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Medicare Plans

How to Avoid Medicare Late Penalties

by Jagger Esch
written by Jagger Esch

While there are many benefits to having Traditional Medicare, the few disadvantages come in the form of late penalties.

Traditional Medicare consists of two parts, Medicare Part A and Medicare Part B. Part A benefits are your hospital benefits and covers any treatment given during hospitalization.

Part B consists of coverage for doctor’s office visits, diagnostic testing, lab work, outpatient surgeries, and ER visits.

Prescription drug coverage is not available on Medicare Part A or Medicare Part B. There is Medicare Part D, which is stand-alone insurance that provides prescription medication coverage.

And while Medicare covers most everything, there’s still out of pocket costs like deductibles, copayments, coinsurance, and other medical expenses.

How to Avoid Medicare Part A Late Penalty Fees

Most seniors are automatically enrolled for Traditional Medicare Part A by the time they turn 65 years of age. If you or your spouse worked for ten or more years, you’ve paid into Medicare and are then enrolled without charge.

If you haven’t previously worked or haven’t fulfilled the required amount of time to become eligible, you may still enroll; however, there may be a premium to pay.

For those not automatically enrolled in Medicare Part A, there’s a timeframe called the Initial Enrollment Period (IEP). The IEP starts the three months leading up to your 65th birthday and then lasts through the three months following your birthday month.

Failing to enroll during this period will result in the Medicare Part A penalty. The Medicare Part A penalty adds an extra 10% to the Part A premiums.

Each year gone without Part A benefits is multiplied by two and then added onto the premium costs. Depending on how long gone without enrollment, will determine the penalty fees as well as how long they will be charged.

How to Avoid Medicare Part B Late Penalty Fees

With Medicare Part B, enrollment is standard, and the Initial Enrollment Period is the same as enrollment for Medicare Part A.

As of 2018, The Centers for Medicare and Medicaid Services (CMS) set the Part B premium as $134.00. This can increase, however, based on income and decrease if ones on Social Security or disabled.

While the IEP’s are the same with both Medicare Part A and Medicare Part B, the penalty is different. The Medicare Part B penalty increases your monthly premium by 10% for every year gone without Part B benefits.

Unlike Medicare Part A’s penalty, with the Medicare Part B penalty, the extra premium charge is paid for the duration of time the Part B benefits are carried.

How to Avoid Medicare Part D Late Penalty Fees

With Medicare Part D, the various private health insurance carriers in your area offer the Prescription Drug Plans (PDP).

As of 2018, the Medicare Part D premium averages around $34.00; however, plan pricing can differ because of location and plan.

Just like with Traditional Medicare, the IEP is effective for the seven months surrounding your 65th birthday. Medicare Part D for prescription drug coverage is optional; however, there is a Part D penalty for not enrolling in the Initial Enrollment Period.

After 63 consecutive days or more having gone without Medicare Part D results in the penalty.

You will be penalized unless you have any of the following:

  • A Medicare PDP
  • A Medicare Advantage Plan or Medicare Part C Plan offering prescription benefits
  • Creditable coverage through employmentor the union with benefits offers at least, if not more, of Medicare’s standard prescription drug coverage.
  • Any other Prescription Drug Plan offered by a different Medicare Plan

 

The Part D penalty is calculated by adding 1% for each month without prescription drug coverage. Once this is determined, the penalty is then rounded to the nearest $.10 and then added onto the monthly premium.

The Part D penalty is permanent and must be paid while prescription drug coverage is active.

Another downside, the penalty may increase every time there’s an increase in the national base beneficiary premium.

Medicare Late Enrollment Exceptions

For Medicare Part A and Medicare Part B, penalty exceptions are possible if you or a spouse carry qualifying health insurance from another source.

Although there are Special Enrollment Periods (SEP) available when an individual loses health insurance from a union or group health plan, they have 8 months to enroll for Traditional Medicare benefits.

If the Medicare beneficiary enrolls during the SEP, no penalties will be enforced.

There is also a late enrollment exception with Medicare Part D. Medicare Part D offers the Extra Help program which subsidizes prescription drug costs for individuals with low income.

This Extra Help Program helps on expenses associated with deductibles, premiums, copays, and coinsurance.

With the Extra Help program, there are no late penalty fees. Another benefit with the Extra Help program is there is no Part D coverage gap which is also known as the. “donut hole”.

Additional Medicare Help

With all the penalties tied to late enrollment, it’s easy to see how quickly the out of pocket expenses can add up.

Most seniors are on a fixed income, you’ll want to enroll in Medicare as soon as possible to avoid any late penalty fees associated with the three parts offered by Medicare.

There are several options in which additional assistance can be provided for seniors carrying Medicare benefits. Opting for a Medicare Advantage Plan or subsidizing with a Medicare Supplement Plan will save you money and provide benefits.

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Medicare Plans

Medicare and Kidney Disease

by Jagger Esch
written by Jagger Esch

Medicare is a federal health insurance program that you pay into throughout your working career. It’s for people who are at least 65 years old or those who are under 65 years old and have a disability.

It’s also for people who have permanent kidney failure, or End-Stage Renal Disease, and need dialysis or a transplant.

Medicare Coverage

Medicare Part A is your Hospital Insurance. Part A helps cover the cost of any inpatient care while in a hospital. Also, inpatient care in nursing facilities (this does NOT include long-term care at these facilities).

There is also coverage for Hospice care and at-home health care, when medically necessary. Most of the time no monthly premium is required for Part A.

To qualify for Medicare Part A, you or your spouse has had to pay Medicare taxes while they worked for at least 40 quarters. Those that work less than 40 quarters have to pay some or all the Part A premium. The Part A premium for 2019 is $437.

Medicare Part B is your Medical Insurance. Part B coverage includes doctor visits and services from your health care provider and any outpatient services or care. Part B covers some at home health care services. Also, preventative services such as test and blood work have coverage.

The Part B premium is $135.50 for 2019. Usually, there is a 20% co-payment that beneficiaries must pay for services and supplies.

Certain medications have coverage under your Part B plan. Therefore, you pay 20% of the cost – as you would any other service under this plan. If you have a Medicare Supplement Plan, that 20% won’t apply to you.

Medicare Part D is what helps pay for prescription drugs. Income determines Part D premiums. If income is low, you may qualify for additional help paying for your Part D prescription drug costs.

After having a kidney transplant, you must take drugs for the rest of your life. The drugs are transplant or immunosuppressive drugs. POST kidney transplant, these drugs reduce the chance of your body rejecting the new kidney.

