Question 1

What is a Medicare Advantage plan?

Accepted Answer

Medicare Advantage (Part C) is an all-in-one alternative to Original Medicare. These plans are offered by private companies approved by Medicare and include Part A (Hospital Insurance) and Part B (Medical Insurance). Many Medicare Advantage plans also offer additional benefits such as prescription drug coverage, dental, vision, and wellness programs.

Question 2

Why have an Agent?

Accepted Answer

Save Time and Money: It doesn't cost you anything to work with a licensed insurance agent. We shop all the carriers for you so you can make an informed decision you can feel confident about. If you have an issue or concern you can call your agent directly and they can fix the problem for you!

Expertise: Our agents are knowledgeable about the local area doctors, hospitals and networks. If you want to receive services from a specific provider or at a certain medical center? We can help you choose the plan that meets those needs. We have over 100 years of combined team experience.

Independent Resource: We do not work for an insurance company. As licensed independent insurance agents we work for you. If you are in an election period and you want to make a plan change, without bias guide you through the process of selecting and enrolling in your new plan.

Things Change: Medicare insurance can be complicated. Each year our agents participate in certification classes to stay up-to-date with Medicare's current rates and coverage as well as any plan changes that take place. We stay informed about your Medicare Insurance options so you don't have to.

Question 3

What is a Medicare Supplement or Medigap plan?

Accepted Answer

Medicare Supplement (Medigap) insurance helps fill "gaps" in Original Medicare. Medigap policies are sold by private companies and can help pay some of the health care costs that Original Medicare doesn't cover, like copayments, coinsurance, and deductibles. Some Medigap policies also cover services that Original Medicare doesn't cover, such as medical care when you travel outside the U.S.

Question 4

What is the difference between Medicare Supplements and Advantage Plans?

Accepted Answer

Medicare Advantage plans are an alternative way to get your Medicare benefits through private insurers, often with added benefits, and often include Part D. Medicare Supplement plans, on the other hand, work alongside Original Medicare to cover out-of-pocket costs. However they don't cover medications so you would need to have a stand alone prescription drug program as well (Part D). You can't have both a Medicare Advantage plan and a Medigap plan at the same time.

Question 5

Does it cost anything to work with an agent?

Accepted Answer

No, it does not cost you anything to work with a Medicare insurance agent. Agents are compensated by the insurance companies they represent, not by the clients they help.

Question 6

What if I am still working past 65?

Accepted Answer

If you are still working past 65 and have health insurance through your employer or your spouse, you may want to delay enrolling in Medicare Part B and Part A without a penalty as long as you have creditable coverage. Once your employment ends or your health insurance is no longer credible, you have a Special Enrollment Period to sign up for Part A, B, C, D, and a Medicare Supplement without a penalty. You may want to also check to see if a Medicare plan would better serve you as you are entitled to come off of your employer coverage outside of open enrollment once Medicare eligible.

Question 7

How do I enroll in Medicare?

Accepted Answer

If you are collecting Social security before 65 your enrollment in Medicare will happen automatically the month you turn 65 unless you delay enrolment. If you are not collecting Social Security when you turn 65 you will have to self enroll in Medicare through the Social Security Administration. You can apply online, by phone, or by visiting your local Social Security office. Enrollment periods include your Initial Enrollment Period, General Enrollment Period, and Special Enrollment Periods.

Question 8

When is my Initial Enrollment Period (IEP) for Medicare Part A and B?

Accepted Answer

Your Initial Enrollment Period starts three months before the month you turn 65 and ends three months after.

Question 9

What are Special Enrollment Periods?

Accepted Answer

Special Enrollment Periods (SEPs) allow you to make changes to your Medicare coverage outside of the usual enrollment periods. SEPs can be triggered by certain life events, such as moving to a new area, losing other insurance coverage, or qualifying for extra help with prescription drug costs.

Question 10

How do I choose a Medicare plan?

Accepted Answer

Choosing a Medicare plan depends on your health care needs, budget, and preferences. Consider factors like the cost, coverage, provider network, and additional benefits when comparing plans. A Medicare insurance agent can also help you understand your options and find a plan that fits your needs.

Question 11

How much does Medicare cost?

Accepted Answer

The cost of Medicare depends on several factors, including which parts of Medicare you are enrolled in and your income. Most people don't pay a premium for Part A if they or their spouse paid Medicare taxes while working. Part B has a standard premium of $174.70 in 2024, which may be higher for individuals with higher incomes. Medicare Advantage (Part C), Medicare Supplement Plans, and Prescription Drug Plans (Part D) have varying costs depending on the plan you choose.

Question 12

What does Medicare not cover?

Accepted Answer

Medicare does not cover everything. Some of the services not covered include long-term care, most dental care, eye exams related to prescribing glasses, dentures, cosmetic surgery, acupuncture, hearing aids and exams for fitting them, and routine foot care.

