Kristina Guerry, Medicare Insurance Broker

Answer: Medicare does not cover for gym memberships. Some plans do offer coverage for it. Please contact a broker and ask about your options, ask if it is a Medicare Supplement or Medicare Advantage plan. Most importantly, make sure you understand your coverage.

Answer: Yes, both spouses need to submit separate forms, if they are applying for Medicare Part B. Medicare is separate, and you will need to do separate applications for essentially everything.

Answer: It depends on your needs and wants. If you want the flexibility to see any doctor and not worry about an insurance company denying your claims, then a Medicare Supplement plan would be worth it. As far as "high-end", if you mean, is it worth it to pay more on one specific Medicare Supplement versus another, you would need to speak with a broker to have a true needs analysis. There are too many variables.

Answer: The real factor is how will your questions be addressed if they are not available. If you only have one person to help you and they are helping multiple clients, then you won't necessarily be able to receive assistance in a timely fashion. Whereas, if the office you work with, regardless of it being local or remote, has more staff, you will have a better outcome. That does not mean you should look at size alone.

It is important to ask who can help you when your agent is unavailable, are notes shared, and how does the organization work together to help you.

Answer: It is highly recommended that you have a Hospital Indemnity Plan if you have a Medicare Advantage Plan, or a High Deductible Plan. What happens if you are hospitalized twice in the same year would depend on how the policy is structured. You should speak with a broker to have them compare a Hospital Indemnity Plan versus what your copay is if you are admitted into the hospital on your Medicare Advantage Plan.

Answer: Most individuals will have a Part B Premium to pay. The standard is $202.90 in 2026. You can enroll in Medicare Easy Pay to have the premiums paid as a monthly deduction instead of snail mail. It is significantly easier to pay from bank deductions. Social Security does not even issue payments via the mail.

Answer: Medicare is funded through payroll deductions, the premiums enrollees pay, general federal revenues. There are some other sources as well.

Answer: If you have Medicare and employer coverage insurance, typically your employer coverage will pay first if there are 20 or more employees. If there are less than 20, Medicare would pay first. You can locate this information on Medicare.gov and look up, "Coordination of Benefits".

Answer: Yes, if your employer coverage was and is considered creditable coverage with Medicare. You are eligible for the Special Enrollment Period (SEP), "I am losing Creditable Coverage that I had through an employer or union."

Please keep in mind, if you are over 65 and not new to Part B, it does not give you the freedom to select ANY Medicare Supplement (Medigap) without health questions.

It does allow you to select a Prescription Drug Plan, Medicare Advantage Plan or use a guarantee issue to obtain either Plan F (if you were eligible for Medicare before Jan. 1st, 2020) or Plan G (if you were eligible for Medicare after 2020).

Answer: If you live in California and are considering a move to another state next year, you should start looking at the plans in your area and the new state before you move. I would start to take a look about two months prior to your move.

If you are on traditional Medicare with a Medicare Supplement (Medigap), the prices could vary drastically, and you may want to consider if you should switch while in California, utilizing your birthday rule if you cannot pass the verbal health questions, or switching after the move.

Either way, you will need to update your address with your Prescription Drug Plan (PDP) to notify them of the move, or shop for a different Prescription Drug Plan.

If you are on a Medicare Advantage plan, your coverage could change drastically, and you absolutely will want to review all of your options to see what will work for you in the new area. This process is significantly easier on you if you contact a broker and explain your situation to them.

Answer: If it is an emergency, the hospital is required to see your parents if they are out-of-state and on a Medicare Advantage plan. Some Medicare Advantage plans may offer additional coverage for out-of-state hospitals, if they are in-network.

If your parents are on traditional Medicare with a Medicare Supplement (Medigap), they can see any provider that accepts traditional Medicare.

If you contact a broker, they can review your parents’ coverage with you while your parents are with you. The broker can even review if there are any savings available for them on their current insurance, if they are missing any coverage, or if there is a different plan that might be more suitable for them.

Answer: You should not necessarily go with the cheapest Medicare plan.

The plans are legally required to be standardized, but the insurance companies do have other factors to take into consideration.

If you contact a broker, they should take into consideration the price, stability, financial rating and the loss ratio in your area when making a recommendation for you.

There are small differences beyond this that could be important to you, for example: Does this company have an online portal for me to look at my claims, update my address, and more?

Answer: The Medicare Advantage 5-Star Special Enrollment Period is different from the Open Enrollment Period (OEP) and the Annual Enrollment Period (AEP). The 5-Star Special Enrollment Period (SEP) allows you to switch at any time throughout the year to a Medicare Advantage Plan that has 5-Stars in your area.

Answer: Most Medicare Advantage plans have a $0 premium.

The catch is you are agreeing to put your Medicare (freedom to choose any doctor) on the back burner.

The insurance company approves or denies claims; if your doctor says you need to have knee replacement surgery, the insurance company may come back and say you should do physical therapy first.

Or, maybe you need to do three sessions of cognitive behavior therapy before they consider your surgery.

In exchange for this, you might have some dental, vision, and hearing coverage and a gym membership.

The copayments and coinsurance start to add up on most of the plans. Typically, the insurance company nickel and dimes you.

