The Medicare Annual Enrollment Period (AEP) is a time when many Medicare beneficiaries can change their plans so their coverage best fits their needs.
If you are enrolled in Medicare, you will receive an “annual notice of change” (ANOC) which explains the changes coming to your current plan for the 2026 year. After reviewing your ANOC, you may decide you need to switch to a new plan.
The AEP for Medicare lasts from 10/15 to 12/7, but once it’s over and you’ve enrolled in a new plan, you may wonder what to do next.
You may wonder if you forgot something important or how you can take advantage of your plan’s new benefits.
Here’s what to do after the Medicare AEP ends:
Review Your Medicare Advantage Plan
If you enrolled in a Medicare Advantage (MA) plan and you decide that it doesn’t fit your needs, you can switch to a different Medicare Advantage plan from 1/1 to 3/31 the . This time period is called the Medicare Advantage Open Enrollment Period (OEP).
For example, if you enroll in a Medicare Advantage plan and it turns out that your doctor no longer takes your new insurance, you may be able to enroll in a new policy that your doctor accepts.* Talk to your agent about what plan options your doctor accepts and see if one of them can work for you.
Be sure to review a new plan’s deductibles, copays, and/or coinsurance. Your agent can help you determine your out-of-pocket costs and what your out-of-pocket maximum will be.
If you decide that Medicare Advantage (or Part C) isn’t for you, you can drop MA and return to Original Medicare (Medicare Part A and Part B) during the OEP. You can also enroll in a Medicare Part D (Prescription Drug) plan and/or a Medicare Supplement (Medigap) plan.
*Medicare Advantage plans are different in every location. We cannot guarantee that your doctor will accept any plans in your area.
Take a Look at Your Medicare Part D Prescription Drug Costs
Original Medicare does not cover most prescription drugs. If you needed Medicare prescription drug coverage during the annual election period for Medicare, you may have either signed up for a Medicare Part D prescription drug plan or a Medicare Advantage plan with prescription coverage.
Some Medicare Advantage plans even cover over-the-counter drugs! Neither Original Medicare nor Medicare Part D cover over-the-counter items. Your agent can help you determine what type of Medicare prescription coverage will work best for you.
Watch your drug costs and make sure that your plan is covering your medications properly. If your insurance company no longer covers one of your prescription drugs, talk to your agent. They can help you file an appeal.
Talk to your doctor before you file an appeal. Find out if there are alternatives that are on your plan’s formulary or if there are any less expensive drugs you can take.
You should also get a written explanation (coverage determination) from your prescription drug plan (PDP). The coverage determination document will go over whether a certain drug is covered, the qualifications to get a certain drug, your costs, and if the plan will make an exception to the coverage rules.
You should ask for an exception from your PDP if:
Your doctor prescribes a drug that’s not on your plan’s formulary
Your healthcare provider prescribes a drug that’s on your plan’s formulary, but you think you should pay less because no lower-tier drugs work for you
Your PDP will send you a letter with the coverage decision. You can file an appeal with Medicare if you disagree with the decision.
The appeals process has five different levels:
1. Redetermination from your plan: In this level, your plan re-evaluates your request for an exception.
2. Independent Review Entity (IRE) review: This is when a third party reviews your request for an exception, which you can request if your plan denies coverage after the redetermination.
3. Office of Medicare Hearings and Appeals (OMHA) decision: You can file an appeal with OMHA if you disagree with the IRE’s decision.
4. Medicare Appeals Council review: If OMHA doesn’t make a timely decision or you disagree with it, you can file an appeal with the Medicare Appeals Council.
5. Federal district court judicial review: This level is reserved for cases that meet a minimum dollar amount. You should get instructions on how to file an appeal in federal court with your Medicare Appeals Council letter.
Evaluate Your Medicare Advantage Plan
The AEP for Medicare is one of the only times of year most people can enroll in a Medicare Advantage plan.* During AEP, schedule a meeting with your agent to talk about your needs. You may determine that a Medigap plan provides all the coverage you need at a price you can afford, or you may determine that a Medicare Advantage plan is a better fit.
Medicare Advantage plans cover additional benefits that can include fitness classes, hearing, dental, and vision coverage. Your monthly premium may be lower with a MA plan, but your doctor network may be smaller.
You must choose a Medigap plan or a Medicare Advantage plan. You cannot have both at the same time.
Use the Open Enrollment Period that starts on 1/1 if you need to cancel your Medicare Advantage coverage and you want to return to your Medicare Supplement plan. For example, let’s say your doctor accepts Original Medicare, but they don’t accept any Medicare Advantage plans in your area.
You may want to enroll in a Medicare Supplement plan if you want coverage for copays and coinsurance. You may be responsible for paying Original Medicare coinsurance if you don’t have a Medigap plan that covers it.
Medigap plans cover different items than Medicare Advantage plans. While MA plans cover additional health benefits, Medicare Supplements cover financial items such as coinsurance and copays.
You can enroll in a Medicare Supplement plan at any time of year, so the time after AEP is a great time to learn about Medigap. Remember — most people can drop Medicare Advantage coverage only during AEP and OEP. You can only get a Medicare Supplement plan if you don’t already have a Medicare Advantage plan.
*Not all plans will be available in your service area or make sense for you.
Meet With Your Agent to Discuss Ancillary Products
Many health insurance agents also sell ancillary products such as life and final expense insurance. The beginning of the year is a great time to contact your agent because they might have more time for you than during the busy AEP for Medicare.
Schedule an appointment to talk about your retirement plan and how you can help your loved ones after you pass away. Write down a list of your long-term goals, financial risks, and plans for your 401(k) or other retirement accounts. The beginning of the year is a great time to create a solid plan for your financial future.
Let Us Help During OEP and Every Other Time of Year
If you have questions about your Medicare coverage, one of our highly-trained, licensed agents can help. An agent may be able to help you find a plan in your area that suits your budget and lifestyle needs. Whether it’s AEP or you’re enrolling in Medicare for the first time, let us help.
Call (833)-567-3163 or contact us here to arrange a no-cost, no-obligation appointment today.
9 Questions a Caregiver Should Ask Their Parent’s Doctor
Being a caregiver can be fulfilling and joyful, but it can also be a lot of work. You may not know where to find information about your parent’s health condition or treatment plan. Luckily, your parent’s doctor can be a valuable resource who you can –– and should –– rely on for answers. Here are nine questions a caregiver should ask their parent or loved one’s doctor:
1. What can you tell me about my caregiving situation?
Every caregiver’s situation is different. Your loved one may have different medical, nutritional, or assistive needs, and your doctor can tell you the best place to start with meeting your loved one’s healthcare needs.
For example, your parent may need non-emergency medical transportation to their various appointments, and they might need special care. Your parent’s doctor may be able to provide contact information for medical transportation services, or even schedule rides to the office. You might not have considered that your loved one may need an EMT-certified driver, especially with rideshare apps like Uber and Lyft offering rides to doctor’s appointments.
When you ask your parent’s healthcare provider about your unique situation, the physician can discuss the individual needs your parent has. Your loved one’s doctor should feel like a partner in providing the best quality care. Your doctor may even tell you ways to take care of yourself, because it can be easy to forget your own needs when you’re so focused on someone else’s.
2. Can you help me connect with other caregivers in similar situations to me?
It can be easy to feel like you’re on your own as a caregiver. An important question a caregiver should ask is what type of non-medical support they might need. Your parents’ provider may recommend resources such as caregiver support groups and online forums. It’s valuable to connect with other people in similar situations.
When you feel like you have emotional support, you’re able to take better care of your parent. It can be easy to feel frustrated or overwhelmed as a caregiver. A support group can give you ideas to cope, tips for providing better care, and/or just lend an empathetic ear. Your parent’s doctor can give you ideas about how to build a support system.
3. What can I do to build confidence in my caregiving activities and skills?
Your parent’s doctor should talk about your parent’s treatment plan and care needs with you. You should feel confident in your abilities to properly administer medications or help with physical therapy. If you’re unsure of how to do something the doctor recommends, ask them to explain the task further.
Ask if there are any shortcuts, tips, or tricks you need to know about. Find out if you can practice complex tasks so you can help effectively. Some tasks may be dangerous to perform on your own, and you may need to find outside assistance. Find out if you need to look into home health care services or if you can perform the tasks on your own.
