Robert Lukasik, Medicare Insurance Broker

Answer: A doctor is allowed to bill Medicare 15% more than what Medicare pays for a given service or procedure. To avoid this you would want a health plan that covers the excess charges so you are not responsible for them.

Answer: Original Medicare does not require prior authorisation for routine shoulder surgery, but it does need to be documented by your doctor that you medically need it. There is no specific timeframe, but they will likely see that you have tried alternative treatments such as physical therapy.

If you have a private insurance company plan along with your Medicare, they will likely require a prior authorisation for surgery and documentation of previous treatments.

Answer: Yes, you can drop your employer coverage and go to Medicare. However, you may want to talk to your employer before doing this, as many employers will not allow you to switch back to employer coverage once you opt out should you want your employer coverage back at a later date.

Answer: Yes, Medicare covers dialysis for in-home and outpatient. In general, you will be responsible for 20% of the cost after a 3-month waiting period. This is also regardless of age also. ESRD patients are given Medicare after the waiting period. It would be wise to consider a Medicare plan to help with the cost of the dialysis, and I can help with that.

Answer: Make sure you clearly understand all the changes that your plan will have for the following year. Any changes will begin at the beginning of the new year. If in doubt, you want to contact an agent or your insurance company to have any changes explained to you.

Answer: You can find out if a particular procedure is covered by Medicare by obtaining the name of the procedure and the billing code and then either calling 1-800-MEDICARE or going to Medicare.gov and using the Medicare coverage tool.

Answer: Once you have applied and Social Security has enrolled you, you should receive your card within 30 days.

Answer: I would not wait until 2027 and the 2-year lookback to be over. Because this was a one-time distribution in 2024 and not a reflection of your actual income, I would request an exemption from the IRMAA rule. Social Security frequently issues exemptions from the IRMAA rule because of this. You need to contact Social Security and request the exemption.

Answer: I would advise them to seek out help to assist them with their questions and to help them understand their options. I would also advise them to seek someone that has experience with many different options, specifically an independent agent that is contracted with different insurance carriers, so they can see and understand all their options and also someone that has experience with the Medicare system and all the programs that are available with Medicare that could possibly save them money and also help them find the plan that works best for their situation.

Answer: Yes. If the C-SNP plan you enrolled in is cancelled, you will have an opportunity to choose a new plan. You will be sent a letter prior to cancellation advising you of this.

Answer: The downfall or financial risk to staying with Original Medicare is you will pay 20% of the services you need or use. You could also have several deductibles for hospital or skilled nursing for multiple stays in a year. Another risk is it does not cover dental, vision or hearing should you need those services, and you will need to get a stand-alone prescription plan to avoid penalties, as it does not cover prescriptions either.

Answer: Not right away. The Insurance company will require you to change your plan to your new residence within 6 months, though. They do this because the monthly premiums are based on geographic location. If Florida has underwriting for Medicare supplement plans, your current and past health history may be a factor in the premiums you pay.

Answer: There could be several reasons why different agents may be pushing different plans. Some reasons could be the agent is only contracted with one or two carriers, or they are only selling commissionable plans; carriers do not pay commissions on some plans. It is important you ask any agent who they are contracted with. Ideally, you want someone that is contracted with all of the carriers in your area to give you the best possible outcome.

Answer: The biggest advantage to working with someone local is that you can meet them in person and develop a relationship of trust. Working remotely, that is a difficult task, and you cannot have a personal connection.

Answer: Medicare itself does not cover acupuncture. However, you may be able to get a plan that would cover a certain amount of acupuncture visits.

Answer: The different benefits you and your friend are receiving are determined by the plan you currently have. You or your friend may have different plans and receiving different benefits.

Answer: Those who are already drawing Social Security prior to age 65 do not have to enroll in Medicare. Social Security automatically enrolls you 4 months prior to your 65th birthday. This is very helpful and convenient and saves time and frustration.

