Is Your Medicare Advantage Plan Going Away in 2027? What 600,000 Seniors Need to Know

Your Medicare isn’t disappearing—but your Medicare Advantage plan might be.

If you have Medicare Advantage, you may have heard some concerning news about changes coming in 2027. Humana has announced that it will discontinue certain Medicare Advantage plans and exit some markets for 2027, affecting approximately 600,000 members.

That may sound alarming, but there is an important distinction: you are not losing Medicare. If your Medicare Advantage plan is ending, you will have options for obtaining new coverage.

The key is knowing what to look for, when to act, and how to avoid simply choosing the first plan that arrives in your mailbox.

First: Don’t Panic! Your Medicare Isn’t Going Away

If you receive a letter saying your Medicare Advantage plan will not be offered in 2027, it does not mean you are losing Medicare.

Medicare Advantage plans are offered by private insurance companies, and insurers can change the plans they offer from year to year.

For 2027, Humana’s announced market and plan changes are expected to affect about 600,000 members. Other insurers are also making adjustments to their Medicare Advantage offerings, so 2027 is shaping up to be a year when reviewing your coverage is especially important.

The good news? You have choices.

What Should You Do If Your Plan Is Ending?

1. Read Every Letter You Receive

If your plan is being discontinued, your insurance company should send you information explaining the change.

Don’t toss that letter into the recycling bin!

Look for language indicating that your plan is ending, terminating, or not renewing for 2027.

This notice is extremely important because it can explain your rights and the options available to you.

2. Don’t Automatically Pick the Plan With the Lowest Premium

A $0 premium can certainly sound attractive—but premium isn’t the whole story.

Before choosing a new Medicare Advantage plan, look at:

• Your doctors and specialists
• Your preferred hospitals
• Prescription drug coverage
• Drug costs and formularies
• Copays and coinsurance
• Maximum out-of-pocket costs
• Dental, vision and hearing benefits
• Transportation or other extra benefits
• Referral requirements
• Prior authorization rules
• The plan’s network

A plan that looks great on paper may not be a great fit if your doctor isn’t in network or your prescriptions aren’t covered the way you expect.

3. Review Your 2027 Options During Medicare Open Enrollment

Medicare’s Annual Enrollment Period runs from October 15 through December 7 each year.

This is the time when Medicare beneficiaries can review their options and make changes for the upcoming year.

For someone whose Medicare Advantage plan is ending, this period can be especially important because it gives you an opportunity to compare the plans available in your area rather than simply being carried into a plan that doesn’t meet your needs.

Don’t wait until December 7 to start looking.

The earlier you review your options, the more time you have to compare your doctors, prescriptions, benefits and costs.

4. Consider Whether Original Medicare Could Be a Better Fit

If your Medicare Advantage plan is ending, you may have more than one path forward.

Depending on your circumstances, you may be able to enroll in another Medicare Advantage plan, or you may have an opportunity to return to Original Medicare and consider a Medicare Supplement (Medigap) policy along with prescription drug coverage.

This is an important decision because Medicare Advantage and Original Medicare work very differently.

Medicare Advantage generally uses a private plan’s network and rules.

Original Medicare allows you to see any doctor or hospital that accepts Medicare, while a Medicare Supplement policy can help cover certain out-of-pocket costs.

However, Medigap eligibility and guaranteed-issue protections can depend on the circumstances surrounding your Medicare Advantage plan ending, so don’t assume you automatically qualify for every Medigap policy without underwriting.

That’s one reason getting advice before making a change can be so valuable.

5. Don’t Let Your Coverage Accidentally Lapse

One of the biggest mistakes you can make is ignoring the notice and assuming everything will simply work itself out.

If your Medicare Advantage plan is ending, make sure you understand:

When your current plan ends.

When your new coverage begins.

Whether you need to actively enroll in a new plan.

Whether you have a Special Enrollment Period or other rights available to you.

The goal is simple:

No gaps. No surprises. No scrambling at the last minute.

Your Doctors and Prescriptions Should Be Part of the Conversation

This is one of the biggest reasons not to choose a new plan based solely on the premium or extra benefits.

Before changing plans, make a list of:

Your doctors

Your specialists

Your preferred hospital

Your medications

Your pharmacy

Then compare that information against the plans available to you.

Your healthcare needs don’t change just because an insurance company changes its plan lineup.

