Steven Whetstine, Medicare Insurance Agent

Answer: I chose to become an Independent Medicare Agent because I wanted to make a meaningful difference in the lives of Medicare beneficiaries. My journey began with a deeply personal motivation. It began helping my parents as they navigated the complex Medicare system while supporting my grandparents.

Over time, I changed my career path from the property and casualty insurance so I could learn the intricacies of Medicare and be able to assist more of my family. Little did I know at the time that I would eventually leave as a captive agent and branch out as an independent agent with my own business.

As I grew more experienced in this field, my passion for helping others only deepened as I continued within the industry. I provided assistance to insurance carriers within the industry to help facilitate more options for Medicare beneficiaries within the market.

Unfortunately, I also witnessed firsthand how some agents exploited seniors, even going so far as to use my business name unethically to boost their commissions. These experiences only strengthened my resolve to operate with integrity and advocate fiercely for those I serve.

Being an independent broker allows me the freedom to get to know my customers, understand their unique needs and provide appropriate solutions tailored to their needs. I am intentional in picking up as many contracts as possible with insurance carriers to facilitate those needs. I receive a lot of referrals because my clients know that I am one who can be trusted. I operate with integrity to the extent that I will enroll clients in products that may not offer commissions. I started with my family. Now, I am here for yours!

Answer: Yes!

You want to find a Medicare agent that is going to be a good fit for you. Identifying what makes sense for you is an important decision to make as you consider your Medicare options.

Some agents are captive agents meaning they represent one company. Some call themselves an independent agent or independent broker. In these instances, you need to have an idea or understanding of what insurance carriers the agent is contracted and appointed with. An independent agent is not limited to how many insurance carriers they are contracted, appointed and certified with. Some call themselves an independent agent or broker with only a few contracts and some have may contracts with many insurance carriers. Personally, I attempt to gain as many contracts as possible and have hybrid contracts as I know not everyone has the same needs.

You will need to make sure that the agent has a license for the state that you file your taxes in. Where you will file your taxes is where your plan is going to be based.

It is good to get an idea if an agent has certain biases. Some agents may influence your decisions to give them the most commissions. Some agents, like myself, will listen to your situation and identify what options make sense.

Answer: In most cases, Medicare does not cover dental services like routine cleanings, fillings, tooth extractions (removals), or items like dentures and implants. Medicare also does not typically cover eye exams for glasses or contacts. However, Medicare does cover certain eye care services if you have a chronic eye condition, such as cataracts or glaucoma. Medicare covers: Surgical procedures to help repair the function of the eye due to chronic eye conditions.

Sometimes, Medicare advantage plans or Part C, will include dental and vision coverage. However, it is important to know what is covered and excluded in the plan with the insurance carrier. Each plan is going to be different as some only provide discounts on dental and vision, some only allow for basic or preventative services, and some have specific coverage limits with various benefits and exclusions.

Medicare Supplement Plans or Medigap Plans do not typically include dental or vision coverage, but insurance carriers may opt to add a rider for dental coverage.

In many cases, it is important to identify your needs. You can purchase stand alone dental and /or vision coverage or sometimes there are Dental, Vision and Hearing plans (DVH plans) that can also provide coverage for the areas where Medicare does not provide coverage.

Answer: It is important that an agent get to know your situation or needs before offering any product or service.

If an agent automatically offers a product without asking you any questions, it may be a good idea to part ways with that agent as they are not looking out for your interests. There is a good chance that the agent may be steering you to a plan that is going to give them the most commissions.

If an agent seems overly aggressive or pushy, that would be a concern. It is important to know key dates and important deadlines as it relates to making Medicare decisions.

Also, it is important that an agent takes the time to answer all of your questions.

If the agent is not willing to answer your questions, then they are also not likely going to advocate for you when you enroll in a plan with them should you need service or assistance in the future.

Answer: It depends on your situation.

