Mike Alexander, Medicare Insurance Broker

Answer: I would recommend that you go to hey moe and enter all your meds to see if they are covered.

The stand alone part d plans allow you to pick your own drug plan.

Answer: When you move to another state you will jave a special enrollment period to change to a plan in your new jome area

Answer: Yes its capped at 2100 for all approved drugs . Your drug must be approved and be on your plans formulary

Answer: If you are on traditional medicare then you must 1st meet your part b deductible of $283, then you would owe 20% of the medicare approved charge and if you have a med supp policy it would pick up the 20%.

If you have a medicare Advantage then you would be subject to a co pay goe every visit

Answer: Some of the medicare advantage plans offer this service check with your plan to see if available.

Plan to get it this year as many of the advantage will reduce these benefits in 2027

Answer: You pay payroll taxes for medicare part a if working

You do pay taxes on your Ssa income but not for medicare except if you are still working then its taxed on your income

Answer: Every year in Jan the part b deductible changes based on inflation and claims data.

Some years it goes up more based on medical cost increases and some years less. But every year it changes. They send out notices also if you have a ssa.gov account you can see it ahead of time and budget for it

Answer: Yes it will cover it based on medical needs

You also may want to get a 2nd opinon so you have the best posdible outcome

Answer: Should not affect your current plan or benefits, based on your conditions you could qualify for a special needs plan with same carrier or another one with better benefits

Thanks

Mike

Answer: Brokers are paid by the insurance companies.

You want a broker to show you all plans not just the ones he recommended and let you choose the plan that meets your needs

Answer: All medigap plans cover up to 50,000 for foreign emergency visits

I would however recommend getting an international medical plan when you travel outside usa as the medigap plans require you to pay 1st and then wait for reimbursement, on the international medical they will file claim for you

Answer: For at least a year, disguard them once you get the new ones.

If its a claim issue i wuld keep them until the claim us settled

Answer: When you turn 65 you have a new enrollment period and can enroll in a medicare supplement plan with out underwriting and be able to get a new Part d plan .

Answer: On an HMO/Pos plan, you must select a primary doctor. You can go to any provider without a referral in the network, and you can go to a non-network provider, but you pay a higher copay

.

On a standard HMO you must pick a primary care provider, and you must have a referral.

No out-of-network benefits

On a PPO, you don't have to pick a primary doctor, and you can freely go out of network

PPO. will give you the best choice of providers

Answer: It is speeding up helping people get enrolled in medicare A&B by allowing clients to do the enrollments on line rather than going in to an ssa office

Answer: ACOs accountable care orgs that control claim costs and improvebquality of care. Ask if your doctor is a member of one of them

Answer: No medicare does not vover any death benefits

Social security has a Death benefit of $255 not much

So you may need life insurance if you dont have funds to covers your final expenses

Answer: Advantage plans in aome areas are lising money and are qithdrawing from the area

Also some plans have too much exposure abd are terminating plans to refuce their footprint and increase profits

Answer: Yes depending on your olan you will have some copays and limits to the # of treatments, check your plan for details

Answer: No all agents are compemsated by the carriers it is illegal for an agent to charge a fee gir his services

Answer: Yes the c pap machine is covered unfer DME durable medical equipmenthe trearments are covered by part b

Answer: Go to wwa ssa.gov 3 months before you turn 65 and enroll in medicare A & B

Then you can decide on either a supplement plan or an advantage plan depending on your budget

Answer: In this case you would qualify for skilled nurding benefit.

Check you plan to see what your out of pocket is.

On Advantage plans you will have more out of pocket for these services.

In a supplement , like a plan G or N, you will have mych less out if pocket

Answer: Divorce has no effect on eligibility but if your incomes is now less after the divorce you may be able to save on your part b premiums.

File an SSA 44 after your divorce

Answer: Part b excess charges are applied qhen you go to a doctor who does not take medicare assignment. The excess charge is 15%.

You can avoid this by making sure your doctor takes medicare by asking them

Answer: Agents who have been in the field for at least 5 years or more are the ones to look for.

Experience, trends and knowing what to do for everyone as everyone is different and experience is needed in the medicare field more than ever

Answer: Yes HSA s can pay for Medicare premiums and

Part d copays and Dr out if pocket exoenses.

Your deductibles and max out of pocket expenses can also be covered

Answer: All plqns change tgeir benefits in Jan of each year ckeck you plan benefits for 2026, you should have received an Anoc letter in Oct with changes to your current plan.

Answer: No you are not in orginal medicare advantage plans are Part c of medicare and not original medicare.

Answer: No in an Hmo you must go to their contracted providers or it 100% out of pocket.

Get you pcp to get you a refferal to a doc in their network.

Also ask the cardi doctor what plans he takes as you may be able to change to a different plan with a chronic Sep enrollment

Answer: Yoy shouLd appLy for LIS (LOW INCOME SUBSIDY) OR depenfing on the state you live in apply for Medicaid..

Answer: Yes they can help you will need to request that they be available when you call and aak for permission to be on the line with you

I would also recommend that you get a power of attorney to save time in the future

Answer: Most all Preventative services are covered annually, some services such as Colonoscopies have time schedules as to how often medicare will approve them unless your doctor files an exception

Answer: With just A & b only you will be responsible for 20% out of pocket with no cap on costs,

We recommend getting a medigap or a Part C plan to reduce your out of pocket and protect you from financial burden

Answer: Yes as long as the doctor has it approved and it is necessary and the medications are in the plans formulary, you can also appeal to have the meds covered

Answer: 1 look at what you want , such as freedom to see doctors you want

2 if you Travel for extended periods outside of your city or

State

3 can you afford a monthly premium for supplements

4 do you have chronic conditions

5 use a professional to help you do a needs assessment

6 everyone is different find the plan N that meets your needs

Answer: M a NY issues as providers leaving due to compensation adjustments,poor client servive,not being able to see specialists they want and many plans are leaving certain areas

Answer: They look back every two years , and will automatically

your irmaa if you have a c h ange is life status or income you should submit an SSA-44 form to have yourvirmaa adjusted

Answer: Some times either the doctors practice drops certain plans or they have a dispute with the carrier and lise their contract

Answer: Medicare only covers spinal manipulation adjustments it does not cover routine Chiropractic care and is limited to # of visits.

