Preguntas frecuentes

Un agente independiente trabaja con varias compañías de seguros, lo que le permite comparar distintos planes y beneficios. Le explicamos sus opciones y le orientamos según sus necesidades individuales.

Le ayudamos a comprender sus opciones de Medicare, comparar coberturas y completar la inscripción. Tomamos en cuenta sus médicos, medicamentos recetados, necesidades de atención médica y presupuesto para ayudarle a tomar una decisión informada.

Le explicamos Medicare Original, el Seguro Suplementario de Medicare, los planes de medicamentos recetados de la Parte D y los planes Medicare Advantage, incluidas las diferencias entre estas opciones.

Revisamos sus prioridades de atención médica, los médicos que prefiere, sus medicamentos recetados y su presupuesto. Luego le ayudamos a comparar los beneficios y costos de los planes disponibles que representamos.

Sí. Podemos revisar su cobertura actual y ayudarle a explorar otras opciones. La posibilidad de cambiar de plan depende de si reúne los requisitos para inscribirse.

Eso depende de la cobertura que elija y de si sus médicos la aceptan. Le ayudamos a verificar si sus proveedores participan en el plan antes de que se inscriba.

Sí. Revisamos sus medicamentos y las farmacias que prefiere para ayudarle a comparar la cobertura de medicamentos recetados y los posibles costos.

Sí. Ofrecemos asistencia en inglés y español para ayudarle a comprender sus opciones con tranquilidad.Se habla español.

A good time to start is about three months before your 65th birthday month. Your Initial Enrollment Period generally lasts seven months: the three months before your birthday month, your birthday month, and the three months afterward. Starting early gives you time to understand your options and coordinate when coverage begins. ABC Medicare Plans Broker helps Long Island residents prepare for enrollment with guidance in English or Spanish.

It depends on your employer coverage and the size of the employer. If you have health coverage through your or your spouse’s current employment, you may be able to delay Part B without a late enrollment penalty. With employers that have fewer than 20 employees, Medicare generally pays first, so delaying enrollment could leave coverage gaps. Check with your employer’s benefits administrator before making a decision. If you contribute to an HSA, review how Medicare enrollment will affect those contributions, too.

Not everyone is automatically enrolled. If you’re receiving Social Security or Railroad Retirement Board benefits at least four months before turning 65, you’ll generally be automatically enrolled in Medicare Parts A and B. If you aren’t receiving those benefits, you usually need to apply. We can help you understand the steps, while Social Security handles most Part A and Part B enrollment applications.

Enrolling in Medicare usually means signing up for Part A and Part B through Social Security. Choosing additional or alternative coverage is a separate step. You might keep Original Medicare and add a Medicare Supplement policy and a Part D prescription drug plan, or choose a Medicare Advantage plan to receive your Medicare benefits through a private insurer. ABC Medicare Plans Broker helps you compare the plans we represent and understand how these choices work together.

Start planning before your employer coverage ends so you can coordinate your Medicare start date. If you delayed Part B because you had coverage through current employment, you generally have an eight-month Special Enrollment Period after the employment or coverage ends, whichever happens first. COBRA does not extend that deadline. Medicare Advantage and Part D enrollment deadlines are separate and may be shorter, so it’s best to review everything before retiring.

You may face a coverage gap and late enrollment penalties, depending on which coverage you missed and whether you qualify for a Special Enrollment Period. If you missed Part B enrollment and don’t qualify for a special period, you can generally enroll January 1 through March 31, with coverage starting the following month. Medicare Advantage and Part D have different enrollment rules. We can help you understand your available next steps.

Medicare Advantage is a private insurance plan that provides your Part A and Part B benefits and usually includes prescription drug coverage. Plans may have provider networks and additional benefits. Medicare Supplement Insurance, also called Medigap, works alongside Original Medicare to help pay certain out-of-pocket costs, such as copayments and coinsurance. It does not replace Original Medicare or provide Part D prescription coverage. You cannot use a Medigap policy to pay Medicare Advantage costs.

If you have Original Medicare and want Medicare prescription drug coverage, you generally enroll in a separate Part D plan. Most Medicare Advantage plans already include Part D, so a separate plan usually isn’t needed or permitted with those plans. If you have other prescription coverage, check whether it is “creditable,” meaning it is expected to pay, on average, at least as much as Medicare drug coverage. Going 63 consecutive days or more without Part D or other creditable drug coverage after your initial enrollment window may result in a late enrollment penalty.

