Marta Iris González, Medicare Insurance Broker

Answer: Wearable health tech will likely integrate with Medicare through:

• Remote patient monitoring

• Chronic disease management

• Medicare Advantage wellness benefits

• AI-driven preventive care

But widespread coverage of devices like smartwatches will depend on clinical validation and Medicare policy changes.

Answer: 🎂 Turning 65 Soon?

Your best time to start looking is 3–6 months before your 65th birthday.

Your Initial Enrollment Period (IEP) begins:

• 3 months before your birthday month

• Includes your birthday month

• Ends 3 months after

Starting early gives you time to compare plans, avoid penalties, and make confident decisions.

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🔄 Already on Medicare?

The most popular time to review options is during the Annual Enrollment Period (AEP):

📅 October 15 – December 7

This is when you can:

• Switch Medicare Advantage plans

• Change Part D prescription plans

• Return to Original Medicare

Coverage changes take effect January 1.

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🏥 On a Medicare Advantage Plan?

There’s also the Medicare Advantage Open Enrollment Period:

📅 January 1 – March 31

You can:

• Switch to another Medicare Advantage plan

• Or go back to Original Medicare (with or without Part D)

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⚠️ Special Situations

You may qualify to enroll or make changes anytime during the year if you:

• Move

• Lose employer coverage

• Qualify for Medicaid or Extra Help

• Have a plan that leaves your area

These are called Special Enrollment Periods (SEPs).

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✅ The Real “Best” Time

The best time to review Medicare options is:

✔ Before you turn 65

✔ Every fall (even if you’re happy with your plan)

✔ Anytime your health, doctors, prescriptions, or finances change

Plans change every year — premiums, networks, drug formularies — so reviewing annually is wise.

Answer: ✅ 1. Burial Funds Can Be Used to Protect Some of the Sale Proceeds

Under Georgia long-term care Medicaid rules, certain assets set aside for burial are not counted toward the Medicaid asset limit — but there are limits you must follow:

• You can designate money specifically for burial expenses — either in a pre-paid irrevocable funeral contract or a designated burial account.

• Georgia allows up to $10,000 excluded per applicant for burial funds, including burial contracts, burial accounts, and certain life insurance face value. 

So yes — the extra money from selling the car can go into a burial account if it is properly designated for burial expenses and kept separate from other funds. 

⚠️ 2. But There Are Rules You Must Follow

To stay exempt from Medicaid’s asset test:

• The burial funds must be in a separate account or contract marked specifically for burial. They cannot be commingled with other money. 

• The $10,000 limit is cumulative — that includes burial accounts plus life insurance face value and prepaid funeral contracts. 

• Any money above the $10,000 burial exemption is still a countable asset and may affect eligibility. 

If her sale proceeds would cause her total countable assets to exceed the Medicaid limit (typically $2,000 for a single applicant), then just placing the extra in a bank account — even if labeled “burial” — won’t automatically protect the excess unless it’s a qualified irrevocable funeral trust or contract up to the allowable amount. 

📌 3. What Often Goes Wrong Online

Some older resources (especially SSI rules or outdated manuals) show much lower burial account limits (like $1,500). Those do not apply to Georgia’s current long-term care Medicaid rules, which follow the $10,000 exclusion. 

That’s why online sources might sound contradictory — they’re often referring to different programs or old rules.

🧠 4. Should You Hire an Elder Law Attorney?

Yes — that is highly recommended. Medicaid planning, especially

Answer: 💙 1. Medicare Savings Programs (MSPs)

These state-run programs can help pay for:

• Part B premiums

• Sometimes Part A premiums

• Deductibles and coinsurance (depending on the program)

The main programs include:

• QMB (Qualified Medicare Beneficiary)

• SLMB (Specified Low-Income Medicare Beneficiary)

• QI (Qualifying Individual)

Eligibility is based on income and limited assets.

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💊 2. Extra Help (Part D Low-Income Subsidy)

The Extra Help program helps pay for:

• Prescription drug plan premiums

• Deductibles

• Copays

You apply through the Social Security Administration, and many people qualify without realizing it.

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🏥 3. Medicaid

If your income is very limited, you may qualify for both Medicare and Medicaid (often called “dual eligible”). Medicaid can help cover premiums and additional medical costs.

