Justin Fox, Medicare Insurance Broker

Answer: Medicare does not require you to provide proof of insurance while you are still working or covered by a working spouse. You will need to provide proof at the time you eventually sign up for Part B.

Answer: IRMAA stands for Income-Related Monthly Adjustment Amount. It is a charge added to your Medicare Part B and Part D premiums if your income exceeds certain thresholds. It is based on a 2 year look back. Social Security mails you an Initial Determination notice. For an Individual the bracket starts at $106k and the Joint income starts at $212k.

Answer: The best way is to confirm first, that your doctor is in network. The second thing to do is ask if the test is medically necessary, and third, ask if the lab you are doing your tests at is also in network.

The other thing is, if it is affordable to you, then you can add a secondary indemnity plan to help pay for the out of pocket or co-pays not paid by your Medicare Advantage plan.

Answer: It is like most years, inflation has made an impact. The costs are adjusted to keep up with the healthcare spending as usual. The part B premium is up form 2025, and the Part B Deductible is up to $283 from $257. The new out of pocket cap of $2100 is in effect for 2026. And the Negotiated prices will take effect. RX like Eliquis and Xarelto which are blood thinners should see a significant copay decrease. Their are 10 total selected by Medicare.

Answer: I would say the Medicare expenses I get asked about a lot that people don't think about or are not aware of, is the IRMAA Surcharge. It is for a higher income, I believe over $212k for a couple, $106k for a single. You pay extra surcharges for Part B an Part D.

Answer: If you are enrolled in a Med Advantage or Part C plan or a Part D rx drug plan, your provider is required to send you an ANOC (annual notice of change). I believe that they have to have it out no later then the end of September.

However, if you are an Original Medicare plan with a med supp (medigap plan) you don't typically receive an ANOC because the plans are standardized and the benefits don't change every year. The premium can change but not the benefits.

So, the answer is, if you have a private Medicare plan (med advantage or a part d rx plan) you get an ANOC every year, but not one for Med supps.

Answer: The best time in my opinion is October 15th. It gives you time to review what you had last year and how it worked for your overall coverage. It gives you plenty of preparation time to review changes, assess your current needs, and compare all the options in your area, that way you won't rush to a decision.

Using the information, make a checklist. If you have changed your rx, if you see a different provider, etc. Then use that to look at all the options available to you. It helps to have an experienced agent to help you.

Answer: Wow! This is an excellent and important question for a lot of people. Medicare coverage for personalized medicine, can be complex, but I believe that the coverage would be as follows.

Original Medicare Parts A and B "generally" covers the routine costs of a qualified trial. That would be like the dr visits, standard cancer treatments chemo, radiation, etc. but most likely not the trial drugs. The medically necessary stuff, like hospital, surgery, tests, scans to make sure of your health status are most likely covered.

However, Medicare, in general, will not cover the experimental drug, or procedure. In my experience, as an agent, is the the trial sponsor will typically have options to cover this.

Your Medicare Supplement or Part C, would typically cover the same things that Original Medicare would cover (testing, procedures, etc.) but might have different cost-sharing.

Your part D would depend on what falls in your Formulary.

Most of the answers that you are after should be available to you through the Clinical Trial Coordinator. It is probably best to get what they say will be covered, by them or by Medicare, in writing.

Answer: This is a complicated question. If you are relatively healthy and do not need extensive medical care, it certainly does. This is because you can find a lot of Medicare Advantage plans that are very low cost or in some cases zero for premium(you still pay your part B premium). They often include extra benefits, such as routine vision, hearing, and dental care. It can also include gym memberships or wellness programs, this could also save you money. Most Medicare Advantage plans include prescription drug coverage(MAPD), that way you don't have to buy a separate Part D plan with an additional premium.

The other side of the coin is, if you have a serious illness, requiring frequent specialist visits or stays, your total out of pocket costs could be higher than with Original Medicare plus a robust medigap plan. The reason is a Medigap plan covers most of Original Medicare's cost sharing (depending on medigap plan selection). Plus you need prior authorizations for certain services, this can sometimes lead to delays, denials of care, or inconvenience.

The bottom line is that every person's care is different and unique. It's important to have an agent you like and trust. That way you can go over your coverage regularly to make sure it fits your needs and budget.

Answer: There are so many rewards for being a Medicare agent.

First, and foremost, helping families with the piece of mind that they have the best matched coverage for their needs.

It is also very rewarding to meet and be a part of my amazing clients and their families ongoing coverage solutions.

I love that feeling of serving a vulnerable, high needs client and assuring they get the best coverage they could possibly have. I believe doing good for others, in turn gets back positive vibes in my own life.

Of course, if you treat enough clients well, you get paid well.

Answer: I think one of the biggest reasons is to get a personalized needs assessment. A quality agent will look at your unique situation, and use their experience to put you in the best solution possible. An agent also gives you the ongoing support you and your family may appreciate, like answering all your questions, reviewing your plans every year to make sure it is the best option going forward, helping to resolve issues with your plan, and in most all cases, it doesn't cost you extra to have an agent (commissions are paid by carrier not client and premiums are the same either way).

Answer: The first choice would be to figure out what is the best strategy for structuring your Medicare coverage. It is important that you have affordable and consistent access to the mental health coverage you need.

Your primary choices will be between Original Medicare paired with a standalone Part D rx drug plan, a Medicare Advantage plan, or you may consider a Med Supp Insurance policy, with Part D.

The most flexible option in choosing your healthcare providers is Original Medicare, which is parts A & B, plus part D, plus Medigap (Med Supp)-Part A covers inpatient mental health care, it i however limited to 190 days lifetime. Then Part B covers 80% (generally) of the Medicare approved amount for psychiatrist and doctor visits (this is for diagnosis, rx management, etc)Outpatient mental health services, and annual screening. Part D will cover the rx that help in managing bipolar disorder. Making sure to match the right formulary and tiers of drugs with plan.

The Med supp will cover the out of pocket costs of Original Medicare, such as your 20% co-insurance for part B services.

Another option is Medicare Advantage. These MAPD's include rx coverage. This is nice because it combines medical and rx coverage into a single plan. These plans have an out of pocket max limit, which original Medicare does not have. The down side is Network restrictions, prior authorization, and cost sharing features.

In conclusion. Consult your healthcare providers about your treatment plan, make a list of your rx, seek a professional to help evaluate and explain the plans properly, Look at the plans carefully, evaluate your needs, make sure your rx co-pays are affordable and all of your healthcare team is covered on your chosen plan. This should ensure you get the mental health care you need and deserve.