John Motsinger, Medicare Insurance Agent

Answer: You can wait, however, there's a good chance you could save money by going on Medicare and even get better coverage. That's why it's important that you get together with an independent Medicare agent/broker like myself, who will do a thorough needs analysis and help you compare your employer insurance to Medicare. There's a good chance you will most likely choose to leave your employer insurance and go on medicare, even though you're still working.

Answer: Staying on employer health insurance instead of going on medicare when they turned 65 is the biggest regret most my clients

Answer: An underrated benefit of original medicare and medicare supplements is that it's a fee for service whereas medicare advantage is managed care. With original Medicare, as long as it's coded as a medically necessary procedure the claims process is pretty seamless. However, with medicare advantage there is typically prior authorization which can involve some red tape.

Answer: Well a PPO does allow you to go out a network whereas an HMO only covers in network do the PPO does offer more flexibility. The best thing to do is work with an agent like myself who has a database that will make sure all your doctors and drugs are covered. This minimizes your chances of going out of network and having bigger bills.

Answer: A good rule of thumb is that Medicare covers everything medically necessary. Asthma is considered a chronic condition and therefore, yes, original Medicare and Medicare advantage plans will cover treatment for asthma. However, you would also need to make sure your plan covered your asthma medicines since drug formularies and tiers can change with each company/plan every year.

Answer: If you are already receiving a social security check, then you will be automatically enrolled in medicare part A&B. If you are not yet receiving a social security check, then you either have to call social security and have them enroll you into medicare part A&B or you need to go online, create a social security account and enroll into medicare part A&B.

Answer: Medicare passed a rule saying that it will not cover these special weight loss drugs like ozempic unless you are also a diabetic. If you are prescribed a weight loss drug, the insurance company will ask the doctor to sign off on a form saying you're diabetic or they will not cover the drug.

Answer: Some medicare advantage plans do offer incentives and benefits for those who meet certain health goals.

Answer: Yes, you can, but you would be subject to underwriting so if you have some health conditions then you might have a hard time finding another medicare supplement insurance company that is willing to insure you. If you do have chronic health conditions, then if you live in kentucky, we can invoke the kentucky birthday rule up to 60 days after your birthday and you'll have guaranteed issue into the exact same medicare supplement plan with another company, thus saving you premium

Answer: You can contact medicare anonymously and notify them of your concern. However I would first contact that billing department or that doctor's office to see if they just accidentally coded you're procedure incorrectly.

Answer: I have a database that will give me an annual estimate of your out-of-pocket expenses based upon how often you go to the doctor

Answer: You can call me and I will put your drug into my database and let you know if it's covered by your current plan. And if it's not, I will see if I can fit you in another plan that will cover your drugs

Answer: Social security and Medicare require you and your employer to fill out special forms proving you had creditable health coverage and also that your coverage is now terminating in order for you to enroll in medicare part B after age 65 and waive the penalty

Answer: Most medicare plans have zero copays on preventive screenings like prostate exam, mammogram screenings and a colonoscopy.

Answer: For decades, we've heard politicians scare us by saying we won't have Medicare funding or Medicare will go away but yet, somehow our politicians have always found a way keep funding medicare.

Answer: It depends on your age but at age 64 and a 1/2 you should always talk to a Medicare specialist like myself so you can decide if you want to enroll in medicare when you turn 65 or if you want to stay on your major medical health insurance until you and or your spouse retire.

Answer: Not if you live in kentucky because in kentucky we have the medicare supplement birthday rule that allows you guaranteed issue into the same medicare supplement with another company every year, up to sixty days after your birthday, thus allowing you to save a lot in premium with keeping the identical coverage. My most recent success story is a client who moved from plan F with one company (where she was paying $418 a mth) an I moved her with guaranteed issue (no preexisting condition limitations) to another plan F with another company and only $223 a month. Imagine how happy she was when I saved her almost $200 a month for the exact same coverage.

Answer: Annual notice of change (ANOC) letters are supposed to be sent out by the end of september of every year.

Answer: Original Medicare will over you in Guam, and the US Virgin Islands. However, please note that Medicare advantage only has limited coverage near the US border.

Answer: I consider a broker to be an independent agent like myself who's licensed and contracted with all the major carriers. This way I can help fit my client into the best plan based upon their needs. While I'm also a Medicare agent, some companies have what's called captive agents, and that means they can only offer plans from that one insurance company. Unfortunately that means they might not be able to fit their client into the best plan based upon their needs and only be able to fit them into a plan that one company offers.

Answer: Medicare only covers skilled nursing facilities and only up to 100 days. You would need long-term care insurance.to cover you past 100 days. Just remember cognitive impairments don't fall under skilled nursing care and therefore are not typically covered by medicare when you're in a nursing home unless you also required skilled care.

Answer: The maximum out of pocket in part D drug cost for 2026 will be $2100. If you are my client, I would find out if you qualified for government assistance or a patient assistance program to help you get those drug costs greatly reduced or even free.

