Leslie Helene Sussman, Medicare Insurance Broker
Leslie Helene Sussman
Senior-Healthcare Solutions
Medicare Broker Licensed in NJ, DE, FL and PA
14+ Years of Experience
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Voorhees, NJ
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Leslie Helene Can Help With:
About Me
Senior HealthCare Solutions offers personalized Medicare plan reviews tailored to individual needs. Recognizing that health insurance is not a one-size-fits-all solution, there are multiple components to consider when choosing a plan. Do not hesitate to reach out for a plan review that aligns with your specific healthcare requirements.
I also assist with retirement planning, applications for extra help resources, life insurance, and worldwide travel insurance.
Q&A with Leslie Helene Sussman
What’s the most important question I should be asking about Medicare that I probably haven’t thought of yet?
Answer: The most important question I would ask is How are my Medications and preferred Pharmacy going to be covered. (which plan would be best to cover my Medications and Pharmacy).
A thorough needs analysis is critical when choosing a Medicare plan.
Are Medicare Advantage plans really “free,” or is that just clever marketing?
Answer: Medicare Advantage plans are NOT free. Most MA plans have a zero monthly premium and some could also have give-back options towards Part B Medicare payment. When reviewing Medicare Advantage plans ALWAYS review the Summary of Benefits to truly understand how the plan is going to work for your Medical and RX needs. Medicare Advantage plans have Co-pays.
I'm turning 65 next month; what are the first steps I should take regarding Medicare enrollment?
Answer: First steps are truly understanding your Plan Options. (Medicare Supplement plus RX plan VS Medicare Advantage). Selecting a broker that has access to multiple plan choices and conducts a Needs Assessment is critical. I have a video for basic Medicare 101 that gives a simple overview of how Medicare will work for you and your 2 choices. If you do not see this video in my profile, please contact me and I will forward to you.
What are the signs that it's time for me to switch my Medicare plan, and how often should I review my options?
Answer: As a Medicare Broker I communicate with my members on plan changes, updates and suggest checking in for plan reviews as changes can happen every year. Annual Enrollment (October 1st - December 7th) is a time to review the new plans for the upcoming plan year.
My goal for my members is to truly have their Medicare plan work for them the best way possible based on medical concerns and Prescriptions.
I also make sure my members know about state and local resources available. State programs are Income based and can provide assistance to out of pocket costs.
Does Medicare fully cover nursing home care, and are there alternatives?
Answer: Medicare covers Medically necessary part-time or intermittent skilled nursing home care services and more (ei Physical and Occupational Therapy).
There are Long-term care resources and local services available.
Medicare typical covers Hospice care.
In your Medicare and You Handbook 2025 page 43-44. If you do not have a Medicare and You handbook - I can email you a digital copy.
What are some ways to ensure your parents feel supported during the Medicare decision-making process?
Answer: I encourage adult children, friends, neighbors and family members of any Parent/Medicare recipient to join in on the Medicare decision-making process.
What’s one Medicare decision that too many people regret later?
Answer: Not understanding all the options initially when new to Medicare. A Medicare Broker can be your advocate to making sure all is set up correctly. When a Medicare beneficiary is new to Medicare and continues to work and still have employer benefits and does not need Part B.
I have had members that paid Part B premium while still keeping employer work benefits.
How do you educate clients who are completely new to Medicare?
Answer: As a Medicare Broker reviewing the ABCD's of Medicare with my clients. I also have a You Tube video: Basics of Medicare.
Part A - Medicare Hospital Insurance
Part B- Medical Insurance
Part C- Medicare Advantage
Part D- Prescription Drug Coverage
*My clients are important to me - there is never a cost for my services. As your broker you will have lifetime support from me on more than just help selecting your Health plan but also: Carrier billing errors, rate shopping, appeals, Prescription coverages, local resources and SO much more.
What should I do if I miss the Medicare Open Enrollment period, and I want to change my plan?
