Jim Tretola, Medicare Insurance Broker

Answer: They can feel free to enroll in Part A and get their card. However, they should not enroll in Part B unless they want to get their own Medicare insurance and begin paying for Part B. If this is less than what their employer Plan costs, they are always able to get their own Medicare. Keep in mind, though, if they have family insurance, they may want to consider all costs involved. Good Brokers will never have you get insurance that is not as good or more expensive than what you already have.

Answer: The calls we all get at home are solicitations to enroll/change your Medicare Plan. They are NEVER from Medicare, and you should NEVER give out your Medicare number. If you do, consider that your Plan will be changed, and you might not like it. I suggest you either

simply hang up or ask them if they have permission to call you and to please provide their NPN number. Trust me, they will hang up. Also, you will be asked immediately if you have Medicare Parts A & B. Simply reply no........ and they will hang up!

Answer: Yes, in fact, there are many Zero-Premium Medicare Advantage Plans, and they are really Zero Premium. However, that doesn't mean there are no costs, such as deductibles and co-pays. Some key things to look at include the exposure for hospital stays, etc.

One thing to remember is that there is built- in protection on Advantage Plans called the

MOOP......... which stands for Maximum Out-of-Pocket yearly amounts. These can range from several thousand to 10-12 thousand dollars per year. There are products to protect you from these possible financial exposures that your Broker should discuss and offer to you.

Answer: Well, this depends on the coverage that your Plan has. Each Plan has different formularies which determine drug costs. Deductibles and co-pays need to be considered. Keep in mind that there is a maximum yearly out-of-pocket of $2,100 per individual.

Answer: Insurance companies are for-profit entities and do not lose money. When Plans become too costly and not profitable enough, Carriers decide to modify and sometimes terminate Plans in certain areas, and focus on enrolling healthier and younger people. Although this may be the harsh reality, there is often a silver lining. When Plans get terminated, it often gives consumers "guaranteed issue", meaning no medical underwriting questions, and the ability to select a MediGap (Supplemental) Plan, or another Medicare Advantage Plan.

Answer: Well, this is more of an opinion question than a fact-based question, and has political

implications. I will steer clear of answering this, as this is something that would be decided through our legislature.

Answer: I would suggest speaking with your Primary Care

Doctor and follow their direction for age and sex appropriate screening

and preventive procedures. Medicare covers many important tests, etc., and

it is always a good idea to stay on top of one's health.

Answer: This can be explained by discussing the Summary of Benefits and out-of-pocket expenses that a Client may be exposed to in an Advantage Plan. Most people understand that everything is NOT for free. Clients enrolling in Zero Premium Plans, should consider other

Plans to protect them from out-of-pocket costs, specifically Cancer and Hospital Indemnity Plans. Many people don not realize that if they are hospitalized for a handful of days, or need Cancer treatment, that they will be spending thousands of dollars. People also do not take enough notice of the Maximum Out-of-Pocket limits on Advantage Plans.

Answer: The best way is to go to www.Medicare.gov. It is fairly easy to do a comparison. You will have difficulty finding a Broker (unless you are already their Client) to do this, as Insurance

companys no longer want to pay commission to Brokers for this service. It is unfair to ask Brokers to take on this responsibility and work............and not get compensated for it.

Answer: Helping guide them through the often confusing rules and choices they need to make. Clients need to fully understand their coverage and out of pocket responsibilities.

Answer: Some Medicare Advantage Plans have Dental coverage, and sometimes that includes some level of coverage for implants. However, you must make sure exactly how much coverage and what the waiting periods might be.

Answer: Short answer is no, however, you SHOULD review your Plan for the coming year, especially if you have a Medicare Advantage Plan. Doctors often drop out of certain networks an dr Plans change. It give everyone an opportunity to review and make a change, if it makes sense. As a Broker, I strongly recommend doing this.

Answer: Always check before you have anything done, This way there will not be surprises. You always have a right to get a price quote.

Answer: The Inflation Reduction Act has 1 Great feature. It limited yearly Out of pocket to $2100.00.

Now, in my opinion........... that is it.

Because of this Act. Insurance carriers have canceled Plans, raised premiums, co-pays, and have mad a decide effort to PUSH Seniors into Medicare Advantage HMO Plans. It has effectively taken away choice for many Seniors. One might say mine might be a political opinion, however, .......... it is FACT. Insurance carriers will NOT lose and need to make up the amounts over the $2,100.00/year, as they will not lose.

