Crystal Burney, Medicare Insurance Agent

Answer: There is no more donut hole. Your max out-of-pocket for prescription drugs in the formulary is 2100.00 for 2026. There is also a program for those who cannot afford the initial cost of high-dollar drugs called the Medicare Prescription Payment plan. Most plans have very low to no cost for tiers 1 and 2 drugs and a deductible for tiers 3-5 drugs. Find a local insurance broker to help you navigate the drugs you are currently on and anticipated drugs, to find out what tier they are on, which affects your bottom dollar.

Answer: Please do not try to figure out all of that mailed mess to you on your own. You are most likely receiving a ton of marketing material,that is not really from medicare. Get in touch with a local agent that can come and meet with you in person and educate you on what is valuable mail and what is noise..

Answer: First steps are to meet with a local licensed broker and review your needs for the future, your broker will usually help you consider health conditions, expected medical needs, prescription coverage, preferred doctors or hospitals, extra benefits, and your budget.

Working with a broker to help YOU determine what type of plan would be in your best interest, is always recommended.

Answer: Original Medicare will cover home health after a surgery, but you must qualify, and your Dr must certify that you are homebound, you need skilled services, and the care must be provided by a Medicare- certified home health agency.

Medicare Advantage plans must cover at least the same as Original Medicare, but they may also offer extra services, after a surgery or hospital stay, depending on the plan

Answer: That is good question. Mental health services are covered by original Medicare, but not fully. You will still have to pay your annual part B deductible and 20% of your billed cost.

Answer: Your cost will depend on how the medication is administered. If you take the medication yourself, such as medication at home, the medication is typically covered under Medicare Part D, and beginning in 2025, the inflation reduction act says you will have a $2,000 annual cap on all Medicare approved, covered prescription drug costs.

If your medication is given to you by a healthcare provider such as infusion , it is usually covered under Medicare Part B . In this case , your cost will vary based on your individual Medicare plans benefits, deductibles and co insurance.

Answer: This is unfortunately a common issue when trying to reach Medicare by phone. One alternative option, that often works quicker is the Live Chat option on their website.

You can go to Medicare.gov and click “Talk to Someone” to start a chat with a representative. This is usually my go-to when I need quick help from Medicare.

Be prepared to provide your full name, Social Security number, and Medicare number during the chat.

If you're reaching out to retrieve your Medicare number for the first time, they may ask you some extra security questions to confirm your identity.

Answer: Medicare Part A does cover key hospital, related services such as inpatient hospital care, skilled nursing facility care, hospice, and limited home health care. However, it does not cover doctor services during a hospital stay like physician visits, surgeries, outpatient care, or prescription drugs. The easiest way to understand it is that Part A pays for the “building” part of your stay, but without Part B, the “doctor” part is not covered. Even with Part A, out-of-pocket costs can be high. In 2025, the deductible for days 1–60 is $1,676, days 61–90 cost $419 per day, and after day 90, it jumps to $838 per day. These costs can occur more than once a year, and there is no cap on how much you may have to pay out-of-pocket, and these costs could incur more than once a year. The good news there are plans available other than just Part A and B, that can help you cover these costs more efficiently, such as Medicare Supplements and Medicare Advantage plans.

Give me a call so we can explore your options, and help you find a plan that fits your specific needs.

Answer: Medicare does not cover nutrition counseling specifically for High cholesterol, under its Medical Nutrition Therapy program, HOWEVER, if you have one of these other conditions, Diabetes, CKD or have had a kidney transplant in the past 36 months, and you receive a referral from your PCP to a registered dietitian, you may be able to receive Medical Nutrition Therapy (MNT), through your Medicare Part B plan. There are some Medicare Advantage plans that offer added nutrition benefits, so it is worth checking with your plan provider to find out more information, about these benefits.

If you need help checking your plan or exploring options that offer nutrition counseling, I'm happy to help.

Answer: I would need to sit down with you for a full assessment of your health, budget, and lifestyle to build a plan that fits your needs, as each individual's needs are different, there are definitely a few different options we can explore.

One option is Original Medicare paired with a Supplement plan and a Part D drug plan, which gives you the freedom to see any doctor nationwide who accepts Medicare. This is great for frequent travelers, or another option is a PPO Medicare Advantage plan that may offer coverage in both states and include a broader network. Some of these plans can work well for people splitting time between two locations.

Answer: In simplified terms MOOP or Max Out of Pocket cost is the most you will have to pay for COVERED healthcare services in a year under your Medicare plan. This means as your copays, coinsurance and deductibles are paid throughout the year, and they meet the MOOP amount, you will not pay out of pocket anymore throughout the year.

For example, if your Medicare Advantage plan has a MOOP of 5,000.00 and you hit that amount in medical costs Copays, Coinsurance and deductibles, during the year, you will not pay anything more for covered services the rest of the year.

Answer: I would not say you made a mistake, everybody's situation is different, and comes with unique needs. I recommend working with a local advisor who can help you evaluate your specific circumstances and explore all of your options so you can make an informed decision that is right for you.

Answer: With a PPO you have more flexibility to see Doctors, and specialist both in and out of network and many plans don't require referrals depending on your specific plan, the out-of-pocket cost may be higher but, you can enjoy more freedom. With an HMO you are generally required to stay in network, and referrals are usually required, to see specialist, you may have fewer provider options, but by staying in network you benefit from lower out of pocket costs.

Answer: What I love most about being a Medicare agent is the opportunity to educate people about the benefits available to them, and how to truly make the most of those benefits. I'm blessed to help individuals find a plan that suits their unique needs and wants. Sitting across the kitchen table, getting to know someone personally, and building a relationship based on trust is the part I treasure most. Walking out the door knowing I’ve helped someone feel more secure about their healthcare, and given their family peace of mind, is a feeling of complete satisfaction and joy.