Answer: If you miss Medicare Open Enrollment - Contact me as soon as possible so we can review available options to you.
Can you describe a time when you helped a client navigate a complex Medicare issue?
Answer: Yes - Medicare can be complex especially for those New to Medicare that continue to work and decide to stay on Employer benefits. I would suggest still contacting a Medicare Broker to confirm your choice. Many times, Medicare can be less expensive than employer benefits (You want to compare). If you are able to continue on your employer health plan -you are able to delay your Part B (not pay the Medicare premium) when you continue to have credible coverage (Part D).
I have clients that pay part B while able to stay on Employer benefits.
What is one of the the most common misconceptions people have about Medicare?
Answer: The biggest and most common misconceptions about Original Medicare is that it is free medical care for those that turn 65.
Medicare is also available to those on Disability (2 years) under age 65.
Original Medicare does NOT cover Routine Dental, Vision, Hearing Aid/Exams (these benefits are available in Medicare Advantage plans). There may be standalone plans to add on to cover these services (Premiums/Co-pays/Co-Insurance can apply).
NO coverage for Cosmetic surgery.
Medicare does NOT cover Medicare expenses when traveling out of the country. (limited emergency care coverage). *Contact me for World-wide Travel coverage quotes.
What do you enjoy most about working with Medicare clients?
Answer: I have been Medicare Licensed since 2011 and have personally enrolled thousands of Medicare clients. Before Covid I met all my members in person - since I am flexible meeting in person, Zoom or having phone conversation reviews.
I always enjoy talking and meeting my Medicare clients.
Do I have to answer health questions when switching from one Supplemental/Medigap plan to another?
Answer: Yes, generally you do have to answer Health Questions when Switching Medicare Supplement/Medigap plans but do not be afraid to review the questions with a Medicare Broker and find out if there are less expensive Medigap plan options for you. Each carrier could have different premiums for the same Health Plan coverage.
Medicare Supplement/Medigap plans are the SAME Medical coverage from Carrier to Carrier BUT not always the SAME premium. It is always good to compare options.
If you are unsure or have questions, please contact me directly and I will be happy to review and let you know if you have options.
What's one piece of advice you wish every senior knew before picking a Medicare plan?
Answer: DO NOT call the ads you see on TV. These are call centers looking to switch your plan that may not be the best option for your Medical and Prescription needs.
When the ads say FREE food cards or other FREE benefits, Please call a local broker and find out the specifics in your area.
Plans that advertise FREE food cards are plans for DUAL eligibles Medicare/Medicaid clients. Qualifying through the state programs for these plans are a requirement.
What is the biggest disadvantage of Medicare Advantage?
Answer: The biggest disadvantage of Medicare Advantage is carriers have a Network of Doctors, Hospitals and more. Each Carrier could have a different Network. Always Review your Preferred Doctors and Hospitals.
Most Carriers include the Majority of Major Hospitals in the plan network. There are some Carriers that can exclude certain Hospitals and Doctors in Network.
Co-pays also - Review your Summary of Benefits to understand the outline of Co-pays.
Can I change my Supplemental/Medigap plan at any time?
Answer: No there is no yearly Annual Enrollment for Medicare Supplement/Medigap like there is for Medicare Advantage/RX Plans.
Typically, Medical Underwriting/review is necessary to change plans. If you are looking to lower premium discuss your options with a Medicare broker.
Underwriting review consists of medical questions, Prescription list, Height/Weight etc.
Contact me with any questions.
How do discount cards and resources affect my Medicare Prescription Drug plan?
Answer: Normally Discount Cards (Good RX and others) may discount your Prescription cost at certain pharmacies. This may be a way to save on Prescriptions when there is a higher copay. These companies may gather your information and market Medicare plans.
There are State Resources available to help with Prescription costs. There are many generic medications that could be $0 copay in Medicare Advantage or Standalone RX plan. Brand Medications can have copays.