4. Can you help me arrange respite care when I need a break?
Providing 24-hour care can be rewarding, but also exhausting. Sometimes you need to take a break. “Respite care” is when your loved one stays at a hospital or other care facility so you can get some much-needed rest. It may give you peace of mind to know that your parent is staying at a facility with qualified professionals.
Your loved one’s healthcare provider can point you in the right direction for finding respite care services.
5. What do I need to know about my parent’s diagnosis?
Every health condition or disease may have different need-to-know information. For example, your doctor may tell you to avoid fatty cuts of beef if your loved one has high cholesterol.
Your parent’s provider should tell you how and when to administer medications, how often you need to make follow-up appointments, and what symptoms to watch out for. The healthcare provider should help you provide the best possible care for your loved one, and that includes knowing the ins and outs of your parent’s health.
6. How will you coordinate with my loved one’s other healthcare providers?
Some diagnoses mean that your parent requires a care team. For example, your loved one might have a gerontologist, a physical therapist, and a neurologist. Ask how the team will coordinate your loved one’s care and keep you in the loop.
For example, some healthcare facilities feature apps to contact care team members if you have questions or need to refill prescriptions. Health facility apps can also include post-appointment notes so you can access any information you need.
7. I found this information on the internet. Is it accurate?
Google has a wealth of information about any disease you can think of. Sources such as WebMD and the Mayo Clinic offer information about symptoms, causes, risk factors, and treatments for a seemingly infinite number of health conditions.
Even though the internet has more information that you could ever need, the information can pose a problem for doctors and patients.
For example, your loved one could fall and bruise their knee. You Google “knee pain,” and read the first web page you see from WebMD. The article you read could have you thinking that your loved one needs a full knee replacement, but all they really need is an ice pack and some over-the-counter pain medications.
Your parent’s doctor will be able to help determine what’s really going on and sort out the facts from the fiction.
8. Should I be concerned about these new symptoms I’m observing?
If your parent has a degenerative health condition or they have new symptoms, ask the doctor if you should be concerned. Your loved one’s healthcare provider will let you know if they need to see your loved one or if you notice something normal. Your parent’s doctor should be available to answer your questions in a timely manner.
9. How will I know when it’s time to look into hospice care?
At some point, your loved one may need to switch from curative (to find a cure) care to palliative (to provide comfort) care. Your parent may be eligible for hospice care if curative care will not work and palliative care is the only option.
Ask your doctor to let you know when it’s time to start palliative care only, and if they know of any resources to find hospice care.
Find Medicare Caregiver Resources
As a caregiver, you’ve got a lot on your plate. Use this list of questions a caregiver should ask their loved one’s doctor can be a valuable source of information if you ask the right questions.
Another valuable resource is your parent’s health insurance plan. If you have durable power of attorney, you can make Medicare decisions for your loved one. A licensed agent with Medicare Plan Finder may be able to help you find a Medicare Supplement or Medicare Advantage plan that suits your healthcare needs and fits your budget. Call 1-844-431-1832 or contact us here to schedule a no-cost, no-obligation appointment today.
Is UnitedHealthcare Dropping SilverSneakers in 2020?
As of January 1, 2019, UHC no longer offers SilverSneakers® with Medicare Advantage plans in 11 states:
California
Connecticut
Illinois
Indiana
Iowa
Kansas
Missouri
Nebraska
Nevada
North Carolina
Utah
Along with Medicare Supplement (Medigap) plans in nine states:
Arizona
California
Connecticut
Illinois
Indiana
North Carolina
Ohio
Utah
Wisconsin
Why Did UHC and SilverSneakers® Part Ways?
According to Sam Warner, who leads UHC’s Medicare Advantage product team, the company’s move away from SilverSneakers® is to “reach a broader portion of our membership” with a “wider variety of fitness resources.” Warner noted that “over 90 percent of policyholders who are eligible for SilverSneakers® “never step foot in a gym.”
Will UnitedHealthcare offer any fitness benefit in 2020?
Fitness Benefit | Medicare Plan Finder
Yes. Starting in 2020, UHC will offer new fitness benefits* with some plans. As plans can vary in every zip code, ask your licensed agent whether or not this benefit can apply to you!
Medicare beneficiaries with certain UHC Medigap plans may feature a fitness benefit that includes gym membership discounts and phone access to wellness coaches along with other health resources.
Medicare Advantage policyholders may be able to join a program called Renew Active™, which will replace SilverSneakers® in January 2020. The Renew Active™ benefit may include access to fitness centers, classes, and group activities along with tools to exercise your brain health.
*Always check with your doctor before starting any fitness program to make sure the program suits your individual needs.
How Does Renew Active™ Work?
The new Renew Active™ program includes a gym membership, an online “brain health program,” and access to local events. You can use the Renew Active™ website to find a facility close to you that participates in the program. Renew Active™ works with popular gym chains and local gyms. It may include some Planet Fitness locations, YMCAs, and more.
At no additional cost, Renew Active™ also comes with a personalized fitness plan. You’ll get an introductory one-on-one personal training session to set your initial goals and then you’ll be able to meet with your trainer at least yearly.
You’ll be able to work on strength, aquatic exercises, cardio, mind & body, and other specialty activities (like self-defense or Zumba®).
Renew Active™ can also coordinate with your Fitbit as well as your AARP® Staying Sharp program.
You can get Renew Active ™ if your UHC/AARP ™ Medicare plan supports it.
When Can I Enroll in a Medicare Advantage or Medicare Supplement Plan?
The Annual Enrollment Period (AEP) is from October 15 – December 7, which is the time of year many Medicare beneficiaries can enroll in new plans or make changes to existing ones.
Some members qualify for a Special Enrollment Period (SEP). Depending on your eligibility, you may have a lifelong SEP, which allows you to make one change per quarter for the first three quarters of the year — instead of only during AEP. Some people may only be eligible for a temporary SEP due to a life change, like moving to a new service area.
If you have just become eligible for Medicare for the first time, you can enroll in Medicare Advantage during your Initial Enrollment Period (IEP).
When You Can Enroll in Medicare Supplement Plans
You can enroll in a Medicare Supplement plan at any time during the year as long as you meet the requirements for Original Medicare (Part A and Part B).
Note: Don’t wait too long to enroll in Original Medicare because once you’re out of your IEP you may require underwriting, because insurance carriers aren’t required to honor your “Guaranteed Issue Rights”.
Tennessee YMCA Locations Breaks Partnership With SilverSneakers ®
In related news, the Tennessee State Alliance of YMCAs decided to leave the SilverSneakers® network. The change is effective January 1, 2020.
The two organizations parting ways means that you must find different coverage if you want to continue exercising at Tennessee YMCA locations.
Tennessee YMCA locations still accept Silver & Fit®, and you may be able to use Renew Fit.
Other Supplemental Benefits With Medicare Advantage Plans
Along with fitness benefits, some Medicare Advantage plans can offer coverage for vision, dental, and hearing services. Other supplemental benefits include meal delivery, non-emergency medical transportation, and drug coverage (prescription and over-the-counter).
Find Medicare Plans With a Fitness Benefit
If you want a Medicare plan with a fitness benefit or any other supplemental benefit, one of our licensed agents may be able to help. Our agents are highly trained and they can help you sort through the plans available in your location. To set up a no-cost, no-obligation appointment, call 844-431-1832 or contact us here today!
This blog was originally published on October 1, 2019. The latest update was on November 26, 2019.
How to Find a Home Chair Lift You Can Afford
A chair lift (also called a stair lift or lift chair) is an assistive device that helps users go up and down stairs without having to climb. The user rides in a seat attached to a track, and the device glides up the staircase. Chair lifts can help people be more independent.
Purchasing a lift chair for your home doesn’t have to be extremely expensive. Here are some ways to get financial assistance for home stair lifts.
How to Find Home Chair Lift Assistance
You may be eligible for federal and/or state financial assistance for purchasing and installing a lift chair. The best way to find out if you qualify for assistance is to apply for the various programs and ask what’s available. If you think you’re eligible, you can apply for Medicare, Medicaid, Social Security, and veterans benefits.
Does Medicare cover stair lifts?
Original Medicare does not cover stair lifts*. However, certain private plans called Medicare Advantage (Part C) plans might. There are hundreds of Medicare Advantage plans available throughout the country, but they can all offer slightly different coverage. Additionally, not all plans will be available in your area.
