Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to Medicare three sixty, where the world of Medicare
is simplified and you are empowered to make informed healthcare choices.
With over two decades of experience and insurance and financial
solutions with host licensed insurance agents Jennifer Lee, you are
guided through the ins and outs of Medicare, whether you
(00:22):
are nearing retirement, navigating your options, or just curious about
what's available. Everything you need to know is covered. Tune
in for knowledgeable insights, tips and answers to your Medicare
questions so you can take charge of your health and
your future. And now Medicare three sixty.
Speaker 2 (00:45):
Welcome to today's Medicare three sixty show. I'm your host,
Jennifer Lee, and we are going to keep deep diving
on the Medicare and new handbook.
Speaker 3 (00:58):
So let us speak in.
Speaker 2 (01:00):
We are going to be on page sixty one, Section
four Medicare Advantage Plan and other Options. So what are
Medicare advantage plans? Definitely something that is quite popular nowadays,
very heavily marketed. Everywhere. You get tons of mail, tons
(01:27):
of calls, tons of texts, emails, you name it right,
It's all over the place. Okay, So a Medicare advantage
plan is another way to get your Medicare Part A
in Part B coverage. Medicare advantage plans, sometimes called Part
(01:51):
C or MA plans, are Medicare approved plans. They're offered
by private companies that must follow rules set by Medicare.
Most Medicare advantaged plans include Medicare Drug coverage Part D.
In most cases, you'll need to use healthcare providers who
(02:14):
participate in the plan's network. These plans set a limit
on what you'll have to pay out of pocket each
year for services covered under Part A and B. Some
plans offer non emergency coverage at a network, but typically
(02:35):
at a higher cost.
Speaker 3 (02:37):
Okay, let me read that again. Sorry.
Speaker 2 (02:40):
These plans set a limit on what you'll have to
pay out of pocket each year for services covered under
Part A and B. Some plans offer non emergency coverage
at a network, but typically at a higher cost. For
certain services or drugs, you may need to get approval
also called prior authorization, from your plan before it covers them.
(03:03):
Most cases, you may also need to get a referral
to use a specialist. Remember, you must use a card
from your Medicare advantage plan to get your Medicare covered services.
Keep your red, white and blue Medicare card in a
safe place because you.
Speaker 3 (03:21):
Might need it later.
Speaker 2 (03:24):
If you join a Medicare advantage plan, you'll still have Medicare,
but you'll get most of your Part eight and Part
BE coverage from your plan, not original Medicare. What are
the different types of Medicare advantage plans? Health Maintenance Organization
(03:45):
HMO Go to page sixty six. HMO Point of Service
HMO POS plan may let you get some services out
of a network for a higher copayment. CO insurance go
to page sixty six. Medical Savings Account MSA plan. Go
(04:06):
to page sixty seven. Preferred Provider Organization PPO plan Go
to page sixty eight. Private Fee for Service PFFS plans
go to page sixty nine. Special needs plans go to
page sevent y. Such exciting topics, because I would say
these are all very confusing, versus I would say, just
(04:29):
Medicare original supplements in medicalp Okay, so no. Go to
pages one nineteen to one twenty two for definitions of
blue words, Medicare advantages plan, and other options.
Speaker 3 (04:43):
We're on page sixty two.
Speaker 2 (04:44):
Now, okay, So what do Medicare advantage plans cover Medicare advantages.
Plans provide almost all of your Part A and B benefits,
including most new benefits that come from law or Medicare
policy decisions. Medicare advantage plan benefits exclude hospice care and
(05:07):
some costs of clinical trials. But if you're in a
Medicare advantage plan, original Medicare will still help cover your
costs for hospice care and some costs for clinical research studies,
and benefits that come from laws or Medicare policies decisions
that the plan doesn't cover.
Speaker 3 (05:30):
Okay. The plan can choose not to cover.
Speaker 2 (05:33):
The cost of services that aren't medically necessary under Medicare.
In some instances where Medicare has an established coverage criteria,
plans may also use their own coverage criteria to determine
if certain services are medically necessary. If you aren't sure
whether a service is covered, check whether your provider before
(05:56):
you get the service. If you disagree with coverage determination,
you could file an appeal Pages ninety eight to ninety
So there is a summary of benefits that you should review.