Your new coverage should work for you.

What About Those Extra Medicare Advantage Benefits?

Many Medicare Advantage plans offer additional benefits that Original Medicare generally doesn’t provide, such as dental, vision, hearing or other supplemental benefits.

If you’re changing plans, don’t assume that your new plan will provide the exact same benefits.

One plan may offer a generous dental benefit while another may offer something completely different.

That’s why a side-by-side comparison is so important.

The Biggest Mistake? Waiting Until the Last Minute

When you receive a notice that your plan is ending, it can be tempting to put it aside and deal with it later.

Don’t.

2027 plan changes are already creating uncertainty for many Medicare Advantage members, and insurers are continuing to adjust their offerings.

Start preparing now.

Gather your medications. Make a list of your doctors. Keep your plan notices. Know your important enrollment dates.

Then sit down with someone who can help you compare your options.

Don’t Let a Plan Change Become a Healthcare Headache

If your Medicare Advantage plan is ending for 2027, you don’t have to figure everything out by yourself.

At Life and Med: Medicare Resource Center, we help local Medicare beneficiaries understand their options and compare available coverage.

We’re a local Medicare resource—not a call center.

Whether you’re staying with Medicare Advantage or considering another Medicare option, we’ll help you look at the details that matter most to you, including your doctors, prescriptions, costs and benefits.

Your Medicare isn’t going away. Your plan may be changing—and that’s something you can prepare for.

Have questions about your 2027 Medicare coverage? We’re here to help.

Life and Med: Medicare Resource Center
216 N. 3rd St., Suite B
Leesburg, FL 34748
352-260-0202

Medicare plan availability, benefits, costs and eligibility vary by individual circumstances and service area. Contact Medicare or a licensed insurance professional for information specific to your situation.

Health insurance can feel frustratingly expensive—especially if you don’t qualify for Medicaid and your Marketplace premium is still more than you can comfortably afford. But don’t assume that going without coverage is your only option.

At Life and Med: Medicare Resource Center, we understand that finding affordable health coverage can feel overwhelming. There are different plans, income requirements, subsidies, deductibles, networks, and enrollment rules to consider.

The good news? There may be options you haven’t explored yet.

Why Don’t I Qualify for Medicaid?

There are several reasons someone might not qualify for Medicaid even when health insurance feels unaffordable.

For example:

• Your income may be above your state’s Medicaid eligibility limit.
• You may live in a state with different Medicaid eligibility rules.
• Your household circumstances may affect your eligibility.
• You may qualify for Medicaid for your children while not qualifying yourself.
• Your income may fall into a coverage gap.

Florida is one of the states identified in the source material as having a Medicaid coverage gap. Adults with income below the federal poverty level can potentially find themselves in a difficult situation where they don’t qualify for Medicaid and also don’t qualify for Marketplace financial assistance.

What If My Health Insurance Premium Is Too Expensive?

If you’ve looked at Marketplace plans and thought, “There is no way I can afford that every month,” you’re not alone.

Changes to federal premium subsidies in 2026 have made health insurance more expensive for many people who purchase their own coverage. Some households that previously received financial assistance may now receive less assistance—or may no longer qualify for a federal premium tax credit.

That doesn’t necessarily mean you should give up on finding coverage.

Instead, it may be time to look at all of the options available to you.

Option 1: Check Whether You Qualify for Marketplace Financial Assistance

Your household income plays an important role in determining whether you qualify for a Marketplace premium tax credit.

When determining eligibility, the Marketplace looks at your projected household income using ACA-specific Modified Adjusted Gross Income, commonly called MAGI.

If your income has changed, make sure your Marketplace application reflects your most accurate expected household income.

Certain allowable tax deductions and contributions may also affect your MAGI, depending on your circumstances.

Important: Don’t intentionally misrepresent your income to qualify for a subsidy. Your Marketplace application should reflect your best estimate based on your actual circumstances.

Option 2: Compare Different Levels of Coverage

If you qualify for Marketplace assistance but the premium is still too high, you may want to compare plans with different premiums and out-of-pocket costs.

For example, a Bronze plan may have a lower monthly premium but higher deductibles and other out-of-pocket costs than a Silver or Gold plan.

A lower premium isn’t automatically the better choice, though.

