Timothy Brown, Medicare Insurance Broker

I'm turning 65 next month; what are the first steps I should take regarding Medicare enrollment?

Answer: Ensure that you have been issued a Medicare ID number prior to enrollment. If you are collecting Social Security payments, the card should have been mailed at least 3 months prior to you 65th birthday. If not, you'll need to sign up for Medicare via ssa.gov.

How do you educate clients who are completely new to Medicare?

Answer: Our company hosts both in person and online Medicare educational seminars on a weekly basis. The in person seminars are hosted at medical facilities and various hotels throughout the state of PA.

Are Medicare plans and requirements different for every state?

Answer: It's possible but it depends on the rules and regulations pertaining to each state. Some of the requirements are consist via CMS (Centers for Medicare and Medicaid Services) rules while other state specific.

What do you enjoy most about working with Medicare clients?

Answer: I enjoy helping Medicare recipients by providing important and necessary information they will need make the best healthcare decisions.

Can I switch from a Medicare Advantage plan to a Supplemental/Medigap plan during the Annual Enrollment Period without answering health questions?

Answer: It depends on the situation. Here are a few scenarios:

1) If the current Medicare Advantage plan exits the market and will not be renewing for the new year, it will create a Guarantee Issue enrollment for a Medicare Supplement for the next year.

2) If you move out of the service area of your existing Medicare Advantage plan i.e. from one state to another, this will also create a Guarantee Issue enrollment into a Medicare Supplement. This scenario is not solely based upon the Annual Enrollment Period but rather the time of the move.

If I move to a rural area, how might that limit my Medicare Advantage plan options?

Answer: There are rural areas that may have a limited number of Medicare Advantage plans or in some cases, not at all. The Insurance carriers determinations are based on the population and the feasibility as to whether or not it makes sense to offer plans.

Can I use a health savings account (HSA) to pay Medicare premiums after I retire?

Answer: HSA funds can be used for qualified medical expenses, which include Medicare premiums for Part A (hospital coverage), Part B (medical coverage), Part C (Medicare Advantage), and Part D (prescription drug coverage).

Why are people unhappy with Medicare Advantage plans?

Answer: Listed are a few reasons that people may be unhappy with Medicare Advantage plans:

1) Reduction in benefits in comparison to previous years

2) Providers no longer accepting plans or now out of network

3) Delays in prior authorization for medically requested procedures

4) Denial of claims for specific procedures

5) Plans exiting the market

If a senior is turning 65 but still working, should they enroll in Medicare or delay it?

Answer: You can apply for Part A which is premium free if you or your spouse worked and paid taxes for at least 10 years. The Part B can be delayed without a penalty if you decide to keep your employer insurance but you also have an option to compare group coverage vs Medicare coverage in terms of premium and benefits.

What are the reasons why I should work with a Medicare agent?

Answer: Medicare agents are required to be certified annually in order to provide up to date information necessary for our clients to make informed decisions. In short, we do the heavy lifting on your behalf.

I'm a green card holder who's been in the US for 4 years and turning 65 soon. Am I eligible for Medicare?

Answer: Legal residents must live in the US for at least 5 years in a row, including the 5 years before applying for Medicare.

I applied for a Medigap plan and got denied because of my health history-how is that even legal when I've paid into Medicare for years?

Answer: Your acceptance into a Medicare supplement/Medigap plan is guaranteed during the 6 month period of when Medicare Part B becomes effective. You're subject to underwriting beyond this timeframe unless you're leaving an employer plan. Unlike Medicare Advantage plans which are guaranteed issue with no health questions, Medigap plans are not regulated by CMS (Centers for Medicare & Medicaid Services). They are private companies.

So I heard something about Medicare drug costs being capped at $2,000 in 2025. Is that really happening or just talk?

Answer: It's definitely happening. The "Donut Hole" is gone which means that the only thing a client is responsible for is the Part D deductible, if applicable, and the prescription copay or coinsurance.

There may be instances where the annual cost is no where close to $2,000 which is a good thing but should the cost reach the catastrophic limit of $2,000, you will continue to receive the remainder of all prescriptions at $0 until the end of the year.

My doctor prescribed physical therapy, but I'm not sure how many visits Medicare will cover. How do I find out?

Answer: It depends on the insurance plan. Medicare advantage plans require prior authorization or pre-certification. called prior authorization or pre‑certification. Note: Members must meet the Centers for Medicare & Medicaid Services (CMS) criteria for medically necessary skilled care

to be covered. Medicare Supplements/Medigap plans do not require prior authorization or have restrictions on visits.

Will Medicare cover everything my current employer plan does?