*Original Medicare may help pay for an elevating seat to help the rider sit and stand safely. The coverage may only cover the seat, which is considered to be durable medical equipment. According to Medicare, home chair lifts fall under home modifications, not durable medical equipment.
Will Medicaid pay for a lift chair?
Medicaid is a state and federal program that helps eligible people receive healthcare coverage. Your state’s Medicaid program may help pay for a lift chair if you qualify.
A DSNP qualifies you for a Special Enrollment Period (SEP) that allows you to make one change per quarter for the first three quarters of the year (January – September). You can make a change in your coverage during the fourth quarter (October – December), but only during the Annual Enrollment Period (AEP), which is from October 15 – December 7. The change you make during AEP will take effect on January 1 of the following year.
Stair Lifts for Disabled Veterans
The Department of Veterans Affairs (VA) may help disabled veterans who cannot safely navigate stairs pay for a stair lift. The benefit applies to veterans whose disabilities are the result of their military service. You may need a home visit and skills evaluation before the VA approves your stair lift.
You may also qualify for VA benefits if you or your spouse is disabled and the disability is not the result of military service. Some veterans qualify for the VA Aid and Attendance benefit, which may help pay for “care-related services.”
If you aren’t eligible for a lift chair due to service-related injuries, and you don’t qualify for the VA Aid and Attendance benefit, local assistance programs called Veterans Directed Home and Community Based Services may help. These are specific to local VA medical centers, and they help veterans live at home, rather than at nursing homes.
Some long-term care insurance policies may cover stair lifts if it means that you can live at home, rather than transitioning to a long-term care facility.
In addition, you may be able to save by looking for used stair lifts. Some manufacturers may offer financing so you don’t have to pay all at once.
Chair Lifts for Stairs With Landings
Chair lifts for stairs with landings come in a variety of configurations to accommodate different types of stairs. Most chair lifts fall into two categories: straight or curved.
Straight Chair Lifts
Straight chair lifts only work on straight staircases without curves or corners. However, you can use multiple straight chair lifts on straight portions of your staircase with landings or turns.
For example, one chair lift can go from the floor to the first landing. Then another can go from the first landing to the top of the stairs.
The advantage to installing multiple chair lifts is that it can be less expensive than one curved lift chair. The disadvantage is that once you reach the first landing, you must get up and transfer to the second chair. The transfer may be unsafe for some people.
Curved Chair Lifts
Every staircase can be different, and to work, most curved chair lifts must be custom-fit to accommodate your home’s twists and turns. However, there are some common configurations that include:
Top or Bottom Overrun: An overrun can be at the top, bottom, both ends of a staircase. The “overrun” is where the stair lift track extends past the staircase and onto the landing and/or the floor at the bottom of the stairs. This feature may make it easier for the user to sit into or stand up from the chair.
Intermediate Landing: An “intermediate landing” is a landing before the top of the stairs. Curved stair lifts can rise with the staircase, become level at the intermediate landing, then continue rising to the top of the stairs.
90° Flat Landing: This is a type of staircase with a landing that has right-angle change of direction in the staircase. Like with the intermediate landing, the lift chair’s track travels up the staircase, levels out at the landing, then travels up again.
180° Flat Landing: The same as the 90° flat landing but the turn is 180° at the landing.
Spiral Stair Lift: These chair lifts feature tracks that curve around the entire length of a spiral or curved staircase.
Original Medicare does not offer coverage for home chair lifts. If you want help finding assistance for a home stair lift, one of our licensed agents may be able to help you find a Medicare Advantage plan, a long-term care policy, or other financial assistance. Our agents are highly trained and they can help you determine the right fit for your budget and medical needs. To schedule a no-cost, no-obligation appointment, call 1-844-431-1832 or contact us here today.
5 Daily Posture Exercises for Seniors
According to Harvard Medical School, America has a posture problem. It may be from looking at your smartphone or sitting on your couch for long periods of time. No matter what the cause is, poor posture affects people of all ages.
Why is good posture so important? As we age, poor posture can lead to back pain, spinal dysfunction, and joint degeneration. Luckily, you may be able to curb some of that damage by practicing good habits and doing these five daily posture exercises for seniors.
How to Improve Posture With Posture Exercises for Seniors
It doesn’t matter when you do these exercises, whether it’s when you first wake up, after you eat lunch, or right before you go to bed. The important thing is that you’re consistent and you do them every day.
1. Spine Extensions
Spine extensions help correct poor posture by putting the spine in a neutral position with the shoulders and chin back. This exercise helps with chest flexibility, which improves breathing and lung function.
To do the exercise,sit with your arms at your sides. Then, sit as tall as you can while inhaling slowly. After that, exhale and relax. Repeat spine extensions 10 times.
2. Wall Tilts
Wall tilts help with lower back posture.
First, stand with your back against a wall. Your feet should be shoulder-width apart with your knees unlocked. Then, place one hand behind your back. Flatten your lower back to place pressure on your hand. Relax, and repeat the exercise 10 times.
3. Arm Raises
Arm raises help improve your rib flexibility to help you breathe easier. By doing the exercise, you increase your ability to lift your ribcage and return your shoulders to the proper position as you breathe.
To perform the exercise, sit or stand with your arms at your side with a neutral spine. Then raise your elbows so that they’re parallel to the floor. As you raise your arms, you should bring your shoulder blades together and slowly inhale. Do 10 arm raise repetitions.
4. Shoulder Blade Squeezes
Shoulder blade squeezes help you keep your spine in a comfortable neutral position. The exercise helps correct poor posture by putting your shoulders below your ears.
Start the exercise by standing with your arms at your sides. Find a neutral position for your spine and pelvis. Then bring your shoulders back and squeeze your shoulder blades together. Relax, and return to your starting position. Repeat the exercise 10 times.
5. Shoulder Circles
Shoulder circles help improve your shoulder and rib cage flexibility. The exercise helps bring your spine into a straight, neutral position.
To do the exercise, sit in a chair with your back straight. Then, slowly raise your shoulders as if you were trying to touch your ears with them. Then lower your shoulders. Do 10 repetitions of shoulder circles.
Good Posture Habits and Posture Correction Reminders
As much as possible, you should practice good posture whether you’re standing, sitting, or lying down.
Good Posture Habits While Lying Down
Try to sleep on your back or side to put less pressure on your spine. Sleeping on your back may be helpful for some people with sleep apnea.
Sleeping on your stomach keeps your head turned to one direction, which can cause neck pain. It also extends your neck backward, which compresses your spine. That can constrict your blood flow and compress your nerves.
Correct Posture While Sitting
Sit with your feet flat on the floor and sit back in the chair. Sit with your chest up and your spine in a neutral position. To find the right posture, try shifting your hips forward and backward until you find a comfortable position.
How to Stand With Good Posture
Stand with your feet shoulder-width apart with your knees unlocked and your arms relaxed at your sides. Then tilt your pelvis forward until you reach a comfortable position Then alternate between arching (stretching backward) and rounding (stretching forward) until you find a comfortable “middle ground.” Then, bring your chin forward until your position feels natural. Your head should feel balanced on your shoulders.
A note about texting and using your tablet: you place a lot of pressure on your neck by looking down at your devices. Try holding your phone or tablet up a bit higher to keep correct posture.
Other Ways to Improve Posture
Along with doing the five daily posture exercises for seniors listed above, you can also look into physical therapy or chiropractic care.
Another great way to improve your posture is yoga, which has many other health and fitness benefits as well. Plus, certain Medicare Advantage plans cover fitness programs that include yoga classes just for seniors!
Get Medicare Coverage
At Medicare Plan Finder, our goal is to help you find health insurance that meets all of your medical needs. Certain Medicare Advantage plans can help cover fitness programs, chiropractic care, physical therapy, and even yoga! If you want to learn more, one of our highly trained, licensed agents may be able to help. To set up a no-cost, no-obligation appointment, call us at 1-844-431-1832 or contact us here today.
OTC Essentials You Need in Your Medicine Cabinet
Millions of people use over-the-counter (OTC) products to help ease back pain, fight the common cold, and reduce fevers every day. Many healthcare providers trust OTC medications as a first treatment option for some conditions.
Most people think of medications such as pain relievers and cold medicines when they think of OTC essentials, but they may not think of items such as pill splitters and sunscreen. All of the above can be considered essential OTC items that you should keep in your medicine cabinet at all times.
