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Frequently Asked Questions About Coverage

Frequently Asked Questions About Coverage

Frequently Asked Questions When Obtaining Coverage

These are very important issues to consider when deciding which Medicare coverage is right for you. Unlike many other brokers, we take the time to make sure all these issues are addressed, and you know exactly what to expect when the need of medical assistance arises. We will take the time necessary to ensure you understand and are comfortable with your health coverage.

Q Will I have to switch doctors?

A Sometimes you will if your doctor does not accept Medicare or the Plan you are on, so we will check that out for you.

Q What is the difference between ‘Advantage’ and ‘Medigap’ plans?

A Advantage Plans are technically Part C of Medicare and these are managed care plans. This means that all the doctors have agreed to accept a negotiated payment from the insurance plan. So as a person enrolled in an advantage plan you must use doctors and facilities “in network”. You can only go outside of the network in emergency situations. Medigap Plans are supplements to Original Medicare and a doctor must accept Original Medicare for costs to be covered.  Original Medicare can be used anywhere in the United States, and several Medicare Advantage plans now offer national networks.

Q How will Medicare affect my prescription drug costs?

A Medicare approves various insurance companies to provide drug coverage to beneficiaries. There is a deductible, co-pays, maximum out of pockets and catastrophic coverage’s. These all change each year as well as the drug plan formularies. Formularies are the list of drugs a plan will cover, not all plans cover all drugs. It is important to have a drug plan analysis done each year during Annual Enrollment Period (October 15th to December 7th). This will assure you are on the plan with the lowest out-of-pocket costs.

Q Is the plan I bought last year still the right plan for me?

A That depends on how you feel about the plan. If you like it and your doctors still accept it and your medications are all covered you can stay on your current plan. If you don’t like it or want to make a change you can only change an Advantage Plan and Drug Plan during AEP October 15th-December 7th and it will start January 1st of the following year. Medicare supplements can be changed at anytime throughout the year, although you MUST answer health questions and be accepted by the new plan to change. They can say they do not want to cover you then you will not be able to change plans.

Q How does Medicare affect my Long Term Care Planning?

A Medicare has very limited coverage for Home Health Care and Long Term Care Facilities. Requires a prior 3-day hospitalization and pays for “rehab” services only. Medicare offers no coverage for Custodial Care.

Did You Know?

Recent studies have shown that the average Medicare recipient spends over $500 too much on their prescription drugs? When placed in an appropriate Prescription Drug Plan, we can eliminate this overpayment.