What is a Medicare PPO (Preferred Provider Organization)?
A Medicare PPO, or Medicare Preferred Provider Organization, is a type of Medicare Advantage plan. It’s different from other Medicare Advantage plans because while you will select one Medicare preferred provider (doctor), you will have the freedom to use other doctors. Your costs will be cheaper if you use doctors, hospitals, and specialists that are within your PPO network, but you do have the freedom to see several different doctors.
What is Medicare Advantage (MA)?
Medicare Advantage plans are owned and operated by private companies instead of the federal government. This means that though they cover everything that Original Medicare covers, they are allowed to add additional benefits like dental, vision, non-emergency transportation, and even physical fitness.
MA is great for people who are looking for ways to save money on healthcare and have coverage for specialty healthcare services.
Medicare PPO plans are just one type of Medicare Advantage. They are called Medicare “Preferred Provider Organization” plans because even though you will select one provider that is “preferred,” you do have the freedom to see other doctors. This is a huge “pro,” especially for people who see multiple specialists for different healthcare concerns.
It is also a convenient option for people who are not comfortable with the idea of having a strict plan network. If you want to get a second opinion on a health concern, or if you decide you want to switch doctors, it will be easier to do so with a PPO than if you had an HMO plan model.
The downside to having a PPO plan is that PPO options are typically more expensive than other plan types. PPOs usually have higher co-payments; this is the cost of flexibility. A Medicare PPO will usually have a co-payment averaging between $10 and $15 per office visit.
Medicare HMO vs PPO
As mentioned, HMO (Health Maintenance Organization) plans are generally cheaper than PPOs. They are different because HMOs require you to select one primary physician that you visit for all of your healthcare needs; you won’t be able to visit another doctor without a referral.
In most cases, HMOs do not require co-payments when you visit your primary physician. Ultimately, your HMO vs PPO decision will come down to whether costs or flexibility are more important to you.
There are very few eligibility limits for Medicare PPO plans. As long as you are eligible for Medicare and reside in an area where a Medicare Advantage PPO plan is available, you probably qualify.
This means that you can qualify for a PPO if you are age 65 or older, have ALS (Lou Gehrig’s Disease), or have been receiving SSDI (Social Security Disability Insurance) for at least 25 months. The only exception to this is for some people who have ESRD (End-Stage Renal Disease). ESRD is the only pre-existing condition that Medicare Advantage PPO plans do not typically cover.
Most PPO plans will charge a monthly premium (in addition to your Part B premium). Costs will vary significantly based on the amount of coverage your plan includes.
For example, a plan that includes prescription drug coverage will have a much higher premium than a plan that does not. You will then have co-payments for most medical services which can range from as little as $10 for a doctors appointment or prescription and up to hundreds for hospital services and procedures. However, there are usually limits on how much you will be asked to pay out of pocket with your PPO plan. This can easily range from $1,000 per year to $4,000 per year or more. Once you hit your out-of-pocket limit, you will be fully covered.
Medicare Advantage PPO Plans Near You
Ready to find a Medicare Advantage PPO (or HMO) plan available in your area? Plans vary by county, city, and even zip code. We can help you look at the options available in your area. To get started, send us a message or give us a call at 844-431-1832.
The Shocking Truth: Does Medicare Cover Vision Care?
Nearly one in three older adults over the age of 65 suffer from some form of vision-reducing eye disease. These diseases include glaucoma, macular degeneration, cataracts, and diabetic retinopathy.
As you age, your risk for these diseases increases. However, Original Medicare does not include a comprehensive vision benefit. Understanding Medicare vision coverage allows you to protect your aging eyes and save money in the long run.
Does Medicare cover vision?
Does Medicare Cover Vision? | Medicare Plan Finder
Your vision is important, and we want to help you understand what Original Medicare (Part A and B) does and does not cover. If you have any additional questions, you can fill out this form, and a licensed agent will get back to you.
Does Medicare cover eye exams and glasses?
Generally, Medicare does not cover eye exams or glasses. This means that if you are only enrolled in Original Medicare (Part A and B) you will have to pay 100% of your costs, including the fees to have your frames fitted.
However, if you had cataract surgery to insert an intraocular lens, Medicare Part B may pay for corrective lenses. This can include a pair of glasses or contact lens, but you must get them through a Medicare supplier.
Medicare will cover the corrective lenses even if you had the cataract surgery before enrolling in Medicare. Plus, both lenses may be covered if you only had cataract surgery on one eye.
If your situation applies, you will pay 20% of the Medicare-approved costs after reaching your Part B deductible. If you want upgraded frames, you will be required to cover the additional cost.
Does Medicare cover eye care?
Routine eye exams, also known as refraction tests, are not covered by Medicare. However, if you have diabetes, your eye exam may be covered. Glaucoma tests and macular degeneration tests are often covered too. If you want coverage for eyeglasses, contacts, and exams, you should consider Medicare Advantage plans.
Medicare Advantage and Vision Coverage
Medicare Advantage plans must cover, at a minimum, the same benefits as Original Medicare. Medicare Advantage plans are growing in popularity because they can offer vision, hearing, and dental coverage.
Benefits will vary by plan, but an MA plan can cover routine eye exams, eyeglasses, contacts, and fittings. There are a few different types of MA plans, but if you are looking for vision coverage, a Medicare Advantage PPO is a good option. These are ideal because even though there is a network you should stick to, you have the freedom to see other providers.
You may not get as much coverage as you would by seeing in-network providers, but at least you have the option to visit a multitude of eye doctors. Want to learn more? Fill out this form, and we are happy to answer any of your questions.
Does Medicare Cover Vision Care? | Medicare Plan Finder
Glaucoma Treatment
Glaucoma is the cause of roughly 20% of blindness in the US. Most glaucoma cases occur in people over the age of 65. Glaucoma occurs when there is a build up of pressure in your eye. The pressure damages the major transmitter from your eye to your brain, also called the optic nerve.
There are a few different kinds of glaucoma based on how the pressure is accumulated into your eye. The main type of glaucoma is open-angle glaucoma and accounts for 90% of cases.
To treat glaucoma, your eye doctor may recommend eye drops to help relieve pressure. Another option is medication, usually a pill, that can work alongside eye drops to relieve the pressure.
The eye drops are typically used as short-term relief while the medications aim to work long-term and attack the parts of your eye that are contributing to the disease. The last resort to combatting glaucoma is surgery.
Is glaucoma testing covered by Medicare?
