Julie Hamilton, RN, Medicare Insurance Broker

Answer: Great question! The Medicare Advantage Open enrollment period occurs from January 1 to March 31 annually. During this time, if you are already enrolled in a Medicare Advantage plan you can make a one time plan change to a different Medicare Advantage Plan, return to Original Medicare, and Enroll in a stand alone Part D prescription drug plan. You can only make a change if you are already enrolled in a Medicare Advantage plan (Part C) at the start of the year. During this time, you cannot switch from original Medicare and enroll in a Medicare Advantage Plan if you don't already have one.

Answer: Working with a licensed agent can help you with education, available options in your area, and talk you through plan selection for the plans that best meet your needs and budget. I am always happy to help my clients through this process.

Answer: No, they cannot cancel your Medigap policy because these policies are guaranteed renewable. Your policy can only be cancelled for two circumstances: 1. Nonpayment of your monthly premium or 2. You were not truthful on your application if you had to answer health questions when your policy was issued.

Answer: Fortunately, medicare covers a whole list of preventive screenings and services. The list of covered services and information about how often Medicare pays for each one can be found here: https://www.medicare.gov/coverage/preventive-screening-services

Answer: The short answer is yes, plans can vary a lot by location but other factors can affect your Medicare coverage as well. Insurance carriers offer different Medicare Advantage and Medicare Part D prescription drug plans, and the plans service area depends on your state and county of residence. Original Medicare and Medicare supplement plans are not tied to a specific geographic area. You can contact your agent to review plans available in your area or if you do not have an agent, search the listings on Medicare Agents Hub for an agent near you.

Answer: Many Medicare Advantage plans are available for $0 monthly premium. You will still have costs associated with receiving care, such as copays, deductibles, and coinsurance, such as per day hospital admission copays. These costs vary depending on your plan. Medicare Advantage plans are when private insurance companies contract with the government to provide Medicare benefits to beneficiaries. You still have to pay your monthly part B premium, even if you are on a $0 premium Medicare Advantage plan.

Answer: Great question! In essence, the higher the star rating the better the quality care you should be able to expect. Medicare Advantage star ratings are released annually by CMS and measure a plan's quality based on things like member satisfaction, healthcare outcomes, and customer service. Star ratings are an important thing to consider when choosing a plan.

Answer: I can completely understand your frustration! PPO (Preferred Provider Organization) health insurance plans do typically offer more flexibility than HMO (Health Maintenance Organization) plans because you can get care out of the PPO network but at a higher cost. PPO plans have several key disadvantages. The individual's out of pocket costs are typically higher in a PPO because the doctor/service is not accepting the plans in network compensation These include higher premiums and out-of-pocket costs compared to HMO plans, the potential for uncoordinated care due to lack of a primary care physician, and the responsibility of managing your own care.

Answer: For people with disabilities, Social Security's Disability Insurance (SSDI) provides monthly income. After 24 months of SSDI, recipients typically become eligible to receive Medicare. People with Lou Gehrig's disease/Amyotrophic Lateral Sclerosis (ALS) or End-Stage Renal Disease (ESRD) can get Medicare sooner. During the 24-month waiting period for Medicare eligibility, some beneficiaries may qualify for other coverage, such as through a former employer or Medicaid, depending on their situation.

Answer: "Extra Help" is a Medicare program to help people with limited income and resources pay Medicare drug coverage (Part D) premiums, deductibles, coinsurance, and other costs. Some people qualify for Extra Help automatically, and other people have to apply. You will get extra help automatically if you get full Medicaid coverage, help from your state paying your Part B premiums (from Medicare Savings Program), or SSI payments from Social Security. If you take brand name medications, you can also check into savings programs with the drug manufacturer and talk to your doctor about generic alternatives.

Answer: In essence, the Scope of Appointment is a consumer protection measure designed to empower beneficiaries by giving them control over the discussion topics and safeguarding them from unwanted Medicare sales solicitations. It ensures transparency and a focused interaction with a Medicare agent. An SOA is a form that outlines the specific topics an agent can discuss with a beneficiary during an appointment or sales call about Medicare plans, including Medicare Advantage and/or Part D prescription drug plans.

CMS regulations require agents to obtain a signed SOA at least 48 hours before any scheduled personal marketing appointment. No, call centers are not exempt from this practice.

Answer: Medigap Plan K will likely offer lower monthly premiums than Plan G but the cost sharing for services will be higher. Under a plan K, you'll share the costs for certain services, meaning you'll pay a percentage of the bill (coinsurance/copayment) for things like Part B services, blood, Part A hospice, skilled nursing, and the Part A deductible up to an out of pocket limit of $7,220. Once you meet this amount, the plan K will pay 100% of the remaining costs for the year.

Medigap Plan G has higher monthly premiums than Plan K but offers more comprehensive coverage, covering most of the gaps in Original Medicare Part A and B, except for the Part B deductible ($257 in 2025). Once you pay the annual Part B deductible, you'll generally have very few out-of-pocket costs for Medicare-covered services with Plan G.

Answer: If you are unable to provide proof of creditable coverage, you will likely face late enrollment penalties for both Part B and Part D. The Part B premium penalty is 10% for each full 12 month period you were eligible for Part B but didn't enroll and didn't have creditable coverage. For Part D, you may pay a penalty of an extra 1% of the national base premium for each full month you were eligible but didn't join a plan and didn't have creditable drug coverage. This amount is added to your monthly Part D premium for as long as you have the coverage and changes annually.

Answer: I'm happy to help you with this question but I would need a little more information. If you are still working and on your employer's health plan, you can delay taking Medicare part B until you retire without incurring any penalties. Some questions I have to be able to best answer your question: Does your employer have at least 20 employees? Is your employer-sponsored health plan less expensive than the cost of Medicare part B? Consider the costs, benefits, and potential penalties associated with both your employer's plan and Medicare Part B. Let me know if I can help :)

Answer: Yes, you will be required to answer health questions when switching from one Medicare Supplement plan or Medigap plan to another. Each insurance company's questions vary slightly, but even if you already have a Medicare Supplement plan, you have to answer questions if you apply for a different plan.