How can I request a replacement Medicare card?

Your Medicare card is proof of your Medicare insurance. If your Medicare card was lost, stolen, or destroyed, you can request a replacement with your personal my Social Security account. If you don’t already have an account, you can create one online at SSA.gov, go to Sign In or Create an Account. Once you are logged in to your account, select the “Replacement Documents” tab. Then select “Mail my replacement Medicare card.” Your Medicare card will arrive in the mail in about 30 days at the address on file with Social Security so be sure to make sure your mailing address is correct before completing the request. If you need to know your new Medicare number now, you have some options. In your personal my Social Security account, you can get your Benefit Verification Letter, which includes your Medicare number. You can also visit Medicare.gov and sign in to see your Medicare number and print an official copy of your card. If you don’t have a Medicare.gov account, go to Medicare.gov and select “Log In/Create Account”. Then, follow the instructions. If you can’t or prefer not to use the online service, you can call 1-800-MEDICARE . Let expert Kevin Leinum help you understand the many parts of Medicare and determine the right fit for you. Give us a call to discuss the options available to you.

/by

Does Medicare pay for assisted living?

Medicare does not cover custodial long-term care such as assisted living facilities but under specific circumstances may cover stays at a nursing home. Medicare covers a range of health services to beneficiaries in any living situation. However, like most health insurance plans, Medicare doesn’t pay for long-term care costs of residency at an assisted living facility or day-to-day custodial care. Under specific circumstances, if a beneficiary requires a short-term stay for inpatient care in a skilled nursing facility that’s not merely custodial or long-term care, it may be covered by Medicare. When is care at a skilled nursing facility covered? Original Medicare will cover a portion of stays for up to 100 days each benefit period at a skilled nursing facility if a doctor determines that you need specialized health services after a qualifying hospital stay. Assisted living facilities do not count as skilled nursing since intensive medical care are not provided by them. In order for a hospital stay to be considered “qualifying” you must be formally admitted to the hospital for three or more days. Neither time spent there under observation, nor as an outpatient before you are admitted count toward the three inpatient days. The skilled nursing facility must be Medicare-care-certified, and a doctor must determine that you need the care. Contact Kevin Leinum your SAN DIEGO Medicare expert!

/by

Does Medicare pay for all surgeries?

Medicare only covers medically necessary surgical procedures. Medicare defines medically necessary services as “health care services or supplies that are needed to diagnose or treat an illness, injury, condition, disease, or its symptoms – and that meet accepted standards of medicine.” Medicare further defines medically necessary services as ones that: Are proper and needed for the diagnosis or treatment of your medical condition. Are provided for the diagnosis, direct care, and treatment of your medical condition. Meet the standards of good medical practice in the local area and are not mainly for your or your doctor’s convenience. To see a list of covered services, including surgeries, you can search the Medicare website. If you are enrolled in a Medicare Advantage plan, they may cover additional surgeries not covered under original Medicare. For both original Medicare and Medicare Advantage, if you are unsure if a surgery you are considering or need is covered, talk to your doctor, Medicare, or your Medicare Insurance company. In most cases, experimental surgeries are not covered by Original Medicare or Medicare Advantage plans. If you are considering having an experimental surgery, check with your doctor to see if it will be covered before you get the surgery. Even if a surgery is covered, you may still have out-of-pocket costs in the form of deductibles, coinsurance, or copays that you are required to pay.

/by

Medicare Advantage plans can be very cost-effective, and in fact, there are plans with $0 premiums.

So how is that possible? To understand how $0 premium plans are possible, you must understand how Medicare Advantage plans are paid. There are two parts to how Medicare Advantage plans get paid. The first is the premium members pay; how the premium is depends on the benefits of the plan you purchase. It can be as low as $0, or in other cases, it can be higher. The second part is the money Medicare pays the insurance company.  Since Medicare Advantage Plans completely replace Original Medicare, Medicare pays the Medicare Advantage insurance company an amount per member based on location, health, and many other factors. It is then the Medicare Advantage insurance companies responsibility to pay for all the health care needed by that Medicare Advantage member. The payment from Medicare makes up the majority of the money the insurance company gets for each member. They then manage their members’ healthcare, negotiate lower physician and hospital costs and drug prices, and many other aspects of healthcare costs. This allows them to provide additional benefits and lower the premiums they can charge even to the point of having $0 premium plans. In addition to the premium for your Medicare Advantage plan, if it is not a $o premium plan, you will still have to pay your Medicare Part B premium and Part A premium if applicable.

