Tony Hardwick, Medicare Insurance Broker

Answer: I am paid an hourly salary and commission. My plan recommendations depend entirely upon the client's needs. I listen intently to find out what's needed and this allows me to find the plan in the area that provides all that's needed. My job is to help others, not inflate my pockets.

Answer: Yes. It covers the "gap" after you reach the plan B deductible, but it doesn't cover the deductible itself.

Answer: First, confirm network status. Ask your plan to arrange care or an exception, or use urgent/emergency care protections if needed. You can also consider switching plans during an enrollment or special election period.

Answer: Yes. If you've been disabled 24 consecutive months you will be automatically enrolled in Medicare at 65. If you're not receiving those benefits, you have to enroll during your initial election period.

Answer: That's due to CMS decision to limit CT scans to ages 50-77 based on evidence of benefits versus harm and the ability to tolerate treatment.

Answer: Yes. Home healthcare is available through Medicare Advantage. Usually it requires preauthorization from your primary doctor but there may be rules like networks, prior authorization, and copays.

Answer: It's because those plans are sold by private insurers that use underwriting. Only during the Medigap open enrollment period or "guaranteed issue" can a company be forced to accept an application without health questions.

Answer: The best way would be to list all your needs, medications, doctor visits, et cetera. Also, consider your monthly Part B premium, if any, and check the deductible and cost for each prescription.

Answer: Medicare offers preventative services beyond the standard screenings. Preventative services for high risk individuals include: 1) Cardiovascular disease risk reduction, 2) Cardiovascular Behavioral therapy, 3) Intensive Cardiac rehabilitation, 4) Cardiovascular screenings, 5) Abdominal Aortic Aneurysm, 6) Annual Wellness visit.

Answer: If you already have disability Medicare you don't have to re-enroll. Turning 65 will allow you to make changes to your current coverage since you will qualify for a new Initial Enrollment Period. This period starts 3 months before your 65th birthday and continues until 3 months after.

Answer: That's correct. The agent of record should have asked for that information to be sure that the options they provided to you had your primary in the network. If your plan is a PPO, you may still be able to see your PCP as long as they accept Medicare payments and accepts your carrier. The downside to that, if they're not in network you'll have a co-payment.

Answer: In Original Medicare, these are additional days that Medicare will pay for after you've been in the hospital for 90 days. You have a total of 60 reserve days in a lifetime.

Answer: No. A Medicare Supplement plan is a private health insurance policy that helps cover out of pocket costs not covered by Original Medicare. A Medicare Secondary Payer refers to situations where Medicare pays after another insurance plan has already paid.

Answer: Medicare covers virtual doctor visits. Part B offers a range of telehealth services including virtual visits, consultations, and some mental health services. These services are not limited to just rural areas.

Answer: The 5 Star special enrollment period is available from 12/8 to 11/30 the following year as long as there is a 5 star plan available in the area.

Answer: In this situation, you may be able to save quite a bit monthly by enrolling in an MAPD plan. A majority of the plans have a $0 monthly premium and include prescription drug coverage. This will put you in a position to discontinue both the Plan G and Part D premium. This would help reduce any potential financial burden. The specialty drugs would be capped at a certain amount depending on the tier it's listed.

Answer: Plans with a star rating of 4 and above receive bonus payments and may offer enhanced benefits, while lower ranked plans may face payment penalties or decreased enrollment.

Answer: Medicare provides comprehensive coverage for critical illness, but critical illness insurance can offer additional financial support by providing a lump sum payment to cover unexpected expenses beyond basic medical care.

Answer: No. Medicare isn't based on health status. Your plan could be terminated if you move outside of the plan's service area, losing Medicare or Medicaid eligibility, or if the plan's contract with Medicare ends.

Answer: The preventative services offered at no cost include screenings, vaccinations, and counseling sessions. For more information you can access the Medicare website.

Answer: Original Medicare doesn't, but Medicare Advantage plans include gym memberships and fitness and wellness programs that encourage healthy behavior. Some also offer gift cards for completing health related activities like getting a flu shot or a wellness visit.

Answer: The 9 states with the "birthday rule" are: California, Idaho, Illinois, Kentucky, Louisiana, Maryland, Nevada, Oklahoma, and Oregon. This allows Medigap policy holders to switch to another plan with equal or lesser benefits within a specific timeframe around their birthday (30-63 days) without needing medical underwriting.

Answer: You can file an appeal if your plan denies a request. You can also appeal if your plan stops paying or providing for all or part of a healthcare service, supply, item, or prescription drug you think you still need. Make sure your evidence of coverage has the correct information about your claim. Ask your doctor, healthcare provider, or supplier for any information that may help your case. For details about your appeals rights, see your evidence of coverage or contact your insurer.

Answer: Medicare has expanded coverage for digital health tools. To be eligible for coverage digital tools must be FDA cleared, used as part of a broader treatment plan, and the provider must incur costs of the tool.

Answer: No, in that case Medicare isn't necessary, but they are eligible to enroll as long as they meet standard eligibility requirements. Tribal members can choose to enroll in Medicare and use it along with IHS care for services not available through IHS.

Answer: Many Medicare Advantage (Part C) plans include a separate drug card benefit that provides extra savings or allowances for over-the-counter (OTC) medications or prescription drugs. These cards help lower out-of-pocket costs for items not fully covered by traditional Medicare. Over the counter items include: cold medicine, vitamins, first aid items, and other non-prescription items.

Answer: You would become eligible for a Chronic Special Needs plan. There are plans that are built specifically for individuals with diabetes, heart conditions, and ESRD.

Answer: If the enrollment period is missed then the client must wait for the next Open Enrollment period, or qualify for a Special Election period if they meet certain conditions, for example, enrolling in a 5 Star plan, having moved to a new area, having a change in Medicaid assistance, or if they're leaving employer coverage to enroll in an Advantage plan.

Answer: I had a caller who was losing their Medicaid assistance because they moved to a different state. I was able to assist them with finding a plan in their new area. Since they lost Medicaid, I suggested a plan with the Part B reimbursement benefit that would provide some of their premium back since the state was no longer paying it. I informed them that they can re-apply for Medicaid in their new state if approved, they would then be able to enroll in a new plan that reflects that they have that assistance and will qualify for a special election period due to regaining Medicaid assistance.

Answer: The most common misconception is that Medicare is expensive. I think people get Medicare Advantage and Medicare Supplement plans confused. Some people have an Advantage plan and call it a supplement mistakenly because it supplements their Medicare A&B.

Answer: Medicare Advantage plans can help save money by providing a $0 monthly premium and providing assistance with prescription costs. If you have no specialty doctors you'll have a $0 co-pay to see your primary doctor. You can even qualify for extra help with prescriptions and drug deductibles.

Answer: In the event they have employer coverage, they should enroll and compare their Medicare Advantage option with their employer coverage to determine which is more beneficial.

Answer: Medicare Advantage plans come with a $0 monthly premium. It does require co-pays for some services. Depending on the level of assistance, some clients may qualify for a plan with $0 monthly premium and $0 co-pays, but that is determined by the level of assistance the client is qualified for.

Answer: The most important question to ask is "Are you happy with your healthcare coverage?" It's also important to ask if the client wants to increase benefit amounts or reduce any co-pays they may have.