Understanding Your Part D Explanation of Benefits

Here is how to read and use this helpful drug benefit summary.

You get a lot of mail from Medicare & your insurance. One document to watch for is your monthly Medicare prescription drug plan “Explanation of Benefits” (EOB).

Think of your EOB as a helpful tool for managing your Part D prescription drug claims and costs.

It’s important to review your Part D Explanation of Benefits!

This document provides a summary of the prescriptions you’ve filled in the previous month and information about your drug coverage, such as:

• Whether you’ve met your deductible (if you have one) and, if not, how much more you need to spend before your plan begins to pay its share.
• What you have paid “out-of-pocket” to date for your prescriptions.
• Which Part D coverage stage you are in

How to Read Your EOB

The first page contains a list of the six sections of information it provides. Let’s take a look at the first three sections in detail.

SECTION 1: Your prescriptions in the last month

• Chart 1 shows a list of your prescriptions filled by date in the past month and which pharmacy you used. Be sure to check the accuracy of this list.
• The chart displays three columns that show the amount the plan paid, what you paid, and any other payments from an organization or a program like a State Pharmaceutical Assistance Program (SPAP).

Near the bottom of the chart, you’ll see the monthly totals paid for your prescriptions. This total will include what was paid by the plan, by you, and by other programs on your behalf, if any.

The information will be identified as “total drug costs”. The section will also provide your monthly out-of-pocket costs. At the bottom, you can view the year-to-date total for what you’ve spent out of pocket on prescriptions. Finally, a total of the three columns indicates what you, your plan, and other organizations, if any, have spent since January 1. This information will be identified as “year-to-date total drug costs”.

SECTION 2: The Part D drug payment stages

In this view, the stage you’re in is identified by a shaded outline—for more information on the stages of coverage, please go here. Here you will see a description of the dollar amount you and/or your plan need to reach before moving to the next stage of coverage. This information will be identified as “total drug costs”. It will also show your current year-to-date “total drug costs,” which indicate how close you are to moving to the next stage of coverage.

The bottom section of the shaded box “What happens next?” gives you the additional amount that you, your plan and others on your behalf (if any) need to spend in “total drug costs” to move to the next payment stage.

This is especially important if you are in the Initial Coverage stage, because you will see how close you are to entering the Coverage Gap (aka Donut Hole), when you will pay more for your prescriptions.

Before you get too close to the gap, you might want to review your medications with your insurance agent or broker to see what you will pay Ask if there are ways to delay entering this stage, such as by switching to a generic medication or using a coupon or Patient Assistance Program.

SECTION 3:“Out-of-pocket” and “total drug costs” amounts and definitions
This section provides your monthly and yearly“out-of-pocket costs” and “total drug costs” along with definitions of what these costs include or do not include.

Additional Information

The last three sections provide information on various topics.

Section four may include changes to your Drug List that affect drugs you take, such as a change to the coverage or cost of a drug.

Section five tells you what to do if you find a mistake in the EOB or have questions.

Additionally, you can find information about protecting yourself from fraud and how to contact the plan or Medicare with your concerns. Section six discusses the plan’s Evidence of Coverage, the benefits booklet that explains the plan and the rules you need to follow to obtain drug coverage. Certain chapters and topics are highlighted that will provide you with instructions if you have issues related to your drug coverage or difficulty paying for your drugs

Want to know more? I can help!

If you would like help finding answers to your 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. I am always happy to help!

The best part about working with me is that it costs you nothing! I am paid by the insurance companies in the form of a commission when I enroll someone in a plan. This is the same way it works when you buy car insurance or your home owners insurance. You do not pay anything to the agent 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.”

HSA & Medicare

IMPORTANT:  When you enroll in Medicare Part A you can no longer contribute to your HSA.

The Good News!

Triple Tax Advantage of HSAs

• Your account contributions are pre-tax or tax-deductible.
• All earnings, interest, and, yes, investment returns are tax-free.
• Any withdrawals for qualified medical expenses are tax-free. Plus, once you reach age 65, all non-medical withdrawals are taxed at your current tax rate, just like a traditional IRA. (If you withdraw money for non-medical expenses before you’re 65, then there’s a 20% penalty.)

Should you delay enrolling Medicare?

Do you live in New Hampshire?

Medicare Savings Account (MSA) Plans

Still have more Questions?

If you would like help finding answers to your 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. I am always happy to help!

The best part about working with me is that it costs you nothing! I am paid by the insurance companies in the form of a commission when I enroll someone in a plan.

This is the same way it works when you buy car insurance or your home owners insurance. You do not pay anything to the agent 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.”

