Tasha Riggs, Medicare Insurance Broker

Answer: If you have a Medicare Supplemental with a drug card you have to change the drug card. Moving is a life event to allow you to change the card. They wont let you keep it

Medicare Advantage you will want to change that plan for a plan that has benefits for your new state and county.

Answer: Medicare supplemental is exactly the same in each state. The Carriers vary but the coverage is exactly the same.

Drug Card and Medicare Advantage have to follow the exact same laws and the exact same coverage has to be the same. HOW It is covered varies by state. Meaning copays can vary from plan to plan and state to state.

Answer: YES! You have a 6 month window from the time you turned 65 get it on a Guarantee issue basis. Meaning you are guaranteed to get it. If you want to change to other supplemental plans after that you will be medically Underwritten and have to be approved.

Medicare Advantage will approve you no matter what and per law they have to cover the exact same things as original Medicare.

Answer: This is not a Medicare Advantage Rule but a MEDICARE rule. All Medicare Supplemental, Medicare and Medicare Advantage has to follow the rule.

To qualify for skilled nursing facility (SNF) services coverage, Medicare patients must meet the

“3-day rule” before SNF admission. The 3-day rule requires the patient to have a medically necessary

3-consecutive-day inpatient hospital stay, not including the discharge day or pre-admission time in the emergency department (ED) or outpatient observation.

The 3-day rule also applies to hospitals and critical access hospitals (CAHs) approved to provide swing bed services for acute care or post-hospital SNF services.

SNF services extend a patient’s care after a hospital or swing bed discharge or within 30 calendar days of their hospital stay (unless admitting them within 30 calendar days is medically inappropriate).

Hospitals, including CAHs, should correctly and clearly communicate the number of inpatient days to SNFs and patients (or their representatives, as appropriate) during the stay and before discharge to make sure all parties fully understand their potential payment liability

Answer: So, today's Medicare question is, "How can I estimate my total Medicare costs if I have a chronic condition like diabetes?" Well, one of the beautiful things about Medicare is there's a lot of programs within Medicare for all your diabetic supplies, needs, and monitors. A lot of those things are covered at no cost, and some with minimal costs. What I would do is reach out to a broker like me in your area, sit down with them, run all your doctors, and run all your prescription drugs through, because a lot of the generic diabetic drugs are covered at no cost. But there are your Ozempic, Wegovy, and Trulicity, those kinds of things, your GLP-1s, which can be very expensive. So, you want to run them through all the plans, through drug cards, and through the Medicare Advantage Plans, because a lot of people are finding that their drugs are actually cheaper on a Medicare Advantage Plan. So, look at all your options and make sure you're picking the right choice. But before you pick a plan, you'll know. I mean, even on Medicare.gov, you could run all your drugs, and you will know every month what all your drugs cost. And as you may not know, but all drugs cap out at $2,000 each year. So, if you really have a really expensive year, $2,000 would be your max. But there's lots of software out there, and there's a lot of brokers out there that can run the cost and give you the cost of every drug, every month. And you will know exactly what your budget is. Thanks for asking.

Answer: So, Medicare question of the day. I'm still working at 67, and I don't know if I need Part B. Why is something so basic so hard to figure out? Again, I would say please consult your local broker. However, I would say with the majority of plans out there, with a few exceptions, if it was me, I'd probably go on Medicare. No, you don't need it if your company has a work insurance for you. However, I love Medicare coverage. I mean, where can you get a plan that has a $257 deductible and everything's covered 100%? I guarantee your work plan doesn't do that. So, I would heavily look at educating yourself on the difference between a Medicare supplement and a Medicare Advantage plan compared to your work plan. Look at all your doctors, all your drugs, compare everything. Because I think 90% of the time, you're going to find out that Medicare is probably far superior in coverage, with a few exceptions. But yes, if you're 67 and for any reason you want to keep your work plan, you don't have to buy Part B yet. The day you decide you want to quit working, you can get Part B, and then you can get a Medicare supplement or a Medicare Advantage plan. But my advice to you is to check it out early. Check out all your options. Just don't go in blind and keep your work plan. Look at all the options and make sure you're making the right choice for you. Thanks.

