Shelly Hefley, Medicare Insurance Broker

Answer: I would find an agent to help you find a supplement plan and a prescription drug plan and cover the gaps. Once you find a Supplement that will approve you then you can cancel the Advantage plan and enroll in a prescription drug plan to avoid paying any penalties.

Answer: If the MRI is medically necessary, they will cover it. Most times it is based on the diagnosis utilized for the client..

Answer: If you have a disability attorney, they typically will help you. If you’ve been on disability for 24 months, you should be eligible for Medicare part B. You can also contact your Social Security administration and they should be able to assist you with that.

Answer: Medicare pays them a stipend to take care of you. It shifts the responsibility financially from Medicare to the insurance company. You will see lots of changes this year and next. Always make sure to talk to a licensed agent who actually works with more than one company to find out what the best plan is for you or if the Best plan is going to a Supplement. Having all of the information available to you helps.

Answer: YES! Fraud is an issue everyone should be knowledgeable about. Fraud is hitting in every aspect of our society and Medicare is no different. Everyone needs to review their Medicare statements for accuracy. If you notice you’re being charged for things that you’ve never received. You need to call Medicare right away.

Answer: Medicare advantage plans are federally, regulated, senior health insurance plans. Medicare pays these plans to take care of each individual client. Different plans have different restrictions, including now referral requirements that Medicare and supplements do not have. Freedom of choice is sometimes compromised by lower premiums. Their networks in the advantage plans many HMO‘s are requiring referrals and PPO‘s have less benefits. The best thing to do is speak with an agent who is well-versed in both supplements and Advantage plans and can walk you through what your best choice would be.

Answer: Yes, telegraphy is still a covered service, also depending on the type of service provided. This also may be dependent on your actual coverage, if an Advantage plan may have written that exclusion into their plan. It’s best to review your coverage with your specific plan or have your local insurance agent assist.

Answer: The important part is that you have credible prescription drug coverage. There are penalties involved in situations if you do not sign up for Medicare and do not have adequate coverage. There are certain rules with Medicare and Medicaid coverage as well as Medicaid and employer group plans. It’s always smart to talk to a licensed agent who deals with this all the time. It should save you time and a lot of hassles.

Answer: Switching from a supplement to an advantage plan is usually done during the annual enrollment period. Which just ended December 7. Some people qualify for special circumstances, a special Enrollment period. You would definitely benefit from speaking to a licensed insurance agent who can direct you in the best way to accomplish this.

Answer: Medicare doesn’t pay for groceries… the advantage plans offer those types of

Benefits - in some instances… usually when a person is covered by Medicare/medicaid.

Answer: Yes, Medicare does cover dialysis both at Centers and in-home. Definitely check with your individual Advantage plans to see where the network would be.

Answer: Yes, since I’m instances if his income goes up, he may not qualify for assistance from the state. Or if his income goes down, then he may qualify for assistance when he previously didn’t. It’s always good to talk to a licensed agent that will sit down with you and explain The nuances of this wonderful program.

Answer: That’s definitely interesting. I would be very interested to hear what plans are offering incentives to enroll.?? That is not something that should be happening- I would be very leery

Answer: Physician staff do not like Advantage plans because there are extra prior authorizations and rules that need to be reviewed. They much prefer the easier Medicare and the Supplement route.

Answer: Well the benefit would be the same if you found us by getting referred by another client- having an agent that you can trust, that you can talk with, hopefully that you appreciate their time and attention to your needs. Not everyone appreciates the time licensed agents put into their training on Medicare every year. Personally, I put in over 100 hours of training and certifications every year to be able to direct my clients to plans that will help them. It is a difficult task and it’s not for everyone. Some people just use Medicare.gov and have no idea what the nuances of plans are. I assist my clients annually and are there throughout the year for problems they may encounter with new issues or medicines.

Answer: It has to be ordered by your physician and approved by your health insurance plan to get them to pay for it. Unless you just want to purchase out of pocket, which is an expensive option but an option nonetheless.