Get Help Paying for Prescriptions

Mainers who cannot afford their medications should know that many public and private programs are available to provide free or low-cost prescription medicines if you qualify.

Tell your insurance agent if you can’t afford your medicines.

Your agent can help you access these programs. As an agent I have a lot of experience helping people find Medicare and individual health insurance coverage for expensive drugs.

And because I deal with this issue almost every day, I know what programs may be best suited to help. Your insurance agent or broker that helps you review your coverage every year also should have a good idea how to help.

I put together the following list of resources that I use every day to help my clients. I hope you find it helpful. If you want my help or just want to ask a question fill out the form at the bottom of this page to send me an e-mail or call me anytime at 207-370-0143 and I will do mt best to help you!

Talk to your doctor

Your doctor’s office can help you apply to these programs themselves or refer you to one of Maine’s 15 hospital-based prescription assistance programs. Don’t put yourself at increased risk of getting sicker by skipping the medicines you need because it’s too expensive.

Whether or not you have a Medicare Supplement plan with a separate Part D prescription plan or an all-in-one type Medicare Advantage plan that includes prescription drug coverage, your cost for prescriptions can increase when you hit the donut hole.

Medicare Savings Programs (MSP, QMB, SLMB, QI)

If you have Medicare but need help with prescription drug costs, the MSP can be a huge help.  Depending on what level you qualify for, you could get help paying for Part B and Part D premiums, copays, coinsurance, and deductibles. [READ MORE]

DEL PROGRAM (Low Cost Drugs for the Elderly or Disabled)

Many people who are either disabled or 62 and older who do not qualify for MaineCare, can get this help. DEL provides an 80% discount off the cost of many commonly used drugs. Some people with high medication costs may be able to get coverage of less commonly used drugs. If you are over 65 and already have Medicare, DEL does not take the place of Part D (Medicare prescription coverage). But, it may help to “wrap around” the Part D coverage in some cases. If you are eligible, it is good to apply for DEL.

Maine Rx Plus

Maine Rx Plus provides a 60% discount off the cost of many commonly used generic drugs at many pharmacies across Maine (only 15% off brand-name drugs). There may be other programs that can help pay more of your drug costs, but if not, it is good to apply for MaineRx Plus.

Community-based Prescription Assistance Programs (CPAPs).

State prescription assistance programs like Maine Rx Plus can be helpful, but sometimes those programs don’t help enough. Community-based Prescription Assistance Programs (CPAPs) can search through their database to find other programs to help with the cost of medications. The CPAPs keep the latest information on a large number of drug company discount cards and discount programs for specific drugs. Staff can provide you with free information and help you to apply for discounts. For more information, see this flyer: Help with Prescriptions.

$4 Generics List Available at Most Pharmacies

Another way to save on prescriptions is by switching to generic. Generic medications can sometimes be less expensive than brand name drugs and may make it easier to find discounts.

Many pharmacies have started providing generic medications for only $4, regardless of your income or insurance status. Smaller, local pharmacies sometimes have generous discount programs as well. It’s a good idea to call the pharmacies nearest to you and ask about any discount programs that they offer.

Each Pharmacy will have a list of drugs they offer at $4. If your drug is not on the list call around. Each pharmacy has a different list so if you don’t find your generic drug on one list it may be on another. [READ MORE ABOUT HOW THESE $4 COPAY LISTS WORK]

Free Samples

Sometimes Health Centers, Hospitals, and Free Clinics are given free samples of certain medications that they can share with their patients. This assistance is usually not a long-term solution, but can definitely help! Whenever you are prescribed a medication, it never hurts to ask if there are free samples available.

Safely Ordering Drugs from Canada

For information about mail-ordering drugs from Canada, visit the Health Canada website to learn how to protect yourself from fraudulent companies.

Help with Private Insurance Co-pays

Even if you have health insurance through the Maine Health Insurance Marketplace, cost may still be an issue. Some people may be able to get help paying their co-pays if they meet certain income and medical guidelines. For more information visit the Patient Advocate Foundation’s Co-pay Relief website or call us toll free at 866-976-9038 for more details.

TRICARE

Military retirees, and some family members or former spouses age 65 and older may be eligible for two programs provided by the Department of Defense: TRICARE for Life and the TRICARE Senior Pharmacy Program. For more information and complete eligibility requirements for the TRICARE for Life and TRICARE Senior Pharmacy Program, contact Sierra Military Health Services (the Northeast Regional Contractor) toll free at 888-999-5195.