Medicare Coverage for Kidney Disease

There are multiple options for Kidney Disease and Medicare coverage. Your condition and state of health are what determines the best plan for you.

Medicare will help pay for kidney dialysis and kidney transplants through Original Medicare. However, if you have ESRD (End-Stage Renal Disease) you typically won’t be able to enroll in a Medicare Advantage Plan.

If you do have ESRD, you’ll receive your benefits through Original Medicare. You’ll also be able to go to any doctor that is enrolled and accepts Medicare – they must also be accepting new Medicare patients.

You’ll have coverage at any hospital or facility that participates with Medicare. With Medicare, you should add Part D to your coverage by joining a Prescription Drug Plan.

Medicare Advantage Plans

As mentioned above, you typically can’t join a Medicare Advantage Plan if you already have ESRD prior to enrollment. If you have ESRD, a Medicare Special Needs Plan may be an alternative option if they’re available in your area.

SNP Medicare Advantage Plans are for those that have serious illness or disease, require institutionalization or beneficiaries with Medicaid.

Medicare Eligibility

Age is not a determining factor for eligibility of Medicare when your kidneys aren’t working any longer. Should your kidneys fail, it would be medically necessary and vital that you receive dialysis on a regular basis.

If one of the following statements or questions applies to you, you should file an application today. There may be waiting periods that apply so don’t procrastinate.

  • If you need regular dialysis
  • You’ve had a kidney transplant
  • You contribute to Social Security or the Railroad Retirement Board
  • Work the time requirement as a government employee
  • Receive benefits or are eligible for benefits for Social Security or RRB
  • If you are the spouse or a dependent child of someone who meets any of these requirements

 

If you qualify for Part A you also qualify for Part B; however, enrolling in Part B is optional.

Once in Medicare Part B, beneficiaries pay a monthly premium for that coverage. To receive all the benefits Medicare will cover for certain dialysis and kidney transplant services, you must have both Medicare Part A and Part B.

If you don’t meet the requirements to qualify for Medicare coverage, your state has options that might help pay for your dialysis treatments. Contact Social Security for further information regarding extra help.

Dialysis Treatments

Medicare coverage for dialysis must meet certain requirements to start the first month of regular dialysis treatment. During the first 3 months of a regular course of dialysis – you must participate in an at-home training program by Medicare.

This program when medically necessary should have coverage under Medicare Part B.

Medicare does NOT cover any surgical procedures or services needed to prep you for dialysis if you should need it; procedures such as fistula.

Only after completing the at-home dialysis training will your Medicare coverage kick in the month you begin regular dialysis. Surgical procedures could have coverage once regular dialysis begins.

Medicare WILL cover a fistula placement or other pre-dialysis services if your doctor prescribes it as medically necessary

Medicare Advantage Plans, like HMO or PPO, often will cover services to and from your dialysis facility for people with ESRD (you will need to check your specific plan to see if transportation is covered).

Your dialysis facility is responsible to provide you with monthly visits from your doctor as well as all the equipment medically necessary for at-home treatments.

Dialysis Cost in a Facility

For those who have Original Medicare, you’ll still pay the 20% coinsurance of the amount that has been approved by Medicare for all services you may need – Medicare pays the other 80%.

Medicare Supplement Insurance (Medigap) may cover all or just some of the 20% coinsurance. Costs may be different it’s important to make sure you understand your plan and what you are paying for.

Kidney Transplants

Coverage can start the first month you go to the hospital for a kidney transplant providing it’s a Medicare network hospital. Your transplant must happen within the month you’re admitted or 2 months after being admitted in order to be covered by Medicare.

Medicare covers the deductible, coinsurance, and any other costs for your kidney donor’s stay at the hospital – neither you nor your donor will be responsible for those costs.

Medicare Part B covers these transplant drugs if certain requirements are met, such as:

  • Eligible for Medicare due to End-Stage Renal Disease (and you’re not 65+ or are disabled)
  • At the time of the transplant, you were already a Medicare Part A beneficiary
  • The transplant surgery must have been performed at a facility that accepts Medicare
  • You must have Medicare Part B, they won’t cover anything prior to enrollment

Say you’re only eligible for Medicare because you have permanent kidney failure, your Medicare coverage for transplant drugs will stop after 36 months from the month of your kidney transplant.

Other options are available to help you pay for these drugs, talk to your healthcare provider for more information. However, Part B does not cover most prescription drugs; Medicare Part D helps pay the costs of prescriptions.

Medicare Continues to pay for transplant drugs when you’re:

  • Previously eligible for Medicare due to age or a disability BEFORE you were diagnosed with ESRD
  • Eligible for Medicare due to age or disability AFTER getting a kidney transplant that Medicare paid for
  • If private insurance paid the primary to your Medicare Part A coverage

All services must have been at a facility that accepts Medicare.

Medicare Coverage for Kidney Disease Education

You are covered for up to 6 sessions of kidney disease education if you have stage 5 kidney disease – typically needing dialysis or a kidney transplant.

These education sessions are important for learning how to cope with your kidney disease, manage life and finances, how to stay as healthy as possible, what you can expect through treatment, and give you an outlet to discuss how you feel. Mental health is just as important as physical health.

Be sure to always consult with your Medicare professional agents to ensure you’re getting the best coverage possible.

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Health Insurance

Center for Medicare Services (CMS) Modernizing with Technology

by Jagger Esch
written by Jagger Esch

For some Medicare beneficiaries, technology changes and advances are beyond their years. However, times are changing, and many beneficiaries are eager to embrace the change.

The Center for Medicare and Medicaid Services (CMS) is the largest single healthcare insurer nationwide. CMS pays upwards of $1.5 billion worth of claims, every day.

The digital age is upon us, our healthcare coordination wants us to know about the benefits and efficiency in using technology with healthcare. Lately, health care has taken up a large share of the U.S. economy and it’s still growing.

In fact, by 2026 it’s predicted that one in every five dollars spent in America will be on health care. As the cost of care rises, the healthcare system is working towards becoming more efficient by accommodating Medicare’s technologically inclined beneficiaries.

CMS is Keeping up With Technology

The CMS is doing more to reach those tech-savvy seniors. As the federal government plays a large part in healthcare delivery and payment, CMS is trying to give easier and more efficient ways for care coordinators to use technology to their benefit.

In early 2019, they created a podcast as well as an app that will help inform beneficiaries about Medicare and provide patients with a digital option to view their health status.

As significant advancements are made in biomedicine – health care delivery is changing for the better. These new technologies can improve the efficiency in healthcare by pushing cost-effective care; in turn, patient outcomes will see an improvement.

