Thomas Magnus, RHU, Medicare Insurance Broker

Answer: Not in ANY way! Life Insurance is an entirely separate form of protection and has absolutely no connection with or affect on anything related to Medicare cost or eligibility. Contact us with any particular questions or concerns regarding Medicare Tom Magnus, RHU

Answer: Each Medicare Rx plan(and there are MANY) uses a Formulary system to categorize drugs they cover. Drugs are listed based on cost, where administered(self or clinic), and various other factors. Your drug will fall into one of 5 or 6 Tier levels. Generic drugs are normally classified as Tier 1. The more expensive the drug, the higher the Tier Level. Repatha is listed at least at Tier Level 3.

Answer: You cannot apply for Medicare due to a disability directly; you must first be approved for SSDI through the Social Security Administration (SSA). You can submit your application online using the SSA Disability Benefits Portal.

To get Medicare due to a disability before age 65, you must first qualify for and receive Social Security Disability Insurance (SSDI) for 24 months. You will then be automatically enrolled in Medicare Parts A and B starting in your 25th month.

Because you are under 65, your Medicare enrollment is usually automatic. You will receive a Welcome Packet and your official Medicare Card in the mail approximately 3 months prior to your 25th month of SSDI benefits.

For more details/guidance, go to: https://www.ssa.gov/benefits/disability/qualify.html

Answer: Rule #1 - If you are told that one type of plan is better than the other, you need to find a more qualified Medicare professional to consult with as it is not a simple answer and depends on several variables.

Answer: Best to consult with a Professional Medicare Broker to discuss your particular situation - likes - dislikes - interests. Medicare is not a "one size fits all" proposition. Your options may be dictated by timing(some plans are only available from October 15 thru December 7 for a January 1 effective date). Others may require you to "qualify" based on Medical Underwriting. Once again, call us for a no cost and unbiased review.

Answer: Medicare DOES cover EMERGENCY transport. If you feel your health would suffer if not transported via ambulance, it should be covered. If you have received a bill, it could be that the Ambulance company does not have your insurance information. Don’t

Give up!

Answer: Additional details are necessary to fully understand the particular issue at hand. Did you first verify that the specialist you want to see is "in network" with the plan you switched to? More details needed. Sorry to not be able to answer your concern.

Answer: This topic attracts many different opinions. And yes - providing coverage/benefits for these exposures will increase the overall cost - BUT especially with Dental, it can also ward off very debilitating and costly other health issues. So the real question may be, "How much do we value our overall health?

Answer: Some people enroll in a Hospital Indemnity Plan as a hedge against Medicare Advantage Prescription Drug(MAPD) Plan Inpatient Hospital Copays. Most plans DO impose a copay for the first 4 to 6 days and can be anywhere from $50/day up to $250 or more per day - usually with a 3-5 day limit per inpatient hospitalization. These copays are not standardized among MAPD plans but can add up to a moderate 4 figure amount.

Hospital indemnity plans are supplemental insurance policies designed to help cover unexpected costs associated with hospital stays. Here are some key points:

Coverage: These plans typically pay a lump-sum benefit for covered medical expenses, including deductibles, copays, and out-of-pocket costs not covered by primary health insurance.

Flexibility: Benefits can be used for various expenses, such as childcare, transportation, and recovery costs, providing financial relief during hospital stays.

Multiple Claims: Many hospital indemnity plans allow for multiple claims, enabling you to use the benefits for different hospitalizations or treatments as needed.

No Waiting Period: With some plans, there is no waiting period for claims, allowing you to access benefits quickly.

Portability: These plans can often be portable, meaning you can take coverage with you if you change jobs or move.

Contact me for more detailed information

Answer: Part D is not required but is ALWAYS recommended. If one fails to enroll when eligible, they can always enroll LATE (between October 15 and December 7 each year for a January 1 effective date). However, there is a 1% per month late enrollment penalty that continues to accumulate until such time that you are enrolled in a plan. This penalty remains with you for your lifetime and is added to your Part D monthly premium. Should you require medication(s) prior to your enrollment effective date, their cost is covered by YOU. For those taking no meds at present, rather than going bare, we ALWAYS recommend going with the lowest cost plan available. Doing so gives you SOME coverage for the remainder of the calendar year and that coverage can be fine tuned to your "current" needs for the next calendar year.

