Medicare Basics:The maze we call


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?

Email me today!

...I get to the pharmacy and they tell me my prescription is $250, not the $45 co-pay I was expecting.


There are co-pays or cost sharing for most drugs. Each carrier's plan has a list of covered drugs called Formularies. Your plan's Formulary may not cover the drug that a doctor has prescribed. As a  patient, it is your responsibility to be aware of the possible cost.


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.

What If...

...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 around

$ 230.00, unless a clinic in your area has a discounted program.

What If....

What if...

...I think I should have Medicaid, along with my Medicare?


The Medicare Savings Program uses Medicaid funds to help eligible persons pay for all or some of their out-of-pocket Medicare expenses, such as 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.
Click this link for income levels:


Texas Health and Human Services

What If...

...I'm just confused?

Call or email me now. I can help you understand your situation and discuss your next steps. Click the "Talk To Me" button on this page or contact me or 512-329-3210.


What If...

...I just want to research various questions on Medicare?

Check out the government website. Their search tool is very good.