The focus is on encouraging innovation and making a new pathway for treating patients. CMS wants to ensure that beneficiaries can access the newest medical technologies; this will improve not only the quality of care received but lower costs while doing so.

Modernizing Medicare due to Latest Technology Advances

In October 2018, the CMS announced they’d revise Medicare’s local coverage determination process. This means more access to new technological health care services.

Medicare was signed into law in 1965, I bet they couldn’t imagine the technological developments or new therapy options we’re seeing today.

Medical technology is developing and at a fast pace. Meanwhile, Medicare’s payment systems are not. Some of Medicare payment policies haven’t seen an update in as long as 10+ years.

As you can imagine this could cause some issues. There’s a good chance some consumers will experience gaps in coverage while waiting for the FDA approval of technology and Medicare paying for the technology.

CMS is still sorting out issues and working on improving the process for covering items/services that will potentially improve the care of all patients. The goal is to help beneficiaries experience a health care system that provides the technology we’ve all grown accustomed to in other aspects of our lives.

For instance, CMS released the Blue Button 2.0 application programming interface (API). This API gives Medicare beneficiaries a digital platform to get their claims data in digital form. This means you can safely and securely use your medical information in third-party electronic applications (apps).

As almost everyone has one, smartphones are basically a way of life at this point. Due to smartphone popularity, app developers are creating programs that use claims data from Blue Button 2.0.

This is giving beneficiaries the ability to understand their health report and manage their health status in the palms of their own hands; and better yet, at their own convenience.

“What’s Covered” app

Early February 2019, the Centers for Medicare and Medicaid Services released a new app. Giving consumers a more modern Medicare experience; this app has direct access through a mobile device to some of Medicare’s most popular content.

The app is called “What’s Covered”. It gives people with Original Medicare and their caregivers an efficient way to check if Medicare covers a certain medical service and/or item.

The What’s Covered app is allowing consumers to use their mobile device to receive more consistent and accurate Original Medicare coverage information.

Some of the most searched questions for the CMS is “What does Medicare cover?”

Having access to this information while you’re at the doctor’s office, hospital, or anywhere you have a mobile connection for that matter, will help you become more educated on your coverage. In turn, will result in a better quality of care for beneficiaries and providers as well.

You can download the What’s Covered app for free in either the Apple App Store or Google Play.

Medicare goes digital: eMedicare

In 2018, the eMedicare initiative was launched by CMS to provide cost and quality information to Medicare beneficiaries. eMedicare is an app that comes with many tools for consumers to use to help them make better health care decisions for themselves and/or their loved ones.

This includes interactive online decision support designed to help you understand and evaluate your coverage options with Medicare. You can also compare costs between Traditional Medicare and Medicare Advantage plans.

Moreover, you have the option with this new online service to see how the different coverage choices will change their anticipated out-of-pocket expenses.

Transparency tools are available so beneficiaries can compare rates of specific procedures. The Medicare Plan Finder has a new web chat option within the app as well.

Of course, those with Medicare may still receive paper copies of the “Medicare and You” handbook as well as Medicare Summary Notices.

Meanwhile, eMedicare is still expanding and improving current consumer service options.

CMS Launches Podcast

February was full of CMS technological launches. The Centers for Medicare and Medicaid Services launched “CMS: Beyond the Policy,” a new podcast.

The podcast will feature updates and changes to policies and programs regarding Medicare.

These topics are presented in a conversational format, making it easily accessible to consumers. The intention of this podcast is to reach more consumers to explain the policies and programs in a fashion that’s more easily understood.

CMS Administrator Seema Verma said:

“The new Beyond the Policy podcast demonstrates our commitment to transparency and outreach by presenting CMS-related policies, updates, and innovations on as many platforms as possible…This program is a direct response to stakeholders’ suggestions that a podcast would be a modern, user-friendly way to stay informed about CMS.”

New podcast episodes will be periodically released; they’ll cover a wide range of topic experts, stakeholders, and CMS Administrator Verma as well.

You can download podcasts on iTunes here, or on Google Play here.

Digital Technology Coordinates Quality Care

According to CMS, Medicare and Medicaid patients with multiple chronic conditions make up about 15% of all beneficiaries. However, at least half (50%) of all costs spent by CMS is due to these patients.

The federal government is seeking out options to better coordinate care for chronic disease management; one option is the accelerated use of telehealth services.

For instance, one way how CMS is keeping up with technology is the new rules for telehealth services.

These new rules are making it easier for consumers to receive treatment. It’s also making it more efficient for providers to acquire authorization for the treatment of opioid patients and for those suffering from behavioral disorders.

As CMS becomes more patient-centered, they’re pushing to create pathways for success. Better coordinated care means adopting payment options for virtual care. Like, paying providers for submitting remote evaluations of photos or recorded videos submitted by their patients.

The Future of CMS Technology

CMS realizes that technology is the way of the future. As the demand grows, they work towards incorporating innovation and technology when managing patient care.

Advancements such as telehealth are beneficial for providers and consumers combined. This digital and remote option gives consumer freedom and convenience.

Whereas the provider can treat patients more efficiently because not all medical related services require an in-office doctors visit.

The population of people with Medicare is growing, in fact, the population is expected to see a 50% increase by the year 2030.

As of the year 2016, about 65% of Medicare beneficiaries stated that they use the internet or internet services almost daily.

Beneficiaries are becoming more digitally inclined; the demand for technology-related health and medical services is growing. You can expect to see more of these medical services options become available over the next few years.

This is great news! New digital and remote treatment options will result in a more efficient healthcare system.

Center for Medicare Services (CMS) Modernizing with Technology

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Medicare Plans

Difference between Medigap Plans and Medicare Advantage

by Jagger Esch
written by Jagger Esch

When it comes to insurance, it would be fair to say you either pay now or pay later. If you pay now, you are choosing to pay a higher premium with the expectation your insurance plan will pay more when you file a claim. The pay later option means a lower monthly premium and leaves the Medicare Beneficiary with a greater out of pocket expense when seeking medical treatment. Difference between Medigap Plans and Medicare Advantage
There are several reasons to choose a Medigap Plan over Medicare Advantage Plans. The comprehensive benefits provided by a Medigap, as known as Supplement Plans can limit or eliminate out of pocket costs. Individuals covered by a Medigap Plan avoid network restrictions and have coverage worldwide. Most importantly, Medicare Supplement Plans allow the insured to budget the cost of their coverage and reduce unexpected expenses.

