Vernon Jones, Medicare Insurance Broker

Answer: I would say many senior simply delay and procrastinate not being focused and attentive to the fact that they turned 65 and certain things need to be addressed. I often tell mine clients to tell other people about me do not let me be a secret agent and share my contact information and encourage them to call me if they have any MEDICARE persons or concern and I can direct them when and what to do so they would not be hit with a penalty for late enrollment.

Answer: Medicare Advantage plans offer "over-the-top" (supplemental) benefits that go beyond Original Medicare, primarily focusing on dental, vision, hearing, and daily wellness to attract enrollees. The most popular, yet often underutilized, benefits include over-the-counter (OTC) allowances, free gym memberships, and non-emergency transportation, though some, such as "money-back" plans, can be overhyped

Answer: Starting January 1, 2025, the Medicare Part D "donut hole" (coverage gap) is eliminated, replaced by a $2,000 maximum out-of-pocket cap on prescription drugs. This means once your father spends $2,000 on covered medications, he pays nothing for the rest of the year, significantly reducing costs for high-drug spenders

Answer: The Medicare Advantage 5-Star Special Enrollment Period (SEP) allows beneficiaries to switch to a 5-star-rated Medicare Advantage or Part D plan once per year, anytime between December 8 and November 30. It is distinct from AEP and OEP because it is not based on a specific calendar season, but rather the availability of a high-quality plan. Differences in Enrollment Periods:5-Star SEP: Runs Dec 8–Nov 30. You can change plans once during this period, but only if a 5-star plan is available in your area. AEP (Annual Enrollment Period): Oct 15–Dec 7. Everyone with Medicare can change plans (Advantage or Drug). OEP (Open Enrollment Period): Jan 1–March 31. Only for those already in Medicare Advantage; allows one change. Key Differences Summary: The 5-star SEP is solely to move to a top-tier rated plan. Flexibility: 5-Star SEP allows changes almost all year, whereas AEP and OEP have strict, narrow windows. Requirement: A 5-star plan must be active in your service area to use the 5-star SEP.

Answer: Doctors often dislike Medicare Advantage (MA) plans due to high administrative burdens, such as strict prior authorization requirements,, which delay patient care and increase paperwork. Other major factors include lower reimbursement rates compared to Original Medicare, denied claims, and restrictive, narrow provider networks

Answer: You do not legally need a hospital indemnity plan, but it is a valuable tool to help cover high out-of-pocket costs (copays/deductibles) in Medicare Advantage plans. If you are hospitalized twice, these plans can pay you cash directly, helping bridge the financial gap, especially for long or multiple stays in one year

Answer: This is a frustrating situation, but it happens, particularly in states like North Carolina with strict continuous insurance requirements. If you have been with them since 2017 and have proof of continuous coverage (even if there was a clerical error), you can fight these charges

Answer: Yes, Original Medicare covers emergency and urgent care in U.S. territories like Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. These are treated as part of the U.S. for coverage purposes, ensuring you have access to services from providers that accept Medicare

Answer:

No, you personally can not unless you are POA for them and it depends on the situation of your parents

Answer: They don’t work with an experienced agent that knows how to do the proper research by getting the seniors medication. The proper research is done to find the most favorable Part D plan at the lowest cost and lowest monthly by premium for the drug plan.

Answer: The first step is to determine your Medicare Initial Enrollment Period, which begins 3 months before your 65th birthday month and ends three months after it. During that seven month month window, you should contact SSA to sign up for Part A and Part B, unless you`re automatically enrolled due to receiving Social Security benefits or covered by a qualifying employer plan.

Answer: No, Medicare does not cover 100% of all medical costs, there are beneficiaries typical face out of pocket expenses like deductible, coinsurance and co-payments.

Answer: As an experienced agent I can say the reason your friend gets Silver Sneakers is because of the type of plan she has which is likely a Medicare Advantage plan that offers the gym benefits Silver Sneakers. I would recommend that through a needs analysis a plan can easily be found for you that offers Silver Sneakers this Fall Open Enrollment Period which is annually October 15-December 7th.

Answer: That will depend on the plan you have and how the Benmedical procedure surgery was coded. These Medicare Advantage plans have different costs and it depends on the plan summary of benefits.

Answer: No, i would advise you to meet with a veteran experienced knowledgeable agent that is a broker for he and/or she should be able to assist you and help you locate the right plan for your needs.

Answer: It depends of you have a Medicare Supplemental plan or if your have a Medicare Advantage plan which does requests you to enroll in a plan in your service area that you would be living.

Answer: You should have a licensed and certified agent/broker to discuss with your options. Yes, Original Medicare will only coverage 80% of your cost and yes you will still need to enroll in a stand-a long drug plan. While with a Medicare Advantage it is all in one medical and drugs and you will have additional benefits not offer through Original Medicare. A true needs analysis should be done work you so you can make the right decision for you.

Answer: Yes, there is a $185 monthly cost to have have Part B and since you are drawing your Social Security it likely coming out of your monthly Social Security check.

Answer: Yes, you should signup for Medicare Part A only and not Part B. If you have creditable coverage with a drug plan on your employer plan.

Answer: Yes, you moving to a rural area can limit your Medicare Advantage plans options by reducing the number of plans offered in that service area, potentially leading to fewer in network doctors and higher cost.

Answer: No, Medicare will not cover your medication, for you should consult with a trained agent to check your drug plan formulary. He or/she should be about to see if your mediation are covered with your plan. The specific coverage for a drug varies depending on the drug formulary.

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.