the authoritative resource for Senior Services

Licensed representatives are often provided with contact information for seniors who have requested information from a carrier or other resource, so it isn’t unusual to hear from a local agent that you may not know. However, you should end the call if you feel rushed to decide or are asked to make a payment over the phone. Otherwise, the caller should be providing you information at no charge.

Medicare Part D will pay for some, or all, of your prescription drug costs. If you enroll in Medicare Part D and have limited income and resources, you may be able to get extra help from this program.

Medigap provides private health insurance that covers Original Medicare payment “gaps.” Medigap will pay for co-payments, coinsurance, and deductibles. Additionally, insurers with OGM see a benefit when purchasing a Medigap policy to supplement their Medicare benefits. Medigap policies will not work with MA plans so an enrollee would need to switch back to OGM. You must also note that some insurers work for employers or unions that pay for additional insurance that Medicare policies don’t cover. The plans (which are known as F, G, K, L, M and N) offer different benefits. Some companies charge more for the exact same plan even though the benefits of each plan with the same letter designations are the same.

A special needs plan (SNP) is a Medicare Advantage coordinated care plan (CCP) designed to provide targeted care and limit enrollment to special needs individuals. A special needs individual could be any one of the following:

• An institutionalized individual,
• A dual eligible* or
• An individual with a severe or disabling chronic condition, as specified by CMS.

*Dual Eligible Special Needs Plans (D-SNPs) enroll individuals who are entitled to both Medicare (title XVIII) and medical assistance from a state plan under Medicaid (title XIX). States cover some Medicare costs, depending on the state and the individual’s eligibility.

Medicare is the nation’s health insurance program for people aged 65 or older. Those younger than age 65 can qualify for Medicare too, including those with disabilities and those who have permanent kidney failure.

OGM helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care. You have choices for how you get Medicare coverage. If you choose to have Original Medicare (Part A and Part B) coverage, you can buy a Medicare Supplement Insurance (Medigap) policy from a private insurance company.

• Medicare Part A helps pay for inpatient care in a hospital or limited time at a skilled nursing facility following a hospital stay). Part A also pays for some home health care and hospice care.
• Medicare Part B helps pay for services from doctors and other health care providers, including outpatient care, home health care, durable medical equipment, and some preventive services.

Other parts of Medicare are run by private insurance companies that follow rules set by Medicare, known as Medicare Advantage (MA).

• Supplemental (Medigap) policies help pay Medicare out-of-pocket copayment, coinsurance, and deductible expenses.
• MA Plans (previously known as Part C) include all services covered under Part A and Part B, as well as prescription drugs and additional benefits bundled into one plan. Additional benefits would include vision, hearing, and dental.
• Medicare Part D (Medicare prescription drug coverage) helps cover the cost of prescription drugs.

As of 2020, Medicare Advantage plans are authorized to offer innovation benefits, including transportation to doctor’s appointments. Medicare Advantage is another way to get your Medicare Part A and Part B benefits through a private insurance company approved by Medicare. To find out if your plan covers this, or if you are eligible to add a plan including transportation please contact our advisors, who are glad to assist at no charge.

Original Medicare (Part A and Part B) generally does not cover transportation to get routine health care. However, it may cover non-emergency ambulance transportation to and from a health-care provider. You need to have a health condition diagnosed or treated and other forms of transportation could endanger your health. Your doctor must provide a written order verifying that ambulance transportation is medically necessary because of your health condition.

For beneficiaries who do not qualify for non-emergency ambulance transportation, there may be non-Medicare transportation services available in their immediate area through local organizations. For instance, your local Area Agency on Aging (AAA) may be able to help you find transportation to and from your health-care provider.

If you are eligible for Medicaid or Program of All-Inclusive Care for the Elderly (PACE), these organizations may also provide transportation for routine medical care. Visit www.Medicaid.gov or www.Pace4you.org for more information.