Robert Rowe, Medicare Insurance Broker

Answer: Premiums are the monthly/quarterly/Annual costs for your insurance coverage. Deductibles are the cost amount you typically have to play before receiving full coverage for covered costs. Copays is just what it sounds like it is a cooperated payment between the insured (client) and the insurance for a given medical bill (typically drugs, specialist visits and outpatient surgeries).

Answer: I think Over The Counter card benefits are the most overhyped benefit on a MAPD. The amounts are typically pretty insignificant in comparison to what you can SAVE on drug costs with the right drug plan or what you can SAVE in doctor visit costs by making sure your doctor and specialists are in network.

Answer: It all Depends on your current coverage and if it’s considered credible coverage in the eyes of Medicare. If you don’t enroll in Medicare but have credible coverage then you are completely fine. However if you don’t enroll in Medicare part A first and then part B between 3 months before or 3 months after your 65th birthday with NO credible coverage then you are subject to part B premium penalties.

Answer: They typically think Medicare covers long term care which in fact it does But for only 21 days fully and 22-90 with very large copays. Long term care is the single largest gap in a Medicare plan.

Answer: Your OTC card isn’t for junk food it is For healthy food intended to be preventative health care spending. Your transportation benefits are for rides to your doctor appointments not to go on dates or run errands. Those are the 2 biggest ones.

Answer: Very recently I had a client who was paying over $300 a month for his Medicare supplement plan, and when I tried to do a rate reduction for that, I uncovered an underlying condition with his heart and it was heart failure. From the heart failure he was prescribed very expensive heart medication‘s that while still covered under his drug plan were coming back with very high costs for him. So what I did was look at C-SNP Options that would actually put those expensive heart medication’s into his tier 6 drug formulary and we ended up saving him just by switching Medicare plans, over $9000 a year in drug costs.

Answer: The biggest regret I see in the field is from clients that switch their plans over the phone and have no idea of their drug cost will be covered or if their doctors are in network and they don’t even have an agent or broker to call/text if they have questions.

Answer: Medicare supplement plans or Medigap plans have discounts for living with a spouse or living with an adult (depending on carrier) on them which can’t get taken away at the time of death or during a plan change and move.

Answer: Yes of course. Working with an agent in person who is willing to always put your needs and your goals into your Medicare plan will bring lots of peace of mind. When it comes to eliminating bills, you are looking at Medicare Supplement or MediGap plans now because it seems you’d rather pay a monthly premium and not have to worry about paying any bills. If you’re set on Medicare advantage there are other ways to fill those gaps of coverage with alternative insurance policies like a hospital indemnity, accident and/or critical illness plan.

Answer: I wouldn’t say it’s headed for a “Crisis” but it’s definitely going to bring about year over year changes. The best way to protect yourself from all the future changes and the noise is through Medicare supplement plans.

Answer: Medicare has a couple ways to help support you through this. Medicare covers annual wellness visits to monitor your progression. Medicare may provide further counseling to discuss lifestyle and behavior change options. Some Medicare supplement plans and many Medicare Advantage plans have a silver sneakers benefit that will cover gym membership costs at participating gyms to help you manage your overall health.

Answer: There’s a couple options for you. The first option is that you may have to contact your doctor and ask that the drug be added to your drug formulary or contact your PDP provider and ask that the drug be covered under the plan. The other option is that you may be dealing with a chronic condition that would require its own C-SNP or Chronic Special Needs Plan. These plans have an extra tier of drug coverage for those using expensive drugs for Heart Failure, Diabetes and End Stage Renal Disease.

Answer: Medicare does quite a lot to address health disparities with its different types of plans: Medigap, Medicare Advantage, D-SNP, C-SNP and I-SNP. Each plan having its own way of covering health disparities in seniors but also the physically and mentally disabled.

Answer: Well cheapest doesn’t always mean lowest cost right? Your no premium Medicare advantage plan might be “cheap” but depending on your health concerns, doctor networks and prescription drugs it could end up being very costly year over year. This is one of the many reasons why it’s valuable to work with a certified Medicare agent.

Answer: I wouldn’t say there’s necessarily a trap with Medicare Advantage plans. There is just more maintenance required for them including annual reviews of your doctor and hospital networks, plan changes with carrier and preparing for the costs of copays and relatively high Max Out Of Pockets.

Answer: Maximum Out-of-Pocket limits are pretty much what they look like. They are the most possible costs you can be charged for a calendar year assuming all care is within network. Typically it will take a catastrophic health crisis to hit a MOOP or multiple serious health concerns within a short period of time. If you ever have a plan with a high MOOP I would recommend looking at hospital indemnity plans to cover that large gap in Medicare.

Answer: You should always apply for Medicare part A while in your Initial Enrollment Period. This is free for qualifying enrollees and gets you registered in the Medicare system and provides your Medicare card and number. When it comes to part B-D that all depends on your retirement status and what benefits you’re granted through former or current employer. If you’re turning 65 in the next 3-6 months you should definitely contact a Medicare/Retirement specialist and create a plan for your health insurance come Medicare eligibility age.