It’s important to consider:

• Monthly premium
• Deductible
• Copays
• Coinsurance
• Maximum out-of-pocket costs
• Prescription coverage
• Doctor and hospital networks
• Whether your current providers participate

The goal isn’t simply to find the cheapest plan.

The goal is to find coverage that makes sense for your healthcare needs and your budget.

Option 3: Look at On-Exchange and Off-Exchange Plans

If you don’t qualify for Marketplace subsidies because your income is too high, you may also want to compare on-exchange and off-exchange ACA-compliant plans.

The source material notes that, depending on the state and plan type, an off-exchange Silver plan may sometimes have a lower full-price premium than an equivalent on-exchange option.

However, premium subsidies aren’t available for off-exchange plans.

That’s why comparing your options carefully matters.

Option 4: Be Careful With “Cheap” Health Insurance

When people are faced with a large health insurance premium, it’s tempting to search for the cheapest alternative available.

But cheaper doesn’t always mean better—or even mean that you’re purchasing comprehensive health insurance.

Some products, including certain short-term plans, fixed-indemnity policies, supplemental plans, direct primary care memberships, and health care sharing arrangements, aren’t the same as comprehensive ACA-compliant health insurance.

Some non-ACA-compliant products may not cover essential health benefits, may exclude pre-existing conditions, or may have benefit limitations.

Before purchasing anything, make sure you understand exactly what the plan covers—and what it doesn’t.

What If I Can’t Afford Any Health Insurance? Consider Short-Term Medical Insurance—Carefully

If you can’t afford comprehensive health insurance and you’re experiencing a temporary gap in coverage, short-term medical insurance may be an option worth investigating.

Short-term, limited-duration insurance (STLDI) is designed primarily to provide temporary protection when someone is between coverage—for example, between jobs, waiting for employer coverage to begin, or waiting for Medicare eligibility.

When Might Short-Term Medical Insurance Make Sense?

Depending on your circumstances, short-term coverage may be considered if you are:

• Between jobs
• Waiting for employer-sponsored coverage to begin
• Waiting for Medicare coverage to start
• Outside the ACA Open Enrollment Period and don’t qualify for a Special Enrollment Period
• Looking for temporary protection against unexpected medical expenses

However, short-term coverage isn’t designed to replace comprehensive health insurance.

What Should You Know Before Choosing a Short-Term Plan?

Short-term plans generally do not have the same protections as ACA Marketplace plans.

Depending on the policy, a short-term plan may:

• Exclude pre-existing conditions
• Require medical underwriting
• Exclude or limit prescription coverage
• Exclude maternity care
• Limit preventive care
• Have benefit exclusions or limitations
• Have different rules for hospital and emergency services
• Not provide the same out-of-pocket protections as an ACA plan

Florida’s Department of Financial Services specifically warns consumers to carefully review these limitations before purchasing short-term coverage.

How Long Can Short-Term Coverage Last in Florida?

For short-term individual policies issued in Florida on or after September 1, 2024, the initial policy period must be less than three months, with the possibility of an extension of up to four additional months if the insurer offers it.

That makes these plans primarily a temporary solution, rather than a long-term replacement for comprehensive health insurance.

One Important Warning

Short-term insurance is not ACA-compliant comprehensive coverage. It does not qualify for ACA premium tax credits, and simply having a short-term policy expire does not create a Special Enrollment Period for an ACA Marketplace plan.

That’s why it’s important to look at all of your options before choosing a short-term plan.

Before You Buy Short-Term Coverage, Ask:

✔ Are my pre-existing conditions covered?
✔ Are my prescriptions covered?
✔ Are my doctors and hospitals included?
✔ Is emergency care covered?
✔ Is maternity care covered?
✔ What is the deductible?
✔ What is my potential maximum financial exposure?
✔ How long will the policy actually last?
✔ What happens when the policy expires?

Florida’s consumer guidance also recommends verifying that the insurance company and agent are licensed to do business in Florida and reviewing the actual policy, exclusions, limitations, and provider network before purchasing.

Don’t Assume Short-Term Is Your Only Option

Before purchasing temporary coverage, it’s worth checking whether you qualify for another type of comprehensive coverage, including an ACA Marketplace plan, employer coverage, COBRA or state continuation coverage, Medicaid, or—if you’re eligible—Medicare. Florida’s Department of Financial Services specifically recommends exploring other coverage options alongside short-term insurance.

