Shane Bullock, Medicare Insurance Broker

Answer: You don't have to do this by yourself! I've seen too many people make mistakes when they try to plan their Medicare coverage alone. Unfortunately, some mistakes can be for life.

Original Medicare and Medicare insurance plans change every year and we agents/brokers dedicate many hours keeping up to date, so you don't have to. Without a doubt, working with a competent agent/broker will save you time and money. The best part is that it doesn't cost you any more to work with us. Do yourself a favor and get a competent agent working for you!

Answer: The most common misconception that I run into is that Medicare will pay for everything. While Medicare does provide much-needed medical coverage, many people are shocked to find out that there are some major gaps that can lead to large out of pocket costs.

For example: Medicare doesn't have a max-out-of-pocket limit, meaning there is no dollar amount that you can reach where you will stop paying for medical services. The program also doesn't cover long-term care (i.e. nursing home or custodial care), dental, vision, hearing, or burial costs. Virtually everyone will need one or more of these services at some point and might find out too late that they aren't covered. Working with a competent agent/broker will help you see what gaps you have and how to get the right protection in place.

Answer: I have many clients who choose Medicare Advantage plans and it works very well for them. That said, no insurance is perfect. The most common issue I've seen with Medicare Advantage plans is when someone enrolls in a plan that doesn't allow them to see the providers that they want to see because of the network it uses. I usually see this when people enroll themselves in a plan, or when they call an 800 number they saw on TV or through the mail. People need to find a competent agent/broker that takes the time to do a thorough assessment before they recommend a plan. If you do run into issues like this, they should be available to help you find solutions.

Answer: You can apply at any time, but you may not be accepted at any time. Medicare supplement (Medigap) plans do not have a nationwide yearly enrollment period like Medicare Advantage (Part C) or standalone Prescription Drug (Part D) Plans do.

Rules do vary from state to state, but in general, there is a one-time Open Enrollment period for Medigap plans - this is the first 6 months after your Part B effective date. In this 6-month period, you can enroll in any Medigap plan you want regardless of your health. After this period, you will most likely have to go through underwriting (i.e. answer questions about your health history) to enroll in a Medigap plan. If you have a serious health condition, you may not qualify. Find a competent agent/broker to help you with this process because each insurance company has their own rules for what they will accept or deny.

Some states have guaranteed issue (i.e. you must be accepted regardless of your health) rules such as a birthday rule, which will give people an opportunity to change plans yearly. Check with an agent/broker to see if you have that opportunity in your state.

Answer: I work with hundreds of Medicare Advantage members in rural areas, so I've seen pretty much every limitation there is to be had. Assuming there are Medicare Advantage options in your new area, there will most likely be few of them. I find that the most limiting factor will often be the plans' network and access to services. Medical, dental, and vision providers are often slower to join Medicare Advantage plan networks in rural areas, particularly if they are new to the area.

If you currently have a Medicare Advantage plan and that plan isn't offered in the area you're moving to, you will have the option of purchasing a Medicare supplement (Medigap) plan without having to go through underwriting. If your new area doesn't have Medicare Advantage options, or you would have enrolled in a Medigap plan earlier but couldn't have passed the underwriting process, this could be a great opportunity.

I recommend working with an independent agent that offers both Medicare Advantage and Medigap plans well in advance of your move to help you weigh all of your options.

Answer: When considering how any Medigap plan works, we need to first start with what Original Medicare Part A and Part B cover. As long as a service is covered by Medicare, your Medigap plan will pick up its portion of your out-of-pocket costs. How much is covered depends on the specific Medigap plan you have. If a service is not covered by Medicare Part A or Part B, then your Medigap plan will most likely not help you with those costs.

Now, Plan F is one of the most comprehensive plans available. Plan F will completely pay any out-of-pocket costs that you would be responsible for due to a Medicare-covered ER visit. You are not responsible for deductibles, copays, or coinsurances for Medicare-covered services while enrolled in a Plan F.

Answer: It's true that around 70% of Americans who are 65 today will need long-term care at some point. Medicare, unfortunately, will not cover true long-term care needs such as nursing homes or custodial care. Medicare will continue to help pay for inpatient and outpatient medical services, but it will not help pay for your stay at a nursing home. To prepare, I recommend working closely with your trusted insurance agent and your financial planner to come up with a plan.

Even though it seems far off in the future, I recommend starting these conversations when you are in your 50s to early 60s. Too many people wait until they are facing a long-term care need to start planning, which leaves them very few options. Unfortunately, many people who leave it until then will likely be forced to see how quickly they can qualify for Medicaid to help them pay for long-term care. It's certainly worth it to plan early.

Answer: If you are already enrolled in Medicare Part A and Part B when you turn 65 because you qualified for it at a younger age, you do not have to re-enroll when you turn 65.

One thing that is often missed is what's known as your Medigap open enrollment period. This is a once in a lifetime 6-month period to enroll in any Medicare supplement (Medigap) plan and they cannot deny you based on your health or pre-existing conditions. This open enrollment period begins the first month you have Medicare Part B AND you are 65 or older. Please work with an agent to determine if you should take advantage of this window, because you will only have it once.

Answer: There are programs called Medicare Savings Programs (MSP) that can help folks with lower income and limited assets pay for their Medicare Part A and Part B premiums as well as penalties (if there are any). Certain MSPs even help with cost-sharing, meaning they can help pay out-of-pocket costs for medical services.

If you think you may qualify, your state Medicaid office will be able to help determine if you qualify for assistance with your Medicare premiums and/or cost-sharing through an MSP. They can also help you submit an application.

Answer: Agents who choose to help people with Medicare have many rules we have to follow. One of these, is that we can conduct one of two different kinds of events at a time: educational or marketing.

If a seminar is about a generic topic like Medicare, it is likely an educational event. The advertisements for these events should specifically include the word "educational". We are prohibited from selling anything during these events, so there will not be any sales pitches. We offer educational events to help the community better understand Medicare-related topics and reach people who don't currently work with a trusted agent.

Marketing events are events about a specific kind of product (e.g. a specific Medicare Advantage plan). Since we are breaking down plan details, this is considered selling even if it feels educational. These events are highly regulated, and we must register each of them with the insurance companies we're representing. We can even be "secret shopped" by the government to make sure we're following the rules. If you've ever seen an agent in a grocery store around a table with insurance company branding, you've seen one kind of marketing event. Remember, we're just there to help you and you will never be obligated to enroll in a plan because you attend a marketing event. You are in control of what the agent does at every step of the process.

I personally love conducting educational events because they're purely academic. It's our chance to show off and use the knowledge we've gained through the many hours we spend learning - so you don't have to! It's also your chance to ask questions and explore the topic in a neutral environment free of sales.

Answer: If you are collecting Social Security or Railroad Retirement Benefits at least four months before you turn 65, then you will be automatically enrolled in Medicare Part A and Part B. You should get your Medicare card in the mail about 3 months before you turn 65.

If you are collecting your Social Security, but you still want to delay enrolling in Medicare because you have creditable coverage through your or your spouse's employer, you must contact Social Security and let them know you plan on delaying your enrollment. Before you do anything, I recommend working with an agent ahead of time to plan your enrollment in Medicare. We can help you navigate the decisions you have for enrolling to make sure Medicare works the way you want it to.