Answer: Original Medicare does not normally cover things like teeth cleanings, cavities being filled and root canals. It only covers what's medically necessary, say if your teeth got knocked out in an accident. Now medicare advantage typically has dental benefits that go above and beyond what original medicare covers.

Answer: It sounds like either the agent who enrolled you didn't verify that your doctor was in network or your doctor possibly could have fallen out-of-network. Unfortunately, you're probably not going to be able to change your plan snce OEP allows only one change and whatever plan you're in on April 1st you're typically in the remainder of the year, unless you have some other type of exception, called a special enrollment period.

Answer: Well, if you're on original medicare and drowning in bills, it tells me you probably don't have a medicare supplement, and therefore, you're having to pay the unlimited 20% since original medicare has no cap. If you couldn't qualify for a Medicare supplement due to your health, then Medicare advantage could be better for you them original medicare because it at least will give you a cap, a Max out-of-pocket, a worst case scenario that you'd have out-of-pocket every year. If you stay on original medicare, there's an unlimited 20% you will be billed

Answer: Unfortunately, when commission is involved, some agents like to push the route that is easier and unfortunately sometimes people who need Medicare a supplement get sold a Medicare advantage plan. However let me note that I have multi millionaire clients on medicare advantage because they just didn't want to pay the medicare supplement premium but most people who have a large estate to protect choose the medicare supplement route. I just make sure all my clients know that Medicare supplement premiums go up every year and there's a good chance their medicare supplement premiums will most likely double in 10 years so I make sure they understand this before I enroll them into medicare supplements.

Answer: This is something they would most likely have to come from CMS, which is the government agency/department that regulates medicare and medicaid.

Answer: You make sure they are working with a knowledgeable agent like myself who isn't trying to make a sale but instead is focused on truly helping them.

Answer: This is the value of an agent like myself. I have a database that will store your drugs. This way I can make sure I fit you in the best plan that keeps your drug costs the lowest. I'm also familiar with assistance programs for drugs and what income levels allow you to qualify for government programs. This way i can help you get your medicines greatly discounted or even free.

Answer: Diseases of the eye like glaucoma are covered by original medicare. However, a routine eye exam and eyeglasses are not typically covered by original medicare. However a lot of medicare advantage plans do add in eye exams and glasses as part of their benefits.

Answer: Make sure your agent has explained to you the difference between Medicare supplement and Medicare advantage plans. Also, make sure your agent does a full needs analysis to help you decide what is the best plan for you. If you don't have assets to protect then a medicare supplement might not be best for you. There's no reason to go broke paying for medicare supplement premiums. However, if you do have assets and an estate to protect then a medicare supplement might be a good fit for you, especially if you have chronic health conditions. However, medicare advantage works well for a lot of people. This is where your agent will help guide you to the best plan based upon your needs.

Answer: I have a client who had partial medicaid, and therefore they were still responsible for copays. They are also an organ transplant survivor and they use an insulin pump. Well, anti rejection drugs and insulin for an insulin pump (by medicare rules) is billed through medicare part B. That meant my client was required to pay 20% of those drugs, and it was costing them almost $200 each month. We reached out to their doctor prescribing the medicine and unfortunately they weren't able to assist them with these drugs. Then I did more research and found out there was no prescription assistance program for these drugs. With that in mind, I wrote a letter to the state of Kentucky medicaid on behalf of my client, and asked them to please make an exception and give my client full medicaid, so they didn't have to pay almost $200 a month for drugs. The state of Kentucky saw the desperate place my client was in and they approved him for full medicaid, even though his income only qualified him for partial medicaid. My client is no longer having to pay $200 each month out of pocket on his drugs and it changed his life. This is what happens when you get a knowledgeable agent like myself that is willing to go the extra mile to help their clients.

Answer: It depends on if you have a medicare supplement or medicare advantage. Medicare supplement can possibly cover up to 80% of your medically necessary medical needs outside the USA. Medicare Advantage does not typically cover people outside the united states except limited coverage near the US border. I always advise my clients when they go out of the country to get travel insurance.

Answer: If you live in the state of Kentucky you can save money on your Medicare supplement premiums by reaching out to me at your next birthday and then we will invoke the KY medicare supplement birthday rule and get you guaranteed issue into the same medicare supplement with another company and possibly save you over $100 per month with the identical coverage.

Answer: I love helping people! Medicare can be very confusing, especially with the changes they implement every year. Put my 13 years of medicare knowledge to work for you!

Answer: Sometimes, insurance companies change the tiers and formularies of drugs so it's very important that you have an agent who will do an annual review with you every fall during AEP to make sure all your doctors and drugs are covered on your plan for the next year. They should even compare if there's a better plan option for you. With medicare supplements you don't have to worry about benefits changing or doctor networks changing, however, the state of Kentucky passed the birthday rule for Medicare supplements so now you have guaranteed issue (with no pre-existing condition limitations) every year up to 60 days after your birthday to change your Medicare supplement plan (with identical coverage) to a different insurance company. I saved one client almost $200 per month by switching her medicare supplement plan F to another company.