Cancer is the leading cause of death worldwide and impacts millions of patients and families each year. Fortunately, genetic testing for cancer, which is growing in popularity, can be a great tool for understanding your risk of developing cancer.
Does insurance pay for genetic testing of cancer? Yes, but coverage determination depends on certain circumstances.
The American Cancer Society estimates that 1 in 3 people in the United States will develop cancer at some point in their life. Data and research show that cancer risk is highest for those between the ages of 65 to 74 years and accounts for the largest portion of new cancer cases found each year.
While you may have a smaller chance of developing cancer if you are under the age of 65, it is still a good idea to get tested as early as possible so that you can make smart decisions about health insurance and your future.
Is Cancer Hereditary?
About 10% of cancers occur in someone who has inherited gene mutations. Hereditary cancer syndromes are caused by mutations in certain genes passed from parents to children.
Researchers have found mutations in more than 50 hereditary cancer syndromes.
These mutations are found in the genetic code of DNA and are represented by the letters A, T, C, and G. These codes can be long – for example, the BRCA 1 code is over 10,000 letters long.
However, not every mistake in the “code” should raise concern for cancer.
Reasons to Consider Genetic Testing for Cancer
If you have an inherited gene mutation, that doesn’t necessarily mean you’ll get cancer. It only means that you’re at a higher risk of developing certain types of cancer.
If your personal history or family history of cancer suggests you are at risk, find out how genetic counseling and genetic testing can help you understand and manage your concerns.
The following populations should also ask for specific types of genetic testing:
Those whose family members have had gynecologic cancer should get tested for fallopian tube cancer. This very rare cancer only affects about 1,500 to 2,000 women worldwide and only about 300 to 400 women are diagnosed with it every year in the United States.
Certain factors may make it more likely that you and your family members can pass cancer on to your loved ones including:
Many cases of the same kind of cancer (especially if the type of cancer is rare) — like ovarian cancer caused by BRCA1 and BRCA2 gene mutations
Cancers that occur much sooner than usual – like breast cancer in a teenager
One person who has multiple types of cancer (like a man who has both colon and prostate cancer)
Cancers that occur in pairs of organs (both kidneys or both breasts, for example)
Siblings who have childhood cancers
Cancer that occurs in the opposite sex of the one usually affected (breast cancer in a man, for example)
Cancer that occurs in several generations (like in a grandmother, mother, and daughter)
Hereditary Genetic Testing for Cancer
The estimated number of new cancer cases in 2018 was 1,735,350. If you are curious about your risk of developing cancer, consider hereditary cancer testing.
Hereditary testing kits can help you understand any mutations you may have and allow you to better prepare for any issues that may arise in the future. Plus, knowing about an inherited mutation gives you the power to take the necessary steps to reduce your risk of cancer or to help detect it at an early stage.
Kits often include a saliva collection kit and a prepaid return label. The testing kits analyze over 30 genes that can contribute to the most common hereditary cancers.
A certified medical professional will review your sample and provide clear results of the absence or presence of any cancer-causing mutations. This information is personalized to you and provides information on how your genetic makeup can impact your family.
Medicare Cancer Test Kits
Fortunately, you can complete a cancer genetic test in the comfort of your own home. This can help alleviate any stress that may come from testing in a doctor’s office.
Most at-home test companies provide return labels so the entire process is convenient and stress-free. However, if you prefer to go into a doctor’s office for your genetic testing, that is also an option.
If you decide to use a Medicare cancer test kit to screen for covered screenings, be sure to follow the test’s directions to the letter. This helps ensure that your test results will be accurate.
Breast Cancer Genetic Testing & the BRCA Testing Cost
It is easy to learn your genetic risk of the most common hereditary cancers, including BRCA 1 and BRCA 2 genes. BRCA stands for BReast CAncer genes. BRCA 1 is on chromosome 17 and BRCA 2 is on chromosome 13.
All it takes is a small DNA sample through saliva.
Plus, the test can be conveniently mailed to you and completed in the comfort of your home. The cost of a hereditary cancer testing kit can range from $100 to $200.
There are multiple genetic testing companies, including Color and 23andMe, but not all are approved by the FDA.
Aging and Cancer
The risk of cancer increases with age, but it’s never too early to start screening. According to the Dana-Farber Cancer Institute, the average age for a breast cancer diagnosis is 61 years.
The average age for a prostate cancer diagnosis is 66 years.
There is no single explanation as to why age and cancer correlate, but researchers believe sunlight, radiation, environmental chemicals, and ingredients in our food are large factors.
Physical exercise, a healthy diet, and adequate sleep can help lower the risk of cancer as you age.
Medicare Coverage and Genetic Testing for Cancer
Medicare beneficiaries who need genetic counseling can get it covered under Medicare Part A and Part B only if it has been ordered by a physician before starting medication covered under Part D or if it is medically necessary in a skilled nursing facility.
Medicare covers certain genetic cancer tests if they’re medically necessary. In 2020, Medicare will cover genetic testing if:
You have recurring, relapsed, refractory, metastatic, or advanced stage III or IV cancer
You have not used the same genetic test for the same cancer diagnosis previously
You have decided to seek further cancer treatment such as chemotherapy and radiation
You have signs or symptoms of a cancer like colorectal cancer that can be clarified or verified with diagnostic testing
You have a first-degree relative who has a known mutation such as Lynch syndrome
Does Medicare Cover BRCA Testing?
How much does the BRCA test cost? The price ranges from $475 to $4,000. Fortunately, Medicare covers FDA-approved genetic testing for BRCA 1 and 2 for those with a personal or family history.
So, it covers hereditary breast, tubal, epithelial ovarian, or primary peritoneal cancer tests as well.
Does Medicare Cover Genetic Testing for Melanoma?
Medicare currently covers the Myriad Genetics myPath and Castle Biosciences DecisionDx genetic tests for melanoma.
Medicare also covers screenings for lung, breast, prostate, and cervical cancer. Screenings are used to detect potential disease and a diagnostic test establishes the presence or absence of the disease.
Does Medicare Cover Genetic Testing for Prostate Cancer?
Medicare covers prostate cancer screening for men over 50 every 12 months. If cancer is detected, Medicare Part B coverage includes a variety of options, including genetic testing to help physicians distinguish between an aggressive and a non-aggressive tumor.
This essential information helps physicians design an optimal treatment plan for their patients.
What Happens During a Genetic Test for Cancer?
A genetic test for cancer may provide some insight into your medical history and the possibility of passing mutated genes on to your loved ones.
Your doctor will first ask you questions about your personal and family medical history such as, “Have you or an immediate family member been diagnosed with cancer?” Based on your answers, your doctor may refer you to a genetic counselor. (A genetic counselor is someone who has advanced training in medical genetics and counseling.)
2. Informed Consent
Before your test, you must give informed consent, which means that you’re aware of and that you agree to the following items:
The genetic test’s purpose
The type and nature of the genetic condition being tested
Possible screening or treatment options depending on the test results
Further decisions you might need to make once the results are back
The possible consent to use the results for research purposes
Availability of counseling and support services
Your right to refuse testing
3. Collecting the Sample
Depending on the test, you may need to provide a saliva, blood, hair, cheek cells (usually a swab from inside your mouth), urine, or stool sample. Once your healthcare professional collects your sample, he or she will send it to the lab for testing.
4. Getting the Results
Once the results are in, your genetic counselor or healthcare provider will tell you about your test results and the next steps you should take.
Questions to Ask Yourself About Medicare DNA Cancer Screening
Does Medicare pay for DNA cancer screening? Yes, because the Centers for Medicare & Medicaid Services (CMS) covers a broad range of FDA approved diagnostic tests, CMS cancer screening is available to detect many types of DNA cancers.
However, as with any type of medical screening, you should know what you’re getting into before you take the test. Before you take a Medicare cancer swab test, ask yourself:
Is this test legitimate? Unfortunately, genetic kits including Medicare cancer swab tests are the latest trend in Medicare fraud, according to many state and federal agencies. Your doctor can tell you what type of test to buy.
Is this test FDA-approved? Medicare will only cover FDA-approved tests.
