Cynthia Nakaya, Medicare Insurance Agent
Cynthia Nakaya
Medicare Agent Licensed in AZ, CA, CO, GA, MO and TX
Contact Details
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Location
Jurupa Valley, CA
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Phone
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Cynthia Can Help With:
About Me
I have a passion for serving clients with excellence. I have been helping others since junior high, when I tutored fellow students. After raising my 3 beloved children, I got my insurance license and now serve you.
For over 13 years, I have helped clients with their insurance needs, specializing in Medicare plans. My goal is to assist clients in finding the right product to save them money and serve their best interests. Clients often ask what the "best" company is. The answer depends on your needs! I do a thorough assessment before recommending a plan, which may be one company for you but a different company for someone else. If I find a plan suiting your needs that I don't represent, I'll contract with them just to help you!
I also help people through selling life insurance. When my life insurance clients pass, their families contact me. I assist them by finding the best prices for final expenses. I don't believe anyone should have to arrange a loved one's funeral alone. This is part of my ministry to help others, and I don't charge for these services.
I enjoy having regular contact with my clients and am always available to answer plan-related questions throughout the year.
Q&A with Cynthia Nakaya
What do you enjoy most about working with Medicare clients?
Answer: I previously specialized in Final Expense insurance, which was very important for my clients' and familys' peace of mind. However, my clients didn't see the benefit in their lifetimes.
With Medicare, I assist my clients immediately and have the potential to save them money and give them more benefits. I can often lower prescription costs through plan reviews. I can be a greater resource and build closer relationships by helping people with their health coverage.
How do you educate clients who are completely new to Medicare?
Answer: When helping clients new to Medicare, I go over their current coverage. If they have a retirement plan, I recommend they discuss their need for Part B Medicare with their benefits administrator. I walk them through the process of applying for original Medicare. Even if I don't sign them up for a plan, my reward comes from knowing they know what to do!
If a client has no retirement plan, I educate them on Original Medicare and go over options for additional coverage. This includes Medicare Supplement as well as Medicare Advantage. If the client is low income, I also help them apply for extra help, so the financial burden of prescription costs is lightened.
I like to begin the conversation about Medicare a few months before my client turns 65 so they don't stress over the process. I'm also happy to help people who are already 65 and need assistance immediately.
What are some lesser-known benefits or services that my Medicare plan might cover that I could be missing out on?
Answer: Different plans have different benefits, of course, but some benefits are more common than others.
For example, over-the-counter benefits are extremely common, with benefits amounts varying greatly from plan to plan. Your benefit may be as low as $15 per quarter or as high as $150 a month, sometimes more. Keep in mind, extra benefits vary depending on geographic location, Plan Sponsor, pre-existing conditions, and even vary by plans within each company!
A lesser-known benefit that some plans have is telehealth. It allows the patient to talk with a provider on a computer, tablet, smartphone, or even a regular phone. The convenience of this benefit cannot be overstated. After all, who wants to go to the doctor with a minor cold, flu, or pink eye? Be sure to follow your physician's advice and go to urgent care if you're feeling especially ill.
Some plans have technical help lines, so if you need help downloading an app on those confounded smart phones, you have someone to turn to.
If you are curious about your extra benefits, call your agent and get the details. I'm also available to help you!
How does moving to a new state affect my Medicare enrollment timeline?
Answer: When you move out of a service area, whether from one county to another, or a different state, you must change plans if you have a Medicare Advantage (MA) or Prescription drug plan (PDP). The ability to change plans after a move falls under a Special Enrollment Period (SEP).
If you don't notify your plan before you move, you have the month you move and 2 months after (3 months total) to change plans. If you notify your plan before you move, you have the month before, the month of, and 2 months after (4 months total) to make a change.
Plans vary greatly by service area, so don't be surprised if you have different benefits, including maximum out-of-pocket, deductibles, co-pays, and co-insurance. Extra benefits may also differ from area to area.
Be advised that some counties with low populations don't have MA plans, so adding a supplement and a PDP may be your only option. Medicare Supplement SEPs are similar but exclude the month before a move. You can join a Medicare Supplement plan the month you move and up to 2 months after. Guaranteed issue is available ONLY if there is no MA plan available in your new service area.
Sound complicated? Contact me and I'll walk you through it.
I picked a Medicare Advantage plan because of the dental and now I found out it only covers cleanings. Why didn't anyone tell me this upfront?
Answer: I'm sorry to hear your expectations weren't met by your plan. The best way to prevent this issue is to look at the Summary of Benefits or the Evidence of Coverage. Your agent should have gone over this information with you. I recommend you get a new agent who will go over all benefits during sign up.
How do I report a suspicious Medicare billing error without getting in trouble myself?
Answer: Don't let the fear of retaliation prevent you from exposing the possible wrongdoing of someone in a position of trust over you. The False Claims Act protects you.
