Medicare Basics: Fitting together all the pieces to the puzzle we call Medicare
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With decades of experience as a caregiver and insurance professional I help fit the puzzle pieces together and determine how Medicare coverage might work for you. When you are Medicare eligible, we will review your options. If you are currently Medicare eligible, even if you have been enrolled for years, we can review everything.
Over 48% of those enrolled in Part D overpay for their coverage and their drugs, sometimes by hundreds of dollars. Is it time for a review of your policies?
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...I received a bill from my primary doctor for my Shingles vaccine. Isn't this a Preventative Benefit?
Common flu and pneumonia vaccines are covered as a Preventative Service under Medicare, but not the Shingles vaccine. Perhaps in the future but currently the average cost is less than $ 200.00. Shop!
I think I should get help from Medicaid, along with my Medicare?
The Medicare Savings Program uses Medicaid funds to help eligible persons pay some out-of-pocket Medicare expenses, such as Part B premiums, deductibles, or coinsurance. For example:
1. (QMB) the Qualified Medicare Beneficiary Program pays Medicare premiums, deductibles, and coinsurance for a person who meets the requirements.
2. (SLMB) the Specified Low-Income Medicare Beneficiary Program pays only Medicare Part B premiums for a person who meets the requirements.
3. (QI) the Qualified Individual Program pays only Medicare Part B premiums to a person who meets the requirements.
4. (QDWI) the Qualified Disabled and Working Individual Program pays only Medicare Part A premiums for a person who meets the requirements.
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I get to the pharmacy and they tell me my prescription is $250, not the $50 co-pay I was expecting.
There are co-pays or cost sharing for most drugs depending on what stage of your Part D coverage you are in. Call your plan for details Each carrier's plan has a list of covered drugs called a Formulary. The plan's Formulary may not cover the drug that a doctor has prescribed. It is the patient's responsibility to be aware of the possible cost. The doctors job is to give you the very best medication and advice.
Know where to find your plan's current Formulary. Be prepared to discuss alternatives if that drug is not covered. There are times that a drug is covered, but not listed on the Formulary, so call your plan to double check. Be prepared to pay cash if it is not listed. The newest drugs in a category could cost upwards of $ 1300.00 for a month’s supply.