Mal Varlack, Medicare Insurance Broker

Answer: Depends on what Medicare program we are talking about.

Original Medicare [Parts A&B] generally DONT cover ROUTINE dental or vision. The exceptions on vision would be an annual DIABETIC retinopathy exam for diabetic people, as well as glaucome screening and macular degeneration treatment. Possibly, a pair of glasses or contacts after cataract surgery. Bottom line is these things being medically necessary thing.

For dental: Only when necessary after an accident or for cancer treatments requiring extractions.

If it is a Medicare Advantage Plan [Part C]; many plans include ROUTINE dental and vision coverage as an allowance. There are copays and coinsurance for crowns, bridges, glasses and additional features like anti-glare, etc; that are typical.

There are dental and vision plans available that if someone doesnt have dental or vision they can purchase without having to answer health questions to obtain the policy. These policies give benefits Year 1, and then more benefits Year 2 and 3. In Year 3 the plan pays the max of what is described in its policy.

Answer: If you are collecting your Social Security the answer is, yes. It is auto deducted and there is no option to "send in a payment" as if there was a coupon book involved. If you are not collecting your Social Security but have enrolled in Part B; only then do you pay your Part B premium via deduction from checking account [or savings], online payment, credit card, or check.

Answer: A checklist you want to have is to make sure that the exact plan you have in your previous state exists in the new state. For instance, plan number H555-000-009; does that plan exist in your new state with the same carrier? Secondly, check if any benefit changed? Also, in your new state, what are the best hospitals, doctors and specialists [if needed] in your area?

Did you notify the plan that you were moving BEFORE you left? Did you notify Medicare?

Answer: The best value planned Medigap plan is not just one plan, as there is no one-size-fits-all needs. The best plan is the one that checks all the boxes for that person period.

Answer: It is now 2025, so this question doesn’t apply or is relevant. You have an affordable option in 2025, as meds are now being capped at $2000.

Answer: Worst decision is not to have a thorough need analysis done so you understand what is covered and what is not by either Original Medicare or Medicare Advantage. You need to understand the long-term implications of one's decision.

Answer: Medicare covers approved clinical trials, but it's for drugs and procedures normally covered by Medicare. Medicare won't cover experimental drugs, devices or studies. It also won't cover extra testing. The trial sponsor should cover the trial. You should verify Medicare trial is approved. But remember, Medicare covers the routine costs while the trial sponsor covers the treatment itself.

Answer: Best advice is to call a professional who can help navigate you through the complexities and help you understand how the different plan types meet your needs.

Answer: When a spouse dies, you don’t get both checks. Instead, Social Security pays the higher of the two benefits. If your husband’s benefit is higher, you would receive his amount as the widow benefit. If yours is higher, you will continue to receive yours.

Answer: Original Medicare can be used anywhere in the US, while Medicare Advantage is limited to networks. Drugs are NOT included with Original Medicare, while Medicare Advantage in many plans DO include drugs. Original Medicare means you still need to get a Medigap plan, because without it, you are subject to 20% coinsurance on use of the plan with NO limit to the out-of-pocket. Medicare Advantage has a maximum out-of-pocket. These are some of the things that are differences to know, but there are more.

Answer: Annual enrollment is Oct 15 - Dec 7. If you are on a Medicare Advantage Plan, then there is an Open Enrollment from Jan - Mar 31, where you can switch to another MA plan or go back to Original Medicare and pick up a Medigap and a Part D. Finally, there are Special Election Periods, where during the year either your state or the Federal govt issue a Special Election due to weather-related disasters, or other issues.

Answer: Different estimates based on type of Medicare plan. Original Medicare with Supplement, you still factor in Part B premiums and the deductible. If you have a Medigap, then it covers the 20%. But Medigap has a premium plus there is Part D premiums for medications. Cost of diabetic medications need to be factored in like copays and the $35 limit on insulin. Factor in test strip costs and CGMs.

With Medicare Advantage, there is still the Part B premiums, but also there is a max out-of-pocket to factor in, and you still have the cost of medications thru the copays.

Answer: At least some of the same care services as Original Medicare. Including part-time skilled home health care, provided the person is homebound and has doctor approval for the care.

Answer: Beware of Plans where there are limited networks. You need referrals. And also pay attention to where it has a high Max out-of-pocket. It’s not a trap. It’s just what to understand before you enroll.

Answer: Manufacturers may offer a discount program. Also, each state has a state pharmaceutical assistance program that you can contact.

Answer: Yes, but unfortunately networks and doctors can still change during the year. Doctors can opt out during the year.

Answer: That depends on the specific needs of the person. Needs such as do you want to get a referral, do you want flexibility to use the plan anywhere, doctor networks, your own health issues, if any.

Answer: Consider the timeframe. You have a limited time to enroll into Medicare after retiring and getting off your employer’s plan. Understand also the options of Medicare - Medicare Advantage versus Medicare Supplements [Medigap]. Get educated.

Answer: With Original Medicare, you can take it anywhere in the country. No referrals, no restrictions to networks.

Answer: There are things that Original Medicare by itself doesn't cover—hence "gaps." Gaps are: dental, vision and hearing—these are NOT covered by Original Medicare. Prescriptions also are not covered. These would all be separate coverage that would need to be done.

