Mark Davisson, Medicare Insurance Agent

Answer: Call a licensed agent and have a conversation. This is the best way to get the right information without you having to research for hours. I recommend selecting a broker who represents several carriers so you are not being sold only what they offer.

Answer: With Medigap policies you are allowed to go to any doctor, any clinic, any hospital that accepts Medicare and there is no such thing as out of network as it is driven by original Medicare.

Medicare Advantage plans are subjected to the plan limitations being either an HMO, where you are required to be in network unless an emergency for any coverage to exist. PPO's offer benefiits for most doctors, but the co-pays are much higher if you are ot in-network

Answer: When you first age into Medicare or drop employment health care coverage allows you 6 months for aging in and 8 months when changing from employer benefits to Medicare.

For those with Medicare, the Annual Election Period is from October 15 through December 7th each year. This is the time when new plans are offered.

If you move out of your service area or have a Special Election Period, then you can also select a new plan depending on your situation

Answer: That is unfortunate. Many plans offer varying levels of coverage for services and they vary greatly. The only plans that are consistent and would cover this is a Medigap plan which charges a monthly premium.

You may want to carefully review your summary of benefits document before signing up for a new plan during AEP.

I hope this helps.

Answer: It depends on the type of plan you have. If you have an MAPD that is an HMO then you will only have coverage for emergency care whenever you are out of your network proximity. If you have a PPO then you are covered in an out of network and can be away from you primary residence for up to 6 months.

The best answer to solving this issue is to obtain a Medicare Supplement which is coverage anywhere and has absolutely no network requirement. You can travel anywhere in the United states and be fully covered for any and all Medicare related expenses at a 100% level. They even provide out of country benefits as well

Answer: The "troop" for medications is set at $2,100 dollars which is far less than they used to cost. The key is you need to make sure the medications are on your father's plan formulary in order to minimize the need to simplify and minimize your cost for these medications.

As for the paperwork, I am not sure what you are referring to but if you reach out to the plan administrators, they will be most helpful in providing insight for you.

Answer: It is my belief that when an agent is only discussing Medicare Advantage plans it i because they are working for a large organization that has likely hired them to sell MAPD's and not supplemental policies.

MAPD plans are governed by CMS and there are very strict rules of engagement that have to be followed. The agent must be AHIP certified and certified with each of the carriers and products they represent.

Over 10 years ago I was hired by Humana and was trained to only sell CMS related products such as MAPD and PDP plans with no training or mention of the optional supplemental policies that operate under entirely different rules. Understanding the complexity of selling supplemental policies also necessitates the understanding of all sorts of rules as to a person's ability to secure one of these policies either through initial Medicare aging in, SEP's guarantee issue, and underwritten, all of which are taken into account when working with potential clients.

Money is always a factor and MAPD plans generally do not carry a monthly premium while supplemental policies do. Each client has different needs so the ability to discuss both options is always in the best interest of the clients we are serving.

Answer: CMS very closely regulates "teaching seminars" from sales pitches. The rules are very detailed in terms of differentiating between these two events as informational meetings cannot discuss specific plans nor ask for your contact information and follow up unless you offer it and request a follow up call. Then, a scope of appointment must be compoleted I believe 48 before a meeting can take place. Advertising for these information meetings must indicate that the gathering is not allowed to sell plan offerings only answer questions concerning general Medicare related questions.

There are several steps the agent has to follow and have the seminar authorized by CMS and the companies they represent.

Answer: If you have an HMO, you will need to find an in network specialist. I cannot think of any other reason a specialist visit would be denied.

Call your plan customer service number and explain your situation and they will work with you.

Answer: Straight Medicare without a supplemental policy or MAPD has no max out of pocket and high deductables making it very risky to not obtain additional coverage. MAPD plans also offer additional benefits such as dental and vision not covered under original Medicare.

Listen to your kids.

Answer: I have found that most people who opt to use MAPD plans that do not have a monthly premium are cheaper for covering health care costs than Medicare Supplemental policies that carry a monthly premium. This is true if the beneficiary does not have a number of health concerns but if hospitalized, MAPD plans have significant co-pays for this while Supplemental policies cover this at 100%.

The trickiest part of this is to project how much health services will be utilized which is often difficult to project.

Answer: The MOOP or maximum out of pocket for prescription drug costs has been limited to 2100.00 per year which is absolutely significant as previously it could be in the thousands.

The catch to this is your prescriptions have to be included in you PDP plan formulary for it to qualify as part of the 2100 you would spend in a given year.

Answer: This is a tough question as many people are resistant to paying a monthly premium for coverage when many times, depending on cricumstances, Medicare supplemental policies will save you money in the long run despite having a monthly premium. That is one of the reasons that they are hard to get as they cover everything regardless of cost as long as you pay the monthly premium.

Conversely, Medicare Advantage plans have very high costs for co-pays for hospitalization and have high maximum out of pocket costs before the plan picks everything up. This number is ofen up to $9,000 per year while Medicare suppemental policies operate as the monthly premium is your maximum out of pocket and gives you the freedom to see any doctor or use any hospital you want that accepts Medicare. Even if you pay 250 per month for one of these plans which is a bit high, your maximum out of pocket for the year will be $250 per month or 3,000, not the 9,000 potential cost of the nonpremium plan.

Answer: It will increase every year as will the cost of part b. This is determined by the federal government and there is no work around.

Answer: Unsure of what a scam represents, one of the most important things a potential client can do is work with a broker who is appointed with several carriers, has been in business for a number of years, and asks questions related to what you currently have, what you like and do not like about your coverage, and what additional resources you are looking for. Depending on the answers, your agent should be able to recommend either a Medicare Advantage plan if you have a SEP or an appropriate medicare supplement plan where the only differences between companies is the price you will pay on a monthly basis.

If you run into someone trying to recommend only one carrier without providing a reason, you are likely speaking with the wrong person.

Answer: Your income must be higher than the average household as Part B recipients pay differing amounts if their income is higher. I believe there are four brackets for this with each income increase rendering an increase in your Part B premium.

Answer: Medicare is a health insurance that operates much differently than the Affordable Care Act plans. Taxes are not part of this and are not associated with taxation.

Answer: You are not allowed to change your prescription drug plan unless you have a special election period or unless it is during AEP. Your recourse is to ask the doctor to prescribe a generic version, ask your doctor to help you with a step program to validate the necessity of the drug, reach out to the prescription plan administrator, call the pharmaceutical company and ask for help, or reach out to Social Security and request "extra help" which is based on income.

Answer: If it was an educational event then you were not treated according to very strict Medicare guidelines who absolutely abhor and penalize agents operating outside of very strict guidelines.

Educational events are prohibited from gathering personal information or presenting any specific plans to the attendees. If this was done, please report that agent to CMS for being in direct violation of federal guidelines for working with Medicare recipients.

Answer: Working with a certified, trained, and knowledgeable Medicare agent will save you many headaches as we are committed to understanding the plan options available to clients, committed to always doing the right thing by our clients even if it is to our detriment, and navigating a relatively complex system with ease.

Our commitment to being of service is what makes Medicare agents excel. If you find one who tries to sell you something else, move on. Not all of the agents are altruistic, but they need to be.

Answer: Thank you for your question. All carriers are required to send out ANOC to every client that holds a policy with them denoting what will change concerning anything and everything that varies from your current policy designations. This includes and co-payment changes, changes to your coverages, and potential changes to your network in rare circumstances.

This is designed to give you as much information possible so you can make an informed decision during annual election period should the changes in your existing plan no longer meet your needs or expectations.

I hope this helps