Tonya Mowan, Medicare Insurance Agent

Answer: When it comes to Medicare, the options can feel overwhelming. Working with a Medicare agent can make the process much easier and more understandable. Here’s why:

1. A Medicare agent can help you understand all the options available and find a plan that best fits your unique healthcare needs and budget.

2. Medicare has a lot of rules and deadlines. An agent keeps you informed about important enrollment periods, helps you avoid costly mistakes, and ensures you’re not missing out on any benefits you’re entitled to.

3. Medicare agents work with a variety of insurance companies. They can show you plans from multiple providers, so you get to compare different options in one place, rather than having to do all the legwork yourself.

4. The Medicare system can be confusing with all its parts and plans. A Medicare agent can simplify things, explain the details clearly, and even assist with paperwork. This saves you time and reduces stress, so you can focus on other important things.

5. Your needs might change over time. Having a Medicare agent means you have someone to call when you need help adjusting your plan, understanding new benefits, or making changes during open enrollment.

6. Medicare agents don’t charge you for their services—they’re compensated by insurance carriers. That means you get expert help at no extra cost to you.

Working with a Medicare agent is about getting the peace of mind that you’re making the best decisions for your healthcare coverage without feeling overwhelmed. It’s like having a knowledgeable guide by your side to help you navigate the Medicare maze!

Answer: PPO plans give you more flexibility in choosing providers and seeking care outside the network, but at the cost of higher premiums and out-of-pocket expenses.

HMO plans are more restrictive in terms of providers and require referrals for specialists, but they typically offer lower costs, making them appealing for those who don’t mind the structure.

Ultimately, the choice comes down to how much flexibility you need and how much you're willing to pay for that freedom. If you prefer a lower cost and don’t mind staying within a network, an HMO could be the way to go. But if you value having a broader choice of doctors and hospitals, especially outside the plan’s network, a PPO might be a better fit.

Answer: I understand your concern about health disparities among minority seniors, and it’s an important issue. While I can’t engage in a political discussion on this topic, I can say that there are ongoing efforts to address health inequities in healthcare systems, including Medicare, through initiatives and programs designed to improve access to care for underserved communities. However, it’s always a conversation worth having about how we can work together to make healthcare more equitable for all seniors.

Answer: The Maximum Out-of-Pocket (MOOP) limit is the highest amount of money you will have to pay for covered healthcare services in a Medicare Advantage plan during a given year. Once you hit this limit, the plan will pay 100% of your covered medical expenses for the rest of the year. This includes deductibles, copayments, and coinsurance, but it does not include things like premiums or non-covered services (like cosmetic surgery or out-of-network care).

Let’s say someone’s Medicare Advantage plan has a $5,000 MOOP. If that person receives treatment for a chronic condition and their total out-of-pocket costs for things like doctor visits, tests, and hospital stays reach $4,800, they’ll only need to pay $200 more for the rest of the year. After that, the plan would cover all additional costs for the year, even if more treatments are needed.

The MOOP is a safety net for Medicare Advantage beneficiaries, protecting them from potentially high medical costs in any given year. It’s important to compare the MOOP limits of different plans when selecting coverage, as a higher premium plan with a lower MOOP might be better for someone with frequent healthcare needs, while a plan with a higher MOOP and lower premiums could suit someone who is generally healthy.

It’s a balancing act between premiums, MOOP, and overall healthcare needs that will vary depending on the individual!

Answer: Yes, Medicare can help cover costs if you're in a clinical trial for cancer treatment—even one based on your genetics.

Here’s how it works:

Medicare covers the regular medical costs you’d have even if you weren’t in the trial—like doctor visits, lab work, hospital stays, and scans.

The trial sponsor usually pays for the experimental treatment or drug being tested.

If genetic testing is part of the trial, Medicare might cover it if it’s needed for your care—otherwise, the sponsor often pays for that too.

To get coverage, the clinical trial and the clinic or hospital must be approved by Medicare and the government.

If you have a Medicare Advantage Plan, it still must cover clinical trials, but your costs (like copays or provider rules) might be a little different.

