Sabri Amara, Medicare Insurance Broker

Answer: Each Chronic Condition has eligibility criteria. There are plans designed for someone with Kidney Disease as well as many plans plans designed for Diabetics, Cardiovascular disorders, Heart Disease. As long as you have a qualifying condition you can enroll in these plans. A benefit is intentional care management/care coordination when enrolling in these plans as well as sometimes better prescription coverage for prescriptions for chronic conditions. To enroll in one of these plans it must be offered where you live.

Answer: Work with an insurance broker. Ideally work with someone that represents multiple insurance companies so they can compare multiple carriers and tell you which plan based on your needs they recommend. During the Annual Enrollment Period everyone on a medicare advantage plan can make a change. If you need to make a change outside of the annual enrollment period which is Oct 15-Dec7 a broker can see if you qualify for another enrollment period to make a change mid year.

Answer: I think SHIP counselor's are the worst. They are state employed individuals that advise on insurance and do not hold an insurance license. In my experience they know just enough to be dangerous and based on interactions with clients of mine they are far from neutral which is what they are supposed to be. Medicare broker's are licensed professionals who recommend and enroll clients into plans they represent. Broker's do not charge you a fee and are paid commission by the insurance company they enroll you in. Brokers are able to compare multiple plans from multiple carriers and tell you why you should not consider a carrier and why you should consider a carrier/plan that they recommend for you. Its important and I encourage you work with a broker and develop a relationship with one that not only enrolls you but also services you if you need something post enrollment

Answer: Food cards are the new wave! Not everyone qualifies but when someone qualifies depending on the state & county you live in i've seen the monthly allowance amount as high as 500/month in some areas. The individuals that qualify for the highest amounts typically have Medicare & Medicaid. Now you may also qualify for this benefit without having Medicaid if you have Medicare and have a specific chronic condition (C-SNP) plans. Different carriers offer different monthly amounts is important to note.

Answer: Under ORIGINAL Medicare part A & B these are considered alternative medicine therefore they are generally only covered in few specific situations.

-Acupuncture is covered only for chronic low back pain lasting at least 12 weeks as well as meeting Medicare's criteria.

-Naturopathic doctors are not recognized by Medicare as Naturopathic doctors but may be recognized as other specialist types

Answer: Depending on when your policy lapsed and why it lapsed the answer may or may not give you what's called a SPECIAL ENROLLMENT PERIOD. ItItss best to consult with an Insurance broker to find out if and when you can make a change or if you have to wait until the Annual Enrollment Period.

Answer: Where employees live or work does not change the rule in place for Medicare employee count. Independent contractors do not count as employees. Full and part time employees each count as an employee. So a company cannot generally say “we have fewer than 20 employees” simply because fewer than 20 work in the U.S.

Answer: Post hospitalization care for stroke is very important. For recovery and rehabilitation typically patients need to go to skilled nursing facility for rehabilitation. Skilled nursing facility can be very very costly if you are only on Medicare only or on a Medicare Advantage plan. Medicare typically covers the first 20 days of skilled nursing facility stay following 3 days inpatient care at a hospital. After 20 days DEPENDING on what plan you are on the costs in 2026 for days 21-100 can be as high as $217/DAY! Not all plans are created equally and its important to understand the coverage your on.

Answer: Shopping your medications with a broker who will look at multiple insurance carriers and plans during the annual enrollment period is most ideal. Cost can vary drastically from one carrier to another. Yet sometimes costs can still be high even if you go with the lowest cost carrier for your prescriptions. Other than shopping coverage around if you qualify for the federal program known as Extra Help you should definitely apply. This will bring down the cost of all of your prescriptions not just one expensive prescription. Also most manufacturers have what is called manufacturer assistance program that you can apply for directly with each prescription manufacturer that may save you a lot of money

Answer: Yes. ALL Medicare Part D plans have what is called a formulary. Formulary is another name for list of covered drugs. You should ways check that all of your prescriptions are covered on a plans formulary during the Annual enrollment period (October 15-December 7) to make sure your prescriptions are covered. If you are outside of the annual enrollment period and a Rx is not in the formulary/covered you can ask for a "Formulary exemption" from your part D carrier. This is a request you make to have a Rx not covered to be covered. While this is not a guarantee it's worth the try.

Answer: Generally PPO's do NOT require a referral to see specialists. You should still check with your plan's summary of benefits as a safe rule of thumb to make sure your plan works that way. With that being said while your insurance may not require a referral to see a specialist some physicians offices require you to have a referral from a PCP to see the specialist.

Answer: Nope. If you reach your plans max out of pocket then your plan will cover your medical costs for the year. Keep in mind Medical and prescriptions have different max out of pocket limits.

Answer: While it may seem overwhelming and the reality is, it is overwhelming options are good. It's important you have choice as when it comes to medicare there is no one size fits all. Many options allow you to get the coverage that works best based on YOUR unique needs.

Answer: Simply put It costs you nothing to work with an insurance agent/broker. I recommend everyone work with a broker vs work with an agent. A broker works with multiple companies and will find the best fit for the client needs. An Agent works for A insurance company and only offers 1 carrier. I like to say as a broker I work FOR my clients not FOR an insurance company.

1. It costs you nothing to work with an agent/broker

2. No one size fits all

3. Compare multiple carriers at once

4. Find the RIGHT fit vs find A fit

5. Different cost and coverage in different plans

6. Rx can vary drastically if you enroll in the wrong plan

7. Clearly explain why a plan was recommended over others

8. Save you time

9. A good agent/broker doesn't only enroll you but also services you after enrollment

10. Experience

Answer: The risk of sticking to only Original Medicare is financial exposure. Original Medicare has no stop loss or out of pocket maximum. With only Original medicare you are responsible for hospitalization deductibles every time you are hospitalized which are not yearly deductibles this is called a benefit period deducible. Also equally as painful you are responsible for 20% of all medical costs with no limit on how much those costs can add up to.