Kendra Siemiesz, Medicare Insurance Broker

Answer: Both stand alone part D plans and Medicare advantage plans are offered through private companies such as united healthcare, Cigna, WellCare, Humana etc. In your situation, you would be looking at what carrier will cover that medication at the most affordable cost for you and how it aligns with the rest of your healthcare needs. For example, most stand alone part D plans have a monthly premium, whereas most Medicare advantage plans often have a $0 premium and I have seen better drug coverage with advantage than most stand alone part D plans. I would suggest talking to a Medicare broker that offers both Medicare advantage and part D plans (like myself) to go over all your available options in your area and see what carrier/plan type will cover you best. There is also a program called “LIS extra help” that significantly helps reduce drug costs and eliminates drug deductibles if approved. That is something I help my clients apply for if I think they may be eligible because it’s a great program not many people know they are eligible for.

Answer: That depends on your area and what plans are offered. The agent that you worked with should have gone over what your copays would be with that plan and make sure you understood the out of pocket costs. If you don't see that many doctors then it may make sense for someone to have a low premium plan because it offsets the few times you see a doctor or hospital. I always look at the big picture with my clients and make sure they are saving the most money throughout the year and are covered exactly how they want to be and have the benefits that matter to them. Most part C medicare advantage plans are a $0 premium or a very low premium and depending on your area the plans with premiums may or may not be better. It also helps to work with a Medicare Broker that is licensed with multiple carriers/companies so you can be sure you are choosing the best one for yourself and your healthcare needs. Hope that helps, happy to review your coverage if you need! Have a blessed day.

Answer: It depends what type of Medicare advantage network you have. If you have a PPO, and that doctor still accepts your PPO even out of network then you can continue to see them (sometimes at a higher cost). With an HMO-POS network, it's also similar to how the PPO works where you would pay a higher cost to see out of network providers as long as that provider agrees to take payment from your insurance. An HMO is the most restrictive where you must see in network providers (unless of an emergency). Throughout the entire year (outside of annual enrollment) there are special election periods where you may be able to change your plan to a different network plan or a different carrier that would accept your doctor if that were to happen. Regardless, you have options and it's best to speak to a license Medicare Broker to go over your options and make sure you can see all your doctors, your medications are covered, and you are set up with the correct benefits to fit your health and financial needs.

Answer: If you have medicare A and B you are able to get a medicare advantage plan where most are $0 premiums and include drug coverage. Depending on your area these are a great addition to original medicare and often include extra coverage and benefits like dental, vision, and hearing coverage. There is also an option for medigap plans if your income allows, these plans have monthly premiums and you must purchase additional drug coverage but you often pay little to no copays for medical services. The bottom line is you have options and can speak to a licensed medicare broker to go over what you qualify for in your area. Im licensed in 22 states and would be happy to educate and assist you in this process as I know it can be confusing! Bonus: it’s medicare open enrollment until December 7th so you have time!

Answer: Yes you can absolutely meet with an advisor or talk to one on the phone about your parent’s medicare benefits. If you are the POA for your parents you would need to be the one to enroll them into a plan. If you are not their official power of attorney, thats okay too, you can still discuss benefits with an advisor, but if you were to change their coverage in any way they would need to be there to enroll themselves with the agent or sign any scope of appointment forms. Ive worked with many individuals and families that have done this and if your parents need assistance you can be there with them every step of the way.

Answer: You could go on Medicare.gov or call 1-800 medicare if you think you were charged for something you did not do. If it was a medical service and you’re not sure what is was for, if you have a secondary insurance I would reach out to them.

Answer: Medicare alone will cover 80% of covered services or durable medical equipment and the client is responsible for 20%. Some advantage plans will cover a personal emergency response system for you at no cost.

Answer: Keep an open mind and don't limit yourself to an agent that just works with one carrier or one product. Make sure you work with someone that is contracted with multiple carriers in your area so that they can find the best fit for you.

Answer: If you just have medicare A and B and that is all, then you would pay 20% for doctors visits. Your friend may have an advantage plan (part c), in addition to her Medicare, where most plans have a $0 copay to see a primary care doctor. She may also have a Medigap plan and pay a premium and then her copay might be covered under that plan.

Answer: A Maximum out of pocket is the most you will pay for covered services in a given year (IF you had the worst year of your life.) Most people never reach that limit, but think of it like a ceiling where IF you reach it, your advantage plan will cover all covered services for the remainder of the plan year. Original Medicare does not have a max out of pocket so costs can add up if that is all you have.

Answer: No it does not, even if it is prescribed. It is considered a controlled substance which is why there are multiple Medicare Marijuana facilities you can purchase it from with a valid Med card. It is not something you can just get from the pharmacy.

Answer: Yes you can, however you may have to answer health questions (called underwriting) and if you have a serious illness which could affect the price you pay for a premium (depending on the condition). When you turn 65, you have 6 months to choose a Medigap plan with no underwriting required.

Answer: This would be a question that could be reviewed with an agent or your current insurance provider. Without access to your plans summary of benefits or evidence of coverage I would not be able to give you a clear yes or no answer because every plans benefits are different.

Answer: A Medicare agent is able to assist you with comparing multiple plan options and benefits in your area. Every year plans and networks change so it is important to always review your current coverage and check for any important updates or new benefits. I know Insurance can be quite confusing and having to check your doctors, medications, new benefits, all the carriers, all on your own can be very challenging and overwhelming for most. That is why an agent is important because they have access to all of that information in one place and can easily guide you in the right direction and make sure you have all the benefits, savings, and coverage you need year after year.

Answer: They both essentially do the same job however a Medicare Broker typically works for multiple private insurance companies like Humana, Aetna, United Healthcare, Etc. A Medicare agent could potentially be tied to only one company (however that's not always the case). They both can assist with comparing plans and helping with benefits and you might want to make sure whoever you talk to works with multiple companies so you can compare all the available plans in your area and not be limited! But to put it short, the two could be interchangeable with how someone may introduce themselves. Hope that helps!