If you are in the initial enrollment period, it may be good to get an idea 3-6 months in advance. Part of this would also depend on which Medicare option you choose.

If you have a life event, it is important to look into your options as soon as possible and determine how much time you have in what is considered a special election period. A life event could include events such as a move or loss of employer coverage to name a few.

If you have a Medicare Supplement or Medigap plan, you can change insurance carriers at any time. There is not a specific timeframe. Please be aware that underwriting may be involved. Many people will review their plan when they receive a notification of a change in premium which tends to happen on the anniversary of the policy.

For Medicare Advantage and Prescription Drug plans, Medicare beneficiaries will receive an annual notice of change notice in September as to all changes that will take place for the upcoming year. For discussions on other plans options, you can start checking into plan options on October 1st. However, you would not be able to make any changes to these plans until the official Annual Enrollment Period which runs from October 15th - December 7th.

If you make an election and are not satisfied with the plan during the new year, you have from January 1st through March 31st to make one change which is called an Open Enrollment Period, and it could be effective as early as the 1st of the following month.

Answer: You will sign up for Part A (Hospital) and Part B (Medical). If you worked long enough, you will not have to pay for Part A. For Part B (Medical), you will have to pay the premium each month.

To start, you will need a letter of creditable coverage through your employer which you can get through your Human Resources or Benefits Administrator. You would need this to complete the CMS-L564 form through social security to reflect proof of employment and that you had employer coverage. Most people sign up through the social security website at ssa.gov which is the gatekeeper for Medicare whether you are taking social security or not. You can also call or visit the local social security office.

Once you get your Part A (Hospital) and Part B (Medical) set up, you will be granted a special election period to identify the options that make sense for you.

Answer: If you are enrolled in the Medigap Plan F, you generally do not pay for any Medicare covered services in the United States. After Part A (Hospital) and Part B (Medical) are covered by original Medicare, the Plan F would pick up the remaining costs as long as it is covered by Medicare.

When you go to the ER and it’s a Medicare-covered visit, you should not expect to pay any copays, coinsurance, or deductibles.

Answer: It depends on your scenario.

If you had already scheduled your knee replacement prior to taking out your policy and you enrolled during open enrollment or a guaranteed issue period, then there was no underwriting and no wait for preexisting conditions. After original Medicare pays for Part A (Hospital) and Part B (Medical), the Plan G would pick up the remaining costs except for the Part B deductible.

If you took out the policy and it was not the open enrollment or a guaranteed issue period, medical underwriting would have applied. Original Medicare will still cover its share. As far as the Medicare Supplement Plan G, there would have been some disclosures included within the policy. Many insurance carriers would not have covered the knee replacement. Generally, they ask for you to keep coverage and contact them after the knee replacement. Some insurance carriers may impose a preexisting condition waiting period and may not cover the costs associated with the knee replacement. Some insurance carriers may not have issued a policy had the knee replacement been disclosed prior to taking out the policy.

Answer: There are multiple ways to address prescription drug costs.

First, you can see if you qualify for "Extra Help." You can visit Medicare.gov/extrahelp to learn more about the program or call 1-800-MEDICARE which is 1-800-633-4227. TTY Users should call 1-877-486-2048.

If you qualify, this can reduce or eliminate your Part D premiums, deductibles, copays, and coinsurance.

You can use prescription discount cards. This includes Clever Rx and Good Rx, and many retail areas offer programs such as Kroger and Walmart with their own savings programs.

State Pharmaceutical Assistance Programs can also help with reducing premiums or copays. You can contact your local SHIP (State Health Insurance Program) and talk to a counselor or Medicaid office to check on eligibility and also possible receive enrollment assistance.

Drug Manufacturers sometimes have programs of their own to provide assistance. You can see if the drug manufacturer offers a patient assistance program to help cover the costs of the medications.

You can check the Health Resources and Services Administration website at hrsa.gov. You can check to see if there is a Federally Qualified Health Center near you. Federal Qualified Health Center pharmacies offer medications at reduced prices under the federal 340B program.

