Common Questions About Medicare

Question: When I enroll in a Medicare Advantage Plan, do I have to change my primary care doctor?

Answer: No. It is not necessary. We work with you to determine who your doctors are and in which plans they participate. We then help you choose and enroll in a plan that best meets your needs. You have the freedom to choose your own doctors, and will we propose a plan based on those choices.

Question: Will my medications be covered?

Answer: We work with multiple companies because everyone’s needs are different. We will review your medications and make sure they are on the plan’s formulary before a recommendation is made.

Question: I am struggling to afford my medications. Can you help me?

Answer: Yes, absolutely. Our well-trained agents have the knowledge and expertise needed to review your eligibility for various programs and inform you about ones you may qualify for that help pay for your medications.

Question: When is the best time to enroll in Medicare?

Answer: It is important to sign up for Medicare when you first become eligible to take full advantage of all the benefits. Typically, this means you should enroll prior to your 65th birthday so that your coverage begins on that date.

You are eligible to enroll in Medicare, and receive your Medicare card, beginning three months before, during the month of, and three months after the month in which you turn 65. You must apply within that seven-month period to avoid any late enrollment penalties.

Question: Is there a best time to enroll in a Medicare supplement plan?

Answer: Three months before, during the month of, and three months after the month in which you turn 65. Our agents will help you determine what plan is the right plan for you—Medicare Advantage, Medicare Supplement, or some other option. It is essential that you meet with one of our agents to review your options and to select your plan within that timeframe.

Question: What is better for me—a Medicare Advantage plan or a Medicare Supplement?

Answer: Every client has different needs. Supplemental plans typically have higher premiums, which have low to no out-of-pocket costs when you visit a doctor’s office or hospital. However you also need to purchase a separate prescription drug plan, as well as a separate dental, vision, and hearing plan, if needed—which are typically included in a Medicare Advantage plan. The premiums on Medicare Advantage plans are much lower and have a maximum out-of-pocket expense for co-pays and other medical related costs. Our agents will review your particular medical needs to help you determine which choice is best for you.

Question: How do I enroll in a Medicare Supplement (also known as “Medigap”) plan?

Answer: Our agents will be able to assist you through that enrollment process, which involves various options. Medicare Supplement plans generally cover only basic physician and hospital care, so you will also need to enroll in a prescription drug plan to avoid potential late enrollment penalties. You may also decide to add on a separate dental and/or vision plan, as these benefits are not included in a Medicare Supplement plan.

Question: Are there specific steps I should take to prepare for enrollment in Medicare?

Answer: When meeting with one of our agents, please have a list of your doctors and medications readily available so that our agent can review the plan options that best meet your needs. Our knowledgeable and experienced agents will ask any and all other relevant questions to ascertain which plan best meets your specific needs.

Question: How do I know if I am eligible for Medicare Supplement Insurance?

Answer: Our agents are well equipped to walk you through every aspect of eligibility, medical underwriting, and all other relevant issues.

Question: Does Medicare cover dental care expenses?

Answer: Medicare does not cover dental care expenses, but there are Medicare Advantage plans that do cover those additional benefits.

Question: Does any Part D drug plan fully cover the donut hole?

Answer: The “donut hole” is the gap between the deductible phase of your insurance plan and your initial coverage limit—at which point you get into your coverage. Once you have spent a certain amount on medications (a combination of your out-of-pocket costs as well as what the insurance carrier pays), you are in the coverage gap—or “donut hole”—during which period your share of costs changes.

Once you meet the maximum of that coverage gap, you enter the “catastrophic phase,” and your cost share changes again.

Within that “donut hole” period you will have limited coverage—but this tends to be a fairly limited occurrence. The more expensive one’s medications, the more likely one might be to sustain a period of time within the “donut hole.” Some programs do provide some additional coverage for such an instance, and Diversity Insurance agents will be pleased to review all of these options to help you make the best choice for your particular circumstances.

Question: What if I move to a new state or spend part of the year in another location?

Answer: If you move to a new state, you will be extended a special enrollment period to review your plan options and make a change if needed or desired. There are also options for so-called “snowbirds”—those who spend the warmer months in the northern part of the country and the colder months in the south—as well as for those who do a great deal of traveling. There are Medicare Advantage and Medicare Supplement plans to meet all of those particular needs.