What About Medicare?

If you’re 65 or older, or you qualify for Medicare because of certain disabilities or medical conditions, your situation is different.

You may have Medicare options that aren’t available to someone shopping for individual health insurance.

And if you have Medicare and limited income, you may also want to explore programs such as:

• Medicaid
• Medicare Savings Programs
• Extra Help for prescription drug costs
• Medicare Advantage plans designed for people who qualify for both Medicare and Medicaid

That’s why it’s important to look at your entire situation, rather than assuming that the most expensive option is your only option.

You Don’t Have to Figure It Out Alone

Health insurance terminology can be confusing. Between premiums, deductibles, subsidies, networks, Medicaid rules, Medicare, and enrollment periods, it’s easy to feel like you’re trying to solve a puzzle with missing pieces.

That’s where working with a local insurance broker can help.

At Life and Med: Medicare Resource Center, we can help you review your available coverage options and better understand how different plans may fit your needs and budget.

You don’t have to navigate everything by yourself.

A Few Questions to Ask Before Choosing a Plan

Before enrolling in health insurance, consider asking:

1. What will my monthly premium be?

2. What is my deductible?

3. How much could I potentially pay out of pocket in a year?

4. Are my doctors and hospitals in the plan’s network?

5. Are my prescriptions covered?

6. Do I qualify for financial assistance?

7. Are there other ACA-compliant plans I should compare?

8. Is there another program I may qualify for based on my age or income?

These questions can help you look beyond the monthly premium and understand the bigger financial picture.

Affordable Health Coverage Starts With Understanding Your Options

If you’re thinking, “I can’t afford health insurance, but I don’t qualify for Medicaid,” don’t assume you’re out of options.

Your income, household size, age, location, health needs, and eligibility for financial assistance can all affect what choices are available to you.

And because everyone’s situation is different, what works for one person may not be the right solution for someone else.

At Life and Med: Medicare Resource Center, we’re here to make health insurance easier to understand and help you explore the options available to you.

Life and Med: Medicare Resource Center

216 N. 3rd St., Suite B
Leesburg, FL 34748
352-260-0202

Don’t let confusing insurance options leave you without a plan. Let’s make healthcare coverage simpler.

Medicare Plan G vs. Medicare Advantage: What’s the Difference?

If you’re exploring your Medicare options, you’ve probably heard the terms Medicare Advantage and Medicare Supplement Plan G.

But are they the same thing?

No.

Medicare Advantage and Medicare Supplement Plan G are two very different ways of getting Medicare coverage. Understanding the difference is important because the way each type of coverage works, what you pay, and how you access healthcare can be very different.

At Life and Med: Medicare Resource Center, we help Medicare beneficiaries understand these choices so they can make informed decisions about their coverage.

Let’s break it down.

First Things First: Plan G Is NOT Medicare Advantage

One of the most common Medicare questions we hear is:

“Is Medicare Plan G an Advantage plan?”

The answer is no.

Medicare Supplement Plan G is a Medigap policy.

It works alongside Original Medicare, helping pay certain out-of-pocket costs that Original Medicare doesn’t fully cover.

Medicare Advantage, on the other hand, is an alternative way to receive your Medicare Part A and Part B benefits through a private Medicare-approved insurance company.

They are two completely different types of coverage.

What Is Medicare Advantage?

A Medicare Advantage plan, also known as Medicare Part C, is offered by a private insurance company approved by Medicare.

Medicare Advantage plans must cover all medically necessary services covered by Original Medicare, although the plan generally manages your benefits through its own rules, costs, and provider network.

Many Medicare Advantage plans also include additional benefits that Original Medicare doesn’t typically cover, such as:

• Prescription drug coverage
• Dental benefits
• Vision benefits
• Hearing benefits
• Fitness or wellness benefits
• Other supplemental benefits, depending on the plan

Medicare Advantage plans also have an annual out-of-pocket maximum for covered Medicare services.

One important consideration is that Medicare Advantage plans can have provider networks. Depending on the plan, you may need to use certain doctors, hospitals, or other healthcare providers to receive the lowest costs.

What Is Medicare Supplement Plan G?

Medicare Supplement Plan G, commonly called Medigap Plan G, is a private insurance policy that works with Original Medicare.

Instead of replacing Original Medicare, Plan G helps pay certain costs that remain after Original Medicare pays its share.

