Steve Houchens, Medicare Insurance Agent

Answer: You should have enrolled in Part A & Part B Medicare and set a time with a licensed agent to discuss your options and what plans are best suited for you needs.

Answer: With a PPO you have the option to see specialist or another doctor besides you PCP without the need of a referral

Answer: You may but you will be subject to going through underwriting if you aren't in a guaranteed issue period and you could be subject to higher premiums or the possibility of being declined

Answer: If you are in a Medicare Advantage plan you need to contact your plan to let them know of your move because if you move outside your plan coverage area you will lose your coverage, and even if you are in a Medicare supplement you always need to inform your plan in case you need to make any changes

Answer: It’s always better and more convenient to work with someone local that you can get to know and trust that will sit down one on one and explain things with you. You can work with someone virtually but at least for me I like a more personal relationship with my client

Answer: To potentially avoid or reduce IRMAA (Income-Related Monthly Adjustment Amount) charges on your Medicare premiums, focus on strategies to lower your Modified Adjusted Gross Income (MAGI), such as making tax-deductible retirement contributions, charitable donations, and strategically timing income and withdrawals.

Answer: Guaranteed issue period for Medicare supplement is 3 months prior to the month you turn 65, the month you turn 65 an d 3 months after the month you turn 65 got a total of 7 months. During this time frame you do not have to answer any health questions and are guaranteed acceptance at preferred rates

Answer: An agent typically represents only one company while a broker represents multiple companies giving you a broader range of products to choose from

Answer: In my opinion it depends on each individual client and their financial situation and generally speaking the older the client gets is when it can save more due to Medicare Supplement prices can increase annually and after several years can become very pricey where as Advantage plans many time have zero or very low premiums plus offer additional added benefits not offered by Supplements.

Answer: Anyone disabled for 24 months become eligible for Medicare at that time which gives you a guaranteed issue time frame for a Medicare Supplement although the premiums are generally higher for clients under 65, and when you reach 65 you will be given another guaranteed issue period and then qualify for regular rates

Answer: Just to make sure to be educated on all your options from a licensed agent or broker and not ask for advice from places such as Facebook or social media where you are getting advice from people that are not educated and know the rules and regulations and many times just repeating things they have heard from others

Answer: Personally I don’t recommend one over the other, instead I educate the client on the pros and cons of each option and help the client decide what plan makes the most since for them bases on health and financial needs of each individual. There is no one size fits all in my opinion as each persons needs and financial situation will vary.

Answer: Annuities can be a very good product for retirement planning for many reasons such as , they can provide an income stream that can run until your death, also for estate planning you can choose you beneficiaries just like an insurance policy and it bypasses probate and generally you can’t loose your additional invest if the market changes

Answer: Probably in my opinion the main disadvantage would be having to work within a network, although I don’t see that as a major disadvantage due to most people are generally used to doing so with major medical coverage. There are some possible out of pocket cost but al long as you have been informed on what those are and understand your plan you know what you have to work with.

Answer: Not making informed choices and many times listening to someone that doesn't actually know what they are talking about and giving bad advice. It’s important to understand all your options and choices

Answer: I personally sit down with new people and take them through the Medicare And You book and make sure they understand the differences in all the plans and options they have

Answer: Yes, if you lose employer-sponsored health coverage, you qualify for an 8-month Medicare Special Enrollment Period (SEP) to enroll in Medicare Part A and/or Part B, or to switch to a Medicare Advantage or Part D plan.

Answer: Either call your agent or the plan itself to see what your coverage provides. Either source should be able Tom find out what you have

Answer: Medicare Part B, also known as medical insurance, helps cover medically necessary doctor's services, outpatient care, home health services, durable medical equipment, and some preventive services, but generally not inpatient hospital care or long-term care. However it’s only covers 80% with no cap on possible out of pocket cost which is why you need to purchase either a Medicare supplement or Medicare Advantage plan to protect yourself from some possible large out of pocket cost and limit you liability.

Answer: That is covers everything which it does not. Medicare A & B covers 80% and no cap for possible liability. Also doesn’t cover things such as dental, vision or hearing or prescription drugs. You need to either purchase a Supplement or Advantage plan to cover those things.

