FAQS

Frequently

Asked

Questions

Can't find the answers you're looking for?

We've compiled some of our most frequently asked questions.

 

If you still can't find the answer you're looking for, contact us!

Broker/Agent FAQs

Does it cost more to enroll in a plan through a broker instead of enrolling direct?

No. Brokers and agents offer plans sold through private insurance companies as the exact same rate the companies do. It does not cost anything extra to enroll through an agent. Any enrollment fees are charged by the insurance companies no matter how you enroll.

If it doesn't cost extra to enroll through a broker, how do you get paid?

Agents and brokers are paid via a commission from each insurance company; this offers us an unbiased approach when comparing the same plan across numerous insurance companies.

I'm so thankful for your assistance, can I give you a gift card or gift of some sort?

We're glad you're so satisfied with our services but, unfortunately, we're unable to accept gifts of any kind.

Can you help me enroll in Medicare Part A and/or Part B?

Unfortunately, agents and brokers aren't allowed to represent Medicare in any way and are unable to enroll you in Medicare Part A nor Part B. However, we can advise you on how to enroll and who to contact.

 
 

Original Medicare FAQs

Does Medicare have agents or brokers?

Original Medicare does NOT have agents and brokers; this is why we are not able to help you enroll in Part A and/or Part B. Agents are not allowed to misrepresent affiliation with Medicare. Be wary of any agent claiming to be a Medicare representative.

Does Medicare cover vision care and/or eyeglasses?

Medicare does NOT cover eye exams, eyeglasses nor contact lenses. Those on Original Medicare have to purchase a separate vision policy if they'd like vision coverage.

What if I've had cataract surgery; then will Medicare cover my eyeglasses or lenses?

If you've had cataract surgery, Medicare Part B MAY help pay for corrective lenses or one pair of eyeglasses (only if you've had cataract surgery to implant an intraocular lens).

Speaking of cataract surgery, does Medicare cover it?

Medicare DOES cover cataract surgery if it's done using traditional surgical techniques or lasers.

Does Medicare cover dental care and/or dentures?

Medicare does NOT cover dental care, dental procedures, cleanings, fillings, tooth extractions, dental plates, dentures, nor any other dental devices. Those on Original Medicare have to purchase a separate dental policy if they'd like dental coverage.

What if I have dental surgery in a hospital; then will Medicare cover it?

Medicare Part A will pay for certain dental services when you're in a hospital if you need to have emergency or complicated dental procedures - even though it doesn't cover dental care.

Does Medicare cover hearing exams or hearing aids?

Medicare does NOT cover hearing aids or exams.

 

Medicare Supplement FAQs

* Will my Medicare Supplement cover my upcoming medical procedure?

This is the question we get asked more than anything. Your Medicare Supplement will cover anything Medicare covers. Medicare is still your primary insurance. Therefore, it's up to Medicare as to whether or not your Medicare Supplement will pay on a procedure. If Medicare approves the procedure and pays, then your Medicare Supplement will also pay for it. If Medicare denies the procedure, then it doesn't even get to your Medicare Supplement; it too will deny the procedure. Medicare approves anything that is medically necessary. If you're unsure whether or not Medicare will approve your upcoming procedure, we highly recommend contacting Medicare to find out. Since we are not affiliated with Medicare, we cannot tell you whether or not Medicare will approve something. 

Do I need both Medicare Part A and Part B to get a Medicare Supplement?

Yes. You need to be enrolled in both Part A and Part B to get a Medicare Supplement. Your Medicare Supplement application can go into effect the same day your Part A and B go into effect.

Do some companies offer better coverage than others?

No. All plans are standardized so, no matter what company you go with, the coverage remains the same. The only difference is the price each company charges.

Will my doctor or provider accept my Medicare Supplement company?

This is the great thing about Medicare! As long as your provider accepts Medicare, they are REQUIRED to accept your Medicare Supplement, no matter what company you have. It's extremely rare to find a provider that does not accept Medicare.

My monthly premium keeps increasing; how can I lower it?

Medicare Supplement companies increase your premium due to inflation. Sometimes, every single policyholder gets a company-wide increase and sometimes, you age into a higher premium category at your birthday. If you live in California or Oregon, you're lucky! We have something called the Birthday Rule. At your birthday, this rule allows you to switch to a company with a lower premium, while keeping the exact same plan - regardless of any existing health conditions.

Can I lose my Medicare Supplement if my health changes?

You cannot lose your Medicare Supplement policy if your health worsens or changes. As long as you pay your monthly premium, your Medicare Supplement company cannot terminate you.

Can I enroll in a Medicare Supplement any time of the year?