In addition, there are foundation grants available in some cases. PAN Foundation, HealthWell, Patient Services Inc, CancerCare, NORD, Patient Advocate Foundation, Good Days, LLS and more offer grants for disease specific conditions. There are often chronic illness funds within these nonprofit and charitable foundations that can assist with prescription costs, and some may help with premiums and potentially travel costs.

Finally, one thing to consider is checking into the Medicare Prescription Payment Plan with your prescription drug coverage. The insurance industry also calls it MP3, and it allows you to spread your costs over the year with capped costs instead of all at once.

Answer: One of the biggest mistakes is choosing a plan based solely on the premium and not factoring the out of pocket costs and pharmacy or pharmacies that will be used.

A Medicare beneficiary will want to check to see if their preferred pharmacy is in the network for the Part D Prescription Drug Plan. Each insurance carrier will have different preferred pharmacies within their network.

It is important that one identifies the correct prescription that will be taken when reviewing the formulary under the plan. It can make a difference if reviewing tablets versus capsules or brand name versus the generic option.

It is important to review the Part D plan annually as your needs may change with prescriptions, and the plans change annually. Premiums, deductibles and copays can shift each year. Also, prescription formularies can change tiers from year to year.

Also, it is a great idea to have a discussion with the medical professionals who prescribe prescriptions to identify which medications would work well to treat you and what options could potentially save you money.

It is always good to look at the bottom line. You always want to look at the total estimated costs rather than which plans offer you the lowest premium.

Answer: It is important to review doctors, specialists and medical facilities within a Medicare Advantage plan as Medicare Advantage Plans operate under a network. Networks can change each year, so it is important to review your plan each year to make sure the specific plan covered doctors, specialists and medical facilities that are important.

Each Medicare Advantage plan will be different, so you will have to check the zip code where you file your taxes each year to verify the doctors are within the network. Each plan will have something along the lines of a "Find a Doctor" or "Provider Directory" option on their website to verify the doctors within the network.

Also, you can contact the doctor's office directly. However, it is important to not only check if they accept the insurance carrier, but also if they accept the plan or are within the plan's network. Some doctors may accept some plans but not others under the same insurance carrier. Perhaps, the doctors will accept HMO plans, but not PPO plans or PPO plans and not HMO plans.

Out of network costs can be costly. Some plans may cover out of network costs while others do not cover out of network costs at all.

Answer: The biggest disadvantage to a Medicare Advantage plan is the limited network of doctors and hospitals and care access. If you choose to see a doctor or visit a hospital, out of network expenses can be very expensive and the plan may not cover out of network expenses at all. Medicare advantage plans may only allow you to use certain durable medical equipment within the plan.

Sometimes, plans may require that you get a referral or prior authorization. For example, the HMO plans may require that you see the primary care physician who is the gatekeeper to get a referral to see a specialist.

Medicare Advantage plans are typically restricted to the local area. If you travel, it is important to consider that you may not be able to see a doctor or specialist unless it is an emergency situation.

Medicare Advantage costs can be unpredictable. You will want to check all of the details of the plan to include copays, coinsurance and deductibles as well as the maximum out of pocket amount for the calendar year. Medicare beneficiaries who choose a Medicare Advantage plan need to consider utilization which factors into the unpredictability of costs.

Answer: There are several major mistakes that Seniors or Medicare beneficiaries make when enrolling in Medicare, but the biggest mistake is missing the initial enrollment period or guaranteed issue period when it first becomes available. If you have health concerns and miss your enrollment period, you could be subject to health underwriting if you miss the initial enrollment period or guaranteed issue period.

Some Medicare beneficiaries assume that Medicare is free. Most Medicare beneficiaries do not have to pay Part A (Hospital) if they or a spouse or former spouse worked at least 10 years or 40 quarters and paid Medicare taxes. Most people have to pay a premium for Part B (Medical).