It comes out every year for that particular plan, and
then also the evidence of coverage that you can review
(06:18):
as well.
Speaker 3 (06:20):
But basically that was just I.
Speaker 2 (06:22):
Feel like a little mumbo jumbo. But let's continue and
I will probably have a breakdown or commentary on this, okay.
Plans may offer some extra benefits. With a Medicare advantage plan,
you may have coverage for things original Medicare doesn't cover,
(06:44):
like fitness programs, gym memberships or discounts, and some vision,
hearing and dental services like routine checkups or cleanings. Some
plans can also choose to cover other benefits like transportation
to doctor visits, over the counter drugs that Part D
doesn't cover in healthcare services. Check with the plan before
(07:07):
you join to find out what benefits it offers, how
much they cost, and if they are there are any limitations.
This is when it kind of gets confusing, right, because
every Medicare advantage plan are different, Their benefits are different,
their qualifications are different, and also the vendors they use
(07:29):
are different. Plans can also tailor their benefit packages to
other additional benefits to certain chronically ill enrollees. These packages
will provide benefits customized to treat specific conditions. Although you
could check with a Medicare advantage plan before you join
(07:50):
to find out if they offer these benefit packages. You'll
need to wait until you join the plan to find
out if you qualify. Get the most out of your
dental benefits. If you're in a Medicare advantage plan, take
charge of your oral health. Contact your plan about dental
services it may cover, in what limitations may apply. Okay,
(08:14):
let us go over the topic of dental benefits because
I think this is definitely like a hot topic.
Speaker 3 (08:24):
As you grow older, your dental needs change, you may need.
Speaker 2 (08:29):
More coverage, more benefits, just more procedures done. I would say,
in a Medicare advantaged plan, not all dental benefits are
created equal. So first, typically they will vendor out these
(08:50):
dental benefits. There are some insurance carriers that have their
own networks, so that's great. It's typically bigger, right, so's
there's just so many kinds. So first they'll have a vendor.
It could be a vendor they use as a third party,
(09:11):
or it's like a vendor that it's not their vendor.
It's basically in their plan, it's their own vendor. Okay,
Then you have your HMO dentals. So what I do
find is that a lot of dentists do not want
to take HMO dental. If they do, they really don't
(09:35):
make a lot when they file those claims. So keep
in mind on the business aspect. Dentists. You know, they
have to take time to follow those claims, make sure
that the codes are correct and correct.
Speaker 3 (09:50):
And so forth. So they typically want to upsell you,
charge you more, use different codes. Okay.
Speaker 2 (10:00):
I mean this is not all the case, but I do.
I do see it more often than none. Okay, then
you're going to have your dental PPOs. Most dentists love
dental PPO. They probably get paid more, maybe it's easier,
but dentists do like the dental PPO insurance.
Speaker 3 (10:24):
Okay.
Speaker 2 (10:24):
So every dentist takes different ones too, so it's good
to know what they like and what they take, especially
if you really like your dentists. I know some clients
love their dentists more than they like their doctor, and
they could change their doctor.
Speaker 3 (10:40):
Okay. So then there's also reimbursements.
Speaker 2 (10:47):
So there are reimbursements where you could go to the
dentists and just as long as it's in the policy
or plan, whatever's covered, you could get reimbursed for your services.
Some is one hundred percent, some as eighty percent some
(11:08):
caps out, so definitely look at those plan options. And
here's another one, right, So on top of you know,
having in dental HMO or PPO or reimbursement, they are
also flex cards.
Speaker 3 (11:28):
So these flex.
Speaker 2 (11:29):
Cards are pretty popular in the last few years and
where you get like a credit card like a Visa MasterCard,
and you're able to swipe at any dental office. And
sometimes these are amounts are huge, sometimes they're not. Sometimes
they give you a quarterly amount. But just knowing your
(11:50):
benefits definitely does matter.
Speaker 3 (11:55):
On that.
Speaker 2 (11:56):
I would say some things to note is that you
can sometimes stack your benefits. So let's take, for instance,
you're on a special chronic plan. Within that chronic plan,
you do get coverage. Then you're also on Medicaid or
(12:20):
medical that also provides you coverage. Then maybe you have
a flex card, so those things could definitely help you out.
Speaker 3 (12:34):
I know your dentists should be helping you out with this.
