2018 Part D Changes

These are some of the changes that you will see for Medicare Part D in 2018.

The standard Deductible will increase by $5.00. The standard Part D Deductible will be $405 for 2018.

What does this mean to you?

If your Medicare Part D Rx drug plan has a deductible, you may pay $5 more out-of-pocket in 2018 before you did in 2017. Most Part D plans exclude lower-cost Tier 1 and Tier 2 prescriptions from the deductible, giving you coverage for lower cost generic medications before you need to meet your deductible.

Beginning January 1, 2018 your Initial Coverage Limit (ICL) will increase $50 to $3,750.

This means that you will be able to buy slightly more medications before reaching the 2018 Donut Hole or Coverage Gap.  A good rule of thumb is that if the full retail cost of your medications is less than $312 per month, you will not enter the Donut Hole.

The Donut Hole discount will increase for both brand-name and generic drugs.

The generic drug discount you get while in the Donut Hole will increase from 49% to 56% and the discount for brand-name drugs will increase from 60% to 65%. So, if your brand-name medication has a retail cost of $400, you will pay $140 for your medication while in the Donut Hole.

Total Out-of-Pocket Costs will increase by $50.

The TrOOP or your total out-of-pocket cost is the dollar figure you must spend to get out of the Donut Hole or Coverage Gap, not including your monthly premium. The 2018 TrOOP will now be $5,000 in 2018.

What is the end result?

In 2018, you will have to spend only a little bit more to get out of the Donut Hole than you did in 2017.  So, to get out of the Donut Hole your total retail medication need to be over $702 per month. In which case you will enter the Catastrophic Coverage phase where you will remain for the rest of the year.

Once you enter the Catastrophic Coverage phase you will pay either 5% of the total retail cost of the drug OR $8.35 for brand-names and $3.35 for generics, whichever is higher.

If you need a more in-depth explanation of how Part D works or want to review what plans will help you avoid the Donut Hole, give me a call. My number is 207-370-0143. I will be happy to help you.

Be sure to read your Annual Notice of Change Letter (ANOC) that should arrive in the mail each year at the beginning of October to see how your plan is increasing – this may help you determine how much you need to budget in 2018 to cover the costs of coverage. [READ MORE …]

If you would like to talk to me, ask a question or schedule a meeting at your home or a nearby meeting place, 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 does 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 pay nothing.

And you will not pay any more than anyone else and you are under no obligation whatsoever to change your plan if you talk with me.

“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

Does the early bird get the worm?

You’ve probably heard the old saying “The Early Bird Gets the Worm.”

Well, as it turns out that expression is completely wrong, both literally and figuratively.

Last week, I was parked in a parking lot, returning phone calls in between appointments and saw these seagulls flying around foraging for food.

If you live in Maine or New Hampshire then you’ve seen seagulls up close and personal, their lives are pretty simple; they basically just wander around all day scouting for some food to eat. (left over lobster roll bun, french fries, etc…)

Every time one of them would find something that may or may not have been edible on the ground, the nearby gulls would immediately dash over and start tugging at the food.

One would steal the scrap from the other and run off with it in its beak, upon which the other gulls would pounce and steal the food again.

It was hilarious to watch, all that was missing was the theme song from The Benny Hill Show!

But there was one seagull who had it in her instinct to separate from the group.

She didn’t have to go far – just far enough to be uninteresting to the rest of the gulls who couldn’t see past their own beaks.

Sure enough, after a while the solo gull discovered a treasure trove of something tasty nearby a dumpster.

While the other gulls were fighting over scraps, this one had a whole half-eaten hamburger or something to herself.

That’s why the saying isn’t true. It’s not the early bird who gets the worm.

It’s the one who has the courage and independence of mind to avoid the crowd and go where everyone else isn’t.

Life, business, and retirement planning aren’t so different than nature: we humans seldom succeed and prosper by following the crowd and doing what’s popular.

so… how does this relate to health insurance??

Keep an open mind!

Don’t pick your insurance plan because “everyone says it’s the best.” Do your own research or enlist the help from a professional like myself and compare rates and costs.

Just because your friend or neighbor said the plan they have is the best, does not mean it’s the best for you.

