Joseph Peck, Medicare Insurance Agent

Answer: Tiers 1 and 2 are the basic generic drugs. Little to no copays on most plans. Tier 3 are the higher generic or newly generic drugs, tier 4 are the name brand and controlled substance, ie opiods. Tier 5bare the specialty drugs, namely cancer drugs.

Answer: Medicare considers dental implants as cosmetic, not medically required. So medicare does not cover this procedure.

Answer: I dont believe it is improving. Its looking for specific words to possibly deny coverage. I have seen nothing that has sped up coverage for a client.

Answer: Hospital stays and skilled nursing coverage could push the max out of pocket the quickest. When hospital is averaging almost 375 a day for 7 days and 214 a day for skilled nursing(after the first 20 days if they are covered) . this makes for big chunks very fast.

Answer: With this administration, they seem to be looking to cut back on procedures rather than add more that will help the patient. I wouldnt hold my breath on this being covered anytime soon.

Answer: If they are on a supplement, bills should be low or non-existent. On advantage plans you deal with copays for pretty much everything until you hit the max out of pocket, which, in most cases, is 4800 and higher.

Answer: Medigap plans are designed to go throughout the country, so you have coverage wherever you go. The only thing needed to do is change their drug plan because all drug plans dont go to everywhere.

Answer: To be honest, they get paid more for advantage plans than supplements. Also less follow up needed from them. I make sure the plan the client gets is the best one for THEM.

Answer: I am always reading and taking classes to stay up to date and informed on all plans and changes. Plus every year we are required to take classes on Medicare advantage and prescription drug plans.

Answer: First choice i believe would be Original Medicare and the G supplement. If unable to get a supplement a chronic care policy would be second best, but look carefully of the ones available. They are not all created equal.

Answer: It all depends on each clients wants and needs. Each supplement does different things, thats why its best to go over all your options with a professional who listens to your needs.

Answer: If you need care and where you are at they do not take your HMO you could be responsible for the whole bill. Also the Primary doctor has to refer to wherever you go, or again, you could be responsible for the whole bill.

Answer: Signing up for medicare is different for each person and the situations they are in. Are they still working? What plan is better? Supplement or advantage plan? All needs to be discussed so they are able to make the best decision for themselves.

Answer: Part a deals with anything that happens inside the hospital when you have been admitted. Outpatient procedures are specific to part b, unless there are complications and patient has to be admitted.

Answer: Regular medicare is not part of a network, so you can go anywhere in the country to be treated. Where as advantage plans are ppo or hmo and doctors need to be in their network or you could end up paying the whole bill.

Answer: I believe it is well past time. Too much has been taken away and nothing added since its inception in 1965/66. Senior care, dental, vision, etc should have been added a long time ago.

Answer: Some advantage plans give meals after you have been in the hospital for a bit, also transportation to doctors, pharmacy, etc. Not all though.

Answer: You should stay on your medigap plan, it travels with you. The only thing you will need to change is your drug plan.

Answer: It may not. Thats why its good to have it checked every year during Annual Enrollment Period. Especially if your drugs have changed.

Answer: When doctors dont take anymore, copays rise, lose coverage. You should have it looked at every year, especially drug plans because coverage for drugs changes every year. Just because you pay more for a plan doesnt mean its better for you. Your needs change as well.

Answer: You will owe 20% of what Medicare Allows after the part b deductible has been met. Medicare will then cover 80%.

Answer: No, you dont have to resign but you have options available to you when you turn 65 that were not available before.

Answer: After you have been on disability for 24 months, you should automatically be put onto Medicare. If not either contact your agent or Social security to be placed on Medicare.

Answer: Cheapest doesnt mean the best for you. Thats why its best to go over with a professional to make sure what plan is best for you and your circumstances. Everyone has different needs to be covered.

Answer: Because they are private insurance and require pre authorizations and decline treatments that can take care of the patient.

Answer: You will have to pay your part b premium as a quarterly payment first, then you can set up, through social security monthly payments after that.

Answer: There are always changes with the numbers regarding Medicare every year. The only ones they have submitted deal with Part D. The deductible will be 615 and maximum out of pocket will be 2100 for 2026. The other number changes have not been posted as of yet.

Answer: Medicare supplements actually do not cover long term care, they do cover skilled nursing when a client has been in the hospital for 4 days and 3 nights and has been prescribed by a doctor, at which point Medicare will cover the first 20 days of care. Days 21-100 normally costs the client 209.50 a day while medicare covers the rest. If more time is needed, back in 1998 congress passed a law stating that medicare is no longer allowed to cover home care, assisted living or nursing home after day 100. The client needs to find different covered for that, WHILE they are healthy.

Answer: You receive which ever is higher, but you only get one of them. There are some instances where you may take his first then take yours when you turn 70. Each case is different just like with Medicare.

Answer: No, Medicare gives your Part b premium to the private company to take over your healthcare needs. Thats why there are a lot of Low to no cost premiums with the plans, they get from Medicare.

Answer: For any advantage plan or prescription drug plan, yes, it is required. For supplements the company will send a letter of changes to Original medicare coverage.

Answer: With an HMO your primary doctor is the gate keeper, meaning all referrals and tests go through him/her. If you go outside of the network, you could be responsible for the entire bill. With a PPO if the doctor is not in your network, you can ask if they will bill your insurance. If they agree, insurance will still cover what they said for in network, you just may be responsible for any extra fees.

Answer: Yes you can. Along with any copays that you need covered. You just cant add to an HSA once you start on Medicare.

