Luke Rhoads, Medicare Insurance Broker

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

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

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

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

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

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

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