Important Questions About Medicare coverage

Tue, Sep 21, 2021 10:39 PM Medicare Medicare Supplement Medicare Advantage Plan

The Annual Election Period (AEP) for Medicare begins on October 15. You can change your Medicare coverage or enroll in a Medicare Advantage (MA) plan during this time. Whether you're new to Medicare or switching plans during AEP, you owe it to yourself to check to see if your Medicare Supplement or Medicare Part D plan covers you for all of the extras or in the event of an unforeseen sickness. Spend some time this year analyzing your possibilities.

We anticipate that many of you will consult with a broker or sales representative to choose the appropriate coverage option for your requirements. Being prepared is a smart idea, and the Aspire Health Plan team is here to assist you! Here are a few less usual, but crucial, questions to ask your broker or sales representative concerning Medicare coverage.

 

Will I be eligible for dental, vision, or hearing benefits?

 

Remember that Original Medicare does not cover the following critical benefits:

 

• Routine dental service, which includes cleanings, dentures, dental plates, fillings, tooth extractions, and other procedures performed in a dentist's office.

• Eye exams, eyeglasses (frames or lenses), or contact lenses are all examples of routine vision care.

• Hearing aids or hearing aid fitting exams

 

MedSupp (Medigap) policies are the same way. MA plans provide optional coverage beyond Original Medicare, including supplemental benefits (such as dental, vision, and hearing coverage) that can help you save money. Some plans provide this as an added bonus, while others include it as part of the basic package. Coverage options differ by plan, so check out the MA plans available in your area to see what they have to offer.

 

How much will I have to pay out of pocket in a year if I get severely sick?

 

The amount you pay for healthcare services, excluding a monthly premium, is referred to as out-of-pocket charges, and the maximum out-of-pocket amount you'll spend annually for healthcare expenditures is referred to as a MOOP. Remember that there is no out-of-pocket limit with Original Medicare (Medicare Part A and Medicare Part B). This means that there is no limit to how much you can spend. The more medical treatments you require, the higher Medicare expenditures you will incur. Out-of-pocket limits are only seen in two MedSupp (Medigap) plans: Plan K and Plan L.

MA plans must adhere to a yearly limit set by Medicare, referred to as the maximum out-of-pocket (MOOP) limit. Some plans, however, set their out-of-pocket maximums lower than the MOOP. Predict how much care you'll need during the year to determine if you prefer a plan that spends more upfront but has lower out-of-pocket fees or a plan that costs less upfront but has the potential to have higher out-of-pocket expenditures throughout the year.

 

Also Read: Does Medicare Cover Dental Implants?

 

 

Are there any other advantages available, such as telehealth, transportation, exercise, or chiropractic care?

 

Supplemental benefits are not available under original Medicare or MedSupp (Medigap) insurance. MA plans provide additional benefits, which are extra benefits that can save you money and help you stay healthy, in addition to everything that Original Medicare covers. Keep in mind that supplement benefit options differ by plan, so check out what each plan has to offer in your area.

 

Do you have any health-related programs or an advocate that can assist me in navigating my healthcare?

 

Doctor's appointments and prescription drugs are only a small part of what healthcare entails. It's all about taking care of the full person when it comes to holistic health. When looking at Medicare coverage alternatives, evaluate what health and wellness advantages each plan provides.

 

Is the plan going to cover me if I become sick while traveling?

 

Whatever happens, make sure your health insurance covers you while you're on the road. Your healthcare coverage when traveling with Medicare is determined by where you travel (inside or outside the United States) and the type of Medicare coverage you have. (This is covered in greater depth in a prior blog post.) If you travel a lot, this is something to think about when looking for Medicare coverage.

 

Do my prescription medications appear on the drug formulary?

 

Prescription drugs are not covered by original Medicare. Medical Supplement Insurance (Medigap) policies aren't any different. This means you'll either have to pay for prescription drugs out of cash or join a separate Medicare Part D prescription drug plan. You can also enroll in a Medicare Advantage plan that includes Part D coverage. Examine the plan's prescription drug formulary or "Drug List," which is a list of prescription drugs covered by the plan, when evaluating Part D or MAPD plan alternatives.

If your prescription drug needs have changed in the last year, and your out-of-pocket prescription expenditures have increased, you may want to look into other plans that may better suit your needs. To compare expenses, make a list of the prescription drugs you're now taking.

 

 

 

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