Answer: Yes Urgent c a re is covered by medicare and all insurers who write medicare plans as well as all part c plans.

Answer: Most all preventative care is covered at 100%. As long as it is coded as preventative care

Make sure your doctors office codes it correctly so you won't have any issues

Answer: You can go to medicare.gov and look up covered procedures. Also you can have your doctor request an appeal to see if medic a re will cover it, you can also call 1 800 medicare, to speak with a livebperson

Answer: Always be s ure your medications are in the formulary, make sure your pharmacy is a preferred pharmacy, and use medicare.gov or heymoe.com to get an independent view before you enroll

Answer: A good agent should not push either product. They should do a Needs Analysis to determine the best plan for each client. When agents tend to push one plan over the other, they do not have the best interests of the client. Every person has different needs, and pushing one plan over another for commission

Another is not keeping the best interests of the client in mind

Answer: 1 restricted list of providers

2 must get a refferal to see a specialist

3 travel outside of your right home area

4 dealing with managed care is s ues

5 not having ability to see specialists younwant if not in network

Answer: Yes you should look at all changes especially your Prescription benefits, co pays and what your value added benefits will look like for the new year.

Always make sure that your plan will be in the area and if thete is a plan change

Answer: Medicare does not cover caregivers, you would need a home care policy or a ltc policy to cover these servicies

Answer: You can ho to an advantsge plan as many have hearing aid benefitsor you can purchase a stand alone plan that includes dental vison and hearing?, but you may have a waiting period

Answer: In rural areas provider networks are limited, you should consider going back to original medicare as doctors are limited in rural areas

Answer: Due to reservation status

Most Native Americans prefer to be treat in their home and the reservations provide home care

Answer: When you cqll tell them the reason you are calling.

If it's to check on your Insurance status, call the Cobc unit.

Sometimes you can go to

The web site at Ssa.gov or medicare.gov and find your answers.

Answer: Yes all plans have different plans, it goes by your county and zip codes.

If you relocate be sure to check and see if your current plan is in your new zip code

Answer: They do but Plans vary so be sure to read your outline of benefits from your plan to see what changes occur.

You should get your Anoc letter in Oct if each year stating any changes

Answer: Sif you have both Medicare and Medicaid

Medicare pays 1st and then Medicaid picks up 100% of what medicare does not pay but you must use doctors who accept medicaid

You can enroll in a dual eligible plan thru a Medicare Advantqge plan to get the most benefits

Answer: Ssa does a two year lookback so if you had the withdrawal in 2024 you should file the ssa44 in 2026 or 2027 depending in when tge funds were dispersed

Answer: Tri care is for retired career Military and is a part of their

Military benefits. It acts as secondary coverage to medicare.

VA care is for Veterans who have served in the military but are not career military,

They get use of Va facility

For medical care. It acts alone and they can also have medicare ans an advantage plan also

Answer: What she needs to do us sell her car to a relative for one dollar, then the relative can sell the car and not deposit this to her account

Make sure you change the title to a relative.

Or she can gift the car to a friend, relative or charity.

Answer: Only for spinal maniulation adjustments

Medicare will not pay for extensive Chro treatments

Medicare will only pay a fixed fee for adjustments

And some providers will not bill medicare

Answer: It will depend on the state you live in.

Some states allow Gurantee issue while some require underwriting.

An exception is if the MAPD plan exited the market.

If so then you may have a GI option

Answer: 1st, make sure all your doctors and hospitals take the Advantage plan. you prefer

A lot of advantageous plans have dental coverage

And you should check to see which ones have the best dental coverage

Answer: Yes if you are 65 or older you should apply for medicare on line at www.ssa.gov.

You should do this 3 months before you retirement date.

Once you have applied then you can look at a supplement or advantage plan

Answer: Go to heymoe.com or Medicare.gov

Type in all your meds and it will give you best options

Medicare.gov is Free

Heymoe.com is an annual subscription service that sends you annual reminder checks

Answer: This wont affect you at all

What will affect you is the irma penality if you have a higher income. Go to medicare .gov and look up Irma costs for psrt B and part D costs

Answer: NEVER ANSWER TELEMARKING CALLS, HANG UP.

NEVER GIVE OUT ANY PERSONNAL INFO, IF YOU DONT KNOW WHO THE PERSON IS.

ALWAYS REPORT ANY HIGH PRESSURE TACTICS TO MEDICARE

Answer: Annual physicals, all screenings and immunizations.

Annual cancer screenings,

Blood work and labs.

Always check with your Doctor to see what options he recommends each year

Answer: Insurance companies must underwrite the risk and make sure they have'a balance of healthy individuals in order to be able to pay claims.

Note all insurance carriers have different underwriting guidelines, so if you are denied by one apply with another as you may be approved.

Answer: The insurance companies pay the agents for enrolling you in certain plans. Almost all agents are paid a commission on each enrollment

Answer: On Traditional Medicare you can go to any hospital or Foctor that takes medicare.

On advantage plans, you must use network providers in order to have lowest cost.

Answer: The only one better is which one gives you the benefits you want.

If you can afford a supplement, then Traditional Medicare is best.

Some peoole like the Extra benefits that advantage has, like dental & vision, whereas some people like the freedom of Traditional Medicare and not have the network restrictions od Advantage plans

Answer: I agree it should not be allowed. They use this to get your personnal Info.

Never speak with any of these telemarketing sales people, ask a local agent or call medicare 800 medicare

To find out if you qualify

Answer: It depends on the state you live in, some states have GI rules and others require underwriting.

