Is it true Medicare doesn’t cover dental, vision or hearing aids?

Under Original Medicare Part A & Part B, the following are NOT covered: Hearing aids or exams for fitting hearing aids. Most dental care, dental procedures, or supplies, like cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices. Medicare Part A (Hospital Insurance) will pay for certain dental services you get when you’re in a hospital. Medicare doesn’t cover eye exams (sometimes called “eye refractions”) for eyeglasses or contact lenses. Medicare Part B (Medical Insurance) covers eye exams for diabetic retinopathy once each year if you have diabetes. You may be responsible for a copay or deductible. Some Medicare Advantage plans offer dental, vision, and hearing supplemental benefits. Talk to your agent to find a plan that provides these if it is important to you. Medicare’s Annual Enrollment Period (AEP) is from October 15th through December 7th. Call Kevin Leinum Medicare Agent – your local Medicare Expert about what Medicare covers or how enrolling in a Medicare Advantage or Medicare Supplement plan can improve your coverage and reduce your out-of-pocket costs.

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Can a Medicare Advantage plan be “free”?

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 have to pay your Medicare Part B premium. Additionally, $0 premium plans typically have higher out-of-pocket costs than other Medicare Advantage plans with higher premiums. Additionally, you will likely have few if any supplemental benefits like dental, vision, hearing, transportation, and the variety of other supplemental benefits you see on higher-priced plans.

So is a $0 premium Medicare Advantage plan right for you? That depends on many factors, including your health status and financial situation.

Kevin Leinum Medicare Agent – 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.

Medicare’s Annual Enrollment Period (AEP) is October 15 – December 7.

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What are Medicare “star ratings” and how are they measured?

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 drug) plan, all the choices can be overwhelming. The star rating program was put in place to help you decide which plan is right for you. Medicare Advantage with prescription drug coverage (MA-PD) plans are rated on up to 44 unique quality and performance measures; MA-only plans (without prescription drug coverage) are rated on up to 32 measures, and stand-alone PDP plans are rated on up to 14 measures. The measures used to determine the ratings, including things like the following: – How the plan emphasizes staying healthy, including things like screenings, tests, and vaccines. – How the plan manages chronic conditions. – The quality of care people with the plan receive. – Member complaint reports. – Plan operations, including things like, how they make decisions about appeals, and the results of audits. – Member experience. You can use the ratings, along with premiums, out-of-pocket costs, and benefits, to choose the right Medicare Advantage plan for you. Kevin Leinum Medicare Agent – your local Medicare Expert – can help you understand the many parts of Medicare. Medicare’s open enrollment period is October 15 – December 7

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How do I know which doctors accept Medicare assignment?

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 charges if they don’t accept Medicare Assignment. They may still accept you as a Medicare patient, but they are allowed to bill you for excess charges by not accepting Medicare Assignment. Medicare “Excess Charges” are related to Medicare Part B services. If you are on Medicare and go to a doctor who does not accept Medicare assignment (accept full payment by Medicare), they are allowed to bill you up to 15% above and beyond what Medicare approves for a specific procedure/doctor office visit.

So how do you know if your doctor accepts Medicare assignment? It is simple, ask them or their office staff.

Kevin Leinum Medicare Agent – your local Medicare Expert – can help you understand the many parts of Medicare and determine what the right fit is for you.

Medicare’s Annual Election Period (Fall Open Enrollment) started – October 15th.

Give us a call to discuss the options available to you.

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

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 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 exceptions to this are medically necessary emergency or urgent care services. HMO-POS stands for Health Maintenance Organization-Point of Service. These types of plans are similar to HMOs in that you are required to receive most services within the network. However, they have a bit more flexibility and allow you to go out of network for certain services or up to a certain dollar amount. Each plan works differently, so you will need to check to see what out-of-network services are covered for your plan. PPO stands for Preferred Provider Organization and has the most flexibility in allowing you to see doctors out of network. PPO plans have two tiers, an in-network and an out of network. If you see a doctor in-network, you will typically pay less out-of-pocket for those services. If you see a doctor out-of-network, you will typically have higher out-of-pocket costs, but the services are still covered. Kevin Leinum Medicare Agent makes Medicare Easy!
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What is “Medigap”?

