Nathan Curry, Medicare Insurance Broker

Answer: This answer would require a needs analysis based on the situation. Remember, Medicare is not one-size-fits-all.

In general, I would say the biggest "trap" with a Medicare Advantage plan is networks. You will be limited to that insurance companies network of doctors and hospitals and networks change often.

Answer: Yes, absolutely. If you are on Medicare with a supplemental plan you can go to any facility that accepts Medicare and receive these tests.

If you are on a Medicare advantage plan, your doctor will need to request prior authorization to the insurance company, if approved, you will need to use a network facility if you're on an HMO. If you have a PPO you would also want to try to stay in-network to keep your costs as low as possible. Always try to obtain these tests from a non-hospital facility to keep your costs down as well.

Answer: Absolutely, Medicare is accepted in PR no problem. My wife is from PR and she has family that travel there often. I doubt you want to spend much time in a Puerto Rican hospital but you would be covered if you had an emergency.

Answer: Yes. This will be a situation where if something happens to you while out of the country you will need to pay for your treatment on your credit card and seek reimbursement when you return stateside.

I just had a client break an ankle in Spain, when she returned we submitted her receipts and discharge paperwork (Get as much documentation as possible) and were able to get her reimbursed 100%.

Answer: Yes, and they have set new marketing guidelines to prevent plans that are not available in you specific service area from being marketed to you but there is still a lot of work to do.

I personally don't have a problem with a plan that is actually available to you in your zip code being marketed to you in a TV commercial especially if Medicare has rated the plan 5 Stars.

Answer: This is not a Medicare covered service. You will need to qualify for your states Medicaid program or be a veteran to have in-home care provided at no cost.

Your can also purchase longterm care insurance (get this earlier in life) or life insurance with a LTC rider.

Answer: You need to review your current plan as well as all the other plans available in your zip code every year during Medicare's annual enrollment period (AEP). This is where working with a broker really makes the process simple and stress free.

Answer: No, all Medicare Supplement rates will increase. Some companies raise rates based on attained age as well as normal company wide rate increases (loss ratio of the plan) . Some companies just raise rates based on the loss ratio only, these plans will have higher premiums initially but increase will be lower and more stable through the years.

Answer: You want to start that process 2-3 months before your planned retirement date. There are specific forms and applications you will need to complete and we all know social security can take its sweet time to process your documents and approve your Medicare benefits.

Answer: This depends on the area you live in but generally you will have higher deductibles, copays, and annual maximum out of pocket on a PPO when compared to an HMO.

I also tell my client, you can go outside of the plans network with a PPO, you will pay more to seek care out of network as well. But, an out of network doctor has no contractual obligation to treat you and may decide not to. We see this quite often in Florida where I am.

Answer: Yes! Go to SSA.gov or call social security 1-800-772-1213 and update your residential address.

You have 60 days before and after your move to acquire a new plan in your new area.

Answer: You certainly can, but most people would rather speak with a local licensed professional who represent all of the plans in their area rather than call 6 or 7 different insurance companies individually.

Answer: Medicare does not pay for groceries, but some Medicare Advantage plans can, if you meet the eligibility requirements.

#1- You have a qualifying chronic condition and there are C-SNP plans available in your zip code you may be eligible for a food card.

#2- You have Medicare and Medicaid and you have a qualifying chronic condition you may be eligible for a food card through a D-SNP plan in your zip code.

Answer: Born after 1955? Medicare Supplemental Plan G is the most comprehensive plan you can get. It covers 5 of the 6 gaps in Medicare. You have to meet the annual Part B deductible and the you pay $0 after that for all of your Medicare approved expenses. It's as close to full coverage as you can get.

Answer: I always tell my clients that these call will come, you can't avoid it. I recently had Thanksgiving dinner with my 81 year old grandfather and the were call him on Thanksgiving Day, good grief.

You can obtain a grocery card 1 of 2 ways.

#1: You qualify for a Chronic Special Needs Plan (C-SNP) These are plans for folks with Diabetes, Heart Disease, Lung Disease, and Chronic Kidney Disease. These plans vary on availability and are not offered everywhere. You will be required to verify your chronic condition upon enrollment.