You apply through your state Medicaid office.

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📌 4. Contact Social Security

If you’re having trouble paying premiums that are being deducted from your Social Security check — or you’re being billed directly — contact the Social Security Administration right away to avoid losing coverage.

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✅ Key Takeaway

If you cannot afford your Medicare premiums, do not ignore the bills. Help is available — and many assistance programs are income-based, not credit-based.

Answer: Yes — Guaranteed Issue rights do exist after the Medicare Open Enrollment Period, but they only apply in very specific situations.

Here’s how it works:

🧾 What Guaranteed Issue Means

Guaranteed Issue means that certain Medigap (supplement) plans must be offered to you without medical underwriting, even after the general enrollment periods have passed.

📅 When You Can Have Guaranteed Issue After Open Enrollment

You may have Guaranteed Issue rights outside of the initial Medigap Open Enrollment Period if one of these situations applies:

✅ Your current coverage is ending involuntarily

For example:

• Your employer group retiree plan is ending

• Your COBRA ends

• You lose Medicaid

• Your plan stops providing Medicare benefits

✅ You’re in a Medicare Advantage plan and it is ending service in your area

If your MA plan leaves Medicare or stops giving you coverage in your county, you get a special right to join certain Medigap plans without health questions.

✅ You move out of your plan’s service area

And your Medicare Advantage or Medigap plan doesn’t follow you.

❌ When Guaranteed Issue Does NOT Apply

Guaranteed Issue rights do not mean you can pick a Medigap plan at any time after open enrollment — only when one of the qualifying events above happens. If none of those apply, you may have to wait for a Medigap Open Enrollment Period or potentially be subject to medical underwriting.

📌 Key Takeaway

Yes — Guaranteed Issue can be available after open enrollment, but only if a qualifying event triggers it. It is not automatically available every year.

Answer: If you delay Medicare Part A because you’re covered under your spouse’s active employer group health plan, you may be able to enroll later without a penalty — but it depends on the size of the employer.

Here’s how it works:

• If your spouse works for a company with 20 or more employees, their employer plan usually pays first, and you can delay Part A (and Part B) without penalty.

• If the employer has fewer than 20 employees, Medicare typically becomes primary at age 65. In that case, delaying enrollment could leave you with coverage gaps and possible late penalties.

Most people qualify for premium-free Part A, so many enroll at 65 even if they keep employer coverage — but if you are contributing to an HSA, enrolling in Part A will stop you from being able to continue HSA contributions.

When your spouse retires or the employer coverage ends, you’ll qualify for a Special Enrollment Period (SEP) to sign up without penalty.

Because rules can vary depending on your situation, it’s always wise to review your specific coverage details before deciding to delay.

Answer: Medicare doesn’t cover 100% of specialist visits.

• Part B pays about 80% after the deductible.

• You pay the remaining 20%, and there’s no out-of-pocket limit with Original Medicare.

• Costs can be higher without a Medigap plan, or with copays/referrals in Medicare Advantage.

That’s why specialist visits can still feel expensive—even after paying into Medicare for years.

Answer: Medicare does cover telehealth, and it can be especially helpful in rural areas.

• Original Medicare (Part B) covers virtual visits with approved providers. You usually pay 20% after the deductible.

• Through Jan 30, 2026, most telehealth visits are covered from your home, even in rural areas.

• After that, most services will require you to be in a rural area and at an approved medical site (not always at home), except for mental health, stroke care, and some dialysis services, which are still covered from home.

• Medicare Advantage plans often offer broader telehealth access from home, sometimes with low or $0 copays.

Answer: What I like most about being a Medicare agent is helping people feel confident and less overwhelmed. Medicare can be confusing, and it’s rewarding to take something complicated and explain it in a way that makes sense—so seniors can make informed decisions about their healthcare.

It’s especially meaningful to know that the guidance provided can protect someone’s health and finances, give them peace of mind, and help them feel supported during an important stage of life.

Answer: Medicare offers limited support for seniors who need assisted living—and in most cases, it falls short.

Medicare is designed to cover medical care, not long-term custodial care. As a result:

• Medicare does NOT cover assisted living facility costs, such as room, board, or help with daily activities like bathing, dressing, or eating.