Likewise, just because Medicare rates one plan higher than another, that ALSO does not mean it’s the best one for you.

You are unique.

Your needs are unique. The only way to be sure you have the best health insurance plan is to shop around.

Plans have different costs and different rates and they each work with different doctors and hospitals.

So it makes more sense to find a plan that will let you go to the doctors and hospitals you choose, rather than the one your friends or relatives choose.

Feeling overwhelmed with all your choices?

I will help you compare Medicare supplement rates and costs so you can choose the best plan!

And it won’t cost you anything!

I do not charge anyone for my help, whether you enroll with me or not.  I get paid by the insurance company when I deliver your application so once we pick the right plan I will help you fill out the application and I will turn it into the insurance company for you. It doesn’t get any easier than that!

You can use the BOOK APPOINTMENT(link is external) button below to set up a time to speak with me on the phone or in person. I can also send you information ahead of time to get you started. 
Book an appointment with Maine Medicare Options using SetMore
Have a question that needs to be answered right away?
Just give me a call at your convenience.  
You can talk to me at (207) 370-0143
or call toll free 866-976-9038. 
Or send me an email using this form –> https://www.mainemedicareoptions.com/contact

Are you turning 65 and still working?  Read this.

Annual Notice of Changes (2018)

3 things to know about the Annual Notice of Change (ANOC)

 

Avoid surprises – Review your Annual Notice of Change each fall!

If you have a Medicare Advantage plan (Part C) you will receive an Annual Notice of Change (ANOC) from your health insurance company at the end of September. If you are new to Medicare, then you may not know what this is.

Who gets one and what should you do with it?

The ANOC is an important notice sent each year to people who have a Medicare Advantage (MA) Plan or a Medicare Part D Prescription Drug Plan.

The health insurance companies that administer these plans are required to send notices to you each year to notify you of cost and/or benefit changes that will take effect starting January 1, 2018.

When should you expect it?

You should receive this notice by September 30th of this year. If you haven’t received it by then, you should contact your plan to ask for it or call your agent to learn about what is changing. Your agent will know everything that is changing and can explain how it will effect you.

If there are changes to your costs and benefits that could raise your costs or get in the way of getting the health care you need, you may want to think about making changes to your Medicare coverage during Medicare’s Fall Open Enrollment Period.

When can you make changes?

Fall Open Enrollment runs from October 15 to December 7 every year. If you make changes to your Medicare coverage during Fall Open Enrollment this year, they will go into effect on January 1, 2018.

Even if you review these notices and decide that there won’t be any major changes to your Medicare coverage in 2018, it still might be helpful to look at other Medicare options and compare them to your current plan.

Another plan in your area might offer health and/or drug coverage at a better price than what you currently pay. To learn more about different Medicare coverage options, call 1-800-MEDICARE or use the Plan Finder tool at medicare.gov or click this link.

Still have questions?

If you would like help comparing your needs against the many Medicare plans out there or if you just want to 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

 

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 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 note 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. These plans do not overlap.

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 “[We] encourages you to keep your private [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 your Tricare or CHAMPVA representative 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

Learn More about Medigap Get a Medigap Quote

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 approve it.  This may take extra time and your VA doctor can say that prescription is unnecessary. 

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 the number above or book an appointment to meet and discuss your options. You can use the BOOK APPOINTMENT button below to set up a time to speak with me on the phone or in person. I can also send you information ahead of time to get you started – your choice!

Book an appointment with Maine Medicare Options using SetMore

Please note: We are only able to give general information about Medicare related issues. If you have questions about your VA coverage, please contact Veterans Affairs directly.

Still have questions or want help comparing the different health insurance plans?  I can help you!

Have a question that needs to be answered right away?
Just give me a call at your convenience.  
You can talk to a licensed insurance agent at (207) 370-0143
or call toll free 866-976-9038. Or send me an email using this form –> https://www.mainemedicareoptions.com/contact

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 any more than anyone else and you are under no obligation whatsoever to enroll in any plans if you talk with me.

“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

Top 5 Medicare Myths

Educate yourself on these common Medicare myths — both your health and your wallet will thank you.

