Vernon Jones, Medicare Insurance Broker

Answer: I give them a little history of Medicare and explain the three different ways one can take their Medicare coverage - either Original Medicare with a drug plan which isn’t a favorable option. I explain to them about a Supplement (Medigap) and a drug plan for the least restrictions, or a Medicare Advantage plan that also includes other benefits, like transportation, an over-the-counter (OTC) catalog, dental, vision, and more depending on their plans offered in your service area.

Answer: You would firstly confirm that the services are medical necessary with your doctor and the therapy provider for Medicare does not have limit on medical necessary outpatient therapy visits rendered.

Answer: There are a few things you needed to consider as you prepare your move from an employer health plan to Medicare prior to retirement. I highly recommend you be aware that your employer`s plan coverage and costs, determine your Medicare enrollment period and decide which Medicare part A, B, D or Medicare Advantage and Supplement plans also known as Medigap fit your needs. You should contact your employer`s HR departments to make sure a smooth coverage transition and ensure you will not experience any gaps in coverage. But I do highly recommend that prior to your retirement that you sign up for Medicare Part B and hopefully if you already have Part A if you are age 65 or older to have a seamless transition into Medicare.

Answer: I personal don’t have resistance to my advice but if they do i would say clients resistance to Medicare advice often stems from a combination of psychological, financial, and informational factors. The complexity of Medicare, coupled with misinformation and the human tendency to seek easy solutions, can lead people to make poor decisions that result in bad plans. I have discovered some seniors listen to what their friends or family member has and believe it is the best option for them which is not the case but they should get advice from a veteran and knowledge broker/agent.

Answer: I would say the most misleading Medicare Advantage as i have seen is leading Medicare Beneficiaries to believe they are eligible for an OTC benefits with food and utilities benefits to all whose enrolls in any plan regardless of their eligibility which is not true.

Answer: Medicare Advantage plans can include extra benefits like vision, dental, and hearing care, but typically restrict you to a network of providers and often require referrals for specialists. I personally would highly recommend that you consider a Medicare Advantage as a logical option since you do have original Medicare Part A and Part B.

Answer: You would benefit greatly by having a licensed and trained knowledge agent/broker to help you find a plan that covers your medication at the lowest price and make sure your doctors are in-network. There maybe situation where some medication are covered on a formulary. Having an experienced agent as myself at “no cost” to you is the proper way to go and keep your prescription cost down at the lowest price.

Answer: No, you likely will not have guaranteed issue for a Medicare Supplement (Medigap) plan if you wait until your COBRA coverage ends in January, because Medicare considers COBRA not to be creditable coverage. You need to secure a Medigap plan now, within six months of your Part B special enrollment period ending on June 30, 2025, to avoid the risk of the 63-day rule.

Answer: Yes, for as long as the cholesterol medication that you are on is covered under your current prescription plan, it will count your out of pocket which includes the coverage gap.

Answer: Yes, Native American Indigenous Medicare

Yes, you should consider having Medicare because while the Indian Health Service (IHS) provides care, it does not cover all needs or services and is not an insurance program, only offering care within its own facilities and programs. Enrolling in Medicare allows you to receive care outside of IHS facilities, access additional services not provided by IHS, and can even provide reimbursement to the IHS when you receive covered services. This dual coverage expands your healthcare options and can help the IHS function more effectively by covering costs for services received at its facilities.

Answer: Absolutely not, Medicare can`t and will not drop you because of health reasons. Your health status does not affect your eligibilty for Original Medicare Part A and B.

Answer: The way to stay up to date with changes in one’s Medicare plan is to have an experienced veteran and knowledgeable broker assigned to you who knows the plans offered each year from the carriers. This way you won’t have to try to figure it out yourself but let the licensed broker do the necessary research for you.

Answer: The different between an agent and a broker is that an agent often only represent one carrier or one line of products and could be captive with one insurance carrier. Why a broker presents multiple insurance carriers and is certified and contracted with many plans and benefits with a variety of plans. The main objective for the broker is to find the plan that is more favorable for the individual based on a needs analysis from the Medicare beneficiary.

Answer: i would explain zero premium as no cost for the actual plan, but there will be cost for service rendered on a Medicare Advantage plan. I call it pay as you go or pay as you use the plan from copays, deductible, co-insurance or out of pocket charges.

Answer: Yes, I am a licensed and certified knowledgeable and experienced broker and I can help you navigate through for those who doesn’t understand Medicare. 😀

Answer: No, a green card holder who has been in the United States for 4 years is not automatically eligible for Medicare. Generally, green card holders need to reside in the US for at least five years to be eligible for Medicare.