Medicare Part A

For 2018, the Medicare Part A deductible is $1340, then the plan pays 100% of hospital expenses for that benefit period. The benefit period lasts 60 days from the start of the hospital visit. If your hospital stay lasts longer than 60 days, you will incur a per day coinsurance.
The Medicare Beneficiary is responsible for that daily coinsurance. After 60 days, or in the event of an unrelated condition, if the Medicare Beneficiary is admitted to the hospital, a new benefit period starts, and the $1340 deductible is applicable, again. This can continue throughout the policy year.

Medicare Part B

Medicare Part B covers preventive services and medically necessary services such as doctor visits, durable medical equipment, diabetic supplies, and drugs administered in a doctor’s office.
The Medicare Part B deductible is $183 for the 2018 year, after the deductible is satisfied, Medicare pays 80%.

Gaps in Coverage

As you can tell, Original Medicare leaves gaps in coverage. There are gaps in Part A and gaps in Part B. Original Medicare does not have any out of pocket maximums or provide any caps to minimize the loss incurred by the Medicare Beneficiary. Your exposure to loss is undefined; there is nothing to protect the Insured person from financial losses.

Take into account that it cost about $5,000 to go to the emergency room. That’s without being admitted and without a gamut of tests. The gaps in coverage left by Original Medicare can be filled quickly and affordably by enrolling in a plan offered by any reputable insurance provider.

Medigap Plans Protect

Medigap plans do have a premium that is in addition to your Medicare Part A and Part B. The premium amount for your Medigap Plan is paid by the Medicare Beneficiary directly to the Insurance Company.

With a Medigap plan, you choose the amount of risk you are willing to take, the premium is reflected in the amount of benefits you elect. Regardless of the underwriting company (the name on the card you carry), the benefits are the same and are differentiated by letters.

Most people choose Plan G. Medigap Plan G, covers everything not covered by Medicare except for the $183 Part B deductible. The Plan F, provides the most protection to the Medicare Beneficiary, and minimizes the medical costs that could be incurred.

Of course, you can save on premium dollars if you are willing to consider some of the other plans. This is where your licensed insurance agent can help, by shedding some light on the various options that will provide the most coverage and still keep the premium within your budget.

Medigap Offers Freedom

You’re free to choose your doctors and hospitals. These plans allow Medicare Beneficiaries to select doctor’s based on their personal preference, in addition to choosing the hospitals they utilize. The only requirement, is that the provider accept Medicare.

The freedom offered by being insured can be liberating. Just ask someone who has been limited to a list of doctor’s or had a claim from a specialty hospital denied. Treatment of medical conditions/ diseases can be determined by the patient and doctor.

The Disadvantages of a Medicare Advantage Plan

Medicare Advantage Plans require the Medicare Beneficiary to use network doctors and hospitals. With most advantage plans, going out of network isn’t an option as there are no out of network benefits. Most have network restrictions and seeing a specialist will require a visit to your primary doctor to obtain a referral.

There are only specific periods during the year when you can enroll or switch to another Medicare Advantage Plan. Otherwise, you can’t change your Plans during the year.
The premium on a Medicare Advantage Plan can be low or even zero. However, the Medicare Beneficiary will incur expenses over the course of the policy year, including deductibles, copayments and coinsurance. Typically, Medicare Advantage Plans have an out of pocket maximum of at least $6,000.

You Get What You Pay For

Medigap Policies are the best choice for securing the most comprehensive coverage. You keep your Original Medicare Parts A and B. Then choose the Medigap Plan that best fits your needs and fills the gaps in coverage left by Medicare. A qualified licensed insurance agent can help you compare the costs and benefits of your options. When comparing your choices, it will become apparent which option will best suit your needs and budget.

Medicare Beneficiaries choose supplement plans for several reasons. Most people buy a Supplement Plan because they want to protect their assets. After more than 40 years in the workforce, it’s prudent to protect that which you have worked so hard to earn.
Others select a Medigap Plan for the freedom to choose their caregivers, hospital and doctors.

Medigap Policies provide coverage at any doctor or facility that accepts Medicare. In addition, these Supplement Plans provide coverage when you travel outside the United States.

When choosing a plan to fill the gaps left by Medicare, Medicare Beneficiaries are electing to purchase one of the Medigap Plan options. These plans offer a set monthly premium amount that Medicare Beneficiaries can work into their fixed income.

A set monthly premium works best for Medicare Beneficiaries as the unexpected out of pocket costs associated with a Medicare Advantage Plans leaves the insured person financially vulnerable.

There are several options available and the best way to shop around for the plan that meets your needs is to contact a qualified licensed agent. Your agent will ask you some questions to better understand your concerns and budget.

Once your agent understands your specific needs, he/ she will be able to check with the carriers in your region to advise which companies offer the best premium amounts for the coverage you’ve elected.

Enrollment into a supplement plan is best when you are first eligible for Medicare Part B. However, if you have delayed enrolling in Part B, because of coverage through your (or your spouse’s) group health insurance plan with an employer, you may be able to enroll in Part B and your Medigap Plan when that coverage ends. You will want to take action prior to the group plans termination day. It’s a good idea to contact your insurance agent as soon as you suspect any changes to your coverage.

Difference between Medigap Plans and Medicare Advantage

Difference between Medigap Plans and Medicare Advantage Difference between Medigap Plans and Medicare Advantage Difference between Medigap Plans and Medicare Advantage Difference between Medigap Plans and Medicare Advantage Difference between Medigap Plans and Medicare Advantage Difference between Medigap Plans and Medicare Advantage Difference between Medigap Plans and Medicare Advantage Difference between Medigap Plans and Medicare Advantage

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Medicare Plans

How New Value-Based Insurance Impacts Medicare Beneficiaries

by Jagger Esch
written by Jagger Esch

The new Value-Based Insurance Design will impact Medicare beneficiaries exponentially. Discover how quality of care in 2020 will be pushed to the forefront of doctor priority.

Medicare beneficiaries are going to see a positive shift in benefit options as early as next year. Patients can expect to see a higher quality of care in 2020 due to new provisions introduced by the Center for Medicare and Medicaid Services (CMS).

One of these incredible provisions is the expansion of Value-Based Insurance Design or VBID for short. A change made in the Chronic Care Act expanded testing of the Medicare Advantage Value-Based Insurance Design Model nationwide.

This is great news! The VIBD model gives plans the ability to create customized benefits for a certain enrollee population. The benefits offered are determined by specific conditions and/or socioeconomic status.

Value-Based Insurance Design (VBID): How it Started

The Centers for Medicare and Medicaid Services (CMS) designed a voluntary VBID model in 2015. This model was created for insurance carriers offering Medicare Advantage plans.

