John Messler, Medicare Insurance Agent

Answer: When we join Medicare, we are all on individual plans. So your benefits will not change with a divorce. Each individual is responsible for maintaining their Medicare plans annually. Divorce could have a positive impact on your Irma or part B cost. Since an individual will be filing taxes as an individual as opposed to a merry couple, the income will possibly maintain the same part B cost or a different amount based on earnings.

Answer: There is coverage for acute and non-acute services after a stroke, depending on your plan and there may be co-pays or coinsurance, but there is full coverage for rehab rehabilitation after a stroke.

Answer: If you purchased a managed care plan, many of them come with dental and vision coverage included. That coverage is usually quite limited to a particular network and limitations on benefits. If you have a Medicare supplement, you can purchase a standalone dental envision plan that will match up to your dentist and eye doctor.

Answer: If you can afford the premium of of a supplement and a part D drug plan, there are no network or case management controlling your health care decisions. There are very few out of pocket costs. You must go to a provider that accepts Medicare and there is a Part B deductible each year.

Answer: If you smoke but stay in your same state and county, You don’t need to make any changes. Medicare does not pay for long term care. If did change markets, you would have a special enrollment period. This would allow you to select a plan in that market. If you are on a Medicare supplement, you don’t need to do anything.

Answer: If you live in a local area, you must be sure that if you’re looking for a managed care plan, you verify the physicians you go to are in network. It’s very important to confirm your prescriptions and all your doctors that they’re on formulary and in network. If you sign up for an HMO understand if the doctor is not in network, there is no coverage. A PPO was more flexible. If you find too many holes in coverage, you may want to consider a Medicare supplement.

Answer: Absolutely! Do not answer the phone of a stranger. Unsolicited calling is against the law. Whenever you speak to an agent, ask for their NPN number. If they don’t give it end the conversation. If they do, you can verify it. I often recommend using somebody local or a referral from somebody you know and trust. There are more and more advertisements on Facebook and other social media. Don’t click on them.

Answer: Guaranteed issue Applies to Medigap supplement coverage. Depending on your state, there is a limited amount of time to be able to enter a Medigap coverage without underwriting when you first applied to Medicare. The other option happens when there’s a loss of coverage because of a plan ending or a carrier pulling out out of a market. This creates a new guaranteed option to enter a supplement.

Answer: I enjoy finding the best option for each senior that fits their needs and their budget. In some cases, there are far less options than in the past, but I continue to educate seniors about networks and formularies to ensure the coverage works.

Answer: This is a great question. Cars are going up for Medigap supplements and the manage care plans are offering less extra benefits and increasing the cost sharing. We can’t predict the future, but Congress has always tried to make Medicare affordable. The latest evidence is the change in prescription drug coverage to reduce the cap from 8000 down to $2000 and next year the max is $2100 before catastrophic coverage takes over.

Answer: With manage care there is a coverage gap. There’s typically a significant maximum amount of pocket so if there is an accident or a diagnosis of a critical illness, the beneficiary should either maintain a max out-of-pocket in reserve or add some additional coverages like hospital indemnity, accident and critical illness.

Answer: Unless you have a significant amount of treatment you will be less expensive with a managed care plan. You will have case management involved in your care as well. The biggest benefit of a supplement is having full control of your healthcare without case management.

Answer: The impact of the inflation reduction act on seniors has had a huge effect. Prior to 2025 there was a coverage gap with a nickname of the donut hole that ran from approximately $3000-$8000 in prescription costs that were the responsibility of the member. Now the top end of cost sharing is only $2100 and the coverage gap has been eliminated.

Answer: The donut hole is no longer in effect. Beginning in 2025 prescription drug benefits significantly reduced the member cost sharing. Now there’s only a deductible. Which is typically the first $500 of the year. This is followed by the initial coverage. From $500 to $2000 and in 2026 will be $2100 beyond that amount. Medicare pays 100% and that period is called the catastrophic period. You also have the ability to have a payment plan to spread out that cost over the whole year.

Answer: If you are 65 or older, Losing a spouse and thus losing your medical benefits, creates a special election to sign up for Medicare. Once on Medicare, medical benefits are all individual regardless of whether you’re married or not. Spouses can have different coverages.

Answer: It all starts with Medicare an and B. Medicare a is the hospital coverage and Medicare B is all your other medical cost. After that is when we hIt all starts with Medicare an and B. Medicare a is the hospital coverage and Medicare B is all your other medical cost. After that is when we have the option to go with a Medigap and traditional Medicare or a manage care plan also known as a part C plan. If you stay with original Medicare and select the Medigap plan, you also need to purchase a part D or prescription drug plan. If you choose a part C or Medicare advantage plan the party benefits are included in that plan.