Answer: A person will likely pay 20% of the Medicare approved amount for the services of an ambulance ride after the person meets their Part B deducible. So, Medicare pays the remaining 80%. And if the ambulance ride is deemed medical necessary and covered by Medicare, the person is responsible for their 20% coinsurance and the deductible if he/she has not met their deductible for that calendar year.

Answer: I would recommend a Medicare Advantage plan. I believe you would have more flexibility through an MAPD.

Answer: Health Maintenance Organization Point-of-Service (HMOPOS) plans are a type of HMO that offers some flexibility in accessing out-of-network care, unlike traditional HMOs which primarily cover in-network providers. HMOPOS plans allow members to receive care from doctors and specialists outside the HMO network, though typically at a higher cost through copayments or coinsurance

Answer: With a Medicare Advantage (Part C) plan, you generally don't pay the Medicare Part A deductible ($1,676). Instead, you'll be responsible for the copay outlined in your specific Part C plan. For example, if your plan has a $350 copay per day for the first 7 days of an inpatient hospital stay, that's what you'll pay. Your Advantage plan replaces Original Medicare's Part A benefits, so you'll follow your plan's cost-sharing rules, not those of Original Medicare.

Answer: It is legal because apparently you were beyond your Open Enrollment period which is a 6 month window that begins the first month you have Medicare Part B. During that time you can enroll in any Medigap plan and you will be accepted for there is no health question. But if you were to try to get a Medigap beyond that age and time you will have to pass the health question and if not you will be declined by the insurance carrier.

Answer: A Scope of Appointment is required by all agent/broker prior to discussing any plans specific which is a requirement by the Centers for Medicare & Medicaid it is to protect the Medicare Beneficiary and assures transparency in the sales process of the Medicare plan Medicare Advantages or Part D plans to be discussed.

No, call centers aren’t exempt from the SOA but it is captured telephonically for they are still required to get consent from the Medicare Beneficiary

Answer: Only if your plan offer that as part of it Summary of Benefit package. But often those that have both Medicare and Medicaid and they has to be eligible for that plan or a Chronic condition grocery maybe apart of the OTC benefits for that plan, but it varies from plan to plan and carrier to carrier for 2025. This Medicare Advantage from carriers does change from year to year.

Answer: SEP is when you have a qualifying event like coverage from a group plan and/or you retiring and you are no longer covered on your job so that allows you to enroll in a medical plan out of the normal enrollment period of AEP which is Annual Election Period which is October 15 - December 7

Answer: Yes, you should sign up in most cases for Medicare when you turn 65 even though you are still working and have creditable coverage and a drug plan on your job, but you would not need to sign up for Part B but instead get Part A only for in most cases it won’t cost you anything for it as long as you have worked 10 years or 40 quarters. Then you wouldn’t be penalized

Answer: I would say one of the most common misconceptions people have about Medicare is they won’t have to pay any more money to have Part B and there is a cost to have a broker to assist them with their medical plan options.

Answer: Yes, there are Medicare Advantage plans that offer additional incentive and rewards the member once they complete a variety of preventative health behaviors ranging from the member getting their annual flu shots, mammograms, pneumonia shots and occasionally often using their free gym membership which is apart of their plan.

Answer: In most cases is not a disadvantage in working with a broker/agent, but broker should be knowledgeable of the information shared with Medicare beneficiaries and their no cost in the broker assisting you. The broker is paid a small commission from the insurance carrier once the broker enrolls that person into a different plan then they before the Agent of record.

Answer: A copays is that you be are to pay your doctors or providers at a doctor visit and also for your medication at a pharmacy based on your medical plan. And a deductible is what you as the insured is to pay prior to your plan paying their part of the cost.

Answer: Yes, if you have true Medicare Supplement plan which is a Medigap there is no network and you can any doctor in the country as long as they accept Medicare.

Answer: You can visit Medicare.gov and Drug plans then Click Find a Plan now, then Your zip code, , then your County, . Select Medicare drug plan apart D, then Click I don't get help from any of these programs. Continue, yes you want to see drug cost when you compare plans. Click Yes, next Add prescription drug name.Example Lisinopril select the Dosage. Add to Drug List as you continue to add more meds. Then Dine Adding Drugs.Select your pharmacies including Mail order, up to 5 choices. Then Clock Continue to View Plans then Compare prices from each pharmacies. CLICK View drugs and their cost. Then compare drugs prices from each pharmacy. 😀

Answer: I am not sure if you can enroll into Medicare for i know people in your case can receive spousal benefits. However i would professional suggest that you contact SSA office, for they should be able to answer that question.