How Medigap is Unique in Minnesota, Wisconsin, and Massachusetts
In most of the United States, Medigap (also called Medicare Supplements) can be characterized by eight different types of plans (A, B, D, G, K, L, M, N). However, there are three states that work completely differently: Massachusetts, Minnesota, and Wisconsin.
A lot of the information you’ll see on the internet about Medicare Supplement plans talks about those eight plans, but we haven’t forgotten about you, Massachusetts, Minnesota, and Wisconsin! If you live in one of those three states, this guide is for you.
Psst…click below to read more about Medicare programs in each state:
If you already have a basic understanding of Medigap, you can skip ahead to the section about your state below.
Medigap is a type of private Medicare insurance that is not technically part of the government-sponsored Medicare program. Medigap plans are also called Medicare Supplements. The two terms can be used interchangeably. To enroll in Medigap, you have to enroll in Original Medicare first.
Additionally, you cannot have a Medicare Supplement plan and a Medicare Advantage plan at the same time. Click here to find out if Medicare Advantage is better for you than Medicare supplements.
What Does Medigap Cover?
Uniquely, Medicare Supplement plans do not typically provide additional health benefits. Instead, Medigap plans provide additional financial protection. For example, let’s say you get sick and have to go to the doctor at least once per month for treatment. Original Medicare may not cover the entire cost for you. You might have to pay your deductible first ($185 for Part B in 2019) and then 20% coinsurance on every visit.
If you have a Medicare Supplement plan that includes deductible and coinsurance coverage, you may not have to pay that $185 and 20%. Instead, you’ll only have to pay your Part B* premium and your Medigap premium.
You may have heard that you cannot be denied Medicare coverage based on your age or preexisting conditions. While that’s true, Medigap is a little different. If you enroll in a Medicare Supplement plan during your Initial Enrollment Period (the time when you first become eligible for Medicare), that holds true. However, if you wait too long to enroll, there is a chance that your plan will be put through underwriting and your prices may increase, or you may be denied coverage based on your age and preexisting conditions.
*Some people may have a Part A premium as well.
Senior couple speaking with a doctor
Minnesota Medicare Supplement Plans
While you can’t get the same eight plans (A, B, D, G, K, L, M, N) in Minnesota that are offered in other states, there are technically modified versions of plans K, L, M, and N available.
Additionally, Minnesota offers two unique plans: The “Basic Plan,” and the “Extended Basic Plan.”
The preexisting conditions underwriting may apply. However, you’ll get a 6-month Medigap enrollment period (where age and preexisting conditions do not apply) if you return to work or if you drop Part B in favor of your employer’s health plan.
80% of foreign travel emergency, then 100% after you spend $1,000 per year out-of-pocket
80% of “usual and customary fees,” then 100% after you spend $1,000 per year out-of-pocket
Minnesota Medicare Supplement Plans
So you’re probably wondering, if the Minnesota Medigap Basic Plan and the Extended Basic Plan both always offer the same benefits, why would you choose one Basic Plan over another?
The answer is that costs can vary and plans are allowed to add some extra benefits. There are four additional benefits that plans are permitted to add to the Basic and Extended Basic plans: Part A inpatient deductible, Part B deductible (no longer available in 2020), usual and customary fees, and non-Medicare preventive care.
At least $30,000 for kidney disease treatment (dialysis, transplants, etc.)
Insulin pumps, self-management training, and other diabetes care
50% and 25% cost-sharing plans are also available, which are similar to Medigap Plan K and Medigap Plan L (which would be available in other states).
So, you might be wondering why you have multiple options to choose from for Wisconsin Medigap plans if they are all supposed to be the same “basic” plan. The answer to that is that plans ARE allowed to add additional benefits other than what is in the basic plan, and the costs can vary. Companies are allowed to add the following benefits:
Why Can’t I get Part B Deductible Coverage in 2020?
When MACRA (The Medicare Access and CHIP Reauthorization Act) passed in 2015, a couple of changes were made that didn’t take effect right away; Losing Part B deductible coverage was one of them.
Congress made the decision to not allow plans to cover the Part B deductible starting in 2020. This decision saves money for the Medicare program and doesn’t have an astronomical effect on you. The Part B deductible was only $185 in 2019. All this means is that you will have to pay $185 out-of-pocket before the rest of your coverage kicks in.
It also means that if you are already enrolled in one of the plans listed above that includes the Part B deductible, you won’t lose that coverage. However, if you decide to switch plans or drop that coverage at any time, you won’t be able to get back into it starting in 2020.
How do I Decide Which Medigap Plan is Right For Me?
Regardless of which state you live in, we have a plan finder tool that can help you compare your options.
We also have licensed agents available to answer your questions and help you make your final decision. To find out if there is an agent near you that you can meet with, call 844-431-1832 or send us a message by clicking the “let’s chat” button in the bottom right corner.
How to Choose the Best Type of Medicare Plan for You
When it’s time to choose a Medicare plan, it’s easy to get overwhelmed. There are quite a few different types of Medicare plans to choose from. Once you choose what type you want – you still have to choose a plan! Making the right choice is important because it may not be easy to change plans if you change your mind.
The Annual Enrollment Period (October 15 through December 7) is when anyone can make changes, and for some people, it’s the only time. If you make the wrong choice, you might have to wait a whole year before you can change again (unless you qualify for the OEP or have a SEP).
Which Types of Medicare Plans are Best for Me?
To figure out which Medicare plan is best for you, ask yourself the following questions:
What specific medical services do I need coverage for (ex: lab tests, blood work, surgery, chemotherapy, dental, etc.)?
How much room do I have in my budget? Am I able to pay a little more to have more benefits?
Would I rather pay more on a monthly basis and pay very little when I visit the doctor, or is it better to pay a small amount every month but risk having higher copayments?
Who are the doctors and other providers who I want to be covered in my plan?
There are four main types of Medicare plans to consider when you begin your Medicare plan search. Start by comparing Original Medicare, Medicare Advantage, Prescription Drug Plans, and Medicare Supplements.
Keep in mind that you cannot have Medicare Advantage and a Prescription Drug Plan at the same time. You also cannot have Medicare Advantage and a Medicare Supplement plan at the same time.
Which plan or combination of plans works best for you?
Medicare Advantage: A private plan that you can purchase once you have Original Medicare. Can add additional benefits such as hearing, vision, dental, fitness, etc. Can include a prescription benefit.
Prescription Drug Plans: Another type of private plan that you can purchase once you have Original Medicare. Usually only includes a prescription benefit.
Medicare Supplements (Medigap): Another type of private plan that you can have in addition to Original Medicare. Adds more financial coverage, like for copayments and deductibles. This type of plan would also require you to have a stand alone part D drug plan.
Different Types of Medicare Plans
Choosing a Medicare Advantage Plan
So, did you decide to go with Medicare Advantage? Great! Now, there are a few types of Medicare Advantage plans that may be available for you. First, ask yourself whether or not you need a large network and whether the freedom to see any doctor is important to you. Then, read through these important differences:
HMO Plans (Health Maintenance Organization) – You’ll select one primary physician. In some cases, you may only receive coverage for that one doctor (unless he or she refers you to a specialist). Requirements may vary based on your plan.
HMO-POS Plans (Point-Of-Service) – You’ll select one primary physician, but you’ll have the freedom to visit any specialist in your network for your other needs. You will be charged a fee for visiting specialists.
PPO Plans (Preferred Provider Organization) – You can see any doctor, but your costs will usually be lower if you choose one that is in your network.
PFFS Plans (Private Fee-For-Service) – You will not need referrals or a primary physician, but you’ll have to pick a doctor that accepts your PFFS plan.
SNP (Special Needs Plans) – Designed for those who are eligible for both Medicare and Medicaid, live in a nursing home, or have a chronic illness or disability.
MSA (Medical Savings Account) – Works like a tax-free savings account for your medical bills. Medicare will deposit money into your HSA. You can use that account to pay for medical expenses.
How do I Pick a Medicare Supplement Plan?
If you’ve decided that you want a Medicare Supplement plan, you’ll want to start by selecting the plan letter that corresponds with the coverage you need. Use the chart below for reference.
Once you’ve made that decision, you may have a few different carriers available in your area to choose from (some smaller cities may not have several options available).
Finding Medicare Plans in your area just got easier. Our Medicare Plan Finder tool can help you not only see what is available, but see which options may be best for your unique needs.
You can enroll by yourself, or you can meet with a licensed agent (for free) who can walk you through the process to make sure you don’t make any mistakes. The licensed agent can also talk to you about a variety of different types of plans in your area and answer all your questions.