Part B covers a glaucoma screening once per year for those who are considered high-risk. You are considered high risk if one of the following applies:
You have diabetes
You have a family history of glaucoma
You are African American and 50+
You are Hispanic American and 65+
You will pay 20% of the cost for the screening after you reach your deductible. If you get the test in an outpatient setting in a hospital, you may also have a copayment.
Age-Related Macular Degeneration Treatment
Age-Related Macular Degeneration (AMD) is the leading cause of severe vision loss in adults over 50. Caucasians have a higher risk of developing AMD and it is more common in women than men.
AMD occurs when there are changes to the macula (a small portion of the retina). There are two different types of AMD – “dry” and “wet”.
There is no treatment for “dry” AMD because the tissue in the macula becomes extremely thin and eventually stops working. “Wet” AMD occurs when the blood vessels leak fluids under the macula. If detected early, “wet” AMD can be treated with laser surgery.
Is Macular degeneration covered by Medicare?
Part B covers certain tests and treatments related to macular degeneration. This includes injection-based drug treatments. If you have age-related macular degeneration, you may be covered. If you are eligible, you will pay 20% for outpatient services after you reach your deductible.
Cataract Treatment
Man Discussing Cataract Treatment With His Doctor | Medicare Plan Finder
All of our eyes have a natural lens. The lens bends light rays that are directed at our eyes to help us see. The lens should be clear. If you have a cataract, the lens is cloudy. This makes your vision look blurry or hazy.
Prescription glasses can be used to correct your vision if the cataract is minor. However, sometimes glasses aren’t enough and cataract surgery is the most effective treatment. The operation involves removing your clouded lens and replacing it with a clear, artificial lens.
What does Medicare pay toward cataract surgery?
Medicare will only cover your cataract surgery if a doctor says it’s medically necessary. Medicare will also cover the related doctor visits after surgery. Unless you have a Medicare Supplement plan, you will be responsible for certain costs including deductibles, copayments, and coinsurance. To learn more about Medicare Supplement plans, send us a message!
Diabetic Retinopathy Treatment
Diabetic retinopathy occurs when the tissues in your retina are affected by blood vessels from high blood sugar. It is the most common eye disease among people with diabetes.
The vision loss from diabetic retinopathy is often irreversible, but early detection can reduce your risk by 95%. Treatment can include blood glucose management through a healthy diet, surgery, and medications like blood vessel growth inhibitors and steroids.
Does Medicare cover diabetic retinopathy?
As we mentioned, Medicare does not cover routine eye exams. However, Part B will cover an annual vision exam to check for diabetic retinopathy if you are enrolled in Part B, have diabetes, and the test is approved by an approved Medicare provider.
Other Vision Coverage Options
If you don’t want Medicare Advantage, you can purchase separate vision plans for seniors and Medicare eligibles. Vision policy premiums vary but are based on your age, health, and family history (disease risk). Most vision plans start at around $15 per month, but yours may be different. You may be able to save money by purchasing a vision plan that is combined with another benefit, like dental.
Private vision plans for seniors and Medicare eligibles and Medicare Advantage vision coverage both usually include annual exams, discounts for surgeries and services, and a specific allowance for glasses and contact lenses. Allowances will vary based on the plan you choose.
Losing Eyesight? Get Coverage!
If you are losing eyesight, now is the time to get vision coverage. Even if you have the healthiest eyes, Medicare Advantage plans can help you become the healthiest version of you.
Beyond vision coverage, they can also include dental and hearing coverage. Plus, some may offer fitness classes like SilverSneakers®! Our licensed agents can help you find the perfect plan that fits your needs and budget. Call us at 844-431-1832 or click here to get in touch with an agent!
Medicare Advantage | Medicare Plan Finder
Medicare for Diabetics and Diabetes Management
Diabetes is one of the largest health issues facing America and affects over 12 million older adults. In fact, the World Health Organization estimates that diabetes will be the seventh leading cause of death by 2030. The risk of developing diabetes increases with age, so it’s important to understand the role of Medicare and diabetes management.
Medicare for Diabetics and Medications
Medicare and Diabetes
If you are diabetic, or even pre-diabetic, your doctor may prescribe you medications like:
Metformin
Glucophage
Glumetza
Sulfonylureas
Meglitinides
Thiazolidinediones
Original Medicare (Part A and B) does not cover prescription drugs. If you are diabetic, you could end up having a high out-of-pocket cost for your medications. A Part D plan is a great alternative to help you save money and get the coverage for medications you need.
You can enroll in a Part D plan on top of your Original Medicare or purchase a Medicare Advantage plan. Medicare Advantage plans can offer benefits like prescription drug coverage, hearing, vision, or dental coverage and even things like meal delivery and transportation to doctor appointments or the pharmacy.
Does Medicare cover insulin?
Insulin can be divided into Original Medicare will only cover insulin that is needed for an external insulin pump and may be covered as Durable Medical Equipment.
Without insurance, the most popular form of insulin (Lantus) can cost over $500. According to GoodRx, the average copay for Lantus is $37.50-$67.70 with insurance.
Original Medicare does not cover other forms of insulin including pens, syringes, or needles. If you need other forms of insulin, a Part D plan or a Medicare Advantage plan with a prescription drug benefit can help!
What does Medicare cover for diabetics?
Medicare Part B covers diabetes self-management training (DSMT) for those who were recently diagnosed. Part B will also cover:
However, there may be limits on how much or how often you can get these supplies.
Medicare Part D covers diabetes supplies including:
Syringes
Needles
Alcohol swabs
Gauze
Inhaled insulin devices
Diabetic Supplies Delivered Directly to Your Door
You can get your diabetic supplies delivered directly to your door. However, you have to use an approved Medicare mail-order supplier if you want to utilize your Medicare coverage. If you prefer to purchase your supplies in a store, Medicare will cover the costs if you buy them at a Medicare-enrolled store or pharmacy.
Types of Diabetes and Symptoms
Patient with Diabetes and Medicare
If you are diagnosed with diabetes, it means that your body struggles to process the sugars in the foods you eat. As a result, your blood sugar levels rise. This means your body cannot produce enough insulin (or produce it in the right way) depending on which type of diabetes you have.