How will this information benefit future generations? You may not want to know if you have genetic mutations that could lead to cancer. However, that information could help your children and grandchildren. If you have gene mutations associated with cancer, you can have Medicare cancer screening. Many forms of cancer can be treated if they’re detected early.
We Can Help You Find the Best Medicare Plans for Cancer Patients
A Medicare Advantage (MA) plan is a great option if you are looking for additional benefits like genetic testing beyond BRCA 1 and 2 and myPath.
Some may even offer fitness classes like SilverSneakers®, which can help promote a healthy, physically active lifestyle and help lower your risk of cancer.
If you’re diagnosed with cancer, you may be eligible for a type of MA plan called a Chronic Special Needs Plan (C-SNP). These plans are specially designed for people with certain chronic illnesses and conditions. Your C-SNP will involve a network of healthcare providers that will coordinate your treatment plan with each other.
If you are interested in arranging a no-cost, no-obligation appointment with a licensed agent to discuss your options for MA plans including C-SNPs, call us at 833-438-3676 or fill out this form.
This post was originally published on November 29, 2018, by Kelsey Davis and updated on March 24, 2020, by Troy Frink.
Does Medicare Cover Cancer Treatment? (Updated for 2020)
The good news is that Medicare does cover cancer treatment, prescriptions, and screenings and might even cover genetic testing, depending on your plan.
Medicare Cancer Coverage: What you Need to Know
Cancer treatment usually involves a combination of treatments that can include chemotherapy, radiation, and surgery. Medicare plans can cover a lot of the costs associated with these treatment options.
What Cancer Treatment Does Medicare Cover?
In order for your treatment to be covered, your doctor must accept Medicare. Outpatient care (including intravenous chemotherapy, certain screenings, and outpatient radiation) falls under Part B.
You may have to pay a copayment, coinsurance and a deductible for each service.
Cancer treatment under Part A (hospital insurance) covers inpatient surgeries and hospital stays. Part A will also cover limited skilled nursing care and home health care services.
Original Medicare Coverage (Medicare Part A and Medicare Part B)
After you qualify at age 65, you’re enrolled in Medicare Part A and Part B, the Original Medicare. Medicare Part A covers inpatient hospital stays, which includes skilled nursing facility care, hospice care, and home health care.
Medicare Part B covers doctor visits, lab tests, and medical equipment and supplies.
Both Part A and Part B cover high-dose radiation treatments to shrink tumors and destroy cancer cells, but in different ways. Part A covers it for inpatients in hospitals.
Part B covers it for outpatients at independent (freestanding) clinics.
Medicare Advantage Plan Coverage
Medicare Advantage Plans are a health care plan offered by private health insurance companies that contract with Medicare and offer the full spectrum of Part A and Part B benefits.
Since these companies are legally expected to provide “equal or better” coverage than the original Medicare, a Medical Advantage Plan is sometimes also known as Medicare Part C.
Medicare Part D Coverage
Medicare Part D Coverage is an optional federal prescription drug plan for Medicare beneficiaries to pay for prescription drug coverage. You can get it as part of your original Medicare (Part A and Part B).
The annual premium for coverage in 2020 is $435, up from $415 last year.
Medicare Supplement Insurance (Medigap) Coverage
Medicare Supplement Insurance (Medigap) is worth buying to lower out-of-pocket costs if you want lower monthly premiums. Medigap plans cover many original Medicare costs, like copayments, coinsurance, or deductibles.
Does Medicare Cover Chemotherapy?
Medicare Part B covers chemotherapy drugs, radiation, and chemotherapy treatment for cancer patients in a doctor’s office, a clinic, a hospital, or even chemotherapy in a skilled nursing facility.
Immunotherapy is a cancer treatment that triggers your own immune system to fight off cancer cells. If immunotherapy is medically necessary, Medicare may cover many types of specialized treatments, for instance, immunotherapy for lung cancer.
Is CAR T-Cell Cancer Therapy Available to Medicare Beneficiaries?
The Centers for Medicare and Medicaid (CMS) approved Medicare coverage for FDA-approved Chimeric Antigen Receptor T-cell (CAR T-cell) to treat specific types of cancer, such as non-Hodgkin lymphoma and B-cell precursor acute lymphoblastic leukemia.
According to the Leukemia and Lymphoma Society (LLS), CAR T-cell therapy works by re-engineering a patient’s T-cells (disease-fighting cells), multiplying the cells, and re-introducing the “new” cells to the body.
Medicare Cancer Screening
Catching cancer in its early stages can make a huge difference in your treatment’s success.
That’s why Medicare offers coverage for preventive screenings for most cancers, including but not limited to:
Breast cancer: Medicare will cover one annual mammogram, and one clinical breast exam (CBE) every two years for all women 40 and older who have an average risk of developing breast cancer. Women who are at a high risk of developing breast cancer can receive one CBE every year.
Cervical cancer: Medicare pays for one pelvic exam and Pap test every two years. If you have a high risk of cancer, Medicare covers those tests once yearly.
Colorectal cancer: Medicare covers certain colorectal cancer screenings looking for pre-cancer polyps for people 50 and older.
Prostate cancer: Medicare covers one digital rectal exam (DRE) and one prostate-specific antigen (PSA) for men 50 and older. Medicare will cover 80% of the DRE and 100% of the PSA.
Lung cancer: If you’re a smoker or have a long history of tobacco use, Medicare will cover low-dose CT scans for lung cancer.
Does Medicare Cover Wigs for Cancer Patients?
Hair loss is a common side effect of certain cancer treatments. Original Medicare and Medicare Supplements do not cover wigs. However, some Medicare Advantage plans may offer coverage for wigs.
Medicare Genetic Testing
Some people are at a higher genetic risk for cancer than others, meaning that they have specific gene mutations. Medicare will cover BRCA1 and BRCA2 genetic testing to find those mutations if you have a personal history of cancer.
Medicare also covers certain genetic tests for melanoma and colon cancer. Depending on where you live, that coverage extends to multigene testing if the initial test indicates multiple mutations.
Most people have to wait for the Annual Enrollment Period (AEP), which is from October 15 to December 7, to change coverage, but you can take advantage of the SEP.
Medicare Chronic Special Needs Plan (C-SNP)
If you are diagnosed with cancer, you may be eligible for a Chronic Special Needs Plan (C-SNP). C-SNPs are a form of Medicare Advantage designed specifically for those with certain chronic illnesses and conditions.
They go above and beyond the coverage that Original Medicare provides. For example, C-SNPs provide coverage for prescription drugs.
Your C-SNP will involve a network of providers that will communicate with each other about your treatment plan.
When to Enroll in a C-SNP
You can enroll in coverage as soon as you receive your cancer diagnosis, but you must get confirmation from your doctor that you have cancer. While you are allowed to enroll in a C-SNP before your doctor verifies the diagnosis, your doctor must verify the diagnosis before you can keep the coverage.
Does Medicare Cover Cancer Treatment After Age 76?
Medicare covers cancer treatment for those enrolled, including medicare coverage over 70 years of age, but there may be a deductible or a copay. It also covers beneficiaries after they turn 76.
Can You Get Medicare Before 65 If You Have Cancer?
If you’re under 65 and get cancer, you are eligible for Medicare if you’ve been receiving Social Security Disability Insurance (SSDI) checks for 24 months or longer or if you have a diagnosis of End-Stage Renal Disease (ESRD).
How to Find an Oncology Doctor Who Takes Medicare
An oncology doctor, or oncologist, is a doctor who specializes in cancer treatment. Oncologists can have one of three different sub-specialties: medical, surgical, and radiation.
Medicare.gov has a tool for finding local oncologists who accept Medicare.
To get started, click here. First, enter your zip code beside the red arrow. We used 37209, because that’s the zip code for our corporate headquarters in Nashville, TN.
Then enter “oncology” in the box above the green arrow. Once you do that, click “Search” beside the yellow arrow.
The next page will let you select what subspecialty you want your oncologist to have. You can select more than one, but for demonstration purposes, we only chose “Medical oncology” (below beside the red arrow).
Then click “View results” beside the blue arrow.
The next page features a list of medical oncologists complete with contact information. Call the doctors to get an idea of what services they provide and if they can treat you.