Medicare is a great program. I know because I meet with people every day who are turning 65 and entering the Medicare system and looking for help and advice on where to start and what to look for.  Medicare saves you from having to pay enormously high private health-insurance premiums, and it protects you from catastrophic medical expenses. But if you’ve heard one of these common misunderstandings about Medicare, you will be glad you found this website.

1. Medicare enrollment happens automatically at 65

Everyone becomes eligible for Medicare at age 65, but actually enrolling in the program is up to you. The only way you’ll be automatically enrolled in Medicare is if you’re already receiving Social Security benefits when you hit your 65th birthday or if you are collecting Social Security Disability payments. In either of these cases, you’ll be enrolled in Medicare Part A (hospital insurance) and Part B (medical insurance) as soon as you become eligible, although it’s still up to you to sign up for any prescription drug coverage, Medigap, or a Medicare Advantage plan. — That’s where I come in! smiley

Read more about How and When to Enroll.

2. You can enroll any time after age 65

This is not quite accurate. Your initial enrollment period for Medicare begins three months prior to your 65th birthday and ends three months after the month which you turned 65. If you don’t enroll during this seven-month period, you’ll have to wait for the next Medicare open enrollment period which happens between January 1 and March 31 and your Medicare benefit will begin on July 1st. And if you are enrolling in a Medicare plan it must be done prior to July 1st!

There are also penalties for late enrollment. If you don’t sign up for Part A during your initial enrollment window, then your monthly premium will go up by 10% for twice the number of years you could have been enrolled but were not. For example, if you file for Medicare Part A three years after you become eligible, then you’ll have to pay a higher premium for six years.

You should also sign up for Part B as soon as you’re eligible. If you don’t, your premium will go up 10% for every year you delayed — permanently.

Read more about How to Correctly Plan Your Enrollment.

3. Medicare is free

This is a big one! Especially with all the advertisements out there saying that plans have no cost or $0 monthly premiums.

Some parts of Medicare and some covered services are indeed free, but there are certainly some costs involved. Medicare Part A, which covers in-patient hospital stays, has no monthly premium if you worked (and paid Medicare taxes) for at least 40 calendar quarters (or 10 years) by the time you enroll. Medicare Part B, which covers outpatient doctor visits, routine bloodwork and similar expenses, has a premium of $134 per month in 2017, although high-income enrollees may pay higher premiums.

Other Medicare parts and plans have a wider range of premiums, often based on the type of plan and where you go for care. As for services, different Medicare parts and plans offer different levels of coverage for various medical expenses. Some expenses may be completely covered by Medicare, such as an annual wellness exam, while others require you to pay a co-pay or meet an annual deductible.

Read more about How can insurance can have a $0 premium?

4. Medicare covers all types of healthcare expenses

The different parts of Medicare cover different types of healthcare. Medicare Part A covers only hospital-related services, while Part B covers other types of medical expenses such as doctors’ visits and lab tests. Part D covers prescription expenses.

Part C, also known as Medicare Advantage, can cover additional services such as vision and dental care. Medigap plans help cover some of the costs that Medicare Part A and Part B don’t cover, but it doesn’t include prescription coverage, dental, vision, and so on. So the exact coverage you have will depend on which parts of Medicare and which specific plans you sign up for.

5. You may not qualify for Medicare

Happily, you cannot be rejected from Medicare coverage just for being sick or having a pre-existing condition. For that matter, pre-existing conditions won’t raise your premiums, either. This should continue to be the case for Medicare even if Congress repeals the Affordable Care Act’s pre-existing condition clause.

Still have questions or want help comparing the different health insurance plans?  I can help you!

You can use the BOOK APPOINTMENT(link is external) button below to set up a time to speak with me on the phone or in person. I can also send you information ahead of time to get you started. 
Book an appointment with Maine Medicare Options using SetMore
Have a question that needs to be answered right away?
Just give me a call at your convenience.  
You can talk to a licensed insurance agent at (207) 370-0143
or call toll free 866-976-9038. Or send me an email using this form –> https://www.mainemedicareoptions.com/contact

Are you turning 65 and still working?  Read this.

There is no obligation to you and no cost to meet with someone.

$0 Premium Plans

How can insurance have a $0 premium?

