Page 57 - November 2022 Issue.indd

people think of as Medicare. Generally,
the plans are owned and operated by WHEN IT COMES TO MEDICARE

large, for profit, Medical Systems who
are required to meet federal standards. YOU HAVE CHOICES.

These serve specific geographical areas
as part of their contract with Medicare. ind the best plan to it your health care needs.
Therefore, when an individual moves

out of that specifically designated area,
they no longer have medical coverage. OPEN ENROLLMENT part HOSPITAL
For instance, if someone had an October 15 - December 7, 2022 A STAYS
advantage plan on the western shore part DOCTOR
and then moves here, generally that Do you need help with your prescription drug costs or B VISITS
Part B premiums? No matter your situation, we can help
insurance plan will not transfer to this
you get answers to your Medicare questions, like: part MEDICARE

area. The member may then shop for
C ADVANTAGE
another Advantage plan in the new • What is Original Medicare and are there other health care options
geographical area using the method of • What do Medicare Parts A, B, C and D mean? part PRESCRIPTION
D
calling Doctors to insure they accept • What are the differences between Medicare and other DRUGS
health coverage?
the new Advantage insurance, calling
• Is Original Medicare enough health coverage for me?
pharmacies to verify new plan drug
• Are my prescriptions covered?
coverage acceptance, and educating
• How much will it cost?
themselves about out-of-pocket costs. • Do I have deadlines to enroll? BBB Rating A+
Or, they can go back into Original as of 3/10/22
Medicare “A”, “B” and prescription LOYALTY As your independent health
“D” and buy a supplemental plan BENEFIT care resource, we can offer
within 63 days of the Advantage plan’s GROUP you Medicare plans from
several private insurance
termination. Loyal Benefit Group, Inc. companies.
Remember: Health care providers and Licensed Sales Agent Kristen Tune 302-745-7355 So you’re guaranteed to
facilities must sign agreements to serve LOYALTYBENEFITGROUP.COM get the plan that may
as in-network providers accepting Agent available every Wednesday from 9-11 AM; be best for you.
every Friday in Downtown Seaford October and November.
Advantage, or the member will pay out
of pocket for their care without benefi t

of the insurance. Since the Advantage to offer “perks”, such as Dental, Vision, “B” services. Remember, these only
plans can limit provider networks, be Transportation, and sometimes food apply to “A” & “B” and do not apply
sure you call your doctors and regular options to potential members. Each to your part “D” out of pocket costs.
facilities to guarantee that they will company handles those requirements Like Original Medicare, prescription
participate in a particular Medicare diff erently, so do not assume that you drug coverage is a separate aspect from
Advantage plan before signing up as a will be getting what you see on TV or Medical and Hospital coverage, and not
member. hear on the radio when talking to an all Advantage plans off er prescription
Advantage salesperson. Know what drug coverage.
Advantage plans are required to your cost share will be when you use
collect the part “B” premium from Unlike Original Medicare, remember
the “perks” of the specific plan you are

beneficiaries, so in 2023 those who
discussing with the salesperson. Find that to manage costs, Medicare
enroll in Advantage during Open
out which dentists and optometrists Advantage (MA) plans can require Prior
Enrollment will still see $164.90 taken
participate in the plan and call them Authorization (PA) before items and
out of their Social Security Check. Th e services are covered. This can prevent

only exception to that would be if one is to verify in network status and individuals from getting unnecessary
in a Medicare Savings Program that pays participation. treatments, but it is also a barrier to care
the premium. Those who advertise “free Be sure to fully understand exactly that prospective Advantage enrollees

Medicare” on the TV and radio may not
how much coverage you get, what your should be aware of.
charge the individuals a premium for
out-of-pocket copays will be for “A” &
their particular Advantage plan itself, so As noted by the Kaiser Family
“B” services, and how high the annual
may advertise it as a “free” plan, but you out of pocket limits will be. For 2023, Foundation in a June 2021 report,
are still responsible to pay the premium the out-of-pocket limit was set at $8,300 virtually all MA enrollees (99 percent)
as a Medicare beneficiary. for in network services and $12,450 are in plans that require prior

for in network and out of network authorization. The report notes that
As part of the contract with CMS, Prior Authorization “is most often
services combined for Part “A” and part
Medicare Advantage plans are required
57