Type 1
Type 1 occurs when your pancreas cannot produce insulin (a hormone produced in the pancreas which regulates the glucose in your blood). It is typically developed at a young age and accounts for less than 10% of cases. If you have type 1, you will need to balance your blood sugar with insulin doses through a shot, pen, or pump. You will also need to pay close attention to the foods you eat and your daily activity level
Warning signs and symptoms of type 1 diabetes include:
Going to the bathroom more frequently
Being thirstier
Having mood changes
Struggling to see or other vision problems
Feeling fatigued
Losing weight without a change in diet or exercise
Type 2
Type 2 is the most common type of diabetes and accounts for 90% of diabetic patients. On the bright side, it is the most preventable and treatable form of diabetes. Unlike type 1, people with type 2 can produce insulin, just usually not enough. This means insulin shots, pens, or pumps may not be needed. Instead, you can monitor your blood sugar and manage insulin levels through medication.
The warning signs and symptoms of type 2 are very similar to type 1, they just take longer to develop. These symptoms include frequent urinating, thirst, mood changes, vision issues, fatigue, and unexplained weight loss. Some symptoms can take several years to surface which means regular check-ups and monitoring your blood sugar levels is crucial, especially if you are diagnosed with prediabetes.
Another sign of type 2 is prediabetes. If you are prediabetic, you probably have high blood sugar, and your body will start to reject insulin slowly. However, your blood sugar levels are not high enough to be considered type 2 diabetic just yet. Eating better, exercising, and losing weight can help prevent the development of type 2 diabetes in the future.
Effects of Diabetes
All types of diabetes should be taken seriously as they can have severe complications and effects on your body. Without proper treatment and management, diabetes can lead to the following health issues:
Heart Disease
Diabetes can raise your blood pressure and cholesterol. Nearly 75% of people with diabetes suffer from some sort of heart-related condition. This can include heart attacks, stroke, coronary heart disease, and many more.
Kidney Damage
Your kidneys are full of small blood vessels. Diabetes can damage these vessels, which impacts your kidney’s overall function. According to the National Kidney Foundation, 30% of type 1 diabetes patients will experience kidney failure.
Hypoglycemia
Hypoglycemia is when your blood sugar levels reach a dangerously low level. These low levels can result in falls, seizures, or even cause you to enter a coma.
Nerve Damage
High blood sugars can make it difficult for your blood vessels to take blood to certain parts of your body. If blood does not get to certain nerve endings, they can be partially or permanently damaged.
Eye Damage
Blurry vision is a warning sign of diabetes. This is because the blood vessels attached to your retinas are getting damaged. If diabetes is left untreated, this condition could worsen.
How to Test for Diabetes
If you have a body mass index over 25, are older than 45, or have been diagnosed with prediabetes, you should be tested for diabetes annually. The most common tests are as follows:
Glycated Hemoglobin (A1C) Test
This blood test shows your average sugar levels for the past 2-3 months. It measures the percentage of sugars attached to hemoglobin (an oxygen-carrying protein in red blood cells). The higher level of blood sugars equates to the higher number of hemoglobin with attached sugars. Two A1C tests of levels greater than 6.5% indicate diabetes. One A1C test between 5.7% and 6.4% indicates prediabetes. Anything under 5.7% is normal.
Random Blood Sugar Test
A random blood sugar test is exactly that – random. There is no fasting and it does not matter when (or what) you last ate. A blood sugar level of 200 mg/dL or higher indicates diabetes.
Fasting Blood Sugar Test
This test requires you to fast overnight. The next morning you take a blood sugar test. Sugar levels less than 100 mg/dL is normal. Anything between 100 and 150 mg/dL indicates prediabetes. If you take two separate tests at different times, and the results are over 126 mg/dL, you may have diabetes.
Oral Glucose Tolerance Test
This test requires you to fast overnight and check your blood sugar levels the next morning. Directly after, you will drink a sugary liquid. Over the next two hours, you will check your levels again. A level of less than 140 mg/dL is normal. After two hours, a level between 140 and 199 mg/dL indicates prediabetes, and anything over 200 mg/dL indicates diabetes.
How to Prevent Diabetes
You can’t change your genes, age, or past behavior, but you can take control of other factors, including:
Exercise: Did you know losing 10 kg (about 22 pounds) over a ten year period can lower your risk of diabetes by 33%? You should aim to get 30 minutes of exercise at least five days a week. If you haven’t been active, start slowly and work towards an overall goal.
Diet: A diet that is high in nutrients and low in glycemic loads are great for preventing diabetes. Green vegetables, beans, nuts, seeds, and fruit can help maintain your blood sugar. However, foods with added sugars, refined grains, and trans fats can have the opposite effect. Avoid fried foods and red meats when possible. Try a healthy soup!
Stress Less/Sleep More: When you are sleep deprived or have unusual sleep patterns, you increase your risk of obesity. As we previously mentioned, obesity plays a large factor in developing diabetes. Stress can impact your sleep schedule and make you toss and turn in the night. Plus, stress releases several hormones that increase your blood sugar. Pay attention to your sleep patterns and stress levels and visit a doctor if you have continued issues.
Diabetes and Medicare Coverage
Diabetes costs America more than $327 billion every single year. If you are diagnosed with diabetes, you may have high out-of-pocket costs. As we mentioned, Part D and Medicare Advantage plans can help save you money and provide the benefits and coverage you need. If you have any questions, or interested in enrolling in a Part D or MA plan, fill out this form or call us at 844-431-1832.
Pneumonia in the Elderly: Causes, Treatment, and Prevention
According to the Centers for Disease Control and Prevention, more than three million Americans develop pneumonia each year. As you age, your risk of developing this infection increases.
Pneumonia can cause serious complications in older adults and can even be fatal. Take this time to educate yourself on the causes, symptoms, treatment, and prevention of pneumonia in the elderly.
What Is Pneumonia?
Doctor Reviewing Lung X-Ray With Patient | Medicare Plan Finder
Pneumonia is an infection that results in the inflammation of air sacs in one or both of your lungs. The tiny sacs fill with fluid and disrupt the process your lungs use to create oxygen. As a result, you may have difficulty breathing. If left untreated, vital organs may not receive enough oxygen, bacteria can enter your bloodstream, and fluid can surround your lungs.
There are two main types of pneumonia – bacterial and viral. Bacterial pneumonia occurs when your immune system is weak from illness, poor nutrition, or age, and bacteria infiltrates your lungs.
If you smoke, abuse alcohol, have a respiratory disease, or have recently had surgery, you have a higher risk because your immune system is weakened. Viral pneumonia is caused by a virus, most commonly the influenza (flu) virus, and is responsible for roughly one-third of all pneumonia cases. Both types can range from mild to life-threatening.
What Causes Pneumonia in Elderly Patients?
