does Medicare cover weight loss drugs Finding effective solutions to manage weight loss can sometimes feel like searching for a needle in a haystack. But what if there was a medication that could help you on your journey? Enter Ozempic, a breakthrough drug making waves in the weight loss community. Does Medicare cover Ozempic for weight loss?

In this article, we will explore how Medicare may give you access to Ozempic, giving you the insights you need to make informed health decisions. We’ll also explore the eligibility criteria, coverage options, and potential costs. Whether you’re already enrolled in Medicare or considering it in the future, this information is invaluable for those seeking weight management solutions.

What is Ozempic?

Ozempic is a medication used to treat type 2 diabetes in the class of drugs called GLP-1 receptor agonists. As a GLP-1 receptor agonist, semaglutide enhances the effects of the naturally occurring hormone GLP-1, which helps lower blood sugar levels. This medication is administered once weekly via injection, making it a convenient option for those managing diabetes. Ozempic is effective in reducing A1C levels and promoting weight loss in patients.

A 0.25 or 0.5-milligram dose of Ozempic currently retails on the Novo Nordisk website for $935.77 without insurance. However, those with private or commercial insurance who are eligible for a prescription may pay as little as $25.  Medicare Part D and Part D copays for Ozempic can be significantly higher, especially if you fall into the Gap (or Donut Hole).   

How Does Ozempic Work?

Ozempic works by mimicking the action of a naturally occurring hormone called glucagon-like peptide-1 (GLP-1) in the body. GLP-1 helps regulate blood sugar levels by stimulating insulin release, slowing down digestion, and reducing appetite. By activating GLP-1 receptors, Ozempic helps lower blood sugar levels, decrease appetite, and promote weight loss.

Who Can Benefit from Ozempic?Weight Loss medications

Ozempic is primarily prescribed to individuals with type 2 diabetes who have not achieved adequate glycemic control through lifestyle changes, such as diet and exercise, or oral diabetes medications alone. It is typically used as an adjunct to diet and exercise to improve blood sugar control.  

GLP-1 also impacts weight via two key mechanisms:

  • Affects the hunger centers in the brain (specifically, in the hypothalamus), reducing hunger, appetite, and cravings
  • Slows the rate of stomach emptying, effectively prolonging fullness and satiety after meals

The net result is decreased hunger, prolonged fullness, and, ultimately, weight loss.

The Benefits of Ozempic for Weight Loss 

Ozempic has gained significant attention in the weight loss community due to its potential benefits. Studies have shown that Ozempic can lead to significant weight loss when used with a healthy diet and exercise. In fact, clinical trials have demonstrated that individuals using Ozempic experienced an average weight loss of 5-10% of their body weight over a 26-52 week period. This is a remarkable achievement, considering many individuals’ challenges when trying to lose weight.

In one large clinical trial sponsored by Novo Nordisk, 1,961 adults with excess weight or obesity who did not have diabetes were given 2.4 milligrams of semaglutide or a placebo once a week for 68 weeks, along with lifestyle intervention. Those who took semaglutide lost 14.9% of their body weight compared with 2.4% for those who took the placebo.

Understanding Medicare Coverage 

Before we dive into the specifics of Medicare coverage for Ozempic, it’s important to have a basic understanding of how Medicare works.

Medicare is a federal health insurance program primarily designed for individuals aged 65 and older, as well as certain younger individuals with disabilities. It consists of different parts, including Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage).

Medicare covers a wide range of medical services and treatments, including prescription medications. However, coverage for prescription drugs can vary depending on the specific plan you have. Some plans may cover a broader range of medications, while others may have more limited coverage. Understanding your specific Medicare plan is essential to determining the coverage options available for Ozempic.

Does Medicare cover semaglutideHow Medicare Covers Ozempic for Weight Loss

To determine if Ozempic is covered by Medicare for weight loss, you need to check whether it is included in your Medicare Part D plan’s formulary. A formulary is a list of prescription drugs covered by a specific Medicare plan. You can typically find this information in the plan’s drug formulary document, which is usually available on the plan’s website or by contacting customer service.

All 21 Medicare Part D prescription drug plans and all 30 Medicare Advantage plans cover Ozempic in the Omaha, Lincoln, and Council Bluffs areas. Depending on the plan, you may or may not have a drug deductible and then copays. Ozempic is usually a tier 3 medication with a hefty copay. Depending on your total medications, you may or may not go into the Gap (or Donut Hole).  

If Ozempic is included in the formulary, it means that it is covered by your Medicare Part D or Part C plan. However, coverage may still be subject to certain conditions. The medication must be medically necessary for the prescribed purpose. Other factors include prior authorization or step therapy.  

Prior authorization requires your healthcare provider to obtain approval from the Part D prescription drug plan before prescribing Ozempic, while step therapy may require you to try other medications before Ozempic is covered.

Review the specific coverage requirements outlined in your Medicare Part D plan to ensure you meet all the necessary criteria for Ozempic coverage.  It is important to understand Medicare covers Ozempic for diabetic and pre-diabetic treatment.  Medicare does not cover Ozempic for weight loss exclusively.  

Why Medicare Does Not Cover Ozempic for Weight Loss

Medicare Part D prescription drug plans were created under the Busch Administration. The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 determined that Part D prescriptions could not cover medications for cosmetic or weight loss reasons. Thus, Ozempic is only covered by Medicare for type 2 diabetes. Ozempic is not covered by Medicare for weight loss.    

Wegovy: An Alternative?Medicare coverage for semaglutide weight loss

Wegovy is a brand-name version of the drug semaglutide, which is the medication Ozempic in a different dosage. The FDA approves Wegovy as a chronic weight management medication, not for type 2 diabetes, like Ozempic.

Medicare, however, does not cover Wegovy because the drug is for weight loss. Medicare does not cover weight loss medications even though obesity is intimately tied to diabetes and a cause of poor health.  

How to Navigate the Medicare Coverage Process for Ozempic

Medicare covers semaglutide for weight lossHere are some suggestions for you to navigate the Medicare coverage process for Ozempic.

Check the Formulary 

Look for Ozempic in your plan’s formulary to determine if it is covered. Note any additional coverage requirements, such as prior authorization or step therapy.

Consult Your Healthcare Provider

Diabetes and pre-diabetes are usually related to obesity. Discuss your diabetes or pre-diabetes in relation to your weight loss goals with your healthcare provider. See if Ozempic is a suitable option for you. They can help guide you through the coverage process and provide any necessary documentation.

Prior Authorization or Step Therapy

If your plan requires prior authorization or step therapy for Ozempic, work with your healthcare provider to complete the necessary paperwork and submit it to Medicare for approval.

Those who are type 2 diabetic or pre-diabetic AND overweight may be able to get access to Ozempic for their healthcare needs, which secondarily includes weight loss.

Dangers of Ozempic

Ozempic, however, isn’t safe for everyone. According to the company, people with the following conditions should avoid using Ozempic:Medicare does not cover Wegovy for weight loss

  • Pancreatitis
  • Type 1 diabetes
  • Under 18 years of age
  • Pregnant or breastfeeding
  • Diabetic retinopathy
  • Problems with the pancreas or kidneys
  • Family history of medullary thyroid carcinoma (MTC)
  • Multiple Endocrine Neoplasia syndrome type 2 (MEN 2), an endocrine system condition

As with any prescription medication, you must consult your doctor or other qualified healthcare provider on whether this medication is safe for you and what dosage is appropriate.

Ozempic Side Effects and Health Risks

There are many side effects of taking Ozempic as a weight loss medication, including

  • Gastrointestinal issues like nausea, vomiting, and diarrhea
  • Constipation
  • Stomach pain
  • Headache
  • Excessive burping
  • Heartburn
  • Fatigue
  • Flatulence
  • Gastroesophageal reflux disease

These most common side effects of Ozempic don’t tend to be dangerous and may dissipate as you grow used to the medication. However, there is potential for more serious adverse effects, such as:

  • Vision problems
  • Swelling in extremities
  • Dizziness or fainting
  • Reduced urination
  • Rash
  • Rapid heart rate
  • Swelling of throat, tongue, mouth, face, or eyes
  • Problems swallowing or breathing
  • Fever
  • Yellow eyes or skin
  • Chronic upper stomach pain

Wegovy, another brand name for semaglutide, may also cause damage to the retina, suicidal ideation, gallstones, pancreatitis, and acute kidney damage.

Moreover, taking semaglutide can increase the chance of developing thyroid tumors, including medullary thyroid carcinoma. Speak with your doctor if you are experiencing any of the side effects listed above. 

“Ozempic Face”  

You may have heard about “Ozempic face” as a side effect of GLP-1 drugs, though the term is misleading because this can be a side effect of any GLP-1 drug or any other cause of rapid weight loss.

The rapid loss of fat in the face can cause:

  • a hollowed look to the face
  • changes in the size of the lips, cheeks, and chin
  • wrinkles on the face
  • sunken eyes
  • sagging jowls around the jaw and neck.

If weight is lost more gradually, these changes may not be as noticeable. However, the faster pace of weight loss that occurs with GLP-1 drugs can make facial changes more obvious.

Spending for the three GLP-1 medications, Ozempic, Rybelsus, and Mounjaro, has skyrocketed in the past year on Medicare.  While more Medicare beneficiaries are becoming diabetic and using these medications, the number far exceed that type of increase.  A significant portion of people on Medicare are now using GLP-1 medications for weight loss.

Medicare Spending on Ozempic Explodes

Ozempic Spending

Impact on Diabetes PatientsWegovy weight loss Medicare does not cover

The popularity of Ozempic’s off-label use for weight loss is driving a global shortage of diabetes drugs. Pharmacies in the U.S., Canada, and Europe have been reporting shortages. My clients have reported to me their experience of not finding Ozempic at their local pharmacy. 

If the shortages persist, people who’ve relied on Ozempic to treat their diabetes may face difficulty adjusting to alternatives. The shortage of Ozempic, driven by its off-label use for weight loss, can have significant consequences for patients with diabetes who genuinely need the medication.

Bottom Line: Medicare Does Not Cover Ozempic for Weight Loss

Ozempic is a dilemma. Most diabetics are overweight, but not all overweight persons are diabetic or pre-diabetic. Medicare does not cover Ozempic for weight loss, but it does cover it for diabetes or pre-diabetes. Weight loss is usually an important element in minimizing the negative effects of diabetes.

Medicare Omaha Nebraska

While Medicare does not cover Ozempic for weight loss, strictly speaking, Medicare does cover Ozempic for a very large population that also needs and will benefit from Ozempic and losing weight.  People aren’t stupid.

It’s actually not a bad solution for an imperfect and overweight world.

 

Medicare Prior Authorization Are you feeling lost and confused about Medicare Advantage prior authorization? You’re not alone. Navigating the healthcare system can be overwhelming, especially regarding insurance processes. But fear not—we are here to demystify it all for you.

This comprehensive guide will delve into everything you need to know about Medicare Advantage prior authorization. From understanding what it is, why it’s necessary to learn how it works, and the steps involved, we’ll break it down in simple terms. There will be no jargon, no confusing terms—just clear and concise information.

What is Prior Authorization?

Prior authorization is a process used by insurance companies to determine whether they will cover a specific medical procedure, treatment, or prescription drug. It is required for certain services to ensure that they are medically necessary and cost-effective.

Why is Prior Authorization Necessary?

Prior authorization prevents unnecessary medical procedures, reduces healthcare costs, and ensures patients receive appropriate care. Insurance companies can control expenses and ensure that resources are allocated efficiently by reviewing and approving or denying requests for certain healthcare services.

Problems With Medicare Advantage Prior Authorization

However, prior authorization can be complex and time-consuming. It requires healthcare providers to submit detailed information about the patient’s condition, medical history, and proposed treatment plan. The insurance company then reviews this information to determine whether the requested service meets its coverage criteria.

While prior authorization can be beneficial in some cases, it can also lead to delays in care and administrative burdens for both healthcare providers and patients.  There are many elements, moving parts, and hands that touch a prior authorization request.  Thus, the process is ripe for mistakes, misunderstandings, and delays.  Understanding the process and requirements can help you navigate this system more effectively.

Prior Authorization Process for Medicare Advantage

Obtaining prior authorization for Medicare Advantage plans involves several steps. Here’s a breakdown of the process.doctor's office calls for prior authorization

Consultation with Healthcare Provider

The first step is to consult with your healthcare provider. They will determine if the service or treatment you need requires prior authorization and initiate the process on your behalf.

Submission of Prior Authorization Request

Once your healthcare provider has determined that prior authorization is necessary, they will submit a request to your insurance company. This request includes all the necessary documentation, such as medical records, test results, and treatment plans.  This is where I see problems arise.  The doctor’s back office uses incorrect codes, forgets test results, and the doctor’s notes are missing essential language.  Then, the request is denied.

Review by the Insurance Company

The insurance company will review the submitted request and evaluate the medical necessity of the service requested. It may also consider factors such as cost-effectiveness and alternative treatment options.

Medicare Prior Authorization approval Approval or Denial

The insurance company will either approve or deny the prior authorization request based on their evaluation. If approved, you can proceed with the recommended treatment. If denied, you have the option to appeal the decision.  The additional problem is the insurance company does not give a reason for the denial, so the provider is clueless about where to begin.  The carrier is not required to give a reason, so the provider needs to commit more resources to find out what is needed or let it go.

Appeals Process

You can appeal the decision if your prior authorization request is denied. This involves providing additional documentation or evidence to support the medicalMedicare Appeal process necessity of the requested service. The insurance company will review your appeal and make a final determination.

