Before joining a Medicare Advantage Plan here are some important questions to ask.

When you are choosing between Medigap and Medicare Advantage or between Medicare Advantage Plans, here are some questions to keep in mind.

Providers, hospitals, and other facilities

• Will I be able to keep my doctors? Are they in the plan’s network?
• Do doctors and providers I want to see in the future take new patients who have this plan?
• If my providers are not in-network, will the plan still cover my visits?
• Which specialists, hospitals, home health agencies, and skilled nursing facilities are in the plan’s network?

Access to health care

• What is the service area for the plan?
• Do I have any coverage for care received outside the service area?
• Who can I choose as my Primary Care Provider (PCP)?
• Do I need a referral from my PCP to see a specialist?
• Does my doctor need to get approval from the plan to admit me to a hospital?

Costs

• What costs should I expect for my coverage (premiums, deductibles, copayments)?
• What is the annual maximum out-of-pocket cost?
  • Note: PPOs have different out-of-pocket limits for in-network and out-of-network care. If you’re considering a PPO, find out what the different out-of-pocket limits are for in-network vs. out-of-network care.
• How much will I have to pay out of pocket before coverage starts. Is there a deductible?
• How much is my copay for services I regularly receive, such as annual physical, routine eye exams or specialist visits?
• How much will I pay if I visit an out-of-network provider or facility?
• Are there higher copays for certain types of care, such as hospital stays or home health care?

Extra Benefits

• Does the plan cover any additional services that Original Medicare does not?
  • Dental costs?
  • Vision?
  • Hearing aids?
  • Acupuncture or Therapeutic Massage?
• Are there any rules or restrictions I should be aware of when accessing these benefits?

Prescription drugs

• Does the plan cover outpatient prescription drugs?
• Are my prescriptions on the plan’s formulary? (https://www.medicare.gov/plan-compare)
• Does the plan impose any coverage restrictions?
• What costs should I expect to pay for my drug coverage (premiums, deductibles, copayments)?
• How much will I have to pay for brand-name & generic drugs?
• What will I pay for my drugs during the coverage gap?
• Will I be able to use my pharmacy? Can I get my drugs through mail order?
• Will the plan cover my prescriptions when I travel?

Do you have more questions?

Call 207-370-0143 to speak to a local agent or use the form below to send an e-mail.

Does Medicare cover transportation?

1. Medicare Part A and B may cover emergency transportation.
2. Medicare Part B may cover medically necessary transportation ordered by a doctor.
3. Medicare Part A and Part B do not cover non-emergency transportation to and from your doctor’s office.
4. Some Medicare Advantage plans may cover trips to your doctor’s office.
5. Some Medicare Advantage plans also cover rides to and from your doctor’s office or fitness center.

Although Original Medicare (Medicare Part A and Part B) does not cover transportation to and from your doctor’s office, many Medicare Advantage plans (Medicare Part C) can cover non-emergency transportation.

In fact, some Medicare Advantage plans partner with ride-sharing services to provide transportation to members.

Some Medicare Advantage plans may cover non-emergency transportation.

Medicare Advantage plans provide the same benefits as Medicare Part A and Part B combined into one simple plan.

Many Medicare Advantage plans may also offer additional benefits such as coverage for prescription drugs, and some plans may also cover things like dental and vision.

In April 2018, the Centers for Medicare & Medicaid Services (CMS) announced plans to expand the list of benefits private insurance companies are allowed to cover as part of a Medicare Advantage plan.

The new expanded Medicare Advantage benefits can include things like:

• Transportation to doctor’s offices
• Wheelchair ramps
• Handrails installed in the home
• More coverage for home health aides
• Air conditioners for people with asthma

These extra benefits are offered as part of an aim to focus on more preventive health and aging-in-place benefits.

Original Medicare and non-Emergency ambulance transportation.

Medicare Part B only covers non-emergency ambulance services to the nearest medical facility that is able to provide you with appropriate care if you have a written order from your doctor saying that it is medically necessary.

If you go to a facility that is farther away, Medicare’s coverage will be based on the charge to the closest facility, and you must pay the difference.

If the ambulance company thinks that Medicare might not cover your non-emergency ambulance service, they should provide you with an Advance Beneficiary Notice of Noncoverage.

Original Medicare and emergency ambulance transportation.

Medicare covers emergency ambulance transportation if you’ve had a sudden medical emergency and your health is in danger.

Medicare may pay for emergency ambulance transportation by helicopter or airplane if your condition requires rapid transportation that cannot be provided on the ground.

Coverage for emergency ambulance transportation depends on the seriousness of your condition.

In some cases, Medicare may cover transportation in an ambulance if you have End-Stage Renal Disease (ESRD) and need ambulance transportation to and from the facility where you receive dialysis treatment.

Medicare transportation costs.

If your ambulance service is covered by Medicare, Medicare Part B typically covers 80 percent of the Medicare-approved amount, and you pay 20 percent (once your deductible is met).

In 2020, the Medicare Part B deductible is $198 per year.

Do Medicare Supplement plans cover transportation?

Medicare Supplement Insurance plans (also called Medigap) are sold by private insurance companies to work alongside your Original Medicare coverage. 

A Medigap plan won’t typically cover transportation, but a Medigap plan can help cover the out-of-pocket Medicare costs that you may face if Medicare covers your transportation.