According to the American Lung Association, there are more than 30 different bacterias, viruses, and fungi that lead to pneumonia. When pneumonia starts to spread through your lungs, your white blood cells will attack the germs. The area will become inflamed.
What Are the Symptoms of Pneumonia in Elderly Patients?
Bacterial and viral pneumonia have different symptoms, and can often be confused with bronchitis or the flu. Bacterial pneumonia can make your temperature rise as high as 105 degrees and cause excessive sweating, a high heart rate, and heavy breathing. Your lips and nails may develop a blue tint from the lack of oxygen. Other bacterial symptoms include:
Green, yellow, or bloody mucus
Fever
Loss of appetite
Low energy
Chills
Chest pain when breathing or coughing
Shortness of breath
On the other hand, the initial symptoms of viral pneumonia have the same symptoms of the flu. Within 36 hours, you may see a small amount of mucus and you may also see a blue tint on your lips. Other viral symptoms include:
Headaches
Muscle pain
Weakness
Worsening cough
Shortness of breath
Pneumonia in Elderly Recovery Time
The average healthy person can recover from pneumonia in one to three weeks, but depending on your immune system, recovery can last weeks or even months.
Coughing is the primary way to get the infection out of your body, and it takes a lot of your energy. Once you clear the infection, it can still take several more weeks to regain your strength.
Pneumonia in Elderly Survival Rate
Pneumonia can form very quickly and can rapidly spread to other parts of your body. The disease puts your immune system into overdrive and your body cannot create enough oxygen for your vital organs. Pneumonia can also worsen the symptoms of your other ailments, like heart disease.
Pneumonia in Elderly With Dementia
Dementia usually refers to a decline in mental ability that seriously impacts a person’s everyday life. Short-term memory loss and confusion and are most common when dementia results from an injury or an infection such as pneumonia.
According to the Alzheimer’s Association, the symptoms of dementia can be different in every person. However, a person may have dementia if two or more of the following functions are impaired significantly:
Memory
Ability to communicate
Ability to focus and pay attention
Reasoning and judgment
Visual perception
Pneumonia in Elderly With COPD
People with chronic lung disease may be more susceptible to pneumonia. The combination of COPD (chronic obstructive pulmonary disease) and pneumonia is particularly dangerous because it presents an increased risk of respiratory failure, which means that your body can’t get enough oxygen or can’t successfully remove carbon dioxide.
If you have COPD and think you might have symptoms of pneumonia, be sure to call your doctor right away.
Pneumonia Treatment
Doctor’s Appointment | Medicare Plan Finder
A doctor can determine if you have pneumonia through physical exams, chest x-rays, blood tests, CT scans, and other tests. Depending on the severity and type of infection there are several treatment options. Most cases can be treated at home with a combination of antibiotics, hydration, fever control, and rest.
However, some cases may require hospitalization. If hospitalized, you will likely receive fluids and antibiotics through an IV as well as breathing treatments and oxygen therapy.
Your risk of being admitted increases if you have another serious medical problem, more severe symptoms, or if you have been taking antibiotics at home and are not recovering.
Can Pneumonia Heal on Its Own?
Pneumonia cannot heal on its own. It’s important to start treating your symptoms as soon as possible. You can treat your symptoms at home, but visiting a doctor and getting antibiotics is highly recommended, especially for older adults and children.
Pneumonia Prevention
Pneumonia in the elderly along with pneumonia in other adults and children can oftentimes be prevented by practicing healthy habits including:
Washing your hands regularly — especially after blowing your nose, using the restroom, or eating.
Since the flu is a common cause of pneumonia, get your flu shot! Did you know Medicare pays for your annual flu shot? Read more about preventing the flu here.
Pneumonia Vaccine
Another form of pneumonia prevention is the pneumococcal vaccine. This can help protect you from bacterial pneumonia and is recommended for anyone over the age of 65.
There are two vaccine types, PCV13, and PPSV23. You and your doctor can work together to help determine which type is best for you. However, please note, the vaccination is not guaranteed to prevent the infection entirely, but it can drastically lower your risk. Your Medicare plan can cover the cost.
Pneumonia and Your Medicare Plan
Practicing a healthy lifestyle is one of the best ways to keep your immune system strong. Medicare Advantage plans can make sure you’re living the healthiest life possible. These plans may offer additional benefits beyond Original Medicare like routine physical exams and a monthly allowance for over the counter products and medications!
We have licensed agents across 38 states who are contracted with all the major carriers! This means they can answer your questions and enroll you in a plan with an honest and unbiased approach. If you have any questions or are interested in arranging a no-cost, no-obligation appointment, call us at 844-431-1832 or fill out this form.
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How to Sign Up for Medicare
An estimated 70 billion baby boomers are nearing retirement, and over 10,000 boomers are turning 65 every single day. If you’re new to Medicare, we can help you understand how to sign up for Medicare and answer your questions about coverage, benefits, qualifications, fraud, and privacy.
How to Sign Up for Medicare
If you currently receive Social Security benefits, you’ll be automatically enrolled in Medicare Part A when you turn 65. You will need to opt into B, and it will be automatically deducted from your monthly Social Security check. However, if you do not receive Social Security benefits, you will need to enroll yourself. You can enroll in Original Medicare (Parts A and B) online, by phone, or by visiting your local Social Security office.
Do you have to sign up for Medicare when you are 65?
The standard age for Medicare eligibility is 65. However, this does not mean you are required to enroll on your 65th birthday.
If you wish to enroll in Medicare when you become eligible, you can enroll anytime during your initial enrollment period. This period begins three months before your 65th birthday and ends three months after. If you choose to postpone enrollment, you may be subject to a late-enrollment penalty. This can result in a 10% Part B premium increase for every year you were eligible but did not enroll. Plus, you will have an additional penalty of 1% the national based Medicare Part D monthly premium for each month you did not enroll in prescription drug coverage.
Medicare Coverage and Benefits
Original Medicare consists of Parts A and B. Part A covers inpatient hospital fees, hospice care, and home health services. Part B covers doctor services, outpatient care, and physical therapy. Most beneficiaries receive Part A for free, but pay a monthly Part B Medicare premium. Beyond Original Medicare, there are Parts C and D, Medicare Advantage and prescription drug plans.
What is Medicare Advantage (Part C)?
Medicare Advantage plans, sometimes referred to as “Part C,” are available through private insurance companies. They cover the same benefits as Original Medicare, but most offer extra benefits like vision, hearing, dental, and even fitness programs like Silver Sneakers.