Answer: Patients can "shop" pharmacies, as some have better pricing than others. They can also request 90 day supplies, and mail order fulfillment as well.

In addition, they can compare pricing on sites, as they often are less expensive than their Medicare plan would be. Although they do not count toward the deductible, they can still save money.

Answer: Private Hospitals may or may not accept Medicare Plans. It depends on which ones they are and which ones they choose to accept. It is always best to check whether they accept your Plan first.

Answer: For many Seniors, especially when we experience bad weather conditions and storms, telemedicine is the next best thing.

They can speak directly to a Doctor without having to travel.

Answer: You Premiums and copays probably all increased.

You should have seen this in your Annual Notice of Change letter you received in October.

If you use a Broker, they should have discussed it with you.

Answer: What do you mean by a much more detailed Plan?

Does she have a Medigap or a Medicare Advantage Plan?

Answer: You will NOT have to pay for an ER visit with Plan F. You pay a high monthly premium, and then......... that is it.

You are much better with a Plan G. The difference in Premium is usually offset in a handful of months.

Answer: The main benefit is that you get to speak to a Local Agent, Local Agent are familiar with the Plans in your area, as well as the Networks and Doctors who work with those Plans. In addition they are aware of "local" reputations, and can help you better than a Call Center Agent from many miles/States away.

Answer: People have a right to choose what they want. Unfortunately sometimes it is what is best for”sold” to them with all the ads. I try my best to make sure they understand, when they deal with me.

Answer: Many do not truly understand their deductibles and out of pocket costs they will be responsible for.

Answer: It would be nice if Seniors truly understood their potential out of pocket costs. Too many simply focus on the $0 Premium and all the “goodies” of their Advantage Plan and do not consider their costs if they have a hospitalization or an illness.

Answer: Original Medicare might be better for frequent travels, as there no networks to consider. However, if people research, many Advantage Plans have coverage in other States, as well as

just having to pay a bit higher out of network copays. That in addition to including a Drug Plan, as well as other perks, is the reason many people are choosing MAPD Plans.

Answer: You should have reviewed your Plan and choices during the Annual Enrollment period, and if they are not optimal, in January, there is the Open Enrollment Period, and you have some options at that time.

Answer: The only "mistake " I see in enrolling in Medicare is Late Enrollment.

Simply not enrolling when they should.

Now, enrolling in Secondary Plans is another story.

Many people do not understand their financial exposure with Plans, particularly

Medicare Advanatge Plans.

While everyone loves $0 Premiums, Part B Givebacks, and Free "Stuff", many do not understand the maximum out-of-pocket (MOOP) potential costs they might incur, or the deductibles and network restrictions, as well as prior authorization policies and hospital costs.

Medicare Supplement, or Medigap Plans, are rather straightforward, and usually do

not hold "surprises". In many Plans, you pay your Premium, your yearly deductible, and

your yearly costs are fairly predictable.

However, many can not afford, or choose not to pay for these Plans.

Answer: I don't understand your question. What happens in relation to what?

Are you talking the payout amount?

Answer: I educate them on what their choices are and patently answer their question. Many people come from a work Plan, so they are very familiar with an Advantage plan, but do not undo medical plans. Once again, education is the key. I do informational seminars throughout the year.

Answer: Unfortunately, the go to question really boils down to one’s budget,Many people can not afford a Mefigap plan, so it is not an option.

However, a Broker can help you look at options, such as a high deductible Medigap plan, if that works for you, or an Advantage Plan complemented by a hospital indemnity and cancer plan, to give you great protection.

Answer: If you missed your window, you must wait until the Open enrollment period, which starts January 1st to March 31st. Other than that, you will need a Special Election period. Check with your Brokef to see if you qualify.

Answer: Your best bet is going on Medicare.gov and entering your RX’s. It will rank apart D plans by carrier and you can see your costs.

Brokers are mostly not compensated any longer to do Drug Plans, So, you must research in your own.

Answer: If everyone could afford a Medicare Supplement Plan, they would probably have one.

Many people choose Advantage plans based upon their budget, and with many having $0

Premiums, as well as including a Drug Plan as well as other benefits, they are quite attractive.