Answer: As with any service, some providers are better than others. Some personalities mesh better with one provider versus another. A lot of things to take into consideration when choosing a provider.

Answer: Medicare will cover one lens after each surgery in a single frame after cataract surgery. It gets very confusing. You need to talk to your optometrist before you go to let them know so it gets billed properly.

Answer: A lot of times that is what it is. Good agents usually don’t have to worry about doing those types of events because they have so many referrals. I’m always happy to get referrals, but it should never sound like a sales pitch. It should be what do you need and this is how we fill your needs specifically.

Answer: Most all plans will help manage chronic pain. The key is to make sure which network you need to be in for that service to be covered at the provider you want it to be covered with.

Answer: Everyone should be assessing their needs every year and thinking towards what your needs and priorities are for the upcoming year. Too many people are taken advantage of by telemarketing companies and have no idea what their plan pays or how a medical

Issue could impact their financial situation. Speaking with an agent yearly helps keep everyone informed.

Answer: Many times they can be a sales pitch but there are some legitimate agents who really are just trying to help people. The best way to find an agent or get information is from someone who is referred to you or has legitimate business experience. Ask your friends that’s the best way to get good referrals.

Answer: Every plan is different and just like people should be individually prepared for your specific needs. Talk with an agent and see what is available that will benefit you in ALL aspects of your medical needs. It’s about more than just the extras!

Answer: As long as your spouse’s plan is credible coverage, which means it’s as good as or better than what you could get with Medicare, you shouldn’t have any problem. However, if the plan is not credible, you need to speak to someone to determine what your cost could be

Answer: That depends on your plans specifically some plans have some lab work at zero cost others have minimal co-pays. You should definitely be able to check with your agent or your plan and they would be able to tell you how it would be covered. Many times the providers office can tell you as well.

Answer: That completely depends on the Advantage plan and their network. Each plan has different networks of doctors. Definitely talk to a local agent before you make that switch. Depending on your location there are a lot of things to consider if you’re currently on a supplement.

Answer: Many times they don’t know who to go to and they get a lot of junk mail that does nothing more than confused them. So now I encourage clients to share my information with their friends so that their friends can go to the person they trust. Hopefully that will encourage everyone to get help sooner rather than later. Agents, good agents that stay up on things and know the rules help people avoid lifetime penalties. Give them someone that can answer their questions directly without calling Medicare or some 800 number.

Answer: Last year there were significant changes in the prescription drug plan guidelines, and every year formularies change. It’s very important to speak to a licensed local agent/broker who can help you choose the right plan for you for each year.

Answer: Just like the Medicare premium, the Medicare deductible changes every year. This only affects people with Supplement plans as the Medicare advantage plans. Do not apply the Medicare part B deductible.

Answer: By utilizing a reputable agent- you do not pay them anything and as long as they are a broker that represents all plans- you should be good!

Answer: Hospital indemnity policies are a great way to help control cost with advantage plans. Or even with any insurance you have that has a very high deductible. There are many states going to the birthday rule for supplements so before you switched to an advantage plan check to see if your state has a birthday rule for supplements. If you have any questions, please feel free to contact me.

Answer: Cataract surgery is covered by Medicare. The out-of-pocket cost depends on if you have an advantage plan or a Medicare supplement. Additionally, if you have a hospital indemnity plan that can help lower your out-of-pocket cost with an advantage plan. The additional information is that Medicare does cover one pair of glasses after cataract surgery per eye. There are also multifocal and different types of lenses that are not covered by Medicare that some providers use. Always ask before you sign up for surgery what type of lens is necessary. Many providers try to give you a fancy lens and it will cost you significantly out-of-pocket just to avoid the possibility of wearing glasses.

Answer: If you were losing your employer coverage, you are definitely in a guarantee issue. But you do have a timeline that you have to work through. It has to be within 63 days or you lose that special enrollment period. Please let me know if I can help you.

