Marc Rheingold, Medicare Insurance Broker

Answer: “You don’t need to learn Medicare. You just need to make a few simple decisions based on your doctors, your medications, and how you like to manage your healthcare. Contact a local Medicare broker to help make this important decision

Answer: Find a local licensed independent broker that writes both Medicare supplements and Medicare Advantage Plans to explain the difference in plans so you can make the best decision

Answer: For a Medicare Advantage Plan PPO:

1. Higher Costs Outside Network: Visiting non-network doctors triggers much higher copays and elevates your maximum out-of-pocket spending limits

2. Prior Authorization Barriers: Insurance companies require pre-approval for many procedures, surgeries, and specialists, causing potential treatment delays or denials.

3. Network and Travel Rules: Plan benefits are tied to specific local counties, meaning non-emergency care is rarely covered when traveling long distances.

Medigap Lock-Out: You cannot buy a Medigap plan to cover copays, and returning to Original Medicare later may be difficult due to medical underwriting.

Answer: 1️⃣ What are the benefits of Medicare Advantage vs. Original Medicare?

Medicare Advantage bundles medical, drug, and extra benefits (like dental/vision) but uses provider networks.

Original Medicare offers the widest doctor choice nationwide but fewer extras unless you add a supplement.

2️⃣ Is Medicare Advantage more beneficial for someone with several health issues?

Sometimes, if they stay in-network and like having an annual cost cap.

Often no for complex or serious conditions due to referrals, prior authorizations, and network limits.

3️⃣ Do more doctors accept Medicare Advantage?

No. More doctors accept Original Medicare.

Medicare Advantage limits you to doctors in that plan’s network.

4️⃣ Do you pay more out of pocket with Medicare Advantage (premiums and doctor bills)?

Lower monthly premiums, but higher and less predictable costs when you use care.

Original Medicare with a supplement usually costs more monthly but far less at the doctor.

5️⃣ Should I talk with an insurance agent?

Yes, especially an independent agent or SHIP counselor.

They can compare plans, doctors, prescriptions, and total cost—not just premiums.

Answer: No — a 65‑year‑old green card holder who has not met the five‑year U.S. residency requirement cannot enroll in Medicare Part A or B yet and therefore cannot incur late‑enrollment penalties.

Answer: The carriers we use do not but if you have a Medicare supplement a strategy would be to change your plan to a high-deductible Medicare supplement plan. If you stay healthy, you would be able to save the money from paying less premiums.

Answer: Medicare Advantage Plans can offer rewards and incentives but only for approved health related activities not for an incentive to enroll

Answer: Whether a Medicare supplement or Medicare Advantage Plan would be the best option for you. Find out when your health plan ends and apply for Medicare Part A and B before your health plan ends.

Answer: Medicare does not pay for non-medical, custodial long-term care. It would be beneficial to look into purchasing a long-term care policy.

Answer: No. Medicare does not fully cover nursing home care.

It only pays for short‑term skilled nursing facility (SNF) care under specific medical conditions—not for long‑term or custodial care. Buying a long-term care policy would be best option

Answer: Medicare Part B does cover a series of cancer screening test at no cost. Just make sure your provider accepts Medicare assignment

Answer: Part B covers physician and out patience services and some additional coverage. It is not enough and would recommend a supplemental plan

Answer: Be aware of suspicious calls especially during the open enrollment period. Do not give out personal information over the phone. When in doubt contact Medicare at 1-800-633-4227

Answer: No, mental health services like therapy are not fully covered under Original Medicare; you are responsible for some out-of-pocket costs

Answer: If you didn’t enroll in Medicare when you first became eligible at 65 and are now retiring, you may need to take some specific steps to avoid penalties and ensure continuous coverage.

Answer: Yes, but for specific uses.

Covered: Ozempic (semaglutide) is covered under Medicare Part D for Type 2 diabetes or to reduce cardiovascular risk

Not Covered: When prescribed Soley for weightloss

Answer: They originally enrolled into a Medicare Advantage Plan and after 12 months they wanted to switch back to original Medicare and purchased a Medicare supplement. Due to health issues, they were not able to qualify for a Medicare supplement here in Florida

Answer: Annual Enrollment Period (AEP) Oct 15 – Dec 7 every year Switch Medicare Advantage (Part C) plans, switch Part D (drug plans), or return to Original Medicare

Medicare Advantage Open Enrollment Jan 1 – Mar 31 every year If you already have Medicare Advantage, you can switch to a different Advantage plan or go back to Original Medicare and join a Part D plan

Initial Enrollment Period (IEP) When you first become eligible (around age 65) Join Medicare for the first time and choose plans

Part D Open Enrollment for 5-star plans Year-round Switch to a 5-star rated Medicare Advantage or Part D plan once per year

Answer: When you join a Medicare advantage plan you basically give up your Medicare part a and B and that health insurance carrier will take care of all your medical needs and prescription coverage