Answer: Okay, oops. Today's Medicare question is that I have a Medigap plan C and I'm curious if my recent bloodwork is included or if I need to budget for extra costs. First off, Medigap is not plan C. So, Medigap is a Medicare supplement, and you would have plan G or N, but not plan C. Plan C is a Medicare Advantage. But the answer to that is that, yes, your bloodwork is included in a Medicare Advantage and a Medicare supplement. So you should have no problem. If it's preventive, it'll be no cost. And if it's in a specialist's office, if you have a Medicare Advantage, it should be covered in your copay for your specialists. If you have a Medicare supplement, depending on what you have, you may pay 20% of that until you hit whatever your deductible is. If it's traditional G or N, it's a $257 deductible. With plan G, everything's covered after $257. So it really depends on what you have. How it's covered is different from plan to plan, but yes, bloodwork is included in all plans. You may pay a small copay, but you should be all right. If you have specific bloodwork you want to ask questions about, give me a call and I'll help you answer.

Answer: They aren't. This is misinformation. Per Law Medicare Advantage plans have to cover the exact same things as Medicare. They cant be different.

How it is Covered is different from plan to plan. Medicare Advantages have Extra Benefits like dental, vision, Hearing, and Over the Counter Items.

They can work out of state, out of network and out of country. Most plans do Not require a referral. Plans very from State to State so contact a local broker who can really educate you.

Answer: YES! I encourage it. Meet with several in your area. You will learn something each time to talk to them. Pick the person who you think will be there for you in the long run.

Do not get pressured to sign up NOW. Wait until you have had time to process who you met and the information given to you.

Do not give into fear tactics or pushy people. This is about you and not them.

Answer: So the Medicare question of the day is, will hospice be covered when I am on Medicare? Absolutely. I just went through this recently in the last couple weeks. Hospice is covered at 100%. You don't need to worry about anything. What I would say about hospice care though is not necessarily the insurance part of it since we do know it's covered at 100% with Medicare. And that's with Medicare supplement, Medicare Advantage, it doesn't matter, it's covered at 100%.

What you really want to do is vet your hospice team. There are a lot of different hospice companies out there. Some people have a misconception of what hospice is. They think that someone's gonna come into the home and be there 24/7. That's not necessarily what hospice does. Hospice is there, they have a skilled nurse, they'll have a CNA, a pastor, a social worker. And then there are a lot of volunteers that will volunteer for story time, music therapy, art therapy, massage therapy, but not all groups do that.

A lot of people with traditional Medicare or traditional hospice care, sorry, will just come in and give you comfort. Comfort meaning they're not sending you to the hospital anymore. You're not going there because they want you to pass at home or wherever you're at in comfort and peace. They're not doing life-saving events for you anymore or that person.

So for instance, if you've got a loved one who's diabetic, let's say, and now there's diabetes or infection in that because there are a lot of people that get amputated toes from neuropathy. And let's say now the infection's going up the toe and you're not losing until you may be losing a foot and you're in your 80s or 90s. Can you really withstand a huge surgery like that? So that would be your family's discretion. It's not that you can't go to the hospital, but it kicks you off hospice and then you gotta come back on.

But do you want to endure that kind of surgery if that's what it is? Yes, they'll give you every antibiotic to keep you going, but do you want to endure the surgery? So these are some really tough conversations that you need to have with your loved ones around you to know what they want. And if and when they do pass, do you want to be cremated? Do you want to be buried? These are uncomfortable conversations that we have to have with our loved ones, but it's really important. And when do you think, and you should talk to all your loved ones around you that you will be caring for when this happens, when is that time?

Answer: Hi there, my name is Tasha Riggs. The question of the day today is, "I went to a free Medicare seminar and it felt like a timeshare pitch. Are any of those events actually helpful?" I would say yes. For 65 years, you've been learning insurance a certain way, and now insurance is completely different, so you're trying to learn a new language. Everybody has a different personality, so certainly there could be really canned, pitchy people. I'm not that way. I'm pretty down-to-earth, and I try to put it in terms that the average person can understand.

Medicare is pretty strict. They have a way, a structure they want you to discuss things. The downside of that is it can sound like an attorney talking because it's so precise; it’s gotta be exact facts, and I get that. That's why I try to say exactly what I'm supposed to say and then explain what that actually means in layman's terms so that you can understand Medicare.

