Leisha Stevens, Medicare Insurance Broker
Leisha Stevens
Medicare Broker Licensed in OH, CA, FL and NC
19+ Years of Experience
Contact Details
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Location
Groveport, OH
Leisha Can Help With:
About Me
Hey there, my name is Leisha, and I am your local Medicare advisor and agent. I specialize in Medicare and am devoted to helping you find the best plan that matches your specific needs and financial situation. I will take care of the daunting task of comparing plans from well-known national and local companies for you. Even better, my services are completely free! Contact me today to explore your Medicare options, and be sure to mention that you found me on Medicare Agents Hub!
Q&A with Leisha Stevens
What do you like most about being a Medicare agent?
Answer: I enjoy assisting others in realizing the advantages available to them. Medicare can often be confusing, so it's really satisfying to see or hear someone get a straightforward answer to their questions.
Are Medicare Advantage plans really "free," or is that just clever marketing?
Answer: No, Medicare Advantage plans are generally not free. While some plans may offer a $0 monthly premium, there will still be other out-of-pocket costs such as deductibles, copayments, and coinsurance.
The average monthly premium for a Medicare Advantage plan is around $17, but this can vary depending on the plan. Additionally, you will still need to pay your Part B premium, which is currently $185 per month.
It's important to compare the costs and benefits of different Medicare Advantage plans before making a decision. Some plans may have higher premiums but offer more coverage, while others may have lower premiums but more out-of-pocket costs
Does Medicare cover emergency care if I'm traveling in a U.S. territory like Puerto Rico?
Answer: Yes, Medicare does cover emergency care in U.S. territories like Puerto Rico. Medicare covers emergency care anywhere in the U.S., including its territories, according to the National Council on Aging (NCOA). Original Medicare, which is Parts A and B, covers emergency care, and Medicare Advantage plans also cover emergency care when traveling in the U.S.
I'm homebound and need remote monitoring for my heart condition. What Medicare benefits might apply to someone in my situation?
Answer: Yes, remote patient monitoring is covered by Medicare if your program meets their guidelines. As healthcare continues to evolve, Medicare has recognized the importance of RPM for improving patient care, especially for the aging population and those with chronic conditions.
How will the Inflation Reduction Act's Medicare drug pricing changes really affect seniors?
Answer: The Inflation Reduction Act (IRA) significantly affects seniors with Medicare, primarily by lowering drug costs through price negotiation, capping out-of-pocket spending, and expanding low-income subsidies. This will mean that many seniors will have access to medications at lower prices and with greater affordability, especially those who rely on chronic disease treatments.
Here's a breakdown of how the IRA impacts seniors:
Lower out-of-pocket costs:
The IRA caps out-of-pocket spending for Medicare Part D enrollees at $2,000 per year. This means that seniors will no longer have to pay the full cost of their prescription drugs once they reach the catastrophic coverage phase, which was previously at a higher threshold.
Medicare drug price negotiation:
For the first time, Medicare can negotiate directly with drug manufacturers for the prices of certain drugs. This will lower prices for those drugs and make them more affordable for seniors.
Expanded low-income subsidies:
The IRA expands eligibility for Extra Help (the Low-Income Subsidy program). This means that more low-income seniors will qualify for reduced copayments for both generic and brand-name drugs.
Capped insulin costs:
The IRA limits cost-sharing for insulin to $35 per month for all Medicare Part D members. This will make insulin more affordable for those with diabetes.
Free vaccines:
The IRA eliminates cost-sharing for all adult vaccines covered by Medicare Part D. This will ensure that seniors can access the recommended vaccines without incurring any costs.
Potential downsides to consider:
While the IRA lowers out-of-pocket costs for some, it could also lead to higher premiums for others.
Some analysts suggest that the price negotiation provisions could disincentivize drug companies from developing new medications.
The changes to Medicare Part D, while beneficial for many, could also lead to some seniors having to pay more for certain medications if their current plan changes.
