Richard Balistreri, Medicare Insurance Agent

Answer: It is important for folks to use a Medicare agent when they are transitioning into Medicare. We educate first and then do all of the research to find plans that meet our clients' needs and budget. We enjoy providing a valuable service for our clients.

Answer: Most Medicare Advantage Plans will have a $0 or very low premium. You will be responsible for paying your Part B Medicare premium.

Answer: As agents, we do a search to see what Medicare Advantage Plans your doctor participates in. The only time you would need to switch doctors is when there is not a plan that your current doctor accepts.

Answer: Medicare covers outpatient mental health intensive programs through Part B, but with some cost sharing. There is optional coverage depending on whether a client has additional Medicare coverage, such as a Supplement or Advantage Plan. The best way to research coverage is to refer to the Summary of Benefits for any Medicare plan you may be enrolled in.

Answer: If you are turning 65 or new to Medicare, you are allowed to purchase a supplement plan with no underwriting, which means you will not be denied coverage. If you elected not to purchase a supplement when you were first eligible, then you could be subject to underwriting, and you may be denied coverage based on your current medical condition. Some states have guaranteed issue rights at any time, so it is important to do some research and speak with a Medicare specialist.

Answer: This could happen if you were both on a Medicare plan with the same company. A lot of companies offer a discount when two people in the same household are enrolled with the same company. The discounts can range from 5% to 15%.

Answer: Medicare does not directly cover mental health services for caregivers unless they are also Medicare beneficiaries. That said, some Medicare Advantage (Part C) plans may offer additional benefits that support caregivers, such as counseling or respite care.

Answer: As long as you were covered by your employer's insurance plan with 20 or more employees, you are now able to transition into Medicare without any issues. You will need to apply for Part A and Part B to begin the Medicare journey. Once you have your number and starting date established, you are eligible to sign up for a Supplement or Advantage plan of your choice. We always encourage folks to watch our educational webinar that explains how Medicare works and what options they have with Medicare. It is important to educate yourself so that you can make the right decisions about your coverage.

Answer: If you're a Medicare beneficiary enrolled in Part A and/or Part B, and you're participating in a qualifying clinical trial, Medicare will typically cover routine costs such as doctor visits, lab tests, and hospital stays, and typical cancer treatments you'd receive whether or not you were in a trial.

For the clinical trial itself, items and services that are part of the trial protocol are covered if they would normally be covered by Medicare

Medicare may not pay for the actual experimental treatment (e.g., a new drug or device under investigation) unless it's FDA-approved for another use and being repurposed.

Answer: You must have Medicare Part A and Part B active to transition into Medicare. You must create an account at www.ssa.gov, if you do not already have one, to begin the enrollment process. If you are applying for Social Security to begin, they will automatically sign you up for both parts of Medicare. If you are going to delay your Social Security, you can sign up for Medicare only.

Once you have your acceptance letter with your starting date, you should contact a Medicare specialist to review your options and educate you about available plans in your area. We always encourage people to watch our educational webinar so that you will be well informed when making decisions about your Medicare coverage. Reach out to us for more information.

Answer: Part B has a medical deductible that everyone pays regardless of what plan you are on. Medicare does not have a maximum out-of-pocket. If you elect to stay on Medicare only, you are exposing yourself to costs that could be devastating. For that reason, you should consider a Supplement plan or an Advantage plan. A supplement plan does not have a maximum out-of-pocket, so after you pay your Part B deductible, Medicare-allowed charges are covered at 100%.

Medicare Advantage plans do have a maximum out-of-pocket, but it can range from $1,000 to $14,000 if you go out of network.

Out-of-pocket refers to the amount you would need to pay before your plan will pay 100% of the Medicare-allowed charges.

Answer: Medicare uses your IRS tax return from two years ago to determine if you owe more than the standard Part B premium. If your income has dropped significantly since then (especially due to retirement), you may be eligible to have your premium reduced.

Your Part B premium is based on the average of your previous two years' adjusted gross income, so when that average drops, you are encouraged to contact Medicare to reduce your Part B premium.

Answer: If you only need basic hospital care, the cheapest way to get Medicare coverage is to stick with Original Medicare Part A only, assuming you qualify for premium-free Part A. This is true if you or your spouse paid Medicare taxes for at least 10 years or 40 quarters.

