Mitchell Jerome, Medicare Insurance Broker

Answer: I would contest that statement as not valid. Statistically the Medicare population is split about 50-50 on those coverages. The Advantage plans are able to give extra benefits which Supplements can't: ie dental, vision, hearing aids, gym memberships, OTC, transportation.

I can safely say neither system is perfect, but they both work and are effective.

Personally as an agent and Medicare user, I've been on an Advantage plan since age 65 (now 73) and have had open heart surgery, gall bladder and cataracts removed. All were done with exceptional care. I always thought I'd only take the Supplement at age 65 but the Advantage plans kept getting richer and richer in benefits, so I went that direction. I present both options to my clients and let them decide.

Answer: Great question. This ANOC is so often missed by consumers because there's so much mail inundating each person during the annual enrollment period. This annual notice of change is simple, clear, and critically important when you want to compare the present benefits to the change in benefits coming in January. It will show line by line each benefit comparison... one of the most important mailings from each insurance company.

Answer: Medicare fully covers your breast cancer screening mammogram at no cost... This is an annual preventative exam.

But if anything suspicious shows up and more testing is needed, that becomes diagnostic — and that’s when cost-sharing kicks in.

Answer: I have been in this Medicare arena for 22+ years, and the digital age is strongly here now. I write hardly any paper applications and have very few paper catalogues in my office compared to ten years ago. People can sign up on plans through agents' hubs and insurance sites already... hard to know how much more can/will be added... then again, I'm no "geek", so there's probably another world out there yet to be activated.

Answer: Medicare actually covers a strong set of heart-prevention services—labs, counseling, diabetes screening, and annual planning visits—all at no cost.

Answer: Plan K will have lower monthly premiums versus Plan G but are you capable of covering the larger coinsurance once you trigger the benefits? Meaning what you're savings in premiums can easily be eaten up in costs for utilization. In other words you'd have to be able to pay 50% of the Hospital deductible, Doctor visits, blood, skilled nursing, I've written many health plans in 22 years but never a plan K...I'd rather look at plan N or Medicare HMO Advantage plans for more comprehensive coverages when funds are tight.

Answer: If you have Medicare A B then you can enroll in Medicare Advantage plans, which are the best fit for people under age 65 and on disability. At this time of year (not Annual Election Period) you can still enroll in plans that would be Chronic Special needs plans (C-SNP)...find an agent that can help you in your area as these plans are not widespread.

Answer: You're correct... PPOs don't require a referral... that's one main reason people take them, besides allowing them to go out of network to see providers. Are you confusing referrals with pre-authorization on procedures... HMO and PPO would require preauthorization for certain treatments.

Answer: I don't think that's an accurate statement. I live in Houston, 4th largest city, and Advantage plans are accepted by the hospitals. They definitely don't take every plan but they do have networks that are Medicare compatible. Main reason insurance co's and hospitals would have a riff is money; can't find an acceptable remuneration rate between them.

Answer: It’s specifically triggered by the loss of eligibility for the C-SNP — not simply by choosing to disenroll. So Medicare is protecting you should this incident occur.

Answer: Original Medicare covers very little dental care. Basically if you had a severe jaw infection, or cancer in mouth; a critical medical need. It will not cover preventative or comprehensive care.

A Medicare Advantage will grant you much more coverage vs original medicare for dental. Depending on the plan you can have some very good preventative and comprehensive care.

Answer: I can only speak for Texas where I"m licensed.

Supplement plans are less costly in the rural areas and Advantage plans are much richer in benefits in the larger urban areas.

Answer: Generally the only time you get a free pass to obtain the Supplement without answering health questions is when you first enter Medicare obtaining Part B. There could be exceptions too if the Advantage plan was being terminated then you'll get options to get Supplements without qualifying health wise.