Look at deductibles, copayments, coinsurance, prescription costs, and charges for out-of-network care. For Medicare Advantage, also compare the annual out-of-pocket limit for covered medical services. Premiums and Part D drug costs do not count toward that medical limit. You generally continue paying your Part B premium with Medicare Advantage, even when the plan has a $0 premium. We help you consider your expected total costs alongside your doctors, medications, and coverage needs.

Original Medicare generally does not cover routine dental care, routine eye exams for glasses, or hearing aids. It does cover certain medically necessary services and specific exceptions. Many Medicare Advantage plans offer additional dental, vision, or hearing benefits, but coverage limits, provider networks, and out-of-pocket costs vary. We can help you review what a particular plan includes.

An HMO generally requires you to use network providers, except for emergencies, out-of-area urgent care, and certain other exceptions. You typically need a primary care doctor and referrals for specialists.A PPO generally allows you to receive covered services outside its network, usually at a higher cost, and typically does not require specialist referrals. Out-of-network providers must agree to treat you. We help you compare the specific rules and costs of available plans.

For Medicare Advantage, check the provider directory for the exact plan you’re considering, then confirm participation with both the insurer and the hospital. A hospital accepting an insurance company does not necessarily mean it participates in every plan that company offers. Check your treating doctors separately, too. With Original Medicare, confirm that the hospital and providers accept Medicare. ABC Medicare Plans Broker can help you check participation before enrollment.

With Original Medicare, you can generally receive covered care anywhere in the United States from providers who accept Medicare. Medicare Advantage coverage for routine care away from home depends on the plan’s network and travel rules, although emergency and urgently needed care are covered outside the service area. If you split your time between Long Island and another state, tell us before choosing a plan so we can review provider access, prescription access, and any limits on extended absences.

The main opportunities include: October 15–December 7: You can change Medicare Advantage or Part D coverage, with changes generally effective January 1.January 1–March 31: If you already have Medicare Advantage, you can make one change to another Medicare Advantage plan or return to Original Medicare and join a separate Part D plan.Special Enrollment Periods: Certain events, such as moving or losing qualifying coverage, may allow changes at other times. We can help you identify which enrollment period applies to you.

Yes. Your plan’s premiums, benefits, prescription coverage, and provider network can change, and your healthcare needs may change, too. Review your Annual Notice of Change each fall and check whether your doctors, medications, and preferred pharmacies still fit your coverage. Reviewing your plan does not mean you have to switch. Diane provides annual reviews to help you decide whether your current plan continues to meet your needs.

Contact your insurer and the doctor’s office to confirm when participation ends and how it affects your care. Ask your plan about another participating provider and whether any temporary continuity-of-care arrangements apply. A doctor leaving the network does not automatically give everyone the right to change plans, although certain significant network changes may qualify for a Special Enrollment Period. We can help you review your options and enrollment eligibility.

Original Medicare generally continues when you move within the United States, but you should update your address with Social Security. Medicare Advantage and Part D plans have service areas, so moving to Suffolk County may require a different plan. Moving outside your current plan’s service area—or to an area with new plan options—may qualify you for a Special Enrollment Period. Contact your insurer before moving so you can coordinate coverage.

Yes, but you must have a valid enrollment opportunity to leave Medicare Advantage. You’ll also need to coordinate your return to Original Medicare, Medicare Supplement coverage, and a separate Part D plan if needed.New York provides year-round Medicare Supplement enrollment protections. Insurers cannot deny a Medigap application or charge more because of your health status. However, a preexisting-condition waiting period may apply in some circumstances, depending on your prior coverage. We can help you review the timing and coverage requirements before making a change.

Yes. You’re welcome to include a family member, caregiver, or another trusted person in your conversation with Diane. Having someone join you can help with taking notes, discussing your healthcare needs, and remembering questions. If someone will be acting on your behalf during enrollment, we’ll explain any authorization or documentation that may be required.

Bring a list of your doctors, preferred hospitals, prescriptions—including dosages—and preferred pharmacies. If you already have coverage, have your current plan information and Medicare card available. Information about employer or retiree coverage, your expected retirement date, and any time you spend living in another state is helpful, too. You don’t need to have every detail ready to start—we can explain what’s needed along the way.