Check with your state Insurance Dept

Answer: Medicare fraud affects all of us. If you see fraud or notice questionable practices Call 800-medicare and report it

Answer: There is a list of all preventative procedures covered on medicare.gov ,

You can also look at your plans outline to see what is covered.

Answer: Yes Medicare will cover all Preventative care exams.

Most all are covered at 100%, and you are encouraged to get all preventative screenings.

Answer: If you just only have A& B , then you have a Hospital Admission deductible and a part b deductible.

Medicare will pay 80% and you pay 20% of charges

If you have a Medigap plan then it will pick up the 20% after a $280 ded.

Answer: The Iv chemo is coveted under Part B of Medicare.

After your Deductible medicare will pay 80% and you pay 20%, if you have a supplement it will pick up to 20%.

If you have a Medicare Advantage plan, then you would pay the 20% up to your MOOP.

Answer: I try to do a needs assessment to see what is important to you.

Medicare is confusing, and I try to educate you on how medicare works, the different parts, when to enroll to avoid any penalty, and to educate you on the different plans. Medicare has and which are best suited for you.

If you are a client who is switching plans

I look at carriers' 5-year rate history, client service reputation, carriers' AM best rating, and, of course, current rates.

Answer: What you need to look at is

1) their 5 year rate history,

2) Am best rating, you want a A or B rating

3) client service

4) How long have they been in business

That is what will determine the value

Answer: Medicaredoes not pay for dental, but some Part C Advantage covers some dental, and some may cover 1 implant, depending upon the plan and the area.

You can, however, buy a standalone dental plan, but you may have a waiting period before it is covered.

If you have a Dmo ( like an Hmo), you may have immediate coverage.

Also, there are dental discount plans that offer immediate coverage if you use their dentists.

Answer: No but you may qualify for a special enrollment period in your area or you can change a plan during OEP fro jan 1st thruar 31st

Answer: COBRA IS NOT CONSIDERED CREDITABLE COVERAGE FOR MEDICARE AND YOU WILL BE SUBJECT TO A PENALTY

YOU SHOULD ENROLL IN PART B within 63 days

In order to have Guranteed issue

Answer: The person who enrolled you should have gone over all the benefits with you in detail; you still may be able to change plans before. March 31st, and get a plan that covers more dental

Answer: You must 1st have your doctor write a prescription for it and medicare will cover it. You must also use an approved medicare vendor

Answer: There is no Disadvantage the broker services are free and does not cost you.

You have a advocate that is there for you to assist do you are not alone

Answer: Medicare will only pay for Standard lens, if you want expanded lens coverage

You must pay out of pocket

Answer: Dental, eyeglasses, Long term care, caregiver care or home care hearing aids,

Medical care outdide USA

Answer: I WOULD CHANGE THE irma penality for part b and part d.

People who have made more income should not be subject to Irma fines.

Reality is ,yes you made more in income, but you have also paid more in taxes. Irma is like double taxation.

Answer: Yes you will have to show proof of employer coverage and get an L564 form from your employer verifing your datess of coverage

Answer: CHEAPEST IS NOT ALWAYS THE BEST.

SEVERAL FACTORS TO CONSIDER

1) HOW LONG HAS THE CARRIER BEEN IN BUSINESS

2) WHAT IS THE CARRIERS AM best rating

3) What is the Carriers 5 year rate history

4) What us the Carriers claim history

5) Customer Service:

Make a service call see how they handle your call

As far as Plans all medigap plans are standard benefits so all carriers have same benefits regardless of rates.

Do your research and make sure the Cheapest one meets all the above.

Answer: You should follow up to be sure that they have met their enrollment timelines and are not being subject to enrollment penalty.

Also make sure they have enrolled in a plan that is right for them and not being pressured into an Advantage plan they dont need

Follow up just to be sure

Answer: Medicare does not cover you outside of the USA.

Some Part C plans cover you for a limited amount for emergency and some Medigap plans will pay up to 50,000 for urgent and emergency care.

If you travel outside the USA, you should consider International Medical for the duration of your trip

Answer: 1st you have to be sure to notify your insurance company of your move, as well as Medicare.

Since you have relocated, you have a special enrollment period to enroll in a plan that is in your new area.

Many of the carriers are in multiple states, and you could stay with the same carrier

Answer: This is considered Durable Medical and yoy must hqve a prescription for the equipment before you can use it

Answer: Special Needs plans are for people that have certain health conditions or you are on Medicaid and Medicare in force.

There are also some plans for people on disability and have ssdi.

Answer: Depending on when you enroll, If you are in the open enrollment period, then you cant be denied, after that depending on the state you reside in you may have to be medically underwritten.

Some states have annual open enrollmemts based on either your birthday or policy renewal.

So in some states you can be denied if you dont meet the underwriting.

If you are losing employer coverage you have GI on med supps as long you apply in a limited window

Answer: You will need a power of attorney, in order to act in their behalf.

Make sure yout POA has specified the POA includes medicare and social security issues, as it must be stated as such

Answer: Yes most do because it saves costs, but i would check with your plan to be sure it is covered.

Not all plans may approve it

Answer: Yes all the plans support this as it lowers costs to the medicare trust funds, to the health plans and providers

Answer: If you have opted out of medicare the plan will no longer pay, unless you are in the Medicare payment system the patient will need to pay you as Medicare will not

Answer: Yes all medicare Part B premiums are based on your income and you have a 2 year lookback

Go to medicare.gov and look at Irma chart

Answer: As long as you are working for an employer of 20 + employees you do not have to sign up for medicare.

You group plan would be primary

If under 20 employees then you need to sign up for A&B

Aa medicare would be primary

If you havw an HSA plan do not sign up for medicare until you retire.

