Michelle de Guzman, Medicare Insurance Broker

Answer: Technology is the furture of Medicare. We already see technology being used byu doctors in the exam room, pharmacists in the dispensing of medications and in the quoting process. Behind the scenes, technology is being used to pay claims, check for drug interactions, and look up past medical histories. In the next 10 years we will see AI help in the quoting process, help identify side effects of medications in populations, identify best practices that lead to better health outcomes for the patients, and AI to encourage and help manage medication and decrease isolation in elderly populations.

Answer: My biggest frustration would be the prescription drug list. In order to properly quote drug costs, I need to know exactly what medication you are taking (correctly spelled), the dosage and frequency. It is very frustrating to come to a meeting where the client is not prepared to share that information. It prevents me from being able to give you accurate information.

Answer: Medicare does not cover silver sneakers. However,many Medicare Supplement plans and Medicare Advantage Plans do cover Silver Sneakers or other brands of gym memberships.

Answer: If you only want to meet with an agent Face to Face then you will need to see a local agent. Find one you click with and is knowledgeable. If you prefer sitting at home and not having to fight traffic and find a parking space, then a virtual agent may be a better fit. Many times you can find a local agent that is ALSO a virtual agent. My cleints find it is wonderful to not have to worry that the weather,, traffic or a cold does not have to prohibit an appointment from happening. I have been a local agent in several locals as we have moved during my 25+ years in our industry. I am both a local and virtual agent.

Answer: If you are not retiring or you do not have medical coverage from your employer, then you need to sign up for Medicare Part B on SSA.gov. If you have employer group coverage and the employer has more than 20 employees, you may remain on your employer group coverage. If you are paying more for your employer group coverage for yourself alone than the Part B premium for Medicare, you may want to explore choosing to go on a Medicare Plan.

Answer: Red Flags would be: The person calling you representing themselves as from your insurance company, but they do not know your date of birth or your Medicare Plan. Do not give your Medicare number over the phone unless you are changing your insurance plan. If you are unsure whether you want to change, then they do not need to know your number. Scare tactics. If someone you do not know calls you and says your plan may be terminated if you do not speak with me, or says something else to scare you into revealing your Medicare ID number. If someone calls and says you MAY be eligible for a food card or utilities payments, then ask you for your Medicare number so they can "check your eligibility". If you do not have a Chronic Disease as outlined by Medicare, then you DO NOT QUALIFY for a food card. This is a Medicare rule. If you have a subsidy from the government to help you pay for medical care, like Medicaid, then you may qualify for help with your utilities.

Answer: Yes, Medicare Part B offers urgent care visits. You will be responsible for the Part B deductible if you have not already met that, and then 20%. If you are on a Medicare Advantage plan, please refer to your Evidence of Coverage to identify your copay for urgent care. If you have a Medicare Supplement, then you will pay based on what your Medicare Supplement does or does not pay.

Answer: Medicare Part B covers Insulin Pumps and seizure monitors for chronic conditions. If you have either of these, you should consider your total out-of-pocket costs per year. You may find that paying a monthly premium will save you a lot of money over a small premium with a large maxiumum out of pocket expense.

Answer: Agents should not be charging the client or Medicare enrollee at all. Medicare agents are paid by the insurance companies to help seniors enroll in the plan that is right for the Medicare enrollee.

Answer: Yes imaging ( MRI and ultra sound) are covered by Medicare. However, some types of imaging like 3D and 4d are not covered. it is important to request an esitmate of costs before having a test like that done.

Answer: If your Parent takes several brand names then I woudl suggest you speak with an Agent to find you what the lowest overall ocst will be. Some brand name medicaiotns will have a lower deductible on higher premium plans and some times the tier the medicaiotn is on in the formualry will make a large difference in the total out of pocket cost. Remember in 2026 the max out of pocket for Part D medications is the deductible plus $2100.

Answer: If you are covered on Medicare Part B only, you are first responsible for the Part B deductible. Once you have met that you will pay 20% and Medicare will pay 80%. If you have a medicare Supplement Plan G you will pay $0 after the deductible is met.

Answer: You might elect not to choose a medicare Advantage plan if there are only HMO plans available in your area and you see doctors in other states. You might not choose a Medicare Advantage plan if you have 2 homes and want to live part of the year in each place. Like a snowbird. And your area does not offer a Medicare Advantage PPO. Or you might not choose a Medicare Advantage plan because you want to pay a premium each month and have stable copays and guaranteed renewal rights.

Answer: Yes. If you have never enrolled in Medicare Part B, and you are losing your Employer-Sponsored Group Health Plan, you get the opportunity to enroll in Medicare Part B with a special election period AND Guaranteed Issue into a Medicare Supplement. If you have Mediare Part A and Medicare Part B and were on an Employer-sponsored group health you may also enroll in a Medicare supplement Plan with guaranteed issue rights.

Answer: Medicare covers eye exams with the Ophthalmologist, who is an MD doctor. Medicare does not cover eye exams with an optomistrist, nor does it cover the cost of glasses except after cataract surgery.

Answer: The elimination of the donut hole means that you will pay a deductible from $0 to $615 in 2026 plus up to $2100 out of pocket and then your copay will be $0 as you will have entered the catastrophic coverage phase.

Answer: If you have a Guarenteed Issues event then you do not have to answer health questions. Otherwise, you will have to answer health questions to switch from one Medicare Supplement to another.

Answer: Medicare Supplement, does have a higher monthly cost, but it gives you peace of mind that your coverage will stay the same year after year. Medicare Supplement plans are standardized and guaranteed renewable from year to year as long as you are current on your premium payments.

Answer: It is important that you review your Annual Notice of Change each year and verify that your doctors and your medicaitons are still available on your plan. Any co-pay cost changes will be noted in the Annual Notice of Change. This is your chance to shop for lower price medication copays and to switch plans if your doctor is no longer in the network.

Answer: Yes. All plan designs are specific to your zip code. Many zip codes may share the same plan, but they will always be different from state to state.

Answer: My first question would be "Are you on a medicare Part D plan or are you shopping for one". If you are currently on a Medicare Part D plan, you can review your plans' formulary to identify if it is a covered medication. If you are looking for a Part D plan, you need to be aware that Medicare does not cover vitamins or cosmetic medications. Also, medications may be a Medicare Part B drug ( administered in the doctor's office) or they may be a Medicare Part D drug. Once you have ascertained that your medications are in fact Medicare Part D drugs, you can look at Medicare.gov/plan-compare/#??year=2026&lang=eng/ Or you can ask a Medicare agent such as myself to look it up for you.

Answer: You will need the CMS form L564E, which your employer signs to verify that you had creditable coverage from your 65th birthday, And you will need the CMS form 40 B, which notifies Medicare of when you want your Medicare Part B to become effective. Those forms are available from me or on line.

Answer: Not all Medicare Advantage plans are suitable for all people. Your mom's doctors and medications are the most important consideration to make when choosing any medicare Plan. My advice is to ask a Medicare Agent who understands Medicare Advantage( not all agents do) which plans have your mom's doctors in network and what the best overall cost and maximum out of pocket would be for her.

Answer: Medicare is unlike any insurance you have ever had. Some terms overlap, but for the most part, it is a whole new language. Having a GOOD Medicare agent means having someone who can help you find a plan that fits your goals and budget. It means having a partner you can call to ask questions all year long about your plan.