Jim Willis, Medicare Insurance Broker

Answer: I’m unaware of any social determinant being utilized to calculate the cost or the benefits of a Medicare advantage plan.

Medicare advantage plans are based on the population. The age of the population the amount of medical care that population needs in the income. These factors are utilized to determine how many benefits will be offered in a given plan in a given area. Material

Answer: The cost of Breztri varies from policy to policy. The lowest co-pay I found was $28. The highest co-pay I found was approximately $170.

You need to be sure that your agent takes all of your prescriptions into account along with your doctors when finding you the proper plan.

Answer: Most HMO's allow you to see a Specialist that is out of network but you will pay a higher copay, possibly 45-50% of the bill.

Compare the difference between the copay on a PPO vs the loss of some of the extras of the HMO.

Answer: If she has a POA (Power Of Attorney) for you or you are present with her and the Agent.

For the most part, she cannot work with the agent on your behalf if you are cognizant and do not need a POA

Answer: Seniors get a lot of advertising regarding Medicare and a lot of it is false ($500 food cards, free dental and vision, $250 a month give back, etc). Help them sort out what is best and true.

Get a good Medicare Agent to go over their plans. Find one that is ethical. I had one client that was 86 years old that had been on a supplemental plan for 21 years with the same agent. She had spent $128,000 and had never been to the doctor.

Get them on a good plan and make sure they follow up with well checks

Answer: Take your bills to your Medicare Agent or to a local Senior volunteer to exam and tell you what they are for.

Once you know what the bills are for, break them into manageable stacks. Save the actual bills you pay for income tax. Trash duplicates and unnecessary bills.

You need to make sure he is taking necessary meds and not experimental or unnecessary meds.

Answer: Carriers will have to adjust their calculations based on the growth of seniors on Medicare.

Medical expenses will need to have better controls. Current expenses are way too high and force the carriers to diminish their offerings.

Answer: Some of the plans are much cheaper than others.

You need to contact a good local agent and check your prescriptions through him

Answer: For the most part, no.

Some Medicare Advantage plans cover Repatha with a co-pay between $55 a month and $220 a month

Answer: When it comes to Medicare Advantage plans, every county may have completely different plans or no plans at all.

What's important, and very few pay attention to it, is the medical and prescription coverage and not the extras.

Answer: Yes, you need to contact a local Medicare Agent to review your prescriptions, doctors and coverages.

Most policies are different in different states.

Answer: Most vaccines are preventative so they are administered at no charge.

The Flu, Pneumonia, Covid and in some cases Shingles are all included. However some policies may not pay for Shingles.

Answer: Yes. If you are concerned about pre-existing conditions affecting your premiums, consider switching to Medicare Advantage as almost 90% of Medicare recipients have done.

Talk to a Medicare Advantage Broker to learn what stories about Medicare are true and what are false.

Answer: You need to make sure you have a licensed Medicare broker who has a license in your state and is appointed by at least the three main companies in your area. There is no need to look further than the one broker.

An honest, ethical broker will compare your needs, your prescriptions and your doctors before making recommendations to you.

Answer: You can get a Medicare Advantage plan that includes dental and vision.

Your other option is to purchase dental and vision insurance from a company that sells same, like Ameritas

Answer: As long as you have credible insurance coverage, no. Part A will come to you but Part B you will have to apply for later. You will need to complete a form from your employer showing what credible coverage was to avoid paying a penalty for not signing up sooner.

Make sure your credible coverage includes coverage for prescription drugs to avoid paying a late enrollment penalty for your drug plan.

Answer: A local agent should be familiar with the doctors, hospitals and pharmacies in your area. They can help you find a Primary Care Doctor or Specialist if need be.

A local agent should be available all year long to help you with copay information, hospital charges, etc. The remote/virtual agents do not know you or the area you live in. They do not know which doctors may not take your insurance.

Answer: That is true. That's why it is important to go to a local agent (not some 1-800 number on TV) who stays up on all the plans the doctors in your area and your medications.

There is no need to worry if you have a local agent who will still work to get you the plan you need.

Answer: Medicare covers medically necessary care, but you must meet the criteria of being "homebound" and require skilled nursing or therapy.

Medicare does not cover long-term or custodial care like full-time personal assistance, but it does cover skilled services such as nursing, physical, and occupational therapy, as well as certain medical supplies and hospice care.

Find a good agent and talk to them about annuities and other savings vehicles to cover long term care.

