Joel Gregory Craven, Medicare Insurance Broker

Answer: Yes your doctor has to prescribe it and you have to have a durable medical supply company to provide the wheelchair or power chair speak to your agent for guidance

Answer: If the medication is covered on the formulary then your max out of pocket is $2000 per year after deductible and not including the co-insurance (your part) I recommend going to Medicare.gov and putting in your medication to see which plan in your county offers the best deal for you. If the drug is not covered on any formulary then you may consult with your doctor for alternatives and or financial help through the manufacturer, your state ship program or seek a grant to cover some or all of the cost. If you are low income you can apply for extra help the social security (ssa.gov) extra help low income subsidy. Consult an experienced agent for help and guidance.

Answer: As much as possible because not knowing your options can put you at a disadvantage so get with a knowledgeable agent for help and advice. Medicare part A you work for and pay into over the life of career. Which includes hospital care. While part B you for or get covered by state Medicaid to cover other medical services like dr visits and outpatient procedures. Part c is Medicare Advantage and part d is drug store drug coverage

Answer: Yes check with your carrier to get more details but yes healthways is one provider that I know of that works with Medicare Advantage plans to include massage.

Answer: No in 2012 I believe president Obama streamlined all Medicare supplemental plans to be the same in every state so now state to state is all the same. What is different is part d drug plans and Medicare advantage plus state run Medicaid has different income levels and different programs based on income need and cost of living economic conditions.

Answer: Get with a local agent to see if there is a SEP (Special Election Period) available in your area county. Also there may be a Chronic Special Needs plan available in your county that may allow you to join during the lockout period. You could also call Medicare.

Answer: Well it depends on which plan you have. For instance, PDP and MAPD have set times of the year when you can change or enroll in a plan. Where as with a Medicare Supplement "Medicare Gap" plans you can usually change month to month based on your health conditions or Guaranteed issued status. Like if you are coming off a creditable group insurance plan then you would have 63 days to enroll in a plan with no underwriting questions. The Annual Election Period (AEP Oct 15-Dec 7) is the time of the year when you can enroll or change MAPD (Medicare Advantage) or PDP (Part D Drug Coverage) There are also what's known as a SEP (Special Election Period) like FEMA declarations, moving state to state, etc. Get with a trained experienced Insurance Agent for more help and guidance.

Answer: Both offer rich benefits, however, Part D is offered as a "stand alone" plan in addition to Original Medicare or with Medicare Advantage which is Part C. However, Medicare Advantage in most cases offers Medicare Advantage without drug coverage for members that also have other creditable coverage that doesn't conflict with MA like the VA (Veteran's Administration). We as agents, don't use words like better best because it can be misleading to the member. What works best for you is your opinion and that's the one that matters. So the short answer is if you don't have other creditable coverage like the VA or a Commercial Policy there can be penalties for not taking Part D. Part C, MAPD (Medicare Advantage with Part D Drug Coverage) is paired with usually the most comprehensive Part D Drug coverage that that Carrier offers. For example, If a company "XYZ MAPD Company" offers 3 Part D Drug plans in your county (Low Medium & High Use) plans, then the "High Use" plan is usually the most comprehensive and the plan that is offered with the MAPD plan. I suggest finding an agent that can research and place the most comprehensive plan for you based on the meds you take and the doctors you see. Special Needs Plans (SNP) sometimes offer drug plans customized to a Chronic Condition like Diabetes or a Chronic Heart Condition. Again find a experienced and trained agent to help you find the right plan for you.

Answer: Wow that’s hard to answer because there are so many different plans and extra benefits such as with Medicare advantage. I try to remember that medical insurance is to cover sickness and illness. Nevertheless the prevention is what I would say….there are over 25 different no cost screenings that I believe everyone with Medicare should take advantage of to catch issues before they advance or become a chronic condition. Screenings like bone density test, diabetic screening, etc

Answer: Medicare.gov or have your agent look it up for you and the carrier usually has a place on their website to look up your medication as well. Sometimes your doctor may have to ask for a formulary exception if the drug is not covered under the formulary and you need the medication.

Answer: Yes if you lose credible coverage through an employer or group insurance you will have a 63 day window to enroll in a plan with no medical questions. You can purchase a Medicare Supplement and enroll in a part D drug plan or you can enroll in a Medicare advantage plan. Give our agency a call for help

Answer: Ask your doctor to check for the best cost of lab test in his or her office. Some carriers use Labcorp or Quest labs for less or even zero lab test cost. Expensive lab test like DNA test may not be covered by Medicare and or the insurance carriers at all. Call the carrier or your local agent to get help with best practices for cost and savings!!! Call our agency for more advice.

Answer: Drug plans are designed each year to cover most categories of meds…. Example: heart meds, blood pressure medication etc but they are not required to cover all brands and or all generics. Step therapy is the term and process used to explain and determine if a brand drug is required over a generic. You may be required to try the generic to see if it works for you as well as the brand name. If the generic doesn’t work well for you or you have issues taking the generic then the carrier may cover the brand name at a higher tier. Your doctor will have to explain this in a request for prior approval for the brand name. If you’ve all tried step therapy and the generic didn’t work for you then the doctor can explain that as well stating you’ve already tried step therapy and still need the brand name. This can take weeks depending on how fast all this information and test are achieved and then reported to the Part D carrier.

Answer: All Medicare advantage carriers follow most of the same rules as original Medicare, however each carrier sets their plan with different copays and numbers of day which that copay applies. Some folk switch out of their Medicare advantage plan when they enter the long term care facility. Please don’t confuse rehab (swing bed hospital) with long term custodial care. If the member needs help with activities of daily living like dressing eating bathing etc ….that is not medical…. That’s total custody of the persons wellbeing care survival feedings etc. Total custody would be covered under a long term care policy or State Medicaid if they are low income, but not Medicare or a medical policy. There is a special election SEP for being institutionalized in a rehab or long term care facility. Then when they move out of the rehab or LTCF, they will generally have a new SEP to enroll back in a mapd. Always contact your agent and get them to help you navigate your plan options. Feel free to reach out to our agency which is licensed and appointed in many states and will consider getting set up in your state to help you be one of our wonderful customers!!!

Answer: Not usually unless your HMO has a POS (Point of service) for medical doctor visits. Usually the HMO will refer you of network only if you have a condition that can not be treated in network. An example of that would be like if you had a rare condition (rare cancers) or maybe a rare blood disorder. However normal stuff is treated in network. Another option is ask the doctor if he would like to come in network with carrier? Then call your agent and have that person follow up with the carrier net-ops manager to see if they would offer the doctor a contract. Of course the obvious, you could change plans to a plan that the doctor accepts. Usually during AEP or a special election.