Tammy Monjaras, Medicare Insurance Agent

Answer: Most people do qualify but not everyone qualifies for Medicare at the age of 65. There is a criteria that is in place for example they must be an American citizen or a lawful immigrant who has lived in the US for at least 5 years.

Answer: The Medicare Part B premium uses a two-year look back to determine your premium or IRMA(Income-Related Monthly Adjustment Amount. The premium is based on a sliding scale. As your income increases or decreases, your premiums will be based on the two-year look-back. However, there is an appeal process available. If you experience a life-changing event such as retirement, marriage/divorce, or loss of income that causes your income to drop significantly from two years ago, you can file an appeal with Social Security using Medicare Form SSA-44. For more information, check out the Medicare Cost Overview for a rate table.

Hope this information helps!

Answer: If you have a Medicare Advantage plan then no you cannot use your original red, white and blue card at a primary care physician’s office. You must use your Medicare Advantage plan. It is your primary insurance.

Answer: Sorry, unless there is a special situation called SEP (Special Enrollment Periods) carriers will not accept an application for a Supplement/ Medigap plan without answering health questions. Work with a Medicare agent to see if you qualify for an SEP.

Answer: We are enter the annual enrollment period (AEP) October 15-December 7. Each Medicare eligible beneficiaries can apply to move plans that will start on January 1. This applies to Medicare Supplement plans, Medicare Advantage plans and Part D drug plans.

OEP- Open Enrollment Period only applies to Medicare Advantage beneficiaries. OEP starts January 1-March31.

SEP- Special Enrollment Period is for special circumstances for enrollment such as moving, losing group insurance coverage etc.

Answer: Medicare fraud does exist. Never give out your Medicare number to someone you don’t know or trust- especially over the phone. Find an agent to work with to advise you on plans that best suite your needs and get to know and trust them.

Answer: The biggest disadvantage to Medicare Advantage plans is that you have to keep your care in a network.,even with the flexibility of a PPO the cost are normally lower if you step outside of network.

Answer: Many Medicare Advantage plans require pre authorization before surgery. It doesn’t mean you have a bad plan.

Answer: Medicare does not pay for smartwatch devices. Your doctor would have to prescribe some other medical device to monitor your heart rhythm that Medicare approves.

Answer: The Medigap plan you applied for is held by a private insurance company and is not part of Medicare. Medicare covers 80 percent of your medical expenses. The medigap plans would cover the remaining 20 percent. As a private insurance company they have the right of refusal due to your health history if you are not eligible for a guarantees coverage period. Normally the guaranteed coverage period is when you initially sign up for Part B or a few other special enrollment periods.

Answer: Technically, there is no longer a “donut hole”. There is a maximum out of pocket of $2000 each year for prescription medication. Call your insurance company to find out where you are in prescription spending and find out what your options are.

Answer: Sure- MOOP- maximum out of pocket spending for medical only. It does not include drugs, dental or vision.

Answer: Hi there! You can enroll in Medicare 3 months before your 65th birthday month, your actual birthday month and three months after. There are always special circumstances if you miss your enrollment period find a local agent to help you navigate Medicare. You may qualify for a special enrollment program.

Answer: A licensed Medicare agent is your best source for answers. I believe a local agent is even better. They know the networks and the carriers. Their knowledge and experience will help you make better decisions.

Answer: If you have origianal Medicare only, you will have to meet the Part A deductable.

Medicare covers semi-private rooms, meals, general nusing, drugs and other hospital serives and supplies.Part B generally covers 80% of the Medicare-approved amount for doctors services you get while in the hospital. Visit Medicare.gov for 2025 amounts .

Answer: I like being a Medicare agent because I get to meet great people and help them understand the choices available to them when choosing a Medicare plan. Medicare can be confusing, I am here to help.