Tami Baker, Medicare Insurance Agent

Answer: With PPOs, you have the ability to go out of Network and pay a higher price plus, you can self-refer to a Specialist.

With an HMO, you must stay in Network or you will pay out of pocket for the entire bill, unless it is an emergency. You also must get referrals to most Specialists. The benefit of an HMO is that most copays are lower & some are significantly less expensive.

Most Companies are also giving more robust Ancillary Benefits to attract you to an HMO.

Answer: Possibly. I would ask the Dr to verify if there are going to be any copays involved for the tests he/she will be performing.

Answer: Cataract surgery is generally covered under your Medicare Plans, with a Copay but, if the Dr is implanting lenses, there could be significant out of pocket expenses. Please make sure to have the Dr explain all options to you before you decide what is the best option for you.

Answer: Yes, you can return to original Medicare during the Annual Enrollment Period or Open Enrollment period. Of course, you would want to get a Prescription Drug Plan at the same time to avoid the Part D Penalty.

Answer: Certain terminology can mean something different to everyone.

To clarify a Medicare Supplement is sometimes referred to as Medigap Insurance.,too I believe these terms came about because Medicare is billed first then the Meicare Supplement for the remaining portion not covered by Medicare.

If these plans fit into your budget they can be a great option. You know all your healthcare costs up front. No surprises. Also, most dont have Networks so you can get your services anywhere that accepts Medicate.

Of course, make sure to get a Prescription Drug Plan to go along with it so you are compliant.

Answer: Costs will always be significantly higher with any Plan when you got Out-of-Network. If it was an HMO, you would not have had ANY coverage if it was a non-emergency situation.

You should always try to choose a Plan that has most, if not all of your Medical Providers (including facilities) In-Network to alleviate paying more.

You may need to choose a different Plan or choose Providers that are In-Network to keep costs down. If it is true emergency, you should be able to the closest Urgent Care facility or ER.

Answer: The best thing about Medicare Advantage Plans is that the help control costs. You know how much services are going to cost you up front.

Also, most Plans have a Maimum Out of Pocket in a given year. Your Medical costs cannot exceed that number (except Prescriptions you pick up at a Pharmacy). Most people never get near that number but, it is a safety net.

Answer: Local Agents are familiar with Providers & Facilities and can generally offer more personalized service for your area.

We know who accepts the Ancillary benefits, as well. Plus, we are your neighbors. We're are always just a phone call away!

Answer: I love my Members and I love helping them save money & time by making sure they are in the right Plan for them.

I know they appreciate my knowledge & help and I appreciate the trust they have in me!

Answer: Most Plans offer nutritional counseling & a lot of Plans offer gym memberships or programs for you to exercise at home.

Some Plans also offer Rewards for staying active and doing annual prevention testing.

Answer: Sometimes there is just too much information given at one-time & people make knee-jerk reactions for whatever the simplest.

We, as Agents,need to make sure we go over things slowly & in a way that people can absorb it. The Prescriptions are usually the most confusing part. I have found that print outs definitely help.

Answer: What are my out of pocket costs if I just choose original Medicare?

What is the penalty if I do not choose a Prescription Drug Plan?

Answer: Medicare does cover up to the first 100 days in a rehab facility if there is proof you are improving but, true Nursing Homes are not covered.

You need a Long Term Care policy to cover full-time care, Medicaid or you pay out of pocket.

Answer: The high deductible with most PDP Plans is the biggest issue most people face. It appears to be a lot less confusing now that the Coverage Gap has gone away but, why are the Deductible & Max out-of-Pocket changing each year? Changes every year only make it more complicated for everyone.

With that said, the PPP payment program has made it easier for Members that take expensive medications & need to spread the payments out more evenly.

Answer: Unfortunately Doctors & facilities can be added or removed at any time. I would ask your Doctor if it was his/her choice or if the Insurance Company dropped him/her.

Ask the Dr which Plans they take, if you really like them so you can switch during Annual Enrollment Period. But, sometimes it ends up being a good thing and a new Doctor can look at you with fresh eyes. Or sometimes, it's good to try a different Insurance Company, too.

You should always talk to a local Advisor who knows your Market well so it's not a lot of trial & error.