Christy Jones, Medicare Insurance Broker

Answer: Yes, Medicare covers screening mammograms once every 12 month period. Diagnostic mammograms are covered as often as necessary with possible copays depending on if a beneficiary has met the deductible or the plan type.

Answer: The Medicare Advantage Open an enrollment period is a 3 month period that beneficiaries that are already on a Medicare Advantage plan can make ONE change to their Medicare Advantage plan. Beneficiaries can also choose to cancel their Medicare Advantage plan and return back to only being on Original Medicare.

Answer: If you’ve been on disability for at least 24 months you will already have Medicare Part A and Part B. Turning 65 gives you another enrollment opportunity if you want to change plans. Sometimes people that have previously been on a Medicare Advantage plan choose to enroll in a Medicare Supplement when turning 65 because they have ‘guaranteed issue’. (Some states offer Medicare supplements for people under 65yo but they are typically more expensive than Medicare Supplements for someone who is 65 or older.) No need to do anything unless you want to review your options to possibly change plans. Medicare Part B will continue coming out of your Social Security check.

Answer: There are many misconceptions that people have about Medicare. One thing people believe is that they won’t have to pay for healthcare once they are on Medicare.. You pay differently with Medicare supplements than you do for Medicare Advantage plans. Your monthly cost will vary between various Medicare supplement companies, and your co-pays will vary between various Medicare advantage companies. There are also different networks that your plan will have to adhere to.

Another misconception is that people pay to have a broker help them. Clients don’t pay their brokers. Brokers get paid like your auto and Home insurance Agent gets paid. Hopefully, they are appointed with several companies so they can help you choose which plan type and company is best for your needs.

Answer: Maybe. Every prescription drug plan has a different formulary. Make sure your prescriptions are covered on the plan that you choose. If your expensive prescriptions are on the formulary, then the Medicare Prescription Payment plan would definitely help. Working with a trusted Broker could also help ensure that your prescription needs are covered.

Answer: I love working with Medicare Clients because I am helping them make one of the most important decisions of their lives, which is how their health needs/issues will be covered. I also help them through some of the most emotional and financial situations when they have health issues. My Clients become friends/family and I don’t take that responsibility lightly.

Answer: No. Most MediGap plans cannot be changed annually as Medicare Advantage plans can be. Some states have a ‘Birthday Rule’ which enables beneficiaries to change MediGap plans within a certain time frame around their birthdays.

Answer: I personally feel that there are more advantages than disadvantages with a PPO. (Although some HMO plans have identical networks to some PPOs) Recently, a disadvantage of a PPO is the increased chance that your plan will be discontinued due to lack of the health insurance company being able to control costs. Some disadvantages of a PPO might be the larger copays compared to HMO

Plans.

Answer: Medicare Seminars can be very helpful. (Some Agents feel comfortable in front of a large group and some don’t.) Seminars are meant to provide information to a large group of people. As always, make sure you know like and trust the Agent you choose to work with. Some Agents prefer to work one on one with their Clients, but doing seminars can help Agents reach more people in less time.

Answer: Premium is definitely NOT the best way to get the best coverage for your personal needs. Make sure to check out all of the details inside of that plan to make sure the plan and network enables you to get your specific wants and needs. Fortunately, you will be able to make a change in plans in the fall, during the Annual Enrollment Period and also during the first quarter during Open Enrollment.

Answer: Most people don’t have annuities. Find a trusted retirement specialist and see if they are a good fit for you personally.

Answer: Seminars can be very helpful to educate beneficiaries about Medicare. If you feel pressured, then that Agent is not a good fit for you. (Agents should NOT make you feel pressured!) Find someone you know like and trust that won’t pressure you, will be available to answer your calls throughout the year, and can help you with issues that might come up. Your first impression/experience should definitely NOT feel like a timeshare sales event.

Answer: There are many differences between the various Medicare Advantage companies. Looking at their network is important. Some companies have National Networks and some companies have smaller/local provider specific networks. You can look at their star ratings, co-pays, and max out-of-pocket costs

Just to name a few of the details. There are many details that you should look at before choosing a Medicare advantage plan to make sure all of those details fit what you need for your specific needs.