I really think it depends on what meeting you go to. There are so many of them, and a lot of people send out these little cards, and you can go get a free meal. Some are put on by independent brokers like me, where we have access to the majority of all the plans. Some of them are put on specifically by carriers, so that carrier might be very broad, but they're going to say, "Hey, talk to us." They might emphasize themselves a little bit more.

There are two different kinds of classes. One is educational, so they can't sell you a product or talk product. The other is more of a sales presentation, and they have to register that with Medicare, which comes with a lot more strict rules. They can actually sell you and not just be educational. So it really kind of depends. I like the educational ones so you can get a brief overview of what's a Medicare Advantage and what's a Medicare Supplement.

Also, one of the things I've noticed is you're going to find people that lean both ways. Some will say supplements are the greatest thing ever, forget about Medicare Advantage. Others will say Medicare Advantage is the greatest thing ever, forget about supplements. I try to be fair about both and just give you the facts about both. There’s a lot of misinformation out there. So again, I guess it really comes down to whose seminar you're visiting. I'd love to help. Again, my name is Tasha Riggs with Health Markets.

Answer: Hi, my name is Tasha Riggs, and today's question is: What do you enjoy most about working with Medicare clients? Oh my goodness, my Medicare clients are my favorite. They become friends throughout the years. I'm loyal to them, and they're loyal to me. They can pick up the phone and call me anytime and ask any kind of crazy question they want to ask. They just become friends. I just love my seniors. I love Medicare in general. I love the coverage that Medicare offers; it's way better than under-65 insurance. Just down-to-earth people. I love all my clients, so yeah, Medicare is kind of my favorite.

Answer: And today's question is, "I need help at home after my surgery. Will Medicare cover a home health aide, or am I on my own?" Well, what are you wanting the home health aide to do? If you need skilled nursing in the home, they can help you strictly with your medical needs. They might help you with prescriptions, get you up and moving, or change bandages. I'm not sure what your surgery entails. When I had cancer, they could help with the drain tubes and things like that, but they're not going to do light house cleaning or laundry or other things around the house that you may need.

There are some Medicare Advantage plans in some states that allow a person to come in, and they might cover maybe 60 hours a year to help with light house cleaning or getting you organized a little bit, but most plans won't cover that. That's a fine line, and when that comes into play, a lot of times your long-term care will have to come in. Long-term care can help bring someone into the house to take care of you, and sometimes they can help clean you up and clean the house as well. So it's really about what you want the aide to do. If it's to help you medically, then yes, skilled nursing can come into the home. Hi, my name is Tasha Riggs with Health Markets.

Answer: Hello, my name is Tasha Riggs with Health Markets, and today's question is: my diabetic medication is super expensive. I've heard horror stories about Part D drugs not covering what people need. Should I get a standalone Part D or get it through Medicare Advantage?

Well, I really don't know how to answer that question unless I know exactly what diabetic medicine you're taking, because I will look up your diabetic medication in the system and figure out which plan will be best for you.

Now, the Novologs and Humalog, a lot of those, especially if you're just doing the basic injectable, not the SoloStar pens but just the needle and bottle, those are super inexpensive. You can get a lot of those for just $35. They're not all that expensive. When you get the SoloStar pen, those are pre-made for you; you just click it and inject it. Those are going to be a little bit more expensive.

When you start taking, I don't want to call it designer, but a lot of the drugs that are helping Type 2 diabetes, like Ozempic and Mounjaro, and the GLP-1s, those will be expensive if they're being used for diabetic reasons. Yes, they could be very expensive. If you are using it for weight loss, it will never be covered. I don't care what insurance you have; if it's being told that it's being done for weight loss, it will not be covered. But if it's being used for diabetes and your doctor can verify that it's being used for diabetes, then yes, there are some plans that will cover it at $47.

With that said, I would really need to know what drug you have and the milligram so I can do a database search to figure out which drug plan would be best for you. Now, you asked whether you should do a standalone drug card or a Medicare Advantage. You will find Medicare Advantage plans will have a lower cost on a lot of the drugs when I run them, and it's probably because the health insurance and the drugs are all rolled into one. So they can get their loss ratio across the whole cost of the whole plan.