Plan G generally helps cover:

• Medicare Part A hospital coinsurance and hospital costs
• Part A hospice coinsurance or copayments
• The first three pints of blood
• Skilled nursing facility coinsurance
• Medicare Part A deductible
• Medicare Part B coinsurance or copayments
• Part B excess charges where applicable
• Certain foreign travel emergency costs, subject to the plan’s limits

Plan G does not cover everything, however.

For example, it generally does not cover:

• Your Medicare Part B premium
• Prescription drugs
• Routine dental care
• Routine vision care
• Routine hearing care
• Long-term care

You would generally need separate coverage for services Medicare and Medigap don’t cover.

Does Plan G Have a Deductible?

This is another question we hear frequently.

Plan G does not have its own annual medical deductible in the same way many other types of health plans do.

However, you are responsible for paying the Medicare Part B annual deductible before Plan G begins paying its share of certain Part B costs.

Once you’ve met the Part B deductible, Plan G generally covers the Medicare-approved Part B coinsurance and copayments for covered services.

There is also a High-Deductible Plan G option in some situations. With that version, you pay a higher deductible before the policy begins paying its share of covered expenses.

Plan G vs. Medicare Advantage: What’s the Difference?

The easiest way to understand the difference is to look at how each type of coverage works.

How the Coverage Works

Medicare Advantage:
You receive your Medicare Part A and Part B benefits through a private Medicare Advantage plan.

Plan G:
You keep Original Medicare and use Plan G as supplemental coverage to help with certain out-of-pocket costs.

Doctor and Hospital Choice

With Original Medicare + Plan G, you can generally see any healthcare provider nationwide who accepts Medicare and is accepting new patients.

Medicare Advantage plans typically have networks, and the rules for seeing providers outside the network vary by plan.

If you travel frequently or spend part of the year in another state, provider access may be an especially important consideration.

Monthly Premiums and Out-of-Pocket Costs

Medicare Advantage plans can have low or even $0 additional monthly premiums, although you’ll still generally have your Medicare Part B premium and may have copayments or coinsurance when you receive care.

Medigap Plan G generally has a monthly premium in addition to your Medicare Part B premium.

In exchange, Plan G can provide more predictable cost-sharing for many Medicare-covered services after you’ve met the Part B deductible.

It’s important to look at the total cost of coverage, not just the monthly premium.

Extra Benefits

Medicare Advantage plans may include additional benefits such as:

• Dental
• Vision
• Hearing
• Prescription drugs
• Fitness benefits

Plan G itself does not generally include these routine benefits.

If you choose Plan G, you would generally need a separate Part D prescription drug plan if you want Medicare prescription drug coverage.

Does Plan G Cover Prescription Drugs?

No.

Medicare Supplement Plan G does not provide prescription drug coverage.

If you have Original Medicare and Plan G and want Medicare prescription drug coverage, you would generally need to enroll in a separate Medicare Part D plan.

This is an important difference from many Medicare Advantage plans, which often include Part D prescription coverage.

Does Plan G Cover Dental, Vision, or Hearing?

Generally, no.

Original Medicare doesn’t typically cover routine dental, vision, and hearing services, and Plan G doesn’t add those routine benefits.

Some Medicare Advantage plans, however, may offer additional dental, vision, and hearing benefits.

That doesn’t automatically make Medicare Advantage better—it simply means the plans are designed differently.

Which Is Better: Plan G or Medicare Advantage?

There isn’t one answer that is right for everyone.

The better choice depends on your healthcare needs, budget, doctors, prescriptions, travel habits, and personal preferences.

Plan G may appeal to someone who:

• Wants to keep Original Medicare
• Values broad provider access
• Travels frequently within the United States
• Wants more predictable cost-sharing for many covered services
• Is comfortable paying a separate monthly Medigap premium

Medicare Advantage may appeal to someone who:

• Wants an alternative way to receive Medicare benefits
• Is comfortable using a plan’s provider network
• Wants additional benefits such as dental, vision, or hearing coverage
• Wants prescription drug coverage included in one plan
• Is looking for a plan with potentially lower monthly premiums

The key is not simply asking “Which plan is better?”

Instead, ask:

“Which type of Medicare coverage fits my situation?”

🧩 Don’t Compare Medicare Plans by Price Alone

It’s easy to look at a plan’s monthly premium and assume the less expensive option is automatically the better choice.

