Nick Morris, Medicare Insurance Agent

Answer: Hi. You would owe your copay for the amount of days you were hospitalized up to 7 days. Any days over 7 would be $0 copay. Your part C plan negates the part A deductible.

Answer: The changes to Part D in 2025 put a cap of $2,000 on how much you might have to pay in a year for medications (this will be changing to $2,100 for plan year 2026), which could be beneficial to someone taking an expensive specialty medicine. You still want to check and make sure the drug is listed on the formulary of the plan you are on.

Answer: With most Medicare Advantage HMO plans, you would not be allowed to see your cardiologist if they were out of network and expect your plan to cover anything. There are a limited amount of HMO plans that do offer out of network benefits for non emergencies so you could see if your plan allows that.

Answer: With Plan N, the cost of an MRI should be covered at no more than Medicare's annual Part B deductible as long as the facility you are using accepts Medicare's assigned rates. I would inquire from the facility if they accept Medicare assignment or not. Assuming they are, know what the annual Medicare deductible is and know that you should not owe more than that. If the facility does not accept Medicare assignment rates, they can legally charge you up to 15% more as excess charges and you would be responsible with paying this excess amount with a Plan N.

Answer: You may or may not have considered everything while picking your plan in the first place. I would suggest consulting with a professional who can help you understand what options you have. Many times, there are opportunities to change your coverage at different times of the year that some people are unaware of. A professional can help assess your situation and let you know your options.

Answer: The first two programs that come to mind are the Extra Help program administered by social security and the Medicare Savings Program that each state administers. Extra Help is a program designed to specifically keep drug prices lower and manageable for those who have it. Medicare Savings Programs are offered through each state's Medicaid systems and may pay for the monthly Medicare premium and/or medical copays and costs for the beneficiary. Both the Extra Help program and the Medicare Savings Program are based on an individual's income and assets. Completing an Extra Help application online also sends your information over to the state you live in to assess your eligibility for the Medicare Savings Program. I always recommend someone with limited income and assets complete the Extra Help application first and then look for a follow up from the state once they have submitted that.

Answer: Checking your drugs versus available plans is the first thing. Sometimes, different plans will put different medications in higher tiers on their formulary versus another plan. There are some independent tools out there like GoodRX or Optum Perks that allow you to price medicine without running these through any insurance plan at major retailers. If you price your medications and notice 1 or 2 that are causing your price to increase, it might make sense to compare the cost of those medications versus your ability to use one of these tools independently of your insurance.

Answer: I do not believe there is one answer to this that applies to all people. Both original Medicare and Medicare Advantage make sense to some people. My best advice is to understand both options and consult with someone about the differences before deciding which makes more sense for you.

Answer: I believe talking with someone who represents multiple carriers and sells both Medicare Advantage and Medicare Supplement is important. These decisions are important, and there is a lot of confusing and conflicting information out there. Talking with someone and comparing the information you get from them with your own assessments and thoughts is something that I think everyone should do. I also believe that signing up with an agent is a good move, because it gives people another contact who generally is not directly associated with that insurance company. That way, if there are issues in dealing with that insurance company, you have someone else outside the organization you can consult with and obtain help from.

Answer: Both Medicare Supplement Plan G & Plan N are good choices for those looking to add a supplement to their Medicare plan. Plan G is the most comprehensive option, leaving the beneficiary only paying the Medicare Part B deductible annually for medical costs. Because this is the most comprehensive option for those aging into Medicare currently, these plans will be a higher monthly cost when comparing to Plan N. For those wanting to save a little on monthly premium and still have coverage that pays for most things, Plan N is a great option. Like Plan G, those who have Plan N are responsible for paying the Medicare Part B deductible annually. Once that deductible has been met, those who have Plan N will still have up to $20 copays when going to the doctor and $50 copays for an emergency room visit. These copays are the only other costs Plan N exposes someone too unless they see a doctor who does not accept Medicare assigned rates. If they see a doctor who does not accept assignment, Plan N would leave the beneficiary paying Medicare excess charges. When a doctor does not accept assignment, they can legally bill up to 15% more, which you would owe with Plan N.

Answer: To my knowledge, Medicare covers a "standard lens" option. People can opt to do more advanced lens options than this standard option, but that will come at whatever cost these upgrade options are.

Answer: If you are wanting to go onto Medicare once turning 65, then hopefully you have already gotten your Medicare part A & B set up at this point. Generally speaking, most people are automatically enrolled in both of these IF they are already set up and drawing a monthly benefit from social security. If someone is not already getting monthly ss benefits, then they are going to need to set up Medicare parts A & B. The easiest way to do this is from social security's website or setting up a call with social security. After this has been accomplished, then you want to decide what exactly you want to do with your Medicare. Are you wanting to add a Medicare supplement and/or Part D drug plan to your Medicare or are you wanting to take out a Medicare Advantage plan instead? Understanding the differences between these options along with the pros and cons are important.

Answer: Technology, as in all aspects of everyday life, will no doubt play a role in Medicare as we move along. Medical coding and getting pre-authorizations are increasingly dependent on technology to experience smooth and seamless processes. Even when shopping and comparing plans, many things are now directing consumers to websites and technology powered tools for these activities. As we progress, I believe technology savvy consumers will be able to better view their coverage plans and benefits in real time via web portals from their carriers.

Answer: In short, Medicare is not really meant to provide true long-term care for people. Medicare does provide up to 100 days of skilled nursing care coverage, at a maximum. It is important to understand that this coverage is truly meant for rehab purposes and, if it is determined that someone is probably past the rehab stage, the coverage can ended before 100 days have been used. For true long-term care, you should consult with an agent or someone who handles these policies and get information on exactly how they work so you can understand your risks and coverage options that are available.

Answer: I think the first thing to do is, if your parent still has the mental capacity to sign and understand documents then you can get with an Elder Law company and have them appoint you as durable POA. Unfortunately, if your parent cannot do this then I believe you are going to need a court to appoint you. For this, I would certainly recommend consulting with an attorney so you have things you will need in order to accomplish this.

Answer: I believe the biggest reason to work with an agent is that, if you do, you will have a personal contact outside of the insurance company to contact for simple questions or if you are ever having a problem dealing with the insurance company directly. Secondly, I would say the overall knowledge of an agent can help you make important decisions about your coverage and options that are available.