Answer: If you have a Medicare Advantage Plan, you should review every year, as they often change.

It is not a bad idea to check prices on Medigap Plans every year or so, as well.

One major sign would be if your Doctors office tells you they will no longer be working with your Advantage Plan.

Medigap Plans, only will change in premiums, not coverage, as they are all the same

Answer: When working with a local Agent, there is a much better chance that they are familiar with the Networks and Hospitals that you use. That is in addition to having local knowledge of things such as the reputation of Providers.

Answer: It depends on your needs, preferences, and financial ability. If money isn't critical, a

Medicare Supplemental Plan gives you a very accurate budget of what your medical

expenses will be for the year.

If you have many medical expenses, it can be a bargain.

Answer: Well, just as it says, there is a maximum out of pocket expense for MOST prescription drugs.

MOST, but not all. You should always check if your med is included in this.

Answer: If you cannot provide proof of creditable coverage, you may be assessed a penalty.

These penalties can go for life, unless you meet certain criteria that waive the penalty.

Answer: If your Parents need help, make sure you oversee any decisions that they make regarding choosing a Plan. Any good Broker must ensure that they are speaking with a competent Senior.

Answer: If you get a Cold Call, out of the blue, and they ask you for your Medicare number, this should be a Red Flag. If you provide your number, consider that your Advantage Plan will be changed. When you go to the Doctor in January, you may find they do not accept your Plan, and you may owe money; you might not owe if you had a correct Plan. These are usually Out of State call centers calling you. People selling Medicare need a signed (by you) Permission to Call form. If you call in, it is a different story.

Answer: It is illegal, not to mention unethical, for Agents to charge for enrolling someone,

as they are paid to do this by the Carriers.

Answer: Only if they are a "Captive" Agent. This means they work ONLY for 1 Carrier and enroll

people in ONLY that Carriers Plans. It is always better to work with someone who represents many Plans.

Answer: You can go to www.ssa.gov and click on Replace your Card.

There is no cost for doing this. If you know your Medicare number and have

written it down, you should be able to provide that number, where needed.

Answer: To be safe, I would absolutely call Medicare and ask what, if any they cover.

I would also check with your Medigap or Advantage Carrier and verify coverage BEFORE doing any treatments.

Answer: Well, I don't think asking "supposed" to change is accurate. However it is a good bet that is will every year, and it will go up somewhat. It is a good idea to know what it is.

Answer: You may want to consider changing Plans. Realize if you use an out of network hospital, your costs will be more.

Answer: MOOPS... are just what they say they are. It lets you know the top end of what your costs will be for the year. it is built in protection on the Advantage Plans and is important to be aware. There are stand-alone Plans, such as Hospital Indemnity and Cancer Plans, that can help prevent hitting these MOOP limits.

Answer: It all depend upon whether you are still working or not and have continuous creditable coverage.

Delaying Social Security is an option that really doesn't effect selecting Medicare at 65, if that is your choice.

Answer: Yes, however the Medicare rules and guideline must be followed for Chiropractors. It is always best to first call your member services to be clear on what to expect.

Answer: Most Advantage Plans require a referral and state that you must use an in-network specialist. If out of network, you may have to pay 100% of the bill. It is always best to first check with your Carrier, before going to the Specialist.

Answer: It all depends upon the Plan, but generally yes, you will need prior authorization. Medicare Advantage Plans are part of managed healthcare, and one goal is to control costs. If this is not something you want, and you can afford it, you might want to consider a Medigap Plan.

Answer: They pay penalties because of Late Enrollment. The rules are very specific and unfortunately, they do go for life. However, in NJ , and other States that have Pharmaceutical Assistance Programs, one of the great benefits of this is that it will waive all the penalties, on both Part B and PDP Plans.

Answer: First off, my condolences on your loss.

As for your Premium increase, everyone’s went up.

Medicare is an individual thing and your Husband’s passing had nothing to do with the increase.

Meet with a Broker and look at your options.

Answer: Your Medicare coverage continues as if you lived at home. Unfortunately, Medicare does not pay for long term care and that is why people are looking into fixed index annuities and other insurance products that have a LTC component in them, without needing medical underwriting. Younger people should seriously consider buying LTC when they can afford it and can qualify for it.

Answer: You should immediately go on www.ssa.gov

and order your Medicare Card with Parts A and B active. Once you have that, you can consider your options with a Broker.

