Darlene Cerezo Swaffar, Medicare Insurance Broker

Answer: If you are collecting Social Security Income, enrolling in Medicare will happen automatically and you will receive your Medicare in the mail 3 months before the month of your birthday. If you are not collecting Social Security, then I would suggest logging into ssa.gov 4 months before your birthday and applying for Medicare online. You will want to enroll in both Part A Hospital and Part B Medical.

Answer: It really depends on where you live and what Medicare Insurance options are being offered. I would suggest going on the medicare.gov website and search for the plans and benefits available in your zip code. Keep in mind that original Medicare does not provide prescription drug coverage or extra benefits such as dental, vision or hearing. If you stay with Original Medicare as your primary insurance, you will have to consider adding those benefits for an additional premium. Medicare does require you to have Part D Prescription Drug coverage and delaying the enrollment may incur a penalty in the future.

Answer: Unfortunately Medicare does not cover in home care for Dementia patients. Homecare as defined by Medicare is post hospital stay of a nurse or physical therapist visit to your home.

Medicare does not provide respite care such as an aide. Long Term Care insurance would provide this benefit.

Answer: Delaying Part D prescription drug plan is the most common penalty I see as an agent. I find that many beneficiaries are not aware of potential penalties for delaying Part D drug coverage. Most say they do not take medications so why do they need a drug plan? There are many opportunities for a low premium to zero premium plans available.

Answer: There is an IRMMA incremental adjustment for Part B and Part D monthly premium based on the Medicare Beneficiary's income. The lookback period to determine the income is 2 years. For instance to determine your premium for 2025, Social Security will look at your 2023 yearly income.

Answer: Using in network providers usually avoids surprise bills. If you use an out of network provider, you may incur Medicare allowable excess charges which can be up to 15% above the Medicare contracted negotiated rate.

Answer: Delaying Part B Medicare and Part D prescription drug costs will incur a penalty when you do apply for it at a future date. The penalties will be in place for the rest of your life once incurred. Having credible medical and prescription coverage from an employer group insurance plan can eliminate the potential penalty. You can find more details in the Medicare and You Handbook, and the medicare.gov website.

Answer: Call Social Security and ask to apply for "Extra Help for Medicare prescription drug" costs. Based on your income, Social Security can determine if you qualify for extra help. The process will take 2-4 weeks. If you qualify then your copays for medications will be less.

Answer: You can check with the State Pharmaceutical Assistance program. Many Medicare Primary Doctors are familiar with how to apply for these benefits for you regarding high cost brand name drugs.

Answer: There is not enough information provided to provide you with an accurate answer. Do you have a PPO Plan? Are you visiting doctors out of network? If it's and out of network doctor, are they charging you for Medicare allowed excess charges? Are there services you are having done that require a co-pay and your benefits were not properly explained to you? Do you have a copy of your Summary of Benefits with you that you can go over and match the medical service to the co-pay?

Answer: If you are collecting social security, then you will automatically receive your Medicare Card in the mail mostly likely 3 months before you turned 65. You must have both Medicare Part A Hospital and Part B Medical effective, before exploring your Medicare Health Insurance options.

Answer: All Medicare Agents must be Certified by either AHIP or NAIB Certification, as well as, for each Medicare Insurance Carrier they represent. Many of the Carriers provide a digital Certification Certificate that the Agent can download and save. Another question you can ask is how long they have been practicing in this field, and if they work part time or full time. Full Time agents in the field for more than 5+ years offers valuable knowledge and experience. Many agents like myself have been practicing full time for 15 years.

Answer: The quick answer is no. Rehab is 24 hour care post a hospital stay or surgery. If you are delaying it, chances are you do not need a "rehab stay."

Answer: Original Medicare does not provide you with Part D Prescription Drug coverage, extra benefits or out of pocket maximum which can protect how much you spend in a year on copays and deductibles. A Medicare Advantage Plan's focus is to provide you those extra benefits and protections.

Answer: This is a common question for which there isn't an easy answer. It is based on what is available to you in your zip code, your eligibility, your budget, If you have doctors that you want to keep, your medications and more. It is best to meet with a Medicare Licensed Agent who will go through a fact-finding process to find out what is important to you. Then they will match available plans to your needs.

Answer: Yes, some telemarketers and tv commercials feel almost predatory in nature. I have had many of my clients share the same sentiments with me.

The guidelines are changing for 2026. If there is a Medicare Insurance Plan offering a food/utility spending card, it will require for you to have a chronic condition to qualify for that benefit. The chronic condition will be determined by the plan evaluating past claims history.

The same rules apply to chronic condition plans or dual eligible plans that offer this benefit.

Answer: It depends on how your doctor coded the physical. If it was coded as preventive, then it should be a zero co-pay. If the physical was billed as diagnostic to follow up on a specific condition, then there can be a co-pay.

Answer: We are contracted with many insurance carriers and provide an unbiased review of your specific needs. Our goal is to help make the process easy and find the best plan choice for you. Another benefit is that the Medicare Agent will be available throughout the year to answer questions, look up doctors, guide you on your benefits and help you with any changes in the future. It's a relationship built over time with trust and support.

Answer: You do not need to complete a form at this time. You can delay your Part B coverage as long as you have credible coverage in its place such as group insurance through an employer. When that coverage ends, you will be eligible for a Special Enrollment Period to sign up for Part B.