Tracy Davis, Medicare Insurance Broker

Answer: Medicare Part A covers services that are administered in the hospital as an in-patient. There are many surgeries that are now being done as outpatient; such as, cataract, knee and hip replacements. These would go under the Part B benefits.

Answer: The great thing about Medicare is that you are not locked in for life. You have options to change your plan throughout the year. If you were to retire, go into a nursing home, change to a new service location, get a chronic condition, etc then you are permitted a special enrollment to change your plans. You have annual open enrollment each year, October 15-December 7, to change your prescription drug plan and advantage plan for the follow year (beginning January 1). You also have an Open Enrollment period January 1-March 31 to switch from one advantage plan to another (say your doctor isn't in network or your prescription is not covered). If you are on a Medicare Supplement (F,G,N) then you have an open enrollment each month of the year to see if you can answer the underwriting (health) questions and re-write your plan with another carrier and reduce your premium ;)

Answer: A copay is what you are going to be responsible when you utilize a medical procedure or even when you pick up your medications immediately. A deductible on the other hand is what you will pay first before the insurance company will pay. So, if you are on a plan that has a $300 deductible for medications (for all tiers) then you would pay the first $300 towards any of your medications before the plan would pick up any of the cost. Once the deductible is met then typically there is a set copayment or coinsurance that you are responsible after that point. A deductible is not to be confused with a maximum out of pocket (believe me it commonly is). The maximum out of pocket is the maximum amount you can pay within a year. Once your maximum is hit then the insurance company is to pay the copayments and coinsurance until the end of the calendar year. This resets at the end of each year.

Answer: You might be able to switch your plan to a chronic condition advantage plan if your health concerns are upon those qualified. These are allowed to switch 1x per year (for each chronic condition) and might actually reduce the copayments and medication costs of the specific chronic condition. You would want to check with your local independent broker to see what is available and how it would cover.

Answer: The great thing with Medicare is there isn't "one size fits all", so each year things are changing and evolving. I have plenty of members that begin their Medicare journey at 65 years old and are healthy. Eventually, they experience some health concerns and are able to utilize additional "add ons" to their plans to fill in the gaps that medicare doesn't cover. I like to partner my Medicare Advantage plans with a Hospital Indemnity plan to fill in those gaps for a small premium. I recommend every senior (well really everyone) to get a cancer protection plan. If you are to get cancer on your advantage plan you can expect to pay at least your maximum out of pocket (sometime 2x- cause cancer doesn't always hit in January).

Answer: That is vague question because it would be different depending on which plan you are utilizing. If you have Medicare Supplement (G or N) and have not satisfied your $257 deductible then you will owe up to that deductible. If you have already satisfied your deductible then you should not have any out of pocket costs accrued. However, if you are on a Medicare Advantage plan then you will be billed the set copayment for that procedure based upon which plan you are on with which carrier.

Answer: There are some disadvantages. Since covid there have been several brokers that come into the Medicare space that are not doing what is in the best interest of the senior population. These individuals are flipping insurance plans just to make commissions, which is giving a negative representation to all the other honerable agents in the field. There are also captive agents that are employed by a specific insurance company and are paid a salary to represent that one particular company, which is biased and not giving the senior the entire picture. Therefore, when selecting a local broker to work with; request to know if they represent the plans in your area (not just one), ask them how long they have been in business and how they operate their business. I am proudly servicing my members year after year and work primarily on referrals- my goal is to make and keep them happy (which I am sure I am doing). I love having the ability to offer them all their options (and will enroll them in a plan even if I do not get commissions paid) because I will always do what is in their best interest!

Answer: When someone is speaking of Medicare Supplement N the biggest thing I hear is the "excess charges" that may be billed. Typically, this is a very small percentage of providers that will not accept the Medicare assignment. It is also important to review how many times you go to the doctor as the "N" plan can charge up to $20 per visit. So, if you go the doctor quit a bit it might be just as cheap to go with a "G" plan with the additional premium. The "N" plan typically does not have as great of a rate increase as the "G" plan does year after year. My members enjoy the "G" plan because they can "set it and forget it" after they satisfy their $257/year deductible they sit back and let the plan pay on their behalf. Either one is very good option; it is just different for each person.

Answer: If you are unable to provide credible coverage after 63 days then you will begin to accrue a late enrollment penalty. This penalty will be attached to your part d plan for the remainder of your lifetime unless you receive Medicaid or LIS for lower earners.

Answer: My members call me and ask for a list of doctors in the area that take their plan. The insurance company also provides an app you can download on your phone and look there for an in-network provider. Most of their websites will also have a way to check to see if a provider is in-network.

Answer: If you are going to be traveling quit a bit then I would recommend that you do a medicare supplement to utilize the lack of networks. A supplement G or N would be a great option (along with an appropriate drug plan) to get you coverage while traveling the United States. There are some PPO plans with good networks that allow you to utilize In/Out of network benefits (you will pay higher copays when out of network). I have several "snow birds" that use their plan both in Indiana and in Florida just the same. It is very important if you are going to go this route to verify that your primary doctors are in-network in both locations (such as snow birds).

Answer: If you are a high earner (2 years prior) then you might be responsible for IRMAA charges. However, if you were at a high paying job and are retiring you can file a life event change form and get the IRMAA charges reduced or eliminated. Some people have investments are higher paying social security, so they will continue to pay IRMAA into retirement. If this is the case then you will have an additional charge on your Part B premium along with your Part D premium for the years you are within the higher tax brackets based on the IRMAA charts.

Answer: Typically medicare is not recognized abroad as it is a United States based plan. I would encourage you to get some travel insurance while you are away to assist in medical costs. I highly encourage GeoBlue; I am currently writing one for some clients at this time for their travels to Germany. I use it personally, when I travel outside of the country and have had excellent experience with the company along with a very affordable premium.

Answer: My best advice would be to get a local independent insurance broker to assist you with this. Each state and sometimes counties can be different with their coverage options. Your local broker will know the plans in your area and be able to guide you with advice and show you what you should expect to pay as far as deductible, premium, and copay/coinsurance on your medications. These change each year, so it is wise to readdress them during annual open enrollment October 15-December 7th. Hope this is helpful.

Answer: If you chose a Medigap plan if you could answer the underwriting questions then you can change your plan each month of the year. Your drug plan would need to be selected during annual open enrollment October 5 December 7. there are special enrollment periods throughout the year; such as, you change residence, you begin receiving Medicaid or extra help, you go in or out of a nursing facility, he retire, are a few examples. It is important to always check medications and doctors when selecting a plan on the advantage side. It is important to check your medications on both the drug plans and advantage plans each year.

Answer: It varies by each hospital, we have one locally that will allow bigger insurance carriers to utilize their hospitals as in-network. However, newer carriers have not been able to access the hospital as an in-network option. This is why it important to find a local broker so they know your area and can assist you with different insurance carriers to find the best insurance plan for your specific needs.

Answer: I love helping simplify a very complex and important decision for seniors. I listen to what your pain points and questions are and answer so you can understand them.