Tanisha Coffey, Medicare Insurance Broker

Answer: The biggest coverage gap in Medicare Advantage plans is the costs for a hospital stay. Though there is a maximum out of pocket on what one will pay in a year, many Medicare beneficiaries are not prepared for the per day costs they would incur if they were hospitalized or the post-release care if they need additional institutional care. Having a hospital indemnity plan can help cover costs for the hospital stay; long term care coverage or tapping into the living benefits of a life insurance policy (if the policy has them) can help with post-release institutional care.

Answer: When a spouse passes away, there's often a financial impact on top of the emotional one. One of the changes that often happens is that the surviving spouse's tax filing status changes from married filing jointly to single. When this happens, the income thresholds at which Income-Related Monthly Adjustment Amount (IRMAA) applies also change. If your Medicare Part B premium increased, it's likely due to an IRMAA being assessed; the fee is based on income tax returns for the previous 2 tax years. If this is the type of increase you're experiencing, it is possible to appeal the IRMAA charge and, if the appeal is won, the IRMAA will be removed. Meanwhile, if you have experienced increases on other Medicare related coverages, if you and your spouse had those services together and had a household discount applied to your coverages, pricing could have increased due to the loss of the discount. Take a close look at your past and most recent billing statements to determine if this is the case. If you're unsure how to do either of those or if you would like help, reach out to your Medicare broker. If you don't have one, I'm happy to be a resource to assist you.

Answer: If a senior is feeling overwhelmed by all of the Medicare options available, it's likely because they don't fully understand the options or how certain ones work together and how others don't.

So, the first thing I would say is to attend a Medicare educational event to learn some of the basics. That will give them a better idea of the possibilities.

The next step is to choose a health / Medicare broker to be their broker. Just like many people have a doctor, accountant, and pet groomer that they can depend on, every senior should have a Medicare broker that they work with year after year.

The broker can help them to understand the options overall, of course... but more importantly, the broker can help the person get clear on what's most important to them and find a plan that fits that; they can also help seniors navigate financial challenges too, directing them to programs and resources that they may qualify for.

So, if you're a senior or the adult child/caregiver or a senior and are feeling overwhelmed, just ask a broker (like me). It's the path of least resistance to get help... and it's free!

Answer: Your options are limited if you miss the set Medicare enrollment periods. So, unless you qualify for a special enrollment period, you will need to stay in the plan you've chosen. To be sure you never miss an enrollment window, be sure to mark down critical dates and set a calendar or phone reminder. Working with a Medicare broker will also help; if you're working with a broker, they'll likely connect with you at the beginning of annual enrollment period (AEP) to help you find the option that will work for you, decreasing the likelihood that you'll want to change plans later on.

Answer: The decision to opt for Original Medicare coupled with a Part D or Medicare Advantage is never a matter of "better." Better is subjective and ever-changing. Instead, think of the decision as what fits your medical and financial needs at the time. For some people, financially, either option is feasible. For others, medically, one may make more sense than the other. Many people will make a decision when first starting Medicare based on their health and financial outlook but it is possible to make a different decision later on. So, again. There is no better overall; just what fits you!

Answer: Unfortunately, Medicare Fraud is real and you do have to be careful.

The first way to protect yourself is to protect your Medicare Beneficiary ID number / your Medicare card. Treat it with the same protection as you would your social security number. It is needed for someone to assist you with health, financial assistance and Medicare-related needs but be sure you trust who you're providing the information to.

The second way to protect yourself is to not accept or give information to people who call you asking about or wanting to tell you about Medicare supplements, Medicare Advantage or "Medicare programs." While all of those things do exist, if you need help, it's better that you make the call to CMS, go to Medicare.gov or connect with a licensed health / Medicare broker. This way, you KNOW who you're contacting and can vet them before interacting with them. Now, the exception is if you attend an event or submit a request to a specific broker to assist you. If you do that, you're giving them permission to contact you. Keep a note of anyone you complete a permission to contact form with so you'll know it's safe to speak with them.