Answer: Key Information on Survivor Benefits Amount: You can receive between 71.5% and 100% of your deceased spouse's benefit amount, depending on your age when you claim. Eligibility: Generally, you must be age 60 or older, or 50–59 with a disability. You may also qualify regardless of age if you are caring for your deceased spouse's child who is under age 16 or disabled. Marriage Duration: You must have been married for at least 9 months immediately prior to your spouse's death. Remarriage: If you remarry before age 60, you cannot receive benefits as a surviving spouse until that marriage ends. If you remarry after age 60, you can continue to receive benefits. Divorced Spouse: If you were married for 10+ years, you may be eligible for benefits. Other Benefits: If both spouses were receiving Social Security, the survivor receives the higher of the two, not both.Lump-Sum Death Payment: A one-time payment of \(\$255\) may be available to a surviving spouse. Steps to Take Report Death: Funeral homes usually report the death, but you should contact the Social Security Administration directly. Apply: Survivor benefits are not paid automatically. You must apply by calling or visiting a local Social Security office. Return Payment: If a payment was deposited for the month of death, you must return it. Disclaimer: Information is based on 2025/2026 Social Security rules. Always consult the Social Security Administration for your specific situation.

Answer: Here are some options for pharmaceutical financial assistance:

Patient Assistance Programs (PAPs): Many pharmaceutical companies, state programs, and nonprofits offer PAPs that can help lower the cost of medications for those who are uninsured or underinsured.

1 Federal and State Programs: Financial assistance options are available from the federal government, state government, and nonprofit organizations to help with prescription medication costs.

2 RxAssist: This platform provides information on various patient assistance programs run by pharmaceutical companies to help patients obtain free or low-cost medications.

3 CMS Programs: Pharmaceutical manufacturers may sponsor programs that provide financial assistance or free medications to low-income individuals.

4 Welvista: This organization offers a medication assistance pharmacy that can fill and deliver prescriptions at no cost to uninsured individuals.

Answer: In this situation it is wise to inquire if there is ANY chance of an exception based on extreme circumstances(if, indeed, this is the case). Short of that being the case your only other option may be to mark your calendar for the opening of the next window of opportunity to occur.

Answer: An Agent is a person that represents one insurance company. A Broker represents her/his client and is usually appointed with numerous insurance companies. There is nothing wrong with working with an agent. However, an agent - without demeaning agents(I've been one) - is a One Trick Pony with tunnel vision with access to ONLY the company they represent. A Broker usually is appointed with several or many companies and is able to "shop the market" so as to provide you with the most cost effective option available at the time.

Answer: In addition to Original Medicare Parts A and B, a Medicare Supplement plan gives you maximum flexibility throughout the USA.

Answer: Medicare Part A and Part B is the same regardless of state of residence. If, in addition to Original Medare A and B, you are enrolled in a Medicare Advantage, Prescription Drug and/or Medicare Supplement plan, it is best to contact your Broker or your Insurance Carrier(toll free number on your ID card) for guidance.

Answer: Hospice care is usually covered by your Part A of Original Medicare(your red, white and blue Medicare card).

You qualify for hospice care if you meet all these conditions:

Your hospice doctor and your regular doctor (if you have one) certify that you’re terminally ill (with a life expectancy of 6 months or less).

You accept comfort care (palliative care) instead of care to cure your illness.

You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions.

Answer: To answer this question, more information your present situation is necessary. Are you enrolled in a Medicare Advantage Plan? If so, the plan has specific Specialist CoPay per visit. If not, are you enrolled in a Medicare Supplement plan in addition to Part B? If so, which Plan? There are 10 of them and some have a copay for office visits, some do not.

Answer: Since copays occur infrequently but premiums are monthly, you probably made the right choice. Between January 1 and March 31 you are allowed to switch to another plan - and - it may make more sense to stick it out for a year. Then total up your copays and change course next year if that makes more sense for you.

Answer: It's always wise to check. Maybe - Maybe Not! For those on a Medicare Advantage Plan you will need to check with your Insurance Company or Broker. A change of county in the same state may or may not result in a change of service area. If your move results in a change of service area then yes, you will need to change plans. If you are on a Medicare Supplement, you need only notify your insurance carrier of your new address.

Answer: Plan G typically has higher premiums than Plan N, so you want to decide whether you want higher monthly premiums or if you prefer to reduce monthly premiums and pay copayments for certain doctor and emergency room visits.

When comparing Medigap Plan G vs Plan N, they both offer substantial coverage benefits, but there are more out-of-pocket costs when enrolled in Plan N such as $20 copay for office visits, $50 ER copay and 15% when seeing providers that do not accept Medicare Assignment/Approved Amount

With Plan G, excess charges are fully covered, but with Plan N, you could be responsible for an additional 15% if you see a provider who charges more than the Medicare-approved amount.