This unbiased approach is a great way to get the help you need when selecting a Medicare plan.
To set up your free meeting with a Medicare Plan Finder licensed agent, call 844-431-1832 or click here.
Medicare Advantage vs. Medicare Supplement
Medicare Advantage and Medicare Supplements (also called Medigap) are very different insurance plans with distinct benefits. The answer to the question “is Medicare Advantage better than Medigap?” depends on your circumstances and needs.
What is Medicare Advantage?
Medicare Advantage plans are private plans (not owned by the federal government) that can offer additional health benefits. To have Medicare Advantage, you have to enroll in Original Medicare first. You may have to continue to pay your Medicare Part B premium even if you have Medicare Advantage (MA), but MA premiums can be as little as $0.
Medicare Advantage plans are not all the same, but they can provide benefits like (click on the links to learn more about each one):
There are many different types of Medicare Advantage plans, although not every plan type may be available in your area.
A health maintenance organization (HMO) is a network of health-care providers and facilities where you choose a primary care physician to coordinate your care.
A preferred provider organization (PPO) is also a network of health-care providers and facilities but typically you do not need to select a primary care physician, and you have more flexible options regarding out-of-network care.
A private fee-for-service (PFFS) plan is a mode of benefit delivery where you are not limited to a network. However, there are no guarantees that your doctor or hospital will accept the plan. If you choose to receive your Medicare health coverage through a private Medicare Advantage plan, you must continue paying your Part B premium regardless, because you remain enrolled in Original Medicare (Part A and Part B), even after joining a Part C plan.
What is Medigap?
Medigap is more different from Medicare Advantage than you might think. While Medicare Advantage plans are able to offer health benefits, Medicare Supplement plans (also called Medigap) offer financial benefits. For example, some Medigap plans can cover your Part B premium.
The chart below explains the differences between available Medigap plans in 2020. You can also use our Medicare Plan Finder search tool to compare plans in your area.
2020 Medicare Supplement Comparison Chart
Comparing Medicare Advantage vs. Medicare Supplement plans
Let’s look at Medicare Advantage vs. Medigap. In short, the difference between Medicare Advantage and Medicare Supplement plans is that one can supply health benefits while the other can supply financial coverage.
Medicare Supplement Insurance is a policy that’s added to Original Medicare, Part A and Part B, to provide additional financial coverage. Medicare Advantage is a private plan option that may provide you with other health benefits that Original Medicare does not cover (like dental, vision, fitness programs, etc.).
You cannot have both Medicare Advantage and Medigap at the same time.
Medicare Advantage vs Medicare Supplements | Medicare Plan Finder
A given plan type (e.g., Plan F) has the same benefits regardless of the insurance company that provides the policy, or the state in which you reside. This is not true of Medicare Advantage plans, however, because coverage details may vary by plan.
Excluding prescription drug coverage, any standard Medigap plan with Part A and B will have more benefits than a standard Medicare Advantage plan. However, as mentioned above, some Medicare Advantage plans offer benefits beyond those found in Part A and Part B.
Some Medicare Advantage plans offer prescription drug coverage (often for an additional monthly cost). With a Medigap plan, in contrast, you would need to enroll in a separate prescription drug plan. When comparing plan options, consider your costs for drug coverage. In some cases, Medigap with a stand-alone prescription drug plan has lower total costs than a Medicare Advantage plan with drug coverage. In other cases, the reverse might be true.
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Real-Life Examples: Medicare Advantage vs. Medicare Supplements
Let’s take a look at some real-life examples to help you decide whether Medicare Advantage or Medicare Supplements are right for you.
If you have Medicare Parts A (hospital coverage), B (medical coverage), and D (prescription coverage) and you are hospitalized for cancer treatments for 90 days, you may have out of pocket costs. The Part A deductible means you would pay well over $1,000 first. Once you meet your deductible, your costs will go down. However, after day 60, you’ll be responsible for a portion of every day that you stay there.
If you have Medigap Plan B, your deductible and many of your other hospital costs will be covered. This plan would be in addition to your Part B coverage, so it would all work together to provide extra coverage.
If you have Medicare Advantage, you may have additional health benefits. You’d still likely be responsible for some of those out-of-pocket hospital costs, but your plan might provide a home healthcare benefit, meaning you can get a private in-home nurse when you are released from the hospital. You might also have coverage for medical equipment, such as bathroom safety equipment or a walker.
Comparison is key: Medicare Advantage vs. Medicare Supplements
When choosing between a Medigap plan and a Medicare Advantage plan, take the time to do your research. Read the benefit descriptions of every Medigap and Medicare Advantage plan you are considering. Be certain to look at:
Monthly premium
Deductibles
Doctor and healthcare facility restrictions
Benefits
Anticipated plan costs given your typical use of health-care and hospitalization services
Prescription drug coverage cost sharing as it relates to your medication usage
In the end, your decision is going to be the one that you feel the most comfortable with. The challenge is often wading through all the material to get to the bottom line. Want to make that a little easier? Give us a call at 844-431-1832.
This post was originally published on October 23, 2018, and was last updated on August 29, 2019.
What Can You Do During the Medicare Annual Enrollment Period?
Watch this brief video first!
Annual Enrollment Period… Explained
Did you know that there are five different Medicare enrollment periods throughout the year? Not everyone will be eligible for every period, but everyone who has Medicare is eligible for the Annual Enrollment Period.
Be sure to keep track of each enrollment period so that you know when it’s your turn to make changes. Don’t go months with a bad plan just because you missed your enrollment period!
What/When is the Annual Enrollment Period?
The Annual Enrollment Period runs from October 15 through December 7 of each year. This is the time when all Medicare beneficiaries are eligible to make changes, which will go into effect on January 1 of the following year. It does not apply to people who have not yet enrolled in any form of Medicare coverage. If you’re enrolling for the first time, you’ll have an “Initial Enrollment Period.” You can use the AEP later to make changes if you don’t like the choices you made during your IEP.
Changing Medicare Plans After the Annual Enrollment Period
There are a few other times throughout the year when you may be eligible to make changes.
The Initial Enrollment Period (IEP) is for those enrolling in Medicare for the first time. If you are aging into the program, this will begin three months before your 65th birthday and end three months after. If you become eligible due to disability, your IEP will depend on your disability status or diagnosis.
The General Enrollment Period (GEP) is for those who missed their IEP. It runs from January 1 through March 31. If you enroll during the GEP, your coverage will begin on July 1. You may face a late enrollment penalty fee for not enrolling during your IEP. If you want to enroll in Medicare Advantage during the OEP, you can do that between April 1 and June 30, or you can wait for the AEP.
The Special Enrollment Period (SEP) is not one specific time frame. You may qualify for a “temporary” SEP if you have a special circumstance that results in a loss of coverage, such as losing a job with coverage or moving to an area where different plans are available. You will likely have 30 days following the event to make a change. Some circumstances, like having a disability, can make you eligible for a different type of SEP. If you are disabled or have low-income and have a special needs plan, you can change plans once per quarter for the first three quarters of the year.
Medicare Enrollment Periods
How can I get a SEP for Medicare?
To qualify to change plans once every quarter for the first three quarters of the year, you must:
Be a member of a Medicare Savings Program or Medicaid
Be part of SPAP (State Pharmaceutical Assistance Program)
During AEP, you can make a number of different changes to your coverage, like:
Enroll in a Medicare Advantage plan
Switch to a different Medicare Advantage plan from what you had
Drop your Medicare Advantage plan and have only Part A and Part B
Add a Part D prescription drug plan
Change to a Medicare Advantage plan with a prescription drug benefit
Change from a MAPD (Medicare Advantage Prescription Drug Plan) to a Medicare Advantage plan without prescription coverage
Change from one Part D plan to another
Drop your prescription drug coverage and return to Original Medicare only
You can also add or remove Medicare Supplement (Medigap) coverage, but keep in mind that you can enroll in Medicare Supplements during any time of year. Enrollment periods to not apply to Medicare Supplement plans. However, if you enroll in Medigap any time past your Initial Enrollment Period, underwriting may apply, leaving you with higher costs than you could have had if you enrolled sooner.
The ability to make these changes every year is more important than you may realize.
Even if you think you’re happy with your plan, plans are allowed to change their benefits and costs every year. Your plan can add or remove benefits and make cost adjustments as they need to. At the same time, new plans are continually entering (and leaving) the market. It’s a good idea to take a look and see if there is a better plan for you each year.