Remember to speak to your doctor about possible side effects, and keep in mind that not all of these products will work for every person.
What OTC Essentials Should Go in My Medicine Cabinet?
OTC Essentials | Medicare Plan Finder
Stock your medicine cabinet with products that can help treat a variety of ailments. You should be able to reach into your medicine cabinet and find something to relieve your symptoms rather than have to run to the pharmacy every time you have an ache or pain.
Always check with your doctor or pharmacist before buying an OTC product. Certain products may interact with your current prescription drugs, and you could end up harming yourself.
Pain Relievers and Fever Reducers
Pain relievers are among the most-purchased OTC products. They can help lower your body temperature if you have a fever and reduce inflammation.
Aspirin: This effective pain reliever and fever reducer has been popular for over a century. Aspirin is a non-steroidal anti-inflammatory drug (NSAID). Some people may find that it irritates their stomach, so many doctors recommend that you take it with food. Even though aspirin is a great addition to your medicine cabinet, it can interfere with blood clotting. If you take blood thinners or you’re about to have surgery, you should avoid aspirin.
Acetaminophen (Tylenol): This pain reliever works differently than NSAIDs. Acetaminophen does not affect inflammation. If you want or need to avoid aspirin, acetaminophen may be a better choice. Ask your doctor how much to take because you can damage your liver if your dosage is too high. Many cold and cough medicines also contain acetaminophen, so if you’re in doubt, check in with your doctor or pharmacist.
Ibuprofen (Advil and Motrin) or Naproxen Sodium (Aleve): These pain relievers are also NSAIDs. They are great for reducing inflammation-related pains such as headaches, arthritis-related joint pain, and muscle pains. Some doctors even prescribe these NSAIDs as post-surgery painkillers. These drugs can also help reduce fevers, making them an important addition to any medicine cabinet.
Cold and Cough Medicine
Colds and coughs are among the most common winter weather illnesses, and they’re highly contagious. If you stock your medicine cabinet with effective cold and cough medicine, you not only help yourself, but you help everyone around you.
Decongestants: These medicines are OTC essentials that can help you breathe easier. Pseudoephedrine (Sudafed) or phenylephrine (Dristan Cold Multi-Symptom and Rynatan) can help clear your airways while your immune system fights off your cold. Note that federal law limits how much pseudoephedrine you can buy per month.
Cough Medicine: You need different cough medicines depending on your type of cough. A dry, hacking cough is best suppressed with dextromethorphan. Robitussin Maximum Strength Cough and Pertussin both contain this cough suppressant.
If you have a mucusy cough, use an expectorant such as guaifenesin to loosen secretions. Brand name products that have guaifenesin include Robitussin PE and Benylin Expectorant Formula.
Rx Discount Card | Medicare Plan Finder
Allergy Medicines
OTC Essentials | Medicare Plan Finder
These medications are great to have on hand during your allergy season, whether it be spring, summer or fall. If you have allergies, many OTC products can help relieve the most common allergy symptoms.
Antihistamines: Diphenhydramine (in Benadryl), chlorpheniramine (in Chlor-Trimeton), and clemastine (in Tavist Allergy 12 Hour Relief) all help relieve sneezing and runny noses. Be cautious with these medications because they all can cause sleepiness. If you need to be alert, look for products with loratadine such as Claritin, because they are not sedating.
Eyedrops: Drops that contain an antihistamine and a decongestant, such as Naphcon A and Opcon-A, can help soothe watery and itchy eyes.
Digestive Aids
Pink Bismuth: You can relieve a multitude of digestive issues such as nausea, indigestion, and diarrhea with pink bismuth (Pepto Bismol).
Calcium carbonate tablets: Tums and Rolaids can both relieve heartburn, which is when stomach acid backs up and irritates your throat. They work by temporarily neutralizing stomach acid. As a bonus, they provide supplemental calcium, which may be deficient in many people’s diets.
Maalox or Mylanta: Are heartburn relief products that may be longer-lasting than calcium carbonate tablets.
Fiber-Based Products for Constipation: OTC essentials such as Metamucil can help treat constipation. Your body is much less likely to become dependent on fiber-based products than laxatives such as Miralax. If you do use laxatives, be sure to only use them on rare occasions.
Topical Products for Your Skin
These items can help make your life easier, safer, or both. You can purchase them at any major drug store.
First Aid Supplies: Your medicine cabinet should include bandages, gauze, and medical tape. These items will keep dirt, dust, and debris from hindering your body’s ability to heal minor cuts and scrapes.
Pill Splitter: Sometimes you need to cut OTC or prescription drugs in half, and a pill splitter is an easy-to-use tool that can help. Whether your pill is too big for you to take or your doctor recommends splitting your dose, your pill splitter will be a welcomed addition to your medicine cabinet.
Pill Organizer: It can be difficult to remember when to take your pills, or if you’ve already taken them. A pill organizer is a handy tool that can separate your pills by when you should take them. Pill organizers usually have different compartments labeled with each day of the week. This makes it easy to know when to take your prescriptions, especially if you’re supposed to take them on a specific day of the week, or every other day, for example.
Textured Bath Mat: Many slips, trips, and falls happen in the bathroom every year. It’s understandable: the floors can be slippery. Use a bath mat with a textured grip to help you get a secure footing and reduce your chance of injury.
Medicine Cabinet Checklist
Use this medicine cabinet checklist as an inventory starting point when stocking essential OTC items. The checklist should only be a guide. Always ask your doctor before you purchase any new OTC medications.
Medicine Cabinet Checklist | Medicare Plan Finder
Where to Purchase Over-the-Counter Essentials
You can find many of the over-the-counter essentials for your medicine cabinet at the following stores?
Many of the stores listed above have a mail-order feature so you don’t have to leave your house when you need OTC products. You may be able to find your favorite OTC items at the following online pharmacies*:
*This is not a complete list of online pharmacies.
A Medicare Advantage Plan With OTC Coverage Can Help Pay for Your OTC Essentials
If you’re eligible for Medicare, you may wonder, “Does Medicare cover OTC drugs?” Original Medicare does not cover OTC drugs. However, certain private insurance plans called Medicare Advantage (MA) plans can offer OTC coverage. Some MA plans offer other additional services such as vision, dental, hearing, and even fitness classes!
A licensed agent with Medicare Plan Finder can help find the right MA plan for your budget and lifestyle. Call 844-431-1832 or contact us here to learn more.
Contact Us | Medicare Plan Finder
This post was originally published on July 26, 2019, and updated on November 19, 2019.
How Does Medicare Cost Sharing Work?
Cost sharing is the reason we have any kind of insurance. In many cases, you don’t pay the full amount of medical expenses if you have health insurance. For example, Original Medicare covers 80 percent of approved costs, and you pay 20 percent. It may sound simple, but it can actually be pretty confusing when you take into account deductibles, copays, coinsurance, out-of-pocket maximums, and premiums.
Medicare Cost Sharing Definitions
Medicare cost sharing may seem more complex than other forms of insurance because Medicare has four different parts, and each one covers something different. Two of those parts are public (Parts A and B), and two are private (Parts C and D).
When you add Medicare Supplements to the mix, things may seem even more confusing. For example, you can’t have both a Medicare Part C plan and a Medicare Supplement plan at the same time. Also, if you have a Medicare Part C (Medicare Advantage) plan, you may not need a Part D (prescription drug) plan because some Medicare Advantage plans cover prescription drugs.
Before we go over what cost sharing looks like for each part of Medicare, we’re going to cover some basic Medicare cost-sharing terminology:
Coinsurance: A percentage of the total cost for medical services. The amount you pay may be different depending on the bill. For example, you may pay 20 percent of the total bill for a doctor visit. If your doctor bills Medicare $100, you’d pay $20.
Copayment: A set amount that you pay for medical services. For example, you may pay $10 upfront for a doctor’s appointment. If your doctor bills Medicare $100, you’d still pay $10 (though you may receive a larger bill for coinsurance later), depending on what your plan pays.
Deductible: The amount you pay out-of-pocket each year before insurance coverage “kicks in.”
Out-of-Pocket Maximum: An overall out-of-pocket spending limit you might have with certain Medicare Advantage plans. Once you reach the maximum, Medicare will cover 100 percent of all approved costs.
Premium: A set amount you pay every month to keep your coverage.
