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News From The Health Insurance Store

Question: My doctor just prescribed me a new medication. The plan I have doesn’t cover it. Is there anything I can do since I can’t change plans until next year?

Answer: There are plenty of ways to solve your dilemma. First of all, you may indeed be able to change to a plan that covers your drug prior to 2020. If you are currently enrolled in PACE or PACENET, or if you qualify and apply, you can change plans right away. For those readers who don’t know, these programs are designed to reduce the cost of medications for seniors. Income limits are as follows: $29,108/year for a single individual and $38,716/year for a married couple. Agents at either of our office locations can help you determine if you qualify and apply, and we never charge a fee for that service or any others we provide.

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Question: Are you required by law to sign up for Medicare and if you don't is there any type of penalty? Also, can you sign up for Medicare when you take social security?

Answer: This is a great question. Far too often people don’t get the correct advice or information regarding opting out of Medicare Part B. Let me answer these questions and give some examples of who should and shouldn’t opt out of Medicare.

First, you’re only eligible for Medicare at age 65 or 24 months after being awarded Social Security/Disability. Those who elect to collect Social Security prior to age 65 are not eligible.

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Question: I’m getting so many ads in the mail from Medicare companies. It’s all so confusing. What should I be looking at so I make the right decision when choosing a Medicare plan?

Answer: The easiest move you can make to take the confusion out of the process is let my agency help guide you to the best plan for your individual health care needs and budget.

That being said, let’s answer your question. Medicare Open Enrollment starts October 15th and ends December 7th. All these companies you’re getting mail from want to convince you their plan is the best by offering what they are calling dental and vision coverage and bragging about a $0 primary doctor co-pay or a free gym membership. Let me give you what I believe to be the most important items to consider when choosing a plan and why.

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Question: From Judy in Monroeville: I’m paying over $200/month for my Medicare Advantage Plan. I’ve read where you advised everyone not to pay more than $100/month for an HMO or PPO. I don’t see how paying less for a plan would be better for me. Would I lose coverage for some medical services? I’m really afraid of that.

Answer: No. You won’t. In fact, if you choose the right plan, you may be able to lower co-pays for services like hospitalizations, MRI’s, Ambulance services, etc., and likely reduce your annual Maximum Out of Pocket, aka MOOP. The MOOP represents the amount of bills you could possibly receive in a calendar year. More than likely you have a MOOP of $6,700. If you needed Chemotherapy, other drugs administered in an outpatient setting like Remicade, have a lengthy stay in a Skilled Nursing Facility, or multiple hospital stays, among other more costly services, it wouldn’t be hard to meet that $6,700.

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Question: I’m a retired Federal Employee and have a Blue Cross Blue Shield plan and Medicare. Am I losing access to UPMC doctors and hospitals next year?

Answer: You will continue to have network access to UPMC doctors and hospitals as long as you have both Medicare Parts A and B. Those who have A only, will not have network access to UPMC.

I’ve been having ongoing discussions with a very informed representative of UPMC who assured me of this. As or more importantly, he also gave me an update on what the process will be for those who may still have Highmark Medicare Advantage HMO’s and PPO’s after June 30th of next year and wish to use UPMC health systems. I’m her to tell you, it’s going to be extremely inconvenient if you remain on your Highmark Medicare Advantage HMO or PPO.

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Erie County Area

1105 West 12th Street, Suite – A
Erie, PA 16501
Phone: 814-920-5275
Fax: 814-920-5276

Fayette/Westmoreland County Area

121 North Pittsburgh Street
Connellsville, PA. 15425
Phone: 724-603-3403
Fax: 724-603-3402

Pittsburgh Area

21 Yost Blvd., Forest Hills, PA 15221
Mailing Address: 128 Forest Hills Plaza, Pittsburgh, PA 15221
Phone: 412-349-8818
Fax: 878-302-3149

Albuquerque/Santa Fe, New Mexico Area

821 Coors Blvd. NW
Albuquerque, NM 87121
Phone: 505-200-0069
Fax: 505-200-0073

Serving These Areas

We proudly serve the health insurance and Medicare needs of the following Pennsylvania areas:  Connellsville, Uniontown, Greensburg, Mt. Pleasant, Scottdale, Irwin, N. Huntingdon, Murrysville, Monroeville, Plum, Lower Burrell, New Kensington, Pittsburgh, Plum, Oakmont, Penn Hills, Forest Hills, Wilkinsburg, East Liberty, Lawrenceville, Bloomfield, Natrona Heights, Leechburg, Washington, Morgantown WV, Latrobe, Monnessen, Jeanette, Erie, Edinboro, Northeast, Girard, Fairview, Union City, Harborcreek, Corey, Meadville, Waterford,  Ligonier, Kittaning, Somerset, Waynesburg, Fayette County, Westmoreland County, Armstrong County, Butler County, Somerset County, Erie County, Crawford County, Venango County, Allegheny Valley, Pennsylvania

We proudly serve the following New Mexico areas: Albuquerque, Rio Rancho, Sante Fe, Bernalillo, Belen, Los Lunas, Espanola, Moriarty, Corales, Tijeras, Cedar Crest, Edgewood, Soccoro, Sandoval County, Sante Fe County, Bernalillo County, Rio Arriba County, Valencia County, Soccoro County, New Mexico