State programs have an application and can take up to 2 weeks to 4 months to be approved. These programs have income guidelines to qualify. Most do not consider assets.
NJ PAAD
PA PACE
If you have questions on the state resources, please contact me for more information.
Is Original Medicare or Medicare Advantage better? Why do you recommend one over the other?
Answer: There is no one plan better that the other. Medicare plan options are a Personal Choice where a review is necessary to determine which option is best for each individual.
I believe in Individual personalized Reviews to determine the best option based on Medical and Medication needs.
How do Medicare Advantage star ratings affect the quality of care I can expect?
Answer: Generally, yes star ratings are an important factor when choosing a plan.
Medicare rates plans based on their health and drug services from poor to excellent. (1 to 5 stars)
5 star rating is the highest/Excellent.
Star ratings are based on factors that include:
1. Feedback from members about the plan's service and care
2. The number of members who left or stayed with the plan
3. The number of complaints Medicare got about the plan
4. Data from doctors and hospitals that work with the plan
If a senior is turning 65 but still working, should they enroll in Medicare or delay it?
Answer: This is important to review with a Medicare broker. If you are able 6-12 months before Turning 65 review with a broker your thoughts about continuing to work and if you are able to stay on your Employer plan. Comparing an Employer plan to Medicare to understand if delaying Part B is necessary.
If this is a decision you are making contact me to review.
How do Social Security and Medicare work together for people with disabilities?
Answer: Social Security and Medicare work together for those Underage 65. After 2 years those collecting Disability will typically automatically be enrolled and qualify for Medicare.
I’m retiring next year—do I need to do anything with my Medicare?
Answer: Yes if you are 65 and / or Medicare eligible please contact a Medicare broker to review options.
If you could change one thing about the Medicare system, what would it be and why?
Answer: Take away the Part D penalty when a Medicare Client does not enroll in a Prescription plan.
Who qualifies for Medicare coverage if they are under 65?
Answer: Please refer back to a previous question on Social Security and Disability. Disability for 2 years qualifies for Medicare benefits.
Does Medicare cover eye exams, or are seniors left paying too much?
Answer: Original Medicare does NOT cover Eye exams. Refer to page 12 in your Medicare and You Handbook 2025. Most Medicare Advantage plans have a Vision benefit that covers a basic eye exam and most times an allowance for Vision wear. Those clients on Medigap/Supplement plans can add on a Standalone Vision plan.
Any questions on this benefit please contact me for more information.
What role do you think technology will play in the future of Medicare?
Answer: The future of technology and AI will play a distinct role in the future.
Insurance carriers are already finding a way to streamline the enrollment process and cut out Brokers.
Medicare is complex and so many choices of carriers having a broker is critical for reviewing plan choices and I consider myself an advocate to my members with helping on state resources, billing issues and more.
Having personalized service will always be valuable.
There is NO cost to have a broker.
In what situations will Medicare pay for medical services in a foreign hospital?
Answer: In most situations generally Original Medicare does not cover medical care in a foreign hospital (Outside of the US).
Medicare Advantage and Medicare Supplement may cover some Emergency Care.
DO not travel without Medical Travel Insurance. It is not expensive and could be lifesaving.
Contact me for quotes on Worldwide travel insurance.
If I move to a rural area, how might that limit my Medicare Advantage plan options?
Answer: Medicare Advantage plans are Network based. Typically, when a Hospital is IN Network and Doctors are affiliated with that Hospital - The Doctors are also in Network.
If you move to a rural area confirm your current plan still covers that area and find out which Hospitals/Doctors/Urgent Care's are IN Network.
If you are unsure contact your Broker or any questions contact me to confirm.
Is Medicare Part A enough for hospital coverage?
Answer: NO Original Medicare PART A is not enough for Hospital Coverage. If you have ever received a bill from a hospital 80% coverage is not sufficient.
