you are on Medicare via disability, you do not need to re-enroll into Medicare. However, you do get certain enrollment rights during you "turning 65" open enrollment period that you were previously not eligible for based on being under 65.

Answer: If you are covered through creditable group coverage or through a spouse's creditable group coverage, you do NOT have to take Medicare Part B or Part D, and you will NOT incur any penalty.

If you do not have creditable coverage and simply choose just not to enroll in Part B and/or Part D, you will incur penalties based on length of time without coverage. They are monthly assessed, lifetime penalties.

Answer: Medicare does not cover long term care. If you have an extended care need, you are going to be responsible for those costs. The BEST way to prepare for those costs is to look into a separate insurance coverage that covers extended care needs. There are a lot of options available based on circumstance and affordability. You can look into things such as trusts to protect assets as well. However, when it comes to paying for extended care needs, you either;

A - Self pay

B - Have insurance

C - Enroll into Medicaid

If you self pay, that can quickly deplete assets and retirement funds. Depending on where the funds are coming from, there may be tax implications. It may also affect planning aspects such as income for spouses and legacy.

If you have insurance, you know at least with the coverage amount you have set up, that you are not paying for that much in care. The main risk would be running out of coverage if the care was longer than the coverage allowed. At least, though, you have protected that equivalent amount in assets during that care period.

Enrolling into Medicaid would mean assets are depleted. There are protections for spouses, but they are limited. There are ways to protect assets and still qualify for Medicaid, however that is beyond my scope, and you should seek information from a lawyer.

Answer: The biggest advantage of working with a local agent is their familiarity with the area, market, networks, hospitals, etc. Any agent can look up the basic information, but a local agent may have a more intimate knowledge and be able to provide a bit more insight into things.

Whether you choose a remote/virtual agent or a local one is 100% your choice and perfectly ok. There is no right or wrong as long as you trust the person you are working with to do the right thing for you!

Answer: The education is very similar; I make sure the clients understand the difference in coverage types.

For a new enrollee, this means explaining both Medicare Advantage and Medigap plans, how they work, and all the benefits they offer. Since they are new enrollees, I also explain how moving from coverage types works, when it can happen, and let them know they have guaranteed issue on any coverage type they choose. I use information gathered to offer the best recommendation I can, as well as the why behind it.

For a current enrollee, it is comparing their current coverage type to the other coverage type available. If they have had claims with their current coverage, I can use those as examples of how the other coverage would have "acted" in that situation. I explain how and when moving coverage would be allowed, the process of how that works, and also the steps we would take if they changed their mind about making changes. I still will offer suggestions and recommendations based on their situation. Depending on the situation, I will be honest if making a change will not be able to be done.

Answer: The Medicare prescription payment plan program is available to anyone who has prescription coverage and may be beneficial. The payment plan takes your estimated total prescription cost for the year, divides it by as many months that are left for the year, and gives you a standard payment amount for those months. This can help if you have medications that are eligible for plan deductibles, have several medications that have co-payment amounts, and/or just want to have a consistent payment amount month to month. You are able to enroll anytime during the year by calling your insurance carrier!

Answer: Your coverage is YOUR coverage. It should be tailored to your specific health needs and situation. Speaking to a professional who can help you understand the pros and cons of both types of coverages, costs, networks, and advising based on your personal circumstances is ideal. Choosing a coverage based on "hear say" or "blind suggestions" may have consequences down the road.

Answer: Honestly, I enjoy getting to know my clients and their specific needs and situations. It is great when I can provide the coverage that meets their needs! I also enjoy hearing from clients when their coverage really helped them out. Maybe it was a surgery, an unexpected hospital stay, or some tests they had done that cost them far less than they were expecting to be billed. Whatever the case may be, knowing I have done the right thing for them is a huge reward!

Answer: As long as you reside in a US Territory, Medicare A and B will cover you. If you have a Medicare Advantage plan, you will likely have limitations of coverage. If you have a Medigap plan, coverage would continue as is.

Answer: In a situation where there is an involuntary loss of coverage, such as losing a spouse who was covering you through their employer, you would be entitled to a Special Enrollment Period. During this period you would be able to opt into Part B, and would have all the same enrollment rights that a first time Medicare enrolle would get. This includes guaranteed issue on any Medigap plan or enrollment into an available Medicare Advantage Plan.

Penalties would be avoided because there was creditable coverage in place and as long as Part B is opted into shortly after loss of coverage.

This is also true for Part D enrollment and penalties.

Answer: Part A has a lifetime limit of 60 reserve hospital days. These days do not regenerate, and if used, are gone.

Many traditional Medicare Medigap plans offer additional lifetime reserve days beyond the 60 Medicare provides. Generally, it is 100 extra reserve days total. This gives a total of 160 lifetime reserve days for the individual.

Answer: If the agent answers your calls, spends the time to make sure you understand the information they are providing, and you trust them and feel comfortable with them, there is absolutely nothing wrong with working with an agent from another state.

However, there is a lot of benefit to having a more local agent. Often times it is easier to sit down face to face when answering questions, dealing with potential issues, looking at benefits, comparing plans, and other situations like that.

The choice is yours, and there really isn't a wrong one!