Services
I’m Contracted With
AETNA, AMERITAS DENTAL, Blue Cross, Blue Shield of MN, DELTA DENTAL, GTL, HEALTH PARTNERS, HUMANA, MEDICA, UnitedHealthcare®, UCARE, WELLCARE
What We Offer
Medicare Advantage Plans
Medicare Advantage (Part C) plans are offered by private insurance companies approved by Medicare. These plans provide all Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) benefits. Most Medicare Advantage plans also include prescription drug coverage (Part D).
When enrolled in a Medicare Advantage plan, Medicare-covered services are generally provided through the plan’s network and are administered by the private insurance company rather than Original Medicare. Benefits, provider networks, costs, and service areas vary by plan.
Health Maintenance Organization (HMO) Plans
A Health Maintenance Organization (HMO) plan generally requires members to receive covered services from doctors, hospitals, and other healthcare providers within the plan’s network.
Exceptions typically include:
- Emergency care
- Urgently needed care when traveling outside the service area
- Out-of-area dialysis services
Some HMO plans offer a Point-of-Service (POS) option that allows members to receive certain services outside the network, usually at a higher cost.
Preferred Provider Organization (PPO) Plans
A Preferred Provider Organization (PPO) plan contracts with a network of doctors, hospitals, and healthcare providers.
Members typically:
- Pay less when using in-network providers
- May receive covered services from out-of-network providers
- Generally pay more when using providers outside the network
Coverage rules and costs vary by plan.
Private Fee-for-Service (PFFS) Plans
A Private Fee-for-Service (PFFS) plan is a type of Medicare Advantage plan offered by a private insurance company.
Under a PFFS plan:
- The plan determines payment amounts to healthcare providers.
- The plan determines the member’s cost-sharing responsibilities.
- Providers must agree to the plan’s terms and conditions before providing services, except in emergency situations.
PFFS plans are different from Original Medicare and Medicare Supplement (Medigap) policies.
Special Needs Plans (SNPs)
Special Needs Plans (SNPs) are Medicare Advantage plans designed for individuals who meet specific eligibility requirements.
These plans are available for certain groups, including:
- Individuals with specific chronic health conditions
- Individuals who qualify for both Medicare and Medicaid
- Individuals who reside in certain institutions or require institutional-level care
SNPs are designed to coordinate care and provide benefits tailored to the needs of the populations they serve.
Other Medicare Advantage Plan Types
Additional Medicare Advantage plan options may be available in certain areas, including:
- HMO Point-of-Service (HMOPOS) Plans
- Medicare Medical Savings Account (MSA) Plans
- Other plan designs approved by Medicare
Availability varies by location and insurance carrier.
Disclaimer
This information is provided for educational purposes only. Medicare plan availability, benefits, provider networks, premiums, deductibles, copayments, and coinsurance may vary by plan and service area. Contact Medicare or a licensed insurance agent for information about plans available in your area.
Not affiliated with or endorsed by the U.S. Government or the federal Medicare program.
Medicare Part D – Prescription Drug Plans
Covered Prescription Drugs (Formulary)
Each Medicare Part D plan maintains a list of covered prescription drugs, known as a formulary. Formularies are developed in accordance with Medicare requirements and may differ from one plan to another.
A plan’s formulary may not include every prescription drug. If a specific medication is not covered, a similar medication may be available. Individuals should review a plan’s formulary and discuss treatment options with their healthcare provider when evaluating coverage.
In certain situations, individuals may have the right to request a coverage determination or exception, subject to Medicare and plan guidelines.
Medicare-approved prescription drug plans may update their formularies during the year in accordance with Medicare requirements. Changes may occur due to new medications, updated clinical information, or other factors approved under applicable regulations.
Generic Prescription Drugs
Generic drugs are approved by the U.S. Food and Drug Administration (FDA) and contain the same active ingredients as their brand-name counterparts. Generic medications must meet FDA standards for quality, safety, strength, dosage form, performance, and intended use.
Generic medications may be available as lower-cost alternatives to some brand-name drugs. Availability varies by medication. Individuals should consult their healthcare provider or pharmacist regarding treatment options and coverage availability.
Drug Tiers
Many Medicare Part D plans organize covered medications into different tiers. The tier assigned to a medication may affect the amount a member pays for that prescription.