Answer: It’s important mainly because in the past you could have potentially spent over $8,000 out of pocket to go through all stages of the coverages. For people on lots of medications or high cost meds this a can be a very big savings

Answer: From an agent or broker stand point it has made enrollment much easier and quicker with electronic enrollments and makes it harder to make mistakes on applications and also much easier to do comparisons between plans as you can compare plans side by side

Answer: The difference is in the plan itself, some plans offer it and some don’t. In some cases plans that offer SilverSneakers may have a slightly higher premium.

Answer: It depends on your personal needs and what you can afford. Some people feel more comfortable with a higher end plan and others may rather save the money. Much like some people prefer a luxury car while others like an economy car, both with get you to your destination. It’s a personal choice.

Answer: The cheapest plan may or may not be your best choice. Depending on your personal needs and budget. It’s always best to look at and compare all your options and be sure you understand the differences in each plan. There is no one size fits all and it’s much better to discuss your choices with a licensed agent rather than depending on options of anyone that isn’t trained and certified to explain all options and not just select plans.

Answer: In all honesty I have no idea how or what could happen in the next decade. There are changes to the Medicare marketplace every year but I have no idea what could change over the next 10 years

Answer: There are a few different types of Special Needs Plans.First a Dual Eligible Special Needs Plan or D-SNP, is for people that are Medicare & Medicaid eligible. Second there are Chronic Special Needs Plans, C-SNP which are for people with a chronic disease or illness such as diabetes, chronic kidney disease, COPD and other specific illnesses.

Answer: I don’t see it as suspicious. Some plans offer additional extra benefits but these shouldn’t be used as incentives to sell or for a client to buy. Different plans may offer different things to set them apart from other carriers but your decision on which plan to purchase should never be the reason to but that plan but to pick a plan that best fits your personal medical needs.

Answer: Medicare generally covers part-time or intermittent home health care services when medically necessary, especially after a hospital stay or skilled nursing facility stay. This includes skilled nursing, physical therapy, occupational therapy, and speech-language pathology services, as well as medical social services and some home health aide care if it's related to skilled care. Medicare, however, does not cover 24-hour care, meal delivery, or personal care when it's the sole need. You can find more extensive break down online if you search or sit down with an agent sometime to go over all of it.

Answer: Being a senior myself I am very pleased with the coverage that I received, although like everything in life most things can be improved upon. Health care in general could probably use some improvements in many ways.

Answer: Yes, Medicare generally covers asthma and other breathing conditions. It covers treatments like inhalers, nebulizers, and medications for conditions like asthma and COPD

Answer: A Medicare Annual Wellness Visit focuses on preventative care and health planning, including a health risk assessment, review of medical history, and creation of a personalized prevention plan, but it's not a full physical

Answer: Yes Medicare covers these but only if they are prescribed by a doctor. There may be some cost sharing for the client but there are also companies available to help with or eliminate the out of pocket cost in many cases.

Answer: Yes many do. It’s important to know the limitations involved for your specific plan, so be sure to ask questions and check those situations before you make a choice on your plan if that’s an important issue for you.

Answer: This is known very well by the Medicare market and it is pretty much going to hit its peak by 2030. This is not a surprise as it’s been known for a very long time. There may be changes and adjustments made but it isn’t going to blindside the industry.

Answer: No, in most cases, Medicare does not cover medical care received outside the United States However there are some exceptions and some Medicare Supplements may cover some emergency coverage for travel abroad. It’s important to know what your plan offers.

Answer: There are already strict marketing practices in place for agents. Although some may not follow the rules in place and particularly seems to be issues with call centers mostly those from outside the USA. Its always helps to get to know your agent and more than just an unknown voice on the other end of the phone.

Answer: Credible coverage is drug coverage that pays at least as much as what Medicare would cover. It is important to avoid a possible penalty on your future prescription drug plan if you don’t enroll in a plan when you are eligible to do so.

