Why everyone needs professional help.

Cutting out the middle-man isn’t always a good thing.

Why You Need An Insurance Agent

It still shocks me when someone asks why they should use an agent instead of just calling the insurance company directly to enroll in a Health Insurance Plan.  But I understand why you might ask this question.  If you get something in the mail and it looks like a good deal then why not just cut out the middle man and buy direct?

The answer is simple.  Because you need the advice and guidance of someone who is trained and experienced.  

Who’s watching out for you?

When you call an insurance company they will only tell you why their plan is better than the others.  They will not tell you what the competition may offer because their job is to sell their plan and only their plan.  Also when they sell direct to you without an agent they increase their profits because they no longer have to pay a commission to an agent.   This money does not get passed on to you. It stays in their pockets or gets paid out to their stockholders.

Your health insurance costs will not be any higher if you choose to work with an agent or if you choose to work directly with the insurance company.  But it may cost you more in the long run if you choose not to talk with an agent.  By going direct you might not learn about the plan that has a lower cost prescription copayment for an expensive brand name drug you take or the one that offers to pay for your vitamins or other health and wellness products.

There are many benefits to working with an agent. 

In my opinion the most valuable benefit to working with an agent is your relationship with your agent. When you have a question or need to help making a change you have someone to call who is knowledgeable and has experience to offer you solid advice.  Someone who cares about maintaining a relationship with you and wants to help you.

Additionally, Independent Agents like myself are trained and tested annually on ALL the health insurance plans we represent.  We know what these plans cover and how they cover it.  Agents also have first hand knowledge of customer experiences with each plan.   Agents talk to their clients on a regular basis and know when their clients are unhappy with a plan and what shortcoming the plans have. The insurance company’s representative is not going to tell you about a bad customer experience but your agent will share their clients experiences with you both good and bad so you get a clear understanding of how the plan operates.

What about shopping online?

Some websites now offer a “comparison” so that you can see clearly how the different plans look “side-by-side.”  These comparisons only show you the basic costs.  They do not show you additional benefits offered such as dental, vision and hearing.   Each plan is unique and has its strengths and weaknesses.   Agents familiar with these plans know what those are and can assist you in making a better decision.

A typical meeting with an agent starts out with a conversation about your needs.   I will ask basic questions to determine what your needs are and when we are through I will show you which plans cover your specific needs.  Then you review these plans with your agent and you ask questions YOU will learn more about the plans so YOU can make the decision as to which plan is right for you.  A good agent is a resource.  Someone who has the knowledge and experience to help guide you in making a good decision and is there by your side every step of the way through the enrollment process and still available afterwards to answer any questions that come up.   

Would you like my help?

If you would like help finding the right dental plan or ask a few questions, you can call me directly at 207-370-0143 or use my simple form on the CONTACT page of this site to send an email message.  The best part about working with me is that it will not cost you anything to talk with me to discuss your options and review the plans that are available.  I am paid by the insurance companies in the form of a commission when you enroll in a plan.  You will not pay anything to meet with me and you will pay the same price for your insurance that everyone pays whether they had my help or not.

“My goal is to help people and I have found great joy in being able to offer my services to people who need my help.”

Book an appointment with Maine Medicare Options using SetMore

Are you turning 65 and still working?  Read this.

 

2023 Medicare Handbook

Updated 2023 Medicare & You Handbook

Available online at: https://www.medicare.gov/index.php/medicare-and-you

Summary:  The Medicare & You 2023 handbook is available free of charge. It’s published by the Centers for Medicare & Medicaid Services (CMS). This is the official government guide explaining the Medicare program in detail. You can get Medicare & You in a variety of formats.  You can get the handbook in an electronic, PDF form or paper form and in English, Spanish, large print, Braille, or audio.

Medicare & You 2023 Handbook

Medicare & You 2023 is an official government publication. Millions of people receive the Medicare & You handbook at their homes by mail each year. CMS usually mails the Medicare & You handbook in the fall of each year. This is to help prepare people for the Annual Election Period, which occurs October 15th to December 7th each year. During this time, Medicare beneficiaries can review their Medicare coverage and make changes, if they want.

Frequently Asked Questions (FAQ)

I’ve had Medicare for a number of years. Why is the Medicare & You 2023 Handbook important to me?

Each year, the Centers for Medicare & Medicaid Services (CMS) publishes a revised Medicare & You Handbook. The purpose of the Medicare & You Handbook is to provide Medicare beneficiaries with up-to-date information about the Medicare program. If you’ve been enrolled in Medicare for a few years, you may want to use the Medicare & You 2023 as a reference guide to the current features of the Medicare program and your rights as a Medicare beneficiary.

