Steven Rodriguez Giudicelli, Medicare Insurance Broker

Answer: The most rewarding part for me is definitely helping people navigate the complexities of Medicare and find a plan that truly meets their needs. It's a great feeling knowing I've made a confusing process much easier for someone and helped them secure important healthcare coverage.

Answer: While some Medicare Advantage plans have a $0 monthly premium, they are not truly "free." You will still be responsible for other healthcare costs, including your Part B premium, deductibles, copayments, and coinsurance. It's crucial to look beyond the premium and carefully consider the plan's overall costs, benefits, network, and rules before making a decision.

Answer: There's a few things to consider: Generic drug costs might be higher because:

* Your plan changed its preferred drug list.

* Different pharmacies charge different amounts.

* The price of the generic drug itself went up.

* You've moved to a different phase of your plan's coverage.

* Insurance rules are shifting slightly.

What to do:

* Check your plan's drug list.

* Call your insurance company.

* Compare pharmacy prices.

* Ask your doctor about other options.

Answer: Yes, you do have to meet your Part B deductible first. For 2025, the Part B deductible is $257.

Once you've paid that $257 for the year, Medicare Part B will generally cover 80% of the Medicare-approved amount for your physical therapy visits. You'll be responsible for paying the other 20%, which is called coinsurance.

So, in short: Deductible first, then Medicare pays most of it.

Answer: Start looking in September or early October. This gets you ready for the main Medicare Annual Enrollment Period, which runs from October 15th to December 7th each year.

New to Medicare? Your Initial Enrollment Period is around your 65th birthday. Start looking a few months before you turn 65. This gives you time to compare options without rushing.

Answer: No, Original Medicare (Part A & Part B) will not drop you due to changes in your health or if you get sick. Once you're enrolled, your coverage for Medicare-covered services generally continues regardless of your health conditions.

Answer: Medicare Part B generally covers remote patient monitoring (RPM) services, which could apply to your heart condition, and it has expanded to include more RPM services. If you are also considered homebound, Medicare may additionally cover home health care benefits that could complement remote monitoring.

Answer: Medicare Advantage plans can offer incentives like gift cards, as permitted by CMS, to encourage enrollment and healthy behaviors. However, it is important to look beyond these immediate benefits and carefully evaluate the plan's coverage, network, and overall suitability for your healthcare needs before enrolling.

Answer: Before you pick a Medicare plan, take a close look at your current healthcare needs, including your doctors, medications, and how often you typically need care, to ensure the plan you choose adequately covers what's most important to you.

Answer: As you retire and move to Medicare, understand your enrollment periods to avoid penalties and familiarize yourself with Medicare Parts A, B, C, and D. Carefully assess your healthcare needs, including doctors and medications, to choose between Original Medicare with supplemental coverage or a Medicare Advantage plan that best fits your requirements and budget.

Answer: To verify a Medicare agent's legitimacy, check their insurance license through your state's Department of Insurance website, such as Florida's. Be cautious of agents who pressure you for immediate enrollment or sensitive personal information.

Answer: Generally, Original Medicare doesn't cover weight-loss programs or medications solely for obesity. However, it may cover preventive weight-loss counseling and nutrition therapy if you meet certain conditions. Medicare does cover some bariatric surgeries, such as gastric bypass and laparoscopic banding, if you meet specific criteria including a BMI of 35 or higher, have an obesity-related health condition, and have tried other weight-loss treatments without success.

Answer: Original Medicare Parts A and B have coverage gaps, most notably in prescription drugs, routine dental, vision, and hearing care. Additionally, beneficiaries face out-of-pocket costs like deductibles and coinsurance for covered services.

Answer: While Medicare premiums are currently based primarily on income, particularly for Parts B and D through the Income-Related Monthly Adjustment Amount (IRMAA), there isn't currently a system in place to adjust premiums based on lifestyle factors like smoking or BMI. Introducing such a system would involve significant legal, ethical, and practical considerations regarding fairness, privacy, and the role of health insurance in incentivizing behavior versus providing a safety net. It's a complex issue with ongoing discussions but no current indication of imminent adoption by Medicare.

Answer: Some hospitals choose not to accept Medicare Advantage plans due to lower reimbursement rates compared to Original Medicare, and the administrative complexities associated with different private insurance plans. Additionally, network restrictions inherent in Medicare Advantage plans may lead some hospitals to opt out of certain contracts.

Answer: The Scope of Appointment (SOA) is a standard form or recorded verbal agreement required by Medicare that outlines the specific types of plans an agent is permitted to discuss with you, making it a normal practice for agents before discussing Medicare plans. While SOAs are generally required to ensure beneficiaries are prepared for the discussion.

Answer: It really depends on your individual healthcare needs and preferences. Medicare Part D is a stand-alone prescription drug plan that you add to Original Medicare (Part A and Part B) if you want drug coverage and prefer the flexibility of Original Medicare. On the other hand, a Medicare Advantage plan (Part C) often includes Part D coverage, along with other benefits like vision, dental, and hearing, but may have network restrictions.

Answer: You will generally be automatically enrolled in Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). You will likely receive your Medicare card a few months before your 65th birthday. If you don't want Part B coverage (for example, because you have other comparable health coverage through a spouse's current employer), you will have the option to decline it.

Answer: While there are projections indicating that the Medicare Hospital Insurance (Part A) Trust Fund may face depletion around 2036, it doesn't necessarily mean Medicare will completely run out of money before you can benefit. This projection suggests that at that point, the fund may not be able to cover 100% of Part A benefits as currently structured, potentially leading to payment reductions. However, historically, Congress has often taken action to address such situations, and various options exist to ensure the program's solvency continues in the future.