Fraud, waste, and abuse hurts us all. It takes courage to report something you think is wrong, but it's the right thing to do. We all must do our part to expose corruption in the system because, in the end, it's our money being misused.
To report something you think is wrong, you have several options. You can call your provider's office and inquire about the charge. They may be able to explain it. If you feel uncomfortable or sense your concern was brushed off, call your plan's member services number and speak with a supervisor about the billing error. You may also call Medicare to voice your concerns. These actions take time, but after you call, you'll feel better knowing you did the right thing.
My kids keep telling me to get a Medicare Advantage plan, but my friends say stick with Original Medicare. Who should I listen to?
Answer: Original Medicare has deductibles and co-insurance and doesn't include drug coverage-part D (If you don't have a PDP- Prescription Drug Plan-and haven't had one for over 63 days after your initial enrollment period has passed, you'll pay a lifetime penalty when you sign up.) With original Medicare, you can go to any doctor who accepts it.
In 2025, part A has a $1,676 deductible. You pay:
Days 1–60: (of each benefit period): $0 after you meet your Part A deductible ($1,676).
Days 61–90: (of each benefit period): $419 each day.
After day 90: (of each benefit period): $838 each day for each lifetime reserve day (up to 60 days over your lifetime).
After you use all of your lifetime reserve days, you pay all costs.
There's a term here, "benefit period". The benefit period lasts for 60 days. If you are out of the hospital for over 60 days, the process starts over, and you pay the deductible again (lifetime reserve days do not start over).
Part B has a $257 deductible, with generally a 20% co-insurance after it's been met. Original Medicare has no maximum out-of-pocket. If you are in the hospital multiple times during the year, the costs can be financially devastating.
Medicare Advantage plans have maximum out-of-pocket limits built into their plans. Depending on where you live, there are both HMOs and PPOs to choose from. HMOs require referrals to see specialists. PPOs are more flexible but costs for out-of-network doctors are higher.
Another option is Medicare Supplement, which works with original Medicare. If you choose this option, you need a stand-alone PDP. Knowing this information should help you decide who to listen to- your children or friends.
My doctor recommended a bone density test. Is this considered preventive care under Medicare?
Answer: This is considered preventative care under Medicare part B, and can be done once every 24 months, or more if your doctor says it's medically necessary. If you have any of the following, your doctor is more likely to recommend it be done more often:
1-You're a woman whose doctor determines you are estrogen deficient and are at risk for osteoporosis
2-Your X-rays show possible osteoporosis, osteopenia, or vertebral fractures
3-You're taking prednisone or steroid-type drugs, or are planning to begin this treatment
4-You've been diagnosed with primary hyperparathyroidism
5-You're being monitored to see if your osteoporosis drug therapy is working
There may be other reasons, depending on your personal medical history, that would cause your doctor to request more frequent scans.
My friend says the new Medicare drug payment plan in 2025 will help with her expensive medications. Would it help me too?
Answer: The changes to part D under the American Rescue Plan change the maximum out of pocket for covered prescription drugs to $2,000 from $8,000 last year. It should help with your costs, given the following circumstances.
The operative term here is "covered". Because this change put a greater financial burden on plan sponsors (Medicare Advantage and PDP companies), many sponsors changed their drug list, or formulary, to lower their costs. So, as long as your drugs are covered under your plan and out of pocket costs exceed $2,000 annually, you should save money under the new law.
If your drugs are not covered under your plan, you can contact them with the help of your doctor and request an exception.
My doctor prescribed physical therapy, but I'm not sure how many visits Medicare will cover. How do I find out?
Answer: The number of physical therapy visits you get depends on what your doctor says. If the therapy is deemed medically necessary, Original Medicare will pay.
However, if you have a Medicare Advantage plan and they deny the therapy, appeal the decision. MA coverage is required to be at least as good as Original Medicare so make sure your plan pays for what your doctor says you need.
I thought I was covered during my snowbird months in Florida, but apparently not. What kind of plan do I actually need for that?
Answer: You didn't say how long you spend in Florida each year, so I will cover several scenarios for you.
If you want to have coverage no matter where you are in the United States, the best option is a Medicare Supplement (Med-Supp) plan that works with original Medicare. Since it doesn't include prescription drug coverage (a PDP), you need to get one in addition to Med-Supp. There are rules that vary from state to state that determine when you can enroll into Med-Supp without medical underwriting, but specific rules on when you can enroll into a PDP. Open enrollment for PDPs is during the Annual Enrollment period from Oct 15-Dec 7 annually. You may also enroll in a PDP if you have a special enrollment period available. Med-Supp allows you to see any doctor anywhere in the country who accepts Original Medicare as payment for services.
If you have a Medicare Advantage (MA or MAPD) plan, you can use it for emergency or urgent care situations when you are out of the service area. You cannot use it for routine services unless it's a PPO. Using a PPO out of network can expose you to higher co-pays. If you are out of your service area for over a certain amount of time- usually 6 months- you may be disenrolled. If you have further questions, I'm happy to answer them.