Steve Garrard, Medicare Insurance Agent

Answer: The two most common types of Medicare Advantage plans are differentiated by network type: HMO and PPO.

HMO means you have a defined network of providers who carry contracts with a specific plan and the plan will only pay for covered services rendered by those providers. Also with an HMO, your PCP must provide a referral before you can see a specialist. The tradeoff for jumping through these extra hoops is that carriers are able to provide a higher level of support to members for their specific ailments because there is higher visibility into medical utilization. As a result, HMO plans often are able to help members prevent more costly medical events from chronic conditions, such as hospital stays, and those savings are passed on to members in the form of lower cost share and a much richer array of extra benefits.

With PPO plans, there are less hoops to jump through. PPO means you have a defined network of providers who carry contracts with a specific plan, but the plan will also pay for covered services rendered by out-of-network providers, typically at a higher cost. Referrals from a PCP is not a requirement. In a PPO plan, you have the option of going to any Medicare-contracted provider who will accept the plan, however you as the member typically will pay more for out-of-network providers. Contracted (in-network) providers will typically have a lower cost share (copay or coinsurance). With out-of-network providers, you may also be faced with bearing the cost of any extra amount charged that exceeds the PPO plan's allowed fee schedule, also known as "balance-billing." When compared to HMO plans, most PPO plan benefits will be less rich because the plan has less control.

With that being said, the types of Medicare Advantage plans actually available to you will ultimately depend on your zip code where you reside. CMS only allows beneficiaries to enroll in plans that are on a specific menu for YOUR zip code. Options typically change from county to county.

Answer: Yes, extra funds from selling the car can typically go into a Georgia Medicaid-approved burial account, but you must ensure it's a specific type of burial trust or prepaid funeral plan that meets state requirements to remain exempt from the Medicaid asset limit. Given the conflicting information and the specific nature of Georgia's rules, consulting a Georgia elder law attorney is the recommended next step to confirm the correct procedure and avoid jeopardizing her Medicaid eligibility.

Answer: The "Extra Help" program, officially called the Low-Income Subsidy (LIS), helps people with limited income and resources pay for Medicare Part D prescription drug costs. It can significantly lower or eliminate expenses for monthly premiums, annual deductibles, and co-payments or coinsurance, with eligible individuals paying very low costs for their medications.

You may qualify if your income is below 150% of the Federal Poverty Level and your resources (like bank accounts or stocks) are below a certain limit, but some people are automatically enrolled. You can apply for Extra Help through the Social Security Administration (SSA) website at www.ssa.gov/extrahelp, by visiting a local Social Security office, or by getting help from your local State Health Insurance Assistance Program (SHIP).

If any of these options to enroll seem daunting, I'm happy to get on the phone and walk anyone through the steps as we do it together online or over the phone (I don't have to be your designated agent).

Answer: Original Medicare will cover 80% of covered charges, leaving the beneficiary to pay the other 20%. To help with that 20% out of pocket amount, the two solutions are referred to as "Medicare Advantage" plans and "Medigap" (Medicare Supplement) plans.

Advantage plans cover everything but copays or coinsurance for services used (fee-for-service model) and will typically not charge a monthly premium. Many times an Advantage plan will include Part D prescription drug (Rx) benefits at no additional premium and can even offer cheaper Rx copays than a stand-alone Rx plan. In addition, Advantage plans can include extra benefits not covered by Medicare, such as dental, vision, hearing, gym membership, and other benefits.

Medigap (Supplement) plans cover the majority, if not all, of your out of pocket medical expense, but charge a substantial monthly premium regardless of how often you use medical services. In addition, Medigap does NOT cover Rx medications, so you are required to enroll in a separate Rx drug plan which will likely also include an additional separate premium. Medigap plans do not offer additional benefits.

Typically I only recommend Medigap for someone who has a complex medical history and risks spending more on an Advantage plan's Maximum Out Of Pocket limit (MOOP) than it would cost to pay the annual premium on the Medigap supplement plan. (MOOP is a safety net with Advantage Plans that prevent you from any catastrophic expenses). Another reason would be to accommodate extenuating provider network access issues. Some people prefer Medigap over Advantage plans because they might have enough financial cushion to not factor premiums into their decision. They simply want the psychological safety of knowing everything is paid for without having to reconcile copays or medical bills.

In my view, it's easy to see why Medicare Advantage plans have become so popular. Who wouldn't want more for less?

