Robert Helmkamp II, Medicare Insurance Broker

Answer: Medicare can be very complex and confusing, you can be new to Medicare and feel overwhelmed by all the terms, but even people on Medicare for years can still find themselves overwhelmed when looking at switching plans. This is why it is so important to work with a local Medicare agent or broker that is licensed and able to explain plan benefits and copays. Having a Medicare broker or agent should never cost you anything to be their client. If you decide to switch or enroll with one you may contact them with any questions you have on your plan, instead of calling a carrier yourself. ALLOW ONE INITIAL APPOINTMENT with an agent before contacting them with questions or concerns.

Answer: Always try to find a licensed Medicare Broker or Agent when looking at enrolling, changing plans, or for more information on copays/benefits. Meeting with them and possibly becoming their client does not cost you anything, we are paid directly by the companies. If you decide to enroll with one they will become your agent and you may contact them with future questions about your plan.

Answer: Original Medicare most times will cover cataract surgery if the cataract is affecting your vision or daily activities. If the surgery is approved, Medicare will cover removal of the cataract, implantation of a standard intraocular lens (IOL), and hospital stay if necessary. When considering Medicare plans, it is much cheaper to have a Medicare Advantage or Supplement Plan when it comes to in/out patient procedures, hospital stays, and doctor copays. With a Medicare Advantage you will have set copays for all doctor visits, er/hospital stays, out/in patient procedures, and added supplemental benefits not offered by Original Medicare like Dental, Vision, and Hearing. The out of Pocket Costs for a cataract surgery with just Original Medicare would be:

Coinsurance: Typically 20% of the Medicare-approved cost

Deductible: The annual deductible for Part B is currently $257 (2025)

Upgraded IOLs: Medicare does not cover the cost of more advanced or specialized IOLs

Answer: No, Original Medicare Parts ( A and B) do not cover Fitness Smartwatches that track heart rhythm or other vitals. Also Original Medicare does not cover Medical Alert Devices. If you are interested in getting either and having it covered by Insurance, some Medicare Advantage Plans offer coverage for these devices.

Answer: As of Nov. 24th 2024 Medicare Covers AI-Powered diagnostic tools to detect Coronary Artery Disease when "it is reasonable and medically necessary as a diagnostic study” and also patients present acute or stable chest pain.

Answer: If you become Medicare Eligible while still working and receive health insurance through your job, you have a choice to stick with either your employers coverage or to enroll in Medicare. When making this decision it comes down to cost, which is more beneficial to you, your employers coverage or Medicare. If you decide to stay with your employers health plan, your employers plan is considered “creditable coverage”. As long as you have had creditable coverage since becoming Medicare eligible, you have a three month Special Enrollment Period when you lose your employers coverage to enroll in Medicare without any penalties.

Answer: If you or your spouse work for an employer that offers medical coverage you may delay enrolling in Medicare Part B. In any other situation you will penalized a late enrollment penalty if you do not sign up for Medicare when first eligible.

Answer: A shrinking workforce could place a significant strain on Medicare funding within the next 20 years due to reduced tax revenue from actively working individuals and an aging population placing a greater burden on the system. As the workforce and number of active taxpaying workers shrinks, fewer workers will be contributing to the Hospital Insurance Trust Fund. As the number of beneficiaries, particularly baby boomers, continues to increase, this will lead to higher overall Medicare spending.

Answer: Technically Yes, you may change your Supplemental/Medigap plan at anytime throughout the year. Unless you are approved for Guaranteed Issue and if you are outside of the 6 month Medigap Open Enrollment Period, which is the first six months after you become eligible for Medicare and enroll in Part B, then you will be subject to medical underwriting. Medical Underwriting factors in your current age, current health status, and any pre-existing conditions. Then the company will either deny coverage due to these factors or issue a policy with a premium that reflects the Medical Underwriting.

MEDIGAP OPEN ENROLLMENT PERIOD: If you enroll in a Medigap/Supplemental plan within the first six months after turning 65, you will be approved for almost any Medigap Policy at the lowest price, regardless if you have pre-existing conditions or health problems.

GUARANTEED ISSUE: Means you can switch Medigap/Supplemental Plans without Medical Underwriting. This only applies to certain situations, like moving out of plan's service area or losing employer sponsored coverage. In very rare occurrences, a company may offer Guaranteed Issue for their Medigap Plans during Annual Enrollment Period.

Answer: While Medicare Advantage Plans offer many additional benefits for no cost that are not covered by Original Medicare, like Dental, Vision, Hearing, OTC Cards, and Part B Premium Reductions, they are limited to a specific network of Doctors and Hospitals. If you use a doctor or have a procedure at facility that is not in the plans network, you will have a higher copay for these services or they may be denied and not covered by the plan. This could potentially lead to higher out-of-pocket costs.

Answer: Most all Medicare-related scams are done through Email or Telephonically. If you receive a phone call or email from an unknown source and they state they are from Medicare, either stating new benefits you are eligible for or trying to discuss your current plan, ignore the calls or emails, do not respond to the emails or call back any numbers. Medicare will always reach out directly via mail if there is any issue with your Traditional Medicare. Unless the prospective Medicare client fills out a business reply card, requesting a broker or agent contact them, then any form of unsolicited contact with a Medicare Enrollee is deemed strictly illegal by the Center of Medicare Services. Never give out personal information like your Medicare ID or Medicare Plan ID Number unless you know this information will be given to a trusted source. While you may enroll in Medicare Advantage Plans Online, it is always highly suggested you speak with a licensed medicare agent or broker first.

Answer: Only having Original Medicare may seem like a logical decision, you are able to be treated by any hospital or doctor who accepts Medicare, so there is no network you need to take into account when finding medical care. The problem is the cost associated with Original Medicare. Without a Medigap Plan, sometimes called a Medicare Supplement plan, you will have deductibles and coinsurance on both Part A and Part B services. Here is the breakdown:

Part A

-Deductible=For each benefit period (starting with a hospital stay), the deductible is $1,676.

(* A benefit period ends when you have not received inpatient hospital care in 60 consecutive days, after this period ends you will need to pay the deductible again if your are admitted to the hospital*)

-Co-Insurance= $0 for days 0-60 $419 per day for days 61-90 $838 per day for days 91 and beyond.

Part B

-Deductible=The annual deductible is $240.

-Coinsurance=Generally, you pay 20% of the Medicare-approved amount for most services after you meet the deductible