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When you become a client, you have access to our licensed client advisors year-round. We’ll handle your enrollment needs, educate you on important Medicare and plan-related topics, and advocate on your behalf. No matter what your plan needs are, we’ll be with you every step of the way.

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Need guidance? You’ve come to the right place. Here are answers to some of the most frequently asked Medicare questions.

For Current Clients

You can reach out to our team of client advisors! Here is our contact information:

Phone number: 1-877-222-1942

Schedule a call: retiremediq.com/schedule

Billing

Your Medicare plan benefits are outlined in your Summary of Benefits, located in your plan booklet provided by your insurance company and available on your insurance company’s website. You can also call us at 1-877-222-1942 and we can walk through your plan’s benefit information with you. The Summary of Benefits gives you a general idea of costs for various procedures, but it is important to note that complicated medical services (such as surgeries) will only be estimates. The final costs will be based on the services billed by your provider and the allowed amounts by the plan.

No, an Explanation of Benefits is not a bill—it is simply a statement sent by a health insurance company to individuals explaining how medical treatments and/or services were paid for on their behalf. If you were to receive a bill for medical services, it would come from your provider or hospital, not from the insurance company. An insurance company will only bill you for plan premiums.

If you believe your bill is incorrect, call us for assistance. We can help guide you in the right direction and assist you in calling your insurance company or provider’s office if needed.

ID Cards & Other Plan Materials

Once your enrollment has been processed, it can take up to two weeks for you to receive your ID card in the mail. In the meantime, we can provide you with your plan policy number that you can use until you receive the card in the mail. You can also create an online account with the insurance company and print a temporary ID card.

The fastest way to secure a new ID card is to call the insurance company or use your online member account to request a new one. When calling, many insurance companies have automated phone prompts through which you can request a duplicate ID card. It usually takes around five minutes to request a new one. You should receive the new ID card in 7-14 business days. Call our team if you need any assistance with this.

Ultimately, you must request a provider directory from your insurance company; however, we encourage clients to search online using the insurance company website which contains more current provider information than printed directories. Providers may leave or join a plan’s network at any time during the year. If you need assistance searching for a provider, call our team for assistance at 1-877-222-1942.

You must contact your insurance company to request plan materials such as the Evidence of Coverage, Summary of Benefits, or Formulary. You can also download the plan materials from your insurance company’s website. Contact us if you need assistance with reaching out to your insurance company.

Traveling or Moving Out of the Area

Medicare plans grant coverage for urgent and emergency care within the United States. For all other non-emergency medical services while traveling, coverage depends on the kind of plan you have. For example, PPO plans offer some extended coverage while some HMO plans require you to stay within your plan’s service area. Please contact our team for details.

Coverage outside of the country varies depending on the plan. To confirm your travel benefits, you can refer to your plan’s Evidence of Coverage and Summary of Benefits or contact our team.

Medicare Advantage (MA) plans are based on the county you live in. If you are moving outside of your current county or to another state, please contact us to discuss your plan options. You may or may not need to change your plan depending on where you move. If you move within the same county, you only need to inform us of your new address.

Prescriptions

The “donut hole” (or coverage gap) is a gap in prescription drug coverage. It occurs after the total cost of your medications during the year has exceeded a certain amount. Call us to discuss any questions you may have about your personal situation.

Your plan might require prior authorization for certain prescription drugs. Before your plan covers one of these drugs, your provider will need to contact your insurance company and explain why it is medically necessary for you. If a medication requires prior authorization, it will be noted on your plan’s Formulary.

A quantity limit is a cap on how much of a medication you can get in a certain timeframe. Insurance companies place quantity limits on certain drugs for safety and cost reasons. If you are prescribed more than the quantity limit, your provider will need to contact the insurance company to confirm that the additional amount is medically necessary.

In some situations, certain vaccinations may be covered. However, most provider offices are unable to bill these claims to your prescription drug plan. Typically, most have an easier time obtaining coverage by getting vaccines from a pharmacy instead of a provider’s office. If you have questions about the specifics of your plan’s benefits, call our team.

Step therapy is a type of prior authorization required by an insurance company. Specifically, it is the process of treating a medical condition with the most cost-effective medication before progressing and providing coverage for a more costly medication.

A prescription drug deductible is the amount you must pay annually before you start paying the fixed copays as outlined by your plan. Not all Medicare plans have a prescription drug deductible. You can refer to your Summary of Benefits to determine your deductible and copay amounts.

Generally speaking, Part B covered medications include those given by a doctor in a medical office or hospital setting; they are determined medically necessary by a provider. Part D medications are generally maintenance medications that you take yourself (the type you pick up from the pharmacy). Please visit Medicare’s website to learn more.

If you are having trouble paying for medication costs, you may have options. If the medication is not listed on your formulary, it is possible for your provider to request a formulary exception from the insurance company by providing medical necessity. Another option is to contact the Social Security Office to determine your eligibility for a federal program called Extra Help. For more tips on how to save on medication costs, watch this video. If you would like assistance or have further questions, contact our team.

During a hospital visit, any routine prescriptions you need that are given by the hospital are considered self-administered drugs. These medications are typically not covered in your hospital co-pay, unless they are required for the hospital services you are getting. You will most likely be billed for the full amount. Once you have paid your bill, you are able to request reimbursement from the Part D portion of your plan through a form called a Prescription Drug Reimbursement Claim Form. We recommend that you check the hospital’s policy on bringing in your own medications, which may allow you to avoid these types of bills. If you find yourself in this situation, contact our team to learn more.

Enrollment Periods

During Medicare’s Open Enrollment Period (OEP), Jan. 1 – Mar. 31, anyone on a Medicare Advantage (MA) plan can enroll in a different MA plan or disenroll from their current MA plan and return to Original Medicare. Individuals can only make one change to their plan during OEP. If a plan change is made, the new plan will go in effect the first of the following month.

Medicare’s Annual Enrollment Period (AEP) is for all individuals on any type of Medicare plan. AEP is from Oct. 15 to Dec. 7 each year. During this time, you can review your current Medicare plan and explore others that may better fit your needs or budget. If you choose, you can enroll in a new plan for the upcoming year. It is important to note any needs that may require an adjustment in coverage throughout the year, that way we can assist you once AEP comes.

When certain life events happen, Special Enrollment Periods (SEPs) allow you to make changes to your medical or prescription drug coverage. Some examples of qualifying life events are moving to a different location or losing other insurance coverage. If you would like to know more about SEPs, please reach out to us.

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