Michael Pyers, Medicare Insurance Broker

Answer: None- We are always a phone call away. We have regular business hours and over 20 years of experience in the Health Insurance industry. We interview you to determine what type of insurance you plan is in your best interest.

Answer: They are not free. You have to pay copays for just about everything and sometimes have a very large out of pocket! So, if you never get sick, they might be a money saver - God forbid if you develop a major illness!

Answer: Working with people who are similar age to me and hold the same values. They are smart enough to figure out that they are working with someone who has the same values. You don't have to tell them you are honest- just let your light shine and they are smart enough to figure that out for themselves!

Answer: Depends, If, you work for an employer that has more than 20 employees and coverage as good as Medicare. That would be considered Creditable coverage, and you could hold off until that coverage ends. However, if you have 40 quarters of paying into Medicare, it would be wise to go ahead and sign up for part A since there would be no premium.

Answer: Yes. As long as you had creditable coverage that ended. You have 60 days to elect Medicare. At which time you could enroll in an Advantage Plan, Medigap plan and Part D Plan.

Answer: They can delay enrollment in Medicare A and B as long as they are working for a group of 20 or more people and the employer coverage is a good as Medicare. However, we always recommend that they go ahead and enroll in Part A.

Answer: That they feel that Medicare is tied to Social Security and that they cannot enroll in just Medicare. They feel that if you have Medicare then you have to collect Social Security also.

Answer: By passing they face amount to your spouse, children, etc. tax free.

Financial Security, the ability to borrow money on the policy.

Answer: Medicare covers medical procedures for your eyes. However, Medicare does not cover routine eye exams. Usually in this area $40-50

Answer: No network on Medicare you can see any healthcare provider as long as they accept Medicare. With an Advantage Plan you have a network of doctors. If you have an HMO, you can only see the Doctors on the Plan or you pay then entire bill.

Answer: Plan G is the top of the heap for current enrollments. However, you can save $ by choosing a plan N.

Answer: Careful planning to make sure that the Medicare Recipient has the best fit for their needs.

We have software that shows carriers current rates, history of rate increases, Planned rate increases and the Carriers Medical Loss Ratio, which could signal a coming rate increase.

Financial rating of carriers are only a part of the equation have seen Carriers that are rated A with a negative outlook. Watch out!

Answer: Some Plans offer Foreign travel. You have a $250 Deductible and then it pays 80 percent until the maximum of $50,000

Answer: You have to answer health questions if you move from one Medigap plan to another. However, you can switch any month of the year as long as you meet the health requirements.

Answer: Then you will automatically be signed up for Medicare. Your Social Security check with have the part B premium withheld from the check you are receiving. Unless you qualify for the extra help available for people with lower incomes and assets.

Answer: Check it over to make the charges are for services you received. The notice will also show if you owe anything. Such as your part B deductible no being met yet.

Answer: Tied to a Specific network of Physicians and Facilities. Must get approval from the plan for some procedures. Such as an MRI.

Answer: Signing up for an advantage plan and then becoming ILL. The out of pocket costs are sometimes staggering. In fact we have had clients call the Disadvantage Plans!

Answer: Limited Physician and Hospital Network. Some Plans might not have the same benefits due to the reimbursement the plans get from CMS. So, benefits not as good as larger metro areas.

Answer: Agents normally only contract and represent only one carrier.

Brokers handle more plans and give you more options.

Using the Medicare Name is not permitted, especially if you represent yourself as being a representative of Medicare.

Answer: 3 months before your 65th birthday. And up to 3 months after. You may delay enrollment if you have a job that gives you creditable coverage if you want to delay signing up for Medicare. Normally if you are receiving Social Security you will be signed up automatically.

Answer: You can file an appeal with the plan. If all else fails, you can contact the Dept of Insurance in your area. Also, you can report the plan to CMS Quality Improvement Organization at 888-524-9900.

