Susan O'Kelley, Medicare Insurance Broker

Answer: Creditable coverage means your health plan or drug plan meets Medicare minimum coverages. Another way to say this is that your existing coverage such as an employer plan will pay and cover at least as much as what a Medicare plan would pay and cover. It’s very important because if you do not have creditable coverage, you could be subject to late enrollment penalties. The Good News is that if you like your employer health insurance and it IS considered creditable, you can stay on the plan – without a penalty. CAUTION: when you decide to retire, there are timelines to move from the employer plan to Medicare. Be sure to understand enrollment timelines to transition smoothly without any penalties.

Answer: With massive amounts of marketing materials on tv and being sent to seniors in the 12 months before they turn 65, it can become overwhelming. This leads to confusion, and for many, it seems easier to bury our head in the sand without realizing or understanding there are important timelines and decisions that can affect them indefinitely. The best way for seniors to get help is to find an agent focused on education, not sales. Agents can help by cultivating an environment of educating by providing clear unbiased explanations of enrollment timelines and coverage options.

Answer: Maybe. If it is considered medically necessary then yes. However, be careful. This service usually will fall under your Part B deductible which means you would pay 20% of the approved amount. Before you get too concerned, the next step is to determine if you have a Medicare Advantage plan with a co-pay? If yes, check your plan to find out how much of the co-pay is required by you. If you have a Medicare supplemental, your co-pay will likely depend on your Medicare supplemental deductible rules. So, to be covered by Medicare, the treatment must be for an active, acute, or chronic condition. It does not cover maintenance visits. And last, but not least your chiropractor must accept Medicare billing, whether it’s through a Medicare Advantage plan or through Original Medicare Part A & B.

Answer: Two of the most common misconceptions are that it is FREE and it covers EVERYTHING. First: Part A (hospital coverage) *might* not cost anything if you've worked at least 10 years and contributed into Medicare. Part B (services) have a standard minimum cost while Drug plans and bundled MAPD plans (that come with drug coverage) might have a zero cost monthly premium but they're going to have deductibles, copays, and co-insurance. Second: Medicare coverage is great - but it does NOT cover 100%. You're responsible for filling the gaps with something like an MAPD plan or a Medigap plan.

Answer: Depending on the type of life insurance policy, you can use it as a financial asset. By that I mean you could take a loan from the policy, use it as loan collateral, enjoy “living benefits” if you become ill, build wealth, and even manage taxes on your nest egg. For example, once you are subject to required minimum distributions (RMDs) from old IRAs or 401ks, you can use the RMDs to pay for policy premiums which means you create tax-free growth and a tax-free death benefit for your family.

Answer: Medicare.gov has a Plan Finder tool online to compare insurance company plans in her area. You can also go directly to the health insurance company website, navigate to the plan's Provider Directory Search tool to confirm her doctors are in the plan's network.

Answer: Yes, your daughter can work directly with a Medicare agent or broker on your behalf. However, you must provide written authorization such as a durable Power of Attorney or Medicare Form CMS-1696 which will appoint a representative to act on your behalf. (Hot Tip: You can also complete the authorization online via your Medicare.gov account.)

Answer: Regardless of whether you are on an individual family plan, an employer plan, or Medicare, you should purchase a Travel Insurance policy - especially when traveling outside the US. A few health insurance plans might pay a very limited amount of emergency coverage but you will pay out of pocket then submit a claim for reimbursement. Assume the worst: No. Coverage. Foreign-travel.

Answer: First, understand that Medicare rates MAPD and Part D drug plans on a scale of 1 to 5 with 1 being the lowest and 5 being the highest. If you are enrolled in an MAPD or Part D Drug plan that is lower than 5 Stars and a 5 Star plan becomes available to your region during the year, you can enroll in the higher rated plan. CAUTION: This Special Enrollment Period (SEP) is not available during OEP or AEP. As a reminder, OEP (Open Enrollment) is from January 1st to March 31st and does NOT apply to Part D Drug Plans. AEP (Annual Enrollment) runs from October 15th to December 7th. To coordinate with AEP, the Medicare Advantage 5 Star SEP is from December 8th to November 30th every year.

