Tonya Mowan, Medicare Insurance Agent

Answer: Yes — it’s absolutely okay to meet with more than one Medicare agent while you’re getting started. Choosing Medicare coverage is an important decision, and it’s smart to talk with different people, ask questions, and compare explanations before you enroll. You’re not obligated to anyone until you actually sign up for a plan. The goal is to find an agent who takes the time to explain your options clearly and helps you feel comfortable and confident with your decision.

Answer: This can be confusing for many. In 2026, Original Medicare (Part A) has a $1736 inpatient hospital deduction per benefit period, which is paid once per hospital stay, not per day. Medicare Advantage plans replace how Medicare pays and instead use the daily hospital copays set by the carriers for the first few days of the stay. You would need to review the amount of the copay in your Summary of Benefits and Evidence of Coverage. Just understand that you will not pay both, it is either the Original Medicare amount or the Carrier copay amount for the hospital stay. To better understand specific questions and amounts it is recommended to speak with an agent to assist you to look at your options depending on health needs, budget, and how often hospital care is expected.

Answer: Medicare Advantage plans sometimes cover necessary eye surgeries. You would need to check with the carrier to see what is covered and what your cost sharing would be. It is going to be evaluated on necessity, location, if prior authorization is needed, and if the facility and surgeon is in network. Please contact your agent and carrier to see what your estimated cost will be.

Answer: Yes, If you lose your job health insurance you are eligible for a SEP (Special Enrollment Period). There are things to think about to make sure you are eligible: date of last day of work, age, Medicare eligible, and do you have Part A and Part B?

It is best to talk to a licensed agent to assist in fully understanding what you need to do and your available options.

Answer: No! The only reasons that you would lose your Original Medicare are things like not paying for your Part B premium (if not auto-deducted from your SSA check), losing your lawful residency in the U.S., or fraud/misuse of benefits.

Answer: Your needs are different from your neighbors. What works for one person may not work for someone else. It is important that you talk to a licensed agent to discover the best options for your situation and needs. This is the best way to make an informed decision on your specific options.

Answer: This is an option, however you may be directed to someone at a call center that may or may not be a licensed representative. Talking with a licensed agent is the best option to discover the best options for your coverage. Also this is a free charge to talk with licensed agents.

Answer: If your parents are 65 years of age they qualify for Medicare Part A and Part B. There are circumstances where they can delay enrollment, however it is important to talk with a licensed agent in your area to understand their options. For you to be their representative you would also have to be their Power of Attorney (POA).

Answer: During the AEP it is generally for individuals who switch from Original Medicare to a Medicare Advantage plan, one MA to another, dropping an MA plan to return to Original Medicare. It does not give guaranteed issue for a Medigap/Medicare Supplement plan. However there are times that an individual can leave an MA plan without the health questions. The initial Medigap Open Enrollment period is 6 months starting the month you're 65+ and enrolled in Part B, there are certain trial rights such as if it is your first time on an MA plan and decide to drop it within the first 12 months you can get a Medigap plan without underwriting, or if you have a Special Enrollment/guaranteed issue rights such as your MA plan leaves your service area, shut downs, or you move out of the service area. Each situation is dependent on your specific circumstances and it is advisable to contact a local agent to discuss your unique situation.

Answer: Your mom is smart to be concerned. Depending on her needs and wants for her coverage it will make the deciding factor. I would advise you to talk to a local licensed agent to go over her options to determine the pros and cons of changing coverage. Each person's needs are unique to their situation and what is best for her friends may not be a fit for her.

Answer: Medigap open enrollment period is the 6 months after you first enroll in Part B. It is hidden in the fine print unfortunately. However, you may qualify for a Special enrollment period where you might not need to undergo underwriting. To best determine this you would need to speak with a licensed agent in your area for assistance.

I would contact a local agent to inquire about your specific circumstances and see if there are options for you.

Answer: All Medicare Supplements are secondary insurance, however not all secondary insurance is a Medicare Supplement. Medicare supplements assist in cost that Original Medicare (Parts A & B) does not fully cover.

Medicare Secondary Insurance is a broad term which means that it will pay after Medicare does. Beside Medicare Supplements there are other coverages that individuals may have, such as: Employer or retiree group coverage, TRICARE For Life, Medicaid, Union Benefits, or COBRA.

It is best to talk with a licensed agent in your area to help you understand and explore the best options for your unique 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.

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: 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 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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!