Speaker 2 (12:38):
But we help you out with this, and those are
one of the things that we go above and beyond
to help the client.
Speaker 3 (12:48):
In their situation.
Speaker 2 (12:49):
So we do help coordinate with your dentists and your coverage,
and we even sometimes go line by line just to
figure out how you don't have any at of pocket costs.
Had a client recently that needed some dental work done
(13:11):
but just couldn't afford it, and we were actually able
to help them get the dental plan, find the office,
use his coverage from his plan, uses coverage for Medicaid
medical and also he wasn't aware of his flex bonus
(13:36):
or you know, that extra that the insurance.
Speaker 3 (13:39):
Company gives him.
Speaker 2 (13:41):
It is quite confusing for someone that's not in the
industry or doesn't do this every day. So we are
definitely here to help you with with That's okay, I
think I covered a lot of dentists. What else on
dental Before I continue, I would say, before you get
(14:04):
any thing done, please get a quote, make sure that
the dental office has the incorrect plan information to bill,
and that they are getting those approvals before you do
your work, because if you do your dental work without
(14:28):
reviewing a quote or how much it's going to cost,
it might be an unexpected cost for you and you
really don't want to be in that predicament, especially if
they're charging you a tooth and nail. I've gone to
(14:48):
dentists that are very reasonable. I've gone to dentists that'll
charge you thousands of dollars for the same service that
someone else would charge me a tenth of the cost.
So be wary of that. We really don't want you
to be put in that predicament on that. Hey, I
(15:11):
think I really touched on dental today.
Speaker 3 (15:15):
But do you have any questions of that? Feel free
to let us know.
Speaker 2 (15:20):
Okay, let us continue. We are still on page sixty two.
Medicare advantaged plans must follow Medicare rules. Medicare pays a
fixed amount for your coverage each month to the companies
offering Medicare advantaged plans. These companies must follow rules set
(15:43):
by Medicare. However, each Medicare advantaged plan can charge different
out of pocket costs and have different rules for how
you get services, like if you need a referral to
use a specialist, or if you must go to doctors,
facilities or suppliers in the plans network for non emergency
(16:06):
non urgent care. These rules can change these each year.
These plans must notify you about any changes before the
start of the next enrollment year. Remember, you have the
option each year to keep your current Medicare advantage plan
choose a different planner switched to regional Medicare.
Speaker 3 (16:27):
Okay, let's go to page seventy one.
Speaker 2 (16:32):
So definitely, because Medicare pays a fixed amount for your
coverage to the insurance companies. Of course, probably these insurance
companies are profiting on this, so that is why it
(16:53):
is heavily advertised marketed. Right, it's the free, free world
of entrepreneurship or business, right that that's why it is
definitely heavily advertised on mailers, phone calls, commercials.
Speaker 3 (17:13):
I see that very often.
Speaker 2 (17:17):
Daytime TV is like on and on about Medicare plans.
Speaker 3 (17:23):
It's a lot, it's a lot. Okay.
Speaker 2 (17:27):
Also notate that the plan must notify you about any
changes before the start of the year.
Speaker 3 (17:36):
And also these insurance.
Speaker 2 (17:38):
Companies do have to get approvals from Center of Medicare
Services CMS every single year on plan changes, and sometimes
once in a while plans are terminated because if it's
too many changes, Medicare is not going to it. So
(18:01):
that's been happening, so watch out for that. A great
license agent will reach out to you to make sure
you are aware of those type of changes.
Speaker 3 (18:11):
That do happen.
Speaker 2 (18:14):
Okay, let's go to page sixty three. Providers can join
or leave a plans provider network during any time during
the year. Your plans could also change the providers in
the network anytime during the year. If this happens, you
usually won't be able to change plans, but you can
(18:35):
choose a new provider. You generally can't change plans during
this year, Okay important. Even though the network providers may
change during the year, the plan must still give you
access to qualified doctors and specialists. Your plan will notify
you that your providers leaving your plans so that you
(18:57):
have time to choose a new one. You'll get this
notice if it's a primary care behavioral provider and you've
gone to that provider in the past three years. If
any of other providers leave your plan, you'll get this notice.
Speaker 3 (19:14):
In certain situations.
