William Wheatley, Medicare Insurance Agent

Answer: The real choice here should be Parts A and B with a Medigap plan and Part D plan for prescription drug coverage versus a Part C Medicare Advantage plan with prescription drug coverage. I will show real-life examples of what one offers for a hospital stay of several days compared to the other. Medicare Advantage is more complete, like a major medical plan, but a Medigap plan is still paired with Medicare Parts A and B and usually helps with paying some of the out-of-pocket co-pays and deductibles. You are responsible fora deductible of around $9,000 and 20% thereafter of the bill.

Answer: Again in what context

If you are their Power of Attorney and you are signing them up or changing their plan to follow up would be in their best interest to make them aware of the choices you made for them. If the context of your question is to cover yourself a follow up with your parents may be a good way of gaining their wisdom on what worked for them. Sorry if this is not what either context covered of your question.

Answer: In actuality it depends what your question is? Like if it involves private account information Medicare number may be your only choice. I ALSO RECOMMEND THE WEB SITE MEDICARE.GOV to maybe find an answer or better number for your question. But if it is plan information involving coverages or treatments covered the answer would vary based on what you have and what your question is. First and foremost this is why I recommend an agent because were trained certified experts but again if you have certain types of plans you may have a care manager to reach out to for specific treatment and benefits. You PCP often has answers or can get thru quicker for answers on medical questions. Again without knowing specifics of your question I would suggest keep trying at Medicare.gov to find specific contact information. or call an agent like myself in your state.

Answer: SCOPE OF APPOINTMENT IS BASICALLY A REQUIRED STEP AND IS WRITTEN NOTIFICATION ON WHAT WILL BE DISCUSSED IN YOUR ACTUAL MEDICARE MEETING CONFINING AGENTS FROM COVERING OR OFFERING SOMETHING YOUR NOT INTERESTED IN. This is 💯 normal and required by Medicare as part of the process to prevent spamming telemarketers. It is okay to offer other offerings as long as it is agreed to after and not done as part of Medicare offerings. No one is exempt from this requirement but it can be done prior to starting spefic conversation.

Answer: Will tell you to contact your states MAC Medicare Administrator Contractor for clarification because States can vary. As far as I know you cannot bill BCBS MA MEDIX because it is a medicare supplemental insurance and you opted out of all medicare which usually lasts two years before being allowed to opt in again. Again each state is different so call your states MAC in your state to verify this.

Answer: First the quick answer is based on age. If you are on Medicare Part A and B and under age 39 once for most tests. If however you are 40+ years of age for mammogram you can get tested annually. For prostate testing annually age 50+. Other test like bone scans ..etc are usually manually but all may require specific documentation from your doctor. Couple other points, annual testing may be subject to meeting deductible and co pay which usually is 20%. Often a reason why it is good to have a medi-gap supplement plan to help cover those cost... if in Maryland, Delaware, Virginia, Ohio, and NY give me a call to find out ! WheatleyInsurance dot com

Answer: If it is an approved Cancer Clinical Trial, Medicare will cover routine costs! Things like Doctor visits, etc., but not things like experimental drugs or research-specific tests. But things that are medically necessary. You still may be responsible for 20% co-pays and deductibles.

Answer: So when you originally have Part A, you would have to reach your deductible of $1676 before Medicare would pay anything. But because you have a Part C plan, you pay forthe agreed terms of your Part C primary. PART C MANAGES THE COSTS NOT MEDICARE PART A AND OR B. In this case, it sounds like your plan requires you to pay $350 a day for up to the first 7 days. Any deductibles would be specified in your plan C. These Part C plans would make your plans co-pay be up to the first 7 days at $350... one other thing, often these plans have a maximum out of pocket as well to limit how much in a plan year you owe before they cover ...

Answer: Honestly, I highly recommend an Agent such as myself because usually a good agent develops a relationship with their clients that is always advantageous to both parties. First off, an agent must be licensed and certified by the state and Federal Government, making them an expert. Second, an agent usually has multiple carriers to offer and is certified by them as well. But again biggest advantage is that a good agent follows up and checks in on the client time to time, and is not just about one sale. Now, all that said, that could be a disadvantage if they're not a good agent and try to steer you to a certain product that doesn't meet your specific needs. Of course, agents like that don't last long! My advice is always to use an agent because of training requirements to be an agent make them a professional expert!

Answer: Urgent care visits would fall under Parts B after you meet your deductible would pay 80% you would be responsible for 20%. Again only after you have met deductible which is different state to state. Medicare Part A would cover in stay Hospital. Part B is for Doctor visits and Urgent Care. BE SURE TO VERIFY THAT YOU URGENT CARE FACILITY OF CHOICE ACCEPTS ORIGINAL MEDICARE PART B !

