Coronavirus & Medicare

24 Hour Nurse Help Lines

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  • Humana – 1-800-622-9529
  • Martins Point Generations Advantage – 1-800-530-1021
  • MEA Benefits Trust – 1-800-607-3262
  • Medi-Share MDLive – 1-888-964-3387
  • Wellcare of Maine – 1-800-581-9952

Medicare will cover coronavirus tests & doctor visits.

Here’s how to get one if you think you have symptoms

Call your doctor. Lab services are covered by Original Medicare and Medicare Advantage plans, but if you want a random test out of the blue, it would not be covered if there’s no medically necessary reason for it. If you suspect you may have been exposed to the COVID-19 virus, call your doctor and in the current environment, if your doctor is concerned, they will say the test is medically necessary. If your doctor bills you for an office visit, that office visit will also be covered.

Let’s discuss the various ways that Medicare will cover the testing and medical care for the two different types of Medicare plans.

Original Medicare and Medicare Advantage plans:

If you have a Medicare Advantage Plan (Part C) in Maine.

Most Medicare Advantage plans in Maine have announced they will waive co-pays for all diagnostic testing related to COVID-19, That includes all member costs associated with diagnostic testing.

Some plans are also offering zero co-pay telemedicine visits for any reason as well as expanding several programs to help people address associated anxiety and stress.

If you have a Original Medicare & a Supplement (Medigap).

Medicare Part B (Medical Insurance) covers a test to see if you have coronavirus (officially called 2019-novel coronavirus or COVID-19). This test is covered when your doctor or other health care provider orders it. You usually pay nothing for Medicare-covered clinical diagnostic laboratory tests.

IMPORTANT NOTE:
Your doctor will need to wait until after April 1, 2020 to be able to submit a claim to Medicare for this test.

Mother always said, “An ounce of prevention is worth a pound of cure.” And she was right!

While the average risk of contracting COVID-19 remains low in the U.S., top experts now warn people in high-risk groups to be cautious – especially if they are elderly and have an underlying medical condition.

“Avoid large crowds, no long trips and above all, don’t get on a cruise ship,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said in an interview on NBC’s “Meet the Press.”

The Centers for Disease Control and Prevention recommends that high-risk individuals stock up on supplies (such as extra medications and groceries), keep space between yourself and others, wash your hands often and avoid crowds. And, if there is an outbreak in your community, remain at home as much as possible.

Symptoms of COVID-19 include fever, cough, shortness of breath and difficulty breathing. Severe cases can lead to pneumonia, severe acute respiratory syndrome, kidney failure and death, according to the World Health Organization.

If you develop any symptoms that are concerning, you should contact your primary-care provider — by phone — for guidance. The CDC has encouraged providers to use their best judgment for who should be tested, which may be based on your symptoms or other factors such as known exposure to an infected person.

If your doctor or other provider thinks you need testing, they’ll contact their local health department or the CDC for instructions on where you can get the test, according to the National Institutes of Health.

The test may involve a swab, blood draw or other method, depending on where the test is administered.

If you have further questions about how your plan will cover testing or treatments call 1-800-Medicare or call the phone number for Member Services on the back of your insurance card.

Still have questions?

Just fill out the form below and we’ll research your question and email or call you back with the answer.


⭐⭐⭐⭐⭐ 5-Star Special Enrollment

Medicare uses information from member satisfaction surveys, plans, and health care providers to give overall performance star ratings to plans. A plan can get a rating between 1 and 5 stars. A 5-star rating is considered excellent. These ratings are designed to help you compare plans based on quality and performance.

NOTE: You can only switch to a 5-star Medicare Advantage Plan, Medicare Cost Plan, or Medicare Prescription Drug Plan one time before November 30 each year.

If you move from a Medicare Advantage Plan that includes prescription drug coverage to a stand-alone Medicare Prescription Drug Plan, you’ll be disenrolled from your Medicare Advantage Plan, including the health benefit. You’ll be returned to Original Medicare for coverage of your health services. You can only switch to a 5-star Medicare Prescription Drug Plan if one is available in your area.

If you move from a Medicare Advantage Plan that has drug coverage to a 5‑star Medicare Advantage Plan that doesn’t, you may lose your prescription drug coverage. You’ll have to wait until your next enrollment opportunity to get drug coverage, and you may have to pay a Part D late enrollment penalty.

