Welcome, Medicare Nation! I’ve had a busy two weeks and have just returned from a conference in Miami for the National Osteoporosis Foundation. I have been flooded with emails, so today’s episode will be a Q&A session in which I address as many of those questions as possible. Join me!
- From Steve in Texas: “I’m turning 65 in July and your program has been helpful to me. Can I change Part D prescription options over time without having to pass insurability determinations?”
- The options can be confusing. You can change Part D plans during the annual enrollment period, from October 15-December 7. You can change plans every year, if needed. You should review your plans yearly, based on your prescription needs and usage.
- From Dottie: “I have a Medicare Advantage Plan with Blue Cross. When I get the benefits summary, do the fees reflect those set by Medicare or do the doctors make these up?”
- Every Medicare insurance carrier negotiates with each doctor and facility so they have a contract for how much the doctor gets paid for services. The summary shows what the doctor usually charges, what your plan covers, and what your co-pay amount is. What you see is what the doctor normally charges, but NOT what you will pay. The negotiated rate will be applied by your plan and you pay your co-pay or co-insurance.
- From Dottie, the 2nd part of her question: “If I want to change to another Medicare Advantage Plan, can I keep my same doctor even if he isn’t in the network?”
- Remember, Medicare Advantage is all about being in a network. It’s a “pay as you go” plan because you only pay for what you need. If your doctor is not in network, you have to decide what’s more important. Do you have to stay with that doctor or do you value the plan’s benefits more? You may need to change plans or pay out of pocket. This depends upon if your plan is an HMO or a PPO. A PPO has an out of network option but you will pay a higher co-pay. An HMO in Medicare Advantage doesn’t allow any out of network options.
I hope these questions and answers have been helpful to you. If need be, we’ll add another show each week just to cover your questions. So, keep those coming! Email me: firstname.lastname@example.org. Remember, you can visit www.medicare.gov for more information.
Do you have questions or feedback? I’d love to hear it!
I may answer one of your questions on the air!
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