You may have to call multiple oncology doctors to find the right one.
We Can Help You Get Covered
A cancer diagnosis can be overwhelming, but the right medical coverage can help give you the chance to get the quality care you need.
If you have cancer and need to enroll in a C-SNP, we will assist you with finding the best insurance plan for you. Call us at 844-431-1832 or contact us here today.
This post was originally published on April 19, 2019, and updated on March 6, 2020.
Seniors Staying Active: How Do You Like to Exercise?
According to USA Today, “seniors need to stay active to be healthy and avert loneliness.” It’s no secret that physical activity has a host of health benefits, but many people simply won’t exercise if it feels like a chore. So how do you keep a routine? Find something you enjoy.
We polled 1,420 people about their fitness routines and what types of exercise they enjoy. Read on to learn our poll results, the benefits of different types of exercise, and how you can get started with your own exercise routine.
Poll Results: How Do You Exercise?
The clear favorite in our poll was cardiovascular activity (walking, running, or biking), which received 748 votes (28.6 percent).
“Other” exercises followed with 296 votes (11.3 percent.)
Exercising with a personal trainer was the least popular with 142 votes (5.4 percent).
Seniors Staying Active With Cardiovascular Exercise
Cardiovascular exercise is the most popular activity with the people we polled. Walking, running, or cycling may be the easiest to start. All you need is the right equipment such as comfortable shoes and clothes or a bicycle.
You can walk pretty much anywhere, and cold weather is oftentimes no excuse to get moving — many shopping malls allow people to walk around before the stores open.
All you need is a good pair of shoes and comfortable clothes and you can start reaping the benefits of cardio exercise. Running may be a bit more high-impact on your joints, but it still has a ton of benefits* for heart and lung health. Bicycling requires more equipment than the other two, but it can be a great way to get outside and explore your neighborhood, provided it’s safe to do so.
*Always consult with your healthcare provider before starting any exercise program.
Benefits of Cardiovascular Exercise for Seniors
Cardio exercise offers a host of benefits that reach from your head to your toes. For example, it increases blood flow to your brain, which decreases your chance of stroke. Cardio can also improve your blood sugar control, which helps relieve stress on the pancreas and reduces your chance of developing type 2 diabetes. Additionally, cardio can aid in weight loss, help fight osteoporosis, reduce chances for a hip fracture, and help manage arthritis pain.
Seniors Staying Active at the Gym
Gyms are a great place for anyone looking to stay active. Many of them have the most up-to-date equipment and they can provide a great atmosphere for like-minded people to meet. Many gyms have staff on hand to answer questions and some even have saunas and hot tubs to help you relax after a workout!
You may even be able to find help paying for gym membership! Some Medicare plans include a fitness benefit that gives you free gym and/or group fitness access! Original Medicare does not offer coverage for fitness services, however, certain private plans called Medicare Advantage plans can. Some Medicare Advantage plans have low $0 premiums, so you’d get benefits such as gym memberships, meal delivery, hearing, dental, and vision for little or no extra cost to you*.
*You still owe the Medicare Part B premium even if you have a Medicare Advantage Plan.
Benefits of Weight Training at a Gym
According to the New York TImes, “In multiple experiments, older people who start to lift weights typically gain muscle mass and strength, as well as better mobility, mental sharpness and metabolic health.” Gyms also usually have cardio equipment, too, so you can develop a well-rounded fitness program.
Seniors Staying Active With Home Gym Equipment
Working out at home can be a great way to stay in shape. You don’t need a lot of equipment to get started, either. You can have a safe and effective workout using dumbbells or resistance bands, and you can modify your routine to accommodate your needs.
For example, some people may not be able to stand up and do shoulder presses. You can do exercises from a chair and still get an effective workout. The key is to know which exercises to perform, how many sets, and how many repetitions.
Home Gym Benefits
You don’t have many excuses to not exercise if your gym is at home. Even people homebound people can reap the benefits of exercise for older adults. You can find equipment at Amazon, Target, Walmart, or even used! Craigslist is a great source to find people who want to get rid of gym equipment they don’t use.
Another benefit is that you get to control what equipment goes into your gym. Sometimes a fitness center will have what seems like an endless amount of machines, but you only use a handful of them. Don’t want a treadmill? Don’t buy one. You can have only the equipment you want. The best part? You likely won’t have to wait in line for any of it.
Group fitness classes have an added social component, which is extremely important for seniors and brain health. Also, many times group fitness classes can help you attend more regularly with the “positive peer pressure” that can result.
If you start attending classes at certain times every week and you skip, your classmates will ask you where you were. That adds an accountability component that just exercising on your own doesn’t have.
Some Medicare fitness programs* can cover this benefit, too! Programs such as SilverSneakers®, Silver & Fit®, and RenewActive™ are included with certain plans. Some Medicare Advantage plans have low $0 premiums*, which would mean that your gym membership would have no additional cost.
*Medicare Advantage fitness benefits are not administered or necessarily endorsed by Medicare or any other government agency.
**You still owe the Medicare Part B premium even if you have a Medicare Advantage plan.
Seniors Staying Active With the Help of Personal Trainers
Following a personal trainer’s plan is a great way to get in shape, especially if you’re new to working out. Your trainer will give you exercises to perform and a routine to follow. They’ll even watch you and make sure you’re maintaining the proper form so you don’t hurt yourself.
However, personal trainers can be expensive. You may owe trainer fees on top of your gym dues. However, some gyms allow you to have a certain number of personal training sessions for free so you can see if the one-on-one fitness coaching is the path you want to take.
Other Ways for Seniors to Stay Active
The exercise methods in our poll aren’t the only ways for older adults to stay active. There are many other safe ways to exercise including, yoga, swimming, hiking, and playing sports. You have seemingly endless options as long as your healthcare provider approves your activity. The most important thing is that you enjoy the activity. Otherwise, you won’t stick with it and you won’t receive the many rewards that exercising can offer.
How to Get Fitness Coverage
Working out at the gym, your local senior center, or taking group fitness classes may be too expensive for some people. Fortunately, you may be able to find help if you have the right Medicare plan.
Every location has different plans with different benefits. If you want to learn more about Medicare Advantage and what benefits (including fitness programs) are in your area, a licensed agent with Medicare Plan Finder can help.
Our agents are highly trained and they can talk to you about your needs and they may be able to find a local plan that fits your budget and lifestyle. Call 1-844-431-1832 or contact us here to arrange a no-cost, no-obligation appointment today.
Have you voted on our poll yet? How do you like to exercise?
Does Medicare Cover Physical Therapy?
Does Medicare cover physical therapy? It depends. Medicare can help pay for physical therapy, which may be a crucial part of injury or surgery recovery. However, Medicare’s coverage has limits.
Every Medicare beneficiary begins with Original Medicare, which includes Part A, hospital coverage, and Part B, medical coverage. Most physical therapy services will fall under Medicare Part B – however, there are specific Medicare guidelines for physical therapy in-home health services and doctor services.
It can be confusing to navigate the different coverage caps and figure out what Medicare therapy coverage you have. Let’s break it down.
Does Medicare Cover Physical Therapy for Back Pain?
Back pain is one of the most common symptoms that leads to physical therapy. As you age, back pain is almost inevitable. It’s easy to fall into bad habits and poor posture. If you have back pain that lasts for a few weeks or longer, most doctors will recommend physical therapy.
A licensed and professional physical therapist will not only help you decrease pain but also educate you on how to prevent back pain in the future. He or she may even teach you some physical therapy exercises to perform at home.
Alternatively, seniors and Medicare eligibles who have a hard time getting to a doctor’s office may opt for a home nurse who is licensed to assist with physical therapy. In most cases, if your home nurse happens to double as a physical therapist, you will be covered under Part B.
Unfortunately, these services are not free.
How Much Does Medicare Pay for Physical Therapy?
Medicare Part B will cover your medically necessary outpatient therapy (physical, speech-language pathology, occupational) at 80 percent, you will likely be responsible for 20 percent of all Medicare-approved costs.
Previously, Medicare only covered up to 80 percent of $2,040 ($1,608) for physical and speech-language therapy services and another 80 percent of $2,040 ($1,608) for occupational therapy services. That meant that, for example, if your physical therapy appointments cost you $100, Medicare would have only covered about 20 visits per year.
