Frequently Asked Questions

The first step I take with my prospects and clients is to go to the Medicare.gov website and input their prescription drugs to determine which plans will cover their medication in it’s formulary and estimate the monthly expense.

For Medicare advantage prospects or clients, the next step is to check if their doctors and medical facilities are in the specific plan’s networks.

For Medicare Supplement prospects and clients, I run multiple quotes from my quote engine and compare Premiums, Industry Ratings, Rate History and pertinent market data.

The Last step is to determine any financial advantage between any 2 plans. The way I help clients do this is to write down all their anticipated medical visits and procedures for the year, then we plan for a few unexpected emergencies for good measure.  Once we have our list, we price out what the different co-pays will be for each plan we are considering.  The last step is to annualize the premium for each plan.  Once you total all the cost, you can determine which plan might have a financial advantage.

Most seniors can not avoid the donut hole. Only those with low incomes can qualify and get “Extra Help” or “LIS” from Social security and will get any help paying prescriptions through the donut hole.

About 80% of Seniors have a annual combined prescription drug usage of $3,700 and therefor do not enter the donut hole.  However, once in the donut hole, the Drug manufacture will discount 60% for Brand names and 49% for Generic.  Seniors will exit the donut hole once their total annual out of pocket expense for prescriptions exceeds $4,950.   At that point they have entered catastrophic coverage and co-pays for all covered drugs will be just a few dollars per month.   Seniors are encouraged to visit Medicare.gov and use the interactive tool to estimate prescription drug costs and coverage.

 

Yes.  All plans offer Emergency and Urgent care across the United States.

Some Medicare Supplement plans (C,D,F,G,M & N) offer foreign travel emergency care with limits

It is very important to understand the difference between Medicare Supplement Plans and Medicare Advantage plans. A Medicare Supplement Plan (AKA :  Medi-Gap plans) are designed to work in conjunction with Original Medicare and offer financial protection for seniors by covering the gaps (Deductibles or co-insurance) in Original Medicare. It is a secondary insurance that your provider will bill for the roughly 20% that Medicare does not cover.  As long as the doctor and facility take medicare, they will honor your policy as long as it has not lapsed.  Premium are locked in for a year and are guaranteed renewable but subject to annual age up increases.  Every 2-4 years insurance companies may increase their entire book of business across the board, but usually no more than 3-6%.  You are free to change your Insurance Company and/or Medicare Supplement Plan at anytime provided you can pass underwriting.  Medicare Supplements no-longer are offered with Drug coverage. Seniors need to enroll in a Medicare Rx Plan or they are subject to a penalty.

Medicare Advantage Plans are Medicare replacement plans offered by private insurance companies and vary from State to State. Plans are equally offered, regardless of age, to all medicare recipients as long as they do not have end stage renal disease. They usually offer affordable co-pays within their HMO or PPO provider Networks.  Most of these health plans offer a embedded prescription drug plan at one low premium.  All plans are required to cap expenses with an out of pocket maximum any where from $3,400-$6,700. Some plans offer extra benefits like Dental, vision and Gym memberships to add value to their plans. Plans are subject to change annually and therefor the Federal Government allows an Annual Election Period (AEP) for Seniors to reevaluate their changing needs.