Timothy Brown, Medicare Insurance Broker

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.

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.

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.

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

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.

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.

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).

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

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.

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.

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

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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

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.

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

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.

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

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.

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.

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

Answer: If you need skilled nursing or therapy, Medicare may cover home health aide services to help with personal care needs. However, if you only need assistance with personal care and not skilled services, Medicare will not cover home health aide services. Home health aide services are a specific type of home health care that provides personal care assistance, like help with bathing, dressing, and using the bathroom.

Answer: No, when a person receiving Social Security Disability Insurance (SSDI) turns 65, their benefits don't automatically switch to Supplemental Security Income (SSI). Instead, their SSDI benefits usually convert to regular Social Security retirement benefits. This conversion typically happens at the person's full retirement age, which is 66 or 67 depending on their birth year.

Answer: Critical illness, heart attack, stroke and cancer plans are optional indemnity plans that can be purchased separately. The plans pay you directly upon a certain diagnosis and are designed to cover non medical and out of pocket costs such as travel, lodging, missed time from work, experimental, treatments, etc. In short, you receive a cash payout that can be used at your discretion regardless of the type of medical coverage because there is no coordination of benefits with insurance companies.

Answer: Two of the biggest disadvantages of a Medicare Advantage plan are that they’re not accepted everywhere and the plans can change annually.

Answer: My recommendation is to purchase international insurance since US plans are limited when you’re out of the country.

Answer: There’s no such thing as an out of network providers with Medigap plans because Original Medicare (Part A & B) is your primary insurance/coverage which means that if your doctor or hospital accepts Medicare the Medigap plan, by default, is also accepted. In fact, the Medigap plan’s function is to cover the approved medical excess charges that are not covered by Original Medicare.

Answer: No Medicare Advantage plan covers surgery fully or 100 percent. You will have a copay for the surgery whether it’s inpatient or outpatient. I would call member services on the back of your insurance card to get an idea of what it will cost.

Answer: It depends on whether you’re currently insured by a group employer insurance plan. If you are, then the answer is NO because the group insurance is deemed as creditable coverage which means you will not be penalized for not signing up for Medicare when or after you turn 65. Signing up for Medicare is only required if an individual 65 or older has no medical insurance at all.

Answer: The coverage options that you feel would best fit your healthcare needs and budget. A Medicare Supplement or a Medicare Advantage plan are the plan options the can address your needs.

Answer: No. Medicare remains your primary insurance. The supplement will still continue to function the same way anywhere in the US.

Answer: Medicare supplement Plan N is the best value option. Keep in mind that all services are the same depending on the plan letter i.e. F, G, N and that the insurance carrier name is irrelevant because Original Medicare is your primary insurance. The goal is to find the plan that costs the least which will be determined by your age and zip code. I can assist with that information.

Answer: No. You don’t have to sign up again but what you will get is a second IEP (Initial Enrollment Period) because you’re aging in/turning 65. You can change plans in October if you’d like or keep the same coverage.

Answer: That depends if you’re on Medicare and enrolled in a plan that provides mental health services. Let me also preface by stating although caregiver burnout is very stressful, it may not qualify under the mental health category which is usually reserved for individuals with certain diagnosis i.e. depression, anxiety, bipolar disorder, etc. There are services/plans that offer respite care which provides caregivers temporary relief/breaks to do something for themselves away from the situation.

Answer: A Medicare plan that covers preventative services such as the shingles shot, flu shot and COVID 19 will be covered at $0

Answer: Higher cost Part D plans can serve two purposes.

1. They may have $0 deductible instead of the $590 deductible for brand name drugs from tiers 3-5

2. The copays for brand name prescriptions are typically lower and are covered whereas a lower premium plans may not cover particular drug.

Answer: The maximum annual out of pocket for prescription drug coverage for 2025 is $2000. There are two ways to find out if you’re enrolled in the best plan.

1. Consult with an agent like myself to run quotes to find the best plan which will be determined by the name of the prescriptions taken.

2 Go directly to Medicare.gov and search for yourself by entering your prescriptions.

Answer: The reason for getting a bill may not be a result of Medicare but rather the difference between an annual wellness visit which is covered by Medicare versus a routine physical which is not. Sounds confusing, I know, but the services are different. An annual wellness visit is designed to prevent disease and/or disability via a health risk assessment whereas a routine physical is catergorized as a general check up.

Answer: Medicare advantage plans and stand alone prescription drug plans can be changed annually during certain enrollment periods, most notably the Annual Election Period which runs from October 15th-December 7th

Answer: Physical therapy is covered under Medicare B (Outpatient Services) but it's the additional coverage (Medicare Supplement or Medicare Advantage) that what your coinsurance or copay:

If you have a Medicare Supplement, all cost that under Medicare Part B will be covered after the $257 annual deductible has been met. If you have a Medicare Advantage plan, you will have a copay for each physical therapy visit. The copay will be listed in the summary of benefits of the insurance carrier.

Answer: As agents, we are required to certify annually on plans and benefits from all insurance carriers that we are authorized to represent.

Answer: Issuance of a Medicare card Part A& B begins after the 4 month of being on dialysis. Once the card is received, you’ll have the option of choosing a plan( Medicare Supplement or Medicare Advantage) to help offset or cover cost that Original Medicare does not.

