Medicare FAQs
Answers to your most commonly asked questions
Read through answers to some of the Medicare questions we hear most often from members like you.
Frequently asked questions about Medicare
Do I need to worry about pre-certifications with Medicare and a supplement?
In most cases, no. Medicare does not require prior authorization for most services. If Medicare approves a claim, your supplement will automatically pay its share.
How do I know if Medicare will cover a service?
You can ask your provider to check with Medicare before your appointment or visit medicare.gov/coverage to look up covered services.
What about coverage for durable medical eqipment such as CPAP machines or orthotics?
Medicare Part B covers durable medical equipment (DME) — like CPAP machines, orthotics, and other prescribed devices — when it’s medically necessary and ordered by your doctor. Once Medicare pays its share, your supplement helps cover the remaining costs, including deductibles and coinsurance.
I'm getting a lot of phone calls about Part D plans and food cards — should I answer these?
Be cautious. Many of these calls are from marketers, not your insurance provider. If you have questions about your Part D plan, contact your plan directly using the number on your card.
What do I need to know about taking a medication like Zepbound for reasons other than weight loss?
Medicare Part D generally covers medications only for FDA-approved uses. Check with your doctor and your Part D plan to confirm if a prescription will be covered.
How does coverage work outside of the United States?
Original Medicare generally doesn’t cover care outside the U.S., but some Medicare Supplement plans include limited foreign travel emergency benefits.
Is there a reason I pay an additional amount for my Part D directly to Medicare (IRMAA)?
Yes. The Income-Related Monthly Adjustment Amount (IRMAA) is an extra premium set by the federal government for individuals with higher incomes.
What are the rules around changing from one Medicare supplement plan to another?
Rules regarding switching plans vary by state. Contact Everence to review your options.
SilverSneakers?
Everence Medicare supplement plans do not include SilverSneakers, but Everence helps cover fitness costs for members who have a Medicare supplement policy. Members can receive up to $10 a month, (or $120 a year), to help cover fitness classes, gym memberships or online classes.* In addition, many local fitness centers offer senior discounts or Medicare-friendly programs.
Will I get a late enrollment penalty if I sign up for a Part D plan now?
Possibly. If you’ve gone more than 63 days without creditable prescription coverage, Medicare may apply a late enrollment penalty when you join a Part D plan.
Can the cost of my medication change throughout the year?
Yes. Drug prices and copays can change as you move through the stages of your Part D plan (such as deductible, initial coverage, and coverage gap).
In today's political atmosphere, is the Medicare program safe?
Yes. Medicare is a federal program established by law, and any significant changes would require congressional action. Your coverage remains secure.
questions?
Contact us
If you have questions or run into any issues, your Everence representative can help, or you can call our Member Services Center at 888-365-5530 or email [email protected].
Disclosure
*This is a value added benefit for being an association member. It is not insurance and not a guaranteed policy benefit of your Medicare supplement policy.