Answer: That depends the on the additional coverage beyond what Original Medicare,(Red, white & blue card) offers. Medicare Advantage/Part C plans can provide coverage similar to employer plans. Medicare Supplements/Medigap plans offered more enhanced medical coverage to Original Medicare Part A & B (Doctors & hospitals) only. Additional coverage for prescription drugs, dental, vision, etc. will require separate plans.

I've heard that once you're on Medicare, you might not need life insurance as much. Is that true?

Answer: Medicare is a health insurance so I'm not sure where life insurance or the lack thereof has any relevance. Life insurance has a face amount that is payable tax free to a beneficiary upon death. Medicare has no such payout.

How does Medicare Part B handle coverage for preventative screenings like mammograms?

Answer: Medicare Part B covers a wide range of preventive health screenings, including cancer screenings, diabetes screenings, and screenings for other conditions, with many covered at no cost to the beneficiary

My pharmacist mentioned the Medicare "donut hole" is going away in 2025. What does that actually mean for me?

Answer: Unlike last year, the annual cost of prescriptions are capped at $2,000 which is the catastrophic limit for 2025. This is good news for recipients that are taking multiple and/or brand name prescriptions. Once the $2,000 out of pocket cost are met, the recipient will receive the remainder of the drugs at $0 for the rest of the year.

I'm confused by all the star ratings for Medicare plans. Do they actually mean anything for the care I'll receive?

Answer: Medicare Star Ratings, a 1 to 5-star system, assess the quality and performance of Medicare Advantage (Part C) and Part D prescription drug plans based on factors like member satisfaction, health outcomes, and plan operations. Typically, the higher the star rating, the better the plan services.

What's a common Medicare myth that even some agents still believe?

Answer: If you 're a Medicare agent, there shouldn't be any myths on your behalf, Our job is to dispel the myths that existing or potential clients believe.

Can you explain what "creditable coverage" means and when it applies?

Answer: Creditable coverage is insurance that meets acceptable criteria and standards established by Medicare. An examples is a major medical employer plan which includes prescription drugs that are as good as what Medicare Part D offers. It applies when an employee decides to retiree or an existing retiree wishes to leave an employer plan when they reach age 65 or beyond.

What is the main benefit of Medicare Part D?

Answer: Part D provides prescription drugs at a lower cost as opposed to paying out of pocket. It also has a annual limit of $2,000 no matter how expensive or the number of prescriptions a person takes. Stand alone Part D plans have an annual deductible that applies for tiers 3 to 5 (brand name) prescriptions.

What's the biggest mistake seniors make when choosing a Medicare Part D plan?

Answer: The 2 biggest mistakes that seniors make when choosing a Medicare Part D plan are:

1. Not verifying the listed prescription or tier level on the plan's formulary.

2. Enrolling in a plan where the monthly premium is excessive in comparison to the monthly cost of the prescriptions. Example: Paying a $103/month for plan for when you're only taking generic prescriptions.

How does the Part D "catastrophic coverage" phase work once I hit the out-of-pocket max?

Answer: Once the $2,000 out-of-pocket max is hit, the cost /copay for all prescriptions will be $0 for the remainder of 2025.

Is it better to get Medicare Part D or Medicare Advantage?

Answer: That depends on your situation. Prescription drug coverage included with Medicare Advantage plans tend to have lower to no Part D deductibles as well as lower copays whereas stand alone Part D plans include a separate premium are subject to a deductible for brand name prescriptions on tiers 3-5.

My Medicare Advantage plan listed my doctor, but now they say he's out of network. How is that even allowed?

Answer: Although Medicare Advantage plans have contractual agreements with healthcare providers, there a certain instances of which there can be a breakdown of negotiations between the parties thus giving doctors the right to refusal to accept the insurance carriers terms. Should this happen, the doctors and healthcare systems will or should notify the affected patients that their current plan is considered out-of-network or not being accepted at all.

What happens if I am already retired and collecting Social Security when I turn 65?

Answer: Any who is retired and currently collecting Social Security benefits will automatically receive their Medicare care as early as 3 months prior to their 65th birthday.

I'm still working at 67, and I don't know if I need Part B. Why is something so basic so hard to figure out?

Answer: Signing up for Medicare Part B is not mandatory or necessary as long as the employee is currently enrolled in their group employer plan which is considered creditable coverage. As a result, you will be exempt you from a late enrollment penalty should you decided to enroll in Medicare Part B past the age of 65, however there's one exception: Signing up for Medicare Part B will be required if the employer has less than 20 employees.

I signed up for a Medicare Advantage HMO, and I'm wondering if I can see a cardiologist out of network without paying everything myself.

Answer: Unless there are special circumstances, you are typically required to see in-network providers if you're enrolled in a Medicare Advantage HMO plan.

In what situations will Medicare pay for medical services in a foreign hospital?