Answer: The current shutdown is due to the present administration trying to cut back on waste and fraud in the healthcare system. The previous administration took billions of dollars out of Medicare to pay for medical care for those who had not earned it. Unless the Democrats get that money back, you will have nothing to fear.

If those billions are given back to the Democrats, the illegal aliens will have have free health care and Medicare will be jeopardized.

Answer: Yes, Medicare covers the "routine costs" for qualifying clinical trials and care for complications.

This includes items and services, like hospital stays and doctor visits, that would be covered by Medicare for you if you weren't in the trial. However, Medicare generally does not cover the cost of the "investigational item or service"

Answer: Simply put, nothing that wouldn't happen anyway. Your Part B premium will come out of your Social Security check and Part A will be paid by your work credits over the years.

Answer: Most Medicare Advantage plans cover at least a part of the cost of hearing aids.

These same plans usually include Dental and Vision as well.

Answer: Medicare Supplements pay everything and no cost.

Medicare has to pay a portion before the Supplement will kick in. The Supplement has copays and deductibles and must abide by Medicare. If Medicare does not pay for the test or procedure, neither does the Supplement.

Supplements can go up every year and the total cost of Supplements, including premiums, can be more than $5000 per year. The Maximum Out Of Pocket for most Medicare Advantage plans is much lower.

Answer: Not at all, they are better plans.

I got into selling Medicare because of a $17,000 out-of-pocket expense with my Medigap and/or supplement

Answer: Medigap plans working in conjunction with Medicare and pay the balance of anything. Medicare pays part of. There are still co-pays and deductibles with Medicare that you may end up owing and there is no maximum out-of-pocket.

The cost of a Medigap plan with a standalone drug plan and a dental and vision insurance policy may well run an excess of $5000 per year where there would be no cost for the Medicare advantage plan. The Medicare advantage plan has to cover everything that basic Medicare covers And may include prescriptions, eyeglasses Hearing Aids and dental.

Answer: There are both HMO‘s and PPO‘s. The HMO uses a fixed network and requires a referral to go out of that network. The PPO does not need a referral to go out of the fixed network.

The HMO usually offers a few better benefits, but there is a drawback of needing a referral.

In addition, there are DSN P’s and CSNP’s for those who have Medicaid or special needs due to their health problems

Answer: Get a good agent, like me, to go over all of your doctors, prescriptions and needs and compare to all of the plans available in your area and help you determine what is best for you. Throw away all the other stuff!

I'm 70 and I get the same crap and the same calls!

Answer: It's one of the many rules people don't read (like having to have a drug plan). The problem is it appears you are getting Medigap because you have been diagnosed with something and the underwriting is to determine what it is.

Consider switching to Medicare Advantage which has no underwriting. It's actually better in any case.

Answer: Depending on how "rural" the area is, your plan choices may be reduced to one or two plans.

Most Seniors don't consider this problem when moving. I have had several call me before moving and ask about their choices. I highly recommend doing that

Answer: That would be the fault of your agent. Not all agents do what they are supposed to do. There is no way to fix this but do it right. Several of the plans reduced dental last October.

When you talk to me, I do a plan comparison between the top three plans in your area. We compare all the benefits and costs in the plan. I then look for your medications and doctors to ensure they are in your plan's network. Once we pick the plan that is best for you, we go through the plan line by line to make sure you understand it and agree to it.

I also offer Dental Plans separate from your Medicare. One plan gives $5000 per year coverage for about $41 a month.

Answer: There is no easy answer to your question. Simply put, most likely yes... but you may have to pay for it. Medicare is separate from Social Security. If you paid Medicare but not Social Security, see next paragraph.

If you have less than 30 work credits with Medicare, the cost for Part A coverage is $518 per month.

Answer: Many Seniors lost their Medicare Advantage plans last October due to changes put in place by the Biden Administration. Funding to Medicare Plans was reduced and Medication costs to the consumer were capped at $2000 putting the costs on the insurance companies.

Because of these changes, many companies eliminated some of the plans they had been selling and created new plans with far fewer extra benefits. A Medicare Advantage plan is still the best for most seniors but that's for another question.

Answer: Supplements work together with Medicare and pay what Medicare does not pay. That is the statement most of them make to you.

Ask what Medicare does not cover, even slightly, and hence your Supplement will not cover either.

