Yasmery Vargas, Medicare Insurance Agent

Answer: What I enjoy most about being a Medicare agent is being able to provide Medicare recipients with the resources they need to make confident decisions on healthcare. With healthcare being one of the most important investments in life, I pride on eliminating the stress of transitioning into Medicare, giving power back to the seniors.

Answer: First and foremost, there are Medicare advantage plans with a premium and there are medicare advantage plans without a premium. Depending on the financial circumstance, when a recipient is responsible for paying their Medicare Part B premium with social security and may not qualify for state assistance, a 0.00 plan may be option to save some money. It is however, still subject to out-of-pocket costs and in some cases higher copays.

While it may seem like clever marketing, In order to be eligible for those plans you must be enrolled in Part A and Part B. When we look at Part B, in most cases it will cost 185.00/month which must be paid in order to enroll into any Medicare health plan including the Medicare advantage option that is 0.00.

Answer: Medicare advantage plans don't offer incentives to enroll. While there are a wide variety of plans out there, Health Insurance companies are just trying to encourage recipients to utilize their insurance to support good health Maintenance. All Medicare advantages are different and may cater to areas differently. All Medicare advantages are different and may offer additional benefits based on financial eligibility. Low-income recipients may be eligible for more benefits, than a recipient who is not classified as low-income.

Answer: When transitioning from a prescription drug plan to a different prescription drug plan, It is extremely important to sit down and review the formulary associated with the plan to make sure your medications are covered. It is also a good practice to consult with your doctors on what insurance they take and/or support for ease of transition. Look out for your Explanation of Benefits and Annual Notice of change later in the year. These documents are made to inform you about what you have and what's to be expected and if there are any changes for the new year. While this may not answer, why there was no warning, hopefully this will help avoid this from happening again.

Answer: Preventive care is not done on the bases of your medicare but on the quality of care from your doctor. A good doctor will provide good care and education to prevent progression of illness. Depending on your insurance and dietary needs set by your physiscian, you can utilize benefits like nutrition health as well as gym memberships to support a good healthy habit which are typically included with your coverage.

Answer: The dental and hearing benefits are underused. It caused many insurance companies to not only reduce benefits but also reduce other benefits like otc spend with restrictions.

Answer: Cancer screenings are typically covered as a preventative service. How often depends on the carrier. Refer to the explanation of benefits for specific details as the amount may be different per carrier.

Answer: You may be eligible for "extra help" through social security. It is a pharmaceutical program that helps cover the cost of your prescriptions. Refer to ssa.gov for more information.

You can also apply for state insurance with your local welfare office. Depending on state they can provide additional resources for local organizations that provide additional services based on eligibility.

Answer: Unfortunately, there are requirements that must be met and a physician must confirm it is medically necessary. In most cases the question is best asked directly to your Healthcare provider and/or your specific insurance company to see if there are accommodations for your particular situation.

Answer: Medicare is not a financial identity. Once you age in to Medicare you are subject to the guidelines set by Medicare/CMS.

Answer: The maximum out of pocket for prescription was reduced to $2000 a year. Once the $2000 has been met between you and your insurance company, your prescriptions would be covered. It will reset every year.

Answer: Stability is key. Just because there's an annual enrollment period doesn't mean you have to shop for a plan every year. I recommend sitting with an agent and having a formal review of your plan. Shop your plan and include all doctors specialist and medications so you don't have to change every year.

Answer: No. All plans are different. Don't drop employee coverage unless you have problems with it or premium is to high.

Answer: You always have the option of going on to medicare.gov and researching medications as well as plans based on need.

Answer: It does not change your eligibility or coverage. Depending on the plan will ultimately decide out of pocket expense.

Answer: You wouldn't chose a medicare advantage plan if you have employer retirement benefits or sucessfully enrolled into a medicare supplement.

Answer: Take advantage of the extra services provided to you by your plan. Most medicare advatage plans include some Nutrition education courses, as well as good health maintanance classes and gym membership. Take advantage of preventive services covered and get your annual check ups done as well.

Answer: Many things can factor in to the loss of a medicare advantage plan. Plan could move out of the service area or be discontinued, you could drop your Part b benefits with social security causing your medicare advantage plan to drop or the loss of medicaid status, depending on the plan, can cause your medicare advantage plan to drop. Anything that changes your eligibility for a plan can cause a medicare advantage plan to drop.