• Medicare may cover medical services a resident receives while living in assisted living, such as doctor visits, physical therapy, skilled nursing care, or medications—just not the housing or personal care portion.

• Short-term skilled nursing care may be covered after a qualifying hospital stay, but this is different from assisted living and is time-limited.

Because of these gaps, many seniors rely on:

• Personal savings or retirement income

• Long-term care insurance

• Medicaid (for those who qualify financially)

• Veterans benefits (if eligible)

Bottom line:

Medicare helps with healthcare needs, but when it comes to assisted living, it provides very limited support, leaving seniors to find other ways to cover most of the costs.

Answer: A Hospital Indemnity Plan is not required if you have Medicare Advantage, but it can be helpful—especially if you want extra financial protection.

With a Medicare Advantage plan, hospital stays usually involve daily copays for each day you’re admitted (for example, days 1–5 or 1–7). These costs apply each time you are hospitalized.

A Hospital Indemnity Plan pays you a cash benefit when you are admitted to the hospital. You can use that money for hospital copays, deductibles, or other expenses like rent, utilities, or transportation.

If you are hospitalized twice in the same year:

• Your Medicare Advantage plan will generally charge hospital copays again for the second stay.

• A Hospital Indemnity Plan would typically pay benefits again for the second hospitalization, as long as it meets the plan’s rules (such as being a new admission).

Bottom line:

If you want help covering repeated hospital copays or added peace of mind for unexpected hospital stays, a Hospital Indemnity Plan can be a useful supplement—but it’s optional, not mandatory.

Answer: Yes—Medicare helps cover the cost of medically necessary treatment, but what’s covered and how much you pay depends on the type of Medicare coverage you have.

• Part A covers inpatient hospital care, skilled nursing (short-term), hospice, and some home health care.

• Part B covers doctor visits, outpatient care, preventive services, and many medical treatments.

• Part C (Medicare Advantage) covers everything Parts A and B cover and may include extra benefits, depending on the plan.

• Part D helps cover prescription medications used in treatment.

Keep in mind that Medicare usually involves deductibles, copayments, or coinsurance, and it only covers treatments that are considered medically necessary.

Answer: You’re not alone—Medicare can feel like a maze with all the letters and rules. The best people who can help you sort it out are licensed Medicare agents or brokers, State Health Insurance Assistance Program (SHIP) counselors, and trusted community or senior resource counselors. They can explain your options in plain language and help you understand what works best for your situation.

The key is working with someone who understands Medicare well and can break it down step by step, so it feels manageable instead of overwhelming.

Answer: ✅ Yes! Your ANOC is one of the most important documents you’ll receive each year from your Medicare Advantage or Part D plan. It tells you what’s changing for the next year — and helps you decide if you should stay or switch plans.

Here’s what to look for 👇

🔍 1. Premiums and Costs – Check for changes in your monthly premium, deductible, and copays.

💊 2. Drug Coverage – Make sure your prescriptions are still covered and haven’t moved to a higher cost tier.

🏥 3. Provider Network – Confirm your doctors, specialists, and preferred hospitals are still in-network.

💚 4. Extra Benefits – Review updates to dental, vision, hearing, or over-the-counter allowances.

📅 5. Coverage Dates – Remember: changes take effect January 1st, so review your ANOC early in the Annual Enrollment Period (Oct. 15 – Dec. 7).

Answer: ✅ Sometimes — but not always. It depends on your health needs and how you use your benefits.

Here’s the breakdown 👇

💵 Potential Savings:

• Lower or $0 monthly premiums compared to Medigap

• Out-of-pocket maximum (unlike Original Medicare)

• Extra benefits like dental, vision, hearing, and gym memberships

⚠️ Possible Downsides:

• Copays and coinsurance can add up if you need frequent care

• Limited provider networks — you might pay more to see out-of-network doctors

• Some services require prior authorization, which can delay care

💡 Bottom line:

If you’re generally healthy and stay within your plan’s network, Medicare Advantage can save money.

But if you have chronic conditions or prefer flexibility, Original Medicare + Medigap may cost more upfront but save you long-term stress and surprise bills.

