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About Your Agent
Throughout his career as a Licensed Insurance Agent, Ben Rodriguez has advised hundreds of Medicare recipients. Since obtaining his degree in Business Finance from Kent State University, Ben has acquired nearly 15 years of experience in financial services and insurance. Having a close relationship with his parents and grandparents has made him especially in tune to the needs of boomers and seniors. Ben is known for his professionalism with a personal touch that he brings to each of his clients.
Licensed Agent / Advisor
5 Ways To Get Your Best Medicare Advantage Plan
Whether you are new to Medicare or are already receiving it, finding your best coverage can be challenging and time consuming. With Medicare there is no "one size fits all." It's great that there are so many options, but it can also be confusing. Fortunately there are steps that can be taken to simplify the process and find your best plan. Below we summarize 5 important areas you'll need to look at when comparing your options.
1. Compare The Main Advantage Plan Types
There are two main types of Medicare Advantage Plans; HMO's and PPO's. HMO stands for Health Maintenance Organization. HMO's are community based plans that have a network of doctors & hospitals that accept the coverage. In most cases HMO's do not cover you outside of their network. With an HMO you'll also assign a Primary Care Physician who is your central contact for care. Your Primary Care Doctor provides you with referrals for specialists and other treatment you may need. HMO's usually have a low or no monthly premium associated with them (in addition to your Part B premium). They will also typically have reasonably low copays for care and certain medications.
PPO Plans are the second main type of Medicare Advantage Plan. PPO stands for Preferred Provider Organization. In contrast to HMO's, PPO's allow you to receive care from their doctor network but also outside the network should you choose. Although you can receive care out of the network, you'll pay more out of pocket than you would in network. In most cases PPO plans do not require you to assign a Primary Care Doctor and receive referrals for specialists. PPO's are more flexible in terms of when and where you can receive care.
Understanding these two main plan types and which best matches your preferences will help you narrow down your options and make it easier to find your best plan.
2. Check Your Doctors & Medical Providers
As mentioned above, Medicare Advantage Plans usually have doctor and medical provider networks. If you have physicians who treat you or with whom you have a long standing relationships; you'll want to make sure they accept the plans you're considering. In working with us we will check your doctors and notify you if your doctor accepts the plan. You can also contact your doctor and ask them directly. Just be sure you provide them with the specific plan name and type.
3. Review The Monthly Cost and Summary Of Benefits
Each Medicare Advantage Plan has a standard document called the Summary of Benefits. It is typically about 10-12 pages long and outlines the important information on any particular plan. That information includes;
The monthly cost of the plan.
Medical coverage, deductibles, and copays for different types of care.
Drug coverage and copays.
Extra and optional benefits such as dental, vision, and gym memberships.
The Summary of Benefits can provide you with the info you need to make a good decision. When working with us, your agent will review it with you and ensure you have a copy for your records.
4. See How Your Prescriptions Are Covered
Medicare Advantage Plans will usually include Part D Prescription coverage. Although Part D Plans are modeled by Medicare each year, how your prescriptions are covered will vary with different plans. Some plans may cover your particular prescriptions at lower costs vs other plans. Examining Part D coverage with any particular plan is important, especially if you take several prescriptions on a regular basis.
5. Evaluate The Insurance Plan Provider
One of the biggest questions to ask is; Who is providing me with my plan? Depending on where you live, there will be several insurance company providers that offer plans. As with anything, some companies are more reputable and higher quality than others. Some questions to be answered are;
Will my plan provider be around next year?
Can they continue to provide me with good service and manage my claims & benefits?
Can they sustain relationships with doctors and hospitals?
The more experienced the plan provider, the better it usually is for you as a member. Fortunately if you're working with us we've put together a selection of experienced and quality providers to choose from.
5 Ways To Save On Part D Prescription Costs
If you're on Medicare with a fixed income, you need to find ways to trim expenses when you can. Whether you are taking just a few medications or several, prescription costs can add up. The good news is that there are several, often overlooked, ways to save on these costs. In our experience from working with clients over the years, these are the top strategies for saving on prescription expenses.
1. Choose The Right Plan
With Part D and Medicare Advantage Plans, there are many different options to choose from. Plans vary in benefits, costs, and covered prescriptions. Due to these factors it is important to evaluate plans based on your current prescriptions as well as potential future needs. There are tools available to compare your available plans and how they cover your prescriptions. When you work with us, your agent will use these tools to provide you with more information and recommend the best plan for you.
2. Apply For Extra Help
If you are considered to be low or moderate income, you'll benefit from the "Extra Help" program. Extra Help, also known as Low Income Subsidy, is a program through Social Security and Medicare that will set your prescription costs at the lowest available copays. If You qualify, no matter which Part D or Medicare Advantage Plan you have, Medicare will determine your costs. Also, if your plan has a monthly cost, Social Security will help pay for all or a portion of the premium. It's fairly easy to apply;
Go to www.socialsecurity.gov/prescriptionhelp to learn more and apply online.
Click Here to download the paper application and apply by mail.
3. Review Your Medications With Your Doctor
One or more prescriptions in your current regimen may be on the expensive end. In the past you may have had a plan that covered them well or you were ok with the costs. Being on Medicare you may need to re-evaluate your medications and explore potential alternatives. Medicare Part D and Advantage Plans don't typically like to cover expensive medications when there are good, low cost alternatives. If this applies to you, talk to your agent and your physician about your options.
4. Go To Preferred Pharmacies Under Your Plan
Part D and Medicare Advantage plans have relationships with different pharmacies, which may vary depending on the plan. In most plans there are preferred and standard pharmacies. In order to increase customers, Preferred Pharmacies have agreed to offer lower copays for prescriptions. The savings can add up to hundreds of dollars each year, so it's important to fill your prescriptions there.
5. Take Advantage Of Mail Order Delivery
Many people are familiar with mail order pharmacies and have used them from time to time. Depending on your prescriptions and your plan benefits, this can be a big potential area for savings. This benefit will work best with your maintenance medications that you take on a regular basis. Because mail order pharmacies don't have retail locations, they're overhead costs can be lower. They can then pass these savings on to you.
5 Ways To Compare Medicare Supplements Vs. Medicare Advantage Plans
When you are covered under Medicare there are 2 primary ways to setup your coverage; Original Medicare A & B and Part C Medicare Advantage plans. Most people who choose Original Medicare also get a Medicare Supplement Policy. Medicare Supplements, also known as Medigap, help cover deductibles and coinsurance costs under A & B. This helps limit your out of pocket costs for medical care.
The second way you can receive Medicare are through Advantage Plans, also known as Part C. Medicare Advantage Plans are health insurance programs provided by private insurance companies. So, instead of receiving your Medicare directly with Original Medicare you are receiving it through a private insurer.
The display below shows you these two primary options.
It's worth noting early on that if you are under age 65 and on Medicare; Medicare Advantage is usually the better choice. Unfortunately Medicare Supplement coverage in Texas is limited and very expensive if you are under age 65.
Your two primary options for receiving Medicare have many differences. The chart below compares them with 5 main areas of consideration.
Work with a licensed insurance agency that hundreds of Texans trust & rely on. We specialize in Medicare Supplements, Medicare Advantage, Part D, and Dental & Vision plans. Our service is designed to be a one stop shop to make it easy for you to get your best value coverage. We are based in Austin, TX and offer plans in the entire state. Our services are provided to you conveniently by phone & online. But don’t take our word for it, check out our 5 star customer reviews and A+ BBB rating.
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