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Ask The Experts: John Wells and Shari Leckenby on Medicare
By Daniel Casciato

About the Experts: John Wells is president of Medicare Specialists of Pittsburgh and Shari Leckenby is a Licensed Specialist with Medicare Specialists of Pittsburgh. Medicare Specialists of Pittsburgh is an Independent Insurance Agency representing many different companies for your insurance needs. The company carefully selected its carriers in order to provide clients with the best level of service, price and coverage.

What’s new in Medicare options this year?
While we anticipate it being your typical annual enrollment period, prescription drug cost will be the major driver this year. If you use expensive medication, you will have to calculate the best plan and carrier for you. Now that the situation between Highmark and UPMC has been resolved, you may even want to consider returning to your previous carrier.

Who should get advice on Medicare and why?
If you’re 65 and older, you should seek advice because a carrier changing their formulary compared to another carrier’s formulary could mean up to a $200 to $300 difference in medication each month. Also, you may have been approached to switch to a Medicare Advantage plan. You may not have a good understanding as far as the differences between Advantage Plans and a Supplement Plan.

Someone who is now 75 may not be as healthy as they were at 65. As a result, an option is to move back to Medicare and pick up a Supplemental Plan while you can still get medically underwritten. As you age, your chance of using more healthcare increases. Even though the Supplemental insurance is more in premium dollars, those plans can greatly reduce your out-of-pocket exposure on the backend.

How can a Medicare Specialist such as yourself help our readers?
We can help you enroll in Medicare. There’s a lot of misinformation about what to do when you turn 65. For instance, many people wonder if they should stay on their group employee coverage or should they drop it and go on Medicare. We can compare your current coverage with what you can get with Medicare. We are licensed with all of the major Advantage Plans, Part D plans and a majority of the Supplemental plans. We educate our clients so they can make the proper decisions on what plan they should choose.
What are some of the biggest mistakes people make when choosing Medicare?
Going to one of the carrier meetings and that’s the only education you receive—that is a common mistake. You limit yourself to the typical three plans they offer. Another mistake is if you don’t understand the differences between a Supplement and a Medicare Advantage Plan. Working with a licensed broker, they can better explain all of your options.

What exactly does Medicare cover? What does it not cover?
Medicare Part A covers hospital and inpatient care. Medicare Part B covers medical benefits such as doctor visits, tests, and durable medical equipment. Advantage Plans may have additional benefits that are typically not covered under Medicare such as dental, vision, and gym memberships.

How do you sign up for Medicare when you turn 65?
If you are already receiving social security benefits you are automatically enrolled into Medicare A and B. Your card will arrive in your mailbox before your 65th birthday. If you are not collecting social security, you have to sign up for Medicare. You can sign up three months prior to your 65th birthday month until three months after your birthday month. You can enroll online at www.medicare.gov or set up an appointment at your local social security office.

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For more information, visit www.medipgh.com

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