It’s important to note that the prior authorization process may vary slightly depending on your specific Medicare Advantage plan and the services you need. For detailed information about the process, consult with your healthcare provider, insurance company, and Center for Medicare & Medicaid Services (CMS).

Standard Medicare Procedures & Services Requiring Prior Authorization

Pre-certified surgeryPrior authorization is typically required for certain medical procedures, treatments, and prescription drugs. While the specific requirements may vary depending on your Medicare Advantage plan, here are some standard procedures and services that often require prior authorization.

Specialized Surgeries

 Complex surgical procedures, such as organ transplants or bariatric surgery, often require prior authorization. This ensures that the procedure is medically necessary and appropriate for the patient’s condition.

High-Cost Medications

Certain prescription drugs, especially those with high costs, may require prior authorization. This helps insurance companies manage expenses and ensure patients receive appropriate medications.

Imaging TestsPre-certify MRI

Advanced imaging tests like MRI or CT scans may require prior authorization. This ensures that these tests are necessary and will provide valuable information for diagnosis or treatment.

Physical Therapy or Rehabilitation Services

Medicare Advantage plans often require prior authorization for physical therapy, occupational therapy, or other rehabilitation services. This helps ensure that these services are appropriate and will contribute to the patient’s recovery.

I have found that skilled nursing facility care is very difficult to get approved, especially if the stay exceeds the initial twenty days.  The impasse is a combination of the skilled nursing facilities (SNF) refusing to submit for a patient with a Medicare Advantage plan.  Many SNFs will not even consider submissions for stays beyond twenty days.  Some seem to not know how to properly submit a reauthorization or claim.  From the insurance company’s side, their restrictions seem overly prohibitive.  This has been a huge source of complaints to CMS and Congress.

Preauthorize durable medical equipment Durable Medical Equipment

Equipment such as wheelchairs, oxygen tanks, or home healthcare supplies may require prior authorization. This ensures that the items are medically necessary and will improve the patient’s quality of life. CMS has a significant history of fraud, waste, and abuse regarding durable medical equipment.

It’s important to check with your specific Medicare Advantage plan to understand which procedures and services require prior authorization. Your healthcare provider can also provide guidance based on your individual needs.

Benefits of Medicare Advantage Prior Authorization

While the prior authorization process can be perceived as burdensome, it offers some benefits for patients and insurance companies. Here are a few advantages of Medicare Advantage prior authorization:

  1. Cost control: Prior authorization helps insurance companies control healthcare costs by ensuring that services are medically necessary and cost-effective. This helps keep premiums affordable for all members.
  2. Appropriate care: Prior authorization ensures that patients receive appropriate care by evaluating the medical necessity of requested services. This helps prevent unnecessary procedures or treatments that may not be beneficial.
  3. Improved outcomes: By reviewing and approving requests for certain healthcare services, insurance companies can help ensure that patients receive the most effective and evidence-based treatments. This can lead to improved health outcomes and better quality of life.
  4. Resource allocation: Prior authorization helps allocate healthcare resources efficiently by ensuring that they are used for the most appropriate and effective services. This helps prevent overutilization of healthcare services and ensures that resources are available for those who need them.

While there are benefits to prior authorization, it’s important to acknowledge the challenges and drawbacks of the process as well.

Challenges & Drawbacks of the Medicare Prior Authorization ProcessMedicare Advantage Prior authorization

While prior authorization serves a purpose in the healthcare system, it has its challenges and drawbacks. Here are some common challenges that patients and healthcare providers may encounter.

Prior Authorization Administrative Burden

The prior authorization process can be time-consuming and requires healthcare providers to gather and submit extensive documentation. This administrative burden can take away valuable time that could be spent on patient care.

Dr. Jesse M. Ehrenfeld, M.D., president of the AMA (American Medical Association), says,

The need to right-size prior authorization has never been greater—mountains of administrative busywork, hours of phone calls, other clerical tasks that are tied to this onerous review process. It not only robs physicians of face time with patients, but studies show that it contributes to physician dissatisfaction and burnout.

Delayed Care

Prior authorization can sometimes lead to delays in care, as the review process may take time. This can be frustrating for patients who need immediate treatment or services.

Starting in 2026, CMS is shortening the time frames for prior authorization decisions. Insurance payers must respond within 72 hours for an expedited or urgent request and seven calendar days (not business days) for a standard request.

Prior authorization denied Denial of Coverage

There is always a risk of prior authorization requests being denied. This can be disappointing for patients hoping to receive a particular treatment or procedure.

Lack of Transparency

Insurance companies may have different criteria and guidelines for prior authorization, leading to confusion and lack of transparency. Patients and healthcare providers may struggle to understand the reasons for a denial or how to navigate the process effectively.

Dr. Jesse M. Ehrenfeld, M.D. describes the problem of the lack of transparency with the insurance companies.

When a request is denied, we often don’t know why. We don’t tell you the reasoning behind the denial. It can take hours and hours to appeal a decision. And then sometimes you wait weeks or even months for a peer-to-peer consult.

The CMS final rule will require insurers to provide specific, very specific denial reasons and public reporting of metrics. How often do they approve? How often do they deny things? How long does it take for a process to actually give a result for a request?

Insurers will also be required to share that information with patients, so that our patients can become informed decision makers when they buy health insurance on the exchanges and make planned decisions. That’s going to begin in 2026 and will go a long way in bringing much-needed transparency and accountability to the entire process.

Appeals Process

While the option to appeal a prior authorization denial exists, it can be a lengthy and complex process. Patients may need to provide additional documentation and evidence to support their case, which can be challenging and time-consuming.

In the efforts to improve the Medicare Advantage prior authorization process, CMS will require, according to Dr. Ehrenfeld,

Plans to support an electronic prior authorization process that’s embedded in the physician’s electronic health records, bringing much needed automation and efficiency to our current very manual and very time-consuming workflow. That change is going into effect in 2027—it’s going to be a game-changer for everybody.

So having direct integration of prior authorization into the EHR (electronic health record) is going to significantly reduce the burden on physicians. And this is where so much of that $10 to $15 billion in savings is going to come from.

Despite these challenges, some strategies and tips can help you navigate the prior authorization process more effectively.

Prior authorization appeal processNavigating the Prior Authorization Process Effectively

Navigating the prior authorization process can be overwhelming, but with the right strategies, you can streamline the process and ensure a smoother experience. Here are some tips to help you navigate prior authorization effectively:

Understand your Medicare Advantage Plan

Familiarize yourself with your Medicare Advantage plan’s specific requirements and guidelines. This will help you understand which procedures and services require prior authorization and what documentation is needed.  This is important because you may have to be the force behind the doctor’s office to pursue approval beyond the initial request.

Communicate with Your Healthcare Provider

It is crucial to communicate openly and clearly with your healthcare provider. They can guide you through the prior authorization process, provide necessary documentation, and advocate for your needs.  The office needs to see that you want the procedure or test because they have limited resources to pursue further requests or appeals from the insurance company.

Gather All Necessary Documentation

Before submitting a prior authorization request, ensure you have all the necessary documentation. This may include medical records, test results, treatment plans, and any additional information requested by your insurance company.  If you can assist in the process, then dig in.  You may also have to be the supervising authority to make sure the office’s back office submits all relevant materials.

Be Proactive

Start the prior authorization process as early as possible to avoid delays in care. Submit your request well in advance of your scheduled procedure or treatment to allow ample time for review. Doctor’s offices are usually overworked and understaffed. To ensure you are taken care of in a timely way, contact the office yourself to see where your prior authorization is in the process. Ask for dates when you should expect tasks to be completed by the doctor’s office and insurance company.

Keep Copies of All Documents

Make copies of all documents related to the prior authorization process, including your request, supporting documentation, and any communication with your insurance company. This will help you stay organized and provide evidence if needed for an appeal. The documents are your records. You and the insurance company paid for the tests, and you have a right to your own copies.

Follow Up with Your Insurance Company

Stay proactive and follow up with your insurance company to ensure your prior authorization request is processed. This will help you stay informed and address any issues or concerns in a timely manner.  Everyone is busy.  Balls are dropped.  People forget.  You make sure none of that happens with your case because you are on it.

How to Appeal a Prior Authorization Denial

If your prior authorization request is denied, you have the option to appeal the decision. Here’s a step-by-step guide on how to appeal a prior authorization denial.

  1. Understand the denial: Carefully review your insurance company’s denial letter. Understand the reasons for the denial and the specific requirements for appealing the decision.
  2. Gather additional documentation: If you believe that the denial was made in error or that additional information could support your case, gather all the necessary documentation. This may include medical records, test results, or a letter of medical necessity from your healthcare provider.  Your provider will need to perform most of this work.
  3. Submit an appeal letter: Write a formal appeal letter to your insurance company. Generally the doctor will need to draft and submit the letter.  He will need to more clearly state the reasons for your request, provide supporting documentation, and explain why you believe the requested service is medically necessary.
  4. Follow up with your insurance company: This is where you can help the process. Stay in contact with your insurance company to ensure your appeal is processed. Follow up regularly. You will be able to follow up more readily than the provider’s office. Get any additional information or documentation requested.

Remember, the appeals process may take time, and no approval is guaranteed. However, following these steps and providing compelling evidence increases your chances of a favorable outcome.

Bottom Line: Understanding Medicare Advantage Prior Authorization May Determine Your Success

In conclusion, understanding and managing Medicare Advantage prior authorization is crucial for both patients and healthcare providers. While the process can be complex and time-consuming, it ensures that healthcare services are medically necessary and cost-effective.

By familiarizing yourself with the prior authorization process, understanding your Medicare Advantage plan requirements, and effectively communicating with

Medicare Omaha Nebraska

your healthcare provider and insurance company, you can navigate this system with confidence and ease.

Remember to stay proactive, gather all necessary documentation, and be prepared to advocate for your needs. In the event of a denial, don’t hesitate to appeal and seek assistance if needed.

Empower yourself with knowledge and take control of your healthcare journey. With the right information and resources, you can successfully navigate Medicare Advantage prior authorization and receive the care you need.

How to pay Medicare IRMAA taxAre you in the lucky top 4% of earners? You will pay more for your Medicare benefits.  The more is IRMAA (Income-Related Monthly Adjustment Amount).  The amount you pay for your Medicare health and prescription drug coverage depends on your level of income.  There is a ladder.

Would you like to avoid paying that tax or possibly pay a smaller portion of it? We will guide you through the key IRS exceptions for Medicare IRMAA (Income-Related Monthly Adjustment Amount). By understanding and leveraging these exceptions, you can potentially lower your Medicare expenses and put more money back in your pocket.

Medicare IRMAA is an additional premium that high-income Medicare beneficiaries are required to pay. However, there are exceptions that may enable you to reduce or even eliminate this extra cost. Knowing the ins and outs of these exceptions can make a significant difference in your healthcare expenses.

In our comprehensive guide, we will break down each exception and provide you with the information you need to take advantage of them. From ‘Life-Changing Events’ to ‘Reconsideration Requests,’ we will explore all the options available to you.

Understanding the IRS Exceptions for IRMAAMedicare taxes

The Income-Related Monthly Adjustment Amount, or IRMAA, is an additional premium that high-income Medicare beneficiaries have to pay. However, the IRS provides exceptions that may allow you to reduce or eliminate this extra cost. Let’s explore these exceptions in detail.

Medicare tax exception Life-Changing Event

One of the exceptions to IRMAA is a life-changing event. This includes events like marriage, divorce, death of a spouse, or work stoppage. If you experience any of these events, you may be eligible for a reduction in your Medicare costs.

To qualify for this exception, you will need to provide documentation of the life-changing event and submit it to the IRS. Documentation is key. The IRS will not take your word for it. You need to prove your income decreased.

Examples of documentation may include a marriage license or divorce decree, death certificate, or proof of work stoppage. By leveraging this exception, you can potentially save a significant amount of money on your monthly Medicare premium.

Medicare IRMAA Exception 1: Marriage or Divorce

Getting married or divorced can have a significant impact on your income and, consequently, your Medicare costs.

If you are recently divorced and you are a lower income earner, you may drop below the IRMAA threshold or at least step down the ladder, which would reduce your tax.
For some individuals, marriage may reduce their income because alimony is lost. The threshold is increased because it is for two persons. The initial threshold for a single individual is $103,000. For married filing jointly, it is $206,000. Either of these lifestyle changes may affect your income in that year and, consequently, your IRMAA tax, even if your income was higher in the previous year.

To take advantage of this exception, you must provide documentation of the marriage or divorce and proof of the change in income. By doing so, you can potentially save a significant amount on your Medicare expenses.

Medicare IRMAA Exception 2: Work Stoppage or ReductionIRMAA work stoppage

If you experience a work stoppage or a significant reduction in your work hours, you may be eligible for an exception to IRMAA. This can happen if you retire, get laid off, or experience a reduction in your income due to other circumstances.  This is probably the most common reason high-income earners should apply for the exception.  Their income was significantly higher the previous year because of work, but the year they retire and must pay the Medicare premium, their income is drastically smaller.  That is what the exception is for.

To qualify for this exception, you will need to provide documentation of the work stoppage or reduction in work hours, along with proof of the decrease in income. By doing so, you can potentially reduce or eliminate the additional premium you have to pay.