Veterans Benefits

CHAMPVA is a health care benefits program through the Department of Veterans Affairs (VA). For the spouse or widow(er) and for the children of a veteran who: is rated permanently and totally disabled due to a service-connected disability; was rated permanently and totally disabled due to a service-connected condition at the time of death; died of a service-connected disability; died on active duty and the dependents are not otherwise eligible for DoD TRICARE benefits. Under CHAMPVA, VA shares the cost of covered health care services and supplies with eligible beneficiaries.

VA and Medicare

As a Medicare-eligible Veteran, you have more options when it comes to healthcare and costs savings programs.  To confirm your options call the Veterans Administration directly at 1-877-222-VETS (8387). [READ MORE ABOUT HO MEDICARE WORKS WITH VA BENEFITS]

HIV/AIDS Assistance

If you have been diagnosed with HIV and you are a resident of Maine, you could get assistance from the State of Maine to get HIV-related medications free of charge. The Aids Drug Assistance Program (ADAP) is a program of the Maine Center for Disease Control and Prevention (Maine CDC), HIV/STD Division. If you are interested in ADAP contact the Maine CDC at (207) 287-2899. You can also contact one of the HIV/AIDS organizations in the state or contact the AIDS Hotline at 1-800-851-2437.

Hospital Programs

Many hospitals in Maine provide free or reduced-cost emergency services to people at certain income levels. Some hospitals go above and beyond just the emergency services and will also provide help with medications and other services. If you have questions about free care in Maine you can call the Maine Consumer Assistance Helpline at 1-800-965-7476.

MedAccess

MedAccess works with individuals and health care providers to identify ways patients can save money on prescription medications. The free program, administered by MaineHealth, helps patients and health care providers evaluate options such as pharmaceutical companies’ patient assistance programs, low-cost generic programs, and Medicare Part D and state and local prescription programs that can help save on prescription medication costs. For more information, see the MaineHealth MedAccess Program. MedAccess is part of the MaineHealth CarePartners Program.

Drug Safety, Effectiveness, and Cost

Consumer Reports Health Best Buy Drugs offers free, trusted educational resources to help you access the safest, most effective, and most affordable prescription drugs available. This resource is a grant-funded project providing independent, evidence-based reports on prescription drugs based on research conducted at the Drug Effectiveness Review Project,

Consumer Reports Health “translates” findings into consumer-friendly reports that are available for free. These reports identify drugs that are as effective and safe as others in its class but often available at a lower cost, as well as provide information about the underlying condition. These recommended drugs are often generic drugs, but in the case that a brand-name drug is superior to a lower-cost drug in safety or efficacy, it is recommended regardless of price. The reports are freely accessible at Consumer Reports Best Buy Drugs, and also available in a printed booklet. Fill out the form below to request a free booklet get mailed to you. Remember to include your address! 😊

Still need help?

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:

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:

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 61^st through 90^th 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).

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.”

The Centers for Medicare and Medicaid Services (CMS) has released the 2020 costs for a standard Part D prescription drug plans.

Here are the highlights for the CMS defined Standard Benefit Plan changes from 2019 to 2020. This “Standard Benefit Plan” is the minimum allowable plan to be offered by insurance company who has a contract with Medicare to offer Part D prescription drug insurance.

• Initial Deductible:
  will be increased by $20 to $435 in 2020.
• Initial Coverage Limit (ICL):
  will increase from $3,820 in 2019 to $4,020 in 2020.
• Out-of-Pocket Threshold:
  will increase from $5,100 in 2019 to $6,350 in 2020.
• Coverage Gap (donut hole):
  begins once you reach your Medicare Part D plan’s initial coverage limit ($4,020 in 2020) and ends when you spend a total of $6,350 in 2020.
• 2020 Donut Hole Discount:
• Part D enrollees will receive a 75% Donut Hole discount on the total cost of their brand-name drugs purchased while in the Donut Hole. The discount includes, a 70% discount paid by the brand-name drug manufacturer and a 5% discount paid by your Medicare Part D plan. The 70% paid by the drug manufacturer combined with the 25% you pay counts toward your TrOOP or Donut Hole exit point.

For example: If you reach the Donut Hole and purchase a brand-name medication with a retail cost of $400, you will pay $100 for the medication, and receive $380 credit toward meeting your 2020 total out-of-pocket spending limit.

Medicare Part D beneficiaries who reach the Donut Hole will also pay a maximum of 25% co-pay on generic drugs purchased while in the Coverage Gap (receiving a 75% discount).
For example: If you reach the 2020 Donut Hole, and your generic medication has a retail cost of $40, you will pay $10. The $10 that you spend will count toward your TrOOP or Donut Hole exit point.

Minimum Cost-sharing in the Catastrophic Coverage Portion of the Benefit

You will be charged $3.60 for those generic or preferred multisource drugs with a retail price under $72 and 5% for those with a retail price greater than $72.

