Jon Cavanaugh, Medicare Insurance Broker

Answer: Medicare does not set a simple limit like “30 days” or “100 days” for home health care.

If you qualify for Medicare-covered home health services, skilled nursing and home health aide services are generally considered “part-time or intermittent” when they total less than 8 hours per day and no more than 28 hours per week combined. In certain limited situations, Medicare may cover up to 35 hours per week for a short period.

As for how long it can last, Medicare can continue covering home health care as long as you continue to meet the eligibility requirements and your doctor or other authorized provider continues to certify that the services are medically necessary. Eligibility is generally reviewed and recertified every 60 days, and Medicare does not set a limit on the number of consecutive 60-day certification periods.

There is an important distinction, though: Medicare does not cover 24-hour care at home or long-term custodial care simply because someone needs help with bathing, dressing, meals, cleaning, or other daily activities. Home health aide services are generally covered only when you're also receiving qualifying skilled nursing or therapy services.

So someone who needs a nurse or therapist at home may qualify for ongoing Medicare home health coverage, but someone who mainly needs a caregiver to stay with them several hours every day may need a different type of long-term-care assistance.

Answer: No, everyone does not necessarily pay the same amount for Medicare.

Most people pay $0 for Part A because they or their spouse worked and paid Medicare taxes long enough.

For Part B, the standard premium in 2026 is $202.90 per month, but some people pay more based on their income. Medicare calls the additional amount IRMAA. For 2026, IRMAA can apply if your 2024 income was above $109,000 for an individual or $218,000 for a married couple filing jointly.

Your costs can also depend on the coverage you choose. Part D prescription drug plans, Medicare Advantage plans, and Medicare Supplement plans can all have different premiums and out-of-pocket costs. Higher-income beneficiaries may also pay an additional IRMAA amount for Part D.

There are also programs that may help people with limited income and resources pay Medicare premiums and other costs.

So when someone asks, “How much does Medicare cost?” there really isn’t one number that applies to everyone. Your work history, income, prescriptions, coverage choices, and eligibility for assistance can all affect what you pay.

Before choosing coverage based only on the monthly premium, I recommend looking at the total cost of the coverage... including premiums, deductibles, copays, prescriptions, doctors, and potential out-of-pocket expenses.

Answer: Yes, generally they can count.

For Medicare’s 20-employee rule, CMS looks at bona fide employees on the employer’s employment rolls, including full-time and part-time employees. The rule does not automatically exclude employees just because they live and work outside the United States.

The key question is whether those workers are actual employees of the same employer, or of a related company that must be combined under applicable ownership rules.

Independent contractors generally would not count toward the 20-employee threshold.

This is especially important before delaying Part B. If the employer is actually considered to have fewer than 20 employees, Medicare may be primary once you’re eligible, and the employer plan may pay little or nothing if you failed to enroll in Part B. You could also face a late-enrollment penalty and a gap in coverage.

Before anyone delays Part B based on the 20-employee rule, I would get written confirmation from the employer or benefits administrator that the plan is primary to Medicare and that the employer meets the Medicare Secondary Payer employee-count requirement.

Answer: You’ve probably seen a lot of advertisements for “Medicare OTC cards,” but there isn’t one standard Medicare card or dollar amount that everyone receives.

An OTC allowance is an extra benefit offered by some Medicare Advantage plans. Medicare.gov confirms that some Medicare Advantage plans cover over-the-counter items that Original Medicare doesn’t cover.

How much is it worth?

There is no universal amount. The allowance depends on the specific Medicare Advantage plan available where you live. Some plans provide an allowance monthly, while others provide it quarterly. The amount, the products you can purchase, where you can use the benefit, and whether unused funds carry over are all determined by the individual plan.

Depending on the plan, covered items might include things such as pain relievers, first-aid supplies, vitamins, cold medicines, dental-care products, and other approved health-related items.

How do you get one?

You generally get the benefit by enrolling in a Medicare Advantage plan that includes an OTC allowance. It is not a separate benefit that you apply for through Social Security or Medicare.

Some Special Needs Plans may also provide additional supplemental benefits to people who meet certain eligibility requirements.

One caution: I would never recommend choosing a Medicare Advantage plan just because it advertises a large OTC allowance. Your doctors, hospitals, prescriptions, copays, maximum out-of-pocket amount, pharmacy network, and other benefits are much more important.

The OTC benefit can be helpful, but it should be looked at as one piece of the plan... not the reason you choose it. I can help you compare the plans available in your area and see which ones include an OTC benefit while still making sure your doctors, prescriptions, and overall costs fit your needs.