Answer: Using a licensed Medicare agent at no cost is incredibly advantageous. If you needed your kitchen redesigned, or your taxes done, or your car repaired, and a subject matter expert was willing to help you through that process at no cost - that's something most people wouldn't think twice about. Sure, you can study and research and read all the fine print and muddle through it yourself, but it depends on how much you value your time and brain power. Using a reputable, experienced, licensed Medicare agent to guide you through the jungle of Medicare nuances and annual changes to ensure you get maximum coverage at the lowest cost and highest value for your unique situation is priceless. (Literally)

Answer: Yes. HSA expenses can be withdrawn tax-free for eligible medical expenses after age 65.

Note, there are additional changes included in the recently passed “Big Beautiful Bill” that will soon affect HSAs. For example, up until recently, the rule has always been that you may only make HSA contributions until you enroll on Medicare. That rule will be changing.

Answer: Yes, there are plenty of incentives offered by plans to help members adopt healthy habits and lifestyles. One of the most common among Medicare Advantage plans is a gym membership or fitness reimbursement benefit.

Each plan is different in different areas of the country. To find out if your plan has such a benefit, call your plan’s member services, usually found on the back of your member ID card or check your Summary of Benefits document.

When shopping for new plan options, always check the Summary of Benefits document (and the more detailed Evidence of Coverage document) to determine what member programs and rewards the plan offers.

Usually, Medicare supplement plans (Medigap) do not offer healthy habit incentives, but I have seen a few that do cover gym memberships or offer fitness discounts. Otherwise, you’re going to find these rewards and programs in the Advantages plans.

Answer: One could argue that COVID-19 was the best thing to ever happen to our healthcare system: It forced so much of the medical landscape that was lagging decades behind in technology to catch up to the digital age, practically overnight.

The first early adoption of Telemedicine (virtual doctor appointments) was spurred around 2010 by health systems serving rural America, a far-spread population who typically do not have convenient access to medical care. As a result, the overall health trends reflect a sicker population in rural areas when compared to urban areas. For about a decade, millions of rural Americans began accessing telemedicine for virtual care when other care was not readily available.

At the same time, a hellscape of disparate medical record systems, fax machines, and old-school paper files existed and were still a dominant limiting factor across the country. It’s no surprise that America’s mainstream health system was slow on the draw to adopt telemedicine.

Fast forward to 2020 when the whole world shut down with COVID-19. Suddenly health providers and patients were unable to see each other in person. Medical providers en masse began clamoring for a digital solution. Gratefully, telemedicine technology vendors and robust best practices had already emerged. Patients who had otherwise been disinclined to meet with a doctor online were suddenly motivated to change their tune and get in line for digital appointments. This was viewed both as a safe and cost effective alternative for patients and providers alike.

Personally, I believe that if COVID had not happened, America would still be languishing in catching up to the digital era. Telemedicine enabled America’s health system to not only survive the pandemic, but gave it the jump start and wake up call it needed to bring the rest of the slow-adopting providers and patients into the digital age.

Today, telemedicine is a widely-accepted, cost-effective, mainstream alternative to in-person care.

Answer: The fact that CMS has FINALLY held PBMs’ feet to the fire and negotiated prices on some of the most outlandishly expensive and frequently used medications is potentially a major game changer. It’s only 10 meds for 2026 but there’s more on the way in coming years. Fingers crossed that it will begin to shift the power back to the Medicare patient to get the Rx care they need and not be priced out.

Answer: It sounds cliche, but my passion is helping people improve their lives. And some of the individuals who need the most help are Medicare beneficiaries. Finding this niche is something I wish I had done decades ago, but I’m glad I am now doing what I love!

Answer: Without knowing your exact plan type or benefit structure, I will provide info on likely scenarios.

Most likely, you have a Medicare Advantage plan and your bill reflects the copay portion of covered ambulance charges (that’s about the range of a typical ambulance MA copay). The actual cost of the emergency transport billed to the plan was likely much, much higher, so chances are you’re only paying a fraction of the billed charges.

If you do not have an Advantage plan, and you only have original Medicare, then Medicare will pay 80% of covered charges, leaving you with 20% patient responsibility (your out of pocket cost). If that’s the case for you, then the $300 may be the 20% coinsurance portion of your bill.

If you pay an additional monthly premium for a Medigap plan (or Medicare Supplement) then your ambulance may have been covered and the bill should be reevaluated.

But if I’m right and you do have an Advantage plan and still think the bill is erroneous after comparing it to your Summary of Benefits document, I would recommend calling the Member Services number on the back of your plan ID card and confirm with them that it was billed correctly.