Melonie Wood, Medicare Insurance Agent

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.

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

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

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: 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: 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: 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: 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: With all the 2025 Medicare Plans & Prescription Drug Plans, once a person reaches $2,000 in cost including 25% of the drug's cost towards the $2,000, there are no more costs to the member, therefore, no more "donut hole."

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: 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: Most carriers have a $0 cost for a tier 1 & 2 drug; many carriers will mail a 90-day supply at $0 cost 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: 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: As technology continues to advance, it will always be a valuable tool, such as submitting enrollments online, checking provider networks, formularies...

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

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 pros & cons of the plans & help the member make the best choice for them.

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: It is difficult to answer this question, 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/copays/coinsurance with Medicare.

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, known as PDP OR a Medicare Advantage Plan, known as MAPD, you will incur a late enrollment penalty that you will pay for the remainder of your life.

Answer: Medicare Advantage changes every year depending on the carriers, star ratings, formularies for medications, provider networks, hospital networks and a host of other benefits. Since Medicare is part of Social Security, depending on what the administration does, will affect Medicare plans.

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: 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/copays/any costs/benefits.

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

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

Answer: In my opinion, Medicare Advantage is a great alternative to Original 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: 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: 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 navigate the confusing world of getting her Medicaid reinstated.

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

Answer: Once a person has been on disability for 24 months, Social Security assigns you Medicare; Social 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: 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 copay/$0 doctor visit/$0 for procedures/$0 hospital stays?

With Medicare Supplement, 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: 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: Most Medicare Advantage plans DO have eye/dental/OTC/travel/...

Original Medicare does not include vision/dental/OTC.

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

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: 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: 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 on the plan.

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

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: 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 Part B premium. In 2025, it is $185.00.

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

Answer: The penalties are based on WHEN a person signed up for Part B/D. This is called the late enrollment penalty.

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

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, outpatient, preventive services.

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: I have a special database that I am able to put a member's medication in which will give us the costs. In 2025, there is no coverage gap.

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

Answer: Depends 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: 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: 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.