Answer: Make life easy, talk to an agent! I have people every week who spent hours and hours or called an 800 number and regretted it every time. Especially when you are turning 65 - there are important decisions to be made and information that these 800 numbers don’t tell you. They’re on a time crunch they work by the phone call so they wanna make it short sweet sign up move on. Talk to an agent who will become your friend for life!

Answer: I would prefer that Medicare ban the overseas phone calls coming into the US. These calls are more intrusive than any celebrity advertisement.

Answer: Yes, Medicare will pay for telehealth, as necessary for covered medical care. Most providers are aware of coverage limits and will not provide services if not covered unless they inform you in writing, before the service is provided.

Answer: 2025 Medicare beneficiaries with higher incomes will pay surcharges, known as IRMAA (Income-Related Monthly Adjustment Amount), on top of their standard Part B and Part D premiums. These surcharges are based on modified adjusted gross income (MAGI) from 2023. For 2025, individuals with incomes above $106,000 and couples filing jointly with incomes above $212,000 will be subject to IRMAA. Basically, these surcharge amounts vary based on income brackets, with higher incomes incurring larger surcharges. So if your income falls in these categories, you may get to pay a surcharge.

Answer: It could be if a supplemental insurance is in place as well. This type of coverage gives you complete peace of mind. No referrals, no networks, no issues just simple coverage.

It’s always best to speak with an agent who can provide you with the best advice for YOU.

Answer: Not having a good agent that will help you choose the right plan for you. It seems easy but I speak with new folks daily that had no idea and are now paying the price for listening to someone who isn’t licensed and really doesn’t know.

Answer: First of all you need to know if the medication is covered under part B or D. Some

Medications- injectable drugs in particular that are given in an office/facility setting are covered by Part B. Other routine medications are covered by Part D, so what type of insurance you have matters as well. Your insurance agent should be able to help you find out. If you didn’t have an agent help you, then you are stuck calling the company who covers your prescription drugs.

Answer: To speak with an actual agent that can compare things. There are significant differences between an advantage plan and a supplement.

Answer: When moving to a different state, you have 63 days to change your Medicare plan on a Medicare advantage plan Medicare supplements have different rules and it depends on if that Supplement is available in the state you live in. Great questions and a perfect time to speak to a Medicare advisor like myself. Feel free to call. I’m happy to help.

Answer: Yes Medicare covers screening services as long as they are preventative and in the list of covered screening services.

Answer: You would need to get on Medicare part B if you have not done so already. Then you have 63 days to obtain other coverage as far as a supplement or Medicare advantage plan.. definitely contact an agent as soon as possible to get on the best plan for you in the most timely manner.

Answer: Working with an agent and ensure you have someone that is up-to-date on the most recent changes. Trying to do things on your own. There are a lot of changes that happen every year in Medicare and I have new clients always saying why didn’t I know that? You don’t wanna be one of those people, paying a lifetime penalty for something that could be avoided

Answer: It is well known to any good insurance agent and that’s why it’s very important when people turn 65 to speak to someone that’s knowledgeable about the rules. Tell your friend your family everyone you know that way more people are educated! You are correct it’s a shame that it’s not a bigger part of what Medicare tells New # enrollees. What state do you live in? Some states have a birthday rule. Feel free to call me and I’ll see if I can help.

Answer: I personally think everyone needs to understand the consequences of not planning for a long-term care. And also understand the benefits of planning for long-term care. It’s a very difficult situation and one that is best planned for the younger we are. Each person has to decide what they can do and there are lots of options many times. Contacting an agent that does Medicare, retirement planning, life insurance, and is well rounded-is usually your best option. That’s why I work so hard to try to be rounded to help my clients.

Answer: If you miss the open enrollment, there are other special enrollment periods that sometimes apply. The best thing to do is talk to a broker who is reputable and licensed that can help you solve that problem.

Answer: Work with a local agent- they will know so many things about the plans and what is truly going on.

