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

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

Important Update: CARES Act expands use of health accounts

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

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

Common IRS-Qualified Medical Expenses

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

Common Over-the-Counter (OTC) Medicines

Examples include, but are not limited to:

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

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

This list is not all-inclusive:

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

Ineligible Expenses

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

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

Eligible Dependent Care Expenses

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

Ineligible Dependent Care Expenses

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

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

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.

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.

Does Medicare Cover Home Health Care?

Home health care services are a valuable Medicare benefit that provides skilled nursing care, therapy and other aid to people who are largely or entirely confined to their homes.

To be covered, the services must be ordered by a doctor, and a home health agency that Medicare has certified must provide the care.

Medicare (Part A and/or Part B) typically covers the following home health services:

• Part-time or “intermittent” skilled nursing care such as changing wound dressings, feeding through a tube and injecting medicine, provided on a part-time or intermittent basis. Your combined home nursing and personal care cannot exceed eight hours a day or 28 hours a week, except in limited circumstances. If you need full-time or long-term nursing care, you probably will not qualify for home health benefits.
• Home health aides to assist with personal activities such as bathing, dressing or going to the bathroom if such help is necessary because of your illness or injury. Medicare covers these services only if you also are getting skilled nursing or therapy.
• Occupational, physical and speech therapy with professional therapists to restore or improve your ability to perform everyday tasks, speak or walk in the aftermath of an illness or injury or to help keep your condition from getting worse.
• Medical social services such as counseling for social or emotional concerns related to your illness or injury if you’re receiving skilled care and help finding community resources if you need them.
• Medical supplies such as catheters and wound dressings related to your condition when your home health agency provides them. This might also include durable medical equipment from the home health agency, such as walkers or wheelchairs, but for those Medicare does not pay the full cost. You usually are responsible for 20 percent of the Medicare-approved amount.
• Osteoporosis drugs for women that are injected – Medicare helps pay for an injectable drug for osteoporosis and visits by a home health nurse to inject the drug if you meet these conditions

Generally, your home health care agency coordinates the services the doctor orders for you.

Medicare does not pay for:

• 24-hour-a-day care at home
• Meals delivered to your home
• Homemaker services (like shopping, cleaning, and laundry), when this is the only care you need
• Custodial or personal care (like bathing, dressing, or using the bathroom), when this is the only care you need

Note: If you have a Medicare Advantage plan, your plan may cover some services not covered by original Medicare. Check with your insurance agent to ask what home healthcare benefits may be covered by your plan.

Who is eligible?

To be eligible for Medicare home health benefits, you must meet all of these conditions: 

• You are home bound. That means you are unable to leave home without considerable effort or without the aid of another person or a device such as a wheelchair or a walker.
• You have been certified by a doctor, or by a medical professional who works directly with a doctor (such as a nurse practitioner), as being in need of intermittent occupational therapy, physical therapy, skilled nursing care and/or speech-language therapy.
• That certification arises from a documented, face-to-face encounter with the medical professional no more than 90 days before or 30 days after the start of home health care.
• You are under a plan of care that a doctor established and reviews regularly. The plan should include what services you need and how often, who will provide them, what supplies are required and what results the doctor expects.
• Medicare has approved the home health agency caring for you.

You’re not eligible for the home health benefit if you need more than part-time or “intermittent” skilled nursing care. You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services. You can still get home health care if you attend adult day care.

Your costs with Original Medicare

• $0 for home health care services.
• 20% of the Medicare-approved amount for durable medical equipment (DME) .

Before you start getting your home health care, the home health agency should tell you how much Medicare will pay. The agency should also tell you if any items or services they give you aren’t covered by Medicare, and how much you’ll have to pay for them.

This should be explained by both talking with you and in writing. The home health agency should give you a notice called the Advance Beneficiary Notice before giving you services and supplies that Medicare doesn’t cover.

Medicare’s website has a search and comparison tool to help you find certified home health agencies in your area. If you have original Medicare, Parts A and B, you can choose any approved agency.

Medicare Advantage (Part C)

If you have a Medicare Advantage plan from a private insurance company, you may have to use an agency that is in the plan’s network.

Before you start receiving care, the agency should let you know, verbally and in writing, whether some of the services they provide are not covered by Medicare and what you would pay for them.

Have more questions?

Use the form below to ask for more information.

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COVID-19 Special enrollment period available to those affected by the pandemic.

On March 13, 2020, President Trump declared a nationwide emergency pursuant to Sec. 501(b) of Stafford Act to avoid governors needing to request individual emergency declarations.

The Centers for Medicare & Medicaid Services (CMS) on May 5th issued a memorandum that clarifies the exceptional conditions that qualify for a special enrollment period (SEP) for individuals affected by a FEMA declared weather related emergency or major disaster.

The agency said that the Special Enrollment Period (SEP) is applicable and available for beneficiaries who were eligible for, but unable to make, an election because they were affected by the ongoing public health crisis.

This SEP is available nationwide to residents of all states, tribes, territories, and the District of Columbia as of March 1 if you were unable to and did not make an election during another valid election period as a result of the emergency. This includes enrollment and disenrollment elections.

How do you know if you qualify?

CMS considers individuals as “affected” and eligible for this SEP under FEMA if you:

• Reside, or resided at the start of the incident period, in an area for which FEMA has declared an emergency or a major disaster and has designated affected counties as being eligible to apply for individual or public level assistance;
• Had another valid election period at the time of the incident period; and
• Did not make an election during that other valid election period.
• Mulcahy also said the SEP is available to individuals who do not live in the affected areas but rely on help to make health care decisions from friends or family members who live in the affected areas.

The SEP is available from the start of the incident period and for four full calendar months after the start of the incident period from March 1 to June 30, 2020.

You will receive one opportunity to make that missed election because of this SEP.

Further, you do not have to provide proof that you were affected by the pandemic-related emergency.

If your insurance representative is unaware of this SEP, they should refer to the following sections in posted manual guidance for details on the SEP:

• Section 30.4.4.18 of Chapter 2 (Medicare Advantage Enrollment and Dis-enrollment) of the Medicare Managed Care Manual.
• Section 30.3.8.17 of Chapter 3 (Eligibility, Enrollment and Dis-enrollment) of the Medicare Prescription Drug Benefit Manual.

Frequently asked questions and answers for this SEP are available at the following links on the CMS website. These will address issues such as eligibility for the SEP and how to enroll:

Questions and Answers on the Medicare Managed Care Eligibility and Enrollment webpage.
Questions and Answers on the Medicare Prescription Drug Eligibility and Enrollment webpage.

Need help enrolling or have more questions?

Use the form below to get help.

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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.

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.

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 find out how Veterans are winning 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.

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.

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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.

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.”

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.

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.

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.