But Medicare costs can include much more than a monthly premium.

When comparing coverage, consider:

• Monthly premiums
• Deductibles
• Copays
• Coinsurance
• Maximum out-of-pocket costs
• Doctor and hospital networks
• Prescription coverage
• Pharmacy networks
• Dental and vision benefits
• Travel needs
• Your expected healthcare usage

Looking at the whole picture can help you make a more informed decision.

❤️ Your Healthcare. Your Medicare. Your Choice.

Choosing Medicare coverage is an important decision because your healthcare needs are personal.

At Life and Med: Medicare Resource Center, we believe you deserve to understand your coverage before making a decision. Our goal is to make Medicare easier to navigate by helping you understand your options, the costs involved, and how different types of coverage may fit your healthcare needs.

Whether you’re turning 65, already have Medicare, or are considering a change to your current coverage, we’re here to provide local, personalized Medicare guidance right here in Leesburg.

Because when it comes to your healthcare, having someone who will take the time to listen and explain your options can make all the difference.

Have Medicare Questions? We’re Here to Help.

You don’t have to figure out Medicare alone.

If you’re wondering whether Medicare Advantage or Plan G may be a better fit for your situation, we can help you understand the differences and review the options available to you.

Life and Med: Medicare Resource Center
📍 216 N. 3rd St., Suite B
Leesburg, FL 34748
📞 352-260-0202

Have Medicare questions? Give us a call or stop by our Leesburg office. We’re here to help make Medicare easier to understand.

This article is for educational purposes only and is not medical, legal, or financial advice. Medicare plan availability, premiums, benefits, provider networks, and eligibility can vary. Always review official Medicare and plan materials before making coverage decisions.

Medicare provides valuable health coverage to millions of Americans, but that doesn’t mean everything always goes smoothly.

Sometimes the problem is a confusing bill. Sometimes a prescription costs more than expected. Maybe your doctor isn’t accepting your plan, Medicare denied a claim, or you’re not sure why you’re being charged for something you thought was covered.

These situations can be frustrating—and trying to solve them on your own can make them even more stressful.

At Life and Med: Medicare Resource Center, we believe you shouldn’t have to navigate every Medicare question by yourself. A local Medicare broker can help you understand your coverage, investigate certain issues, and point you in the right direction when a problem comes up.

Here are 7 common Medicare complaints and what you can do about them.

1. “Why Am I Being Charged for My Medicare Part B Deductible?”

One frustrating situation occurs when a beneficiary believes they’ve already paid their Part B deductible, only to receive another bill asking for the deductible.

This can happen because Medicare applies the deductible based on when claims are submitted and processed.

For example, you may pay a provider expecting that payment to satisfy your deductible. However, another healthcare provider or laboratory could submit a claim to Medicare first. Medicare may then apply the deductible to that claim instead.

That can leave you wondering why another provider is asking you for the same amount.

How Life and Med Can Help

When you receive a Medicare bill that doesn’t seem right, don’t simply ignore it.

A Medicare professional can help you understand how the claim was processed and determine whether you need to contact the provider, Medicare, or your insurance company.

Keep your Medicare Summary Notices, Explanation of Benefits documents, and provider bills. Having those documents available can make it much easier to figure out where a billing problem occurred.

2. “Why Is My Medicare Premium Higher Than I Expected?”

Another common complaint is an unexpectedly high Medicare Part B or Part D premium.

Some beneficiaries are surprised to discover that their Medicare premiums can be affected by their income.

This is known as IRMAA—the Income-Related Monthly Adjustment Amount.

Medicare generally uses tax-return information from two years earlier when determining whether an income-related adjustment applies.

That can create a frustrating situation for someone who has recently retired or experienced a significant reduction in income.

For example, your tax return from two years ago may show a much higher income than what you’re earning today.

What Can You Do?

If you’ve had a qualifying life-changing event that caused your income to decrease, you may be able to ask Social Security to reconsider your IRMAA determination.

Depending on your circumstances, documentation may be required.

How Life and Med Can Help

We can help you understand what IRMAA means, discuss the general reconsideration process, and help you identify the appropriate next step.

If you’re paying an income-related Medicare surcharge and your financial situation has changed, don’t assume there’s nothing you can do.

3. “Why Am I Getting So Many Bills With My Medicare Advantage Plan?”

