Mariela Arana, Medicare Insurance Agent

Answer: Medicare Advantage plans are often HMO type of plans. This means that routine visits should be done (In Network). When you travel, keep in mind that you are more than likely out of your network. It means that you would have access to doctors in emergency type of situations. However, if you are simply trying to have a routine type of visit, the plan will usually have restrictions in your local county and within your medical group. PPO plans and Medicare Supplements will provide a broader option base. Currently, many insurance companies have pulled away from PPOs and are no longer offering them. The best way to see a doctor of your choice, is to be on a Medicare Supplement. However, a Medicare Supplement will have an additional premium cost for that freedom. Medicare Supplements do not come with extra benefits. They are only for medical care.

Answer: Yes, some Medicare Advantage plans cover acupuncture. They can do it in various forms. It can be that they provide for the acupuncture alone including routine visits. The plan may require a provider authorization. In some cases, they will combine it with chiropractic services. And in others, they can even put monies on debit (flex) cards to allow for use at an acupuncture office.

Answer: Medicare Part D is for your prescription drug plan only. You will not get anything else for the premium price that you pay. If you get a Medicare Advantage Plan, you will be getting Hospital (Part A), Medical (Part B) and the Prescription Drug (Part D) and on top of that, many plans will also include coverage for dental, vision, hearing, transportation, and gym membership in some cases. The important thing to know is whether you are comfortable being in an HMO type of network. Some people feel that by being in a network, helps ease the coordination of care. If you are looking for added coverage, a Medicare Advantage plan would have more benefits included.

Answer: Many people think that Medicare covers everything and that they will never pay anything out of pocket. When they find out that Original Medicare is only going to cover 80% of the costs, they get surprised and even upset. I often hear people say that they expected it to not cost as they got older. So, financially speaking, people find that monies are stretched a lot more than they realized prior to retirement. We do not do enough preparing people with knowledge to really understand what costs will look like and how best to avoid pitfalls. I make efforts to educate people prior to turning 65. It is my goal to extend as much knowledge as possible, so that people make informed decisions. I do community events at hospitals, restaurants, community centers and invite as many people as we can fit into rooms, so that they know. Afterwards, I walk them through the process and make sure to continue that guidance. A good agent is always, teaching and communicating, so that the client truly benefits.

Answer: Neighbors, family and people in the community often have things to say about how we spend our money. The main thing is finding out if you require a Medigap plan or not? If you have conditions that require you to see multiple doctors and you need to be in various different medical groups, then that might be necessary. Medigap plans act like life insurance in the sense that you cannot be on them if you have certain conditions. So, when people know that they have serious health concerns many will stay on these plans. Remember that leaving a MediGap/Medicare Supplement plan can mean that you may not return to it. They do require underwriting. So, what a neighbor may have is good health. They may never experience a need and it could be just fine. However, each person is different. My job is to check all those variables. For some people, spending on something that is "free" seems crazy, but if they come to a place where a doctor will deny approvals to see specialists out of network, they may change their minds. It really comes down to what a person has medically going on. And further, what a person can handle comfortably paying. I check for both and see what makes the best sense. One thing that is good for one person, may definitely not work for the other. Our neighbors, friends and people in the community only see us from the outside, they do not know what medical conditions we have, what medications we take and many times what our finances can tolerate. These conversations are best had with a professional in which the confidence of private medical and financial areas can be openly discussed. One can never know, what condition a person has that might be private and not shared with others. So, a good assessment will determine that. My job is to really see for sure what makes sense, and trust me, nothing is crazy. It is all about assessing risk and doing what is right for each individual client.

Answer: No, you do not have to pay taxes to receive Medicare. You already had taxes removed from you while you were becoming eligible for it. When we work the years prior to 65 and complete our 40 credits which equals 10 years of work, that suffices. Thus, now that you are a recipient, you will not be paying additionally.

Answer: I don't believe that it is overkill. It really comes down to your needs. If you have chronic conditions that will require that you see various specialists and provide freedom in choosing those doctors it can be very good. You must remember that Medicare Supplements are designed for people who can afford them. This being said, you also must keep in mind that the cost will increase as you age. So, thinking about the future and looking at your budget being fixed is crucial. I have seen many people start Medicare Supplement plans when they are healthy at 65 and have income. Unfortunately, by age 80 the premiums have increased several times and they are no longer healthy. Another point to always note, is that a Medicare Supplement will only cover Medical types of costs and that you are still required to purchase a prescription drug plan and any dental, vision, hearing or gym costs separately. So, when making your decisions, you must extrapolate out for years of costs and know whether you will be able to pay all of these various pieces separately.