Licensed agents are required to go through a training and certification process before they can sell to you. They are usually trained on what’s going on in the area that they sell in. They may be able to tell you about plans that you haven’t even heard about before, and they can help you sort through your options. It does not cost anything to meet with a Medicare Plan Finder licensed agent.
Can you Auto-Renew Medicare?
In most cases, you do not have to renew your plan each year. Your Medicare coverage will automatically continue as long as you want. The only reason your plan wouldn’t renew is if that specific plan itself leaves your service area or leaves Medicare.
However, that does not mean that you shouldn’t review your coverage each year. Have your finances or your healthcare needs changed? Has your plan changed its benefits or costs? Ask these questions every year to make sure you’re still getting the coverage you need.
New to Medicare
What’s new in 2020?
There are a few 2020 Medicare changes that may affect what you want to enroll in this year:
As of 2019, you may be able to change your Medicare Advantage plan during the OEP
How to Make Medicare Plan Changes
You can enroll in a new Medicare Advantage plan by getting help from a licensed agent. If you haven’t enrolled in Original Medicare yet, be sure to do that first by contacting Social Security either online or at 1-800-772-1213. You can also visit your local Social Security office.
To get in touch with a licensed agent in your area, click here or call 844-431-1832 (TTY 711). You can also go straight to our Medicare Plan Finder tool.
How to Protect Yourself from Medicare Scams, Fraud, and Abuse
The Annual Enrollment Period (AEP) will be here before you know it. AEP is the most popular time of year for beneficiaries to change or enroll in a new plan. However, this means Medicare scams, fraud, and abuse are at all all-time high. Medicare Plan Finder makes understanding these risks easy, so you feel protected year-around.
Medicare Fraud and Abuse
The government loses millions of dollars each year due to Medicare fraud and abuse. This causes Medicare prices to increase. The government has created laws to protect all parties involved in Medicare and Medicaid.
These laws promote healthy relationships between agents, carriers, and clients to prevent the insurance industry from becoming profit-based, instead of care-based. Your coverage should be more important than profits.
Medicare fraud includes:
Knowingly making false claims or misrepresenting data
Intentionally giving or receiving rewards for goods and services
Promoting one health service over another
Billing Medicare for appointments that never happened or for more than what actually happened
Medicare abuse includes:
Billing for unnecessary services
Excessive supply purchases
Misusing codes
Learning about Medicare Scams | Medicare Plan Finder
Medicare Fraud and Abuse Laws
The government has implemented the following:
False Claims Act (FCA) – Protects the government from being overcharged on goods or services. No proof of intent is required.
Anti-Kickback Statute (AKS) – Agents cannot knowingly reward referrals for health care programs.
Physician Self-Referral Law (Stark Law) – Doctors cannot make referrals to health care companies in which they have an interest.
Criminal Health Care Fraud Statute – Cannot defraud; bill for unnecessary medical goods and services (like drugs that are not needed or wheelchairs for those who are not impaired).
What Can You Do?
Don’t become a victim! If you aren’t sure about a health agent’s validity, ask for licensing information or work with Medicare Plan Finder. To help fight Medicare fraud and abuse, report any suspicious activity to 1-800-HHS-TIPS (1-800-447-8477). You can also report the activity online.
Plan Finder Tool | Medicare Plan Finder
Common Medicare Scams
A licensed Medicare agent is required to abide by strict rules when contacting seniors and Medicare beneficiaries. It is illegal for anyone (including an authorized Medicare agent) to show up at your front door without permission.
Also, keep in mind that no one associated with Medicare will ever call you to update your information. The following are common Medicare scams you need to look out for:
Grandparent Scam
One recent scam involves adults calling the elderly and pretending to be their grandchildren asking for money. They’ll say that they are in some form of trouble and need money.
To avoid this grandparent scam, be sure to ask for a personal detail that only your real grandchild would know the answer to. It is easy to assume you would recognize their voice, but if someone calls in a panic, your adrenaline may kick in, and their voice is the last thing you’re worried about.
Medicare Coverage Helpline Scam
In recent years, there has been a television commercial targeting current Medicare beneficiaries. The advertisement is from the “Medicare Coverage Helpline” and claims that if you have parts A and B, you are eligible for vision, dental, and prescription drug plans due to a recent Medicare health reform.
The commercial will provide a 1-800 number. Do not call that number. If you are interested in vision, dental, or prescription drug coverage, one of our licensed agents can discuss plans that are specific to your area. To get started, click here.
Medicareplans.com Scam
Medicareplans.com is an out-dated link that was a fake marketplace for those searching for a Medicare plan. While this link is no longer active, it is important to be careful when reviewing different companies and websites.
Look for websites that start with “https” instead of “http.” The “s” indicates a secure website. If you have doubts, a simple google search like “[Insert Company Name Here] Scam” can show any potential scam information.
Medicare Phone Scams
Medicare phone scams are probably the most common way that seniors and other Medicare beneficiaries are taken advantage of. In some cases, a scammer may call you and pretend to be from Medicare and offer you free services if you provide your Medicare number or Social Security number.
In other cases, a scammer who claims to be from Medicare may say that they need to validate your information to keep you from losing your benefits. The real Medicare program will never ask for this information. Never give these numbers away over the phone.
One phone scam in particular, the “can you hear me” scam, is easy to fall victim to. The scammers use this question to get a “yes” answer from people, which they would then edit to make it seem as though they were agreeing to purchase a product or submit information. If you answer the phone and someone you don’t know asks, “Can you hear me?” hang up right away.
Medicare Refunds
Scammers will often try to catch your attention by saying you have Medicare refunds. The scammer’s goal is to get your bank information. Common reasons for Medicare refunds include changes or enhancements to Medicare or lawsuits with private insurance companies.
If for some reason you are entitled to a Medicare refund, a check will be mailed to you directly. No one will ever call asking for your bank information.
How to Avoid Medicare Scams
Medicare scams can be easily avoided. CMS (Centers for Medicare and Medicaid Services) suggests the following tips for avoiding scams and fraud:
Treat your Medicare card like a credit card. Keep it in a safe spot and never give out your number to anyone other than your doctors.
Do not accept an offer for free gifts or money in exchange for your Medicare information.
Don’t accept services that aren’t usually covered by Medicare unless a doctor that you trust tells you that it is necessary.
Will Medicare Ever Call You?
Medicare will never call you randomly and ask personal questions. If you are already covered by Medicare, they have all the information they need. If someone from Medicare needs to contact you, they will find a more official communication route.
If you have any additional questions about Medicare communication, or if who is contacting you is legitimate, contact a Medicare customer service representative at 1-800-MEDICARE (1-800-633-4227).
Medicare Scams | Medicare Plan Finder
Free Stuff for Seniors From the Government
Seniors and Medicare beneficiaries can fall into specific categories that scammers will use to their benefit. Scammers will sometimes call pretending to be from the government and offer free health checkups or free medical supplies.
During these fake calls, they will use common senior health conditions to act like they know specific details about your health. The scammer has no idea you have diabetes or high blood pressure; all they know is that a handful of seniors have those conditions. Scammers are hoping you will also fall into that category.
Some scammers have been known to give names and addresses of your doctor. It is unknown how they receive this information. Even if the caller ID looks reputable, don’t trust them so quickly.
Technology has continued to evolve and faking caller ID has become easier and easier. Don’t trust if someone says they are providing free products or services from the government. Scammers will say all you have to pay for is shipping costs, then get access to your credit card information.
How to Stop Medicare Phone Calls
As we mentioned, Medicare will not call you without your permission. If you receive a phone call about your Medicare plan, but did not consent to a call, it is likely a scam.
To help prevent calls from unknown numbers, don’t answer unknown numbers unless you’re expecting a call from a legitimate company (like us!). You will receive a voicemail if the call is legitimate.
If you have a smartphone, you can download apps that detect scam calls and block the calls instantly. You can also put your number on the National Do Not Call Registry.
How to Block Specific Numbers
Both iPhone and Android users can block specific numbers from calling. This is a useful tool because many scam callers will cycle through phone numbers. Once you block a number, you will not receive calls from that number unless you unblock it.
How to Block Phone Numbers on an iPhone
First go to you to your most recent calls. Then find the number you want to block and tap the “i” icon. That will lead you to the contact information associated with that phone number.
That will lead you to your most recent calls. Then find the number you want to block and tap the “i” icon. That will lead you to the contact information associated with that phone number.
How to Block Phone Numbers on an iPhone Step 1 | Medicare Plan Finder
Then scroll down to where you see “Block this Caller” and tap on the words.
How to Block Phone Numbers on an iPhone Step 2 | Medicare Plan Finder
The final step is verifying that you want to block the caller.
