Elenys Peraza, Medicare Insurance Agent

Answer: The Extra Help program, also known as the Low-Income Subsidy (LIS), is a federal initiative designed to assist Medicare beneficiaries with limited income and resources in paying for their Part D prescription drug costs. If you qualify, this program can significantly reduce or even eliminate your monthly premiums, annual deductibles, and co-payments for covered medications. Eligibility is generally based on your annual income and the value of your assets (like savings and investments), though your primary home and car are typically excluded from this calculation. You can apply directly through the Social Security Administration to see if you qualify for these savings.

Answer: Survivor Benefits

- If your husband passes away and you were married for at least 9 months, you may qualify for survivor benefits.

- You can receive up to 100% of his benefit if you claim at your full retirement age (FRA).

- If you claim earlier (as early as age 60), the amount will be reduced.

You Can’t Collect Both Full Benefits

- Social Security will pay one benefit at a time—either your own retirement benefit or your survivor benefit, whichever is higher.

- If your own benefit is lower than your husband’s, you can switch to his survivor benefit.

- If your benefit is higher, you’ll continue receiving yours, and won’t receive his in addition.

Answer: 5 Ways to Get Peace of Mind with Medicare

1. Know Your Health Needs—Not Just Your Coverage

- Track your prescriptions, doctor visits, and anticipated procedures.

- Use that data to compare plans based on total cost, not just premiums.

2. Use a Yearly Medicare Review Checklist

- Create a bilingual checklist that covers:

- Network changes

- Drug formulary updates

- Copay shifts

- Out-of-pocket max comparisons

- This turns open enrollment into a guided process, not a guessing game.

3. Consider Medigap for Predictability

- Original Medicare + Medigap offers stable costs and nationwide access.

- You avoid surprise bills from out-of-network providers or high Advantage copays.

4. Work With a Trusted Agent (like you!)

- Agents can flag hidden costs, explain plan changes, and advocate for better options.

- You can even offer pre-enrollment workshops to help clients feel empowered, not overwhelmed.

5. Use Tools Like BenefitsCheckUp or SHIP

- These free resources help identify financial assistance programs and plan comparisons tailored to individual needs

Answer: - If you value freedom to choose any doctor, especially if you travel or split time between states, Original Medicare + Medigap might be your best bet.

- If you want all-in-one coverage with extra benefits and don’t mind staying in-network, Medicare Advantage could save you money and simplify things.

- If you have chronic conditions, compare how each plan handles your specialists, prescriptions, and out-of-pocket costs.

Answer: You Can Delay Medicare If:

- Your employer has 20 or more employees

(This makes your group health plan “creditable” under Medicare rules.)

- You’re covered by an active group health plan through your current job

(Not COBRA, retiree coverage, or Marketplace insurance.)

In this case, you can:

- Enroll in Part A now (usually premium-free), unless you're contributing to an HSA.

- Delay Part B until you retire or lose employer coverage.

- Use your Special Enrollment Period (SEP)—an 8-month window after your coverage ends—to sign up for Part B without penalties.

ATTENTION: You Should Enroll Now If:

- Your employer has fewer than 20 employees

(Medicare becomes primary at 65, and delaying Part B could lead to coverage gaps and penalties.)

- Your coverage is not from active employment

(COBRA, retiree plans, or individual insurance don’t count as creditable.)

Answer: What’s Covered Under Medicare Part B

Insulin Pumps & Continuous Glucose Monitors (CGMs)

- Covered as Durable Medical Equipment (DME) if prescribed by a doctor.

- Includes:

- Insulin pumps

- CGM sensors and transmitters

- Blood glucose meters, test strips, and lancets

- You typically pay 20% coinsurance after meeting your Part B deductible.

Seizure Monitors

- May be covered if deemed medically necessary for managing epilepsy or other seizure-related conditions.

- Requires:

- A prescription from your doctor

- Documentation showing the device is essential for treatment or safety

- Use of an approved supplier that accepts Medicare assignment.

Important Notes

- Not all brands or models are covered. You must confirm that the device is on Medicare’s approved list and that your supplier is in-network.