Answer: Many people like the simplicity of Medicare and a Supplement. There are very few rules to go by. With the Medicare advantage plan there are networks and other rules that have to be followed.

Answer: I think the question is what type of coverage do you have? And many Advantage plans have copayments for ambulance rides. If you would like to call me, I’m happy to go over that with you.

Answer: You can enroll three months prior to your birthday. I was strongly suggest you talk to an agent who is a broker. Brokers can handle supplements, advantage, plans your prescription drug plans. Definitely make sure that your agent is going to help you with everything there are some agents that do not help with drug plans. Please feel free to contact me. I will help you figure out what’s best for you.

Answer: Get an agent who can explain what these are and why you may be getting them. It’s important to be able to understand what you are actually responsible for and what could be a mistake or billing error.

Answer: This is when an agent sitting down with you is important. I familiarize myself with your specific situation, this helps give you the best advice for which type of plan is best for you.

Answer: That is the maximum amount you could be responsible for in a given year. These are important and not always discussed, particularly by telemarketers. Everyone should know what their max out of pocket could be.

Answer: The best way to discuss that is to sit down and look at what your plan is. If your friend is comfortable, I’m happy to look at her cards and tell you the difference between the two plans. There are so many plans out there. It’s hard to say

Answer: When you first turn 65 or go onto Medicare, you have a guarantee issue. That is the most important time to make sure you get on the right supplement if you choose to do a supplement. Advantage plans you can change with no health history questions. It’s very important to get with a good agent that will get you on the right plan for you.

Answer: Medicare does not routinely pay for dental. Only certain dental if it is sustained in an accident. Most dentists do not want to bill Medicare due to limiting charges and not being participating.

Answer: Each person is different and I look at financial situation and Health. If you’re in bad health and can’t afford a supplement then that might be the way to go…. But if you’re financially struggling, there are a lot of good advantage plans that may save you money and give you some extra benefits

Answer: If you go out of network you would be paying the entire cost. If you would discuss options, please call me - you have a couple of days to make the change. After 4/1/2025 you are stuck on the HMO until 2026

Answer: No, that’s a great idea but if you are healthy, it’s time to see if you can get more cost effective coverage.

Answer: By using a local agent that you can meet with and contact when you have questions. Trying to do it yourself can sometimes work but if you aren’t confident in your knowledge, it can backfire on you.

Answer: If you have a supplemental coverage, it should pay your hospital co- insurance. It is always best to have a licensed broker review your specific coverage and help you be informed.

Answer: YES - you need to talk to a financial planner like myself to be sure your insurance is compliant and to determine if you need part B or not.

Answer: A Medicare supplement is always best for snowbirds - it covers you anywhere! But sometimes that is not affordable so Medicare Advantage plans that have a wide network which would cover your providers in both locations!

Answer: The decision to enroll in Medicare is partially decided on their current coverage. Cost of the current coverage and the limits of that coverage play a big part in determining the need for additional coverage. Sometimes it is best to have Medicare as a second coverage and utilize other ways to cut back on the cost of Medicare!

Answer: I enjoy helping clients understand their benefits and how to use them accurately. I like to have clients be able to get their care in the most cost effective ways! By planning, clients can cover themselves and avoid issues down the road

Answer: Not understanding the options and how their choices will affect their healthcare for the rest of their lives. By passing up the opportunities to enroll during guaranteed enrollment periods, they could cost themselves significantly financially over the years.

Answer: Know all of your options and why the agent is steering you to a particular type of plan. Each person should understand the differences between supplements and advantage plans. They need to understand how their individual health should definitely be taken into account when choosing between supplement and advantage plans.

Answer: We sit down at their kitchen table or in my office and go over the ABCs of Medicare and we spend a couple of hours talking about how services are covered and what their needs are. We discuss the options available and how their needs are best served.

Answer: The benefits of a local agent is to have someone who knows the trends with your state or town particularly. I refer my clients to providers I know will help them and take good care of them. I get to know my clients on a personal level. Virtual agents only know what the computer tells them.