Jonathan Paddon, Medicare Insurance Agent

Answer: "Better" is a relative term. Which is better depends on the individual. There are positives and negatives to both options. Is a size 10 shoe better than a size 8? It depends on the size of your foot! Some people prefer regular or "original" Medicare because there are no doctor networks and prior authorizations. So you have more freedom to choose your doctors and your doctors don't need to get extra approvals for services. However, there is no cost limit or "maximum out of pocket" with original Medicare. Therefore, most people on original Medicare will want a Medicare supplement or Medigap policy to cover the portion of costs that Medicare doesn't pay. (For example, 20% of part B or outpatient medical services). And for a Medicare supplement you will pay an extra monthly premium which not everyone can afford. A licensed independent health insurance agent can look at your specific situation and help you find the best fit based on your needs and budget.

Answer: Higher income individuals may be subject to the Income Related Monthly Adjustment Amount (IRMAA) resulting in paying more that the standard Medicare Part B premium, as well as an additional amount added to your Medicare part D prescription drug plan premium. If this applies to you and you have a qualifying life event such as income reduction due to retirement, you can file form SSA-44 with the Social Security Administration to request a a premium reduction to reflect your new lower income. Otherwise you would have to pay the higher amount for up to two years until your premium would be recalculated based on your tax return. (Your Medicare premium is based on your tax return from two years prior unless you have a qualifying life event and file form SSA-44).

Answer: That depends on if your current doctors are in-network with the Medicare Advantage plan. An independent agent that works with multiple companies can look up your doctors and tell you if there is a plan in your area that would have all of them in-network.

Answer: You will need to enroll in part A and B of Medicare through the Social Security Administration with a requested start date corresponding to the end of your employer health plan. You can do this online at SSA.gov or by calling your local Social Security office and scheduling a phone appointment. If you are over the age of 65, you and your employer will need to complete the form CMS-L564 Request for Employment Information to show you had employer coverage during the time you delayed enrolling in Medicare. This keeps you from having to pay the part B late enrollment penalty.

Answer: Assuming your parent is mentally capable of signing a legal document, they can sign a Medical Power of Attorney document to appoint you as their representative. A Financial Power of Attorney document may also be called for, as well as a HIPPA authorization to access medical records and a living will or advance directive to stipulate what treatments they desire if they become unable to make medical decisions for themselves. If they are no longer capable of signing these document, you will likely need to petition a court to appoint you as your parent's representative in these matters. Note that laws can vary between states. You should always consult with an attorney before proceeding with any of the above.

Answer: I local agent is more likely to have direct knowledge and experience with the specific plans available in your area. Since plans vary depending on where you live, it is important to work with someone who knows the ins and outs of the options available to you. In addition, I local agent is more likely to be available for the long haul, so when you have questions or need to look at other options, you can go back to the same person who already knows you and your situation.

Answer: The tiers on your part D plan can be thought of as "copay levels" that each of your medications is assigned to. Many plans have 5 tiers. In general, the higher the tier, the higher the copay you pay at the pharmacy. So, medications assigned to tiers 1 and 2 are usually lower cost medications such as generics. Tiers 3 through 5 are usually more expensive brand name medications. Note that you may have to pay the full cost of your medication until you have met your plan's deductible before you pay the copay corresponding to a particular medication's assigned tier.

Answer: It is true that the Inflation Reduction Act caps the cost of covered insulins at $35 per month for Medicare part D members. If your insulin shot up in price, then it is possible that your plan dropped your particular brand of insulin from its list of covered medications (called the formulary). As it is likely too late to change your plan until the fall open enrollment period, you basically have two options. You can talk to your doctor about finding an alternative insulin on your plan's formulary that would be similar to the one you are currently taking. Alternatively, you can submit a request to your plan to make an exception for your current insulin to be covered. Your plan will consider your request based on your doctor's documentation of why you need that particular medication.

Answer: Yes with a couple of caveats. Medicare will pay for inpatient rehab in a skilled nursing as long as the rehab stay is preceded by a 3 day stay in a hospital. This is called the "Medicare 3-day rule." And it is true that beginning the rehab stay can be delayed by up to 90 days after the hospital stay, pending recovery from the surgery. However, if the delay is longer than 30 days, it must be medically inappropriate to begin rehab sooner to remain covered. Also, the above rules apply to Original Medicare. If someone is enrolled in a Medicare Advantage plan, they will have to follow the guidelines set forth by their particular plan. Medicare Advantage members are not subject to the 3-day rule, but their plan will still have to approve any inpatient rehab stay based on medical necessity.

Answer: Under original Medicare, an annual wellness visit includes a review of current health status and medications and a health questionnaire to assess pressing health needs or risks. Although not a full physical, the visit will allow your doctor to create a written plan outlining recommended preventative services such as screenings and immunizations.

Answer: I enjoy the opportunity to help folks who are new to Medicare to understand how the program works and what their options are. It is particularly satisfying to help someone feel confident that they are making a choice that fits their budget and preferences and no longer be confused about all the different options.