What topics are included in the Medicare & You 2023 Handbook?  

The Medicare & You Handbook contains information on

  • Medicare Part A (hospital insurance)
  • Medicare Part B (outpatient/medical insurance)
  • Medicare Supplement (Medigap) insurance
  • Medicare Advantage plans
  • Medicare Part D prescription drug coverage and the “donut hole”

Medicare & You 2021 lists many Medicare-covered services. Also, the Medicare & You 2021 handbook has a chart comparing key features of Medicare Part A and Part B under the federal Medicare program with Medicare Advantage. Inside Medicare & You 2021 you’ll also find information on such topics as getting help with the cost of Part D prescription drug coverage, and much more.

What topics are not included in the Medicare & You 2023 Handbook?

Medicare & You 2023 doesn’t include plan-specific information – for example, when it comes to Medicare Advantage plans or Medicare prescription drug plans. If you have a Medicare Advantage or Medicare prescription drug plan, you’ll find plan-specific information in your plan’s 2022 Evidence of Coverage and Summary of Benefits. The Annual Notice of Change (ANOC) explains changes in the 2022 plan and benefits.

What if I didn’t get a Medicare & You 2023 handbook in the mail?

You can call Medicare at 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week. TTY/TTD users can call 1-877-486-2048. A Medicare representative can check your address on file and get a Medicare & You 2023 handbook mailed to your home.

Can I get the Medicare & You 2023 Handbook in other formats?

Yes. You can get an electronic version of Medicare & You 2021 from the Medicare website. In fact, if you want to “go green” as the kids say these days and inform Medicare you wish to receive communications electronically rather than by postal mail. You can download a PDF to your computer. Keep in mind Medicare & You is about 130 pages long. If you choose to keep it in an electronic format, you can find topics using key word searches and hyperlinks from the table of contents. You can get the Medicare & You 2021 handbook in English or Spanish. You can also download a copy of Medicare & You in large print or Braille. You can listen to audio podcasts of Medicare & You 2021 chapters. Finally, you can order paper or CD versions of Medicare & You by calling Medicare at 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week. TTY/TTD users can call 1-877-486-2048. You get Medicare & You free of charge.

Would you like to learn more about your Medicare coverage options? 

I can help. Give me a call at 207-370-0143 or email by clicking here.

Speak with a licensed sales agent

Call (207) 370-0143 or schedule a meeting.

6 Things to Know When Comparing Medicare Plans

There are many things to consider when it’s time to choose a Medicare Plan. 

For example:

  1. How much are your premiums, deductibles, and other out-of-pocket costs? 
  2. How much do you pay for services like hospital stays or doctor visits? 
  3. Is there a yearly limit on what you could pay out-of-pocket for medical services? 
  4. Which doctors and hospitals do you need access to?  
  5. What prescriptions must be covered?  
  6. Can you qualify for extra help?  

By working with a local Medicare Advisor you get unbiased access to all your available options. We also make sure you understand each of the options, and keep you informed of new plans or changes to existing plans occurring each year.

Here the important points we will review with you in order to help you find the Medicare plan best suited for you.  

Medicare Costs 💸

With Original Medicare there’s no limit on out-of-pocket cost per year, unless you have supplemental coverage or a Medicare Advantage Plan (Part C).

When comparing out-of-pocket costs, remember to also include what you pay each month for your plan’s premium.

This is often overlooked and can cost you thousands more if you’re not careful. Your agent can easily help you compare costs of each option, so you can feel confident the plan you choose fits your budget and risk tolerance. 

Since so many details surrounding your costs & benefits are not covered beyond the benefit summary we help you with a deeper look at the plan in order to gain a complete understanding of the costs associated with each benefit and to make sure you understand all your benefits and how to access them.

Medical Coverage ⚕️

Medicare Supplements and Medicare Advantage Plans all offer coverage beyond that of Original Medicare.

Medicare Supplements work in combination with Original Medicare (Parts A & B) by filling in the gaps of Original Medicare.

These plans do not have networks and offer flexibility to see any doctor or use any hospital in the country as long as the provider accepts Medicare payments. But these plans do not offer additional benefits, such as dental, vision or hearing aids.

Medicare Advantage Plans offer the actuarial equivalent of all the services Original Medicare covers. Most do far better than this minimum requirement.

Some plans offer extra benefits that Original Medicare doesn’t cover – like vision, hearing, or dental.

By helping you understand the pros and cons of each option, you’ll be confident in the selection you make each year.  

Prescription Drugs 💊

Prescription drug coverage is a vital component to your plan choice, not only for the coverage it provides, but in order to avoid penalties and fees according to the Medicare regulations.