I recommend that when you decide to retire to sign up for medicare 3 months prior to retirement

Answer: No you will get the higher of the two benefits or widows benefit

I would recommend a visit at your lical Ssa office to speak to a counsler to make sure you are getting tge most benefit

Answer: There ia no one best plan

What to look for is

1) Are all your doctors in the plan

2) what is the plan star rating, stay away from a plan that haa less than a 3 star rating

3) make sure the hospital you want takes the plan.

4) look at your max out of pocket (moop)

5) make sure it covers your meds

6) check customer service ratings

7) make sure the carrier has been in your market for at keast 3 years or more.

The best plan is tge one that meets all your needs

Answer: You should have your doctor file the appeal qith both medicare and your secondary insurance co.

Make sure they aak for an expidited appeal

Answer: In some cases this may be approved; if its approved by medicare it wouls be covered at 80%.

You should ask your doctor to get pre approval from medicare as these procrdures can be pricey.

Answer: Part b is the outpatient benefit of medicare. Its pays your benefits outside the hospital you will pay a premium amount each month based on your income,

You must have part b in order to get a medigap plan or an Advantage plan.

Answer: You should call the Doctors office and ask their billing dept what medicare advantage plans they accept, make sure you give them the Plan code on your id card.

If your mom wants to switch back to the medigap she had before she can call medicare and ask them to disenroll from the advantage plan.

Be wary of trusting the sales people, begore you sign up always call your doctors to make sure they accept that oarticular plan.

Teaditional Medicare and ia medigap is always the best option.

The advantage plana are going thru Market turmoil now and are not as stable as traditional medicare.

Answer: 1st set up an online account at www.ssa.gov.

You can apply on line for medicare.

Then you will need either a medi gap or advantage plan.

On LTC, medicare does not cover That, so you need a special type policy that will cover LTC.

I would consult with an advisor on this issue

Answer: No as long as you maintain

Creditable coverage you will not have a penalty.

When she does retire you will need two forms to apply for part B form 40-b and L564. I would do this 3 months before she retires.

You can go to ssa.gov and print out the forms and have them ready

Answer: Medicare will cover at 80%

If you have an advantage plan many of them offer tele health at a 0 co pay, you may want to check for plana in your area.

If you have a supplement like a Plam G , aome of tge supplemental carriers offer tele health.

You can also enroll in services like tele doc gor an additional premium

Answer: You will automatically be enrolled in A& B if you are on disability, and not have employer coverage

Answer: You have to be careful and not be swayed into enrolling in a plan that is not right for you.

I agree its a marketing tactic to steer you into a certain plan, so beware

Answer: If its done in the hospital on an overnight stay then yes other wise it would be covered under part b

Answer: For medical and hospital once you reach the Moop,for that year, then you would not have any out of pocket except for Pres drugs

Answer: Mwducare only covers 100 days of skilled nurding care

For long term care you would need a long term care policy which is a seperate plan.

If you cant afford it, you should get with an estate attorney and set up a miller trust to protect your assets

And qualify for medicaid

Which will pay for Ltc.

Note your miller trust haa to be in place for 5yrs before you go into the nursing home.

Be sure to plan for it

Answer: If you have an SSA.gov online account you can go on line and print a card and order a new one.

You can also go to a local SSA office , but be aure to bring an picture ID with you

Answer: You will have a copay , look under out patient surgery benefits on your plan ir call the member service # on your id card to get your co pay amount

Answer: You must file am SSA 44 form, its available on ssa.gov

Then you have to mail it to your local SSA office in your zip code.

Be sure to send by Certified mail.

You should contact your Cpa as they know how to fill out this form.

Ssa approves about 70% of ssa44 firms that are filed properly

Answer: As long as the Blood test is medically nessesary it is covered. In some cases if its denied, you can appeal it.

Make sure your foctor codes the test as preventative and its usually covered

Answer: This is important because it limits your cost each year on covered drugs to a total of 2100.

Some meds can be expensive and this limits your annual cost.

Bear in mind that this total only applies to covered drugs in your plan formulary.

If you have drugs not covered by medicare you would need to look for other sources to help pay for non covered drugs.

Places like the co pay assistance programs you can find on google.

Just type in the drug name and type coupons or co pay assistance

Answer: Medicare will pay for a ct scan, but it has to be preapproved by medicare doctor and be deemed necessary

Answer: No but you wil need to check and aee if you plan will cover that drug or use an alternative like good rx

Answer: In most cases you would lose that employer coverage. And you will need to enroll in medicare a and b

And either a medigap or advantage plan

Answer: Part d will cover some of these meds if you Doc gets it approved due to a medical issue. Not everyone will get it approved

Answer: Medicare does not give any discounts, the amount you pay for medicare is based on your income.

On Medigap policies some give discounts based on family status and other factors.

If you are on Medicaid also, you may get your part b premium waved

Answer: People think medicare will cover you for caregiver care, it does not

Medicare will cover skilled nursing care for 100 days, if deemed medical necessary

Answer: Once you are on Disability for 2 years, you are auto enrolled in Medicare

In some cases you can be fast tracked in Medicare A & B.

Answer: You should get an estate attorney and set up a trust to have income flow into a trust so as not to go into personnal income to minimize your IRMA penalty

And alao consultbwith a Tax advisor

Answer: Life insurance is simply Risk Management to protect your family and provide funds for your estate obligations.

A good rule of thumb is 5 to 8 times your income in face amount. EXAMPLE:

If your income is 100,000

You should have 500 yo 800,000 in life insurance in place to protect your family and estate.

Answer: Medicare Part A covers SN at 100% fir 1st 20 days, for days 21 to 100 you have a copay of $217 per day for up to 100 days

Medicare does not cover Long term care, you would need an Ltc policy in place to cover a nursing home.

Answer: Medicare does not cover Nursing Home Care, it will only cover Skilled Nursing Facility for a limited # of days, Review your Medicare and You Handbook for complete details

Answer: income wont affect your eligibility, but it can subject you to an income penalty on your Part D you can check the income Chart on Medicare . gov for your penalty.

