Leslie Kaz, Medicare Insurance Agent

Answer: What I like most about being a Medicare agent is the ability to make a confusing topic simple to understand and even simpler to implement.

Answer: This is a fantastic idea. As research progresses and the results of different modalities become clear, I would be very interested to see this happen.

Currently, insurance companies are generally willing to cover only the "standards of care," which are guidelines developed by the AMA to ensure the public is protected from unproven or ineffective treatments. While there is considerable anecdotal evidence supporting alternative treatments, it is crucial to scientifically validate those that demonstrate positive outcomes and meet rigorous safety standards to safeguard public health.

I hope the new HHS director will approve funding for research into alternative therapies that show promise of beneficial outcomes for everyone. Fingers crossed!

Answer: Medicare generally does not cover dental implants or most dental care, as it considers them non-medically necessary. Original Medicare (Parts A and B) typically only covers dental procedures if they are integral to a covered medical procedure, like jaw reconstruction after an accident. However, some Medicare Advantage (Part C) plans may offer limited dental coverage, including implants, but this varies by plan and often comes with restrictions or additional costs.

Answer: Medicare’s coverage for prescription apps and digital therapeutics (DTx) is limited but evolving, particularly for chronic conditions. Original Medicare (Parts A and B) typically does not cover DTx, as these tools often fall outside defined benefit categories. However, recent developments show some progress; so the answer would depend on what your currently using.

Answer: Yes, it’s time for an overhaul. Medicare’s core structure doesn’t match today’s senior care needs. A system that prioritizes prevention, tech, and comprehensive benefits would better serve an aging, tech-savvy population. But the scale of change required—financially, politically, administratively—means it’ll likely come in fits and starts, not a grand redesign. For now, your best bet is leveraging Advantage plans or advocating for specific reforms like DTx coverage.

Answer: Since you’re already on Medicare due to disability insurance and will turn 65 in October 2025, you do not need to sign up for Medicare again. When you turn 65, your Medicare coverage will continue seamlessly, but your eligibility reason shifts from disability to age. This happens automatically—no need to reapply.

Answer: The worst Medicare-related decision is not enrolling in Medicare Part B when first eligible, without having creditable coverage from an employer or spouse’s plan. This can lead to lifelong premium penalties (10% per year delayed) and gaps in coverage, leaving you vulnerable to high medical costs. Always confirm eligibility and coverage options with Medicare or a trusted advisor to avoid this costly mistake.

Answer: When you enter a skilled nursing facility (SNF) for rehab, Medicare Part A typically covers up to 100 days per benefit period, provided you meet eligibility requirements (e.g., a qualifying 3-day hospital stay, skilled care needs, and admission within 30 days of hospital discharge). Here’s how it breaks down:

Days 1–20: Medicare covers the full cost of SNF care (assuming the facility is Medicare-certified and care is medically necessary).

Days 21–100: You pay a daily coinsurance ($204 in 2025), and Medicare covers the rest. Supplemental insurance (like Medigap) may cover this coinsurance.

After 100 days: Medicare Part A stops covering SNF care, regardless of whether you still need rehab or have transitioned to long-term care.

Answer: Yes, you can switch from a Medicare Advantage (MA) plan to Original Medicare mid-year if diagnosed with a serious illness, and you may be able to enroll in a Medigap plan, but there are specific rules and considerations:

Answer: Medicare can cover occupational therapy (OT) for arthritis or mobility issues, but coverage depends on the type of Medicare plan you have, the setting of the therapy, and specific requirements.

Answer: A Medicare Summary Notice (MSN) is a statement you receive every 3 months if you have Original Medicare. It’s not a bill—it shows the medical services you received, what Medicare paid, and what you may owe. Review it carefully to make sure the information is correct, compare it with your doctor’s bills, and keep it for your records. If you notice any mistakes or charges for services you didn’t receive, report them to Medicare at 1-800-MEDICARE.

Answer: Medicare Area How Late Marriage Affects It

Part A May qualify for premium-free based on new spouse’s record after 1

year of marriage

Part B & D Premiums Joint income may raise costs via IRMAA

Employer Coverage May delay Part B if spouse is still working and has group health

Enrollment Periods SEP applies if you lose spouse's employer coverage

Discounts Some Medigap/Advantage plans offer household discounts

Answer: 1. Initial Enrollment Period (IEP)

Who it's for: People turning 65 or newly eligible for Medicare.

When: Begins 3 months before, includes the month of your 65th birthday, and ends 3 months after (7 months total).

What you can do: Enroll in Part A, Part B, and/or a Part D drug plan or a Medicare Advantage (Part C) plan.

2. Annual Enrollment Period (AEP)

When: October 15 to December 7 every year.

What you can do:

Switch from Original Medicare to a Medicare Advantage plan or vice versa.

Change or enroll in a Part D prescription plan.

Switch from one Medicare Advantage or Part D plan to another.

Coverage begins: January 1 of the following year.

3. Medicare Advantage Open Enrollment Period (MA OEP)

When: January 1 to March 31

Who it's for: People already enrolled in a Medicare Advantage plan.

What you can do:

Switch to a different Medicare Advantage plan.

Drop your Advantage plan and return to Original Medicare (and optionally add Part D).

4. General Enrollment Period (GEP)

When: January 1 to March 31

Who it's for: Those who did not sign up for Part B during their Initial Enrollment.

What happens: Coverage starts July 1 and late penalties may apply.

5. Special Enrollment Periods (SEP)

When: Triggered by specific life events, such as:

Losing employer coverage

Moving to a new area

Qualifying for Medicaid or Extra Help

Other significant changes in your life or plan availability

What you can do: Make changes to your Medicare Advantage or Part D plans without waiting for AEP.

Answer: 5-Star Special Enrollment Period (SEP)

What it is:

A Special Enrollment Period that allows Medicare beneficiaries to switch to a 5-star Medicare Advantage or Part D plan, even outside of regular enrollment periods.

When:

Once per year, any time between December 8 and November 30 of the following year.

(Right after AEP ends on December 7.)

Who qualifies:

Anyone enrolled in Medicare who lives in an area where a 5-star rated plan is available.

You do not have to currently be in a 5-star plan — this SEP lets you switch into one.

What you can do:

Switch from any Medicare Advantage plan (even another 5-star) to a 5-star Medicare Advantage plan.

Switch from Original Medicare + Part D to a 5-star Medicare Advantage plan.

Switch Part D drug plans if a 5-star Part D plan is available.