However, the Medicare AEP only lasts from October 15 through December 7 of each year. Some people may qualify for a Special Enrollment Period and may be able to change plans outside of the AEP, but for many, this will be the only time to change plans!
What you Should do During Medicare AEP
Even if you think you have the best Medicare plan in the world, here are a few things you should definitely do during or leading up to Medicare AEP (October 15 – December 7). If you need help with this, we advise giving us a call.
1. Check Eligibility for Savings.
Apply for LIS (Extra Help) prescription drug savings program) and other Medicare Savings Programs to see if you could be saving money. If you have low income, you may even want to try applying for Medicaid! The results could influence what coverage you are eligible for this AEP.
2.Analyze your Current Medicare Coverage.
Did you receive your ANOC (Annual Notice of Change), and is anything in your plan changing? These letters are usually sent and received every year at the beginning of September.
What insurance do you have now?
Do you have Original Medicare only, or do you have a private plan as well?
Do you have enough coverage?
Does your plan fit into your budget, or could you be saving more money?
Are all of your doctors and prescriptions covered by your current plan?
Ask yourself these questions and take notes, because there may be something better out there.
3.Notate your Life Changes.
Did you start seeing a new doctor this year, or do you have a problem with your current doctor? Not all plans accept the same doctors, so make sure you’re documenting your current physicians so you can easily confirm they are in network with any potential plans you’re considering for the new year.
Did you gain or lose a job, or suddenly develop financial stress? There are multiple ways to manage your Medicare based on a budget and a licensed agent can walk you through the options you may qualify for.
Were you diagnosed with a new health condition that requires expensive treatments? Some plans are specifically designed for certain chronic conditions.
Think about not only your past year but what you expect to happen over the next year. Think about what type of coverage you might need to get yourself through it all.
4.See What Medicare Plans are Available this Year.
Every year, new Medicare plans may come to the market, and old plans may change what they are offering. It’s important to look at the new information instead of just assuming that your old plan will stay the same. If your plan does change what they are offering, you will be notified – but it is important to look at other changes in your area as well.
Maybe there’s a great new doctor you’ve wanted to see, but she doesn’t accept your current plan! Or, maybe you suddenly have access to a plan with a five-star rating, when previously you only had access to four-star plans!
An important thing to note is that new benefits are not available to review and discuss each year until October 1st. You may need to speak with a licensed agent to ensure you’re reviewing the plans for the upcoming benefit year and not mistakenly comparing plan benefits that will ultimately be changing.
5.Schedule an Appointment with a Licensed Agent.
We know it’s nice to think that you can do it all yourself and that with the internet, you don’t need an insurance agent anymore! But, that’s not always true. The benefits of meeting with a licensed insurance agent are simple: it’s free, it’s easy, and it can’t hurt!
Our agents are licensed and represent a variety of different insurance companies, meaning they are not all biased towards one plan option.
Your plan won’t cost any more money whether you meet with an agent or not, so meeting an agent can only help you. A licensed agent can walk you through everything that is available in your local area and help you select the best option based on your needs. Plus, let us repeat – the meeting is free!
What you Should not do During AEP
We’re here to help, so we don’t want to only talk about the positives. Here are some things that you should NOT do during the Medicare AEP:
1. Don’t Jump into a new Medicare Plan Too Fast.
Do you understand how to choose a Medicare plan? Sometimes good deals are tempting, and it’s easy to jump into a shiny new plan because the costs are lower or there’s an added benefit. Make sure you’ve considered everything before you switch because it might not be easy to switch back. Make sure that your doctors work with the new plan, it covers your prescriptions, and there aren’t any hidden costs. Also, make sure the new benefit is something that will actually be useful to you!
2.Don’t Misunderstand Medigap.
Medigap, or Medicare Supplements work differently from Medicare Advantage and other types of Medicare plans. Technically, Medigap enrollment is not limited to the AEP. However, that does not mean that you should just change back and forth between different Medigap plans any time.
If you enroll in Medigap outside of your Initial Enrollment Period (when you first become eligible for and enroll in Medicare), you may be put through an underwriting process and may have higher fees based on your age and any preexisting conditions. Medicare Advantage and Part D plans do NOT take age and preexisting conditions into account, but Medigap plans if you wait too long to enroll.
3. Don’t Avoid Researching Medicare Plan Options.
If you already know the name of a carrier, you might be tempted to go straight to their website and enroll in a plan that looks good online. However, there may be more than one carrier offering plans in your area. So, how do you look at all of them easily?
Start by using a plan comparison tool, like our free Medicare Plan Finder. Then, once you’ve compared a few options, consider taking that research to a licensed agent who can talk to you about what you’re looking at and why the differences matter.
Ready for AEP?
To schedule an appointment with one of our licensed agents, call 844-431-1832 or click here. We can’t wait to help you get the coverage you deserve!
Medicare for Veterans with VA Benefits
As a veteran, you might have access to free or almost-free health care through the Department of Veterans Affairs (VA) – but veterans over the age of 65 can still benefit from enrolling in Medicare.
VA care is limited to providers who accept VA treatment, and having Medicare coverage will expand your doctor network as well as provide supplemental coverage opportunities.
If you’re nearing Medicare eligibility, you should decide whether or not to add to your VA coverage by enrolling in Medicare. Medicare and VA coverage together may provide more services than VA benefits alone.
Who qualifies for VA benefits?
Almost everyone who has served in active military duty is eligible for VA benefits. Since 1980, you must have served for 24 continuous months or for the full time for which you were called to active duty or you must have been honorably discharged to be eligible.
The VA encourages all servicemen and women to apply as there are many exceptions that may leave you eligible for benefits you didn’t even know you were eligible for. The VA states that some veterans can receive “enhanced eligibility” if they:
Are a former POW (prisoner of war)
Received the Purple Heart Medal or the Medal of Honor
Have a service-connected disability of 10% or more
Hold a VA pension
Were discharged from service for a disability
Served in a Theater of Operations for 5 years after discharge
Served in Vietnam (1962-1975)
Service in the Persian Gulf (1990-1998)
Were stationed at Camp Lejeune for 30 days or more (1953-1987)
Are catastrophically disabled
Have a household income below the VA’s National Income
Veterans health insurance applies to active service members and their families as well as retired or injured service members and their family members. In many cases, family members of deceased veterans can receive veteran health insurance as well.
Some veterans may have to pay a copay for doctor visits and prescription drugs, but others may receive free appointments. VA care is not limited to service-related illnesses and injuries.
VA Prescription Drug List
Not sure if the VA covers your prescription drugs? You can download this official VA prescription drug list from the VA. The VA prescription drug list can tell you all generic drugs that the VA covers and what dosage form or other restrictions there are. This is is from July 2018, but the list is subject to change.
What are the VA hospitals near me?
There are 1,921 VA facilities across the country. If you’re looking for a VA hospital or VA clinic near you, you can use the VA’s official guide to search by your address or zip code.
What are the VA wait times in my area?
Wait times at VA facilities have been a problem for years. The U.S. Department of Veterans Affairs has conveniently created a tool that allows you to search VA wait times in your area, so you can know before you go.
Use the tool to search your address and find VA hospitals or VA clinics near you. Select what type of facility or doctor you are looking for and how far you are willing to travel, and you can find out what your best option is to avoid wait times.
One of the biggest problems with VA facilities, which you will see when you use the search tool, is that you may have to wait a few weeks to get an appointment.
That’s fine if all you need is a yearly checkup, but if you have a serious health issue that you’re worried about, you may find yourself needing to visit another facility that is not covered by Veterans Affairs just so that you can get the care you need. That’s where Medicare may be able to help (if you are eligible).
Does VA coverage include VA dental (VADIP)?
VA dental can be purchased through the VADIP (VA Dental Insurance Program). Services include diagnostic and preventative services (like cleanings), oral surgeries, emergency dental treatments, and restorative treatment. Depending on the plan selected, you may be responsible for a monthly premium and copayments for services.
VA coverage does include routine eye exams and testing, like for glaucoma. It only covers eye glasses in certain circumstances. To qualify for VA eye glasses, you must:
Have a service-related disability
Be a former Prisoner of War
Have been awarded a Purple Heart
Receive Title 38 benefits
Receive increased pension due to being housebound or needing regular aid
If you do not qualify based on the above, you may still qualify if you suffer from stroke, diabetes, multiple sclerosis, vascular disease, or geriatric chronic illness.
Additionally, if while receiving VA care for other symptoms you have a negative reaction to a prescription or you require cataract surgery or brain surgery that interferes with your vision, you may qualify for VA eye glasses.
If you’re blind or have low-vision already, you may qualify for extra vision services.
Does VA coverage include VA hearing aids?
Once you have VA coverage, there are a few ways you can get VA hearing aids. You’ll need to start by visiting a VA Audiology and Speech Pathology Clinic for a hearing evaluation. If a doctor recommends hearing aids for you, your VA coverage will cover your hearing aids, any necessary repairs, and batteries.
To order VA hearing aids batteries, use the blue VA Form 2346, “Request for Batteries and Accessories.” You should have received this with your last battery order. You can send it to “VA Denver Acquisition and Logistics Center, P.O. Box 25166, Denver, CO 80225-0166.”
If you do not have this form or would prefer to use the phone, you can call the Denver Acquisition & Logistics Center (DALC) at 303-273-6200 and press “one.” You can also press “two” to speak with a customer service agent or “three” for hearing aid repair concerns.
If you have a Premium Account with eBenefits, you can also request hearing aid batteries from ebenefits.va.gov. You’ll need your last name, last four digits of your SSN, and date of birth.
Similar to VA, Tricare is available to retired service members and those who are discharged for disease or disability. Some Veterans are eligible for both VA benefits and Tricare. Generally, the VA provides more coverage but Tricare provides more flexibility.
Tricare coverage can include care received in a VA facility. This comparison sheet from Tricare shows the differences. To enroll in Tricare, you must already have Medicare Part A and B.
Since you do not have to go to a VA hospital or VA clinic to receive TriCare covered care, you can use the TriCare website to search for a TriCare provider near you. However, your network can be expanded even further if you add Medicare coverage.
Tricare Dental Program
There are six classifications for TriCare Dental Programs:
Active Duty Service Members
Active Duty Family Members
Guard/Reserve Family Members
Retired Service Members and Families
Each plan comes at a different cost with a different level of coverage. Generally, TriCare dental plans can cover:
Preventative care (cleanings, exams, x-rays)
Gum and oral surgery
Crowns & dentures
Do veterans need Medicare?
Technically, veterans do not need Medicare because many veterans qualify for VA benefits and TRICARE. However, a private insurance plan called a Medicare Advantage (MA) plan may offer supplemental benefits that you can’t receive with just VA benefits.
For example, some Medicare Advantage plans have a $0 monthly premium (like this Humana plan) and some even come with a fitness benefit. That could mean that your Medicare Advantage plan provides a gym membership. VA benefits and TRICARE do not.
VA Benefits and Medicare Advantage Together
Even if you already have veterans benefits through the VA, Medicare can help you expand your provider network (more doctors and pharmacies, shorter wait times) and potentially provide more financial coverage.
Medicare Advantage comprises of Medicare Part A (hospital coverage), Medicare Part B (medical coverage – doctor visits), and can include other benefits like dental, vision, hearing, fitness, transportation, etc.
If your VA coverage does not include enough prescription drug coverage for you, you can also get a Medicare Advantage plan with prescription drug coverage.
The good news is that we can help you find a Medicare Advantage plan that will help fill in the gaps in your VA coverage and get you the care and coverage you deserve. Some plans even have $0 premiums, so you may be able to get Medicare Advantage’s supplemental benefits at no additional cost! Click here to get in touch with a licensed agent or give us a call at 844-431-1832.
This post was originally published on October 5, 2017, and updated on January 13, 2020.
How to Find a Medicare Office Near You
While you can handle most of your healthcare online, some things are better handled in person at the Medicare office near you. Your local Medicare office may be able to help you enroll in Medicare, get a replacement Medicare card, and answer many other important questions.
Medicare offices are located within Social Security offices. Here are the simple steps to locate a Medicare office near you.
Visit the SSA website and use their field office locator tool.
Click on “Locate An Office By Zip.”
Enter your zip code and click “locate”
You’ll now see a list of the Medicare offices in your area. You’ll see each Medicare office’s address, phone number, office hours, and any other additional notes. Take a look at the screen shots below.
Why and How to Contact a Medicare Office
Calling MEDICARE allows you to:
Check your claim status
Find out if your medical service or product is covered
Ask your billing questions
Check your account balance for Part A or B
Report a lost or stolen Medicare card
Keep in mind that the Medicare office near you can’t help you with your private plan (like Medicare Advantage, Medicare Supplement, etc.). For questions with your private plan, you can contact your insurance agent or your insurance company directly.
Social Security hours will vary by location. When you use the office locator tool, you’ll be able to see their hours and their phone number.
Medicare Phone Number
The main Medicare helpline number that you can call with billing, claims, medical records, or expenses questions is 1-800 MEDICARE (1-800-633-4227)/TTY 1-877-486-2048.
Medicare Mailing Address
The main Medicare office (CMS office, Centers for Medicare and Medicaid Services) is located in Woodlawn, Maryland. There are additional regional Medicare offices in D.C., Boston, New York, Philadelphia, Atlanta, Chicago, Dallas, Kansas City, Denver, San Francisco, and Seattle.
If you need to mail something to Medicare, use the following address:
Medicare Contact Center Operations
PO Box 1270
Lawrence, KS 66044
Regional offices are as follows:
Washington, D.C. The Hubert H. Humphrey Building 200 Independence Ave., S.W. Washington, DC 20001
Boston, MA John F. Kennedy Federal Building 15 New Sudbury St., Room 2325 Boston, MA 02203-0003
New York, NY 26 Federal Plaza, Room 3811 New York, NY 10278-0063
Philadelphia, PA 801 Market Street Suite 9400 Philadelphia, PA 19107-3134
Atlanta, GA Atlanta Federal Center, 4th Floor 61 Forsyth Street, SW, Suite 4T20 Atlanta, GA 30303-8909
Chicago, IL 233 North Michigan Ave, Suite 600 Chicago, IL 60601
Dallas, TX 1301 Young Street, Room 714 Dallas, TX 75202
Kansas City, MO Richard Bolling Federal Building 601 East 12th Street, Room 355 Kansas City, MO 64106-2808
Denver, CO 1961 Stout Street, Room 08-148 Denver, CO 80202
San Francisco, CA 90 7th Street, #5-300 (W) San Francisco, CA 94103-6706
Seattle, WA 701 Fifth Avenue, Suite 1600 Seattle, WA 98104
Can you get Medicare Online?
Yes, you may not have to visit your local Medicare office or call Medicare at all.
As long as you feel comfortable using your computer instead, you can apply for Medicare, manage your benefits, get answers to your questions, and even request a new Medicare card all online.
If you do want to visit your local Medicare office in person instead, it may be a good idea to call ahead and make sure that they can help you with your question or concern.
Why would you need to go to a Social Security Office?
Most things can be done online nowadays, but there are still a few non-Medicare related tasks that you may need to visit your local Social Security office for. For example, there are ten states that don’t allow you to get a replacement Social Security card online, though this may change in the future. The ten states are Alabama, Connecticut, Minnesota, Nevada, New Hampshire, Ohio, Oklahoma, Oregon, Utah, and West Virginia.
Other services you may need to handle in-person are completing benefits applications with a translator, applying for survivor benefits, and getting a Social Security number for the first time if you didn’t get one as a baby.
How do I get a New Medicare Card?
When you first enroll a Medicare, you’ll receive a “Welcome to Medicare” packet in the mail with your Medicare card.
If your Medicare card is lost, stolen, or damaged, you’ll need to request a replacement card immediately through Social Security. Be sure to request a new card quickly so that you don’t have to wait for coverage at your next doctor’s appointment.
Your doctor might be able to look up your Medicare number, but it will be easier and faster if you can present your card.
When you use the online service, you should receive your Medicare card in the mail within 30 days. It will be automatically shipped to the address on file with Social Security, so make sure the address in your account is correct.
1-877-772-5772 (TTY 1-312-751-4701, M-F, 9 AM to 3:30 PM)
Your local RRB office
What to do if you Lose Your Medicare Card
Have you lost or misplaced your Medicare card? A lost Medicare card can be very dangerous as it contains your social security number. Losing your Medicare card is similar to losing your social security card. That’s why starting this year, new Medicare cards will be slightly different. We’ll discuss that and show you a new Medicare card image in a bit.
If you need to order a new Medicare card because of a lost Medicare card or changed information (like if you change your name or address), your first step should be to contact Social Security and let them know. You can also print a copy of your Medicare card by signing into My.Medicare.gov (you may need to create an account). If you still have your old Medicare card or if you find your lost Medicare card, be sure to cut it up and throw it away so that no one can steal your information.
What is a Medicare Card
When you enroll in Medicare for the first time, you’ll receive a red, white, and blue Medicare card in the mail. If you are automatically enrolled in Medicare Part A, you will receive your plastic Medicare card about three months before your 65th birthday so that you will already have it when your plan becomes active.
Your plastic Medicare card proves that you have Medicare health insurance and will tell providers (doctors, pharmacists, hospitals, etc.) what type of coverage you have and what day your coverage begins. You should keep your plastic Medicare card with you at all times so that if you have to see a doctor for any reason, you can prove that you have Medicare coverage and avoid being overcharged.
New Medicare Cards 2018
In 2017, CMS (Centers for Medicare and Medicaid Services) decided to launch a new version of the red, white, and blue Medicare card. The big change is that instead of having your Social Security number plastered on your card, you’ll be assigned a Medicare number.
You should treat your “MBI” or Medicare beneficiary identifier number the same way you treat your Social Security number – don’t give it out unless you know it’s necessary and you trust the person you’re giving it to. However, it is much safer to carry a card with your Medicare number than your Social Security number!
Everyone should have received a new Medicare card by early 2019. The last batch was reportedly shipped in October 2018. If you never received one, be sure to contact Social Security right away (or ask your insurance agent for help).
The new plastic Medicare cards will not affect your benefits – it will only protect your security.
Unlike the old plastic Medicare card you may have, new Medicare cards will not be plastic. They will be made of paper to make it easier for providers to use and make copies. We recommend purchasing a cheap plastic cover for your Medicare card. You can buy a pack of card covers (like these) in bulk on Amazon or stop by your favorite local office supplies store, like Staples or Officemax.
If you have questions about your Medicare plan or these new Medicare cards, call your agent! If you don’t yet have an agent, call Senior Market Advisors at 1-844-431-1832.
Avoiding Medicare Card Scams
Scammers might try to get your Medicare number from you. Remember that Medicare will never call and ask you to verify your number – they already have that information. If someone calls you and asks for your Medicare number, and you weren’t expecting them to call, do not give it to them. The only people that should need your Medicare number are your doctors, your insurance agents, and your private health plan (if you have one).
Here are some tips for protecting your identity in regards to your new Medicare card:
A Medicare employee will never call and ask for your social security number or banking information. If someone does call you asking for that information, it may be a scam. Do NOT give out your social security number to someone who claims to be calling from Medicare unless you know you can trust the person on the line.
If someone asks you to pay for a Medicare card, it is a scam. Medicare cards are always free and you should receive one automatically when you enroll.
If someone tells you that your benefits will be revoked if you do not give information or money, it may be a scam. The only people that should ask you for money are your doctors or your plan’s billing department. Be sure to always know who you are talking to.
In fact, click through to our guide on Medicare scams to learn how to block unknown scam callers on your phone. Read about common scams to look out for so you can be as prepared as possible.
*This post was originally published on 9/7/17. It was last updated on 1/7/20.
Does Medicare Cover Physical Therapy?
Does Medicare cover physical therapy? It depends. Medicare can help pay for physical therapy, which may be a crucial part of injury or surgery recovery. However, Medicare’s coverage has limits.
Every Medicare beneficiary begins with Original Medicare, which includes Part A, hospital coverage, and Part B, medical coverage. Most physical therapy services will fall under Medicare Part B – however, there are specific Medicare guidelines for physical therapy in-home health services and doctor services.
It can be confusing to navigate the different coverage caps and figure out what Medicare therapy coverage you have. Let’s break it down.
Does Medicare Cover Physical Therapy for Back Pain?
Back pain is one of the most common symptoms that leads to physical therapy. As you age, back pain is almost inevitable. It’s easy to fall into bad habits and poor posture. If you have back pain that lasts for a few weeks or longer, most doctors will recommend physical therapy.
A licensed and professional physical therapist will not only help you decrease pain but also educate you on how to prevent back pain in the future. He or she may even teach you some physical therapy exercises to perform at home.
Alternatively, seniors and Medicare eligibles who have a hard time getting to a doctor’s office may opt for a home nurse who is licensed to assist with physical therapy. In most cases, if your home nurse happens to double as a physical therapist, you will be covered under Part B.
Unfortunately, these services are not free.
How Much Does Medicare Pay for Physical Therapy?
Medicare Part B will cover your medically necessary outpatient therapy (physical, speech-language pathology, occupational) at 80 percent, you will likely be responsible for 20 percent of all Medicare-approved costs.
Previously, Medicare only covered up to 80 percent of $2,040 ($1,608) for physical and speech-language therapy services and another 80 percent of $2,040 ($1,608) for occupational therapy services. That meant that, for example, if your physical therapy appointments cost you $100, Medicare would have only covered about 20 visits per year.
Beneficiaries were receiving notices titled, “Advance Beneficiary Notice of Noncoverage.” The notice will tell you what Medicare will can or cannot continue to cover so that you can make informed choices about whether or not you want to continue your physical therapy.
Thankfully, physical, occupational, and speech therapy patients with Medicare won’t have that problem in 2019.
Medicare Physical Therapy Billing
When it comes to paying the bills for your physical therapy, you may want to consider adding either a Medicare Advantage plan or a Medicare Supplement plan. Even though Original Medicare Part B covers physical therapy, the cap will hold you back. Adding Medicare Advantage or Medicare Supplements may give you the coverage you need to pay the bills.
The good news is that everyone who is eligible for Original Medicare is also eligible for Medicare Advantage and Medicare Supplement plans. You can’t have both, so you’ll have to choose one.
Medicare Advantage plans are offered by private insurance companies and are designed to add additional covered services like dental, vision, hearing, fitness.
Alternatively, Medicare Supplement plans do not provide coverage for additional services but instead provide additional financial coverage. These plans are designed to help you pay for your coinsurance, copayments, and deductibles. You’ll have to decide what makes the most sense for you and your needs: more financial coverage, or more covered services?
Your physical therapist can discuss the physical therapy benefits specific to your condition and personal medical history.
Does Medicare Cover Transportation to Physical Therapy Appointments?
Original Medicare does not cover non-emergency medical transportation. Some Medicare Advantage plans can cover Medicare transportation benefits including travel to and from doctor’s appointments.
How to Find a Physical Therapist Who Accepts Medicare
Finding a local physical therapy practice that takes Medicare may be easier than you think. If you’re looking for physical therapy near you, click here to get started. Medicare.gov’s Physician Compare website allows you to find providers who specialize in the services you need including physical therapy.
Enter your zip code beside the red arrow. We used our home office’s zip code in Nashville, Tennessee, which is 37209. Then type “physical therapy” in above the yellow arrow. After that, click “Search” beside the orange arrow.
You confirm the service you need on the next page. If the boxes beside “Physical Therapy” and “Select all specialties related to ‘physical therapy'” are white, click in them to make both boxes have check marks. Then click “View results.”
The last step is scrolling through the list of providers and making some calls. You may have to call more than one physical therapy practice to find one that fits your medical and budget needs.
Need a New Medicare Plan?
Our agents can help you decide if Medicare Advantage or Medicare Supplements are right for you. We have agents in 38 states and we’re constantly growing!
Plus, our agents are licensed to sell plans from many of the major insurance carriers in your area, which means we are NOT biased. We can help you set up an appointment with an agent who can show you how to choose the right Medicare plan for your needs.
This post was originally published on January 4, 2018, by Anastasia Iliou, and was most recently updated on January 6, 2020, by Troy Frink.
Medicare Inpatient vs. Outpatient: Why It’s Important to Know the Difference
Do you know the differences between inpatients and outpatients? The lines can get blurry, but the differences are important for your Medicare plan. Your classification as an inpatient or outpatient determines the coverage you get from Medicare.
Medicare Inpatient vs. Outpatient Coverage
In some cases, an overnight hospital stay does not automatically make you an inpatient. It is easy to assume that you are an “admitted” patient and receiving inpatient services if you are brought to a private or semi-private room, but that may not be the case. You may just be under observation and considered an outpatient.
If you’re getting emergency care, same-day surgery, x-rays, or lab tests, you may be under observation if you stay overnight. You aren’t considered an inpatient until a doctor admits you to the hospital.
Original Medicare Coverage for Inpatient and Outpatient Stays
You may notice that your Medicare card has two different dates for starting coverage: one for Part A, and one for Part B.
Difference Between Medicare Observation Status and Admission Status
For inpatient classification, a doctor has to purposely keep you at the hospital overnight and then formally admit you as such. Once you’re admitted, you have “admission status.”
A doctor may keep you for several hours under observation before deciding to admit you. During those hours, you have “observation status,” and you’re considered an outpatient. Any approved services during that time will be covered under your Part B.
Generally, as an inpatient you’ll only need to pay a one-time Medicare Part A deductible, then you’re covered for 60 hospital days. The Part A deductible is $1,408 in 2020.
You will owe $352 per day from days 61 to 90 in 2020. You will owe $704 per day for each additional day after day 90, provided you have lifetime reserve days. You must be out of the hospital for 60 consecutive days before your hospital coverage “renews.” According to the Medicare Rights Center, you get 60 lifetime reserve days, and once you run out, you are responsible for paying the full amount of your hospital expenses.
With Medicare Part B, you may need to pay 20 percent of the approved doctor services you receive in relation to that hospital inpatient stay. For outpatient services, you’ll pay a copayment or coinsurance for all services you receive. The rest is covered by Part B.
Medicare Prescription Drug Coverage
In most cases, prescription drugs that are part of your hospital visit will not be covered under your Part A or Part B. Medicare may cover prescription drugs as part of procedures, like anesthesia for knee replacement surgery, for example.
For the most part, you’ll need either a standalone Medicare Part D (prescription drug plan) or a Medicare Advantage plan if you want coverage for prescription drugs.
Medigap & Medicare Advantage Inpatient and Outpatient Benefits
Medigap (Medicare Supplement) plans are private insurance plans that cover the same services as Original Medicare. Your monthly premium covers financial items such as coinsurance and copays.
In 2020, there are eight different “letters” of Medicare Supplement plan. Each letter offers a different level of benefits. For example, Plan A covers Part A coinsurance and hospital costs, Part B coinsurance and copayments, blood work copays up to three pints, and hospice coinsurance and copayments.
Medicare Advantage plans are different. It’s important to know the distinction between the two because you cannot have both a Medigap plan and a Medicare Advantage plan.
The difference between Medicare inpatient and outpatient care may seem confusing. A licensed agent with Medicare Plan Finder may be able to help you find the right plan to cover your needs.
Our agents are highly trained and they can assess your needs and see if plans in your area can meet them. If you have questions and would like to speak to one of our licensed agents, please call 1-844-431-1832 or contact us here to arrange a no-cost, no-obligation appointment today.
This post was originally published on July 13, 2017, by Anastasia Iliou. The latest update was on January 2, 2020, by Troy Frink.
Medicare Transportation Solutions
As ridesharing services like Uber and Lyft grow in popularity, more and more Medicare Advantage plans are including transportation services as a benefit. In 2018, CMS (Centers for Medicare and Medicaid Services) announced that in 2019, Medicare Advantage plans will have more freedom to provide coverage for services such as food delivery and transportation.
Does Medicare cover transportation for medical services?
Medicare Part B may cover emergency ambulance transportation to a hospital or skilled nursing facility if transporting in a different vehicle would put your health at risk. Medicare may cover non-emergency transportation in an ambulance if you have a written doctor’s note explaining why an ambulance is medically necessary.
Medicare generally covers up to 80% of the transportation associated costs, but you are responsible for the remaining 20%. If you don’t want to pay for these out-of-pocket costs, a Medicare Supplement plan can help you get full coverage.
Sometimes, Medicare Advantage plans cover non-emergency transportation through third-party vendors. As long as the vendor works with your health plan, you may be able to receive rides to and from doctor’s appointments, pharmacies, and hospitals.
Medicare Transportation Services
Ground medical Transportation services can cost hundreds or even thousands of dollars (depending on distance), and air medical transportation can cost well over $10,000.
In an emergency, you should always call 911. If you’re not in an emergency, you can shop around and compare prices with different ambulance and medical transportation services in your area.
Medicare Transportation By State:
While there are a handful of national players, there are several local medical transportation companies in each state.
Medicare Transportation Arizona
The most popular private transportation services in Arizona include:
Arizona Ambulance Transport
ABC Ambulance covers the greater Phoenix region. They provide rapid response times alongside basic patient transportation services.
Medicare Transportation Kentucky, Indiana, and Ohio
The most popular private transportation services in Kentucky, Indiana, and Ohio include:
Yellow Ambulance (KY, IN)
MTS Ambulance Services (KY, IN, and OH)
Rural/Metro Corporation (20 states)
Heartland Ambulance Service (IN)
Yellow Ambulance is the preferred transportation provider for Louisville and Bullitt County in Kentucky and Floyd and Marion County in Indiana. They provide basic and advanced life support, specialty care transport (dialysis, ventilator, chemotherapy), long-distance transportation, and bariatric transport.
MTS has 24-hour paramedic crews and offers emergency and non-emergency transportation. This includes rides to hospitals, dialysis treatments, and cancer treatments. They also offer wheelchair van service in KY, IN, and OH.
Rural/Metro is a semi-national company that provides emergency and non-emergency transportation. They also have a community fire protection program and offer personal emergency response systems.
Heartland Ambulance Service offers emergency transportation, basic and advanced life support, and a fixed wing air ambulance. They are available in several central Indiana locations.
TransCare serves Terre Haute, Indianapolis, Vincennes, and Columbus. They offer transportation to and from hospitals, dialysis treatments, doctor appointments, and radiation therapy.
Medicare Transportation Louisiana
The most popular private transportation services in Louisiana include:
Acadian Ambulance Service (LA, MS, TX, and TN)
A-Med Ambulance Service
Acadian serves 70 counties/parishes in Louisiana, Texas, Mississippi, and Tennessee. Their largest state is Louisiana. They offer emergency transportation, air services, non-emergency transportation, and bariatric transport.
A-Med serves the greater New Orleans region including Metairie, New Orleans, Kenner, Jefferson Parish, Orleans Parish, Saint Bernard Parish, and Plaquemines Parish. They offer medical transportation to hospitals, nursing homes, and critical care facilities. They also offer wheelchair van transportation.
Medicare Transportation Northeast
The most popular private transportation services in the Northeast include:
Citywide Ambulance (NY)
Lifeline Ambulance (NY)
Northeast Community Ambulance (PA)
Citywide Ambulance provides basic and advanced life support, bariatric transports, airport transfers, long-distance transport, and luxury transportation options. They serve the greater New York area.
Lifeline provides basic and advanced life support and transportation to and from nursing homes, rehab hospitals, dialysis, radiation, assisted living centers, and retirement centers.
Northeast Community Alliance provides 24/7 emergency transportation. Plus, they offer non-emergency transportation to and from doctor’s appointments, dialysis treatments, and hospital discharges.
Medicare Transportation Northwest
The most popular private transportation services in the Northwest include:
Olympic Ambulance (WA)
Northwest Ambulance Transport (WA)
Tri-Med Ambulance (WA)
Olympic Ambulance offers 911 response, basic and advanced life support, and bariatric transports. They also provide wheelchair van transportation to those who need it.
Northwest Ambulance Transport provides advanced and basic life support in a mobile hospital setting. They also provide standby coverage for several cities in the area.
Tri-Med Ambulance offers ambulance services and critical care transport. They also provide wheelchair accessible transportation for medical treatments or doctor visits.
Medicare Transportation Tennessee
The most popular private transportation services in Tennessee include:
Lifeguard Ambulance Service (IL, TN, OK, TX, AL, GA, SC, and FL)
American Medical Response
Lifeguard serves several states and provides EMS solutions to rural and urban locations. They offer emergency and non-emergency transportation, health system partnerships, and mobile integrated healthcare.
BlueShield EMS provides ambulatory cars, wheelchair vans, stretcher vans, and ambulances for basic and advanced life support.
American Medical Response provides basic and advanced life support, ventilators, and bariatric transportation services to the greater Nashville and Davidson County area.
Medicare Transportation Texas
The most popular private transportation services in Texas include:
City Ambulance Service
First Medical Response of Texas
City Ambulance Service serves the entire states of Texas. They provide basic and advanced life support, and wheelchair, dialysis, and chemotherapy transportation.
First Medical Response of Texas provides a mobile intensive care unit providing advanced life support. They also provide EMT basics, bike medical teams, and medical gators.
BestCare offers non-emergency, emergency, and critical care medical transportation. They also offer air ambulance, wheelchair service, dialysis transports, and long-distance transfers.
How to Use Medicare TransportationServices
Medicare transportation can be used for emergencies and non-emergencies. This can help ensure transportation to and from providers, doctor offices, pharmacies, therapy, critical care units, nursing homes, assisted living facilities, etc.
Medicare Transportation to Doctor’s Appointments
Medicare Advantage plans can help cover the costs of utilizing private transportation companies like the ones above. You can request a ride just before you need to leave your home, or you can schedule a pick-up in advance.
Medicare Transportation to Dialysis
If you have End-Stage Renal Disease (ESRD) and require dialysis, Medicare may cover non-emergency transportation to and from a dialysis facility. However, they will only cover the closest facility.
If you choose to be transported to a facility further away, Medicare will not cover it. If there are no facilities within your local area, Medicare will pay for the nearest facility outside of your area.
Medicare Part B covers ambulance services, but only when necessary. For example, if you are bleeding heavily, unconscious, or need immediate treatment and can’t wait until you get to the hospital, Part B can cover your ambulance transportation. This is only covered if the ambulance is taking you to the nearest facility – you can’t make a special request.
Air ambulance transportation may be covered if your location can’t be reached easily by ground or if obstacles like heavy traffic can stop you from getting the care you need in a timely fashion.
Non-Emergency Medical Transportation
If you need a ride to a doctor’s appointment or a hospital that does not warrant an ambulance, you may have options.
You may want to start by calling your local Office on Aging. They may have a program in place to help you out regardless of your healthcare plan. Some Medicare allow transportation benefits through Uber, Lyft, and other ridesharing services.
These plans will require that you have a specific need for transportation, and you would only be able to use your coverage for healthcare-related transportation. This can include rides to doctor’s appointments, pharmacies, and other healthcare providers.
TheFuture of Medicare Transportation
Ride-sharing companies have grown significantly in recent years. Uber and Lyft have dominated the industry. There are 75 million Uber users and 23 million Lyft users. Medicare Advantage plans are capitalizing on this market and providing new benefits to MA enrollees.
Medicare and Lyft
Some carriers are quickly forming partnerships with Lyft to provide enrollees transportation to and from Walgreens and CVS pharmacies. They have plans to create a “no-cost” service that provides insured transportation to and from health appointments.
This is not intended to be a replacement for emergency transportation, but an extra alternative for non-emergency situations. Lyft Concierge is a website that allows you to schedule or book a ride from a computer alongside your plan’s coverage.
Medicare and Uber
Uber has plans to partner with several organizations nationwide. They will provide transportation to patients traveling to and from their medical appointments.
Uber will allow parents, caregivers, and medical staff to schedule transportation on your behalf. Plus, Uber has created “Uber Health” which is a HIPAA-compliant and cost-effective way for you to book rides with your plan’s coverage.
Medicare and Roundtrip
Roundtrip, a digital NEMT marketplace for the betterment of health, is offering transportation as a benefit for 2020 Medicare plans. Roundtrip works with hospitals, health systems, paratransit, and health plans nationally to remove transportation as a barrier to health and wellness.
With Roundtrip, members can efficiently book all levels of transport: rideshare, Medical Sedans, Wheelchair Van, and Non-Emergency Ambulances (BLS, ALS, SCT, Bariatric Ambulance with our easy-to-use platform. The Roundtrip software is HIPAA compliant and verifies member eligibility. Roundtrip uses real-time GPS tracking and automatically sends text and call notifications to the members about their rides.
Talk to your insurance agent to find out if Roundtrip is included in your plan.
Pick a Plan With Medical Transportation Coverage
If your plan does not offer transportation and you would like to have that benefit, we may be able to find a better plan for you. It all depends on your location and eligibility. We can send one of our agents to your home for a free appointment to figure out what your plan options are.
Just complete this form to request a call or call us at 844-431-1832.
This post was originally published on May 31, 2018, by Anastasia Iliou, and updated on December 4, 2019, by Troy Frink.
Does Medicare Cover Weight Loss Programs ?
Did you know that you can use your Medicare coverage to fight obesity? Medicare coverage for weight loss can include obesity screenings, obesity counseling sessions, nutritionists, and qualified dietitians. It may even include gym membership discounts. If you think eating well and exercising is too expensive, think again: your Medicare plan can cover it!
Medicare Part B Weight Management Services
Since obesity is classified as a disease, Medicare Part B covers it like any other ailment. It all starts with your “Welcome to Medicare” annual wellness visit when you first enroll, and it continues with your yearly wellness visits. At your appointments, your doctor should check your height, weight, blood pressure, and BMI – all things that can help your doctor diagnose you with obesity and provide proper treatment. These appointments do not require cost-sharing.
If your doctor considers you at risk for obesity, you may be eligible for preventative counseling and even appointments with a nutritionist. Medicare Part B can cover medically necessary obesity counseling and nutrition therapy.
Obesity commonly leads to heart disease. Medicare Part B covers cardiac rehabilitation (exercise, education, and counseling) for those who have had a heart attack, heart failure, or a related surgery.
Nutritionists & Dietitians
Your doctor may recommend that you see a nutritionist or dietician.
Be careful when choosing a nutritionist or dietitian, because Medicare does not cover all of them. For Part B to cover this service, you must medically require it, and the nutritionist or dietitian must accept Medicare assignment. Medicare only covers trained nutritionists under Part B as MNT (medical nutrition therapy). Any patient who has diabetes, kidney disease, or has had a kidney transplant is eligible based on medical need.
Obesity Screenings & Counseling
As long as you have Medicare Part B and have a BMI (body mass index) of 30 or higher, you are eligible for obesity screenings and counseling. The National Heart, Lung, and Blood Institute has a free BMI calculator on its website, but a doctor’s screening will be much more accurate. Your BMI is the percentage of your bodyweight that is made up of fat. Remember that some fat is healthy – you are not aiming for a BMI of zero. A healthy BMI is between 18 and 25. Lower than 18 is too little, 25-30 is a bit high, and above 30 is obese.
When you do get your free obesity screening, you might consider behavioral counseling for body fat loss. Your primary physician should offer their own obesity counseling. If not, they might recommend another Medicare-covered service.
The only true “Medicare weight loss programs” are fitness programs.
Original Medicare (Part A and Part B) does not cover gym memberships or fitness programs, but private plans may include a gym membership or fitness center discounts. These are usually offered through major Medicare fitness programs such as SilverSneakers® and Silver & Fit®.
Plans with these benefits are not available in every county. Look over your plan or speak with your agent if you aren’t sure about fitness coverage in your Medicare plan.
Obesity Is a Disease
In 2013, the American Medical Association officially started recognizing obesity as a disease. As such, with a BMI of 30 or higher, you can qualify for “obesity behavioral therapy.
The disease affects approximately ⅓ of Americans, and this recognition allows it to be taken more seriously in the medical community and increase research funding. The classification also helps decrease the stigma involved with obesity. It is a commonplace lie that obesity is merely the result of overeating and a lack of exercise. Some people lack the mental strength to control their eating habits and others are incapable of exercising for one reason or another. Saying that obesity is a disease opens the door for obesity counseling and physical therapy as a form of treatment.
Obesity is a common disease in the senior citizen community due to a reduction in physical activity and a lack of access to good nutrition. Additionally, other common senior conditions like heart disease, diabetes, and physical impairments can make it harder to focus on nutrition and exercise. That’s why it’s so important to use your Medicare coverage for healthy eating, exercise, and weight loss.
Does Medicare Cover Weight Loss Surgery/Bariatric Surgery?
Medicare Part B covers bariatric surgeries such as gastric bypass surgery and laparoscopic banding surgery (LAP-BAND). However, you must meet certain criteria. For example, your doctor must determine that Medicare weight-loss surgery is necessary.
Bariatric surgery is a procedure that reduces the amount of food the stomach can hold, effectively forcing you to eat less. However, it is invasive and not recommended for everyone.
Medicare does NOT cover cosmetic surgeries, such as excess skin removal for weight loss surgery.
Types of Bariatric/Weight-Loss Surgeries
The most common bariatric surgeries are a gastric bypass, a sleeve gastrectomy, an adjustable gastric band, and a biliopancreatic diversion with duodenal switch.
Generally, bariatric surgery is recommended for people with:
A gastric bypass is a weight-loss surgery that has been performed for over 50 years, making it the most experienced bariatric operation. In this procedure, a large section of the stomach is stapled off, creating a pouch that connects to the small intestine. The pouch can only hold a few ounces of food, so patients are unable to eat as much as they used to (and won’t feel as hungry).
This procedure requires that patients make major dietary changes. Protein, vitamin B12, iron, and calcium become increasingly important. Sweet and fatty foods must be avoided.
A sleeve gastrectomy is performed laparoscopically. About 75% of the stomach is removed, causing it to form a “sleeve” shape. This procedure is used for people with a BMI over 40. It often results in 60% weight loss.
A sleeve gastrectomy cannot be reversed. It typically does not have an effect on diet (except for during recovery time).
Adjustable Gastric Band
A laparoscopic gastric banding procedure is the least invasive. A soft, silicone ring with an expandable balloon is implanted at the top of the stomach. It basically creates two compartments for the stomach. The patient will only eat enough food to fill the top part. Over time, the food will pass through into the second (original) compartment of the stomach and will be digested.
This surgery is newer and was not approved until 2001. There may be some long-term complications with this surgery, such as frequent vomiting, implant malposition, erosion, or weight loss failure.
Biliopancreatic Diversion with Duodenal Switch
The duodenal switch procedure starts with a sleeve gastrectomy. Then, the lower intestine is divided, leaving only a few feet of intestine connected to the digestive tract.
This procedure usually results in the greatest weight loss, but patients will likely have frequent and loose bowel movements and gas. Patients will also need to be closely monitored for healthy vitamin, mineral, and protein levels.
In some cases, a doctor or surgeon may recommend that you undergo the sleeve gastrectomy first, then revisit the duodenal switch in 9-12 months.
The duodenal switch often results in 60-80 percent excess weight loss within two years.
Finding a Doctor for Obesity Treatment
Your primary physician can at least help you get started on your obesity treatment but might refer you to a nutritionist or other specialist if necessary.
Be sure to check with your plan network to make sure your doctors and specialists are covered. You can use Medicare.gov’s Physician Finder to find out if a doctor accepts Medicare, and visit your private plan’s website to find out if your doctor or specialist is in your plan’s network.
Are There any Medicare-approved Weight Loss Programs?
Medicare has not formally approved any weight loss programs or fad diets. Speak to your doctor before joining a new program. Here is some information about popular weight loss programs.
Recently, private Medicare Advantage plans have been given the ability to cover more benefits, and dietary programs like this could be one of them. However, it is more common to find Medicare Advantage plans that cover Medicare fitness programs and nutritionists.
Optifast is advertised as a “medically-supervised” and “science-based program that delivers weight loss for health gains.” On average, Optifast users ave lost 30 pounds over 26 weeks (which is a healthy ratio). They’ve also seen decreases in blood glucose levels, blood pressure, and cholesterol.
The program provides meal replacements that include 100% of the recommended daily value of 24 different vitamins and minerals. There are five daily servings. Optifast comes in shake mix, bars, soups, and chewable vitamins.
The Jenny Craig plan includes a variety of foods and a personal consultant that you can connect with weekly. The meal plans ask you to eat every two to three hours and allow you to mix in your own fresh fruits, vegetables, and dairy. Three entrees and two snacks cost less than $25 per day.
In some areas, you’ll be able to visit and pick up your food from a local weight loss center. Otherwise, you can join Jenny Craig online.
Weight Watchers revolutionized fad dieting with their point system.
Each Weight Watchers user will have a unique amount of “points” they are able to use each day. Every piece of food is awarded a point value (though some may be worth 0 points). Your daily point budget is based on your age, height, weight, and sex. Technically, you can eat whatever you want as long as you don’t go above your daily points budget.
Weight Watchers is not very expensive, starting at $3.07 per week for the digital-only plan. You can download the Weight Watchers app and do it all yourself!
What’s nice about the Weight Watchers diet is that you don’t have to eat frozen foods shipped to you, you can keep buying your own groceries and cooking healthy meals. You may even be able to keep enjoying some of your favorite foods, as long as you enjoy them in moderation.
Medicare for Diabetes and Weight Loss
Obesity can put you at a higher risk of developing diabetes. You can use your Medicare coverage to help prevent both obesity AND diabetes.
Medicare Part B covers diabetes self-management training (DSMT), blood sugar monitors, blood test strips, lancets devices, lancets, therapeutic shoes or inserts, and external insulin pumps.*
Additionally, Medicare can cover your participation in the 16-session Diabetes Prevention Program if you:
Have a BMI over 25 (23 if you are Asian)
Have never been diagnosed with either diabetes or ESRD
Have not participated in this program before
Have a hemoglobin A1c test result of 5.7-6.4%, a fasting plasma glucose result of 110-125 mg/dL, or a two-hour plasma glucose result of 140-199 mg/dL (test results must be from the past 12 months)
Medicare Part A covers hospital stays, and Medicare Part B covers physician services. If you are over the age of 65, you automatically qualify for Medicare coverage. You can also qualify by receiving SSDI (Social Security Disability Income) for 25 months or more or by being diagnosed with either ALS (Lou Gehrig’s Disease) or ESRD. Most people will get premium-free Part A but will have to pay a monthly premium for Part B.
To add more to your Medicare plan, the best option is to enroll in a MAPD, or Medicare Advantage Prescription Drug plan. These plans include everything that Part A and Part B covers plus prescription drug coverage and other benefits like dental, vision, and fitness programs like SilverSneakers® and Silver & Fit®.
We have benefits advisors in 38 states that can help you select the best Medicare Advantage Prescription Drug plan for your needs. Some people may even be able to get a MAPD plan with a $0 premium! To find out more, chat with us, send us a message, or give us a call at 844-431-1832.
This post was originally posted on June 22, 2017, and was last updated on December 3, 2019.
Dental Vision Hearing Insurance for Seniors and Medicare Beneficiaries
It’s important to always be mindful of your overall health. That includes everything – from the aches and pains you feel to your teeth and your eyesight!
Unfortunately, Original Medicare does not include extensive dental, vision, and hearing insurance for seniors and Medicare beneficiaries. If you are looking for dental, vision, and hearing insurance, you should consider a Medicare Advantage plan.
Original Medicare only includes Part A (hospital coverage) and Part B (doctor coverage), but Medicare Advantage plans, also called Part C, generally include dental benefits, vision benefits, hearing benefits, prescription drug coverage, and more!
Original Medicare covers limited dental, vision, and hearing procedures:
Oral examinations as part of another hospital stay
A jaw disease, oral cancer, face tumor, or face fracture-related procedure
Infections caused by dental procedures
Severe and medically necessary eye procedures and tests such as cataract surgery and corrective lenses following surgery
Macular Degeneration, Glaucoma, and Diabetic Retinopathy tests
Hearing tests that are a part of your primary physician’s routine well-visit
Does Medicare pay for hearing aids?
Original Medicare does not cover everything. Medicare Advantage plans can add the following hearing insurance for seniors benefits:
Treatments for hearing problems
Hearing aid fittings
Hearing aid exams
Hearing Aid Costs
Medicare Advantage health insurance plans can help cover hearing aid costs associated with fittings, exams, and tests.
Hearing aid costs can range anywhere from $400 to $4,000 per ear. Even if the initial device isn’t too expensive, you may have to pay the costs of a hearing aid fitting, hearing aid exams, and replacement hearing aids every five years or so.
When you add everything together, you could be paying thousands of dollars over your lifetime for your ear care. Luckily, a Medicare Advantage plan is a solution that may help you out financially.
Hearing Aid Brands
When choosing hearing aid brands, details matter! Have an idea of your budget, your ear size, and how you will be using the hearing aid. Will you wear it all day long? Can you afford to splurge a little on your hearing aid?
Some of the most highly-rated hearing aid brands are Phonal, Unitron, Signia, Sonic, and Widex – but be careful! Not all Medicare Advantage plans will cover all hearing aid brands. Be sure to carefully look at the provider network before you select a plan to make sure that hearing aid brands you like are included. Some insurance companies may also give recommendations.
Hearing Aid Types
Just like there are numerous hearing aid brands, there are also numerous hearing aid types. Some of the most common hearing aid types are as follows:
Custom-fitted to your ear canal
Invisible when worn
Great for mild to moderate hearing loss
Custom-fitted to your ear canal
Custom-made to fit in your ear canal with small portion showing outside of the ear
Great for mild to mildly severe hearing loss
Custom-made to fit outer portion of your ear
Great for mild to severe hearing loss
Barely seen when worn
Uses electrical wires instead of a plastic tube
Great for mild to moderate hearing loss
Housed in casing behind the ear
Tube directs sound into earmold fitted inside the ear canal
Great for moderate to severe hearing loss
Medicare Dental Coverage
Original Medicare doesn’t cover everything. Medicare Advantage plans can add the following dental insurance for seniors:
Dental issues caused by another procedure, such as for jaw disease or a kidney transplant
Dentures and denture care
Fillings and extractions
Does Medicare pay for dentures?
If denture or dental implant coverage is important you, then you should consider a Medicare Advantage plan as dental insurance for seniors.
Medicare Advantage (MA) plans provide Part A (hospital coverage) and Part B (medical coverage) plus additional coverage like prescription drugs, vision, hearing, and dental health!
Most Medicare Advantage dental plans cover dentures and much more — cleanings, x-rays, annual exams, fillings, pullings, and root canals.
Supplemental Dental Insurance for Seniors on Medicare
Seniors and Medicare eligibles may not find the oral health coverage they need with Medicare Advantage or Medicare Supplement plans. For example, a Medicare Advantage plan might cover routine dental services (like preventive care), but not major services like dental implants.
Medicare Supplements (Medigap) are private plans that cover financial items like Original Medicare copays and coinsurance. With a Medicare Supplement plan, you pay a monthly premium and you don’t pay a separate copay or coinsurance when you visit the doctor*.
You cannot have both a Medicare Advantage and a Medicare Supplement plan at the same time. It’s important to know how each type of plan can save you money. Contact your agent to discuss the difference between each type of plan, and ask how you can save money with each. Talk to your agent about your dental care needs, too. Your agent may be able to find a plan in your area that meets your budget needs along with your medical needs.
If you need additional coverage, you may be able to find private dental insurance plans that cover items such as dental implants, cosmetic dentistry, or orthodontics. Private dental plans, like Medicare Advantage plans, may be available as a dental PPO, HMO, or other plan type.
*Plan benefits can vary by plan. Some Medicare Supplements cover copays for doctor’s appointments. Medicare Supplements only help cover Medicare-approved charges.
Dental Discount Plans
Instead of a dental insurance plan, you may be able to find a dental discount plan in your area. With a dental discount plan, you’ll pay an annual fee upfront (instead of a monthly premium). You won’t have copayments, but you’ll have discounted rates on your dental services (if you see a network dentist). You would pay the dentist directly. Talk to your agent about discount plan options.
Medicare Vision Coverage
Original Medicare does not cover everything. Medicare Advantage plans can add the following vision benefits:
Routine eye checkups
Medicare Eyeglasses Providers
Each Medicare Advantage plan will have its own provider network. That means that not all Medicare eyeglasses providers will accept the plan you choose.
When shopping for a Medicare Advantage plan, you should always look at the provider network and make sure that your favorite doctor or other vision provider accepts the plan you choose.
Medicare Advantage PPO
There are several different types of Medicare Advantage plans. If you’re looking for dental, vision, or hearing insurance for seniors a Medicare Advantage PPO plan is a good way to go. PPOs are one of the most popular types of Medicare Advantage plans.
A Medicare Advantage PPO is ideal because even though there are doctor and pharmacy networks, you can go to other doctors and pharmacies. You may not have as much coverage with out-of-network doctors and pharmacies, but at least you have that option.
You do not need to select one primary care doctor and usually do not need referrals, meaning that if you need to go to a vision specialist, you can technically go to any provider.
Medicare Advantage plans are convenient because all the coverage you need can be rolled into one plan with one monthly premium. Some MA plans even offer low deductibles in exchange for high premiums!
Enroll in Medicare
Are you interested in getting dental, vision and hearing insurance for seniors? A Medicare Advantage plan may be the perfect solution!
Our agents with Medicare Plan Finder can answer any questions you may have and may be able to help you find the best plan for your needs and budget. If you’re interested in arranging a no-cost, no-obligation appointment, fill out this form or call us at 844-431-1832.
*This post was originally published on March 16, 2017, by Anastasia Iliou. The latest update was on November 26, 2019, by Troy Frink.
Why Vitamin C is Important for Seniors
Vitamin C is an essential vitamin with several health benefits, but the body does not produce it naturally. As you age, it becomes more and more important to keep up with your diet and make sure you’re getting enough vitamins and nutrients.
The recommended daily vitamin C intake is 75mg for women and 90mg for men. That might sound like a lot, but one orange can get you at least halfway there. There are several ways to incorporate vitamin C into your diet and to make sure you’re getting enough. No excuses!
What is Vitamin C?
Vitamin C (L-ascorbic acid) is a water-soluble vitamin, meaning that it dissolves quickly in the body. While animals can “make their own” vitamin C, humans cannot produce it. Since it dissolves so quickly, it’s important to intake vitamin C every single day.
Vitamin C is necessary for the “biosynthesis of collagen, L-carnitine, and certain neurotransmitters,” and is “involved in protein metabolism,” according to the National Institutes of Health. Biosynthesis is the process of creating complex molecules that are essential for survival.
In layman’s terms, Vitamin C and biosynthesis are necessary for healing and healthy body functions.
Vitamin C Benefits: What is Vitamin C Good For?
Aside from assisting in the body’s natural biosynthesis process, vitamin C is a:
Antioxidant – Vitamin C is a strong antioxidant, meaning it helps defend the body against harmful diseases. It can also improve white blood cell function, making it an all-around fantastic immunity booster.
Blood Pressure Reducer – Studies have shown that Vitamin C can help relax the blood vessels, resulting in reduced blood pressure.
Heart Disease Preventative – Vitamin C has been shown to lower the risk of heart disease, especially when taken naturally as part of a diet instead of through supplements.
Gout Preventative – Vitamin C may reduce uric acid in the blood, helping to prevent gout, a painful form of arthritis.
Iron Absorber – Vitamin C can help the body absorb iron properly, making it extremely useful for vegetarians and those who don’t eat enough red meat or who are anemic.
Memory Enhancer – Studies have shown that people with dementia had low levels of vitamin C, and low levels have overall been linked to forgetfulness.
Eye & Tooth Booster – The American Optometric Association cites vitamin C as an important vitamin for vision and dental health.
Vitamin C Side Effects
It is unlikely that you can have a vitamin C overdose, though it is recommended that you don’t take in more than 2,000mg per day. If you get all your vitamin C from food, it can be very hard to have that much in one day. However, it is possible to have 2,000mg or more in one day if you get your vitamin C from supplements.
It is unlikely to overdose and experience vitamin C side effects, but it can cause:
The Dangers of a Vitamin C Deficiency (Scurvy)
Scurvy is the body’s response to a lack of vitamin C. A vitamin C deficiency can cause:
Dry hair and skin
Easy bruising, bleeding gums, and nosebleeds
Weakened tooth enamel
Decreased ability to fight infection
Scurvy is a severe form a vitamin C deficiency, and it mostly affects older and malnourished adults.
How to Get The Right Vitamin C Dosage
The easiest and healthiest way to make sure you’re getting enough vitamin C each day is to incorporate it into your diet. Most foods that have good amounts of vitamin C have other important nutrients in them as well. For example, oranges and orange juice are well known for being a good source of vitamin C, but they also have plenty of potassium, folate (vitamin B9), and thiamine (vitamin B1).
Vitamin C Foods
Many fruits and vegetables are high in vitamin C, including:
Vitamin C Drinks
If you prefer, fruit drinks can have a lot of the same value as pieces of fruit. However, be aware that many fruit juices are full of added sugars and may not be a healthy long-term solution. If you have the ability to make your own fresh-squeezed orange juice, that can be a great healthy alternative. An eight-ounce glass of fresh-squeezed orange juice can contain 125mg of vitamin C, more than the recommended daily amount!
Grapefruit juice, cranberry juice, pineapple juice, and prune juice can also provide great vitamin C value.
Vitamin C Supplements
You can find vitamin C supplements in various forms, like serums, powders, tablets, gels, and gummies!
Vitamin C Tablets, Pills, and Gummies
You can find most any supplement you’re looking for in tablet, pill, or gummy form from your local pharmacy or grocery store. Consider these examples (which can also be purchased from Amazon):
Generics: Many drugstores will have generic versions of these supplements which may be cheaper than their brand-name counterparts (but usually include the same important ingredients).
Vitamin C Serum
Vitamin C serums are usually meant to be used on the skin, so it’s a good idea to consult with your doctor or dermatologist before using a product. This example we found from InstaNatural is designed to be an anti-aging and blemish defense as well as a hydrating serum.
Vitamin C Powder
If you don’t want to take a pill but you need another form of a vitamin C supplement, you might want to try a vitamin C powder. Powders like this one from Nature’s Way are meant to be stirred into an eight ounce glass of water. You can also mix it into a smoothie or juice! This powder contains 500mg of vitamin C and only has 15 calories in it.
Emergen-C has a similar product, but it contains other nutrients as well. This one produces an orange fizzy beverage which includes vitamin C, thiamin, riboflavin, niacin, vitamin B6, folate, and vitamin B12.
We couldn’t go without mentioning the other host of products that Emergen-C offers (and no, they are not sponsoring this post)! Aside from vitamin C and adult immune health support, Emergen-C also has energizing products, sleep aids, and kids immune support!
Each Emergen-C product has slightly different ingredients, but we wanted to look at the Emergen-C Probiotics Plus product designed for daily immune health support. This product has an orange flavor and will provide 250mg of vitamin C (less than other products but still more than your daily recommended intake), and 110mg of potassium. It also lists out fructose, citric acid, maltodextrin, and malic acid.
While those extra ingredients can seem a bit scary, a lot of them are found naturally in the foods we eat. For example, malic acid is what contributes to the sour taste of many fruits. Additionally, nutritionfacts.org said that by weight, citrus fruits are about 10$ citric acid. So, you might be getting these ingredients in your daily diet anyway.
Still, taking supplements does not mean that you can always eat unhealthy foods. These supplements are meant to literally supplement your diet, meaning you should still focus on eating healthy.
Emergen-C vs Airborne
Airborne is another great product that advertises a “blast of vitamin C.” Both products contain very similar ingredients but come in different forms and flavors. For example, this product from Airborne has a “Very Berry” flavor and comes in the form of a tablet that will dissolve in a glass of water.
Yummy Vitamin C-Filled Meal Ideas
If you have a hard time incorporating vitamin C-filled fruit and vegetables into your diet, consider these sneaky tricks:
Add sliced strawberries to your morning cereal or oatmeal
Freeze fresh fruit juices in a popsicle mold for a natural alternative to the sweet treat
Include leafy greens in your sandwiches and burgers
Use berries instead of chocolate chips in your pancakes and muffins