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Medicare can be overwhelming and confusing but we are here to help. We can help with
- Medicare Education
- Individualized Medicare Assessment
- Health Care Plan Selection
- Federal & State Financial Assistance Programs
- And more
Welcome to Medicare!
Whether you just turned 65 or have been on disability for the last 24 months, have endured End Stage Renal (ESRD), or have Lou Gehrig's disease (ALS), welcome.
You may have recently applied for Medicare and received your Medicare card, also referred to as your Red, White, and Blue card. This card has many benefits that we will explain briefly below.
- Medicare is the national health insurance program for people 65 and older, however, people with certain conditions such as a disability, End Stage Renal Disease (ESRD), or Lou Gehrig's disease (ALS) may become eligible for Medicare prior to age 65.
- Medicare is divided into various parts: A, B, C, and D
PART A
- Covers a portion of costs for inpatient care in hospitals, skilled nursing facilities, hospice, and in the home.
PART B
- Covers a portion of costs for: Services from doctors and other health care providers, outpatient care, home health care, durable medical equipment (like wheelchairs, walkers, and other equipment)
- Preventive services (like screenings, vaccinations, and annual wellness visits)
PART C (This is Medicare Advantage)
- Medicare Advantage plans serve as an alternative to original Medicare. These plans offer additional benefits that Original Medicare does not (like glasses, dental and prescription drugs). It combines parts A, B, and D into one convenient card.
PART D
- Covers a portion of costs for prescription drugs which may include recommended shots and/or vaccines. A deductible may be associated with these plans.
** For additional information, please click on the drop boxes below to see how we can best serve you.
We know that health care is never one size fits all. Therefore, we want to listen to you in order to determine how to best serve you.
Contact Us to learn the benefits of a Medicare Management subscription and start yours today.
We desire is to assist you with managing your medicare needs. Our goal is to make this process simpler by assisting you with the following:
- Identifying the correct Medicare plan for you by providing an impartial Medicare needs assessment.
- Medicare Education - helping you understand more about eligibility requirements, enrollment periods, costs, and Medicare language
- We also offer these educational sessions in group settings for businesses, community and fraternal organizations, housing councils, etc.
- Medicare education is available in Spanish as well
- Mail Classification Services [MCS]
- Overwhelmed with Medicare related mailings? We will assist and teach you how to identify what mail is legitimate versus what is junk mail.
- Ancillary Benefits and managing your ancillary benefit needs
- Additional Benefits Application Process
- We will assist you complete State and Federal applications to see if you qualify for additional benefits like Extra Help or Medicaid
- Billing Invoices & Claims
- We can work with you to resolve billing disputes and Medicare claims
- Benefit Reminders*
- We can help you maintain your best health with this unique service that reminds you of annual and bi-annual preventative screenings
- Regardless of your Medicare plan, we will alert you of all the benefits and preventative screenings your plan provides to ensure you never miss out
- New Card Services
- Have you ever lost or misplaced your Member ID or Social Security Card? We can assist you with obtaining a duplicate today.
- Click here to learn the benefits of a Medicare Management subscription and start yours today
Original Medicare does not cover the ancillary benefits described below. In most cases, the client is responsible for these costs however, private insurance can provide these benefits. Ancillary benefits are miscellaneous medical expenses covered by private insurance companies which may include:
- Dental: There are various ways to obtain dental coverage. Some providers offer riders or stand-alone plans while others include limited coverage as part of their Medicare coverage plan (e.g. cleanings, x-rays). Regardless of the option you choose, these plans may include deductibles, copayments, or coinsurance.
- Vision: Routine eye exams should be a part of your yearly preventative checks. This is particularly important for people with underlying conditions such as diabetes. Medicare advantage plans/ standalone plans assist with yearly eye exam costs and may also provide allowances for eyewear.
- Transportation: This is a limited benefit for medically necessary clients who are deemed Medicaid eligible. If you are unsure whether you qualify, please contact us. For those who are not Medicaid eligible, but still require assistance with transportation, please click here so we can connect you with our local resources.
Original Medicare does not cover prescription drug coverage. In order to obtain drug coverage, you must enroll in a stand-alone Prescription Drug Plan(PDP) or a Medicare Advantage plan (Part C). Before you select a plan here are some terms you should know:
- Formulary - a list of prescription drugs covered by the Medicare insurance plan.
- Deductible - the amount of money you have to pay before your health care insurance begins paying for your medical services.
- Copayment - a fixed amount you have to pay (e.g. $10) for a covered health care service after you have paid your deductible.
- Co-insurance - the percentage of costs of a covered health care service you pay (e.g. 20%) after you have paid your deductible.
Many plans place prescription drugs into different levels, called tiers on their formularies. Drugs in each tier will have a different cost (e.g. drugs in lower tiers generally cost less than drugs in higher tiers).
- Tier 1 - these are preferred generic drugs that are commonly prescribed with the lowest copayments.
- Tier 2 - these are generic drugs with a copayment that is a little more than Tier 1.
- Tier 3 - these are preferred brand name drugs with no generic equivalent. They are the lowest cost brand name drugs on the formulary and the copay is more than Tier 2.
- Tier 4 - these are non-preferred brand name drugs that cost more and are not available in the preferred drug tiers.
- Tier 5 - these are specialty drugs that are used to treat very complicated medical conditions and have the highest copayment. These drugs can be a generic or brand name.
Contact Us to learn how we can help you lower your prescription drug costs.