Answer: It’s important to follow up to make sure that they completely understood what they were told by their agent and to make sure that if they were enrolled in a plan that they knew and understood that they were in fact changing coverage

Answer: The short answer is no. Medicare only pays the first 80% which Leaves you with 20% to pay with no cap on the out of pocket meaning if you were to have a hospital bill of $100,000 dollars your amount you would owe would be $20,000. And that amount might sound high but I had a client last year that had an outpatient hysterectomy and her bill was $97,000. So you definitely need a Medicare Supplement or Medicare Advantage plan to protect you and at least limit your potential out of pocket cost.

Answer: Maximum out out pocket or MOOP is referring to medical cost and the most you will spend out of pocket for the year. This doesn't include prescription cost as that is a totally different issue. MOOP is after any deductibles and copays have been met it will be the most you will have to pay for any medical cost.

Answer: Well when you say original Medicare with a part D plan you are leaving out the most important factor which is also having a Medicare Supplement or Mefigap plan. If you have original Medicare paired with a Medicare Supplement, then you do not have to worry about Network and finding doctors that will accept the plan.

Answer: After you have been on disability for 24 months you are then eligible for Medicare. This will go back to your entitlement date to start the 24 months counting period.

Answer: My personal thoughts on this matter is that hospital indemnity policies are extremely important to couple with a Medicare Advantage plan to help fill the gaps and help offset the potential out of pocket costs to the client. They are generally inexpensive and in my opinion well worth the cost.

Answer: The open enrollment period is to give a chance to change plans for any reason your are happy with the plan you have if that be network issues or just find another plan that suits your needs better.

Answer: Depending on you financial situation you could possibly be eligible for LIS or low income subsidy or possible or help available and I feel it’s always worth checking for any extra help you qualify for.

Answer: That would depend on your own personal needs and financial situation. You would need to talk to an agent that is versed and knowledgeable on both plans and can explain all options available to you and what would work best for you personally. I don’t feel there is a one size fits all plan but should be individualized for you.

Answer: You should absolutely know both and understand all your options before making a choice. There are many differences and you should talk with someone that will explain all options to you.

Answer: Without knowing what type plan you have versus what type plan your friend has it’s very hard to give a specific answer but it could be the difference between having a Medigap plan versus a Medicare Advantage plan. It could depend on what is available in your area but definitely sounds like it’s not an apples to apples comparison. That only way to know for sure would be to discuss it with an agent to review your options

Answer: In my experience anyone that has been unhappy with an advantage plan has been due to not having had benefits fully explained to or didn't understand potential out of pocket cost that could be involved. Generally it comes down to not understanding the coverage completely.

Answer: In my experience that can be a common problem of finding dentists in networks for all plans. If you have a specific dentist that you want to keep then you should try to find a plan that your specific dentist accepts but just be sure you aren’t giving up other benefits that may be more important. There are different solutions to this problem that could include getting a stand alone dental plan or some plans offer a reimbursement type coverage that allows you to go to anyone you want and submit a claim to reimburse you directly. Most importantly it’s best to weigh all benefits and choose the plan that fits the most important benefits you need if that be dental or another benefit that more important. Just be sure you understand all the benefits your plan offers.

Answer: Medicare savings programs can help in many ways depending of your income and what you qualify for. It can help pay for a portion or all your part A or B premiums and also help with out of pocket prescription cost. All depends on what you personally qualify for.

Answer: Hospitals do accept Medicare Advantage although they can pick and choice which plans they accept to be in network for. Its always important when picking a plan to make sure if the hospital you would want to use accepts the plan you are looking at. They are not obligated to take every plan offered excepted in an emergency situations.

Answer: You should talk with an agent or someone that knows and understands both options. Both are good and just different. The most important thing is to understand fully the differences and choose which is best for you. I don't believe in a one size fits all approach. Know your options and choose from there.

Answer: You would need to get an attorney involved and become their legal power of attorney or their medical decisions. That would need to be done before you could legally do anything along those lines.

Answer: A PPO will give you freedom to go to any doctor you choose without a referral from a primary care physician but if you go out of network you will pay more out of pocket but PPO plans do have networks just like an HMO the main difference if your primary care physician does not have to direct all your care.

