Frequently Asked Questions
We know you have questions about Medicare and all its many parts, plans, and enrollment periods. Wanda Dimare and the Wandacare Team are here with the answers and information to help you choose the best Medicare coverage for you.
What Is Medicare and how does it work?
Medicare is a federal health insurance program administered by the Centers for Medicare and Medicaid Services (CMS), part of the U.S. Department of Health and Human Services (HHS). It is designed to provide medical coverage to individuals that are aged 65 and older, as well as to those with certain disabilities.
Government-funded Medicare (also called Original Medicare) has two parts: Part A covering hospital insurance and Part B covering medical insurance. You have the option to sign up for additional “parts,” such as coverage for prescription drugs, vision, and dental through private insurers with plans supplemented by Medicare.
Medicare pays a set amount for covered services, and you will be responsible for any deductibles, copayments, or coinsurance in a cost-sharing, fee-for-service structure. With Original Medicare, this is an 80/20 split, with Medicare covering 80% and you responsible for the remaining 20%.
What services does Wandacare offer?
For over a decade, Wanda Dimare has been helping people in Lakeland and the greater Polk County community to better understand and navigate Medicare so they can confidently choose the best plan for their medical needs.
As our client, your needs always come first, which is why the Wandacare Team offers our services for free. We provide free education resources, so you can better understand the parts of Medicare and what coverage is offered. In a free consultation, we’ll get to know you so we can provide personalized plan recommendations based on your current care needs, desired coverage and benefits, and budget. We’ll work one-on-one with you to go through each plan, what it covers, and what it will cost, providing detailed free plan quotes and policy writing. Our team of licensed and local independent agents know the best plans available in the Polk County market and are certified to write policies for any carrier in the market.
We are the most knowledgeable about local plans and policies, but we’re not here to sell insurance policies. We’re here to help you. Our team walks with you throughout your entire Medicare journey, from researching plans to guiding you through the enrollment process to advising you during annual open enrollment to ensure your plan is still meeting your needs and providing the best coverage for you at the best price.
What is the difference between Original Medicare and Medicare Advantage?
Original Medicare is the government-funded and managed insurance that provides the hospitalization and medical coverage of Parts A and B. Medicare Advantage Plans, also known as Medicare Part C, are offered and managed by private insurance companies approved by Medicare. Essentially the government pays the private insurance company to cover your Medicare benefits, and your healthcare services are coordinated through the Medicare Advantage Plan, rather than federal Medicare.
Medicare Advantage Plans provide Part A and B coverage, but usually also include prescription drug coverage (Medicare Part D), as well as additional benefits like dental and vision plans, and wellness and fitness programs.
What are the costs of Medicare Part A and Part B coverage?
The majority of people who are eligible for Medicare do not have to pay a premium for Part A hospitalization coverage, as they’ve already paid for it through Medicare payroll taxes during their working years. Anyone who worked and paid Medicare tax for ten years or more qualifies for premium-free Part A coverage. However, Part A coverage does have an inpatient hospital deductible to meet. For 2023, that deductible is $1,600.
For Part B medical insurance coverage, the majority of people eligible for Medicare will pay some form of monthly premium. The Part B premium, deductible, and coinsurance rates are set annually, based on income according to the Social Security Act. For 2023, the monthly premium is $164.90, with the annual deductible being $226. Medicare then pays 80% of healthcare costs and the individual is responsible for paying 20%.
What is and is not covered by Medicare?
Medicare Part A covers inpatient hospitalization care, including hospital admittance, skilled nursing facility care, hospice care, and some home health care services.
Medicare Part B medical insurance covers medically necessary and preventative healthcare services, including preventive screenings, annual wellness checkups, doctor visits, lab work, outpatient and ambulatory services, and durable medical equipment. It also covers some in-patient services that Part A doesn’t cover, such as some home health care, physical and occupational therapists, and mental health services (inpatient and outpatient), as well as partial hospitalization.
Prescription drug coverage (Medicare Part D) is not included in the federal Medicare program. All Medicare Part D plans are offered by private insurance companies and supplemented by Medicare. The drugs covered, costs, and monthly premiums will vary based on the plan provider.
Medicare does not cover dental care or dentures, eye exams or glasses, cosmetic surgery, massage therapy, hearing aids, concierge doctors and medicine, or routine physical exams beyond the annual wellness checkup. Many of these benefits are included with Medicare Advantage Plans (Medicare Part C) from private insurers, which also usually include Part D prescription drug coverage.
Ultimately, what Medicare does and does not cover is based on federal standards and national Medicare coverage, as well as local coverage based on the plans and providers in your area.
The Wandacare Team has over 10 years of experience serving the Polk County community with free Medicare resources. As independent agents, we can write policies for any carrier in the market and know the plans available in our local market. We’ll help you find the right plan with the coverage you need.
How do I enroll in Medicare?
Once you turn 65, you can take advantage of Medicare benefits by enrolling during your Initial Enrollment Period, which begins three months before your 65th birthday month, includes your birthday month, and continues for three months after your birthday month.