Answer: If you only have original Medicare A B then you'll pay deductibles and coinsurance. If you're in the hospital over 24 hours then you'll pay the Part A deductible $1736 (2026 rate) and then 20% for the doctor treatment. But if you have a Medigap plan it will cover those gaps. If plan G you'd pay only the Part B deductible $283 (2026) then everything else is covered. If you have an Advantage plan you'd have copays or coinsurance for outpatient surgery.

Answer: I'd have to say when Joe "Willie" Namath, the famous football star would get on TV and say "FREE, FREE, FREE" to whatever he was hawking. First of all the correct lingo would've been "no charge." If we legitimate agents used that language we'd been fined up and down.

Answer: You can't reduce the IRMAA charges. They have a 2-year look-back window... so if retire, you might have a good chance to see it naturally be reduced if income reduces over time. Personally, I've had several executive clients of mine relay to me that a visit to SSA, sitting before a person, they were able to reduce their IRMAA charges. They basically pleaded they were retired and not making that income anymore. So what do you have to lose? Go to SSA and make a case.

Answer: Depends on the circumstances. Medicare Supplements can be changed anytime of the year but you must "qualify" by properly answering the health questions. It's not a guarantee they will accept you. Medicare Advantage plans generally are accepting applications during the Annual Election Period Oct 15-Dec 7. Then from Jan 1-March 31 people with Advantage plans can make another change if necessary [MAOP]. Then there are Special Election periods [SEP] during the year for people with Chronic conditions, Dual eligibles (Medicare-Medicaid) and Institutional situations. Yes it is overwhelming to shift through all this; so get an agent to help you so as not to make the wrong choice.

Answer: Once you retire, you can use your health savings account to pay for some of the Medicare premiums and expenses. You will no longer be able to contribute to your HSA account once you retire but now it’s time to use the money and it will be tax-free as long as you use it for acceptable medical needs. You can use it to pay your Medicare part B premium your Medicare part D drug coverage premium you can use it to pay your Medicare part C advantage plans, but you cannot use it to pay your Medicare supplement premium.

Answer: Yes. The IRMMA surcharge began in 2007 and focuses on higher income enrollees. They go back the past two years of income.

Once One retires that income can decrease since the two year window will continually be changing.

Answer: The Medicare prescription drug plan is quite complicated. Often times these Discount cards or alternative sites-Good Rx can be very beneficial in getting your medicines at a better price than what Medicare‘s drug plans offer. Having multiple options is very important for that reason.

Answer: The plans are designed by the government and marketed through the private insurance companies. Each company has different underwriting rules. You may be rejected by one company yet accepted by another so the company that takes you is the one I like. There are too many good companies to list. I like working with AM Best “A” rated companies.

Answer: Absolutely not! You have a huge deductible and incur very high finanacial risk. Get a Supplement or Advantage plan.

Answer: Yes eye exams are covered and so are diseases of the eye. Best to have a Supplement or Advantage plan thereby having full coverages without gaps.

Answer: These are unfortunate situations that could've been avoided if they had reached out to an agent upon getting on Medicare. Knowledge is powerful and some people bypass the free counseling that an experienced agent can provide... then it costs them in the end... sometimes for life! These are penalties for generally late enrollment.

Answer: Yes if you're outside of the open enrollment period (ie turning 65 and picking up Medicare A B) then you have to address health questions. There are some exceptions to the rule that might qualify you for a Guaranteed Issue position and bypassing the questions.

Answer: I don't believe AI will replace agents wisdom and years of experience... most people want to talk to a human being not a computer.

Answer: Many times I've helped clients through complicated issues and generally it's around their medications. I can calculate to the penny what their costs will be. I can help them get onto Patient assistance programs when appropriate.

Answer: As an independent agent representing a plethora of companies I can hone in on the best health & drug plans matching their particulars. They know that I'm working in behalf of their best interests and manuevering through very complicated material to get them the strongest plans. Very rewarding for me after 23 years in business to hear the gratefulness from my clients.