The purpose of this VBID model? To test the impact of offering Medicare Advantage organizations (MAOs) more flexibility in the design of benefits. Things like reduced cost sharing or extra supplemental benefits to patients with certain chronic conditions.

CMS stated in the VBID model 2020 – this model was created to lessen Medicare expenses while improving the quality and coordination of health care for Medicare beneficiaries.

Before the VBID model, Medicare Advantage organizations were unable to offer VBID due to federal requirements (they wanted benefits to remain consistent).

Particularly, MAOs needed to abide by the requirement that:“All plans must be offered at a uniform premium, with uniform benefits and cost-sharing throughout the plan’s service area…to all Medicare beneficiaries with Parts A and B of Medicare.”

Now, CMS has lifted the uniformity requirement for qualified Medicare Advantage organizations in half of the U.S.

25 States included: Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania, Alabama, Michigan, Texas, Tennessee, California, Colorado, Florida, Georgia, Hawaii, Maine, Minnesota, Montana, New Jersey, New Mexico, North Carolina, North and South Dakoda, Virginia, and West Virginia.

VBID testing in these states allowed for the following diseases: chronic obstructive pulmonary disease (COPD), diabetes, congestive heart failure, history of strokes, coronary artery disease, hypertension, mood disorders, and variations of the different categories.

Since the initial model release, nearly 60,000 beneficiaries were affected. Alabama, Michigan, and Texas will allow testing for dementia and rheumatoid arthritis.

Mid-January 2019 the CMS announced the upcoming changes to the VBID model for the following year (2020). Changes include allowing plans in ALL 50 states and U.S. territories to apply.

This includes plan types that weren’t initially part of the VBID model.

For instance, plan types such as Regional Preferred Provider Organizations (RPPO) and all Special Needs Plan (SNP) types – Chronic Condition SNPs (C-SNP), Dual Eligible SNPs (D-SNP) and Institutional SNPs (I-SNP) will be included in the VBID model for the calendar year 2020.

The updated VBID model for 2020, gives an opportunity to new MAOs that might want to apply. Thus, MAOs should look over the current VBID model for Medicare Advantage to see what it has to offer.

One example of how the value-based insurance design will impact Medicare patients in 2020 has already begun. Since the Medicare Advantage program started broadening benefits, beneficiaries are continuously enrolling in them over Original Medicare plans.

Enrollment for MA plans is expected to reach an all-time high in 2019. According to CMS, 22.6 million Medicare beneficiaries are signed up for this program.

VBID Benefits in 2020

Come January 2020, Medicare Advantage (MA) plans can offer reduced cost-sharing and extra supplemental benefits. Benefits for enrollees will be more customized to their situation than ever before.

The same is true for benefits that aren’t directly related to health care. Benefits such as transportation for home health and home care providers can be a huge help for many beneficiaries.

According to a recent nationwide poll, (conducted by the National Aging and Disability Transportation Center) about 1 in every 5 older adults will give up driving privileges after their 65thbirthday.

Access to covered transportation services can assist home health-care agencies, by helping clients get to and from important health-related appointments.

About 3.6 million people (mostly older patients) will miss health-related appointments every year. Benefits of transportation services should lower this number greatly.

This updated VBID includes more benefits specific to managing chronic conditions, telehealth services, for those who qualify for a low-income subsidy, and (or) are dual-eligible.

Participating MA plans can offer telehealth services as a substitute for in-person health care visits. If the MA plan will cover face-to-face visits for a health issue – then the MA plan will also cover telehealth services.

CMS is testing out another new program, hoping to effectively influence members to create healthy behaviors by offering more meaningful rewards and incentives.

Rewards and Incentives programs

These RI programs have allowed costs that better reflect expected benefits for health-care, up to the annual limit. Reflections should promote a healthier lifestyle, prevent injuries and illness, and aid in using health care resources efficiently.

Medicare Advantage plans offering a Prescription Drug Plan (MA-PDs) can offer RI programs too. Likewise, RI programs are provided to patients who take Medicare-covered Part D prescription drugs.

RI programs are also for those participating in the following: disease state management programs, medication therapy management with health-care providers (or pharmacists), and preventative health services.

Lastly, enrollees are required to stay updated with prescribed medications – including the understanding of any generic alternatives that may be more cost-friendly.

VBID Hospice Benefits
Although it’s not in place just yet – come 2021, the VBID model testing will allow MA plans to offer benefits for Medicare’s hospice coverage.

Recent updates were created to give more access to hospice-related services and provide better coordination between hospice providers – ultimately providing better hospice care for members.

The highly anticipated 2021 CMS update to VBID, allowing hospice benefits is expected to have the largest impact. Hospice care is not currently a covered benefit in Medicare Advantage plans, so for beneficiaries, this is BIG NEWS.

Value-Based Insurance Design has Cost Reduction in Mind

The current versions of Medicare Part D and Medicare Advantage haven’t been updated in over a decade. The CMS debates were well over-due for an upgrade.

As times are changing, so are the advances in health care. What worked for benefit options a decade ago – isn’t quite good enough for recent years. One example is, the technological options available today, like telehealth services.

The idea behind VBID is to provide Medicare patients with optimal coverage options, lessening the costs for beneficiaries, and making the entire Medicare program more efficient.

Aiming to promote a healthier lifestyle at a more affordable rate – VBID is still proposing Medicare Advantage expansion plans. Expect more updates and changes to be launched over the next few years.

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Health Insurance

How to Protect Yourself from Insurance Fraud

by Jagger Esch
written by Jagger Esch

When discussing the financial world, insurance is probably one of the safer aspects according to statistics. This doesn’t mean immunity from insurance fraud.

For seniors, this is a cause of concern as many don’t use a computer regularly.

The biggest issues regarding insurance fraud among consumers are stolen social security numbers, fake insurance policy placement, and scams looking to steal any personal information possible.

The good news is you don’t have to be caught off guard. Be proactive and protect yourself against insurance fraud. Also, don’t be afraid to report fraud.

Tips to Protect yourself From Insurance Fraud and Scams

Applying for or changing insurance policies and sorting out life insurance options will have you contacting many different agents.

We’ve put together some tips to help keep your personal information more secure during this process.

Research Agent Licenses

When working with any new insurance agent you should investigate their insurance agent license information, before you give any personal information out.

Make sure your agent is legitimate; remember all non-fraudulent agents and brokers in the US are licensed.

To inquire about an insurance agents’ license information, go to your state insurance regulator’s website.

While doing your research, if you uncover their license doesn’t exist or has been suspended – stop working with them and look for another agent.

Lock your Credit, Protect your Social Security

For the longest time, most insurance companies required social security numbers on all insurance applications. Luckily for us, times have changed.