/by

What does “step therapy” mean in Medicare drug coverage?

Each Medicare Part D plan has a list of covered drugs that are called a formulary.  Within every formulary, there are a set of rules applied to the prescription drugs covered by the plan. One of those rules is called step-therapy.  If you get a prescription for a medication that has step-therapy rules, there is a process you will have to go through depending on the kind of drug you were prescribed (generic, preferred generic, brand name, etc.). There can be several drugs that are therapeutically equivalent, which means they essentially do the same thing but may have slightly different ingredients. Think of buying a generic brand of ibuprofen vs. buying Motrin ibuprofen over the counter at a drug store. There are the same variations for prescription drugs as well.  Step Therapy is a process that requires members to start with the most cost-effective drug (the first step) and only move on to other, more expensive, or risky medications (additional steps) if necessary. The exact number of steps and requirements can vary depending on the drug. Let expert Kevin Leinum help you understand the many parts of Medicare and determine the right fit for you. Give us a call to discuss the options available to you.

/by

What is the “Doughnut hole” in Part D Medicare coverage and how does it work?

Most Part D drug plans have a coverage gap (also called the “donut hole”). There is a limit on what the drug plan will cover for your prescription drugs when you are in the donut hole. The donut hole begins after you, and your drug plan has spent $4,430 in 2022 for covered drugs. This amount changes yearly. Once you reach the donut hole, you will pay 25% of the cost of brand-name prescription drugs. Even though you will only pay 25%, almost the full price of the drug will count as out-of-pocket costs to get you out of the donut hole. Your 15% and what the manufacturer pays (95% of the drug’s cost) will count. You will pay 25% of the price for generic drugs, and your Part D plan will pay the remaining 75%. How the coverage for generic drugs is different than how it does for brand-name drugs. Only the 25% you pay for generic drugs will count toward getting you out of the donut hole. Things that count towards getting you out of the donut hole: Your yearly deductible, coinsurance, and copayments The discount you get on brand-name drugs in the coverage gap What you pay in the coverage gap Things that don’t count towards getting you out of the donut hole: – The drug plan premium. – Pharmacy dispensing fee. – What you pay for drugs that aren’t covered. Call Kevin Leinum about how enrolling in a Medicare Advantage or Medicare Supplement plan can reduce you…

/by

What does a Medicare drug formulary with tiers mean?

Every Part D plan has something called a formulary, which is a list of drugs covered under the plan. Each formulary has a set of tiers, and in most cases, Part D plans have between three and six tiers. A lower-tier drug usually has lower copays or coinsurance than a drug in a higher tier. For example: Tier 1 – Lowest copay, usually generic drugs Tier 2 – Medium copay includes some low-cost brand-name drugs Tier 3 – Higher copay includes brand-name drugs that have generic versions also available Tier 4 – Higher-co-pay brand-name drugs, and some specialty drugs Tier 5 – Highest copay includes high-cost specialty prescription drugs Suppose you have been prescribed a drug in a high tier, and a drug that is similar or therapeutically equivalent is also available in a lower tier at a lower price. In that case, you can ask your insurance company for an exception to get the lower coinsurance or copay.

Kevin Leinum – your local Medicare Expert – can help you understand the many parts of Medicare and determine what the right fit is for you. Give us a call to discuss the options available to you.

/by

ADDRESS

8144 La Mesa Blvd
La Mesa, Ca. 91942

PHONE

(619) 886-5665

We do not offer every plan available in your area. Currently, we represent 8 organizations which offer 75 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Assistance Program (SHIP) to get information on all of your options. This is a proprietary website and is not associated, endorsed, or authorized by the Social Security Administration, the Department of Health and Human Services or the Center for Medicare and Medicaid Services. This site contains decision-support content and information about Medicare, services related to Medicare and services for people with Medicare. If you would like to find more information about the Medicare program, please visit the Official U.S. Government Site for People with Medicare located at http://www.medicare.gov.

© Copyright - Capstone Services. All Rights Reserved.