For brand-name drugs, You would pay $8.95 for those drugs with a retail price under $179 and 5% for those with a retail price over $179.

Maximum Co-payments below the Out-of-Pocket Threshold for certain Low Income Full Subsidy Eligible Enrollees: will increase to $3.60 for generic or preferred drug that is a multi-source drug and $8.95 for all other drugs in 2020. [Read more about these programs]

If you live in Maine or New Hampshire and would like to learn more about the new Medicare plans for 2020 or to go over the changes in your plan, you can call me at (207) 370-0143 or CLICK HERE to send me an email message.

You can also 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 in the mail if you choose.   

Have a question that needs to be answered right away?  You can talk to a licensed insurance agent by calling (207) 370-0143 or toll free 866-976-9038.

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

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

Providers, hospitals, and other facilities

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

Access to health care

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

Costs

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

Extra Benefits

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

Prescription drugs

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

Do you have more questions?

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

IMPORTANT NOTE: Social Security and Medicare do not make phone calls. If either entity needs information from you they will send a letter. They only communicate via the US Postal Service.

“If anyone calls you and asks you for information such as your social security number or Medicare ID number – HANG UP!”

I have been getting a lot of calls recently from clients saying they have been called by someone pretending to work for Social Security or Medicare. They start the conversation innocently enough but then they ask for your Medicare ID number or Social Security number or bank information. If this happens to you – HANG UP!

Social Security and Medicare already have this information. They would never need to ask you for it.

• Hang up. If someone calls claiming to be from Medicare, asking for your Social Security number or bank information to get your new card or new benefits, that’s a scam.
• Don’t give personal information to a caller claiming to be from Medicare. You can’t trust caller id. These calls can be spoofed so they look like they’re coming from Medicare even when they’re not. Before you give any personal information, initiate your own call to Medicare at 1-800-MEDICARE.
• Report the call. Report Medicare imposters at 1-800-MEDICARE or ftc.gov/complaint. The more they hear from you, the more they can help fight scams.

The video below will help you recognize the scammers who ask for your Medicare number so you can get a back or neck brace or who say they need your information or money so you can get a new Medicare card. And you’ll hear from an FTC expert about how to avoid these scams:

The FTC worked with AARP to create a series of videos about imposter scams – including Medicare scams, IRS imposters and robocalls. While the videos are aimed at older Asian Americans and Pacific Islanders, the tips apply to everyone. Watch the video below about how you can protect yourself from Medicare scams: 

For more information about stopping imposter scams, visit ftc.gov/imposters. And to learn about how to stop unwanted calls, including using call blocking technology, go to ftc.gov/calls.

Have more Questions? I can help!

If you would like help finding answers to your 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. I am always happy to help!

The best part about working with me is that it costs you nothing! I am paid by the insurance companies in the form of a commission when I enroll someone in a plan. This is the same way it works when you buy car insurance or your home owners insurance. You do not pay anything to the agent 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.”

If you have a Medicare Advantage plan then you probably have an Over-The-Counter (OTC) benefit.

What is it? And How to use it?

Many of this year’s Medicare advantage plans have an OTC benefit.  This benefit provides each member a monthly fixed amount of money to use to order common over-the-counter items available to order through a catalog or at your local pharmacy. 

If your plan has this benefit you will receive a monthly, quarterly or annual amount to purchase over-the-counter products, including things like:

• Smoking Cessation: Nicotine replacement patches
• Oral Health: Toothpaste, toothbrushes, floss
• Pain Relief: Ibuprofen, acetaminophen
• Allergy: Allergy relief tablets
• Cold Remedies: Cough drops, daytime/nighttime cold medicine
• Digestive Health: Heartburn relief tablets, daily fiber
• First Aid: Bandages
• Incontinence: Bladder control products

The monthly benefit with most plans does not roll over month to month.  In other words, it is a use it or lose it system so make sure you understand how your benefit works.

If you’d like to learn more about what your plan offers or need a copy of the catalog for ordering, use the form below and we’ll call you or you can call us at 207-370-0143.

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]

“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.”

Does Medicare cover transportation?

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

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

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

Some Medicare Advantage plans may cover non-emergency transportation.

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

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

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

The new expanded Medicare Advantage benefits can include things like:

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

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

Original Medicare and non-Emergency ambulance transportation.

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

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

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

Original Medicare and emergency ambulance transportation.

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

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

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

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

Medicare transportation costs.

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

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

Do Medicare Supplement plans cover transportation?

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

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

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

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

Get more from your Medicare coverage.

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

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

Have a quick question? Send an email.

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