5-star plans are identified with this special icon:

How to compare plans using the Medicare Star Rating System

Part D drug plans and Medicare Advantage Plans vary greatly in terms of costs and coverage. Each year plans can change their coverage and costs for the new calendar year. This means that every year you should review your plan’s coverage and compare it with other plans in your area to make sure you have the coverage that is best for you.

If you’re working with an agent you can ask them to help you review your options. If you are doing it alone then you’ll have to examine each new plan’s coverage, costs, drug coverage, and the pharmacies in its network to see if it best meets your current needs.

After considering all these important factors to narrow down your choices, you can use the plan’s star rating from Medicare to help you make a final decision.

Medicare Advantage Plans are rated on how well they perform in five different categories:

  • Staying healthy: screenings, tests, and vaccines
  • Managing chronic (long-term) conditions
  • Plan responsiveness and care
  • Member complaints, problems getting services, and choosing to leave the plan
  • Health plan customer service

Part D plans are rated on how well they perform in four different categories:

  • Drug plan customer service
  • Member complaints, problems getting services, and choosing to leave the plan
  • Member experience with the drug plan
  • Drug pricing and patient safety

REMEMBER: Before you consider a plan’s star rating, make sure the plan’s coverage and costs suit your needs. For example, if you are considering a Part D plan, be sure the new plan covers your drugs at a cost that works for you.

Where can I find information on my plan’s star rating?

Star ratings can be found using Medicare’s Plan Finder tool or by calling 1-800-MEDICARE. New plan quality ratings come out each October and apply to the next calendar year (for example, plan ratings for 2021 will be available in November 2020).

How can I use the star ratings to inform my plan choice next year?

You can use star ratings to compare plans in your service area by the categories listed above that Medicare finds important indicators of the insurance company’s performance. Remember that a plan’s star rating is only one factor to look at when comparing plans. Even though a plan has a high star rating, it may not be right for you. You should also consider the plan’s costs, coverage, and network for providers and pharmacies.

TIP

Working with an agent can save you time and money. Agents have experience with the insurance companies that offer plans in the local area. Agents can give you important feedback on which plans their clients are happiest with and will also update you each year on important changes. Best of all, working with an agent costs you nothing.

Be careful of low rated plans.

If Medicare gives a plan fewer than three stars for three years in a row, It will be flagged as as low-performing. The symbol Medicare uses to show that a plan is low-performing is an upside-down red triangle with an exclamation point inside of it (similar to a caution sign).

Medicare will notify you if the plan you are enrolled in is flagged as low-performing. You will not be removed from the plan, but you may want to check the plan’s costs and coverage to make sure it is still a good plan for you.

What is the Five-Star Special Enrollment Period?

Generally, you can only change your plan or enroll in a new plan during specific times. Special Enrollment Periods (SEP) are periods of time outside normal enrollment periods, triggered by specific circumstances.

If you want to enroll in a plan or change plans, you can take advantage of an SEP to join or switch to a five-star Medicare Advantage or Part D plan. This means that you can enroll in a Medicare Advantage Plan or stand-alone Part D plan in your service area that has an overall plan performance rating of five stars. You may only use this SEP once per calendar year.

  • This SEP begins December 8 of the year before the plan is considered a five-star plan (remember that ratings come out in November) and lasts through November 30 of the year the plan is a five-star plan
  • Enrollments in December are effective January 1
  • Enrollments from January to November are effective the month following the enrollment request

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.Shortcode

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.

Less than 20 employees?

If you work for a small company (under 20 employees), you MUST enroll in Medicare at 65.

You need to sign up before turning 65

If you work for a small employer (less than 20 employees) then you will need to sign up for both Parts A & B before you turn 65. This is because Medicare becomes the primary payer of your health costs and your health insurance is no longer responsible for the portion of the bill that would be covered by Medicare.

Different Rules for Small Companies

The laws that prohibit large insurers from requiring (or even persuading) Medicare-eligible employees to drop the employer plan and sign up for Medicare do not apply to companies and organizations that employ fewer than 20 people.

Medicare Pays First

When you turn 65 Medicare automatically becomes primary and the employer plan provides secondary coverage. In other words, Medicare settles your medical bills first, and the employer plan only covers services that it covers but Medicare doesn’t. Therefore, if you fail to sign up for Medicare when required, you will essentially be left with no coverage.

