Mary Green, Medicare Insurance Broker

Answer: Medicare brokers should never charge a consultation fee. The reason is that they are compensated by insurance companies if you choose one of the products the broker represents. They should always be upfront about this, it's an ethics violation if they charge you.

Answer: There are several different programs available to Medicare beneficiaries who need assistance with medication costs. One of the programs is called Extra Help, and offers income-based relief in the form of a subsidy. You can apply for this subsidy through your local Social Security office.

Another program is called a Patient Assistance Program, and is also income-based. These programs are available by applying through the pharmaceutical company producing the high priced medication. Just call the customer service number of the pharmaceutical company, or ask your physician to apply for you.

Medicare drug plans offer a payment plan option that allow you to spread your drugs costs over a 12 month payment plan to make it easier on people who might have to meet a large deductible at the beginning of the year..

Answer: Medicare will cover any medically necessary post-surgery recovery needs. Such items as rehab stays, home health assistance, physical therapy, medical equipment needs and follow-up care is all covered as needed.

Answer: You may fit the criteria for having some of those costs covered under a Medicare program for lower income beneficiaries. The name of the program is Medicare Savings Program. You can apply at your local Medicaid office. Medicare Savings Program may subsidize your part B premium and potentially deductibles and coinsurance costs. It looks to me like you could qualify for some or all of those savings.

Answer: If you mean, "Does my Part D plan cover the medication?", check the formulary. If you don't have access to the formulary, call your plan. The number is on the back of your drug card. Original Medicare only covers certain medications that are administered in a healthcare facility. Your doctor should also know if Medicare covers it. If you have checked these resources and still don't know, call Medicare. They will tell you.

Answer: Medicare supplement plan G covers approximately 100% of costs after meeting the annual Part B deductible of $286 at a higher premium than supplement N. Supplement N has a lower monthly premium but charges out of pocket costs that include a copay at the doctor and the ER visits as well as not covering excess fees or the annual Part B deductible. Be sure you compare the potential costs against the potential savings before you decide.

Answer: No, you don't need to prove your coverage is under a group plan. If you stay on his insurance past 65 and then go on Medicare A and B, you will need a Form CMS L564 showing that you had a group health plan. That will prevent any late enrollment penalties from being charged on your Part B premium.

Answer: Medicare Advantage plans have surgical benefits for medically necessary surgery. You should be able to look at your plan benefits and find what the co-pay will be for a covered surgery. It should give you either a flat fee co-pay or a % of total cost co-pay. If you are not sure by looking through your summary of benefits, you can call your plan's customer service number and they can tell you.

Answer: Work with your doctor from the beginning since Medicare will need your health care provider to submit a letter stating that motorized equipment is medically necessary and that other walking aids are insufficient (canes, walkers, etc). You may need to enlarge some doorways in your house to accommodate the size of the equipment, and the equipment provider must work with Medicare for billing purposes. Depending on everything being handled properly, you may have to pay the 20% co-pay for the chair.

Answer: "Zero premium" gets your attention, doesn't it? It makes people think, "How can insurance be free?". I explain to my new clients that it just means"zero additional premium out of your pocket ". You are already paying the premium, it's the Medicare Part B that is charged to your social security benefit. Medicare pays that Part B premium to the Advantage plan company, and it covers the insurance plan benefits they are offering.

Answer: That agent was breaking CMS rules by calling you without your permission and talking about a Part C benefit that could potentially be available to you if you qualify. If anyone calls you without your permission and talks about benefits available with a Part C plan, you should find out who they are, what company they are with, and report them to Medicare.

Answer: Patients using their Medicare for legitimate healthcare reasons can be affected by Medicare fraud in various ways. If your Medicare account is billed for benefits you never received, and it's a benefit that Medicare only approves a certain number of times, you might at some point want or need that specific benefit and Medicare could deny coverage because in their record you've already reached your limit. A doctor could prescribe the wrong medication if your medical records show fraudulent tests with accompanying false diagnoses. Fraudulent costs to the Medicare program makes it more costly to maintain than it actually is, and threatens future Medicare viability as a needed program for the beneficiaries who qualify.

Answer: Medicare plans can include co-pays, co-insurance, and deductibles that beneficiaries are charged depending on the covered service. MOOP is the dollar amount "cap" that a plan puts into place which guarantees that a beneficiary's out-of-pocket medical expenses will not exceed that dollar amount. After the MOOP cap is reached, the plan will cover any additional care at 100%.

Answer: If a Dr creates a care plan for a Medicare beneficiary after a surgery or a serious illness, Medicare will pay for in-home care such as wound dressing, assistance with daily functions, medications and the like. Nothing full-time, but home health nurses are compensated through Medicare to assist recovery in certain critical situations.

Answer: In my opinion, the biggest mistake seniors make with their Rx plan is not changing it once they enroll. AEP has an important function for Medicare beneficiaries, and that open window ensures that when the drug and advantage plans change (as they do annually) they are not stuck in a plan that no longer works for them.

Answer: Each company she considers for her upcoming plan change should have a search tool on their website for locating network practitioners so she can check on that before making her decision. If she isn't tech savvy, you might need to help her with that. You can also call the company and ask them to help with that.

Answer: The most important thing to know is who is administering your Medicare benefits. If you have original Medicare, the government is administering your healthcare. If you're enrolled in a Medicare Advantage plan, a private insurance company is administering your Medicare benefits. They have to offer at least the same benefits as original Medicare and follow Medicare rules and regulations, but they may have some of their own rules and some of their own benefits as well. Look those plans over carefully before you choose.

Answer: In my experience, there are many who don't realize that approaching 65th birthday means they need to take certain steps with regard to their Medicare insurance. Without the pertinent information or knowledge of the rules of the system, they can miss a critical election period and end up paying some permanent consequences.

Answer: As you've probably heard, nothing is free. The plans that advertise zero premium can be misleading, but you will notice in the small print or hear in the disclaimer that you must keep paying your Part B premium. Heads up, there's your answer. Medicare pays your Part B premium to the plan, ergo your Part B premium becomes the plan premium. Zero premium simply means you don't have to pay any additional premium to the plan over and above your Part B premium.

Answer: My Go To strategy when helping someone choose between Medigap and Medicare Advantage is to sit down with my client and crunch the numbers. That helps determine which option will make the most financial sense given their average utilization of healthcare. Which option will most likely offer them everything they want in terms of benefits at the lowest cost.

Answer: The key term or concept to keep in mind when it comes to medical procedures your plan will approve and pay for is "medically necessary". If the lens you need offers benefits superior to those provided by the basic monofocal lens, it's most likely it is considered an unnecessary premium product and will not be covered.

Answer: Some PPO plans might be structured differently when it comes to expensive procedures or out-of-network providers. Check your plans rules to see if they are asking for a referral or is it just a pre-authorization. Also, some specialists require referrals before they will see a new patient.

Answer: One of the reasons some MD's refuse to accept Medicare is because some payment estimates for procedures are based on old data which can result in underpayments. The complaint is that the current system of provider reimbursement doesn't keep up with inflation. This problem can cause seniors to be forced to leave a trusted healthcare provider who is familiar with them and find a new, unfamiliar and unknown, physician.