#2: If you qualify for Medicare and Medicaid. You would be eligible for a Dual Special Needs Plan (D-SNP) you would also have to have a qualifying chronic condition to receive the grocery benefit.

Answer: A local broker will have a much better idea of the local healthcare landscape compared to a telesales agent. They will know the local hospital systems and they will know what plans work for people in your area and what plans to avoid.

Also, telesales agents a hourly + commission employees who will never think about you again after they write your policy. Someone who is local is more likely to follow up with you every year and make sure your on the best plan for the coming new year.

Answer: The best thing you can do is find a local BROKER. Someone who represent multiple insurance companies. If an agent only shows you one or two products, run!

Answer: Not obtaining a Medicare supplement plan during their initial enrollment period. You have 6 month before and 6 months after your Part B effective date to obtain a Medigap plan without medical underwriting. Miss that window, all bets are off.

Answer: Not obtaining a Medicare supplement policy during their initial enrollment period. You have 6 months before and after you Part B effective date to obtain a Medigap plan with out medical underwriting (this varies by state but applies to most states).

Answer: Medicare Parts A&B do not cover hearing aids. If you have a Medicare Supplemental plan they also do not cover hearing aids, you would want to purchase an ancillary policy for that, most people add a DVH (Dental, Vision, and Hearing) policy. Prices do vary, but for a quality DVH plan you looking around $100 per month.

If you are on a Medicare Advantage plan many insurance companies do offer hearing coverage. Weather it be copays based on the hearing aid level of quality, or a dollar amount they would pay (example $500 per year per ear)

Answer: That question does not have a black and white answer. That depends on your budget, doctors, and medications. Medicare is not one size fits all, thats why there are so many plan options.

I will say this, generally, the RX costs and deductibles are lower on Medicare Advantage plans when compared to standalone Part D drug plans.

Answer: To give a quick answer, I would say the most beneficial part of telemedicine is that it gives seniors who travel frequently (snowbirds) the ability to talk with their provider and obtain medication refills without an office visit. My grandparents are in their 80's and still spend 4 months of the year in Florida and they both utilize telemedicine while avoiding winter.

Answer: As long as your Medicare Part A & Part B are both active on or before January then yes! You seek medical services immediately.

Answer: Most Medicare Advantage plans are "Premium Free", in most cases you will still pay your Medicare Part B premium.

However, they are not "Cost Free", with a Medicare Advantage plan you will still be subject to deductibles, copays, and coinsurance until you meet the plans annual maximum out of pocket (MOOP) for the year.

Answer: If you have a Medicare Supplemental plan you would do nothing. Once a major diagnosis hits you would not be able to change or switch your insurance company because that would require medical underwriting.

If you're on a Medicare Advantage plan depending on the time of year and the nature of the condition, you may be able to join a C-SNP (Chronic Special Needs Plan) or you may have to wait for the Medicare Annual Enrollment Period

Either way, it would be best to speak with a local BROKER!

Answer: Honestly, I tell all of my clients if you can afford a Medicare Supplemental plan that is what you should do.

Now, if it's financially burdensome or you are very healthy and can't justify the additional premium every month then let's look at your Medicare Advantage plan options.

Being in a MA plan is the safer route over just having Part A & Part B.

Why? Because with original Medicare you have no max out of pocket, so one major health event can really add up. With an Advantage plan you will have an annual out-of-pocket max.

Answer: No. This is a benefit offered by most of the Medicare Advantage plans. Although, some insurance companies do offer gym memberships with their Medicare Supplement products too.

Just having Part A & Part B will not entitle you to a free gym membership.

Answer: Yes, you will need to have your HR department complete the L564 for both of you. You can upload them online at SSA.gov or you can stop by your local social security office.

Answer: Not necessarily. Medicare generally does not cover routine vision care, eyeglasses, contact lenses, or monovision lenses for vision correction. Medicare does provide coverage for corrective lenses after cataract surgery, but upgrades or specialty lens will be out of your pocket.

Answer: Original Medicare does not cover any prescription that you pick up at the pharmacy. Only medication administered by a physician is covered under Part B.

If you have Original Medicare with a Medicare Supplement, you would need a separate Part D prescription drug plan and would want to make sure Symbicort is included on that plan's formulary.