Speaker 2 (19:17):
Your plan will also help you choose a new provider
to continue manage doing your healthcare needs. Help you continue
needed care that's already in progress, Notify you about the
different enprollment periods available to you and options you may
have for changing plans. Read your notices carefully so you
(19:38):
are aware of any changes and can change plans if
you aren't satisfied. Either during open enrollment or specially enrollment period.
If you qualify when an in network provider or benefit
isn't available or can't meet your medical needs, your plan
must help you get any medically necessary services outside the
(20:03):
provider network at the in network.
Speaker 3 (20:06):
Cost sharing compare.
Speaker 2 (20:09):
If you have original Medicare, you don't need a referral
to use a specialist. In most cases page fifty seven,
you generally don't need prior approval to use a covered benefit.
Speaker 3 (20:23):
Okay, that was a lot I wanted to talk.
Speaker 2 (20:26):
More about that, but important read the information you get
from your plan. If you're in a Medicare advantage plan,
review the annual notice of change and evidence.
Speaker 3 (20:37):
Of coverage from each plan year.
Speaker 2 (20:39):
Annual notice change includes any charge it changes in coverage, costs,
and more that will be effective in January. Your plan
will send you a printed copy by September thirtieth. Evidence
of coverage gives you the details about what the plan covers,
how much you pay, and more. In the next year,
(21:00):
your plan will send you a notice or printed copy
by October fifteenth. It will include information on how to
get it electronically or by mail. If you don't get
these important documents, contact your plan considering sign up for
an electronic version of the Medicare New Handbook at Medicare
dot gov slash go slash digital, since you'll get costs
(21:22):
and coverage information from your plan. So let me retouch
on this. I was gonna say, Okay, so I have
been seeing a bigger influx a plan provider networks changing
within a year.
Speaker 3 (21:45):
It's pretty crazy because of what's happening.
Speaker 2 (21:48):
His insurance companies, the medical groups, and the hospitals have
contracts and sometimes they're up for renewal and one party
wants more less or that's not profitable for them, or
just be it however they see fit with their organization, right.
(22:08):
But what happens is that us, the client, the person
with the care, disrupts the care. Of course, if you're
not going to the doctor specialist, it's not going to
disrupt your care. You could definitely just move to a
different medical group or doctor.
Speaker 3 (22:27):
But it's just.
Speaker 2 (22:28):
Very important when you are receiving care for certain illness
or procedure that the transition of care does go smoothly.
And those are the things that we definitely help a
client with to go over your options plan ABC right,
(22:50):
because sometimes these negotiations they run till the end of
exploration and you think it's going to go one way,
plans have been changed. Then what happens They come to
a conclusion and an agreement and that doesn't And this
happens because by law they do have to send out
(23:14):
notification to their patients, and so sometimes it's a big scare,
and sometimes it does really happen. So that's really when
we come in to help you figure that out. Also,
keep in mind that you can change your provider, your
(23:37):
primary medical provider, or your medical group every single month.
Speaker 3 (23:43):
So if it's.
Speaker 2 (23:44):
One medical group that you hate now for some reason,
you could definitely change the following month. There are cutoffs
for each month depending on the carrier, so definitely look
into that. And I just explained that there is an
annual notice of change every single year comparing what's changed
(24:08):
for the following year. So that's also something great to
review and go over with your licensed independent insurance agents.
And the evidence of coverage if you're just wanting to
read all that definitely is there. I'm going to stop here.
We're going to continue on page sixty four until next time.
(24:32):
I'm your host, Jennifer Lee. Medicare three sixty show. Feel
free to reach out anytime, as we are always wanting
to be a helping hand to those that need help
and those that just want to review or just.
Speaker 3 (24:45):
Call us and talk.
Speaker 2 (24:47):
Well, catch you next time. You have a wonderful day.
Speaker 3 (24:50):
Bye bye.
Speaker 1 (24:53):
Thank you for joining the program. Medicare three sixty. Hope
you found today's episode insightful and empowering. Remember understanding your
Medicare options is key to making the right choices for
your health and financial well being. If you have questions
or topics you would like covered in future episodes of
Medicare three sixty, don't hesitate to reach out and speak
(25:17):
with our licensed insurance agent. Until next time, Stay informed
and take charge of your healthcare journey. This has been
Medicare three sixty, your trusted source for all things Medicare.
