Frequently Asked Questions

Open enrollment period applies to Madeicare Advantage (Part C) and Prescription (Part D ) plans.  Medicare Supplement (Medigap) plans can be changed any time of the year but you may need to answer health questions.  Rules concerning Medicare Supplement plan changes are somewhat state dependent.  The best time to get a Medicare Supplement is within the first 6 months of Part B eligibility.   

Part B is a vital part of your Medicare coverage.  Medicare descibes Part B as "Medical" or "Outpatient Coverage" but it covers inpateint and outpatient surgical services, diagnostic tests and prceedures, therapies, lab services, home health services, durable medical equipment, part B medication and blood transfusions.  If you do not take Part B when first eligible it most likely would be because you have creditable coverage through an employer or union plan.  Otherwise, you would be subject to the Part B late Enrollment Penalty, LEP.

Many times beneficiaries believe that since Original Medicare doesn't cover vision that it won't cover catract surgery.  However, cataract surgery is considered medically necessary and it is covered under original Medicare.  Do be aware that many times a doctor will recommend a premium intraocular len.  This upgrade is typically not covered and the beneficiary would need to pay the difference between the standard intraocular lens and the premium lens.

Typically Medicare does not provide coverage for dental care.  There are very rare circumstances where dental work may be considered medically necessary and in this case thr procedure would be covered.  Medicare beneficiaries have the option of getting dental coverage through Medicare Advnatage (Part C) plans that offer dental as an extra beneift or by purchasing a "stand alone" dental plan.  These plans also provide dental and softimes hearing coverage as well.

Shingles vacines are covered though the coverage is provided through the Part D (prescription drug) plan.  Both Medicare Advantage and "Stand Alone" part D plans as of January 2023 are required to cover shingles shots at 100%.

Medicare supplemental plans (Medigap) follow Medicare as to what care is approved.  Medically necessary procedures are covered by Medicare.  Gym memberships may be provided as an extra benefit but are not part of the standard Plan G coverage.

Yes and No.  While there is not a stated maximum out of pocket, since Plan G covers all Medicare services at 100% after the beneficiary pays the Part B deductible, that deductible is the only out-of-pocket costs a beneficiary will incur.

Original Medicare does not include prescription coverage ao a plan G would not provide any prescription benefit.  Beneficiaries utilizing Original Medicare would need to purchase a "stand alone" prescription plan.  

Plan G does not cover the PArt B deductible ($240 in 2024).  Only beneficiaries who turned 65 before January 1, 2020 or were eligible for Medicare Part A before January 1, 2020 can purchase a plan that covers the Part B deductible.

Medicare brokers get paid by the companies they represent.  This means there is absolutley no cost to a beneficiry for utilizing the services of a Medicare broker.  This is a great benefit but also worth a word of caution.  Make sure you work with a broker you trust and who takes the time to educate you about all the policies available so you can make an infomred choice.

Plan G is a designation of a Medicare Supplement or medigap plan.  These plans are purchased when a beneficiary is on Original Medicare to fill in the gaps of Medicare.  Advantage plans (Part C), on the other hand, is an alternative to Originial Medicare.  A beneficiary would be able to have a Plan G and Original Medicare or a Medicare Advantage plan, but not both!

Medigap, or more commonly referred to as Medicare Supplements, fill ine coverage gaps of Original Medicare such as Deductibles, Co-pays and Co-insirances.  Medigap plans are provided by private insurers and the plans use letters as designations.  We have helped thousands of indviduals chose which Medigap plan is right for them!  You can click on the following link for more informatin on Medigap plans:  https://www.medicare.gov/health-drug-plans/medigap/basics/compare-plan-benefits

The first test as to whether Medicare will cover a procedure is that of whether the procedure is considered medically necessary.  While that sounds pretty general it does give confidence that if it is something that is a medical issue, Medicare will be there.  Along with the Medically Necessary test, you need to be sure your provider accepts Medicare and Medicare assignments.  Obvioulsy the provider needs to be able to bill Medicare but also they need to be willing to accept assignments so you don't risk incuring up to a 15% excess charge.  The last consideration is that the procedure is coded properly.  Many procedures have multiple codes and it the wrong one is used the claim may be denied.