Answer: Part D plans can change annually. Some prescriptions may end up being classified on a higher tier. Some Part D deductibles may increase. In 2025, we saw many Part D deductibles increase! Some Part D plans have deductibles that apply to all Tiers, and some Part D plans have deductibles that only apply to prescriptions that are on Tier 3, 4, and 5. It’s important to take note of changes made to your Part D plans annually.

Answer: I personally would not say that would be ‘good coverage’. You will only have 80% coverage since Part A and Part B cover 80%. If you only have Part A and Part B, you are leaving yourself open for the possibility of huge and devastating medical bills.

Answer: Medicare Advantage plan benefits can change every year. Some plans have preventative only, some have comprehensive coverage and some plans don’t have any dental coverage at all. Original Medicare doesn’t cover dental, and MA plans sometimes do. If you had a Broker help you with your enrollment, he/she would’ve been able to send you and talk through those details. I’m sorry you didn’t realize the way your dental was covered. That’s frustrating.

Answer: It’s your choice. You can stay on your employer plan or you can sign up for Medicare. (Do you cover other family members on your employer plan? That’s also something to consider when making a change.) You should meet with a trusted Health Insurance Advisor. A Health Insurance Advisor can compare your current Employer plan to the options you would have if you chose to be on a Medicare plan and help you decide what type of plan would be best for you and your specific situation. One of the big differences I see when I help people compare their Employer plan to various Medicare plans is that employer plans tend to have a very high medical deductible and Medicare plans do not. Compare your options and see what works better for your personal needs, coverages, and finances.

Answer: The Annual Enrollment Period is when you can see what changes are being made to your stand alone prescription drug plan (PDP) or your Medicare Advantage plan for the following calendar year. These plans have changes every calendar year. AEP is the opportunity for you to see those changes and make sure those plans still fit your medical and prescription needs for the following calendar year. Some of the important changes to note are whether your doctors are still in the network and make sure that your prescriptions are still on the plan specific formulary. If you are not happy with your plan then I

AEP is your opportunity to make changes.

Answer: Medicare Advantage plans are not “free “. It’s a different way to pay for your health services. Some Medicare Advantage plans have a $0 premium per month. When you use the services you may or may not have a co-pay. Medicare Advantage plans are state specific as well as county specific.

Answer: Medicare related scams are everywhere! Do not reply to emails! Do not click on advertisements! Do not reply to text messages! Do not answer phone calls! If it’s important (and not a scam), they will leave a message. When you reply to any of these potential/fraudulent sales tactics, you are giving the scammer permission to sell your information or call you continuously. Find a trusted Broker in your area that you can call (and they will answer). There are so many scams telling you can ‘get the benefits you deserve’, or pretending to be your bank or something that you supposedly purchased online. It’s unfortunate that there are so many scams that are aimed at all ages. My advice is to not answer/reply/ or click on things that make you think you are missing out or getting something for $0 cost. I hope this helps!:-)

Answer: Medicare Advantage plans have specific provider networks and hospitals. As long as your preferred doctors and hospitals are in those networks then an MAPD might be a good fit for you.

Answer: You can absolutely keep your same doctors as long as they are contracted with that Medicare Advantage plan. It’s important to look at the plan specific physician directory when choosing and researching Medicare Advantage plans. Many doctors contract with both MA plans as well as Original Medicare.

Answer: I would consider other options during the Annual Enrollment Period. Various MA plans are contracted with different hospitals. Your preferred hospital may also have a Medicare Advantage plan that is specific to that hospital.

Answer: You should first look at the network. Is it a National Network or regional network? Also, look at the details in how each plan covers your medical needs outside of your area. Many plans cover you for Emergency or Urgent Care out of area. Some plans will cover a certain dollar amount if you choose to go out of network. Some plans will have National Networks, so if you spend time in multiple states you are able to have access to multiple doctors in the National Network. International travel is different. Some plans will cover a percentage of international medical bills if it’s an Emergency. Some plans will reimburse the member 100%, but the member will have to pay all costs upfront. Working with a Broker that knows all of the plan details would be beneficial. I also suggest purchasing a travel policy if traveling internationally.

