Luke Rhoads, Medicare Insurance Broker

Answer: I would recommend finding a trusted local agent that has all the carriers available in your area. Then don't make any changes to your coverage until you run it by your agent.

Answer: Medicare advantage plans can have limitations on dental coverage. It is important to understand the plans benefits and limitations when making your plan selection. Common limitations examples are annual cap, network limitations, cost sharing, and waiting periods.

Answer: Once gene therapy receives FDA approval as a medically accepted treatment it is likely to be considered for coverage by medicare. Currently the standard for coverage determination is treatments for injury and illness need to be reasonable and necessary.

Answer: Medicare plans are individual plans. So it generally does not affect your medicare coverage or costs. Although your spouses work history could make you eligible for premium free Part A, or if your household income exceeds certain limits it could increase your part B premium.

Answer: I think telehealth will be more prominent. I also think that artificial intelligence will play a much bigger role in people's health care. I imagine medicare will make necessary changes as the healthcare industry as a whole evolves.

Answer: My biggest frustration when helping clients enroll is having difficulties with the remote signature process.

Answer: A serious illness by itself does not qualify you for a special enrollment period. You need to be eligible to make plan changes according to your enrollment eligibility. Examples are new to medicare, moving out of the area, being affected by a disaster, loss of creditable coverage. If you are outside your initial enrollment period (6 months after you are enrolled in part B) you would not be guaranteed issue of a medigap policy, and would have to go through underwriting. Depending on the illness may be denied coverage or have to pay higher premiums.

Answer: Medicare does not cover long term custodial care, nursing homes, or assisted living facilties. You will need to explore options like qualifying for medicaid or looking into long term care insurance.

Answer: The Extra Help program, officially known as the Low-Income Subsidy (LIS) for Medicare Part D, helps individuals with limited income and resources afford prescription drug costs. It can reduce or eliminate drug costs, help with premiums, and cover costs above copayments. To qualify you must be below 150% the federal poverty level, and have assets less than about $17k. Some people are automatically enrolled if they are on other government programs like medicaid.

Answer: Generally concierge medicine has a membership fee that is not covered by medicare. This provides additional services and benefits that go above and beyone what medicare would cover. You have to make sure the concierge takes medicare, and they are still bound by the billing and practices of the medicare plan that you are on. Co-pays and deductibles would still apply as defined by the plan benefits.

Answer: Medicare and Medicare supplement plans are separate entities. During your initial enrollment period when turning 65 you are guaranteed issue of the medigap policy. After that period you would be subject to underwriting where the insurer could choose to approve, deny, or adjust premiums dependent on underwriting.

Answer: You should understand why the carrier denied coverage, research the specific reason. Then you should file an appeal. In your appeal explain why you believe the decision is incorrect including supporting documentation.

Answer: Yes that is accurate. They have closed off the doughnut hole, and are providing much better coverage for prescription drug costs. The max out of pocket for is $2000 for 2025.

Answer: Yes medicare is expanding coverage for these cutting edge technologies. Some examples are coronary artery disease, diabetes, and stroke prevention.

Answer: I would say the most cost effective way to structure medicare coverage is Medicare Advantage Prescription drug plan with ancillary plans like hospital and critical illness to supplement the co-pay gaps.

Answer: Do you want to have everything covered anywhere you want to go with no benefits or prescription drug coverage for a higher annual healthcare cost that can rise substantially as you age, or do you prefer to have co-pay exposure with some additional benefits and good prescription drug coverage for less every month.

Answer: Yes a limited network of dentists in areas is a common problem. The carrier website has a provider search tool that you can use to see the in-network dentists in your area.

Answer: Once you reach $2000 out of pocket for the year you have $0 co-pays for the remainder of the calendar year for your prescription drug costs.

Answer: Not in the least. The insurers are very good at what they do, and they are more efficient with the resources provided by the government. Which is our tax dollars and benefits that we deserve from our working lives. Plus medicare advantage plans come with all the goody benefits.