Medigap plans, also called Medicare Supplement plans, are designed to work alongside Original Medicare and reduce your out-of-pocket costs. Original Medicare only covers about 80% of your Medicare Part B health care expenses. That leaves you responsible for paying for the additional 20%, which can be costly if you are diagnosed with a severe illness. By purchasing a Medicare Supplement plan, you buy some peace of mind by minimizing your financial risk/responsibility. Medigap plans are standardized and have letter names (A-N), allowing you to easily compare various insurance companies’ plans. Medigap plans do not cover prescription drugs, so you will also need to purchase a stand-alone Part-D prescription drug plan if you enroll in one. Call Kevin Leinum Medicare Agent – your local Medicare Expert about what Medicare covers or how enrolling in a Medicare Advantage or Medicare Supplement plan can improve your coverage and reduce your out-of-pocket costs.

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Is it possible to switch between Medicare Advantage and original Medicare?

If you are enrolled in Original Medicare and wish to enroll in a Medicare Advantage plan, you can do so during the Medicare Advantage Annual Enrollment Period (AEP). AEP takes place every year from October 15th through December 7th. If you enroll in a Medicare Advantage plan during AEP, it will be effective January 1st of the following year. If you are enrolled in a Medicare Advantage plan and wish to go back to Original Medicare, you can do so at any time. However, if you want to enroll in a Part-D prescription drug plan, you can only do that during AEP. As a result, it will be essential to make the change back to Original Medicare effective January 1st, so you don’t have any coverage gap. Kevin Leinum Medicare Agent – 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.

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How do I change my Medicare coverage?

The process for changing your Medicare coverage depends on the type of plan you have. For Medicare Advantage and Part-D, unless you qualify for a Special Enrollment Period (SEP), you can switch to any other Medicare Advantage plan available in your area during the Annual Enrollment Period (AEP). AEP takes place every year from October 15th through December 7th. Any changes made during AEP will be effective January 1st of the following year. You can also make one change during the Open Enrollment Period (OEP), which runs from January 1st through March 31st every year. The change will be effective the 1st of the following month. If you have a Medicare Supplement plan, you can make a change any time during the year. However, you may be subject to medical underwriting and could be declined or receive a higher rate based on your health status. To make a change to your overage, contact your Medicare expert at Kevin Leinum Medicare Agent. The experts at Kevin Leinum Medicare Agent help you understand the many parts of Medicare and determine the right fit for you.
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Do I need a Part A or a Part B if I’m still working?

If you are still working at 65 and have health insurance through your employer or a union, the answer depends on the size of the company you work for. If your employer has fewer than 20 employees, Medicare is your primary insurance. In this case, you will need both Part A & B since Medicare will pay first, with your group insurance paying secondary. If your company has more than 20 employees, there is no need to enroll in Part A or Part B as your employer group insurance will be primary. When you stop working, or your employer group coverage ends, you have an 8-month Special Enrollment Period to sign up for Medicare. One important thing to be aware of is if you choose COBRA after you stop working and do not enroll in Medicare Part A and Part B, you may have to pay a late enrollment penalty when your COBRA ends and you enroll in Medicare. You will also have to wait until the Medicare General Enrollment Period (January 1st to March 31st every year) to enroll, which may cause a gap in your health care coverage. If you are unsure about what you need to do when turning 65, call Medicare Agent Kevin Leinum and he will review your situation and provide guidance on what you should do.

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You may incur a Part D late enrollment penalty

You may incur a Part D late enrollment penalty if, for any continuous period of 63 days or more after your Initial Enrollment Period is over, you go without one of the following: A Medicare Prescription Drug Plan (Part D) A Medicare Advantage Plan (Part C) (like an HMO or PPO) or another Medicare health plan that offers Medicare prescription drug coverage Creditable prescription drug coverage The Part D late enrollment penalty is an amount added to your Medicare Part D monthly premium once you enroll in a Part D plan. The amount of the late enrollment penalty is calculated based on how long you went without Part D or creditable prescription drug coverage. The penalty is calculated by multiplying 1% of the “national base beneficiary premium” ($32.74 in 2020, $33.06 in 2021) times the number of full, uncovered months you didn’t have Part D or creditable coverage. The national base beneficiary premium can change from year to year, so your penalty amount may change as well. To avoid any penalties, get in touch with a Medicare expert from Kevin Leinum Medicare Agent several months before you turn 65 or if you are over 65 and are going to lose your employer group health insurance.

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ADDRESS

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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.

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