Taylor Langlois, Medicare Insurance Agent

Answer: My first question is "Who did you talk to?" Did you enroll online by yourself? Did you call the company directly and speak to a sales agent? Did you talk to an independent agent? If you enrolled online, the plan provides what's called a "Summary of Benefits" that lays out all of the plans benefits and costs. You would've been able to read it when enrolling. If you spoke to a sales rep, whether through a carrier or independent, they should have gone over that with you.

Answer: Enroll in Part A; it's usually free. Delay Part B only if your employer/spouse's plan has 20 or more employees. There's no late penalty that way and you have an 8-month SEP to enroll after your employer coverage. If under 20 employees, I would enroll fully at 65.

Answer: Medicare doesn't cover routine physical exams (you pay full cost). It only covers a free Annual Wellness Visit, which isn't a physical. Your doctor likely billed a non-covered physical. Not everybody's coverage works the same as well. Check with your insurance to see how the provider billed them.

Answer: Most of the time it's because they didn't fully understand how it works before enrolling. Medicare Advantage has provisions like provider networks, prior authorizations, and annual plan changes. If someone is looking at Medicare Advantage, they first need to examine their options carefully, look at the out-of-pocket costs, and not just go head-over-heels when looking at the added benefits like dental, vision, OTC, etc.

Answer: Medicare doesn't cover assisted living. The reason why is because that care involves custodial services such as help with daily activities, not skilled medical care, which is Medicare's primary purpose. Those services are usually covered either out-of-pocket, through a traditional long-term care policy, a hybrid policy like an annuity or life insurance, or under your state Medicaid program if you meet their eligibility criteria.

Answer: Yes, bone density tests count as preventive care under Medicare Part B like for those at risk of osteoporosis, covered every two years with no out-of-pocket cost if your provider accepts assignment.

Answer: Medicare rarely covers herbs, supplements, or homeopathy, so it's usually out-of-pocket. Some Advantage plans throw in extras like acupuncture if it fits your needs. Check your plan and don't assume standard coverage.

Answer: I'd say the best way to assist any family member when making any decisions is to do what we do: listen to what the major concerns are, walk with them through their options, and give them confidence so that they're doing what's best for them.

Answer: There's three signs I always tell people it's time to go shopping for other options:

1) Cost changes (prescriptions, copays, premiums, etc.)

2) Health changes like new meds or complications

3) Doctor changes

I'll also throw in if your benefits change on your coverage. Those are all reasons I'd want to review my coverage to see if anyone is offering better.

That being said, I will always tell people that a good time to check your coverage is at least once a year. Typically we do that review with our clients anyways.

Answer: Unfortunately Uncle Sam forgot to include your eyes, ears, and teeth with Medicare. There are instances where Medicare covers eye exams, but they have to be tied to specific medical conditions like annual glaucoma screenings for high-risk folks, cataract surgery, or exams for diabetic retinopathy. Thankfully there is vision coverage for pretty much any instance you find yourself in with Medicare.

Answer: It's kind of a loaded question, but if we're talking in terms of what's available to seniors nowadays, it's hard to beat the Plan G. Right now it strikes that sweet spot between comprehensive coverage and cost. Excluding the Part B deductible, it kicks in to cover 100% of Medicare-approved costs like hospital coinsurance, Part B coinsurance, skilled nursing facility care, and even excess charges that my second-place option, a Plan N, doesn't cover. I've had a lot of people tell me "but I googled it and only 2-3% of doctors bill those excess charges so why wouldn't I just get a Plan N if it's usually cheaper?" and I will say that it's very attractive for many individuals. That's not to just completely trash other options, but the case for the Plan G though is just simply peace of mind, something I know most seniors ask for with their Medigap policies. Individuals that want predictable costs will generally be more satisfied going that route.

Answer: One of the most common misconceptions about Medicare is that it covers all healthcare costs for seniors. Turns out, Medicare doesn't cover every single healthcare expense. Additionally, many assume it includes long-term care (like nursing homes) or dental, vision, and hearing services, but these items are not covered under original Medicare. People often learn this the hard way when they realize they need supplemental insurance like Medigap, Medicare Advantage, and other tertiary coverage options to fill those gaps. It’s a rude awakening for those who think Medicare = free healthcare, hence the need to fully understand your options to make the best decision for yourself.

Answer: It sounds cliché coming from me, but the biggest mistake seniors make is not having an independent agent acting on their behalf. When calling into insurance companies for help, their sole job is to sell you their product, whether it's the best option for you or not. You want someone who has a financial incentive to assist you in finding the right type of coverage by going over all your options and not leaving anything to chance. Imagine a doctor that only wrote you prescriptions from one pharmaceutical company; you'd have questions about their motives just as I would too.