While new regulations for some property and casualty insurers don’t require social security numbers on applications anymore. Most property and life insurers however, will still require SS numbers.

Meaning, if you’re simply looking for a quote, don’t give them your social security number; it’s not required. Any credible insurance agent won’t be shocked if you request to wait until the end to give them your SS number.

Not many agents will tell you this, but the only true effective way to completely protect your social security number, is to totally freeze your credit.

Due to recent new federal legislation regarding SS numbers, everyone in the United States can freeze their credit file, for free.

Once you have gone through the difficult process of freezing your credit, you can stop worrying about fraud; get some peace of mind.

The problem is, after you freeze your credit, unfreezing it to re-gain access – is just as difficult.

Be wary of writing out checks directly to Insurance Agents

When making payments, you should be adamant about writing out payments to the name of the insurance company itself, rather than the agent. Sometimes, there’s one-off situations that require you to break this rule.

Although it’s rare, specific types of insurance will have you write out checks to an agency.

If your agent asks you to make a check out into their name, a red flag should go up.

To be safe, call the insurance company directly and ask if you can pay them directly. Sometimes the only option is to write a check directly to the agent. In this case, you should inquire about a fidelity bond.

Premium Embezzlement

To branch off when discussing insurance agents and fraud issues, premium embezzlement is a thing and yes, it does happen.

Some individuals who work for a licensed and credible insurance firm are simply up to no good. Reports have been made that they’ve scammed consumers for their personal gains.

One way of scamming might be, a fraudulent agent will collect your premium payment and instead of giving it to the insurance company – they just pocket your money.

Meanwhile, as a consumer, you believe your premium has been handled accordingly and count on using your coverage when needed. Unbeknownst to you, your premium was never actually paid.

On the contrary, your insurance company assumes you’re not keeping up your end of the deal; resulting in cancellation or may not renew your policy.

You should be receiving a copy of your policy, an insurance ID card and/or receipts of payments made. If you haven’t gotten proof, or you stop getting proof of payments made, this is a sign that your premiums haven’t been submitted.

Contact your insurer immediately and get to the bottom of this as quickly as possible to prevent a loss in your coverage.

Medicare Insurance Fraud

Medicare’s Affordable Care Act doesn’t require beneficiaries to get a new ID card. If you’re contacted by someone impersonating a government or Medicare professional and are asked to pay for a new insurance card, it’s a scam.

If this happens, don’t share any personal information with them; hang the phone up immediately, and contact your non-emergency local police department to report the call and phone number.

Check financial strength ratings

Ratings and reviews can still be protection by making you aware of any shady behavior other consumers may have experienced.

A variety of governmental state agencies regulate all insurance nationwide. Meanwhile, their financial portion is rated by 4 private rating agencies.

However, these agencies are NOT associated with the government.

Each rating agency has its own rating system; insurance specialist AM Best is the easiest to comprehend. AM Best rates insurers with metric on their Financial Strength Rating.

Consumers want to look for A- and above.

It’s important when buying any sort of cash value life insurance and when considering annuities, to check all prospect ratings.

Don’t Trust Phone Calls and Check Website Credibility

Just because you saw it on a website, or you get a phone call with information – doesn’t mean it’s factual.

A good rule of thumb is, if it’s important enough you’ll receive an official notification in the mail. No insurance underwriter is going to call you and ask for your social security number or your bank account information.

The bottom line is that you don’t just give up that information over the phone when asked.

Even if you get a letter from your insurance company requesting personal information in the mail, call your agent or insurance company and confirm the request is authentic.

Should you get a phone call inquiring your personal info, promptly hang up and call the number on the back of your insurance card.

Be Cautious of “Phishing” Scams

These same rules apply for websites and emails. Sharing information online should be done with caution.

An insurance company doesn’t typically email you asking for additional information, unless you’re signed up for online billing.

The danger with phishing emails

Some emails appear to be from a legitimate source; these emails are phishing scams.

E-mail scams try to get you to volunteer your personal or account information, like your passwords, credit card and bank numbers, and social security numbers.

Be careful what links you click on and don’t send your personal information to anyone until you’ve verified the source. If you’re unsure, then explore.

Steering Clear from Fraud

There’s not a single guide on the market that can completely keep us protected from any type of fraud or scams.

These tips should help you feel safer and provide you some tools when combating shady situations.

Not everything is what is seems. Insurance scams and fraudulent activity has gotten more convincing with the advances in technology.

It has become harder to detect, stay alert and protect your personal information; after all, it does belong to you. With these tips you can protect yourself from insurance fraud in the future.

 

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Vision

Medicare coverage for Macular Degeneration or Vision

by Jagger Esch
written by Jagger Esch

When it comes to Medicare, it’s important to know what services are covered. While many services are covered under Medicare, there are still inquiries about vision and macular degeneration coverage.

Services that are considered elective, such as vision, dental, and hearing, are usually not covered under Original Medicare. So, will Medicare provide coverage for macular degeneration or vision?

Certain conditions, since they are considered medical, will be covered under Original Medicare. A great example is age-related, Macular Degeneration.

What Vision Services are Covered by Original Medicare?

Conditions such as cataracts surgery and glaucoma treatment are covered benefits.

Medicare will cover diseases or illnesses related to vision services. If you’re at risk for having glaucoma or you’ve been diagnosed with diabetes, then Medicare Part B will cover an annual eye exam.

Also, treatment of medical conditions such as infections and screenings for hereditary conditions are usually covered by Medicare.

What Vision Services are Not Covered by Original Medicare?

There are many options available for Medicare Beneficiaries to choose important services that are not considered medically necessary, such as a stand-alone Vison, Dental or Hearing policy.

Vision Services Medicare won’t cover:

  • Routine vision care like an eye exam
  • Glasses without cataracts
  • Contacts

 

Medicare will only cover diseases and infections of the eye. If your treatment is considered Medically necessary, you might receive coverage.

Routine eye care isn’t considered necessary unless there is an underlying medical condition making it necessary, such as diabetes or glaucoma risk.

Will a Medigap Plan offer coverage for Macular Degeneration?

A Medicare Supplement, often referred to as Medigap, covers the gaps in Original Medicare.

Macular Degeneration is covered under Original Medicare, so a Medigap plan will be required to cover treatments for it as well. When you have a Medicare Supplement, the insurance carrier covers the 20% that Medicare isn’t covering.

Having a Medicare Supplement plan allows you to choose any doctor in the nation that accepts Medicare Assignment. Meaning you have more freedom and a better chance for quality care.

Is Macular Degeneration Covered by a Medicare Advantage Plan?

