Stephanie Yarberough, Medicare Insurance Broker

Answer: The transition into Medicare can be a confusing process. We bring clarity through education and enjoy watching our clients go from feeling overwhelmed at the start of an appointment to breathing easier and feeling confident in their decisions by the end.

Answer: During the Annual Enrollment Period you will most likely need to answer health questions if swtiching from a Medicare Advantage Plan to a Medicare Supplement/Medigap plan unless you have a special exception that allows you to not go through medical underwriting. If you are attempting this process, it's best to start in October so that you have enough time to confirm you are through medical underwriting before the enrollment period ends, as you will need to put a stand-alone Part D plan in place as well.

Answer: If you are working with a qualified Medicare Insurance agent, they should be educating you on the difference between a Medicare Supplement Plan and a Medicare Advantage Plan and making recommendations based on your specifics. There should not be an agenda or "pushing" one plan type over another. Ultimately, it is the member's decision.

Answer: Medicare does not cover hearing aids. You will need to pay out of pocket unless your insurance plan offers hearing aid coverage.

Answer: Medicare A&B is a necessary starting point, but does not offer comprehensive coverage. There is no drug coverage included with Medicare A&B for starters, and there is still some large out-of-pocket exposure, such as an uncapped 20% coinsurance on all medical services. This is why a Medicare Supplement and Part D plan or a Medicare Advantage Plan is always recommended to put in place in addition to Medicare A&B.

Answer: Calling an insurance company directly will only give you information about their specific plans, as that is all they have available to offer. This is very different from using an independent broker who can compare costs and coverage across many companies in one meeting and make recommendations based on your specifics, without obligation to any.

Answer: Medicare Advantage Plans can be a cost-effective method for individuals seeking limited or moderate medical care, as the monthly premiums are generally much lower than those of a Medicare Supplement Plan. You do have copays and coinsurance on a Medicare Advantage Plan, so it really depends how much and what type of medical care you are using as far as overall costs.

Answer: Through your working years, you have most likely paid FICA taxes, which have helped to fund Medicare costs. This does not mean all your medical services are covered 100% in retirement. There is still cost sharing involved and depending what kind of Medicare Insurance plan you choose determines what that coverage and costs look like.

Answer: The Medicare drug payment plan can be useful to people who have a deductible on their plan and will see a lot of high costs up front in the calendar year for their medicines. They can break this large amount into more manageable payments spread throughout the year.

Answer: It sounds like you have a Medicare Supplement Plan where you pay a monthly premium in order to receive very little in medical bills because the Supplement pays the remaining 20% after Medicare pays 80%. If your friend has a $ 0-premium plan, it would be a Medicare Advantage Plan, and they would pay copays or coinsurance when they use medical care. The plans work very differently from each other.

Answer: Medicare may cover up to 100 days of skilled care if certain criteria are met, such as a 3-day hospitalization first, a need for skilled care upon release, and continued improvement. If the care turns custodial at any point, Medicare will most likely no longer cover the skilled care stay. This is an important area to understand, and there are stand-alone skilled care insurance policies that can be put in place to protect against this significant financial exposure.

Answer: Your Medigap insurer cannot terminate your policy as long as you continue to pay your monthly premium. When you receive an annual price increase, this is very standard and happens due to aging and/or the company is implementing a price increase across the board for all members. A price increase is never due to your specific health situation - that is not allowed.

Answer: Depending on the area of the country that you live, it's possible there are $0 premium Medicare Advantage Plans available. You will still have a monthly premium for Medicare Part B. Choosing a $0 premium Medicare Advantage Plan often means higher copays and coinsurance on medical services than a plan with a premium. It's important to work with a licensed Medicare Insurance broker who can show you the pluses and minuses of multiple plans.

Answer: Medicare Advantage plans are network-based. Some rural areas might have more limited access to medical facilities if you are enrolled in a Medicare Advantage Plan, this varies greatly depending on the state and county you live in. It's always best to work with a licensed insurance broker who can check doctors, networks and plan options available to you.

Answer: Medicare does not provide any prescription coverage. It is extremely important that you have either a stand-alone Part D prescription plan or drug coverage included in your Medicare Advantage Plan when you make the transition into Medicare. Even if you are not currently taking medicines, you are required to have creditable Part D coverage or you could start accruing a lifelong penalty.

Answer: The $2,000 out-of-pocket max on prescriptions can be a significant help to those with expensive medicines. After the members' out-of-pocket cost has reached $2000 within one calendar year, there is no cost for any medicines filled through the Part D portion of the plan the rest of the year. One very important factor to be aware of is that the prescription MUST be included in the insurance plan's formulary. If the medicine is not on the formulary, the insurance company does not have to cover it and it is not capped at $2000. This is one reason why it's so important to check your coverage and plan formulary each year.

Answer: Medicare does not cover routine eye exams, but it does depend on the coding that the medical facility bills. If there is something in the exam medically based, that can be covered by Medicare. Glasses or contacts are not covered by Medicare except for a basic pair of glasses after approved cataract surgery. Many people will choose to add on vision insurance to help cover the costs Medicare does not.

Answer: The world of an insurance broker is never boring, as each client's situation and specifics are different. I have had many clients that received misguided advice from a 1-800 number or even local Govt organizations before coming to me and ended up in a Medicare Insurance Plan that caused them significant out-of-pocket financial exposure, or they could not see the doctors they wanted to see. I have then provided a thorough explanation of options that were often not explained to them originally and navigated enrollment windows to get them on an insurance plan much better suited for their needs.

Answer: Navigating the parts of Medicare, enrollment timelines and choosing a Medicare Insurance plan can be an overwhelming and confusing process, but it's such an important decision and can have substantial long-term consequences. My encouragement to every person approaching Medicare eligibility is to find a local independent broker that knows the medical systems and insurance plans in their area well and can offer a broad overview of many different companies and plan options within one appointment. There should be no charge to you for an insurance broker’s expertise and assistance.