How it works.
Medicare is confusing.
I am here to help unravel it!
My job is to ask you questions about your lifestyle (Are you a home-body or heading out in your RV?), who your doctors are (Local, or do you want the freedom to go to anyone in the USA?), what your current health status is (Are you as healthy as a horse? Perhaps you are diabetic?), what medications you are on (Tier 1&2 generic/brand generic? Are you taking insulin? Perhaps you are taking an expensive medication and need to discuss costs and how you might get additional help), your budget (Tight, I want the best plan available regardless of the cost, or somewhere in between?) and do you have other health care coverage (Tricare, VA, Union/Employer benefits)?
Your answers to these questions will help me guide you to the plan that is right for you. And your plan may be completely different from your spouse or partner’s plan. That’s why these questions are so critical.
My philosophy is that my job is to ask the right questions and give you my professional recommendation. You job is to make the best decision possible for you.
Feel free to call me with your Medicare questions or concerns.
Hi! I’m Susanne,
and I love knowing I help people understand confusing insurance policies. I love to take Insurance-ese and translate it into English for my clients. I have worked in Finance and Insurance since 1986 and I love what I do. I approach each new client with a fresh perspective, because my job is to give you a fantastic insurance education, and ask you enough questions about YOU and your lifestyle and desires, to put you in the best possible plan for you, whether it’s a Medicare Supplement plan with a Part D stand-alone drug plan, or a Medicare Advantage plan.
When I first learned about insurance I was shocked by how little coverage I had and how much I was paying for it. At that moment, I knew I had found my calling. I could take my intense need to properly protect people and could ask enough questions to make sure I got my client the best plan possible.
From life insurance to auto and home insurance, and now to Medicare, I know that each person has specific needs and there is no cookie-cutter, one-size-fits all plan. I need to ask you questions, find out about your needs, and then help you pick the best plan for you.
For me on a personal level:
I’m married to my best friend Ernie. In 2020 it will be 25 incredibly short years of marriage. Where did the time go? I’m also a voracious reader, love to rescue animals, and take waayyyy too many photos when I’m on vacation.
I’m fortunate that I found a career at a young age that has fascinated me since 1986. I look forward to giving you an education, and I will let you know if the plan you currently has is the best one for you, or if I have something better.
I care that you are protected properly, whether that is with me or not. Let me sit down with you, in person or virtually, and ask health as well as lifestyle questions. I would love to confirm that you have a great plan already!
2220 Otay Lakes Road
Chula Vista, CA 91915
(619) 200-3594 TTY 711
susanneromo @ yahoo.com
CA License #0720743
Reach out to me.
This is a solicitation for insurance.
Frequently Asked Questions
What is Medicare?
Medicare is a federal health insurance program for eligible US citizens and legal residents. Medicare is individual health insurance, not a family or group plan. Each person must meet Medicare eligibility requirements as an individual.
Who can get Medicare?
Medicare is for US citizens and for legal residents who have lived in the US for at least the previous 5 years. You must be 65 years old, or have a qualifying disability and have received disability benefits for 24 months. Also, people with end-stage renal disease (ESRD) or ALS may be eligible sooner.
What does Medicare cover?
Original Medicare is the core coverage provided by the federal government. It has two parts. Part A and Part B. Part A is hospital insurance. Part B is medical insurance. Part A covers services provided during an inpatient hospital stay. Part B includes doctor visits, tests or exams your doctor may order, and other outpatient services. Part B also includes your Annual Wellness Visit and Durable Medical Equipment that is medically necessary and prescribed by a doctor. Please note, Medicare does not cover everything. It does not include coverage for prescription drugs, routine dental, vision and hearing care. It also does not cover long-term-care such as in a nursing home.
How much does Medicare cost?
Most people are familiar with deductibles, premiums and copays. What you may not be as familiar with is Coinsurance. Coinsurance is an amount you pay when the medicare service cost is split with you. This is based on a percentage. For example, the cost of the service is covered 80% by Medicare and you pay the remaining 20%. . Most people who have paid into the system for 10 years will have a premium-free Part A. However, there is a Part A deductible, which amount changes every year. This would be based on your specific circumstances. There is no out-of-pocket maximum with Original Medicare on shared costs.
Where can I get more coverage?
Since there is not a maximum out-of-pocket annual cost for Original Medicare, you may want to explore other options. You have two options for more coverage. The first option is to add a Medicare Supplement and Part D prescription drug plan to Original Medicare. The second option is to choose a Medicare Advantage plan (Part C). Many Medicare Advantage plans include drug coverage and additional benefits. All three of these option components are provided by private insurance companies, so you may have a number or plans available for you to choose from in your area.
How do Medicare Advantage (Part C) plans work?
Medicare Advantage plans must provide all the benefits that Original Medicare does. In Medicare Advantage (Part C), the plans combine Part A and Part B in one package. Most Medicare Advantage plans include prescription drug coverages. They may offer additional benefits such as fitness programs, wellness programs, dental, vision and hearing care. It may be familiar to you with what your employer provided for health insurance coverage.
How do I get Medicare Prescription Drugs (Part D)?
You have two options regarding prescription drugs. One way you can get drug coverage is through a stand-alone Part D Plan, or as part of the Medicare Advantage plan (Part C). Both options are offered by private insurance companies, not the federal government.
Each Part D or Medicare Advantage plan will have a list of specific drugs covered. This is called a ‘formulary’. Each plan has its own list of drugs they cover, but every plan must cover a range of both generic and brand-name drugs that are needed by people on Medicare. Each formulary has different tiers of drug costs, with Tier 1 costing less than Tier 5. It is important to know what drugs you are prescribed and to understand the cost differences between plans.
When can I enroll?
It is critical to pay attention to your enrollment options to avoid late penalties and potential gaps in coverage.
There are different enrollment periods available to you. There is the Initial Enrollment Period, which starts 3 months before your birthday month, your birthday month, and the 3 months following your birthday month.
If you miss your IEP, you have another chance to enroll called the General Enrollment Period, which runs from January 1 to March 31 every year.
You may qualify for a Special Enrollment Period (SEP) if you work and have employer coverage past age 65, or if you move from your plan’s coverage area.
Medicare Advantage Open Enrollment is specifically for Medicare Advantage plan members and runs from January 1 to March 31.
You may also change your coverage choices during Medicare Annual Enrollment, which occurs during October 15 – December 7 every year.
Local Resource Center
This is a list of professionals and services in San Diego that I personally put my stamp of approval on. If you are looking for a referral for something not on this list, please contact me and I will personally find a referral for you.