Melonie Wood, Medicare Insurance Agent

Answer: I work with all types of Medicare members/ Low Income/ Rural/ members on disability & truly believe the key is to educate my members, answer their questions , help them navigate the very complex world of Medicare, help them get on Medicaid IF they qualify, help them find affordable solutions for their medications, Medicare Plans & be a resource for Medicare Members. I am considered an expert in this area.

I am knowledgeable, friendly, honest, experienced, dependable, reliable & my members love working with me.

I meet my clients at their home where they feel secure in sharing their questions & concerns.

Answer: I have put together an easy to read Medicare Presentation that I share with all members. This helps answer many questions, explains the difference between Medicare Advantage & Medicare Supplements/ Part D Drug coverage. It shows How Medicare rates all the plans from 1 to 5 stars. The difference between HMO & PPO, and I also have a leave behind piece for members

Answer: Depend on where the member lives, what they are looking for, price, carrier & if the members are looking for ancillary benefits ( dental, vision, OTC, food.....)

Answer: In most case Medicare Supplements are underwritten health questions, so in moving from one plan to another, in most cases the answer is yes

Answer: I carefully review everyone's plan including giving the members an enrollment book that clearly outlines costs for providers/ facilities/ medications, so my members do not have "surprise" costs

Answer: I have a special database that I am able to put a members medication in which will give us the costs . 2025 there is no coverage gap.

Answer: Once a member reaches the $2000 out of pocket cost there is no more cost to the member. If the member is paying $0 for their medication, there is still a retail cost. 25% is counted towards the $2000 out of pocket maximum

Answer: A member will have only Part A IF they are still working & covered on their employer plan. Once a person leaves their employer plan, they must apply for part B which covers doctors, medical equipment, out patient, preventive services

Answer: Depends on why you did not take Medicare. If a person has employer insurance, which is considered "credible coverage" then when a member leaves the employer plan, they need to contact social security & sign up up for Medicare. This must be completed within 63 days of ending the employer plan

Answer: The penalties are based on WHEN a person signed up for Part B/D this is called Late Enrollment Penalty

Answer: I usually recommend a PPO as you can go to an out of net work provider, sometimes at a higher costs depending on the plan, more providers take PPO. PPO is Preferred Provider. HMO requires referrals, and usually have very narrow networks that you MUST stay in, if you go out of network, YOU pay

Answer: They need to look at the cost. If an employer plan is cheaper, I always recommend they stay on the employer plan. With Medicare, you have a part B that you pay for, Social security will take your Part B premium out of your social security. If you do not take social security yet, you will be billed for your apart B premium. In 2025 is is $185.00

Answer: No, If you are still on an employer plan, otherwise a person turning 65 MUST sign up for Medicare. You can sign up 3 months before, the month of your birthday & 3 months after. You have 7 months to sign up for Medicare

Answer: Medicare Part B, or medical insurance, covers medically necessary services like doctor's visits, outpatient care, and certain preventive services

Answer: It really isn't since original Medicare only pays 80%, the member is responsible for 20% of everything which can become costly. and you have to PAY for Part D every month & pay for your medication. A Medicare Advantage Plan includes drug coverage with Tiers 1 & 2 usually $0 costs , depending g on the plan

Answer: I leave it up to the member where they would like for me to meet with them, usually at their home, or a convenient place they are comfortable with

Answer: If a member likes their plan, they can find out where else they can go for services, they also can change their plan, and possibly get an exception to go to their hospital

Answer: Most people on dialysys are covered on their plan. A member on Medicaid-Medicare, all cost would be covered, depending on their plan & cost share

Answer: Most Medicare Advantage Plans DO have eye/dental/OTC/Travel/.... Orginal Medicare does not include vision/dental/OTC

Answer: The only imbalance that occurs with a Medicare Advantage is IF their medications are not on that carrier's formulary. Otherwise many of the members medications will be covered and typically are $0 costs for a Tier 1 & Tier 2 medication

Answer: Both Medicare Supplement Plans & Medicare Advantage are good plans for members depending on many factors: Do you Travel a lot out of state? Are costs a concern ? Do you want to be able to go to any provider ? Do you want to pay up front monthly with $0 co pay/$0 doctor visit/$0 for procedures/ $0 hospital stays/......

