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Medicare Tips


Q: Roy, tell us about yourself and your qualifications My basic background has been in business consulting. After being honorably discharged from the Air Force I was employed with a consulting company to work with the Air Force at Headquarters NORAD in Colorado Springs to develop some computer software to aidin their mission of protecting the US from foreign threats. Further as a consultant I led a group of analysts and consultants to develop a system for Blue Cross/Blue Shield of Arizona. Over the next many years, I had the honor of working with companies like Frito-Lay, Sun Oil Corporation, Dell and WIPP. More to the point, our agency is dedicated to serving the people in Eddy and Lea counties. We are committed to “Customer Service”. My background as a consultant was and is to help customers solve problems and offer solutions to fit their needs, not ours. Health insurance including individuals, groups, Medicaid and Medicare is a perfect fit for us. We love helping people find the right plan for them. Medicare Health Plans require yearly training and updates concerning every company and the plans they offer. Q: Medicare can be confusing. How should people start who want to learn more about Medicare? Medicare plans and options ARE confusing. If someone wants to research plans, they can go to Medicare. Gov on the internet and find an abundance of information. It’s easy to get caught up in the details and not find the exact answer originally sought. Every year Medicare sends a booklet “Medicare and You” which has some good basic information. It’s sent to everyone over 65 entitled to Medicare benefits. Q: What materials do they need to gather in advance? What research do they need to do?It is important for Medicare Beneficiaries to have a list of their current medications and dosages. Additionally, itis very helpful to have a list of current physicians and specialists handy. In order to enroll in Medicare Plan or Prescription Drug plan, beneficiaries must have their Medicare card available. The Medicare Card information is necessary to process any enrollment in any type of Medicare or Drug plan. The card is a Red White and Blue card and it lists the Medicare Claim number, the Part A and Part B effective dates and also tells us how the client’s name appears through the Social Security system. Additionally, special programs are available for low income Medicare Beneficiaries. Most people do not know they qualify for Prescription Drug Extra Help and help getting their Part B premium to Medicare paid on their behalf. Agents like myself, can determine if a client qualifies and help them apply. Q: What’s the most common misconception when it comes to Medicare? Medicare is not free. Beneficiaries earn full Medicare Benefits by working at least 40 quarters(10 Years) throughout their lifetime, and paying taxes into Social Security and Medicare. Medicare does not cover all costs. There are deductibles and coinsurances that are part of what a beneficiary pays. The Part B to Medicare costs $144.60/month for 2020 plus a $196 annual deductible that has to be met first. This if for outpatient services only. Part A to Medicare is the Hospital coverage and deductibles must be met before Medicare pays. If a person hasn’t worked enough quarters in their lifetime, Part A can be purchased for a fee. Generally speaking, Medicare pays 80% of the outpatient medical costs and the individual picks up the remaining 20%. It is critical Medicare beneficiaries get additional coverage to go along with their Medicare. As many of you know, most procedures these days are done on an outpatient bases, and the 20% coinsurance can go into the many thousands of dollars. It is our job to review your current coverage and make sure you have protected yourself financially. Q: Tell us about the different plans that exist? There are 3 types of plans that a Medicare Beneficiary can join to protect themselves financially and enjoy extra benefits. The 3 plans are Medicare Supplements, Medicare Advantage Plans and Part D Prescriptions drug plans. Medicare Supplement plans allow a beneficiary to go to any doctor who accepts Medicare. Standardized plans are available from a wide range of carriers and the plan you choose determines your rate. These plans do require medical underwriting unless an individual has guarantee issue rights. There is always a premium attached to these plans and the premium will go up every year. Remember, you also have to continue to pay your Part B premium to Medicare. Basically, these plans allow you to go to any doctor and any hospital in the country who accepts Medicare, and no referrals are required. Remember, these plans are pricey and we always want to enroll someone in these plans who can afford the premiums over their lifetime. Additionally, Medicare Beneficiaries will need to purchase a Part D prescription drug plan to have full coverage for Medical and RX needs. Medicare Advantage plans are your other choice. These plans combine your Medicare Part A, B and D into one plan and are called PART C TO MEDICARE. The plans are offered through private insurance companies and the most common plans offered are HMO’s, PPO’s, and Special Needs plans for low income Medicare beneficiaries. Medicare Advantage plans ask you to stay inside a network of providers to get all of your care except in an emergency or urgently needed care. The plans come at very low or no premiums and offer you all sorts of extra benefits Medicare does not offer. Basically, you pay as you use services through fixed copayments or coinsurance. Medicare Advantage Plans offer extra benefits like Dental, Vision, Health Club memberships, Hearing, transportation and Over the Counter RX benefits. Enrollment in these plans has exploded throughout the country and are becoming more available in smaller rural counties like Eddy and Lea counties. Additionally, new plans are coming to Eddy and Lea county for those beneficiaries who have Medicare and Medicaid. These plans offer generous extra benefits that Medicare beneficiaries don’t get through their Medicaid coverage. This is very exciting news for folks in our counties. Q: What can you tell us about prescription drug plans? Prescription drug plans are more complex. All plans have different formularies and drug costs. It is important to check your plan every year during the Medicare Annual Enrollment to make sure you are not paying too much for your prescriptions. If you find a better plan, you should make the change during the Medicare Annual Enrollment Period which is October 15th through December 7th. If a person has the time, they can go to Medicare. Gov and enter their prescriptions including dosage, frequency and quantity purchased to compare plan by plan to see which one is the most cost effective. I have seen a person make a simple mistake here and the monthly cost being in the hundreds or thousands of dollars. Prescription Drug plans are typically offered in most Medicare Advantage plan offerings. If you have a Medicare Supplement, you must also enroll separately in a Part D plan. Q: Why isn’t it a good idea for someone to get their coverage online or by calling a number I saw on TV?Basically, when you call into a TV ad, you are only getting information about that carrier’s benefits and the telesales team will try to enroll you in their plan. Don’t forget you have choices! There are also call centers that represent all plans, but those folks don’t know anything locally about our doctors and hospital networks in our counties. Realize that your local agents typically represent all plans, have been specially trained by all carriers, and they will sit down with you and evaluate you needs and help you choose the correct plan. Don’t have an 800 number as your agent! Use a local agent who is there for you and knows your area. Also, TV ads cover plans across the nation and very few of those plans and plan benefits are available here in Eddy and Lea Counties. A gentleman in our office this morning was trying to get a drug plan that wasn’t offered in New Mexico . The telephone agent he was talking to told him it wasn’t available and to call Medicare for more information. That didn’t help. Another person purchased their health insurance over the phone and it turned out not to be insurance, but a discount for services card that isn’t accepted by any of our local doctors. That didn’t help, money was spent and nothing to show for it.Q: What are the benefits of working with a local insurance agency? First and foremost, we don’t charge for our services. Our commissions are paid by the carriers and are embedded in their yearly administrative costs. Additionally, our compensation is the same no matter what plan you choose. There is no incentive financially for an agent to not put you on a plan that fits your needs. What you get is our very best time and attention to your needs. We work diligently with every customer to ensure the providers are in network, the prescription drug plans are covering the needed prescriptions and you understand what you are purchasing.

Q: Is there any other information you’d like to share? It’s difficult to get the word out to people to let them know what is available and that there is a local agency dedicated to them and their families. If anyone has a question, they can call us, Roy Willis or Jennifer Vasquez at 575-885-3276 or come to our office at 312 N Canal St, Suite C (Farmers Insurance)

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