Lyle Affleck, Medicare Insurance Agent

Answer: The best part about being a Medicare agent is the people I get to work with. I learn a lot from my clients, about their lives, and the wisdom they impart. I feel like I am doing something significant for them, by helping get the proper coverage.

Answer: Your ability to sign up for Medicare is in no way connected to your starting Social Security payments. You sign up for original Medicare benefits through Social Security, and work with a competent Medicare advisor to get you on the plan you need. You can start looking at Medicare plans 3 months prior to the month you turn 65. You have 7 months to select a plan without incurring any penalties.

Answer: The majority of Medicare Advantage Plans will force you to stay within their network. Remember, though, that your part B will (after your initial Part B deductible) will pay for 80% of the visit as long as the doctor accepts Medicare. You can still see the doctor though they may be "out of network" knowing you will have more than the usual amount out of pocket.

Answer: We offer both in-home education appointments and various educational seminars in the area to educate those who will soon be eligible for Medicare benefits. The best time for people to get educated on the benefits available to them is 6-12 months prior to their becoming eligible for Medicare.

Answer: A common misconception many people develop is that Medicare Advantage plans are the only type of Medicare available today. The truth is that there are a lot of different types of plans (Advantage plans, Supplements, Hybrid, Traditional, etc.). It can be very confusing. The best thing someone looking at Medicare can do is to find a competent advisor that will guide them in the right direction to a plan that will fit their needs and their budget. Medicare is certainly not a one-size-fits-all solution to senior healthcare. Knowledge is power, and there is nothing that can bring peace of mind better than knowing you are covered for the "what-ifs" that come your way.

Answer: To put it simply, no. Medicare Part A will only cover in-patient services offered through hospitals. Outpatient services (including those performed at surgical centers) are covered under Medicare Part B. But remember that a Part B plan, in and of itself, will only cover 80% of the total bill. That is why having a Medicare Supplement or a Medicare Advantage plan is so vitally important.

Answer: As a Medicare recipient, your Original Medicare (Parts A & B) will cover you anywhere you go. But it is not designed to pay the entire bill. Medicare Advantage plans are designed to fill in the gaps the original Medicare leaves behind. But a lot of Medicare Advantage plans only offer regional coverage. If you seek care outside of your policy's coverage area, you would likely be denied coverage for those appointments. Having just original Medicare (Parts A&B) and a prescription drug plan (Part D) would be more beneficial in this scenario, though the coverage would not be complete.

Answer: To a limited extent, yes. If the ship is either in a US port, or within 6 hours of a US port, Medicare would cover at least SOME services received on a ship. Outside of those parameters, coverage cannot be guaranteed. It is advisable to look into international travel insurance or to get a Medicare Advantage or Medicare Supplement plan that includes international coverage.

Answer: The 'donut hole' is no longer an issue when it comes to Medicare Part D (prescription drug) plans. During the Biden administration, CMS (Centers for Medicare & Medicaid Services) changed the way Part D plans were structured. They eliminated the dreaded 'donut hole' and capped the Maximum Out of Pocket (MOoP) for prescription drug plans at $2,000 (for 2025). Those MOoPs will likely increase year over year as will the premiums for the various prescription drug plans, but you won't have to worry about extra costs for receiving too many medications in a year.

Answer: The short answer to this question is 'no." There is only one time when an individual can apply for a Medicare Supplement and not have to answer the medical questionnaire, and that is during the recipient's initial application process (the first time they are signing up for Medicare. You CAN switch from an advantage plan to a supplement, but you will HAVE to go through underwriting.

Answer: Under new rules, you may have to jump through a few hoops and get prior authorizations to increase the number and/or frequency of certain procedures (i.e. more frequent colonoscopies), but, in general, if your doctor says it is necessary for your health, they will be covered by your Medicare plan.

Answer: I absolutely believe that the advertising of Medicare Advantage plans should be more closely regulated. I speak with a lot of seniors whose knowledge of what was available to them was grossly limited. They made poor decisions about their care based on the limited knowledge they had. Medicare Advantage plans are not always the best choice for people's care.

At the same time, I believe this is a problem, not with agents, but with the insurance carriers and their marketing tactics. I don't think this can be solved with another form agents have to get signed in order to conduct business (there are enough of those already). There needs to be more truth and transparency in the marketing of these products.

Answer: Due to the nature and design of Medigap plans, you do not have to change your insurance coverage, as long as you still hold onto your original Medicare. You may want to see if the costs will increase for your plan, though. Different service areas (determined by your ZIP code) could change the premium cost of your plan, even if the plan itself does not change.

Answer: This is a question whose answer is different for every individual and is something better suited to ask a trusted financial advisor; not an insurance agent. In general, however, the longer an individual waits to collect their Social Security benefits, the higher the monthly payout becomes.