Nancy Suozzi-Vidal, Medicare Insurance Broker

Answer: SSDI is based on having a disability and qualifying for payments that you have paid into thru your work history; similar to SS benefits. Those on SSDI are eligible for Medicare before 65 after 24 months collecting disability payments (they will consider start date when deemed eligible). Some conditions will qualify for Medicare immediately or sooner.

Many Medicare Advantage plans offer additional benefits for specific chronic conditions.

SSI is disability for low income; not based on work history. SSI recipients typically qualify for Medicaid. It is possible to receive SSI and SSDI. This individual would then qualify for both Medicaid and, after 24 months of SSDI benefits or sooner if exception, Medicare regardless of age.

Answer: When I research appropriate plans for a client, I start with their preferred providers and prescriptions. Then I compare viable plan premiums, copays, deductibles, coinsurance, need or no need for dental, vision and other value-added benefits. Also, number of specialists, frequency as well as any known upcoming procedures, treatment are very helpful. Typically plans have a “give and take.” The challenge is determining the plan that is cost effective overall based on client’s anticipated utilization. So, I would never recommend a plan just because it has the lowest monthly premium.

Answer: No, Medicare does not cover routine vision care such as eye exams by an optometrist nor eyeglasses. You are eligible for eyeglass under Medicare only after cataract surgery. Medicare does consider an Ophthalmologist a specialist so these services are covered under Medicare.

Medicare Advantage plan may offer routine vision benefits such as routine eye exam and benefits for eyeglasses or contacts. Best to use their participating vision retailers.

Answer: An individual’s current health conditions, budget, doctors, Rx as well as many other unique factors come into play when deciding the type of Medicare plan. For example, a consumer who can afford a supplement Plan G (Medigap), may want the travel benefits or just the ease of setting and forgetting. That certainly does not mean this consumer would not save money with a Medicare Advantage plan.

I don’t agree with the statement that MA plans are “free.” You may likely find a $0 or low premium MA plan. Unlike the Supplement G, there are OOP costs by service with some exceptions for PCP visits and preventative services.

Supplement plans are your traditional risk model for insurance where you pay a high premium monthly for services you may or may not receive. Our government created Medicare Advantage plans as an alternative to that model in 2006.

Other factors are high utilization of services as well as if you reside in a state that does or does not have underwriting for Medicare Supplement plans. Another consideration is that Supplement plans do not include Part D, dental or vision which are added costs in addition to your high premium monthly.

In NY and CT, for instance, there is no underwriting for Supplement plans,therefore, there is more incentive to save money by enrolling in a MA plan initially. This means that when you become more in need of health services, you will not be charged more for existing health conditions when you switch.

There are considerations, of course, whether a consumer qualifies for a subsidy or Medicaid. In the case of Medicaid, sale of a Supplement plan is prohibited and unnecessary.

Selecting your Medicare plan is based and individual needs, preferences and resources. This is why I educate, research, review and compare all options so the consumer can decide what plan is best for them at that time.

Answer: There are some individuals that their actual income puts them over the income limits to be eligible for Medicaid. Qualified medical expenses can be applied to the income excess, thus qualify one for Medicaid.

You should have/should apply for Medicaid. Based on your income it is possible you are subject to a monthly spend-down. Paid and unpaid Medical expenses can be credited toward your spend-down. The concept here is to "stops the bleeding" so you don't continue debt and can continue servicing your healthcare needs. Once your expenses are all credited, most likely you will be eligible for Medicaid without a spend-down (assuming your income is low).

A way to easily manage this - so you would not be bankrupt- is by setting up a pooled trust. There are companies that do just pooled trust for Medicaid Spend-downs. I refer my clients for this service.

I also recommend enrolling in Dual Advantage plan since you are eligible for Medicaid, as long as the spend-down is met via medical expenses and/or routine monthly applicable expenses via the pooled trust.

I have had much experience with this scenario. There are resources but they aren't "advertised" and can seem complicated.

I hope this is helpful to you. There is more to explain but this is a good start of the concept.

Here to help.

Answer: No you do not need to reenroll in Medicare. You will automatically transition to age-based Medicare. You do have a new enrollment period available to you for Medicare plans. Typically your disability will change to social security benefits.

Answer: First we need to define universal. Are we debating within the US or worldwide?

In the US, we already have socialized medical programs, Medicare and Medicaid. These specialized programs in the US do not exist/are not recognized in other countries. Personally, I do not think a world-wide healthcare system could support the increased aging population and access to qualified providers which can have extreme differences - even just different areas of the US - let alone across the globe.

We often learn, for example, when provider organizations continue to grow, they get too large and our no longer able to service their population effectively. Eventually, these overgrown establishments need to decentralize and/or, more likely, down size. Same with healthcare in general.

The US healthcare system is very complex. I think a very important aspect of reducing cost is simplification. My thought is that we have socialized medical programs that have existed for decades but have not been updated to our current healthcare needs. So we have been putting band-aids in place creating loads of exceptions. Instead of spending trillions of dollars trying to reinvent the wheel, how about spending less money to continually improve the programs we have? Simplifying , reducing fraud, waste, abuse allows for funding to be applied for what is was originally planned. This also reduces funding of duplicate programs that are still not accomplishing their original directive.

It could well be possible, with the right minds involved, to create some sort of universal general healthcare coverage, with the hope of a simple, ease-to-understand option.

Certainly Medicare which is currently in the US based on collection of FICA in most cases, would drastically change if looking at Universal. There has been talk within the USA to have Medicare for all. In the later case, still significant changes. Before we take on universal, I think we have a lot of work to provide much better healthcare here

Answer: Determine why the doctor is stating this… typically certain criteria need to be met; prior authorization typically required so you can know in advance if approved or not;

If Medicare is primary, get specific procedure codes from provider’s biller and contact Medicare;

If Medicare Advantage, you can discuss with your carrier reason for denial and determine what further info needs to be submitted by your doctor

Answer: Routine services that would normally be covered under Medicare may be covered for participation in a clinical trial. But, clinical trial services and experimental treatment will not be covered. Any covered services would most likely be subject to prior approval. Likewise, your OOP responsibility would apply for covered services. Your provider should work with Medicare or other Medicare plan coverage carrier regarding specific criteria to actually participate. I also recommend the patient discuss with a carrier nurse to determine any patient responsibilities.

Answer: You still want to try to secure a plan that has most or all of your preferred providers participating. A PPO plan will give you the option to see a nonpar doctor should that need arise. There is an added cost, however, if that situation arises with an HMO, you will be responsible for 100% for the nonpar provider.

Answer: Meeting amazing, unique people everyday and being able to give back by offering my assistance, expertise in a confusing yet very important subject matter