A  Medigap policy is actually a supplement sold by private insurance companies to fill the “gaps” in what original Medicare parts A & B does not pay. If you are in the Original Medicare Plan and also have a Medigap policy, then your Medicare and your Medigap policies will both pay their shares of covered health care costs. Usually that is about 80% Medicare and 20% Medigap. Remember that Medigap policies usually only cover the same things that original Medicare covers. They help pay the percentage of your medical costs that Medicare doesn't pay. So that being the case, they can't pay for things not covered by Medicare. Things like hearing aids, eyeglasses, and most dental procedures or devices. 


Medigap policies, by law, must all have the same specific benefits, dependent on which plan, A thru N, you choose and regardless of which company you buy your plan from. Insurance companies can only sell you a government standardized Medigap policy. So you can compare them easily company from company... the plan benefits are the same, regardless of where you buy it or what you pay. So what difference does it make then where you buy your Medigap plan?  There is a really big difference between agents and agencies after the sale, when you need help with a problem. Especially if you answer a robot-call that your caller ID says is located near your home location, but in reality the caller is somewhere hundreds of miles away. What is different is the premium cost and how rate increases are calculated. So most people shop by choosing a stable carrier through a trusted agent that they can count on to provide good service along the way. So you can compare them easily company to company... the plan benefits are pretty much the same, regardless of where you buy it or what you pay. There is a really big difference between agents and agencies after the sale, when you need help with a problem. Especially if you answer a robot-call that your caller ID says is located near your home location, but in reality the caller is sitting in a small cubicle somewhere hundreds of miles away. When doing business over the phone about something as sensitive s healthcare don't you want to know who you are talking too? Wouldn't you like them to be familiar with the resources available to you in your local area? Of course you would! Wouldn't you like them to know your doctor and hospital choices, and understand and care about your preferences? Of course you would, that only makes good sense. Just because the person on the telephone claims to have checked all those things out... what happens if they didn't check them out? Your prescriptions ordered by your trusted Dr may end up not being covered. You may find your Doctor doesn't accept your new plan. Always choose a trusted agent that is willing to sit down with you in person or that you chose to call.. as opposed to pressing one to be connected to an agent by a robotcall. 


Medigap policies must follow Federal and State laws. A Medigap policy must be clearly identified on the cover as “Medicare Supplement Insurance.” Each plan, A through L, has a different set of basic and extra benefits. It’s important to compare Medigap policies because costs can vary. The benefits of any Medigap Plan A through L are the same for any insurance company because the government sets those standards. Each insurance company decides which Medigap policies it wants to sell.


So to recap... when you buy a Medigap policy you must already have Medicare Part A and Medicare Part B.  Buying a Medigap policy doesn't relieve you from having to pay the monthly Medicare Part B premium and you will still need a Prescription Drug Plan part D. Your Medigap Insurance policy is a separate bill from the insurance company. You and your spouse must each buy separate Medigap policies. Your Medigap policy won’t cover any health care costs for your spouse. Your Medigap policy won't cover any healthcare cost not covered by original Medicare. Medigap Plans are a good choice for some people contact me for a more in depth comparison of the different plans I represent.. Please call me for an appointment at 740-502-2784. I look forward to serving you!



Senior Benefit Advantage sunrise at Ohio's  Marblehead Light

Medicare Advantage plans are relatively new. They were created under the Balanced Budget Act of 1997. These plans are commonly called Medicare Part C. Medicare Advantage plans are very different than Medigap plans. Sometimes you will hear them referred to as Medicare replacement plans by medical billing offices, because members get their benefits from a private insurance company instead of original Medicare. Congress designed this program to give senior citizens a lower-premium option than Medigap plans. Since they also have very little Medicare underwriting they are a good coverage option for people who missed their Open Enrollment Period and now cannot qualify for Medigap, due to health conditions. Medicare doesn't much like Medicare Advantage Plans being called replacement programs and your Doctors billing department is actually incorrect to use that language because it’s not entirely accurate. You can never permanently replace your Medicare by joining any Medicare plan. Instead you are just choosing to get your benefits from a private company for the rest of the calendar year. You can always return to Original Medicare during any valid election period. Medicare Part C plans, for the most part, have lower premiums than Medigap plans do. This is because you are agreeing to treat in the plan’s network and pay copays as you go. The network may be an HMO network, where you’ll need to choose a primary care physician and get referrals. The BIG news though is that there are more choices today than there have been in the past. So if you have tried unsuccessfully in the past to get a Medicare Advantage Plan during open enrollment you may very well find you have multiple choices this year. Let us help you find out... Please call me for an appointment at 740-502-2784. I look forward to serving you!





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All individuals entitled to Medicare Part A or enrolled in Part B will qualify for Part D coverage. It's called a voluntary prescription drug benefit that will not be automatically added to your Medicare Benefits... but lets be honest.. what you're really volunteering for are penalties in the form of higher premiums that actually last the rest of your life. So if you never enroll there are no penalties if you change your mind and enroll later you will pay a significantly higher cost, depending on how much later you enroll. There is an exception to the rule on Part D not being automatically added to a consumers Medicare benefits and that is if that consumer is eligible for both Medicare and Medicaid.

Most Medicare Advantage Plans (Part C Plans) include Part D as a benefit in the package. Medicare contracts with private companies to offer the Part D benefit. These companies are called Prescription Drug Plan Sponsors (PDPs) or Medicare Advantage Drug Plan Sponsors (MA-PDs). You have the opportunity to purchase the Part D benefit from a PDP in your own  area as a stand alone policy, or as part of an Advantage (Part C) Policy.

Each Part D plan has its own list of covered drugs, which varies by plan type and carrier. So In order to make sure your routine prescritions are covered, you’ll need to compare the medicines you take against the list of covered prescriptions before choosing a plan that you’re interested in. The list is arranged in levels commonly referred to as tiers. The least expensive drugs, including generics, are on the lowest level. Next, you’ll find the slightly more expensive name brands. The highest level contains the most  expensive drugs. 












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What Choice Do I Have?

I have opened an office in Coshocton to better serve my clients in East Central Ohio.  My office hours are by appointment, because I spend most of my time on the road providing personal service to clients across Northeast Ohio and East Central Ohio.  I do a lot of group meetings in Senior Centers, Churches, and other venues.  Many senior citizens and disabled folks need help and have transportation problems that prevent them from making an appointment to see me in the office. So I go to their location and help them where they are! I do my best to make it as easy as possible for clients to meet with me when they need my help! If you or a loved one find yourself in that situation please know that I am here to help you. If you live in the eastern half of Ohio I'm only a phone call away, give me a call today 740-502- 2784. In Akron, Canton, Massilon, Medina, Youngstown, Millersburg, New Philadelphia, Mt Vernon, Dover, Cambridge, Coshocton, Zanesville and all the little towns in between. Calling this number will connect you with me, Rhonda Kraus, a licensed insurance agent.

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