It’s therefore extremely important to sign up for Medicare before you turn 65 because if you do not sign up during your initial enrollment period you will have to wait until January to enroll and your Medicare benefit will not begin until July 1st, leaving you at risk.

NOTE: Signing up for Medicare Part B when you also have employer insurance will not jeopardize your chances of buying supplemental insurance after your employment ends. When Medicare is primary to the employer plan, you have the right to buy supplemental insurance with full federal protections if you do so within 63 days of the employer coverage ending.

Occasionally some insurance companies may offer to cover claims even if you don’t have Part B. Don’t risk it. The insurance company could change that decision at any time without warning, and leaving you stuck with all the expenses that Part B would normally cover. It’s not worth the risk.

“I always advise my clients to enroll in Parts A & B if the employer has fewer than 20 employees. It’s better to be safe then sorry.”

Todd Reagin, Insurance Broker

One Exception

The ONLY exception to this rule is for employers who participate in a “multi employer plan.”  In this case if one of the employers has more than 20 employees then all the employers in the group are entitled to an exemption and employees can postpone their Part B coverage. You can read more about that exception here: https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/EmployerServices/Small-Employer-Exception

Would you like my help?

If you would like to talk to me or schedule a meeting at your home or my office, you can reach me 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 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.

Dental: Insurance vs. Discounts

In 2020, many Medicare Advantage plans will offer dental & vision coverage as an extra benefit. But for those who don’t have dental coverage, or don’t like their plan’s option, may want to find a plan on their own.

Choosing either dental insurance or a dental discount plan can save you money, but there are important differences to consider before deciding which route to choose.

Dental insurance versus dental discount plans

Before jumping into details, here’s a quick overview of the two types of dental plans:

Dental insurance

Most dental insurance plans operate pretty much the same way. Although benefits vary, plans generally fully cover preventative care, like two cleanings and one set of X-rays per year. They also tend to cover about half the cost of major procedures such as root canals, bridges, and crowns.

Most plans have annual deductibles of $50 to $100 and usually limit annual coverage amounts, with a median cap of $1,000. Some plans may or may not cover orthodontics or have lifetime limits on the amount covered for implants, so that’s also something to consider when shopping around.

Insurance companies often have a “network” of dentists and some plans will only cover work done by this network while other plans may offer flexibility to see dentists outside this network but often at a lesser amount of coverage.

With the high cost of dentistry, it’s easy to see how paying for a plan with a low annual max plus a monthly premium may not make sense. According to their annual survey, the American Dental Association Health Policy Institute says the average cost of a cleaning for an adult in the US is $73 to $130; fillings, $108 to $246; crowns, $959 to $1,650; implants, $1,200 to $2,500; and root canals, from $613 to $1,200.

Dental discount plans

With a discount plan, you pay a monthly or annual membership fee and will receive a discounted price on services. Monthly membership fees for an individual range from about $10-$15.

Dental discount plan networks may be more limited than insurance networks, and compared with insurance, the out-of-pocket costs are often higher for patients. You can get full coverage of preventive care with some discount plans, but it is much less common than it is with insurance.

Discounts range from about 20-50 percent, with routine procedures getting the highest discounts. But unlike dental insurance, with discount plans there are no caps. You keep getting the discount on all services for the entire year and the discounts do not end.

Factors to consider when choosing one option over another

At first glance, you may think the only difference between dental insurance and a dental discount plan is the cost and amount of coverage, but there’s more to consider.

When do you need coverage to start?

Some insurance plans may allow you to get a cleaning or X-ray right away, but there are often waiting periods.

It’s common to see six-month waits for for major services. These waiting periods prevent consumers from abusing the insurance plan — using the insurance for a procedure and then dropping it right away.

By contrast, dental discount plans don’t have any waiting periods. It may take a few business days for your membership to go through. If you have an immediate (non-emergency) need, you may be able to pay for a dental discount plan and get a discount on the procedure a few days later.

How many options do you want?

An important consideration is how many dentists you can choose from, and if there’s a well-rated in-network dentist nearby. If you already have a dentist you like, check with the office to see if it will accept the insurance or discount plans you’re considering.

Which option is best for you?