How to Block Phone Numbers on an iPhone Step 3 | Medicare Plan Finder
How to Block Phone Numbers on an Android
First, go to your most recent calls. Then tap the “i” icon under the phone number you want to block.
How to Block Phone Numbers on an Android Step 1 | Medicare Plan Finder
Then tap the three dots as shown below.
How to Block Phone Numbers on an Android Step 2 | Medicare Plan Finder
Then select “Block.”
How to Block Phone Numbers on an Android Step 3 | Medicare Plan Finder
Medicare Helpline
Protecting yourself from Medicare scams may seem like an impossible task. Now that you understand the common Medicare scams you will know what to watch out for.
If you are ever suspicious or have questions regarding Medicare fraud, call the Medicare Helpline. They can answer any questions you may have. The Medicare Helpline is a 24-hour toll-free line and can be reached at 1-800-MEDICARE.
Also, you can help eliminate Medicare fraud by reporting suspicious activity. Call the Medicare fraud line at 1-800-447-8477 or report the incident online.
Enroll in Medicare
The risks of Medicare scams does not lower the importance of proper Medicare coverage. We are dedicated to helping you choose the best plan from all of the options available in your area. Why do we need your information?
Zip Code: We need this because Medicare plans are different in every zip code.
County: We ask for your county because sometimes zip codes fall into more than one county.
Email and Phone Number: We ask for your contact information because we want to have a conversation with you about helping you find a great health plan.
Birthday: Sometimes we’ll ask for your birthday to help us ensure that you qualify for Medicare benefits.
Medicare Plan Finder and other legitimate resources will not ask for your Social Security Number or Medicare number before speaking with you. If someone who you do not know asks for your SSN or Medicare number, do not give out that information until you know that it is safe to do so.
We are here to discuss the best Medicare coverage for your needs and budget. If you’re interested in speaking with a licensed Medicare agent or scheduling a free no-obligation appointment, fill out this form or call us at 844-431-1832.
This blog was originally published on 10/1/18, and was updated on 8/21/19.
A Guide to Medicare Chronic Lung Disease Coverage
Chronic lung diseases affect millions of people in the United States. It falls under the fourth leading cause of death. Thankfully, the Centers for Medicare & Medicaid Services (CMS) considers chronic lung disorders to be one of the qualifications for a Medicare Special Needs Plan.
As you age, it’s easy to brush off symptoms as “part of the aging process.” You might even purposely ignore certain symptoms because they “aren’t that bad,” and you don’t want to pay for treatment – but your symptoms could be indicative of a bigger problem and should not be taken lightly.
If you are diagnosed with chronic lung disease, you may qualify for a Medicare Special Needs Plan that can save you thousands of dollars in doctor visits and treatment costs. Qualifying for a Special Needs Plan means you will also qualify for a Special Enrollment Period, which allows you to change plans more often.
Let’s take a look at what all of this might mean for you.
What Is Chronic Lung Disease?
Doctor and Nurse Discussing Chronic Lung Disease With Patient | Medicare Plan Finder
Chronic lung disease refers to any condition that causes long-term obstructions to a person’s airways. They can cause the following symptoms:
Shortness of breath after little or no physical exertion, or shortness of breath after normal exercise plus a brief rest period
A persistent cough – one that lasts longer than a month
Mucus or sputum production lasting a month or longer
Labored breathing
Swollen feet, ankles or legs
Blue lips
If you experience any of these symptoms, you should talk to your doctor immediately. Chronic lung disease can severely impact your quality of life and shorten your lifespan considerably. The faster you get started on treatment, the better.
SEP-Qualifying Disabilities
To qualify for a SEP (Special Enrollment Period) due to a disability or disease, your condition must be “severe or disabling.” The list of chronic lung diseases below would automatically qualify you for a SEP because you would be eligible for a Medicare Special Needs Plan, or SNP.
Once you qualify for a Special Enrollment Period, you won’t be restricted to the Annual Enrollment Period (AEP) anymore.
Usually, AEP is the only time of year that Medicare beneficiaries can switch Medicare Advantage plans. It only lasts from October 15 through December 7. Those with a SEP are eligible to make one change per quarter (January – March, April – June, July – September). The fourth quarter is excluded because you’ll be able to switch like everyone else from October 15 through December 7 (the Annual Enrollment Period).
Chronic Lung Diseases List
The Centers for Medicare & Medicaid Services (CMS) specifically defines the following lung disorders as chronic lung diseases that could make you eligible for a Medicare Special Needs Plan:
Asthma
Chronic bronchitis
Emphysema
Pulmonary fibrosis (PF)
Pulmonary hypertension
Lung cancer is a qualifier as well (though it is listed in the “cancer” category instead of “chronic lung disorders.”
Severe COPD as a Qualifying Disease
You might be wondering, “what about severe COPD? Does Medicare cover COPD?” Medicare Part B can cover COPD diagnosis and treatment.
To begin, Medicare Part B covers your doctor’s visits at 80%. Start by asking your doctor about COPD and getting tested. Then, Part B also will cover a comprehensive pulmonary rehabilitation program for moderate to severe COPD (chronic obstructive pulmonary disease). If your doctor offers this treatment, you will only owe 20% of the Medicare-approved amount with Part B (after the Part B deductible). If you are hospitalized, your treatment will fall under Part A, and you may owe a hospital copayment.
Emphysema and bronchitis are forms of COPD, so a COPD diagnosis may mean that you also qualify for a Special Needs Plan (SNP) and a Special Enrollment Period. In that case, you may be able to get even more coverage.
SNP plans often come with care coordination. That means no more confusing phone calls and mixed messages between all your different doctors!f
What Chronic Lung Disease Treatments Will Medicare Cover for COPD?
Two main diseases fall under the term COPD: chronic bronchitis and emphysema. There currently is no cure for COPD. Early detection can help you manage your symptoms and continue to live a “normal” life with COPD.
One of the main things to keep in mind when living with COPD is that seemingly small things like seasonal allergies or air pollution can cause serious exacerbations. It’s important to take every small infection or symptom seriously.
COPD Oxygen Therapy
People with COPD may have low blood oxygen levels, which is called hypoxia. Supplemental oxygen, or oxygen therapy, can help prevent heart failure and improve quality of life in COPD patients.
Some people may need long-term oxygen therapy 24 hours per day. Others may only need supplemental oxygen during exercise, sleep, or air travel.
You can get oxygen therapy in three ways:
Oxygen concentrators
Oxygen-gas cylinders
Liquid-oxygen devices
Remember that you cannot smoke or stay near an open flame while using any of these devices.
Medicare Part B will cover your device as well as any accessories (like mouthpieces or tubing), maintenance, repairs, and the oxygen itself. You will only be responsible for 20% of the costs with Part B.
Uniquely, Medicare requires a five-year obligation with whichever company you use to rent your oxygen equipment. After five years, you will be able to rent new oxygen equipment from a separate provider.
COPD Prescription Drugs with Medicare Health Insurance
While no prescription can cure COPD, there are several that can help you manage your discomfort. Some examples may include:
Bronchodilators (in an inhaler; relaxes the airway muscles)
Inhaled steroids (reduce inflammation)
Phosphodiesterase-4 inhibitors (reduces inflammation and relaxes the airway muscles)
Sometimes, when patients have severe emphysema or severe COPD, doctors may recommend surgery. There are three COPD surgeries:
Lung Volume Reduction: Small portions of damaged tissue are removed from the upper lungs, creating extra space so that your diaphragm is more productive. The procedure is minimally invasive. A small valve is placed in the lung.
Bullectomy: Bullae (large air spaces) are removed from the lungs to improve airflow.
Lung Transplant: A lung transplant comes with huge risks, but can also have huge rewards. This procedure requires that you meet specific criteria outlined by your doctor. After a lung transplant, you’ll need to take immune-suppressing medications for the rest of your life.
Medicare coverage for your surgery would fall under Part A, but you’ll still have copayments and a deductible. Some Medicare Advantage plans might provide more coverage.
COPD and Medicare Supplement
A Medicare Supplement (also called Medigap) plan can be a great way to cover the extra costs associated with COPD. However, most people will find that a Medicare Advantage plan is better for COPD than a Medicare Supplement. That’s because you cannot be denied for Medicare Advantage based on preexisting conditions. However, you can be denied Medicare Supplement coverage.
There are two times when you can get a Medicare Supplement plan without medical underwriting. One is when you’re signing up for Medicare health insurance for the first time, and the other is if you lose your current coverage due to no fault of your own and need a new plan.
Lung Cancer Screenings
If you’ve been diagnosed with COPD, your doctor may recommend annual lung cancer screenings, because about one percent of COPD patients develop lung cancer. Medicare Part B covers yearly lung cancer screenings with Low-Dose Computed Tomography (LDCT) if you meet one or more of the following conditions:
You’re 55-77 years old
You don’t display any lung cancer symptoms
You smoke currently or quit smoking within the past 15 years
In the past, you smoked at least one pack per day for 30 years
A doctor orders the screening
Inhalers Medicare Will Cover
In many cases, inhalers will fall under prescription coverage (meaning you will need either a Part D prescription drug plan or a Medicare Advantage plan that includes prescription benefits). However, your inhaler may be considered “durable medical equipment,” which is covered by Part B. There are two COPD inhalers covered by Medicare Part B: controllers and rescue relievers.
Controllers: A doctor may prescribe this type of inhaler to help keep your symptoms from worsening. Different types of controllers are:
Short-acting Anticholinergic Bronchodilators
Long-acting Anticholinergic Bronchodilators
Corticosteroids
Phosphodiesterase-4 Inhibitor (PDE-4 Inhibitor)
Combinations of Corticosteroids and Long-acting Beta-agonists
Combinations of Long-Anticholinergic Bronchodilators and Corticosteroids
Rescue Relievers: These inhalers are reserved for emergencies for fast, short-term symptom relief. Different types of rescue relievers are:
Short-acting Beta-agonist Bronchodilators
Combinations of Short-acting Anticholinergic and Short-acting Beta-agonist
The right inhalers can help keep your day-to-day symptoms at bay and step in when a flare-up occurs. Your doctor will be able to help you get the right prescription medications and inhalers for you.
Does Medicare Part D Cover COPD Inhalers?
Medicare Part D plans can cover COPD inhalers (bronchodilators and steroids), but there may be some cost-sharing required. One study found that out-of-pocket annual costs for inhalers with a Part D benefit ranged from $494 to $1,197 in 2015.
It’s important to speak to an insurance agent before you invest in Medicare Part D because there may be cheaper plans out there, or you may qualify for savings that you don’t even know about. You can get in touch with an agent by calling 844-431-1832.
What Treatments Will Medicare Cover if I Have Lung Cancer?
Doctor Explaining X-Ray Results | Medicare Plan Finder
Along with initial lung cancer screening, Medicare will cover certain cancer treatments. Different Original Medicare treatments and services fall under Parts A and B.
Hospital visits and stays, including the treatment you receive while staying at the hospital while you’re considered an inpatient. Note: You can still be considered an outpatient while you stay at the hospital if you’re considered to be on “observation status.”
Care at skilled nursing facilities following a three-day hospital stay
Many chemotherapy drugs administered intravenously in a doctor’s office or outpatient clinic
Some oral chemotherapy drugs
In some cases, Medicare will cover second opinions for non-emergency surgeries, and even third opinions if the first two opinions differ.
Medicare can help cover your lung cancer screening and treatment so you can be in the best health possible. A qualified professional can help you determine which plan will cover what you need while taking your budget and lifestyle into consideration.
Does Medicare Cover Pulmonary Rehabilitation?
People with COPD, pulmonary hypertension, interstitial lung disease, cystic fibrosis, and those who have had a lung transplant can all benefit from pulmonary rehabilitation, also called respiratory therapy.
A pulmonary rehabilitation program includes both education and exercise to help you manage your breathing and increase your stamina. It may also include testing to find out if oxygen supplements would help you.
You’ll meet with a medical professional two or three times per week for a few months in a hospital outpatient setting. During that time, you’ll complete exercises like stretching, weight lifting, walking, and cycling. The staff member assisting you will walk you through each step of the process. Since the goal is pulmonary rehabilitation (not weight loss), everything will be focused on your breathing and stamina.
Since pulmonary rehabilitation programs usually occur in hospital outpatient settings, your Medicare coverage will fall under Part A. You will likely owe the hospital a copayment for each session. In some cases, your rehabilitation might occur in a doctor’s office instead, in which case it would fall under Part B, and you would owe 20%. To get your Medicare coverage for this service, you will need a direct referral from a doctor. If you qualify for both Medicare and Medicaid, this service might fall under your state’s Medicaid physical therapy coverage.
How many visits does Medicare cover for pulmonary rehab?
The CMS Medicare guidelines for pulmonary rehab state that “Medicare will pay for up to two (2) one-hour sessions per day, for up to 36 lifetime sessions (in some cases, up to 72 lifetime sessions) of PR.” To qualify, your care must take place within one of the qualified pulmonary rehab centers that your doctor refers you to.
Does Medicare Cover COPD Prevention?
The number one cause of COPD is overexposure to lung irritants like cigarette smoke, pipes, cigars, air pollution, and chemical fumes. It is possible to achieve overexposure purely from second-hand smoke.
In some rare cases, COPD can also come from a genetic condition called “alpha-1 antitrypsin deficiency.” The condition refers to low blood levels of alpha-1 antitrypsin, a protein from the liver. Additionally, some people with asthma develop COPD.
The best way to prevent COPD is to avoid smoke and harmful chemicals. However, if you fear you may have already been exposed, some Medicare-covered services may help you prevent further damage.
To begin, you may wonder what tests are covered by Medicare. You can ask your doctor for a pulmonary function test. Your doctor will use either spirometry or plethysmography, both of which are noninvasive. Both tests have a mouthpiece that will measure your breathing; the difference is that a plethysmography can test for lung residual volume and total lung capacity, while spirometries cannot. Since these tests are not medically necessary, Original Medicare does not cover spirometry, but your private plan may. Regardless, spirometries can cost less than $100 out of pocket. Medicare will cover a plethysmograph when your doctor deems it necessary.
No matter what your test results are, you can prevent COPD exacerbation by getting your annual flu shot, which would be covered at your doctor’s office under Part B.
COPD Services, Medications, and Treatments That Medicare Does Not Cover
It’s important to recognize that Original Medicare (Parts A and B) does not cover prescription drugs. While some of your inhalers may be covered under Part B, any other drugs related to your COPD treatment will not be covered. For prescriptions, you’ll need to choose between either a Medicare Advantage plan that includes a prescription benefit or a Part D prescription drug plan. You cannot have both a Medicare Advantage plan and a Part D plan at the same time, so you’ll have to choose one or the other.
One exception is that if you have a lung transplant, Medicare Part B will continue to cover your immunosuppressant drugs as long as you had Medicare Part A at the time of transplant. If you did not yet have Medicare when you received your transplant, you may need to seek alternative drug coverage through a Part D plan or certain Medicare Advantage plan to get coverage for your immunosuppressants.
Additionally, Medicare will not cover experimental treatments or drugs.
What to Do if Medicare Won’t Cover the COPD Drugs, Treatments, and Services You Need
If you’re finding that Medicare either does not cover the COPD services you need or does not cover them enough, it might be time to look into a form of Medicare extended coverage. COPD patients and anyone with chronic lung disease symptoms may find that Medicare Advantage Prescription Drug plans and Medicare Supplements (two types of private Medicare plans) are worth the investment – but you can’t have both types.
Remember that if you are diagnosed with chronic lung disease, you may be eligible for a Special Needs Plan. In turn, you’d be eligible for a Special Enrollment Period (meaning you don’t have to wait until the fall to change plans).
A Medicare Supplement plan (Medigap) can help you by covering those pesky deductibles, copayments, and other charges related to your Medicare coverage. For example, Medigap Plan G covers hospital coinsurance and copayments. It’s a great plan choice for anyone preparing for surgery or an extended hospital stay.
A Medicare Advantage Prescription Drug plan can help you with your COPD by providing the prescription drug coverage you need. Some of these plans might also cover additional therapy sessions, extra surgery coverage, etc. Each plan is different, so it’s a good idea to speak with an insurance agent who understands all of your available options.
COPD patients might also qualify for a Medicare Advantage Special Needs Plan, a type of Medicare Advantage that is specifically designed for your needs and may provide additional benefits.
To speak with an insurance agent in your area for free, call 844-431-1832. You can also start by using our Medicare plan search tool.
Get Coverage for Your Condition
Chronic lung disease is not something that should be taken lightly. If you think you might qualify for a Special Enrollment Period with your condition, call Medicare Plan Finder at 844-431-1832 or contact us here today. We can help you determine your Medicare status and find the right plan to suit your budget and lifestyle.
Find Medicare Plans | Medicare Plan Finder
Medicare Hearing Aids Coverage
Hearing aids can turn your entire life around, but you may need a private Medicare plan to be able to afford it. Original Medicare (Part A and Part B) will only cover hearing tests under limited circumstances. That means no ear treatments, no hearing aids, or anything else.
Not every Medicare-eligible person needs ear treatments, which is why Medicare does not consider it an “essential benefit”.
Does Medicare Cover Hearing Aids Costs?
Doctor’s Appointment | Medicare Plan Finder
Hearing aids can cost anywhere from $400 per ear to $4,000 or more per ear. Even if the initial device is not too expensive, you’ll have to remember that you’ll need to pay the costs of a hearing aid fitting, hearing aid exams, cleanings, and replacement hearing aids every five years or so.
Some providers may offer free cleanings and fittings with your hearing aid. When you add everything together, you could be paying thousands upon thousands over your lifetime for your ear care. Luckily, there is a solution that can help you out financially.
You may be able to get cheaper hearing aids by ordering online. However, by ordering a hearing aid online, you miss out on the doctor consultation and fitting.
Even if you think you don’t need the doctor consultation, remember that an experienced doctor can give you the medical advice you need to determine what kind of hearing aid you need and help you get the right fit.
Does Medicare Cover Hearing Tests?
Medicare does not cover hearing aid tests, fittings, or routine hearing exams. Medicare Part B will only cover hearing and balance tests if your doctor orders them to diagnose medical conditions.
Medicare Advantage Plans that Cover Hearing Aids
The easiest way to get Medicare coverage for audiology appointments, treatments, hearing aids is to enroll in a Medicare Advantage plan. While some separate hearing benefit plans are available, it’s often not as cost-effective.
Medicare Advantage is a plan offered by private insurers that covers hospital visits, doctor visits, and other benefits like prescription drugs, vision, dental, and hearing.
Every year, you have the chance to enroll in a Medicare Advantage plan between October 15 and December 7. You should start thinking about your needs now so you can be ready to switch in the fall!
Not all Medicare Advantage plans cover hearing benefits, so make sure you read everything carefully before you buy. Some plans will require that you buy a hearing aid from a specific provider.
Hearing loss affects more than just your hearing. Your hearing is directly connected to your sense of balance, so hearing loss can lead to more trips and falls, leading to higher medical bills.
Additionally, people who experience hearing loss or more likely to also experience high blood pressure, depression, and even dementia. Hearing aids can reduce all of these symptoms and side effects.
Signs of Hearing Loss
Some signs of hearing loss might include:
Trouble focusing on a person’s speech, especially when there is background noise
Tinnitus (ringing in the ears)
Finding yourself constantly raising the volume on your television or radio
Having a harder time hearing extremely high or extremely low pitches
Missing certain consonant sounds like “sh,” “th,” and “p.”
Leaving your car’s turn signal on because you don’t hear it
Not hearing your alarm clock in the morning
Hearing Loss Prevention
Some hearing loss prevention is purely the result of old age, but there are certain ways you can prevent the development of this ailment. The best way is to avoid circumstances where you will be surrounded by loud noises. Wear earplugs when attending concerts or events with big crowds, pay attention to the volume on your radio and TV, don’t sit too close to the speakers, etc.
You should also be sure to attend your yearly wellness exams. Your doctor may or may not check your hearing during these appointments (you may face an extra co-payment for audiology). Medicare Advantage plans often including a hearing benefit so that you can get coverage for regular hearing exams.
About Medicare Hearing Aids
While hearing aids can’t give a deaf person the ability to hear, they can help people with minimal to moderate hearing loss regain some hearing ability. Hearing aids effectively make sounds louder. There are a handful of ways to lose hearing ability, but hearing aids help those who have sensory cell damage in the inner ear.
Types of Hearing Aids
Medicare Hearing aids can work in two different ways: analog and digital. Analog hearing aids convert sound waves into amplified electrical signals. Digital hearing aids convert sound waves into numerical codes, then amplify them.
There are six different types of analog and digital hearing aids: IIC, CIC, ITC, ITE, RIC, and BTE. Your doctor may recommend one type over another based on your specific hearing needs and your budget.
IIC (Invisible n Canal) – Fitted for your ear canal and invisible when worn. For mild to moderate hearing loss.
CIC (Completely in Canal) – Fitted for your ear canal, small handle may be visible; for mild to moderate hearing loss
ITC (In the Canal) – Fitted to your ear canal, small portion will show; for mild to mildly severe hearing loss
ITE (In the Ear) – Fitted to your outer ear; for mild to severe hearing loss
RIC (Reciever in Canal) – Barely visible, open and comfortable fit; uses electrical wires (as opposed to a plastic tube). For mild to moderate hearing loss
BTE (Behind the Ear) – Fitted behind the ear, directs sound into a mold inside the ear; for moderate to severe hearing loss
Best Hearing Aids on the Market
Your doctor may recommend one hearing aid brand over another, and we recommend listening to your doctor’s opinion. However, we can tell you that some of the most highly-rated hearing aid brands are Resound, Phonak, Starkey, Widex, and Oticon.
If you’re getting coverage for your hearing aid from a Medicare Advantage plan, be careful. Your plan may require that you select from specific Medicare hearing aids. You should also consider that some hearing aid companies will offer trial periods.
Get Your Medicare Hearing Aids
Before you select and purchase a hearing aid, be sure to speak to a Medicare agent about finding coverage for your ear care. We recommend Medicare Advantage for most seniors and other Medicare-eligible people with hearing deficiencies.
Most people who are eligible for Medicare are eligible for several different Medicare Advantage plans. Our agents are licensed to sell most of those plans and can help you select the best one for your needs. To set up your free appointment, send us a note or call us at 844-431-1832.
Contact Us | Medicare Plan Finder
*This post was originally published on February 22, 2018, and updated on August 19, 2019.
How do I Check my Benefits for Medicare and Other Programs?
Have you recently performed a healthcare benefits check up? Are you missing out on the benefits that you qualify for? They can be hard to keep track of when there are so many out there. There are benefits available for everything from your health to the food on your table, and they all have different eligibility requirements. Thankfully, there are tools out there that can help you keep track. One of our favorites is benefitscheckup.org.
What is My Benefits Checkup?
BenefitsCheckUp is a free financial and healthcare benefits check up tool offered by the National Council on Aging. They scan over 2,500 federal, state, and private benefits programs for eligibility standards to keep their tool up-to-date. When you visit benefitscheckup.org and click on “Find My Benefits,” you’ll get results for all the programs that you might be eligible for based on your:
Zipcode
Gender
Birth year and month
Monthly gross income (including your spouse, if applicable)
Marital status
Veteran status
Race/ethnicity (optional)
Your report will reveal what programs you may be eligible for, which can include (but is not limited to):
Adult daycare
Adult education
An Alliance for Accessible Hearing Care (AUDIENT)
Donated Dental Services (DDS)
Elderly Nutrition Program/Home delivered meals
Foreclosure prevention
HUD Public Housing or Section 8
Legal assistance
Low Income Home Energy Assistance Program (LIHEAP)
Medicaid
Medicare
Medicare Savings Programs
Program of All-Inclusive Care for the Elderly (PACE)
Retirement benefits
Social Security
State Children’s Health Insurance Program (SCHIP)
Supplemental Nutrition Assistance Program (SNAP)
TRICARE
Tax credits
Transportation benefits
Check Benefits Online
Who is the National Council on Aging?
The NCOA, or National Council on Aging, partners with governments, businesses, and nonprofit organizations to support aging adults. NCOA’s mission is to “improve the lives of millions of older adults, especially those who are struggling.” They accomplish this by finding ways to help seniors make more money, save more money, participate in healthy social programs, remain in their communities, and fight fraud, waste, and abuse.
How to Check my Health Benefits
You can check your health benefits online, but there are a few different ways to do that depending on what health benefits you have. If you have marketplace health insurance, go to healthcare.gov, then complete these steps:
To check your Medicare enrollment status online, visit Medicare.gov at this link. Enter your information, then click “continue.” You will need your Medicare card for your Medicare number. You won’t be able to continue until you’ve answered all the questions.
To check your Medicare eligibility online, go to Medicare.gov at this link and complete the series of questions. It is important that you answer them accurately to find out if you are eligible.
When you’re done, you can click on the button that says “Eligibility & Premium Calculator Home” at the bottom, and then click on “Calculate my premium” to find out what your Part B premium will most likely be.
Check Medicaid Status Online
Checking your Medicaid status online isn’t quite as easy as Medicare because Medicaid is different in every state. Your state might have its own application portal where you can track the status of your application and find out more about your benefits. You can also visit your local Medicaid office (usually a Social Security building or another government office) or call to check your application status, but know that it could take a few weeks.
How do I Check Medicaid Eligibility?
Checking your Medicaid eligibility will be different in each state as well. Medicaid eligibility is based on your income and ability to pay for your healthcare services, but each state’s income limits are slightly different due to the cost of living and other factors. Check with your state’s page, here, to find out if you might be eligible.
Check Medicaid Eligibility
How to Check my Financial Benefits
Checking your financial benefits is easy with today’s online tools. Health benefits aside, the major welfare benefits are TANF, SNAP, EITC, Supplemental Security Income, and housing assistance.
Social Security benefits can begin when you retire. To be eligible for Social Security retirement benefits, you must have worked for at least ten years. The longer you’ve worked, the higher your benefit can be. For example, if you wait until you are age 70 to retire, your benefit may be higher than if you retire at age 62.
If you don’t qualify for Social Security retirement benefits, you might instead qualify for SSI, or Social Security Income. To qualify for SSI, you must be either blind, disabled, or over the age of 65, and you must have limited income and resources. Qualifying for SSDI (Social Security Disability Income) is different. SSDI eligibility is based on means, severity, and work. That means you must have low income due to your disability/inability to work substantially, a severe disability, and must be incapable of working and earning a livable income. If you receive SSDI for at least 25 months, you may also qualify for Medicare (even if you re under 65).
What Tax Benefits do I Qualify for?
There are lots of different types of tax benefits out there. The best way to make sure you’re not missing out on any tax benefits is to meet with a tax accountant before you file each year. Retirees might qualify for the tax credit for the elderly and disabled. To qualify, you must be:
Age 65 or older at the end of the tax year
A legal U.S. citizen or resident alien (or married to one)
Earning less than:
$17,500 if single
$20,000 if married but only one spouse qualifies
$25,000 if married
$12,500 if married but living and filing separately
How do I get Income Assistance Through TANF?
TANF stands for Temporary Assistance for Needy Families. TANF is not a government handout. It promotes job preparation and job hunting, helps to reduce unprepared pregnancies, and encourages healthy marriages. TANF is both federal and state-based, similar to Medicaid.
The government has a TANF budget every year that is divided among the states. Each state then has the ability to determine how much each state is allowed to give out and can adjust the eligibility standards.
Check with your state’s Health and Human Services office to find out if you’re eligible. Many states have TANF applications built into their Medicaid applications, so you can apply for both programs at the same time.
Collecting Unemployment After Retirement
Some states have different requirements. For the most part, if you are not retired and lose your job after age 62, you can apply for unemployment. You may be able to receive Social Security and unemployment at the same time. However, if you are retired/over 65, you may not be able to collect unemployment. You’ll have to rely on your senior tax break and your Social Security retirement benefits instead.
Check Benefits Online
Other Benefits you Might be Eligible for
Government assistance can extend far beyond healthcare and income. You may be eligible for meal assistance, free or low-cost housing, and more!
What Veterans Benefits am I Eligible for?
You can qualify for VA (Veteran’s Affairs) healthcare benefits as long as you served the full period for which you were called to active duty or at least 24 continuous months. If you served prior to September 7, 1980, the time period limit may not apply to you. It also may not apply if you were honorably discharged.
You can qualify for TRICARE if you are a uniformed or retired uniformed Service member or family member, a National Guard/Reserve member or family member, a survivor, a former spouse, a Medal of Honor recipient, or otherwise registered in the Defense Enrollment Eligibility Reporting System (DEERS).
You may also be able to qualify for disability compensation, memorial benefits, pension, home loans, education, job training, life insurance, and more.
What Housing Benefits am I Eligible for?
Public housing options tend to be a bit limited, so the eligibility standards can be strict. Eligibility depends not only on your income and citizenship status but also on whether you are elderly or disabled or if you have dependent kids. Eligibility can change based on where you live, so it’s best to contact your local PHA (Public Housing Agency) and fill out an application.
How do I Check Eligibility for SNAP Benefits?
SNAP eligibility depends on your location and household income. You must apply for SNAP in the state that you legally reside in. Use this website to find your local office (click on your state) to apply for SNAP.
Can I get Meals on Wheels?
Meals on Wheels operates through different local programs throughout the nation. Each programs’ eligibility requirements are slightly different, but for the most part, you will need to be homebound and over the age of 60 (some people under 60 may be able to qualify). Some people may be able to get Medicare Advantage plans that offer Medicare meal delivery services through Meals on Wheels.
Meal Delivery Services
How else can I Check my Benefits?
There are several ways to check on your current benefits and to see what you’re eligible for. We encourage anyone who is receiving benefits to check with a licensed agent who understands health insurance programs. You can also visit your local Social Security or other government offices to ask about benefits in person.
We also recommend that you find a great lawyer and a great accountant. Benefitscheckup.org can tell you if you might qualify for free or low-cost legal assistance.
Using a licensed agent to check your benefits and find out what you’re eligible for can prove to be extremely useful. Licensed agents are often familiar with the rules and regulations set in place by both the federal government and your state. Additionally, they are often able to help walk you through the application process for benefits.
We have licensed agents available who can sell Medicare Advantage, Medicare Supplements, Medicare Part D, and sometimes more. To get started, click here or call 844-431-1832.
What Is a Medicare Advantage HMO?
A HMO, or Health Maintenance Organization, is a type of Medicare Advantage (MA or Part C) plan. HMO plans always offer the same benefits as any other Medicare plan, but they are also able to provide additional benefits, many plans include vision, dental, and hearing coverage.
HMO plans are different from other Medicare Advantage plans because they require a strict network and you will usually need to select and stick with one primary care doctor.
Pros and Cons of Medicare HMO Plan Networks
PCP Discussing HMO Referral With Patient | Medicare Plan Finder
The HMO option is certainly not for everyone. Having a strict network means that you will turn to the same doctor for most of your healthcare needs.
Some plans are called “HMO POS,” or HMO Point-of-Service plans. These allow you to see providers outside of your network for certain services. If you need to use that benefit, you will usually have to get approval from your plan first, and your provider needs to recommend the other provider.
For example, if your primary care physician (PCP) suggests that you need to see a nutritionist or other specialist, your PCP can refer you to a nutritionist that he or she trusts and send a request for coverage to your HMO. The “con” to the HMO option is that your plan can deny your out-of-network coverage.
The “pro” to selecting one primary physician and having a Health Maintenance Organization is that all of your care is grouped together and managed in one place. Your providers usually work together to manage your care, preventing unnecessary costs.
A licensed agent with Medicare Plan Finder can help you determine if a HMO is right for you. Our agents can help you find the right plan based on your budget and lifestyle needs. To learn more, call 844-431-1832 or contact us here.
Contact Us | Medicare Plan Finder
Medicare HMO vs. PPO
Where an HMO requires a very specific network, a PPO, or Preferred Provider Organization, can cover services outside of your network. With a PPO plan, you’ll be able to see any provider without needing a referral from your primary physician.
Granted, the added flexibility of a PPO plan comes with a higher premium than an HMO plan. If costs are your primary concern, HMOs are the way to go – but if you can afford the flexibility, a PPO may be for you.
If you have questions about HMOs vs. PPOs, your agent can answer all of them and help you make the right choice for you.
What is Medicare Advantage?
Medicare HMO plans and other types of Medicare Advantage plans are great options for people who want more coverage than what Original Medicare provides.
Original Medicare is what everyone who has Medicare will have, but its coverage is limited. Medicare Advantage plans can add anything from extra medical coverage to additional benefits like home healthcare, telemedicine, and full dental coverage.
Many MA plans can offer coverage for whole health benefits. Along with additional medical and dental benefits, MA plans can offer coverage for meal delivery, non-emergency medical transportation and even fitness classes!
Your agent can discuss the differences between other types of Medicare plans like Medicare Supplements and Medicare Advantage plans.
Medicare Advantage | Medicare Plan Finder
HMO Eligibility and Costs
HMO Costs | Medicare Plan Finder
Most people who are eligible for Medicare are eligible for HMO plans. The only exceptions are that not every county has HMO plans available, and most HMO plans do not accept Medicare beneficiaries with ESRD (End-Stage Renal Disease).
Just like your Original Medicare coverage, you will receive a card in the mail when you enroll in a HMO plan. When you visit a doctor or hospital, use your HMO card instead of your Medicare card to get the most coverage.
Every Medicare Advantage plan is different, but you will generally be responsible for paying certain costs.
All HMO plans come with a premium you will owe every month, but some are as low as $0.
You’ll also be responsible for paying copays such as $10 or $20 when you see a doctor and you may have to pay a deductible before your coverage starts.
Medicare Advantage plans are rated based on the following criteria:
How easy it is to access preventive services (such as annual physical exams and health screenings)
Care coordination between providers
How often plan members receive treatment for chronic conditions
Member satisfaction
Plan performance from year to year
Customer service quality
Five-star HMO plans may be available in your area. Talk to your agent to learn more.
Medicare Advantage HMOs Near You
Medicare Advantage HMO plans are not available in every zip code. However, we have highly-trained, licensed agents in 38 states who can help you discover the options available in your neighborhood. To get started, send us a message or give us a call at 844-431-1832.
Contact Us | Medicare Plan Finder
This post was originally published on February 26, 2019, by Anastasia Iliou and was updated on August 12, 2019, by Troy Frink.
Guide to Medicare Mental Health Coverage
Mental illnesses, even though you can’t always see them, are just as real and treatable as physical diseases. Depression and anxiety can affect you physically in the same way that an illness can. In fact, depression IS an illness.
It can cause extreme fatigue and lethargy to the point where getting out of bed seems impossible. It can also lead to oversleeping or insomnia, as well as overeating or starving. It’s important to take care of your mental health just as you would your physical health.
Does Medicare Cover Mental Health?
Therapy Appointment | Medicare Plan Finder
Seniors and Medicare eligibles may have an increased risk of developing depression for both physical and mental reasons. Weakened immune systems and other ailments make the brain more susceptible to mental illnesses, which are most often the result of a chemical imbalance in the brain.
The anti-socialization that retirement can bring can easily affect one’s mood and lead to depression. Managing your mental health can relieve stress, improve memory, help you sleep better, and boost your overall mood.
With those circumstances in mind, you may wonder, “Does Medicare cover mental health?” Yes, but only under certain conditions.
Medicare Mental Health Benefits for Inpatient Care
Medicare Part A covers mental health services that you receive in an inpatient hospital setting. The out-of-pocket costs are the same regardless if you receive treatment in a general or psychiatric hospital.
You can only receive coverage in a psychiatric hospital for 190 days per your lifetime. If you are already hospitalized when you enroll in Medicare, you can be reimbursed for up to 150 hospital days.
Part A hospital coverage is broken into 60-day periods. First, you must pay your deductible, which is $1,408 in 2020, but after this is met, your first 60 days are completely covered.
If you are still in the hospital after 60 days, you will need to pay $352/day for days 61-90, and $704/day for days 91-150. Your Part A coverage will end after this time. However, once you have been out of the hospital for 60 days, your “day count” resets to 0 and this cycle can start over.
2020 Medicare Part A Copayments
Medicare Outpatient Mental Health Coverage
Medicare Part B covers all doctor visits related to mental health. That means any psychiatrists, psychologists, social workers, nurses, therapists, and addiction center visits are covered by your Medicare.
Counseling or therapy sessions are slightly more limited because they are only covered under Medicare if you see a doctor who accepts Medicare assignment. More specifically, this includes:
Individual and group therapy
Substance use disorder treatment
Occupational therapy
Active therapy (art, dance, music therapy)
Family counseling
Lab tests
Annual depression screening
Prescription drugs you cannot administer yourself
Original Medicare will cover these services at 80% of the Medicare-approved amount. This means you will likely pay 20% coinsurance after you meet your Part B deductible. However, keep in mind that your provider must take Medicare assignment, otherwise, Medicare will not pay for the services.
How to Find a Medicare Therapist
Psychology Today has a tool that can help you find a local therapist who takes Medicare. To get started, click here. Then enter your zip code. We used 37209, which is the zip code for our corporate offices in Nashville, Tennessee.
How to Find a Medicare Therapist Step 1 | Medicare Plan Finder
That will lead you to a page that lists the therapists in your area. From there, you can further filter your search results by therapist specialties and the qualities that matter most to you, such as gender, age, and faith.
How to Find a Medicare Therapist Step 2a | Medicare Plan Finder How to Find a Medicare Therapist Step 2b | Medicare Plan Finder
Medicare Mental Health Costs
Medicare mental health costs will vary based on your unique situation and personal needs. Treatment can range as low as $1,000 or as high as $9,000. Thankfully, Part D, Medicare Supplements, and Medicare Advantage plans can help lower your out-of-pocket costs.
Mental Health and Part D
Original Medicare does not cover prescription drugs. A Part D prescription drug plan is a great alternative to help cover the costs of any antidepressants or other health-related drugs.
Part D plans have an annual deductible of $435 for 2020. This means that every year, you will need to spend $435 before your coverage starts. Since Part D plans are sold by private insurance companies, each plan may be a little different. Some plans may waive, reduce, or charge the deductible up front.
Once you’ve reached your Part D deductible, you will enter the initial coverage phase. You’ll stay in this phase until you spend $3,820 in 2019. During this time, you will need to pay a copay for every prescription based on the plan’s drug formulary (list of drugs that are covered).
Drug formularies are organized by tiers according to co-payments. For example, a generic, tier-one antidepressant may only cost you $32, whereas a tier three, brand-name antidepressant can cost you $133.
Any drug labeled as “preferred” will be cheaper. Plus, you may be eligible for extra prescription drug cost savings through Medicare Extra Help. To learn more, or to schedule an appointment to discuss the best Part D plans in your area, fill out this form, or give us a call at 844-431-1832.
Part D Checklist | Medicare Plan Finder
Mental Health and Medicare Supplements
Medicare Supplement plans can add financial benefits and help you save in the long run on mental health coverage and other health-related costs. These plans help pay for things like copayments, coinsurance, and deductibles.
There are ten different plan types (A, B, C, D, F, G, K, L, M, N) and each plan offers different coverage and pricing. Your best bet is to speak with a licensed agent. If you’re interested in arranging a no-cost, no-obligation appointment, fill out this form or give us a call at 844-431-1832.
Medicare Supplements Plan Finder | Medicare Plan Finder
Mental Health and Medicare Advantage
Medicare Advantage plans must cover, at a minimum, the same as Original Medicare. However, they generally often several more benefits such as prescription drug coverage, hearing, dental, or vision coverage, OTC pharmacy allowance, non-emergency transportation, and group fitness classes like SilverSneakers®.
A licensed agent can help you find the best plan at the best rate that is specific to your needs and budget. Fill out this form or give us a call at 844-431-1832 to get in contact with a licensed agent.
Find Medicare Advantage Plans | Medicare Plan Finder
Improving Your Mental Health With Medicare
Did you know that stress and depression can weaken your immune system? Your mental health affects you physically as well as emotionally. Thankfully, Medicare provides benefits that can serve as “mood boosters” to help keep you both physically and emotionally healthy. Learn how emotions affect the body and how you can stay healthy.
Depression is all-too-common among seniors and Medicare eligibles, and it can often come from the stress of aging or physical health conditions. The feeling of stress is triggered by the release of the hormone cortisol, which slows down motivation and metabolism.
This means that stress can cause you to not only lose the motivation to eat healthily and exercise, but also lose the metabolism to break down fatty foods, ultimately leading to unhealthy weight gain. Aside from weight gain, the influx of cortisol can inflame the immune system, weakening it and making it easier for you to catch infections and get sick.
On the same side of the token, a positive mood will allow you to heal more quickly. If you take a positive attitude with your illness or injury, your immune system will stay stronger and you’ll have less cortisol holding you down.
Medicare Mood Boosters
Fitness Class | Medicare Plan Finder
What makes you happy? All the little small things that you enjoy can help you heal emotionally and physically, as the two are connected. Consider starting with your senses – do you have a scent that makes you happy? Light a candle or spray a fragrance. Do you have a sound that makes you happy? Play some music.
A lot of people find that physical activity is a great mood booster. Medicare’s SilverSneakers® program promotes healthy social and physical behaviors for people like you. The program revolves around group exercise programs hosted within gyms and YMCAs including activities like strength, flexibility, walking, and yoga classes.
The group setting gives you an opportunity to socialize with other seniors in your area, and the activities will help strengthen your physical health.
If SilverSneakers® is a benefit included in your Medicare plan, you should receive a list of participating facilities. Then, all you’ll need to do is bring your SilverSneakers® card with its 16-digit member number to the facility.
Get Medicare Mental Health Benefits
To enroll in a Medicare Advantage plan or to find answers to any questions you have about your mental health coverage, click here or call 844-431-1832.
Contact Us | Medicare Plan Finder
This blog was originally published on May 18, 2017, by Anastasia Iliou, and was updated on August 9, 2019, by Troy Frink.
