Michael Crocker, Medicare Insurance Broker
Michael Crocker
Michael E Crocker
Medicare Broker Licensed in SC
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Location
Simpsonville, SC
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Phone
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About Me
Michael is a Medicare Insurance specialist who has lived in the upstate of South Carolina for 38 years. He is a graduate of the University of Southern Mississippi with a B.S. in Industrial Engineering Technology. In addition to insurance sales, he is the director of the NewStart Church/Bread of Life Food Pantry and is an active volunteer in working with the homeless and hungry of Greenville County. He and his wife wife Amanda have made the Greenville metro area their home since 2006, and he is the proud father of two sons, Zachary and Avery. He looks forward to assisting you will all of your insurance needs.
Q&A with Michael Crocker
What is the biggest mistake seniors make when enrolling in Medicare?
Answer: Not utilizing a trained, licensed, and certified local professional to explain their options and make sure that whichever plan they choose covers their drugs and doctors. A mistake in one of these areas can cost a senior thousands in unnecessary bills. Since plans vary so much by location, only a local agent familiar with local plans and networks can properly advise seniors in their unique circumstances.
Can you describe a time when you helped a client navigate a complex Medicare issue?
Answer: I once met an individual who had paid thousands of dollars over the years due to a late enrollment penalty. I assisted him with filing an appeal and we were able to get his penalty completely removed.
Which Medicare Supplement plan (Medigap) offers the best value for most seniors, and why?
Answer: The answer to this question depends on a number of factors, including the senior's age, location, and risk tolerance. These factors are important because some carriers specialize in providing value to seniors who are turning 65, while others tend to focus on seniors who are older. In addition, the competitiveness of a carrier (with regards to monthly premium) often depends on the zip code of the applicant. Finally, some carriers offer a stronger Plan N or innovative Plan G, while others tend to focus on Plan G.
How do discount cards and resources affect my Medicare Prescription Drug plan?
Answer: Discount cards can be helpful in certain situations. Just be aware that any prescription purchases on discount programs do NOT count against your annual maximum out-of-pocket limit, so if you are trying to get to the limit as soon as possible so that your drug costs fall to zero, you may want to avoid discount cards.
My plan covered my cataract surgery but not the lenses I actually needed-how do they get away with that?
Answer: Medicare typically covers the cost of the surgery itself, including the removal of the clouded lens and implantation of a a basic intraocular lens (IOL) only. If you or your doctor believes that a specialty lens is a medical necessity, you may file an appeal with Medicare (if you have original Medicare) or your Medicare Advantage plan (if you are on an MAPD).
Why might Original Medicare with a Part D plan be better than a Medicare Advantage plan for frequent travelers?
Answer: Medicare Advantage plans utilize networks to help keep costs down, while Original Medicare is taken by any provider that accepts Medicare. However, emergency room and urgent care visits are generally covered anywhere in the US on Medicare Advantage plans. Also, many large Medicare Advantage plans now have nationwide PPO networks, so that even for routine, non-emergent or non-urgent care, a member only needs to call his/her customer service number to find a local in-network provider when out of town.
What are the most overhyped benefits of Medicare Advantage plans that seniors should be wary of?
Answer: The most "overhyped" benefits of Medicare Advantage plans are those "benefits" that don't exist at all, at least not for most people. One common example is a "grocery card." It's an old bait and switch ploy that has been used by disreputable telemarketers for years: Call an unsuspecting senior and ask him/her if they would like more information on getting on a plan that gives them hundreds of dollars for groceries each month. The problem is these benefits are usually available only to Medicare recipients who have a low enough income to qualify for full Medicaid benefits. That rules out the vast majority of seniors, but the telemarketer now has the senior on the phone and can apply pressure to move them to a new plan anyway, without doing a proper needs analysis.
I'm in the donut hole and can't afford my medications. What are my options right now before the 2025 changes?
Answer: This appears to be an old question...there's no donut hole in 2025, and COVERED prescription drugs are capped at $2000. The "covered" part of the statement is important, because plans are not required to cover all drugs, and if you enroll in a plan that does not cover all of your drugs it is possible to exceed the $2000 limit, maybe even by a large amount (depending on the cost of your non-covered drugs).
