Dawn Young, Medicare Insurance Agent
Dawn Young
HealthMarkets Insurance Agency, Inc
Medicare Agent Licensed in OK and TX
Contact Details
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Location
Jenks, OK
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Phone
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Website
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Facebook
Dawn Can Help With:
About Me
I am a local Oklahoma agent with almost 30 years experience working with Medicare. 18 of the years, I have been with HealthMarkets Insurance Agency, Inc. My customers will tell you I take my career seriously and work hard to maintain customer relationships. When the decision is made to have become your agent, I remain your agent and ask you to call me with all your questions and concerns. If I am unable to help, I will conect you to someone who can! In otherwords, call me first not the frustrating 800#'s! Putting the customer first is always the priority, listen, educate, consult, protect the customer with excellent coverage and just as importantly, build a relationship!
I work with many major insurance carriers that offer Medicare Supplements, Prescription Drug Plans, Medicare Advantage, Hospital, Cancer, Critical Illness, Life policy's and many more products to chose from. Let's build coverage that will meet your medical needs, staying within a budget and work with your life style.
Q&A with Dawn Young
So I heard something about Medicare drug costs being capped at $2,000 in 2025. Is that really happening or just talk?
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
If someone enrolls in a MAPD C-SNP and gets disenrolled for not providing a CCV form within 60 days, is there a SEP to enroll in another MAPD plan?
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
Are there any tax benefits tied to paying Medicare premiums as a retiree?
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
918.230.8883
How often can I change my Medicare Plan?
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.
Can I switch from a Medicare Advantage plan to a Supplemental/Medigap plan during the Annual Enrollment Period without answering health questions?
Answer: Hello,
To qualify as Guranteed 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 918.230.8883