Answer: Have a list of doctors, medications, and durable medical equipment you use or need for daily living. Make it a point when you sit down with your agent, this list you made needs to be in network with your coverage. Don't settle for less.

Answer: Durable medical equipment or home modifications are covered, just NOT at 100%. Most durable medical equipment has a copay or coinsurance of 20% associated if I'm not mistaken.

Answer: There are 8 states currently that have the Medigap Birthday rule. The Medigap Birthday Rule allows you to move from one supplement plan to the next without underwriting. Each state has a unique set of rules and time frame. Look at the state's specific rules for exact time frame. Oregon, Idaho, Illinois, Oklahoma, California, Nevada, Maryland, Louisiana.

Answer: If you are on Original Medicare and receive inpatient care in a hospital for longer than 90 days, Medicare Part A gives you an extra 60 days. These are called lifetime reserve days because you can only use them once in your life.

Answer: The short answer is Yes. If you are outside of your enrollment window and attempt to enroll in a Medicare supplement, you will be subjected to the underwriting questions. Its best practice to enroll in a Medicare supplement plan when you are new to 65 as it is a guaranteed issue.

Answer: Medicare already provides a pretty significant list of preventative service covered under Medicare. If there is a plan you are looking at in specific, refer to your explanation of benefits for reference to specific preventative services you would like to see or know are covered.

Answer: The best time to look at Medicare options is when something medically changes, or you received a new medication. Your Medicare plan should work for you no matter what phase of life you are in.

Answer: Original medicare does not have a maximum out of pocket. Your bills will continue to come in as its used. Its not 100% medical protection. medicare supplement(medi gap) picks up what original medicare does not in terms of medical bills.

Answer: Yes. Medicare is a standard requirement after the age of 65. In most cases a penalty will be assessed for not having medicare.

Answer: The only reason you should work with a medicare agent is because of the quality of understanding you get from quality agent. A true agents purpose is to do right by the consumer. A true agent should be able to communicate the medicare Information clearly, communicate why its important and how it affects you annually. They should be able to not only be responsive but cater to finding a plan where you dont have to change your Dr's or hospitals to use the plan. They will provide you with an annual review to make sure you are always in the best place medically. A quality agent is strong enough to put commission aside to help there consumer.

Answer: Yes, However every situation is different. Refer to the benefits explanation to learn more about what they cover and how they cover those specific conditions.

Answer: Most preventative services and procedures are covered under Medicare. Refer to your benefits explanation guide for specifics. There are other preventative procedures that must be medically necessary to be covered.

Answer: Your doctor can choose the insurances they take. If the doctor opts out of taking an insurance, They will now by default become out of network with that insurance company as they do not have to bill them. It is always good to make sure that you are up to date with the insurances your doctor's office takes as they can change.

Answer: Cataract surgery is typically classified as a " medically necessary outpatient procedure." Because it is deemed a medically necessary procedure, it is covered under Medicare. Lenses, contacts, sunglasses, Bifocals used for vision improvement are usually subject to your vision benefit associated to your specific vision plan. I will add, there are critical illnesses in the eyes that exist where glasses are medically necessary. Refer to your benefits for specific.

Answer: Most agents are now equipped enough to do either virtual or in person visits. It is better to have a local agent that can do both, in case there are issues that may require paper forms.

Answer: Yes. There are various programs through your local state that help with premium costs and reducing prescription costs. In Pennsylvania a good example is PACE/PACENET or Extra Help through social security. M3P Payment plan is also available.

Answer: An insurance carrier is not going to give you the comparison your looking for. They can only offer you what's best for you based on what they have available. 9 times out of 10, If you call in to an insurance company after enrollment and the call center cannot answer your question over the phone, they may dispatch an agent to see you locally.

Answer: The biggest mistake seniors make is not educating themselves on Medicare prior to enrolling in Medicare. Not everything out there is as good as its painted out to be.

Answer: What I enjoy most about working with my Medicare clients is the satisfaction of being able to say that after every appointment I've solved a problem. I pride on showing my Medicare clients that I'm committed to making sure they are not only educated but thoroughly understand their insurance decision. It's important to understand some clients need more than just one phone call or more than one meeting and I pride on being there every step of the way.