Medicare Advantage plans have one monthly premium, and you only pay for the services you use rather than paying a higher cost upfront. You may want to enroll in Medicare Advantage instead of Original Medicare alone. If MA is not right for you, consider Medigap.
What is Medigap?
If you are enrolled in Original Medicare, you are eligible to purchase a Medigap plan, otherwise known as Medicare Supplements. These plans help pay some of the costs that Original Medicare does not cover – your copayments, coinsurance, and deductibles. Most Medigap plans do not cover additional benefits like vision, hearing, dental, and prescription drugs. They are sold by private insurance companies. You can search Medicare Supplement Plans here.
What is Medicare Part D?
You may have noticed by now that Original Medicare (Parts A and B) does not include prescription drug coverage. Even though it isn’t included in your initial plan, you will encounter penalty fees if you do not purchase a prescription drug plan during your initial enrollment period.
Part D plans will have a formulary or list of qualifying prescription drugs. The list is usually divided into tiers according to cost. Keep in mind that your out-of-pocket drug costs will vary according to the plan you choose. Costs will also depend on your premium, deductible, copayments, and coinsurance.
How do I compare Part D plans?
The best way to compare Part D plans is to contact a licensed agent in your area. We happen to have thousands of agents across 38 states! Plus, our Medicare Part D Plan Finder Checklist can help make sure your needs and wants regarding Part D coverage are clear. The checklist has six short sections and shouldn’t take long to complete.
Does Medicare offer free preventive services?
Once you’ve had Medicare Part B for at least 12 months, you are eligible for a zero-cost yearly Medicare wellness exam. The purpose of this wellness visit is to work with your doctor to identify any concerns and to develop a plan for staying healthy. In addition to the annual wellness exam, there are a number of additional services, screenings, and vaccinations covered at no cost including:
Turning 65 is certainly the most common way to qualify for Medicare, but there are a handful of other ways to qualify. You may also qualify for Medicare if you are under 65, have received Social Security Disability Insurance (SSDI) for more than 24 months or if you are diagnosed with either Lou Gehrig’s disease or ESRD.
What are the different Medicare enrollment periods?
Initial Enrollment Period
Every Medicare beneficiary will have an IEP, or Initial Enrollment Period, during which they are eligible to enroll in Medicare. Your IEP will begin three months before you turn 65 and will end three months after, giving you a total of a seven-month enrollment period. For example, if your birthday is April 1, your IEP will last from January 1 through August 1.
General Enrollment Period
The General Enrollment Period runs from January 1 to March 31 every year. This is when, if you missed your IEP, you can enroll in Medicare for the first time. Your coverage will begin in July. If you decide that you would like to enroll in a Medicare Advantage or prescription drug plan, you can do so from April 1 through June 30. The reason for that time gap is that you cannot enroll in Medicare Advantage or Part D until you have Original Medicare.
Annual Enrollment Period
AEP occurs from October 15 through December 7 of each year. This is when you have the ability to review and change your existing Medicare Advantage Plan or Medicare Part D Plan.
Special Enrollment Period
You can either have a SEP for a set period of time, or you can have a lifelong SEP. A SEP allows you to enroll in a new Medicare plan or make changes to your current coverage outside of the normal enrollment periods. If you qualify for a SEP, you should take advantage of your ability to get yourself into a better plan. To see if you qualify for SEP, click here.
Open Enrollment Period
Medicare Open Enrollment 2019 will run from January 1 through March 31. During this time, you can switch between:
One Medicare Advantage plan to another Medicare Advantage plan
A Medicare Advantage plan with prescription drug coverage to Original Medicare with Part D prescription drug coverage
Medicare Advantage to Original Medicare only, with the option to add a prescription drug plan
Do I qualify for Medicare’s Extra Help Program?
The LIS, or Low-Income Subsidy program, is a federal prescription drug plan discount program often called “Medicare Extra Help.” LIS helps Medicare beneficiaries who do not qualify for Medicaid but still need help paying for prescription drugs. Plus, those with LIS have a special enrollment period and can change plans at any time!
To have LIS, you must have a Part D or Medicare Advantage plan. LIS can help cover late enrollment penalty fees if you enroll in Part D or Medicare Advantage too late. It also helps with coverage issues if you enter the Medicare donut hole.
LIS qualifications are based on income and assets. The limits change every year, but a licensed agent can help you with eligibility information. Thousands of seniors & Medicare eligibles out there don’t even know that they are eligible! We can help. Click here to get in contact with an agent.
Medicare Fraud and Privacy
It’s important to keep your personal information protected. Your Medicare number is just as valuable as your bank account and social security number. It’s important to understand the appropriate steps to replace a lost Medicare card and to watch out for common Medicare scams.
How do I replace a lost Medicare card?
If you need to replace a lost Medicare card, visit Social Security’s website, call Social Security at 1-800-772-1213, or visit your local Social Security office. Please note, it can take up to 30 days for your card to be mailed to you. If you have moved or have a different address, you need to report this information to Social Security before they can send you a new card.
What are common Medicare scams?
Ransom Some people will call and act like they are a relative of yours. They will claim to be injured or in trouble. Try to call that relative first rather than believing the random caller.
Fake Telemarketing Real telemarketers will not ask for your Medicare number. Plus, they cannot call without your permission.
Fake charities Some telemarketers may lie and say they are from a charity and ask for money. Never give out your financial information over the phone.
“Can you hear me?” If you answer the phone and someone asks if you can hear them, hang up immediately. This is a common scam where your response is used to make it sound as though you were agreeing to something.
Who can help answer other Medicare questions?
If you have any other questions or concerns about Medicare and related coverage options, please do not hesitate to contact us. Our licensed agents are contracted with the major carriers in your state and can answer these questions with an unbiased and honest approach. To get in contact, fill out this form, or call us at 844-431-1832.
Take Advantage of Medicare Wellness Exams and Preventative Benefits
Medicare offers many benefits at zero cost to recipients, but many of the 59 million Americans enrolled are either not aware of all the Medicare wellness benefits or are simply not taking full advantage of all of these offered services.
For example, in 2014 only around 14% of Medicare recipients received the freeMedicarewellness exam covered under Medicare Part B. This exam, known as the Annual Wellness Visit, or sometimes known as the acronym AWV, is covered at zero cost to recipients.
What is Included in Medicare Wellness Exams?