Where if you have a standalone drug card, it's a standalone drug card; they can't take their medicine losses and spread it out through a healthcare plan. So a lot of times, standalone drug cards are more costly premium-wise per month, and the cost of the drugs a lot of times are more expensive because there's nowhere to share the loss in the cost of the drug. So that's why you'll find Medicare Advantage plans will have, most of the time, a lower cost when you run them side by side.

Answer: Depends on where you live. Some places have many choices some have only a few. Some counties have no choices. I would evaluate that before I move. I would look into my health options, what local hospitals are close, and what kind of care can I get. Do I need to travel for better care?

Answer: Medicare will cover Cataracts. The more expensive upgraded Crystal lenses are and "option" not medically needed but nice to have or get if you can afford it.

Medicare will cover the regular lenses.

Answer: An Agent Typically works FOR the insurance company. A Broker works with more than one.

As a broker I do contract with all the Medicare plans but some agents may only have some of them companies. You can ask them who they are all contracted with so you feel you are getting a fair understanding of all options not just the ones they represent.

Answer: No you do not need to. You only have to change the drug card.

You have a qualifying life event so you can explore all options in your area

Answer: My concern would be why did they deny it.

Home Health Care is a Skilled Nursing Code.

Doctor has to certify that you are home bound and that you need a nurse to come in and do basic MEDICAL needs for you. Example is wound care or Medicine care and PT.

They don't stay very long. They come in and do the medical care needed and leave.

They would have to have a reason why you can come to them to get approved.

It is also only approved for 30 days and can be extended if the doctor approves it. It has to be recertified every 60 days. It is meant for short term and that you are healing and getting better.

If you need it all the time and your not getting better then that will be under Long Term Care. That is a separate policy and not covered by Medicare.

If you want to file an appeal here is the link:

https://www.medicare.gov/providers-services/claims-appeals-complaints/appeals

Answer: Generally speaking Medicare tends to cover more benefits than employer coverage.

Even if your employer pays for your premiums the coverage when you use it , is typically far superior. The network of doctors is very very large. I

Answer: Yes they do. All medically needed items will always be covered. Ask your doctor what is best for you. They can even do a peer to peer review with your carrier to make sure you get the treatments you need

Answer: Do a back ground check on the broker you are working with. Do a google search, Check out there referrals and network of people they work with. Make sure they have access to a majority of the medicare plans so they are not biased and sign you up with only the ones they work with

Answer: All of them!!! Look at your brochure for your plan. I would get all my preventive that fits who I am and get it all done. Its worth it!

Answer: Call customer service on the back of your card or call your broker who set you up. They will have that answer.

Answer: No that is not normal. You must have just picked a plan with lower coverage. There are many plans that will Cover up to 2000 in dental and you can pick any dentist.

When open enrollment occurs I would change plans that have all your doctors, drugs and better dental coverage.

Answer: I can help you!!!!! I agree it is super confusing because you learn insurance a certain way for 65 years. Medicare is totally different. I always tell people its the best thing about turning 65 because the coverage is so much better!

contact me for any personal help. That is my direct cell phone. No big company. Just me

Answer: Medigap or original Medicare will only Cover Medical bills. Medicare Advantages will cover hearing exams and some of the hearing aids. Some of the companies own hearing companies so they can offer the aids at a MUCH lower cost.

If you want to keep original Medicare you can buy and DVH plan. Dental Vision Hearing and get a discount. I have had clients get a good deal at Costco as well

Answer: I cant say that it is. If you have Original Medicare then you pay 20% of your bills and no drug coverage. If you get a supplement or Medigap to cover the 20% and a drug card then it will Cover your 20%. However the premiums are higher and they do go up every year. It is only medical coverage. ( no dental or vision) It allows you go to anyone who accepts Medicare.

Medicare Advantage has to cover the exact same things as original Medicare. So they myth that they cover less is not accurate. It is a law they have to cover the same things but they also cover more. An example is many have Dental , Eye , hearing and over the counter coverage that original Medicare does not. They come in forms of PPO's so you can use them anywhere that accepts Medicare and you can use them out of state and country. The network is typically large. The Doctors now have to bill the carrier you picked and not Medicare. It does NOT replace Medicare. Nothing can replace your Medicare.