Whether you take prescription medicines or not, Medicare requires you to have minimum drug coverage. This can be obtained by enrolling in a Part D stand alone plan, Medicare Advantage Plan that includes drug coverage, or what Medicare deems “creditable coverage” like larger employer group plans, retiree plans, or veteran coverage. 

When you meet with your Plan Advisor, we will run a calculation with the Medicare.gov Rx Tool, taking your specific medications into account, ensuring they are covered under the desired plan and with an affordable copay

We will also help you apply for extra help or other available subsidies to cover the costs of medicines, as there are several resources and programs we can apply for.

For prescriptions alone, it pays to schedule a consultation. 

Doctor and Hospital Choice 😷

We will always start with helping you find a plan that your desired Doctors and Hospitals accept and we will confirm that your primary care physician is able to refer to the specialists when necessary. 

Many plans offer some out-of-network coverage. For out-of-network physicians we will help confirm that those doctors will accept your chosen plan as an out of network benefit. This is yet another important feature that our local agent will provide for you.

Quality of Care

The quality of care and services offered by plans and other health care providers can vary. 

Medicare Advantage plans are now graded on certain quality scores by Medicare, known as Star Ratings. A Star Rating is like the reviews you may read about with a local business or vendor.

It is important for you to know the star ratings as they also impact the funding of your selected plan, which may impact plan stability and costs.

Customer service is an important part of using your insurance. This is why having an agent is so important. If you cannot get the answers you need from your insurance company you can always rely on your agent to help.

With over 10 years of experience helping people with these Medicare plans in Maine I have gained a vast knowledge of how these plans work and help my clients resolve issues quickly and easily when the customer service rep on the phone cannot.

Travel Coverage ✈️

Original Medicare does not cover care outside the US so if coverage during travel is important to you, be sure to share this with your agent during our meeting.

Certain Medicare supplements do have travel features. Most Medicare Advantage plans cover emergencies or urgently needed care services outside the US as well.

Whatever your needs, we will review the plans and find one that travels with you.

Would you like my help? (it’s free!)

If you would like help understanding your costs or need help finding a plan or if just want to ask a few questions, you can  207-370-0143 or use my simple form on the CONTACT page of this site to send an email message.  

The best part about working with me is that it will not cost you anything to talk with me to discuss your options and review the plans that are available.  I am an independent insurance agent and I am paid by the insurance companies (not you) in the form of a commission when you enroll in a plan.  

You will not pay anything to meet with me and you will pay the same price for your insurance that everyone pays whether they had my help or not.

“My goal is to help people and I have found great joy in being able to offer my services to people who need my help.”

Understanding Deductibles & Penalties

Like all insurance plans, Original Medicare has deductibles for both Parts A and B. In addition, Medicare Part D plans usually have an annual deductible. And Medicare Part C plans, better known as Medicare Advantage plans, may also have yearly deductibles but some do not.

What Does Medicare Cost?

The Medicare program employs a cost-sharing model that includes monthly premiums, deductibles, and coinsurance or copayments. The Centers for Medicare and Medicaid Services (CMS) sets the rates, working within the budget they’re allotted by the White House each year.

Medicare premiums and deductibles vary for each “part” of Medicare.

Original Medicare includes two parts: A and B.

Medicare Part A is commonly referred to as hospital insurance, because it covers inpatient services received in a hospital or skilled nursing facility.

Medicare Part B is commonly referred to as medical insurance. Part B covers outpatient services, including doctor visits, mental health care, lab work, and durable medical equipment.

Medicare Advantage plans (Part C) are sold by private insurance companies. Every Advantage plan must provide the same benefits you get with Original Medicare, but most Part C plans also provide additional coverage, such as prescription drugs, routine vision and dental care, and hearing aids.

Medicare Part D provides prescription drug benefits. These plans are also sold by private insurance companies also. You may join either a standalone Part D prescription drug plan (PDP) or a Medicare Advantage Prescription Drug plan (MA-PD).

Speak with a licensed sales agent

Call (207) 370-0143 or schedule a meeting.

Todd Reagin Maine Medicare Insurance Agent Local Agent help with costs Medicare Advantage Medicare supplement costs compare prices in Maine

The Medicare Part A Deductible

Unlike most types of insurance plans, the Medicare Part A deductible is figured by benefit period, not annually. A benefit period begins the day you are admitted to the hospital as an inpatient and ends once you go 60 consecutive days without receiving inpatient care.

The Medicare Part A deductible is $1,484 per benefit period in 2021. You pay $0 copays for the first 60 days you receive inpatient hospital care. After that, your Part A copays are:

$371 per day for days 61 through 90
$742 per day for days 91 through your 60 lifetime reserve days
NOTE: If you have a Medicare Advantage plan or Medicare Supplement Insurance (more commonly known as Medigap), your plan may pay some or all of these costs.