Answer: You should go ahead and apply for your PART A and PART B with Social security. While your Medicare information comes in, I recommend attending a seminar or webinar to learn about medicare (Stay away from company specific seminars as you want the most information catered to original medicare so you don't get caught up in what one insurance covers over another) prepare a document for youreslf that highlights all your doctors and current prescriptions to make sure they are in network while shopping plans. After all that I recommend calling an insurance broker or meeting with one virtually to find out what your options are based on your current network of doctors and hospitals. Remember you don't have to change your doctors to satisfy an insurance plan, Find a plan that works for you that your doctors take.

Answer: If you miss your enrollment window for Part B or Part D you are subject to a penalty as it is standard for social security. There are programs that may help with the Part D penalty but it is crucial not to miss your enrollment periods to avoid the penalty.

Answer: Original Medicare can bleed you dry. When you have a chance review your options with a broker, it's never too late to review your Medicare options as a supplement could work or Medicare advantage could work.

Answer: When looking for an educational event on Medicare, it is important to look for those that express Medicare 101 or non-specific to any carrier in particular. This is crucial, if you would like to make sure that your Medicare advise remains neutral to Medicare and not carrier specific information. Medicare seminar should not feel like a sale.

Answer: Current Medicare Part D Annual Maximum out of pocket is $2000 for 2025. Once you meet the out of pocket maximum your medications are covered for the rest of the year.

Answer: It all depends on the consumers situation. There are many programs offered that consumers who are low income can take advantage of. These programs are not only beneficial but, in some cases, also saves consumers money on both medications and premium payments based on eligibility. The big thing to remember is that a Medicare advantage has upfront cost like copays and or premium payments depending on the plan. It may also include benefits like dental, vision and hearing. In that instance, Medicare advantages may save you money in the long run since your dental vision and hearing may be included in your plan/premium.

Answer: You will be subject to penalties. The big thing to do sooner rather then later is sign up for a Prescription Drug Plan. There are programs that you can apply for, such as Extra help if eligible. These programs open what is called a Special election period, for which you can move into a plan if eligible.

Answer: If you are in good health and enrolled in a plan that the premium may be too high, during the open enrollment period, you can apply for a different supplement plan. Key is that if you leave your supplement plan, you will be subject to underwriting on the new one. There are 2 key rating features when shopping a supplement plan based on premium. The first is rate based on 'attained age' which tends to be a steadier premium increased and 'community based' which tends to be assessed and increased based on the community premium increase.

Answer: You have 4 election periods permitted in the year. You can change during your Initial enrollment period, Annual enrollment period, open enrollment period, Special election period. The special election period can happen at any point in the year. It must be a qualifying life event. Included are new Medicaid eligibility, new extra help, New Pace/Pace net recipient, lost any of the things mentioned is also eligible for an SEP.

Answer: All plans are created dependent on the region they are in. Most insurance companies establish their plans based on a needs or risk basis assessed in the area. It is the reason why when relocating, you must have your plan re-evaluated as the network and providers can change or in worst case, An insurance company pulled a plan from being available in your area.

Answer: The income used to determine IRMAA is your Modified Adjusted Gross Income (MAGI) It is known as your AGI plus tax-exempt interest and dividends from municipal bonds from two years ago. Your 2023 Modified Adjusted Gross Income determine your IRMAA in 2025. For 2025, if your income is $106,000 or less, your part B premium assessed would be $185.00 for 2025. If you make greater than 106,000 but less, then 133,000 Your IRMAA goes up by 74.00 making your part B premium 259.00. Refer to your social security award letter for an explanation to part B premium increase.

Answer: It is important to find a knowledgeable individual willing to not only educate you on Medicare but walk you through the importance of understanding Medicare before making a decision. Finding a Medicare expert that is a broker is crucial because you know that they may not be captive to any companies giving the flexibility to show you options. Most of us have systems equipped to do company comparisons.

Answer: Some companies offer Support classes and, in some cases, treatment. Refer to your benefits guide to see specific details.

Answer: The most common misconceptions people have about Medicare is that everyone can get it. You must meet the requirements in order to enroll in Medicare.