Answer: Yes, you may still be able to enroll in Medicare even if you never paid into U.S. Social Security because you worked overseas.

The important distinction is that Social Security work credits generally determine whether you qualify for premium-free Medicare Part A, not whether Medicare is available to you at all.

If you’re 65 or older and don’t have enough U.S. work credits, you may still be able to enroll in Part B and purchase Part A if you meet Medicare’s citizenship and U.S. residency requirements. If you’re a lawful permanent resident rather than a U.S. citizen, you generally must have lived continuously in the United States for at least 5 years before applying.

Also, check whether you qualify for premium-free Part A through a spouse’s work record. That can make a significant difference.

One important point for people who worked overseas: Social Security has agreements with certain countries that may allow foreign work credits to help you qualify for Social Security retirement benefits, but SSA specifically states that those foreign credits do not count toward qualifying for premium-free Medicare Part A.

So the answer is yes, Medicare may still be available, but whether you pay for Part A depends on your U.S. Medicare-covered work history, your spouse’s work history, and your individual circumstances.

I’d be happy to help you review your situation and determine which Medicare enrollment rules apply before you enroll.

Answer: I wouldn’t pay that $5,000 until someone takes a closer look at those bills.

Ask the provider for a full itemized statement showing what they charged, what Medicare paid, what was adjusted, and what they say is still owed. Then call 1-800-MEDICARE and have them compare the bills against Medicare’s records.

You can also contact your local SHIP counselor for free help reviewing the charges.

And since this was your late husband’s medical debt, don’t automatically assume you personally owe it. That can depend on the estate and the circumstances.

Answer: Usually, albuterol rescue inhalers are covered through Medicare Part D, but the exact inhaler and cost depend on the person’s drug plan and formulary.

One important update: brand-name ProAir HFA was discontinued by the manufacturer in 2022, although generic albuterol HFA alternatives are still available. ProAir Digihaler was also discontinued in the U.S. in 2024.

So if someone tells me they use ProAir, I’d usually check their plan for generic albuterol or another covered equivalent rather than assuming that exact brand is still available.

Answer: If you’re on Original Medicare, Part A covers up to 90 hospital days in a benefit period, and then you have 60 lifetime reserve days you can use. Once those reserve days are gone, Medicare generally stops paying for that inpatient stay and you could be responsible for the full hospital cost.

The good news is your regular hospital days can reset with a new benefit period after you’ve been out of the hospital or skilled nursing care for 60 days. Medicare Advantage plans can work differently, so I’d always check the specific plan before assuming you’ve “run out” of coverage.

Answer: Yes... but it's during Medicare’s Annual Open Enrollment, October 15 through December 7, you can change your Part D drug plan for the following year.

Just keep in mind, the January 1 through March 31 Medicare Advantage Open Enrollment Period works differently and doesn’t normally let you switch from one standalone Part D plan to another.

If you’re unsure which enrollment period applies to you, I’m happy to help you sort it out.

Answer: I think that’s a fair question. Medicare has started covering some treatments that used to be considered more “alternative,” but the coverage is still pretty limited.

For example, Medicare Part B can cover acupuncture for chronic lower-back pain, with up to 20 treatments in a 12-month period when the person is improving. It also covers certain chiropractic spinal manipulation, but generally doesn’t cover things like routine massage therapy.

From my perspective as a broker, I’d like to see Medicare continue looking at treatments that have solid evidence behind them... especially when they can help seniors manage pain, maintain mobility, and potentially reduce reliance on medications. The important part is making sure the treatment is proven safe and effective.

Also, some Medicare Advantage plans may offer additional benefits beyond Original Medicare, so it’s worth checking the specific plan rather than assuming something isn’t covered.

Answer: Yes, Medicare generally covers shoulder replacement surgery when your doctor determines it is medically necessary.

Your cost depends on whether the surgery is performed as an inpatient or outpatient procedure. With a Medicare Advantage plan, check the surgeon, hospital, prior authorization requirements, and expected copay before scheduling.

Answer: It can. Medicare does not look at the full sale price of your home... it looks at the taxable profit reported on your tax return.

If that profit pushes your income high enough, your Part B and Part D premiums could increase, usually about two years later. Many homeowners qualify to exclude part or all of the profit, so it really depends on your specific tax situation.

Answer: Yes, Medicare can cover a Dexcom continuous glucose monitor if your doctor prescribes it and you meet the coverage requirements, such as using insulin or having a history of serious low blood sugar.