Once you’ve had Medicare Part B for at least 12 months, you are eligible for a zero cost yearly* Medicare wellness exam. The purpose of this wellness visit is to work with your doctor to identify any risk factors to watch, as well as to develop a plan for staying healthy.
*Keep in mind that the AWV is available every twelve months. For example, if your first AWV is June 2, you cannot recieve your next one until June 2 of the following year. If you make your appointment for June 1, you may not be covered.
During the wellness visit, your doctor, nurse practitioner, or another health care professional will review things like your health history, take measurements such as weight and body mass index (BMI), and will help develop a preventative care plan tailored for you.
Some items that may be reviewed during your Medicare Wellness Visit include:
A Health Risk Assessment (HRA) questionnaire
Review of personal medical history and family medical history
Measurements including height, weight, BMI, and blood pressure
Assessment for any cognitive impairment and mood disorders
Review of any difficulty you may be having in performing day-to-day tasks
Your health care provider may also help you establish a plan for potential risk areas including fall prevention, nutrition, weight loss, and tobacco cessation.
What is not Included in your Medicare Annual Wellness Visit (AWV)?
It is important to know that the Medicare Annual Wellness Visit covers a specific set of wellness services and is different than an annual physical, which is not covered by Medicare. It is also important to note that any additional services performed during your Medicare exam may result in an additional copay or deductible cost.
For example, Mary is 68 years old and visits her doctor a few days after her birthday, as she does every year for her free Medicare wellness exam. During the visit, Mary mentions that her right foot has been bothering her, and after further examination, her doctor orders a blood test to check for gout.
In this scenario, Mary’s wellness visit is still free, but she may pay a copay for the additional foot examination as well as the blood test.
Medicare Wellness Exam vs. Annual Physical
The annual wellness visit is not the same as the yearly physical you may be familiar with. For a typical physical, your healthcare provider will perform a hands-on, head to toes exam including lung, abdominal, and neurological exams. Medicare exams are different.
The Medicare annual wellness visit includes similar assessments but does not include any exams that require the healthcare provider to physically examine you. During your wellness visit, your provider may schedule additional preventative screenings, or may further examine any issues you are having.
What to Bring to Your Medicare Annual Wellness Visit
One of the main purposes of the annual wellness exam is to identify any potential health risks and develop a plan to manage them. So, you will want to share your family and personal health history with your provider in as much detail as possible.
Some things to bring include:
Medical and immunization/vaccination records
Detailed personal and family health history
Detailed list of medications and supplements including dosage and frequency
Full list of health care providers you are currently seeing
Other Medicare Wellness Benefits
In addition to the annual wellness exam, there are a number of additional services, screenings, and vaccinations covered at no cost including:
Alcohol screening
Bone mass measurements
Cardio screening
Colorectal screening
Diabetes screening
Hepatitis screening
HIV screening
Lung, prostate, and cervical cancer screenings
Medicare Vaccine Coverage and the Medicare Flu Shot
Medicare Part B also covers some other Medicare wellness benefits like preventative vaccines, including yearly flu shots. Ask your doctor about getting your flu shot during your Medicare exam.
However, Medicare does not provide maintenance coverage for other vaccines including Shingles, Tetanus (Tdap), and Meningococcal. These vaccines and additional immunizations are typically covered under Part D prescription drug plans.
To ensure you are covered for these vaccines and other prescription medication, you can add a Part D plan to Medicare Parts A and B, or choose a Medicare Advantage plan that includes Part D coverage.
Other Ways to Make the Most of Your Medicare Plan
Find Doctors in Your Plan Network
Some carriers have doctor and hospital search engines so you can see which doctors are covered under your plan. ZocDoc is a great non-affiliated doctor search website as well. If you continue to use a doctor that is outside of your plan, you’re wasting potential savings that you’ll receive if you visit a doctor who is within your plan’s network.
Use Generic Drugs
The same goes for pharmacies and drugs. Your coverage is likely much higher for generic brand prescription drugs, so ask your doctor for a generic version when he gives you a prescription. Your coverage includes mail-order prescriptions as well. Mail-order is often cheaper because there are fewer labor costs! Plus, you can buy bigger supplies.
Know Your Additional Benefits
Some Medicare plans include discounts and freebies like gym memberships, massages, nutrition classes, support groups, and even LASIK surgery. Some even provide “rewards” in the form of discounts if you stay healthy.
Get More Benefits with Medicare Advantage
There are many Medicare preventative services that Original Medicare covers, but do you need more?
A Medicare Advantage plan is a private Medicare plan that includes your Part A and Part B benefits and can extend your coverage to include more things like:
A Medicare Advantage Plan and Part D prescription drug coverage can help cover you for these additional costs and help you live the healthiest life possible. Our agents can help you understand all of your plan options and enroll you in a plan that fits your specific needs and budget. If you interested in arranging a no-cost, no-obligation appointment, fill out this form or call at us 844-431-1832.
Does Medicare Cover Flu Shots?
The Centers for Disease Control and Prevention (CDC) estimates that each year, there are over 31.4 million outpatient doctor visits due to the flu virus in the United States.
Anyone can get the flu, even the healthiest of people, which is why it’s important to take the necessary preventive measures. Getting an annual flu shot is the best way to prevent the flu. If you’re eligible for Medicare, you probably wonder, “Does Medicare cover flu shots?”
High Dose Flu Vaccine
Doctor’s Appointment | Medicare Plan Finder
With age comes beauty…and a weakened immune system! If you are 65 years or older, you are considered high risk for developing influenza.
The high dose flu vaccine is a great option for Medicare eligibles because it contains the three flu strains that are most likely to cause the flu. Plus, it contains four times the flu virus antigen than a regular flu shot. Research shows that the high dose flu vaccine leads to 25% fewer cases of the flu than the standard flu shot.
High Dose Flu Vaccine vs Regular Flu Shot
The regular flu shot is recommended for those six months or older while the high dose flu vaccine is designed specifically for those over the age of 65. Both vaccines take approximately two weeks to build immunity in the body. The peak of flu season is January through March but can start as early as October and extend as far as May, so it’s important to get vaccinated as soon as possible.
Flu vaccines are completely safe and have weakened viruses, meaning the flu shot cannot cause the flu. The high dose flu vaccine and the regular flu shot can both cause side effects, but, side effects may be stronger with the high dose flu vaccine. Getting any flu vaccination is the first step to protecting yourself against the flu.