You’ll apply to enroll for Medicare through the Social Security Administration (SSA). This is to verify your eligibility. You can enroll in person at your local SSA office, on the phone with the SSA’s toll-free number, or through the SSA website.
If you miss your Initial Enrollment Period you can enroll during the Medicare General Enrollment Period (GEP), which runs from January 1 to March 31 every year. However, your coverage won’t take effect until July 1, and you may incur late enrollment penalties of 10% on each part.
If you have another form of insurance (such as an employer healthcare plan or coverage with a spouse) and choose not to enroll in Medicare at age 65, you can be eligible for a Special Enrollment Period to enroll in Medicare when that coverage ends without incurring any penalties.
Once you are enrolled in Medicare, you will then have various annual and open enrollment periods (depending on the “parts” you’ve selected and plan type) when you can make changes to your plan or coverage.
The Wandacare Team can walk you through the entire process, from your initial enrollment to annual open enrollment for any changes or new coverage selections you wish to make.
Who is eligible for Medicare?
Medicare eligibility is based on age or medical condition/disability. Individuals aged 65 and older are eligible for Medicare. People receiving disability benefits, either from Social Security Disability Insurance (SSDI) or Railroad Retirement Board (RRB), can qualify for Medicare regardless of age. Those with End-Stage Renal Disease (permanent kidney failure) or ALS (Lou Gehrig’s Disease) are eligible for Medicare as soon as they start receiving disability benefits, or if they are the spouse or dependent child of an individual eligible for disability benefits.
Is my Medicare card issued automatically when I reach 65?
No, you are not automatically enrolled in Medicare or issued a Medicare card when you turn 65. You’ll need to apply for Medicare through the Social Security Administration (SSA). Once you have completed enrollment, you’ll receive your Medicare card.
Do I need to update my Medicare Advantage Plan and Part D prescription drug plan if I’m moving to Florida from another state?
If you are moving from one state to another, you may need to update your Medicare Advantage Plan and/or Part D prescription drug plan to ensure you don’t experience any disruption to your coverage or pay higher costs. That’s because Medicare Advantage plans and Part D prescription drug plans can vary from state to state, even by county and zip code.
If you’re relocating to Florida from another state, you’ll want to check with your plan provider to see if the Medicare Part D and Advantage plans you’re currently enrolled in are available in your area of Florida and if the plan provider has in-network doctors, hospitals, healthcare providers, and preferred pharmacies in the area.
If your current plans are not available and you find you will have to go out of network (and pay more) for your healthcare needs, you’ll want to update your coverage to a plan designed for your new location. The good news is that moving to a new state qualifies you for a Special Enrollment Period (SEP), which allows you to make changes to your Medicare coverage without having to pay any penalties.
Polk County is the fastest growing county in Florida and one of the fastest growing in the entire country. As new residents join our community every day, the Wandacare Team is ready with expert, localized Medicare information that can help make the transition to a new Medicare plan a seamless one.
Which Medicare Advantage Plan is the right choice for me?
The right Medicare Advantage Plan for you is the one that meets your requirements based on your health needs, budget, and desired coverage and benefits.
Start by evaluating your healthcare needs, looking at what care and services you’re using currently (including doctors, therapies, and medications) and what you may need in the future. Which plan best meets those needs and includes the healthcare providers you’re currently seeing?
Be sure the plan is providing the coverage and benefits you want. Many Medicare Advantage Plans include benefits like gym memberships, vision or dental coverage, and transportation services to and from medical appointments. These additional plan benefits often come at an additional cost. Will you use all the benefits you’re paying for?
Compare costs of plans and what each is giving you. Look at premiums, deductibles, copayments, network providers, and the additional benefits to be sure you’re getting the best coverage for you, at the best price.
The Wandacare Team can provide comparison information on all the plans available to you. With personalized guidance and recommendations based on your unique needs, we’ll help you choose the best Medicare plan for you, at the best price.
How can I choose the right Part D prescription plan?
You want to be sure your prescription drug plan provides the medications you need at the best price to stay within your budget. To choose the right plan, compare plans for what medications they cover, which pharmacies are considered in-network, and how much you’ll have to pay out of pocket.
Start with a list of all the prescription drugs you’re currently taking, and compare your list to the plan’s list of covered drugs. Be sure all the medications you take are covered. Look at how you’re currently getting your prescriptions filled. If there’s a pharmacy you prefer to use, make sure it’s part of the plan’s preferred pharmacy network, which can mean lower copayments on your medications.
Consider any restrictions a plan may place on medications (such as requiring prior authorization to fill a prescription), as well as any extra benefits offered (like drug delivery service).
Then, once you know what drugs and pharmacies are covered, look at the cost of coverage. Consider premiums, deductibles, and the cost-sharing structure of each plan. See how the plan handles the coverage gap (the limit of what the drug plan will cover for medications) and if additional coverage is offered for the gap phase.
The Wandacare Team can provide comparison information on all the Part D plans available to you. With personalized guidance and recommendations based on your medication needs, we’ll help you choose the best prescription drug plan for you, at the best price.
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