If you have (or can get) both Medicare and Veterans’ benefits, you can get treatment under either program. Generally, Medicare and the U.S. Department of Veterans Affairs (VA) can’t pay for the same service or items. Medicare pays for Medicare-covered services or items. The VA pays for VA-authorized services or items. Each time you get health care or see a doctor, you must choose which benefits to use. For the VA to pay for services, you must go to a VA facility or have the VA authorize services in a non-VA facility. If the VA authorizes services in a non-VA hospital but didn’t authorize all of the services you get during your hospital stay, then Medicare may pay for any Medicare-covered services the VA didn’t authorize. 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.

No. You are not required to enroll in Medicare when you become eligible. However, if you do not enroll, it may be challenging to receive all of your Medicare benefits. There are two main parts of Medicare to be aware of for this discussion – Part A, which is coverage for inpatient hospitalization services, and Part B, which is coverage for outpatient services (doctors, medical tests, etc.). Medicare Part A: Assuming you collect Social Security when you turn 65 (you needn’t be collecting it, only eligible to), there will be no premium associated with Medicare Part A (thus no penalty if you delay claiming it). Medicare Part B: There is a monthly premium associated with Part B, but if you have “creditable” healthcare coverage from an employer when you turn 65, you can defer enrolling in Part B until your employer coverage ends, and there will be no Late Enrollment Penalty for waiting. 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.

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.

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.

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.