Answer: For one thing, making unsolicited calls to a Medicare recipient is against the law. Per CMS regulations. And Ohio revised code 3901-8-09.

Answer: The doughnut hole was eliminated in 2005 by the Inflation Reduction Act. The maxumum out of poket is now $2000. After you reach the $2000 limit your covered Medication will be a zero cost share. Also, you can request to make monthly payments on the $2000.

Answer: It is covered by part A Medicare. Patients must have life expectancy of 6 months or less. It is for palliative care only. Not for clinical care to cure.

Answer: It is determined by medical necessity that the patient requires. However, after around $2400 of therapy the physician must submit proof that continued therapy is necessary.

Answer: Actually, a Medigap plan might have been a better fit for you. Once you have met your Part B deductible, you would be done paying for Medicare Approved services. However, now if you have certain pre-existing conditions, you may not be able to sign up for a Medigap plan.

Answer: There is no maximum out of pocket for straight Medicare. You would have to pay for a Medigap Plan, but it seems like pay me now or pay me later.

Answer: Not that simple. So many things to consider, network, co-pays, maximum out of pocket. If it seems to good to be true, it probably is.

Answer: They usually have limited networks. However, some are PPO and you can see any Dentist and pay a little more.

Answer: Normally, if you are drawing Social Security then you are automatically signed up for Medicare.

Seems funny, if you are on Social Security, then after 24 months on Social Security Disabilty you should already be signed up for Medicare. You will, have a limited period of time to sign up for different Medicare plans and have guaranteed issue.

Answer: They need to make sure that the Medicine is on the formulary of a plan before enrolling.

They also need to check for overall cost per Medicare.gov. They need to make sure that the pharmacy they use is covered and other options for Pharmacies are in the preferred network for the lowest cost for Meds.

Answer: Should eliminate confusing, deceptive ads. Plans should present the true facts including the fact that you may have a huge out of pocket.

Answer: Sound like you have 2 different types of plans. However, Medicare advantage plans for the most part, but not all have a $0 premium and a large out of pocket maximum. Plans vary by area usually counties and basically base the plans on the amount of $ they received from CMS for that area (SMS capitation rate)

Answer: Plans have a Formulary of covered Medications. All plans have to cover several Medications for each therapeutic class but not necessarily the Medication's you take. Make you check the formulary of the plan you intend to enroll in before making that decision!

Answer: Varies by Employer, please contact you spouses HR department at his work. You may need to get a new plan, but you will have a limited time to sign up for a new plan!

Answer: We have quite a few people who have had advantage plans and have become ILL. The copays, coinsurance, large out of pocket expense have caused these people to rename them to Disadvantage Plans. Agents really like to sell Advantage Plans, as the compensation is quite a bit more that of Medigap plans.

Answer: Social Security and Medicare are 2 different programs. You have a limited time - 3 months before and 3 months after you become eligible at 65. However, if you have creditable coverage that is as good as Medicare at your employer (over 20 employees) you may delay enrolling in Medicare until a later date. You will have a limited window to apply then.

Answer: Medicare Part B Coinsurance is 20% of the Medicare approved amount and there is no maximum out of pocket. Medicare does not cover certain procedures i.e. cosmetic surgery, routine dental, routine vision, or hearing aids.

Answer: There are very strict rules about unsolicited contact with a Medicare Beneficiary. The problem is lack of enforcement. If you get one of those calls, tell them it sounds good, but why would want to deal with a criminal? The centers for Medicare and Medicaid (CMS) does not police these plans,but rather allows the MAPD plans to police themselves. Kind of like the fox guarding the Chicken Coop!

Answer: Because of extra work involved with referrals, pre-certifications, and the fact that most HMO's don't pay enough for the extra work. You can tell if your doctor has only HMO's, his office address is lot 13 Oak Grove Trailer Park.

Answer: The main reason is that the Compensation is higher on Medicare Advantage than on Medigap Plans. That is not a reason that is conducive to proper customer service, but rather greed!