Medicare Part A Cost Sharing
Medicare Part A is hospital insurance and it covers inpatient procedures, hospice care, and skilled nursing facilities. Many Medicare eligibles don’t pay a monthly premium for Part A. If you don’t meet the “premium-free Part A” requirements, you may pay up to $458 per month in 2020.
The 2020 Part A deductible is $1,408. For inpatient hospital or skilled nursing facility stays, you may pay:
Days 1-60: $0 coinsurance
Days 61-90: $352 coinsurance per day in 2020
Days 91 and beyond: $704 coinsurance per day in 2020. You may be able to use “lifetime reserve days,” which are “extra” days Medicare may cover. You may have up to 60 lifetime reserve days. Once you’ve used your lifetime reserve days, you may be responsible for paying 100 percent of hospital services.
Medicare Part B Cost Sharing
Medicare Part B is medical insurance, and it helps pay for outpatient medical services such as doctor’s appointments, emergency medical transportation, outpatient therapy, and durable medical equipment (DME).
The standard Part B premium is $144.60 in 2020. You may have to pay more depending on your income.
The deductible for Medicare Part B is $198 in 2020. After you meet the deductible, you may pay 20 percent coinsurance of the Medicare-approved total amount.
2020 Medicare Part B Premiums
Medicare Part C Cost Sharing
Medicare Advantage (MA or Part C) are private plans that can cover additional benefits such as prescription drugs, dental, hearing, vision, and fitness classes. You must be enrolled in both Part A and Part B before you can enroll in a MA plan.
Premiums for MA depend on the plan*. They can be as low as $0, but as much as $200. The average premium in 2020 is $23.
Each Medicare Advantage plan may have a different deductible, copay, and/or coinsurance payment. In 2020, the Medicare MOOP (Maximum Out-Of Pocket) spending amount is $6,700**.
Your agent can help you decide if a Medicare Advantage plan is right for you.
*You will still have to pay your Part B premium even if you have a Medicare Advantage plan.
**Medicare MOOP only applies to Original Medicare-covered services. It does not apply to supplemental benefits.
Medicare Part D Cost Sharing
Medicare Part D is prescription drug coverage. You may have to pay a monthly premium, for which the average cost was $33.19 nationwide in 2019.
The 2020 Part D deductible is $435, meaning that Part D plans cannot charge a deductible any higher than that. Many plans may have lower deductibles. Your coverage won’t start until you’ve met your plan’s deductible.
After you meet the deductible, you’ll pay 25 percent of both generic and brand name drug costs. For example, if a prescription drug’s total cost is $40, you’ll pay $10, and your insurance plan will pay the remaining $30.
If your plan requires you to pay a copay or coinsurance, those costs will go toward your TrOOP (True Out-Of Pocket). For example, if your plan requires a $15 copay for a drug, that money will go toward your out-of-pocket limit.
After you pay $6,350, which is the TrOOP threshold, you enter Catastrophic Coverage, and you’ll pay only five percent of your prescription drug costs.
Medicare Supplement (Medigap) plans have a different cost sharing structure than MA plans. Medigap plans have eight standardized coverage levels*. In 2020 there are eight different coverage levels:
2020 Medicare Supplement Comparison Chart
Medicare Supplement plans work like this: You pay a monthly premium** and the plan covers the financial items in the chart above. Medigap plans only cover Medicare-approved costs, not additional benefits like MA plans.
Talk to your agent to discuss your needs and whether a Medigap plan is right for you.
**You will still be responsible for paying Part B premiums with a Medicare Supplement plan.
We Can Help You Navigate Medicare Cost Sharing
Cost sharing with Medicare may seem complicated, and a licensed agent with Medicare Plan Finder can help you determine what you need. Our agents are highly trained, and they can find the Medicare Advantage, Medicare Supplement, and/or Medicare Part D plans in your area. To arrange a no-cost, no-obligation appointment with an agent, call 1-844-431-1832 or contact us here.
FreeStyle Libre Medicare Coverage
FreeStyle Libre is a continuous glucose monitor (CGM) that consists of a small, water-proof, fully disposable sensor that you wear on your arm for 14 days, plus a reader device.
The reader shows your blood glucose levels in real time, and it doesn’t require a finger stick like most CGMs do. FreeStyle Libre is approved for monitoring blood glucose levels in both Type 1 and Type 2 diabetics.
FreeStyle Libre Medicare coverage is much like other Medicare coverage for durable medical equipment (DME). You may have to pay coinsurance or copays, and you have to purchase your DME from a Medicare-approved supplier.
How does FreeStyle Libre Medicare Part B coverage work?
Medicare Part B is medical insurance, and it helps pay for outpatient doctor’s appointments, preventive care such as diabetes screenings, and durable medical equipment (DME). In order for Medicare to approve your DME, your doctor must prescribe it, and it must be a device that will last for three years or more.
You may be responsible for 20 percent of approved Medicare costs for FreeStyle Libre including the equipment itself and your doctor’s supervision.
Medicare Supplement Coverage for FreeStyle Libre
Medicare Supplements (Medigap) plans are private insurance plans that can help pay for expenses that you may incur with Original Medicare (Part A and Part B) such as coinsurance and copays. They work like this: you pay a monthly premium, and your copays and coinsurance, including what you’d pay for durable medical equipment, are covered.
Medicare Advantage FreeStyle Libre Coverage
Medicare Advantage (MA or Part C) plans are also private plans. They work differently than Medigap plans because MA plans offer additional benefits rather than help paying for financial items.
You cannot have both a Medigap plan and a Part C plan, so it’s best to contact your agent to discuss your individual needs, including coverage for diabetes and durable medical equipment.
How much does FreeStyle Libre cost without insurance?
According to GoodRx, FreeStyle Libre can cost about $135 every two weeks. That adds up to $3,510 per year.
Medicare Coverage for Insulin
Original Medicare does not help cover insulin unless it’s in conjunction with an insulin pump. Medicare Part D or certain Medicare Advantage plans may help cover insulin products such as Lantus and Novolin.
According to GoodRx, Lantus is the most popular insulin drug. The average copay is $37.50-$67.50.
Where can I get FreeStyle Libre?
You can get FreeStyle Libre at most major pharmacies, however, Medicare may only cover the device if you get it at a “participating DME supplier.” According to Abbot, the FreeStyle Libre manufacturer, Medicare will help pay for the device if you purchase it from one of the following suppliers:
Advanced Diabetes Supply
Better Living Now
Byram Healthcare
CCS Medical
Diabetes Management & Supplies
Edgepark Medical Supplies
Edwards Health Care Services
HealthLink Solara Medical Supplies
J&B Medical Supply
Mini Pharmacy
United States Medical Supply
In order for Medicare to cover your durable medical equipment, your doctor must say it’s medically necessary. You may need to have periodic follow-up appointments in order for Medicare to continue covering FreeStyle Libre.
How do I use a FreeSyle Libre system?
With the FreeStyle Libre 14-day system, you’ll wear a small sensor on the back of your upper arm that automatically* monitors your glucose 24 hours a day.
Instead of finger pricks**, you simply swipe the reader over the sensor on your arm for a painless, one-second scan. Each scan provides an up-to-the-minute glucose reading, a graph to spot trends, and an eight-hour history of your glucose levels.
*The FreeStyle Libre system requires a one-hour warmup period when you first wear the device before you can check your blood glucose levels.
**You may still have to prick your fingers in certain situations including when your symptoms don’t match your CGM readings and when you suspect that the readings may not be accurate.
Difference Between FreeStyle Libre and Other Constant Glucose Monitors
According to the Diatribe Foundation, a company that distributes information about diabetes, another CGM called the Dexcom G6 received Medicare DME approval in early 2019.
Like Abbot’s FreesStyle Libre, Dexcom’s G6 is covered for people on “intensive insulin therapy like multiple daily injections or use of an insulin pump.”
Both devices feature a smartphone app that you can use to closely monitor your blood glucose and manage your insulin treatment. According to Diatribe, Medicare covers CGM smartphone apps “including sharing features.”
The main differences between FreeStyle Libre and G6 are the “warmup periods” and how long you can wear the devices. FreeStyle Libre features a one-hour warmup period, and you can wear the device for two weeks. The Dexcom G6’s warmup period is two hours, and you can wear the device for 10 days.
Who needs constant glucose monitoring?
