Ron Gambles, Medicare Insurance Agent

Answer: Between Medicare Advantage and Original Medicare with a Med Sup Plan and a Rx plan, which will best meet my specific healthcare needs in the long term? It is important to get a full understanding of the benefits and downsides of both options before choosing.

Answer: The trade-off is cost. While you will gain a greater degree of flexibility, your portion of cost-sharing will increase what you pay out of pocket. Also, your cost could be further affected if you do not contact the Plan to verify the out-of-network treatment you are seeking is medically necessary and will be covered.

Answer: In general you should contact your plan, particularly if you have an Advantage Plan. They typically have specialized treatment classes that target specific conditions.

Answer: Generally, services such as yearly immunizations for example, flu, shingles and routine screenings like mammograms'. However, these are typically limited to a set number for a given period. For a full comprehensive list contact your Plan.

Answer: The short answer is that it will impact at least three variables; cost, scope of coverage and types of coverage available. Where this actually lands is an open question with no certain answer until it is decided.

Answer: The first thing you can do is decide and enroll into a plan when you first become eligible. You will need to assume responsibility to gain an understanding of how to navigate the Medicare processes, or have a reliable loved one to assist you. Shop for the Rx plan that best meets your needs at the best price, they change every year.

Answer: Always consult with your Plan when you relocate. It may or may not be necessary because each Plan varies in it's geographical coverage.

Answer: You can enroll. However, you will be required to pay both Part A and Part B Premiums out of your own pocket in addition to premiums for a Medicare Supplement Plan, Rx Plan or whatever Premiums for an Advantage Plan. All of which will be very costly for the average person.

Answer: More than likely private insurers will lobby to set limits on that expansion. It will also probably result in cost increases somewhere in the plan.

Answer: Every year CMS publishes a Publicly available (Online) guide called "Medicare and You". It explains in great detail the Process of how Medicare works. It also highlights the rights and responsibilities of Medicare Beneficiaries. I would encourage you to work with your agent to get more information, the key is taking control of your healthcare by seeking the answers.

Answer: With an increasing number of new Medicare enrollees each year, the higher demand on the resources available in the Hospital Insurance trust fund, shortfalls are expected by 2036. However, given the current efforts to reduce government expenditures, particularly for Medicaid, Medicare and Social Security … we are in a period of heightened uncertainty.

Answer: Medicare Part D covers the Shingles vaccination. Part D is a prescription drug plan that you would purchase from a CMS approved Insurance provider. It is typically purchased to compliment a Medicare Supplement Plan. Or, one is bundled with a Medicare Advantage Plan.

People with a Part D plan usually do not pay out of pocket for most vaccines, including for the Shingles vaccine. Neither Part A or B covers the Shingles vaccine.

Answer: Medicare Advantage Plans are "Coordinated Care Plans" where as, Supplement Plans are not. What that breaks down to is that the Advantage Plan Provider and willing Physicians agree to provide care in agreed process in a variety of different formats. For example, an HMO, PPO or PFFS. These all have particular guidelines that must be followed in the healthcare process.

On the other hand, Med Sup Plans do not function this way. There are no "Coordinated Care" formats to adhere to, a beneficiary is free to see any physician that accepts Medicare and most do.

So, this is a very basic distinction between the two. Both have "pros and cons", it really means that you should get an accurate understanding of how each work. Then you will have to decide which will work best for you.

Answer: As of today, the current cost structure is that the highest prescription drug deductible is $590. After that the cost to you will be 25% of the cost in the form of coinsurance until your prescription drug expenditure reaches a max of $2000. This includes any payments made on your behalf from the Extra Help program.

Answer: Yes, they absolutely do. The Star Rating system is a tool created by the Centers for Medicare and Medicaid Services (CMS) for indicating the quality of services provided by Advantage Plans and Prescription Drug Plans. This system was designed to specifically aide beneficiaries in selecting the best plans possible.

Also, as incentives for Plans to constantly review their processes to maintain CMS standards and excel in patient care. They are rated in 5 categories that have a direct impact on patient experience. Plans with an Overall 5-Star rating is the highest possible rating. A Plan with a 5-Star rating in a single category does not make it the highest ranked Plan.

Answer: These days technology is evolving with blistering speed. No, I do not think Medicare's technology is outdated and inefficient. Much like purchasing a new car, laptop computer or cell phone every year to keep up with the latest upgrade … could easily be considered as wasteful spending.

Likewise, seeking to make technology upgrades across the board in short intervals would be costly. So, prudent evaluations are made to access the need to make upgrades that would improve performance in areas that are not keeping pace with the demands.

Answer: Hmmm, I must say that I'm not a fan of AI driven "Customer Service."

While it may benefit on the "Man-Power" side in terms of staffing, I think that the "human-touch" will be absent for the beneficiaries … but we will have to wait and see how it works out.

Answer: Life Insurance is foundational to every financial plan. It is first an economic hedge against the sudden loss of a family member. Regardless of which family member it is that passes away … at minimum it prevents the surviving loved ones from having the unexpected expense of a funeral in addition to grieving over the lost loved one.

However, the importance of carrying the proper amount and type of life insurance serves many more expansive purposes than just providing for mere burial expenses. Just a few examples; income replacement for a growing family, child's college tuition planning, retirement planning, Long-Term care planning, Estate Planning and more.

So, life insurance has evolved well beyond just serving as merely a death benefit, though that is still a key feature. Today, it also provides "living benefits". If you have not had a recent Life Insurance review with your agent, I encourage you to initiate a conversation. Not having the right amount of coverage or type, is not as bad as having no coverage … but it's a close second place.

Make the call, do not assume it's good … be certain that you've made the best plans possible.