While tier structures vary by plan, a typical example may include:
- Tier 1: Preferred generic drugs
- Tier 2: Generic drugs and certain preferred brand-name drugs
- Tier 3: Non-preferred brand-name drugs
- Specialty Tier: High-cost specialty medications
Cost-sharing amounts, including copayments and coinsurance, vary by plan and tier level.
In some circumstances, individuals may be eligible to request a tiering exception or other coverage review, subject to Medicare and plan requirements.
Important Considerations
When comparing Medicare Part D plans, it may be helpful to review:
- Covered prescription drugs (formulary)
- Pharmacy network participation
- Monthly premiums
- Deductibles
- Copayments and coinsurance
- Coverage rules and restrictions
Because formularies, costs, and coverage requirements can change, individuals should review plan materials carefully each year.
Disclaimer
This information is provided for educational purposes only and is not a complete description of benefits. Medicare Part D plan availability, costs, covered drugs, pharmacy networks, and coverage rules vary by carrier and service area. Refer to official plan documents for complete details regarding benefits, limitations, exclusions, and coverage requirements.
Home Health Care Plans
Home Health Care Insurance Plans may be available to help provide financial assistance for certain home health care services. Coverage, benefit amounts, eligibility requirements, and limitations vary by policy.
Depending on the plan, benefits may help cover eligible expenses associated with home health care services provided by qualified healthcare professionals. Benefits may be paid directly to the policyholder, subject to the terms, conditions, limitations, and exclusions of the policy.
Individuals should carefully review plan documents to understand covered services, benefit amounts, waiting periods, exclusions, and any other policy requirements before enrolling.
Disclaimer
Benefits, availability, eligibility requirements, and coverage provisions vary by policy and carrier. This information is provided for educational purposes only and is not a complete description of benefits. Refer to the policy for complete details of coverage, limitations, and exclusions.
Cancer, Heart Attack, Stroke Plans
Cancer, Heart Attack, and Stroke Insurance policies are supplemental insurance products offered by private insurance companies. These policies may provide benefits for eligible covered conditions, subject to the terms, conditions, limitations, and exclusions of the policy.
Original Medicare and Medicare Advantage plans may cover certain medically necessary services related to the diagnosis and treatment of cancer, heart attack, or stroke. However, individuals may still be responsible for out-of-pocket costs such as deductibles, copayments, coinsurance, and non-covered expenses.
Depending on the policy selected, supplemental insurance plans may provide:
- Lump-sum cash benefits upon diagnosis of a covered condition
- Benefits for certain covered treatments or services
- Benefits for eligible screening or wellness services, where available
- Financial assistance for covered expenses as outlined in the policy
Benefit amounts, covered conditions, eligibility requirements, and policy provisions vary by carrier and plan.
Some policies may include underwriting requirements, waiting periods, pre-existing condition limitations, or other restrictions that may affect eligibility and benefits.
Important Considerations
When evaluating Cancer, Heart Attack, or Stroke Insurance policies, it may be helpful to review:
- Covered conditions and benefits
- Benefit payment provisions
- Eligibility and underwriting requirements
- Waiting periods
- Pre-existing condition limitations
- Exclusions and policy limitations
- Premium amounts
Availability and benefits vary by carrier and state.
Disclaimer
This information is provided for educational purposes only and is not a complete description of benefits. Cancer, Heart Attack, and Stroke Insurance policies are underwritten by private insurance companies and are not a substitute for major medical insurance. Benefits, premiums, eligibility requirements, limitations, exclusions, waiting periods, and availability vary by policy, carrier, and state. Coverage is subject to the terms and conditions of the policy. Review official policy documents carefully for complete details regarding benefits, limitations, exclusions, and eligibility requirements.
Not affiliated with or endorsed by the U.S. Government, the federal Medicare program, or any government agency.
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Medicare Supplement Insurance Plans
Medicare Supplement Insurance (Medigap) policies are offered by private insurance companies and are designed to help pay certain out-of-pocket costs associated with Original Medicare (Part A and Part B). Medigap policies are available only to individuals enrolled in Original Medicare.
