If you’re interested in learning more about your health plan choices, please complete the form below.
Who is Medicare Pathways?
Our objective is simple: To provide education on the plans and services available to you, then provide a solution to your benefit needs that saves you money. We accomplish this with an emphasis on quality coverage, competitive premiums, and the overall simplification of insurance matters.
Our approach is direct: To analyze our clients’ complete insurance needs, design a responsible protection program, and recommend insurance that is the most cost effective for each situation.
Medicare Pathways will act as your insurance advocate and help you choose the right plan at the right price. Your licensed agent will find out what is most important to you when it comes to your healthcare coverage, educate you about all of your plan options, and assist you in every step of the way.
We make the review and enrollment process simple with our advanced technology which allows us to complete multiple comparisons at one time. We are available at your convenience, over the phone, and without the intrusion of an agent coming to your home.
We are proud to serve families and businesses of all sizes for multiple generations. We look forward to the possibility of helping you.
It is our pleasure to provide outstanding customer service at Medicare Pathways. We work closely with our clients to recommend ideal solutions and resolve any issues they may experience promptly. If you experience any issues with your health plan, please contact Medicare Pathways at your convenience for renowned customer service support. Thanks for choosing us!
Why should you schedule an annual review of your health plan?
We are here to help review your plan at no-cost and no-obligation to change your plan or enroll in new coverage. Find out if your plan is expecting a rate increase or other changes may impact your treatment plan.
Are you paying too much for prescription drugs?
Too many beneficiaries are exceeding their budget due to rising costs of prescription medications. Did you know that you could be paying too much for your prescriptions?
We can help you compare plans at no-cost and with no-obligation to enroll in coverage to ensure you are in a plan that meets your medical & financial needs.
Learn more about the Medicare Pathways vision and how we help beneficiaries save money on prescriptions drugs, take advantage of their plan benefits, and connect you with resources in your community.
When can I enroll in Medicare Supplements?
When you’re first eligible
Your 6-month Medigap Open Enrollment Period is your best time to buy a Medigap policy. Generally, you will get better prices and more choices among policies. You can also buy any Medigap policy sold in your state, regardless of whether you have health problems. Your Open Enrollment Period automatically starts the first month you have Medicare Part B (Medical Insurance), and you’re 65 or older. It cannot be changed or repeated. You may not be able to buy a Medigap policy after this enrollment period. If you can buy one, it may cost more due to past or present health problems.
During Open Enrollment
Generally, insurance companies are allowed to use medical underwriting to decide whether to accept your application and how much to charge you. However, regardless of your health problems, you can buy any policy the company sells for the same price as people with good health during your Medigap open enrollment period.
Depending on your situation, buying a Medigap policy differs.
- Those 65 or older– Your Medigap Open Enrollment period starts when you enroll in Part B and cannot be changed or repeated. Most of the time, it makes sense to enroll in Part B when you’re first eligible; otherwise, you may have to pay a Part B late enrollment penalty.
- Turning 65– The best time to buy a Medigap policy is the 6-month period that starts the first day of the month you turn 65 and enroll in Part B. After this enrollment period, your options to buy a Medigap policy could be limited and more costly.
- Those Under 65– Federal law doesn’t require insurance companies to sell Medigap policies to those under 65. You may not be able to buy a Medigap policy until you turn 65; but, it is required in some states for Medigap insurance companies to sell you a Medigap policy, regardless if you’re under 65. But if you are able to buy one, it may cost you more.
- You have group health coverage through an employer or union– Depending on whether you or your spouse are currently working and you have group health insurance through an employer or union, it may be best to wait to enroll in Part B. (Employer plans often have similar coverage to Medigap.)When your group health coverage ends, you’ll get a chance to enroll in Part B without the late enrollment penalty. Your Medigap open enrollment period starts when you enroll in Part B; if you enrolled in part B while under the employer coverage, your Medigap open enrollment period would start in response. Unless you bought a Medigap policy before needing it, it’s possible to miss your enrollment period entirely.