Medicare IRMAA Exception 3: Loss of Income-Producing Property

If you experienced a loss of income-producing property, such as rental properties or investments, you may be eligible for an exception to IRMAA. This can happen if your rental property becomes unprofitable or if you experience significant losses in your investments.

IRMAA lost property income I had a high-net-worth client who lost significant rental income because of flooding in Missouri. His properties produced nothing for several years as he settled with insurance companies and repaired buildings.

To qualify for this exception, you will need to provide documentation of the loss of income-producing property, along with proof of the decrease in income. By leveraging this exception, you can potentially lower your Medicare costs and save money.

Medicare IRMAA Exception 5: Loss of Pension Income

Pension plans go bankrupt. Some pensions are for a particular duration. The cessation of a pension may impact your income significantly enough to affect the IRMAA tax.

To qualify for this exception, you will need to provide documentation of the change in income, along with proof of the decrease in income. By taking advantage of this exception, you can potentially reduce or eliminate the additional premium you have to pay.

Medicare IRMAA Exception 6: Employer Settlement Payment

Employers pay out settlements to employees for many reasons.  These settlements may increase income in a given year or for several.  The settlement may have its own legal stipulations.

To qualify for this exception, you will need to provide documentation of the change in income, along with proof of the decrease in income. Some legal settlements may be placed legally outside of your modified adjusted gross income.  By taking advantage of this exception, you can potentially reduce or eliminate the additional premium you have to pay.

Medicare IRMAA Exception 7: Correcting An Erroneous Determination

Sometimes, the IRS may make an erroneous determination regarding your Medicare costs. If you believe that the IRS made a mistake in calculating your IRMAA, you can submit a reconsideration request and provide additional documentation to correct the error.

To qualify for this exception, you will need to provide evidence that the IRS made an error in its determination. This can include documentation of your income, tax returns, or any other relevant information that supports your case. Correcting an erroneous determination can potentially save you a significant amount on your Medicare expenses.

Applying for a IRMAA exception

To apply for an exception to IRMAA and reduce your Medicare costs, you will need to follow a few steps.

First, gather all the necessary documentation to support your case. This includes marriage or divorce certificates, death certificates, proof of work stoppage or reduction, documentation of the loss of income-producing property, proof of a change in tax-exempt income, or evidence of an erroneous determination.

Next, complete the appropriate forms provided by the IRS SSA-44 (12-2023). These forms may vary depending on the exception you are applying for. Make sure to fill them out accurately and include all the required information.
Once you have completed the forms, submit them to the IRS along with the supporting documentation. It is crucial to keep copies of all the documents and forms for your records.

After submitting your application, the IRS will review your case and make a determination. If your exception is approved, you will receive a notification informing you of the reduction or elimination of your IRMAA.
By applying for an exception and reducing your Medicare costs, you can put more money back in your pocket and have a significant impact on your overall healthcare expenses.

Bottom Line: Don’t Ignore the IRMAA Exceptions

Leveraging the key IRS exceptions for IRMAA can reduce your Medicare costs. Whether you have experienced a life-changing event, a change in income, or an erroneous determination, understanding these

Medicare Omaha Nebraska

Christopher J. Grimmond

exceptions can significantly reduce your healthcare expenses.

Don’t let high-income Medicare premiums burden your finances. Take the necessary steps to apply for an exception and potentially reduce or eliminate your IRMAA. By doing so, you can save money and have more control over your healthcare expenses.

Medicare Part B Cancer drugsWith the rising prevalence of cancer diagnoses, obtaining affordable and accessible cancer drug coverage with Medicare is critical for patients.  Medicare, the government health insurance program primarily for individuals age 65 and older, is vital in ensuring that cancer treatments are financially attainable.  Many of my clients will call me when they receive a diagnosis of cancer.  As you can imagine, the experience is overwhelming and frightening.  Their first question is what they should do about their insurance to ensure maximum coverage.

This article will explore the implications of Medicare’s cancer drug coverage on affordability and access.  We will consider the various components of Medicare, including Part B and Part D, and how they differ in covering cancer drugs.  Additionally, we will examine the potential out-of-pocket costs that Medicare beneficiaries may face and discuss strategies to navigate these expenses.

Aspects such as drug tiers, formularies, and specific cancer treatments covered by Medicare will also be explored.  By the end of this article, you will understand the implications of Medicare’s cancer drug coverage on affordability and access.  You will be empowered to make informed decisions regarding your healthcare needs.

Understanding the Implications of Medicare Coverage for Cancer Drugs

Medicare provides crucial coverage for cancer drugs, ensuring beneficiaries can access potentially life-saving treatments.  However, it’s important to understand the implications and costs of this coverage to make informed decisions and navigate the system effectively.

Part B Or Part D

One key aspect to consider is the difference between Medicare Part B and Part D coverage for cancer drugs.  Medicare Part B covers drugs administered in a medical setting, such as chemotherapy drugs.  These drugs are typically covered at 80% of the Medicare-approved amount, with the remaining 20% being the beneficiary’s responsibility.  Part B coverage is often more comprehensive for cancer treatments, including essential drugs like intravenous chemotherapy and supportive medications.

When clients tell me their medication falls under Part B, I am relieved.  Treatments, like chemotherapy drugs, insulin pumps, and Prolia injections in the doctor’s office, are completely covered when you have Original Medicare and a Medicare Supplement.  On Medicare Advantage, there is a maximum out-of-pocket that puts at least a cap on costs.

Part D Formularies

On the other hand, some oral cancer medications and medications used for supportive care, such as anti-nausea drugs, are placed under Part DMedicare Part D cancer drugs prescription drug plans.  Private insurance companies approved by Medicare offer Part D plans, and coverage may vary depending on the specific plan.  Medicare Part D prescription drug plans are not as robust in their coverage compared to Part B.

It’s important to carefully review Part D formularies, which are lists of covered drugs, to ensure that the necessary cancer medications are included.  Expensive medications, including expensive cancer drugs, are very expensive on a Medicare Part D plan.  While there are limitations, and in 2025 there will be a $2,000 cap, generally, the medications are still very expensive if they are covered.

Understanding the differences between Part B and Part D coverage is crucial for effectively navigating Medicare’s cancer drug coverage.  You may not have much choice when it comes to cancer drug treatment and where it falls in terms of Medicare insurance.  But, by knowing which drugs fall under each part, beneficiaries can determine the most appropriate coverage for their specific needs and minimize out-of-pocket costs.

Does Medicare cover cancerAccessing Affordable Cancer Drug Coverage Under Medicare

While Medicare plays a significant role in providing cancer drug coverage, beneficiaries may face challenges and barriers when trying to access affordable medications.  These issues can impact both the affordability and availability of cancer drugs, making it difficult for patients to receive the treatments they need.

High Cost

One common challenge is the high cost of cancer drugs.  Many cancer medications come with a hefty price tag, and even with Medicare coverage, beneficiaries may still face substantial out-of-pocket costs.  This can create financial burdens, especially for those with fixed incomes or limited financial resources.  Additionally, certain cancer drugs may not be covered by Medicare, leaving beneficiaries to shoulder the entire cost themselves.

Confusing System

Another barrier to affordable cancer drug access is the complex nature of Medicare’s coverage policies.  Understanding the intricacies of drug tiers, formularies, and coverage restrictions can be overwhelming, leading to confusion and potential errors in selecting the most suitable coverage option.  The lack of clarity and transparency regarding coverage details can further complicate the process of accessing affordable cancer drugs under Medicare.

Medicare Part D and its Impact on Cancer Drug Coverage

Medicare Part D plays a significant role in providing coverage for cancer drugs obtained from a pharmacy.  This component of Medicare offers beneficiaries the opportunity to access prescription medications, including oral cancer drugs and supportive care medications.

Private insurance companies approved by Medicare offer Part D plans, which vary in terms of premiums, deductibles, and copayments.  Beneficiaries must carefully review and compare different Part D plans to ensure they choose the most suitable coverage.

Formulary

One key consideration when exploring Part D coverage is the formulary.  Formularies are lists of drugs covered by each Part D plan.  These lists can vary from plan to plan, so it’s essential to review them to ensure that the necessary cancer drugs are included.  Some medications may be placed in higher tiers, resulting in higher out-of-pocket costs for beneficiaries.  Understanding the formulary and the associated costs can help beneficiaries make informed decisions and minimize their expenses.

Medicare Part D coverage gapMedicare Gap or Donut Hole

Another important aspect of Part D coverage is the coverage gap, commonly known as the “donut hole.” The coverage gap occurs when beneficiaries reach a certain spending threshold, and their out-of-pocket costs increase until they reach catastrophic coverage.

However, it’s important to note that the coverage gap is gradually being phased out due to the Affordable Care Act.  By 2020, beneficiaries are responsible for only 25% of the cost of their medications while in the coverage gap.  The Inflation Reduction Act of 2022 put a cap of $2,000 on Part D drug costs in 2025.

Run the Numbers

When we run clients’ medications, we can show them the cost of the medication in the initial phase of drug cover and the gap phase.  The software also performs calculations showing approximately when you will fall into the gap phase of the Part D prescription drug coverage.  So you can at least see what you will be paying each month and make the appropriate adjustments.

Exploring the intricacies of Medicare Part D coverage is crucial for beneficiaries seeking affordable and accessible cancer drug coverage.  By understanding the formulary, costs, and potential coverage gaps, individuals can select the most suitable Part D plan and ensure that their necessary cancer medications are covered.

Medicare appeal processMedicare Cancer Drug Coverage Appeals Process 

Medicare beneficiaries may encounter situations where their cancer drug coverage is denied or not approved as expected.  I find this rare, except with experimental procedures.

In such cases, it’s important to understand the Medicare appeals process to challenge these denials and ensure access to necessary medications.  That being said, before beginning the formal appeal process, check to make sure the provider’s back office correctly processed the preapproval.  I’ve found that some doctors’ office do not go through the insurance company’s required protecals.  As a consequence, the authorization is denied because an incorrect code was used, the wrong form was submitted, or inadequate documentation accompanied the request.  Once it is clear the preapproval was correctly done and denied, move on to the formal appeals process.

The appeals process consists of several stages.  Each is designed to allow beneficiaries to present their case and request a reconsideration of the initial decision.  Following the proper steps and providing the necessary documentation to support the appeal is crucial.

Step 1

The first step in the appeals process is the redetermination stage.  This involves submitting a written request to the Medicare Administrative Contractor (MAC) that made the initial decision.  The MAC will review the case and decide.  If the redetermination does not favor the beneficiary, they can proceed to the next stage.

Step 2

The second stage is the reconsideration stage.  This involves requesting reconsideration by a Qualified Independent Contractor (QIC) who was not involved in the initial decision.  The QIC will review the case and decide.  If the reconsideration is not in favor of the beneficiary, they can proceed to the further stages of the appeals process.

Step 3, 4, & 5

The subsequent stages include a hearing by an Administrative Law Judge (ALJ), a review by the Medicare Appeals Council, and, finally, a judicial review by a federal district court.  These stages provide additional opportunities for beneficiaries to present their case and challenge the denial of cancer drug coverage.

Navigating the Medicare appeals process can be complex and time-consuming.  However, it is an essential avenue for beneficiaries to pursue if they believe their cancer drug coverage has been unfairly denied.

Seeking assistance from healthcare advocates or legal professionals specializing in Medicare appeals can be beneficial in guiding individuals through this process and increasing their chances of a favorable outcome.

Maximizing Medicare Coverage for Cancer Drugs

Here are some tips to help make the most of their Medicare coverage.

Review your Medicare Plan Annually

Medicare plans can change yearly, including drug formularies and costs.  It’s important to review your plan during the Annual Election Period, Oct 15th–Dec 7th.  Ensure that your current medications are covered and affordable under the plan.

I send out emails and letters to my clients every year during Annual Election Period to remind them.  The client will tell me that their medications have not changed, but I emphatically remind them that it doesn’t matter.  The drug plans change, and in some cases, the change can be drastic.  Premiums go up, deductibles go up, tiers change, and drugs are dropped and added to plans.  For the little time it requires, the review can save hundreds if not thousands of dollars.

Utilize Prior Authorization

Some cancer drugs may require prior authorization from Medicare before they are covered. Work closely with your healthcare provider to ensure that the necessary documentation is submitted.  Over the years, I have had clients denied because the doctor’s office did not properly submit the request.  Sometime I got the client to encourage second try with the correct codes and documentation, and it worked.

Explore Patient Assistance Programs (PAP)

Many pharmaceutical companies offer assistance programs that provide eligible individuals with financial assistance or free medications. Research and inquire about these programs to determine whether you qualify for assistance.  I have a number of clients who come to me who are on these programs before they even get on Medicare.  Some programs will even continue once you are on Medicare.

These programs provide free or discounted medications to individuals who meet specific eligibility criteria.  Each program has its requirements, so it’s important to research and apply for programs that may apply to your situation.  Pharmaceutical companies are always testing their medications.   You may qualify, depending on your health issues, for free medications as part of a study.

Nonprofit OrganizationsMedicare covers chemotherapy

nonprofit organizations and foundations may offer financial assistance or grants specifically for cancer patients.  These organizations aim to alleviate the financial burden associated with cancer treatment and provide support to individuals in need.  Research and reach out to these organizations to explore potential assistance options.

It’s important to note that these alternative options may have their own eligibility criteria and limitations.  However, for individuals who do not qualify for Medicare or need additional assistance, exploring these alternatives can be instrumental in accessing affordable cancer drugs.

