Ja'el Michael, Medicare Insurance Agent
Ja'el Michael
United Healthcare
Medicare Agent Licensed in TN and NV
8+ Years of Experience
Contact Details
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Location
Knoxville, TN
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Phone
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Website
About Me
Greetings! I'm Ja'el, a Medicare insurance agent dedicated to serving your local area. Medicare is my area of expertise, and I'm committed to helping you pinpoint the most suitable plan for your individual needs and budget. I'll handle the research and comparison of plans from top national and local companies, so you can relax. Plus, my assistance comes at absolutely no cost to you. Reach out to me today to discuss your Medicare insurance possibilities, and remember to mention you found me through Medicare Agents Hub!
Q&A with Ja'el Michael
How can I tell if my Medicare Advantage plan is financially sustainable long-term?
Answer: On an individual basis, check the plans star rating and look over the insurance companies general reputation and history.
It can also be good to ask your favorite doctors office what Medicare insurance plans they like to work with. Certain plans are better in some counties/states than others. Often the doctors billing department can tell you which insurance companies are quicker to pay their bills, pass prior authorizations, and approve care.
How do I change my Medicare plan during open enrollment?
Answer: One option is to call your local insurance broker or licensed agent. If you enroll in a plan through a trusted agent, that person can serve as an additional resource you can contact with healthcare or coverage questions at no additional cost to you, since insurance companies compensate licensed agents for helping members with their coverage.
Another option is to call 1-800-MEDICARE or visit Medicare.gov to review your plan options. Just keep in mind that if you enroll directly through Medicare, you would typically contact the member services number on the back of your insurance card anytime you need help with your plan benefits or coverage questions.
Either way, it’s important to provide your doctors, prescriptions, and preferred pharmacies so you can help ensure your medications and providers are covered during the transition.
Does Medicare cover shoulder replacement surgery?
Answer: Yes, if your doctor feels it is necessary. Medicare Part A covers Hospital and Medicare part B covers Medical expenses like doctor visits.
If you only have Medicare Part A and Part B, you will have out of pocket costs though. As you can see on the Medicare website here: https://www.medicare.gov/procedure-price-lookup/cost/23472/
If you have additional coverage like supplemental/ Medigap coverage or a Medicare Advantage Plan, it changes your costs. Please contact your member services for precise numbers.
I called to ask about a knee replacement and suddenly they said I need prior authorization. I thought my plan was supposed to be good-what's going on?
Answer: If you have a Medicare Advantage Plan or Part C, these plans mean your primary insurance is no longer Medicare, but rather the company on your member card. Typically these companies ask for Prior Authorizations as an additional step to verify the necessity of many procedures. If you have one of these, the best thing is to ask that the prior authorization be sent in as "expedited" for a roughly 72 hour response. Otherwise, it can take 14 days or so for it to process.
If you would like as little red tape as possible, so less need for prior authorizations. You may want to consider staying with original Medicare as your primary, then adding a supplement/ medigap plan G for secondary coverage with a stand alone prescriptions drug plan. This way Medicare pays 80%, your supplemental plan G picks up the other 20% (after the part B deductible). As long as Medicare approves it, the supplemental plan must pay their part too. AND you have the flexibility to go to any doctor accepting Medicare across the country.
What's one Medicare decision that too many people regret later?
Answer: Many who don't take medications decide to wait to get prescription drug coverage when they start with Medicare. The problem they face later is, there is a penalty for not having credible prescription drug coverage after having medicare for 63 days. That penalty grows the longer you go without drug coverage, and you only feel it when you want to enroll in drug coverage again. That penalty is added on to every premium for the rest of your life, unless you have special circumstances like Low Income Subsidy's.
I'm turning 65 next month; what are the first steps I should take regarding Medicare enrollment?
Answer: First step would be meeting with a local licensed insurance agent. There are many variables involved and meeting a professional can help you create a personal plan while avoiding any unnecessary expenses.
I keep hearing about Medicare Part D changes for 2025. Will these actually lower what I pay for my prescriptions?
Answer: It depends, the Inflation Reduction Act of 2025 reduced the out of pocket maximum from $8000 to $2000 specifically for Medicare presciption coverage. So if you have expensive medications, this could absolutely save thousands of people significant money, also ensuring they don't need to stop taking vital medications due to cost.
Alternatively, in that transition, more cost was put on the insurance companies, which can effect members. After this change many Medicare Advantage plans added deductibles on prescriptions and had to decrease some of the added value benefits to make up the cost.
Overall, the most important things to keep in mind:
1) Review your prescription coverage EVERY October. They can change drastically.
2) While reviewing it, make sure your prescriptions are in the plan formulary. Otherwise, the cost for those prescription does not count toward your out of pocket maximum.
What do you like most about being a Medicare agent?
Answer: I view retiring and the introduction to Medicare to be like sailing. You are excited for the relaxation and experiences to come but there's a bit of a storm you need to cross first. I'm your experienced guide you can trust to know that while the waves are tossing the boat, it can be scary or stressful, but you know i'm going to get you through unscathed. My joy is to take the stress from my clients by listening, creating a step by step plan, and them knowing i'm just a call away.