With Medicare Supplenet you pay monthly whether you go to the doctor or not, these plans can be expensive/ are medically underwritten & you must buy a Part D also. Medicare Advantage includes drug coverage/ caps your costs, are usually $0 monthly premium/ $ for your doctor unless a specialist

Answer: Once a person has been on disability for 24 months, social security assigns you Medicare, socoal security will hold back 6 months to see if the disability will resolve itself. There is no age requirement IF a person is on disability

Answer: Not being educated on the many different plans/ benefits/ physician networks/ HMO vs PPO/ additional benefits/ co pays/ Medicare start ratings for Medicare Advantage/ not knowing you must have PArt D/ ...

Answer: I had a sweet older lady who had lost her Medicaid-Medicare & was not aware that she no longer qualified for her current Dual Eligible plan. I spent several hours on the phone with her & Medicaid helping her naviagte the confusing world of getting her Medicaid reinstated.

Answer: I always recommend to clients to meet with someone in person as they are right there with the member, can answer questions, build a rapport & usually have free promotional stuff to give them

Answer: In my opinion, Medicare Advantage is a great alternative to Orginal Medicare & Part D, as Medicare Advantage is a "Pay as you go" you only pay IF you use your plan. Most plans have a cap with co-pays, Medicare Advantage includes many additional benefits such as OTC/Dental?Vision/Transportation/...

Answer: On Prescription Plans Part D, all depends on the Part D plan, formulary/ what Tiers the medications fall in.

Answer: on Medicare Advantage Plans there is NO underwriting, so regardless of the health of someone, everyone can get a Medicare Advantage Plan is long is their Part A & B are in effect. Medicare Supplements require medical under writing and based on results could require much higher monthly premiums

Answer: The worst mistake, which I see often is incorrect information. Fraud agents telling members they can get $3000 for food/ Not meeting with someone in person to learn what Medicare is, what Medicare can do for someone, review plans in your zip code, understand , compare the plans & make the best choice for you.

Answer: By making a fast decision without checking IF their doctor is in network, depending on someone else for advice, signing up without truly understanding what their plan is/co pays/ any costs/ benefits

Answer: Someone who is retiring and has Medicare Part A & is still on employer insurance will need to have their employer obtain the employee's Part B. Otherwise they will be unable to get any kind of Medicare Advantage OR Medicare Supplement

Answer: Medicare Advantage changes every year depending on the carriers, star ratings, formularies for medications, provider's networks, Hospital networks/ and a hosts of other benefits. Since Medicare is part of Social Security, depending on what the administration does, will effect Medicare plans

Answer: First check with Social Security and make sure you are issued your red, white & blue Medicare Card. This is original Medicare. Next you will need to sign up for a Prescription Drug Plan OR Medicare Advantage Plan. IF you do not sign up for a Prescription Drug Plan, know as PDP OR a Medicare Advantage Plan, known as MAPD, you will incur a late enrollment penalty that you will pay for the reminder of your life

Answer: It is difficult to answer this questions as there is NO information on what type of paperwork you are having difficulty with. A good agent , like myself can help a member navigate the challenges of bills/ co pay/ co insurances with Medicare

Answer: Medicare gives everyone 7 months to enroll in a plan. 3 Months before your 65th birthday, the month of & 3 months after. Should a member miss the 7 months, they need to wait until Annual Enrollment (AEP) to sign up & may have a penalty unless the person has an employer plan

Answer: PLEASE MEET WITH A LICENSED AGENT who is able to write several carriers, not just have an appointment with ONE Medicare Carrier. This way the agent can discuss the pro's & con's of the plans & help the member make the best choice for them

Answer: Unscrupulous agents will not check networks providers and tell members their doctor takes the plan. This is why it is so important to meet with an agent in person.

Answer: Depending on the plan, if it's an HMO or PPO, many PPO plans DO cover acupuncture. not many cover alternative options, this is why you need to look at each plan carefully

Answer: As technology continues to advance, it will always be a valuable tool, such as submitting enrollments on line, checking provider networks, formularies, ......