Some States vary on this. Some states and counties just don't have access to Medicare advantage. In that instance, you will need a medigap.

The Medicare Advantage is also Guarantee Issue : Which means everyone is accepted regardless of medical back ground. Supplemental or Original Medicare you have to be medically approved or healthy to be accepted unless you are in your original enrollment period.

Answer: You should go to SSA website and apply for part D Extra Help program.

You will need bank statements and tax return information and any retirement benefits to see if you qualify. If you want to talk to someone at Social Security you can contact them.

You can even look at Medicare's website and research Medicare part D extra help. I would also consider looking at LIS : Limited income subsidy. It may help with copays and premiums

Answer: There is no Trap. Medicare advantages have to cover the exam same things as Medicare. It is a law. Medicare advantage is a Guarantee issue and gave give you extra benefits that Medicare supplements can not. Medicare supplemental is only medical.

Medicare Advantage can have coverage for Dental, Vision , hearing, Over the counter and healthy foods if you qualify.

Answer: Yes. As long as your providers contract with Medicare. It is up to the provider to be contracted by Medicare to take their payments

Answer: Per Law all preventative is free. I am not sure why your doctor would bill you. My guess is they did not code it as preventative but as diagnostic.

Answer: The question today is, what's the most important question I should be asking about Medicare that I haven't thought of yet? Well, since I don't know what questions you've thought about, let me share this: when you go on Medicare, you do have to go to ssa.gov and apply for A and B. You have to have both. You've got to find something that covers 20% of the bills because Medicare only covers 80%. You need to cover that 20%, and you also need a drug card.

There are only two ways to do that: one is with a Medicare supplement, and the other is with a Medicare Advantage plan. Both are absolutely amazing. I think the biggest thing people don't know about the two is that with a Medicare supplement, the doctors bill Medicare directly. With a Medicare Advantage plan, the doctors bill the carrier you bought it from, whether it's United, Blue Cross, or Cigna.

Another important point is that I hear a lot of times, and I've literally seen it on doctors' websites, that it says it replaces Medicare. Medicare Advantage cannot and will not replace Medicare. Nothing replaces Medicare. To a doctor, it may feel like that because they're billing the carrier instead of Medicare, but it does not replace Medicare. So, you always have to keep A and B.

The reason why that's so important is that many times when someone goes on a Medicare Advantage plan, they think it replaces Medicare. I've had this happen with a client who said, "My doctor told me it replaced my Medicare." So, if it replaced my Medicare, why am I spending $186 a month on Medicare and then having it come out of my Social Security? He went and canceled it, thinking it replaced his Medicare, and now he doesn't have insurance for a year and is being fined by the IRS for not having B or D.

So, it's very important to know that Medicare Advantage does not replace Medicare. Medicare is still involved; they're just paying the bills in the background. Remember, Medicare Advantage plans don't replace Medicare.

Answer: It will depend on your plan that you pick. The cost and coverage will be different based on the Drug card you buy or the Medicare Advantage plan you buy.

Answer: Most Medicare advantages cover more than cleanings. If you worked with a broker you needed to ask them how the dental works and what they will Cover. You can also call me and I can advise

Answer: 1-800-Medicare

If I understood your questions I bet I could guide you or answer them directly

Do you have a broker? Call them and maybe they can guide you

Answer: Medicare Advantage has enrollments from Oct 15 to Dec 7. Then from Jan 1 to March 31 you get one more chance to change.

Medicare Supplemental or Medigap is all medically underwritten so you can apply anytime as long as you know you can qualify.

Answer: You need to get a Medicare advantage or a Medicare supplemental. You don't want just Medicare. You would be responsible for 20% for all bills with no end in site.

Answer: Depends on the plan. Most my clients go on Medicare even if it costs more because the coverage is stronger. For instance a Plan G is only a 257 deductible then you have 100% Coverage.

Answer: If I knew what you have I could understand what you have.

If you got a supplemental with a high deductible then you will be paying 20% of your bills until you hit 2700.

If you have a medicare advantage and it is no cost you should not have any surprise billing. It should only be the copay shown. I would have to look at your plan to understand what is happening

Answer: Many plans come with 50,000 in medical travel insurance. If you have that then yes.

