Sandra Teel, Medicare Insurance Broker

Answer: It's okay that you don't understand. Medicare is complicated. There are so many options, and every state and county are different So what works for your friend in another state or county may not work for you. Don't just talk to your financial advisor or call one insurance company that can only tell you about their plan. Talk to a professional Medicare Broker who can tell you about all your options.

Answer: I take the time to start at the beginning and walk them through the whole process. Once they get their Medicare card, then we sit down and look at all the options available to them. One size does not fit all, every situation is different, so I personalize what options best suit their needs.

Answer: There are two maximums out of pocket limits to consider.

The first one is on prescription drugs.

In 2024, Medicare changed the way prescription drug plans work. Out with the old and in with the new $2,000 maximum amount you will pay for your covered prescription drugs. Our prescription drug plan insurance company keeps track of how much you've paid for your prescriptions and when you have reached your maximum, your covered prescriptions will drop to zero amount for the rest of the year.

The second maximum out of pocket to know about is with the Medicare Advantage plans.

If you have a Medicare Advantage Plan, commonly known as a Part C, the insurance company keeps track of how much you pay for co-pays and co-insurance through the year. Once you reach the plans maximum out of pocket amount, then the insurance company pays the remaining co-pays and co-insurance for the rest of the year. Each plan has a different Maximum out of pocket amount, so knowing what that amount is important.

Make note that if you only have original Medicare, there is no maximum out of pocket amount for your 20% co-insurance.

Answer: Possibly. The only time I recommend anyone to stay on original Medicare is if they are also on the State Medicaid program that will pay for your 20% co-insurance.

 

There is no maximum out of pocket amount with original Medicare. That means you will continue to pay your 20% with no limit.

If you chose a Medicare Advantage plan there would be a maximum out of pocket amount to help keep your costs under control. Choosing the right Advantage plan is very important. Getting help from a professional Medicare Insurance broker will help you see if your doctors accept Advantage Plans along with which ones they accept. It would also help cover your prescriptions premium because most Advantage plans include prescription drugs.

If keeping your doctors are the most important thing, and they don't accept Advantage plans, you might possibly qualify for a Medicare Supplement plan (Medigap) to help cover your costs.

Answer: If you have a Medicare Advantage plan and you have missed your opportunity to make a change in the Open Enrollment Period, then perhaps you might have the ability to make a change using one of the several Special Enrollment Periods (SEP) that are allowed by Medicare.

Some of the SEP's include things like the following:

1) Have you moved to another county or state? Have you recently moved back to the United States after living abroad? Have you moved into or out of a skilled nursing facility?

2) Have you lost Medicaid? Or lost the Extra Help for prescription drugs? Did you lose the PACE program?

3) Have you recently been granted Medicaid or Extra Help with prescriptions? Do you have a Chronic condition like diabetes or heart disease?

4) You could join a 5-star rated plan

5) Were you affected by a FEMA disaster?

There are many other SEP's that you might possibly qualify for. So, talk to a local Medicare Insurance Broker to know all your options.

Answer: If you have incurred a higher Part B premium because you were considered a high-income earner, you can ask Medicare for a reconsideration if your income has dropped significantly.

Every year Medicare looks at your Adjusted Gross Income from 2 years previously to determine what you will pay for Part B. If you were a high-income earner, then you received a letter letting you know that your Part B premium would be adjusted. In that letter there is an explanation of how to apply for a reconsideration.

If your income has decreased significantly and takes you to a lower premium bracket, Medicare will automatically decrease your Part B premium to match the new lower premium level when they look at your filed income taxes.

Answer: Medicare can be very confusing. There are so many rules and penalties that scare people. It makes me happy to help people understand what applies to them, and what does not apply. Because I am a broker, I'm able to help them all the way through the process so they feel confident in the choice they make with their insurance option. My clients become my friends, and I'm available when they have questions.

Answer: Yes. If you are losing your employers insurance, whether you are retiring or losing your coverage for other reasons, it opens up a Special Enrollment Period (SEP) of time for you to get onto Medicare.

Please note that COBRA coverage is not considered credible coverage by Medicare, so you will still need to apply for Medicare if you are offered Cobra.

Once your employer coverage ends, or your COBRA coverage begins there is a limited time you have to get your Medicare coverage before you will be penalized.

Please reach out to a professional Medicare Broker so they can help navigate you through the process.

Answer: Things like wheels chairs, walkers, canes, sleep apnea machines, insulin pump etc. are considered durable medical equipment or DME. If you are only covered by original Medicare, (meaning that you do not have any additional Medicare coverage like an Advantage Plan or Medicare Supplement Plan), DME is covered by Part B and you will pay 20% of your DME costs.

If you are on a Medicare Advantage Plan or Medicare Supplement Plan you will likely pay less for your DME depending on the type of plan you have.

Your doctor must write you a prescription for the DME. You then take that prescription to a durable medical equipment place to fill it. Be careful filling it at a pharmacy, they often will bill it incorrectly to the Part D of Medicare and not Part B.

Answer: Even if you are under the age of 65 and you have been on Social Security Disability (SSDI) for 24 months or more, you most likely are already on Medicare. Once you turn 65, then you have another opportunity to use a "Special Enrollment Period" to change your Medicare plan if you'd like.

You do not automatically get Medicare because you are on Social Security unless you have been on SSDI for 24+ months. Most people who are not on SSDI have to sign up for and start Medicare at the age of 65.

Answer: Very good question. Be aware of agents that can only sell one type of Medicare plan or an agent that only works for one insurance company. You don't want to get railroaded into something that might not be your best option.

When you are looking into Medicare insurance options, you need a Broker. Brokers are contracted with several different insurance agencies and can offer information on all types of Medicare insurance options.

A Medicare Broker who offers all the Medicare options has more training with Medicare and is able to explain the differences between the different types of plans available in your area.

There are pros and cons to each type of plan. A good Broker will take the time to explain each one to you, so you can make the choice of what works best for your situation.

If you have questions, please feel free to reach out to me.

Answer: Good Question. Health changes happen as we get older. How your health change can affect your Medicare plan will depend upon the type of Medicare plan you have. For instance:

1) If you have a Medicare Advantage plan, it would be wise to take a look at your plan in the Annual Enrollment Period (Oct 15- Dec 7th) to see if there is another Medicare Advantage plan that will cover your health condition better. Some Medicare Advantage plans have "Chronic" condition plans that would help with certain chronic conditions like diabetes, and heart disease.

If you have a qualifying chronic condition, you might be able to make a change to the new plan sooner that the Annual Enrollment period. Be sure to call a Medicare Insurance Broker to find out if you qualify to make a change.

2) If you have a Medicare Supplemental Plan (Metsup) then you do not have to make any changes. You can choose to see any Medicare specialist doctor for your health condition.

If you are confused, please be sure to reach out and get help from a Medicare Insurance professional that works with both types of plans.