Flu Shot Side Effects
The risk of developing side effects from the vaccine is higher in a high dose flu vaccine rather than the average flu shot. These side effects can include pain, swelling or soreness at the injection site, and headaches or muscles aches. These side effects may be less than ideal.
However, seniors and Medicare eligibles can have significantly higher complications from the flu. The phrase “better safe than sorry” certainly applies, because .
Flu-Related Complications
The flu can lead to several complications. These complications can range in severity, but should always be taken seriously.
Minor complications include fever, headache, tiredness, cough, body ache, and vomiting.
More severe complications include pneumonia, dehydration, muscle inflammation, and sinus infections. Plus, the flu can worsen long-term health conditions like heart failure, asthma, and diabetes.
Does Medicare Cover Flu Shots?
Medicare Part B covers outpatient care, preventive services, ambulance services, and durable medical equipment. Flu shots are considered a preventive service, so Medicare will cover 100% of the cost for one flu shot per year.
The Part B deductible does not apply to this service, so as long as you are enrolled in Medicare and the doctor or clinic accepts Medicare, you are fully covered.
Medicare Advantage plans are required, at a minimum, to provide the same benefits as Original Medicare (Part A and B). This means that if you are enrolled in a Medicare Advantage plan, your flu shot is fully covered, too.
The premiums and deductibles may vary per plan, however, if the plan has a deductible, a flu shot may not apply.
Where to Get a Flu Shot
If you don’t know where to get a flu shot, the CDC has a free resource to locate flu shot providers in your area. To get started, click here. Enter your zip code beside the red arrow. We used 37209, which is our corporate headquarters’ zip code in Nashville, Tennessee. Then click “Go”, which is beside the green arrow.
Flu Shot Finder Step 1 | Medicare Plan Finder
The next page lists the flu shot providers in your area complete with address and contact information. Call the providers with any questions about how to get your flu shot.
Flu Shot Finder Step 2 | Medicare Plan Finder
Let Us Help You Find the Right Medicare Plan
Getting an annual flu shot is just one of many ways to practice a healthy lifestyle. If you’re looking for coverage beyond Original Medicare that will help you become the healthiest version of you, a Medicare Advantage plan may be a perfect fit!
A MA plan can provide vision, dental, and hearing coverage. Plus, some may offer fitness classes like SilverSneakers®! Our licensed agents are highly trained can help you find the perfect plan that fits your needs and budget. Call us at 844-431-1832 or click here to get in touch with an agent!
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This blog was originally published on November 6, 2018, by Kelsey Davis and updated on August 30, 2019 by Troy Frink .
Home Care Services vs. Senior Assisted Living
Nearly half of everyone over the age of 65 needs some form of assistance in their daily routine. That’s approximately 18 million seniors! When choosing between home care services and senior assisted living, it’s important to consider the costs, qualifications, and available services before making a final decision.
Home care services allow you to get the assistance you need in the comfort of your own home and is great for anyone who is chronically ill, disabled, recovering from surgery, or needing basic assistance. Senior assisted living is an affordable way to get 24/7 care that includes interaction with other residents and eliminates the need of hiring, scheduling, or managing caregivers. This is great for those who have difficulty moving around and require more medical supervision. Both home care and assisted living focus on providing care, but the specifics of what is provided differ.
What Services Does Home Care Provide?
The three major types of home care services are:
Personal Care and Companionship
Personal care and companionship can provide assistance with self-care including bathing, grooming, and dressing. They also help with fall prevention by assisting with movement around the home. Meal preparation, cooking, light housekeeping, laundry, and other errands are included. Plus, this type of care allows you or a loved one to have companionship which can help with isolation issues, especially in the winter. Personal care and companionship can be long or short-term and is great for those who need basic help around the home.
Private Duty Nursing
Private duty nursing can help with basic medical services inside the home. This includes monitoring vital signs and administering medications. Ventilator, tracheostomy, gastrostomy, catheter, and feeding tube care may also be included. Private duty nursing care is typically long-term and is ideal for those who have a chronic illness, injury, or disability.
Home Health Care
Home health care includes several short-term nursing services. This includes physical therapy, occupational therapy, speech-language pathology, medical social work, and other home health aide services. Home health care is often short-term and is recommended by a physician. Home health care can help patients recover from an injury, illness, or hospital stay.
What is Assisted Living for Seniors and Medicare Eligibles?
Senior assisted living provides 24/7 care, meals, housekeeping, laundry, transportation, recreational activities, and wellness programs. Plus, facilities may offer on-site pharmacies, physical therapy, and even salon services.
Another large benefit of assisted living is social activities and entertainment. Many facilities have common areas including libraries, cafes, and game rooms. Plus, there are several social activities offered like gardening groups, book clubs, and movie nights.
Senior assisted living can help you or a loved one rest easy knowing that all care is personalized to meet any and all health needs. Emergency first aid, medication management, pharmaceutical services, and maintenance of medical records is often provided to residents. Some facilities have a staff physician who provides routine checkups.
Senior Assisted Living and Home Care Services Costs
It’s important to look at the price tag when making a decision. Home care and assisted living offer different services and their prices reflect that.
What Does Home Care Cost?
The cost of home care services is unique to each situation. According to NPR, the average costs for home care services are:
Personal Care and Companionship: $70/day or $18,200/ year
Private Duty Nursing: $19/hour or $19,760/year
Home Health Care: $21/hour or $21,840/year
There are several companies that provide home care services, but the prices will vary. Plus, there are several other costs that are not included. Keep these in mind when looking at your budget. These costs include groceries, personal hygiene items, household items, transportation, rent or mortgage, utilities, and maintenance.
What is the Average Cost of Senior Assisted Living?
The type of residence, size of the apartment, services included, and location of the community are all factors that can increase the overall cost of senior assisted living. Costs can range from $2,200 to $6,000 per month depending on the cost of living for each state. However, keep in mind these are all-inclusive costs and eliminate the cost of rent, utilities, maintenance, meals, and personal care if you or a loved one lived at home.
Senior Assisted Living and Home Care Services Qualifications
Assisted living and home care each have a specific set of qualifications. Before finalizing on a plan option it’s crucial to know if you qualify.
How Do You Qualify for Home Care?
Within the three types of home care, personal care and companionship is the only type that doesn’t require a prescription. Plus, if Medicare or Medicaid is covering some of the costs, there are different qualifications. To qualify you must meet the “homebound” criteria as established by the Centers for Medicare and Medicaid and require skilled care on a part-time basis in order to improve or maintain your health issue. If you meet these requirements, Medicare will cover your costs, but only if you receive your care from a Medicare-approved home health agency.