If you’re ready to see some plans right now, use the Compare Plans tool here.

We have all seen the ads on TV or gotten something in the mail advertising Medicare plans with $0 monthly premium or $0 co-pay for prescriptions or for a doctors visit or a routine eye exam.  And I am often asked how these Medicare Advantage plans can be “free”.

$0 Premium Medicare Advantage Plans do actually cost you nothing per month for the insurance plan and they also often times offer other services or generic prescriptions for $0 but these plans are not actually free.

This is because you have to pay for Medicare to be eligible to enroll in these plans and Medicare has a monthly premium.

Some parts of Medicare and some covered services are indeed free, but there are definitely some costs involved. Medicare Part A, which covers hospital services, has no premium if you worked (and paid Medicare taxes) for at least 40 calendar quarters by the time you enroll. Medicare Part B, which covers doctor visits and similar expenses, has a premium of $134 per month in 2017, although high-income enrollees may pay higher premiums.

Other Medicare parts and plans have a wider range of premiums, often based on the type of plan and the provider or service you use. Medicare parts and plans offer different levels of coverage for various medical expenses. Some expenses with these plans may indeed have a $0 co-pay, while others require you to pay a higher co-pay or meet an annual deductible.

Under Medicare law, these private insurance companies that offer these plan are contracted with Medicare to provide Medicare Advantage (also called Medicare Part C) plans must offer the same benefits as Original Medicare (Parts A and B.)

All beneficiaries with Medicare Part B need to pay the Part B premium, even if they obtain their benefits through a Medicare Advantage plan, regardless of the plan premium. Because the federal government pays insurance companies a certain amount for each beneficiary that the plans cover, this is how the insurance company can offer plans with $0 premiums. Because they are getting money from Medicare to offset the costs.

However, $0-premium Medicare Advantage plans might not always be the most affordable option.

Even if you enroll in a plan with a $0 premium, you could have other out-of-pocket expenses that might add up over the year. So, it’s a good idea to compare a the Medicare plan’s deductible, out-of-pocket maximum and co-payments, as well as the monthly plan premium.

As you can see, the cost of a plan’s monthly premium isn’t all there is to choosing which plan is right for you.

If you would like help comparing Medicare plan options that fit your budget and health needs, you can contact me using the CONTACT page on this site or by calling me directly at 207-370-0143.

Get to know me by clicking the “About” link on the menu above. There are also links below so you can schedule a phone appointment or have me email you details on Medicare Advantage plans that could be right for you.

Would like my help?

If you would like to talk to me, ask a question or schedule a meeting at your home or a nearby meeting place, 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 any more than anyone else and you are under no obligation whatsoever to enroll in any plans if you talk with me.

“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

 

Popular Donut Hole Questions

Popular Donut Hole Questions

During this time of year, many people will begin to enter the Coverage Gap or “Donut Hole” portion of their Medicare Part D coverage and find their coverage costs changing. 

If you have already purchased medications with a retail value of $3,700 you are in the 2017 Donut Hole.

Question:  I have purchased medications worth $3,390 toward my 2017 Donut Hole, my next brand-name drug purchase has a retail cost of $400, bringing me into the Coverage Gap.  Will I get a Donut Hole discount on the full $400 retail price or just the $90 that falls into the gap?

Your Donut Hole discount (which is 60% in 2017) only applies to the $90 portion of the retail drug price that falls into the Coverage Gap.  Since your purchase “straddles” two phases of coverage, you pay your cost-sharing for the Initial Coverage phase (for example, $40 for a Tier 3 brand drug) and the brand-name Donut Hole discount applies to the remainder of the retail price falling into the Donut Hole. 

Therefore, your total drug cost is the cost-sharing you paid in the Initial Coverage phase plus the discounted cost in Donut Hole. (Note: The combined cost of the Initial Coverage phase and the Donut Hole phase will never exceed your drugs total retail cost.) 

Question:  If I use only one brand drug that costs $347 and have a $47 co-pay, will I enter the 2017 Donut Hole?

Yes. If your retail drug costs average $347 you will exceed your Medicare plan’s Initial Coverage Limit of $3,700 and enter the 2017 Coverage Gap or Donut Hole in early-November. 

