Martha Lopez-Elkind, Medicare Insurance Agent

Answer: The short answer to this question is: It Depends.

There are many changing parts with plans being added and in some cases taken away by insurance carriers.

Make sure you are speaking with a local, knowledgeable, professional agent who specializes in all things Medicare. This is a complicated, ever changing area of the health care industry that merits to be looked for what it is.

I recommend that you take your time and find an agent who will listen, answers your questions in a timely manner, and guides you in the right direction. That is the difference between a good agent and a great agent who at the end of the day, might save you more than just money.

Answer: Happy Early Birthday! You get to join the almost 70 million people already enrolled in Medicare.

Medicare is our country's health insurance program for people age 65 or older. You may also qualify if you have permanent kidney failure or receive Disability benefits.

For starters, make sure that you're enrolled in Part A (Hospital Insurance) and Part B (Medical Insurance) through Social Security. Medicare.gov is a great source of information regarding Medicare.

Keep in mind, you have a 7 month window to sign up, 3 months before your birthday month, on your birthday month and 3 months afterward. After this window closes, and if you don't have creditable coverage you might face penalties.

Make sure to speak with a local, knowledgeable, professional Medicare agent who specializes in Medicare plans, as this can be a complicated area of the ever changing health insurance world.

Answer: Typically, Medicare Advantage plans offer health plans with zero premium, low or no deductible and low or at least manageable maximum out of pocket (MOOP) expenses. In addition, these plans cover you prescriptions (PDP) PartD, as well as other benefits (State by State basis), such as dental, vision,etc.

Compare that to Medicare Supplement (Medigap) where you would normally have to pay a monthly premium with discounts to dental, vision and drug plans with the option to go anywhere Medicare is accepted, you get to decide what option is best for your needs.

Answer: Getting a health insurance plan with a low premium, usually means you will have more out-of-pocket expenses. (think pay now or pay later). If you don't go to the doctor's often it might be adventitious for you to enroll on a low premium plan but if you have medical conditions or simply know that you'll need to see your primary care and/or specialists on a regular basis, then a plan that offers a higher premium with a lower deductible and lower overall out-of-pocket might be the better alternative.

Answer: Normally, it's better to work with a local agent, who is fully versed in your market. That being said, if you prefer to work with someone you know who lives in another state, the first question you might want to ask is he/she licensed in your state? How knowledgeable are they in your state's plans? And last but not least, how many insurance companies are they appointed with?

Answer: Due to recent congressional actions, Medicare cuts are a valid and serious concern particularly for those with low incomes, individuals in Medicare Advantage plans, and certain healthcare providers. Reduced benefits and fewer plan choices: Many MA plans have responded to funding cuts by reducing extra benefits, such as vision and dental, and by increasing cost-sharing and deductibles. Some insurers are trimming or exiting unprofitable markets. Steps you can take: Stay informed during Open Enrollment (October 15 to December7) to understand changes to your specific plan for the upcoming year. Review your plan. Compare all available options in your area. Explore financial assistance: If you have limited income, re-examine your eligibility for Medicare Savings Programs and Part D subsidies.

Answer: It depends. You can be denied a Medicare Supplement (Medigap) plan if you apply outside of a guaranteed issue period- this is a 6-month window that starts the first month you have Medicare Part B and are 65 or older. You can also be denied if you have certain pre-existing conditions, such as cancer, heart disease, or diabetes. Generally, your guaranteed acceptance rights are generally limited to your 6-month Medigap Open Enrollment and specific circumstances where federal or state law provides those protections.

Answer: I love the fact that I can help seniors navigate the very complicated world of Medicare. I also enjoy becoming a friend that they can trust and rely upon. I put my clients needs and wishes first because I put myself in their shoes and my goal is to be of service to them.

Answer: The elimination of the donut hole is a positive change that reduces or simplifies costs by capping your annual out-of-pocket drug costs at $2,000, after which you will pay nothing for your covered medications for the rest of the year. You'll also have the option to pay your out-of-pocket costs in monthly installments, spreading the cost over the year instead of paying in full at the pharmacy. Also, there is an enhancement to the low-income subsidy (LIS) program, extending more benefits to more individuals.

Answer: I'm passionate about educating clients who are new to Medicare, because they appreciate learning about Medicare, Medicare Parts and the benefits that they're entitled to. I can also speak about what's new in the Medicare world, such as new plans, new policies and procedures as well as bringing the "human touch" and answer all of their questions.

Answer: There are several ways that you can go about ensuring that your medications will be covered affordably. By taking advantage of a new Medicare tool known as the Medicare Plan Finder Tool during open enrollment to compare costs for plans in your area. Another option is working with your doctor to understand and address plan requirements like step therapy or prior authorization for certain drugs. Also, consider enrolling in the Extra Help program if you have limited income and assets.

Answer: Medicare Advantage also known as Part C, can be a great option because it provides with Medicare-approved plans from a private company that offers an alternative to Original Medicare and Medigap. Medicare Advantage must cover all services covered by traditional Medicare Parts A (Hospital Insurance), and Part B (Medical Insurance) and typically offer extra benefits such as prescription coverage as well as vision and dental coverage.

Answer: Medicare is a federal health insurance program in the U.S. primarily for people age 65 or older but it also covers younger individuals with certain disabilities such as those with End-Stage Renal Disease (ESRD) or ALS, and people with renal failure. Medicare has four parts: Part A(Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage), and Part D (Prescription Drug Coverage).

Answer: When ordered by a doctor and provided by a certified agency, Medicare covers skilled home health services like nursing, physical, occupational, and speech therapy, plus medical social services, supplies, and durable medical equipment(DME). As well as personal care that's needed to maintain your health if you need skilled nursing or therapy services. Not covered services, are: Live-in caregivers or 24/7 care, homemaker services, custodial care which is personal care that helps with daily living activities, such as bathing or dressing, if it's the only care you require.

Answer: If you are retiring and haven't signed up for Medicare beyond 65, it's important to contact your local Social Security office to enroll in both Parts A and B and provide the CMS-L564 form from your employer as proof of creditable coverage to avoid a late enrollment penalty. This will create a Special Enrollment Period(SEP) that begins when your employer coverage ends.

Answer: Medicare Advantage(Part C) plans may offer more extensive coverage for holistic services like acupuncture or fitness programs, though these benefits may vary by plan and requires providers to be medically accepted or licensed as well as be in-network providers. Advantage plans commonly include vision, hearing, dental, and wellness benefits, benefits which are not covered by original Medicare.

Answer: Medicare can cover long-term treatment for a specific chronic condition. It will require your medical provider to provide medical notes and sufficient tests and exams to justify the ongoing treatment.

Answer: X-rays, exams, or therapies can be ordered by medical providers who are working with Medicare meaning, they are Medicare providers who work under Medicare and get paid by Medicare.

Answer: Why should you work with a Medicare agent? Because I'm going to have your best interest at heart! I'm going to explain and provide you with all the information and answer all of your questions. Also in most cases, I can assist resolve your issues without having to waste your time calling the insurance company!