Dawn Young, Medicare Insurance Agent

Answer: To begin you may apply for "Extra Help" for prescription drugs. This application, if you chose, will be sent to the state you reside.

You may Google "Apply for Extra Help". Be sure you apply thru the Social Security site. Here is the website: https://www.ssa.gov/medicare/part-d-extra-help

You may also contact your Department of Human Services to help.

Hopefully this will get you started.

Answer: Find a trusted broker who is appointed with several carriers and is knowledgeable in plans that would best serve you.

Answer: A Medigap Plan F pays 100% of the emergency room visit. There is no copay or deductible. You must continue to pay your premium to the insurance company and stay enrolled in your Medicare Part A and Part B to ensure coverage.

Answer: First you will need to sign up for Original Medicare Part A and Part B. You may either call the Social Security office to set appointment to enroll or you may go to SSA.gov to enroll in Original Medicare. After you have received your Beneficiary number you will be able to enroll in plans to help fill the gaps of Original Medicare and enroll in Part D. There are several options to concider after being enrolled in Original Medicare. Finding a broker who is appointed with several carriers and is familiar with the plans is very helpful.

Answer: It depends why you missed your window and which window are you speaking of. It would be best to contact Medicare or a broker who is familiar with all the Special Election Periods available to you.

Answer: The best place to find out the prescriptions covered on Part D is Medicare.gov. This site allows you to add your medications and pharmacy. The site will then look for plans that cover Repatha and make suggestions to different carriers and plans benefits.

Answer: Hello,

When you are ready to sign up for Part B there will be a form, CMS-40B to enroll or you may go to SSA.gov to enroll in Part B only. You will also need to fill out the for CMS-L564 which is completed by you and the employer offering group coverage. This form states you were enrolled in creditable employer group coverage which allows you to enroll in Part B during a Special Election Period. If the coverage offered from the employer was credible you will not have a penalty to pay. Group coverage is usually credible coverage which means it offers the same if not more benefits than Original Medicare.

Answer: That's a loaded question. 1. Original Medicare is easy to work with as far as payment and approval for services. 2. Just like Under 65 plans there are networks of doctors within Medicare Advantage plans. Not all doctors are contracted with every carrier. 3. Personally, I feel it is a bit selfish on the doctors part to not like Medicare Advantage as they do not have to pay the outrageous premiums for a Medicare Supplement Gap plans that work with Original Medicare. Medicare Advantage plans must offer the same benefits as Original Medicare. Medicare Advantage plans are managed by private insurance companies and not the Federal Government. In other words, private insurance companies save money for beneficiaries and are able to offer additional benefits. 4. On a positive note with a Medicare Advantage plan you do not pay or pay very little for coverage. If you are not using the benefits you are not paying monthly premiums like you do with supplement or gap plans. You pay as you go....

It really comes down to what works best for you and the coverage you are seeking. It's not what the doctor wants. It's what you want...

Answer: Working with a Broker who offers several plans with different carriers allows for familiarity with different product to be able to compare benefits and networks

Answer: This is a question that requires understanding of risk. If staying with Original Medicare Part A and B you will be subject to much higher out of pocket expenses. Medicare Part C helps lower that risk significantly.

Thanks for asking!

Dawn Young

HealthMarkets Insurance Agency

Answer: It depends on if the medication is on the insurance company’s formulary. If it is not on the formulary you may request special coverage for the medication. This requires the doctor to submit notes and or letter stating why the medication is needed. You would need to contact the insurance company to receive more information on how to request coverage.

Answer: Hi

Adding household income can change things for your Medicare if you qualify for assistance such as Extra Help (for scripts), Low Income Subsidy and Medicaid. The coverage will remain the same along with your Part B premium.

Thanks for asking!

Dawn Young

HealthMarkets Insurance Agency

Answer: Hi,

You may contact a Medicare Broker, like myself that will help research insurance companies keeping in mind the medications you take ,the pharmacy you like to use and coverage that won’t break the bank.

Another suggestion would be to go to Medicare.gov and click the “Find Plans” button. This site allows you to add your scripts and pharmacy.

Thanks for asking!

Dawn Young

HealthMarkets Insurance Agency

Answer: Hi! Yes you definitely are. You have 60 days from the time you lost coverage to find a new Medicare plan.

Hope this helps. Call if you need more information.

Dawn Young

HealthMarkets Insurance Agency

Answer: Hi,

PPO’s are great. You have the freedom to visit any doctor that accepts Medicare. The down side would be going out of network means you have a higher out of pocket cost.

Hope this helps. Please reach out if you need additional help.

Dawn Young

HealthMarkets Insurance Agency

Answer: Hi!

Thanks for contacting me. Yes you may but you might have to go thru underwriting. Oklahoma has a Birthday Rule that was passed a couple of years ago. In short the rule states that you may change supplement carriers at the time of your birthday with guaranteed issue. This rule helps with lowering premiums.

If I can help with anything Medicare related, please be sure to reach out.

Dawn Young

HealthMarkets Insurance Agency

Answer: Hello,

To qualify as Guaranteed Issue you must be within 6 months of your Part B effective date or within the first 12 months of having a Medicare Advantage plan. Below are additional Special Election Periods (SEP) that qualify for Guranteed Issue with Supplement Plans:

Examples of situations where guaranteed issue rights apply during a SEP:

Moving out of a Medicare Advantage plan's service area: If you move and your Medicare Advantage plan doesn't offer coverage in your new location, you have a guaranteed issue right to enroll in a Medigap plan in your new area.