Answer: If you stay on original Medicare without picking a Medigap plan, you’re responsible for the 20% that Medicare a Medicare B don’t pay. This can be a substantial cost. You’ll also want to ensure you have a part D plan or your subject to penalties once you decide to get a party plan.

Answer: People that are on diabetes are eligible to be on a chronic special-needs plan. This will give extra attention and support for diabetes.

Answer: You didn’t make a mistake choosing a Medigap plan. Travel is one of the considerations. You’ve also preserved your right to make your own choices without managed-care telling you how long and where and whether a procedure can happen.

Answer: If you were on a Medigap plan, that’s going to be it. You’ll probably be on that plan forever but regarding your prescription drug plan you’re gonna wanna look at your options annually. If you’re on a Medicare advantage plan you may stay on a plan multiple years, but you will want to pay attention to the plans available in your area Every year.

Answer: I believe the common Memphis is that Medicare is too confusing. Most people just don’t take the time to properly learn. When I sit with a client the first time we discuss how Medicare works and what their options are. When it’s all done most people believe that it is a lot easier, but if you make a mistake because you didn’t do enough research, it can cause some issues. Asking the local agent for help and asking enough questions about your situation. Will ensure you get the best plan for you.

Answer: If you sign up for a Medicare plan and then learn after AEP that another plan is a five star plan, you can switch to that plan at any time. A five star plan offers an anytime move to that plan because it’s the highest rated available. So regardless you sign up for a Medicare plan and then learn after AEP that another plan is a five star plan, you can switch to that plan at any time. A five star plan offers an anytime move to that plan because it’s the highest rated available. So regardless of AEP or OEP, you can always switch to a 5 star plan in a special enrollment period.

Answer: I don’t want to be an alarmist and say that Medicare Has a crisis looming. With all the baby boomers, turning 65, it will tax the system and eventually long-term care as well. There are things Congress can do to preserve and protect the system. We hope this gets done.

Answer: Medicare plans don’t change price based on income. But your cost for part B are based on the IRMAA chart. Yes there can be changes if someone continues to work and yet their income level fluctuates from previous years.

Answer: If the government stays shut down, then there will be major disruption to the Medicare world. This will includes payments and authorizations and also including initial Medicare cards out to those turning 65.

Answer: Your Medicare plan is really a decision upfront. Are you gonna go with a Medicare advantage plan with zero premium and pay as you go or pay for a supplement and have less out-of-pocket cost? With all of the changes and annual adjustments with manage advantage plans, I recommend Medicare supplements if they can afford them. I understand that most Americans are going to be on manage care plans so if that’s the case, we just find the best plan for them. This caused a causes an annual process of looking at options every year. If you have a supplement, you’re pretty much going to stay put, but you are going to look at prescription drugs, plans every year.

Answer: That is a great question. I start with getting a good history, understanding all of their prescriptions and positions and healthcare needs right now and ensuring that the providers are in network in the hospital is in network. With regards to prescription, I want to ensure they’re on the formulary. And then finally asking about ability to pay for a Medicare plan. Affordability is a big part of considering options. Based on all of those answers, I’ll get a good picture and we’ll do the best we can to find the best plan.

Answer: If there’s something wrong in a Medicare statement, your first call is to member services for your Medicare carrier. Another direction is to actually call the provider and speak to billing and have them explain if they have properly build Medicare for all of the services or are they waiting for a final decision?

Answer: Medicare only pays for skilled nursing care usually following a hospitalization or an event. Dementia is not covered in long-term care. It Is considered not skilled so it usually requires moving into a memory care facility assisted living or into a nursing home. As long as the resident has assets, they’ll pay out-of-pocket and once their assets have been depleted, they can apply for Medicaid and be covered going forward. you’ll want to check to ensure the facility you have chosen will accept Medicaid if this may be a scenario that you might get to.

Answer: There is no medical underwriting when you sign up for Medicare in many states. In some states after the initial enrollment, people may be subject to underwriting to sign up for a supplement. You should check with your state to see what rules apply. Once you’re on a supplement, they are very few out-of-pocket moving forward And there is no case management telling you where and how long you can stay in rehab or skilled care. Plans have different amounts of co-pays and coinsurance for all types of treatments so dialysis as part of that.

Answer: Medicare advantage plans will require networks. Regarding travel and that is domestic travel, depending on where you go there may be very few options in network. Meanwhile, on a traditional Medicare with supplement, all you have to do is find a provider that takes Medicare and you’re good. International travel is a different story And I strongly recommend people take out travel health insurance. It’s very inexpensive and it will cover you beyond emergency care which is covered under the domestic Medicare policies. Sometimes you need more than emergency care.

