Michael Ryan, Medicare Insurance Broker

Answer: Work with an Advisor that can research all available plans available to you. One that will prioritize your doctors and prescription not insurance companies.

Answer: That everything is free. Not true. There are many ways to get coverage for what Medicare doesn't cover.

Answer: Typically no.. There will be some questions needed for underwriting some plans outside of the Guaranteed Issue windows.

Answer: Most are HMO plans that will restrict you to a provider network. The last several years there are PPO plans available in many areas that provide access to care outside of a network.

Answer: Quick answer is most likely. Do your research first.. Many Advantage plans have dental coverage. Coverage and benifits will vary.. I would not make dental coverage your primary focus in choosing an Advantage plan.. If one doesn't find what they need for dental care in an Advantage plan there are many stand alone plans that will.

Answer: You actually have several options. Sounds like you have a HMO Advantage plan where you live. One option would be to stay on original Medicare with a supplemental plan. That would allow you access to any provider that accepts Medicare across the country. Another option would be a PPO Medicare Advantage plan if its available in you area. Several national carriers have network providers across the nation and would also provide coverage out of network.

Answer: Great question.. It happens occasionally.. I represent all the major plans and focus on their doctors and prescriptions not the shiny objects that some plans offer. So I don't run into it very often.. When I do it usually has to do with an added benefit.. Example: I recommend a plan that fully covers all their docs and prescriptions. Say it has a $1500 dental benifits.. They see a plan with a $3000 benifits and they decide to go with that.. However that plan doesn't have the same coverage for doctors rxs. It's not that they got bad plan, they just end up making a decision based on that shiny object that reduced the real important coverages.

Answer: With Original Medicare and no supplement, you'll pay 20% of the Medicare-approved amount for a medically necessary ambulance ride after meeting your Part B deductible, which is $257 in 2025.

Answer: No, Medicare generally doesn't fully cover nursing home care, especially for long-term custodial care, but it may cover some skilled nursing facility (SNF) stays under specific conditions, like following a qualifying hospital stay.

Here's a more detailed explanation:

Medicare's Coverage:

Medicare Part A can cover skilled nursing facility (SNF) care for a limited time (up to 100 days) if you meet certain conditions, including a qualifying hospital stay of at least three days.

Custodial Care:

Medicare typically doesn't cover custodial care, which is the type of care that helps with activities of daily living (ADLs) like bathing, dressing, and eating.

Skilled Nursing Care:

Medicare may cover skilled nursing care in a nursing home, or in your home (with home health care), if you need short-term skilled care for an illness or injury and you meet certain conditions.

Medicaid:

If you need long-term care and don't qualify for Medicare, you might explore Medicaid, which can help cover long-term care costs in a nursing home.

Other Options:

Consider long-term care insurance, or explore veterans benefits if applicable. There are other options available that will assist. For the most part it entails preplanning not waiting until the services are needed.

Answer: First and foremost enroll in both Part A and B if you havent already done so.

Make a list your important doctors and prescriptions. Contact an independant agent that works with many if not all of the carriers and different types of plans ie Med Sups, Medicare Advantage, Prescription Drug plans to narrow down your options for you. While you can find most of this information independently, what you wont find is the detailed information that can make a difference in your coverage. Especially in 2025 with the significant changes in ALL of the prescription drug plans. You can start the rieview and application process as early as 3 months before needing it in place...

Focus on actual care thats needed now and will happen in the future.. One of those calls I get from time to time starts with "remember that plan we talked about, I should have listened to you instead of goin out on my own" There's no cost in working with an independant agent, there could be a significant cost in not doing so..

Answer: Work with an independant agent that has access to all the plans..

The changes in 2025 to Part D has caused every plan to review and adjust coverage. Not every plan covers every drug in their forumulary. This was the area I spent the most time on this year for my clients to help them get the coverage needed...

Answer: You can change your Medicare plan during specific enrollment periods throughout the year. Here are the key times when you can make changes:

1. **Initial Enrollment Period**: This is when you first become eligible for Medicare, typically around your 65th birthday. It lasts for seven months (three months before, the month of, and three months after your birthday).

2. **Annual Enrollment Period (AEP)**: From October 15 to December 7 each year, you can switch from Original Medicare to a Medicare Advantage plan, change from one Medicare Advantage plan to another, or switch from a Medicare Advantage plan back to Original Medicare.

3. **Open Enrollment Period for Medicare Advantage**: From January 1 to March 31, if you are already enrolled in a Medicare Advantage plan, you can switch to another Medicare Advantage plan or go back to Original Medicare.

4. **Special Enrollment Periods (SEPs)**: Certain life events, such as moving, losing other health coverage, or qualifying for Medicaid, may allow you to change your plan outside of the usual enrollment periods.

It's important to review your plan options annually, as your health needs and plan offerings may change.