Answer: Yes. There is a 2-year look back on your income, and if it is over certain thresholds, then you are charged a higher premium for Part B. You can apply for an exemption if you have recently had a life-changing event such as retiring and your income is substantially lower than it was 2 years ago.

Answer: Do not give personal information to someone you do not know over the phone. Do not buy your Medicare plan, benefits or anything over the phone. Ultimately, you do not know who you are talking to or where your information ends up.

Answer: You should contact an independent Medicare agent to see if you have a special election period available to you that would enable you to switch your plan.

Answer: The word better would be the reflection of someone’s personal opinion and experience with a particular carrier. The Center for Medicare publishes star ratings for every plan, and this can be a useful way for people to see how a particular plan is rated.

Answer: There would be no doctor network that would have to be adhered to. You could see any doctor that accepts Medicare. It should be noted that you would be subject to the current Medicare Part A and Part B deductibles, coinsurance and copays.

Answer: No, you will not. Medicare does not generally cover healthcare outside of the United States except in limited medical emergencies in a foreign country that is closer than the nearest U.S. hospital. If you are living abroad, you should still consider keeping your Medicare, though, if you plan to return to the United States, to avoid penalties. However, it may not be worth the cost if you do not plan to return and plan to live abroad permanently and will not travel very frequently.

Answer: Many Medicare Advantage plans offer zero premium plans. This is not a scam. Carriers are subsidized to facilitate your health care. This is how they are able to offer zero premium plans.

Answer: No, you should not expect a copay. Plan F covers emergency room visits, and you should not have a copay.

Answer: Yes, they are. Medicare plans are designed to represent a certain geographical area, and they can be substantially different from one area to another.

Answer: Choosing a plan that covers mental health therapies. Not all plans cover these equally. Finding the one that addresses your needs is the best option.

Answer: There may be a special election period that would allow you to switch your plan. Contacting a certified agent can help you see if you can change your plan.

Answer: Alternative therapy is available in some plans. When this is desired, you want to make sure the plan you are considering covers these types of therapies.

Answer: When considering changing plans, there are many things that need to be considered. Checking your current doctors with the new plan is essential to ensuring the plan will work adequately.

Answer: Everyone’s situation is different. Only after doing a thorough needs assessment can we determine what is the best way to go.

Answer: Yes. You should not receive a bill but should receive an explanation of benefits and what was paid on your behalf.

Answer: Not taking the time to meet with an independent agent to go over plans. Many just choose the plan a friend or family member has, and it ends up not working for them and costing them more money. Everyone’s situation is different, and even the smallest difference can cost money that could have been avoided.

Answer: I like meeting and helping people. Knowing that you are helping them with one of the most important aspects of their everyday life is very rewarding.

Answer: I offer a personal Medicare 101 class. I explain all the different parts and what they do and what to expect. I also go over all the different costs in each part.

Answer: Most plans offer no-cost preventive exams such as mammograms. There are other exams that are no cost as well.

Answer: As an independent certified agent, I can help you sort through all of it, from a personal Medicare 101 discussion to choosing the right plan. I answer all of your questions, and I am available year-round for any help or health questions that may come up.

Answer: As an agent, I help my clients sort through their mail and keep what may be important and throw out what is not. I also show them what mail to respond to and what mail will generate more mail and phone calls.

Answer: Medicare plans are required to cover some prescriptions in every category. Not all plans will cover the same prescriptions though. It is important to find the plan that covers your prescriptions.

Answer: The best way is to contact an independent agent that is contracted with all the carriers in your area. The agents, along with you and your parents, can compare all plans and together find the plan that meets all your parents’ needs.

Answer: You can certainly assist your parents with the enrollment process. This process can be confusing for many people, and assisting your parents with the help of an independent agent is your best solution.

Answer: The 2 most common penalties are not enrolling in Part B in the timeframe required. Part D penalties are also common, as many people do not know you are required to have this coverage even if you are not taking any prescriptions.

Answer: Working with a certified independent agent gives you the opportunity to compare all plans available to you. Not all agents are qualified to show you all plans and may only show you what they are certified to show you.