Justin Doherty, Medicare Insurance Broker

Answer: Medicare as a whole operates on a "medically necessary" basis. If your blood tests are considered medically necessary, they are typically covered under Part B. However, if you receive blood test that are considered "elective", they are not likely to be covered. These would include situations where you might be required to have blood tests for employment purposes.

Answer: Medicare allows a few scenarios where you can wait to sign up for Part B or Part D. For example, if you or a spouse is working and has coverage available from an employer, you may be able to stay on the plan and wait to enroll in Part B, and/or Part D. However, if you do not have "credible" (coverage as good as or better than Medicare) coverage and you do not sign up for Medicare Part B or Part D when you first become eligible, you will pay penalty amounts once you do sign up.

Answer: No, outpatient surgeries, when medically necessary, are covered under Part B. Part A helps cover inpatient stays, skilled nursing facility stays (for skilled level care), and hospice.

Answer: Medication costs to the pharmacy are subject to change. Depending on your Part D plan, you may end up paying more if the pharmacy has to increase their charge in response to the price they had to pay to their supplier. Also, if your pharmacy network changes (although uncommon), that could also change what you're being charged.

Answer: Annuities can play a tremendous role in retirement planning. If you have all of your money in the market, you're susceptible to market losses. Simply put, you can lose your hard earned savings. Also, if you keep your money in the bank, you typically earn very little interest. Thus, annuities can help protect your money, pass more easily to your beneficiaries, and still allow your money to grow without the risk of losing your principle.

Answer: Perhaps. If you're in a "season" where you have frequent health needs, you will certainly pay more out-of-pocket costs. However, if your year-after-year health is consistently healthy, you may still spend less with your Medicare Advantage plan. That being said, if your health is costing you high copays and you anticipate continued healthcare needs, you may want to consider switching to a Medigap policy if you're able. Either way, you're going to pay, you just have to decide which way fits your needs best.

Answer: Typically, yes, you will need to answer health questions when switching from one Medigap plan to another. There are some insurance companies that allow you to upgrade to a more comprehensive plan (with that same company) without answering health questions. Others may allow you to downgrade to a less comprehensive plan. However, if you are changing to another company, you will likely need to answer those. The exceptions to this would be if you live in a state that allows you to change companies and/or plans without health questions. Generally this must be done near your birthday.

Answer: For now, there are only 7 apps that are eligible under Medicare. However, coverage generally requires a prescription and an unusual billing process that involves the providers instead of pharmacies. Sadly, these hurdles will likely cause more roadblocks to getting help paying for digital therapeutics.

That being said, the 7 apps currently eligible are:

1) SleepioRx for insomnia 2)Daylight for anxiety 3) Rejoyn for depression 4) reSET for substance use disorder 5) reSET-O for opioid use disorder 6) Somryst for chronic insomnia 7) MamaLift Plus for maternal mental health

Answer: For seniors that use expensive medications, this will likely reduce their costs as they will only pay $2,000 for covered medications. Depending on plan availability, some seniors will pay more in monthly premiums than in previous years. That's because the insurance companies have to offset the cost of the lower maximum. For others that generally only use few, inexpensive, generic medications, they'll not likely see much difference.

Answer: Original Medicare does not cover hearing aids. You will either pay out-of-pocket or use a separate hearing insurance policy. However, some Medicare Advantage plans do offer coverage of hearing aids. The benefit amounts and types of aids vary by plan.

Answer: The premium is the amount you pay every month for your insurance. Medicare Part B premiums are withheld from your Social Security benefit. If you have a Medicare Supplement policy or a Medicare Advantage plan, you may have an additional premium. When you need services, you must first pay your deductible amount to the provider(s) (unless your plan has a $0 deductible). Once you have paid that amount, you generally have a copay amount payable for each service. Some services will require a coinsurance percentage instead of a flat copay amount. Generally, the coinsurance is 20% and those are applied to services like Durable Medical Equipment, Medicare Part B covered medications (IV, Infusions, etc.), Diabetic supplies, etc.

Answer: No, you cannot be dropped because of a health condition. In fact, your premium cannot be changed because of your specific health reasons either.

Answer: Your health should not change your Medicare plan. However, you should review your plan options to make sure your plan will adequately cover the health needs of your new condition.

Answer: This depends entirely on your age and current insurance situation. If you are already eligible (or will be eligible upon your retirement date), you will need to verify your enrollment in Medicare. This will be automatic if you're also receiving Social Security income. However, if you are not yet receiving SS retirement income, you will need to actively apply for Medicare by contacting Social Security. You will also want to make sure you have your new Medicare Advantage plan, or Medigap plan applied for prior to your work insurance being terminated.

Answer: If the following criteria is met, Medicare will likely cover the services: The care is medically necessary; The cruise ship is in U.S. waters (within six hours of a U.S. port) when you receive the care; The doctor providing care is legally allowed to provide medical services on a cruise ship.

Outside of that, Medicare generally does not cover health services while onboard a cruise ship.

Medicare Supplement (Medigap) policies and Medicare Advantage plans may help cover those expenses. Separate travel insurance policies may also be purchased to cover health services while onboard a cruise ship or in a foreign country.

Answer: In some ways, yes, and in other ways, no. For many people, Medigap (Medicare Supplement) policies are not affordable. Staying with regular Medicare without a supplement is not appealing because of the potential out of pocket costs associated with your health needs. MA plans do offer a maximum amount you can pay each year, as well as smaller co-pays for more common, less expensive services, as well as additional benefits not offered by Medicare. That being said, regular Medicare is very user friendly and when combined with a Medigap policy is a very comprehensive medical coverage. With more people choosing MA plans, that is likely to increase the costs of Medigap policies making them less affordable for even more seniors.

Answer: In short, Medicare Advantage plans cover the same services as regular Medicare. However, the amount you pay for services may be higher or lower than regular Medicare. In addition, the MA plans may offer additional benefits not covered by Medicare, such as routine Dental, Vision, Hearing, and more. The way the plans operate are also different. With MA plans, you generally have a network of providers to use, while regular Medicare allows you to use any doctor that accepts Medicare. Your personal preferences on out of pocket costs vs monthly premiums will play a large roll in helping you decide which type of coverage will best meet your needs.

Answer: Medicare coverage is generally based on medical necessity (as determined by CMS). Unfortunately, only the Monofocal lenses are deemed medically necessary and the other lenses, such as multifocal, toric, EDOF, and LAL are considered NOT medically necessary and are therefore, not covered by Medicare. As such, most insurance companies follow this same rule of thumb and also cover only the monofocal lenses.

Answer: The 3-midnight rule is a common requirement that a plan member be admitted as an in-patient in a hospital for 3 full days (3 overnights) before being transferred to a Skilled Nursing Facility. In most cases, the plan will not cover the SNF stay if the plan member did not satisfy this (and other) requirements.