Sagrario "Sage" Dyer, Medicare Insurance Broker

Answer: I know that I am beating a dead horse, but ALWAYS use a local, licensed independent broker/agent! Brokers do the shopping for you. We take the time to get the certifications, sit in the trainings, ask the questions, run scenarios, and learn and educated beneficiaries on how to best use their Medicare plans.

If you are happy with your plan and are happy with the changes when you get your Annual Notice of Change, you do not have to pick a plan every year. If you are getting bills that you did not expect, or were not explained to you when you picked a plan, you need to find an agent you like, trust and would recommend to your family.

I tell my clients to question any bill they were not expecting or always call me if they have questions.

Answer: For many on a stand alone Part D, specialty medications, or Tier 4 and 5 drugs, are being charged as a co-insurance, or a percentage of the price, which can be between 30% and 50% of the actual price. If you are paying a higher price, it's a good idea to ask a local agent to review your Part D plan and see if the plan is even covering your medications at all. You can also ask your pharmacy or call the plan directly to ask about the cost.

If the plan is not covering your specialty medication, remember that you can should be asking your a doctor to ask the plan for an exception to include it into the formulary. The plan must respond with 72 hours of the request. You may have to go through Step Therapy, prior authorizations or quantity limits, but the amount you will pay will go toward a $0 co-pay in the long run.

If Medicare approves of the drug being a covered medication, than your Part D has to cover it. This means that what you pay, the plan pays and the manufacture goes toward your TrooP of $2,100 initial coverage amount. One you reach the $2,100, you pay $0 for the rest of the year. The beginning of the year is the most expense because you are paying your deductible first, but after that, if your medication is costing nearly $1,000 a month, you should be reaching your maximum out of pocket by mid-March. You can also ask the plan to put you on a payment plan, which will spread the cost out evenly through out the year.

Always remember, ask a local agent for help. Great agents provide these reviews at not cost to you, but they are also not getting paid by the plan to help, since many so be plans have de-commissioned their Part D plans, so be prepared with your drug list and take note of the suggestions.

Answer: Yes! This will be covered under Part B prevention features. Always check with your local pharmacy for availability and possible need for a referral from you primary doctor.

Answer: Maximum-out-of Pocket is your safety net amount. In case of an unfortunate catastrophe accident or costly medical illness, know that once you have paid up to the MooP amount, the plan and Medicare continue to pay your covered medical services 100%. MooP could avoid filing for bankruptcy incase of an unfortunate situation.

Caution. The MooP starts all over if you change plans

Answer: Medicare Part B pays 80% and you would pay 20% of the approved amount designated by Medicare for that ambulance ride. You pay the 20% of the base rate approved by Medicare. The amount may not be what the ambulance service charges insurance companies.

Answer: Making a difference in people's lives after explaining the possibilities and opportunities available to them to get healthy while on Medicare and Medicare plans I love being honest, transparent, and informative. Building relationshipswith, not just with seniors who become my clients, but their families. I have adopted and have been adopted by lots of new grandparents, brothers, sisters and cousins.

Answer: Can you be more specific? Are you asking about signing up for Medicare or a Medicate plan?

If you miss your window for Medicare and are turning 65, you have to wait to apply between Jan 1 and March 31 during Medicare general election. This may cause you to incrue a penalty.

If you missed your window to enroll in a private Medicare plan, you will need to wait until Annual Enrollment Period between Oct 15 to Dec 7.

Always consult a local, Medicare Advisor before deciding you have missed an opportunity. There are several variables not mentioned in this question.

Answer: If you have Original Medicare, Part A and B, you are paying your part B premium of $202.90 monthly, your are still responsible for 20% of the cost. If you have a Medicare Advantage, your specialist cost is a predictable amount that should remain the same, as long as you are on that plan. Please contact a local agent to do a review of your plan.

Answer: Always work with a local agent who has a vested interest in your community. Do they have star ratings? Do they do reviews with their clients every year, send out bday and thank you cards? Have them check your meds and doctors? Hospitals? Rehab and physical therapy centers? Why do they think this would be a good plan for you? Interview them!

Answer: Dialysis is covered at 80% by Medicare. If you have a Medicare Advantage plan, you are responsible for the 20%, which will go towards your Maximum Out of Pocket expense for the year. There are Medicare plans designed for persons on dialysis where the cost may be $0.

Answer: Medicare covers 80% of the standard cataract surgery. If you have a Medicare Advantage plan, you may have a more predicable out-of-pocket expense for the hospital or ambulatory surgical center. It does not cover custom procedures, such as the monovision.

