Ruben Trejo, Medicare Insurance Broker

Answer: Medicare negotiating lower prices on high cost prescription drugs in 2026 is a big WIN for seniors. It means, more people can actually afford their meds, and stop feeling that constant pressure at the pharmacy counter.

Answer: To get a wheelchair covered, you need a doctor visit so they can document the need and write an order. Then you take that order to a Medicare approved DME supplier who handles the paperwork and billing. With Original Medicare, Medicare usually pays 80% after the deductible, and with Medicare Advantage you must use the plan’s in network supplier and often get prior approval, so always check first.

Answer: Yes, a Guaranteed Issue can still be available after Medicare Open Enrollment ends, but only if you qualify for a special situation. It is not based on the calendar, it is based on life events like moving, losing employer coverage, or your plan ending. If you do not have one of those situations, then health questions usually apply, so it is important to review your options before making a move. Hope this helps.

Answer: If a green card holder hasn’t reached 5 years of U.S. residency, they aren’t eligible for Medicare yet, so there’s no penalty at age 65. The clock doesn’t start until they actually become eligible, and once they hit that five year mark they can enroll without any late fees. Hope this helps.

Answer: Great question! Your doctor decides what care you need based on your health. The insurance company follows Medicare’s rules to decide what they’ll pay for. So, your doctor makes the medical decisions, and the plan makes sure those services meet Medicare’s coverage guidelines.

Answer: If you travel outside the U.S. a lot, Medicare Advantage usually isn’t your best option since it offers little to no coverage overseas. Some plans might help with emergency care abroad, but those benefits are rare and limited. Original Medicare with a Medigap Plan G or N gives you more freedom and some coverage for foreign travel emergencies. To stay fully protected, it’s always smart to add travel medical insurance when you head overseas.

Answer: Original Medicare and most Medicare Advantage (MAPD) plans don’t cover long-term in-home dementia care, only short-term skilled or medical home health services. For daily care or supervision, your best option is usually Medicaid, long-term care insurance, or private pay support programs. Hope this helps.

Answer: There isn’t one “best” MAPD plan in South Carolina, because it really depends on your doctors, prescriptions, and what benefits matter most to you. The smartest move is to compare top options like Aetna, Devoted, and BlueCross BlueShield, etc. based on your specific needs and budget.

Answer: She’s had Medicare Part A and B since 2006 due to disability, but when her husband retired in April 2024, she lost her other coverage and now only has A and B since she missed open enrollment. Social Security also dropped her SSI and switched her to straight SS, so she needs help figuring out what steps to take next.

Answer: A copay is just a set fee you pay at the doctor or pharmacy. A deductible is the amount you’ve got to pay first each year before your insurance really kicks in.

Answer: If you are homebound and need monitoring for your heart Medicare can help in two ways. First, if your doctor says you are homebound Medicare covers home health services like skilled nursing care therapy and sometimes a home health aide. Second, Medicare Part B covers remote patient monitoring. This means you could have a blood pressure cuff a heart monitor or a scale at home that sends information directly to your doctor so they can keep track of your condition without you leaving the house.

The best thing to do is talk with your doctor. They will document that you are homebound decide what type of monitoring or equipment you need and set it up through a Medicare approved provider.

Answer: Your provider has to send your Annual Notice of Change by September 30th every year. Most people see it arrive in the mail toward the end of September, so you’ll have it before October. That notice explains any changes to your plan for the next year, things like premiums, copays, prescriptions, and doctors. If you don’t get it by the end of September, just call your provider and ask them to send another copy.

Answer: What I love most about being a Medicare agent is the people. Sitting down with a senior who feels lost or overwhelmed and watching the weight lift off their shoulders when they realize it doesn’t have to be complicated. That moment right there fires me up every single time.

I love the relationships. These aren’t just clients to me. They become friends, family, people who trust me with something that really matters. And I don’t take that lightly.

I love knowing I’m making a real difference in my community. It’s not about pushing policies. It’s about protecting people, caring for families, and making sure folks feel seen, heard, and taken care of.

And I love the challenge. Medicare is always changing, and that keeps me sharp. It pushes me to grow, to keep learning, and to lead my team the right way.

This isn’t just a job. This is my purpose.

Answer: If you’re taking a pricey specialty medication, the 2025 changes are going to make a big difference because your out-of-pocket costs will be capped at $2,000 for the year, and after that you won’t pay anything else. On top of that, in 2026 Medicare will start negotiating prices on certain high-cost drugs, so not only will you have that $2,000 limit, but some of the medications themselves could actually come down in price.

Answer: If you just moved and you're on a Medicare Advantage or drug plan, you'll probably need to switch since those go by ZIP code, but don’t stress, you get a Special Enrollment Period to handle it. If you’ve got Original Medicare, you’re good, just make sure to update your address with Social Security.

Answer: If you’re at high risk for heart disease, Medicare DOES cover some extra preventive services that can really help.

They’ll cover things like a cardiovascular screening every 5 years, that checks your cholesterol and other key levels. And you also get a yearly visit with your doctor to talk about heart health and how to stay on track with things like diet and exercise.

If your doctor sees any other red flags, there may be more services Medicare can cover, too, but it depends on your situation.

Answer: Discount cards can be a nice little hack for saving money on prescriptions, but they come with a catch, they don’t count toward your Medicare Part D out-of-pocket costs. Sometimes, they’ll get you a better deal than your plan’s copay, but other times, your Part D coverage is the smarter choice. Think of them as a backup tool in your savings toolbox—use them when they work in your favor, but don’t rely on them to help you hit your deductible or out-of-pocket max!

Answer: There’s really no "one-size-fits-all" answer, it really depends on the individual's needs. Original Medicare gives you more freedom to see any doctor that accepts Medicare and works great if you pair it with a Medigap plan to cover out-of-pocket costs.

Medicare Advantage can be a solid choice if you want lower monthly premiums, extra benefits (like dental, vision, and hearing), and a max out-of-pocket limit, but you’ll need to stick to a network of doctors. I don’t push one over the other, I just place both options in front of my client, ask the right questions, and help them find what works best for their health and budget needs.

Answer: The new 2025 Medicare Part D out-of-pocket cap is a HUGE WIN for seniors! It limits how much they have to spend on prescriptions, making medications more AFFORDABLE, PREDICTABLE, and way less stressful.

Answer: Had a client who was completely confused choosing between Medicare Advantage and Medigap (a Medicare Supplement Plan), worried about costs and whether their doctors would be covered. I broke it down for them, helped them understand their options, found the best fit for their needs, and made sure they didn’t get stuck with unexpected expenses.

Answer: One of the biggest mistakes when enrolling in Medicare is when a Medicare recipient assumes they’ll be automatically enrolled in Medicare when they turn 65, but that’s not always the case. If they don’t sign up during their 7 month Initial Enrollment Period (IEP), which starts three months before their 65th birthday and ends three months after, they could face permanent late enrollment penalties and delays in coverage.