Answer: Zero premiums just mean no cost for the plan, but there are several costs along the way when you use the healthcare. There is caution throughout that starts with deductibles, co-pays, and coinsurance.

The supplements have premiums that average about $200 but there are minimal out-of-pocket after that just a part B deductible and very little coinsurance and co-pays, depending on the specific plan.

Answer: Medicare does not cover hearing aids. Some managed care plans have extra benefits that have allowances for exams and hearing aids. There is usually part that is paid for by the senior.

Answer: Medicare does not pay for groceries. Some managed care plans have extra benefits that do include a small monthly or quarterly benefit for OTCs and healthy food. Those amounts are subject to change every year.

Answer: Medicare Advantage programs are actually recalling. The reduction in the cap on seniors for prescription drugs from $8000 to $2000 has been great for seniors but a major cost to the insurance companies causing them to pull back extra benefits and pull out of some markets.

Answer: Before selecting an agent find out information about them. Get a reference from family or friends and then when you sit down interview them on their experience and whether they represent one or most of the plans available in your area. If an agent is only appointed with one or two companies, then they probably won’t even try to offer you options beyond that. Every agent should disclose at the beginning of the meeting how many plans they represent and how many they don’t and if you’re OK with that, you can move forward.

Answer: If you were on disability and already on Medicare prior to age 65 you don’t have to do anything different upon your birthday. Every year at the AEP you do have the option to look at your plans and consider your options.

Answer: Medicare plans offer different extra benefits. The Medcast plans don’t offer dental or vision, but the coverage is outstanding. The manage care plans are trying to entice consumers to sign up because of the extra benefits. The most important thing is to look at the coverages and that your doctor is in network and your prescriptions are on formulary. The next thing is once that’s been established looking at the extra benefits might include a silver sneakers or a gym reimbursement and another plan might have a good dental coverage. These are all secondary things after you confirm the healthcare coverage meet you or needs.

Answer: I like helping people. Learning about every person situation, including their healthcare needs, prescriptions, and what they can afford allows me to find the best plan to fit their budget. I try to explain Medicare so they can understand it and are making the best choice for them.

Answer: The best way for seniors to protect themselves against Medicare scams is to not answer their phone if they don’t recognize the number. Unsolicited calling to seniors about Medicare is illegal. Don’t ever give out information especially your Social Security or Medicare number to random people over the phone.

Answer: if a Medicare agent is trying to sell you life insurance as well as a Medicare plan then you should walk away. Life insurance should never be part of a meeting. That’s supposed to be about Medicare. Most Medicare agents also are licensed to sell life insurance. If you want to learn more about What life insurance needs, you might have schedule that as a separate meeting from the one discussing your Medicare options.

Answer: I believe working with a local agent versus somebody over the phone that you’ve never met before can be someone that you can get references on and meet with face-to-face. It is much easier to get a good opinion on someone after meeting and talking with him then just someone over the phone.

Answer: We always must be careful when we hear opinions from friends and neighbors about the cost of anything. People tend to leave out some important facts that might have a big impact on the cost. For example, are people on a Medigap plan or on a manage care plan. Yes on some plans even with manage care that can be a difference in pricing from one county to the next in terms of what is available. Some managed care plans. Have zero premiums and others cost anywhere from $10 to over $100 per month. A PPO might be more expensive than an HMO. With the meg plan you will pay a premium, but there’s much less out-of-pocket cost than a managed care plan that might have a zero premium, but a co-pay every time you go to the doctor.

Answer: When sitting with an agent who were explaining the difference between a Medicare advantage plan and a Medigap plan, the two questions that are asked are what are your active healthcare needs? And how much can you afford to pay for your Medicare plan? I consider a Medigap plan the best healthcare coverage available. The managed care plans are good coverage, but they come with strings attached. These strings are out of pockets are higher and more often as well and case management is part of the decision-making process for care. So if a few hundred dollars a month is too much for your Medicare then the managed care plans might be a better choice.

Answer: This is part of the fact gather gathering before enrollment. It’s important to collect a list of all the prescriptions used by the senior and see how they fit into the different plans. We can find out if they are on or off formulary and or what tier they fall under. For example, tears one and two are typically, generic and lower cost with lower co-pays while tears 34 and five are often a larger cost share. This is very important when comparing plans do not only consider the premium but the out-of-pocket each month for their prescriptions.

Answer: Medicare participants with an income above the threshold must pay a surcharge based on their income. IRMAA is the calculation of the surcharge for people that have earnings above 100k for an individual or 200k for a couple. So your earning history was higher than your friends. The IRMAA increase are capped at income of 500 K per individual and 750 K per couple.