Russell Scott, Medicare Insurance Agent

Answer: Not necessarily. But it is always advisable to check and make sure your coverage is adequate for working in your new location. You also might want to consider your options as there might be opportunities to save money on making a change to a plan in your new area.

Answer: Preventative care, like mammograms, is covered at 100% of the cost by Medicare. There is a specific list of all of the preventative care services that are provided, and you can learn more.

Answer: In general, no. Outside of certain times in life when you are either new to Medicare Part B or if you're under a guaranteed issue period for a certain reason, you'll have to answer health questions in order to be qualified to join a Medigap plan.

Answer: Absolutely. This is YOUR Medicare. It's last health insurance you'll ever have. Be careful with it and choose wisely WHO you do business with. If it takes vetting a handful of agents before you're comfortable with the decision you make, so be it.

Answer: There is no "trap" of Medicare Advantage plans. These plans, like many other things in life, are to be purchased with an understanding of what they are and what the benefits and limitations are. Far too many people are sold something they end up not liking simply because of surface-level benefits that seem attractive. When minor details are focused on, major problems can occur because facts that would have been helpful in determining if the overall plan was suitable go ignored. (such as whether or not your providers are in network or if the plan covers prescriptions at all). Do your due diligence and vet the person selling you the plan.

Answer: MAPD plans are split into two specific financial buckets: the medical bucket and the prescription bucket. Generally speaking, anytime you're considering a plan's MOOP you're only taking into account the costs that you've incurred for your medical care. This also takes into consideration copays and coinsurance costs for in-patient hospitalization. It's wise to understand that there are several things that DO NOT go towards a person's MOOP. These include copays and coinsurance on prescription drugs, costs toward ancillary (or additional) benefits associated with the plan like dental, routine vision and hearing. Also, costs incurred on things that are not covered by the plan are also usually excluded from the MOOP calculation.

Answer: Yes, as long as you're active on Medicare and/or a Medicare plan, you can use all of the benefits of the plan starting January first.

Answer: The medicare deductible updates and resets every calendar year. Even if your Medicare went into effect in the middle of the previous year and you met your deductible, you will have to meet it again for the new year.

Answer: MA, MAPD and PDP plans are created and exist on a calendar year basis. That means that every January 1st of each year your plan benefits will update with the changes that we approved for the following year. Members are usually notified of these changes each fall in advance of January.

Answer: Medigap policies generally do not have in or out-of-network benefit considerations that an insured has to make. The acid test (generally) is as long as your provider bills Medicare and is willing to see you as a patient, they'll bill your medigap policy as secondary insurance.

OON on Medicare Advantage is slightly different. Although a provider will be paid the customary amount equal to original Medicare, they do not "have" to bill your PPO out of network if they choose not to. If this happens most insurance companies have a process that members can go through to file for reimbursement.

Answer: Yes, Medigap policies are able to be purchased outside of the highly advertised Medicare enrollment periods. As long as your primary coverage is original Medicare A&B you can apply for a Medigap insurance policy.

Answer: Generally, some of the worst decisions I've seen Medicare beneficiaries make were on the heels of advice that was given to them by uninformed family members in good faith. It's helpful to listen to their opinions and concerns but always seek real advice from a local, reputable professional with years of experience who can help you look at your situation from all angles in order to make the very best decision possible.

Answer: Everyone approaching age 65 should be aware of what they should and shouldn't do as it pertains to enrolling in Medicare. You should educate yourself on your rights and options and seek a reputable agent in your area who can answer questions about your unique situation.

Answer: SNP plans are Medicare Advantage plans that exist to cover certain subsets of the population. Specifically lower income individuals and those with chronic illnesses like diabetes and heart failure. These folks generally have higher utilization, and these plans specifically address the concerns and needs of these populations in order to help achieve better health outcomes.

Answer: These plans have been around since the late 90's. There was a concept called "Medicare Plus Choice" back then which brought in private carriers. MA plans have become a powerful part of the Medicare ecosystem now. Over half of the eligible population has now opted to enroll in Medicare Advantage. However, if it's not your preference you can continue taking your A&B coverage as primary and consider a traditional Medigap policy to lower your costs.

Answer: The length of time having Medicare doesn't impact your costs on utilization. Specialist visits are billed under Part B of Medicare. There is an annual deductible as well as 20% coinsurance on Part B charges that Medicare beneficiaries are subject to pay. There are other insurance policies such as medigap plans that can help with these costs.

Answer: For people new to Medicare, I would say that they're surprised by how strong the overall coverage can be in comparison to other insurance they've had (ACA, Group Health). Many times they're able to lower their monthly costs while having stronger benefits. Pay less get more doesn't happen often but this might be one of those rare moments that life gives you.

Answer: Not necessarily. In the world of Medicare insurance options you should think of the financial side of things like this- It's "pay me now" or "pay me later" insurance. Medigap policies are generally more expensive premium-wise each month but offer less out-of-pocket exposure for the insured in terms of utilization. These are more "pay me now". MAPD plans often have low or no premiums to pay each month but might have larger out-of-pocket costs on utilization. There's no free lunch. It's pay me now or pay me later.

Answer: What is the most efficient way to cover the larger out-of-pocket expenses that can come up in retirement? Examples include cancer diagnosis, extended hospital stays, short-term and long-term care.

Answer: That's correct. The out of pocket total for covered drugs is capped at $2,000. No more donut hole!!! :)

Answer: One decision that too many people make and regret later is not enrolling in a Part D benefit before they "need" it. Typically, this leads to unnecessary late enrollment penalties and possibly even a serous gap of time where you are purchasing an expensive prescription without any coverage before you can enroll in a plan. It's possible to take care of your Part D coverage for little to no premium. Consider enrolling in Part D as soon as you're eligible for Medicare. There's two times in life when you'll think about it:

1. When you're enrolling in Medicare

2. When it's too late

Answer: Use discernment like you would choosing a doctor, plumber or contractor. Medicare is the last health insurance you'll ever have. Choosing WHO you are working with to help guide you now and as time goes on should be of high importance. A good agent is knowledgeable and will display a passion to educate you. If you feel like you're being pressured to do something that isn't in your best interest, chances are you're right. The amount of insurance companies and plans is finite. All brokers are generally able to sell all the same thing. Pick the one that proves themself beyond just the transactional side of simply selling you a plan.

Answer: Any specific disparities among seniors on Medicare should be studied and addressed. Incentivizing MA plans in certain areas to engage with and promote healthier outcomes amongst certain populations would help,

Answer: I wish every senior would ask their broker the following questions before signing up for any insurance plan:

1. Are all of my doctors covered?

2. Are all of my medications covered and if so, is there a deductible and what tier is each drug on?

3. What happens if I have a problem? Can I call you? Tell me exactly how you will help.

Answer: The "disadvantage" of MA plans is similar to comparing the experience of purchasing a lemon from a bad car dealer. The plans themselves generally aren't leading to a particular disadvantage in and of themselves. It's often the person who sold the plan who didn't do their job properly regarding drug formulary considerations, network limitations and setting out-of-pocket expectations for the Medicare beneficiary. MA plans are appropriate for some people and for other they're not. Just like selling someone a sedan when they really needed an SUV. It drives down the road. It has a gas pedal but it might just not do all the things that the consumer needs it to do for them.

Answer: I love taking seemingly complex subject matter and breaking it down into bite-size pieces for my clients. I have nearly 2 decades of experience in the Medicare space and put my expertise above nearly everyone else in the industry.