Rob Baer, Medicare Insurance Agent

Answer: You will after 24 months of receiving disability payments. Getting Medicare before age 65 requires you to be blind, disabled, or End Stage Renal Disease. So once your on disability for 24 months you will be auto enrolled into Medicare.

Answer: It would seem suspicious until you realize why they do it. These carriers are paid $1000-$1200 or more each month to provide you with a plan. Medicare is paying the carrier to give you a plan. How each carrier spends on the plans that really what differentiates the plans. Do they offer you cash back or incentive to enroll, or are they using the funds to offer extra dental, vision, and hearing. Or do they keep it to offer you a great health plan?

We each have different health and therefore can find a plan to fit us. United Healthcare offers 28 plans in NC. They are trying to make one that fits each person.

Answer: the 2 most common misconceptions is that Medicare covers everything, and that Medicare is free once you hit age 65.

Answer: The Inflation Reduction Act did fix insulin costs to a maximum $35 per month per type, provided it is on the carriers approved list. It sounds like your insulin may no longer be covered by your plan. Reach out to you plan, and ask. If they no longer cover your brand you have the option to change plans or change brands of insulin to one they do cover.

Answer: There are 3 types of special needs plans. Institutional, Chronic Health, and Dual eligible and each one was designed for a specific group of people. Institutional is for persons in skilled nursing institutions. Chronic health plans are designed for persons with perticular health issues specified by the plan. EX: Diabetes or Chronic heart plans require the beneficiary to have diabetes of heart disease which must be verified by a doctor. Dual plan require the beneficiary to be on both Medicare and Medicaid which must be verified as well.

Answer: I hope not as people need choices. Privatization would most likely restrict access to care and force higher healthcare cost by monopolizing carriers.

Answer: Contact the carrier and the provider to determine it the claim was properly submitted, filed, and transmitted correctly. Mistakes happen and no on is exempt.

Answer: Yes, all industries require regulations, and the Medicare Industry is no exception. There are bad actors that need to be caught and stopped from harming people. More can always be done to help stop fraud, waste, and abuse.

Answer: Medicare Advantage has a network based on the plan type, either in HMO, PPO, PFFS. PPO and PFFS plans may go out of network based but most likely at a higher cost share. Medigap plan require that the doctor accept Original Medicare.

Answer: You would be responsible for all expenses from any out of network doctor for all HMO plans unless it is a HMO POS for that particular issue such as cardiology. Meaning that the plan has insufficient cardiologist in network (minimum 2), and must allow beneficiaries to see outside cardiologist due to lack of in-network doctors.

Answer: It would depend on the type of surgery. But most eye surgeries and/or cataracts surgeries would be an outpatient procedure, and the relative outpatient copay would apply.

Answer: Learn your plan so you know what is considered billable and what is net. Or contact your carrier and ask them.

Answer: Knee surgery is normally considered and outpatient procedure, and therefore would fall under the Part B Medicare. It would then depend on the plan you had as to your portion of the cost.

Under original Medicare you would pay 20%, and if you had a Medicare Supplement the 20% would be covered and you would pay up to $283 for your portion of the Part B deductible if it has not already been met.

If you are on a Medicare Advantage plan it would be the outpatient procedure copay which can vary on some plans based on if were performed at a hospital or Surgery Center as many carriers have separate fees based on where the surgery took place.

Answer: Being married or single does not affect your Medicare Advantage plan but many Medigap/ Supplements plans do offer household discounts for room mates or multi person plan discounts.

Answer: Yes and No. All supplement plans are exactly the same for each individual lettered plan, although some may offer additional benefits for an additional premium, such as a gym membership.

Medicare Advantage plans vary by state and region, and most have multiple plans per state to choose from, which vary by region or county.

Answer: Generally yes, unless you are within your new to Medicare Guaranteed Issue time period, or your old carrier and /or plan has left the market, which provides you a Guaranteed acceptance to pick a new plan.

Answer: Medicare agents are certified and trained annually on Medicare rules and laws and have been trained and certified by each carrier they wish to represent.

A local Medicare agent knows the networks, healthcare providers, and pharmacies, to help you choose a plan that actually fits you and your budget. To a local agent, you are a person not a number, and you have a person to contact who you can rely on to assist you.

Answer: Having a local Medicare agent gives you access to the agent and their knowledge to keep you informed of changes to Medicare and your plan in the ways that it can impact you. Call Centers and Insurance carriers direct are limited in their ability to help individuals. Call Centers are contracted to sell a limited number of plans only for the carriers they contract with, and Carriers are limited to only offering their plans, limiting your access to to all other available plans. Like shopping for a car and going to Ford, who will never tell you about the other brands, regardless if one may better fit for you. Going to medciare.gov shows you all the plans available but you must do all the research yourself and know which plans are contracted which which hospitals and healthcare providers and keep up with the annual changes yourself.

Local brokers know the networks, and providers, and can help you find the plan that best fits your needs at the lowest out of pocket costs, and notify you each year if you need to make changes.