Answer: Some plans do have coverage for things along that line although it may not cover the complete cost. You would need to shop plans and find the best options available

Answer: You will be bombarded with junk mail from many sources and your best option is to find an agent you trust to guide you through your choices. Unfortunately I don’t know a way to stop the mail. I am an agent and on Medicare myself and I receive mail and sales calls regularly. Calls are a little easier to stop sometimes but mail is a little different due to the fact that there is no regulations against mailing like there all for unsolicited calls

Answer: Plan N is a very comprehensive plan but the best way to know for sure is to call the customer service number on the back of your card but your doctor should be able to check and see as well with no problem.

Answer: I would be skeptical if any agent pushed one plan over another if that be an Advantage plan or a Medicare Supplement. Many agents may not be certified to sell advantage plans as you need specific training to sell them so they might push what they can sell which limits your options. It’s best to talk with an agent that can sell both types of plans as well as represents multiple carries to be able to actually choose the plan that fits your needs the best. There is no one size fits all. Check all your options.

Answer: The main change for 2025 is with the inflation reduction act the out of pocket cap is at $2000 annually which is a big reduction over the past years and also a payment plan was put into effect to stretch the cost out over the year so you don’t have to come out of pocket for those big hits until you hit the max out of pocket.

Answer: You and your initial enrollment. Which is three months before the month you turn 65, the month you turned 65 and three months after you turned 65. During this time you have a guaranteed issue. In which you can join a Medicare Supplement without any underwriting.

Answer: The best was is to work with an agent that is contracted to sell multiple plans so you have more than one option. If you are already in a plan each year you can shop for a different plan if you like and if you use the Birthday Rule that will give you a guaranteed issue./For 60 days after your birthday each year, and if you don’t use that, you would have to go through underwriting and possibly see if you could get a plan that was cheaper if you qualified.

Answer: Some specialists require a referral not necessarily a requirement from the plan, but you still need to use doctors within the network or you will pay more for their services.

Answer: There used to be 4 stages to drug coverage starting with the deductible phase then the initial coverage phase then after you reached that phase of money spent you hit the coverage gap (doughnut hole) then the catastrophe phase and all done you could be out approximately $8,000 , now there is not coverage gap and an annual max out of pocket of $2,000 and also the option of a payment plan to spend out the cost for the year which may make it easier if you have very expensive medication that have high copays

Answer: Some options would be to see if your doctor could prescribe a medication that would work for you issues that have a cheaper co-pay , shop to see if there is a plan that covers your medications better because plan formularies do differ. You could also see if you qualify for extra help getting those medications covered

Answer: Generally no, the only possible reason would be if the company went under but if that happened you would have a chance to get another plan of the same type guaranteed issue. The only reason they could terminate your specific coverage would be for non payment of premiums or fraud or abuse.

Answer: Dental implants are generally not covered by original Medicare. Some exceptions may exist in the case if it was medically necessary such as having jaw reconstruction due to an accident or something along those lines. Some advantage plans or stand alone dental plans may cover partial cost but you would just need to shop and compare benefits as coverage varies greatly between plans.

Answer: Most hospitals, public and private except original Medicare and supplement plans with exceptions being VA hospitals are something along that line. Medicare Advantage plans are different as hospitals may require you to use on that is in network for that specific plan. In case of emergency they all much except as in network.

Answer: They will generally come out around October or November to give you a chance to review before AEP is over.

Answer: Generally they come out around October or November so to give time to review before AEP is over. If you don’t receive yours in appropriate time you may call your plan or your agent to help you get one.

Answer: Plans do not have to cover every medication available and all formularies may vary from plan to plan. If there is a specific medication that you need your doctor can request a formulary exception to try to get approval. You may have to try other similar medications first to see if they work for you but if not all that will need to out through you doctor.

Answer: No you don’t have to sign up again but since you are aging in you will have a new guaranteed issue enrollment. If you choose to enroll in a Medicare supplement plan. You can check all your options and see what is the best for you to do.

Answer: Your income will not affect your Medicare eligibility. What it could affect is how much your part B premium would be. That is based on your annual income and the standard is $185 a month , but if your income is over a certain amount that premium can go up and also if your income is low enough, you can also get extra help to help pay for that premium. But your income loan will not affect your eligibility for Medicare that is based on age, and if you have paid in enough over the years to qualify for it