Cancer Organizations

Cancer-specific organizations like the American Cancer Society may also offer resources and support services for cancer patients on Medicare.  These organizations can provide information on financial assistance programs, educational materials, and support groups to help individuals navigate their cancer journey.

Utilizing these resources and assistance programs can help Medicare beneficiaries access the support they need in terms of understanding their coverage and obtaining affordable cancer drugs.  By taking advantage of these resources, individuals can enhance their overall healthcare experience and improve their quality of life during cancer treatment.

Medicare treatments for cancerBottom Line: Research your Medicare Cancer Drug Coverage

You can not control whether you get cancer or not.  You may not have much control over the treatment, but you can see the costs and what insurance covers.  Understanding the implications of Medicare’s cancer drug coverage, including the differences between Part B and Part D, the challenges and barriers faced, and the various strategies and resources available, empowers beneficiaries to make informed decisions and navigate the system effectively.

By reviewing Medicare plans annually, utilizing prior authorization, and exploring patient assistance programs, beneficiaries can maximize their coverage and minimize out-of-pocket costs.  Additionally, alternative options such as Medicaid and Patient Assistance Programs can provide additional support for individuals who may not qualify for Medicare or need extra assistance.

Are you searching for a trustworthy Medicare Advantage plan insurance agent near you? Look no further! In this article, we will provide you with key tips and insights to help you find the right agent to meet your healthcare needs. Medicare Advantage plans offer additional benefits beyond the basic coverage of Original Medicare.  Choosing the right plan can be overwhelming. So, who’s the trustworthy Medicare Advantage plan insurance agent near me?

Finding a trusted agent involves more than just a quick Google search. It requires careful consideration and research. We will guide you through the process, outlining important factors to consider when selecting an agent. From checking their credentials and experience to evaluating their customer satisfaction ratings, we will provide you with the tools you need to make an informed decision.

By the end of this article, you will clearly understand what to look for in a Medicare Advantage plan insurance agent near you. So, let’s dive in and find the perfect agent to help you navigate the complex world of Medicare Advantage plans.

Medicare Advantage insurance agents near you Understanding Medicare Advantage Plans

Medicare Advantage plans, also known as Medicare Part C, are private health insurance plans that provide an alternative to Original Medicare. These plans are offered by private insurance companies approved by Medicare. They combine the coverage of Medicare Parts A and B, and often include additional benefits such as prescription drug coverage, dental, vision, and hearing services, and wellness programs.

Medicare Advantage plans come in different types, including Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), and Special Needs Plans (SNPs). Each type has its own network of doctors, hospitals, and other healthcare providers. It’s important to understand the differences between these plan types and choose the one that best suits your needs.

The Importance of a Trustworthy Medicare Advantage Insurance Agenttrustworthy insurance agent

Navigating the world of Medicare Advantage plans can be confusing.  That is why working with a trustworthy insurance agent is crucial. A reliable agent can help you understand the complexities of different plan options, guide you through the enrollment process, and provide ongoing support for any questions or concerns you may have.

A trustworthy insurance agent is knowledgeable about Medicare rules and regulations, stays up to date with changes in the healthcare industry, and has a good understanding of the Medicare Advantage plans available in your area. They should be able to explain the pros and cons of each plan, and help you determine which plan aligns with your specific healthcare needs and budget.

Researching Medicare Advantage Insurance Agents Near Me

When searching for a Medicare Advantage plan insurance agent near you, it’s important to conduct thorough research to ensure you find a trustworthy professional. Here are some key steps to follow.

checking out a Medicare agent near meChecking for Licenses and Certifications

Start by checking if the agent is licensed to sell Medicare Advantage plans in your state. The agent should hold a valid insurance license and be authorized to sell Medicare products. You can verify their license status with your state’s insurance department or through the National Insurance Producer Registry (NIPR) website.

Local Department of Insurance Website

For Nebraska, you can go to the Nebraska Department of Insurance website. Once there, look at the tabs on the top of the page. Go to Policyholder. Under that tab, there is Agent/Company Search. Click Agent/Agency Search. Pick the state and choose the licensee. Type in the last name. You don’t need the agent number, but it helps, especially with common last names. There is your agent.

The importance of checking out an agent is you can quickly verify if he is licensed in your state. You can see how long he has held an insurance license. The date of the first activation will be there.

That may not be completely accurate, however. I noticed my activation date is 2012. I was first licensed in Nebraska in 2002, but I moved outside of Nebraska for a short time. My residence insurance license was not Nebraska, I was a non-residence licensed agent for Nebraska. Then, I returned in 2012 to Nebraska. So, the Nebraska Dept of Insurance site does not show the lifetime duration of a licensee.

Insurance Company Appointments

Toward the bottom of the page are the agent’s appointments. You must be licensed to sell insurance in a particular state. You must be licensed in each state you sell, and you must be appointed with each insurance company before you sell their products.

Medicare Certification

Insurance company appointments may require product training before you can be appointed. Sometimes you must pay a fee to be appointed. Insurance companies that offer Medicare Advantage plans require the agent to pass the AHIP exam. You only get three tries to pass the exam. If you fail the 3rd try, you cannot sell any Medicare Advantage plans or Part D prescription drug plans for any insurance company in any state.

After you pass the AHIP, you submit the certification to the insurance company.  Then, you must pass the individual product training for each Medicare product you wish to sell. Again, there is a limited amount of time you can take the test to pass.

Then, the appointment paperwork is completed.  Your appointment is listed on your state insurance department’s website. If not appointed, the agent cannot sell that company and/or product.

I recall meeting with a couple once whose financial advisor said he could get them any plan they wanted, including Medicare Advantage. I was suspicious because most financial advisors who offer financial advice as their primary business generally do not get deeply involved in Medicare. When I looked them up on the Nebraska Dept of Insurance, they were not appointed with any of the Medicare Advantage carriers in the area.

Reading Reviews & Testimonials

Online reviews and testimonials can provide valuable insights into the quality of service provided by the Medicare Advantage insurance agents near you.Medicare insurance agent reviews

I do not like to shop, so I use Amazon for a lot of my shopping. Once I know what I want, I look at star ratings and reviews. More and better reviews, the higher the chance I click on that product.

Look for reviews on reputable websites, such as Google, Facebook, or the Better Business Bureau. Pay attention to overall ratings, as well as specific feedback regarding the agent’s knowledge, responsiveness, and ability to help clients find suitable Medicare Advantage plans.

It’s important to note that while reviews can be helpful, they should be considered along with other factors. Negative reviews may not always reflect the agent’s true capabilities, as individual experiences can vary. Use reviews as a starting point for further investigation and gathering more information about the agent.

Referrals from Friends and Family

Reach out to friends, family members, or colleagues who have experience with Medicare Advantage plans. Ask them if they have worked with a trustworthy insurance agent and if they would recommend their services. Personal recommendations can be invaluable, as they come from people you trust who have first-hand experience with the agent’s professionalism and expertise.

Keep in mind that everyone’s healthcare needs are different, so while a certain agent may have been a great fit for someone you know, it doesn’t guarantee the same experience for you. Still, personal recommendations can help you narrow down your options and consider agents who have a proven track record of delivering excellent service.

Most of my new clients come from client referrals. The difference between referrals and prospects who come to us through other marketing avenues is usually night and day.

The trust level is already there because a trusted friend or family member referred them. The prospect starts learning about Medicare and the insurance products right from the start because they trust us. While we still work on building repertoire, there is enough trust present so they are listening attentively and learning what they need to know from the beginning.  They can make much better decisions about their Medicare.

Meeting with Medicare Advantage insurance agents near meMeeting with a Medicare Advantage Insurance Agents Near Me

Once you have identified a few potential Medicare Advantage insurance agents near you, it’s time to schedule consultations to further assess their suitability. Meeting face-to-face or having a phone conversation allows you to gauge their expertise, ask important questions, and evaluate their communication skills.  Trust is built not only upon believing the person has your best interest at heart.  Trust is also built on competence.  Does he know what he’s talking about?

During the meeting, pay attention to the agent’s ability to explain complex concepts clearly and understandably. They should be patient, attentive, and willing to address your concerns. Consider their level of professionalism, as well as their ability to listen and tailor their recommendations to your unique needs.

Do they show you the universe of Medicare Supplements, Medicare Advantage plans, and Medicare Part D Prescription Drug plans in your area?  Or do they go immediately to only one or two companies? Or do they only do Medicare Advantage or only offer Medicare Supplements?

You want an independent agent or broker who represents most companies and plans in your areas and can objectively and impartially present all your Medicare options. Then, he can take you through the process of matching the various plans and their benefits to your unique needs and concerns. One size does not fit all.

Questions to Ask a Medicare Advantage Insurance Agent

To ensure you make an informed decision, it’s essential to ask the right questions during your meetings with potential insurance agents. Here are some basic questions to consider:Questions to ask about Medicare Advantage plans

  1. Can you explain the different types of Medicare Advantage plans available in my area?
  2. How do these plans differ in terms of cost, coverage, and network of providers?
  3. What additional benefits can I expect from the Medicare Advantage plans you recommend?
  4. How do I know if my preferred doctors and hospitals are included in the plan’s network?
  5. What prescription drug coverage options are available?
  6. Can you provide an estimate of the monthly premiums, deductibles, and out-of-pocket costs for the plans you recommend?
  7. How do I qualify for extra help with Medicare costs, such as the Low-Income Subsidy?

Asking these questions will help you gain a better understanding of the agent’s knowledge, expertise, and ability to find a plan that meets your healthcare and financial needs.

Comparing Quotes and Plans

comparing Medicare plans After meeting with several insurance agents and gathering information, it’s time to compare the quotes and coverage options they have provided. Keep in mind that the lowest premium may not always be the best option, as it’s important to consider factors such as deductibles, copayments, and the network of providers.

Evaluate the coverage options based on your specific healthcare needs. Consider factors such as prescription drug coverage, access to specialists, and the availability of preferred hospitals or healthcare facilities. Consider the estimated out-of-pocket costs for each plan, including copayments, coinsurance, and deductibles.

Enrolling in a Medicare Advantage Plan with Your Local Agent

Once you have thoroughly researched and compared the different Medicare Advantage plans and insurance agents, you should have at least a couple of names to answer the questions: who’s the trustworthy Medicare Advantage plan insurance agent near me?

Contact the chosen agent and inform them of your decision. They will guide you through the enrollment process, ensuring that you understand the terms and conditions of the plan you have selected.

Remember to review all the relevant documents, including the Summary of Benefits and the plan’s provider directory. If you have any doubts or questions, don’t hesitate to reach out to your agent for clarification.

At Omaha Insurance Solutions, we have taken thousands of clients over the years through the process of understanding and selecting the Medicare plan that best fits their needs, and each year, we review that

omaha Nebraska medicare insurance agent

Christopher Grimmond

plan to make sure it still meets their needs.

Give us a call at 402-614-3389 for a free, no-obligation consultation to find out your Medicare options.

 

Nebraska Medicare Advantage Plans 2024Are you ready to unlock the potential benefits of Medicare Advantage in your area? Look no further. This informative article will explore the advantages of Medicare Advantage plans and how they can enhance your healthcare coverage.

Medicare Advantage, also known as Medicare Part C, goes beyond what Original Medicare provides. With a Medicare Advantage plan, you can enjoy additional benefits like prescription drug coverage, dental care, and vision services in one convenient package. But that’s not all – some plans even offer fitness memberships, transportation services, and telehealth options.

By delving into the specifics of Medicare Advantage, we’ll help you understand how these plans work, what they cover, and whether they align with your unique healthcare needs. We’ll also examine how you can find the right plan for you in your local area.

Don’t settle for one-size-fits-all healthcare coverage. Discover the customized benefits and added features that Medicare Advantage plans can offer. Read on to learn more about the advantages waiting for you right around the corner.

What is Medicare Advantage?

Medicare Advantage, also known as Medicare Part C, is a type of health insurance plan offered by private insurance companies that contract with Medicare. These plans provide an alternative way to receive your Medicare benefits, combining the coverage of Parts A (hospital insurance) and B (medical insurance) and often including additional benefits not covered by Original Medicare.

One key characteristic of Medicare Advantage plans is that they are required to provide at least the same level of coverage as Original Medicare. However, many plans go above and beyond. They put a cap on spending. Original Medicare is unlimited. There are small copays for services. Original Medicare Part B is an unlimited 20%. Part D prescription drug plans are usually included. With Original Medicare, you must purchase a separate Part D plan. Many Medicare Advantage plans have no deductible for the prescription side of the plan in the Omaha, Lincoln, & Council Bluffs areas. Most of the Part D plans have a large deductible. The most common deductible for 2024 is $545. Medicare Advantage offers additional benefits such as dental care, vision services, and hearing aids. That would be a separate policy and monthly premium on Original Medicare.  

In summary, Medicare Advantage plans offer a comprehensive and convenient way to receive your Medicare benefits, often with added benefits not available through Original Medicare alone.

Medicare Advantage Enrollment & Eligibility

Now that we’ve explored the benefits of Medicare Advantage let’s discuss how you can enroll in a plan and determine your eligibility.licensed insurance agent for medicare

To be eligible for Medicare Advantage, you must meet the following criteria:

  • You must be enrolled in both Medicare Part A and Part B. You still must continue to pay your Medicare Part B premium.  
  • You must live in the service area of the Medicare Advantage plan you wish to enroll in. If you leave that area, you will be disenrolled. You will then need to enroll in another plan in your new area in a timely manner.  

