Lou Spatafore, Medicare Insurance Broker

Answer: CMS (Medicare) requires agents and brokers to obtain a signed Scope of Appointment from a beneficiary 48 hours prior to meeting to discuss Medicare Advantage or Part D drug plans. The scope will outline what the prospect is interested in discussing and no other business can be discussed. This is to protect the beneficiary from predatory agents who will "bait and switch" to sell more profitable products. There are no exemptions but the 48 hour waiting period does not apply to inbound unscheduled sales calls. A telephonic or electronic SOA must still be obtained.

Answer: Unfortunately you cannot disenroll from Medicare Part A to continue contributing to an HSA if you are still working. By enrolling in Medicare you lose the HSA contribution eligibility. You still have access to the funds in the account but can no longer contribute.

Answer: Medicare has tiers of cost in their Part B and part D premiums and are based on your income. This does not affect the average Medicare beneficiary unless you’re in those high-income brackets.

Insurance companies operate on different levels, and their cost structure includes high and low deductibles, that can affect your cost.

Answer: Medicare Parts A&B will be accepted by any provider who accepts Medicare patients. Medigap plans are also accepted. Medicare Part C (Advantage) HMO plans will only be accepted by in-network providers, PPO plans will be accepted by out-of-network providers but the cost is higher than in-network.

Answer: Yes, wellness visits are included with a Medicare Advantage plan at no cost. These visits are part of the preventive care services covered by Medicare Advantage plans, which must provide the same medical services as Original Medicare Parts A and B. This includes the annual wellness visit, which is a free part of preventive care.

Answer: If you have original Medicare without a Medigap plan you are at great financial risk. You will be responsible for the Part A deductible of $1736 if you are hospitalized and Medicare will only pay about 80% of your medical costs and you will be required to pay the 20% balance with no maximum cap. For instance, if you had a surgery and hospital stay that costs $500,000, Medicare will only pay about $400,000 and you are responsible for the rest, or $100,000. This could have an adverse effect on your retirement plan. If you have a Medigap Plan G or N your plan cover your portion including the Part A deductible. A Medigap plan mitigates your financial risk for medical coverage costs.

Answer: You can certainly work directly with a carrier but you may not get the best plan available for your needs or budget. As a broker I will discover what your needs are and what you can afford or are willing to pay for a plan. I have appointments with all the major plans in your area and if there is something out there that is a better fit than what I can offer I will help you enroll in that plan. I will make sure you know the pros and cons of each option and you will ultimately decide what is best for you.

Answer: You've heard that nothing is free in this world and especially so with health care plans. There are zero dollar premium Advantage plans but there is a trade off. You will have copays, deductibles and maximum out of pocket costs not to mention the high cost if you receive services out of the plan's network. You need to study the plan thoroughly and ask questions of your broker if you don't understand. You don't want to buy a plan because it looks like a no cost or low cost option and be surprised later with high cost medical bills.

Answer: As a broker I am paid a commission by the carriers. The cost to the beneficiary is the same if they enroll with a broker or direct but the services provided by the agent/broker can be invaluable. As professionals we help our clients find the best plan for their needs and budget. I don't ever recommend a plan based on commission. My first concern is the welfare of my clients.

Answer: Many providers are not accepting Medicare Advantage plans for a host of reasons. First of all there is an administrative burden and prior authorizations are required before services can be provided. This puts a strain on the doctors and the patients. They also don't receive payment in a timely manner which effects the practice's cash flow. To sum it up, the doctors don't like Advantage plans because it restricts their ability to provide the best care for their patients.

Answer: Medicare beneficiaries who are new to Medicare need to be aware of the rules such as when to sign up and enroll in Parts A,B and D to avoid costly lifetime penalties. they should be made aware of their options on how to fill the gaps left by original Medicare. A professional Agent or Broker will explain the rules and options in clear easy to understand language.

Answer: Yes, Medicare can cover weight loss counseling and in some cases bariatric surgery or other procedures if they are deemed medically necessary. Medicare does not pay for commercial weight-loss programs or for meal plans.

Answer: Routine dental care is not covered by original Medicare. If you have a Medicare Part C that does have dental coverage you can check the plans website to determine what providers are available. Also, you can call your dentist's business office for a list of plans that are accepted.

Answer: You can qualify for Medicare under the age of 65 if you are disabled and have been on Social Security Disability Insurance for 2 years. Also if you have end-stage renal disease or amyotrophic lateral sclerosis (ALS). The waiting period is waived for these conditions. Medicare Part A will be premium free, however there is a premium for Part B.

Answer: Yes, you can enroll in Medicare parts A&B and have a plan in place to cover most of your medical costs. You will still have deductibles and copays. Without a Medigap or Advantage plan you could be subject to very high out of pocket costs that could effect your financial retirement plan in a negative way.

Answer: When I first meet with a Medicare prospect turning 65 and first becoming eligible they are under the assumption that their medical bills will be completely covered by Medicare. They sometimes go into sticker shock when I inform them that they will pay for Part B Medicare at a cost over $200 a month and are responsible for the deductibles of over $1700 for Part A and more than $280 for Part B. Then they will pay for 20% of all their medical costs from there. That's when I let them know they have options to lower their costs.

Answer: As a Medicare Beneficiary myself including my wife I like to take the time to explain the workings and benefits of Medicare. It's a confusing topic and it's my job to simplify the process. I have been in sales my entire adult life and taking the time to explain and to always be available after the sale to answer questions or handle concerns is what I like to do best. Anyone can write someone a plan but to take the time to determine what is best and to service a client when needed is most important.

Answer: Medicare Advantage plans are good for those who believe that they won't have a lot of medical services and are cost conscious but there could be some risks. If the need for extensive medical treatment occurs down the road the beneficiary may not have the health requirements to choose a Medigap plan that will reduce out of pocket costs. Also, Advantage plans require networks and preauthorization for medical treatment. Choosing a Medigap plan over an Advantage plan lessens the risk in the case of poor health as we age,

Answer: The trend that has saved seniors the most is in the drug plans. The elimination of the "Donut Hole", lowering the cost on insulin and the max out of pocket for drugs ($2100 in 2026) has had the most impact to lower the costs of Medicare.

Answer: Medicare will accept you as that is what you qualified for from your employment contributions. A Medigap plan is provided by private insurance companies and with some exceptions there is medical underwriting to determine eligibility except during the initial election period when you have guaranteed issue rights.

Answer: If there is a 5 star Advantage plan available in your area you can change to it anytime of the year. It takes effect the first of the following month upon enrollment. The Annual Election Period happens once a year from October 15th to December 7th when you can change or choose an Advantage plan that will take effect on Jan 1. Open Enrollment Period is from Jan 1 to March 31 when you can change your Medicare Advantage plan or drop it and go back to Original Medicare. You can then sign up with a stand alone drug plan with a Medigap plan. The change will take effect the first of the following month after the change is made.

Answer: You should work with a professional Medicare Agent or Broker who will ask the right questions to help determine what plans would best suit your needs and budget. They take into account your provider choices, the prescription drugs you take. the needs you have for ongoing treatment and the affordability of the plan based on your income. A caring agent/broker will only do what is best for you and not what is best for him or her.

Answer: Generally Medicare does not approve experimental treatments or clinical trials except in cases of qualified clinical trials. To verify if the the clinical trial is qualified you should call Medicare at 1-800-MEDICARE or visit www.medicare.gov.