Before Medicare Part A will pay for care received in a skilled nursing facility, you must first spend at least 3 consecutive days as a hospital inpatient. In addition, the Skilled Nursing Facility care must be related to your hospital stay and happen within the 60-day benefit period.

Part A coinsurance for skilled nursing facility care is $0 for the first 20 days and $185.50 per day through day 100. You are responsible for all costs from day 101 and beyond.

Time you spend in the hospital under observation status is not included as part of the benefit period. Until you are admitted to the hospital, Medicare Part B applies. Do not assume you are an inpatient – even if you’ve been given a room and stayed overnight. Always ask a member of the hospital staff whether you have been admitted as an inpatient.

Additional Medicare Part A Costs

Although around 99 percent of Medicare beneficiaries qualify for premium-free Part A, that remaining 1 percent accounts for hundreds of thousands of people. If you or your spouse did not work and pay the Medicare payroll tax for 40 quarters (10 years), the standard Medicare Part A premium is $471 in 2021. If you paid Medicare taxes for at least 30 quarters but less than 40, the standard premium is $259 per month.

The Medicare Part A Late Enrollment Penalty

People who delayed Part A enrollment for a full 12 months and who do not qualify for a Special Enrollment Period (SEP) may also owe a late penalty. The Part A late enrollment penalty is 10 percent for twice the number of years you could have had Part A but did not.

1 year = 2 years paying the penalty
2 years = 4 years paying the penalty
And so on.

Please note that, when it comes to calculating Medicare late enrollment penalties, Medicare does not looks at calendar years but 12-month periods starting from when you could have enrolled but did not.

The Medicare Part B Deductible

The 2020 Medicare Part B deductible is $203. This is an annual amount that you must spend out-of-pocket before your Part B benefits kick in.

Additional Part B costs include:

Standard Part B premium is $148.50 per month in 2021. Most people pay the standard premium. However, if your yearly, modified adjusted gross income exceeds $87,000 (filing singly) or $174,000 (married filing jointly) you will also have to pay an additional Income Related Monthly Adjustment Amount known as IRMAA.

The Medicare Part B Late Enrollment Penalty

If you do not sign up for Medicare Part B during your Initial Enrollment Period (IEP) and do not qualify for a Special Enrollment Period, you may owe a late enrollment penalty.

The late penalty is 10 percent of your premium for every 12-month period in which you could have signed up but did not. So, one full year is 10 percent, two full years is 20 percent, and so on. However, unlike Part A, you will pay the late enrollment penalty for the entire time you have Medicare Part B.

This is why we strongly encourage people to talk to an agent or broker who knows the rules and can explain when you need to enroll in Part B. Delaying could cost you thousands of dollars over your lifetime.

The Medicare Advantage (Part C) Deductible

All of your Part C costs vary according to your Medicare plan. This includes the deductible, copays, premium, and coinsurance (if applicable).

The Medicare Part D Deductible

The standard Medicare Part D deductible is $445 in 2021. However, some prescription drug plans set a lower yearly deductible. In addition to the deductible, most Part D plans have monthly premiums and copays or coinsurance payable at the time of purchase. Please check with your plan to verify out-of-pocket costs for Part D.

As with Medicare Part B, high earners enrolled in Part D may owe the IRMAA surcharge.

If you have a Medicare Advantage Prescription Drug plan, you may have a separate deductible for your prescription drug coverage.

The Part D Late Enrollment Penalty

As with Parts A and B, there is a late enrollment penalty for Part D. Like Part B, you pay this penalty for the entire time you have Medicare prescription drug coverage.

Unlike Parts A and B, you begin accruing this late fee once you go 63 consecutive days without creditable prescription drug coverage. In this case, “creditable” means a prescription drug plan that provides comparable benefits to Part D at a similar price. (In other words, a prescription discount card is not the same thing as a prescription drug plan.)

The Part D late enrollment penalty calculation is based on a percentage of the national base beneficiary premium, which changes every year. In 2021, the base beneficiary premium is $33.06.

You pay 1 percent of this “base” premium for every month you go without creditable prescription drug coverage, then round that number to the nearest dime. If you go 6 months without coverage, the calculation looks like this:

$33.06 X 1% X 6 = $1.9833

Rounded to the nearest dime, your late penalty would be $2. This is then added to your monthly premium every month for the entire time you have Medicare prescription drug coverage.

Compare Your Medicare Plan Options

When comparing your Medicare plan options, look carefully at both benefits and the total out-of-pocket costs. I can help you compare Medigap, Part D, and Medicare Advantage plans in your area and explain the subtle differences between the plans and help you choose a plan that covers all your doctors and prescriptions at the lowest cost to you.