Beneficiaries were receiving notices titled, “Advance Beneficiary Notice of Noncoverage.” The notice will tell you what Medicare will can or cannot continue to cover so that you can make informed choices about whether or not you want to continue your physical therapy.
Thankfully, physical, occupational, and speech therapy patients with Medicare won’t have that problem in 2019.
Medicare Physical Therapy Billing
When it comes to paying the bills for your physical therapy, you may want to consider adding either a Medicare Advantage plan or a Medicare Supplement plan. Even though Original Medicare Part B covers physical therapy, the cap will hold you back. Adding Medicare Advantage or Medicare Supplements may give you the coverage you need to pay the bills.
The good news is that everyone who is eligible for Original Medicare is also eligible for Medicare Advantage and Medicare Supplement plans. You can’t have both, so you’ll have to choose one.
Medicare Advantage plans are offered by private insurance companies and are designed to add additional covered services like dental, vision, hearing, fitness.
Alternatively, Medicare Supplement plans do not provide coverage for additional services but instead provide additional financial coverage. These plans are designed to help you pay for your coinsurance, copayments, and deductibles. You’ll have to decide what makes the most sense for you and your needs: more financial coverage, or more covered services?
Your physical therapist can discuss the physical therapy benefits specific to your condition and personal medical history.
Does Medicare Cover Transportation to Physical Therapy Appointments?
Original Medicare does not cover non-emergency medical transportation. Some Medicare Advantage plans can cover Medicare transportation benefits including travel to and from doctor’s appointments.
How to Find a Physical Therapist Who Accepts Medicare
Finding a local physical therapy practice that takes Medicare may be easier than you think. If you’re looking for physical therapy near you, click here to get started. Medicare.gov’s Physician Compare website allows you to find providers who specialize in the services you need including physical therapy.
Enter your zip code beside the red arrow. We used our home office’s zip code in Nashville, Tennessee, which is 37209. Then type “physical therapy” in above the yellow arrow. After that, click “Search” beside the orange arrow.
You confirm the service you need on the next page. If the boxes beside “Physical Therapy” and “Select all specialties related to ‘physical therapy'” are white, click in them to make both boxes have check marks. Then click “View results.”
The last step is scrolling through the list of providers and making some calls. You may have to call more than one physical therapy practice to find one that fits your medical and budget needs.
Need a New Medicare Plan?
Our agents can help you decide if Medicare Advantage or Medicare Supplements are right for you. We have agents in 38 states and we’re constantly growing!
Plus, our agents are licensed to sell plans from many of the major insurance carriers in your area, which means we are NOT biased. We can help you set up an appointment with an agent who can show you how to choose the right Medicare plan for your needs.
This post was originally published on January 4, 2018, by Anastasia Iliou, and was most recently updated on January 6, 2020, by Troy Frink.
Signs of Depression in Older Adults
Depression is more than just feeling sad from time to time. It’s a serious mental health issue that can be treated. It can cause severe symptoms that affect your entire life including how you think, feel, and handle day-to-day activities such as sleeping and eating.
Depression is a legitimate illness. It’s not something you can just “shake off” one day, and it doesn’t mean that you’re weak or that you lack willpower. It’s important to know the signs of depression in older adults so you can find the treatment you need.
Types of Depression
According to the National Institute on Aging (NIA), there are several types of depression. The most common types of depression are major depression and persistent depressive disorder.
Major depression involves severe symptoms that affect your ability to work, sleep, study, eat, and find joy in life. A person may experience an episode of major depression only once, however, multiple episodes are more common.
Persistent depressive disorder is a depressed mood that lasts for two years or more. A person diagnosed with persistent depressive disorder may have episodes of major depression with periods of less severe symptoms in between.
It might be difficult to recognize depression in older adults because they may show different symptoms than younger adults. For example, sadness is not the main symptom for some older adults. They may have less obvious symptoms of depression like restlessness, or they may not be willing to talk about their feelings. Doctors may be less likely to recognize that you have depression.
Sometimes older people who are depressed feel tired, have trouble sleeping, or seem irritable. Sometimes the attention problems that depression can cause look like Alzheimer’s disease or other brain disorders. Older adults may have medical conditions such as heart disease, stroke, or cancer, which may cause symptoms of depression. Certain medications can also have side effects that contribute to depression.
There are many symptoms associated with depression, and they can vary from person to person. If you have any of the following symptoms for more than two weeks, you may have depression. Symptoms of depression can include:
Persistent sad, anxious, or “empty” mood
Feelings of hopelessness, guilt, worthlessness, or helplessness
Loss of interest in activities you once enjoyed
Fatigue or a lack of energy
Talking or moving slower
Difficulty focusing, remembering, and/or making decisions
Difficulty sleeping, waking up in the early morning, or oversleeping
Unplanned weight gain or loss
Suicidal thoughts, suicide attempts, or thoughts of death
Aches or pains including headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease with treatment
Depression Risk Factors
Several factors can contribute to depression including:
Genetic factors: People who have a family history of depression may be more likely to develop it than people whose families do not have a history of the disease.
Personal history: Older adults who had depression when they were younger are more at risk for developing depression later in life than people who did not have the illness earlier in life.
Brain chemistry: People with depression may have different brain chemistry than people who do not have the disease.
Stress: Situations such as the loss of a loved one or a difficult relationship can trigger depression.
Age: Depression can occur because of the changes that happen as you age. For example, some older adults have a condition called ischemia, which means restricted blood flow. With ischemia, the brain may not get the blood it needs to function. A condition called vascular depression can result, which also puts the person at risk for heart attack, stroke, or other hematologic disorders.
Depression can co-occur with other serious medical conditions such as diabetes, cancer, heart disease, and Parkinson’s disease. Depression can make these conditions worse. Sometimes medications taken for these physical illnesses can cause side effects that contribute to depression. Your doctor may be able to help find the best course of treatment with the fewest side effects.
What Caregivers Need to Know About Depression
It can be difficult to detect depression in your loved one. For example, grieving after the loss of a loved one is normal, and it oftentimes doesn’t require professional mental health treatment according to the National Institutes of Health.
If you notice that your loved one has signs and symptoms of depression, make an appointment with the doctor. Know what questions to ask your loved one’s doctor and go into your doctor prepared with notes about:
Any symptoms your loved one has even if they unrelated to the reason for your appointment. Write down when their symptoms started, the severity of symptoms, if they’ve occurred before, and the treatment for the symptoms.
Key personal information such as any major stresses or recent life changes
All medications, vitamins, or other supplements that your loved one takes. Be sure to include the medication’s dosage and the frequency at which your loved one takes them
Caregivers Can Also Experience Depression
It may be easy to forget about yourself when you spend so much time and energy on your loved one. Caregivers can experience depression, too. According to the Family Caregiver Alliance, many people with symptoms of depression don’t think they’re depressed. Caregivers may have unique concerns when it comes to their own depression including:
Dementia caregivers experience depression at higher rates. People who care for loved ones with dementia are twice as likely to suffer from depression than other caregivers. Dementia caregivers spend more time with their loved ones than other caregivers, and they may experience the following issues:
Physical and mental health issues
Less time to do the things they enjoy
Less time with other family members
Increased family conflict
Women experience depression at higher rates than men: According to the Family Caregiver Alliance, about 12 million women experience major depression each year, which is double the rate of men. Physical factors such as iron, vitamin D, and Omega-3 fatty acid deficiencies along with menopause and thyroid disease can contribute to depression.
Men experience depression differently than women. Men are less likely to report feelings of depression to their doctor, and they’re more likely to “self-medicate” with alcohol or other substances.
Depression can persist even after you place your loved one in a care facility. It can be stressful to move your loved one into a long-term care facility. Even though you may get some much-needed rest, you may feel guilty or lonely, which may contribute to major depression.
You can also look for online and in-person support groups that focus on the needs of specific caregivers. For example, some support groups are only for dementia caregivers.
Other caregiver resources include educational materials and respite care, which is when your loved one stays at a hospital or long-term care facility to give you a break. Medicare will cover respite care only if it’s a part of hospice care.
