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How Local Medicare Specialists Help with Medicare Advantage

The federal Medicare program offers great benefits to its enrollees, but it’s far from perfect. That’s why it’s important to have Local Medicare Specialists on your side. Our team has helped thousands of beneficiaries enroll in Medicare and other plans like Medicare Advantage. 

So, how are Local Medicare Specialists different from all those other insurance agents? When you enroll with us, our team will ensure you get all the help you need with your Medicare plans. Whether it’s time to change your plan, deal with denied claims, or have questions about how your plan works, we’ll be there to help.

Changing Your Medicare Advantage Plan During AEP

AEP, the Annual Election Period, is the busiest time of year for Medicare advisors. It begins on October 15 and ends on December 7. During this time, we help all of our clients review their Medicare Advantage or Part D plans and help them change their plans if they wish to do so.

The Annual Election Period gives you the opportunity to change, drop, or enroll in Medicare Advantage or Part D for the first time. Whether you are changing your current Medicare Advantage plan or enrolling in Medicare Advantage for the first time, we can help!

Local Medicare Specialists work with all the top-rated Medicare Advantage plans in Arizona, so we can help you compare all the plans in your area to find the one that fits your healthcare needs and budget. We’ll gather all your important health information - your doctors and prescriptions - and find the plans that align with those needs.

Before any Medicare advisor can discuss plan details, you’ll need to sign a Scope of Appointment (SOA) form. Once we have this document signed, we’ll go through all the details of the plans you’re interested in. We’ll discuss the plan’s coverage, networks, cost-sharing amounts, and extra benefits. We’ll also review your prescriptions and make sure they’re all covered on the plan’s drug formulary.

Now, it’s not uncommon to run across some problems when you’re enrolled in Medicare. Medicare Advantage plans have a few rules and requirements you must follow, but our team is here to make sure you get any issues sorted out quickly. Let’s talk about a few things you might face.

Denied Claims and Coding Errors

Unfortunately, denied claims are part of having a Medicare Advantage plan. If you receive a bill for a service that you don’t think is correct, you can call Local Medicare Specialists to find out if the bill is correct or if you might need your provider to resubmit the claim.

Sometimes, a denied claim is just due to a simple coding error. Your doctor’s office must send a list of service codes that were completed at each appointment. There are many codes to choose from, and some of them are very similar. This can result in the office sending the wrong code or even the insurance company paying incorrectly.

A coding error could result in non-payment from your insurance company or a larger bill for you. Consult your Medicare Advantage plan’s summary of benefits to find out how much you should be billed for each service. If you get a bill that is larger than you expected, you should contact Local Medicare Specialists, your healthcare provider, or the insurance company to inquire about the service.

Page with "Claim Denied" written on it.

Medicare Advantage Drug Exceptions

Medicare’s prescription drug coverage gets a little complicated. Even if you aren’t new to Medicare, Part D is still confusing. You can get prescription drug coverage as a stand-alone Part D plan, or it can be included in your Medicare Advantage plan. Either way, the coverage works the same way.

Medicare prescription drug plans do have restrictions. Each plan is different, but there are a couple of restrictions you should watch out for. First, some medications have quantity limits and require prior authorization. Your doctor will have to fill out a form to send to the insurance company before you’re given any prescription that requires prior authorization.

A prescription may also require step therapy. This is a technique used by insurance companies to save money - both for themselves and for you. Step therapy requires you to try a cheaper alternative medication before getting one that is more expensive. If one of your regular medications requires this, you can file for an exception to get the prescription covered. However, not all exceptions are granted.

Get Medicare Advantage in Arizona

Don’t enroll in your Medicare plans alone. Even if you know which plans you want, having an advisor on your side will ensure you get help when you need it. Local Medicare Specialists can help with Medicare Advantage plans, Medigap plans, Medicare Part D plans, and more. Find a Medicare advisor in Arizona and get started on your Medicare journey today.

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We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area which are United Healthcare, Aetna, Humana, Cigna, Blue Cross Blue Shield of Arizona, Centene, Devoted, and Scan. Please contact, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.

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