Paul Granen, Medicare Insurance Broker

Answer: A Medicare Supplement, or Medigap, is a supplement to Original Medicare offered by private insurance companies. Your Medicare (Red, White & Blue card) is what you paid into. MedSupps are underwritten, very similar to life insurance. Being denied by one carrier does not mean that another company will not accept you. Each company has their own underwriting criteria.

Answer: Plan benefits are very much location dependent. Not just State, but County or Parish. Some of the larger cities and metro areas often have richer plans and lower co-pays, which is relevant to provider participation in a particular market. The opposite may be true in very rural areas.

Answer: I am assuming that you are on a Medicare Advantage plan and not a Medicare Supplement. Medicare Advantage plans have co-pays for various ervices. Honestly, $300 sounds about average for many plans. This is not unusual or uncommon. Quite the contrary. The co-pay should be listed in your Summary of Benefits.

Answer: Generally, yes. But it depends on your definition of "covered". As long as it is a service approved by Medicare, it would be able to be claimed. How much your responsibility is depends on several factors. For example, if you have Original Medicare and a Medicare Supplement Plan F and Medicare pays the claim, you would generally have no out of pocket expense. The supplemet would pick it up. If you have a Medicare Advantage plan, the co-pays will vary widely with different plans available in your area.

Answer: The short answer is - it depends. Some plans have very little dental coverage and some have much more. Some plans also will have a co-insurance for comprehensive or major work, where others will have none. There are many variances by insurance company, specific plan, as well as the level of assistance the beneficiary may be entitled to. It is imprtant that the plan details are explained and compared properly. A good independent agent will do a plan comparison and go over the benefits of each plan and explain what is included and what is not. Beware of being "sold" on only one or two benefits of a particular plan without getting all of the details.

Answer: This will depend entirely on the benefits of your specific plan, as well as where the surgery takes place. If it is an outpatient surgery, then there should be a co-pay as outlined in your summary of benefits.

Answer: The short answer is no, but you can. If your employer is a large group (at least 20 employees), they can not force you to exit your group plan and go on Medicare. Having said that, it may not be a bad idea depending on your income, how much the group insurance is costing you, and what your benefits and deductibles look like. You generally have the option of deferring Part B until you are ready to leave the group plan. We sit down with our clients and review their current summary of benefits and costs to see if it would make better financial sense to stay put or make the move.

Answer: Generally speaking, many people who do have dementia will have someone close to them with a healthcare power of attorney to make decisions. At the very least, someoen with the cognitive ability to assist in making those decisions should be present. The beneficiary or insured should be able to understand the choices being made. And if not, we as responsible agents should not move forward without someone present that can.

Answer: That's a great question that can honestly not be simply answered without an individual review. In order to help you select the most appropriate plan for you, we would review a list of your doctors and other providers, in addition to your current medications list. Not all drug formularies are the same and networks certainly are not. Also, each person's preference may be different with what they would like to have and what isn't so important. Some plans may have a Part B giveback with higher co-pays. Dental benefits and other ancillary or additional benefits may or may not be offered and everyone's priorities are different. A good agent will take all these things into account and present options for you to make an informed decision.

Answer: That's a great question. First off, are they properly licensed. You can go to the dept of insurance for your state and search for the insurance license. This will generally let you know how long they have been licensed, whether or not they are a resident or non-resident licensed producer in your state, and many (not all) will show you a list of insurance companies that they are appointed with.

You can also search them on Google to see if they have any Google reviews. Facebook or LinkedIn is also another way to search for people. It is not necessarily a bad thing if you don't find them. Some people honestly just choose not to use social media. Having said that, it can be a tool to compile a more complete picture of who you might be dealing with.

I hope this healps a little.

Paul Granen

Granen Insurance

Answer: Having an advantage plan does not absolve you of bills unless you have Medicaid also. A solution, if you can be underwritten and approved, may be a Medicare Supplement, also known as Medigap. A supplement can pickup most if not all of the part that Medicare does not pay.