How to Prevent Depression
According to WebMD, doctors don’t know if it’s possible to “prevent depression altogether.” However, you may be able to keep it from returning if you’ve already had an episode. Some therapists use a treatment called mindfulness-based cognitive therapy (MBCT), which combines cognitive therapy with mindfulness.
According to the Mayo Clinic, cognitive therapy is a type of psychotherapy that helps the patient change negative thinking patterns that can come with depression. Mindfulness is the “self-regulation of attention with an attitude of curiosity, openness, and acceptance, according to Psychology Today.
Other ways to help prevent depression include changes to your lifestyle and nutrition habits. Even though there’s no guaranteed way to prevent depression, you can:
Find ways to improve your self-esteem and manage stress.
Reach out to friends and family during difficult times
Get regular medical check-ups and make a doctor’s appointment if you don’t feel right.
Treatment for Depression in Older Adults and Medicare Coverage
Even the most severe depression can be treated, according to NIA. Treatments often include therapy — usually talk therapy — and prescription drugs.
Depression can get a lot worse if you wait to seek help, so it’s important to talk to your doctor as soon as you notice something is wrong.
You can receive Medicare coverage for depression treatment if you are 65 or older, have ALS or ESRD, or have received SSDI for at least 25 months.
Medicare Part B may cover behavioral health services like psychiatrist or psychologist appointments. Counseling or therapy sessions may be limited because they are only covered under Medicare if your doctor accepts Medicare assignment. Behavioral health services can include:
One-on-one and group therapy
Substance abuse treatment
Active therapy (art, dance, music therapy)
Annual depression screening
Prescription drugs you cannot administer yourself
Original Medicare will cover these services at 80 percent of the Medicare-approved amount. This means you may pay 20 percent coinsurance after you meet the Part B deductible. For example, if your psychologist bills Medicare for $200, you’ll pay $40.
Other treatments for depression can include antidepressants, which are prescription drugs that can help ease symptoms of depression. Original Medicare does not cover prescription drugs. However, Medicare Part D or certain Medicare Advantage plans do.
Medicare Advantage policies are private insurance plans that can offer additional benefits to help treat and prevent depression such as depression screening, possible reduced therapy costs*, and fitness classes!
*A Medicare Advantage plan may offer coverage for therapy services. You may still owe a copay.
**You are still responsible for the Medicare Part B premium even if you have a Medicare Advantage or a Medicare Supplement plan.
Get Medicare Mental Health Coverage Today
Whether you need a Medigap plan, a Medicare Advantage plan, and/or a standalone Medicare Part D plan, a licensed agent with Medicare Plan Finder may be able to help.
Our agents are highly trained and they can help you assess your needs. Your agent can see what plans are available in your area and help you determine what’s right for you. Call 844-431-1832 or contact us here to set up a no-cost, no-obligation appointment.
Medicare Inpatient vs. Outpatient: Why It’s Important to Know the Difference
Do you know the differences between inpatients and outpatients? The lines can get blurry, but the differences are important for your Medicare plan. Your classification as an inpatient or outpatient determines the coverage you get from Medicare.
Medicare Inpatient vs. Outpatient Coverage
In some cases, an overnight hospital stay does not automatically make you an inpatient. It is easy to assume that you are an “admitted” patient and receiving inpatient services if you are brought to a private or semi-private room, but that may not be the case. You may just be under observation and considered an outpatient.
If you’re getting emergency care, same-day surgery, x-rays, or lab tests, you may be under observation if you stay overnight. You aren’t considered an inpatient until a doctor admits you to the hospital.
Original Medicare Coverage for Inpatient and Outpatient Stays
You may notice that your Medicare card has two different dates for starting coverage: one for Part A, and one for Part B.
Difference Between Medicare Observation Status and Admission Status
For inpatient classification, a doctor has to purposely keep you at the hospital overnight and then formally admit you as such. Once you’re admitted, you have “admission status.”
A doctor may keep you for several hours under observation before deciding to admit you. During those hours, you have “observation status,” and you’re considered an outpatient. Any approved services during that time will be covered under your Part B.
Generally, as an inpatient you’ll only need to pay a one-time Medicare Part A deductible, then you’re covered for 60 hospital days. The Part A deductible is $1,408 in 2020.
You will owe $352 per day from days 61 to 90 in 2020. You will owe $704 per day for each additional day after day 90, provided you have lifetime reserve days. You must be out of the hospital for 60 consecutive days before your hospital coverage “renews.” According to the Medicare Rights Center, you get 60 lifetime reserve days, and once you run out, you are responsible for paying the full amount of your hospital expenses.
With Medicare Part B, you may need to pay 20 percent of the approved doctor services you receive in relation to that hospital inpatient stay. For outpatient services, you’ll pay a copayment or coinsurance for all services you receive. The rest is covered by Part B.
Medicare Prescription Drug Coverage
In most cases, prescription drugs that are part of your hospital visit will not be covered under your Part A or Part B. Medicare may cover prescription drugs as part of procedures, like anesthesia for knee replacement surgery, for example.
For the most part, you’ll need either a standalone Medicare Part D (prescription drug plan) or a Medicare Advantage plan if you want coverage for prescription drugs.
Medigap & Medicare Advantage Inpatient and Outpatient Benefits
Medigap (Medicare Supplement) plans are private insurance plans that cover the same services as Original Medicare. Your monthly premium covers financial items such as coinsurance and copays.
In 2020, there are eight different “letters” of Medicare Supplement plan. Each letter offers a different level of benefits. For example, Plan A covers Part A coinsurance and hospital costs, Part B coinsurance and copayments, blood work copays up to three pints, and hospice coinsurance and copayments.
Medicare Advantage plans are different. It’s important to know the distinction between the two because you cannot have both a Medigap plan and a Medicare Advantage plan.
The difference between Medicare inpatient and outpatient care may seem confusing. A licensed agent with Medicare Plan Finder may be able to help you find the right plan to cover your needs.
Our agents are highly trained and they can assess your needs and see if plans in your area can meet them. If you have questions and would like to speak to one of our licensed agents, please call 1-844-431-1832 or contact us here to arrange a no-cost, no-obligation appointment today.
This post was originally published on July 13, 2017, by Anastasia Iliou. The latest update was on January 2, 2020, by Troy Frink.
Does Medicare Cover Orthotics?
When you have foot problems, it may seem like every little movement you make causes excruciating pain. Even standing still can be difficult. Orthotics can provide relief for people experiencing orthopedic problems such as osteoarthritis, foot pain, or back pain.
Medicare is a great resource for eligible beneficiaries to help pay for medical expenses. Orthopedic care can come with a hefty cost, and you may want to know, “Does Medicare cover orthotics?” Yes, but only if your condition meets certain requirements.
Does Medicare Cover Orthotic Shoes or Inserts?
Orthotic shoes are custom-fitted footwear designed to reduce the patient’s pain for a variety of health conditions including:
Metatarsalgia: chronic pain in the ball of the foot
Plantar fasciitis: chronic breakdown of soft tissue around the heel
Bunions: a painful, bony bump on the outside of the big toe
For the most part, Medicare does not cover orthopedic or inserts or shoes, however, Medicare will make exceptions for certain diabetic patients because of the poor circulation or neuropathy that goes with diabetes.
Medicare may cover the fit and cost of one pair of custom-fitted orthopedic shoes and inserts once per year for those patients.
How Much Does Medicare Pay for Orthotic Services?
Podiatrists are doctors who specialize in the feet and ankles, and they prescribe and design medically orthotic devices. Orthopedic devices as part of a leg brace fall under Medicare’s guidelines for durable medical equipment (DME).
In order for Medicare to cover orthotics, your doctor must first determine that orthopedic care is medically necessary. Medicare Part B may cover about 80 percent of the Medicare-approved cost, and you may have to pay the remaining co-insurance. The company that supplies your DME must be Medicare-approved.
Does Medicare Cover Orthotics for Plantar Fasciitis?
Plantar fasciitis, also called “Policeman’s Heel,” is an often self-treatable and diagnosable ailment involving inflamed tissue on the bottom of the foot. You may feel stabbing pain near your heel. It can usually be treated with physical therapy, shoe inserts, steroid injections, and surgery in some cases.