Another mistake Medicare beneficiaries is not taking the time to understand their options. If an option is not affordable, it is important to look at what makes sense to according to finances and looking at ways to receive "Extra Help" to address the financial concerns.

Even if you are healthy or do not take any prescriptions, it is important to make sure that you have coverage. A person's health can change at any time. If you miss an election period, then you can face lifetime penalties on both Part B (Medical) and Part D (Prescription Drug Coverage). Also, you may have to wait until those timeframes become available.

It is a good idea to get Medicare through a licensed agent you can trust. They can be an advocate for you in the event you experiences any challenges with Medicare or with your plan to include claim issues. If you enroll directly with the plan itself, you may not have that free benefit that is available to you.

Answer: If you feel like a Medicare seminar is like a timeshare pitch, it may be important to trust your gut feeling.

Unfortunately, there are bad actors out there that will hold Medicare seminars to push certain Medicare products because it will give them the most commissions. Often, this is a person that is holding seminars to push Medicare Advantage plans.

While Medicare Advantage plans are not a bad option for some people, it is a good idea to go to an Educational seminar or ask an agent the pros and cons for both Medicare Advantage plans and Medicare Supplement plans. You would want an unbiased perspective to identify what option makes sense for you.

A licensed and ethical agent will ask you questions to identify what Medicare options make sense for you and your specific situation.

If you ever feel any pressure to sign up now, it also can be a warning sign. The only time where you may ever need to sign up immediately is if you waited until the last minute for your election period and may be forced to make a decision as soon as possible. Identify an agent you can trust that can guide you through the process.

Answer: It is good that you are skeptical with going with the cheapest Medicare plan. It is important to identify which plan makes sense for you.

The cheapest month to month plans are typically Medicare Advantage plans. While this may not be a bad thing for your situation, you do want to make sure that you choose the plan that makes sense for you.

Choosing the cheapest plan will usually mean less coverage and a limited network. When you choose that option, you will want to make sure your preferred doctors, specialists and medical facilities are in the network. In addition, you will want to make sure your prescriptions are covered and identify the preferred pharmacies in the plan to make sure it makes sense for you. Less coverage can mean more copays. deductibles and coinsurance as you utilize the plan. Often, there is a maximum out of pocket annually for these plans. Choosing a Medicare Advantage plan can mean that there is no out of network coverage in many cases, and the service would be limited to your geographic area unless it is considered an emergency situation.

Cheaper plans can elect to change their coverage annually. Often, you will receive the annual notice of changes in September prior to the Annual Enrollment Period. Cheaper plans tend to mean less stability and can mean cuts to benefits or higher copays, deductibles and coinsurance over time. It is important to evaluate if a cheaper plan makes sense for you if you have a chronic condition as expenses can really add up as you utilize the services. Some people opt to add coverage through an indemnity plan to address the gaps in coverage and out of pocket expenses.

Answer: Medicare can be very complex with Parts A, B, C, and D and if choosing a Medicare Supplement or Medigap Plan, there can be Plans A through Plan N.

Medicare plans can change from year to year. It is important to make sure that the options continue to make sense for health and financial needs. Sometimes, rates can go up astronomically, and it may make sense to shop around to ensure that the plan continues to make sense from a financial standpoint.

Following up can provide more peace of mind, and boost confidence that the proper decision was made that is specific to health and financial needs. It can help reinforce key topics on the Medicare discussion. It allows time for processing thoughts on Medicare, and address any further questions or concerns about the Medicare options.

Answer: In Medicare, there are three major types of Special Needs Plans with Medicare. They are specific to Medicare Advantage plans. It is important to review which plans are available in your geographic area.

Institutional Special Needs Plans are very specific to a nursing home level of care or in a nursing or assisted living setting.

Dual Special Needs plans are specific to Medicare Beneficiaries who have both Medicare and Medicaid.