The same applies if you have a Medicare Advantage plan that includes prescription drug coverage. Always check the plan's formulary, which is simply its list of covered medications, to see whether Symbicort is covered and what your cost would be.

Answer: No, Original Medicare does not include SilverSneakers or other fitness programs such as Renew Active or Silver&Fit. Those benefits are most commonly included with Medicare Advantage plans.

There are also a few Medicare Supplement companies that offer fitness benefits with certain plans, but it's not standard. If having a gym membership or fitness benefit is important to you, it's definitely something worth looking at when comparing your Medicare options.

Answer: One of the biggest misunderstandings I see is people thinking Medicare will pay for long-term care or a nursing home if they need one later in life. Medicare does not cover long-term custodial care. It can cover skilled nursing care for a limited period of time if you meet Medicare's requirements, but that's very different from paying for someone to live in a nursing facility long term.

Long-term care has to be planned for separately. That could mean paying out of pocket, certain VA benefits for those who qualify, purchasing traditional long-term care insurance, or using a life insurance policy with a long-term care rider. If you don't have another way to pay, Medicaid may eventually become an option once you meet your state's financial and eligibility requirements. With nursing home costs easily running thousands of dollars per month, this is something I always encourage people to think about before they actually need the care.

Answer: Yes, absolutely. In fact, many of the Medicare clients I work with have an adult child helping them through the process.

Your daughter can gather information, compare options, attend appointments, ask questions, and help you evaluate plans. The only limitation is that if she is not your legal Power of Attorney (POA), she cannot enroll you in a Medicare plan on your behalf without your participation.

Once we’ve identified the best option, we’ll simply schedule a time when you’re available and complete the enrollment together. That can be done through a three-way phone call, a Zoom meeting, or an in-person appointment. Many families find this approach helpful because it allows everyone to be involved in the decision and ensures that the parent understands and agrees with the coverage being selected.

Answer: Artificial intelligence is likely to play a significant role in how Medicare processes and approves claims in the future. AI could help speed up the review process by rapidly analyzing large amounts of data to detect patterns, flag potential fraud, and ensure claims comply with coverage guidelines. This could result in faster approvals and fewer delays for people waiting for critical care or reimbursement.

However, it is critical to strike a balance between efficiency and accuracy. Human oversight will still be required, particularly in complex cases, to ensure that people are not unfairly denied coverage. Overall, AI has the potential to improve the system's efficiency and responsiveness.

Answer: Long-term nursing home care is not fully covered by Medicare, as is commonly believed. Medicare Part A may cover a short stay in a skilled nursing facility, but only under certain conditions, such as following a qualifying hospital stay and requiring skilled care. Even then, the coverage is limited to 100 days. The first 20 days are completely covered, but on day 21, there is a daily copay.

Medicare does not cover long-term custodial care, which includes assistance with daily tasks such as bathing, dressing, and eating. Long-term care insurance, Medicaid (if you qualify financially), hybrid life insurance policies with long-term care benefits, or personal savings and assets are all options for paying for this type of care.

Answer: Thinking that Medicare covers everything 100% including dentistry, vision, hearing, and long-term care is one of the most often held false beliefs about Medicare. The truth is, Original Medicare (Parts A and B) has gaps in coverage, which is why many people need additional plans like a Medicare Advantage or a Supplement to help cover those out-of-pocket costs. It catches a lot of people by surprise if they don’t plan ahead.

Answer: One of the most common misconceptions people have about Medicare is thinking that it covers everything 100%, including things like dental, vision, hearing, and long-term care. The truth is, Original Medicare (Parts A and B) has gaps in coverage, which is why many people need additional plans like a Medicare Advantage or a Supplement to help cover those out-of-pocket costs. It catches a lot of people by surprise if they don’t plan ahead.

Answer: What I enjoy most about working with Medicare clients is being able to simplify a complicated process and help people feel confident in their decisions. Medicare can be overwhelming, especially with all the different parts, plans, and rules. I really enjoy breaking it down, answering questions, and finding the best plan to fit each person’s needs. It’s rewarding knowing they walk away with peace of mind and coverage they can count on.