Podiatrists often prescribe treatment for plantar fasciitis. If your doctor is able to prove that it is medically necessary and the prescription is required, you may be able to get coverage at the Medicare-approved amount. Additionally, there may be some Medicare Advantage plans in your area that provide coverage for orthotics for plantar fasciitis.
Does Medicare Cover Orthotics for Weight Loss?
According to the Hospital for Special Surgery (HSS), orthotics can help ease the extra stress on the feet for overweight people. Medicare does not cover orthotics for people who are overweight just because they are overweight.
Medicare may cover weight loss services such as surgery and/or nutrition counseling for people who qualify. Some Medicare Advantage plans even cover fitness programs!
You may also be able to get over-the-counter benefits with some Medicare Advantage plans. So, even though you may not qualify for prescription orthotic coverage, you may be able to find coverage for over-the-counter products you can find at your local drugstore or mail-order pharmacy.
Does Medicare Cover Orthotics After Hip Replacement Surgery
Sometimes doctors prescribe hip braces as a part of hip replacement surgery recovery. However, hip braces oftentimes don’t include a foot orthotic device. Medicare may help pay for the hip brace as part of your DME coverage, but coverage may not include an orthotic device.
According to Dr. James P. Ioli, DPM, a podiatrist with the Harvard Medical School, you should have a physical therapist assess your “pelvic, hip, knee, ankle, and foot movement” to examine how your “soft tissue restrictions [muscle and cartilage stiffness]” and flexibility contributes to your pain. The physical therapist can address your pain and make recommendations to manage it.
Does Medicare Cover Transportation for Orthotics Appointments?
If you don’t need an ambulance, some Medicare Advantage plans cover non-emergency medical transportation to doctor’s appointments, to the hospital, and to the pharmacy. Contact your agent to learn more about Medicare Advantage supplemental benefits.
Does Medicare Cover Podiatry?
While Medicare will only cover orthotics if they’re part of a leg brace or for diabetes, Medicare will cover treatment for the following conditions:
Morton’s Neuroma is irritation of nerves in the toe. One common sign of Morton’s Neuroma is numbness, and podiatric treatment for Morton’s neuroma includes using a metatarsal pad, cortisone injections and surgery in some extreme cases.
Plantar Fasciitis is when the plantar fascia tears. The breakdown causes severe pain with standing and walking. Patients usually experience the most pain first thing in the morning because the calf and foot muscles tighten up overnight.
Plantar Fasciitis treatment includes physical therapy for proper stretching exercises, wearing a splint at night and cortisone injections. If pain becomes severe, a podiatrist might recommend surgery.
The pain and stiffness associated with bunions usually worsen gradually. Podiatrists normally start small with treatment and prescribe bunion pads, toe spacers or shoe inserts. If those items fail, the podiatrist may recommend surgery.
Stress fractures occur after repeated blows to an area cause tiny fractures. Common causes of stress fractures include walking, running, frequent jumping and playing sports.
Most stress fractures will heal on their own after the patient walks with crutches or uses a walking boot. In some severe cases, the fracture won’t heal because it’s in a complex foot bone, and surgery will be the only course of action to correct it.
Peripheral Neuropathy is caused by nerve damage. The damaged nerves are unable to send the proper messages from the central nervous system to the rest of the body.
Peripheral Neuropathy causes the patient to experience pain, burning sensations, numbness, tingling, and weakness. Common Peripheral Neuropathy causes include:
Peripheral Neuropathy has no cure, and treatment only relieves the patient’s symptoms. The most common treatment for neuropathic pain is prescription drugs, but also topical creams, gels, and patches. In some cases, a cortisone sympathetic nerve block can provide temporary pain relief.
Medicare will only cover your treatment if your podiatrist says it’s medically necessary. Medicare Part B may cover 80% of the Medicare-approved costs. You will be responsible for the Medicare Part B deductible in order for Medicare to cover podiatry.
Podiatric Care Not Covered by Medicare
Medicare does not cover routine podiatry services, because CMS doesn’t consider them to be medically necessary. Some of those treatments and services include:
Foot cleaning and soaking
Removing corns and calluses
Treatment for flat feet
Get Medicare Coverage for Orthotics and Podiatry Today
Medicare will only pay for limited podiatric services, and having the right coverage can make all the difference in your quality of care. The licensed agents at Medicare Plan Finder are highly trained and ready to help you find a plan to suit your budget and lifestyle. Call us at 833-431-1832 or contact us here today.
This post was originally published on May 28, 2019, and updated on December 11, 2019.
5 Common Types of Mental Illness In The Elderly
Most of today’s senior citizens grew up in a time when mental illness was almost never discussed in public. Over the years though, the stigma around mental health has largely eroded and conversations about mental health often dominate the national discourse.
As mental illness becomes less taboo, its far-reaching impact on society is coming more into focus. For example, the effects of mental illness in seniors are studied much more closely than ever before.
Common Types of Mental Illness In Seniors
With this more extensive research, it’s easier to see what mental health issues are common in the elderly population. The most prominent issues in senior mental health are:
Depression is often cited as the most endemic mental illness in the elderly population today. Many older adults may shrug depression symptoms off as simply “feeling down,” meaning it often goes undiagnosed and may be even more pervasive than the research suggests.
There are many risk factors that specifically contribute to depression in the elderly. Retiring from work can cause strong feelings of boredom or listlessness, and the death or illness of a spouse can leave many stressed and sorrowful.
Not only can depression exacerbate the symptoms of other chronic health issues, it is also noted as a symptom of more severe mental disorders like dementia. This means seniors and their loved ones must be vigilant in watching for these depression symptoms:
Feelings of sadness, hopelessness, or emptiness
Lack of motivation or interest in previously enjoyed activities
Trouble concentrating and decision making
Thoughts of suicide or self-harm
Anxiety disorders can take many different forms, such as obsessive-compulsive disorder (OCD), panic disorder, or generalized anxiety disorder. These are usually characterized by intense fear or nervousness over issues most would consider normal, routine aspects of everyday life – locking doors or finding a parking spot, for example.
Like depression, anxiety in older adults is extraordinarily common and is often underdiagnosed. Older adults are especially prone to ignoring this illness, perhaps because the conventional medical wisdom of previous decades downplayed psychiatric symptoms if no physical issues existed.
It is important to note however, that some physical symptoms such as restlessness or fatigue may accompany anxiety, further confusing a potential diagnosis. Be on the lookout for these symptoms of anxiety in the elderly:
Irrational, obsessive, or catastrophic thoughts
Isolating behavior and withdrawal from others
Irritability or agitated moods
Fatigue and muscle soreness
3. Bipolar Disorder
Bipolar disorder is usually diagnosed in younger people, whose moods can swing quickly from elation to depression. If this diagnosis is made when the person is an older adult, it is referred to as late onset bipolar disorder and it is more likely to manifest as agitation.
Diagnosing bipolar disorder in seniors is made even more difficult by the misinterpretation of symptoms. Many of the warning signs of late onset bipolar disorder might be dismissed as simply the natural effects of aging. Furthermore, some symptoms may resemble the side effects of certain medications, like antidepressants and corticosteroids.
As the population steadily increases, the number of cases of late onset bipolar disorder is expected to rise along with it. Professional help should thus be sought if you or those close to you observe any of these bipolar symptoms in adults:
Agitation and irritability
Hyperactivity or distractibility
Loss of memory, judgment, or perception
Similar to bipolar disorder, schizophrenia is a condition usually diagnosed in younger individuals. Late onset schizophrenia is the terminology used when this disorder is observed in patients over the age of 45.
Schizophrenia is characterized by a broad range of symptoms, from the so-called “negative” symptoms, like loss of interest or enthusiasm in activities, all the way to delusions and hallucinations. While late onset schizophrenia is less common than the early onset variety, older sufferers are more likely to experience these severe symptoms.