Ask what are all of the copays, deductibles, and other costs that the supplement does not cover

I have had peopple sit down in front of me and tell me they paid nothing for their doctors during the year. By the time we added their premiums, drug plan costs, deductibles and copays, we came up with about $6200. I have a $1900 maximum out of pocket expense on my Medicare Advantage plan with all the same coverages they had. I have switched over 700 people and ALL of them are happier with the Medicare Advantage plan

Answer: I fully believe in selling my clients on Hospital Indemnity plans that cover all of the hospital copays for about $21 per month.

There are also indemnity plans that cover ambulance costs, cancer and heart attack coverages, etc. I personally have a policy that includes targeted cancer treatment in addition to indemnity coverages, cancer and heart attack lump sum coverages. I pay $88 per month for all of these coverages.

Why pay for a supplement when you can get a Medicare Advantage plan with drug coverage and all of these extra indemnity coverages for $88 per month?

Answer: Medicare costs are directly tied to the medical and prescription costs available to all of us. The current administration is working on reducing the price of prescriptions as well as other medical services. These costs go up with the economy and inflation as well as fraud and abuse.

The Democrats in Congress have always blamed the Republicans for cutting Medicare while the Republicans have always accused the Democrats of overspending of Medicare.

The reality is that Medicare and its costs are a truly bipartisan issue where medical costs must be controlled as well as fraud, waste and abuse.

Answer: As long as you meet the requirements of the insurance company, you can get a Guaranteed issue Medigap plan.

The question is why wouldn't you consider a Medicare Advantage plan instead? The cost is lower or zero with more benefits. The Medigap plan has copays, deductibles and does not cover some things at all if Medicare does not cover it.

Answer: It depends on who puts it on and what they have to say.

A good Medicare Information Session will explain all aspects of Medicare and the types of plans. If they are focusing on one plan, it's a marketing lecture.

You need to have an agent who will sit down and discuss your health problems, medications, and doctors and help you find the plan that is best for you.

Answer: I need a lot more information to answer your question.

1. Are you employed

2. Does your work provide insurance

3. Do you intend to pay for your Medicare out of pocket

4. Why are you delaying your Social Security?

5. If you wait until 70 to collect, the amount you will lose will take you until the age of about 84 to break even. You can contact me.

Answer: You need to be on a PPO that has network doctors in your home state as well as in Florida.

I have several different plans that do both except I don’t know what your home state is

Answer: The star ratings actually have nothing to do with the quality of care that you will receive

The star based on returns from clients of a given insurance company and their opinions on what they’re receiving in the way of benefits, care and coverages.

Answer: Part of the process of shopping for a Medicare advantage plan is to find a good agent who will check to make sure that all of your doctors are in the plan that you have chosen.

It’s far more likely her doctors are in the plan and available and more places than the current Insurance she has.

Answer: Yes you are

Loss of employer coverage is one of the standard SEP‘s. You have to get signed up rather quickly, preferably within 30 days after losing your employer coverage.

Answer:

It really depends on where you’re traveling to. Many of the Medicare advantage plans work in most if not all states. The Aetna elite plan works in all 50 states I have found.

So the answer your original question is yes you probably could’ve done better with a Medicare advantage plan without a premium and most charges covered as long as you stay within network, but their network covers all 50 states

Answer: Generally speaking, Medicare does not cover long-term care or custodial cost.

Long-term care insurance is quite pricey if you are in your 50s or older. Talk to a Medicare agent that is also licensed to handle annuities. The agent can help you utilize your 401(k) to roll it tax free into something like an immediate annuity that would handle the payments For long-term care without losing your money.

Answer: Medication’s fall into several tiers, depending on the age, commonality, patents, etc. most common medication’s, like blood pressure, meds, statins, antibiotics, and some COPD and asthma drugs, generally fall into tier one or tier 2 and will likely have very low or no co-pays.

Newer drugs, biologics and some drugs popular due to their use and success rate will generally be priced in tiers three or tier 4 and have co-pays ranging from $40 to several hundred dollars. You may be able to get a tier exception from the drug plan working with your doctor that can drop a co-pay several hundred dollars.

Answer: Every plan has different coverages and a different formulary. You need to study the PDP and compare it to your prescriptions.

Most people are better off with a Medicare advantage plan covers their drugs with the plan.

Answer: It depends On your prescription costs.

At this point it appears to be costing most seniors more unless they have expensive drugd

Answer: They’re not really free as there are copays and deductibles but they’re still cheaper than supplements in the long run

Answer:

I like being able to find the right plan that best benefits the Client

I also use my medical knowledge to help them get the right doctor and/or procedure