Robert Silva, Medicare Insurance Agent
Robert Silva
Robert L Silva Insurance Agency
Medicare Agent Licensed in NV, CA, CO and SD
Contact Details
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Location
Reno, NV
Robert Can Help With:
About Me
Navigating Medicare shouldn't be a solo journey. You deserve the personalized, local support that only an independent agent can provide. There is no cost to you for my services. I am compenstated directly by insurance companies, allowing me to focus entirely on finding the right solution for your needs. I am located in Fallon, Nevada and have an office in Reno, Nevada. I service Washoe, Churchill, Lyon, Storey, Carson City, and Douglas Counties.
Q&A with Robert Silva
Why not just call the insurance carrier directly?
Answer: If you want to enroll in a plan on your own, you could call the carrier directly. However, if you sign up using a broker that is contracted with that carrier, you will be able to get the same plan at the same cost. In this latter case, the insurance carrier generally pays the broker that signed you up a small commission every month that you are on the plan. That commission provides the funding for a good local broker to provide services to you beyond the original sale. For example, a broker can help you find the care you need within the network, assist with Prior Authorizations, help you solve billing problems, and help you change plans if necessary.
If you enroll on your own, you would not have access to a broker that is getting paid to help you. And it costs you nothing.
I changed my plan during Open Enrollment and now I can't see my regular specialist. Isn't this what the whole review period is supposed to prevent?
Answer: Medicare Advantage Plans contract with medical providers in order to be able to make medical services available to its members. For this reason, whenever considering a plan change, it is very important to check to see that the providers that are important to you are in network for the plan you sign up for.
I encourage all of my clients to think of their plans as a Medical Plan first and foremost. Does the plan provide access to all of the providers they want to see? Are all of their prescriptions in the formulary? What is their maximum out of pocket exposure? These questions should always be addressed when considering a plan change.
A good local broker will help you navigate your options by asking these questions.
Note as well, that a provider has the option to stop taking the plan at any time. If that happens, it is something that could not have been avoided. In that case, though, you may want to consider if there is a continuity of care issue. If there is, call the number on your insurance card, and ask the insurance company to cover that provider until the end of the year. The Annual Election Period (October 15th to December 7th) is your opportunity to do a review with your local broker to look for a new plan that will better fit your needs beginning the following January 1st.
Does Medicare cover CPAP machines and sleep apnea treatment?
Answer: A good way to find out if original Medicare covers anything is to refer to the booklet "Your Medicare Benefits" on medicare.gov. It is a bit tricky to find, but once you find it, you can download it. There is a discussion on page 29. Basically, you have to go through the paces first: A potential trial of CPAP therapy and meet with your doctor or other health care provider, and they document in your medical record that you meet certain conditions and the therapy is helping you.
When you sign up for a Medicare Advantage plan, most of the original Part A and Part B services will be covered by the Medicare Advantage plan. Those few services that are not transferred to the Medicare Advantage plan (such as hospice) are retained by and paid for by original Medicare. Between the two (original Medicare vs Medicare Advantage) all of the services in the "Your Medicare Benefits" booklet are covered.
The coverage for the CPAP machine will be covered as Durable Medical Equipment. The typical arrangement is that you rent it the equipment for 13 months. After that, the machine belongs to you. CPAP machines have a way to send your data to the doctor wirelessly. So be sure to use it. Otherwise the insurance company may not want to pay for it. Visits to a sleep doctor will come under a Medical Specialist. As well, the sleep specialist may order at home or outpatient sleep studies which are also covered.
I'm worried about the 'donut hole' in my Part D plan. How do I manage my medication costs once I enter it?
Answer: The "donut hole" to which you refer has been officially and permanently eliminated. Prescription drug plans now have only the following possible phases:
1. Deductible phase (determined by the plan, but will not exceed $615 per year in 2026)
2. Initial Coverage Phase (during which you pay the tier pricing described in your summary of benefits or evidence of coverage).
3. Catastrophic Phase. During this phase you pay nothing for the rest of the year for prescription drugs that are in the formulary. The maximum out of pocket costs to you (including the deductible) in 2026 prior to reaching the catastrophic phase is $2100.
When will my provider send my Annual Notice of Change?
Answer: Medicare Advantage plans can change every year on January 1st. Insurers of Medicare Advantage Plans are required to provide a notice to the Medicare beneficiaries on their plans that contains information about the changes to the plan benefits by September 30th each year. The notice is called the Annual Notice of Change. Many companies send the Annual Notice of Change well in advance of the September 30th deadline. If you are on a Medicare Advantage plan, you should receive your Annual Notice of Change (or ANOC) sometime during the month of September.
