Mary Salmon, Medicare Insurance Broker

Answer: AI can possible streamline claims process by automatically reviewing the claim information and verifying benefits. This could cut down on the time it takes to process a claim. It can also help in fraud prevention by verifying the services billed match the patient’s medical condition and available treatment options.

Answer: Medicare can be very overwhelming. It’s a lot of information. I suggest you reach out to a certified licensed Medicare agent to help simplify the process and help guide you on the options that most suit your needs.

Answer: Medicare covers cataract surgery, including the removal of the cataract and basic lenses. However, special lenses are considered elective and not covered by Medicare.

Answer: If you are still working for an employer with at least 20 employees and have employer group health insurance, you can postpone part B. I recommend that you get part a while still employed and then enroll in part B when you retire. It is important to speak with a Medicare specialist to determine if your employer group coverage is considered creditable.

Answer: It is best to use a Medicare plan finder such as on the medicare.gov website. These tools can help you compare plans based on your particular prescription drugs so you can shop based on co-pay costs. You can also visit with a licensed Medicare agent to help with the process.

Answer: Medicare plans are based on location, specifically ZIP Codes. Not all plans are available in all ZIP Codes. So when you move from one county to another county or one state to another state, it is very important that you speak with a licensed agent to find a plan in your new ZIP Code.

Answer: Once a person is past their Medicare open enrollment for a Medicare supplement, guaranteed issue is no longer available. The only exception to this is if they were enrolled in an Advantage plan and the carrier pulled the plan from the market. At that point the beneficiary has a guaranteed issue to go back to Original Medicare and enroll in a supplement.

If a beneficiary decides to enroll in an Advantage plan, those plans are guaranteed issue during Annual Enrollment Period Oct 15-Dec 7 each year for a January 1 effective date.

Answer: The most common enrollment period is Annual Enrollment Period which runs from Oct 15-Dec 7 every year. This is when Medicare beneficiaries can review their Medicare Advantage plans and make changes for the upcoming calendar year. The second enrollment period is called Open Enrollment Period which runs Jan 1-Mar 31 every year and is when beneficiaries with a Medicare Advantage plan can switch to another Medicare Advantage plan or return to Original Medicare.

Answer: Yes, the costs for Medicare increase every year. As more and more people get older and age into Medicare, healthcare costs also increase. It is a valid concern that Medicare costs are growing at an unsustainable rate.

Answer: Medicare covers medically necessary and approved treatments. ACA requires that health insurance cover routine patient care costs for people who are in approved clinical trials. However, Medicare does not cover experimental treatments that are not part of the clinical trial. So there could be gaps in your Medicare coverage. Having a supplemental cancer policy is helpful in this situation.

Answer: It is extremely important to do an annual review of your prescription drug plan with a reputable licensed agent. The agent should be asking for an updated list of all medications and your preferred pharmacy. By checking your medications against the available plans in your area and their formularies, you can choose a plan that best fits your needs and keeps the prescription drug costs to a minimum.

Answer: Original Medicare has deductibles and co-insurance that is required to be paid by the beneficiary. Medicare pays 80% of approved charges after the deductibles, leaving the beneficiary with the remaining 20% to be paid out of pocket. The benefit to having a medigap plan (Medicare Supplement) is to pay the Part A deductibles and coinsurance as well as the Part B coinsurance on your behalf.

Answer: If you see a suspicious Medicare billing error, you should start first with the doctor or clinic to verify the charges. If necessary, you can call 1-800-MEDICARE to report it. It is important to identify fraud and abuse within Medicare.

Answer: Medicare covers many different cancer screenings. Depending on the type of cancer screening, it may cover an annual screening or it could be every 2-5 years depending on age and type of screening. You should talk to you doctor about cancer screening and what they recommend.

Answer: IRMAA is the income-related monthly adjustment amount -- this is an additional fee beneficiaries must pay for Part B and Part D depending on their modified adjusted gross income from the income tax return two years prior. Charitable donations can reduce your adjusted gross income. Also think about contributing money to a tax deductible retirement account. For people with vacation homes or property, selling that property will definitely effect your income for that year so it is important to consider whether to sell the property or keep it.

Answer: Medicare does cover asthma and other breathing conditions like COPD. Medicare Part B covers durable medical equipment such as nebulizers and CPAP machines. It is important to note that Original Medicare has deductibles and coinsurance that will apply. Having a medigap plan will help with the out of pocket expenses not covered by Original Medicare. Part D is prescription drug coverage and it will cover medications needed for treating asthma and other breathing conditions.

Answer: A Medicare Advantage plan requires Medicare beneficiaries to pay copays for many services including in-patient hospitalization. A hospital indemnity plan can provide financial assistance by paying you a specified amount for each day you are admitted to the hospital, up to the maximum benefit period you have chosen when selecting your hospital plan.

Answer: Because Medicare Supplements (medigap plans) are standardized, you can keep your same policy when moving from one state to another. However, rates vary from state to state so it is advisable to check the rates to see if your rate is changing. The first thing you need to do is update your address with your carrier. Then check the rates to see if you need to shop your plan based on the new rates.

Answer: The biggest disadvantage to Medicare Advantage plans are the copays, coinsurance and networks. While most Advantage plans are low or no premium, the out of pocket expenses can really add up. A lengthy hospital stay with a surgery can cause a major financial hardship for Medicare beneficiaries.

Answer: Telehealth for mental health is covered by Part B where beneficiaries pay 20% of the Medicare-approved amount. This includes virtual visits with licensed mental health professionals. Those on Medicare Advantage plans may have access to mental health apps but these extra benefits vary from plan to plan and by location.

Answer: If you have Original Medicare with a medigap plan, you do not need to make any changes to your coverage. However, Medicare Advantage plans are region-specific so if you move from state to state or to a US territory, you will need to change plans to find a plan available in your new area.