Take care,
Welcome to Medicare three sixty, where the world of Medicare
is simplified and you are empowered to make informed healthcare choices.
With over two decades of experience and insurance and financial
solutions with host licensed insurance agents Jennifer Lee, you are
guided through the ins and outs of Medicare, whether you
(00:22):
are nearing retirement, navigating your options, or just curious about
what's available. Everything you need to know is covered. Tune
in for knowledgeable insights, tips and answers to your Medicare
questions so you can take charge of your health and
your future. And now Medicare three sixty.
Speaker 2 (00:45):
Welcome to today's Medicare three sixty show. I'm your host,
Jennifer Lee, and we are going to keep deep diving
on the Medicare and new handbook.
Speaker 3 (00:58):
So let us speak in.
Speaker 2 (01:00):
We are going to be on page sixty one, Section
four Medicare Advantage Plan and other Options. So what are
Medicare advantage plans? Definitely something that is quite popular nowadays,
very heavily marketed. Everywhere. You get tons of mail, tons
(01:27):
of calls, tons of texts, emails, you name it right,
It's all over the place. Okay, So a Medicare advantage
plan is another way to get your Medicare Part A
in Part B coverage. Medicare advantage plans, sometimes called Part
(01:51):
C or MA plans, are Medicare approved plans. They're offered
by private companies that must follow rules set by Medicare.
Most Medicare advantaged plans include Medicare Drug coverage Part D.
In most cases, you'll need to use healthcare providers who
(02:14):
participate in the plan's network. These plans set a limit
on what you'll have to pay out of pocket each
year for services covered under Part A and B. Some
plans offer non emergency coverage at a network, but typically
(02:35):
at a higher cost.
Speaker 3 (02:37):
Okay, let me read that again. Sorry.
Speaker 2 (02:40):
These plans set a limit on what you'll have to
pay out of pocket each year for services covered under
Part A and B. Some plans offer non emergency coverage
at a network, but typically at a higher cost. For
certain services or drugs, you may need to get approval
also called prior authorization, from your plan before it covers them.
(03:03):
Most cases, you may also need to get a referral
to use a specialist. Remember, you must use a card
from your Medicare advantage plan to get your Medicare covered services.
Keep your red, white and blue Medicare card in a
safe place because you.
Speaker 3 (03:21):
Might need it later.
Speaker 2 (03:24):
If you join a Medicare advantage plan, you'll still have Medicare,
but you'll get most of your Part eight and Part
BE coverage from your plan, not original Medicare. What are
the different types of Medicare advantage plans? Health Maintenance Organization
(03:45):
HMO Go to page sixty six. HMO Point of Service
HMO POS plan may let you get some services out
of a network for a higher copayment. CO insurance go
to page sixty six. Medical Savings Account MSA plan. Go
(04:06):
to page sixty seven. Preferred Provider Organization PPO plan Go
to page sixty eight. Private Fee for Service PFFS plans
go to page sixty nine. Special needs plans go to
page sevent y. Such exciting topics, because I would say
these are all very confusing, versus I would say, just
(04:29):
Medicare original supplements in medicalp Okay, so no. Go to
pages one nineteen to one twenty two for definitions of
blue words, Medicare advantages plan, and other options.
Speaker 3 (04:43):
We're on page sixty two.
Speaker 2 (04:44):
Now, okay, So what do Medicare advantage plans cover Medicare advantages.
Plans provide almost all of your Part A and B benefits,
including most new benefits that come from law or Medicare
policy decisions. Medicare advantage plan benefits exclude hospice care and
(05:07):
some costs of clinical trials. But if you're in a
Medicare advantage plan, original Medicare will still help cover your
costs for hospice care and some costs for clinical research studies,
and benefits that come from laws or Medicare policies decisions
that the plan doesn't cover.
Speaker 3 (05:30):
Okay. The plan can choose not to cover.
Speaker 2 (05:33):
The cost of services that aren't medically necessary under Medicare.
In some instances where Medicare has an established coverage criteria,
plans may also use their own coverage criteria to determine
if certain services are medically necessary. If you aren't sure
whether a service is covered, check whether your provider before
(05:56):
you get the service. If you disagree with coverage determination,
you could file an appeal Pages ninety eight to ninety
So there is a summary of benefits that you should review.