Answer: The best way to avoid surprise lab bills is to make sure that the lab is in network with your plan. Don't just assume that it is. You can also ask for a good faith estimate and compare it with your plan details.

Answer: Yes, when peoples health fail, and they are unable to make quality decisions regarding their healthcare themselves having a predetermined third party assisting can make a big difference. It provides peace of mind knowing that your wishes will be respected, and reduces family conflicts. It also makes a court having to intervene less likely. Which can be costly an complex.

Answer: Medicare savings programs help low income and people with limited resources pay for their medicare costs, including premiums, deductibles, coinsurance, and co-pays.

Answer: Prescription Drugs, dental vision hearing, and long term care aren't covered. There is a part A deductible ($1676) for inpatient hospital stays and $419 per day copay for days 61-90 and $838 per day for days 91-150 (lifetime reserve days). Part B has a deductible of $257 and then it is 80%-20% coinsurance for outpatient services. Meaning the medicare benficiary pays 20% of all outpatient services with no cap.

Answer: Medicare advantage brokers have access to a provider search tool. Any broker worth their salt will look up prescription drugs and providers during their client needs assessment when determing which plan is right for the clients specific situation.

Answer: When your husband dies, you will not receive both your Social Security benefit and his survivor benefit. Instead, you will receive whichever amount is higher.

Answer: Medicare and it's associated plans and options do not cover the room and board cost of a continuing care retirement community. Although medicare plans will provide coverage for some of the services that may be available in such a community like skilled nursing and dr visits.

Answer: You'll have to meet your deductible, then you inpatient services will be covered for days 0-60 after 60 days you will have the following co-pays with original medicare.

Deductible: $1,676 per benefit period.

Coinsurance:

$419 per day for days 61-90 of a hospital stay.

$838 per day for lifetime reserve days (days 91+).

$209.50 per day for days 21-100 of skilled nursing facility care.

Answer: Yes a bone density DEXA scan is considered preventative care and would be covered for eligible individuals every 24 months.

Answer: It depends on your definition of good coverage. You can enroll in Part A and B and nothing else, but it leaves significant exposure to medical expenses such as inpatient hospitalization, 20% of your out patient services, and prescription drug costs.

Answer: Providers dont like medicare advantage plans because of the administrative complexity, lower reimbursement rates, and requirements for prior authorization.

Answer: Original medicare, medicare advantage, and medigap plans generally will not provide coverage outside of the US. There are some exceptions. Certain Emergencies and situations where the closest hospital is in a bordering country. Traveling through Canada from Alaska, and on a cruise ship.

Answer: The part A deductible $1632 for inpatient hospilization, the co-pays for any stay longer than 60 days. Then the most likely and biggest risk is the part B 80%-20%. Meaning you pay 20% of your outpatient services provided with no cap on your exposure.

Answer: The first steps are to become educated on your options to determine what course of action is best for you. Do you plan on keeping working? Does your employer provide a health plan? Should you enroll in original medicare part A part B and part D, with medicap or go with a Medicare advantage with prescription drug plan.

Answer: Medicare generally does cover skilled nursing and home care while it does not provide coverage for assisted living and extended stays in nursing homes.

Answer: You can consider comparing the costs of other plans. Also look into a Medicare savings plan to see if it meets your needs.

Answer: Medicare doesn't have a traditional annual physical, they instead have a welcome to medicare visit and an annual wellness visit. Both would have a zero dollar co-pay. Your friend may have received services above what is covered under the visit.

Answer: I don't think Medicare Advantage plan ads are misleading. I believe that once a benficiary receives the proper education about the gaps in original medicare and the options available to transfer that risk, that they have a easier time making the decision.

Answer: One hidden Medicare expense that catches many people off guard is the cost of long-term care such as nursing home or extended in-home care.

Answer: Helping make medicare simple, and protecting my clients from the financial risk of high medical expenses.