Once you meet these eligibility requirements, you can enroll in a Medicare Advantage plan during specific enrollment periods. 

  • Initial Enrollment Period (IEP) occurs when you first become eligible for Medicare, typically three months before your 65th birthday, the month of your 65th birthday, and three months afterward.  
  • Annual Enrollment Period (AEP) takes place from October 15th to December 7th each year, during which you can switch or enroll in a Medicare Advantage plan.
  • Special Election Periods (SEP) occur for special circumstances. For example, you move out of the service area. Another common SEP is when you lose employer health coverage. There are many others.    

It’s important to note that Medicare Advantage plans may have different networks of doctors and healthcare providers, so it’s essential to confirm that your preferred healthcare providers are included in the plan’s network before enrolling. Each area has its unique circumstances.

Medicare Advantage in the Omaha, Lincoln, & Council Bluffs areas is exceptionally good when it comes to networks. There are four provider networks: CHI (Catholic Health Initiative), Methodist Health Systems, Nebraska Medicine (UNMC), and Bryan Health. All of these networks work with the six insurance companies with Medicare Advantage contacts in the area.  

Medicare Advantage near meOriginal Medicare vs. Medicare Advantage

Original Medicare is only Part A for hospital and Part B for doctor visits and outpatient services. Part A currently has a deductible of $1,632 for an event in 60 days. Part B is a 20% coinsurance that is unlimited.  

Medicare Advantage covers the same as Part A & Part B, but there is a maximum out-of-pocket (MOOP). The MOOP is potentially $8,850 in-network and $13,300 out-of-network. These amounts are the maximum cap a plan can have. All Medicare Advantage plans MOOPs in Omaha, Lincoln, and Council Bluffs are much lower.  The most popular plan MOOP is $3,800. 

Medicare Advantage plans have small copays for various services. For example, doctor visits maybe 0-$10, emergency rooms $120-$135, and outpatient surgeries $250-$350. All of the copays go against the maximum out-of-pocket (MOOP).  

How to choose the Right Medicare Advantage Plan for You

With numerous Medicare Advantage plans available, choosing the right one that meets your healthcare needs is crucial. Here are some factors to consider when selecting a Medicare Advantage plan:

Medications CoveredMedicare Open Enrollment

Run your medications through the various software available, including the Plan Finder on the Medicare.gov website. Make sure your medications are on the formulary. Look for the plans with the lowest total copays for your medications.  

Provider Network

Medicare Advantage Provider networksMedicare Advantage is managed care, so there are networks, versus Original Medicare, which is fee-for-service (FFS). Check to make sure your doctors and hospitals are in the plan network.  

We are fortunate to have strong network affiliations with the Medicare Advantage plans in Omaha, Lincoln, and Council Bluffs. There are four networks: CHI, Nebraska Medicine, Methodist Health Systems, and Bryan Hospital. All six Medicare Advantage companies in our area work with these networks. However, we still check to confirm providers are in the network.  

Maximum Out-of-Pocket in Budget

The maximum out-of-pocket is the most you must pay in a calendar year. Does that amount work in your budget? A Medicare Supplement coupled with Original will cost approximately $2,000-$3,000 per year, depending upon your age and location. You will pay the monthly Medicare Supplement premium regardless of any medical expenses. With an Advantage plan, you only pay copays if you see a doctor or have something done medically.   

HMO vs. PPO

Medicare Advantage plans that are Health Maintenance Organizations (HMO) will only pay for services provided in the plan’s network. That is the limitation. When traveling, you are covered anywhere for an emergency.  

Medicare Advantage plans that are Preferred Provider Organizations (PPO) cover services in and out of the network. Out-of-network care providers who accept Medicare but are not in the local service area network are covered. Those providers may charge more, and the maximum out-of-pocket expenses are usually larger.  

PPO plans are best for people living in multiple locations or with limited local network coverage. Again, a PPO Medicare Advantage Plan has no real advantage in the Omaha, Lincoln, and Council Bluffs areas because all providers are in the four local networks.  

Many insurance companies with Medicare Advantage contracts also have national networks. That means you can access doctors and hospitals in other parts of the country far from home, still be in the network, and pay in-network copays. It is always important to confirm a provider’s status before seeking treatment. I have had a number of clients leave the Omaha area and go to facilities in other states while on their HMO Medicare Advantage plan and pay in-network copays.  

Medicare Advantage copaysCopays

To explore the Medicare Advantage plans available in your area, you can use the Medicare Plan Finder tool on the official Medicare website (medicare.gov). This tool allows you to enter your zip code and compare the different plans offered in your local area.

The Medicare Advantage comparison tool is helpful when looking at copays. There are many plans, and copays differ from plan to plan and service to service. If you are looking through company sales brochures, you will become cross-eyed. A comparison tool, either at Medicare.gov or through an insurance agent you are working with, will make the review process much more manageable.  

Over the years, I have listened to many clients voice their opinions on which copays are more important than others. I try to make clients aware of essential copays and the differences between the plans. They come to their own conclusions and rankings for the plans based on what they see.   

Additional Benefits

The big attraction of Medicare Advantage is the additional benefits. It is interesting to listen to clients’ comments and compare the additional benefits between plans. Those who don’t wear glasses pass over that benefit, and those who have issues with their teeth will laser focus on the size of the dental benefit and the network.  

Over-the-counter (OTC) benefits are getting a second glance this year because some companies reduced their amount, and another company kept it comparatively large. When the plans are very similar in terms of all other benefits, one benefit, like OTC, can make the deciding difference.  

Once you have covered these essential aspects of the plans in your area, you should have a feeling about which plan (or plans) best address your needs. Going through this checklist will narrow your selection to a plan or couple of plans that will serve you best.  

Exploring Medicare Advantage Plans in Your Area

Medicare Advantage Plans in NebraskaSome large metro areas have many, many plans. In the Omaha area, we have six insurance companies that offer 27 Medicare Advantage plans in the Nebraska counties of Douglas, Sarpy, Washington, Cass, Saunders, and Lancaster, and five insurance companies offer 26 plans in Pottawatomie County in Iowa.  

So there is an excellent variety. The complaint I hear quite often is that there are too many choices. The large number of plans and the different copay amounts and benefits are overwhelming and make the selection process confusing for many of my clients.  

If an independent agent lives and works in the area, he should be able to compare and explain most plans. One of the problems I have with agents out of call centers in Florida, California, or the Philippines is that they do not know the local area and the plans because they don’t live here. They are unaware of the subtle differences between the companies and plans. The telesale agent has no lived experience or history with the Medicare Advantage plans in Omaha, Lincoln, and Council Bluffs.  

Their primary concern is to switch you into the plan they are selling so they get paid. If there are problems later, they will not be there to answer your calls. They may not even be in the business after Open Enrollment.      

Bottom Line: Is Medicare Advantage Right for You?

Medicare Advantage plans offer a wealth of benefits and added features that can enhance your healthcare coverage. From additional benefits like prescription drug coverage and dental care to added perks like fitness memberships and telehealth options, Medicare Advantage plans provide a comprehensive and convenient way to receive your Medicare benefits.

When considering Medicare Advantage, it’s important to carefully compare the plans available, review their coverage and benefits, and consider your specific healthcare needs. Doing so lets you choose the right Medicare Advantage plan that aligns with your preferences and provides the coverage you require.

Unlock the potential benefits of Medicare Advantage in your area. With over two decades of experience at Omaha Insurance Solutions, we know the Medicare Advantage plans well in Nebraska & Iowa. We can guide you through the selection process. 

omaha Nebraska medicare insurance agentWith the right plan, you can enjoy comprehensive benefits, cost savings, and a more convenient healthcare experience. Take control of your healthcare today and call us at 402-614-3389 to speak with an insurance agent professional to explore the possibilities of Medicare Advantage.

 

Medicare Supplement Quoting softwareAre you trying to navigate the complex world of Medicare but overwhelmed by the sheer number of options available? Enter the Medicare supplement quoting tool – your secret weapon to unlocking the power of Medicare. This article will explore how this innovative tool can help you get the most out of your Medicare coverage.

A Medicare supplement quoting tool effortlessly compares plans, costs, and benefits from various insurance carriers. Instead of spending hours on research and guesswork, this user-friendly tool gives you a comprehensive overview of available options, helping you make informed decisions about your healthcare coverage.

Whether new to Medicare or looking to switch plans, this digital tool simplifies the process. It offers personalized quotes based on your specific needs and budget, allowing you to find the perfect Medicare supplement plan that suits you best.

Understanding Medicare and Medicare Supplements

Medicare is a federal health insurance program in the United States that primarily covers individuals aged 65 and older, as well as some younger individuals with certain disabilities. While Medicare provides essential coverage, it doesn’t cover all healthcare costs. There are big gaps in coverage.  That’s where Medicare supplements, also known as Medigap plans, come in.

Medicare supplements are private insurance plans designed to fill the gaps in Medicare coverage. These plans help cover out-of-pocket expenses, such as deductibles, co-payments, and coinsurance. However, with numerous insurance carriers offering a wide range of Medigap plans, choosing the right one can be overwhelming.

The Importance of Comparing Medicare SupplementMedicare supplement quoting tool

Comparing Medicare supplement policies is crucial to ensure you get the coverage that best meets your needs and budget. Each plan offers different benefits, and the costs can vary significantly between carriers. Without a clear understanding of the available options, you may end up paying more for coverage that doesn’t align with your healthcare requirements.

Medicare supplement plans are standardized, meaning the benefits for each type of plan are the same across carriers. However, the prices can differ; some carriers may offer additional benefits or discounts. By comparing plans, you can identify the most cost-effective option that provides the coverage you need.  Why pay more for the exact same coverage?

Introducing Medicare Supplement Quoting Tools

Medicare supplement quoting tools are online platforms that allow you to compare and evaluate different Medigap plans, costs, and benefits from various insurance carriers. These tools simplify the process of finding the right plan by providing you with personalized quotes based on your specific needs and budget.

Instead of manually researching and contacting multiple insurance carriers for quotes, Medicare supplement quoting tools streamline the entire process. With just a few clicks, you can access a wealth of information and make informed decisions about your healthcare coverage.

How Medicare Supplement Quoting Tools Work

Medicare supplement quoting softwareMedicare supplement quoting tools draw their information from insurance companies’ filings with the state insurance commissioner.  Each insurance company must file its policy with the commissioner, and the commissioner’s office must approve it.  When changes are made to the policy, including price and premium changes, those changes must be updated with the commissioner’s office.  All quoting software pulls from this one source.

Typically, you’ll need to input details such as your age, location, gender, and tobacco usage into the software. Some tools may have the ability to see underwriting guidelines.  Usually, it is better to go to the actual insurance company website and their quoting software to get more detailed and accurate quotes.  The multi-company software, however, enables you to narrow down the pool of likely policies, but it cannot get into the particulars of the company’s underwriting and application process.  The individual insurance company website software can.

Once you’ve entered the necessary information, the quoting tool will analyze the data and present you with a list of Medigap plans available in your area. You can then compare the benefits, costs, and ratings of each plan side-by-side.

Market Insights

Depending on the sophistication of the software, the quoting instrument can get very granular.  You can see age increase pricing, history of rate increases, and the number of policies by state and nation for each company.  The loss ratio and percentage of market share may even be listed.  This type of information will not be very helpful to most people because it is unfamiliar.  A professional who understands the data and is trained to interpret it accurately will need to provide context.

This information and insight allow you to evaluate your options and choose the plan that offers the best combination of coverage and affordability.

The more important consideration is the future increases.  As you age, the cost of a Medicare Supplement goes up.  There are rate increases because medical costs go up.  The number and size of claims ultimately determine how much the insurance company increases the premium to offset expenses.  That is all in the future and hard, if not impossible, to predict.  The information from the Medicare Supplement quoting software does give some insight, but does not predict the future.

Access to Medicare Supplement Quoting Tool

Computer software is usually not free.  The Medicare Supplement software we are talking about is not cheap.  Most people will not pay the price to have access to the software to do one orPicking the best medigap plan in Omaha Nebraska two quotes.  You usually get access to the software through an insurance agent.  Most independent insurance agents or brokers who offer many different companies use quoting tools.  At Omaha Insurance Solutions, we use the CSG Actuarial software.

I attended a Medicare Supplement conference over a decade ago in Florida.  In the main hall, where all the vendors gathered, I ran into CSG.  I had been looking for a good Medicare Supplement quoting software.  In the course of the conversation, I found out a number of the owners and employees were from Mutual of Omaha.  Then I asked where the company was located–Omaha, Nebraska.  I had to fly to Florida to find software that was in my own backyard.

While there are other quoting tools out there, CGS is the industry standard and widely used.  I have found them superb.

For those who do not work with an experienced insurance professional, you can get access to a quoting tool on your MyMedicare.gov personal account.  Inside the account, you can run your own quotes.  The tool is very rudimentary, but it certainly gives you prices and can narrow down the number of companies you may wish to consider.

Benefits of Using a Medicare Supplement Quoting Tool

Using a Medicare supplement quoting tool offers several benefits.

Time-Saving

Instead of manually researching and contacting insurance carriers, the quoting tool provides instant access to personalized quotes from multiple providers.  In Nebraska and Iowa, there are over 40 insurance companies offering more than 300 Medicare Supplements.  That’s a lot to sort through.  The software does it in an instant.

Comprehensive Overview

The tool presents you with a comprehensive overview of available Medigap plans, allowing you to compare benefits, costs, and ratings in one place.  Reseaching a company and policy would take hours.  With the tool, the information is at your finger tips.