Answer: Only if you have employer coverage. The 20% coinsurance that Medicare A& B doesn’t cover exposes you to potential high out of pocket cost when it comes to hospitalization, surgery of any other catastrophic event. Also Medicare A & B doesn’t have an out of pocket maximum which is the reason why it’s important to have addition coverage such a Medicare Supplement or a Medicare Advantage plan to offset the expenses.

Answer: My advice is to consult with a broker, such as myself to educate you on Medicare first and then go over plan options before you commit to signing anything, enrolling in a plan or giving up your Medicare ID. If you want a no cost, non-biased consultation where I can show & tell you everything you need to know so that you can make an informed decision on your healthcare options, call me at (717) 363-8041 or email [email protected]

Thank you,

Tim Brown

Answer: Yes there are certain plans that cover acupuncture but I’ve not seen alternative therapy in any Medicare Advantage plans.

Answer: The copay in a Medicare Advantage plan eliminates the Part A deductible. These plans are subsidized by the Federal Government and CMS (Centers for Medicare & Medicaid) and are designed to lower out of pocket costs in comparison to Original Medicare Part A & B.

Answer: Yes. Continuous glucose monitors are classified as durable medical equipment (DME) which is covered under Medicare Part B.

Answer: Without a Medigap plan, you will be subject to 20% coinsurance of charges that Medicare doesn’t cover. It may seem insignificant for a doctors office visit but it can be very costly if a catastrophic event occurs or hospitalization or a surgery is necessary.

Answer: You have a few options when it comes to hearing aid coverage:

1) Enroll/sign up for a stand alone plan that covers dental, vision & hearing. They usually includes these 3 benefits under one plan.

2) Enroll in a Medicare Advantage plan that includes hearing aid benefits.

3) MDhearing.com is a low cost hearing aid plan option.

Last thing, some recipients believe that “covered” means that you pay nothing for the benefits or services which is not true. There is usually or copay or coinsurance for various benefits.

Answer: Call Medicare at 1 (800) 633-4227 to order a new card. It takes about 4 weeks to get a new one but you can also ask them to provide your Medicare ID over the phone if you need it right away. Last thing. Medicare is open 24/7 so my advice is to call them off hours to get a faster response.

Answer: The following $0 vaccines that are covered by Medicare under multiple plans and classified as a preventative service are:

Flu

Shingles

COVID

Answer: One of the biggest misconceptions that people have about Medicare is that covers everything including non Medicare services such dental, vision and hearing aids.

Answer: The benefits of working with a local agent vs a remote agent is the in-person experience of someone showing you, in real time, all of your options not to mention the rapport that is established during the conversation. Last thing, most remote and/or call center reps like and are trained to enroll clients in plans, sight unseen, meaning that don’t show or give you anything tangible to verify the summary of benefits before you commit to a plan.

Answer: All Medicare approved services are covered under a Plan G after the annual deductible is met. Keep in my, Original Medicare Part A & Part B is your primary insurance and that is who the doctor/hospital bills first. The supplement pays the 20% of the cost that Medicare doesn’t pay for after the annual deductible. No surprise bills afterwards and the biggest take away is that there are NO prior authorization hurdles to jump over.

Answer: I would limit my options to no more than 3 and do business with the agent or broker that you feel most comfortable with and is showing all of the carrier and plan options available in your zip code.

Answer: No. Dental benefits do not fall under Original Medicare Part A & B but it can be an available under a Medicare Advantage plan. Keep in mind that dental implants are considered a cosmetic procedure and are very expensive which is the reason that most dental plans don’t cover it or offer a limited amount.

Answer: Don’t give your Medicare information to unsolicited callers trying to entice you into enrolling in a plan by offering benefits that sound too good to be true. These benefits require certain eligibility such as being on both Medicare & Medicaid. One final comment, if anyone claims that they are calling you from or on behalf of Medicare, they are lying. Medicare does not call, text or advertise on social media i.e. Facebook, etc. Mail is the only form of communication for Medicare, Social Security and the IRS.

Answer: It depends on if you’re currently collecting Social Security benefits. If so, you will automatically receive a Medicare card as early as 3 months before your 65th birthday with the coverage effective the first day of your birthday month. If you’re not collecting Social Security, you can apply for Medicare Part A three months prior to your 65th birthday. The question is whether should apply for Part B at the same time which will depend on employer coverage. You can delay Part B enrollment without a penalty as long as you maintain employer group coverage even if your past age 65.

Answer: What is the cost for Medicare Part B which changes annually and the timeframe to enroll in Part B (Medical) and Part D (Prescription Drugs) before incurring late enrollment penalties. Lastly, what are my options to help cover the copays & coinsurance that Medicare doesn't pay for.

Answer: The donut hole has been eliminated for 2025 and the overall annual maximum out pocket has been reduced $2000. Once the maximum has been met, the cost of the prescriptions will be $0 for the remainder of the year. It doesn’t necessarily lower the cost but you’ll reach the annual maximum much faster. There’s also a program called M3P which allows you to spread the cost of the prescriptions on a monthly basis.

Answer: Enrollment in a Medicare Supplement/Medigap is year round however changing a plan will depend on your ability to pass medical underwriting or qualify for guaranteed issue

Answer: Yes, you can be denied coverage for a Medicare Supplement under the following circumstances:

1) You don’t qualify medically because of your health history and/or current health status/condition and current prescriptions

2) You don’t live in a guaranteed issue state where medical underwriting isn’t part of the process

3) You don’t have a guaranteed issue options such as leaving employer group insurance, an existing plan leaving the market or moving from one state to another where you're now out of the service area.