Depending on the plan selected, a Medigap policy may help pay some Medicare cost-sharing expenses, including:
- Copayments
- Coinsurance
- Deductibles (where permitted by law)
Some Medigap plans may also provide benefits for certain healthcare services that are not fully covered by Original Medicare, such as eligible emergency healthcare services received while traveling outside the United States. Benefits vary by plan.
How Medigap Works
When a Medicare-covered service is received:
- Original Medicare pays its portion of the Medicare-approved amount for covered services.
- The Medigap policy may pay all or part of eligible remaining costs, depending on the plan’s benefits and policy provisions.
Medigap policies do not work with Medicare Advantage (Part C) plans. Individuals enrolled in a Medicare Advantage plan generally cannot use a Medigap policy to pay Medicare Advantage plan costs.
Important Considerations
When evaluating a Medicare Supplement Insurance policy, it may be helpful to review:
- Monthly premiums
- Covered benefits
- Out-of-pocket costs
- Provider access
- Carrier availability in your area
Benefits, premiums, and plan availability may vary by insurance company and state.
Disclaimer
This information is provided for educational purposes only and is not a complete description of benefits. Medicare Supplement Insurance (Medigap) policies are sold by private insurance companies. Benefits, premiums, limitations, exclusions, and availability vary by policy, carrier, and state. Policies are designed to supplement Original Medicare and do not include prescription drug coverage. Review official policy materials carefully for complete details regarding benefits, limitations, exclusions, eligibility, and enrollment requirements.
Not affiliated with or endorsed by the U.S. Government or the federal Medicare program.
Hospital Plans
Hospital Indemnity Insurance is supplemental insurance that may help provide cash benefits for eligible hospital-related expenses. These policies are offered by private insurance companies and are designed to complement, not replace, major medical coverage.
Depending on the policy selected, benefits may be payable for covered hospital services such as inpatient hospital stays or other eligible hospital-related events. Benefit amounts, eligibility requirements, limitations, and exclusions vary by policy and insurance carrier.
Many Hospital Indemnity policies pay a fixed cash benefit directly to the policyholder for covered services, regardless of other insurance coverage, subject to the terms and conditions of the policy.
Some policies may require applicants to answer health-related questions or meet other underwriting requirements to determine eligibility.
Important Considerations
When evaluating a Hospital Indemnity Insurance policy, it may be helpful to review:
- Covered benefits and benefit amounts
- Eligibility requirements
- Waiting periods, limitations, and exclusions
- Premium costs
- Policy terms and conditions
Benefits and availability vary by carrier and state.
Disclaimer
This information is provided for educational purposes only and is not a complete description of benefits. Hospital Indemnity Insurance policies are underwritten by private insurance companies and are not a substitute for major medical insurance. Benefits, premiums, eligibility requirements, limitations, exclusions, and availability vary by policy, carrier, and state. Coverage is subject to policy terms and conditions. Refer to official policy documents for complete details.
Not affiliated with or endorsed by the U.S. Government, the federal Medicare program, or any government agency.
Burial & Final Expense Plans
Burial and Final Expense Insurance are types of life insurance that may help provide funds to assist with expenses incurred at the end of life, such as funeral, burial, cremation, memorial, or other related costs. Benefits, coverage amounts, eligibility requirements, and premiums vary by policy and insurance company.
Original Medicare and Medicare Advantage plans generally do not provide coverage for funeral, burial, cremation, or other final expense costs.
Some Final Expense insurance policies may require applicants to answer health-related questions as part of the underwriting process, while other policies may have different eligibility requirements. Policy approval, coverage amounts, premiums, and benefits are subject to the terms and conditions of the policy.
Disclaimer
This information is provided for educational purposes only and is not a complete description of benefits. Final Expense and Burial Insurance policies are underwritten by private insurance companies. Availability, eligibility, premiums, benefit amounts, limitations, exclusions, and policy provisions vary by carrier and policy. Coverage is subject to policy terms and conditions. Review the policy documents carefully for complete details.
Not affiliated with or endorsed by the U.S. Government, the federal Medicare program, or any government agency.
Dental, Vision, Hearing Plans
Original Medicare generally does not cover most routine dental care, routine vision care, or routine hearing services. Coverage for these services may be available through certain Medicare Advantage plans or through separate insurance or discount programs offered by private companies.