Informed Decisions

By having all the necessary information at your fingertips, you can make informed decisions about your healthcare coverage, ensuring you choose the plan that best suits your needs and within your budget.  I find so many people who over pay for the same coverage because they did not effectively shop.

Cost-Effective

Medicare supplement quoting tools help you identify the most cost-effective plan by comparing prices from different insurance carriers side-by-side.

Factors to Consider When Using a Medicare Supplement Quoting Tool

While Medicare supplement quoting tools can simplify the process of finding the right plan, there are a few factors to consider.

Medicare supplement Plan G vs Plan NAccuracy of Quotes

While the tool provides personalized quotes, the actual premiums may vary based on additional factors such as your health conditions or the insurance carrier’s underwriting guidelines.

On rare occasions, the quoting software is different from the company website.  The new prices may not be reflected immediately.  The software has the potential to show the different underwriting classes, but you will not know the client’s underwriting class until you make the application and it is confirmed by the insurance carrier.  The agent always needs to let the client know that she could be denied or rated.  Most agents initially show the lowest rate, which is preferred.

The only way to guarantee the best rating is during a person’s initial enrollment into Medicare.  After that, they are subject to underwriting.

A few years ago, I ran a quote for a lady.  I only showed the preferred health category.  It was an awesome price compared to what she was paying on her current Medicare Supplement.  When we started the application process, however, she was subject to the insurance company’s underwriting guidelines.  She was not tall enough for her size.  Consequently, she went from a preferred rating to a standard rating.  The Medigap price went up, but the price was still significantly less than what she was currently paying.  She asked why the price was higher than what I initially quoted.  I explained it was because of her weight.  She was so offended that she would not consider switching to the lower-cost supplement even though it would have saved her $700 a year.

Coverage Options

The quoting tool may not include all available Medigap plans in your area. It’s essential to research and verify the options presented by the tool to ensure you have a comprehensive understanding of the available plans.

Some agents may not show all of the companies and policies in your area. They may not write a particular carrier for various reasons. They could be prohibited from writing a company.  The agent may consider the company to be inferior, so they exclude it from the list.  The agent, or agency, may have a sweetheart deal with a handful of companies.  Those are the only ones they show.

Additional Benefits

Some insurance carriers may offer additional benefits or discounts not included in the quoting tool. It’s worth exploring the carrier’s website or contacting them directly to learn more about their offerings.  A couple of Medicare Supplements offer a free gym membership.  Almost all have in-house discount programs.  But I would say it is rare they offer anything more of substance without additional premium.

Knowing Data Is Different Than Understanding Data

Many people will look at a spreadsheet of Medicare supplement prices and think they understand what it means.  They may even have very detailed information on the company and its policies.  Someone could have told them what the terms and categories all mean.  Why is it that with all the data and the Ivy League-educated analysis, stock pickers still get it wrong and lose money in the market?

Knowing information is not the same as understanding what the data means.  I’ve watched the Medicare Supplement landscape for over a decade.  It shifts like the sands of the desert.  Tools are helpful, but there is a lot that goes into interpreting the data.  And none of it guarantees the future.  Personal experience as an agent with thousands of clients and years in the industry helps me understand the Medicare Supplement universe.  A company’s track record gives the best idea, as long as the CEO or ownership doesn’t change, but at best, choosing a Medicare Supplement, even with sophisticated instruments, is an educated guess.

Bottom Line: Use The Tools to Improve Your Odds

The Medicare Supplement quoting tools more quickly and easily enable you to accurately evaluate many Medicare Supplements in your area.  The side-by-side comparisons reduce the chance of overlooking a policy or making a mistake trying to recall a price.  The tools sift and narrow down your choices, but they don’t make the choice.  The tools do not predict future premiums or guarantee success.

The exercise of running a Medicare Supplement quote will improve your chances of picking a good plan.  An experienced and trustworthy insurance professional will increase your

omaha Nebraska medicare insurance agent

Christopher J. Grimmond

odds of success even more.

Give us a call at 402-614-3389 for a free consultation with a licensed insurance agent professional about your Medicare Supplement plan.

 

medicare supplement underwriting cheat sheetAre you struggling to understand the intricacies of Medicare supplement underwriting? You’re not alone. Navigating the insurance world can be daunting, but fear not – we’ve got you covered. In this medicare supplement underwriting cheat sheet, we’ll unlock the secrets of insurance underwriting for Medigap policies. We’ll make it easier for you to understand and find the coverage that meets your needs.

Whether you’re new to Medicare or have been enrolled for years, underwriting can be confusing. But it doesn’t have to be. We’ll break down the process step-by-step, explaining the factors that insurers consider when determining your eligibility and pricing for Medicare supplement plans. From medical history and pre-existing conditions to age and location, we’ll leave no stone unturned.

Armed with this knowledge, you’ll be better equipped to navigate the Medicare supplement landscape and make informed decisions about your coverage. So, grab your pen and paper, and let’s create your own Medicare Supplement underwriting cheat sheet together. By the end of this cheat sheet, you’ll feel confident and empowered to take control of your healthcare coverage.

Develop Your Own Cheat Sheet for Medicare Supplement Insurance & Underwritinginsurance company underwriting process

Medicare supplement insurance, also known as Medigap, is designed to fill the gaps in original Medicare coverage. While original Medicare covers many healthcare expenses, it doesn’t cover everything.

Part A currently has a hospital deductible of $1,632 per event in a 60-day period, and Part B has an unlimited 20% coinsurance. That’s why you need a Medicare supplement policy to fill in the gaps.

Private insurance companies offer these policies to help you pay out-of-pocket costs such as deductibles, copayments, and coinsurance.  How do you get a Medicare Supplement policy?

The Basics of Insurance Underwriting

During your Initial Enrollment Period into Medicare, the insurance company is required to sell you a Medicare Supplement without asking any health questions–underwriting.  After your one-time Initial Enrollment Period into Medicare, you will need to answer health questions and pass underwriting to purchase a Medicare Supplement in most states.

Underwriting is the process insurance companies use to assess an applicant’s risk and determine eligibility for coverage. When it comes to Medicare supplement insurance, underwriting plays a crucial role in determining whether you’ll be approved for a plan and how much you’ll pay in premiums.

When people are denied during underwriting or rated, they are usually not happy. Some people are even upset and offended. I understand. I get rated as obese myself under most insurance underwriting. I’ve been lifting weights since I was twelve, so there is plenty of muscle. But guess what? My body fat is not 6%, either, so I’m fat. So, I pay more. I am working hard on trying to grow taller for my weight category. So far, it has yet to work.

Of course, the people who pass underwriting are happy, but they should be happy because others were not allowed into their insurance pool. Because a certain level of health is required, the number of clients can be covered with an affordable amount of premium. You want as low a number of claims as possible because that keeps your premiums low. The same goes for car insurance, homeowners insurance, and boat insurance. When there is a natural disaster, like hail or hurricanes, that is why premiums usually go up afterward.

Sometimes, actuaries get the underwriting wrong because insurance companies WANT to insure more people. The more people they insure; the more money they make usually–if they do it correctly.

When they do it incorrectly–in other words, poor underwriting standards–the result is that people with potential health issues get into the pool.  There are more claims than what the actuaries planned for, and the insurance company must make up the difference by increasing premiums for everyone.

Why Underwriting is Important in Medicare Supplement Insurance

Underwriting is necessary in Medicare supplement insurance because it helps companies manage risk. By assessing an applicant’s health status and other factors, insurers can determine the likelihood of the individual filing claims and estimate the potential costs they may incur. This allows them to set appropriate premiums that reflect the risk level the insurance company is taking on.

Medicare supplement underwriting cheat sheetFactors Considered in Medicare Underwriting

Here is the meat of what you are looking for.  During the underwriting process for Medicare supplement insurance, several factors are taken into consideration. These factors can vary slightly depending on the insurance company, but some common ones include:

1. Age: Younger individuals may be seen as lower risk than older individuals with more health issues.

2. Gender: Although gender-based pricing is not allowed in some states, it may still be a factor in underwriting. In Nebraska & Iowa, Medicare Supplements are priced based on gender, and men are always more expensive.

3. Location: The area where you live can impact the cost of healthcare and, therefore, affect underwriting decisions.

I mainly do Medicare insurance in Nebraska and Iowa. I’m amazed at the price differences between Nebraska and Iowa, Omaha and Lincoln, and urban and rural areas.  Ultimately, some areas are healthier than others and consequently have fewer claims.  Thus the premiums are lower.

4. Medical history: Insurance companies will review an applicant’s medical history to assess pre-existing conditions and potential risks. As part of the application process, you give the insurance company permission to access various insurance resources that give a history of your health. You list your current medications and the dosage on the application.  Medications tell a great deal about your health profile.

5. Tobacco use: Smokers may face higher premiums due to the increased health risks associated with smoking. Some companies do not count you as a smoker during your Initial Enrollment Period into Medicare. We definitely highlight these companies to our new clients who are smokers.

6. Enrollment period: The timing of your application can impact underwriting decisions, as there are specific enrollment periods where guaranteed issue rights apply. This particular issue is NOT relevant to Medicare supplements in Nebraska and Iowa. There are no special periods, like the birthday or anniversary rule.

Common Underwriting Requirements

Insurance companies may require applicants to go through underwriting when applying for Medicare supplement insurance. The underwriting requirements can include:

Medical Underwriting

This involves answering health-related questions on the application form. People always ask if there is a physical; there is no physical. The health questions only take 5-8 minutes to answer.  The medical side of underwriting is all done electronically.  In a moment, insurance companies can scan your medical records and prescriptions to make a determination.  Some companies have the whole process so automated that I get an answer within seconds.

Pre-existing Conditions 

Insurance companies may ask about pre-existing conditions and impose waiting periods or exclusions for specific conditions. For example, most health questions begin with a qualifier: “In the past two years . . . .” “In the last six months . . . .” “Do you take _____ amount of insulin?”

Just because you had cancer in the past, a heart attack in the past, or a stroke in the past, you are NOT automatically disqualified.  The bigger questions is how longer go did it occur, what has been your health since, and was the problem rectified?

Guaranteed Issue Rights

There are specific situations where insurance companies must offer coverage without underwriting, such as when an individual is losing other health coverage. There are restrictions; for example, you can only select Plan G.

Medicare regulations in Nebraska and Iowa only have a Medicare guarantee issue for when you lose an employer health plan and are on Medicare. Nebraska & Iowa do not have a Medicare Supplement Open Enrollment.

How Medicare Underwriting Impacts Premium Rates

Underwriting can significantly impact the premium rates you’ll pay for your Medicare supplement insurance. Based on the information gathered during the underwriting process, insurance companies determine the level of risk you represent and adjust your premiums accordingly. If you’re considered a higher risk, you may face higher premiums, while lower-risk individuals may enjoy more affordable rates.  In some cases, the risk is too high, and the company denies coverage.

Implement Your Medicare Supplement Underwriting Cheat Sheet

Navigating the underwriting process for Medicare supplement insurance can seem daunting, but by developing your own medicare supplement underwriting cheat sheet, you can increase your chances of success.

Research and Compare Plans

Before applying, research and compare different Medicare supplement plans to find the one that best suits your needs.  We do hundreds of Medicare Supplement applications a year.  We know the companies that are strict or more lenient.  Some companies will cover insulin-dependent diabetics; many will not.  We know the levels of A1C that are acceptable to some insurance companies and will be rejected by others.  Rheumatoid arthritis is immediately rejected by some companies but is allowable under certain circumstances by others.  Each company picks its segment of the market it wants to go after and specialize in.  We help our clients find the needle in the haystack.

Understand the Underwriting Process.

Familiarize yourself with the underwriting requirements of different insurance companies so you know what to expect during the application process.  Understanding the process may be as simple as losing a few pounds. That will get you into a better health class and a lower premium.

Adjust your diet and then visit your doctor to have your blood tested. Reduced cholesterol or A1C levels may be enough to push you into the next underwriting category.

Be Honest and Accurate.

Provide truthful and accurate information on your application to avoid any complications or potential issues later on.  They will know if you are a smoker.  You will not be able to avoid the smoking rate by not disclosing tobacco use, even chewing.

Seek Professional Assistance

If you’re unsure about the underwriting process or need help with your application, consider contacting a licensed insurance agent professional or broker specializing in Medicare supplement insurance.

At Omaha Insurance Solutions, we know the landscape of Medicare Supplements in Nebraska and Iowa.  We can direct you to the plan that will be most favorable to your health circumstances and budget, especially if you have some health challenges.  Insurance professionals do not cost you anything.  The price is exactly the same if you do all the work yourself or use an insurance agent.  Why not use someone who has a thorough knowledge of the plans in your area?  Give us a call at 402-614-3389.

Common Underwriting Mistakes to Avoid

When going through the underwriting process for Medicare supplement insurance, it’s essential to avoid common mistakes that could potentially lead to application denials or higher premiums.

Providing incorrect information

Ensure that all the information you provide on your application is accurate and current.

I have clients who are “too honest.”  They think if they explain and justify certain health issues, the insurance company will understand and forgive. In my experience, when the underwriter hears certain words and phrases, they sometimes overreact.  As scientific as they try to make it,Medicare underwriting questions underwriting is still a very human process.  It is the job of the underwriter to protect the insurance company.   We then have to contact the doctors and go through a difficult and lengthy process to explain the health situation so the person is passed through underwriting.