Answer: Medicare Advantage Plans definitely save you money…….IF, you are healthy and do not require treatment.

It is important to consider all factors such as you health, your budget, and your preferences

Answer: The short answer is yes; however, you must realize that Part B (the medical part) only pays 80%, and you may be responsible for the remaining 20%. The plus of just having Part A and B is that there generally are no networks, prior approvals, or preauthorizations......... and you only pay monthly for Part B. It is all about understanding what each type of coverage each type of insurance provides.

Answer: If you have a Medicare Advantage Plan, this is a standard procedure, as it is "Managed Care", and why Premiums are often $0 or very low. If this doesn't work for you, and you can afford it, you might consider a Medicare Supplement Plan.

Answer: It might be a very good idea to help protect you from thousands of dollars out of your pocket, especially if you have an Advantage Plan.

Answer: There are many questions, but perhaps the most important is what will my maximum out of pocket for the year.

Answer: If you have had no other medical expenses in the calendar year. Yes, you must first pay your yearly deductible, then your physical therapy will be covered at 80%. So, to limit this financial exposure you should consider either a Medigap or Medicare Advantage Plan.

Answer: I think the penalties that go for life, should be taken a look at.

Often there are Special Election Periods for various reasons, so I think there should be some flexibility.

However, as I don’t make the rules, I do my best to help people navigate them.

For example, qualifying for and getting PAAD program in NJ, cancels these late enrollment penalties.

Answer: Generally speaking the answer is Yes

However these employer plans must be recognized as credible coverage.

Answer: While many Medicare Advantage Plans are $0 Premiums, there are many other costs involved. However, there is a built in maximum out of pocket on all plans. The Government helps these premiums to be $0, as they are encouraging managed healthcare to help keep costs down.

Answer: Doctors can go in and out of networks at their discretion. It is always important when reviewing your Plan for the next year, whether they are in or out. If this is untenable for you, a Medigap Plan should be considered, even if it must be one with a high deductible and a low premium.

Answer: Yes, as long as they are licensed in your State and are familiar with the Plans and Networks. You should ensure they are certified with all the Major carriers in your State.

Answer: You should not owe a Penalty; however, you must make sure your Wife's work Plan is considered Creditable Coverage by Medicare.

Answer: It all depends on whether they are in the Advantage Network, and if not, what the added costs will be if they are out-of-network. You can always continue to see your Doctor, but it may cost you more. If always seeing your doctor is a priority, and you can afford the Premium, you may want to consider Medigap Plans.

Answer: It all depends on your definition of cost-effective. If you mean the least cost, then Traditional Medicare, having just Part A and Part B, would be the least expensive. Coupled with a low-cost Prescription Drug PDP Plan, this would be the least expensive. However, a Medicare Advantage Plan, especially one with a $0 Premium, would provide greater coverage while keeping expenses down to a minimum, and it generally includes Prescriptions, Dental, Vision, and Hearing protection. One must remember that everyone is healthy and doesn't need coverage..........until they are not healthy! So, everyone must make choices, and should discuss their options with their Broker.

Answer: Once you put out $2000 for 2025, and $2100 in 2026, you will not have to pay for Medicare Part D drugs going forward.

Answer: Sure. As long as they are educated and understand what they are speaking about. Granted, it is easier to relate to someone close to or over 65, but it doesn't mean a younger person can't help you.

Answer: Why wouldn't you? This creates a Special Election Period, and if you have an Advantage Plan, your network of nearby Doctors may change.

Answer: First, check if your Plan is being terminated. If so, you must pick a new Plan by the end of the year. This is NOT a bad thing, as it will give you Guaranteed Issue of a Medicare Supplemental Plan, with NO medical underwriting that you may not have otherwise qualified for. If this is not want you want, you can pick one of the Medicare Advantage Plans that are available.

Answer: The ones I do are worth it. They are INFORMATIONAL ONLY. I do not ask for people to sign in and I explain what is going on this year, and if they would like, they fill out a Permission to Call (PTC) form.

Answer: The 3 midnight rule refers to having to spend 3 nights in the hospital to qualify as an Admission.

There is a major difference between Admitted and Under Observation, as to how benefits start in.

It is very important to ascertain the status of a patient.