Would you like my help?

Call 207-370-0143 or schedule a meeting.

Todd Reagin Maine Medicare Insurance Agent Local Agent help with costs Medicare Advantage Medicare supplement costs compare prices in Maine

Lower Insulin Costs in 2021

Maine medicare part d insulin drug costs 35 dollars novalin novalog humalin humalog n r vial insulin pens cost 35 in maine for 2021 relion walmart

Good news! Some Medicare Advantage and Part D plans in 2021 will provide supplemental benefits for insulin, including during the coverage gap (or Donut hole) phase.

A new program in 2021 called, the Part D Senior Savings Model will weigh the effects of offering people who are enrolled in Medicare more choices of insurance plans that would lower your out-of-pocket costs of insulin to $35 for a one-month supply – and these costs will stay at $35, even when you hit the Donut hole!

High insulin costs, in the past, have been a huge burden on many of my clients, being detrimental to their health and their finances.

During Medicare’s Open Enrollment this year, if you are a diabetic, you should review which plans in Maine will participate in this new program and what that may mean to the cost of your insulin and other medications.

Who is Participating?

In 2021, there will be 1,635 prescription drug plans participating in the Part D Senior Savings Model, including both Medicare Advantage Plans and stand-alone Part D Prescription Drug Plans.

  • For a full list of the drugs effected, click here.
  • To see all the plans that are participating, click here.
  • To talk to a local expert about this program, click here.

Why the New Model?

The new Part D Senior Savings Model was created in response to President Trump’s plan to lower the cost of insulin. For carriers with products participating in this model, a one-month supply of insulin would not cost any more than $35.

The model also intends to decrease Medicare expenses by offering a variety of supplemental benefits to cover costs such as copays and initial coverage.

The Part D Senior Savings Model’s goal is to provide beneficiaries with higher quality care and will benefit those who have either a Part D Prescription Drug plan or a Medicare Advantage Plan.

When Will These Changes Take Place?

Beginning with the Annual Enrollment Period for the 2021 plan year, which runs from October 15th to December 7th, participating insurance companies will offer Mainers on Medicare beneficiaries these supplemental benefits for insulin. The drug companies will pay the 70 percent discount for your insulin, if it is included in the program.

Under the new program, Medicare plans in Maine will offer Mainers more choices that will allow them access to more types of insulin. With the maximum copay being $35, the model projects members saving an average of over 66 percent in annual out-of-pocket costs on insulin.

Additional information on the 2021 Part D Senior Saving Model, including fact sheets and press releases, can be found linked at the bottom of the CMS report.

Would you like my help?

If you would like to talk about this program or schedule a meeting, you can reach me at 207-370-0143 or use my simple form on the CONTACT ME page of this site to send an email message.

The best part about working with me is that it w not cost you anything to discuss your options or to review the plans that are available.  I am paid by the insurance companies in the form of a commission if you enroll in a plan, just like your car insurance agent.

You will not pay any more than anyone else and you are under no obligation whatsoever to enroll in any plans if you meet with me.  My goal is to help you and I have found great joy in being able to offer my services to people who need my help.

If you are diabetic and using insulin,
you may be able to save a lot of money.

Call me today and I will be happy to explain all your options and help you compare plans so you can choose the coverage you need for a price you can afford.

Schedule a phone call or meeting today.

I can answer all your questions over the phone or we can talk face-to-face and I can help you with everything you need to know. I have all the forms and applications you need and I can also help you complete them.

Read more…

It’s Open Enrollment!

Not happy with your current Medicare Insurance Plan? Or just curious if there is a better plan?

Like the song says… “You better shop around!”

This is very good advice!

Whether it is groceries, heating oil, or anything else, everybody wants to get the best value for their money. And today’s options for health insurance can be pretty darn costly. That’s why it’s a good idea to shop around for the right Medicare Advantage or Prescription Drug Plan.

Cost is not the only thing to consider when comparing plans.

There are dozens of Medicare Supplemental plans available in Maine this year, all with different costs. 

Keep the following things in mind when you compare plans to make sure you get the best plan!

  • What are the monthly premiums and deductible costs?
  • What will you pay for the benefits and services you’re likely to use?
  • Is there a limit on what you will have to pay out-of-pocket for the year? 
  • Will you have to change pharmacies if you change plans?
  • What benefits are most important to you? Such as Dental, Vision, Chiropractic

Comparing costs of prescription drug coverage is another part of the cost puzzle. 

  • Do you know how much your prescriptions will cost?
  • Does the plan cover the drugs you take? 
  • What pharmacies will give you the best price?
  • Will the Part D coverage gap (“donut hole”) effect you? If so, when?