Answer: no you must work at least 10 years to be eligible for Medicare . you can check wih your state for medicaid as you will not qualify for Medicare

Answer: Medicare will cover Medically necessary Hme Health Care for 20 Hours each week.

You should also look into Long Term Care for more benefits also

Answer: Once you are eligible for SSDI, then you must wait for Two years and then you will get Medicare, However, depending the date of your Disability, they may Fast Track your SSDI app and make you eligible for Medicare at an eariler date

Answer: Yes but plans can add or Drop doctors at any time during the year, in aome cases you will have an sep to change plans, One of the new proposals is that if a provider leaves a plan it will give you an Sep to change plans

Answer: You may be able to enroll in another plan if you hqve a special enrollment in your state. You can also change plans during the oep frim jan 1st to March 31st

Answer: For some Advantage works best , for some, for others Traditional medicare is best. Each person has their own needs, a good advisor will show you both

Answer: Some medicare advantage & Supplementplans offer limited international coverage for accidents and urgent care.

I always recommend An International Medical plan when you Travel outside the usa

Answer: Do a full needs assesment to be sure that you are picking the right plan at the right time. Contact a professional, avoid answering the phone from telemarketing.

Its against the law for people to call you randomly.

Be aware do your research 1st.

Answer: Hime Health care is covered by medicare, caregivers are not.

Some SNF medicare provide a small amount of caregivers aide, yu woul need to check with your currwnt plan.

Answer: All Advantage plans have forms of a pain management & Chronic care management. Some Advantage plans have Special needs plans , called SNF, & C-SNP plans that cater to these individuals.

Check n Medicare.gov to fibd plans in your state.

Answer: Some plans have value added services for chronic iillness. check what is called C Snp plans in yoyr area or go to medicare.gov

Answer: Acupuncture is covered by some medicare advantage plans with a small copay

It has been quite effective for some people with chronic pain management

Answer: On some of the chronic special needs plans, they have some adfitional benefits if uou have certain chronic conditions.

Also some of the plans have expanded drug formularies.

Ask the agent if any of the plans are in your area.

Answer: Every year they adjust the income amounts based on the inflation index. So if you were denied one year before, you may want to reapply, as you may now be eligible.

Answer: MEdiCaRE WILL COVER 80% OF APPROVED MEDICARE CHARGES,

As long as the provider will accept medicare assignment

Answer: You are subject to 20% coinsurance with no cap on expenses.

You should have a medigap or an advantage plan to reduce your financial risk

Answer: If you have a medi gap you can change every month on advantage plans you can change during Aep and oep

Answer: You can ask for an appeal or exception for that med

In some cases ask your doctor if there is atrail program fir that med ,

Answer: You have an open enrollment due to loss in coverage, you should look into both an Advantage plan and a supplement depending in your current state.

Answer: Yescmake sure the plan you have in in your New State.

Also be sure to change your address with SSA and medicare

Answer: You should interview several agents. Look for how long they have been in the business, if they can look at all plans for you and not dteer you into a plan they want to push

Answer: Depending on health conditions some may be approved, it also depends on the type of plan you have, as some advantage plans havevthus coverage

Answer: In 2026, medicare will limit some Tele Doc services as a lot of the covid era enhancements are not available in the fitute.

Answer: If you meet certain conditions and are unable to drive to the Drs office, telemedicine will be covered

Answer: You should review every year, before Dec 7th.

You should also make sure all your doctors take that plan

Answer: Yes it is covered by Part D, you need to see if your plan has it in their formulary, and what tier level it falls

Answer: Always ask for generics 1st,

Get a larger dose of the drug and use a pill cutter to cut it in half, you will save 50%

Ask your pharmacy if they have coupons you can use.

Use mail order more

Answer: Yes some drug formularies cover it , You would need to review your Drug plan formulary qith your carrier

Answer: The best way is to go to your Carriers web site and chek provider search,

It will give you the most accurate information

Answer: IRMMA, LATE ENROLLMENT PENALTIES FOR PART B & D are common, but you can appeal them if you have had a change in life status

Answer: No medigap is your best choice, you can shop carriers to get a better rate if you can qualify consider a high ded plan G or a plan n to save premium dollars

Answer: The strain on costs will impact premiums, and congress will need to raise the age for eligibility and increase the medicare taxes to sustain the increase in the aging population

Answer: With Concierge medicine , most doctors don't take medicare assignment so you would pay 100% out of pocket. Make sure the doctor also takes medicare, and if he does, you will have to file the claim as most concierge docs won't file vlaims

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Answer: If you are on an Advantage you should check with them to be sure they are in your new county

If not you will need to change plans, also be sure to notify SSA with your new address

Answer: Access to Certain doctors and having to deal with managed care restrictions.

Also Advantage plans change every year and may terminate you plan

Answer: You should look at Traditional Medicare and a medi gap plan, you pay a monthly premium, but your only out of pocket is a $288 annual deductible, you pay a premium, but you have predictable costs and no surprizes

Answer: Regular Medicare allows you to see any doctor or hospital that takes medicare, and you don't have to deal with networks

Answer: Yes in most cases they save in premium cost, but all advantage plans have out of pocket costs you must pay that varies with Hmo and Ppo plans

Answer: You must have them em present or have legal POA. You can also have them request with the agent that they have given you the right to listen in their behalf

Answer: The fact thst with Traditional Medicare, you can go to any Dr or Hospital in the USA thatvtakes Medicare, you are not subject to a network or prior approvals

Also if you need access to Major specialty Hospitals, like Md Anderson the Mayo Clinic or John Hopkins you havvthst with Traditional Medicare.

