Ted Wallus, Medicare Insurance Broker

Answer: Local and even regional agents will have a better idea of carriers in the local market. Not all insurance carriers are national. There are also state-mandated laws and regulations regarding guaranteed issue rights and medicaid programs that may be available. Your local agent will also be informed about hospital systems and those likely to be in each carrier's network.

Answer: The main benefit of a Part D Prescription Drug Plan is access to prescription medications at negotiated pricing. Non-covered drug costs can get quite expensive, and solutions like GoodRx, CostPlusDrugs, and TrumpRx don't offer discounted pricing on all drugs.

I often advise clients to pick up a Part D plan and utilize secondary platforms like GoodRx, CostPlusDrugs, and TrumpRx to help lower the prices of particular drugs if pricing is better there.

Don't forget, if you don't take any prescriptions and decide to forgo a Part D drug plan, you could face months without prescription drug coverage if you need it later and/or penalties for delaying signup.

Answer: Search for a local independent broker and have them educate you to Medicare.

If they pass your “gut check”, have them:

1) do a deep dive on plan recommendations

2) make sure they provide context to why they are recommending the plans they are

3) have them show you both a Supplement/Medigap and Medicare Advantage solution with cost estimates.

4) get prescription copays, too.

Then, become a client and connect annually to review your plan and throw out the junk mail!

Answer: In my opinion it’s more valuable to tell the difference between one who cares and values the outcome for their client and those who don’t.

Brokers with a huge client list have a lot of experience but are going to be hard to get time with and just because of the pure demands from their current clients.

If you can find someone with two to five years experience they will have made it past the hurdle of year 1, still be invested in growing their client list, and enough bumps and bruises to know what they are talking about.

Check websites like LinkedIn to see how long they’ve held their position or sites like Google to scan client reviews.

Answer: That is simply not true. One insurance covers healthcare costs. The other, security for loved ones and assets if you expire and are no longer able to meet obligations like a mortgage, children’s schooling, etc.

If you are of Medicare age (65+), you may however have less obligations to cover than say in your 30s, 40s and 50s and therefore should recalculate your death benefit and weigh options like converting your term policy to a permanent one.

Answer: Ancillary benefits like dental and vision have taken a hit with most plans as insurance carriers focus on maintaining core benefits under pressure from eroding profit margins. Most established plans have a specific network that your dentist will need to be a member of for you to get the best “bang for your buck”, so to speak.

What I mean by that is many carriers also allow you to submit for reimbursement with out of network dentists but the reimbursement rate is typically not as high as what you’ll get from an in-network dentist.

Newer carriers will sometimes offer a flat dollar amount in a flexible spending card that you can use with any dentist. They need to offer more compelling options for members to make up for having less name recognition and things like more limited Physician networks.

At least that’s what I’ve seen.

Answer: There is a distinction between an Agent and Broker.

As an independent broker I am able to contract with multiple carriers and compare a variety of plans. Because of this, I can work with clients to educate them to options and then choose the plan that they would like.

Enabling freedom of choice and helping people sort out the alphabet soup of Medicare Insurance is fun and rewarding!

Answer: If you have Medicare and SSI you need to apply for Extra Help. Typically, you will receive a paper application in the mail that comes from Social Security. I’ve see this form included in client’s mail when they first sign up for Medicare.

If you have both Medicare and Medicaid, qualifying for LIS or Extra Help should be automatic based on your income. Your Medicaid eligibility would likely qualify you for LIS/Extra Help.

Answer: As a low-income senior, you should apply to the Medicare Savings Program.

By applying to that program, you will automatically be checked for qualifying for Extra Help, the main Prescription Drug discount program for Seniors.

By applying to the Medicare Savings Program at the start, if you qualify for additional benefits, like having co-pays and your Part B deductible paid for they will notify you.

I hope this helps!

Answer: This is where terminology can get mixed up, and plan specifics are important. Some folks ask, does "Medicare" pay... but they could mean, Original Medicare, A+B, Medicare Advantage Plans | Part C", or a Medicare Supplement (Medigap) Plan.

That's why it's so important to speak with a reputable independent broker, but I'll answer as best as possible without that further clarification.

If as an outpatient surgery, which most hip, knee, and shoulder replacements fall under, Medicare Part B would pay 80% of the cost. The other 20% would be on the beneficiary. That would be a sizeable bill, hence why so important to get additional coverage.

If as an outpatient surgery, under a Part C or Medicare Advantage plan, if in-network, you would likely have a flat co-pay. In the states where I write plans, the co-pay is about $300 per surgery. Not a bad deal for a $0 dollar premium Medicare Advantage plan.

If as an outpatient surgery, with Original Medicare Part A + B, plus a Medicare Supplement, depending on how comprehesive the Supplement is (F, G, N, etc.) you will likely have no co-pay. Medicare Part B will cover 80%, and your Supplement will cover the 20% balance.

Answer: With Medicare Part B, after your premium, you also have a $257 annual deductible. After the deductible is met, it is 80/20 coverage, meaning 80 percent of the cost is covered by Medicare for services such as outpatient surgery, infusions, labs, ER visits, doctor visits, durable medical equipment, and more.

The other 20 percent needs to be covered by you, the beneficiary, and has NO limit. This leaves you with a tremendous amount of risk and exposure.