For example, if your ambulance ride to the hospital is covered by Medicare Part B, some types of Medicare Supplement plans will cover your Part B deductible, and all Medigap plans provide at least some coverage for your Part B coinsurance costs.

Medicare Supplement plans and Medicare Advantage plans are very different things, and you cannot have a Medigap plan and a Medicare Advantage plan at the same time.

Get more from your Medicare coverage.

To learn more about your Medicare Advantage plan options and to compare plans that cover transportation that may be available where you live, call and speak with a local licensed insurance agent today.

Call 207-370-0143 or toll free 866-976-9038.

Have a quick question? Send an email.

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Qualified Medical Expenses for Health Savings Account (HSA) health insurance plans and Medicare Savings Account (MSA) Medicare Advantage plans.

The following is a summary of common expenses claimed against Health Savings Accounts (HSAs) & Medicare Savings Accounts (MSAs). Due to frequent updates to the regulations governing these accounts and arrangements, this list does not guarantee reimbursement and is to be utilized as a guide for the submission of claims. For more information on IRS-qualified medical expenses, go to IRS.gov/Pub502.

Important Update: CARES Act expands use of health accounts

The new CARES Act expands eligible expenses for HSAs, FSAs, and HRAs:

• Feminine hygiene products are now qualifying medical expenses.
• You can now use your HSA or MSA for over-the-counter (OTC) medications without a prescription. See the Common Over-the-Counter (OTC) Medications section below for examples.
  • Many products being discussed in the news, such as lodging, disposable masks, and hand sanitizer, are considered qualifying medical expenses only with a prescription (Rx) or letter of medical necessity (LMN) from a doctor.
  • These changes will likely take effect gradually. Not all retailers will update at the same time, which may result in inconsistent shopping experiences. Such issues are likely to be resolved soon. For information on reimbursing yourself for out-of-pocket medical expenses from your HSA or MSA contact your plan.
• You can now use your HSA or MSA for telehealth services before reaching your deductible. You can use your HSA or MSA for telehealth for qualified expenses. Both instances are effective until Dec. 31, 2021.

Common IRS-Qualified Medical Expenses

• Acupuncture
• Ambulance
• Artificial limbs
• Artificial teeth*
• Birth control treatment
• Blood sugar test kits for diabetics
• Breast pumps and lactation supplies
• Chiropractor
• Contact lenses and solutions*
• Crutches
• Dental treatments (including X-rays, cleanings, fillings, sealants, braces and tooth removals*)
• Doctor’s office visits and co-pays
• Drug addiction treatment
• Drug prescriptions
• Eyeglasses (Rx and reading)*
• Fluoride treatments*
• Feminine hygiene products
• Fertility enhancement (including in-vitro fertilization)
• Flu shots
• Guide dogs
• Hearing aids and batteries
• Infertility treatment
• Inpatient alcoholism treatment
• Insulin
• Laboratory fees
• Laser eye surgery*
• Medical alert bracelet
• Medical records charges
• Midwife
• Occlusal guards to prevent teeth grinding
• Orthodontics*
• Orthotic Inserts (custom or off the shelf)
• Over-the-counter medicines and drugs (see more information below)
• Physical therapy
• Special education services for learning disabilities (recommended by a doctor)
• Speech therapy
• Stop-smoking programs (including nicotine gum or patches, if prescribed)
• Surgery, excluding cosmetic surgery
• Vaccines
• Vasectomy
• Vision exam*
• Walker, cane
• Wheelchair

Common Over-the-Counter (OTC) Medicines

Examples include, but are not limited to:

• Acid controllers
• Acne medicine
• Aids for indigestion
• Allergy and sinus medicine
• Anti-diarrheal medicine
• Baby rash ointment
• Cold and flu medicine
• Eye drops*
• Feminine antifungal or anti-itch products
• Hemorrhoid treatment
• Laxatives or stool softeners
• Lice treatments
• Motion sickness medicines
• Nasal sprays or drops
• Ointments for cuts, burns or rashes
• Pain relievers, such as aspirin or ibuprofen
• Sleep aids
• Stomach remedies

Services That May Be Eligible with a Letter of Medical Necessity Completed

This list is not all-inclusive:

• Weight-loss program only if it is a treatment for a specific disease diagnosed by a physician (e.g., obesity, hypertension, heart disease)
• Compression hosiery/socks, antiembolism socks or hose
• Massage treatment for specific ailment or diagnosis
• CPR classes for adult or child
• Improvements or special equipment added to a home or other capital expenditures for a physically handicapped person

Ineligible Expenses

Listed below are some services and expenses that are not eligible for reimbursement. This list is not all-inclusive:

• Aromatherapy
• Baby oil
• Baby wipes
• Breast enhancement
• Cosmetics and skin care
• Cotton swabs
• Dental floss
• Deodorants
• Hair re-growth supplies and/or services
• Health club membership dues
• Humidifier
• Lotion
• Low-calorie foods
• Mouthwash
• Petroleum jelly
• Shampoo and conditioner
• Spa salts

Eligible Dependent Care Expenses

• Au pair services
• Babysitting services
• Before- and after-school programs
• Custodial or eldercare expenses, in-home or daycare center (not medical care)
• Nursery school
• Pre-kindergarten
• Summer day camp (not educational in nature)

Ineligible Dependent Care Expenses

• Clothing
• Food/meals
• Kindergarten and higher education/tuition expenses
• Overnight camp

*Some restrictions apply or prior qualifications must be met. Please contact your plan or a tax specialist for more information.