A Medicare Advantage plan is required to provide coverage at least as good as Original Medicare.

It’s important to know that just because they’re required to cover everything that Original Medicare does, it doesn’t mean the treatment and doctors choice’s you have with Original Medicare are the same.

When enrolling into a Medicare Advantage plan it’s important for you to review the follow documents:

  • The Provider Directory
  • Drug Formulary
  • Evidence of Coverage.

 

Medicare Advantage plans require you to follow their network of doctors, hospitals and specialists.

This means your doctor may recommend one treatment and your plan can come back and say, no you can be treated but it must be this lesser cost option.

Having Macular Degeneration

Many people live with Macular Degeneration, one of the biggest tips to dealing with it is learning contrast.

For many people with the condition, it is difficult to tell the difference between certain colors, such as black and navy blue. Using items that provide a sharp contrast will help improve the ease of simple life tasks.

If you have a light-colored countertop or table, then using dark-colored drinking glasses or dishes will help you see things more clearly.

As the condition continues to develop, blurry or blind spots can start to appear in the center of your vision. Then, with time these spots can get larger.

When this occurs driving, reading, an even recognizing faces, becomes difficult.

Medicare & Macular Degeneration

Macular Degeneration is a severe disorder that causes vision loss. It is common for beneficiaries to be battling this condition; fortunately, Original Medicare will cover it.

There are two different types of Macular Degeneration:

  1. The Dry type progresses slower and causes small white or yellowish deposits to form on the retina. This causes deterioration over time.
  2. Wet Macular Degeneration is when abnormal blood vessels develop under the retina and grow toward the macula. These blood vessels tend to bleed, leak fluid, or break causing damage to the macula and causing it to pull away from his base.

Macular Degeneration Treatments?

The treatment for Macular Degeneration is considered medically necessary; hence they will be covered by Medicare.

Some examples of treatments covered for Macular Degeneration are Lucentis, Eylea, and Verteporfin. While there are many other covered treatments, these are some of the most common.

Dental, vision, and hearing services are usually aren’t medically necessary and therefore, not covered.

How do I Help a Family Member or Loved One with Macular Degeneration?

When someone becomes visually impaired, they can start to feel isolated and depressed.

Over time, frustration sets in due to tasks that used to be routine becoming difficult, and even some hobbies and leisure activities can seem impossible.

Make sure you keep encouraging them to take on challenges and resolve problems without feeling overwhelmed. Just being a friend can make a difference.

Care requires a team effort of health care professionals, family and friends and sometimes even community volunteers.

How do I Approach Needing to ask for Help with Macular Degeneration?

While it’s very important to try and maintain your independence. You should speak to family members for assistance with certain things that are increasingly more difficult.

Don’t let pride get to you, we all need help at some point in life. The only way to receive help, is to ask for it. If you never ask, you’re denying yourself help.

Having a direct conversation with someone to let them know what you’re having difficulty with and learning your limitations will help ease the frustration.

There are many Low-Vision organizations dedicated to helping people with developing vision impairments. Reaching out to community organizers could benefit you tremendously.

Most Importantly, you can get assistance with low-vision aids for daily activities, government benefits, and large print and audio materials.

 

 

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Health Insurance

Diabetes and Medicare Coverage

by Jagger Esch
written by Jagger Esch

Receiving coverage for Diabetes is especially important for those on Medicare. Having additional insurance coverage makes managing diabetes easier.

Diabetes is a medical condition in which the body doesn’t produce enough insulin, which ultimately leads to an increased amount of glucose in the blood.

Insulin is a hormone produced by the pancreas which in turn produces glucose (sugar). Glucose is needed to produce energy for the body’s cells function properly.

When the body is unable to do so on its own, it will need assistance in moving the sugars out of the blood stream and into the tissues after eating.

Diabetes Better Explained

There are two types of Diabetics:

Type 1 Diabetes

  • Commonly referred to as juvenile diabetes
  • Insulin-dependent
  • Considered an immune disorder (The immune system attacks the cells within the pancreas that produce insulin.)

 

With type 1 diabetics, it’s a chronic condition without a cure. Insulin injections are required for management of the disease.

Type 2 Diabetes

  • Is more common later in life.
  • The leading causes for type 2 diabetes include:
    • Poor diet
    • lack of exercise
    • an unhealthy lifestyle
  • Type 2 diabetes is insulin resistant

 

The body will still produce insulin, it just doesn’t use it properly. Type 2 diabetes can be treated with both injectable insulin and oral medications.

The good news is that with type 2 diabetics, the disease can be managed with medications, exercise, weight loss and eating diabetic friendly recipes.

In some cases, type 2 diabetes can even be reversed.

Treatment for Diabetes Management

There are different types of treatments available for management of both types 1 and 2 diabetes.

For most diabetics, their blood glucose is monitored daily from a meter and then their insulin dosage is calculated accordingly by using a sliding scale.

Insulin in injectable form comes in:

  • rapid-acting
  • short-acting
  • intermediate-acting
  • long-acting

 

With injectable insulin, a needle and syringe are used to draw the medication up, and then injected intramuscularly.

Pre-filled insulin pens are also available for multi-use and easy disposal. An added benefit of the insulin pens is the simplicity and convenience.

Insulin pumps are available and deliver small amounts of medication throughout the day.

These pumps can be worn outside of the body. A small tube connects to the pump and delivers medication to a needle placed underneath the skin.

Another type of pump is attached directly onto the body and delivers medication through a self-adhesive pod.

Artificial Pancreas

Individuals with an artificial pancreas will still need to manually adjust the amount of insulin the pump delivers.

But the good news is, the artificial device frees up time by keeping the blood glucose levels stable and even works while you’re sleeping.

With the pancreatic transplantation, the already destroyed islets are replaced with new islets to reproduce the insulin.

The procedure itself is taken from the pancreas of an organ donor and then transferred to the individual with diabetes.

This procedure is still under investigation, individuals interested in this procedure must be enrolled in the islet transplantation research study.

Diabetes and Medicare Coverage

By now, most individuals with Traditional Medicare know that Type A covers your hospital benefits and Type B covers your outpatient benefits.

Medicare Type B will typically provide 80% coverage of any of your doctor’s visits and outpatient treatments, lab work, physical therapy and diagnostic testing.

Your Medicare Part A benefits will also come in handy at 80% coverage for any surgical procedures done in a hospital setting.

So, individuals interested in bariatric surgery or an artificial pancreas may be eligible for insurance coverage for the procedures.

Medicare Part D Prescription Drug Coverage for Diabetics

As anyone with diabetes knows, home self-care is of vital importance when managing the disease.