Answer: ✅ Great question! Medicare Part B covers several heart-related preventive services at no cost when provided by a participating provider:

🩺 Cardiovascular Disease Screenings – Blood tests for cholesterol, lipid, and triglyceride levels every 5 years.

💖 Cardiovascular Behavioral Therapy – Once a year, you can meet with your doctor to discuss healthy habits like diet, exercise, and quitting tobacco.

⚖️ Obesity Screening & Counseling – For those with a BMI of 30 or higher, ongoing sessions help manage weight and reduce heart disease risk.

🏃 Diabetes Screenings – Covered up to twice a year for those with certain risk factors.

💊 Blood Pressure & Lifestyle Counseling – Often included as part of your Annual Wellness Visit.

💡 These preventive services help catch problems early — and empower you to take control of your heart health.

Answer: The best choice depends on your health needs, budget, and lifestyle — it’s worth comparing both before enrolling.

Answer: Yes!

Medicare Part B covers telehealth visits for mental health and substance use disorder services — including therapy and counseling — when provided by:

Psychiatrists

Clinical psychologists

Licensed clinical social workers and counselors

You can receive care from your home, a clinic, or another approved location using video (and in some cases, audio-only) telehealth.

As of now, these telehealth mental health services remain covered through at least the end of 2026, thanks to recent Medicare extensions.

This means you can continue getting the support you need — safely and conveniently — wherever you are.

Answer: Yes — but coverage is limited to specific conditions.

Medicare Part B covers Medical Nutrition Therapy (MNT) only for people with:

• Diabetes (Type 1, Type 2, or gestational)

• Chronic kidney disease (not on dialysis or on dialysis)

• Kidney transplant within the last 36 months

This benefit includes a nutrition assessment, follow-up visits, and counseling by a registered dietitian or qualified nutrition professional.

Therapeutic supplements (like vitamins or minerals) are not covered under Medicare unless they are part of a medically necessary, doctor-prescribed enteral or parenteral nutrition (for example, tube feeding or intravenous nutrition).

Answer: The Medicare Part B premium is projected to increase to about $206.50 per month in 2026 (up from $185 in 2025).

📈 Why the increase?

• Rising medical and prescription costs

• Higher use of outpatient services

• Inflation and program expenses

💡 Remember: The official amount will be confirmed by CMS in late 2025, and higher-income earners may pay more due to IRMAA adjustments.

Plan ahead — staying informed helps you manage your health and budget with confidence.

Answer: Here’s how it helps:

🛡️ Replaces lost income for your loved ones

🏠 Covers debts like mortgage or loans

🎓 Secures your family’s future goals

📈 Builds cash value you can use later

💰 Adds stability to your retirement and estate plans

Life insurance = peace of mind today + financial security tomorrow.

✨ Plan smart. Protect what matters most.

Answer: Many doctors find Original Medicare simpler and faster to work with, while MA plans often come with more red tape and less flexibility — even though these plans can offer valuable benefits to patients.

Answer: Si te quedas solo con Medicare Original (Partes A y B) sin un plan Medigap, corres un alto riesgo financiero porque:

•No hay límite anual de gastos de tu bolsillo.

• Pagas deducibles y 20% de copago por la mayoría de servicios médicos.

• Hospitalizaciones o tratamientos costosos pueden generar miles de dólares en facturas.

• Medicare no cubre dental, visión ni audífonos.

Un plan Medigap ayuda a cubrir esos costos y te protege de gastos médicos inesperados.

Answer: Yes — a bone density test (DEXA scan) is considered preventive care under Medicare.

Medicare Part B covers a bone mass measurement once every 24 months (2 years) if you’re eligible — or more often if medically necessary.

You qualify if you’re at risk for osteoporosis, for example if:

• You’re a woman who is estrogen-deficient and at risk for osteoporosis

• You have vertebral abnormalities or fractures

• You’re taking (or have taken) long-term steroid medications

• You have primary hyperparathyroidism

Cost: If your doctor accepts Medicare assignment, you pay $0 for this test.

It’s a great preventive benefit to help detect bone loss early and protect your bone health!

Answer: You’re fine for now — no penalty.

Enroll in Part B when your wife retires or her active employer coverage ends.