Answer: This is question that can’t be answered with accuracy until a Broker has more information. When comparing employer plans to Medicare plan coverage, there are many things to consider. What does your Employer plan cost? Does the prescription coverage count as ‘credible coverage’? What are the specific benefits? What is the medical deductible?

When you meet with a trusted Medicare Broker, make sure you have all of those details so you can compare what your specific Employer plan covers and what Medicare plan options cover in your state/county.

Answer: I would suggest that people find a Medicare Broker that can explain everything and educate them on their options. A trusted advisor that can educate and provide support throughout the year will definitely alleviate feeling overwhelmed.

Answer: Part A and Part B will cover 80% of Medicare covered services. You should meet with a trusted Broker to see what your options are to cover the other 20%. Also, you’ll want to make sure to get enrolled in a Prescription Drug Plan so you have prescription coverage. (Even if you don’t take any prescriptions, you need to have prescription coverage.) If you go longer than 63 days without ‘credible prescription coverage’, you will receive a lifetime late enrollment penalty.

Answer: The dental network depends on the company and the plan. Some dental coverages can cover Dentists even if they’re out of network. If they’re out of network, as long as they bill the company, the company will pay some of the charges and the Dentist can bill the patient the remaining amount. This is called ‘balance billing’ the patient if the Dentist wants more $ than the contracted dental reimbursement.

Answer: You can order a new Medicare card through your SSA.gov account online. You can also call 1-800-MEDICARE or stop by your local Social Security office.

Answer: The ‘donut hole’ was also known as the ‘coverage gap’. If beneficiaries took name brand/expensive/Tier 3,4,or 5 prescriptions, they might ‘hit the donut hole’. If they hit the donut hole, their prescription copays would be very expensive for the remainder of the year until the total cost for their prescriptions hit $8,000, then they were bumped into the catastrophic phase with low copays.

In 2025, the donut hole went away, and many prescription plans introduced an expensive ‘prescription deductible’. Now, the beneficiary will pay the deductible the first time they fill an expensive prescription (Tier 3,4,&5). After they pay their deductible, the beneficiary will pay the regular copay for whatever Tier their prescription is on. (All plans are different.)

The maximum out of pocket for prescriptions in 2025 is now $2,000, instead of $8,000. If a beneficiary pays $2,000 for their prescriptions, their prescriptions will be $0 for the remainder of the calendar year. The total starts over each calendar year.

Answer: Medicare premiums and plans can change annually. It’s good to make sure their plan is still available and that they are covered. Big changes have affected Medicare plans and costs especially in 2025 and going forward. It’s helpful for children to make sure their parents’ medical needs (as well as their prescriptions) are covered year over year.

Answer: The IRMAA is based on your income 2 years previously. You can Google IRMAA and see what income level you are at and how much ‘extra’ you will be charged for Part B and Part D. The more you made, the more you will have to pay. The IRMAA changes every year. You can also appeal the IRMAA if you’ve had a ‘life changing event’ such as retirement.

Answer: You should apply with Social Security for a program called extra help. Extra help is also referred to as low income subsidy.

Answer: No. Medicare won’t drop you for health reasons. They will drop you if you don’t pay your premium. Part B will be taken out of your Social Security check. If you don’t collect Social Security you will have to pay quarterly or monthly. Just make sure you pay your premium and you will be fine.

Answer: Original Medicare does not cover vision exams. If you choose to get a Medicare Supplement, you will need an additional policy to cover vision or pay out of pocket for an eye exam. Most Medicare Advantage plans DO cover vision, and you can get an annual eye exam covered for no cost.

Answer: Preventative screenings, such as mammograms are covered at a $0 copay for the beneficiary. Medicare covers several preventative screenings at a $0 copay.

Answer: It's always best to have a list of your current costs and needs when you meet with a Broker. Your Broker can go over the various types of plans in your county/state and help you figure out what type of plan will best fit your personal needs. There are some Medicare Advantage plans that are specifically for people with chronic conditions such as diabetes, so see if there is a chronic plan available in your county.

Answer: Some plans cover acupuncture and alternative therapies and some do not. Plan benefits like these vary from plan to plan as well as state to state.