I have some clients buy extra coverage depending on the type of travel

Answer: Once you hit the 2,000 max out of pocket everything is Covered 100%

There is no Catastrophic phase anymore No donut hole

Answer: If you did not request information about Medicare do not answer the phone for random people who call you out of the Blue about Medicare.

Only talk to people that you signed a written agreement for them to talk to you.

I would also google their name they work for. Not the insurance company name and their personal name to see if they have a reputation.

For instance, If you google my personal name you will see great reviews about me and my team.

If you google each medical company you will get mixed reviews.

You have to know and trust the person who is giving you recommendations.

Answer: Yes

Part A is free and it is a 10% penalty if you don't sign up for that

Part B cost 185 a month.

Part D for Drugs : The fine is 1% each month so 12% each year

I would go to www.ssa.gov 3 months before apply for A and B

If you want to keep your work plan you do not have to sign up for B. However, even though you can keep your work plan and it maybe no cost, Medicare has stronger coverage and your costs when you use it will be lower.

I would find a local broker you can trust and talk to them.

I am also always available so you can talk through it to see which way is best for you

Answer: The notice is used to Notify beneficiaries of decisions on a claim made for Medicare.

I would open it and see what claim they are talking about. If you have questions I would call them.

Answer: Yes!! Once you meet the deductible you will have 100% as long as the providers you are seeing accept Medicare. Physical Therapist may not may not take Medicare so make sure they are contracted with them.

Answer: They believe Medicare Covers Long term care. It does not. After 90 Days in a Skilled Nursing or Hospital and you are not getting better you will need extra assistance above what your health plan will cover.

Answer: Medicare Supplements premiums go up every year and so do the drug cards. You pay that larger premium each year weather your sick or not.

On Medicare advantages, most of them premiums are No cost and you pay Copay as you use them. The Copays control the costs and the copays cap out each year. Less than 1% ever hit the max copay or max out of pocket on a Medicare advantage plan.

You may have a few bad years but not every year and over time Medicare advantages do save you money. Not just on premiums but they also have extra dental, Vision, hearing and over the counter items that Original Medicare does not.

Answer: Medicare supplemental or original Medicare is Only health

Medicare Advantages have all the extra bells and whistles. Most of them have Eye wear coverage.

If the Eye exam is for a medical reason it will be covered under all plans

Answer: Yes a majority of Medicare Advantages are free.

Medicare advantages you pay a copay as you use it.

Many of them come with dental, vision, hearing, over the counter items, and some healthy foods!!

Answer: It is good to know if your drugs get super expensive that you can not spend more than 2,000 in a year. There was no cap before and the donut hole was financially hurting people.

I love the 2000 cap!!

Answer: No. The regulations make is harder for honest people and the seniors. The issues is that the dishonest people are NOT following the rules. Calling Seniors with permission to contact forms. They are signing them up without Scope of Appointments.

The high pressured scammers are the problem and not following any rules. I get calls every 10 minutes from people trying to pressure me and make false claims about insurance and I am a broker!!

Answer: Many advertising is a marketing tactic to get you to call them. I would avoid calling numbers on TV and avoid answering calls you did not request. I would find an actual broker with good reviews on google to speak to. Some of those benefits are available and some only for certain clients. If you ask from April to September they cant pressure you into a sale since it is not open enrollment so that maybe a good time to ask questions with out being pressured.

Answer: Meet an agent at their office. Look at their google reviews. Get references.

Do not work with a person who randomly calls you. No one is legally allowed to call you unless you give them your consent.

Answer: You can apply for LIS. Limited Income Subsidy.

Some Medicare advantage plans will help pay for part B if you really need it.

Answer: The Medicare card will automatically come to you if you have disability benefits. You do not need to do anything!

Answer: You may have to pay more upfront costs for drugs. You may need to pay a drug deductible.

I would run the cost of your drugs each year to see what it will cost.

Answer: People hear that Medicare advantages are all HMO and need referrals. That is not true. They are also PPO's and the networks are VERY large. You can travel and even go out of country and you do not need referrals!

Answer: Getting information from Friends and Family and not an expert in the field.

Your friends and family understand what they have but they don't see the whole picture and how it works as a whole. Get advice from a true broker who has access to All or a majority of the plans. Not an agent who is selling only one or two products.