You’ll still pay a $1,676 deductible per benefit period in 2025 and a daily coinsurance after 60 days of hospital stay.

Answer: The biggest mistake seniors make when enrolling in Medicare is to do it yourself. When you enroll yourself, you are the agent of record, and we can not help you. If you use an agent that you trust to enroll you, they become the agent of record and can represent you if you have an issue with a carrier. They can also keep you informed about current Medicare issues and make sure you are enrolled in the plans that meet your personal needs and budget.

It is always to your advantage to have an advocate on your side to help you with Medicare enrollment. Know your agent. Don't just call an 800 number in the likelihood that you will never speak to the same person more than once.

Answer: There is a maximum out-of-pocket of $2,000 for 2025. You need to make sure your medication is covered by your Part D plan so that it counts towards the deductible. After you reach the deductible, your medications should be covered for the remainder of the year without you paying anything more. This cap could provide significant financial relief to those with high medication costs.

Answer: Your best option is to contact the programs available in your state or residence. Medicare Extra Help (Low-Income Subsidy) or State Pharmaceutical Assistance Programs (SPAPs). You can apply online: https://www.ssa.gov/extrahelp or call Social Security at 1-800-772-1213.

Answer: We recommend Plan G most often. After you pay your Part B deductible of $257 for 2025, all of your Medicare-allowed charges are covered at 100%. If you want to save a little money, a Plan N offers very similar coverage, but you will have a copay of $20 for doctor visits and $50 for ER visits if not admitted. Also, it does not cover the 15% excess charges that some doctors and hospitals could charge.

Answer: Medicare's coverage for digital health tools is evolving. Some digital therapeutics, particularly those related to mental health, are now reimbursable, although coverage for other chronic conditions may still be limited. Coverage for digital therapeutics targeting various chronic conditions is still under consideration in 2025.

Answer: Medicare Part B covers preventive screenings like mammograms to help detect health issues early, often at no cost to the beneficiary if certain conditions are met. Your doctor should verify coverage before proceeding with all types of preventative screenings.

Answer: Your friend is probably referring to the $2,000 maximum out-of-pocket for 2025. After you reach the $2,000 threshold, your Medicare-approved prescription will be at a $0 cost for the remainder of the year. You also have the option in 2025 to request an expensive medication be put on "smoothing." This is a new plan this year that allows you to request an expensive drug be put on a monthly payment plan instead of paying the total amount all at once. Your pharmacy will contact the drug company on your behalf to set this up for you.

Answer: It is never a mistake to go with a Medigap plan. If you need to save money because premiums have increased, consider another Medigap plan, such as Plan N. There is a copay of $20 for doctor visits and $50 for ER visits if not admitted. A Plan N also does not cover 15% excess charges, but the premium can be $30 to $60 lower per month. It is best to consult with a Medicare specialist that can compare premiums for you. Keep in mind that if you want to go back to your original plan, you may be subject to underwriting, depending on your state options for Medigap plans.

Answer: We provide a Medicare webinar that anyone can watch at their convenience that is educational only. We cover the things you need to know to transition into Medicare.

Answer: Wow, great question. We always educate our clients on the difference between a supplement and an advantage plan. When you are first eligible for Medicare, you have guaranteed issue rights to get on a supplement without underwriting. If you have already been diagnosed with a medical condition, it may be your only chance to have a supplement that pays 100% of Medicare-allowed charges after you pay your Part B deductible. You can go to any doctor or facility in the United States, and you do not need referrals. You and your doctor get to decide what is best for you following Medicare guidelines.

Too often, agents only discuss Advantage plans because they are compensated with a higher commission for selling these plans. We do what is right and educate first. The decision to go on a Supplement or Advantage plan should be your choice, not the agent assisting you.

Answer: Plan G pays 100% of Medicare-allowed charges after you pay your Part B deductible. Plan K is less expensive, but it only covers Part B allowed charges at 50% until you hit the maximum out-of-pocket limit. For 2025 it is $7,060. After that it will pay 100%, just like a Plan G with a few exceptions.

Plan K also does not cover 15% excess charges that may be allowed. And it does not cover foreign travel emergency services. These are things to consider when comparing the two plans.