Understanding all the options for Medicare can be confusing. Sandy will answer your questions and clarify the insurance options you have. Sandy likes to keep it simple and make it easy for you to understand. The consultation is free of charge to you and your loved ones.
With a few simple questions, Sandy can help compare Medicare plans to determine where you are financially exposed or if the plan you have is the proper fit for your situation.
Sandy has a strong commitment to be knowledgeable from start to finish. She helps make the process easy from Medicare enrollment to choosing and signing up for the right plan that works for you and your loved ones.
Times have changed and Sandy wants to meet you where you are most comfortable. She offers in-person and telephonic consultations, and video call consultations if you prefer to see each other face to face.
Medicare Supplements, also known as Medigap policies, are sold by private insurance companies to help you cover the out-of-pocket costs left behind by Medicare.
Original Medicare only covers 80% of your Part B expenses. The other 20% comes out of your pocket if you do not have a Medicare Supplement policy also referred to as Medigap. If you were to have a lengthy stay in a hospital or expensive treatments at outpatient facilities, you can see how that could add up.
Medicare Supplements pay that 20% for you.
Medicare Advantage, also known as Medicare Part C, is a plan provided by private insurance companies.
These plans are normally designed with copays and coinsurance throughout the plans as a form of cost share that the client would assume when joining one of these plans. Most plans may offer additional benefits at no additional cost to you.
The plan covers everything traditional Medicare covers (hospital insurance and medical insurance) as well as emergency and urgent care.
Most plans also include prescription drug coverage.
Deductible – the amount you pay for covered services before the Part D plan begins to pay. Some plans may have a lower deductible or none at all.
Initial Coverage – you are responsible for paying a copay or coinsurance for covered drugs unit you reach the annual out of pocket spending threshold.
For 2025, the threshold is $2000. Once this is met, the insurance company pays 100%.
New in 2025 is the Medicare Prescription Payment Plan (M3P). This plan allows you to pay out-of-pocket cost for prescription drugs in monthly amounts.
Original Medicare only covers dental, vision, and hearing when it is related to inpatient or outpatient medical necessity.
DENTAL COVERAGE
Medicare has very limited dental coverage that is only meant to protect your general health in order for another Medicare-covered health service to go smoothly.
It does not cover routine checkups, cleanings, fillings, dentures (full or partial), or most tooth extractions. Medicare Supplements also will not cover these additional benefits.
On the other hand, certain Medicare Advantage plans will sometimes include additional dental benefits as part of their network based plan.
Original Medicare only covers dental, vision, and hearing when it is related to inpatient or outpatient medical necessity.
HEARING BENEFITS
If you only have Original Medicare, it does not cover hearing aids. Part B does cover some hearing tests, such as diagnostic hearing and balance exams. You will have to go through your primary care provider for your initial screenings. Once they recommend that you need additional treatment, your Part B coverage will pay for a portion of the costs.
You can enroll in a stand alone plan that combines the dental, vision and hearing benefits. The monthly premium is low and allows you to have more coverage than what you would normally be provided otherwise with just Original Medicare.
Original Medicare only covers dental, vision, and hearing when it is related to inpatient or outpatient medical necessity.
VISION COVERAGE
In most cases, Original Medicare does not include coverage for routine eye exams, eyeglasses, or contact lenses.
However, the drawback is it will only offer this benefit once per lifetime and they only pay for a standard pair of eyeglasses. You would be responsible for the cost of upgraded frames.
If you are wanting routine eye exams and more than one pair of eyeglasses or contact lenses (or better than the standard frames), then finding a stand-alone plan or one where vision benefits are included will be required.