Answer: After entering your into www.medicare.gov, check Mark Cubans’ site that is VERY helpful but does not cover all meds like Medicar.gov does: www.cost plus.com

Answer: Potential answers to this question are many and varied. Best to consult with your financial advisor, CPA or estate planning attorney

Answer: It all depends on several factors that must be considered:

1) Are YOU paying the premium or is your Employer? If it is your Employer, MAYBE you should keep it... Depending on the next consideration:

2) What is your Annual Deductible? If it is HIGH and you use your health plan frequently, you MAY be better off with Original Medicare and a Supplement, as your Annual out-of-pocket cost with Medicare is capped and you will know up front, the maximum you'll spend each year.

3) You DO want to speak with a Medicare Specialist to ensure you are on the right track. On the other hand, a low or zero premium Medicare Advantage Plan may keep your expenses down due to relatively low copays for various benefits and treatment, and these plans often come with gym membership, vision, dental, and hearing benefits, case management, and more.

Answer: Anyone or company marketing Medicare Advantage plans as "free" is violating the law. One MAY market them as "Premium Free" but they are NOT free since they DO impose copays for most services/benefits. They may be "lower cost" than traditional Medicare and available with zero premium - but they are not "Free".

Answer: Check with your Prescription Drug plan to determine the benefits afforded by the plan. It may be easiest to phone the toll free Customer/Member services number on your ID card to get specifics - also ask to be directed to a source where you can view these benefits with your own eyes and save them to a printed document or to a computer file.

Answer: Ultimately it is best to phone the customer/member services number on your Medicare Insurance ID card. Please note that although there IS usually a "limit", additional visits "can" be approved by presenting documentation of anticipated continued progress/healing by your doctor/and/or physical therapist.

Answer: Medicare operates on the concept of "Medical Necessity". If your doctor believes a blood test is necessary in order to diagnose a condition you are experiencing, it should be covered by Medicare Part B. https://www.hhs.gov/answers/medicare-and-medicaid/what-does-medicare-part-b-cover/index.html

Answer: 1) Medicare Advantage plans have their own set of "rules" that must be understood and followed in order to successfully benefit from the plan.

2) Sometimes people do not fully understand how their Medicare Advantage plan works prior to joining.

3) Sometimes people do not realize that this is Managed Care and sometimes takes longer for procedures to be approved by the plan.

4) This is sometimes due to the agent doing a poor job in explaining how these plans work.

5) Currently 54% of the Medicare Eligible population are using Medicare Advantage plans

6) Since these plans involve lower or no monthly payments for membership, members are surprised/disappointed when confronted with a co pay for the procedure. Instead of paying a monthly premium for benefits one seldom uses, one IS responsible for a share of cost for some benefits.

Answer: Your Part C plan with a private insurance company replaces your Government Part A and B Benefits - and also includes a Part D Rx plan. Accordingly, your Medicare Benefits are now defined by the Part C plan and must be equal to or superior to the Original Medicare Part A and B benetits - therefor you would be subject to the $350/day for days 1-7 for each hospital admission.

Answer: Rather than going into detail ussing my own verbiage, I prefer providing you with the Real Deal directly from CMS - Centers for Medicare and Medicaid Services. Feel free to reach out with questons/concerns/https: https://www.medicare.gov/publications/02226-medicare-and-clinical-research-studies.pdf

Answer: Learn about the Birthday Rule. If your state of residence recognizes it, you'll have the option of moving to a Medicare Supplement plan of equal or lesser value, ie., Plan G with one carrier to Plan G or N or a Hi Deductible G, to another without having to answer health questions - in other words, you cannot be denied to option of switching if your state allows it. Best to speak with a Broker specializing in Medicare to receive professional guidance.

Answer: Medicare enrollemnt cannot be back dated. However, one is always able to appeal to CMS. Centers for Medicare and Medicaid Services. There's always the possibility that your appeal will be successful - depending on circumstances surrounding the appeal. While one is always easily able to appoint a friend or relative as one's Legal Representative to transact on one's behalf, circumstances may have prevented this. It never hurts to ask - worst case scenario is to be told "no".

Answer: Typically Medicare operates on a tern known as "Medical Necessity" which is usually established and supported by your Primary Care provider and Specialist(s) labs, images and documentation. . As long as these criteria are met, an exception is a probability. It may also helpful to be able to Advocate for oneself or have another close by that possesses those characteristics.