Currently, doctors are unsure what causes late onset schizophrenia and why it is different from its other forms. Some have theorized that it is a subtype of the disorder which is triggered by life events. Regardless, it is vitally important that seniors and their loved ones keep an eye out for these late onset schizophrenia symptoms:
Delusions or hallucinations
Disorganized speech or behavior
“Negative” symptoms (absence or lack of interest in normal behaviors)
Though it is classified separately from mental illnesses by the medical community, dementia is still a disorder that severely affects mental health. There are many different stages and forms of dementia but the most common incarnation is Alzheimer’s disease, which affects around 3 million people over age 65.
Alzheimer’s and other forms of dementia can develop from the natural cognitive decline that happens as we age, drawing a startling link between aging and mental health. All demographics should make mental health a priority but seniors especially should watch for these dementia symptoms:
Disorientation or confusion (forgetting dates, years etc.)
Decrease in memory
Decline in ability to communicate
Mood swings and emotional issues
Treatment & Medication
Mental illness treatment can be a tricky process and it begins with a proper diagnosis of the condition’s type and cause. To do this, your doctor may administer several different types of tests, from cognitive and psychiatric evaluations to brain scans and lab tests.
Several different mental conditions have symptoms that overlap and make them difficult to diagnose without extensive medical experience. Once the condition is properly diagnosed, a doctor may suggest one of these common forms of mental illness treatment.
The most common forms of outpatient mental illness treatment are based around medication or psychotherapy, often used in conjunction. The efficacy of these treatments varies from person to person and sometimes multiple treatment options must be attempted before an effective one is found.
For depression and anxiety disorders, pharmacological methods of treatment usually utilize antidepressants. These can be prescribed in addition or as an alternative to psychotherapeutic approaches like “talk therapy.” The Anxiety and Depression Association of America (ADAA) also suggestsregular exercise and a balanced diet as ways of staving off these common mental illnesses, stressing the link between brain and gut health.
The primary medications used in treating bipolar disorder and schizophrenia in seniors are classified as antipsychotics, usually prescribed at a lower dosage than people diagnosed at a younger age. For non-drug treatments of more severe cases, inpatient care is often required for proper rehabilitation.
For the treatment of dementia in the elderly, no cure is currently known. But the symptoms can be managed and the Alzheimer’s Association recommends a non-drug approach before attempting medication. These can begin with something as simple as changing the environment of those with dementia to remove obstacles and promote a general ease of mind.
If these non-drug approaches are not effective, certain types of medications like cholinesterase inhibitors and memantine may be prescribed to temporarily relieve some symptoms. Other approaches may include the use of antidepressants or anxiolytics, depending on the specific behaviors and symptoms that manifest.
With the more serious mental illnesses widely seen among seniors, outpatient care may not be an option. Those suffering from bipolar disorder or dementia may not be able to maintain their daily functions on their own and must turn to medical services that can attend to their needs 24 hours a day.
For example, the most common form of therapy for conditions like schizophrenia is a psychosocial approach, where a team of doctors, nurses, social workers and other professionals work in close contact with the patient to monitor their symptoms, both mental and physical, and help them maintain social skills and daily activities.
In these severe cases of mental illness, the accessibility of quality inpatient care has been shown to be a determining factor in recovery. The psychosocial interactions common in inpatient care are now considered to play a necessary role in a comprehensive intervention plan, as isolation can intensify many of the symptoms of these conditions.
What mental health services does Medicare cover?
When faced with one of these potentially life-changing illnesses, it is important to know what exactly is covered by your health insurance. Depending on the condition and its severity, some patients may need an extended stay in a hospital, which can quickly skyrocket the cost of care. Fortunately, Medicare covers many mental health services.
Medicare Part A Coverage
The types of mental health coverage offered differ depending on which elements of Medicare you are covered by. Medicare Part A covers inpatient care, or the medical services you receive while staying in a hospital. The out-of-pocket costs not covered are the same regardless of the type of hospital, general or psychiatric.
Medicare measures your use of hospital facilities using benefit periods. These benefit periods are tallied in increments of 60 days, beginning on the day you’re admitted to a hospital and ending when you haven’t used any hospital services for 60 consecutive days.
If your stay is in a general hospital, there is no limit to the amount of benefit periods Medicare will cover. In a specialized psychiatric facility though, Part A will only pay for up to 190 days of inpatient care during your lifetime.
For further information on how the co-payments break down, check out this handy graphic or see our more in-depth article here.
Medicare Part B Coverage
Medicare Part B will cover most of the cost associated with outpatient mental healthcare. This primarily includes any doctor visits that may relate to your mental health, including appointments with psychiatrists, psychologists, nurses, and social workers.
Therapy and counseling may or may not be covered depending on if the doctor accepts Medicare assignment. Finding a therapist who takes Medicare is now easier than ever, using tailored search tools like the one developed by Psychology Today, available here.
After you meet your Part B deductible, Medicare will cover 80% of their approved amount to the doctor or therapist. This leaves a 20% copay that will have to be paid out-of-pocket. For some, this may still be too expensive and that’s where Medicare Advantage, Supplement, and Part D plans can help!
Medicare Advantage, Supplement & Part D Coverage
There are several types of supplemental coverage that can help pay for Medicare mental health benefits.
Part D plans, for example, offer coverage for prescription drugs which are not covered by original Medicare. For the year of 2020, these plans will have an annual deductible of $435 but, since they are provided by private insurance, there is some variation in the deductible, which may be waived, reduced, or charged upfront.
Medicare Advantage plans, also referred to as Part C, can offer far more benefits than parts A and B alone, including prescription drugs, dental and vision coverage, and group fitness classes tailored to seniors.
Alternately, you may choose to apply for a Medicare Supplement plan, which provides additional financial benefits to help with mental health-related costs like copayments and deductibles. There are up to ten distinct types of Medicare Supplement plans (designated alphabetically from A – N). Each plan may differ in coverage and price.
Whatever supplemental coverage you are looking for, it is best to seek the help of a licensed agent who can fully explain the details of each plan and find one that works best for you or your loved one. To contact one of these professionals directly for free, no-strings-attached information, fill out this form or give us a call at 844-431-1832 and get covered today!
Does Medicare Cover Weight Loss Programs ?
Did you know that you can use your Medicare coverage to fight obesity? Medicare coverage for weight loss can include obesity screenings, obesity counseling sessions, nutritionists, and qualified dietitians. It may even include gym membership discounts. If you think eating well and exercising is too expensive, think again: your Medicare plan can cover it!
Medicare Part B Weight Management Services
Since obesity is classified as a disease, Medicare Part B covers it like any other ailment. It all starts with your “Welcome to Medicare” annual wellness visit when you first enroll, and it continues with your yearly wellness visits. At your appointments, your doctor should check your height, weight, blood pressure, and BMI – all things that can help your doctor diagnose you with obesity and provide proper treatment. These appointments do not require cost-sharing.
If your doctor considers you at risk for obesity, you may be eligible for preventative counseling and even appointments with a nutritionist. Medicare Part B can cover medically necessary obesity counseling and nutrition therapy.
Obesity commonly leads to heart disease. Medicare Part B covers cardiac rehabilitation (exercise, education, and counseling) for those who have had a heart attack, heart failure, or a related surgery.
Nutritionists & Dietitians
Your doctor may recommend that you see a nutritionist or dietician.
Be careful when choosing a nutritionist or dietitian, because Medicare does not cover all of them. For Part B to cover this service, you must medically require it, and the nutritionist or dietitian must accept Medicare assignment. Medicare only covers trained nutritionists under Part B as MNT (medical nutrition therapy). Any patient who has diabetes, kidney disease, or has had a kidney transplant is eligible based on medical need.
Obesity Screenings & Counseling
As long as you have Medicare Part B and have a BMI (body mass index) of 30 or higher, you are eligible for obesity screenings and counseling. The National Heart, Lung, and Blood Institute has a free BMI calculator on its website, but a doctor’s screening will be much more accurate. Your BMI is the percentage of your bodyweight that is made up of fat. Remember that some fat is healthy – you are not aiming for a BMI of zero. A healthy BMI is between 18 and 25. Lower than 18 is too little, 25-30 is a bit high, and above 30 is obese.
When you do get your free obesity screening, you might consider behavioral counseling for body fat loss. Your primary physician should offer their own obesity counseling. If not, they might recommend another Medicare-covered service.
The only true “Medicare weight loss programs” are fitness programs.