Compared with having no coverage at all, you can save money with either a dental insurance plan or a dental discount plan.

If you already have a dentist whom you like to visit and are looking to save money, your best bet may be to ask which options your dentist accepts and compare the costs for your general needs. When you don’t have a dentist, it can be a bit easier because you can choose the plan that offers the best coverage and then look at the list of dentists that accept the plan you chose.

For those who regularly get cleanings and don’t have a history of dental problems, a dental discount plan could provide adequate coverage for a low monthly fee. Although you may only break even or save a little money on your twice-a-year cleanings and annual X-ray, you’ll have some added security in knowing you can save money on other procedures. However, since the discount plan isn’t likely to cover the entire cost for major work, you may want to have some savings set aside for an emergency.

More ways to Save On Dental Care

With or without dental insurance, there are many ways to make dental care more affordable. Check out these strategies.

Get covered if you can.

For seniors over 65, Medicare doesn’t cover dental services, but you can buy a Medicare Advantage plan with dental coverage. Some Medicare Advantage plans charge additional premiums for dental and some offer dental coverage at no additional costs.

If you’re a veteran and have a service-connected disability, you may be eligible for free comprehensive dental care from the Department of Veterans Affairs. Other veterans can buy dental insurance at a reduced rate and some Medicare Advantage plans offer plans specifically tailored to compliment your VA benefits.

Click here to read more about how Veterans can win big with Medicare Advantage!

Time your treatments.

If you need an expensive procedure, ask your dentist whether you can space out the treatments so that you can apply the cost against two annual limits instead of one by starting near the end of one year and finishing in January.

Create a dental emergency fund.

Put aside money you might have used for premiums. Instead of paying an insurance company $50 per month for a plan, transfer that money to a savings account each month and use that money when you need it.

Check out medical expense accounts.

Ask whether your employer offers tax-advantaged accounts to help save and pay for dental expenses not covered by its insurance, such as a health flexible-spending account (FSA) or a health reimbursement account (HRA).

And if you have a high deductible health plan (HDHP), you can fund a Health Savings Account (HSA) with pre-tax money and use it on a range of healthcare costs including dental.

For most dental expenses the IRS will allow HSA payments for “diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body.” As long as the expenses are not eligible for reimbursement through insurance or other sources.

Go to a dental school.

You could pay 30 percent to 40 percent less on dental services at university dental schools compared to a private practice. You’ll get care from students supervised by dentists but the downside is that it’s very time consuming.

It’s much slower because the student is doing work under the supervision of an instructor. Visits are longer and care that could be done in a few sessions in a dental office could take a few months to complete.

Check a community health center.

Some community health centers offer dental care and charge on a sliding scale based on your income. But they may have limited services and, possibly, waiting lists. Call your local health department or state dental association, or go to Tooth Wisdom to find clinics near you.

Do some haggling.

Whether or not you have insurance, you pay a lot for expensive procedures so you should compare prices for big ticket items. Use FAIR Health to research prices where you live.

Dentists are often open to negotiating prices and may offer a discount if you pay for a procedure when you get the service. Some dentists also offer in-office dental plans for people without benefits.

Spread out services.

Many employer plans provide 100 percent coverage for getting a checkup twice a year. But if you’re paying on your own and in good dental health, once a year may be enough according to American Dental Association guidelines.

The ADA also says that adults with generally healthy teeth only need bitewing x-rays every 18 to 36 months. There’s no one-size-fits-all dental treatment though. You can go to the ADA’s MouthHealthy.org site for more information on paying for dental care, preventive care and recommended frequency of visits.

Would you like more information or help comparing plans?

I am here to help. If you have a question or want more information just send me an email message!

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.

2020 Medicare Costs

2020 Medicare Parts B Premium and Deductibles

The Centers for Medicare & Medicaid Services (CMS) has finally announced the 2020 Medicare premiums, deductibles, and coinsurance amounts.

Medicare Part B Premium will be $144.60 per month in 2020

Medicare Part B covers doctors and specialist visits, outpatient hospital services, certain home health services, durable medical equipment, and other medical and health services not covered by Medicare Part A. 

Each year the Medicare premiums, deductibles, and coinsurance rates are adjusted according to the Social Security Act.

