Making decisions regarding Medicare can be overwhelming. Not only are there many options, but some information can be unreliable or driven even by commissions. That’s not the case at Specialized Benefit Advisors. Our licensed Medicare advisors are here to help you navigate the options and make the best decision for your specific needs.
We represent the following carriers:
What is Medicare?
Medicare is a federally-administered health insurance program. There are two main types of Medicare – Part A and Part B – which each cover certain healthcare costs. Part A covers inpatient hospital expenses, as well as hospice and home health care. Part B covers other healthcare expenses, like doctor visits, lab tests, and routine preventative care. Collectively, Medicare Parts A and B are referred to as “Original Medicare.”
What is Medicare Advantage?
Medicare Advantage is a type of Medicare plan administrated by private insurance companies who partner with Medicare to provide both Part A and Part B coverage, as well as other benefits such as prescription drug coverage.
Who is eligible for Medicare?
Individuals who are 65 or older are eligible for Medicare, as well as some younger individuals with disabilities or End-Stage Renal Disease.
What is Medicare Part D and is there a late enrollment penalty?
Medicare Part D is the prescription drug benefit component of Medicare and is available to individuals who are enrolled in Medicare Part A and/or B. There is a lifetime late enrollment penalty for Medicare Part D if you choose not to enroll during your initial enrollment period.
When can I enroll in Medicare?
Medicare has 4 enrollment periods:
- Initial Enrollment Period – begins 3 months before your 65th birthday and ends 3 months after the month that you turn 65.
- Annual Enrollment Period – begins October 15 and ends December 7 annually.
- Open Enrollment Period (for Medicare Advantage only) – allows you to make changes to your Medicare Advantage plan from January 1 through March 31.
- Special Enrollment Periods – are available under certain circumstances throughout the year, such as moving out of your existing plan’s service area or retiring from a job that previously provided your benefits.
Can I delay Medicare Part B if I have other coverage?
There are a handful of situations that allow you to delay Medicare Part B penalty-free, like having group health plan coverage through an employer or spouse’s employer, or having TRICARE and being an active duty service member.
What if I wait to enroll in Part B?
Waiting to enroll in Medicare Part B can result in penalties and gaps in coverage.
What is the difference between a Medicare Advantage plan and Medicare Supplement plans?
Medicare Advantage plan offer both Medicare Parts A and B coverage. They may also offer additional benefits like prescription drug coverage, dental, and vision coverage. With Medicare Advantage you will have copays, deductibles, and premiums. Medicare Supplement, or Medigap, is additional insurance that fills the gaps in Original Medicare to help reduce your out-of-pocket expenses.
While both Medicare Advantage and Medicare Supplement are sold through private insurance companies, they cannot be used together. Our agents can help you determine which plan type is best suited for your needs and budget.
When will I get my Medicare ID card?
You can expect to receive your red, white, & blue Medicare card in the mail after you enroll. If you already receive Social Security Benefits you will automatically be enrolled in Medicare when you turn 65 and can expect your card to arrive about 2 months before you turn 65.
How do I order OTC?
Over-the-counter (OTC) drug benefits vary by plan. Some plans may allow you to place a mail order for over-the-counter medications online, over the phone, or by mail. If you have questions regarding how to order OTC for your specific plan, please reach out to an agent.
Can I change my current PCP?
If you are enrolled in a Medicare Advantage plan you will need to choose a Primary Care Physician (PCP) to manage your healthcare and refer you to see specialists depending on the type of plan chosen if HMO or PPO. Changing your PCP is as simple as filling out a form or contacting your insurance plan member services and can be done at any time during the year
How do I get my prescriptions at a lower cost?
Prescription costs vary based on each plan’s formulary. We can review your plan to determine if you have the most cost-effective plan for your needs. Additionally, there are a variety of programs that can help reduce your out-of-pocket drug expenses. We would be happy to meet with you to discuss what options are available and best for you.
Are there any programs available to help with prescription costs and Medicare costs?
Extra Help or Low Income Subsidy is available for help with prescription drugs
Your state offers 4 types of Medicare savings programs:
- Qualified Medicare Beneficiary (QMB) Program
- Specified Low-Income Medicare Beneficiary (SLMB) Program
- Qualifying Individual (QI) Program
- Qualified Disabled and Working Individuals (QDWI) Program
Our agents can help you determine if you qualify for any of these programs and assist you with the application process.
Why do I need additional coverage?
Even with Medicare, you may still have out-of-pocket expenses like copays, deductibles, and premiums. Additional coverage can help fill in the gaps so you end up paying less out-of-pocket. Our agents can help you determine if you need additional coverage and what kind will work best for your needs.