Original Medicare (Part A and Part B) does not cover gym memberships or fitness programs, but private plans may include a gym membership or fitness center discounts. These are usually offered through major Medicare fitness programs such as SilverSneakers® and Silver & Fit®.
Plans with these benefits are not available in every county. Look over your plan or speak with your agent if you aren’t sure about fitness coverage in your Medicare plan.
Obesity Is a Disease
In 2013, the American Medical Association officially started recognizing obesity as a disease. As such, with a BMI of 30 or higher, you can qualify for “obesity behavioral therapy.
The disease affects approximately ⅓ of Americans, and this recognition allows it to be taken more seriously in the medical community and increase research funding. The classification also helps decrease the stigma involved with obesity. It is a commonplace lie that obesity is merely the result of overeating and a lack of exercise. Some people lack the mental strength to control their eating habits and others are incapable of exercising for one reason or another. Saying that obesity is a disease opens the door for obesity counseling and physical therapy as a form of treatment.
Obesity is a common disease in the senior citizen community due to a reduction in physical activity and a lack of access to good nutrition. Additionally, other common senior conditions like heart disease, diabetes, and physical impairments can make it harder to focus on nutrition and exercise. That’s why it’s so important to use your Medicare coverage for healthy eating, exercise, and weight loss.
Does Medicare Cover Weight Loss Surgery/Bariatric Surgery?
Medicare Part B covers bariatric surgeries such as gastric bypass surgery and laparoscopic banding surgery (LAP-BAND). However, you must meet certain criteria. For example, your doctor must determine that Medicare weight-loss surgery is necessary.
Bariatric surgery is a procedure that reduces the amount of food the stomach can hold, effectively forcing you to eat less. However, it is invasive and not recommended for everyone.
Medicare does NOT cover cosmetic surgeries, such as excess skin removal for weight loss surgery.
Types of Bariatric/Weight-Loss Surgeries
The most common bariatric surgeries are a gastric bypass, a sleeve gastrectomy, an adjustable gastric band, and a biliopancreatic diversion with duodenal switch.
Generally, bariatric surgery is recommended for people with:
A gastric bypass is a weight-loss surgery that has been performed for over 50 years, making it the most experienced bariatric operation. In this procedure, a large section of the stomach is stapled off, creating a pouch that connects to the small intestine. The pouch can only hold a few ounces of food, so patients are unable to eat as much as they used to (and won’t feel as hungry).
This procedure requires that patients make major dietary changes. Protein, vitamin B12, iron, and calcium become increasingly important. Sweet and fatty foods must be avoided.
A sleeve gastrectomy is performed laparoscopically. About 75% of the stomach is removed, causing it to form a “sleeve” shape. This procedure is used for people with a BMI over 40. It often results in 60% weight loss.
A sleeve gastrectomy cannot be reversed. It typically does not have an effect on diet (except for during recovery time).
Adjustable Gastric Band
A laparoscopic gastric banding procedure is the least invasive. A soft, silicone ring with an expandable balloon is implanted at the top of the stomach. It basically creates two compartments for the stomach. The patient will only eat enough food to fill the top part. Over time, the food will pass through into the second (original) compartment of the stomach and will be digested.
This surgery is newer and was not approved until 2001. There may be some long-term complications with this surgery, such as frequent vomiting, implant malposition, erosion, or weight loss failure.
Biliopancreatic Diversion with Duodenal Switch
The duodenal switch procedure starts with a sleeve gastrectomy. Then, the lower intestine is divided, leaving only a few feet of intestine connected to the digestive tract.
This procedure usually results in the greatest weight loss, but patients will likely have frequent and loose bowel movements and gas. Patients will also need to be closely monitored for healthy vitamin, mineral, and protein levels.
In some cases, a doctor or surgeon may recommend that you undergo the sleeve gastrectomy first, then revisit the duodenal switch in 9-12 months.
The duodenal switch often results in 60-80 percent excess weight loss within two years.
Finding a Doctor for Obesity Treatment
Your primary physician can at least help you get started on your obesity treatment but might refer you to a nutritionist or other specialist if necessary.
Be sure to check with your plan network to make sure your doctors and specialists are covered. You can use Medicare.gov’s Physician Finder to find out if a doctor accepts Medicare, and visit your private plan’s website to find out if your doctor or specialist is in your plan’s network.
Are There any Medicare-approved Weight Loss Programs?
Medicare has not formally approved any weight loss programs or fad diets. Speak to your doctor before joining a new program. Here is some information about popular weight loss programs.
Recently, private Medicare Advantage plans have been given the ability to cover more benefits, and dietary programs like this could be one of them. However, it is more common to find Medicare Advantage plans that cover Medicare fitness programs and nutritionists.
Optifast is advertised as a “medically-supervised” and “science-based program that delivers weight loss for health gains.” On average, Optifast users ave lost 30 pounds over 26 weeks (which is a healthy ratio). They’ve also seen decreases in blood glucose levels, blood pressure, and cholesterol.
The program provides meal replacements that include 100% of the recommended daily value of 24 different vitamins and minerals. There are five daily servings. Optifast comes in shake mix, bars, soups, and chewable vitamins.
The Jenny Craig plan includes a variety of foods and a personal consultant that you can connect with weekly. The meal plans ask you to eat every two to three hours and allow you to mix in your own fresh fruits, vegetables, and dairy. Three entrees and two snacks cost less than $25 per day.
In some areas, you’ll be able to visit and pick up your food from a local weight loss center. Otherwise, you can join Jenny Craig online.
Weight Watchers revolutionized fad dieting with their point system.
Each Weight Watchers user will have a unique amount of “points” they are able to use each day. Every piece of food is awarded a point value (though some may be worth 0 points). Your daily point budget is based on your age, height, weight, and sex. Technically, you can eat whatever you want as long as you don’t go above your daily points budget.
Weight Watchers is not very expensive, starting at $3.07 per week for the digital-only plan. You can download the Weight Watchers app and do it all yourself!
What’s nice about the Weight Watchers diet is that you don’t have to eat frozen foods shipped to you, you can keep buying your own groceries and cooking healthy meals. You may even be able to keep enjoying some of your favorite foods, as long as you enjoy them in moderation.
Medicare for Diabetes and Weight Loss
Obesity can put you at a higher risk of developing diabetes. You can use your Medicare coverage to help prevent both obesity AND diabetes.
Medicare Part B covers diabetes self-management training (DSMT), blood sugar monitors, blood test strips, lancets devices, lancets, therapeutic shoes or inserts, and external insulin pumps.*
Additionally, Medicare can cover your participation in the 16-session Diabetes Prevention Program if you:
Have a BMI over 25 (23 if you are Asian)
Have never been diagnosed with either diabetes or ESRD
Have not participated in this program before
Have a hemoglobin A1c test result of 5.7-6.4%, a fasting plasma glucose result of 110-125 mg/dL, or a two-hour plasma glucose result of 140-199 mg/dL (test results must be from the past 12 months)
Medicare Part A covers hospital stays, and Medicare Part B covers physician services. If you are over the age of 65, you automatically qualify for Medicare coverage. You can also qualify by receiving SSDI (Social Security Disability Income) for 25 months or more or by being diagnosed with either ALS (Lou Gehrig’s Disease) or ESRD. Most people will get premium-free Part A but will have to pay a monthly premium for Part B.
To add more to your Medicare plan, the best option is to enroll in a MAPD, or Medicare Advantage Prescription Drug plan. These plans include everything that Part A and Part B covers plus prescription drug coverage and other benefits like dental, vision, and fitness programs like SilverSneakers® and Silver & Fit®.
We have benefits advisors in 38 states that can help you select the best Medicare Advantage Prescription Drug plan for your needs. Some people may even be able to get a MAPD plan with a $0 premium! To find out more, chat with us, send us a message, or give us a call at 833-438-3676.
This post was originally posted on June 22, 2017, and was last updated on December 3, 2019.
Is UnitedHealthcare Dropping SilverSneakers in 2020?
As of January 1, 2019, UHC no longer offers SilverSneakers® with Medicare Advantage plans in 11 states:
Along with Medicare Supplement (Medigap) plans in nine states:
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?
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.
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
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.