It comes out every year for that particular plan, and
then also the evidence of coverage that you can review
(06:18):
as well.
Speaker 3 (06:20):
But basically that was just I.
Speaker 2 (06:22):
Feel like a little mumbo jumbo. But let's continue and
I will probably have a breakdown or commentary on this, okay.
Plans may offer some extra benefits. With a Medicare advantage plan,
you may have coverage for things original Medicare doesn't cover,
(06:44):
like fitness programs, gym memberships or discounts, and some vision,
hearing and dental services like routine checkups or cleanings. Some
plans can also choose to cover other benefits like transportation
to doctor visits, over the counter drugs that Part D
doesn't cover in healthcare services. Check with the plan before
(07:07):
you join to find out what benefits it offers, how
much they cost, and if they are there are any limitations.
This is when it kind of gets confusing, right, because
every Medicare advantage plan are different, Their benefits are different,
their qualifications are different, and also the vendors they use
(07:29):
are different. Plans can also tailor their benefit packages to
other additional benefits to certain chronically ill enrollees. These packages
will provide benefits customized to treat specific conditions. Although you
could check with a Medicare advantage plan before you join
(07:50):
to find out if they offer these benefit packages. You'll
need to wait until you join the plan to find
out if you qualify. Get the most out of your
dental benefits. If you're in a Medicare advantage plan, take
charge of your oral health. Contact your plan about dental
services it may cover, in what limitations may apply. Okay,
(08:14):
let us go over the topic of dental benefits because
I think this is definitely like a hot topic.
Speaker 3 (08:24):
As you grow older, your dental needs change, you may need.
Speaker 2 (08:29):
More coverage, more benefits, just more procedures done. I would say,
in a Medicare advantaged plan, not all dental benefits are
created equal. So first, typically they will vendor out these
(08:50):
dental benefits. There are some insurance carriers that have their
own networks, so that's great. It's typically bigger, right, so's
there's just so many kinds. So first they'll have a vendor.
It could be a vendor they use as a third party,
(09:11):
or it's like a vendor that it's not their vendor.
It's basically in their plan, it's their own vendor. Okay,
Then you have your HMO dentals. So what I do
find is that a lot of dentists do not want
to take HMO dental. If they do, they really don't
(09:35):
make a lot when they file those claims. So keep
in mind on the business aspect. Dentists. You know, they
have to take time to follow those claims, make sure
that the codes are correct and correct.
Speaker 3 (09:50):
And so forth. So they typically want to upsell you,
charge you more, use different codes. Okay.
Speaker 2 (10:00):
I mean this is not all the case, but I do.
I do see it more often than none. Okay, then
you're going to have your dental PPOs. Most dentists love
dental PPO. They probably get paid more, maybe it's easier,
but dentists do like the dental PPO insurance.
Speaker 3 (10:24):
Okay.
Speaker 2 (10:24):
So every dentist takes different ones too, so it's good
to know what they like and what they take, especially
if you really like your dentists. I know some clients
love their dentists more than they like their doctor, and
they could change their doctor.
Speaker 3 (10:40):
Okay. So then there's also reimbursements.
Speaker 2 (10:47):
So there are reimbursements where you could go to the
dentists and just as long as it's in the policy
or plan, whatever's covered, you could get reimbursed for your services.
Some is one hundred percent, some as eighty percent some
(11:08):
caps out, so definitely look at those plan options. And
here's another one, right, So on top of you know,
having in dental HMO or PPO or reimbursement, they are
also flex cards.
Speaker 3 (11:28):
So these flex.
Speaker 2 (11:29):
Cards are pretty popular in the last few years and
where you get like a credit card like a Visa MasterCard,
and you're able to swipe at any dental office. And
sometimes these are amounts are huge, sometimes they're not. Sometimes
they give you a quarterly amount. But just knowing your
(11:50):
benefits definitely does matter.
Speaker 3 (11:55):
On that.
Speaker 2 (11:56):
I would say some things to note is that you
can sometimes stack your benefits. So let's take, for instance,
you're on a special chronic plan. Within that chronic plan,
you do get coverage. Then you're also on Medicaid or
(12:20):
medical that also provides you coverage. Then maybe you have
a flex card, so those things could definitely help you out.
Speaker 3 (12:34):
I know your dentists should be helping you out with this.
