Getting the most out of your Medicare Plan

When going through the benefits of your Medicare Plan a lot of people feel overwhelmed by all the new information in a short period of time.  After a couple of days, it’s easy to forget some of the extra benefits your plan may have included.

1. Travel Benefits: Does your plan have travel benefits for when you leave the state you live in, but still within the USA?

  • In the event of an emergency and you are out of state regardless of if the plan has “travel benefits” or not, your plan will cover the same as if you were “in-network” until you are in stable condition. Once you are in stable condition you will need to relocate to an in-network facility or pay the higher “out-of-network” costs associated with your plan.
  • If you have a plan that has network restrictions, and you travel out of state for several months, some plans have a “travel benefit” you can activate before you leave. Once you activate the travel benefit everything will be covered as if it was in-network regardless of if you are in an emergency or you have “routine” appointment.  Find out what your plans travel benefits are before you take a trip outside of your service area.  When traveling internationally there is some emergency coverage with most Medicare Advantage plans, but I would recommend buying extra insurance for when traveling internationally.

2. Gym membership: Most Medicare plans have some type of gym membership included. They will use “Silver Sneakers”, “One Pass”, or a similar type of program.

  • Most of these programs will pay a flat fee on your behalf each time that you visit one of their in-network gyms as opposed to a monthly membership fee.
  • You can go to the gym programs website and look at the gyms in your area. If you like the pool at one gym and the walking track at another you can go to different gyms just not on the same day.  Each visit will cost the same amount to the gym membership provider (OnePass, Silver Sneakers) regardless of where you go.  The only restriction is one visit a day.

3. Meal benefits: Did you know that many plans have a meal benefit for when you are in the hospital or skilled nursing facility? You can call or have someone call on your behalf and let the insurance company know you have been in the hospital, or a skilled nursing facility and see if your plan has a meal benefit.  If they have a meal benefit let them know you would like them to send you meals! Many insurance companies have programs that will send you a couple meals a day for up to 6-8 weeks.

4. Over the counter allowance: Many Medicare Advantage plans have a quarterly allowance for over-the-counter items that will differ by insurance company and by plan.  Most of the programs will have a magazine mail order option as well as an in-store option.  You will either use your membership card or some insurance companies have a separate card that can be used to redeem benefits.  This quarterly allowance can be used for Aspirin, vitamins, heating pads, scales, and many other over-the-counter items.  The items may be brand specific so it’s important to pay attention to the details of the program and any limitations a particular product may have.

5. Drug Scholarship / Patient Assistance programs: If you have an expensive medication that you are having trouble affording most pharmaceutical companies have programs to help people afford their medications. You do not need to quality for Medicaid or any other form of financial assistance in order to qualify for most programs.  I have seen some people approve for a “Patient Assistance” program that allows you to make 50- 65k annually.

  • You can find the programs by Googling (internet search) the drug name and patient assistance program.  Example: “Lantus Patient Assistance Program”.
  • You can also look up the manufacture of the drug. You can do a search for the manufacture’s patient assistance program.  Example: “Pfizer Patient Assistance Programs” and there will be one or more websites that will have a list of the drugs that are available for a Patient assistance program, links to the application, and some have a phone number and someone will help you though the process.

Most companies have several programs to help reduce or eliminate the cost of the drugs.  Not all drugs have a patient assistance program.  This can be a good way to reduce your cost for the drug as well as get a costly drug off your Part D.

6. Prior Authorizations: Many Medicare Advantage Programs or Stand Alone Part D plans may require prior authorizations before some testing, medical procedures, or some RX Drugs can be approved.

  • Read your evidence of coverage when you get it and keep it in a spot you can refer to it later if need be.
  • Call the number on the back of your membership ID card to see if something requires prior authorization. It is better to check with the insurance carrier and see if they need a prior authorization and be told you do not need one, than you have something done medically then find out after the fact that you needed a prior authorization because the claims were denied.
  • If you find yourself in a situation where claims are being denied, set up a 15-min consultation right away. The sooner we can catch billing issues the easier it is to resolve them before they become a bigger issue and more difficult to resolve.

If you need assistance, please go to the website and schedule a 15-Min consultation to go over your situation and we will come up with a game plan on what we need to do next.

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