Michael White, Medicare Insurance Broker

Answer: Do you know if they are independent agents or if they work for a specific carrier? An agent who works for a specific carrier will only review that carrier's plans and no plans from other carriers. Also, I would make sure that the agents are doing a detailed needs analysis with you to see what is important for you and your needs. At that point you should hear from them about some of the same policies availble in your specific area that others might be proposing as well. If you do not feel comfortable with the recommendation, you can always speak with another agent.

There are a lot of great agents out there who will have your best interests at heart and that will do the right thing for you. Don't be afraid to reach out until you find one that you are comfortable working with for your needs.

Answer: Creditable coverge means that any employer health insurance coverage must be equal to or better than what Medicare offers. This applies to both health and prescription coverages from employer health plans and is necessary to make sure that you can avoid having any penalties for not having Part B and/or Part D coverage. Also, the group plans must have more than 20 employees as well to avoid these penalties.

Answer: Yes, you need to work with an agent who can help you search for plans that are availble in your new state/county. Most plans are based off your zip code so when you move to a different state some plans and even some carriers are not active in various states and even if they are availble, you would still need to notify the carrier.

Answer: Once the IRA (Inflation Reduction Act) was initiated the "Donut Hole" was removed. Now the maximum out of pocket for prescriptions is only $2000 for 2025 plans and $2100 for 2026 plans. Also, if you have a high cost on one, or more, of your prescriptions then you can work with the carrier to smooth your payments, or spread out your payments over time.

Answer: This is a great question and one that we are asked almost daily. The best answer is that even with employer's coverage it is in the clients best interest to consult with a Medicare Agent/Broker to see how the two coverages compare and to make sure that if choosing the employer's coverage that the client would not have any penalty charges for passing on Medicare when in their Initial Enrollment Period. After the review it should be clear to the client if Medicare or their employer's coverage would be best for them.

Answer: Everyone is different and has different healthcare needs. For someone who wants to have flexibility and go to whatever Dr they want and not be bound by a network then they can visit any Dr, so long as that Dr accepts Medicare. Other people travel and having a Medicare supplement allows them to get coverage throughtout the US. Again, it is up to everyone and their personal lifestyle and healthcare needs. Both options can be good for you depending upon your needs and lifestyle.

Answer: Original Medicare does not cover chiropractic costs. There are, however, several of the insurance carriers that have an advantage plan benefit that will help cover chiropractor visits with a co-pay or coinsurance.

Answer: Obviously the best is to review and make sure that you are on the right plan for your prescriptions first. Then, you can utilize prescription savings/discount cards such as Good Rx, Glic Rx, or SingleCare to potentially help reduce your cost as well however, if you utilize one of the discount cards then the amount paid would not count towards your TROOP (true out of pocket) maximum.

Answer: Great question! With Medicare Advantage if you go to an out of network provider typically it will not be covered unless your plan is a PPO in which then you would generally be responsible for 50% of the charges. If you are on Medigap plan there are no networks so as long as the providers accept Medicare there would be no cost differences for your appointments.

Answer: Original Medicare does not have any networks when it comes to your care. It is important to make sure that any Dr or hospital accepts Medicare.I would also encourage you to have a Medicare Supplement/Medigap plan as well to absorb your responsibility of paying the left over 20% that Medicare doesn't cover. As far as a comparison with and Medicare Advantage plans, most of these have networks that they want you to stay in for your covered healthcare needs althought some might allow you to go out of network at a higher cost you. Regardless, if there is an emergency your healthcare would be covered at any hospital.

Answer: Starting to take a new prescription in itself is not necessarily reason to change your plan. I would advise reviewing your plan as well as the new medication to make sure that it is covered by your plan and or if there might be a better plan for covering it if necessary. Always review with a licensed agent when possible!

Answer: The biggest over-hyped benefits are the food cards, Part B giveback, and hearing aid benefots. Obviously they are beneficial to eligible clients but they are definitely overhyped.

Answer: That Medicare doesn’t cover all charges and procedures and that there is a monthly charge for your Part B.

Answer: I love helping people and when I can help a client understand their options and assist them in making the best choice for them and their family it is very satisfying. Also, I have worked with the Sr community for the past 23 years and I have a great rapport with them and can understand the psychology of where they are in life and help them navigate this period of their lives.

Answer: It is totally dependent upon your needs as well as the plan you are on. Both can have their advantages but you should review them with a licensed agent/broker to see what is best for you and your needs.

Answer: You should be with an agent/broker who will take the time to review your plan with you every year as there are changes with plans as well as within plans that should be discussed to see if you are going to be impacted by the plan changes. If a key benefit or coverage is dropped or the benefit is reduced then you should see if there are better options available.

Answer: There are several plans designated special needs in Medicare Advantage. These are either going to be dual plans or what we commonly refer to as D-SNPs for those on Medicaid and Medicare. Also, there are C-SNPs that are for those diagnosed with chronic illnesses. The special needs plans are tailored for their benefits to help those with these needs.

Answer: Yes, Medicare can cover Hospice care so long as your Dr shows that it would be medically necessary and that you have a terminal diagnosis.

Answer: Generally local agents might know your networks better than a remote agent and a local agent might have an office you could visit if necessary where as a remote agent could be inaccessible.

Answer: Generally you can change enrollment plans every year during Annual Enrollment Period. There may be other opportunities to make changes based on what is call Special Election Period which is determined by several different factors. Speaking with an advisor could help clear this up for you.

Answer: Not speaking with an advisor sooner. Many people are so overwhelmed that they just enroll without knowing what they should do or what plan is best for them.

Answer: First you should decide if you will need to take Part B or stay on employer’s coverage. Then you need to apply for your Medicare Card via ssa.gov or by going to your local Social Security office to enroll.

Answer: Yes. If PT is medically necessary then you will be responsible for 20% of all the bills unless you are enrolled in a Supplement or advantage plan.

Answer: Absolutely! Generally everything you pay into your medical healthcare including all co-pays as well as any co-insurance payments will add up throughout the year. The MOOP is the maximum amount that you would have to pay in any given year. This does not include your prescriptions.