Answer: Choosing anything based ONLY on price - especially Medicare - can mean you miss out on maximizing benefits that apply to you and your family's lifestyle. Your health insurance journey is unique to you, your family, your health, your preferred doctors, prescriptions, etc. It's important to understand the relationships between deductibles, copayments and coinsurance as well as doctors, prescriptions, and preferred hospitals. Many so-called "cheap" plans leave you open to higher expenses, unexpected costs and have fewer value-added benefits. Go with a plan that fits you and your lifestyle, not your friend's.

Answer: The short answer is that just being on Medicare does not reduce the need for life insurance because they are two different concepts. Medicare is health insurance and helps cover the financial costs associated with health care - while you are alive. There are many different types of life insurance with the most common being a policy that provides a death benefit to your family - after you pass away. Other types of policy can be structured to fund financial goals, or even provide "living benefits" through long-term care riders but none of these replace Medicare.

Answer: Medicare only covers LIMITED in-home care and there is specific criteria that must be met. Unless your Mom is on Medicaid, it's important to remember that Medicare does not cover long-term care. Some MAPD plans, MAPD Special Needs Plans and the PACE Program (all-inclusive care for elderly) may offer some varying levels of benefits depending on eligibility and service areas. Each state has it's own Medicaid programs so be sure to contact your state's Medicaid division for guidance and the PACE program is not currently available in every state.

Answer: Cross-check the billing document with your Medicare Summary Notice. (Hot Tip: you can also access your Medicare notices logging into your www.medicare.gov account.) Then contact your doctor's billing department. Ask about incorrect billing codes or diagnosis codes, duplicate services, or denied services. If needed, you might need to double check your insurance Evidence of Coverage and contact your insurance company for clarification. If the billing issue becomes something you can't resolve with the doctor, you can file a dispute with Medicare via 1-800-Medicare or online at Medicare.gov. If you have a Medicare agent - although they can't solve the problem for you - they might also be able to point you to resources.

Answer: While there are still unscrupulous agents around, most agents are ethical. Sometimes the biggest issue is that an agent doesn't listen carefully to your concerns. And for most of us Medicare beneficiaries, those concerns are making sure our doctors are in network, our prescriptions are covered, and the solution fits our budget and lifestyle.

Answer: Indeed, a prolong shutdown coupled with Congressional roadblocks, would affect both providers AND beneficiaries in several ways. For just a few examples, providers would suffer from delayed payments (which then affects their cashflow) and specific to telehealth services they would not be reimbursed for services provided after the waivers expired. This could be critical for hospitals and skilled-nursing facilities. For beneficiaries, loss of telehealth and at home Acute Hospital Care could be huge. For example, there is already limited access for rural areas so losing telehealth access means the beneficiary might be required to visit a clinic. For those participating in At Home programs, beneficiaries will be transitioned back to hospital acute care.

Answer: Yes - if your Dad's income changes (ie due to job income increases or decreases), the cost of Medicare Part B AND Part D could increase or decrease. This comes from the Modified Adjusted Gross Income, MAGI, which then affects the annual Income Related Monthly Adjustment Amount (IRMAA). If your Dad was paying MORE for his Part B/Part D and has a reduction in income, he can appeal to get the premium reduced. Note: MAGI is not on your tax return. Check back for additional resources on calculating MAGI as well as more info on IRMAA.

Answer: It might not be better to update your plan often - JUST to update it. And selecting a plan that will work long-term is great, but..... Always at least review your Medicare plan every year.

Answer: It's all about getting to know the person. Find out about what's important to them and ask about preferences for their doctors and scrips. Then go over the difference in costs, coverages, and coverage limits such as Copays & Cost Sharing (MAPD) versus a fixed monthly premium with a low annual deductible (Medigap). Sometimes using language such as "Bundled with Part D" (MAPD) versus "A la Carte" (Medigap with standalone Part D) helps paint the "big picture" of the difference between Medicare Advantage versus Medigap/Medicare Supplemental plans.

Answer: A seasoned broker will take the time to listen to your concerns and engage with you to talk about UNBIASED options. They will ask you about your preferred docs, ask to see if you have prescriptions and prescription costs that you are concerned about. An inexperience broker might be new (less than a few years in the business) or might only have access to a few carriers or options. Most important: They don't try to "sell" you. An experienced agent is someone you should feel works with you - not just trying to make a quick buck. (Don't forget about crowd-sourcing for reviews, testimonials, etc.....)