Part A helps pay for hospital stays and inpatient care typically at 80% coverage. Plus there is also a Deductible to meet. The biggest disadvantage with only Part A coverage is there is NO cap on the Out of pocket you could be responsible for.
Medicare Advantage plan has a cap on the Max Out of Pocket (MOOP)
Medicare Supplement/Medigap covers hospital coverage
Does Medicare Advantage cover acupuncture or alternative therapies in some plans?
Answer: Yes Some Medicare Advantage plans may cover Acupuncture. Always check your Summary of Benefits. The Acupuncture benefit could be covered for chronic low back pain only. Not all providers could be included.
also See page 30 in your Medicare and You Handbook 2025
What is the biggest mistake seniors make when enrolling in Medicare?
Answer: Comparing plan choices, Doctor/Hospital Network, Urgent Care network, Pharmacy /Prescription network.
Find out about local resources available, State and Federal (Medicaid).
Contact a local Medicare Broker to find answers to your questions.
What should I look for in a Medicare plan if I travel frequently both domestically and internationally?
Answer: If you travel within the US - reviewing plan choices that offer a Nationwide network is key.
If you travel internationally - Travel insurance is available based on your dates of travel.
Review with a local Medicare Broker, contact me for specific questions.
How will the new 2025 Medicare Part D out-of-pocket cap impact seniors and prescription drug costs?
Answer: 2025 Part D reduced the Maximum Out of Pocket (MOOP) to $2k per year.
What’s the likelihood of Medicare covering gene therapy as it becomes more common?
Answer: Yes - I am sure the likelihood is good of coverage to become more common.
Medicare sometimes offers coverage for certain high cost treatments through specialized programs.
Medicare is likely to expand coverage for gene therapy as more evidence supporting its benefits and effectiveness emerges and as the treatments become more common and potentially more affordable.
Also have your Doctor submit an authorization for treatment to confirm coverages.
I’m on a supplemental Plan N, and I’m curious if my recent MRI is covered or if I’ll get stuck with a big bill.
Answer: Yes generally your MRI will be covered after your Medical Deductible in 2025 of $257.00.
Why am I paying more for Medicare Part B and D than my friends? What is IRMAA and how is it calculated?
Answer: IRMAA stands for Income-Related Monthly Adjustment amount.
IRMAA is a surcharge added to Medicare Part B and D premiums when your yearly income is above certain thresholds.
2025 Income limit for IRMAA is $106,000.00 for individuals and $212,000.00 for couples.
Income over $106k could bring your Part B premium from $259 - $628.90 plus Part D and additional $13.70 - $85.80 a month.
If your income reduces while on Medicare you can submit an appeal through Social Security.
I signed up for a Medicare Advantage HMO, and I’m wondering if I can see a cardiologist out of network without paying everything myself.
Answer: Generally HMO needs to be IN Network providers. Contact your carrier to request an approval for Out of Network Specialist. You must get approval and not always guaranteed.
I’ve been on a Part D plan for a while, and I’m wondering why my generic prescriptions suddenly cost more. Did something change?
Answer: Each year the Medicare formulary and Prescription plans on covered Medications could change and be a different copay than the previous year. If you have a Medicare Broker have them check for you.
Is paying for a high-end Medicare Supplement plan really worth it, or is it overkill?
Answer: Medicare Supplement plans all have premiums based on age/zip code. Each year you could see an increase in premiums. Medicare Supplement plans will aways increase as you get older unfortunately. The last couple years the increases have been greater than ever before.
If you are someone that has medical concerns, sees many specialists, in the hospital several times a year it may be worth the monthly premium to keep your plan.
If your monthly premium is getting to be too much to afford along with other expenses, food, housing and other necessities - review with a local broker your plan choices.
There is a trial right period those on Medicare Supplement can switch to Medicare Advantage for the first time for 12 month period. After 12 months if you decide you want to go back on your Medicare Supplement plan you may be able too.
See page 78 in your Medicare and You Handbook 2025. Reach out to a local Medicare Broker with additional questions.