Thermon Holliday, Medicare Insurance Agent

Answer: Medicare an entitlement provided by the US gov. for those who are citizens and have contributed to the Medicare trust via federal insurance tax. There are specific benefits that are included, SilverSneakers is not one. The gym/fitness program known as SilverSneakers is an ancillary benefit that is optional. There are no guidelines or requirements to offer the benefit. It is typically offered, by carriers, to standout from their competitors.

Answer: This answer must be responded to with another question; is there any disadvantage? For as long as I have used our healthcare system, it has been "clunky" at best. To say it's broken is an overstatement but to say it runs smoothly would be a lie. It offers, at best solutions to our aligments while potentially costing us everything we have to gain access or full provider services. To make a clear point Medicare Advantage can be disappointing to the extent of our expectations. Medicare Advantage was not designed to solve ALL healthcare concerns. It has been advertised and promoted to do so. But when have we ever believed advertising?

Answer: Simply, 'Access & Choice'.

Access- the availability to use any and/or all available Medical resources.

Choice- the ability to determine your Service Provider, without permission or referral.

Answer: Typically, if you or someone is receiving SSDI (Social Security Disability Insurance) for 25 contiguous months, they will automatically be enrolled in Medicare during the 25th month. Their benefit will begin on the first day of the 26th month.

Answer: Your friend's cataract surgery is a covered service per Medicare. Not as an 'individual' procedure but more importantly as a preventive procedure against blindness. Her request for a particular "lens" (assuming you are referring to eyewear) isn't apart of the cataract procedure and has a separate benefit designation. After the successful surgery, she would need to review her plan benefits for its vision provisions.

Answer: Nothing! Yes, it is true. There is no jeopardy or late penalty for not enrolling in PART A when you're on a "credible" employer group healthcare plan. Please note, Credible. To determine if the plan you're on is credible, you can ask the HR benefit manager. I'd by chance they don't know, you can always contact us.

Always here to help,

Thermon Rick Holliday

Answer: There are varieties of "agents" within Health Insurance. When looking for a Medicare agent, I would first make sure they are independent and not captive. Captive agents, are licensed but only represent one carrier. Independent / Broker agents will represent more than one carrier. Secondly, I would always ask if the broker has a favorite plan choice and why. Finally, I would inquire about the broker's length in the industry?

TRH Insurance, we're here to help.

Answer: Medicare is Individual private insurance; and does not complement other private insurance. It is a mistake to believe Medicare is a part of or in addition to VA Benefits or Employer plans. You may, in certain instances, have both benefits. For example, you may have Tricare (VA benefit), which requires you to have an active Original Medicare plan. On the otherhand, Employer group health plans may offer a retirement health benefit which could be a Medicare plan, paid for to some extent by the employer. In either case, a qualified broker will be able to clear the confusion and guide you properly.

You can always contact TRH Insurance, we're here to help.

Answer: You are covered. Depending on the Insurance carrier, you may have to do one of the following:

#1. Pay your bill. Keep the receipt for reinbursement

#2. Determine if the Doctor or facility will accept the carrier payment

#3. Use Urgent and /or Hospital emergency services before private M.D.

When traveling it is recommended to add "Travel Insurance " coverage. Although, Medicare is available to cover services, you don't want any delays due to misunderstandings or other situations.

Answer: Working with Medicare actually means, working with Insurance Carriers. Depending on the type of Medicare plan you choose and are currently under your options will vary.

Option #1. Supplemental insurance; provides the simpliest access to care regardless if tech level.

Option #2. Advantage coverage; would require approval for any and all procedures.

Bottom-line, you have choices in the matter.

Answer: Personally, I believe the added benefits of health-tech, specifically wearables will be a great addition to a physician's toolboxes. With this tech, a physician can review actual data points opposed to relying on patient memory.

Answer: The best way to clarify this question is by answering to initial points.

#1. Medicare is an individual program sponsored by the federal government. There are no group or family plans.

#2. If this is an initial entry into Medicare there are lots of options based on the individual's need for healthcare, distance to providers, and use of medication.

The simple answer is I would speak to an agent or broker in your local market who knows the local providers Hospital systems and medical groups. If that isn't available then I would reach out to a broker from the state or region who has the resources to determine and answer those questions for you.

Answer: The typical answer id , no. Your network is usually defined. Try this:

1. You may ask the provider (Specialist) if they would consider contracting with your medical

group.

2. Negoitate an out of pocket fee.

3. Ask your Primary Care Provider (PCP) if he has a recommendation to a Specialist of similar status./expertise.

There are always ways to get the reuslts you want, you'll just have to ask.

We help our clients, get the resultd they want. Call TRH Insurance

Answer: Local agents should have more knowledge of the local marketplace: doctors, medical groups, etc. They should be able to offer insights to assist in your selection process. However, a virtual rep. If educated and studied, they may have similar abilities.

We have both local knowledge and national coverage to offer to our clientele.

Contact me

Answer: Interestingly, this question is rarely asked. I often wonder why? This would be the first question I'd want answered!

The answer is simple, money/costs that simple. If you plan to rely on Original Medicare only, you will have an unlimited financial risk. Some may point to the 20% as a capped amount. However, the true issue is 20% of what number? 20% of $100.00 ok, but 20% of $100,000.00 is much different.

Medicare Advantage plans have a true Hard Cap. Once you reach the predesignated max out-of-pocket (MOOP), that is it. Your financial responsibility has ended.

