Q&A with Taryn Mott

Taryn Mott, Director of Provider Referral Operations and Training and long-time licensed insurance agent, answers your questions about all things Medicare.

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Taryn’s corner

Dear Taryn,
Do prescription co-pays go towards the Maximum Out Of Pocket (MOOP) on Medicare advantage plans?

Dear Jim,
No. Only medical copays, parts A and B, go towards the MOOP. The only exception is Part B drugs such as chemotherapy. Part B drugs are administered in the physician’s office and generally have a 20% cost share which goes towards the Maximum Out Of Pocket.

Dear Taryn,
How do you decide which plan is best for your client?

Dear Sarah,
I start with prescription drugs by looking up their medications on medicare.gov. Then I narrow the search by how many Rxs are covered. After seeing who has the best drug coverage, I narrow the plans down by looking at the network and their list of physicians. This allows me to pick the best benefits based on the individual’s needs.

Dear Taryn,
How do you market yourself during Open Enrollment Period? (OEP 1/1-3/31)

Dear MacKenzie,
CMS states we cannot market a one-time change during OEP. OEP is designed for beneficiaries who are not happy with their selection to make a one-time change. The one-time change may be used to switch to a new MAPD plan or back to Original Medicare with a PDP. With that said, I do not market to OEP. However, I do Market Chronic Special Needs Plans, Dual Plans, and Turning 65. CSNPS can be enrolled into all year. Duals can change plans every quarter during the first 3 quarters, and those aging into Medicare may select a plan throughout the year as well. They have the 3 months before their 65th birthday, the month of their birthday, and 3 months after. There is also opportunity to enroll those who are losing their group coverage due to retirement. When I Market to these beneficiaries, naturally somebody who would like to make a one-time change during OEP will contact me.