April Gruber, Medicare Insurance Broker
April Gruber
Oklahoma Integrity Insurance Group LC
Medicare Broker Licensed in OK, AL, AR, KS, MI, NC and TX
6+ Years of Experience
Contact Details
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Location
Blanchard, OK
About Me
With Integrity Insurance, you can rest assured that a personal touch is a part of every solution. Insurance, Social Security, Medicare, and retirement planning are often scary topics, especially with the constant changes within our federal, state and even local government regulations. When you work with us, we will take the time you answer all of your questions, ensuring you every opportunity to make the most educated decision possible. Integrity and transparency are the very heartbeat of everything we do.
Directions to My Office
Q&A with April Gruber
I have Original Medicare, a Medigap Plan G, and a Part D plan, but I'm still facing high costs for my specialty medication. What options exist for someone in my situation?
Answer: You can review the formulary for your drug plan to determine if an alternative medication is available at a lesser cost. Then discuss that medication with your prescribing physician. You can contact the manufacturer of the medication and see if they offer any coupons or discount programs. You can see if you quality for Extra Help through the Social Security Administration. Due to regulatory changes over the last few years, all Medicare prescription plans are required to offer a new program that assists consumers pay for their prescription drugs. This program is called the Medicare Prescription Payment Plan, or M3P for short. This plan allows you to take the total cost of all your medications and make monthly payments divided across the duration of the current year, up to 12 months if beginning in January. If this program could benefit you or you have a change to your medications mid year, I encourage you to reach out to your insurance carrier and find out what options they offer to support you in your health journey.
Lastly, you can see if a discount drug program like GoodRX could offer you cost savings. The only drawback to programs like GoodRX, will be that nothing you pay out of pocket while using those programs will apply to your maximum out of pocket costs regarding your medications. For some individuals, this is not an issue. However, for some it does make a huge difference in the amount of money they spend on their medications from year to year.
Regardless, it is always a good idea to meet with a reputable broker to discuss your options.
What are the reasons why I should work with a Medicare agent?
Answer: First I would encourage you to know the difference between an agent and broker. According to CMS (Centers for Medicare and Medicaid Services), an "agent" represents only one insurance carrier, where a "broker" represents many. A Broker like myself, offers an unbiased approach to comparing plans available in your market. The processes should include reviewing your medications and doctors to ensure that they are well covered by any option you are considering. It is our mission to eliminate your confusion through education and a partnership to help identify your needs and find coverage that meets those needs within your budget. You should feel supported and empowered by your agent or broker. If you don't, find a new one. Be comfortable and confident with the person you work with.
Can Medicare help cover in-home care for dementia patients who wander or need supervision 24/7?
Answer: That's a great question. In short, the answer unfortunately is no, but there are other resources that might be available for your loved one.
Medicare will cover medically necessary home health care (short-term, intermittent skilled care), but there are some key requirements:
- A physician must attest that the patient is homebound and needs skilled nursing or therapy
- Care is part-time or 'intermittent' (generally 8 hours or less daily, up to 7 days per week, for 21 days or less)
- Services are provided by a Medicare-certified home health agency
Medicare does NOT cover:
- 24/7 in-home care
- Personal or custodial care (help with bathing, dressing, supervision, or companionship) unless it's part of the skilled care plan
Often times, families find themselves patching together multiple resources to help meet their loved one's care needs. Think of it as a patchwork quilt. Government programs are usually the best place to start. Medicaid (state-based health insurance), unlike Medicare, does cover long-term custodial care. But exactly what is covered can vary from state to state. Many states offer Home and Community Based Services (HCBS) Waivers that help individuals with dementia gain access to care at home instead of an institution. Keeping your loved one in a familiar environment as long as possible. Eligibility for Medicaid is based on income and assets, and because those amounts vary by state it is important to get with your local Medicaid office for those details and to apply for their services. For those who are eligible for Veterans' Benefits, VA Aid and Attendance Pension can help pay for in-home care, assisted living, or nursing home care.
For those who plan ahead, a Long-Term Care policy can help cover costs for in-home caregivers, assisted living, or nursing home. Policy costs and details vary from plan to plan, and should be purchased earlier in life. It is always wise to work with an experienced broker who is familiar with local resources.