Outside Open Enrollment
Unless you’re eligible due to one of the situations below, there’s no guarantee that an insurance company will sell you a Medigap policy if you don’t meet the medical underwriting requirements outside your open enrollment period.
In some states, you may be able to buy another type of Medigap policy called Medicare SELECT. If you buy a Medicare SELECT policy, you have the right to change your mind within 12 months and switch to a standard Medigap policy.
Situations for eligibility outside open enrollment.
- You’re under 65 and are eligible for Medicare because of a disability or End-Stage Renal Disease (ESRD) – If you have ESRD, you may not be able to choose your desired, or any, Medigap policy before you turn 65. Federal law doesn’t require insurance companies to sell Medigap policies to those under 65. States that require at least one kind of Medigap policy to be offered to people with Medicare and under 65 are: Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, New Hampshire, New Jersey, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Texas, Vermont, and Wisconsin.
- You have health problems – During the Medigap open enrollment period, an insurance company can’t use medical underwriting. Meaning, an insurance company cannot do any of these things based on your health problems.
- Refuse to sell you a Medigap policy it offers.
- Make you wait for your coverage to start (except as explained below).
- Charge you more for a Medigap policy.
- You have a pre-existing condition – if you have a pre-existing condition, the insurance company may make you wait for coverage.
In some cases, the insurance company can refuse to cover your out-of-pocket costs up to 6 months for pre-existing health problems. After this “pre-existing condition waiting period,” the Medigap policy will cover the pre-existing condition. Coverage for a pre-existing condition can be excluded if treated or diagnosed within 6 months of when coverage of the Medigap policy starts. After 6 months, Medigap will cover the excluded conditions.
Even if your Medigap policy doesn’t cover your out-of-pocket costs, when you get Medicare-covered services, Original Medicare will still cover the condition. Still, you’re responsible for the coinsurance or copayment.
- You have a pre-existing condition and are replacing “creditable coverage” – If you purchase a Medigap policy during your Medigap open enrollment period in order to replace “creditable coverage (Medigap),” it’s possible to avoid or shorten your waiting period for a pre-existing condition.
If you have had 6 months or more of continuous prior creditable coverage, the Medigap insurance company cannot make you wait for health care coverages that count as creditable coverage, but they’ll only count if the break in coverage doesn’t exceed 63 days.
- You have other insurance – If you have group health insurance through an employer or union, your Medigap open enrollment period starts when you enroll for Part B.
- You have a guaranteed issue right – If you have a Medigap policy when you have a guaranteed issue right (or “Medigap protections”), the insurance company cannot use a pre-existing condition waiting period.
What should I know about Medicare Advantage?
:What does Medicare Advantage cover?
Medicare Advantage Plans cover all of the services Original Medicare covers, as well as emergency and urgently needed care. But, even if you have a Medicare Advantage Plan, Original Medicare still covers the cost for hospice care, some new Medicare benefits, and some costs for clinical research studies.
In addition to what is covered in Part A & Part B, Medicare Advantage plans can offer additional coverage and benefits. Some plans will cover dental, vision, hearing, and some fitness programs. Plans could also provide coverage and services like transportation to doctors visits, over-the-counter drugs, and other services promoting health and wellness. Plans can offer tailored benefit packages to certain chronically-ill enrollees designed to treat specific conditions.
Always check with the plan before you enroll to see the offered benefits, if you qualify, and if there are limitations.
If a service isn’t considered medically necessary, your plan may choose not to cover costs. Check with your provider if you are unsure if a service is covered.
You may have to pay the full cost of a service you need that isn’t considered medically necessary, but you have the right to appeal the decision.
You can request an organization determination if you have a Medicare Advantage Plan to check if a service, drug, or supply is covered. To get an organization determination, contact your plan and follow the instructions to file a timely appeal.
You may also get plan directed care (when your plan provider refers you for a service or to a provider outside your network without getting an organization determination beforehand)
What you pay for a Medicare Advantage plan varies depending on several factors. Your out-of-pocket costs will depend on:
- If the plan changes a monthly premium (several Medicare Advantage Plans have a $0 premium. If you join a plan that does charge a monthly premium, you will pay it along with the Part B premium (and the Part A premium if you don’t have a premium-free Part A)).
