Terry Krefting is a long-time BCBSND sales professional who’s helped hundreds of people in western North Dakota navigate the Medicare maze. We asked about the most common questions he gets.
Many are pretty basic. Others are more complex. Here’s what he passed along:
Q: What does Medicare cover?
A: Generally, after you pay 20 percent, Medicare covers 80 percent of medically necessary maladies.
Part A is hospital coverage.
Part B is physician coverage.
Part D is prescription drug coverage.
Q: Why do I need a supplement to my Medicare coverage?
Medicare doesn’t cover everything; for example, you are responsible for deductibles, copays, routine physicals, eye exams and many other things.
Medicare supplements help fill the gaps, which is why they are often called Medigap policies.
See what’s covered with supplements.
Q: What if I see a doctor who does not participate with Medicare?
A: Some doctors won’t see Medicare patients because the government pays them less than they are reimbursed for non-Medicare patients.
But that’s the beauty of BCBSND plan F.
You can see doctors who don’t have an agreement with Medicare. As long as it’s a treatment Medicare approves, BCBSND pays the difference between the doctor’s charge and what Medicare is willing to pay, including the deductible.
Q: If I don’t like my plan, I can switch it during open enrollment each fall, right?
A: There’s a misconception about the annual Medicare open enrollment. That period deals with your prescription drug plan, not your Medicare coverage or your supplement coverage.
That’s why it’s important to enroll in Medicare when you’re first eligible and shop carefully for your supplement. Changes down the road are subject to medical underwriting and can cost considerably more than if you enroll right away.
Q: What happens to my supplement if I go out of state for the winter?
A: People with the most popular plan, plan F, don’t have to worry about staying in network. If your medical treatments are Medicare eligible, BCBSND will cover the deductibles—even out of state.
One thing Terry passes along to anyone he speaks with about Medicare supplements is this: Localized service is one of the primary reasons North Dakotans consider BCBSND. Until you run into a problem, you’ll never know how valuable it is to walk into one of the service offices across the state and talk face-to-face with someone who knows what you’re going through. It’s a huge difference compared to a company that can just offer you an 800 number.
Check back later this month to see what others in North Dakota are asking.