For 2020, the Medicare Part B monthly premiums and the annual deductible are increasing. The standard monthly premium for Medicare Part B enrollees will be $144.60 for 2020, an increase of $9.10 from $135.50 in 2019. If you are paying quarterly you bill will increase to $433.80.

Medicare Part B Annual Deductible will be $198 in 2020

The annual deductible for all Medicare Part B beneficiaries is $198 in 2020, an increase of $13 from $185 in 2019.

If you have a Medigap plan that does not cover the Part B deductible then you must pay this amount first before your plan picks up any costs.

Medicare Part B Income-Related Monthly Adjustment Amounts for people with Higher Incomes

If you earn more than $87,000 and are single or more than $174,000 and are married your Part B monthly premium will be increased based on your income.

These income-related monthly adjustment amounts (IRMAA) affect roughly 10 percent of people with Medicare Part B. The 2020 Part B total premiums for high income beneficiaries are shown in the following table:

Beneficiaries who file individual tax returns with income:Beneficiaries who filejoint tax returns with income:Income-related monthly adjustment amountTotal monthly premium amount
Less than or equal to $87,000Less than or equal to $174,000$0.00$144.60
Greater than $87,000 and less than or equal to $109,000Greater than $174,000 and less than or equal to $218,000$57.80$202.40
Greater than $109,000 and less than or equal to $136,000Greater than $218,000 and less than or equal to $272,000$144.60$289.20
Greater than  $136,000 and less than or equal to $163,000Greater than $272,000 and less than or equal to $326,000$231.40$376.00
Greater than $163,000 and less than $500,000Greater than $326,000 and less than $750,000$318.10$462.70
Greater than or equal to $500,000Greater than or equal to $750,000$347.00$491.60

Premiums for high-income beneficiaries who are married and lived with their spouse at any time during the taxable year, but file a separate return, are as follows:

Beneficiaries who are married and lived with their spouses at any time during the year, but who file separate tax returns from their spouses:Income-related monthly adjustment amountTotal monthly premium amount
Less than or equal to $87,000$0.00$144.60
Greater than $87,000 and less than $413,000$318.10$462.70
Greater than or equal to $413,000$347.00$491.60

Medicare Part A Premiums/Deductibles

Medicare Part A covers inpatient hospital (overnight hospital stays), skilled nursing facility, and some home health care services. About 99% of Medicare beneficiaries do not have a Part A premium since they have earned the minimum 40 quarterly credits as they earned their Social Security benefit.

The Medicare Part A inpatient hospital deductible that beneficiaries will pay when admitted to the hospital will be $1,408 in 2020, an increase of $44 from $1,364 in 2019.

The Part A inpatient hospital deductible covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. In 2020, beneficiaries must pay a coinsurance amount of $352 per day for the 61st through 90th day of a hospitalization ($341 in 2019) in a benefit period and $704 per day for lifetime reserve days ($682 in 2019).

For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 of extended care services in a benefit period will be $176.00 in 2020 ($170.50 in 2019).

Part A Deductible and Coinsurance Amounts for Calendar Years 2019 and 2020 by Type of Cost Sharing
 20192020
Inpatient hospital deductible$1,364$1,408
Daily coinsurance for 61st-90th Day$341$352
Daily coinsurance for lifetime reserve days$682$704
Skilled Nursing Facility coinsurance$170.50$176

People age 65 and over who have earned fewer than 40 quarters and certain persons with disabilities pay a monthly premium in order to voluntarily enroll in Medicare Part A.

Individuals who had at least 30 quarters of coverage or were married to someone with at least 30 quarters of coverage may buy into Part A at a reduced monthly premium rate, which will be $252 in 2020, a $12 increase from 2019.

Certain uninsured individuals who have less than 30 quarters of coverage and certain individuals with disabilities who have exhausted other entitlement will pay the full premium, which will be $458 a month in 2020, a $21 increase from 2019.

What will you pay?

Well, that depends on what type of insurance you have. Some people have insurance plans called Medigap plans that cover 100% of your out of pocket costs so they do not pay any deductibles or copays.

Other people who have Medicare Advantage Plans may pay very little per month (in some cases $0 per month) and will only pay copays when they see a doctor or other providers.

Would you like to know more?

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 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 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.”

Book an appointment with Maine Medicare Options using SetMore

What is Fall Open Enrollment?

