Judith Carney, Medicare Insurance Broker

Answer: Your Medicare benefits travel with you meaning you can use any doctor, emergency care or hospital anywhere in the USA while traveling. Just like at home, it's best to verify that the service provider accepts Medicare before utilizing their services. Now go pack your bag!

Answer: I believe at one time we all thought the passage of that Bill would keep insulin prices to only $35 per month; I know I did when I heard the announcement. Then I started working with healthcare and Medicare plans to learn that there are different "kinds" or categories of insulin including "rapid-acting, long-acting and pre-mixed" varieties. Medicare Part D and each Medicare Advantage plan can have different negotiated prices, copays, and formularies, which significantly affect how much patients pay.

Always be certain to verify the full name of your prescribed insulin and dosage information with the formulary of the plan and check the pricing level before signing up for your coverage.

I do this for all my clients!

Answer: Healthcare represents 17.6% GDP (gross domestic product) which represents the percentage of the total US economy. These statistics available are from 2023 with anticipated or projected increases.

Medicare spending represents the single largest component of government healthcare expenditure, with Medicare spending growing 8.1% to $1,029.8 billion in 2023, representing 21 percent of total National Health Expenditures. This substantial growth reflects both demographic shifts toward an aging population and increased utilization of medical services among Medicare beneficiaries. The program’s expansion demonstrates the federal government’s commitment to providing comprehensive healthcare coverage for seniors and disabled Americans.

In 2023 $4.9 Trillion was spent for healthcare (7.5% increase over 2022) with $14,570 per person (per capita) spent for each individual. Let's break that HUGE number down even more:

Medicare Spending (2023) | $1.03 Trillion | 8.1% annual growth

Medicaid Spending (2023) | $871.7 Billion | 7.9% annual growth

Private Insurance Spending (2023) | $1.46 Trillion | 11.5% annual growth

Hospital Expenditures (2023) | $1.52 Trillion | 10.4% annual growth

Prescription Drug Spending (2023) | $449.7 Billion | 11.4% annual growth

Answer: Many of today's Medicare Advantage plans are moving into HMO (Health Maintenance Organizations) in an effort to control costs while providing care to our seniors. The biggest disadvantage of Medicare Advantage is often the restricted provider networks, which can limit access to healthcare providers and may result in higher costs for out-of-network care. Additionally, these plans frequently require prior authorization for services by a primary care physician, leading to potential delays in receiving necessary care.

Answer: The financial foundation of Social Security and Medicare Part A rests on a pay-as-you-go model. Today’s workers pay for today’s retirees, creating a system that depends entirely on maintaining an adequate ratio of workers to beneficiaries.

This ratio has collapsed over the decades. Social Security Administration data shows there were 16.5 workers per beneficiary in 1950. By 1960, that had fallen to 5.1-to-1 as the program matured. It continued declining to 3.7 in 1970 and hovered around 3.3 through the 1980s and 1990s.

Today, approximately 2.8 workers support each beneficiary. Projections show this will fall to just 2.1 workers per beneficiary by 2040. This means two workers will have to fund the benefits that 16 workers supported in the program’s early years.

Answer: I enjoy working with my clients, providing them with honest and compassionate care as we review all the possibilities for their upcoming healthcare needs. It's not easy when we have to share such personal information about ourselves; for some of our seniors this is a time where their vulnerabilities are totally exposed. I recognize this and do my best to make it more comfortable while we work through the process.

Answer: Medicare Part D cannot deny coverage for a brand-name drug solely because a generic is not available, as long as the drug is on their formulary and deemed medically necessary by your doctor. However, they may require prior authorization or step therapy to justify its use over other options.

If the brand-name drug is included in the plan's formulary and is medically necessary based on a doctor's prescription, it MUST be covered. However, plans may require prior authorization or step therapy, which means you might need to try a different medication first before the brand-name drug is approved for coverage.

If a specific brand-name drug is not listed in the formulary, you can request an exception. This process typically requires documentation from your physician explaining why the brand-name drug is necessary for your treatment. Each plan has its own rules, so it's important to check with your specific Medicare Part D plan for details on coverage and any necessary steps for approval.

Answer: This is one of the biggest concerns for a senior especially on a budget. Start by estimating your potential healthcare expenses, including premiums, deductibles, and out-of-pocket costs. Medicare Advantage plans, some are offered at a ZERO monthly cost, can be an effective way to manage increasing health expenses. Remember to review any plans annually during the "Open Enrollment Period" so you will have greater chances of avoiding underwriting while renewing or updating your plan. Also, consider setting aside funds in a health savings account that may offer additional coverage options to help manage costs.

Answer: In 2025, the maximum out-of-pocket expense for prescriptions was $2,000; in 2026 it will be $2,100. Once you have paid these amounts for prescriptions, the catastrophic coverage of Medicare Part D automatically begins - you will pay nothing for the rest of the year for prescription drugs that are covered in the plan, which should provide financial relief for those struggling with high medication costs.

Answer: Medicare offers more flexibility in choosing healthcare providers, as you have a choice to see any doctor or hospital that accepts Medicare without network restrictions. It also typically does not require prior authorizations for services, which can simplify access to care compared to Medicare Advantage plans.

However, you may be interested in learning that Medigap Plans help cover out-of-pocket costs associated with original Medicare, such as copayments, coinsurance, and deductibles. Specific benefits vary by plan, but most cover costs like hospital fees and some emergency medical services when traveling abroad.

Answer: You can structure your Medicare coverage in various ways to ensure you receive the care you need. Participating in Medicare Part B is imperative and covers your outpatient mental health services. Once Part B is selected you should review other plans including Medicare Part D or Medicare Advantage plans with prescription coverage, or possibly a Medi-gap plan with a standalone prescription plan. Locating an independent agent to help you review all of these options should bring you comfort while choosing the best coverages to meet your needs and these services are provided to you at no additional cost.

Answer: Choosing the cheapest plan may sound good, but most likely this will result in higher out-of-pocket expenses when you actually need the benefits of services or medications. It's important to review and evaluate the plan's benefits to ensure the coverage meets your healthcare needs. Utilizing an independent healthcare agent to explore the options available is a smart way to choose, and having the help of an expert does not add to the cost of your plan.

Answer: Working with a Medicare agent does not add to the cost of the plans, but it does provide you with an expert who can review multiple plans and customize the best choice to fit your needs. Agents can save you time by gathering and presenting information on various plans, making the decision-making process easier. They help clarify complex terms and conditions, ensuring you understand your options fully. An agent will guide you through the process eliminating mistakes and insuring deadlines are met and the necessary paperwork is completed, avoiding costly penalties .

After enrollment, an agent can assist clients with any needs that arise such as answering questions about benefits or assisting with filing claims. Your agent should be a reliable resource for you throughout the term and again during annual renewals, especially if your needs have changed.