Answer: See if you can apply for an exception, as well as if there are alternative medications. Manufacturers coupons can also help.

Keep in mind yearly out of pocket for Medications will be capped at $2,100.

Answer: There are programs that assist with lower incomes. In addition, you can consider Medicare Advantage plans that offer a Part B Give Back that can lower your cost.

Answer: I would always go with someone who you know, like, and trust. If they are unknown, I would always ask for referrals and see if they did a good job for someone you know.

Answer: Medicare should always serve as the basis of your Medical care. As Medicare does not cover long term care, younger people and those who can afford it, should consider long term care policies. Those who are older and can’t pass the medical questions, should consider fixed index annuities and other insurance products, that do not require medical underwriting and can greatly help in their later years with help in the home or Assisted Living.

Answer: Well, this is an opinion question, so I will offer my opinion.

As a Senior who has paid into this system all my life, my answer is absolutely YES.

However, I do believe there should be checks and balances, so that it is not abused.

Alternative treatments should be studied for results and if they prove effective, should be allowed.

Answer: I believe that face to face is always the best, however when this is not possible, a Zoom meeting works very well.

Answer: It depends what your employer Plan covers and WHICH type of Medicare Plan you choose.

Most employer Plans are very similar to Medicare Advantage Plans, so they would be the best comparison that your Broker can help you with.

Answer: You absolutely should speak with a Broker who can point out the differences and you can more clearly consider what is better for you

Answer: This is up for discussion, but many people do not like the restrictions of networks and prior approval and pre authorization for services.

In addition, there are maximum out of pocket yearly limits which can be substantial.

Answer: Medicare does not, however some Medicare Advantage Plans do offer incentives for taking care of yourself and getting appropriate screenings, etc, All Plans differ and this is what you can discuss with your broker.

Answer: Unless you have a stand alone dental plan, you will absolutely save with coverage from a Medicare advantage plan. Just make sure your Dentist accepts that plan.

Answer: Absolutely. Your independent brokers can review all available options and plans and help you choose what is best for you.

Answer: Only deal with people you know and trust and NEVER give out your Medicare number to a stranger on the phone.

Answer: Yes you are. Make sure you get on a new plan within 60 days of leaving your Plan. Remember, you will have Guaranteed Acceptance on a Medigap Plan…. with no medical underwriting.

Answer: Yes, it is free, as long at is an annual wellness visit, and it is your Primary Care Foctor that is in network for your Plan.

Answer: If you do not have Guaranteed Acceptance, that is, unfortunately, the rule. Certain States(like New York), are different and do not require Medical Underwriting. Insurance Companies do not want to lose money and there is a push toward managed care, which has many people going into Medicare Advantage Plans.

Answer: The first thing I would say is you should never give out your Medicare number to stranger on the phone. Also, anyone selling Plans must have a signed (by you) Permission to Call form, as no one is allowed to make "unsolicited "cold calls to Medicare recipients.

Most phone calls will ask if you have Medicare Part A and Part B. If you say Yes, and give them your Medicare number, you can count on being enrolled in a Medicare Advantage Plan that you may or may not want and may or may not be good for you.

Answer: Most of the time, the answer is no, but there are times when it is yes. What you should know is that rates vary by state, and certain States may have underwriting requirements if you move. Plus, if your current Carrier does not operate in that State, you will have to find another Carrier to apply to.

Answer: You should know that a Medicare Advantage Plan, by Law, covers all that Original Medicare Part A & Part B cover, with the main benefit of covering the 20% that is not covered by Part B. There are many factors to consider, which should be discussed with a Licensed Broker.

Answer: Generally speaking, Original Medicare does cover ambulance service to the hospital; however, there are certain conditions that must be met.

Answer: There is no easy answer to this, as it depends on your personal situation. Your health, your budget, your preferences, all need to be considered. I discuss this with Clients all the time.

Answer: It depends upon what kind of Plan you have. You should discuss options with your Broker,

as there are usually decisions that can be made that should help you.

Answer: You can check with your Broker, or call the member Services number on the back of your ID card, and ask to verify the benefits, or look at your Plan book, assuming you have one.

Answer: The Annual Notice of Change (ANOC) Letters should be sent out by September 30th.

It is very important to read them, especially if your current Plan might be one that is being terminated.