Medicare’s Fall Open Enrollment runs from October 15 through December 7 each year, and it’s a time when you can make changes to your Medicare coverage.

During Fall Open enrollment, you can

  • Switch to a new Medicare Advantage Plan
  • Switch to a new Part D prescription drug plan
  • Switch from Original Medicare to a Medicare Advantage Plan
  • or Switch from a Medicare Advantage Plan to Original Medicare

Between October 15 and December 7, 2017, you can make as many changes as you need to your Medicare coverage. The final change that you make will go into effect on January 1, 2020.

To prepare for Fall Open Enrollment, you should begin to think about two major things:

First, think about your current health and drug coverage.

If you have Original Medicare, review the 2020 Medicare & You Handbook. This will outline your benefits for the upcoming year. If you aren’t satisfied with Original Medicare or if you are looking for more benefits, Fall Open Enrollment is a good time to make changes.

If you have a Medicare Advantage Plan or a stand-alone Part D drug plan, you should receive an Annual Notice of Change (ANOC) and an Evidence of Coverage (EOC) from your plan in late September or early October.

These documents outline which providers, pharmacies, drugs, and services your plan covers, and what costs you will be responsible for. These documents also tell you what will change in 2020. If you aren’t satisfied (for example, if a drug you need is no longer on your Part D plan’s formulary, or a provider you see is no longer in your Medicare Advantage Plan’s network), you can make changes during Fall Open Enrollment.

Even if you are happy with the coverage you get, you should review your current coverage and look at other options in your area to see if there are other plans that cost less and/or better suit your individual needs in the coming year. Many plans in 2020 have added Dental and Vision along with Hearing Aid coverage and some even cover over-the-counter items.

Next, think about costs.

Costs can vary widely between different kinds of Medicare Advantage and Part D plans. Some Medicare Advantage Plans charge an additional premium on top of the Part B Medicare premium. Some Part D plans require people to pay a deductible, while others do not.

Another plan in your area could offer you the same or better health and/or drug coverage at a more affordable price or have fewer coverage restrictions. Research shows that people with Medicare prescription drug coverage could lower their costs by shopping among plans each year. The lowest cost Part D prescription drug plan in Maine is $13.20/month.

How do you compare plans?

To prepare, create a list of all the health care providers you see, prescription drugs you take, and pharmacies you use. Contact your agent or call each of the the plans available in your area and ask how they will cover your doctors and drugs. Also remember to ask about extra benefits such as Dental, Vision, Fitness and Over-The-Counter items. You can also research the plans on medicare.gov

If you have questions about this or would like help reviewing the plans available, you can reach out to me using the CONTACT button on the menu at the top of this website or by calling (207) 370-0143.

Read more about working with an agent.

Would you like my help?

If you would like help finding the right plan or 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

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.

Medigap: New Rules for 2020

Enrolling in Medicare and choosing a Medicare Supplement is bewildering enough. Now, a law change that takes effect January 1, 2020 appears to be complicating matters even more.

For people who become eligible for Medicare on or after Jan. 1, 2020, you can no longer buy a Medicare supplement plan that covers your Part B deductible.

These Medigap plans include two types of plans (Plan C and Plan F), the most popular of the 10 types of Medigap plans.

President Barack Obama signed the Medicare Access and CHIP Re-authorization Act (MACRA) into law on April 16, 2015. The goal of this change was to require seniors to have more skin in the game, prompting them to think twice before seeking unnecessary medical care.

But the change doesn’t apply to everyone.

If you turn 65 before Jan. 1, are already enrolled in a Medigap plan or you are already enrolled in Medicare then you can still switch to or purchase Plan C or Plan F, with some limitations.

Plan F is not ending. Anyone who had Medicare prior to that date can enroll and may keep that plan. There’s a lot of confusion. People are making an assumption they’re going to get kicked off of these plans and in the last few months I’ve had to do a lot of clarifying.

Here’s what you need to know:

What is Medi-gap?

It’s an additional insurance policy, also known as Medicare supplement insurance, that fills in some or all coverage “gaps” left by Original Medicare.

What gaps are those?

Original Medicare (Part A and Part B) covers hospitalizations (Part A) and doctor’s visits (Part B), mostly for people age 65 and over. But it requires you to pay about 20% of the costs.