The third way to protect yourself is to attend Medicare events--general education or events that talk about specific plans in your area. Generally, you'll get qualify information and can make well-informed decisions from there...or at least narrow down what you may want to do or gain a better understanding of options in general.

Finally, work with a health / Medicare broker. Agents typically work for a single company; brokers represent many. As such, most will be able to give you the pros and cons on any option you're considering. They can become your go-to person year after year so you'll have someone who knows you, your needs and can help you choose what's best based on your financial and medical needs each year. If you have more questions, give us a call. We'll do our best to answer.

Answer: Some procedures or medications require prior authorization or special approval for Medicare beneficiaries. Many doctor offices will call and verify this for you. However, if you want to take matters into your own hands to be certain, you can call your Medicare Advantage provider to get confirmation one way or the other. If you have a broker who assists you each year, they can also assist you with finding out; if not, and you need help, contact us.

Answer: Medicare Advantage plans can work in any area--suburban or rural. However, it is important to confirm that your physicians are in network and your medications are on the carrier's formulary with the plan you choose. If not, though the plan does work in the area, it may not work the way you want or need it to.

Doctors, prescriptions, and hospitals that are in-network or are covered typically change to some degree every year. The carrier and/or plan you use one year may or may not be a good fit for the next. So, it should be an annual practice to review all of those things annually. This is one of the key reasons it's beneficial to work with a broker to assist you each year. Getting help won't cost you a thing... but not being vigilant, well, that could be very costly. Don't hesitate to give me a call if you have any further questions or need assistance.

Answer: I believe that the giveback is the most oberhyoed benefit of Medicare Advantage plans. Many people get excited about the wording of "give back". What it does, providing monies back on a part B premium, can be helpful or even ideal for some at certain points in the later years. However, there is often a tradeoff for giveback plans, which can show up as slightly higher costs in some of the other areas of the plan. So, while they can be helpful and right for some Medicare beneficiaries, they're not always the best option and some clients need to resist the temptation.

Answer: Whether you're using Part D or if you have a Medicare Advantage plan, carrier formularies change each year. So, it's important that you always check formularies when reviewing your Medicare coverage during open enrollment. Also, enter your medications and dosages with doing the review. This will allow you to look at the projected costs for the upcoming year. This can help plan financially or to clearly see which option is the best for you to insure you can have the medication you need and less stress over how to pay for it. Meanwhile, some states offer programs that can assist with prescription drug coast for qualifying individuals. Consider looking into what your state offers and sit with a Medicare Broker who can guide you.

Answer: If you're have Original Medicare and switch to a Medicare Advantage plan, it is not guaranteed that you will be able to maintain all of your doctors. Medicare Advantage plans have specific networks. So, when considering a switch to a Medicare Advantage plan, it's important that you have a list of your current doctors. When working with clients, we always use that information to check to see if the doctors are in network for the carrier you're looking at. Each carrier will have different networks. So, some, none or all of the doctors may be in network, depending on the carrier you're considering for your Medicare Advantage Plan. For the doctors who are not in-network, you would need to select an in-network physician and use the in-network physician instead; if you continued to see an out of network physician, the costs associated with doing so would be fully your responsibility.

Answer: It's important to follow up with your parents after discussing Medicare so that you understand the type of health insurance coverage that they have. Original Medicare and Medicare Advantage plans work differently. Knowing the difference between the two and which they have can help you to help them if you need to step in due to changes in finances or health.

Answer: Your Medicare Advantage HMO has a specific network of physicians, laboratories, hospitals, etc. If you stay in-network, you will be responsible for costs as expected based on your plan with cost-sharing from your Medicare Advantage provider. If, however, you opt to see an out of network physician, your plan won't cover that. The full financial responsibility will fall on you.