- Don’t buy first and hope for reimbursement. Always verify coverage before purchasing to avoid unexpected costs.

- If you have a Medigap plan, it may help cover the 20% coinsurance.

Answer: Starting January 1, 2025:

The donut hole will be eliminated, and there will be a $2,000 annual cap on out-of-pocket drug costs. Beneficiaries can also spread costs evenly throughout the year, instead of paying up front.

Answer: “How will my Medicare choices today affect my flexibility and costs?”

Most people focus on immediate coverage, doctors, prescriptions, and premiums.

Why It’s a Game-Changer

- Medigap vs. Medicare Advantage

If someone chooses Medicare Advantage now, they may lose the right to switch to Medigap later without medical underwriting. That’s huge if their health declines.

- Drug Coverage Gaps

Skipping Part D because they “don’t take meds” now? That can trigger late enrollment penalties and leave them exposed later.

- Network Restrictions

Some Advantage plans work great locally—but if someone moves or travels often, they may face limited access or higher out-of-network costs.

- Long-Term Cost Planning

A plan with low premiums today might have high out-of-pocket costs later, especially if chronic conditions develop.

Answer: No Penalty If These Conditions Are Met

- Your wife’s Blue Cross Blue Shield plan is through active employment (not COBRA or retiree coverage).

- Her employer has 20 or more employees, which means the plan is considered creditable coverage under Medicare rules.

- You enroll in Medicare Part B during your Special Enrollment Period (SEP)—which lasts 8 months after her employment or coverage ends.

Watch Out For These Exceptions

- If her coverage is COBRA, retiree insurance, or from a small employer (fewer than 20 employees), Medicare may consider that non-creditable. In that case, you’d need to enroll in Part B at 65 to avoid penalties and coverage gaps.

- If you miss the SEP window after her coverage ends, you could face a 10% penalty for each 12-month period you delay Part B without creditable coverage.

Answer: Enroll in Medicare Part A (Hospital Insurance)

- Why? It’s usually premium-free if the person or their spouse paid Medicare taxes for at least 10 years.

- When? Most people enroll at 65 even if they’re still working, unless they’re contributing to a Health Savings Account (HSA)—in which case they should delay Part A to keep making tax-free contributions.

Delay Medicare Part B (Medical Insurance) if Eligible

- When is it safe to delay?

- The senior has active employer coverage (not retiree or COBRA).

- The employer has 20 or more employees.

- Why delay? To avoid paying Part B premiums while still covered by employer insurance. They’ll get a Special Enrollment Period (SEP) to sign up later without penalties.

Enroll Immediately if:

- The employer has fewer than 20 employees.

- The coverage is not group-based (e.g., Marketplace, COBRA, retiree plans, Christian health ministries).

- They have no insurance or are self-employed.

In these cases, Medicare becomes primary, and delaying could lead to coverage gaps and late enrollment penalties

Answer: Outside of Open Enrollment or without Guaranteed Issue Rights:

- You may face medical underwriting, meaning the insurer can:

- Deny coverage based on health conditions

- Charge higher premiums

- Impose waiting periods for pre-existing conditions

Common reasons for denial include:

- Chronic respiratory diseases (COPD, asthma with frequent inhaler use)

- Heart conditions (AFib, CHF)

- Cognitive disorders (Alzheimer’s, dementia)

- Neurological diseases (ALS, epilepsy, MS)

- Use of oxygen or nebulizers

Answer: The most rewarding part of being a Medicare agent is the impact that ripples through families and communities. Guiding seniors through one of the most confusing systems they’ll ever face, often in their own language. Educating people who’ve been underserved or misinformed, and watching their confidence grow. Building trust in communities that rely on you not just for answers, but for advocacy.

Answer: Working with a Medicare agent isn’t just helpful; it can be a game-changer, especially when you're navigating the maze of plans, benefits, and annual changes.

Answer: Annuities can play a powerful yet sometimes misunderstood role in retirement planning. Think of them as a way to turn a lump sum of money into a personal pension, offering predictable income when paychecks stop rolling in.