Answer: So there are several possible meanings for this term, "Creditable Coverage". The first is just about reputatiob of carrier providing coverage you can trust. Based on rating and company solvancy. But more likely then not this is a term used when say in prescription drug plans a new or existing Medicare member wants to keep their existing drug plan for long as they can without 61 day penalty. Un this example the plan the customer wants to keep from employer must be Creditable and meet standards of minimum requirements. An example may be a Veteran who wants his VA plan prescription drug plan. This would be a Creditable plan so in the future if he or she ever changed to Part D drug plan there would be no penalty for exceeding 61 day or longer without joining Medicare Part D. So again it's more likely the meaning looking for is the ladder. Great Question!

Answer: So the easy answer is No. You shouldn't have to change anything, but report your new location to Social Security and the Medi Gap carrier. But the better answer is you shouldn't have to change anything as far as your A and B Medicare coverage because it is, of course, a Federal program. But your Medi Gap plan may change based on location, etc. And could change the premium cost. A good agent, such as myself, who is trained, will tell you the best next steps are to report first to Social Security of your move and to the Medi Gap Carrier as well. Then, A quick look or review of other options is always a good thing, especially if your Medigap plan is tied to a specific HMO network, which might not be available in a New location. Again, know that changing a plan can often save money or be pricier with new underwriting required.

Answer: So Medicare plans part A and B accepted and cover all 50 states. Then you would want to apply for a Medicare Part F if eligible 2020 or G that covers Intrrnational travel. Although important to realize that you may have to buy a separate policy altogether like indemity since Medicare Gap coverage usually has a $60,000 Max lifetime coverage. Note: Part C Medicare Advantage plans is restricted by your local HMO and definitely not the answer for someone who travels a lot.

Answer: Yes, in most cases, a Medicare Advantage HMO recipient who chooses to see a cardiologist outside the plan's network for non-emergency care will have to pay the full cost. 

Consider this: HMO plans generally require you to receive all non-emergency medical care and services from providers within their specific network. These providers have agreed to the plan's negotiated rates and terms.

Their is No Out-of-Network Coverage: If you voluntarily go out of network, the plan typically will not cover any of the costs, making you responsible for the entire bill.

There is one Exception (Emergency/Urgent Care): The only exceptions are medically necessary emergency care, urgent care, or out-of-area dialysis, which all Medicare Advantage plans must cover at in-network rates, regardless of the provider's network status.

Prior Authorization/Referral Exception: In some rare cases, if a specific required specialist (like a specific type of cardiologist) is not available within the plan's network, your primary care physician (PCP) can request a prior authorization or network exception from the plan. If approved, the service might be covered, but this must be done before you receive the care. So definitely discuss with your PCP.

Answer: Yes, while Original Medicare (Parts A and B) has the same coverage across all 50 states, Medicare Advantage (Part C), Medicare Supplement (Medigap), and Part D prescription drug plans vary significantly by state due to differences in plan availability, costs, specific rules, and provider networks. Some states can have unique rules for certain plans, and the number and types of plans available, as well as their premiums and benefits, are determined by local market conditions and state-specific regulations

Answer: No you do not have to sign up again because you are already enrolled due to a disability. Your coverage will continue seamlessly. You will have an opportunity to make changes to your plan during your IEP Initial Enrollment Period. This is 3 months prior to your 65th birthday and three months after your birthday. Turning 65 just means the reason for your Medicare changes to age and not a disability. Options to consider Joining Medicare Advantage plan Part C. Adding a Prescription Drug Plan part D, which you should do to avoid a penalty later if you enroll in a drug plan later. But again this is not required . You may already have a drug plan. The last option to consider is a supplement plan called Medi-Gap plan to offset out of pocket expenses.

Answer: Original Medicare is made up of separate parts. Part A is for Hospital coverage and used to be referred to by many Seniors as the Hospital plan. PART B is more for Outpatient services like Doctor office visits. You still have deductibles and are responsible for co-pays and other out-of-pocket costs. Medicare Advantage MA and Medicare Advantage Prescription Drug Plan MAPD are managed by approved private health care carriers and include, if you choose, prescription drug plans and often with $0 Co-pays, etc. Both Medicare Parts A and B, as well as Medicare Advantage plans, have many ways of meeting your specific needs. Some prefer Medicare Parts A and B with supplements, or what are called medigap plans, to help cover the gaps in coverage and money out of your pocket. Others like the all-in-one Medicare Advantage with Doctors, Hospital, and Prescription coverage in a network of providers, all included in that network. Which one is better? That is up to you, and you will have to decide based on your specific individual health assessment. We look forward to providing the information to help you make an informed choice.

Answer: The easy answer is AEP Annual Enrollment Period, but depending on whether you are already enrolled in, let's say, a Medicare Advantage plan and you develop a Chronic qualifying condition, you would be eligible for Enrollment immediately into a CSNP Chronic Special Needs Plan. if deemed necessary. SNP special needs plans are often eligible as needed, and you can be enrolled in them if deemed necessary at any time of the year. This is true of the ISNP Institutional Special Needs Plan as well. Let's say a stroke has forced you into a nursing home or other type of healthcare facility, like a physical rehab... etc.

