Tammy Stoner, Medicare Insurance Broker

Answer: Choosing the wrong plan at the time of open enrollment can cause financial distress. It is important to find a qualified agent to assist with all the details of Medicare and available plans. While getting information from family or friends can be helpful, not every plan is the right fit for every person.

Answer: A Medicare broker is independent and contracted with multiple companies that provide coverage in conjunction with Medicare. For example, Medicare Advantage plans and Medicare Supplement plans.

A Medicare agent would work directly for Medicare.

Answer: Medicare Advantage plans must provide at least the same benefit coverage as original Medicare.

If Medicare covers a preventative screening, then the Advantage plan must allow the same.

Answer: A CMS (Centers for Medicare and Medicaid Services) form SOA Scope of appointment is required for an agent/broker to discuss Medicare approved plans like Prescription drug plans (part D) or Medicare Advantage plans (part C). This form must be signed 48 hours prior to discussion. The exceptions being a "walk in" or "inbound" call. Or within 4 days of a valid enrollment period.

Call centers are held to the same rules and cannot give specific details to plans in the area without a SOA.

Answer: Historically, Medicare will not cover experimental treatments.

Medicare may cover clinical trials, labs, Dr. visits, and costs associated with the clinical trial. Medicare may not cover additional costs outside of the clinical trial. It is suggested that pre-approval may be best practice before beginning some clinical trials.

Answer: The "Medicare agent" calls are frustrating for both members and agents.

CMS rules on marketing allow members of a plan to be contacted and offered other benefits.

It is true there may be a plan specific benefit that offers groceries, however, there are often qualifying conditions that must be met to be eligible. Your trusted agent knows what plans are available and what a beneficiary would qualify for.

You may request to be on a Do Not Call list

Answer: Medicare will cover most medically necessary lenses, but not premium or advanced lenses to enhance vision.

While this is frustrating, there are options to assist with coverage. One may choose to enroll in an advantage plan that offers additional coverage for vision. Also, a supplemental vision plan may help mitigate the additional cost for lenses, frames, or contacts.

Answer: An imbalance exists with prescription drugs due to the availability of generics to brand name prescriptions.

With more and more drugs being manufactured in the United States, and the expiration of patents, there is a possibility that drug prices will decrease.

That being said, the inflation reduction act of 2022, capped the cost of Medicare prescriptions to $2000 annually. This act does not lower the cost of the drug but caps the out-of-pocket cost to help with budgeting for expensive medications.

Answer: There are many factors that go into choosing a Medicare plan. Each and every person that I meet with has different health needs and budgets.

Original Medicare has gaps and holes in coverage that are the responsibility of the patient. Medicare will not cover enhanced benefits like Dental, Vision, or Hearing.

A Medicare advantage plan may have enhanced benefits with 0-low monthly costs, but can become costly if there is a constant medical need for services.

A Medicare Supplement will have a monthly premium (can increase with age) in addition to Medicare but offers coverage in excess of original Medicare.

Answer: The changes to Medicare part D for 2025 are that there is a cap to how much a person would spend for medications. It does not lower the cost of Medications

If a person has expected costs over $2000 for medications, they are encouraged to enroll in their plans PPP prescription payment plan. The plan will take over billing and budget over the year the cost of medications to $2000. You will no longer pay the pharmacy but send a monthly payment in to the plan.

Answer: Medicare is for those (and or spouse) that are turning 65 that have paid Medicare taxes for usually 10 yrs, or with qualifying disabilities, end stage renal failure, or ALS (amyotrophic lateral sclerosis) before that age.

Once it has been determined by Social Security that an individual can no longer work do to disability, then that person could qualify for SSDI. Once this person has received benefits for 2 years, they become eligible for Medicare.

Answer: Depending on the plan, time of year, and the health condition it could possible to change plans.

My expertise can help you make the right decision for your continued health care.

If you are turning 65 or this is your first time on Medicare part B, it is imperative that you speak with a licensed agent to help you make the right decision regarding your health coverage.

Answer: Yes, moving to a new state has several requirements with Medicare. First, notify Social Security of the move. The Social Security office will notify Medicare.

If you have an advantage plan in a previous state, you may not be able to use it in your new location. If you have a Medicare supplement and prescription drug plan, you will need to contact each to notify of the move. You may need a different part D.

The move may benefit you in finding a different health plan that may not have been available in the previous state.

Contact me up to 2 months prior to the move or within 2 months after to find out what is available.

Answer: Typically, prescription costs are similar between Medicare Advantage and Medicare part D.

Formulary listings (tiers) are often mirrored.

Some Advantage plans may have lower costs on prescriptions due to being all inclusive and with lower co-pays. The other benefit may be no additional cost for a stand alone part D plan.

I can help you navigate the differences to choose the best plan for you.

Answer: Medicare doesn't care if you can see, hear, or chew.

Medicare will not cover dental that is not medically necessary, like fillings, crowns, or dentures.

Medicare does not cover contacts or eyeglasses beyond the first basic pair after cataract surgery.

Medicare will not cover hearing aids.

Medicare will not pay for experimental treatments, routine physical exams, foot treatment, or cosmetic services.

These items may have coverage inside an Advantage plan, but an advantage plan may not be the best fit if there is a heavy medical need.

Allow me to help you make the right choice for your health coverage.

Answer: Enroll in the prescription payment plan through your RX plan to budget the costs of your medicine.

You will be capped at $2000 per year and can enroll at any time.

You may have an option to submit to the manufacturer of the drug for discounts or grants. Often times this will be based off income or assets.

Answer: If enrolled in a Medicare Advantage plan, contact your member services. If the drug is not on formulary, then the Dr. will need to submit a formulary exception.

If you have a stand alone drug plan, contact them directly. Again, a formulary exception may be required.

Answer: Every client I meet is treated as though their Medicare is a complex issue.

Over the last 10 years, I have helped 100's of clients find the right plan at the right price for the right reasons. Some are easy decisions, others are more difficult, but each is very important to ensure the best coverage available.

Answer: Yes, Medicare will now cover the shingles vaccine.

The Inflation Reduction Act 2022 removed the high co-pays associated with the shingles vaccine.

Answer: Do not be afraid to report or call on a billing error.

Most billing errors can be corrected with a simple phone call to the billing department. Other instances may need assistance by a Medicare representative or your insurance agent.

I am happy to help my clients fix errors and get the most of the benefits.

Answer: Depending on the advantage plan, cataract surgery may have an outpatient co-pay. Some plans may offer additional benefits to assist with glasses after surgery.

Medicare with a supplement would be covered if the annual deductible for part B is met.

Medicare may pay for the first basic pair of glasses after surgery.

Answer: It is not required to enroll in Medicare if an individual is still working and has credible health coverage.

Depending on the situation, some companies may require enrollment to part B. If an employee sponsored plan has high costs and deductibles, it may be more cost effective to enroll in Medicare vs employer plan.

Be cautious. If you do not enroll when first eligible, you will be assessed a LEP late enrollment penalty.

A comprehensive review with me will help you determine which option is best.