Only you can determine what mix of benefits and costs will work best with your needs and budget, but I can help. 

I can help make it easy to compare plans so you can pick one that best meets your needs. 

I can explain everything you need to know and after you’ve narrowed your choices to a few really good plans, together we will review those plans to get more details about their benefits and services. 

I work with all the insurance companies and plans available and I have helped hundreds of people with this decision. I understand these plans and how they work and I can help you understand them too.

And the best part is – you pay nothing for my help!

That’s right. I help you review your plan options and answer all your questions and it won’t cost you a cent!

Why?

This is what agents do. Just like with your car insurance or home owners insurance, as your agent I work for you and I get paid by the insurance companies to help you. And not just now but throughout the year.

I am trained by each insurance company on how their plans work and what they offer plus I have clients who use these plans which gives me real experience helping them year after year.  So, I know which plans are the most popular and why.

Another great thing about having someone on your side is that I am available throughout the year if you have any questions or need help!  So, if you have a problem with the insurance company or if you don’t understand something you get in the mail, I will be here to help with that too!

No one plan is perfect for everyone.  Each plan is different, just like each person is different.  I will help you understand the differences so you can the right choice with confidence!

Would you like my help?

If you would like to talk to me or schedule a meeting at your home or a nearby meeting place, you can reach me by calling 207-370-0143 or use my simple form on the CONTACT ME page of this site to send an email message. 

Again, the best part about working with me is that it will not cost you anything to meet with me to discuss your options or to review the plans that are available.  I am paid by the insurance companies in the form of a commission if you enroll in a plan.  You will not pay any more than anyone else and you are under no obligation whatsoever to enroll in any plans if you meet with me.

“My goal is to help you and I have found great joy in being able to offer my services to people who need my help.”

Book an appointment with Maine Medicare Options using SetMore

VA Benefits and Medicare

Learn how your VA Benefits and Original Medicare work

VA Benefits and Medicare: What You Need to Know

As a Medicare-eligible Veteran, you have more options when it comes to healthcare. The transition to Medicare can be confusing, so this article will list a few points that all vets should know when they become Medicare eligible.  To confirm your options call the Veterans Administration directly at 1-877-222-VETS (8387).

VA Benefits and Medicare

It is important to know that Veteran’s (VA) plans and Medicare do not supplement each other. In other words: VA plans only cover care at VA facilities, and Medicare only covers care at Medicare assigned doctors and hospitals.

Should You Enroll in Medicare Part A If You Have VA Benefits?

Yes. You can have both Medicare and Veterans (VA) benefits at the same time.  It is strongly recommended that all veterans enroll in Medicare Part A (Hospital Coverage) when they turn 65 and generally there is no additional cost for Part A. This will allow you receive hospital coverage should you go to a non-VA facility.  According to the VA’s website “All Veterans are encourage you to enroll in Medicare health insurance.Source: VA.gov

Should You Get Medicare Part B If You Have VA Benefits?

Yes, It is strongly recommended that all veterans enroll in Medicare Part B (Medical Coverage) as well as part A when they are eligible. (Click here to learn more about when to enroll.)

There is a monthly fee for Part B but it is worth it. If your VA Benefits are dropped at some point OR, and this is important, if your local VA facility does not cover all health services, you could pay 100% out of pocket for a serious illness.

The VA highly recommends that you enroll in Part B as well. Please contact Veterans Affairs directly (1-877-222-VETS (8387)) with questions about specific care at Togus or another local facility.

Should You Get a Medigap or Medicare Advantage If You Have VA Benefits?

If you would prefer to see a local doctor or go to a local hospital or healthcare facility for your care then you should consider a Medicare Advantage or Medigap plan to supplement your Medicare coverage. Read more about these types of plans here.

Most people agree that veterans do not need a Medigap plan if they qualify for ChampVA. However, if you aren’t enrolled in ChampVA, a Medigap plan will fill in the gaps such as deductibles, copays, and coinsurance, as well as other benefits when seeking care outside of the VA, or outside of the U.S. and its territories.

Make sure to speak with one of our agents before enrolling in any supplemental plan to ensure that it is actually beneficial for you.

Here are two reasons why you may want to enroll in a private Medicare Supplement plan:

  1. You do not live near a VA facility

  2. You are enrolled in one of the VA lower priority groups, and could potentially lose your benefits

“There is no guarantee that in subsequent years Congress will appropriate sufficient funds for VA to provide care for all enrollment Priority Groups. This could happen if you are enrolled in one of the lower Priority Groups. This would leave you with no health care coverage.” Source: VA.gov

READ MORE ABOUT HOW VETS ARE WINNING WITH MEDICARE ADVANTAGE

VA Benefits and Medicare Part D

The choice of whether to enroll in Part D is up to you. In most cases, you don’t need a Medicare Prescription Drug Plan, aka Medicare Part D, as VA plans may offer more coverage than Medicare’s Rx coverage.

