Sophia Davis, Medicare Insurance Broker

Answer: Helping people understand their coverage better. Many times patients don't seek help because they don't understand what is covered and what isn't. I encourage my clients to ask me any and every question they have about insurance and how it works. One of my mottos in life has always been "The only stupid question is the one you didn't ask!"

Answer: I look at it from a pricing stand point. Just like a loyalty program at a supermarket, you get better pricing when you are using what they offer. A PPO might give you more options to choose from, however, it can leave your pocketbook more susceptible if something catastrophic were to happen.

Answer: Rewards! Many carriers offer a rewards program for doing certain things like a Flu Shot or Wellness Exam. Many clients simply leave this money on the table because they don't know about it.

Answer: In many instances, yes! Most commonly used medications will remain primarily stable. Patients who take Tier 3 or higher medications, but not enough medications to reach the Max-Out-Of-Pocket threshold, will likely be most affected.

Answer: Think of it like this... Premium= What you pay monthly in order to have access. Just like you pay monthly to have Netflix or Hulu. Deductible= What you have to pay first. Kind of like when your parents said "If you can save $1,000 towards your first car, we'll help you with the rest (limitations apply)" Copay= A set dollar amount you pay for a certain service. It's like Pay-Per-View. You have the monthly service but some things you just have to pay a little more when you want to use them.

Answer: There are many factors that go into ensuring you are on the correct plan for you. I would really need more information in order to answer this question. Please feel free to reach out to me Monday-Friday 9am-6pm (330) 967-5232.

Answer: Having a change in your health status is always a great reason to take a closer look at your coverage. It may or may not be necessary, but it's always worth a look.

Answer: If your biologic is administered at a facility, this is typically billed under Medicare Part B instead of D, therefore the Inflation Reduction Act changes will have no bearing. What will help is being on a plan with a lower Max-out-of-Pocket cost.

Answer: Community knowledge and engagement! Having a local agent gives you access to in-person training they may offer, as well as, increased knowledge of the providers and programs close to home.

Answer: This is definitely part of the review process. At OIS, we always ask our clients to make sure to give us the name of ALL Doctors they are currently seeing and have previously seen. With that said, sometimes sacrificing a doctor is what is needed in order to have the best possible coverage for you for that year. Make sure to look at the bigger picture.

Answer: Simple! Clarification! You Agent should be on the call with you to ensure you are getting accurate information that you understand. Plus, if we are aware of what is going on, we can help you facilitate the follow up!

Answer: If you have the working quarters, Part A will go into effect automatically. You are not required to take Part B as long as your employer offers Medical and has more than 20 employees. You should always talk to an Agent to go over your specific circumstances.

Answer: Once you have chosen a Medicare Advantage plan, all billing goes to the plan. Original Medicare will not pay claims. Think of it like this. If a man sells a car to another man, who then sells it to another, the first is not responsible for any terms agreed to by the other two.

Answer: Medicaid is the best option. At that income level, you may not qualify for FULL benefits, however you could possibly qualify for partial. Partial may cover your Part B Premium for you. Also, look into your states Agency on Aging and apply for Extra Help aka LIS.

Answer: Typically, with an HMO, you are responsible for all costs when using out of network services. Some exceptions may be made in certain circumstances. You can each out to the carrier and request a "Network Exception". There are no guarantees, but it's an option.

Answer: You'll need to get ahold of an agent licensed in your new state. You'll have a 60 day window to select a local plan. If you do not make a selection during that time, you may be placed back on Original Medicare with no prescription drug coverage.