Answer: Depending on the state that you live in, Medigap companies are legally able to decide if they are willing to take on the risk of insuring you.

You're not being denied "Medicare." You're being denied insurance that would cover the portion that you'd be responsible for if you did not have a Medigap.

It is important to find out WHY you were turned down; that way you can inform your agent, and your agent can see if there is another company that you can apply with.

Answer: No, your Medicare Supplement plan renews automatically. It is a good idea to shop your plan every year to see if you still have the best price.

Keep in mind, if there is a better price, you will have to be able to go through underwriting to obtain the lower price, depending on what state you live in.

Answer: Yes, Medicare covers medically necessary ambulance rides.

It falls under Medicare Part B (outpatient service).

Answer: You can change your Medicare plan at any time throughout the year. You will need to be able to pass the underwriting process.

There are a series of verbal health questions; once that is completed, we wait to receive an answer from the new insurance company.

There are no enrollment periods once you are already on Medicare, unless you live in a special state that has a birthday rule, anniversary rule, or open enrollment year round.

Answer: Medicare hospital days reset based on 60 days of you being released. That means you would need to stay out of the hospital for 60 days straight before your days would reset.

Answer: You are correct that you must first meet your Part B deductible, as there is a high chance that the procedure will be outpatient.

Once your Part B deductible has been met, you should see no costs for Medicare-approved services.

Answer: I educate my clients on the differences between Medicare Advantage and Medigap.

After the client has decided which route to look at, we begin to narrow down the options together. The entire process is based on education first.

Answer: Yes, you have an 8-month Special Enrollment Period to enroll in Medicare, but it is not based off of COBRA. It is based off when your employer coverage ends. COBRA is only creditable for delaying your Medicare Part D plan. That is, as long as the COBRA is considered creditable coverage for Part D. I would recommend having a conversation with a broker one to two months prior to your employer coverage ending to have a plan and confirm that you understand everything.

Answer: As long as your husband's employer coverage is considered creditable coverage, you can delay enrolling into Medicare, including Part D. One to two months prior to coming off of his coverage, you should have a conversation with a broker on how to enroll, when, and what your options are. Keep in mind, for Part B and Part D, you will need to have proof that you had creditable coverage since you were 65.

Answer: Yes, you can elect to have your daughter work with a broker on your behalf. You should be there or on the phone to give consent to allow her to do so. I recommend that you understand what coverage you are enrolling in and buy her something nice for helping take care of your insurance.

Answer: Life insurance helps offset the costs that your loved ones will experience once you are gone. Another important type of coverage to look at is long-term care and annuities.

Answer: You will not be penalized if you do not enroll in Medicare when you turn 65, if you are eligible and have creditable coverage outside of Medicare. If you do not, you will be penalized for not enrolling into Medicare.

Answer: Medicare typically covers anything that is medically necessary. The key is to find out what you pay, as rarely will you see anything covered at 100% across the board. Original Medicare versus Medicare Advantage will have different costs. The same is true for what the medication is, and what plan you have.

Answer: The only common penalty on Medicare I come across is the Part D late enrollment penalty. If you ignore communication sent to you after enrolling into a drug plan when over the age of 65 that is asking for you to verify that you have had creditable prescription drug coverage since you were 65, you will be assigned a Late Enrollment Penalty for Part D.

Answer: Zero-premium means there is not a monthly premium. You still typically have medical care costs while on the plan.

Answer: A higher star rating may indicate higher satisfaction and fewer complaints. It is so rare to find a 5-star rated plan that if one was in your area, you could switch to it outside of the usual enrollment period. The star rating should not be the sole factor that you consider when you are looking for your health coverage. You need to make sure your doctors are in-network, your prescriptions are covered, and you understand what your costs will be.

Answer: Stair lifts are not typically covered by Medicare. Medicaid may offer some assistance. You can always check if there are any local programs in your area that offer assistance to help cover the costs of stair lifts.

Answer: It depends on if you have Medicare Advantage or Original Medicare. Original Medicare does not have a cap on medically necessary visits as of 2026.

Answer: Medicare Advantage PPO plans do not require referrals for every service. There are some services that may require a referral. You can usually find out what services in your Summary of Benefits.

Answer: There is no definite price. It depends on what plan you have. You should contact your prescription plan.

Answer: You typically receive your Annual Notice of Change (ANOC) before the Annual Enrollment Period (AEP) starts. AEP lasts from Oct. 15th to Dec. 7th at midnight.

That usually means you will receive your ANOC sometime before October 1st.

Please make sure you check your email and look in your spam/junk folder, if you elected for electronic notifications.

Answer: Medicare is introducing a trial program, GLP-1 Bridge, from 07/01/2026 to 12/31/2027.

For the treatment of obesity and weight loss, you may be eligible to have Foundayo (tablet), Wegovy (injection or tablet) and Zepbound Kwikpen (injection) with a $50 copay.

If the pharmacy bills your drug plan, it will be rejected.

Answer: A broker that works with Medicare will be able to see multiple different insurance companies, whereas if you call the insurance company directly, they are captive agents that can only sell their product. That means you could be presented a product that is not in your best interest.

We are unbiased and work for you instead of the insurance companies.