Chronic Special Needs Plans are for people with chronic or severe conditions. This can include individuals with chronic heart conditions, cardiovascular disease, diabetes, autoimmune diseases, and certain neurological diseases. These plans offer benefits specific to the chronic and severe conditions and offer an enhanced coordination of care for Medicare Beneficiaries who have this plan.

Answer: When choosing Medicare options, it is important to know what is important to the Medicare Beneficiary and Healthcare needs.

Some factors may include health risks and needs, financial concerns, lifestyle preferences and how one chooses to receive treatment or care.

For example, if your preference is to receive care through the Mayo Clinic, the Mayo Clinic only accepts original Medicare and Medicare Supplement or Medigap Plans. They do not accept Medicare Advantage Plans.

If you like to travel or reside in more than one state in the year, then Medicare Supplement or Medigap plans typically make more sense. You are not limited to a network and can receive your medical care anywhere. With a Medicare Advantage plan, you typically have to wait until you get back to your local area within your network unless it is a medical emergency.

If someone has a chronic or severe condition, I evaluate their situation. Is it during their initial enrollment period? That has to be considered as there are no underwriting questions for a Medicare Supplement Plan or Medigap Plan and factor high utilization. Otherwise, a chronic special needs plan may be appropriate for the person if they meet the criteria for the plan.

If one would like more flexibility in their care, a Medicare Supplement or Medigap plan may make sense because you do not have to get a referral and you can see any medical professional or visit any facility as long as they accept Medicare whereas you have to verify that your medical professionals and facilities are within the network with a Medicare Advantage plan.

Would you prefer to pay a higher premium with less out of pocket expenses, or would you rather have no premium or much smaller premium and pay the out-of-pocket expenses as you utilize the plan?

There are many things to consider when choosing the appropriate Medicare plan for you!

Answer: Take the time to understand the difference between Part A (Hospital), Part B (Medical), Part C (Medicare Advantage) and Part D (Prescription Drug Coverage) along with the Medicare Supplement or Medigap plans.

Know your Medicare timeframes and when you can choose your plans.

Do not wait until the last minute as it can add to the stress of feeling overwhelmed.

Medicare.gov has a lot of free resources and 1-800-Medicare or 1-800-633-4227 can answer general questions about Medicare.

State Health Insurance Programs or SHIP is a free resource that is available in every state. This gives people an opportunity to ask questions to help navigate the complexities of Medicare and they provide insurance counseling.

Consider whether or not your preferred doctors, specialists, and medical facilities will accept your plan. Identify which plans will minimize your out-of-pocket expenses for prescriptions with the pharmacy of your choice. Evaluate your situation carefully to consider not just premiums, but copays, coinsurance, and deductibles. You want to evaluate your total out-of-pocket expenses when you consider your options.

Find an Independent Agent or Broker you can partner with whom you can trust and can be an advocate for you. Independent Agents or Brokers can simplify the process, and can identify what makes sense for your particular situation. Also, Independent agents use resources that will help identify what makes sense financially, and tend to keep informed of changes within the industry.

Answer: Original Medicare with a Part D is better than a Medicare Advantage plan for frequent travelers as doctors, specialists, and medical facilities that accept Medicare will accept Original Medicare. It is important to consider a Medicare Supplement Plan or Medigap Plan to address some of the other 20% of costs that original Medicare does not cover. If you travel outside your geographic area, chances are you are going to travel outside of your network which means that costs could be more expensive or may not be covered. If you travel outside of the network, you are mostly covered in the event of an emergency situation.

Part D Prescription Drug Plans offer a nationwide network. In many cases, there are more than one preferred pharmacy within the network for fulfilling prescription drugs, but many also will allow you to fulfill it at other pharmacies at the standard pharmacy rates which could mean higher copays or coinsurance.

The bottom line is if you travel frequently and may become ill on the trip, you have more flexibility and can see a doctor or specialist immediately without having to wait until you get back home to get back to your network. There are no network restrictions with original Medicare and Medicare Supplement or Medigap plans. You also do not need referrals.