Answer: Maybe - open this link for details:

https://www.medicare.gov/coverage/bone-mass-measurements

And - open THIS link for a COMPLETE list of 2025 Medicare Approved and FREE Preventive Services - NOTE - Double Check as These Benefits may change Annually

https://www.medicare.gov/coverage/preventive-screening-services

Answer: ALWAYS(and rarely do I use that word) consult UNBIASED data sources such as the official government medicare website: www.medicare.gov or Kaiser Family Foundation: kff.org or Medicare Rights Center: https://www.medicarerights.org/

Note: KFF is the leading health policy organization in the U.S.

As a one-of-a-kind information organization, we bring together substantial capabilities in policy research, polling, and journalism in one organization to meet the need for a trusted, independent source of information on national health issues—one with the scope and reach to be a counterweight to health care’s vested interests and a voice for people.

We are headquartered in San Francisco with a building in Washington, DC, conference centers in both offices, and staff members in almost every state. Dr. Drew Altman, KFF’s president and chief executive officer, founded the modern-day organization in 1991. You can read more about the organization’s history, mission, focus, and key programs in a president’s message by Dr. Altman.

Answer: It depends on the cost/benefit of that coverage vs Medicare. Part A/Hospital coverage is premium free. Part B/Medical Insurance has a $185 monthly premium in 2025 - more if you are a high income earner. Cost of Medicare Supplement and Part D Rx plan $125-$150/month. Or...a Medicare Advantage plan with zero to $100/month premium and copays for services - While your employer coverage may or may not be 100% paid by your employer, the plan probably has a $1,000 annual deductible and Medicare has @57 this year. A bit of discussion and planning with a Medicare Professional will go a long way for you!

Answer: Let me answer this question with a question - Better for who? There are too many variables to address in a short post. This link goes over the basics and gives one a "rough" idea of some differences - speaking with a Medicare Expert with some fine grit sandpaper will ensure a good fit.

https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/your-coverage-options/compare-original-medicare-medicare-advantage

Answer: Part of the 2024 Inflation Reduction Act/IRA, the $2,000 cap applies to all costs for drugs covered by Medicare Part D plans, including deductibles, copayments, and coinsurance. It does NOT apply to premiums and medications not covered by Part D plans, including those under Medicare Part B. For more details visit: https://www.cms.gov/newsroom/fact-sheets/medicare-advantage-and-medicare-prescription-drug-programs-remain-stable-cms-implements-improvements

Answer: The philosophy behind insurance is to protect against large, unexpected catastrophic loss. When focusing on one aspect of a Medicare Plan, one must also consider what is MOST IMPORTANT for that plan to do for them when being admitted to the hospital for whatever reason. So... the answer is - probably yes. And another question becomes: What are my potential OVERALL costs via one plan versus another?

Answer: Yes Indeed. With passage of the IRA - Inflation Reduction Act, Medicare Beneficiaries will pay no more than $2,000 annually for their medications. Since some people cross this threshold already on January 1 and since we know there is no free lunch - we can also deduce that these costs don't simply vanish and vaporize in mid air. There are MANY changes affecting premiums, co pays, broker commissions - all in an attempt for the Rx industry to claw back some of their losses caused by this consumer friendly provision.

Answer: It is a downgrade from the commercial insurance I've had over the years. And... nothing could be further from the truth! Most people are thrilled with their Medicare coverage.

Answer: Do not rely on TV advertising. Use your network. Word of mouth cannot be beat as it will guide you to those with a proven and trustworthy track record.

Answer: For written guidance, consult unbiased documents such as the 2025 Guide to Medigap published by our Federal Government: https://www.medicare.gov/publications/02110-choosing-a-medigap-policy-a-guide-to-health-insurance-for-people-with-medicare.pdf

Actions speak louder than words. Rely on friends, relatives, associates for referrals to Professionals with a Proven Track Record. Their success comes from doing well by their clients. There is no better or reliable advertising!

Answer: These costs vary depending on where you need ambulance services, the type of transport required(ground or air), the condition and en route treatment needs of the patient and number of miles transported. Average basic and advanced services cost $940 and $1,277, respectively in 2025.

Answer: Medicare spending increases annually. This is due to more and more people qualifying for Medicare, earlier diagnosis and longer life expectancies, advances in technology and the cost of delivering services through medical professionals.

Answer: It is ALWAYS prudent to purchase Travel Insurance when traveling outside the USA. One must simply program this cost into your travel plans. Plans are available via several companies - do a google search for more information.

Answer: Original Medicare does NOT cover Hearing Aids. The cost of these must be borne by you. HOWEVER - some Medicare Advantage plans have SOME coverage for Hearing Aids.

Answer: It pleases me to make Medicare simple. Go ahead - shop around. The come back to me to untangle the spaghetti brain! My clients really appreciate this feature/benefit.