Question 1

Why is it important to consult a professional about my Medicare needs?

Accepted Answer

Medicare is a combination of government and insurance. The insurance end of it is plagued by high overhead, and all of these overhead costs take away money from the system that provides benefits. You want to minimize your exposure to insurance company variabilities and get down to the options that best meet your needs, like premium costs, deductibles and copays. However, insurance companies have the final say in decisions about your particular set of medical situations, and they have the power to make those decisions whether you like it or not. So, you need to understand what you’re giving up. I’m here to help you understand who the players are and how you can make the best of the situation.

Question 2

What does Medicare cover?

Accepted Answer

In terms of general coverage, Medicare is a very good system for covering mainstream things like doctor visits and treatments. It doesn’t cover cosmetic services or all experimental treatments, but it covers fundamental services. The major gap in coverage for most people is dental coverage. I can talk to you about what Medicare will cover for you.

Question 3

When can I sign up for Medicare?

Accepted Answer

You can sign up for Medicare three months ahead of your 65th birthday, but there are other qualifications depending on whether you’re employed and continue to work after age 65. Since you’re dealing with large bureaucracies, my suggestion is to apply as early as you can. If there’s a problem, the consequences can be in perpetuity, so you want to give the bureaucracies as much time as possible so you can deal with any mistakes or issues.

Question 4

How do I apply for Medicare?

Accepted Answer

You can apply at medicare.gov. As a representative, I can give you exact directions on how to do that.

Question 5

How do I get Medicare Part B if I already have Part A?

Accepted Answer

This often happens when someone works beyond age 65 and has Part A but needs to get Part B when they retire. My website has a resource page that spells out exactly what to do.

Question 6

What if I can’t afford my medications?

Accepted Answer

Medicare requires that you have a drug plan, but they don’t have their own, so they open it up to insurance companies in your county. In Santa Clara County, there are 30 different insurance companies that offer drug plans. As you can imagine, companies charge whatever they want and every plan has its own details. The programs are very complex and sometimes defy logic, but I can help. I can get a list of medications you’re taking, along with the frequency and dosage, and run it through the system to find the best coverages and lowest out-of-pocket medication prices.

Gary Sutton - Medicare Services

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Gary Sutton: Finding the Balance