Susan Thomas, Medicare Insurance Agent

Answer: I believe you are wanting to compare a group health plan (offered through your work) with your current Medicare Advantage plan. To be able to make a fair comparison, it would be necessary to access the full benefits packages from both plans, such as the premiums paid, the deductibles and copays, as well as the max-out-of-pocket amounts for each and do a side-by-side comparison. Without having your specific group plan information available (and I can't find it online), it's not possible to do a truly reliable comparison.

Meeting with a licensed agent, providing him/her with that information, and allowing them to do the comparison for you would help you better understand how these health plans differ and possibly identify what you most value in a plan.

Generally speaking, though, a group health plan may have options that a Medicare plan doesn't have, like employer subsidized premiums and the ability to add dependents. You may even be able to keep a group plan and add Medicare Part A while you're still working to provide additional hospital coverage. Once you leave your group plan and go onto Medicare Parts A, B and D, you will need to make decisions like whether or not to start Social Security, whether a Medicare Advantage (Part C) is best or staying with Original Medicare and adding a Medicare Supplement. A qualified agent--especially one who is also a Financial Advisor--can be a great asset in helping you navigate these important decisions without endangering future opportunities or incurring negative financial consequences.

Answer: Some Medicare agents work for a large agency where they are captive agents for the company. Typically, these agents work with clients over the phone rather than in person, and you may never be able to reach them again with questions but will need to call an 800 number.

Independent agents may be contracted with a variety of companies through which they can offer Medicare services and give you a better comparison of products rather than just one company's plan. Also, you are more likely to get better customer service by calling your agent directly (someone who knows your individual situation) instead of calling an 800 number for generic advice. Additionally, you may be able to meet with them in person on a regular basis each time annual enrollment comes around so that you don't miss important opportunities to improve your plan or save money.

Be sure to ask your agent what services they provide, what companies they represent, if they meet in person or only via phone or video conference, if they call/email you each annual enrollment to offer a personal review of your plan, and if they charge any additional fees for their services.

Answer: You are in control of whether or not you receive your Medicare benefits and of your enrollment status. Typically, everyone who is a US citizen or legal resident, is 65 or older, and meets the work requirement is eligible for Medicare Parts A, B and D. However, you must pay your premiums for Part B and D in order to retain this coverage. Failure to pay the premiums or opting out is your choice; however, reenrollment after a lapse in coverage will most likely incur a penalty added to future premiums that cannot be waived.

There are exceptions, of course. If you are under 65 and are on SSDI and qualified for Medicare due to a disability, you may lose your Medicare if you recover from your disability. If you are a child or dependent getting Medicare benefits from a parent or adoptive parent or legal guardian and you age out of the system and become financially self-reliant, you could lose your Medicare benefits.

Answer: Yes, but only under very specific circumstances. If they have end-stage renal disease or a qualifying disability, they can qualify for early Medicare benefits. Alternatively, they can receive some benefits through parental records, if the circumstances fit.

Typically, children are more likely to qualify for other programs, such as Medicaid, CHIP, or subsidized healthcare insurance through Healthcare.gov.

If you have a specific circumstance in mind, feel free to submit a more specific question.

Answer: That depends on whether your same plan is also available in the new county. I recommend contacting your agent to help you navigate the options in your new county and switching you to a new plan, if necessary.

Answer: Acupuncture is covered if deemed medically necessary, but only for chronic lower back pain. Medicare typically does not cover other forms of naturopathic medicine. If you are concerned about your treatment options, particularly in the event of a severe illness, like cancer, heart attack, stroke, or end-stage renal failure, I recommend considering adding a critical illness policy that will pay a single lump sum upon diagnosis, which you can use however you like. I help my clients with options like these to find creative ways to get the help they think best.

Answer: Your Medicare premiums will likely increase when that gain is added to your taxable income, unless it was your primary residence. In that case, you can exclude the entire amount (up to $500,000). If, however, your premiums do increase, they will stay that way for at least two years. There are potentially other ways to mitigate the impact of large influxes like these. As a Medicare Specialist and a Financial Advisor, I help my clients navigate hurdles like these.

Answer: Hospital Part A doesn’t follow the 80% coinsurance rule. That applies to Part B (medical) only. Under Part A, you will see charges associated with deductibles, copayments and, potentially, daily coinsurance amounts if you have used up your initial 60 days of hospital stays. There are separate charges for stays in skilled nursing facilities. I recommend looking into a Medicare Advantage plan or a Medicare supplement to help offset those expenses.

Answer: Yes, green card holders can get Medicare if they meet the requirements: age, residency, and work history. If you have a qualifying disability, you may also be eligible prior to age 65. Let me know if I can help!

Answer: Turning 65 is your golden opportunity to get the best coverage available through a Medicare Supplement Plan G without any medical underwriting. (Your health problems won’t keep you from getting the best plan available at the preferred rate!)

Enrollment is available now for a supplement. You can also enroll in any drug plan that will cover the medications you need; however, you can also get your provider to write a pre-authorization letter if necessary for drugs Medicare may not initially cover. You can enroll in your drug plan 90 days before your 65th birthday.

A qualified Medicare agent can help you with the options, enrollment process, timing, and may even help you with future plan changes. Call me if you need someone in your corner!

Answer: Yes, you can, provided you are enrolled in Medicare Parts A & B; however, it’s not necessary simply to be able to choose a doctor you like, and it could end up costing you thousands in unnecessary costs. I recommend that you meet with your Medicare agent or give me a call, as the best option will be to do a review of your current group coverage and network, compare it to what you would pay on a Medicare Supplement with a Part D, and choose the best option.

Supplements have no network, and the Plan G offers platinum level coverage, so you could pick your doctor and drop your current group plan, as long as it makes sense financially. I would love to walk you through all your options.

Answer: Having a dedicated agent benefits you in a variety of ways. It gives you access to a real person who is an expert in the field and able to tailor their advice to your particular situation, needs, and budget. It gives you someone you can call or email directly as questions arise who knows you and your history so you can avoid long waits on 800 numbers to talk to strangers. In some cases, you may even be able to meet with them throughout the year in person. In my case, I also keep track of all my clients’ plans and alert them to changes, opportunities to save money, or better options during annual enrollment. I also am a highly licensed financial advisor and an expert in many types of insurance, so I am able to help my clients with nearly any question related to financial planning in retirement. Also, there is no extra charge to have someone like me in your corner helping you navigate the room of smoke and mirrors we call Medicare.

Answer: Yes, Medicare covers cancer screenings of various kinds as a standard preventative service that is typically covered at 100% if obtained through a provider who accepts Medicare. How often you can obtain them is based on the type of test, your age, your level of risk, and your doctor’s recommendations.