So, you likely won’t pay for the treatment being studied, but you may have some costs for regular care, like usual Medicare copays or coinsurance.

Answer: When you switched to a new Medicare Part D plan, the new plan has different rules for your medications. That’s why some of your drugs now need prior authorization—which means the plan wants your doctor to explain why you need the medication before they’ll pay for it.

No one may have warned you because:

Each plan has its own list of covered drugs and rules, and

These details aren't always clear unless someone checks your exact medications before you switch.

What you can do now:

Ask your doctor to send in the prior authorization.

Call your plan to see if there’s a similar drug that doesn’t need approval.

Next time you switch plans during an enrollment period, have someone review your full medication list first.

Answer: To compare medicines (generic and brand names) make a list of them. You can either check on Medicare.gov or speak with an agent to assist you with this process. Plans have different formularies and cost. It is advised to have a conversation with an agent and your doctor to look at the cost of medicines at your preferred pharmacy.

Answer: I enjoy assisting others in making the most informed decision for their circumstances and needs. It is challenging for some to understand the world of Medicare. There are a lot of options, it can be challenging for individuals to make the best decisions for their specific needs. I feel that I can assist them and help others find the plans and answers they are looking for. I always continue to educate myself on the changes and learn something new daily that may help others in this important decision.

Answer: Some of the important questions that sometimes are forgotten are the what ifs:

What happens if I'm in the hospital for weeks?

Will Medicare help if I need Rehab or a skilled nursing facility?

What if I need Home Health?

How will my plan handle high medication cost or specialty treatments?

There are several what ifs in this world and how someone views them could make an impact on one chooses a plan to address their concerns.

Answer: To qualify or OT an individual would need a referral from the doctor with a care plan. Medicare Part B helps cover OT when medically necessary. Understand that there may be out of pocket cost depending on your plan coverage such as the Part B deductible for the year and copays. This is where you need to talk to your plan carrier or agent to help you understand the coverage.

Answer: Assisted Living is an area that Original Medicare and Part B do not cover, however there may carriers that have some assistance or an individual can use savings, have a long-term care insurance coverage, or assistance form programs like Medicaid to help cover the cost.

Answer: There are many decisions to consider. However, you will still need to visit the Social Security office to complete signing up for Medicare regardless so that you do not have penalties.

Questions to consider are: you are continuing to work, do I have credible coverage and how do I find out?, not retiring just yet, how can I delay enrollment?, Why do I have to complete this now?

It is best to talk to an insurance agent that can assist you in the steps so that you have the best options for you. Each situation is different and your situation would need a conversation with someone so that you can understand the process for you.

Answer: The need for Critical illness coverage is sometimes needed for individuals that may have history of medical conditions that increase the possibility for something to occur.

Critical illness coverage provides a lump-sum payment if you're diagnosed with a serious condition like cancer, heart attack, or stroke. It helps cover extra expenses that Medicare might not, such as travel, home care, or lost income.

Each person has different needs and it is always best to speak with an agent to discuss your needs.

Answer: If you're over 65 and have a year where your income is unusually high—like from investments—you could face higher Medicare premiums due to IRMAA. You might be able to avoid this by reporting a life change, like retirement, to Social Security using Form SSA-44. Planning your income or spreading distributions over time can also help lower the risk. Always talk with a tax or financial advisor to see what works best for your situation.

Answer: The new $2,000 cap on out-of-pocket drug costs means people won’t have to pay more than that for their medications each year—making it much easier to afford essential prescriptions. The calculations are figured by CMS and there are many situations that an individual circumstance is where they do not spend that much. It is best to talk to an insurance agent and have them explain how your plan coverage works with the $2000 out-of-pocket for your situation.

Answer: When your husband dies, you do not receive both your full Social Security benefit and his. Instead, the Social Security Administration (SSA) will pay you the higher of the two benefits, not both.

If your Social Security benefit is less than your husband’s, you may qualify for survivor benefits based on his record. If your benefit is more than his, you will keep your own.

In the event that this occurs it is best to set an appointment with the SSA office and discuss your situation with the SSA representative. They will provide you with the list of documents that you will need to complete the process.