Answer: Your eye surgery should be covered under your Medicare Advantage plan. You will owe a copay for outpatient surgery at an 'Ambulatory Surgical Center'. This copay can be less than an outpatient surgery copay performed at the hospital. Check your Summary of Benefits to see what your copay will be. You can also call your insurance company (or Broker) to see what your copay would be.

Answer: Hospice is covered by Original Medicare. If you are on a Medicare Advantage plan, Original Medicare will take over when covering hospice benefits related to their terminal illness.

Answer: No. Medicare does not cover long-term nursing home care. There are long-term care policies that would cover part of those costs. Medicare covers short term care in skilled nursing facilitieswhen medically necessary.

Answer: There are many financial issues that affect someone’s eligibility/premiums with Medicare. Some beneficiaries automatically qualify for Medicare if they’ve been on disability for 24 months. Some beneficiaries can get lower prescription and premium costs (called Low Income Subsidies) based on a lower income. Some beneficiaries have an increase in the Medicare premiums if they have a higher income. This is called an ‘Income Related Monthly Adjustment Amount’, or IRMAA.

Answer: When someone has a change in coverage, they qualify for a Special Election Period’ so they can make a change outside of the annual enrollment periods. Find a Broker and get the coverage you need.

Answer: As a former educator, I enjoy educating people about Medicare and their plan options. My favorite thing about being a Medicare agent is taking care of my Clients. My Clients end up being like family. Helping them navigate through health issues and situations that can be very stressful, gives me a deep satisfaction and purpose.

Answer: Some companies are already using AI to review claims. AI is so new that there are a lot of questions as to its efficiency with the various claims. It’s important for Medicare beneficiaries to look at each claim and advocate for their needs.

Answer: I will meet with Clients in person or via phone appointment. I will review Medicare basics and will let them know what their options are according to their specific state and county. We will review the various types of medicare plans. We will also talk about provider networks, their prescriptions, and what their personal health needs are.

Answer: Annual Notice of Change paperwork is mailed out at the end of September. Brokers are allowed to talk about those changes no earlier than October 1st of each year. If a person would like to change plans, the Annual Enrollment Period begins October 15th.

Answer: Medigap insurers may cancel plans based on lack of payment for premium and sometimes if you move out of an area that they service.

Answer: Yes annual notice of change paperwork is mailed out at the end of September every year. Brokers are allowed to discuss those changes no earlier than October 1.

Answer: Every hospital has their own network of plans that they accept. Private hospitals are no different. Some plans are in network with various hospitals and some plans are out of network.

Answer: Medicare advantage plans are not only state specific but also county specific. If you move out of state or from one county to another, your current plan may not be available in your new state and/or county.

Answer: Original Medicare (Part A and Part B) covers 80% of your Medicare covered hospital and doctor bills. A Medicare Supplement plan helps cover the other 20%. When you ONLY have original Medicare (Part A and Part B), your financial risk is having to come up with 20% of all of the Medicare bills you might incur.

Answer: I need more information to answer this completely. Do you only have Original Medicare (Part A & Part B) that covers 80%? (Then you are responsible for the other 20% including deductibles.) Do you have a Medicare Supplement in addition to Part A & Part B, that helps cover the other 20%? If you have a Medicare Supplement plan, what Plan do you have? Various plans cover costs and co-pays differently. (You might pay for a Plan F, Plan G, Plan N, Plan L, Plan K, etc.)

Medicare Advantage plans also have various costs, coverage structures and copays, so I’m not sure of you would be better off having gone with a Medicare Advantage plan. Medicare Advantage plans are county specific according to your Primary residence.

Answer: There are many reasons that somebody would want to switch their Medicare plan. Coat/monthly premium might be one thing that might make somebody change their Medicare Supplement or Medicare Advantage plan. Prescription coverage/the formulary might be another reason a Medicare recipient might look around/compare/see what's available to them according to their prescription needs. You should review your Medicare plan or standalone prescription plan every year. When you compare the various plans available in your area, you can make sure that your plan still meets your needs for coverage as well as your needs financially. A 3rd reason to compare your plan annually might be whether or not your doctor accepts your plan.

Answer: Original Medicare does not cover cataract surgery because Medicare doesn’t cover vision. If someone is on a Medicare Advantage plan, most MA plans have vision coverage. In that case, the member will have a co-pay for outpatient surgery when having cataract surgery.

