Page 53 - September 2021 Issue.indd

Research shows that part “D” Medicare (Advantage) being advertised

beneficiaries can lower costs by shopping on TV, radio, and through the mail
other plans. Even if you are satisfi ed with in Caroline County. If your income

your current drug plans formulary for qualifies you, and your lifestyle would
2022, it is still a wise decision to look work with the geographical limitations,
at other plans for the upcoming year to contact Mary Moran to enroll you
compare costs and tiering diff erences. during OE if you are currently in QMB.
Due to the current Covid environment, If not yet a QMB beneficiary but are
SHIP will not be having on-site face to income eligible, contact Mary Moran ASSISTED LIVING FACILITY
face appointments this year. By utilizing for an application for QMB enrollment
tried and true methods, we will continue process. If you are not eligible for QMB ĂŝůLJ ĐƟǀŝƟĞƐ
to serve your Open Enrollment needs but you call the number on the screen, RN on Call
successfully again this year! Call your talk to a phone solicitor, reply to a mail ,ŽŵĞ ŽŽŬĞĚ DĞĂůƐ͕
Caroline County SHIP, Mary Moran, solicitation, or click on the link, you will ^ŶĂĐŬƐ Θ ĞǀĞƌĂŐĞƐ
at the above numbers for assistance be told after their song and dance sales >ĂƵŶĚƌLJ Θ ,ŽƵƐĞŬĞĞƉŝŶŐ

comparing, and enrolling in, part “D” pitch that there is nothing available in
>ŝĐĞŶƐĞĚ ƚŽ WƌŽǀŝĚĞ
plans during Open Enrollment. your area. So, change the channel, hang ĂƌĞ ĨŽƌ >ĞǀĞůƐ ϭ͕Ϯ͕ϯ
up, close the computer window, or shred
This time of year is when we get DĞŵŽƌLJ ĂƌĞ
those solicitations to save yourself time
bombarded with slick advertising from ^ƉĞĐŝĂů ŝĞƚ Θ ŝŶŝŶŐ ƐƐŝƐƚĂŶĐĞ
and aggravation!
all possible sources about Medicare WŽƐƚͲƌĞŚĂďŝůŝƚĂƟŽŶ WĂƌƚŶĞƌƐŚŝƉƐ
opportunities offering vision and All Medicare Advantage programs are ǁŝƚŚ ŽĐƚŽƌƐ ĂŶĚ dŚĞƌĂƉŝƐƚƐ
dental. Behemoth sized health systems for profit entities. It is network-based ĂŶĚ ŵƵĐŚ ŵŽƌĞ͘͘͘

are nationally advertising Medicare Medicare insurance subcontracted out
Advantage, which is technically by the Federal Medicare program to save www.arcadia-living.com
Medicare, but is not Original Medicare. the Federal system money. Medicare Arcadia of Denton
This advertising is frustrating to both Advantage (MA) is called “C” in the 701 S. 5th Ave

beneficiaries and rural Medicare alphabetical language Medicare uses! (Formerly Gables at Caroline)
professionals because, generally, it is “A” for Hospital, “B” for Medical, “C” Come Home to Arcadia
not available here on the Eastern Shore for Advantage, “D” Prescription Drug
and the blanket advertising offering coverage.
These health care systems enter into
vision and dental gets people’s hopes HMO Advantage networks diff er from agreements with Medicare and are under
up for “better” coverage, only to be plan to plan. So, depending on which CMS oversite. Depending on the plan,

disappointed to find it is not available local Advantage plan one is enrolled different rules, costs, and restrictions
here! Grrrrr!!

in, patients must only see in network apply to beneficiaries. Just like Original
The type of Medicare Advantage doctors within a certain geographical Medicare, by and large they take the
generally being advertised is HMO profile. Advantage is typically more monthly part “B” premium of $148.50
(Health Maintenance Organization) restrictive with coverage than Original out of one’s Social Security check every
localized insurance. Advantage PPO Medicare, in that it generally allows month. Advantage plans can also charge
(Preferred Provider Organization) plans only a certain number of tests, visits, or additional premiums for additional
are more regional and comprises an treatments per year. Benefi ciaries must coverages, such as prescription drug
entire state. In Maryland, PPOs tend to choose a primary care physician who coverage, vision, dental, and hearing.
be employer based. SNP (Special Needs determines what treatment is needed. Depending on the plan, the advertised
Plan) is for those with specifi c diseases The primary care provider must issue a add-ons of hearing, vision, and dental

and characteristics. None of these are referral to all specialists, or the cost of the place strict limits on services, how
available on the Eastern Shore for the specialist care will not be covered. A plan much the plan will cover, and how oft en
average Joe and Josephine! may require the provider to ask the plan’s coverage can be used. For many, the drug
permission, or prior authorization, for plan they off er, with its limitations and
University of Maryland is the only certain services. If one chooses to see a restrictions, is your only option. If one is
Advantage plan available in our area, doctor out of network, the plan provides enrolled in Advantage with prescription
and they have chosen to only accept zero coverage, and the entire cost of drug coverage, you cannot enroll in a
individuals or couples who are QMB medical services is on the benefi ciary. stand-alone Medicare part “D” plan,
eligible. (Qualified Medicare Benefi ciary) Any services preformed outside of the since this will disenroll you from the

This means that if an individual’s income plan’s restrictions is paid for out of entire Advantage plan!

is higher than $1,083 per month, or a pocket by the benefi ciary.
couple’s income is higher than $1,457 The biggest perk is that Advantage
per month, they do not qualify for the spreads the part “B” 20%, annual

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