Answer: You always have to remember that plans are generally for a year, unless you fall under a Special Election Period during the year. That is why it is very important to consult with a local agent who you know. like and trust before making any decisions about a Medicare plan.

Answer: No, it did not and not all insulins were part of the Reduction Act negotiated medications. A beneficiary maybe paying more due to the plans rise in deductible or a change in the medications tier level. Contact the plan's member services on the back of the card and ask what the estimated price will be over the course of the year.

Answer: Medicare does not offer dental and vision. One must get a Medicare Advantage plan that offers such features or get a stand alone dental and vision plan.

Answer: There is no such thing as a better plan. What is better for you, may not be better for another beneficiary. Staying with original Medicare and a stand alone prescription plan allows beneficiaries the freedom to see any provider who takes Part A and B, anywhere in the country, often without referrals, although some procedure may require prior authorizations. If a beneficiary thinks that they may one day want to use the Mayo Clinic, John Hopkins or other specialized facilities for medical opinions, these organization are limiting their acceptance of Medicare Advantage plans.

Part C, or Medicare Advantage plans, offer predicable cost and some $0 premium plans. The major carriers offer travel benefits and national networks, along with ancillary add-ons such as dental, vision and hearing. As the plans change, beneficiaries must always remember that Medicare Advantage plans are medical service plans, not dental, vision or hearing plans.

Better is not always best. Having a local agent review your plan annually is crucial to knowing what is better for one's health.

Answer: You should be doing a plan review every year to see if switching plans is in your best interest when it comes to your health during 2025. Making sure that your doctors are still in network and that your medications are covered is crucial in making a decision to change to another plan, either within the same carrier or to a completely different company. Always speak to a licensed, independent agent, preferably a local specialist, when thinking about changing plans. Good agents should be offering their services at no cost, great agents will education you on the plan and how to use it to your advantage.

Answer: ANOCs are usually sent in early to mid September. Please remember, these changes are not set in stone and agents cannot talk about any concrete benefits until October 15the during Annual Enrollment Period. Make sure to contact your agent or a local agent with any questions you might have and always request a review if these have been changes in your help, doctors and medications.

Answer: For many years, Medicare Advantage plans got a bad wrap. Networks of providers were very small and they were advertised as extremely restrictive. A beneficiary must stay within the network of providers, depending on the plan, it may not travel well if you are an avid explorer to other states and rural areas, and referrals maybe required to see specialist or have a procedure. Over the years, Medicare Advantage plans have gotten more competitive and offer many benefits that target overall health, although if a person wants to see a providers at the Mayo Clinic, or other specialized medical facilities, these places do not take Medicare Advantage plans.

Answer: Too many people have said that that they wished they would have spoken to a licensed, independent Medicare agent before making a decision to sign up for Medicare, and a Medicare plan. Many beneficiaries hear about the part B premium and automatically refuse to sign up because they don't want to pay it and they end up getting a penalty. Too many people do not know they have to have a Part D plan or that there are $0 plans that check the box, and end up getting a penalty.

Answer: The plan N is an excellent plan to have. The idea is that is will pay for an MRI if Medicare approves and pays it's 80% of the bill. Remember that when you sign that form of responsibility with that provider at the time of service, there is a clause that says that if your insurance does not pay the bill, you are responsible for the entire cost.

Answer: Denials for coverage happen for various reasons. First, contact your agent for help. You should always be using a licensed, knowledgeable agent just for this reason.

Aside from that, check to make sure that the specialist is in the network. Does that carrier require a referral or prior authorization to see this specialist? Contact the insurance carrier and ask the reason for the denial and say, "What needs to happen so that I can get this request approved?" You may have to see another specialist, but if this is important to you, please remember to exercise your right to file an appeal with the carrier.

Answer: Yes, Medicare has approved this medication for coverage through Part D. Different plans cover it at different tiers and different prices. Make sure to check the plan formulary and the pharmacy for accurate pricing.

Answer: Original Medicare allows you to see in provider around the country who take Original Medicare Parts A and B. There are no networks restrictions and no need for prior authorizations (in a majority of situations) or referrals. Part D, although a voluntary program, is essential to keep medication cost down and avoid penalties.

Answer: Contact a local Medicare specialist to get you started on exploring if you are eligible for your Part A & B. You may incur penalties for not signing up on time or not signing up at all.

Answer: We are licensed and insured, and possess the knowledge to explain how the coverages work for each plan. When you work with a local Medicare agent/advocate, you are supporting a local business and helping an agent build a reputation of trust and expertise ,and or not.

Answer: Every year, you should speak with a licensed and local Medicare agent/advocate who is knowledgeable about your state's plans. They should review your plan to make sure your cover is keeping up with your lifestyle and changing health needs.