Private insurance companies may offer dental, vision, and hearing plans designed to help provide benefits for covered services. Coverage, provider networks, premiums, deductibles, copayments, coinsurance, benefit amounts, and exclusions vary by plan and insurance carrier.
Some plans may have eligibility requirements, waiting periods, coverage limitations, or exclusions for certain conditions or services. Individuals should carefully review plan materials to understand covered benefits and any applicable restrictions before enrolling.
Important Considerations
When comparing dental, vision, or hearing plans, it may be helpful to review:
- Covered services and benefits
- Provider network requirements
- Monthly premiums
- Deductibles, copayments, and coinsurance
- Benefit maximums and limitations
- Waiting periods and exclusions
Plan availability and benefits vary by carrier and service area.
Disclaimer
This information is provided for educational purposes only and is not a complete description of benefits. Dental, vision, and hearing plans are offered by private insurance companies. Benefits, premiums, provider networks, limitations, exclusions, waiting periods, and availability vary by policy and carrier. Review official plan documents carefully for complete details regarding coverage, eligibility requirements, limitations, and exclusions.
Not affiliated with or endorsed by the U.S. Government, the federal Medicare program, or any government agency.
Frequently Asked Questions
what is a medicare advantage plan?
A Medicare Advantage Plan, also known as Medicare Part C, is a Medicare-approved health plan offered by a private insurance company.
Medicare Advantage plans provide your Medicare Part A and Part B benefits. Many plans may also offer additional benefits, such as dental, vision, hearing, and prescription drug coverage. Benefits, costs, and availability vary by plan and service area. You must continue to pay your Medicare Part B premium, if applicable.
Where can I get help paying for Medicare?
Financial assistance programs for people with limited income and assets include:
Extra Help is a program to help people with limited income and resources pay Medicare prescription drug program costs, like premiums, deductibles, and coinsurance. If you get Extra Help but you’re not sure if you’re paying the right amount, call your drug plan. Your plan may ask you to give information to help them check the level of Extra Help you should get.
Medicaid is a joint federal and state program that:
- Helps with medical costs for some people with limited income and resources
- Offers benefits not normally covered by Medicare, like nursing home care and personal care services
In some cases, Medicare Savings Programs may also pay Medicare Part A and Medicare Part B deductibles, coinsurance, and copayments if you meet certain conditions.
Programs of All-Inclusive Care for the Elderly (PACE) is a Medicare and Medicaid program that helps people meet their health care needs in the community instead of going to a nursing home or other care facility. With PACE, you have a team of health care professionals working with you and your family to make sure you get the coordinated care you need. Usually they care for a small number of people, so they really get to know you. When you enroll in PACE, you may be required to use a PACE-preferred doctor.
What is the difference between Medicare & Medicaid?
Medicare and Medicaid are both government health care programs but they are very different. Medicare is generally for people who are older or disabled. Medicaid is for people with limited income and resources. Some people qualify for both Medicare and Medicaid. Depending on eligibility, Medicaid may help pay certain Medicare premiums and cost sharing. Eligibility, benefits, and cost-sharing vary by state and individual circumstances.
I am Disabled - when can I get Medicare?
You automatically get Part A and Part B after you get one of these:
- Disability benefits from Social Security for 24 months
- Certain disability benefits from the RRB for 24 months
You don’t need to sign up if you automatically get Part A and Part B. You’ll get your red, white, and blue Medicare card in the mail 3 months before your 25th month of disability.
When you decide how to get your Medicare coverage, you might choose:
- A
There are specific times when you can sign up for these plans, or make changes to coverage you already have.
8 Things to Know About Medicare
- You must have Medicare Part A and Part B.
- A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.
- You pay the private insurance company a monthly premium for your Medigap policy. You pay this monthly premium in addition to the monthly Part B premium that you pay to Medicare.
- A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you’ll each have to buy separate policies.
- You can buy a Medigap policy from any insurance company that’s licensed in your state to sell one.
- Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medigap policy as long as you pay the premium.
- Some Medigap policies sold in the past cover prescription drugs. But, Medigap policies sold after January 1, 2006 aren’t allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).
- It’s illegal for anyone to sell you a Medigap policy if you have a Medicare Advantage Plan, unless you’re switching back to Original Medicare. In other words, you cannot have both a Medigap policy and a Medicare Advantage Plan.
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dm@derekmccoy.com
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