Answer: The conversation should be about you, not the Medicare broker. You are fully in control. Their recommendations should be based on what you've told them. Generally, the first decision is about which route to go: Original Medicare or Medicare Advantage. For most people, this decision is based on their health, how they want to access doctors / health services, the lifestyle they want to live and, of course, cost.

When it comes to carriers, plans and supplements, you're looking closer at the details of what's included. Again, the recommendation from the broker should still align with what you've told them about your health and preferences. So, make sure you're giving each person the same information / responses; if not, that absolutely could lead to differing advice.

It's also important to pay attention to who you choose to speak with as that can impact the options you're presented with or the advice given. If you're sitting with a Medicare agent who only works for / with on carrier, you may have fewer options than if you sit with a Medicare broker who works with multiple companies.

Answer: Whether or not you should look at getting a new Medicare plan depends on the type of coverage you currently have. If you have Original Medicare, it's not necessary to do so as you can see any provider you choose. If, however, you have a Medicare Advantage plan, you should absolutely review your plan. Carriers do not offer plans in every county. So, it's important to know which carriers offer plans in the county you're moving to. Additionally, even if your current carrier does offer plans in the county, they may or may not offer your current plan.

Answer: Many Medicare Advantage plans do include dental related services as part of the plan, which Original Medicare does not. So, while you may save specifically on the dental cleanings, you may or may not save money overall. And, if you do save money, there will be some tradeoffs if you opt to switch. As such, it'd be a good idea for you to compare Medicare Advantage plans in your area with your current Original Medicare coverages thoroughly to see which is best for you. A Medicare broker can assist you with that if you need assistance.

Answer: For those who opted for Original Medicare, the Medicare Summary Notice is a standard report showing the services Medicare paid for on your behalf. It also shows costs you may have paid or should expect to pay for services you had. It is NOT a bill though. When you receive a Medicare Summary Notice, take a few minutes to review to to make sure the services listed are accurate.

Answer: Realistically, I would need more information to provide advice for your specific situation. Generally, your best option is to apply for your state's Medicaid program. There are varying levels of Medicaid coverage, which would help to provide financial relief if you qualify.

Answer: It is not guaranteed that Part D changes would help in your situation. You may want to look into programs offered by your state that may be able to assist with the costs, ask your doctor if they can assist by connecting you with the pharmaceutical company to see if they have any patient assistant programs. Finally, if those are not options or they've been exhausted already, it may be time to review Original Medicare vs Medicare Advantage to see which would be best for you based on your current health and needs.

Answer: The payments you paid into Medicare during your working years covers services related to Medicare Part A and the premium you currently pay for part B covers that. If you were applying for Medigap, that means you opted for Original Medicare. Original Medicare requires you pay 20% of costs. Medigap is not part of Medicare. It is a supplement that one can obtain if they want to lessen the potential out of pocket costs related to the 20% Medicare doesn't cover. So, they are not one in the same. Medigap is a supplement provided by a 3rd party insurance company to cover part of that 20% that would be your responsibility. As such, as with most health insurance (primarily excluding employer-provided plans, ACA & Medicare) and health insurance supplements or indemnity plans, acceptance to cover an individual is at the carrier's discretion. The only time Medigap plans typically are not underwritten (medical conditions not considered) / at the carrier's discretion is when you first start Medicare.

Answer: Just like with other types of insurance, working with a Medicare broker can help you to fully understand your options and which coverages do and don't work togethers. Working with a Medicare broker also gives you access to an experts who can help you look at your options holistically, giving you a better understanding of how your Medicare choices are impacted by other financial decisions you may need to make if you're working after 65 or whether you're retired. Finally, working with a Medicare broker can help you to learn about or apply for programs for which you may be eligible for based on your income or your specific health challenges.

Answer: The short answer is: No. You do not have to pay for Medicare if you live part of the year abroad. If you chose not to do so, there are some things to consider. First, if you opt not to pay for your Part B, that could leave you without health insurance coverage for everything besides hospital-related stays. It could also result in a permanent late penalty on your Part B premiums whenever you did resume Part B coverage.