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Getting the Most from your Medicare Insurance Coverage


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Ever wonder if there’s more value or benefit you could be getting from your Medicare Advantage or Medicare Supplement insurance plan?

Medicare advisers Whitney Stidom, Director of Sales Operations at eHealth, and Richard Cantu, Founder and President of GoMedigap, offer great tips to help you get the most value from your coverage, regardless of the type of plan you have.

Whitney Stidom eHealth MedicareRichard Cantu eHealth Medicare

What is a common mistake that Medicare Advantage members make with coverage?

Whitney Stidom: A lot of people assume all their doctors are in network. Medicare Advantage plans usually have smaller networks than traditional Medicare Parts A and B, so you should confirm whether your doctor is in network before signing up. If certain doctors aren’t in network, you have the right to ask them to join, but they often decline. You can also get a list of participating doctors from your insurance provider or call them to find a participating doctor.

What can members do if a prescription isn’t covered by their new plan?

Stidom: When you join a new plan, all your medications are covered during the first 90 days, whether they’re on the formulary or not, so fill all prescriptions right when you start your new plan.

After those 90 days, you’ll have to switch to a covered alternative. Medicare Part D plans, including Medicare Advantage plans with a drug benefit, must cover at least two alternative medications within the same therapeutic class. You have the right to request an exception if the alternatives don’t work for you.

What are some common benefits of Medicare Advantage plans that people might not know about?

Stidom: They often include dental, vision and hearing (also known as DVH) coverage, either built into your plan or as an optional benefit. If your plan doesn’t currently include DVH, call your insurance agent to ask about whether adding it is possible.

You may also pay less for your medications by ordering them through the mail. Many plans have no copays when you mail-order a 90-day supply of maintenance medications.

Another good way to save money on medical expenses is to prevent them before they happen. You should take advantage of the many preventative services Medicare covers, including yearly wellness visits, exams, screenings, shots and lab tests.

Ask your doctor which of these services are right for you. If you have transportation issues, 39% of Medicare Advantage plans include nonemergency rides to the doctor, according to the AARP.

What happens if a Medicare Supplement insurance company unexpectedly increases premiums?

Richard Cantu: Medicare Supplement plan premiums often go up every year. These increases are applied to all members across your region or state; an insurance company can’t single out individuals for a rate increase. They’ll tell you in advance (usually 30 days), which gives you time to consider other plans, and other companies may offer better rates.

With eHealth and GoMedigap, our Rate Watch service team may contact you proactively if we see an opportunity to get you better value on a Medicare Supplement plan.

How can a Medicare Supplement insurance plan help if a member gets sick or injured while traveling?

Cantu: One great advantage of using traditional Medicare Parts A and B with a Medicare Supplement plan is that your coverage extends to any doctor or medical facility in the U.S. that accepts Medicare. If you’re traveling overseas, many of these plans will also provide foreign travel emergency coverage.

If you would like assistance, your eHealth licensed insurance agent can explain more about what your plan covers and other options that may be available in your area.

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