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How do I actually submit a bill to Medicare?

In almost all cases, if you are enrolled in a Medicare Advantage plan, you will not have to worry about submitting bills to Medicare. However, if you are enrolled in Original Medicare or Medicare and a Medicare Supplement, there can be times…

Do Medicare Advantage payments count towards my "out of pocket" maximum?

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Your out-of-pocket costs will be limited by your plan's Maximum Out-Of-Pocket (MOOP) limit for Medicare Advantage plans. If you are enrolled in a PPO, your plan will set two MOOPS's, one for in-network costs and another for a combination of…

What's the difference between a Medicare Advantage HMO and a PPO?

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HMO stands for Health Maintenance Organization and is a type of plan that requires you to see doctors in its network. If you see a doctor outside the network, you will be responsible for all of the costs. The only exception to this is medically…

Can a Medicare Advantage plan be "free"?

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In some respects, yes. There are Medicare Advantage plans available that have premiums that are $0. However, it is important to know that it does not mean that all of your care is free. You may not have a plan premium to pay, but you will still…

How do I know which doctors accept Medicare assignment?

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First off, let's define what Medicare assignment is and the impact it can have on your out-of-pocket costs. One of the most significant potential gaps in Original Medicare is healthcare providers' ability to bill you for something called excess…

What happens if my Medicare doctor is not in the network?

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The answer to this question depends on the type of Medicare plan you have. When we talk about Medicare plans with networks, we are generally talking about Medicare Advantage HMO, HMO-POS, or PPO plans. HMO stands for Health Maintenance Organization…

What happens if my doctor no longer accepts Medicare payment?

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While most doctors accept Medicare, some do not. If you turn 65 and your physician does not accept Medicare, you will have some decisions to make. Choosing to stay with a doctor that does not accept Medicare can result in high out-of-pocket…

What are Medicare "star ratings" and how are they measured?

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Medicare rates Medicare Advantage and Part D (prescription drug plans) using something called Medicare stars. A 5-star rating is the best, while a 1-star rating is the worst. When you’re trying to choose a Medicare Advantage or Part D (prescription…

What does a Medicare drug formulary with tiers mean?

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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…

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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.