Answer: Medicare Advantage Plans on TV, Mailers, and Social Media are not always advertised to you specifically. You must remember that insurance companies have plans that can be nationwide offerings. What is best, is to consult with your local agent. We have access to the plans that are being offered in your specific zip codes. Keep in mind that in some states there are up to as many as 450 options. It is a huge amount of information to sort through. My job is to do a proper needs assessment to establish which specific plan will work the best for you. Most people do not look at the fine print in most of the commercials and get caught up speaking to people in other countries even. It is very important to speak with a professional that actually knows the market and can deliver on finding the best coverage.

Answer: You can call Medicare directly and advise them of this. Have your Evidence of Benefits ready, so that you can tell them who billed and for what charge. There have been a lot of reports of fraud in the Medicare space, and the Centers for Medicare and Medicaid are cracking down. Reporting the fraud will help. Usually, it will show the date of service and who provided the service. Let them know all the details.

Answer: Some seniors don't understand the difference between Medicare and Retirement. Now that we are living longer, Medicare and retirement are not both at age 65. This tends to confuse many seniors and then they do it in a rush because they are worried about late penalties. I do my best to start conversations with seniors prior to age 65. Personally, I do Turning 65 events and work in senior centers, retail stores, clinics and places where they are free to ask me questions. I also send out reminders to all of my active clients each year letting them know it is time for reviewing their plans.

It is important that a senior establish a relationship with an agent because the agent is there to provide consultation, education, and research their best plan options. It is best to go with a broker that is local and has a handle of what is going on with Medical Groups, and Insurance Companies at large. If person is active in the community and entrusted with doctors, dentists and even accountant offices, it usually means they are writing enough business to have a good feel of what is best for you. Remember that, there are many agents out there, but the best ones must have your back.

Answer: Some carriers provide household discounts if both a husband and wife are on Medicare Supplements. The other thing to do is to look at the coverages for different types of plans. Usually, one can assess whether the coverage is as necessary throughout or if a copay can be charged instead only when used. It comes down to shopping around and speaking with your broker to assess whether some of the are as required or not. Every carrier usually has certain plans that they are competitive on.

Answer: The lowest premium does not equate to the lowest cost. What one should be concerned about is the maximum out of pocket costs on a Medicare Advantage Plan. The other area to pay attention to is the prescription deductible. If you are on a Medicare Supplement, then the most important thing to check for is the highest coverage. Each carrier uses different pricing on Medicare Supplements and in some cases you can get household discounts too. I would always consult to see what conditions you have and the services that you are expecting to use. Some people require more care because they do have chronic conditions and that should be assessed when purchasing a plan.

Answer: The biggest disadvantage for people who want to have freedom and go wherever they want, would be the limitation of having to be in a network. Most Medicare Advantage plans require that the doctors you are being referred to all be part of the same medical group. Typically those doctors would require showing that they take the same plan and are all in the same medical group. Trying to go outside of the network would incur out of pocket expenses and cost the client.

Answer: Each Medicare Advantage Plan, as well as stand-alone prescription drug plans have their own formularies. It would require a needs assessment to discover what the specific plan coverage is. Some plans also charge a deductible for certain tiers. Therefore, we would need the exact medication, strength and dosage to answer what the costs would be.

Answer: It depends on your situation. Everyone can make changes during the Annual Enrollment Period. This is usually between October 15th through December 7th. If you already have a Medicare Advantage Plan you can also change your plan from January 1st-March 31st. All other people, require special circumstances and must apply during special election periods. Some examples of that would be, if a person has a chronic condition, or is in a dual plan for Medicare and Medi-Cal recipients. It is a good idea to check with your broker, as there are different types of special election qualifications.