Answer: Unfortunately, there are many agents that will tell people they can get free groceries when they don’t actually qualify for that benefit. It is helpful to let people know that there is a benefit like that available but they don’t tell you that you must qualify for that particular plan. Most of the time plans with a with a grocery benefit are for people that have low income and qualify for Medicaid.

Answer: Special needs plans are Medicare Advantage plans. They are designed for people who have specific health conditions or needs. There are special needs plans specifically designed for people who have Medicaid. There are also chronic special needs plans designed for people who have specific chronic conditions..

Answer: As long as you have ‘credible coverage’ (for example, coverage with an employer group plan) you will not be penalized for delaying your Medicare enrollment.

Answer: If you miss your sign up window for Part B you’ll need to wait and sign up for Part B during the General Election Period, from January 1st-March 31st. If you miss your initial election period to sign up for a Prescription Drug Plan (Part D), you will need to wait until the Annual Enrollment Period from October 15th-December 7th. Late enrollment in Part B as well as Part D will result in lifetime late enrollment penalties.

Answer: The coverage gap went away for 2025. There is now a $2000 max for prescriptions. As long as your cholesterol medicine is on your prescription drug plan formulary it will count towards the $2000 max. If your prescriptions were to reach/exceed $2000, your prescription

cost over $2000 would be zero dollars for the rest of the calendar year.

Answer: Ozempic is covered by your prescription plan, as long as it’s on the formulary. Check your formulary whether on your Medicare Advantage plan or your stand alone prescription drug plan if you are on Original Medicare.

Answer: They need to know ALL of their Medicare plan options and what each plan covers as

well as the costs. A Broker should have experience with both and examples to share to help the Client make an informed decision as to what they feel is best for them.

Answer: I go over both types of plans and we talk about all of the differences between them. We discuss their current health needs as well as the cost differences between the two types of plans. How will they use their plan? How much do they want to spend on a plan? I have clients on both Medicare Supplements as well as Medicare Advantage plans, and my goal is to have a happy client.

Answer: Get with a Broker that can help you apply for various programs based on your income. (You can also go to Social Security and Health & Welfare to see if you qualify.). Some programs will cover your Medicare premiums, but you have to qualify for them. Some qualifications are based on your income and financial situation.

Answer: Medicare Advantage plans are county specific and available in the county of your primary residence. Each county has different plans available. (Medicare Supplements are state specific.). There are many differences in coverage and ‘extra benefits’ like Dental/Vision/and Hearing. Original Medicare doesn’t cover those things and Medicare Advantage plans sometimes (not always) have those additional benefits.

Answer: There are many mistakes that can be made, but I think the biggest mistake that I see people make is not enrolling a couple months ahead of when they need coverage. Sometimes, it can take 60+ days to get your Part B in place.

Answer: Sit down with an independent Broker who is well versed in both Medicare Supplements as well as Medicare Advantage plans. Their service doesn’t cost you anything and can be very helpful when making those decisions.

Answer: Possibly. Talk with a Broker who can present other Medicare options that are available to you based on your primary residence. There might be plans that are less expensive monthly that will also cover you when you travel.

Answer: Apply for Part A and Part B immediately if you haven’t already. A&B covers 80% of medical costs, then talk to a Broker to see what your options are to get the additional 20% covered. Choose an Independent Broker who can present all of the plans available. Also, choose a Broker that you like and trust that will be available to you when you have questions in the future.

Answer: Some ads say ‘Grocery Benefit’ and ‘Get what you deserve’. Those extra benefits are typically for people who have Enhanced Medicaid. (If you don’t have Medicaid then you won’t qualify for those benefits, but it gets the phone ringing!) Once you call the number on the advertisement, your information is sold to many different Agents and your phone never stops ringing. I show beneficiaries the various plans available to them, go over the differences in all of the companies and plans, and see if they qualify for Medicaid. Based on their qualifications, health needs, finances and other things, I am able to make realistic plan recommendations.

Answer: You can enroll in a Medicare Advantage plan that includes those benefits or you can purchase a separate Dental/Vision/Hearing plan with your Medicare Supplement plan. Some Medicare Supplement companies offer discounted dental and vision benefits.