Question 13

What is the penalty for late enrollment in Medicare Part B?

Accepted Answer

If you do not sign up for Medicare Part B when you are first eligible and do not have other creditable coverage, you may have to pay a late enrollment penalty. This penalty is added to your monthly Part B premium and can last as long as you have Medicare. It is 10% for every 12 month period.

Question 14

What is the penalty for late enrollment in Medicare Part D?

Accepted Answer

If you do not enroll in a Medicare Part D plan when you are first eligible and do not have other creditable prescription drug coverage, you may have to pay a late enrollment penalty. This penalty is calculated based on the number of months you went without Part D or creditable coverage and is added to your monthly premium. It is 1% per month you were eligible to have it and did not have other insurance.

Question 15

What is the Medicare Part D coverage gap?

Accepted Answer

The coverage gap, also known as the "donut hole," is a period in the Medicare Part D prescription drug plan where you may pay more for your prescriptions. After you and your plan have spent a certain amount on covered drugs, you enter the coverage gap and are responsible for a higher share of prescription costs until you reach the out-of-pocket threshold.

Question 16

Can I get help paying for Medicare costs?

Accepted Answer

Yes, there are programs available to help with Medicare costs, such as Medicaid, the Medicare Savings Program, and Extra Help for prescription drug costs. These programs are based on income and resource limits.

Question 17

What is Original Medicare?

Accepted Answer

Original Medicare includes Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). It is provided by the federal government and covers many health care services and supplies, but it does not cover everything, which is why many people choose to get additional coverage through Medicare Advantage or Medigap plans.

Question 18

Can I be denied a Medicare Supplement plan?

Accepted Answer

If you apply for a Medicare Supplement plan during your Medigap Open Enrollment Period, which begins when you are both 65 or older and enrolled in Part B, you have a guaranteed issue right. This means you cannot be denied coverage based on health conditions. Outside of this period, you may be subject to medical underwriting and could be denied coverage. Although there are several other guaranteed issue scenarios you may qualify for.

Question 19

What are the different types of Medicare Advantage plans?

Accepted Answer

Medicare Advantage plans come in several types, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) plans, and Special Needs Plans (SNPs). Each type has different rules about how you access care and what is covered.

Question 20

What is Extra Help with Medicare prescription drug costs?

Accepted Answer

Extra Help is a program that helps people with limited income and resources pay for Medicare prescription drug costs. This assistance can cover premiums, deductibles, and co-payments, and it can also help reduce the cost of medications.

Question 21

Can I use any doctor with Medicare?

Accepted Answer

With Original Medicare, you can use any doctor or hospital that accepts Medicare. Medicare Advantage plans often have networks of providers you must use to get the lowest costs. Some plans, like PPOs, allow you to use out-of-network providers at a higher cost.

Question 22

What is a Medicare Special Needs Plan (SNP)?

Accepted Answer

A Medicare Special Needs Plan (SNP) is a type of Medicare Advantage plan designed for individuals with specific diseases or characteristics. SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve. There are three types of SNPs: Chronic Condition SNPs (C-SNPs) for individuals with severe or disabling chronic conditions, Institutional SNPs (I-SNPs) for those who live in an institution or require nursing care at home, and Dual Eligible SNPs (D-SNPs) for those who have both Medicare and Medicaid.

Question 23

What is a Medicare HMO?

Accepted Answer

A Medicare Health Maintenance Organization (HMO) plan is a type of Medicare Advantage plan that requires you to use doctors, hospitals, and other providers in the plan's network, except in emergencies. You typically need a referral from your primary care doctor to see a specialist. HMO plans often have lower premiums and out-of-pocket costs.

Question 24

What is a Medicare PPO?

Accepted Answer

A Medicare Preferred Provider Organization (PPO) plan is a type of Medicare Advantage plan that offers more flexibility in choosing healthcare providers. You can see any doctor or specialist, but you pay less if you use providers in the plan's network. PPO plans do not require referrals for specialists and generally have higher premiums and out-of-pocket costs compared to HMOs.

Question 25

What is Medicare Part D?

Accepted Answer

Medicare Part D is prescription drug coverage available to anyone with Medicare. It is provided through private insurance companies that are approved by Medicare. Part D plans help cover the cost of prescription drugs and protect against higher costs in the future. You can get Part D coverage through a standalone prescription drug plan or as part of a Medicare Advantage plan that includes drug coverage.

Question 26

How does Medicare work if I have employer health insurance?

Accepted Answer

If you have employer health insurance when you become eligible for Medicare, Medicare coordination with your employer plan depends on the size of the employer. If your employer has 20 or more employees, your employer insurance is primary, and Medicare is secondary. If your employer has fewer than 20 employees, Medicare is primary, and your employer insurance is secondary. It's important to understand how the two plans work together to ensure you have the coverage you need and avoid potential penalties.

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