Only your plan’s retail drug costs count toward entering the Donut Hole. Your co-pay has no impact on entering the Donut Hole, but will impact when you exit the Donut Hole.  

Question:  I am in the Donut Hole and now have a new prescription that is not on my plan’s list of covered drugs.  Do I get a discount on my new medication and will my costs count toward getting out of the Donut Hole?

No. Only Medicare Part D prescription medications found on your plan’s formulary receive the 60% brand-name discount or 49% generic drug discount. Non-formulary medications and medications excluded from the Medicare Part D program, do not qualify for the Donut Hole discount and your non-formulary drug purchases do not count toward meeting your 2017 total out-of-pocket drug spending (TrOOP) limit of $4,950 — the amount you need to spend to exit the Donut Hole.

If you are using a non-formulary medication, you can ask your Medicare plan for a Formulary Exception which is a type of Coverage Determination. 

If your Medicare Part D plan denies your request, you have the right to appeal your plan’s decision.  For more information, you can click here to read about Formulary Exceptions. https://www.cms.gov/Medicare/Appeals-and-Grievances/MedPrescriptDrugApplGriev/Exceptions.html

Do you have a question not answered here?

Click here to ask a question.

If you would like help comparing your needs against the many Medicare plans out there or if you just want to 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

 

 
 

HIV Test is Covered

Medicare covers annual HIV screenings for everyone with Medicare.

The HIV screening is performed as a lab blood test and must be prescribed by your doctor or other health care provider.

Medicare Advantage Plans cover all preventive services the same as Original Medicare. This means Medicare Advantage Plans will not be allowed to charge cost-sharing fees (coinsurances, copays or deductibles) for preventive services that Original Medicare does not charge for as long as you see in-network providers. 

If you see healthcare providers in Maine or New Hampshire that are not in your HMO or PPO plan’s network, charges will typically apply. If you want to know if a provider is in or out of network you can call the phone number on the back of your insurance card or you can contact us for help.

HIV is the virus that can lead to Acquired Immunodeficiency Syndrome, or AIDS. There have been many advances in treatment, but early testing and diagnosis play key roles in reducing the spread of the disease, extending life expectancy, and cutting costs of care.

Need more help comparing the different health insurance plans?  I can help you.

 

You can use the BOOK APPOINTMENT(link is external) button below to set up a time to speak with me on the phone or in person. I can also send you information ahead of time to get you started. 
 
Have a question that needs to be answered right away? Just give me a call at your convenience.  You can talk to a licensed insurance agent at (207) 370-0143
or call toll free 866-976-9038.
 
 
 
Book an appointment with Maine Medicare Options using SetMore

 

Are you turning 65 and still working?  Read this.

 

There is no obligation to you and no cost to meet with someone.

Medicare Advantage (Part C)

Medicare Part C is available through Medicare Advantage plans, and is an alternative to Original Medicare (Parts A and Part B). Medicare Advantage plans are health insurance plans offered by private health insurance companies approved by Medicare. Medicare Advantage health plans (such as HMO, PPO or PFFS plans) are legally required to offer at least the same benefits as Original Medicare, but can include additional coverage as well, such as routine vision or dental benefits, health wellness programs, or prescription drugs.

One benefit of Medicare Advantage plans is that you can get your prescription drug benefits (Medicare Part D) included under the same plan, instead of having to enroll in a separate stand-alone Medicare Prescription Drug Plan. These plans give you the convenience of having your Medicare Part A, Part B, and Part D coverage through a single plan.

Medicare Advantage plan costs and coverage details can vary depending on the insurance company and county that you live in.

What are the different types of Medicare Advantage plans?

As mentioned, Medicare Part C coverage details can vary depending on the insurance company, so it’s always a good idea to compare the Medicare Advantage plan options in your specific location. The following are types of Medicare Advantage plans that may be available in your location:

Health Maintenance Organization (HMO) plans: These plans offer a network of doctors and hospitals that members are generally required to use to be covered. Because of this, HMOs tend to have strict guidelines, meaning that any visits and prescriptions are subject to the plan approval. If you use providers outside of the plan network, you may need to pay the full cost out of pocket (with the exception of emergency or urgent care). You generally need to get a referral from your primary care doctor to see a specialist.