I thought I was covered during my snowbird months in Florida, but apparently not. What kind of plan do I actually need for that?
Answer: It sounds like you are on a Medicare Advantage plan with a very limited network. Medicare supplements (unlike Medicare Advantage plans) don't have networks, so that's an option if you are able to pass underwriting or have a guaranteed issue opportunity. Another option is a to see if there is a Medicare Advantage plan in your area with a nationwide PPO network. Several of the larger carriers offer nationwide coverage this way. A good local broker will be able to assist you in finding such a plan.
I've been dreading hitting the donut hole each year. How will its elimination in 2025 change what I pay throughout the year?
Answer: There's no donut hole in 2025; instead, there is a $2000 limit on what you can spend on covered prescription drugs. The "covered" part is extremely important; if you purchase a prescription that isn't covered by your plan, the cost of the drug doesn't apply to the $2000 limit.
If I need hospice care in the future, can my Medicare plan cover it?
Answer: Yes. Hospice care coverage is unique in that original Medicare covers hospice care, even when you are on a Medicare Advantage plan. The specific rules for hospice care coverage are located at https://www.medicare.gov/coverage/hospice-care. This link covers when you are eligible for hospice care, for how long, etc.
Can you help me understand Maximum Out-of-Pocket (MOOP) limits in Medicare plans, from your experience as an agent?
Answer: The MOOP for your Medicare Advantage plan is your "worst case scenario." It specifies the most you are personally liable for in a given calendar year, assuming you have a host of medical issues throughout the year and are paying co-pays for doctor visits, outpatient surgeries, hospital stays, cancer treatments, etc. Add all of these up and you can not be billed for more than your MOOP.
There are a few MOOP-related issues to be aware of: 1) a very small percentage (less than 2%) of Medicare recipients hit the MOOP in a given year; 2) the MOOP for your Advantage plan is for medical services only, and does not include drug costs. There is a separate $2000 drug MOOP for 2025; 3) If you are on a PPO, there will be two MOOP: one for in-network expenditures and a second, higher figure that includes both in-and-out-of-network expenditures.
I'm turning 65 next month and the amount of Medicare mail I'm getting is overwhelming. How do I sort through all this?
Answer: Ignore the mail unless it's from Social Security. Then, ask friends, family, etc. for the name of a good independent broker to help you navigate through turning 65. Treat your search for a broker like you would if you were moving into a new area and needed to find a doctor or auto mechanic. Like a doctor, a licensed broker is licensed, trained, and insured to help you. Make sure the broker is independent (not beholden to any single company) and offers both Medicare Supplements and Medicare Advantage plans so that he or she can fairly and intelligently explain the pros and cons of each.
What is the trap of Medicare Advantage plans?
Answer: I prefer to think of them as "holes" rather than "traps" because a "trap" implies that someone was deceived. I educate my clients on the potential "holes" in Medicare Advantage plans so that they are prepared for every eventuality. The first major hole is cancer treatment. A cancer diagnosis can result in months of expensive treatments and quickly eat up your maximum out of pocket (MOOP) on an MA plan. For this reason, I encourage all MA recipients to purchase an inexpensive cancer policy that will pay or help pay the out of pocket expenses of cancer treatment. The second major hole in MA plans is hospitalization; it is not unusual for MA plans to have $1k to $2K copays for multi-day hospital stays. I encourage clients to purchase inexpensive hospital indemnity plans for extra protection, just as with cancer plans.
So I heard something about Medicare drug costs being capped at $2,000 in 2025. Is that really happening or just talk?
Answer: It's happening, but with some caveats: 1) to be covered by the $2000 cap, a drug must be covered by your drug plan. Drug plans are not required to cover all drugs, so if you purchase a drug that hasn't been approved by your drug plan, the cost of that drug does not apply to the $2000 limit. 2) Any premiums you pay for your drug plan do not count toward the $2000 limit, so if you are on a plan that has a say, $100 per month premium, the $1200 you pay per year for your premium is in addition to the $2000 cap.