My recommendation is like Sergeant Joe Friday used to say, “Just the facts, mam, just the facts.”

Failing to disclose pre-existing conditions

Be thorough when disclosing any pre-existing conditions, as failure could result in coverage denial or exclusions.  They will find everything.  I guarantee.

Where this situation becomes sticky is with surgeries.  One of the questions that is on every application is: “Has a medical professional recommended you have any surgical procedures?”  Or, “Do you have any medical procedures scheduled, such as cataract, joint replacement, or hip replacement surgery?”  Or words to that effect.

The new insurance company does not want to get stuck with a surgical bill that should go to the existing insurance provider.  After the surgery is completed and you are fully recovered, then you can proceed along with the application.

If you are not forth coming with that information and you do have a surgical procedure done after going on the new policy, like cataract surgery, the insurance company is in a position to say that you were not honest on the application.  Then they will deny the claim.  You will then be responsible for the full cost out of your pocket.

Honesty Is the Best Policy

Over the years, I have had prospective clients not disclose important information, “forget,” or lie.  “I forgot the doctor said I have a mild case of Alzheimer’s.”  “I only smoke once in a while.”  “The cancer is really slow growing.  The doctor said it’s tiny.”  “I didn’t know it was COPD.  I thought it was bad asthma.” 

While I’m sympathetic to harsh medical circumstances and the desire to reduce insurance costs, it doesn’t alter the reality they will not be offered a new Medicare Supplement.  The whole endeavor ends up being a waste of time for everyone involved.

Fortunately, systems are in place where insurance companies are almost infallible in finding out medical history.  That is a good thing because if a policy were issued under materially false circumstances, the person who made false or misleading claims would be in serious financial hazard. The process protects everyone involved.

Not Reviewing Your Application

Review it carefully before submitting it to ensure all the information is correct and complete.  When an application is denied by an insurance company, there is a record. Medicare smoker health class Even if there was a mistake made in the application process, it is not as simple as reapplying with the same insurance company or another.  Depending on the situation, the person may be prevented from reapplying for several months.

Medicare supplement underwriting cheat sheetHow to Improve Your Chances of Approval

While the underwriting process for Medicare supplement insurance can be strict, there are steps you can take to improve your chances of approval:

1. Maintain good health: Adopt a healthy lifestyle and manage any existing health conditions to demonstrate that you are a lower risk.

2. Consider alternative plans: If you’re facing difficulties with underwriting, explore alternative options, such as Medicare Advantage plans, which may have less stringent underwriting requirements.

3. Seek professional guidance: If you need clarification on the underwriting process or assistance with your application, consult a licensed insurance agent or broker who can provide tailored guidance.

Bottom Line: Mastering Medicare Supplement Underwriting

Navigating the world of Medicare supplement underwriting doesn’t have to be overwhelming. By understanding the basics of underwriting, the factors considered, and the common mistakes to avoid, you’ll develop your own medicare supplement underwriting cheat sheet. Research different plans, gather necessary documentation, and seek professional guidance. With these tools, you will have a checklist to go through during the underwriting process and find the Medicare supplement plan that best meets your needs. So, take control of your healthcare coverage and unlock the secrets of Medicare supplement underwriting by building your own cheat sheet.

Get Your Own Expert Medicare Underwriting Guide

At Omaha Insurance Solutions, we are happy to share with you our wealth of knowledge & experience with Medicare Supplement underwriting.  Our Medicare Supplement underwriting cheat sheet was developed over a

omaha Nebraska medicare insurance agent

Christopher J. Grimmond, MA, CFP

decade with thousands of clients.  We have learned the lessons of Medicare Supplement underwriting.

The cost is EXACTLY the same whether you use an insurance agent or call the insurance company directly.  The difference with us is you see all of the insurance companies and Medicare Supplements, not just one or two.

Our loyalty is to our clients, not to an insurance company.  We can change companies on a dime.

And when your cost goes up, we are not going to say keep the policy.  We are going to look for the same coverage with a solid A-rated company at a lower cost.  If you can call the insurance company you have your policy with, I guarantee they will not recommend another insurance company.

We know the subtleties of the underwriting process and which company will be most favorable to your health situation. Not all companies are created equal, and we have learned the hard way over the years which ones to trust.  You’ll get that experience with us.

Over the years, we’ve learned a thing or two about Medicare Supplements and underwriting. We also take care of all the paperwork, follow-up, and headaches that come with dealing with an insurance company.  Call us for a free consultation at 402-614-3389.  

Medicare Advantage Part C BenefitsAre you looking to maximize your healthcare coverage? In this article, we will explain the benefits of Medicare Advantage Part C, helping you make informed decisions about your healthcare options. Medicare Advantage Part C offers an alternative to traditional Medicare coverage, providing additional benefits and services to enhance your overall healthcare experience. 

With Medicare Advantage Part C, you can enjoy prescription drug coverage, vision and dental care, and even fitness programs. These additional services can save you money and provide comprehensive coverage tailored to your specific needs. 

But how do you know if Medicare Advantage Part C is correct for you? We’ll explore the eligibility criteria and factors to consider when weighing your options. Understanding the ins and outs of Medicare Advantage Part C will empower you to make the best choice for your healthcare needs. 

So, if you’re ready to take control of your healthcare coverage and get the most out of your benefits, keep reading. Let’s dive into the Medicare Advantage Part C world and discover the possibilities it holds for you.

Understanding the Basics of Medicare Advantage Part C Benefits

Medicare Advantage Part C, also known as Medicare Advantage Plans, is a comprehensive healthcare option offered by private insurance companies approved by Medicare. It combines the benefits of Medicare Parts A & B, and usually Part D, as well as additional services and coverage options. Medicare Advantage Part C is managed care, which means it is a network system. Doctors, hospitals, and clinics contract with the insurance company.

One of the key advantages of Medicare Advantage Part C is that it often includes prescription drug coverage, known as Medicare Part D, which is not included in Original Medicare. This means you can cover all your healthcare needs, including medications, under a single plan. Additionally, many Medicare Advantage plans offer extra benefits such as vision and dental care, hearing aids, and even fitness programs to help you stay healthy and active.

But how do you know if Medicare Advantage Part C is right for you? Let’s explore the eligibility criteria and factors when weighing your options.

The Benefits of Medicare Advantage Part C

Medicare Advantage Part C offers a wide range of benefits that can significantly enhance your healthcare coverage. These benefits canMedicare Advantage in Lincoln Nebraska include:

  1. Comprehensive coverage: Medicare Advantage Part C combines the benefits of Medicare Parts A and B, providing hospital insurance (Part A) and medical insurance (Part B) in one plan. This means you have coverage for hospital stays, doctor visits, preventive care, and more.
  2. Prescription drug coverage: Many Medicare Advantage plans include prescription drug coverage, allowing you to obtain your medications conveniently through the same plan. This can save you money and reduce the hassle of managing multiple insurance providers.
  3. Additional services: Medicare Advantage Part C plans often offer additional services not covered by Original Medicare, such as vision and dental care, hearing aids, and wellness programs. These services can help you maintain your overall health and well-being.
  4. Out-of-pocket cost protection: Medicare Advantage plans have a cap on out-of-pocket expenses, providing financial protection in case of unexpected medical costs. This can bring peace of mind and help you plan your healthcare budget more effectively.

How to Qualify for Part C

Omaha Medicare agentTo be eligible for Medicare Advantage Part C, you must meet the following requirements:

  1. Enrollment in Medicare Parts A and B: You must be enrolled in both Medicare Part A (hospital insurance) and Part B (medical insurance) to be eligible for Medicare Advantage Part C.
  2. Residency: You must reside in the service area of the Medicare Advantage plan you wish to join. Residency is important to remember. I have had clients move without telling me or the plan. They are then surprised when their coverage doesn’t work or is even canceled. 

It’s important to note that eligibility requirements may vary depending on the specific Medicare Advantage plan and insurance provider.  There are special needs plans for those on state Medicaid or with chronic health conditions like diabetes, COPD, or heart disease.  These plans have additional requirements.  

Review the requirements and seek guidance from a qualified insurance agent to ensure you meet the eligibility criteria. These plans have even richer benefits for those who qualify.  

Differences Between Original Medicare Vs. Medicare Advantage

While Original Medicare and Medicare Advantage Part C both provide healthcare coverage, there are some key differences between the two:

  1. Coverage options: Original Medicare consists of Part A (hospital insurance) and Part B (medical insurance), while Medicare Advantage Part C combines both Parts A and B into a single plan. Medicare Advantage plans also often include additional benefits, such as prescription drug coverage and extra services.
  2. Network restrictions: Original Medicare allows you to go to any doctor or hospital that accepts Medicare, while Medicare Advantage plans typically have a network of providers you must use to receive full coverage. However, some Medicare Advantage plans offer out-of-network coverage for higher out-of-pocket costs.
  3. Cost structure: Original Medicare deductibles and coinsurance have no cap or maximum out-of-pocket. Many purchaseMedicare Advantage in Council Bluffs Iowa additional coverage—a Medigap plan—to cover the significant gaps in coverage.  This additional insurance comes at an additional cost.  Medicare Advantage has minimal copays with a maximum out-of-pocket as well as additional benefits. Most of the Medicare Advantage plans in the Omaha, Lincoln, and Council Bluffs area have zero monthly premium. You simply continue to pay your Medicare Part B premium, which you are paying anyway.
  4. Flexibility: Original Medicare allows you to see any specialist or visit any healthcare provider without a referral. While some Medicare Advantage HMO plans in other parts of the country require referrals to see specialists, the Medicare Advantage plans in the Omaha, Lincoln, and Council Bluffs areas are open access.  Open Access means you can see any specialist in the network without a referral.  

Considering these differences can help you determine which type of coverage aligns best with your healthcare needs and preferences.

Choosing the Right Medicare Advantage Part C Plan

Medicare plans in IowaChoosing the right Medicare Advantage Part C plan requires careful consideration of your healthcare needs and personal preferences. Here are some factors to consider when selecting a plan:

  1. Coverage and benefits: Review the coverage options and benefits offered by different Medicare Advantage plans. Consider your specific healthcare needs, such as prescription drugs, vision, and dental care, or fitness programs, and choose a comprehensive plan for your requirements.
  2. Provider network: Check whether the plan’s network includes your preferred doctors, hospitals, and specialists. Ensure the plan’s network is convenient and accessible for your healthcare needs.  All four networks work with the Medicare Advantage plans in the Omaha, Lincoln, and Council Bluffs areas. If the provider is part of CHI, Nebraska Medicine, Methodist Health Systems, or Bryan Health, they will be in the network.
  3. Costs: Compare the costs associated with different Medicare Advantage plans, including monthly premiums, deductibles, copayments, and coinsurance. Consider your budget and evaluate which plan offers the most cost-effective coverage for your needs.

I recommend starting with the maximum out-of-pocket (MOOP) amount and the star rating. Maximum out-of-pocket is what you have at risk. The star rating can help you narrow down the plans that have been around for a while and have a good service record.   

Researching and comparing different Medicare Advantage plans can help you select the best plan that aligns with your healthcare needs and budget.  At Omaha Insurance Solutions, we help clients evaluate the universe of Medicare plans quickly & easily using our sophisticated but user-friendly software, and with over a decade of experience, we know the local Medicare plans intimately.  

Exploring Additional Benefits  

Medicare Advantage Part C plans often provide additional benefits that go beyond what Original Medicare offers. These benefits can vary depending on the specific plan and insurance provider, but commonly include:

  1. Vision and dental care: Many Medicare Advantage plans cover routine vision and dental services, including exams,Medicare plans in Bellevue cleanings, and eyeglasses.
  2. Hearing aids: Some plans offer coverage for hearing aids and related services, helping you maintain your hearing health.
  3. Fitness programs: Medicare Advantage plans may provide access to fitness programs, gym memberships, or wellness classes to help you stay active and improve your overall health.  I belong to the Genesis Health Clubs in Omaha.  My membership is almost $600 a year.  I would be very happy to have my health insurance plan pay that fee.  I’m looking forward to Medicare.  In the Silver Sneakers and Renew Active Programs, you can actually join multiple gyms.  You are not limited to one chain or a single club.  
  4. Transportation services: Certain plans offer transportation services to and from medical appointments, ensuring you can get the care you need even if you don’t have reliable transportation.

These additional benefits can significantly enhance your healthcare experience and provide you with comprehensive coverage tailored to your specific needs.  Original Medicare does not provide these benefits.  If you want additional benefits, you must purchase them at additional costs.  

Best medicare plans in NebraskaCommon Misconceptions about Medicare Advantage Part C

There are several misconceptions surrounding Medicare Advantage Part C. Let’s address some of the most common ones:

  1. Limited provider choice: While provider networks are not an issue with the Medicare Advantage plans in the Omaha, Lincoln, and Council Bluffs areas, it certainly may be a concern in other places.  There are typically, however, many options to choose from within most networks. Additionally, some plans offer out-of-network coverage for higher out-of-pocket costs.
  2. Lack of coverage for pre-existing conditions: Medicare Advantage plans cannot deny coverage based on pre-existing conditions. They must cover all services covered by Original Medicare, even if you have a pre-existing condition.
  3. Difficulty changing plans: Medicare beneficiaries have the opportunity to change their Medicare Advantage plans during the Annual Enrollment Period, which typically occurs from October 15th to December 7th each year. They also have a second opportunity during the Open Enrollment Period, which occurs from January 1st to March 31st, to make a one-time change to a Medicare Advantage plan.  
  4. Higher costs: While Medicare Advantage plans have copays and coinsurance, these copays are generally small and have a cap.  Medigap plans have a monthly cost that increases with age and usually exceeds annual copays on Medicare Advantage plans most of the time in most years.

