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Thank you for being a client of RetireMEDiQ. We look forward to continuing to assist you in any way we can. Whether you simply have a question or are considering changes to your existing Medicare plan, you’ve come to the right place.

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As a RetireMEDiQ client, you have lifelong access to valuable Medicare resources and advice. Here are answers to some of the most frequently asked Medicare questions.

Billing

Your Medicare plan benefits are outlined in your Summary of Benefits, located in your plan booklet provided by your insurance company and on the insurance company’s website. You may also call us at 1-877-222-1942 and we can walk through your plan’s benefit information with you. The Summary of Benefits will give 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 covered 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 a bill is incorrect, you may call our team 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 for you to use until you receive the card in the mail. You can also create an online account with the insurance company and print off a temporary ID card.

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

Ultimately, you must request a provider directory from the 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 of the year. If you need assistance searching for a provider, you are welcome to 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 are welcome to contact our team for assistance in reaching out to the 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 is dependent on the kind of plan you have (for example PPO plans offer some extended coverage while HMO plans require that you stay inside your plan’s service area). Please contact our team for details.

Coverage outside of the country varies depending on the plan. You may refer to your plan’s Evidence of Coverage and Summary of Benefits or contact our team of client advisors to assist you in clarifying your travel benefits.

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 our team to discuss your plan options. It may or may not be necessary to change your plan depending on where you move. When moving within the same county, you will only need to inform us of your new address.

Prescriptions

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

Your plan might require prior authorization for certain prescriptions to make sure they are used correctly. Before your plan will cover these drugs, your provider will need to contact your insurance provider and provide an explanation as to why the medication is medically necessary for you.

A quantity limit is a limit on how much medication you can get in a certain timeframe. Insurance companies place quantity limits on certain prescriptions for safety and cost reasons. If you are prescribed more than the quantity limit, your provider will need to send a medical note to the insurance company to prove medical necessity for the additional amount.

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

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

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 the amount of your deductible and copay amounts.

Generally speaking, Part B covered medications include those administered by a doctor in an office or hospital setting and are determined medically necessary by a provider. Part D medications are generally maintenance medications that you take yourself (the kinds 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 documentation for its necessity. Another is to contact the Social Security Office to determine your eligibility for a federal program called Extra Help. If you would like assistance or have further questions, please contact our team.

During a hospital visit, any routine prescriptions you need that are dispensed by the hospital are considered self-administered drugs. These medications are typically not covered by your hospital co-pay unless they are required for the hospital services you are getting, so 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 advise you check the hospital’s policy on bringing in your own medications, which may allow you to avoid these types of bills. Please contact our team to learn more.

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