Answer: It has allowed those who can't get to a doctor or specialist the ability to speak with them from afar. Secondly, some telemedicine uses trackable devices, which allow the providers the data needed to assess vitals and address any issues rapidly rather than waiting for the appointment date.

Answer: The top two trends that will have a positive impact are going after Medicare Fraud, Waste and Abuse. The second trend is the limits on copays for certain medications. Both of these drive up costs that are only passed on to those who truly need the help.

Answer: Biggest mistake is that seniors think their medications and/or plans don't change. They don't get a yearly review to make sure the plan hasn't changed.

Answer: Original Medicare doesn’t cover: Medications, Dental, Vision, Hearing, up to 20% of health costs, and there is no limit to that 20%, and it does not cover a traditional yearly physical; instead, it covers a one-time Welcome to Medicare visit within the first 12 months. Then, after the 12 months, it covers a Wellness visit, which is an assessment and not an exam.

Answer: First step, enroll in your Part A and B through the Social Security website. You will receive a letter first informing you of your Medicare number and Part A, B and D premiums.

Second, once you have your number, call a broker who can go over your options, and you can decide which path you want to take to supplement your Original Medicare coverage - either Medicare Advantage or Medicare Supplement. Through this needs analysis, you will be informed of all the options associated with either path.

Answer: Use in-network labs only. In other words, use your HMO or PPO's contracted labs to get coverage.

Also, your doctor's office if the labwork is considered in-network with my plan.

Finally, there is with your policy what is called an EOC or Evidence of Coverage. A very lengthy document to go through, so it's best to call your Medicare Advantage Plan and ask about labwork and what the costs may be for you.

Answer: Some people are healthy at 65 or retirement from the workforce and decide not to enroll in a Part D prescription drug plan because they don't take any meds... at that time. The problem with that is that later on in their retirement, when they are starting to take medications, they are faced with a late enrollment penalty added to their monthly Part D premium.

Answer: It really boils down to if it is deemed as medically necessary. Smart watches on Original Medicare: typically no. A medical-grade heart monitoring device under Part B of Original Medicare can be considered medically necessary, but this is beyond a smart watch.

With a Medicare Advantage (Part C) plan, though, some plans may provide an additional benefit like coverage or reimbursement for a smart watch. Best to call member services on the back of the Medicare Advantage Card to find out if it is covered.

Answer: No, you don't have to sign up for Medicare again when you turn 65, since you are receiving it because of the disability. But at 65, you may have other options, like switching a plan or Medicare Supplements. Always a great idea to review what you have now with a broker who will go over your options.

Answer: Always best to call a broker who gives you all your options before either turning 65 or leaving an employer plan. The right broker will tell you the timeframes you’re looking at. But please note the state of NY is different. In NY, it’s always Open Enrollment, meaning you won’t miss your window of opportunity there, and insurers cannot deny you coverage.

Answer: Yes. Versus you having no plan at all or Original Medicare. Absolutely. Medicare Advantage Plans have a “cap” on the amount you spend out of pocket yearly. With Original Medicare (just the red, white and blue card), you don’t have a cap and are subjecting yourself to 20% of the cost of healthcare and THERE IS NO LIMIT. Also, instead of paying the full bill for a visit or a medication (if covered), you pay a copay (a set amount) or a coinsurance (a specified percentage).

Answer: Each Medicare Plan has a “formulary”, which is a document that states which medications are covered in part or fully by that particular plan. You can either call Member services on the back of the card and speak to a representative or call your broker who can also look up your plan and give you the answer as you both go over your medications.

Answer: If you don’t want to expose yourself to potentially paying the Max out-of-pocket on a plan, or exposing yourself to paying a $200-some-odd daily skilled nursing benefit after the 20th day of rehab or other copays that may hurt financially and emotionally to pay; then YES. I would highly recommend taking out a Hospital Indemnity Plan to offset expenditures you are subjected to pay in the Medicare Advantage Plan. Namely, the 2 expenses I mentioned, but there are others: cancer meds administered in hospital, as an outpatient or doctor's office; ambulance rides are not free either.

Hospital Indemnity Plans can be structured to cover some or all of the out-of-pocket costs of these as well. Even if you go twice a year. They pay you directly, and some are what are called Guaranteed Issue. That means, depending on the carrier and your age, you don’t have to answer health questions to qualify.

Answer: Is it concerning? On the one hand, the only other option is a Medicare Supplement (or high-deductible Medicare Supplement) or do nothing and just have Original Medicare. Being that health costs have increased significantly and that more people are looking to not pay now and pay later (as they use their plan), it is the only option. Other factors like the cost of living have made Medicare Advantage for those eligible attractive. Whereas they would have to pay a monthly premium for a Medicare Supplement. So, in that regard, it’s the best option for those budgeting or trying to make ends meet.

On the other hand, it does leave the fact that there are 6 major Medicare Advantage companies (there are some regional Medicare Advantage carriers) and these 6 you could say are monopolizing the market. So, in that regard, their pockets are so deep that they can lobby for laws and regulation that benefit their stock prices at the expense of the true intention of healthcare.