Diabetic people need constant glucose monitoring because their bodies can’t produce insulin or efficiently use the insulin it makes. Insulin is a hormone that regulates blood sugar levels.
FreeStyle Libre is best for diabetics who use insulin pumps or need multiple insulin injections per day. According to the Mayo Clinic, if you don’t manage diabetes, it may lead to the following complications:
Along with managing blood glucose levels, a balanced diet such as the Mediterranean diet, exercising regularly, and maintaining a healthy weight may help prevent type 2 diabetes or manage type 1 diabetes symptoms and complications. Work with your doctor to develop a comprehensive treatment plan.
If you have diabetes and you want to learn more about Medicare coverage for FreeStyle Libre, a licensed agent with Medicare Plan Finder can help.
Our agents are highly trained, and they may be able to find plans in your area that cover fitness programs, meal delivery, hearing, and/or routine vision care. To set up a no-cost, no-obligation appointment to discuss your needs, call 1-844-431-1832 or contact us here now.
The Ultimate Guide to Medicare Coverage for Arthritis
Arthritis is an inflammation of the joints. The condition can affect one or more joints, and it can cause pain and stiffness. According to the Centers for Disease Control and Prevention (CDC), approximately 54.4 million adults 18 and older have diagnosed arthritis, and the “prevalence of arthritis increases with age.”
Some types of arthritis may be preventable and the symptoms may be manageable. Medicare may cover different treatments and services for arthritis.
Common Types of Arthritis
There are more than 100 types of arthritis, but the most common types are:
Rheumatoid arthritis is an autoimmune condition in which the immune system attacks your joints and organs. Rheumatoid arthritis has no known cause. According to the Mayo Clinic, your primary care provider may refer you to a rheumatologist if you have the following symptoms:
Tender, warm, and/or swollen joints
Stiff joints that are worse in the morning or periods of inactivity
Inflammation tests such as erythrocyte sedimentation rate (ESR)
Rheumatoid Factor (RF) tests to look for antibodies that indicate rheumatoid arthritis
Imaging tests such as X-Ray, MRI, and Ultrasound to examine joints
Medicare Coverage for Rheumatoid Arthritis
Original Medicare helps cover doctor-recommended diagnostic testing for RA, doctor’s appointments, and some doctor-administered drugs such as disease-modifying antirheumatic drugs (DMARDs). Other covered treatments can include physical therapy, over-the-counter (OTC) drugs such as ibuprofen, and corticosteroids (inflammation relief drugs) such as prednisone. In rare circumstances, your doctor may recommend surgery.
Original Medicare does not cover prescription drugs that you take at home, but Medicare Part D or certain Medicare Advantage plans might.
Medicare Advantage plans are private insurance plans that can cover benefits Original Medicare does not such as meal delivery, OTC drugs, and non-emergency medical transportation.
Osteoarthritis
According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), osteoarthritis is the most common type of arthritis. The disease causes damage to a joint’s protective cartilage, which wears down over time. Osteoarthritis can affect any joint, but it most commonly occurs in the hands, knees, hips, and spine.
Joint stress caused by repetitive physical activity (sports, active jobs, etc.)
Osteoarthritis can have the following symptoms:
Joint stiffness, especially after sitting for long periods of time
Swelling or tenderness in one or more joints
The feeling of bone on bone, or a “crunching” feeling
Osteoarthritis Treatment and Medicare Coverage
Treatment for osteoarthritis includes over-the-counter drugs such as Tylenol and ibuprofen. Prescription-drug treatment can include antidepressants such as Cymbalta, which can ease arthritis-related pain if OTC drugs don’t work. Medicare Part D and certain Medicare Advantage (MA) plans can cover prescription drugs, and some MA plans may cover OTC drugs.
Non-medication treatments can include physical therapy, occupational therapy, and if the condition becomes severe, surgery such as osteotomy and joint replacement.
Psoriatic Arthritis
Psoriatic arthritis is an autoimmune condition like rheumatoid arthritis. Like rheumatoid arthritis, psoriatic arthritis can cause joint stiffness and pain. According to the Arthritis Foundation, about 30 percent of people who have the skin condition psoriasis also get psoriatic arthritis.
Symptoms of psoriatic arthritis include:
Joint pain and stiffness
Tendon or ligament pain
Rashes or changes to fingernails and toenails
Fatigue
Limited range of motion
Vision problems
Psoriatic arthritis is also linked with irritable bowel syndrome (IBS), Crohn’s disease, and other digestive issues such as diarrhea.
Medicare Coverage for Psoriatic Arthritis
Psoriatic arthritis treatment includes prescription drugs such as DMARDs and corticosteroid injections, and topical treatments such as calcipotriene. Over-the-counter treatments include topical treatments such as salicylic acid gel and NSAIDs.
Fibromyalgia is a condition that causes chronic pain, fatigue, memory problems, and changes in mood. It is not one disease, but a collection of manageable symptoms. The cause is unknown. Symptoms include:
Pain: The most common fibromyalgia symptom is widespread pain in the joints, bones, and muscles.
Fatigue: Many people with fibromyalgia experience exhaustion, flu-like fatigue, and/or disturbances to sleep.
Problems with concentration and mood: Depression is a common symptom of fibromyalgia, along with difficulty concentrating or performing simple mental tasks. Stressful times often exacerbate these symptoms.
Headaches: People with fibromyalgia often experience tension headaches and/or migraines.
Fibromyalgia Treatment
Treatment for fibromyalgia does not cure the condition, but it helps manage symptoms.
According to the Arthritis Foundation, “There are currently three FDA-approved medications for fibromyalgia –– pregabalin, duloxetine and milnacipran.” Some Medicare Part D and Medicare Advantage plans may cover those drugs.
Other treatments can include exercise, acupuncture, and biofeedback, which teaches people how to change physiological functions such as slowing a rapid heart rate.
Gout
According to the Arthritis Foundation, “Gout is a form of inflammatory arthritis that develops in some people who have high levels of uric acid in the blood.” Gout usually starts in the big toe or a joint in the lower body. Gout usually starts after an illness, injury, or infection, and it affects one joint at a time.
Gout Treatment
According to the Arthritis Foundation, gout treatment includes medication and “lifestyle changes.”
Prescription drugs to treat pain and inflammation include colchicine and corticosteroid injections. Drugs to reduce uric acid include Zyloprim and Uloric. OTC medications include NSAIDs.
If you have a gout flare-up, you should take anti-inflammatory medication, ice and elevate the joint, stay hydrated (but not with sugary soda), relax, and ask for help to perform daily tasks.
Get Medicare Coverage for Arthritis Today
If you need help getting Medicare coverage for arthritis, an agent with Medicare Plan Finder can help. Our agents can help determine your budget, lifestyle, and medical needs, and search for a plan in your area that suits you. To set up a no-cost, no-obligation appointment with a licensed agent, call 1-844-431-1832 or contact us here today.
Common Neurological Disorders in the Elderly
According to the World Health Organization, “neurological disorders are a common problem. For example, 50 million people have epilepsy.” Some common neurological disorders in the elderly like Alzheimer’s disease and Parkinson’s disease become more likely as you age, and there’s no sure-fire way to prevent those diseases. That makes having resources to get the proper healthcare such as health insurance and access to the right doctors extremely important.
Click on the Links Below to Learn More About Common Neurological Disorders in the Elderly
List of Neurological Disorders in Elderly Patients
Neurological disorders are diseases and conditions that affect the central nervous system (brain and spine). According to the US National Library of Medicine, there are more than 600 types of neurological disease. Here’s a list of common neurological disorders in the elderly:
Diseases caused by genetic factors, such as Huntington’s disease
Problems with the way the nervous system and/or skeletal system develops, such as spinal stenosis
Degenerative diseases, in which nerve cells are damaged or die, such as Parkinson’s disease and Alzheimer’s disease
Diseases of the blood vessels that supply oxygen and nutrients to the brain, such as stroke
Injuries to the brain and/or spinal cord
Seizure disorders, such as epilepsy
Brain cancer
Medicare Special Needs Coverage for Chronic Diseases
Original Medicare (Parts A and B) may cover many preventive services & screenings, diagnostic screenings, and treatment for neurological diseases. Some neurological conditions may make you eligible for a special type of Medicare plan called a Chronic Special Needs Plan (CSNP).