Who Qualifies for Assisted Living Facilities?
Qualification for senior assisted living is largely dependent on the level of care a resident needs. You or a loved one may qualify if assistance with daily living facilities like personal care, hygiene assistance, mobility, meals, and medication management is needed.
Those who require daily nursing services from extensive medical needs may not qualify. The application process is the same regardless if you or a loved one lives in a private residence, rehabilitation center, nursing facility, or a hospital. The typical application process includes facility admission paperwork, medical history, physical, and tuberculosis (TB) test or chest x-ray.
Role of Medicare and Medicaid
Medicare only covers the third type of home care services: home health care. The only cost you may have is 20% of the Medicare-approved amount for durable medical equipment. Medicare typically does not cover the costs of senior assisted living. However, Medicare may cover qualified healthcare costs while living in the facility. This includes doctor visits, lab tests, certain preventive services, physical therapy, and medical supplies.
Medicaid may cover some of the costs of home care services, but the coverage will vary by state. In some cases, Medicaid can be used to pay for some assisted living costs through a Medicaid waiver, but there is often a waiting list.
Making a Decision
Home care services and senior assisted living are two options that could greatly impact you or a loved one’s quality of life. There is an abundance of information available which can make finzaling a decision difficult. Are you a caregiver and looking to help a loved one? Our Ultimate Aging Parents Checklist can help you prepare for what is often a tough decision and discussion.
Medicare and Medicaid may only cover a small amount of the total costs. However, Medicare Advantage plans may provide additional coverage beyond Original Medicare and include benefits like hearing, dental, or vision coverage.
At Medicare Plan Finder, our goal is to make sure you have the coverage and benefits that enable you to live the healthiest lifestyle possible. Plus, we make sure you are informed on important information like the Medicaid look-back period and how Medicare and Medicaid work together. Our licensed agents can help answer any questions you may have about Medicare Advantage, prescription drug coverage, and Medicare supplements. If you’re interested in arranging a no-cost, no-obligation appointment, call us today at 844-431-1832 or fill out this form.
Drug Price Transparency: Everything You Need to Know
Drug Price Transparency: Everything You Need to Know
The Henry J Kaiser Family Foundation estimates that $1 out of every $6 in Medicare spending is for prescription drugs. These medications play an important role in the health of 59 million seniors and Medicare eligibles. Drug price transparency is crucial in informing consumers and developing new strategies that address the issue of rising drug costs.
How is CMS involved?
Earlier this month, CMS proposed a new drug price transparency rule that was targeted at direct-to-consumer television advertising. This rule would require drug manufacturers to publish wholesale prices during commercials. This will allow beneficiaries to make informed drug purchasing decisions, especially beneficiaries with high deductibles and drug costs.
Direct-to-consumer television advertising can dramatically impact a beneficiary’s purchasing decisions. These commercials can spark informational discussions between beneficiaries and their health care providers, but understanding the costs is crucial when making a final decision.
State vs Federal Legislation
Several states across the US are implementing new bills and laws that require drug companies to not only report but also justify any dramatic increases in their drug prices. Since early August, there have been over 100 bills introduced into legislation addressing the different issues of drug price increases. 30 states have drafted a total of 60 drug price transparency bills.
States are feeling the pressure to improve the sustainability of their budget and promote coverage access to all of their residents. As the push for drug price transparency rises, more states may begin to explore new laws and federal legislation could be impacted. Many of these proposed changes are in the works and may be finalized in the near future.
How should you choose a pharmacy, doctor, or Part D plan?
Do you already have a primary pharmacy? Are you concerned about enrolling in a plan where your doctor is out of network? Our agents at Medicare Plan Finder work with nearly every carrier in your state. Agents can help you enroll in the plan that best fits your needs, budget, and network requirements. Ready to learn more? Call us at 844-431-1832 or fill out this form to arrange a no-cost, no-obligation appointment with a top agent.
Understanding The Benefits Of Medicare Advantage
Medicare Advantage is a coverage option that provides more benefits than basic plans. It includes Original Medicare, which is made of Medicare Part A (hospital care) and Part B (medical/doctor care), plus additional services such as prescription drug coverage, dental, and vision coverage.
Medicare Advantage plans are sometimes confused with Medicare Supplement (Med Supp) plans, but they are completely different. While Medicare Advantage (MA) includes extra service coverage, Medicare Supplement plans provide more financial coverage (but not more services).
Medicare Advantage Benefits
Hospital stays, skilled nursing care, home health care, etc. (essentially Part A)
Doctor visits, outpatient care, preventative services, etc. (essentially Part B)
Hearing care, vision care, fitness programs, wellness services, nurse help lines, prescription drug coverage, etc. (Part C)
Prescription drug coverage (essentially Part D)
Types of Medicare Advantage Plans
HMO Plans(Health Maintenance Organization) – You’ll select one primary physician and only see that doctor, unless your doctor recommends another specialist (such as a cardiologist or dentist).
HMO-POS Plans(Point-Of-Service) – You’ll select one primary physician but can also visit other specialists in your network for a fee (like a cardiologist or dentist) even without a doctor recommendation.
PPO Plans(Preferred Provider Organization) – You can see any doctor, but in-network doctors will be much cheaper for you.
PFFS Plans(Private Fee-For-Service) – You will not need referrals or a primary physician, but not all doctors will accept this plan.
SNP (Special Needs Plans) – You are only eligible if you have a chronic illness or disability, live in a nursing home, or are dual-eligible for Medicare and Medicaid.
MSA(Medical Savings Account) – Medicare will deposit money into a separate bank account for you to use for Medical expenses.
Enrollment Periods
There is a seven-month window during which you can enroll in Medicare. It lasts from three months before your 65th birthday through three months after. During this period, you can purchase a Medicare Advantage plan for the first time or add any additional coverage. Additionally, you can always add or change your plan during the annual enrollment period, or AEP (October 15th through December 7th every year).
You may qualify for a SEP (Special Election Period), during which you can enroll even though it is not during AEP or your initial enrollment period. You can qualify if you:
Move residences to an area where different plan options are available
Move to an area where the nearest hospital or doctor’s office is out-of-network
Are released from incarceration
Lose Medicaid eligibility
Leave a job or start a new job that offers different plans
Were in a plan that is now discontinued
Do you still have questions about Medicare Advantage or are you hoping to purchase a plan? Set up an appointment with one of our licensed agents today. Call us now at 1-844-431-1832.