The Annual Election Period (which runs from October 15th to December 7th) provides you the opportunity to make changes to your coverage for the upcoming year. Plan changes made using the Annual Election Period will be effective on January 1st.
Your Annual Notice of Change letter is important. When you receive it, review it right away to help you decide whether or not you want to make an Annual Election Period change. Even better, look to your local broker who will help you understand the changes you are seeing in the context of the local and national markets. That information will help you decide whether or not you want to pursue a change. Sometimes it is better to stay put because the grass is not always greener on the other side of the fence!
I am moving to a different county in my same state, should I look at getting a new Medicare plan?
Answer: I assume that this question refers to a Medicare Advantage Plan (which has a defined service area). Check your existing plan Summary of Benefits or Evidence of Coverage to see if your new county is in the service area of the plan you currently have. If your existing specific plan is available in both counties, then you don't have to change plans. Be careful: Insurance companies list their plans by county, so even if the insurance company has a presence in the new county, your existing plan may not be available there.
If you don't have to change plans, I would still contact the plan to change your address.
Whether or not your plan is available in the new county, I suggest you contact a local agent that understands how Medicare works and is familiar with the plans and providers available in the local area to help you determine how you want to move forward in the future.
In the case of any change to your address, be sure to update your home address with Social Security.
I'm turning 65 next month; what are the first steps I should take regarding Medicare enrollment?
Answer: If you are still working and have creditable group health insurance for an employer that has 20 or more employees, you can delay Part B if it makes sense to do so. Whether or not you pick up Part B (along with its premium) is your choice. To help with that decision consider the costs and coverages of your existing plan, the cost and coverage of Medicare, and how they'd work together if you had both.
Otherwise, to avoid late enrollment penalties (especially for Part B), you should strongly consider signing up for Part B. The easiest way to do this is to create an account on the Social Security website (www.ssa.gov) if you don't have one. Once there, you can apply for Medicare. If you or a spouse contributed to Medicare for 40 quarters (10 years) then there will be no premium for Part A. Part B will have a premium.
If you have Part A and Part B, then you have the option of going with a Medicare Advantage plan.
I suggest that you work with a local broker that understands Medicare, your local market, and will take the time to help you understand your situation and needs so you can make an informed decision about the best way to move forward.
I worked for the federal government for 30 years and took early retirement. How does my federal retirement affect my Medicare options?
Answer: The Federal Health Employees Benefit system is a different system than Original Medicare (by that I mean Medicare Parts A and B). You can have both at the same time. If you do, you can eliminate most of your out of pocket costs. It is important as to know:
1. How much Part B and Part D will cost you if you pick them up.
2. How the Part B and D late enrollment penalties work!
Your decision whether or not paying for Part B and will depend on your financial situation and the FEHB insurance you are carrying into retirement. Most of the time it makes sense to pick up Part B. But I have seen a few situations where it doesn't make sense to pick up Part B. Be aware that you will have to pay a late enrollment penalty if you want to pick up Part B in the future. And that penalty stays with you for all the time you'd be enrolled in Part B. (Part D is similar).
if you look at the OPM website, you will see in the brochure for your current plan a section that covers how that plan works with Medicare. When you look at that, you might be confused about Medicare Advantage. Medicare Advantage plans are private plans that have a contract with Medicare. If you sign up for one of those, most of your Part A and Part B Original Medicare benefits are provided through that plan instead of Original Medicare.
Some of the FEHB plans have their own Medicare Advantage plan that coordinate so that most or all of your coinsurances, copays, and deductibles are eliminated. There is a tradeoff: All Medicare Advantage plans have provider networks. Your FEHB plan does too. Insurance companies have to contract with providers in order to provide the services to you.
There is quite a bit to this. I suggest you work with a good local broker that understands your local market to help you navigate the best path forward for you in your particular income and family situation. Also, talk a look at the Medicare sections of the OPM brochures for your current plan as mentioned above.
What happens to my Medicare coverage if I enter a skilled nursing facility for rehab but then need long-term care?
Answer: Sad to say, but Medicare doesn't pay for long-term care. It will only pay while there is a prognosis for improvement.
If you are planning ahead, you should talk with this with your financial planner as there are a variety of products that you can purchase the cover long term care. In particular, there is long-term care insurance, life insurance policies with a long term care rider, and annuities that pay for long term care. These options are far easier to do for young people for obvious reasons.
If you need long term care now, but cannot afford it, Medicaid covers long term care. You have to qualify for it on the basis of limited financial resources. You will likely need to spend down your assets before Medicaid pick it ups. Be aware, though, that the State will look to your estate after you pass to get reimbursed. I suggest talking to a trusted financial planner that knows about and has experience on this topic so that he or she can help you make a plan for you.