It is usually covered through Medicare Part B. With a Medicare Advantage plan, the supplier, approval rules, and your cost can vary, so I always recommend checking the plan before ordering it.

Answer: Yes, Medicare generally covers hip replacement surgery when your doctor determines it is medically necessary.

Part A may cover it as an inpatient procedure, while Part B may cover it if performed outpatient. Medicare Advantage plans also cover medically necessary hip replacements, but your copays, hospital network, and prior authorization requirements can vary by plan. Always check the plan’s rules and expected costs before scheduling surgery.

Answer: Medicare does not have a family plan. Each spouse has their own coverage and pays their own premiums.

You may each choose different Medicare Advantage, Supplement, or Part D plans based on your doctors, prescriptions, and healthcare needs. Most people receive Part A premium-free through their own or their spouse’s work history, but Part B and other coverage are still individual.

Answer: I wouldn't call any health plan completely free. Some Medicare Advantage plans do have a $0 monthly plan premium, but that doesn't mean you'll never pay anything. You'll still pay your Part B premium and may have copays when you see a doctor or receive care. I always tell people to look at how the plan works when they actually need it, not just the monthly premium.

Answer: Your daughter can help and with your permission, she can talk with the broker, ask questions, and help compare your options.

You would still need to make the final decision and complete the enrollment unless she has legal authority, such as power of attorney, to handle it for you.

Answer: The way I explain it is that with Medicare Advantage, you still receive the Part A and Part B benefits available through Original Medicare. Many Medicare Advantage plans also include prescription coverage and added benefits like dental, vision, hearing, and fitness programs. Some Medicare Advantage plans even have a $0 additional monthly premium, although you still pay your Part B premium. That can provide a lot of value, but you still want to make sure the plan works with your doctors, prescriptions, and individual needs.

Answer: I'd say the biggest mistake is choosing too quickly and assuming it will be easy to change later. People often focus on the monthly premium or extra benefits without checking their doctors, prescriptions, and what they'll pay when they actually need care. They may also not realize that getting a Medicare supplement later isn't always guaranteed. I encourage people to look beyond what works today and think about what may work for them long term.

Answer: The CMS-L564 form is usually needed when you've delayed Part B because you had health coverage through your own or your spouse's current employment and are ready to enroll. If you and your spouse are both enrolling, you'll each need your own form. If only one of you is enrolling, only that person needs to submit it.

Answer: SilverSneakers is not included with Original Medicare. However, some Medicare Supplement and Medicare Advantage plans include SilverSneakers or a similar fitness benefit. It depends on the plan and what's available where you live. I recommend reaching out to a local independent Medicare broker to see what's offered in your area.

Answer: If you're referring to monovision during cataract surgery, it depends on exactly what your surgeon is recommending. Medicare Part B covers medically necessary cataract surgery and a standard conventional lens. However, any additional testing, premium lens features, or services used to correct near vision may not be covered.

Your UnitedHealthcare Supplement may pay some or all of the remaining Medicare-approved costs, depending on your specific plan and whether you've met the Part B deductible. It generally won't cover charges that Medicare considers noncovered.

Before the surgery, ask the surgeon for the exactly lens name and a written breakdown of covered and noncovered charges. You can also have a local independent Medicare broker review your Supplement benefits, but the surgeon and UnitedHealthcare should confirm the final billing details.

Answer: If you have Original Medicare, SilverSneakers is not included. Some Medicare Supplement plans may offer SilverSneakers or another fitness program as an extra benefit while you remain on Original Medicare. Some Medicare Advantage plans offer fitness benefits as well.

I recommend reaching out to an independent Medicare broker in your area. They can check which plans offer it in your area.

Answer: If you only have original Medicare, Symbicort would not be covered. Coverage would typically come through a Part D prescription drug plan or a Medicare Advantage plan that includes drug coverage.

Since every plan has its own drug list, it's important to check whether it covers brand-name Symbicort or the generic version and what your cost would be.

I recommend reaching out to an independent Medicare broker in your area. They can check plans from multiple carriers to see how Symbicort is covered.

Answer: There are a lot of Medicare plans out there and the same plan isn't going to work for everyone. A good agent should listen to what you need, know the plans available in your area, and help you understand your options.

If you call an insurance company directly, they can only tell you about the plans they offer. An independent Medicare broker can look at options from different carriers and help you find one that fits your needs.

I also think there's real value in working with someone local. You have someone nearby who understands the local plans and who you can actually call when you need help.