Answer: If you need to go to the hospital in another country, you'll likely need to pay for medical expenses upfront, even if you have insurance. Your U.S. health insurance may not cover medical costs abroad, and Medicare and Medicaid certainly do not. You'll need to make arrangements for payment, translation (if needed), and potentially medical evacuation if needed. Based on these results, my recommendation would be to purchase short term international health insurance which is very inexpensive.

How do Social Security and Medicare work together for people with disabilities?

Answer: A person that that has a qualifying disability and is collecting Social Security income as a result will automatically receive a Medicare card after 24 months of being disabled and unable to return to work.

I've been dreading hitting the donut hole each year. How will its elimination in 2025 change what I pay throughout the year?

Answer: The Inflation Reduction Act of 2025 has reduced the out-of-pocket maximum for prescription drug coverage to $2,000. There will be no additional cost beyond this point, meaning the copay for any and all medications for the remainder of the year will be $0 after the $2 000 limit has been reached. As it's been in the past, low cost generic prescriptions are typically not a concern but as it relates to brand name prescriptions, here's some is some useful information:

1. Depending on the plan, you may now incur a coinsurance instead of a flat copay

2. Some Medicare Advantage plans may now have a Part Deductible for various tiers

I have a family history of colon cancer. Will Medicare cover more frequent colonoscopies for someone in my situation?

Answer: If someone is deemed to be at high risk for colon cancer, Medicare will cover frequent colonoscopies every 2 years. Your doctor or other health care provider may recommend you get services more often than Medicare covers. An additional plan such as a Medicare Supplement or a Medicare Advantage can provide such additional coverage.

What happens if I delay Medicare Part A enrollment because I'm still on my spouse's employer plan?

Answer: Nothing. PA There are no penalties for delaying Part A or B and long as you remain on your spouse's employer plan and the company has over 20 employees. However, you have the option of evaluating to see if if makes financial sense to stay on her employer plan or explore Medicare plan options.

Don't you think Medicare will eventually be privatized completely?

Answer: I have no idea and I'd rather not speculates on a subject of which I have no direct involvement. We will just have to wait and see.

I'm taking a brand-name medication that doesn't have a generic version. How can I find a Medicare Part D plan that will cover it at a reasonable cost?

Answer: Since prescription drug cost vary per carrier, the best way to find the lowest cost is to work with an agent for assistance or go directly to Medicare.gov

I live in California but might move to another state next year. How will my Medicare coverage change if I relocate?

Answer: Medicare is a federal health insurance program so it will not change but the type of additional coverage such as a Medicare Advantage plan may be affected. If you're enrolled in a Medicare Supplement, only the monthly premium will be affected.

What's the likelihood of Medicare covering gene therapy as it becomes more common?

Answer: I'm sorry say but I have no idea. That decision will be determined by CMS (Centers for Medicare & Medicaid Services)

I need home health care after my surgery, but Medicare denied coverage. What are my appeal rights?

Answer: Question for you; Has your doctor submitted a physician certification form stating that home healthcare is necessary. If the answer is yes, then you can appeal withe decision.

Aren't those Medicare seminars just sales pitches in disguise?

Do Medicare Advantage plans save money?

My mom is considering switching to a Medicare Advantage plan because her friends say it's better. She's scared of losing her current doctors. How can we check?

Answer: The best way to confirm in-network providers is to verify via the insurance carrier’s website or to call directly.

What should I look for in a Medicare plan if I travel frequently both domestically and internationally?

Answer: A plan that has foreign travel benefits which are usually found in Medicare Supplements plans. Medicare supplements also give you the freedom and flexibility to see any doctor or hospital in the US that accept Medicare. One final suggestion; I would highly recommend purchasing foreign travel health insurance if you’re going to be out of the country. It’s really inexpensive because it’s not a permanent policy. Ask your travel agent about available options.

I just enrolled in Medicare, and I've got my Part A and B, but I'm hearing there are gaps in coverage. What are these gaps exactly?

Answer: Some of the gaps in Original Medicare (Part A&B) are as follows:

1. Medicare only covers 80% of approved medical charges. You’re responsible for deductibles and the 20% coinsurance.

2. Medicare does not provide prescription drug coverage. It’s your responsibility to enroll in a stand alone Part D prescription drug plan or enroll in a Medicare Advantage plan that includes prescription drug coverage.

3. OriginalMedicare has NO out of pocket spending limits which is the reason why additional coverage is a necessity. There are 2 plan options that will help mitigate this situation which are a Medicare Supplement (Medigap) plan with a stand alone Medicare Part D drug plan or a Medicare Advantage(Part C) plan). Note: You cannot enroll in both plans.

Can I get a Medigap plan with Guaranteed Issue if I'm losing my employer coverage?

Answer: Yes you can. The following Medicare Supplement/Medigap Plans are Guarantee Issue:

Plan F: If born before January 1, 1955

Plan G: If born after January 1, 1955