- If your plan pays any of your monthly Medicare Part B premium (Some plans may pay part of or all of your Part B premium).
- If your plan has a yearly deductible or any additional deductibles.
- How much you pay for a visit or service (copayment or coinsurance). For example, some plans may change a copayment of $10 or $20 per doctor visit (These amounts can be different than those under Original Medicare).
- If you go to a doctor or supplier who accepts assignment if you are in a PPO, PFFS, or MSA plan, or you go out-of-network.
- Which healthcare services you need, and how often you need them.
- If you follow the plan’s rules, such as using network providers.
- If you need extra benefits and if the plan charges for them.
- What the plan’s yearly limit on your out-of-pocket costs for medical services is.
- If you have Medicaid or receive help from your state.
If you have a Medicare Plan, each fall you will be sent these notices concerning your plan:
- “Evidence of Coverage” (EOC) – This notice provides details about what the plan covers, how much you pay, and more.
- “Annual Notice of Change” (ANOC) – This notice provides details about any changes in coverage, cost, and more coming into effect in January.
While individual plans will vary, there are overarching differences to consider when deciding between Original Medicare and a Medicare Advantage Plan.
Doctor and Hospital Choices:
- You can be seen by any doctor and go to any hospital in the US that takes Medicare. (In most cases, you will not need a referral to see a specialist.)
- In most cases, you will only see doctors and other providers in your plan’s network (for non-emergency care). Some plans may offer non-emergency coverage out of network; however, it may be at a higher cost. You may need a referral to see a specialist with a Medicare Advantage Plan.
- For Part B covered services, you will generally pay 20% of the Medicare-approved amount after meeting your deductible (also known as coinsurance).
- You will pay a monthly premium for Part B. If you join a Medicare drug plan, you will pay a separate premium for Medicare drug coverage (Part D)
- What you pay out-of-pocket will not have a yearly limit unless you have supplemental coverage (like Medicare Supplement Insurance (Medigap))
- You may be able to get Medigap to help pay your remaining out-of-pocket costs. Or, you can use coverage from a former employer or union or Medicaid.
- Your out-of-pocket costs may vary depending on the plan.
- You will pay a monthly Part B premium, and you may have to pay the plan’s premium in addition. Your plan may have a $0 premium and may help pay all or part of your Part B premium (most Medicare Advantage plans include Medicare drug coverage (Part D)).
- Your out-of-pocket cost for services Medicare Part A and Part B cover will have a yearly limit. After reaching your plan’s limit, you will pay nothing for services Part A and Part B cover for the rest of the year.
- You cannot buy and do not need a Medigap policy.
- Original Medicare will cover most medically necessary services and supplies in hospitals, doctor’s offices, and other healthcare facilities (some benefits, like eye exams, most dental exams, and routine exams, are not covered under Original Medicare).
- You can get Medicare drug coverage by joining a separate Medicare drug plan.
- For most cases, you will not have to get a service or supply approved ahead of time for Original Medicare to cover it.
- Medicare Advantage plans must cover all medically necessary services that Original Medicare covers. Many plans offer additional benefits that Original Medicare does not cover (like some routine exams and vision, hearing, and dental services).
- Most plans include Medicare drug coverage (Part D). With most Medicare Advantage plans, you cannot join a separate Medicare drug plan.
- In some cases, you may need to get a service or supply approved ahead of time for the Medicare Advantage plan to cover it.
- Generally, Original Medicare will not cover care outside of the US. You might be able to buy a Medigap policy that covers emergency care outside the US.
- Medicare Advantage plans will not generally cover care outside the US; however, some plans may offer coverage of emergency and urgently needed services when traveling outside of the US through a supplemental benefit.
Can I Schedule an Appointment?
You can schedule an appointment with our Booking Calendar at your convenience. Click here to select a time and date to connect with your licensed sales agent.