Understanding these misconceptions can help you make informed decisions about Medicare Advantage Part C and ensure you have accurate information when considering your healthcare options.

Tips for Maximizing Your Medicare Advantage Part C Benefits

To make the most of your Medicare Advantage Part C benefits, consider the following tips:

  1. Review your plan annually: Medicare Advantage plans can change their coverage and benefits each year. Take the time to review your plan’s Annual Notice of Change (ANOC) to ensure it still meets your healthcare needs.  Check the cost of medications for the coming year.  We offer an annual review to our clients.  However, some clients ignore our letters, emails, and phone calls to meet.  We get distressed calls in the new year when plan changes catch up with some folks.  
  2. Stay within your plan’s network: To receive full coverage and avoid higher out-of-pocket costs, use healthcare providers within your plan’s network. If you need to see a specialist or receive services outside the network, consult your plan’s guidelines for appropriate referrals or prior authorization.  As I said earlier, this is generally not an issue in our area with doctors and hospitals; problems can arise with dentists and optimists who are not within the network.  Double-check with the network because providers do change who they work with.  
  3. Take advantage of additional benefits: Explore the extra benefits offered by your Medicare Advantage plan, such as vision and dental care or fitness programs. Utilizing these services can help you stay healthy and maximize the value of your plan.  These Medicare Advantage Part C benefits save you money.  I’m surprised when clients don’t utilize the over-the-counter benefit.  In some cases, that is hundreds of dollars not coming out of your pocket.  
  4. Understand your costs: Familiarize yourself with your plan’s copayments, deductibles, and coinsurance to avoid unexpected expenses. Knowing your costs upfront can help you budget for healthcare expenses more effectively.  I always recommend clients talk with the doctor’s back office before any procedure is performed.  Make sure the office received any prior approvals and find out the approximate cost to you beforehand so there are no surprises.  

Following these tips can optimize your healthcare coverage and ensure you get the most out of your Medicare Advantage Part C plan.

Bottom Line: Making the Most of your Medicare Advantage Part C Benefits

Medicare Advantage Part C offers a comprehensive and flexible alternative to traditional Medicare coverage. With additional benefits such as prescription drug coverage, vision and dental care, and fitness

omaha Nebraska medicare insurance agent

Christopher J. Grimmond, MA, CFP

programs, Medicare Advantage plans can provide you with comprehensive coverage tailored to your specific needs. Understanding the basics of Medicare Advantage Part C, eligibility criteria, and differences from Original Medicare is crucial in making informed decisions about your healthcare options.

By choosing the right Medicare Advantage Part C plan, exploring additional benefits, and maximizing your coverage, you can take control of your healthcare and enjoy comprehensive and cost-effective coverage.

If you’re ready to maximize your healthcare coverage and get the most out of your benefits, consider exploring the possibilities of Medicare Advantage Part C. Take charge of your healthcare journey today.  Give us a call at Omaha Insurance Solutions at 402-614-3389 to view the Medicare Advantage Part C plans you are eligible for in your area to ensure a healthier and more secure future.

 

 

 

 

 

 

 

 

 

Medicare Plan finder Comparison ChartIs it overwhelming to choose the best Medicare plan for your needs? With so many options available, it’s understandable. But worry not because we have your ultimate solution – the Medicare Plan Comparisons Chart.  

The best way to compare is side-by-side.  We can see each relevant benefit or cost in chart form and compare apples to apples. There is still a lot of information to comb through and remember, but a chart helps to reduce some of the confusion and the mental work of remembering what each Medicare plan offers. 

Whether you’re looking for a plan that covers prescription drugs, outpatient surgeries, or dental more favorably, you can look at your options in the Medicare plan comparison chart.

By utilizing this user-friendly chart, you can easily compare different plans side by side, evaluate their features and benefits, and make an informed decision based on your unique healthcare needs.

Choosing the right Medicare plan is crucial because it directly impacts your overall health and pocketbook. At Omaha Insurance Solutions, we aim to simplify your Medicare selection process by providing all the necessary information in one place. With a Medicare Plan Comparisons Chart, you can confidently select the plan that meets your specific requirements and enjoy peace of mind knowing that you have made the best choice for your healthcare coverage.

Understanding Medicare Plans

Medicare is a federal health insurance program that provides coverage for individuals aged 65 and older and younger individuals with certain disabilities. It consists of different parts, each covering specific services and treatments.

To understand which Medicare plan is best for you, it’s essential to familiarize yourself with the different types of plans available and their respective coverage options. This knowledge will enable you to make an informed decision based on your healthcare needs.

Types of Medicare PlansCompariing Medicare Plans

There are four main types of Medicare plans: Original Medicare (Part A and Part B), Medicare Advantage (Part C), Medicare Supplement Insurance (Medigap), and Prescription Drug Coverage (Part D).

  1. Original Medicare (Part A and Part B): This is the traditional Medicare plan offered by the government. Part A covers hospital stays, skilled nursing facility care, and some home health services, while Part B covers doctor visits, outpatient care, and preventive services.
  2. Medicare Advantage (Part C): This is Medicare offered through a private insurance company approved by Medicare. It provides all the benefits of Original Medicare, along with additional coverage for prescription drugs, dental, vision, and hearing services.
  3. Medicare Supplement (Medigap) plans are designed to fill the gaps in Original Medicare coverage. They help pay for out-of-pocket costs such as deductibles, coinsurance, and copayments. Private insurance companies offer Medigap plans, which are standardized across the states.
  4. Prescription Drug Plans (Part D): Part D plans are standalone plans offered by private insurance companies. They provide coverage for prescription drugs and can be added to Original Medicare, Medicare Advantage, and some Medicare Cost Plans.

Medicare Plan Comparison Chart

The Medicare Plan Comparisons Chart is a powerful tool that allows you to compare different Medicare plans side by side. It provides a clear and concise overview of each plan’s coverage details, costs, and additional benefits.

Medicare Plan Comparison Chart

Where Can You Find A Chart?

A public tool is on the Medicare website.   Type Medicare.gov in your browser address bar and hit enter. You will be taken to the official Medicare website. Click on the button for “Find health & drug plans.” You can create your own account or just type in your zip code without creating an account.  

Choose the type of plans you wish to compare: Medicare Advantage Plan (Part C), Medicare drug plan (Part D), or Medigap policy.  

Click the button that applies to your situation. Do you get financial help with your plan or not? If you qualify, financial help would be from Nebraska or Iowa Medicaid. Have you qualified for EXTRA HELP? Click Next.  

Prescription Drug Comparison

The tool will ask if you wish to include drug costs—type in the specific medications with the dosages.  

You may use various filters, but before that, scroll down and look at the plans first. You can look at each plan individually and study the benefits and pricing. There is also a box to check “Add to compare” to examine the plans side-by-side.  You are limited to 3 plans at a time. 

At the bottom of the screen, you can see the plans’ names and a comparison button. Click the comparison button to bring them up on the screen. The plans will be placed side by side, and all the categories will be matched up between them.  

You can see the similarities and differences between the plans in one place and make your determinations. The limitation is that the Medicare.gov software does not provide great detail about the plans individually or together.  

At Omaha Insurance Solutions we use a propriety software that goes into much greater detail about each plan. You can see the most common medical plan details: doctor & specialist visits, inpatient & outpatient surgeries, skilled nursing stays, MRIs, and X-rays, etc., compared side-by-side and line by line. Medications are calculated in various totals and subtotals. The provider network search tool is right there to access and find out if your doctors are in the plan or not.  We run hundreds of these Medicare plan comparison charts each year for the Medicare plans in the Omaha, Lincoln, & Council Bluffs areas.  Contact us for a FREE comparison at 402-614-3389.  

Medicare Plan Comparison Chart Interpretation

How do you interpret and analyze the information in front of you? Information can be overwhelming when there is a lot of it, and it is new and unfamiliar. Medicare plan comparisons

We help clients understand the information and how to weigh the various benefits, particularly in relation to their specific needs and ways of handling their health concerns.  

Working with thousands of clients over many years with different health concerns that repeatedly ask many of the same questions, we have learned how to quickly assist you in evaluating and interpreting the information as it is relevant to your needs, situation, and budget.  

The chart includes information such as monthly premiums, annual deductibles, coinsurance, copayments, and maximum out-of-pocket costs. It also highlights any limitations or restrictions that may apply to a plan.

By using the chart, you can quickly identify which plans offer the specific coverage you need. For example, if you require prescription drug coverage, you can quickly identify the plans that include Part D that cover your prescriptions at the most affordable prices. If you frequently travel and need coverage outside your local area, you can find plans that offer nationwide coverage.

Key Factors to Consider When Choosing a Medicare Plan

When comparing Medicare plans, there are several key factors to consider. These factors help you determine which plan best suits your needs and preferences. Here are some important considerations:

  1. Coverage: Evaluate each plan’s coverage options. Consider your existing health conditions and any specific treatments or services you anticipate needing in the future.
  2. Cost: Compare the costs associated with each plan, including premiums, deductibles, coinsurance, and copayments. Consider your budget and how much you can afford to pay for healthcare services.
  3. Provider Network: Check whether your preferred healthcare providers, such as doctors and hospitals, are included in the plan’s network. This ensures that you can continue receiving care from your trusted providers.
  4. Prescription Drug Coverage: If you take prescription medications, ensure the plan offers comprehensive coverage for the needed drugs. Review the formulary to see if your medications are included and at what cost.
  5. Additional benefits: Some Medicare plans offer additional benefits such as dental, vision, hearing coverage, OTC (Over-the-Counter) items, free gym memberships, and transportation. Consider whether these benefits are important to you and, whether they justify the additional cost, and which provide the maximum coverage.

How to Use the Medicare Plan Comparisons Chart EffectivelyMedicare Plan Finder tool

The Medicare Plan Comparisons Chart is designed to simplify choosing a Medicare plan. Here are some tips on how to use the chart effectively:

  1. Identify your healthcare needs: Before using the chart, take some time to assess your healthcare needs. Consider factors such as existing health conditions, prescription medications, and any specific treatments or services you anticipate needing in the future. This will help you narrow your options and focus on the plans that meet your requirements.
  2. Focus on relevant information: The chart provides detailed information about each Medicare plan, including coverage details, costs, and additional benefits. Focus on the information that is most relevant to your needs. For example, if you require prescription drug coverage, pay close attention to the details of Part D plans.
  3. Compare side by side: One of the greatest advantages of the chart is that it allows you to compare different plans side by side. This enables you to evaluate their features and benefits in a clear and concise manner. Take advantage of this feature to identify the plans that offer the specific coverage you need.
  4. Consider the cost: While coverage is necessary, it’s also essential to consider the cost associated with each plan. Evaluate factors such as monthly premiums, deductibles, copayments, and coinsurance. Consider your budget and how much you can afford to pay for healthcare services.
  5. Seek assistance if needed: If you find the process overwhelming or have specific questions about the chart or Medicare plans, don’t hesitate to seek assistance. Reach out to a licensed insurance agent or contact Medicare directly for guidance. Making an informed decision based on accurate and up-to-date information is important.

Medicare Comparisons chartBottom Line: Finding the Best Medicare Plan for Your Needs

Choosing the best Medicare plan for your needs is a crucial decision that directly impacts your healthcare coverage and bank account. With the help of the Medicare Plan Comparisons Chart, you can simplify this process and make an informed decision based on your unique healthcare needs.

By understanding the different types of Medicare plans, comparing their coverage options, and considering key factors such as cost, provider networks, and additional benefits, you can confidently select the plan that meets your specific requirements.

Remember to utilize the Medicare Plan Comparisons Chart effectively, focusing on relevant information, comparing plans side by side, and considering both coverage and cost. If needed, seek assistance from

omaha Nebraska medicare insurance agent

Christopher Grimmond

licensed insurance agents, or contact Medicare directly for guidance.

With the right Medicare plan in place, you can enjoy peace of mind, knowing that you have made the best choice for your healthcare coverage. We take people through this process daily. At no cost to you, we will show you the plans in your area that you are eligible for, break down the information on the chart, and match up with your unique needs and concerns. Call us at 402-614-3389 for a free consultation with a licensed insurance professional.  

 

What Our Clients Are Saying About Omaha Insurance Solutions

Steve S.

When it came time for me to enroll in Medicare, I had no idea what the process was or what types of coverage to expect. Christopher at Omaha Insurance Solutions took care of all of those questions and alleviated any anxiety with the process. His patience is outstanding and is outdone only by his knowledge of the products he represents. His services cost nothing, and he advocated for the best plan to fit my specific needs. I highly recommend Omaha Insurance Solutions when looking for answers to Medicare questions.

Paul K

The Medicare decision process was overwhelming for me. Chris and Angi did an exceptional job of laying out pros and cons for each option and patiently listened to my concerns and answered my questions. I never felt pressured to make a decision or steered in a direction that I was not 100% comfortable with. I trust Chris and would not hesitate to recommend Omaha Insurance Solutions to my family and friends.

Paul & Terri P.

Medicare can be confusing, but Chris did a great job of explaining all our options to us. He patiently answered all our questions and gave us knowledgeable advice. We are so appreciative of Chris and Angie’s guidance, and we highly recommend them to anyone needing help with Medicare insurance.