For details and comparisons, contact us.

Answer: Medicare is a Federal Government entitlement program. All 'government' programs are sustainable as long as the "government" chooses to maintain these programs. The reality is, tax payers, American and non-American, have paid into the system and its ulitmate sustainablity will be based on utilization. Since no one person lives forever, there will be a turn toward higher utilization, as the Boomers age. There will be a critical-mass point where the checks & balances will need to be strictly enforced to insure longevity and sustainablity for future generations.

The simple answer, it depends.

Answer: Nope. Original Medicare only covers 80% of costs. If you, a friend or loved one only has Original Medicare Parts A&B, you are at risk of receiving medical bills for the balance of services (20%).

Don't go it alone!

Answer: There are "No Traps" within Medicare Advantage plans. Contrary to what some may say or think, Medicare Advantage plans clearly layout benefits and have built-in "stop loss" features to protect members from so-called traps.

Ask your agent to detail the benefits before enrolling into a Medicare Advantage plan. You should be aware of all your options and control.

Answer: As an agent, I want to help my clients find the right plan for themselves. Frustration sets in when I meet with a potential client who wants what their neighbor has or recommended they should have. No two people are alike, although Medicare plans may be similar, individual need always determines the recommendation. Without a clear needs analysis, I cannot and should not make any recommendation for a Medicare plan.

'Diagnosis without Prognosis is Malpractice'

Answer: You are covered, however, you will have a co-payment to satisfy. Plan N, has clearly structured benefits. Ask an agent for clarifications regarding Medicare Supplement Insurance Plans.

Answer: There are three (3) steps to take if you will be turning 65 in the coming months.

#1. Create a Social Security "My Account". This provides access to SSA.gov and all your benefit details. Most importantly, this is where you initially enroll in Original Medicare.

#2. Determine if you plan to continue working past 65 years old. If you are covered by a creditable employer health plan, you may not need to enroll at 65 years. old. (Consult with a Broker/Agent for more detailed determinations)

#3. If you do want to enroll and are working, terminate any Federal Pre-Tax benefits programs you're participating in as they will create a tax penalty if not stopped prior to enrollment into any part of Medicare.

Note - Consult with a Broker/Agent for more detailed determinations before Medicare enrollment.

Answer: How does Medicare work if I become unable to speak for myself?

Regardless of circumstances, if you were to become incapacitated and unable to communicate your healthcare wishes you, will need to have a legally designated party to speak for you. Typically, this requires a Power of Attorney. The majority of Medicare members simply believe my loved ones can make healthcare determinations for me. Unfortunately, not always true. Get a Power of Attorney (POA) for Healthcare today!

Answer: More people are choosing to stay in their homes longer. If you have a Medicare Advantage Plan you DO NOT have "in-home" care but you do have "respite" and/or in-home services available to you, based on your current plan's benefits. Many Medicare Advantage Plans include in-home services like: meals, companions, and varied other benefits. You need to review the benefits with your agent to fully understand what is available to you, under your plan. If you need a review or would like to know what else is available please contact me or my team.

Answer: Absolutely, that is exactly what the funds saved into an HSA are for, "Health Savings Account". If you want to maximize the benefits of your HSA, look back at any years you may have made an out-of-pocket medical payment. If so, you are able to reimburse yourself for the full value of the payment.

Thermon (rick) Holliday

Answer: Medicare offers US-Citizens a window of enrollment that is 7months long. However, you may opt to continue to utilize your Employer Group Health Plan. If so you extend your initial enrollment period until you decide to leave the Employer Group Health Plan.

Answer: in 2017, my mother was diagnosed with Lymphoma. Her prescribed treatment cost $2100 per mo. This is why the $2000 annual limit is HUGELY important or would you prefer uncapped cost for "prescribed" medications?

Thank you President Biden.

You may not like the President while they serve. However, I can tell you, if they create good policy, it's all we can ask for.

Thermon Rick Holliday

"Medicare Plan Expert"

Answer: Although, the actual amount may vary by state, I would contact your local Medicaid office for assistance. Then I would follow up with your Medicare Plan to see what different plans may be available for members at your income level. Don't forget to contact your agent or broker. You shouldn't have to go it alone.

Thermon "Rick" Holliday

Answer: I 'love' helping people. When I know I've been able to help someone improve their life through, education or advice on Medicare, I feel like I have truly accomplished someone, that day. There is no greater satisfaction than knowing a client or future client has the ability to access proper healthcare, and by doing so allows them to live a full, fruitful life. With all we, as Americans must do to make it in today's world. Having removed one weight from around a persons neck seems like a small task.

Thermon "Rick" Holliday

Answer: In simple terms,

Medicare Advantage plans are created by private insurance companies and are approved by "Medicare" (CMS). This allows them to change (with approval) which areas they cover, what benefits they offer, and even whether a plan exists at all. For 2025, because of pressures from the federal government, Medicare (CMS) regulation changes, and companies just tightening their belts, more plans than usual are leaving certain areas. This means some of you will have to choose new coverage or switch to different types of Medicare. The final and probably most telling reason: more people than ever are turning 65 years old and are qualified for Medicare (12,000 per dy in California)

If you find out that you've lost or are losing your Medicare Advantage Plan;

#1. You’re not alone,

#2. You have the right and the time to find a new plan that fits your needs.