Theodore Carpenter, Medicare Insurance Broker

Answer: 1 Goto medicare.gov

2 Click on find health and drug plans

3 Put your zipcode in and click continue underneath where you put your zip code in.

4 Select Medicare drug plan (part d)

5 Select I don't get help from any of these programs if that's the case.

6 Select YES to if you want to see your drug costs when you complete plans.

7 Add your drugs

8 Once you have added all your drugs, it will return to you with plans, and it will tell you if your drug is covered under the drug plans listed.

Answer: There are too many moving parts to answer this question. Contact an agent in the city and state to where you are moving to and ask the question to them.

Answer: Moving to a new state triggers a Special Enrollment Period(SEP), allowing you to switch Medicare Advantage or Part D plans if your old one isn't available or if you want to enroll in a new one for your new location. Your SEP either the month before you move, if you notify your plan in advance, or the month you notify your plan, if you notify it after you move. For Original Medicare (Part A and Part B), you only need to update your address, as your coverage remains the same nationwide.

Special Enrollment Period (SEP):

Moving to a new state gives you an SEP to switch to a new plan.

Notify Before You Move: Your SEP begins the month before you move and lasts for two full months after you move.

Notify After You Move: Your SEP begins the month you notify your plan and lasts for two more full months.

Act Quickly:

It is a good idea to sort out your Medicare coverage as soon as possible when you are planning a move.

Answer: Medicare pays for most all of the preventive tests and blood work. However, if something arises from the testing, you may have low out-of-pocket expenses related to the Part B deductible of $257.

Answer: No, Original Medicare does not provide in-home care for dementia patients who wander or need 24/7. This is why buying long-term care is necessary to protect yourself from such situations.

Answer: Once you have been on disability for at least 24 months, you will qualify for Medicare. You'll want to join a Medicare Advantage plan that has a $0 monthly premium and generally low copays for doctor visits and hospital stays.

Answer: There are 3 phases now for Part D. The Deductible phase, where you must pay up to $590. Then you enter into the "initial coverage phase," where you pay 25% of all your drug needs until you reach the $2100. At that point, you enter the catastrophic phase where everything is covered at 100%.

Answer: Medicare was never designed to cover long-term care. You pay nothing for an acute illness for 20 days, and then the copay is $150 per day. If it's determined that you are not showing improvement, Medicare will not cover it at all.

Answer: Not in my opinion. The cost of a G plan is not that much more expensive than a Plan N or others. Seniors like the fact that you only pay $257, and the rest is paid by Medicare, which is very attractive to most seniors. Medicare Advantage is more appealing when the member is 75 to 80 when the premiums get to be pretty expensive.

Answer: There are no significant changes in the LIS program. The Part D deductible will rise in 2025, but the troop(true out of pocket) for Part D is reduced to $2100 in 2026.

Answer: The primary reason is that your husband's income puts you into a higher IRMAA (income-related Monthly Adjustment Amount), triggering a higher tax filing status as a single person. After your husband's death, your income is now compared against lower thresholds for individuals, causing your rates to rise.

Answer: It's most likely that a medicare supplement plan is a better match for you because you can go to almost any provider that accepts Medicare, regardless of where you are. However, it's best that you also get international health care travel insurance because a supplement will only generally cover 80% up to $50k.

Answer: You do, in fact, have to get prior approval, especially for the powered wheelchair. These are covered under part B, and once you have met the part B deductible, it will be covered 100%. You have to make sure that you are getting the equipment from a Medicare-approved provider.

Answer: Most people believe Medicare will pay for their long-term care needs, when in fact, Medicare will only pay if it's a chronic illness as opposed to an acute illness. Acute means you're going to recover from it. Chronic means you are not going to recover from the illness.

Answer: My parents moved into a CCRC (Continuing Care Retirement Community), and Aetna claimed they were out of network, so they were not going to cover it. I appealed it, stating that there's a term called "Home Rule," which means they had begun living in the assisted living division, and my dad had no choice but to move to the skilled nursing division when he broke his hip. They finally agreed, and we got it paid for.

Answer: Typically, your coverage begins on the first day of the fourth month of continuous dialysis. There is an exception for home dialysis, which can allow coverage to start sooner, but you have to enroll in the home training program.

In-center dialysis:

Your coverage typically starts on the the first day of the fourth month of dialysis.

Home dialysis:

You can receive Medicare coverage starting on the first day of your first month of home dialysis, provided you begin a home training program before the end of your third month.

Answer: The main types of Medicare Advantage plans (Part C) are Health Maintenance Organization (HMO) plans, Preferred Provider Organization (PPO) plans, Private Fee-for-Service (PFFS) plans, and Special Needs Plans (SNPs). Other types include HMO Point-of-Service (HMOPOS) plans, which are a variation of HMOs, and Medical Savings Account (MSA) plans. Each type has different rules for provider choice, network use, and referrals.

Answer: Medically necessary part-time or intermittent skilled nursing care, like:

Wound care for pressure sores or a surgical wound

Patient and caregiver education

Intravenous or nutrition therapy

Injections

Monitoring serious illness and unstable health status

Physical therapy, occupational therapy, and speech-language pathology services (if you meet certain conditions)

Medical social services

Part-time or intermittent home health aide care (only if you’re also getting skilled nursing care, physical therapy, speech-language pathology services, or occupational therapy at the same time), like:

Help with walking

Bathing or grooming

Changing bed linens

Feeding

Injectable osteoporosis drugs for women who meet certain criteria

Durable medical equipment

Medical supplies for use at home

Answer: People are leaving Medicare Advantage plans because you have to mess with it every year to make sure your always getting the best deal. Also you have to mess with if your doctor is still in the network. However, I help my customers in doing this so it is an easier option.

Answer: I have always discussed prices with the customer in advance so they thoroughly understand the cost and the coverage they will be getting. Because of the way I do business, I rarely have a cancellation of the policy that I'm offering to my customers.

Answer: I can email them a link so they are able to complete an applicatino on their own convenient time. I'm still available most everyday and all day for guidance with the link and any other questions they may have.

Answer: I love making it an easy choice as Medicare is confusing and hard to understand. It's refreshing to my clients that I do alot of the heavy lifting for them making it easy for them.