In summary, the IRA
I've heard Medicare covers home health care, but what exactly does that include?
Answer: Medicare's home health care coverage primarily includes skilled nursing care, therapies (physical, occupational, speech), and medical social services, provided in a part-time or intermittent basis. It also covers certain medical supplies, durable medical equipment, and home health aide services (only if you're also receiving skilled nursing or therapy).
I need home health care after my surgery, but Medicare denied coverage. What are my appeal rights?
Answer: If Medicare denies coverage for home health care after surgery, you have the right to appeal the decision. You can file an appeal with Medicare, and if that's not successful, you can continue the appeals process through multiple levels.
Here's a breakdown of the appeal process:
1. Initial Appeal (Level 1):
You can start by appealing the decision with your Medicare plan or, if you have Original Medicare, with the Medicare administrative contractor (MAC).
2. Reconsideration (Level 2):
If the initial appeal is denied, you can request a reconsideration by a Qualified Independent Contractor (QIC).
3. Independent Review Organization (IRO):
If the reconsideration is also denied, you may be able to request an external review by an independent review organization (IRO).
4. Office of Medicare Hearings and Appeals (OMHA):
If you still disagree, you can request a hearing before the OMHA.
5. Medicare Appeals Council:
If the OMHA decision is not favorable, you can request a review by the Medicare Appeals Council.
6. Federal Court:
In certain circumstances, you may be able to take your case to Federal court for review.
Important Considerations:
Deadlines:
There are specific deadlines for each level of appeal, so it's important to understand and follow those guidelines.
Supporting Documentation:
You should gather any relevant medical records, documentation, and supporting evidence to support your appeal.
Fast Appeal:
If the denial is urgent, you may be able to request a fast appeal.
Helpful Resources:
You can find information and assistance through the Medicare website, the State Health Insurance Assistance Program (SHIP), and other organizations.
In summary, if Medicare denies your home health care coverage, you have a right to appeal. Start with your plan or the MAC, and if necessary, proceed through the subsequent levels of the appeals process. Be sure to meet deadlines and gather any supporting documentation to strengthen your case.
I am on ssi Disability. I turn 65 in June. I also just got Humana health. So does it be change to SSI?? Or does my SSI -Disabiliy just go on til death.
Answer: Hello, is Humana Health a Medicare Advantage plan? Also, for the rest of your question, you have to call Social Security; they determine when disability payments change from one status to another.
If I move to a rural area, how might that limit my Medicare Advantage plan options?
Answer: Moving to a rural area can significantly limit Medicare Advantage plan options. Medicare Advantage plans typically have limited networks of in-network providers, and these networks may be less comprehensive in rural areas, making it harder to find specialists or access the necessary care. You might also find fewer plans available in your new area, potentially forcing you to choose between a limited plan or returning to Original Medicare.
Limited Provider Networks:
Medicare Advantage plans usually require you to see doctors and use hospitals within their network to receive full coverage. In rural areas, where there may be fewer healthcare providers overall, finding a network that includes the specialists you need can be challenging.
Fewer Plan Options:
Rural areas often have fewer Medicare Advantage plans offered compared to urban areas. This can limit your choices and make it difficult to find a plan that meets your specific needs and preferences.
Potential for Out-of-Network Coverage:
Some Medicare Advantage plans offer limited out-of-network coverage, but this is often more restricted than with Original Medicare, which covers any provider who accepts Medicare.
Special Enrollment Periods:
Moving out of a plan's service area triggers a special enrollment period, giving you time to switch to a new plan or return to Original Medicare.
Coordination of Care:
In rural areas, you might find it harder to coordinate your care with specialists who are part of the plan's network, especially if you need to travel significant distances.
Important Considerations:
Research your new area:
Before moving, research the Medicare Advantage plans offered in your new location and review their provider networks.
Contact your current plan:
If you plan to move, notify your current Medicare Advantage plan to see if they offer coverage in your new area. If not, they can help you find a new plan or return to Original Medicare.
Consider Original Medicare: