Home » Medigap » Page 3
Tag:

Medigap

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.

0 comment
0 FacebookTwitterPinterestEmail
Mature senior businessman talking by mobile phone.
Medicare Plans

When Does Medicare Annual Enrollment Period End? Soon!

by My Senior Health Plan
written by My Senior Health Plan

If you need to make changes to your Medicare coverage for the upcoming year, mark your calendar for December 6th! It’s when the 2020 Medicare Annual Enrollment Period (AEP) will end.

After that date, you will not be able to make changes to your existing Medicare coverage until next October.

In case you’ve been thinking about making changes to your existing Medicare plan, now is the time to take action!

Book your appointment as soon as possible

While December 6th may seem a ways off, November is a busy month for everyone, including your plan providers.

Additionally, Thanksgiving falls on the 28th of this year, a little over a week before the end of AEP.

If we factor in weekends, the available time for getting an appointment and processing your application starts to narrow.

Get in early to get the one-on-one attention you deserve

During AEP, your carrier’s calendar fills up fast and they get strapped for time. Each application is time-intensive, requiring much more than a simple phone call or filling out a form.

During your scheduled appointment, your plan specialist will discuss your existing benefits and any Medicare changes that may affect your plan. For instance, this year, some beneficiaries may not qualify for Medicare Plan F.

Once you and your plan specialist have worked out what you need, they’ll submit any plan changes. The insurance carrier must then approve the application.

If any adjustments need to be made, your plan specialist will let you know, discuss your options, and resubmit your application.

The AEP application process—from your consultation to plan approval—must be completed by December 6th.

How to prepare for your Medicare plan call

Once you have a scheduled appointment with your plan provider, take some time to prepare for your AEP appointment.

After all, Medicare can get complicated. That includes understanding plan changes you can make during AEP 2020.

Here are some questions to consider:

Have you had the same plan for two or more years?

It’s easy to get comfortable with an existing plan. Maybe you receive the Annual Notice of Change letter each year and figure you don’t need to make any changes.

However, your health needs may have changed—or improved. Maybe you no longer take medication because your health improved. By revisiting your prescription drug plan, you may be able to adjust your benefits and save some money on coverage costs.

Were you happy with your coverage last year?

If you made changes to your plan last AEP or started receiving Medicare benefits for the first time, you may want to assess how well your insurance plan held up.

Did you have enough coverage? Are you comfortable paying the same deductibles for another twelve months? Were there any surprises? Make a note of your experiences and share them with your plan specialist.

Are there additional services or medications you may need this year?

Maybe you and your medical provider are monitoring a health condition. Now is an excellent time to talk to your physician about a timeline for treating it.

If you decide to take action this year, you will want to make sure you have the right coverage.

Also, if you wish to make changes to your Medicare benefits, make sure your healthcare provider will accept your new plan.

Taking charge of your healthcare

If you’ve decided your Medicare benefits are working well for you, that’s great! However, should you want to make any changes to your existing coverage, you must make an appointment with your plan specialist as soon as possible.

The MySeniorHealthPlan.com team can answer all your questions and guide you through the process. Call today toll free: 877.255.6273

 

0 comment
0 FacebookTwitterPinterestEmail
Medicare Plans

Understanding Medicare Enrollment

by Garrett Ball
written by Garrett Ball

When is the Medicare Open Enrollment Period?

The Medicare Open Enrollment period is terminology that many people often use to refer to the end of the year period during which you can change medical and prescription plans. However, there is definitely some confusion about this period and some misuse of the term. Let’s clear up the Medicare open enrollment period confusion. Understanding Medicare Enrollment

Medicare Open Enrollment: When You First Turn 65 or Start Medicare

The actual Medicare open enrollment period is when you first turn 65 or go on Medicare Part B. During this time period, you have “open enrollment” into a Medigap (Medicare Supplement) plan. This open enrollment period lasts for 6 months starting with the first day of the month you turn 65 (or your Part B effective date if that date is later). During this time, you cannot be made to answer any health questions or undergo any medical underwriting to be approved on a Medigap plan.

Likewise, when you turn 65 or start on Medicare Part B, you have an “initial election period” during which you can select a Part D plan (prescription drug plan) without restriction or penalty. This initial election period lasts for 7 months – the month you turn 65 and three months on either side of that month. During this time, you can select any Part D plan without restriction or penalty.

If you are opting to go with a Medicare Advantage plan, you get the same initial election period as detailed above – 7 months including the month of your 65th birthday and three months on either side of that month. Understanding Medicare Enrollment

So, What is the Annual Medicare Enrollment Period?

The period that occurs annually, at the end of each year, is actually the “annual election period” or AEP. This period does not apply at all to Medigap policies (Medicare Supplements). On the contrary, this period only applies to Part D and Part C (Medicare Advantage).

The annual election period runs from October 15 to December 7. During the AEP, you can make changes to your Part D prescription drug plan or your Part C Medicare Advantage plan. Any changes that you make will take effect at the start of the following calendar year.

Many people often mistakenly think that you can also make unrestricted changes to your Medigap plan during that period; however, that is not the case. While you certainly can compare and change your Medigap plan during that period, you do still have to answer medical questions and be approved (3 Steps to Compare Medicare Supplement Plans). It is not, technically, an open enrollment period for Medigap plans though. Understanding Medicare Enrollment

How to Prepare for the Medicare Annual Election Period?

If you have either a Part D plan or a Medicare Advantage plan (Part C), you will receive a notice of plan changes for the following year in the mail. This usually comes in late September or early October. It is crucial not to merely disregard this mailing. Some of these plans change drastically each year, and you don’t want to get stuck in a deteriorating plan. Understanding Medicare Enrollment

When you receive your notice of plan changes, you should look over it carefully. It should show a side-by-side comparison with the previous year’s benefits. See what changes have been made and decide, based on the plan changes, your satisfaction with your plan, and any changes to your health or finances, whether you want to “shop” for a new plan.

If you do want to shop for a new Part D or Advantage plan, keep in mind that you can do so during the annual election period, which runs from October 15 to December 7. Understanding Medicare Enrollment

0 comment
0 FacebookTwitterPinterestEmail
How Aging with Friends Fills the Void of Being Alone
Medicare Plans

United Healthcare Plan G

by Garrett Ball
written by Garrett Ball

United Healthcare Plan G: Old Plan, New Company

Plan G is an increasingly popular Medigap plan, even more so with the announcement of the end of Medigap Plan F. Plan G has been increasing in market share and momentum as a viable alternative to the most common plan, Plan F. Now, one of the largest providers nationally of Medigap plans is entering the Plan G fray. United Healthcare AARP Plan G
United Healthcare Plan G is now being offered in many states, as of 7/1/2017. United Healthcare partners with AARP for Medicare plans, giving them a broad national reach and making them a leader in the Medicare insurance marketplace.

For the last few years, United Healthcare has been one of the few major players in Medigap plans that did not offer a Plan G. They have focused the majority of their Medigap marketing efforts on Plan F and Plan N. However, now that is changing.

United Healthcare currently offers Medigap plans in all 50 states. The United Healthcare Plan G is being offered in 25+ states starting in July. Other states are expected to approve the Plan G rates in the coming months.

What You Need To Know

Keep in mind that all Plan G’s are the exact same – they all provide identical coverage and go by the standardized Medigap coverage chart. Plan G is full coverage at the doctor and hospital, with the exception of coverage of the Medicare Part B deductible (currently $183/year). That is the only out-of-pocket costs that you are responsible for on this plan.

The plan standardization means that you can compare plans from United Healthcare with plans from other companies with the assurance that you will receive the same Federally-standardized benefits.

Likewise, in addition to the coverage being standardized, the way that the plans work is the same as well. All Medigap plans pay claims through the Medicare “crossover” system – this is Medicare’s electronic system for coordinating payments between Medicare and your Medigap plan.

Also, all Medigap plans can be used at any doctor or hospital that takes Medicare, nationwide. So there are no networks with Medigap plans. United Healthcare AARP Plan G

Medigap rates are determined by a variety of factors, including where you live, your gender, and your age. So, it is prudent to compare plans for your specific situation before making or considering a plan change.
United Healthcare AARP Plan G United Healthcare AARP Plan G United Healthcare AARP Plan G United Healthcare AARP Plan G United Healthcare AARP Plan G United Healthcare AARP Plan G United Healthcare AARP Plan G United Healthcare AARP Plan G

United Healthcare AARP Plan G

0 comment
0 FacebookTwitterPinterestEmail
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

0 comment
0 FacebookTwitterPinterestEmail
Preventative Care Covered by Medicare
Health Insurance

Preventative Care Covered by Medicare

by Garrett Ball
written by Garrett Ball

Preventive care is, without a doubt, a significant factor in your physical well-being. This is also true, maybe even more so, as you age. Fortunately, after years of having limited coverage of preventive care, Medicare does now cover more preventive care. The key for the Medicare beneficiary is being aware of these and taking advantage of them. Preventative Care Covered by Medicare

Annual Visits Covered by Medicare

“Welcome to Medicare” Visit – Each Medicare beneficiary is entitled to a “Welcome to Medicare” visit within their first 12 months of being on Medicare Part B. During this visit, your provider will help you map out your current health situation and any future follow-up or ongoing needs (What Does the Welcome to Medicare Visit Cover?). Make sure your provider knows that this is your “Welcome to Medicare” visit, as this is coded differently than the annual wellness check (see below) and can cause problems if not handled correctly.
Annual Wellness Check – After your initial visit, each Medicare beneficiary can also do an annual wellness visit. During this visit, which is completed with your primary care doctor, you will review any further preventive care needs as well as your current health concerns or questions.

Preventive Services That Medicare Covers at 100%

Now, Medicare covers many preventive care services at a 100% level, as long as they are deemed to be “medically necessary”. Keep in mind that what Medicare considers “medically necessary” is person-specific in some cases – it can be based on your past health history, family history and other medical variables. Here is a list of medical preventive services that are covered by Medicare Part B at 100%:

  • Abdominal Aortic Aneurysm (AAA) Screening: This is for at-risk beneficiaries. You are considered at-risk if you have a family history of AAA or are a tobacco user
  • Alcohol Misuse Screening and Counseling: This is designed to eliminate/reduce alcohol use for someone considered to be misusing alcohol by their primary physician
  • Bone Mass Measurements: Medicare covers a bone density measurement every two years for people at risk for osteoporosis. Those classified as at risk for purposes of this screening are: estrogen-deficient women, those with vertebral abnormalities, those taking steroid treatments, those with hyperparathyroidism, and those that take an osteoporosis drug
  • Cardiovascular Risk Reduction: ALL Medicare beneficiaries are eligible for this visit. Doctors should screen for blood pressure and provide behavioral counseling and diet-related tips
  • Colorectal Cancer Screening: Medicare covers this for people age 50 and over. This includes a fecal occult blood test, flexible sigmoidoscopy (once every 4 years), and/or colonoscopy (once every 10 years or once every two years for those that are high risk)
  • Depression Screenings: Covered annually for all Medicare beneficiaries and must be performed in a primary care setting
  • Diabetes Screening: This is covered by Medicare either once or twice a year, depending on your risk factors, current health and whether you have been diagnosed as pre-diabetic
  • HIV Screening: Medicare covers this annually for all beneficiaries
  • Heart Disease Screening: Medicare covers this once every five years to test for cholesterol, lipid, and triglyceride levels
  • Mammograms: All women (over age 40) are eligible for an annual screening
  • Medical Nutrition Therapy: Medicare covers medical nutrition therapy, which may include dietary counseling for those with certain chronic diseases or risk factors
  • Obesity Screening/Counseling: Medicare covers screening for those that are classified as obese to help you lose weight. The baseline used for this is a body mass index (BMI) or 30 or more.
  • Pap Smears/Pelvic Exams/Breast Exams: If you are considered low risk, Medicare covers this every two years. If you are considered high risk, Medicare covers one exam per year.
  • Prostate Cancer Screenings: Medicare covers a blood test for prostate cancer for all male beneficiaries once per year
  • Smoking Cessation: Medicare covers two counseling attempts at quitting smoking per year
  • Vaccines and Immunizations: Medicare covers flu shots (once/year), pneumonia shots (once/lifetime), hepatitis B, and shingles (covered through Part D with some cost-sharing)

Preventive Services That Medicare Covers at 80%

There are other preventive care services that Medicare covers at 80%. If you have a Medigap plan, your plan may pick up the remaining 20% depending on which plan you have. Here is a list of those preventive services:

  • Colorectal Cancer Screening: This applies to Barium enema once every 48 months (or once every 24 months for someone classified as high risk)
  • Glaucoma Screening: Medicare will cover this at 80% if you are at risk (family history, diabetes, etc)
  • Prostate Cancer Screening: Medicare covers the digital rectal exam once a year for all male beneficiaries over age 50
  • Diabetes Self-Management Training: Medicare covers up to 10 hours of training during your first year if you are at risk of complications of diabetes or have recently been diagnosed

 

Overall, Medicare is covering much more preventive care than it has in the past. It is up to each Medicare beneficiary, in conjunction with their medical providers, to stay on top of this. Make sure you take advantage of the preventive care options that you have at your disposal as a Medicare beneficiary. Preventative Care Covered by Medicare

Preventative Care Covered by Medicare

Preventative Care Covered by Medicare Preventative Care Covered by Medicare Preventative Care Covered by Medicare Preventative Care Covered by Medicare Preventative Care Covered by Medicare

0 comment
0 FacebookTwitterPinterestEmail
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?

Does Medicare Cover Hearing Aids? Does Medicare Cover Hearing Aids? Does Medicare Cover Hearing Aids? Does Medicare Cover Hearing Aids? Does Medicare Cover Hearing Aids? Does Medicare Cover Hearing Aids? Does Medicare Cover Hearing Aids? Does Medicare Cover Hearing Aids? Does Medicare Cover Hearing Aids? Does Medicare Cover Hearing Aids?

0 comment
0 FacebookTwitterPinterestEmail
Medicare Plans

What are the different types of Medicare supplement plans?

by Kylie Johnson
written by Kylie Johnson

All Medicare supplement policies

Medicare supplement insurance, also known as Medigap, is designed to cover some or all of the costs a patient is responsible for before Medicare Parts A and B will pay anything, copays required by Medicare Parts A and B and amounts over the maximum that Medicare Parts A and B will cover. The different Medigap plans are standardized between companies, meaning consumers will receive the same coverage for Plan A (or whichever plan they select) regardless of which company they buy it from. There are 11 plans, each designated by a different letter, and each one covers different things. (Medigap plans are not labeled with letters in Massachusetts, Minnesota and Wisconsin, so-called waiver states.)

Plan A

Plan A covers additional days in the hospital after Medicare benefits are exceeded, copayments and coinsurance, hospice care and up to three pints of blood.

Plan B

Plan B covers everything that Plan A does and also covers the deductible required by Medicare Part A.

Plan C

Plan C covers everything that Plan B covers as well as the deductible required by Medicare Part B, 80 percent of medical care costs occurred when traveling abroad and the coinsurance for stays in skilled nursing facilities.

Plan D

Plan D is the same as Plan C, but it does not cover medical care costs occurred when traveling abroad.

Plan F

Plan F covers everything covered by Plan C and also covers any excess fees charged by a doctor or hospital that Medicare does not cover.

Plan F—High Deductible

The high deductible version of Plan F has the same coverage as the standard Plan F, but individuals must pay a high deductible, often over $2000, before the policy covers anything.

Plan G

Plan G covers everything the standard Plan F covers except that it does not cover the Medicare Part B deductible.

Plan K

Plan K covers additional days in the hospital after Medicare benefits are exceeded and 50 percent of the following: Part B coinsurance, up to three pints of blood, hospice care, coinsurance for skilled nursing facilities and the deductible for Part A.

Plan L

Plan L covers the same things as Plan K, but it pays 75 percent on the services where Plan K pays 50 percent.

Plan M

Plan M covers additional days in the hospital after Medicare benefits are exceeded, copayments and coinsurance, hospice care, skilled nursing facility coinsurance and up to three pints of blood. It also covers 50 percent of the Part A deductible and 80 percent of charges while traveling abroad.

Plan N

Plan N is identical to Plan M, except it fully covers the deductible for Part A and requires a small copay for office visits and trips to the emergency room.

Medicare SELECT

A type of Medigap policy which typically charges lower premiums so long as the policyholders uses approved networks of hospitals and doctors.

Who should consider purchasing Medicare Supplement Insurance?

Retirees

Anyone reaching retirement age should begin researching health insurance options for those 65 and over. Deciding on a plan before turning 65 may allow some consumers to get special discounts.

Seniors

Older seniors may wish to purchase Medicare supplement insurance if they’re concerned about paying for an unexpected medical need.

People with qualifying disabilities

Individuals with qualifying disabilities, usually those that make them eligible for social security disability, may be allowed to purchase Medicare supplement insurance before they turn 65.

Affinity Group Members

Affinity groups like AARP may offer members advantages if they buy Medigap through the organization.

0 comment
0 FacebookTwitterPinterestEmail
Health Insurance

How To Select A Medicare Supplement Company

by Kylie Johnson
written by Kylie Johnson

Plan Availability

Medicare supplement insurance plans are standardized by law and are named with letters. The standardization means that every company’s Plan A offers the same coverage, but not all companies sell every plan. And sometimes companies offer different plans in different states.

  • Plans by company: If you want to purchase coverage from a specific company, start by looking at the plans that company sells in your area.
  • Plans by type: If you are more concerned with the coverage provided than the company selling it, start by looking at plans and then determine which companies offer those plans in your area.
  • Plans by geography: Medigap policies are standardized in a different way in the so-called waiver states of Massachusetts, Minnesota and Wisconsin.

Price

Maximum out-of-pocket expenses and deductibles are standardized between companies. However, the monthly price may vary greatly between companies depending on your age, where you live, discounts and medical underwriting. To make sure a plan is financially beneficial, multiply the monthly premium by 12 and add any out-of-pocket cost you may need to spend. Weigh that cost against the chance you’ll spend more than that amount on healthcare if you do not have supplement insurance.

  • Monthly premium: Monthly premiums for the same policies are not standardized the way coverage is, so consumers should get multiple quotes before enrolling in any policy.
  • Discounts: Some companies offer discounts for paying your premium in full annually, for enrolling when you’re 64 or 65 and/or for having multiple policies with the same company. Consider getting quotes from companies you already have policies with, and ask the agent if discounts exist for current customers.

Customer service

Because coverage is the same regardless of which provider you select, a company’s customer service is an important factor to consider when selecting a new Medigap provider.

  • Available hours: Look at the hours when you can reach customer service representatives by phone. Make sure the contact information and hours for customer service representatives or agents, not just sales representatives, are listed.
  • In-person availability: If you would prefer to work with someone in person, ask about local agents. Some companies let you place a request for a local agent to contact you, so you only have to submit your information and then wait to be called.
  • Existing relationships: If you already have a policy with a company you like, you may wish to talk to the agent who manages your current insurance. They may be able to tell you about special discounts.

Reputation

A company’s reputation may help you choose between insurers with similarly priced plans.

  • Financial strength: Working with a financially stable company ensures that it will be able to pay for services long into the future , even if costs rise substantially or a disaster requires the company to pay for care for hundreds or thousands of policyholders. A.M. Best, Moody’s, Fitch and Standard & Poor’s are independent agencies that rate insurance companies’ financial stability. You can visit these agencies’ websites to see how they rate the financial stability of a specific company. Although many companies list a rating on their website, you can see the most reliable and recent rating on the independent agencies’ websites.
  • Years in business: The amount of time a company has been in business can indicate that they have reliable business practices and good customer service. You may also wish to compare how long a company has offered Medicare supplement insurance.
  • Recommendations: Ask friends and family members to tell you about their experiences with different insurance companies. Read online reviews to determine how the company deals with customers.

Extra features

Some companies offer additional features and benefits for policyholders. Be aware, these extra features are not a part of the insurance so they could be changed or eliminated at any time during the policy term.

  • Informational seminars: Some companies offer regular meetings and seminars to help customers understand insurance options and/or Medicare more generally. These seminars can help consumers make the best choice for their situation.
  • Informational guides: Some companies send customers free pamphlets and other informational materials. These guides give consumers some guidance so they can ask agents specific questions.
  • Healthcare perks: Some companies give customers free access to some healthcare services, like medical hotlines or preventative care discounts.

Other insurance offerings

Because companies may offer discounts for individuals who already own multiple policies with them, you may want to choose a company that sells several types of policies that interest you. A company’s other offerings may indicate how experienced they are in dealing with Medicare-related plans and/or people in your age group.

  • Auto/home insurance: Companies that have an extensive number of products for protecting your home or automobile will likely offer multiple policies that meet your needs, so a multiple-policy discount would be easy to qualify for.
  • Life insurance: Many companies that sell Medicare supplement insurance also offer life insurance policies. These companies might offer multiple policy discounts or might be accustomed to working with recent retirees.
  • Health insurance: Companies that offer health insurance may be better at helping individuals choose Medigap policies that meet their needs.

Buying periods

When is the best time to buy?

The best time to buy a Medigap policy is during the Medigap open enrollment period. The period begins on the first day of the month in which you turn 65 or older and enrolled in Medicare Part B. Buying within the enrollment window means:

  • Guaranteed issue: Insurance companies must sell you a policy.
  • Pre-Existing Coverage: Pre-existing health conditions are covered.
  • Can’t Be Charged More: Buying within the six-month window means people suffering from medical conditions can buy coverage for the same price as people without health issues.
  • Switching Medigap: You can switch Medigap policies, but you risk a penalty if you don’t switch during the open enrollment window. People switch because they want to cheaper Medigap policy, or because they need more benefits.

What if you buy outside of the enrollment period?

If you apply for Medigap coverage after your open enrollment period, there’s no guarantee that an insurance company will sell you a Medigap policy if you don’t meet the medical underwriting requirements, unless you’re eligible due to one of the situations below:

  • Disability: You’re under 65 and eligible for Medicare because of a disability or end-stage renal disease.
  • Pre-existing conditions: Coverage for the pre-existing condition can be excluded if the condition was treated or diagnosed within six months before the coverage starts under the Medigap policy. After the six-month period, the Medigap policy will cover the condition that was excluded.
  • Other insurance: If you have group health insurance through an employer or union, your Medigap open enrollment period will start when you sign up for Medicare Part B.
0 comment
0 FacebookTwitterPinterestEmail
Newer Posts
Older Posts