Answer: Yes every year the deductible changes along with your part b premiums and the cost of living adjustment

Answer: A trusted advisor in you community who will do a Medicare one on one with you, and not someone who is just selling you a product

Answer: A local agent can come to your home for a face to face

Meeting. A local agent is invaluable, and builds a relationship with you , not an AI call center

A local agent is important to you community and builds a trust worthy relationship as a real person, not a call center agent

Answer: Sales seminars are yes, I recommend only going to an educational event and not a sales seminar, so you don't get a hard sell on one product

Answer: Doing a needs assessment to dertimine their needs,

Asking questions about what they need and what is important to them as an individual

Answer: With a 5 star plan you can enroll any time during the year and are not limited by Aep or Oep

So you have year round enrollments

Answer: No Medicare is for life as long as you pay you part b premiums.

That is the only way you could lose medicare

Answer: PROVIDING VALUE ADDED SERVICES AND EDUCATING PEOPLE TO MAKE THE RIGHT CHOICES

Both with meficare and retirement benefits

Answer: Not being able to change plans

Mid year, and being stuck in a plan that does not work for them with doctors

Answer: Not picking the right plan at the time of enrollment, and losing the guarantee issue right for a medicare gap plan

Answer: If you have had creditable employer coverage, you needs to apply for Medicare A & B

Use an advisor who will help you with the application, to avoid ant penality

Answer: 1) Always use an independent agent who represents you and not an insurance company

2) Never use a Captive Agent who only represents one company

3) Never use a Call Center agen

4) use a local agent who is nearby who you can reach when needed

5) a good agent will do a needs assessment before he talks with you

Answer: Apply for extra help and Lis (low income subsidy) thru SsA or medicare.gov. a good advisor will assist you

Answer: In some cases but must be pre-approved. It has to be medically necessary, but is not easy to get covered

Answer: No that's a political terminology , Medicare is easy to fix and control thru payroll taxes,but both political parties use it as a campaign issue

Answer: That Medicare is free and it covers everything, medicare is an 80 % plan , a d you must find additional coverage to cover the 20%

Answer: Yes this is preventative procedure, however if you are on an Advantage plan, it must be pre approved and you would need to use the in network provider

Answer: I never say 0 premium, I always say no additional premium, othrt than you part b premium,

You will always have to pay your part b cost, unless you are very low income

Answer: No all mefi gap plans increase d ue to medical claims and age. Some plans have rate guarantees for limited times, but ask will increase over time

Answer: You should consider Traditional Medicare and a medi gap plan, to be sure you can go to the doctors you want and need. I would avoid an Advatage plan which could restrict your choices

Answer: You may want to consider an Ma only advantage plans, many of these work we.l with VA coverage, and some even give you a part b give back

Answer: I do a medicare one on one with them, showing how Medicare works, I never try to sell them on a product, education is the key

Answer: The experienced broker will always do a eeds assessment, so he can determine your needs and be able to show you all the plans

Answer: Many states have this rule with more added each year, check the states you are in for details.

States that has this rule , tend to have more costly premiums

Answer: They can inform you of that plan, but you should use medicare,gov to search all the plans in your area. I would only attend educational events and not sales events, that tend to pressure you

Answer: Faster

Processing of claims, and less wait time for the Doctors and insurance company,

It will take some time but it should be a more efficient method

Answer: No meficare secondary insurance is an employer plan that pays second to Medicare, depending on how many employees in your company

Answer: 3 months before your birthday, the month of your birthday and 3 months after you turn 65,

Failure to do so could cost you a late enrollment penality

Answer: Helping educate them about medicare and assisting with their plan and enrollments.

We help en r oll them with meficare and SSA retirement benefits, saving them time and money

Answer: You time limits and when is the right time to enroll.

, in order to avoid a late enrollment penalty which can be costly

Answer: Yes you are able to get. An Sep, but you should enroll within s 63 days of your coverage termination

Answer: No they are not free, when you elect enrollment in an Advantage, Medicare sends you Medicare money to the advantage plans who is then responsible to pay all your bills, not meficare,

Carriers get from 800 to 3000 per month for each person who elects an Advantage plan, and Medicare is not responsible for you treatment, the carrier is

Answer: If it's approved by Medicare then its covered , if not there may some other programs that can exist with the vost

Answer: You should contact your insurer and sign up for the M3P program, Medicare prescription payment plan, also look at Canadian pharmacies and discount programs out there, and ask you Doctor to see if he has samples or knows of a discount plan

Answer: Yes because it limits consumer choice. Advantage plans appeals

because of premium cost, but they a t is not the full story

Answer: Make you read your Medicare and you Handbook each year, and review your plans benefits.

You should have been made aware of the Ambulance co pays

Answer: Several things to consider

On the Health plan you should look at many Factors

1) look at thr Star ratings of the Plan, I would pick a plan that has less than 3 stars with Cms

The star ratings tell you if the plan has adequate benefits, and provides good client service

2) Make sure you Know the difference between an Advantage plan and traditional Medicare with

A Medi gap plan, There is a huge positive to Traditional Medicare.

3) How long has the plan been in business in your area, Stay away from New plans with less than 3 years in the market you are in.

4) Never answer a tele marketing call about medicare, only call a trusted advisor

5) on an Advantage plan, make sure you call your doctors and ask them what Hmo, & Ppo plans they accept and check on the plans formulary.

6) only use an independent Advisor, who works for you and not the insurance company, that way you get the plan that will work for you

7) make sure your advisor does a needs assessment, and not just pitch you plans he wants to sell

8) Make sure you are dealing with a seasoned advisor who has at least 5 + years in the business

9) Ask the advisor for references from their clients

10) Do not answer random calls, its illegal for someone to call you without you 1st requesting the call

Answer: Hello Bankruptcy wont affect your medicare

You will have all options avaliable

Be sure to continue to pay your Part B premiums, so your coverage will not lapse

Answer: ONLY IF IT IS A MEDICAL NECESSITY, DUE TO YOUR HEALTH AND IS PRE APPROVED,

ELECTIVE BARIATRIC SURGERY IS NOT COVERED

Answer: YOU PROVIDER WILL NOT SEND IT , YOUR ADVANTAGE PLAN WILL SEND USUALLY IN OCT OF EACH YEAR. BE SURE YOU REVIEW AND MAKE SURE THE PLAN STILL COVERS WHAT YOU NEED IT TO DO , YOU HAVE FROM OCT 15TH TO DEC 7TH TO CHANGE PLANS IF YOU NEED TOO

Answer: YES MEDICARE COVERS HOSPICE CARE. BOTH TRADITIONAL MEDICARE AND MEDICARE ADVANTAGE PLANS COVER HOSPICE CARE, ITS PART OF THE MEDICARE PROGRAM.