Medicare Advantage plans often use copayments and coinsurance for healthcare services.

You might pay one copay when you visit your doctor and then receive another bill because you were sent to a laboratory or another healthcare provider.

That can make your healthcare expenses feel unpredictable.

For someone who doesn’t understand how their Medicare Advantage plan works, the costs can come as a surprise.

How Life and Med Can Help

When reviewing Medicare Advantage coverage, it’s important to look beyond the monthly premium.

We can help you compare factors such as:

• Primary care copays
• Specialist copays
• Hospital costs
• Outpatient services
• Prescription costs
• Maximum out-of-pocket limits
• Provider networks

During an applicable enrollment period, we can also help you compare other available Medicare options.

The plan with the lowest premium isn’t necessarily the plan with the lowest overall healthcare costs.

4. “Why Did My Prescription Cost So Much?”

You arrive at the pharmacy expecting to pay one amount—and suddenly you’re being asked to pay much more.

Sound familiar?

Prescription costs can vary depending on how your Medicare drug plan categorizes a medication.

Your plan’s formulary determines which medications are covered and how they are classified.

A medication placed on a higher tier may have a higher cost to you.

Other factors can also affect what you pay, including:

• Your plan’s deductible
• Drug tier
• Copayment
• Coinsurance
• Preferred pharmacy
• Quantity limits
• Prior authorization requirements

How Life and Med Can Help

We can review your prescription coverage and help you understand why a medication may have a particular cost.

In some circumstances, your doctor may be able to request a tier exception or determine whether an appropriate alternative medication is available.

Never stop taking a prescribed medication simply because the price is too high. Talk with your healthcare provider about your options.

5. “Why Isn’t Medicare Paying for My Medical Equipment?”

Medicare can cover certain types of durable medical equipment (DME) when specific requirements are met.

Examples may include:

• CPAP equipment and supplies
• Blood glucose monitors
• Walkers
• Wheelchairs
• Other qualifying medical equipment

One common source of confusion is using a supplier that isn’t approved or contracted for your particular Medicare coverage.

How Life and Med Can Help

The process can depend on what type of Medicare coverage you have.

If you’re enrolled in Medicare Advantage, you generally need to use a supplier that participates in your specific plan’s network.

If you have Original Medicare with a Medicare Supplement, Medicare’s supplier requirements may apply.

Before ordering expensive medical equipment, check whether the supplier is approved or in-network for your coverage.

Doing this beforehand can help prevent an unpleasant surprise later.

6. “Why Isn’t My Medicare Supplement Paying My Bill?”

Here’s an important Medicare fact that sometimes surprises people:

A Medicare Supplement plan does not automatically pay for every service Medicare doesn’t cover.

Medicare Supplement insurance generally helps pay certain Medicare-covered cost-sharing amounts, such as deductibles, copayments, and coinsurance.

If Medicare denies a service because Medicare doesn’t cover that service, your Medicare Supplement generally won’t simply step in and pay the bill.

What Can You Do?

First, find out why Medicare denied the claim.

Was the service:

• Not covered by Medicare?
• Billed incorrectly?
• Missing required information?
• Subject to a coverage rule?
• Considered medically unnecessary under Medicare’s rules?

How Life and Med Can Help

We can help you understand the explanation you received and determine what questions you should ask Medicare or your healthcare provider.

Sometimes a billing problem is simply a matter of a claim being submitted incorrectly.

Understanding why something was denied is the first step toward determining what to do next.

7. “I Just Started Medicare—Why Isn’t Medicare Paying My Doctor’s Bills?”

This can be especially confusing when you’re newly enrolled in Medicare.

You may have received your Medicare card, presented it to your doctor’s office, and expected Medicare to pay the claim—only to discover that the claim was denied.

One possible reason is that Medicare’s records may still show another insurance plan as your primary coverage.

This can happen when someone:

• Retires after age 65
• Leaves employer coverage
• Changes employer coverage
• Transitions from employer insurance to Medicare

How Life and Med Can Help

When Medicare’s records don’t accurately reflect which insurance should pay first, the claim can end up in the wrong place.

Getting the coordination of benefits corrected may require contacting Medicare and your former employer’s insurance administrator and then having the healthcare provider resubmit the claim.

A Medicare professional can help you understand what information needs to be corrected and where to start.