One important note is that if you have a Medicare Advantage plan that is being terminated,

PLEASE hold on to this letter, as this letter will give you Guaranteed Issue for a Medicare Supplemental Plan....... WITHOUT MEDICAL UNDERWRITING! That could possibly greatly save you money, especially if you have current or pending medical issues.

These ANOC letters also state the Premium cost and benefit changes in your current Plan going forward. This can help you to investigate a new Plan, if you would like to.

Answer: If you travel extensively and do not want to be worried about whether or not a Provider is in a particular network, or don't like dealing with referrals or prior authorizations..

Also, if you really like to have a predictable budget........ and can afford the Premiums of a Med Supp Plan.

Answer: Most likely. In fact, your top-end out-of-pocket will be $2000 for 2025. This amount is expected to increase for 2026.

Answer: Make sure you follow the rules, so as not to get hit with penalties. There are specific times and number of days that you must apply and get your Medicare Card with both Parts A and B active.

Your independent Broker ( like myself) can advise you.

Answer: If not ban, curtail them. The celebrities getting paid to pitch Plans, most likely do not have the same Plans they are pitching. It is very misleading with all the promises, without explaining everything. That is impossible in a 30-60 second commercial.

Answer: Keeping just Original Medicare can prove costly, as Part B only pays for 80% of the Medical bills. Considering and Advantage Plan, or a supplemental Plan as secondary insurance, is a smart choice.

Answer: That is very highly doubtful. If Medicare fails, it will be the USA failing as a Country. Currently there are efforts to ensure those who deserve and qualify, and paid into the benefits, will continue to be able to use them. Fraud and abuse are being eliminated. Our Government is making sure to keep Medicare solvent.

Answer: The best way is to discuss with an Independent Broker who handles all the Plans in your area and can discuss what the choices are when you consider your Health, your Doctors, your lifestyle, and of course your budget.

Answer: This is a long and complex anserr that hopefully our government is on top of.

I would suppose that taxes must be raised during people’s working years.

Answer: I believe there are strict rules, however unfortunately not everyone follows them.

Consumers should be educated on what snd what is not allowed.

Answer: Yes it will. Different aspects of it are covered by different parts of Medicare.

Essentially, everything is covered except:

Over the counter medications

Some experimental or alternative therapies

Non medically necessary services.

Answer: While it is difficult to predict the future, Medicare Advantage Plans are growing in popularity. They are considered managed health care and as time goes on, will help control prices and ensure preventative measures for better health. Many people choose them because they include prescription medications and other benefits, as well as often zero or low Premiums.

Answer: They are. Medicare Supplement Plans act as someone’s secondary insurance when they have Original Medicare with both Parts A &B as their primary insurance coverage.

Answer: If the Seminar is an Informational Only seminar, you can’t be enrolled in a Plan.

They are intended to answer general questions in a relaxed and informal arena, without any obligation.

Answer: Yes, Original Medicare will cover urgent and emergency care in all US States and territories. If the provider accepts Medicare, you will have coverage like if you would in the mainland States.

Answer: No. You must use your Medicare Advantage card. Your Advantage card Plan essentially “replaces” your Original Medicare card.

Unless in an emergency situation, you may have to see another Doctor.

Often, you will just have to pay a higher cost pay for an out of network provider.

Answer: There are Medicare Plans that take this into consideration, such as Chronic and Dual

Special Need Plans. It is important to work with a Broker who can help you get the best Plan for your unique needs. Even people under 65 can qualify for Medicare under certain conditions.

Answer: If you really like your Prkmary Care and other Docyors, picking a Plan that does not include them, or the Hospitals that you use, can be very troubling. Researching this is a must.

Answer: When a Spouse passes away, beneficiaries receive the higher of the two monthly payments. However, the lower payment does go away,

Answer: Yes, and in 2026 it will increase to $2,100

This is a benefit of the Inflation Reduction Act.

There are positive and negative actions caused by this Bill, but the Medication Out of Pocket cap is certainly a positive one.

Answer: All Plans can have differences. I help navigate and simplify. PPO’ provide a broader network, but you may still need a referral.

If this doesn’t appeal to you, if you can afford it, consider a Medicare Supplemental Plan.

Answer: I have been a Certified Senior Advisor for many years. I enjoy helping Seniors, as Medicare can be very confusing and there is great satisfaction in helping Seniors.