Answer: October 1st is when the plans are released to the agents. We can begin to go over them, but cannot start signing up until October 15th. In the meantime, plans can change and do. Often they will put on the plans that the plan could change after Jan 1.

Answer: In 1998, Medicare passed a law that said that medicare can no longer cover Home Health care, Assisted living and/or Nursing home. It will cover for up to 100 days for rehab, but cannot go past that. Thats the reason its a good idea to look into plans that can help take care of those concerns before it is needed. Very few companies do that now. I happen to be one who does.

Answer: I would love to say that there is nothing to concern yourself with, but i really dont know what is about to happen. So many changes happening now and in the future that it is too hard to tell.

Answer: Most get talked into the most expensive plan because they believe its the best plan. They also dont know they can change them every year. I check every year for my clients their Part D plans to make sure they are on the best one for them and their prescriptions. They can save hundreds of dollars just having it checked every year.

Answer: To make sure you have coverage on your prescriptions and also to help avoid any penalties and/or fees that could happen if you dont have credible coverage.

Answer: There are different options to look at to see what you may qualify for, even a possible special enrollment period. To be able to help I would need more information on your situation, but definitely would be able to get you answers.

Answer: As of 2025,there is no longer a donut hole. Pricing will not raise after the deductible has been met. If you end up paying 2000 out of pocket for Medicare covered prescriptions from a network pharmacy, your prescriptions will then become $0 for the remainder of the year.

Answer: Yes medicare does. Its with the Part B side of medicare. Durable goods and services. Its the advantage plans that can cause an issue.

Answer: Networks, doctors can refuse at any time. Advantage plans can decline help. In an hmo the doctor decides where you go.

Answer: Are they bills for treatment or the part B premium? If for the premium there is a mix up at Social security if you are getting your checks now. The premium is supposed to be coming off the top of your monthly check. If its for treatment, there is a $257 deductible to be covered then your responsibility is 20% of the medicare approved amount if you dont have coverage to cover that.

Answer: The agent should have questioned the things that are most important for you in your coverage and made sure the plan you picked would fit your needs.

Answer: How can i figure out which is the best way for me to be on medicare? Supplement? Advantage plan. Contact me and i help you figure out whats best for YOU.

Answer: The practice can drop a plan anytime, even in the middle of the year. There was to be a new special enrollment period for when this happened starting this year so you can change plans to keep your doctors. If your plan is a PPO you can ask if they will bill your plan anyway. You may also need to change your doctor.

Answer: Depends on the plan. If you stay with original medicare you will actually have more medical coverage and no networks, Whereas with an advantage plan, you get dental and vision, but then you deal with networks and more being declined by private insurance.

Answer: Most offer some type of dental, mostly basic. Some offer extra coverage that you can pay for. This is one of the things to make sure your dentist takes and if the extra is needed,

Answer: If you have a supplement, there is no need to change, supplements are good throughout the United States. You would only need to look at a new drug plan for the area you move to. If an advantage plan, it will need to be changed due to the move.

Answer: With the F plan, there is no copay. The F is the last plan that was able to cover the part b deductible. It was ended in Jan of 2020 for new enrollees.

Answer: That its best to see and hear ALL your options before you make the best decision for you. Medicare is different for each person.

Answer: If they ask for your medicare number or social security number. Medicare will not call you, they use the mail and/or email if thats what you signed up for.

Answer: You can go on medicare.gov to do online or even call medicare to report it. I have helped some of my clients navigate this.

Answer: You can go anywhere in the country to be taken care of. The doctor only needs to accept medicare, which about 98% take medicare. So no worries about being in the network or if they will accept your insurance.

Answer: Licensing is public knowledge. You can look up on your states government site or on NIPR. You can also ask them for their license number.

Answer: You can use it one time outside of the OEP and the AEP. You need to make sure that the 5 star plan is coverage is beneficial for you.

Answer: At 65 you have other options that are available to you with your medicare coverage. Its good to go over with a professional to make sure you have the best coverage available for you.

Answer: Was the specialist not in network? Also does your primary need to write a letter of exception to have it covered?

Answer: More people being able to see doctors without worry of coverage would make for a healthier country and help reduce medical coverage costs.

Answer: You would have less choices for doctors and hospitals, which would reduce the amount of advantage plans that would be in network for you. Also could affect drug coverage as well.

Answer: I put the numbers side by side to see what is covered and how, to make sure you are on the correct plan for you.

Answer: Each situation is different. I look at the options that you have to make sure you are on the best coverage for you, plus making sure you dont worry about penalties and fees.

Answer: Each situation is different. That is why i come out, review your scenario, and figure out what is best for you.

Answer: You can if it's your first time on an advantage plan and in your first 12 months, or if you are in your initial enrollment period, just turning 65.

Answer: Going with the plan their "friend or relative" has. Medicare is different for each person. I make sure my client is on the coverage that it best for them.

Answer: I enjoy getting to know my clients. Making sure that they know that i am here to help and will be here to answer any and all questions and concerns they may have.

Answer: Get with an agent to make sure what you are eligible for, making sure there are no penalties and fees. Plus making sure the client isnt already covered with a work plan.

Answer: Its best to look into it early so they know what to expect and when so there is a game plan. Want to start early due to the fact that we are dealing with the government and if there is something else needed we can get it taken care of with no last minute surprises.

Answer: We sit down and breakdown on a sheet how each part works for them with a worksheet. Then i show how each type of coverage works with original medicare so that they may make the best decision for themselves.

Answer: When working with an agent face to face, its more personalized to you. I make sure that we find the plans that are specific to your needs, also you can see i am a real person and i am close by for any questions or concerns that may arise. I let my clients know that i will be their 1-800 number if needed.