Speaker 2 (12:38):
But we help you out with this, and those are
one of the things that we go above and beyond
to help the client.
Speaker 3 (12:48):
In their situation.
Speaker 2 (12:49):
So we do help coordinate with your dentists and your coverage,
and we even sometimes go line by line just to
figure out how you don't have any at of pocket costs.
Had a client recently that needed some dental work done
(13:11):
but just couldn't afford it, and we were actually able
to help them get the dental plan, find the office,
use his coverage from his plan, uses coverage for Medicaid
medical and also he wasn't aware of his flex bonus
(13:36):
or you know, that extra that the insurance.
Speaker 3 (13:39):
Company gives him.
Speaker 2 (13:41):
It is quite confusing for someone that's not in the
industry or doesn't do this every day. So we are
definitely here to help you with with That's okay, I
think I covered a lot of dentists. What else on
dental Before I continue, I would say, before you get
(14:04):
any thing done, please get a quote, make sure that
the dental office has the incorrect plan information to bill,
and that they are getting those approvals before you do
your work, because if you do your dental work without
(14:28):
reviewing a quote or how much it's going to cost,
it might be an unexpected cost for you and you
really don't want to be in that predicament, especially if
they're charging you a tooth and nail. I've gone to
(14:48):
dentists that are very reasonable. I've gone to dentists that'll
charge you thousands of dollars for the same service that
someone else would charge me a tenth of the cost.
So be wary of that. We really don't want you
to be put in that predicament on that. Hey, I
(15:11):
think I really touched on dental today.
Speaker 3 (15:15):
But do you have any questions of that? Feel free
to let us know.
Speaker 2 (15:20):
Okay, let us continue. We are still on page sixty two.
Medicare advantaged plans must follow Medicare rules. Medicare pays a
fixed amount for your coverage each month to the companies
offering Medicare advantaged plans. These companies must follow rules set
(15:43):
by Medicare. However, each Medicare advantaged plan can charge different
out of pocket costs and have different rules for how
you get services, like if you need a referral to
use a specialist, or if you must go to doctors,
facilities or suppliers in the plans network for non emergency
(16:06):
non urgent care. These rules can change these each year.
These plans must notify you about any changes before the
start of the next enrollment year. Remember, you have the
option each year to keep your current Medicare advantage plan
choose a different planner switched to regional Medicare.
Speaker 3 (16:27):
Okay, let's go to page seventy one.
Speaker 2 (16:32):
So definitely, because Medicare pays a fixed amount for your
coverage to the insurance companies. Of course, probably these insurance
companies are profiting on this, so that is why it
(16:53):
is heavily advertised marketed. Right, it's the free, free world
of entrepreneurship or business, right that that's why it is
definitely heavily advertised on mailers, phone calls, commercials.
Speaker 3 (17:13):
I see that very often.
Speaker 2 (17:17):
Daytime TV is like on and on about Medicare plans.
Speaker 3 (17:23):
It's a lot, it's a lot. Okay.
Speaker 2 (17:27):
Also notate that the plan must notify you about any
changes before the start of the year.
Speaker 3 (17:36):
And also these insurance.
Speaker 2 (17:38):
Companies do have to get approvals from Center of Medicare
Services CMS every single year on plan changes, and sometimes
once in a while plans are terminated because if it's
too many changes, Medicare is not going to it. So
(18:01):
that's been happening, so watch out for that. A great
license agent will reach out to you to make sure
you are aware of those type of changes.
Speaker 3 (18:11):
That do happen.
Speaker 2 (18:14):
Okay, let's go to page sixty three. Providers can join
or leave a plans provider network during any time during
the year. Your plans could also change the providers in
the network anytime during the year. If this happens, you
usually won't be able to change plans, but you can
(18:35):
choose a new provider. You generally can't change plans during
this year, Okay important. Even though the network providers may
change during the year, the plan must still give you
access to qualified doctors and specialists. Your plan will notify
you that your providers leaving your plans so that you
(18:57):
have time to choose a new one. You'll get this
notice if it's a primary care behavioral provider and you've
gone to that provider in the past three years. If
any of other providers leave your plan, you'll get this notice.
Speaker 3 (19:14):
In certain situations.