Answer: I have conducted many of these seminars and I feel like it is dependent on the person presenting the information. I like to open my seminars to questions and answers. I give people instructions on how to get their Medicare. I tell them things to avoid, and show them what types of options they will have. I explain things in detail, so that each person that attended walks away with more knowledge than when they walked in. It is always my goal to engage with people and have them feel like this was a good seminar. Oftentimes, I get called back and even get referred to others because people have friends and family with similar questions. If it is done correctly, you should walk away in a place of comfort and not feel pitched or like you were held hostage. Ideally, the person who presents, should understand their audience and see what is important to them. In some cases, I even speak in Spanish if my group is Spanish speaking. The idea is for people to understand a complicated subject matter that is always changing and effects your health.

Answer: I believe that some agents go with the intention of obtaining clients. However, some of us, go with the intention of helping seniors overall. I have done many seminars during my career. I do all kinds of seminars which are about Medicare to some degree,but sometimes can be about how to avoid scams and fraud. I teach these with Police Officers, and city officials. Sometimes, I do seminars about health in general, and I bring doctors to talk about health concerns that impact plans, like diabetes and heart issues. I also, have seminars that are about avoiding slips and falls and show people with what plans can do for them. In all my years of presenting, my Medicare seminars are educational. The truth is, that if people learned and were comfortable, they will reach out to me, and/or provide their information because they want me to become their agent. I like to be of service and build rapport.

Answer: If you missed your window to sign up? It will be a good idea to check for creditable coverage first. If you were working and can prove that, then you may not get penalized. Proof would have to be submitted to the Social Security office from your employer. If there is no creditable coverage and you simply missed the deadline, the best thing is to apply as soon as they will allow you to. The longer that you go, the larger the penalties. If you have Medicaid the government will not charge you the penalties. Unfortunately, for those who do not receive financial assistance by way of Medicaid the penalties do stay. So, be vigilant and call them or visit an office as quickly as possible.

Answer: Part A, may not necessarily be enough hospital coverage. In Medicare, the standard amount of time a person can stay in the hospital is 100 days. Anything after that, is considered Long Term Care and would be the responsibility of the patient. It is a good idea to consider what kinds of coverage you may need, as Medicare is limited to the 100 days. There are some exceptions in cases where a person might have a dual plan that is including Medicare and Medicaid coverage. However, even with that, they usually will not go more than 150 days total and it is considered an extra coverage for that specific plan. When a person is concerned about a disease that could make them spend longer periods in a hospital, we want them to think of additional coverage. Also, the younger is when they apply for long term care coverage, the lower the cost of obtaining it and the more likely to get approved. They usually will require underwriting for those types of policies. So, being younger and thinking of the future makes a difference.

Answer: You should enroll within the Initial Enrollment Period window to avoid penalties on Medicare Advantage plans. The Government assumes that you will apply 3 months before your birthday, the month of your birthday, or three months after your birthday. If you go longer than that, you should expect to pay a penalty on your Part B premium. The only time that they do not impose a penalty is when a person continues to work and can prove that they have had creditable coverage. You also want to avoid the part D Prescription drug penalty.

Answer: It depends on whether , or not your doctors are in the same medical group. I advise to always provide all doctors names, addresses and phone numbers. Usually, I will spend time doing research to make sure things align to avoid issues. If a doctor is not in network, I would advise of this and we could determine whether, or not that is a vital doctor to keep.

Answer: Medicare Advantage plans tend to have coverage for basic cleanings embedded into the plans. The amounts vary by carrier and in some cases require you to stay in network. Some plans do higher amounts for chronic conditions and special needs. It is important to speak to your agent for a complete needs analysis. I do my best to assess the situation, and find the coverage to match needs.

Answer: This is a personal choice and can only be decided upon based on a person’s needs. A thorough analysis helps determine the answer. One can only evaluate this by verifying doctors, medications, financial impacts, and understanding any medical, physical and social needs. We must always take continuity of care into consideration. I would only know what works for my client, after asking the questions that would help us determine what would work long term.

Answer: I personally like having the ability to know my clients and their situations because I can help them. Many times, my role is that of an educator and it gives me great satisfaction to know that my clients understand their plans and get their needs met. I am here to help. You could say, the more I help others, the better things are. When you serve others, things just flow better.

Answer: I have seen many people regret looking more at extra benefits and not paying enough attention to the actual medical coverages. I am here to get to know my clients and their needs. Unfortunately, some people many in impersonal settings do not care and just look to close deals. I would say developing a relationship with your agent is crucial and removes regret.