Yes and no. If you are in perfect health, you can apply for a Medicare Supplement anytime and go through underwriting. This is when you CAN be denied due to health reasons. However, there are situations when you CANNOT be denied. It is best to apply for a Medicare Supplement plan when you are first eligible: while in your Open Enrollment period or when you're eligible for a Guarantee Issue (such as coming off a group plan). Contact us for more information regarding Guarantee Issue and Open Enrollment periods.

 

Medicare Advantage FAQs

Can I enroll in a Medicare Advantage plan anytime of the year?

No. You can enroll in a Medicare Advantage plan when you first become eligible Medicare. Outside of your initial enrollment period, you can also enroll during the Annual Enrollment Period (AEP) which runs from October 15th to December 7th each year.

Can I disenroll, cancel or change my plan any time of the year?

No. You can only disenroll, cancel and change your plan during the Annual Open Enrollment Period (October 15 - December 7), Medicare Advantage Open Enrollment Period (January 1 - March 31) or during a Special Enrollment Period (SEP). Contact us for more information on Special Enrollment Periods.

If I switch to a Medicare Advantage plan, can I get my Medicare Supplement back?

If this was your first time enrolling in a Medicare Advantage plan, you can get your Med Supp back only if you switch during your first 12 months of having the MA plan. Otherwise, you may not be able to get your Medicare Supplement back. You can apply for a Medicare Supplement plan by going through underwriting however, an insurer can deny you coverage based on health history.

Is my Medicare Advantage plan accepted everywhere Medicare is?

No. In most cases, Medicare Advantage plans have a network of preferred providers. You will need to check with your plan and/or provider to make sure your plan is accepted.

What happens if my primary care doctor leave my MA plan's network.

In most cases, you will have to find a new physician that's in your plan's network. On occasion, you may be able to keep seeing your provider out-of-network, but it will have higher out-of-pocket costs.

 

Prescription Drug Plan FAQs

What if my prescription drug isn't on my plan's formulary?

If your particular drug isn't on your plan's formulary, you may need to change the drug you're using or pay more for it. In most cases, your plan must offer a drug that's similar to the one you're taking; ask your doctor if there's a comparable prescription to the one you're taking that also appears on your plan's formulary. Otherwise, you will have to pay full price for your drug. You can always apply for an exception as well, but there's no guarantee your plan will accept it.

Can I enroll in a prescription plan any time of the year?

No. You can enroll in a plan (and we highly recommend you do) when you first become eligible for Medicare. Outside of this initial enrollment period, you can only enroll during the Annual Enrollment Period (AEP) which runs from October 15-December 7, unless you qualify for a Special Enrollment Period (SEP). Contact us about more information about Special Enrollment Periods.

Do PDP star ratings really matter?

Star ratings are given by the Medicare system to help you know how well a plan is doing with regards to its quality and performance. While a higher score is desirable, we don't recommend choosing a policy purely based on its star rating. A plan with a lower star rating may cover and pay for your drugs more than a plan with a higher star rating. 

Do I have to be enrolled in both Medicare Part A and Part B to get a PDP?

No. You have to be enrolled in at least one of the two to get a stand-alone drug plan.

What is the PDP late enrollment penalty?

Medicare penalizes you for every month you go without a drug plan beginning when you first become eligible for Medicare. The amount of the penalty depends on how long you went without a plan. Medicare calculates the penalty by multiplying 1% by the national average premium. This amount is added to your drug plan premium once you do decide to enroll and lasts as long as you are enrolled in a plan.

Why do my prescriptions cost so much more this year than they did last year?

Almost all prescription plans have a deductible. At the beginning of the year, your drugs will appear to cost more than what you were paying toward the end of last year because you haven't met your deductible yet. The other reason your drugs could cost more is because your plan changed it's formulary. Every year, your plan can change which drugs they cover and how much of each drug they will cover. This is why it's important to have your drugs ran through Medicare's Drug Plan Finder every year. This year's plan might not be the best plan for you next year.

Why is my neighbor's PDP premium so much less than my PDP premium?

Keep in mind, drug plans depend completely upon the exact prescriptions you take. Even if you and your neighbor live in the same zip code and are the same age, your prescription plan premium can be quite different. You don't want to be on the plan your neighbor has if your prescriptions aren't covered.

What is "Extra Help"?

Extra Help is a program designed to assist those with a limited income with paying the costs of their drug plan. Medicare may notify you via mail if you qualify. If you have Medicaid or Medi-Cal, you also qualify for Extra Help. If you're unsure whether or not you qualify, contact Medicare directly to find out.

What is the "donut hole" or coverage gap in prescription plans?

The donut hole, or coverage gap, is a period of time where you pay more out-of-pocket for your prescriptions until you reach catastrophic coverage. This coverage gap begins when both you and your plan have spent a set dollar amount on your prescriptions.