Trial period for Medicare Advantage: If you disenroll from a Medicare Advantage plan during the first year of enrollment, you typically have guaranteed issue rights to enroll in a Medigap plan.

Losing employer coverage: If you're retiring or leaving a job with employer-sponsored health insurance, you may have a SEP to enroll in Medicare Part B and a Medigap policy, with guaranteed issue rights.

Losing other coverage: If you have other coverage that pays after Medicare (like certain employer or union plans) and that coverage ends, you may have a SEP and guaranteed issue rights to enroll in a Medigap plan.

Thanks for asking, Dawn Young HealthMarkets Insurance Agency , Contact me.

Answer: Hello,

Hope this answer helps: Medicare does not generally cover 24/7 in-home care for dementia patients who wander or require constant supervision. While Medicare may cover some home health services, such as intermittent skilled nursing care and therapy, it does not cover the custodial care (like bathing, dressing, and toileting) or the constant supervision needed for wandering.

Here's a more detailed breakdown:

What Medicare might cover:

Home Health Services: Medicare Part A may cover a limited amount of home health care, but only if the individual is "homebound" and requires intermittent skilled nursing care or therapy, like physical therapy or speech therapy.

Hospice Care: If a dementia patient transitions to hospice care, Medicare Part A will cover hospice services, which can be provided at home.

Medicare Advantage Plans: Some Medicare Advantage plans may offer additional benefits for individuals with chronic conditions, including some assistance with activities of daily living, but these benefits vary by plan.

PACE Programs: The Program of All-Inclusive Care for the Elderly (PACE) can provide comprehensive medical and social services, including some home healthcare, for eligible older adults with dementia.

What Medicare does not cover:

24/7 Custodial Care: This includes assistance with activities of daily living like bathing, dressing, toileting, and meal preparation.

Constant Supervision: Medicare does not cover the cost of 24/7 supervision for wandering or safety concerns.

Long-Term Care in the Home: Medicare is not designed to pay for long-term custodial care in the home.

Other potential funding sources:

Medicaid: Medicaid may provide coverage for in-home care services for individuals who meet specific financial and medical criteria.

Private Pay: Families may need to pay for in-home care services out-of-pocket.

Long-Term Care Insurance: Some individuals may have long-term care insurance policies that can help cover the costs of in-home care.

Answer: Hello,

Hope this answer helps. Retirees who wish to deduct their Medicare premiums must choose to itemize their deductions on IRS Form 1040. The premiums paid for all parts of Medicare, including Medigap, are generally considered to be deductible medical expenses (though some restrictions may apply).

For more information regarding income for Seniors you may copy and paste this link in your browser, https://www.ssa.gov/benefits/medicare/medicare-premiums.html

Thanks for reaching out

Dawn Young

HealthMarkets Insurance Agency

Contact me.

Answer: Yes, if someone is disenrolled from a Medicare Advantage C-SNP for failing to provide a required Chronic Condition Verification (CCV) form, they generally have a Special Enrollment Period (SEP) to enroll in another MAPD plan. This SEP typically begins when the individual is notified of their disenrollment and lasts for two months.

Thanks for reaching out.

Dawn Young

HealthMarkets Insurance Agency

Answer: Yes, the information is correct. Keep in mind the $2000 amount is based on two things, medication on the drug plans formulary and True Out of Pocket (TROOP) cost which includes any medications on the formulary which the pharmaceutical helps with the cost. If your medication is not on the formulary or you have a request for the type medication to be covered, it will not go towards TROOP. See below for Google AI:

AI Overview:

In 2025, Medicare Part D is undergoing significant changes, primarily focused on lowering out-of-pocket drug costs for beneficiaries. The most prominent change is a $2,000 cap on annual out-of-pocket spending for prescription medications. This cap applies to all covered drugs and includes deductibles, copayments, and coinsurance. Additionally, the "coverage gap" or "donut hole" is eliminated, simplifying the Part D benefit structure.

Key Changes for 2025:

Out-of-Pocket Maximum: A $2,000 annual limit on out-of-pocket drug costs replaces the previous system with a coverage gap and higher maximum.

Coverage Gap Elimination: The coverage gap, where beneficiaries previously faced high costs, is removed, simplifying the cost-sharing structure.

Simplified Cost Sharing: Beneficiaries will pay a deductible, then a percentage (25% in the initial phase) of drug costs until they reach the $2,000 out-of-pocket limit.

Catastrophic Coverage: After reaching the $2,000 out-of-pocket limit, beneficiaries enter catastrophic coverage, where Medicare pays a larger share of the costs, and beneficiaries pay very little.

TrOOP: True Out-of-Pocket (TrOOP) costs, which track what beneficiaries pay, are adjusted to reflect the new out-of-pocket maximum and the elimination of the coverage gap.

These changes are part of the Inflation Reduction Act (IRA) and are designed to make prescription drugs more affordable and accessible for people with Medicare.

Thanks for reaching out,

Dawn Young

HealthMarkets Insurance Agency