10/13/2025
Hi, everyone! It's Lisa from the office! You may have received an email from Medicare that talks about Open Enrollment which is October 15th through December 7th. Let's get into it!
I am on disability and currently have a Medicare Advantage HMO plan that I'm hoping to change to get better coverage for my medical needs. For myself, I will be looking at Medicare Advantage PPO plans to better cover my artificial eye and any surgeries that I may need in the future, such as lid revisions.
One of the most important things to consider is HOW the artificial eye will be covered. It's easy to ask Medicare or a private insurance agent/broker if artificial eyes (known as "Durable Medical Equipment") are covered, and your agent may tell you something simple like "coverage is 80 / 20, or 75 / 25, or 50 / 50", but it ISN'T that easy. Some questions are:
*Is the coverage percentage of "allowed" or "billed" charges?
*Does my ocularist take the insurance plan(s) I am considering? (please call us to verify)
*Is there a deductible that needs to be met first?
*Should I consider a PPO plan or an HMO plan?
The general insurance options are:
1. Original Medicare (parts A and B) primary with a Medicare Supplement (Medigap) plan secondary
2. Medicare Advantage plan (replaces Original Medicare, includes NO Supplement)
It can get very confusing, so having a broker is very helpful (which I do). If you're not sure who to call, we also have a patient who is a licensed broker in Washington and Idaho, and is happy to help. Since he is a patient, he knows exactly what questions to ask! If you're doing it on your own but need help, please feel free to give us a call at the office: 509-747-6148. We can help interpret the "insurance lingo" and help you find the best plan for you!