Mike Cooper, Medicare Insurance Broker

Answer: Please allow me to first explain the difference between an HMO and a PPO. An HMO gives you benefits in-network ONLY. If you choose to go out-of-network, there's no benefits there... so you'll pay full price.

A PPO gives you in-network benefits... and, it will allow you to go out-of-network. There's just typically a higher cost for the out-of-network options.

Generally speaking, the benefits in an HMO tend to be better. Why? Consider this... the insurance company controls ALL of the costs in an HMO. The doctors and hospitals have already contractually agreed to the carrier's/insurance company's reduced pricing/negotiated rate.

In a PPO, the insurance company does NOT control the out-of-network pricing, so they will (again, generally speaking) protect themselves by reducing the benefits available in their PPO policies vs the HMO.

The downside of an HMO? You might be required to get a referral in order to see a specialist. Sounds like a pain in the butt... and often it is. Why is this often a requirement?? Welp... if you self-diagnose yourself with brain tumor (God-Forbid) and your diagnosis is inaccurate, that high-paid neurologist is going to be a little upset if you were wrong. They don't make money of the office visits, they make $$ on surgeries. For this reason, they prefer a medical doctor check you first.

In Summary:

Talk to a qualified agent. A good agent can help guide you through the benefits that make the most sense based on your needs and your budget. If they can find a strong network of doctors and hospitals... and you're somewhat flexible with your chosen doctors, we can help simplify your decision making process!

Blessings-

Mike Cooper

Answer: Define "Cheapest"... Lowest monthly cost is always going to be a Medicare Advantage Plan (typically $0 per month). Some carriers can even pay a portion of the Part B premium (further reducing the $206.50 - typically coming out of your SSI check).

Cheapest can get pricing if something big happens (God Forbid). With your financial exposure ranging from $3000 to $5000 to $10,000 depending on your Max Out-Of-Pocket. So..."Cheapest" is pretty subjective. Let's schedule a call together and we can work together to determine the Best Strategy for you (based off your needs and your budget)!

Blessings-

Mike Cooper

Answer: The human brain only has so much space in it for insurance/Medicare talk... As an Agent, I have to prioritize both the relevance of info and the way it's shared. It's a bit like threading a needle. All of that said... it is REALLY important to me that you understand your options and how to use them. Myself and my Assistant are always here for you... if you have questions down the road.

We're here to serve you... based on your needs and your budget.

Answer: As an Agent, I try to remain neutral as to my own preferences between Original Medicare and Medicare Advantage. That said, there are some critical details which really need to be shared.

Network:

Original Medicare has Medicare's largest network... comprising around 98% of doctors and hospitals in the nation. Some of the Top Tier providers, like Mayo, John C Hopkins, Scripts... and a growing number of others do NOT accept Medicare Advantage plans.

Approval:

For some time now, Medicare Advantage plans have been developing a reputation (a bit behind the scenes) for NOT approving procedures and surgeries. Your doctor submits an approval request... and a large number of those requests are being denied ("In 2023, insurers fully or partially denied 3.2 million prior authorization requests...").

A friend's (and fellow agent's) mom started into Medicare with an Advantage plan. Her doctor's requests for an MRI were declined twice! Her Agent/son was still able to move her over to an Original Medicare plan... and $100's of thousands of dollars later, (PRAISE God!!) she is now cancer FREE! Her portion? Less than $250.

As an Agent, your Choice is your Own... AND... you need to know the Playing Field.

Some Agents are extremely biased in how they steer their clients. I know of Agents that have 95% of their clients in Original Medicare... while other Agents have 95% Medicare Advantage plans. Make sure your Agent's bias is your Preference... NOT theirs.

Blessings-

Mike

Answer: Insurance/Medicare can be a stressful thing to deal with... AND... this is NOT an "Ostrich + Head In Sand" moment.

Plan benefits are shifting around every year... and this year, more than usual.

Now... if you're like most folks, the effort required in "Learning everything you need to know..." is WAY more than you desire to invest.

Solution? Easy!

Find an Independent Broker... who has more than 5 Carrier/Insurance Company options to choose from... and if your Gut APPROVES of them... let them know what benefits are most Important to you (Part B Give Back, Dental/Vision/Hearing/Doctor Network, etc.)... and let THEM do the work for you.

In Summary:

A Good Agent is there to Help you... NOT Sell you a policy. And their services cost you $0*.

*If they're charging you a fee for their services.... RUN!

Answer: Certain Medicare plans do offer international travel benefits... though I don't recommend you put your eggs in that basket. Travel insurance is reasonably priced... and the coverage is often more comprehensive.

Answer: Did you know? Prescription formularies (i.e., the list of medications your plan does/does not cover) can change year over year? What's covered this year... might not be covered next year. If it is covered, the price you're used to paying... could change.

It's always best to have your agent verify your latest list of prescriptions during the Annual Enrollment Period (AEP). This takes place 10/1 - 12/7 each year.

NOTE: A growing trend with carriers is refusing to pay agents commissions on Prescription Drug Plans (PDPs)... That said, make sure your agent cares more about your best interests than the commissions.

Answer: Absolutely! Your agent can help confirm that your doctors are still in-network... your prescriptions are still in-formulary.

If you've been happy with the plan and all of those things are still in-network/formulary... they can help clarify the plan changes and then help you determine if that is STILL the best policy for the incoming year.

Blessings-

Mike Cooper

Answer: Let's face it, insurance is confusing! Adding the federal government into the mix does NOT simplify things. Folks are often experiencing resistance to change, and when you lack confidence in where to even start... you can get mentally stuck.

A good agent aligns themself with YOUR best interests. Unless you're trying to become an agent (being playful), the "do it yourself" approach is going to be daunting for most. A knowledgeable agent will share the important stuff... while saving your brain from an overdose of the irrelevant/less relevant stuff.

When picking an agent, simply trust your Gut (not your heart, head, or feelings). Your Gut will NEVER lead you wrong!

Blessings-

Mike Cooper

Answer: As long as your prescriptions are within the plans Formulary (list of covered medications), you will not pay more than $2000 for those prescriptions in 2025 ($2100 in 2026). That's a sizable decrease from $8000 in 2024.

IMPORTANT:

If you have a Medicare Advantage plan, that $2000 "catastrophic" prescription cap is completely separate from your medical max-out-of-pocket (MOOP). That might be uniquely different from what you're used to with the insurance you had prior to Medicare.

Answer: It is literally a full-time job to keep up with all the various changes happening within Medicare. Then you have the carrier side, and understanding their strengths and weaknesses. That's just the tip of the iceberg for the insurance side.

Now, let's shift to your side of things. You have your own unique needs and wants. Whether it's finding the best care available or the least expensive option, your needs and budget are important to you.

Finally... the agent side of things. Ever experienced a pushy salesperson? It's one thing to wrestle a salesman when you know the playing field... but when you don't?!? Take your time. Find an agent that puts your interests ABOVE their own. It doesn't cost you a thing to have an expert on your side!

Answer: Be An Advocate...

Children of Medicare aged parents might consider researching the agent they themselves can relate to most. A good agent will patiently simplify how Medicare works... with you (the adult child) FIRST. Once you understand how Medicare works, you can assist your parent(s) in understanding which options best fit their needs and their budget. Your confidence increases their confidence. You can become a unified team! Pick your agent wisely... and your Team will Thrive Together!