Robert Helmkamp II, Medicare Insurance Broker

Answer: It seems that your friend may be on a Medicare Advantage plan that has no premium, while you are most likely on a Medicare Supplement Plan, which has a monthly premium. Nationally, Medicare Supplement plans range from $90 to $300 monthly depending on age and underwriting. Differences like copay amounts and supplemental benefits (Dental, Vision, Hearing) allowances for Medicare Advantage Plans can be different depending on which zip code you live in, but not premiums. So your friend will pay the same premium as you for the selected Medicare Advantage plan in your state, regardless of zip code.

Answer: Medicare Supplement Plans cover nationwide, so unless your current Medicare Supplement Plan is not available in your new state, you do not need to do anything.

Medicare Advantage Plans depend on which county you live in, so if you are currently enrolled in a MA Plan you will need to switch to one that is available in your new state and county.

You will have a Special Enrollment period, where you will able to view and enroll in a new plan for your new address. It begins the month before you move and lasts until 2 months after you move.

You should always contact a trusted and verified Medicare Broker located in the area where you will move to. They will be able to verify if your current Medicare Supplement Plan is available in your new state and also be able to show you all of the plans for that county if you will be using Medicare Advantage.

Answer: What I love most about being a Medicare Broker is putting clients on a plan that suits their specific needs and is better than what they are currently on. Since I am contracted with many Medicare Companies, I can show clients a variety of different plans and have them decide what will work best. I also love the business relationships I form with my clients.

Answer: Medicare can be confusing a lot of the time, while google search has improved every year, you still should contact a medicare broker or agent when having concerns. If you are still currently working, receive medical benefits through your job, and would like to keep your jobs plan, then you do not need Part B. Employer coverage counts as credible coverage, so you will not incur a late enrollment penalty when you decide to begin your Part B. You will need to enroll in Part B when you lose your employer coverage or if Medicare would be better and more cost efficient.

Answer: The disadvantage of a HMO plan is that you must use doctors that are in network with that certain plan in order to have the services covered. Any medical services received from an out of network provider will not be covered and patient will pay entire cost. PPOs allow you to see doctors outside the plans network, usually for a set higher copay, but PPO plans will usually have higher copays for most all services compared to HMO plans.

Answer: Telehealth options are available for beneficiaries who live in rural areas, this is covered under original medicare part B. Under original medicare, after you meet your part B deductible, you will be responsible for 20% coinsurance. Many medicare advantage plans offer telehealth visits with primary care providers or specialists, sometimes at a $0 copay. Medicare advantage may be a option to consider.

Answer: It is extremely rare to enroll in a Medicare Supplement/Medigap Plan without medical questions or underwriting. Unless there is a special enrollment period or you have guaranteed issue rights, if you do not enroll in a Medicare Supplement within the first six months of becoming Medicare eligible, you will have medical questions and underwriting. This could either increase your expected premium or coverage could be denied.

Answer: Only having Original Medicare may seem advantageous. You are able to be treated by any doctor/specialist who accepts Medicare. If you are admitted to the hospital, after paying your Part A deductible, you will pay $0 for days 1-60 in the hospital, during that deductibles benefit period.

Why add another premium on top of my monthly Part B?

The problem with only having Original Medicare is the cost of co-insurance and not having an Annual Out-of-Pocket Maximum on those co-insurance payments.

Under Original Medicare Part B in 2027, after you have paid your annual Part B deductible, you will pay 20% of the Medicare-approved amount for all Part B Services. This includes:

-Doctors and Clinical Services

-Outpatient Care

-Preventative Services

-Medical Equipment

-Mental Health Services

NO Out-of-Pocket Maximum=Original Medicare does not have a yearly limit on how much 20% coinsurance they can charge you.

Nearly all Medigap plans will have no coinsurance or copayments once you have satisfied your annual Part B deductible.

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: Medicare Advantage Plans often include additional benefits at no extra cost that Original Medicare does not cover — such as Dental, Vision, Hearing, OTC cards, and Part B premium reductions. The main tradeoff is that Medicare Advantage plans require you to use a network of doctors, pharmacies, hospitals, and healthcare facilities to receive covered services.

There are two common network types within Medicare Advantage: HMO and PPO.

HMO (Health Maintenance Organization)

A plan that requires you to use a specific network of doctors and hospitals contracted with the insurance company. HMO plans typically offer richer supplemental benefits like Dental, Vision, and Hearing, but you must use in network providers to receive services.

Key Features:

1. Primary Care Physician Required You must choose a PCP within the plan’s network.

2. Referrals Required A referral from your PCP is needed to see a specialist.

Out of Network Care: Not covered, except for true medical emergencies.

PPO (Preferred Provider Organization)

A more flexible plan that allows you to use the plan’s network of providers or go out of network. Out of network care is covered at a higher cost than in network care. PPO plans generally have higher copays and offer fewer supplemental benefits compared to HMO plans.

Key Features:

1. No Primary Care Physician Requirement You are not required to select a PCP.

2. No Referrals Needed You can see specialists without a referral.

Out of Network Care: Covered, but you pay more than you would in network.

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: 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: 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: 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: 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: 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: 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: 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: 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.