Diana Pedersen, Medicare Insurance Agent

Answer: 1.Network Restrictions: MA plans can have limited provider networks

2.Prior Authorization Delays and Denials: MA plans frequently require prior authorization for treatments, which can delay or deny care.

3.Plan Terminations and Market Exits

4.Difficulty Switching Back to Original Medicare:

Answer: There are two types of plans -

1. Medicare Supplements: you can typically change anytime during the year as long as you qualify medically on some plans

2. Medicare Advantage plans: after your first 12 months, you are only able to change during the Annual Enrollment Period, or Open Enrollment Period or a Special Enrollment Period.

Answer: The "Donut Hole" has been eliminated for 2025. There is a cost for Prescriptions for the year of $2000 as long as they are covered medications. Also, there is a program call mppp or m3p that will help break down the costs over a 12 month period. Please give me a call and I can help explain this~

Answer: Medicare Part B covers 80% of the cost of cataract surgery and post-surgical corrective lenses. You must first meet the annual deductible, which is $257 in 2025, and pay 20% of the cost of cataract surgery. A Medigap plan will cover the remaining 20% cost you are responsible for paying.

Answer: Medicare Plan C is a Medicare Supplement or Medigap policy - This covers bloodwork

Medicare Part C is a Medicare Advantage plan - This plan typically has a Maximum Out of Pocket annually and it will depend on your plan what your copays will be or if the bloodwork test is covered based on what type of test they did.

Answer: Getting married late in life does not affect your Medicare coverage or costs. but it can impact costs of premiums: Each person files for Medicare individually

1. If filing jointly your income is now greater to where you will have the cost of IRMAA added to your Medicare Part B and Medicare Part D monthly costs

2. If you didn't work for a total of 10 years in the US, then you will have to pay for Part A

3. If your income is increased, then you may not qualify for some extra help, like Medicaid.

Answer: Medicare covers MNT for high cholesterol, particularly associated with other health conditions like diabetes or heart disease. The therapy aims to help manage cholesterol levels through dietary changes and lifestyle modifications. Medicare fully covers medical nutrition therapy (MNT) services. However, this requires a referral from a doctor.

Answer: Each year, you should sit down with a licensed Medicare Broker to have them verify the best plan for you based on your current medications, so you can be on the right plan based on your needs for the following year. The Inflation Reduction Act is mean to lower prescription drug prices. Certain insulins are capped at $35 per month, while others can be higher. The cost for copays of covered prescriptions, as of 2025 due to the Inflation Reduction Act, has a catastrophic limit of $2000 for the year.

Answer: Medicare Advantage plans that offer over-the-counter (OTC) allowances will load the benefits either onto a prepaid debit card or on a membership card to be used per the plan guidelines for the year. This offers members a convenient way to shop online or at specific retailers for these OTC products.

Answer: Sometimes these two programs, Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI), are confused with each other. They are both managed by the Social Security Administration, yet are different programs.

SSI is available for those 65 or older with or without a disability and at any age for those who are blind or disabled with no work history requirement. SSDI is available for those who are disabled and have sufficient work history to qualify.

It is possible to receive payments from both programs if the amounts of both are small enough. SSDI payments cause a reduction in the amount of SSI. If the SSDI payments you receive are high enough, this can disqualify you from getting SSI payments.

Answer: The Five-Star Special Enrollment Period allows Medicare recipients to switch to a five-star Medicare Advantage, Medicare Cost Plan, or Medicare Prescription Drug Plan available in their area. This enrollment period occurs once per calendar year, starting on December 8th and ending on November 30th of the following year.

OEP is Open Enrollment Period is from 1/1 to 3/31 each year - Those who are currently on a Medicare Advantage plan have the option to move to a different Medicare Advantage plan or go back to original Medicare A/B with a prescription drug plan.

AEP is Annual Enrollment Period and is from 10/15 to 12/7 each year - This is the time of year when Medicare recipients are able to make changes to their current Medicare plans and Part D prescription plans for the following year.

Answer: High deductible Plan G: A cheap way to have great coverage if you get very sick. This is basically a major medical type of policy.

Medigap (Medicare Supplement): Provides coverage for things not covered by Medicare Parts A and B.

Medicare Advantage plans also have some options that could be affordable monthly where some are $0 monthly premium.

Medicaid: Based on factors such as medical condition or income level, you may be eligible for free or nearly free Medicaid coverage.

Medicare Savings Programs: For people 65 and older with low income to help with premiums and out-of-pocket costs.

Answer: You will want to find out what your care options are with your plan. You might have virtual visits or you can get travel insurance.

Many insurance providers include access to a 24-hour hotline that you can call for medical advice.

If you need to see a doctor while you’re traveling, you might be able to set up a virtual appointment with your primary care doctor.

Medicare doesn't cover outside of the US but there are a few plans that can cover this cost. You will want to talk to your Broker about those options.

Answer: Apply for Medicare Part B by creating a 'special enrollment period'.

Fill out Medicare Forms CMS L564 and CMS 40B

Typically, what I tell my clients is that this needs to be done at least 2 months before your retirement or when your creditable coverage (health insurance) from your employer ends. You have a 63 day window after your medical coverage ends after age 65, to not be subject to a Part B penalty.