Answer: I tell my clients that when selecting their plan, they should consider what is most important to them, whether they want the lowest price. For some who have a family history of say Cancer, or some other chronic disease, and just haven't had issues yet ... they may want a more comprehensive plan and are willing to pay those costs. Purpose is why it is so important during AEP to work with a licensed Professional Agent to allow them to help you see your available options that meet your specific needs or purpose for coverage!

Answer: Medicare Parts B covers things like Home Oxygen and if you qualify pay 20% of costs while medicare pays 80%. You must first have medical documentation to support the need for at home and or portable oxygen. COPD treatments like inhalers would fall under Part D drug plan coverage. This coverage would also be available in Medicare Advantage special needs plan ...A Chronic care plan called a CSNP as COPD is considered a qualifying Chronic needs plan. If enrolled a team would help provide all your COPD needs as well as your other medical needs if necessary.

Answer: There is no wrong answer here. Medicare Advantage is a complete Part C complete medicare solution. Often, Medicare Advantage includes a Prescription plan, a network of providers that meet your needs and a lower co pay or no co pay at all. A Medi gap plan is a plan that covers all or most of your out of pocket costs. A specific plan that meets a need like Part D drug plan or Hearing Vision ...etc. Medigap plans often are designed to work with Parts A and Parts B of regular Medicare but do have in most cases a monthly premium cost. But again the point is neither is wrong or right answer. If either Medicare Advantage or Medicare Parts Aand B meet your specific needs its more a choice of what plan works best for you within your budget!

Answer: I care and want to help. Before they all passed I was my parents and brothers primary caregiver. I seen first hand the mess that wrong coverage can cause. It is why I sell Insurance. I Retired from Law Enforcement went back to business school to help people. I Literally enjoy providing Peace of Mind Protection while maintaining a relationship with my neighbors because I care we all do at Wheatley Insurance Dot com!

Answer: The short answer is Yes. Agents are required by both the CMS Federal Government, State Government, and individual Carriers they represent to get extensive training, licensing, and recertification each year. AS An INDEPENDENT Agent I have often multiple carriers i represent. Meaning I may be able to put you in a better plan to meet your specific needs than you even know exists! So to sum up your question you could fix your own car for less. You also could apply first aid to an injury... but something as serious as your Medicare Health Care would be better in the hands of a licensed professional? Again, not for ease of signing up but for you and your Peace of Mind Protection.

Answer: As a Agent for Wheatley Insurance a USABG Signature Independent Agency I get asked this question often in the market I cover Delaware, Maryland, New York, Ohuo, Virginia. And because of CMS regulations I must qualify my answer as generic Educational information only. I therefore cant mention specific carrier plans I represent. So with that said... Yes, many Medicare Advantage plans are available that include Dental. It is important that you evaluate your dental needs versus what is included with Medicare Advantage plans, or Supplement Dental plans options as well, to meet your specific needs. Many Medicare Advantage plans cover preventive care. Some Medicare Advantage plans have more comprehensive plans. But be sure to check your specific needs vs. Cost and Money Out of Pocket for more extensive coverage. Because often you will have a deductible, co pay, and even some cost sharing depending on plan chosen. But there are plans that provide dentures, caps, root canal, ... etc! Very few include things like Implants... Again I can't name specific plans here but hope this helps! Thanks for your question for all your Health and Life Insurance Needs providing Peace of Mind Protection.

Answer: The short answer is a higher rate of denied claims,slow reimbursement, and extensive prior authorization requirements for treatments by private insurers. This is more costly for hospitals and lees profitable. The real truth is both parties share blame as Hospitals charge above normal charges for procedures insurance companies work for profit and limiting price over charges from one hospital to another and physician charges is in best interests for all. Think ofbit this way if a hospital charges $50 for a pill 💊 like Tylenol but another facility only charges 10 isn't it in best interests to try to stop that excessive charge for all parties? Most don't want to hear it but it is important that a Medicare Advantage or Medicare patient it the best quality care and the cost be national average not a reason to be greedy!

Answer: If you are remaining with same carrier in most cases you will not have too. But if you are moving from one carrier to another supplement carrier yes, you will have to answer their specific questions.

Answer: First, As a Professional Medicare Licensed Agent you must be licensed by each state you sell in. Second, you must be AHIP certified to be recognized by Federal Government. Third, after all that including 5 ctrdits awarded for your training, you still then must be certified by each carrier you represent. Finally, I Coach Bill am a trusted neighbor who have coached for generations youth sports...I personally have also been primary care taker in my Family and treat my clients as neighbors who can trust me to be there and my trained expertise to provide you with "Peace of Mi d Protection!" You trusted me to help lead your kids,trust me to meet your specific needs with your health and life insurance needs. Not a call center, not a number ...a friend and neighbor you can Trust Coach Bill!