BE SURE THE HOSPICE COMPANY YOU USE , TAKES MEDICARE BEFORE YOU USE THEM

Answer: IF YOU ARE IN A TRADITIONAL MEDICARE AND HAVE A MEDI GAP, YOUR ONLY OUT OF POCKET WOULD BE $257 ,THEN MEDICARE PAYS 100%

IF YOU ARE ON A MEDICARE ADVANTAGE, CHECK YOUR SUMMARY OF BENEFITS FOR THE AMOUNT OF YOUR COPAY

Answer: THIS IS ALSO CALLED AN ANOC (ANNUAL NOTICE OF CHANGE) FROM YOUR ADVANTAGE CARRIER. REVIEW IT AND SEE IF THAT PLAN STILL MEETS YOUR NEEDS.

IF YOU ARE ON TRADITIONAL MEDICARE A & B, IT IS USUALLY SHOWING YOU WHAT MEDICARE PAID ON YOUR CLAIM.

YOU SHOULD KEEP YOU SUMMARY NOTICES AND SET UP A FILE FOR MEDICARE AT HOME OR IN YOUR COMPUTER FOR FUTURE RECORDS.

Answer: IF YOU ARE ON A MEDI GAP , PLAN F , G OR N, YOU CAN GO TO ANY DOCTOR THAT TAKES MEDICARE ,

IF YOU ARE ON AN ADVANTAGE PLAN (PART C), YOU MUST BE SURE YOUR DOCTOR TAKES THAT PLAN AND IS IN NETWORK

IF YOU HAVE A RARE DISEASE, I WOULD RECOMMEND A MEDI GAP VS AN ADVANTAGE PLAN.

Answer: MEDICARE PART D IS THE PRESCRIPTION DRUG PLAN FOR MEDICARE, WITH PART D YOU ARE NEVER OUT OF POCKET FOR MORE THAN 2,100 FOR FORMULARY MEDICATIONS, THEN PART D PAYS 100% OF YOUR DRUG COSTS.

ALSO MEDICARE PART D PROVIDES YOU ACCESS TO THE M3P PROGRAM, WHICH ALLOWS YOU TO SPREAD THE 2100 OVER A 12 MONTH PERIOD, INSTEAD OF PAYING IT UP FRONT.

PART D IS A GREAT BENEFIT TO SENIORS.

Answer: IT DEPENDS IF YOU HAVE CREDITABLE EMPLOYER COVERAGE YOU WILL NOT BE PENALIZED. YOU HAVE 3 MONTHS BEFORE YOU TURN 65, THE MONTH OF YOUR BIRTHDAY , AND 3 MONTHS AFTER TO ENROLL IN MEDICARE WITHOUT A PENALITY.

AGAIN, IF YOU HAVE EMPLOYER COVERAGE, THEN YOU WILL NOT BE PENALIZED. YOU MUST HOWEVER SUBMIT AN l564 FORM FROM YOUR EMPLOYER TO VERIFY PRIOR COVERAGE, IF YOU ARE OVER 65.

YOU DO NOT HAVE TO SIGN UP FOR MEDICARE IF YOU HAVE EMPLOYER COVERAGE, YOU CAN SIGN UP FOR PART A ONLY WHICH IS THE HOSPITAL PART OF MEDICARE , YOUR EMPLOYER PLAN WOULD BE PRIMARY COVERAGE, PART A HAS NO COST TO YOU. HOWEVER IF YOU HAVE AN HSA, (HEALTH SAVING ACCOUNT), YOU CANNOT HAVE A OR B OF MEDICARE.

ONCE YOU DETERMINE THE DATE YOU WILL RETIRE, YOU MUST STOP HSA CONTRIBUTIONS 6 MONTHS BEFORE YOU ENROLL IN MEDICARE

Answer: THAT IS IS FREE AND IT PAYS EVERYTHING, AND THAT ITS AUTOMATIC, IT IS YOUR RESPONSIBILITY TO ENROLL IN MEDICARE A AND B, CALL ME FOR HELP IN ENROLLING IN MEDICARE , WE DO FOR YOU AT NO COST, OUR SERVICES ARE FREE

Answer: MEDICARE WILL PAY 80% OF THE MEDICARE APPROVED CHARGE, AND YOU WOULD PAY 20% , IF YOU ARE ADMITTED TO THE HOSPITAL, YOU WILL HAVE ROUGHLY A 1700 DEDUCTIBLE THEN MEDICARE WOULD PAY THE REST, YOU CAN REVIEW THE AMOUNTS ON MEDICARE.GOV. OR CALL OUR OFFICE FOR UPDATED AMOUNTS FOR 2026

Answer: NOT DOING AN INDIVIDUAL NEEDS ASSEMENT , TO MAKE SURE YOU ARE ENROLLED IN THE RIGHT PLAN FOR YOU. I ALWAYS DO A NEEDS ASSESMENT BEFORE I EVEN QUOTE ANY PLANS OR RECOMMEND ANY PRODUCTS.