Answer: Many plans already cover the additional benefits of Dental/Hearing/Vision at no additional costs. The amounts covered vary depending on the area and the specific plan

Answer: Most carriers have a $0 cost for a tier 1 & 2 drug, many carriers will mail a 90 day supply at 0 costs for tier 1 & 2. I also advise members to get a GoodRx Card as well, and if someone is on an expensive drug, tier 3 or 4, most pharmaceutical companies have a patient assist program to help with expensive medications

Answer: When someone is on disability through Social Security, and the person has been on disability 24 months, they become eligible for Medicare, Social Security will hold back another 6 months in the event the disability is resolved, so after a total of 30 months, the person will then acquire Medicare regardless of age.

Answer: This is why it is so important to actually meet with an agent in person who has several carriers they write for. The agent can put the members in the carrier's formulary to make sure the medication is covered

Answer: With all the 2025 Medicare Plans & Prescription Drug Plans, once a person reaches $2000 in cost including 25% of the drugs cost towards the $2000, there is no more costs to the member, therefore, no more "donut hole"

Answer: Yes, bone density tests are considered a preventive service under Medicare Part B, and are covered once every 24 months (or more often if medically necessary) if you meet certain criteria,

Answer: The "donut hole" (or coverage gap) in Medicare Part D prescription drug coverage is being eliminated in 2025, meaning once your out-of-pocket costs reach $2,000, you won't pay anything for covered medications for the rest of the year.

Answer: Whether you can keep your current doctors with a Medicare Advantage plan depends on whether they participate in the plan's network and if you choose a plan that allows you to see out-of-network doctors (PPO).

Answer: If you re on disability for 24 months, you qualify for disability. Medicare will hold back 6 months to see if the disability resolves itself. After 30 months a person on disability will get a Medicare Card

Answer: Most Virtual visits are available at $0 costs for the member, depending on the Medicare Plan. If Telehealth is available, that benefit will be listed in the Evidence of Coverage

Answer: Your Medicare Advantage will cover cataract surgery, most Medicare Advantage plans will have an outpatient co pay for the facility, and a co pay for your surgeon. You will need to talk to your agent OR the carrier to find out yur co pays, what your plan will pay & additional benefits

Answer: If a person misses the Open Enrollment time frame that runs January 1st through March 31, then depending on where the member lives, they may be able to use a disaster SEP to change plans, if they are a veteran, they may be able to use the Veterans SEP; If they move, they can use the Move SEP and finally can call Medicare directly.

Answer: Regardless of what type of Medicare Plan you have/ Medicare Supplement/ Medicare Advantage/ Original Medicare, all cover Hospice Care

Answer: Insurance plans, including Medicare, typically cover the cost of standard monofocal intraocular lenses (IOLs) for cataract surgery, but they often don't cover the extra cost of more advanced lens options like toric, multifocal, or extended depth-of-focus (EDOF) lenses. This is because these advanced lenses offer additional features beyond basic vision correction and are considered "premium" upgrades.

Answer: HMO stands for Health Maintenance Organization and is a type of plan that requires you to see doctors in its network. If you see a doctor outside the network, you will be responsible for all of the costs. The only exceptions to this are medically necessary emergency or urgent care services.

Answer: IRMAA (Income-Related Monthly Adjustment Amount) affects Medicare Part B and Part D premiums for those with higher incomes. To find out if it applies to you, check your Medicare notice or the Social Security Administration (SSA) website. IRMAA is calculated based on your Modified Adjusted Gross Income (MAGI) from two years prior, and the SSA sends you a notice if you're subject to it.

Answer: Even with Medicare, specialist visits can cost money due to deductibles, coinsurance, and potential charges from non-participating providers. Medicare typically covers 80% of the Medicare-approved amount for most services, meaning you'll need to pay the remaining 20% (coinsurance) after meeting your deductible. Additionally, if your specialist doesn't accept Medicare assignment, they may charge you more than the Medicare-approved amount.

Answer: A Medigap policy might be a good fit for you if you want to reduce your out-of-pocket costs for Original Medicare. The best time to buy one is during your Medigap Open Enrollment Period, which is the six-month period starting on the first day of the month you turn 65 and enroll in Part B.