There’s also an annual deductible for hospitalizations (not yet set for 2020, but $1,364 in 2019) and for Part B ($185 in 2019). Long stays in a hospital or nursing home can lead to additional and substantial out-of-pocket costs.

How does Medigap work?

There are 10 different plans, ranging from letters A through N (with some letters missing), that offer different levels of coverage. Most Medigap enrollees have chosen Plan F, which covers all out-of-pocket costs, including all deductibles. That means your only medical cost, aside from prescription drugs, is your monthly premium, which can be quite high since the insurance company is picking up 100%.

What’s changing?

Congress now has effectively barred Medigap plans from covering Medicare’s Plan B deductible, which is $185 in 2019. Only Medigap plans C and F covered the Part B deductible.

Who’s affected?

The change applies only to those who become Medicare eligible after Jan. 1, 2020. That includes those who turn 65 or become eligible through disability in 2020 or later.

What if you are already enrolled in Plan F?

Nothing changes for you. You can keep your plan or switch to another plan with lower costs. Anyone already 65 also can enroll in either plan C or F if they’ve not already done so, if they want to switch Medigap plans or if their Medicare Advantage plan ends.

What if you haven’t enrolled in Medicare because you have not retired and are insured through work?

As long as you turned 65 before Jan. 1, you’ll still be able to enroll in Plan F when you retire.

What if you have a Medicare Advantage plan and it suddenly ends after January 2020? Will you be able to choose Plan F in the future?

Good news! The answer is Yes. If you lose your Medicare Advantage (Part C) plan through no fault of your own or move out of the plan’s service area, you have 63 days to enroll in another Medicare Advantage or Medigap plan and you can choose Plan F.

What can you do if Plan F is not an option?

Plan G is now the most generous plan. It covers everything Type F covered except for Medicare’s Plan B deductible.

Will Plan G cost you more?

It’s more expensive than other plans, but not necessarily Type F plans. In recent years, Plan F’s monthly premiums have increased more dramatically.

Even with the Part B deductible factored in, Plan G costs less than Plan F, and many of my clietns have already changed from F to G and are seeing savings of over $200.

Is Medigap right for you?

If you travel a lot or if you maintain homes in different states then you may want to opt for a Medigap plan because it doesn’t limit you to a specific doctor or hospital network like Medicare Advantage plans.

Anyone with expensive ongoing medical costs like oxygen or chemotherapy will also find Medigap plans will protect them from large out-of-pocket expenses.

My advice to everyone is to talk to an expert. Find a local insurance broker who lives and works with clients in your area to discuss the pros and cons between the different plans. An local agent will have other clients enrolled in these plans and can give you valuable feedback on what his/her clients have experienced.

If you call the insurance company directly they will only tell you how perfect their plan is and why you should enroll. An agent’s job is to watch out for your best interests so I tell people the good and the bad so you can decide if the plan is a good fit.

There are a lot of choices which is good for the consumer but the large number of choices can be quickly overwhelming. It’s best to consult a professional who can help you narrow down your choices.

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 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.

Dentists Who Care for ME event

On Friday, November ​1st, 201​9, dentists across Maine will be teaming up for the ​11th Annual Dentists Who Care for ME event. Dental professionals and specialists will be offering free oral care at their offices for adults who have no other access to dental care.

Free services will be offered by dentists in Biddeford, Portland, Scarborough, Skowhegan, South Portland, Topsham and other towns across Maine. You can see a list of all locations here -> https://www.medental.org/dentists-who-care-for-me/locations

What services are free?

The free care being offered will include cleanings, fillings, extractions or referral to a specialist. People will be able to get one treatment each.

In addition to dentists, dental hygienists will also be on hand to help educate people, especially those who rarely see a dentist, about caring for their teeth.

When and Where?

Most of the participating offices will open at 8 a.m. Friday but their hours will vary.

Services will be offered on a first come, first served basis so get there EARLY!

To see a complete list of the participating dental offices, go to www.Dentistswhocareforme.com

If you miss this event or if there is no dentist in your area participating, check to see if your current medicare plan offers any dental coverage or check out the following posts to see how you can get dental coverage with Medicare. There are a lot of options this year for dental coverage so it pays to look at your options.

Would you like my help?

If you would like help finding a plan that covers more dental and vision coverage or 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

Read more about working with an agent.