CSNPs are plans designed to fill the needs that a chronic disease like a neurological disorder may cause. For example, many CSNPs offer coverage for services not included with Original Medicare such as prescription drugs, meal delivery, and extended home health care services. They also feature coordination of care between your healthcare providers.
If you have a CSNP, you may be eligible for a Special Enrollment Period (SEP), which allows you to make changes to your coverage as your medical needs change, rather than at specific times of the year. Many Medicare enrollees have to wait until the Annual Enrollment Period (AEP), which is from October 15 to January 7.
All of the diseases on the above list may qualify you for a CSNP and a SEP.
Amyotrophic Lateral Sclerosis (ALS)
According to the ALS Association, “ALS, or amyotrophic lateral sclerosis, is a progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord.”
The most noticeable symptom is progressive muscle weakness, which may mean that you can’t firmly grasp a pen in ALS’ beginning stages Other early symptoms include tripping, muscle cramps, or bouts of uncontrollable laughing or crying may surface. As the disease progresses, you’ll lose muscle control including the muscles that enable you to walk.Eventually, the disease will cause the breathing muscles to stop working, and the lungs may collapse.
Medicare Coverage for ALS
ALS is one of two diseases that may make you eligible for Medicare before you turn 65. The other is ESRD. According to the ALS Association, your Medicare benefits start as soon as you become eligible for SSDI.
ALS is a chronic condition that may make you eligible for a CSNP, which may cover home care, meal delivery, and/or prescription drugs. Original Medicare may cover extended home care services, including:
Skilled nursing services (such as assistance with a feeding tube or ventilator) if you need them on an intermittent or part-‐time basis. Skilled nursing services are usually provided by a registered nurse (RN) or a licensed practical/vocational nurse (LPN/LVN).
Assistive (personal) care services (such as help with bathing or getting dressed) may be covered, but only when they are needed to support skilled nursing care, and only on an intermittent or part-time basis. Medicare does not cover assistive care if it is the only care that you need. Assistive care services may be provided by a home health aide (HHA) or certified nursing assistant (CNA).
Therapy services such as physical therapy, occupational therapy, and speech-‐ language pathology services when these services are necessary to help you maintain or regain the ability to move, perform everyday tasks for self-care, speak, or swallow safely. A licensed therapist must oversee the services in order for Medicare to cover them.
Medical social services (such as counseling) are covered by Medicare when your doctor orders them.
Medical supplies and durable medical equipment (DME). Disposable medical supplies are covered by Medicare when they are used as part of your care. Medicare also pays 80 percent of the cost for durable medical equipment (such as a hospital bed, walker, or wheelchair) when the doctor prescribes the equipment for in-home use.
Medicare may also cover a second opinion if you receive an ALS diagnosis.
Brain Cancer
Brain tumors — masses of cells that occur in your brain — may be cancerous (malignant) or not (benign). Tumors may start in the brain (primary brain tumors), or they may start in other parts of the body and spread to your brain (metastatic, or secondary brain tumors).
Brain Cancer Symptoms and Treatment
You should see a doctor if one or more of these symptoms become consistent and bothersome:
New onset of, or a change in headache patterns
Headaches that gradually become more frequent worse
Unexplained nausea or vomiting
Vision problems, such as blurred vision, double vision or peripheral vision loss
Gradual loss of sensation or movement in an arm or a leg
Difficulty balancing yourself
Speech difficulties
Confusion
Changes in personality or behavior
Seizures, especially if you don’t have a history of seizures
Hearing problems
Risk factors for brain tumors include family history and radiation exposure.
Neurological exams and imaging such as MRI are the most common methods to test for brain tumors. Your doctor may recommend a CT scan to look for cancer in other parts of the body.
Your doctor may recommend surgery, depending on the size and location of the tumor. Your doctor may also recommend chemotherapy, radiation, and/or targeted drug therapy. Rehabilitation therapies after your treatment may include occupational therapy, physical therapy, and speech pathology.
Dementia & Alzheimer’s Disease
Dementia is a term used to describe a syndrome with symptoms that include memory loss, difficulty with problem-solving, and struggling with language and processing thoughts.
There are over 100 types of dementia, and Alzheimer’s disease is one cause. Some forms of dementia can be temporary. Other types can be cured. Alzheimer’s disease is neither temporary nor curable.
Dementia Symptoms and Treatment
Dementia symptoms can be changes in cognitive ability or psychological changes.
Cognitive changes
Memory loss
Difficulty finding the right words during conversation
Getting lost while driving familiar routes
Difficulty with logical reasoning or problem-solving
Difficulty completing complex tasks
Difficulty planning and organizing daily activities
Difficulty with muscular coordination and motor functions, such as hand-eye coordination
Being confused or disoriented easily
Psychological changes
Changes in personality
Depression
Anxiety
Irrational, inappropriate, or out-of-the-ordinary behavior
Paranoia
Agitation
Hallucinations
Treatments for dementia include medication for memory such as cholinesterase inhibitors and memantine. Some doctors may prescribe antidepressants, anxiolytics, or antipsychotic medications in people who display drastic behaviors.
Some researchers believe that herbal remedies, dietary supplements, and certain foods can enhance memory and prevent Alzheimer’s. Some examples include coconut oil, coral calcium, and omega-3 fatty acids. Researchers also suggest that memory games and puzzles can help prevent dementia or slow its progression.
Medicare may cover testing for dementia and Alzheimer’s like cognitive tests during your Annual Wellness Visit.
Some nursing homes and assisted living facilities feature memory care services, which is a specific type of long-term care for dementia patients. Original Medicare does not cover room and board for assisted living or nursing homes, however, certain life insurance or long-term care insurance policies can. Medicare Part A and Part B may help pay for medical expenses while you live in a nursing home or assisted living facility.
According to NAEC, treatment for epilepsy has different levels of care: primary, neurologists, and epileptologists and epilepsy centers.
Primary Care: The first level of epilepsy care starts with an evaluation in an emergency room or at a primary care provider’s office. Treatment usually includes anti-epileptic medication. According to NAEC, the first medication prescribed will effectively control seizures without causing side-effects for many patients. If the doctor finds an effective way to control seizures, further specialized epilepsy evaluation may be unnecessary.
Neurologists: If a primary care provider can’t find a way to control seizures within three months, the primary care provider will refer the patient to a neurologist. A neurologist is a doctor who specializes in diseases of the brain and central nervous system. Once the seizures are under control, the patient can be transferred back to the primary care provider.
Epileptologists and Epilepsy Centers: If a patient continues to have persistent seizures or side effects may be transferred to an epileptologist, which is a doctor who specializes in epilepsy. Some patients may be transferred to a specialized epilepsy center. The third level of care aims to reduce the frequency of seizures and/or medication side effects for patients.
According to the Epilepsy Foundation, Medicare Part D and certain Medicare Advantage plans cover prescription drugs. The Epilepsy Foundation and NAEC are working to ensure that patients have access to the “therapies they need” because “epilepsy medications are not interchangeable.”
Some drugs may be too costly for patients, and low-income patients may qualify for LIS (Low Income Subsidy) or Extra Help. Eligibility is based on your income and/or assets and the Federal Poverty Level. Ask your agent to help you apply if you think you may qualify.
Symptoms usually appear between the ages of 30 and 50, and they worsen over a period of 10-25 years. Ultimately, the person “succumbs to pneumonia, heart failure, or other complications.”
According to HDSA, “Everyone has the gene that causes Huntington’s Disease.” However, only people who inherit the “expansion of the gene” will develop Huntington’s disease and they are more likely to pass the expanded gene to their children. Every person who inherits the expanded gene will develop Huntington’s disease. Eventually, the disease will affect the person’s “ability to reason, walk, and speak.”
Huntington’s Disease Symptoms and Treatment
Huntington’s disease symptoms include:
Changes to personality and mood swings
Depression
Forgetfulness
Impaired judgment
Irregular gait
Involuntary movements
Significant weight loss
Slurred speech
Difficulty swallowing
If you’re no longer able to work, Huntington’s disease may qualify you for SSDI. You may be eligible for Medicare if you’ve collected SSDI for at least 25 months, even if you’re younger than 65.
Medicare may cover the following tests for Huntington’s disease:
Genetic counseling and testing
Home health assessments
Motor assessments to examine eye movement, involuntary movements (chorea), gait, coordination and slowness in movement and stiffness
Neurocognitive testing
Neurological exam
Psychiatric consultation
There is no cure for Huntington’s disease, but Medicare may cover the following treatments:
Occupational therapy
Physical therapy
Psychotherapy
Speech therapy
Individual and family counseling
Palliative care
Medicare Part D or certain Medicare Advantage plans may cover the following medications:
Antidepressants
Antipsychotic medications
Involuntary movement medications
Mood-stabilizing medications
Multiple Sclerosis
Multiple sclerosis is another common neurological disorder in the elderly. According to the National Multiple Sclerosis Society, “multiple sclerosis (MS) is an unpredictable disease of the central nervous system” that interferes with the flow of information within the brain, and between the brain and the rest of the body.
Multiple Sclerosis Symptoms and Treatment
Symptoms of MS include:
Fatigue
Difficulty walking
Tingling or numbness
Weakness
Dizziness and vertigo
Pain and itching
Depression
Mood swings
Irritability
Spasticity (stiffness and muscle spasms)
Vision problems
Cognitive changes such as the inability to process and remember information
Testing for multiple sclerosis can include MRI, spinal fluid analysis, and blood tests to rule out any other medical conditions.
MS can cause damage to the myelin, which is a mixture of proteins that increases nerve impulse transmission speed. The damage blocks or slows nerve impulse transmission. If myelin is damaged, sometimes corticosteroids can help repair the damage.
A comprehensive MS treatment plan can include rehabilitation that focuses on function — meaning the treatment helps you improve your ability to perform safely and effectively at home or work. Other treatments include medications such as Avonex and Gilenya to help manage symptoms and/or modify the course of the disease.
Parkinson’s Disease
Parkinson’s disease affects the central nervous system. Over time, the disease affects movement and symptoms get worse. Symptoms of Parkinson’s start small, such as a barely noticeable tremor in one hand. Other symptoms include:
Slowed movement that can make simple tasks more difficult over time
Muscle stiffness
Quick, slurred, or soft speech
Changes to posture or balance such as slumping over when standing
Parkinson’s may be caused by genetic and/or environmental triggers. Rare genetic mutations may be associated with the disease. The mutations cause changes such as Lewy bodies, which are abnormal protein aggregates that form in nerve cells, and alpha-synuclein (a protein) in the Lewy bodies. Scientists believe that alpha-synuclein is the number one indicator of Parkinson’s.
Risk factors include a family history of Parkinson’s, age (most people who develop the disease are 60 or older), sex (men are more likely than women to develop the disease), and environmental factors including exposure to pesticides.
Parkinson’s causes are unknown, so there’s no proven way to prevent it. However, some research shows that regularexercise and caffeine may reduce the chances of developing Parkinson’s.
Testing for Parkinson’s includes analyzing tremors, movement, muscle stiffness, and balance. Your doctor may refer you to a movement disorder specialist for further diagnostic testing.
According to the US National Library of Medicine, paralysis is the loss of muscle function in part of your body. Most paralysis is due to spinal cord or neck injuries or stroke. Other causes include ALS or autoimmune diseases.
In order for paralysis to qualify you for a Special Needs Plan, your paralysis must be “extensive.” Qualifying paralysis includes:
Monoplegia: Paralysis that only affects only one arm or leg
Hemiplegia: Paralysis that affects one arm and one leg on the same side of your body
Paraplegia: Paralysis affects both legs
Quadriplegia or tetraplegia: Paralysis that affects both arms and both legs
If your paralysis makes it so you can’t work, you may qualify for SSDI. You may be eligible for Medicare after you receive SSDI for 25 months. You may also qualify for Medicare when you turn 65.
Medicare Part A may cover hospital services, skilled nursing care, home health care, and hospice care. Medicare Part B may cover occupational therapy and DME such as powered wheelchairs.
Polyneuropathy
Polyneuropathy is the most common type of peripheral neuropathy. The condition is a result of nerve damage outside of the brain and spinal cord. It can often cause weakness, numbness, and/or pain, usually in your hands and feet. Sometimes polyneuropathy can cause difficulty swallowing, breathing, and/or moving your eyes.
Polyneuropathy is most-commonly caused by diabetes. Less commonly, polyneuropathy develops due to hereditary causes. Sometimes the causes are unknown.
According to the Mayo Clinic, testing for polyneuropathy includes blood tests, imaging tests such as CT or MRI scans, and a neurological examination including EMG.
Treatments include medications such as pain relievers, anti-seizure medications such as Lyrica, topical treatments such as capsaicin cream, and antidepressants such as Pamelor and Silenor. Pain from diabetic polyneuropathy may be treated with Cymbalta.
Other treatments include nerve stimulation (TENS), plasma exchange and intravenous immunoglobulin, physical therapy, and/or surgery.
Spinal Stenosis
Spinal stenosis is when the spaces in your spine become more narrow. The narrowing can put pressure on the nerves within the spine. Sometimes, spinal stenosis doesn’t produce symptoms. Other people may experience pain, numbness, a tingling sensation, and/or muscle weakness. Symptoms can become worse over time.
Cervical stenosis is when the narrowing occurs in your neck, and lumbar stenosis occurs in the lower back. Both types of stenosis can cause numbness and tingling and/or weakness. Cervical stenosis can cause problems with balance and walking, neck pain, and/or bladder dysfunction. Lumbar stenosis can cause back pain and/or leg cramps or pain. According to the Mayo Clinic, you should see a doctor if you experience any of those symptoms.
An overgrowth of bone, herniated disks, tumors, spinal injuries, and/or thickened ligaments (tough cords that connect the vertebrae) can cause spinal stenosis. The condition mostly affects people over 50, but conditions such as trauma and genetic diseases may cause stenosis.
Your doctor may use spinal imaging tests such as MRI, X-rays, or CT to diagnose spinal stenosis and pinpoint the cause.
Treatment for Spinal Stenosis
Your doctor may prescribe over-the-counter pain relievers such as ibuprofen, prescription pain pills such as oxycodone, antidepressants, and/or anti-seizure drugs such as Neurontin. Other treatments can include physical therapy, corticosteroid injections, and/or a decompression procedure that uses “needle-like instruments to remove a portion of a thickened ligament in the back of the spinal column.”
Your doctor may also recommend surgery or alternative therapies such as chiropractic care and acupuncture.
Stroke-Related Neurologic Deficit
According to the Mayo Clinic, a stroke occurs when the blood supply to part of your brain is stopped or limited. The blockage deprives your brain of oxygen and nutrients, which causes brain cells to die. Strokes can cause a neurologic deficit, which is abnormal functioning of an area of the body. The deficit happens when the brain, spinal cord, muscles, or nerves have weaker functioning.
The most common cause of stroke is blood clots either in one of the arteries that supply the brain with blood (thrombotic stroke) or in an artery away from your brain (embolic stroke). Other causes of stroke include blood vessel ruptures or leaks (hemorrhagic stroke).
Risk factors for stroke include:
Hypertension
Smoking
Diabetes
Obesity
Alcoholism
Sedentary lifestyle
You can help prevent a stroke by watching your diet, quitting smoking, exercising regularly, and avoiding excess alcohol use.
Stroke Symptoms and Treatment
According to the American Stroke Association, you should use the acronym FAST to spot signs of a stroke and know when to call 9-1-1. FAST stands for:
Face drooping, which means one side of the face droops or it’s numb.
Arm weakness, which means that one arm feels weak or numb.
Speech difficulty, which can mean slurred speech.
Time to call 9-1-1. Call 9-1-1 if the person displays any of these symptoms, even if they’re temporary. These symptoms indicate an emergency, and the person needs to get to a hospital.
Other symptoms include sudden confusion, trouble seeing, walking, and/or a severe headache that doesn’t seem to have a cause.
According to Medicare.gov, “Medicare covers medical and rehabilitation services while you’re in a hospital or skilled nursing facility.” Medicare Part B may also help pay for physical therapy and occupational therapy.
Medicare preventive services for stroke include:
Cardiovascular disease screening such as blood cholesterol screening
Find Coverage for Common Neurological Disorders in the Elderly
Some of the most common neurological disorders in the elderly and other Medicare eligibles can be prevented, treated, and/or managed. The right health insurance plan can help. An agent with Medicare Plan Finder can see what’s available in your area and give you information. Our agents can assist you with finding a plan that meets your budget, medical, and lifestyle needs. Call 1-844-431-1832 or contact us here to set up a no-cost, no-obligation appointment today.
