Question 1

What is Medicare Advantage?

Accepted Answer

Medicare Advantage, also called Part C, is offered by private insurance companies approved by Medicare. It usually combines Part A, Part B, and often Part D prescription drug coverage.

Question 2

What is the difference between Original Medicare and Medicare Advantage?

Accepted Answer

Original Medicare is run by the federal government and lets you use any provider that accepts Medicare. Medicare Advantage is offered by private insurers and often uses provider networks.

Question 3

What is Medicare Supplement or Medigap?

Accepted Answer

Medicare Supplement, also called Medigap, works with Original Medicare to help reduce out-of-pocket costs. It can help cover certain copays, coinsurance, and deductibles.

Question 4

Does Medigap include prescription drug coverage?

Accepted Answer

Medigap plans sold today do not include prescription drug coverage. Most people need a separate Medicare Part D plan for medications.

Question 5

What is Medicare Part D?

Accepted Answer

Medicare Part D is prescription drug coverage offered by private insurance companies approved by Medicare. It helps cover medication costs based on the plan’s formulary.

Question 6

When is the Medicare Annual Enrollment Period?

Accepted Answer

The Medicare Annual Enrollment Period usually runs from October 15 to December 7 each year. During this time, many people can review or change Medicare Advantage and Part D plans.

Question 7

Can I switch Medicare Advantage plans later?

Accepted Answer

Yes, but timing matters. Most people can switch during Annual Enrollment, Medicare Advantage Open Enrollment, or a qualifying Special Enrollment Period.

Question 8

What is the difference between HMO and PPO Medicare Advantage plans?

Accepted Answer

HMO plans usually require in-network care and may need referrals. PPO plans generally offer more provider flexibility but may cost more for out-of-network care.

Question 9

Do Medicare Advantage plans require prior authorization?

Accepted Answer

Many Medicare Advantage plans require prior authorization for certain services. This can include imaging, surgeries, skilled nursing care, or other covered treatments.

Question 10

Do Medicare Advantage plans have an out-of-pocket limit?

Accepted Answer

Yes, Medicare Advantage plans include an annual maximum out-of-pocket limit for covered medical services. Original Medicare does not include this protection by itself.

Question 11

Why do Medicare plans change every year?

Accepted Answer

Plans may update premiums, copays, drug formularies, provider networks, and benefits each year. Reviewing your plan annually helps avoid unexpected changes.

Question 12

How can I find a Medicare plan that includes my doctor?

Accepted Answer

You should check the plan’s provider network before enrolling. A local Medicare agent can help confirm whether your doctors and hospitals are included.

Question 13

What is IRMAA?

Accepted Answer

IRMAA is an income-related adjustment that can increase Medicare Part B and Part D premiums. It is based on your reported income from prior tax years.

Question 14

What is a Special Enrollment Period?

Accepted Answer

A Special Enrollment Period allows certain Medicare changes outside normal enrollment windows. Qualifying events may include moving, losing coverage, or plan changes.

Question 15

Why work with a local Medicare agent?

Accepted Answer

A local Medicare agent can help compare plan options, explain networks, and review coverage based on your area. This can make Medicare decisions easier to understand.

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Know exactly what to do this Annual Enrollment — before December 7.

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Enrollment caps: the early bird gets the worm

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NPN

Paul Barrett, CMIP

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medicare@paulbinsurance.com

(631) 358 5793

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