Preferred Provider Organization (PPO) plans: Medicare Advantage PPO plans offer a network of doctors and hospitals for beneficiaries to choose from. Unlike an HMO, you have the option to receive care from health-care providers outside of the plan’s network, but you’ll pay higher out-of-pocket costs. Medicare Advantage PPOs don’t require you to have a primary care doctor, and you don’t need referrals for specialist care.

Private Fee-for-Service (PFFS) plans: This type of plan allows visits to any Medicare-approved doctor or hospital, as long as the plan’s terms and conditions of payment are accepted by the provider. Keep in mind that you’ll need to find providers that contract with the plan each time you are receiving treatment.

Special Needs Plans (SNPs): These plans limit enrollment to beneficiaries who have certain chronic conditions, are institutionalized, or qualify for both Medicare and state Medicaid (also known as dual eligibles). Benefits, provider options, and prescription drugs are tailored to meet the needs of the plan’s enrollees.

How do I know if I am eligible for a Medicare Advantage plan?

In order to be eligible for Medicare Part C, you must be enrolled in both parts of Original Medicare (Part A and Part B). Once you have Medicare Part A and Part B, you are generally able to enroll in a Medicare Advantage plan, provided you live in the plan’s service area and do not have end-stage renal disease (ESRD).

There are some exceptions where you may be able to enroll in a Medicare Advantage plan even if you have end-stage renal disease. For example, if you’re enrolling in a Special Needs Plan that targets beneficiaries with end-stage renal disease, you may be eligible to enroll in this type of Medicare Advantage plan.

To learn more about other situations where you may be eligible for Medicare Part C if you have end-stage renal disease, you can contact us using the contact page on this site. You can also contact Medicare at 1-800-MEDICARE (633-4227); 24 hours a day, seven days a week.

Those with other health insurance coverage (a union or employer-sponsored health plan, for example) should get more information about their existing coverage before enrolling in a Medicare Advantage plan. It is possible you could lose your existing coverage once you enroll in a Medicare Advantage plan. Furthermore, if you discontinue the other plan for Medicare Part C coverage, you may not be able to reinstate your original coverage if you change your mind. It is generally a good idea to check with your current benefits administrator before you enroll in another health-care plan.

If you’d like to learn more about Medicare Advantage plan options or if you’d like help finding coverage that may fit your needs, 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. 

“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

Read more about other types of plans and options …

The Doctor is In (Maybe)

The doctor’s in, but is your doctor really IN?

Even if the sign says, “The doctor’s in,” you need to double check, because even if the doctor’s in, he or she may not be in your Medicare’s plan network. And depending on the type of plan you have, you may not have coverage outside of the network. That is the case with most HMO plans. Click here to learn more about these types of plans.

First, find out if your doctor “participates” in Medicare and takes assignment. Then, ask if the doctor has specifically “opted out” of Medicare. If she has opted out, you may want to find another doctor unless you can pay cash for the services.

Then – as with any insurance plan – you need to know your numbers. If you’re about to enroll in Medicare Advantage or Medigap, ask your agent to clearly spell out for you all your out-of-pocket costs — deductibles, co-pays, coinsurance and your coverage limits.

What if you have a Medicare supplement plan, like Plan F or Plan N?

Some Medicare Supplement plans (or Medigap plans as Medicare calls them) can be a problem too if you doctor does not accept Medicare assignment.

The term “Medicare assignment” may mean little to you until you find out that a new doctor you are seeing does not accept what Medicare pays for a given service. A “non-participating” doctor who does not accept the assigned cost can charge up to 115 percent of the Medicare approved amount.  This means that Medicare & your supplement plan will still pay for the services this doctor provides even if he does not accept assignment, but you may have to pay some of the costs plus the 15% extra charges.

Wondering if any of this applies to you?

There is a simple way to find out. Work with an agent who can tell who’s in and who’s out and whether or not your plan will pay when you encounter these 15% excess charges.

CALL ME TODAY!

If you would like help comparing your needs against the many Medicare plans out there or if you just want to 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.”

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