Answer: YOU WOULD FIRST CALL CMS (MEDICARE). YOU SHOULD REPORT ANY SUSPECTED FRAUD OR ERRORS, BOTH TO CMS, YOUR CARRIER AND YOUR DOCTOR. THIS HELPS PROTECT THE MEDICARE TRUST FUND

Answer: I ALWAYS DO A NEEDS ASSESMENT WITH YOU, TO DETERMINE WHAT PLAN WILL WORK BEST FOR YOU, I DONT WORK FOR AN INSURANCE COMPANY, I WORK FOR YOU,

WE ALWAYS REVIEW YOUR INDIVIDUAL NEEDS, AND EVEN IF THE PLAN YOU CHOOSE IS NOT ONE WE REPRESENT, WE WILL STILL HELP YOU GET ENROLLED IN THAT PLAN, IF IT FITS YOUR CRITERIA FROM THE NEEDS ASSESMENT. I WILL ALWAYS DO WHAT IS RIGHT FOR NEEDS, WE OBJECTIVELY REVIEW AND DO NOT STEER YOU TO A PARTICULAR PLAN

Answer: YES HE MAY BE SUBJECT TO IRMMA ADJUSTMENT TO HIS PART B AND PART D PREMIUMS, HOWEVER IF HIS INCOME IS LOWER, HE CAN FILE AND SSA-44 FORM TO APPEAL HIS IRMMA ADJUSTMENT, THEY USUALLY APPROVE ABOUT 70% OF IRMMA APPEALS.

Answer: THE GOVERNMENT SHOULD KEEP MEDICARE PROTECTED DURING THE SHUTDOWN,

YOU MAY EXPERIENCE SOME DELAYS IN PHONE SERVICES AND PERSONNEL BUT I DO NOTE SEE ANY ISSUE, IF YOU ENCOUNTER ANY DENIAL, DELAY OR YOU SHOULD REFILE THE CLAIM, ONCE THE GOV REOPENS AND IS AT FULL SERVICE. MY OPINION IS THAT THEY WILL RESOLVE THE ISSUE, AS THE POLICTICAL PARTIES, DOES NOT WANT THIS HANGING OVER THEM DURING MID TERM ELECTIONS.

Answer: MEDICARE HAS HOME HEALTH CARE SERVICES, FOR MEDICAL ISSUES, FOR 20 HOURS A WEEK. IF YOU NEED CAREGIVER SERVICES, THEN YOU WOULD NEED A LONG TERM CARE OR HOME HEALTH CARE POLICY.

IF SHE IS ON MEDICAID AND MEDICARE, SOME ADVANTAGE PROVIDE SOME CARE IN THE HOME, BUT IT IS LIMITED.

THERE ARE SOME HOME CARE POLICIES THAT HAVE GURANTEE ISSUE, SO SHE MAY BE ABLE TO APPLY FOR ONE OF THEM FOR ADDITIONAL HOME CARE.

Answer: SINCE YOUR NEEDS CHANGE , IF YOU HAVE A PART D OR AN ADVANTAGE ITS GOOD TO DO A REVIEW EVERY YEAR BETWEEN OCT 15 TO DEC 7TH. THESE TWO PLANS CHANGE EACH YEAR AND ITS IMPORTANT YOU REVIEW THE PLANS YOU HAVE AND MAKE SURE THAT THEY ARE THE BEST FOR YOU IN THE COMING YEAR, BENEFITS ON PART D AND PART C (ADVANTAGE PLANS) ARE ONLY GOOD FOR ONE YEAR AND EACH YEAR , THEY CAN CHANGE.

ON MEDI GAP PLANS , THEY RENEW EVERY YEAR AND THEY AUTO ADJUST TO ANY MEDICARE CHANGES, SO ON A MEDI GAP , PLANS F, G OR N, YOU DONT HAVE TO DO ANYTHING , AS THEY AUTO RENEW.

Answer: The best value for a medi gap plan will depend on yout individual needs

A plan N or a High Ded plan G can give you some affordable options all carriers benefits are standard, they compete on Price & Service.

Answer: The needs of everyone is different so its important to have a trusted advisor to do a needs assesment to be sure the plan you pick meets your needs.

You do have options if you selected the wrong plans and you may have some options to change plans.

Answer: Yes you can get exceptions for chronic conditions from Cms or use your plans customer service, or file an appeal with Cms

Answer: Its best to use a trusted advisor or use medicare.gov to make sure your Doctors are in the plans network.

Also call your doctor

Answer: Yes there are too many marketing companies who use captive agents that use high pressure tatics, to churn seniors into switching plan that dont need too.

Telemarketing should be outlawed for 65+ seniors.

BEWARE IF YOU GET A CALL ASKING FOR YOUR PERSONNAL INFO

Answer: Ypu can elect part A only which has hospital only care

But unless you have employer group coverage, you could be subject to a late enrollment penality on your part B cost

Answer: DUE TO THE INFLATION REDUCTION ACT, FUNDING HAS BEEN CUT FOR ADVANTAGE PLANA AND PART D PLANS. ADVANTAGE PLANS ARE UNDER A LOT OF FINANCIAL STRAIN SUE TO INCREASED COST.

LOOK FOR REDUCED BENEFITS FOR YEARS TO COME

Answer: You will need to enroll in Medicare A and B, 2 MONTHS BEFORE YOUR 65TH BIRTHDAY THE MONTH OF YOUR 65 BIRTHDAY OR 2 MONTHS AFTER YOUR 65TH BIRTHDAY. OR YOU WILL BE SUBJECT TO A PENALITY ON YOU PART B COST AND PART D COST

Answer: You can change any time, however you may need to answer medical questions.

Depending on the state you live in that has a birthday rule, you can change each year on your birthday. Some states let yoy change on policy anniversary

Answer: If they are on a Medigap, they wont have any issues.

If on an Hmo, they can only use the hospital if its for urgent care or emergency care.

Answer: IN SOME CASES , YOU CAN CHANGE PLANS, IF YOUR DOCTOR CHANGES AFFECT YOUR QUALITY OF CARE OR ASK YOUR PRIMARY Dr for a new refferal. Some plans like POS or PPO plans have out of network benefits.

Answer: You need to get a trusted advisor and go to medicare.gov for plan details.every one has different needs and you need to be sure the plan you get is the right one for you.

Many choices an experienced advisor can assist you