Michelle Setchell, Medicare Insurance Agent
Michelle Setchell
AJ Advisors
Medicare Agent Licensed in CA
Contact Details
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Location
Livermore, CA
Michelle Can Help With:
About Me
With over two decades of experience in the insurance industry, I have established myself as a trusted advisor and expert in employee benefits. There are a lot of questions to be answered when moving from employee benefits to Medicare, and my background makes me uniquely qualified to work with retirees who are transitioning from the workplace to retired life. I am dedicated to simplifying the complex world of healthcare insurance for seniors. Based in the heart of the San Francisco Bay Area, I serve clients from all walks of life, offering personalized, unbiased guidance on Medicare plans that best fit each individual's specific needs.
Q&A with Michelle Setchell
I am on ssi Disability. I turn 65 in June. I also just got Humana health. So does it be change to SSI?? Or does my SSI -Disabiliy just go on til death.
Answer: To answer your question, we'll have to make a couple of assumptions first:
- If you’ve been receiving SSDI for at least 24 months, you’re already enrolled in Medicare Part A and likely Part B. This is automatic for SSDI recipients, regardless of age.
- Your Humana plan is likely a Medicare Advantage plan (Part C), which replaces Original Medicare (Parts A and B) and may include Part D (prescription drugs)
If these assumptions are correct, at age 65, your Medicare eligibility continues, but your SSDI benefits will probably convert to Social Security retirement benefits. The monthly payment amount typically stays the same, and your Medicare coverage is unaffected. You don’t need to take action for this conversion; the SSA handles it automatically:
- Since you’re likely already enrolled in Medicare due to SSDI, turning 65 won’t require re-enrollment. Your Medicare Part A and Part B (or your Humana Medicare Advantage plan) continue seamlessly.
- If you’re enrolled in a Humana Medicare Advantage plan, it remains active unless you choose to change plans.
That said, turning 65 triggers your Initial Enrollment Period (IEP) for Medicare (3 months before to 3 months after your 65th birthday, April–September 2025). During this period, you can:
- Stay with your current Humana Medicare Advantage plan.
- Switch to another Medicare Advantage plan.
- Return to Original Medicare (Parts A and B) with or without a Part D plan.
I'd be happy to review the details of your specific situation with you to ensure that you get set up with the best plan(s) for your individual needs!
Does Medicare cover cancer screenings, and how often can I get them?
Answer: Yes! Medicare Part B covers cancer screenings like
- annual mammograms for women 40+
- pap smears and pelvic exams every 24 months (every 12 months for high-risk individuals)
- colonoscopy every 10 years for those 50+ (every 2 years for high-risk individuals)
- annual PSA tests and digital rectal exams for men 50+
- annual low-dose CT scans for lung cancer in eligible smokers aged 50–77
These are all provided at no cost if they are preventive and performed by a Medicare-approved provider; however, diagnostic follow-ups may incur 20% coinsurance once the Part B deductible is met. Contact Medicare or your broker if you have questions on specific cancer screenings!
Does Medicare cover nutrition counseling for high cholesterol?
Answer: Yes, Medicare Part B covers nutrition counseling, known as Medical Nutrition Therapy (MNT), for certain conditions, including high cholesterol, when provided by a registered dietitian or qualified nutrition professional. MNT is covered for specific conditions like diabetes, kidney disease, or a kidney transplant in the last 36 months. High cholesterol alone isn’t explicitly listed, but if it’s part of a broader condition (e.g., cardiovascular disease or diabetes), your doctor may deem MNT medically necessary.
What do you like most about being a Medicare agent?
Answer: I find helping people navigate the complex and often overwhelming Medicare system one of the most rewarding aspects of being a Medicare agent. I also enjoy educating clients, breaking down confusing options into clear choices, and ensuring they find a plan that fits their healthcare needs and budget. It affords me the opportunity of making a meaningful difference in my clients’ lives.
I've heard Medicare covers home health care, but what exactly does that include?
Answer: Medicare covers home health care for eligible beneficiaries under specific conditions. It typically includes:
- Part-Time or Intermittent Skilled Nursing Care: Services like wound care, injections, or monitoring of serious conditions, provided by a registered nurse or licensed practical nurse.
- Physical Therapy: To help regain movement or strength after an injury or illness.
- Occupational Therapy: To assist with daily activities like dressing or eating.
- Speech-Language Pathology Services: For issues with speech, swallowing, or communication.
- Medical Social Services: Counseling or help with social resources, like finding community support.
- Home Health Aide Services: Limited assistance with personal care (e.g., bathing, dressing), but only if you’re also receiving skilled nursing or therapy.
To qualify, you must meet the following conditions:
1) You must be homebound (unable to leave home without significant effort or assistance)
2) Services must be ordered by a doctor as part of a care plan.
3) The home health agency must be Medicare-certified.
Note: Coverage is under Medicare Part A or Part B, with no cost for services, but a 20% coinsurance may apply for durable medical equipment (e.g., wheelchairs).
Exclusions: Medicare doesn’t cover 24/7 in-home care, homemaker services (like cleaning or cooking) if that’s the only care needed, or meals delivered to your home. For specifics, check with your doctor or Medicare agent or broker, as coverage will depend on your situation.