Blood glucose monitoring strips, glucose monitors, lancets and external insulin pumps are all considered Durable Medical Equipment.

Once a physician deems any of the above devices as medically necessary, your Medicare Part D will pick up a portion of the cost.

Unfortunately, neither Medicare Part A or Medicare Part B have prescription drug coverage. Meaning, you’ll need to obtain a Medicare Part D Plan.

Part D will provide you with coverage for:

  • Medications (which can be pricey)
  • And supplies like
    • Syringes
    • Needles
    • alcohol swipes
    • And gauze!

Additional Medicare Help for Diabetics

There are a variety of other Plans available in which you can enroll for additional Medicare coverage.

Medicare Part C, also known as Medicare Replacement Plans can provide more coverage than what Traditional Medicare benefits offer.

However, these Plans usually come with policy limitations and most often require prior authorization.

Medicare Supplement Plans can also be purchased and will work in conjunction with your already excellent Medicare benefits.

These Plans provide additional coverage and individuals end up with less out of pocket expenses.

Diabetes and Long-term Care

After being diagnosed with diabetes, aftercare is extremely important.

Not only will you need to make sure your disease is well maintained by taking your medications and living a healthier lifestyle, but, routine eye exams, foot care for neuropathy and diabetic ulcers and other treatments are medically necessary.

Additionally, with diabetes the circulatory system is affected as well as the kidneys and central nervous system.

Diabetes can also cause:

  • Cardiovascular disease
  • Hearing impairment
  • Alzheimer’s disease.

 

You’ll want to closely follow the care plan created by your healthcare provider so that potential life-threatening complications don’t arise.

Medicare benefits will provide coverage for your routine follow-ups with your endocrinologist and any other specialists needed to co-manage this life-altering disease

With Diabetes becoming more popular, preventative measures have become utmost importance among Americans.

Nearly 10% of the world’s adult population has been diagnosed with Diabetes.

Inactivity and increased obesity are a major contributing factor as to why the disease has been on the steady incline.

Over the age of 65 it’s vitally important to have Medicare coverage to make sure all your healthcare conditions can be well controlled.

While this disease can be life-changing, remember, you remain in control of your life. Take control of your diabetic health so you can live a long, happy, and healthy life!

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Prescription Programs

Does Medicare Cover Hearing Aids?

by Jagger Esch
written by Jagger Esch

As you get older, you start to think about your health in new ways. Things you never were too concerned about before now become a top priority. One of these things is hearing. Hearing loss is a common and sometimes frightening development that takes place as you age. Does Medicare Cover Hearing Aids?

Causes of Hearing Loss

A variety of circumstances can cause hearing loss. External causes, like long-term exposure to noise pollution, are common. Internal causes, such as genetics or illness, can also play a major role in hearing loss.

Do You Need Your Hearing Tested?

If you have noticed that you are having trouble hearing, you may need a hearing test. Sometimes, symptoms can come on very gradually, so it’s difficult to be sure. If you notice that you are asking people to repeat themselves, or that people seem frustrated that you can’t hear them, this can be an indicator before you even notice yourself. Also look for symptoms such as ringing or feeling like your ears are plugged. Keep in mind that, even if you show no symptoms now, as you age you will likely need a hearing exam at some point in your life.

Where to Buy Hearing Aids

Typically, hearing aids need to be prescribed by a doctor and can be very expensive. Thanks to the Over the Counter Hearing Aid Act of 2017, hearing aids will soon be able to be bought over the counter at a more affordable price. These hearing aids are for people with mild to moderate hearing loss. The goal is to make the market more competitive so that costs for hearing aids everywhere reduce.
Until this happens, and as hearing issues progress, you will still unfortunately be paying a high cost for hearing aids if you don’t have the right coverage.

Understanding Medicare Coverage for Hearing

It is important to understand fully what you are covered for when it comes to hearing as you age. As with most Medicare coverage, Medicare covers services that they find medically necessary.

Diagnostic Hearing Exams

Routine hearing exams are not covered under Medicare. Under Medicare Part B, diagnostic hearing and balance exams can be covered if ordered by your health care provider to determine whether you need medical treatment. One example of this would be testing for the cause of vertigo or dizziness. Under these circumstances, you are still partially financially responsible. If the test is done in a hospital, the hospital copayment will be due. If the test is done outside of a hospital, the Medicare 20% coinsurance applies. Medicare supplement plans are available which will pick up these costs.

Medicare Coverage for Hearing Aids

One of the most common things people wonder about as they start to approach age 65 is Medicare coverage for hearing aids. This is because hearing aids can be very pricey. Not only are the actual hearing aids themselves costly, but the tests and exams required to determine need of the hearing aids!
Medicare does not cover hearing aids, routine hearing exams, or the exams for fitting hearing aids. This leaves a big hole in your health coverage should you just accept this fact. Fortunately, there are alternatives and supplements to Medicare insurance. However, not all of these will provide you with the coverage you need, either. Here is a breakdown of different plans you may have heard of and what hearing services they do – and don’t- cover.

Medigap

You may have heard of Medigap before. It is also commonly known as Medicare Supplement insurance. This is private insurance that supplements Medicare A and B. Many people use these plans to assist with medical out-of-pocket costs. It is important to remember that Medigap doesn’t pay for services not covered by Medicare. Instead, it pays for remaining costs that would typically be out-of-pocket for the patient.
There are ten different types of Medigap plans, and each has different benefits. None of them cover hearing aids.
These plans can still help you with hearing service costs. For Medicare Part B covered diagnostic hearing tests, Medigap will pay the 20% coinsurance. Some plans, such as Plan C and Plan F, will pay the deductible as well.

Medicare Advantage

Medicare Advantage is another option you may have heard of, and is also privately issued. It is also referred to as Medicare Part C. It provides the same benefits as Medicare Parts A and B, and in some cases additional benefits. With certain plans, hearing exams may be covered, but hearing aids are typically not covered by Medicare Advantage.

Help with Costs and Expanding Your Coverage

If you are looking to reduce your costs when it comes to hearing services, there are a few things you can do. Enrolling in a Medigap plan will help you cover out of pocket costs when it comes to doctor-ordered diagnostic hearing tests.

You can also expand your Medicare coverage by adding specialized Dental, Vision, and Hearing plans to your Medicare plan. These plans are affordable and can cover your routine hearing tests. They even sometimes cover hearing aids.

To find out what type of coverage is best for you, compare rates and plans here. You will find an easy-to-follow system and help from qualified individuals who can help guide you to the right plan.

Does Medicare Cover Hearing Aids?

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