Robin Mulcahy, Medicare Insurance Agent

Answer: In my opinion... the government needs to sit down with the doctors and the insurance carriers to renegotiate the terms and conditions of the Medicare contract. Reimbursement rates to the doctors and insurance carriers need to be recalculated based on today's economic climate.

Everyone needs to remember that professionals working with the senior community have a very important duty to serve and protect Medicare beneficiaries.

Answer: With Original Medicare, you are not limited to using healthcare providers within a specific network. You may use any provider as long as they accept Medicare assignment.

Answer: You would need to first satisfy the Medicare part B deductible, then you would need to pay 20% coinsurance.

Answer: The Centers for Medicaid and Medicare Services (CMS) publishes the "Medicare For You" booklet and mail it to Medicare recipients annually.

It outlines and explains everything you need to know about Medicare open & special enrollments periods and penalties.

Answer: Medicare will only pay for care in a skilled nursing facility after a hospital stay. If you are recovering from a procedure or illness and no longer require full-time hospital care but are unable to care for yourself at home.

Days 1 - 20 are usually covered at 100% or for a small daily copay. There is a co-pay of $218 per day for days 21 - 100. After 100 days you are responsible for the entire cost.

If you require nursing care just because you are no longer able perform the activities of daily living, Medicare will pay nothing.

Answer: The Medicare Annual Enrollment Period (AEP) occurs every year from October 15th - December 7th, where you can change from one Medicare Advantage plan or Part D plan to another Rx plan to another. This plan change takes effect onJanuary 1 of the following year.

There are also Special Enrollment Periods (SEP) available throughout the rest of the years for certain qualifying circumstances.

Answer: The Inflation Reduction Act limits the annual out-of-pocket drug costs for Medicare Beneficiaries. As of January 1, 2025, the annual out-of-pocket maximum is $2,000 annually.

Answer: When enrolled in a Medicare Advantage plan, the plan supersedes the cost sharing of Original Medicare.

You will only be responsible for the $350 per day copayment for each day that you are an inpatient at an in-network hospital.

If you are in the hospital more than 7 days, your Medicare Advantage plan will cover 100% of the cost for the remainder of your hospital stay.

Answer: Many Medicare Advantage plans also offer nationwide provider networks.

Advantage plan's monthly premiums are much lower than Medigap plans, but you will have small copays for medical services. These plans have annual out of pocket amount maximums that limit how many copays you would be responsible to pay.

I would suggest comparing how much you are paying annually for your Medigap premiums to the annual maximum limits on the Advantage plans available in your area.

There is a good chance that you would pay less with a plan that has a lower monthly premium and copays for the actual medical services you receive.

Advantage plans also include additional benefits such as Rx medications, dental, vision and hearing aids.

Answer: I like helping seniors to help understand how Medicare works. I assist them with finding a plan that best fits their specific needs.

Answer: Yes, many Medicare Advantage plans include a free health club membership. Some plans also offer incentives to members for completing preventative health screenings.