Remember that any prescription prescribed by a non-VA doctor needs to be approved by your VA doctor for the VA to cover it.  This may take extra time and your VA doctor can say that prescription is unnecessary.  Many veterans use a Medicare Advantage plan as a back up because they don’t cost you any extra. [READ MORE]

What about the Part D Penalty?

Good news! Your VA drug coverage is considered creditable coverage so the Part D late enrollment penalty does not apply to you. If you choose not to enroll in Part D when you are first eligible you can still enroll later on in Part D without paying a penalty.

For further questions about Medigap, Medicare Advantage or Medicare Part D, please call (207) 370-0143 or schedule a phone call to discuss your options.

CLICK HERE TO SCHEDULE A PHONE CALL

Switching To Medigap

How to switch to a Medigap plan if you have Medicare Advantage.

Switching to Medigap (Plan G) from Medicare Advantage requires some planning. There are several important things you should know.

Even if you haven’t thought about changing plans before now, understanding your rights and your options is important. Here I’ll discuss when, how and why to consider changing plans.

When can you dis-enroll from a medicare advantage plan?

There are two times each year you are allowed to disenroll from your Medicare Advantage plan.

  • The Annual Open Enrollment Period (AEP)
  • The Medicare Advantage Open Enrollment Period (MA-OEP)

The Annual Open Enrollment Period (AEP) takes place each year in the fall from October 15 through December 7.

The Medicare Advantage Open Enrollment Period (MA-OEP) is something new that was created when Congress passed the Bipartisan Balanced Budget Act in 2018. It is one last chance to change your policy for the year if you missed the Annual Open Enrollment or made a mistake during Open Enrollment. It takes place from January 1 through March 31 each year.

There are also other enrollment periods available, such as your Initial Enrollment Period (IEP) when you turn 65 and Special Enrollment Periods (SEP) that you may qualify for when you move outside the plans service area or when you retire and lose your employer group health insurance plan or qualify for another reason. [READ MORE ABOUT ENROLLMENT PERIODS]

If your goal is changing from a Advantage plan to Medigap, you need to apply as early as possible during your enrollment period. You want to be sure the Medigap plan accepts your application before you cancel your Advantage plan.

“The most important thing I tell all my clients is to never cancel a policy before they have confirmation from the new plan. It’s best to wait until you have a confirmation letter or insurance card from the new company in your hands before cancelling your old plan.”

Todd Reagin, Local Agent in Maine

Some Medigap Plans can deny you if you have a pre-existing medial conditions.

If you miss the Medigap open enrollment period, some companies can deny you coverage or charge more because of preexisting conditions. But, sometimes, you qualify for a special enrollment period that grants guaranteed issue rights.

These rights vary from state to state. To learn about what rights you have, you should talk to a licensed insurance agent who specializes in Medicare plans and is certified to help people understand all the rules and regulations of Medicare.

Would you like my help?

I am licensed by the state so I know what consumer protection laws exist to protect my clients. I am also certified to help people with Medicare Part C and D plans each year which guarantees my knowledge of Medicare regulations is current.

The best part about working with me is that it will not cost you anything to talk with me to discuss your options and review the plans that are available.  

I am paid by the insurance companies in the form of a commission when you enroll in a plan.  You will not pay anything to meet with me and you will pay the same price for your insurance that everyone pays whether they had my help or not.

“My goal is to help people and I have found great joy in being able to offer my services to people who need my help.”

Vets win BIG in 2020!!

The big news this year is the introduction of PREMIUM GIVE BACK plans (also known as Part B Premium Reduction plans)

What is a Premium Give Back Plan?

Every person on Medicare is required to pay for Medicare Part B. This is automatically taken from your monthly Social Security check or you pay it quarterly. Medicare Advantage (Part C) plans may choose to offer to reduce its members Medicare Part B premium by giving back a portion of that monthly premium.

There are plans available this year that pay back up to $55 per month! Lowering your Part B Premium to $89.60!

You get Over-the-Counter items and Dental Coverage too!

In addition to this Part B reduction many of the plans available this year also offer coverage for over-the-counter (OTC) items such as aspirin, cough syrup, allergy medicines like Flonase and more.  These OTC programs also provide things like knee braces and supports, rubbing alcohol, thermometers, blood pressure cuffs, and even toothpaste and toothbrushes!