Speaker 2 (19:17):
Your plan will also help you choose a new provider
to continue manage doing your healthcare needs. Help you continue
needed care that's already in progress, Notify you about the
different enprollment periods available to you and options you may
have for changing plans. Read your notices carefully so you
(19:38):
are aware of any changes and can change plans if
you aren't satisfied. Either during open enrollment or specially enrollment period.
If you qualify when an in network provider or benefit
isn't available or can't meet your medical needs, your plan
must help you get any medically necessary services outside the
(20:03):
provider network at the in network.
Speaker 3 (20:06):
Cost sharing compare.
Speaker 2 (20:09):
If you have original Medicare, you don't need a referral
to use a specialist. In most cases page fifty seven,
you generally don't need prior approval to use a covered benefit.
Speaker 3 (20:23):
Okay, that was a lot I wanted to talk.
Speaker 2 (20:26):
More about that, but important read the information you get
from your plan. If you're in a Medicare advantage plan,
review the annual notice of change and evidence.
Speaker 3 (20:37):
Of coverage from each plan year.
Speaker 2 (20:39):
Annual notice change includes any charge it changes in coverage, costs,
and more that will be effective in January. Your plan
will send you a printed copy by September thirtieth. Evidence
of coverage gives you the details about what the plan covers,
how much you pay, and more. In the next year,
(21:00):
your plan will send you a notice or printed copy
by October fifteenth. It will include information on how to
get it electronically or by mail. If you don't get
these important documents, contact your plan considering sign up for
an electronic version of the Medicare New Handbook at Medicare
dot gov slash go slash digital, since you'll get costs
(21:22):
and coverage information from your plan. So let me retouch
on this. I was gonna say, Okay, so I have
been seeing a bigger influx a plan provider networks changing
within a year.
Speaker 3 (21:45):
It's pretty crazy because of what's happening.
Speaker 2 (21:48):
His insurance companies, the medical groups, and the hospitals have
contracts and sometimes they're up for renewal and one party
wants more less or that's not profitable for them, or
just be it however they see fit with their organization, right.
(22:08):
But what happens is that us, the client, the person
with the care, disrupts the care. Of course, if you're
not going to the doctor specialist, it's not going to
disrupt your care. You could definitely just move to a
different medical group or doctor.
Speaker 3 (22:27):
But it's just.
Speaker 2 (22:28):
Very important when you are receiving care for certain illness
or procedure that the transition of care does go smoothly.
And those are the things that we definitely help a
client with to go over your options plan ABC right,
(22:50):
because sometimes these negotiations they run till the end of
exploration and you think it's going to go one way,
plans have been changed. Then what happens They come to
a conclusion and an agreement and that doesn't And this
happens because by law they do have to send out
(23:14):
notification to their patients, and so sometimes it's a big scare,
and sometimes it does really happen. So that's really when
we come in to help you figure that out. Also,
keep in mind that you can change your provider, your
(23:37):
primary medical provider, or your medical group every single month.
Speaker 3 (23:43):
So if it's.
Speaker 2 (23:44):
One medical group that you hate now for some reason,
you could definitely change the following month. There are cutoffs
for each month depending on the carrier, so definitely look
into that. And I just explained that there is an
annual notice of change every single year comparing what's changed
(24:08):
for the following year. So that's also something great to
review and go over with your licensed independent insurance agents.
And the evidence of coverage if you're just wanting to
read all that definitely is there. I'm going to stop here.
We're going to continue on page sixty four until next time.
(24:32):
I'm your host, Jennifer Lee. Medicare three sixty show. Feel
free to reach out anytime, as we are always wanting
to be a helping hand to those that need help
and those that just want to review or just.
Speaker 3 (24:45):
Call us and talk.
Speaker 2 (24:47):
Well, catch you next time. You have a wonderful day.
Speaker 3 (24:50):
Bye bye.
Speaker 1 (24:53):
Thank you for joining the program. Medicare three sixty. Hope
you found today's episode insightful and empowering. Remember understanding your
Medicare options is key to making the right choices for
your health and financial well being. If you have questions
or topics you would like covered in future episodes of
Medicare three sixty, don't hesitate to reach out and speak
(25:17):
with our licensed insurance agent. Until next time, Stay informed
and take charge of your healthcare journey. This has been
Medicare three sixty, your trusted source for all things Medicare.
Take care,
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