Some plans offer $1,000 to $2,000 in dental coverage this year and these are all available for a $0 cost monthly premium plus the give back on your Part B premium.

So, why are these plans ideal for veterans and not for everybody?

If you’re a veteran then you are able to get your prescription drug coverage through the VA system. Many of the plans that offer the Part B Reduction do so by not covering your prescription drugs.

So, if you need prescription drug coverage, these plans would not be the best choice for you. There are many other plans that offer these same benefits and include prescription drug coverage so shop around. You might find a much better plan this year!

If you are a veteran or know a veteran who also has Medicare it would be wise to look at these plans to see if it would be a good fit. You could be missing out on some great benefits!

Want to know more?

If you would like to talk to me or schedule a meeting, you can reach me at 207-370-0143 or use the simple form below to send an email message.

The best part about working with me is that it will not cost you anything to discuss your options or to review the plans that are available.  I am paid by the insurance companies in the form of a commission if you enroll in a plan. Just like your car insurance agent!

I will help you shop around to find the plan with the best price and the most benefits. My goal is to help you and I have found great joy in being able to offer my services to people who need my help.


If you are turning 65 this year or retiring, you may have questions.

Call me today and I will be happy to explain all your options and help you compare plans so you can choose the coverage you need for a price you can afford.

Schedule a phone call or an in-person meeting.

I can answer all your questions over the phone or we can meet face-to-face and I can help you with everything you need to know. I have all the forms and applications you need and I can also help you complete them.

Open Enrollment Is Here.

While attending a family reunion this summer, a distant cousin told me all about her “horrible” drug coverage. I told her she should review her options every year because there could be a better plan available for her.

Even if you’re happy with your current Medicare Advantage or drug plan, make sure you review your plan changes to avoid costly, unexpected changes that will take effect January 1st.

Why is it so important to pay attention to Open Enrollment?

You may be happy with the plan you have today, but the Part D drug plan or Medicare Advantage plan you have today is NOT the same plan you’ll have in the next calendar year or the year after. And when you chose that plan it may have been the best at the time but since them a new insurance company could have come into your area offering a plan that was not available before or the company you’re with could have a new plan that is less expensive.

This year there are 3 companies in Maine and New Hampshire that have introduced new plans with lower costs. One company has a new plan that is nearly identical to another plan that is $800 per year more expensive!

Each January 1st marks the start of a new plan year.

A new plan year means insurance companies can – and often do – make changes to their plans that can cost you. If you’re not paying attention and simply let your plan renew, these are changes you’ll have to live with for better or worse in the new year.

Here are some important things that insurance companies can change:

For Medicare Part D Prescription Drug Plans:

  • Your monthly premium.
  • Your annual deductible.
  • Your out-of-pocket co-pays.
  • The drug formulary (listing of medications the plan covers). Just one medication leaving your plan’s formulary can cost thousands over the course the year.
  • The network of pharmacies.
  • The pharmacy cost-sharing.
  • Coverage rule for medications (quantity limit, step therapy, prior authorization)
  • Coverage of medications in the Coverage Gap, commonly known as the donut hole.


For Medicare Advantage health plans:

  • Your monthly premium.
  • Your out-of-pocket co-pays and coinsurances.
  • The annual out-of-pocket spending limit. Each year these limits continue to creep up. Is your plan’s limit going up this year?
  • The network of providers.

Each year, prior to the Open Enrollment Period, your Medicare Advantage or drug plan must send information about changes in benefits and costs for the upcoming calendar year. Take time to study that information.

You can make changes anytime between October 15 and December 7.

If you have concerns about your coverage, you can use the Medicare Plan Finder to compare plans located at www.medicare.gov

Or, if you prefer to have an unbiased review your coverage by someone who has the knowledge and experience to help you choose the right plan and explain all your options just give me a call and I’ll be happy to help you.

Would you like my help?

If you would like to talk to me or schedule a meeting at your home or a nearby meeting place, you can reach me at 207-370-0143 or use my simple form on the CONTACT ME page of this site to send an email message.

The best part about working with me is that it will not cost you anything to meet with me to discuss your options or to review the plans that are available.  I am paid by the insurance companies in the form of a commission if you enroll in a plan.

You will not pay any more than anyone else and you are under no obligation whatsoever to enroll in any plans if you meet with me.  My goal is to help you and I have found great joy in being able to offer my services to people who need my help.

If you are turning 65 this year or retiring, you may have questions.

Call me today and I will be happy to explain all your options and help you compare plans so you can choose the coverage you need for a price you can afford.

Schedule a phone call or an in-person meeting.

I can answer all your questions over the phone or we can meet face-to-face and I can help you with everything you need to know. I have all the forms and applications you need and I can also help you complete them.

1 2 3