Surgeons perform more than 3.8 million cataract procedures every year in the United States. As you age, your risk of developing cataracts increases. Approximately half of all Americans will develop cataracts by age 75.
Before factoring in health care coverage, cataract surgery can cost $3,700 to $7,000 per eye. If you have one of the millions of cases of cataracts, you may wonder, “Does Medicare cover cataract surgery and implants?” Yes. Medicare covers these costs for qualified Medicare beneficiaries.
How Much Does Medicare Pay for Cataract Surgery?
Original Medicare (Part A or Part B) generally* does not include vision coverage. However, cataract surgery is an exception. Medicare Part B covers basic lens implants and cataract removal.
If your provider recommends an advanced lens implant, you may need to pay some or all of the additional costs. It’s essential to talk with your doctor to get a clear understanding of the necessary procedure.
*Medicare Part A may cover emergency services in a hospital.
Medicare Part D, which is the prescription drug plan, may cover any prescription medications you need after you have had your cataract surgery.
Incidentally, any medications you need before surgery, such as prescription eye drops, will be covered by Medicare Part B. Part B will also cover eyeglasses or a set of contact lenses for cataract surgery that implants monofocal intraocular lenses (IOL).
Since Part D has no deductibles, you may be responsible for a specified copayment amount that you must pay when you get your prescription drugs.
What Type of Cataract Surgery Does Medicare Cover?
Medicare covers two types of surgery: manual blade surgery and laser surgery.
Medicare will also pay for an intraocular lens (IOL), which corrects presbyopia or astigmatism, but only if these lenses should be replaced because of cataracts.
Does Medicare Pay for Laser Cataract Surgery?
Medicare coverage for cataract surgery doesn’t depend on the surgical method. Medicare will cover 80% of the cataract removal and basic lens whether the procedure is conventional or bladeless with a computer-controlled laser. Similar to conventional surgery, laser surgery requires you to pay the additional costs if you require an advanced lens.
Does Medicare Pay for Cataract Surgery With Astigmatism?
Since you can correct astigmatism with glasses, Medicare will only cover a cataract surgery with astigmatism if the cataract surgery itself is considered necessary. If this is the case, Medicare will pay for the cataract surgery.
Does Medicare Cover Glasses or Contacts?
For the most part, Medicare does not cover routine vision care, glasses, or contact lenses. However, Medicare can make an exception
You may be wondering, “How much does Medicare pay for glasses after cataract surgery?” After your surgery, Medicare will cover 80% of the costs for prescription glasses or contacts, but you must purchase them through a provider who accepts Medicare assignment.
You will be responsible for the remaining 20%. Some beneficiaries have trouble getting Medicare to cover the pair of glasses or contacts.
If you are denied coverage, you can appeal the decision and request that they are covered. If you already paid for them out of your own pocket, you can request reimbursement.
You and your health provider can write a letter to add to your appeal, just be sure to state that you had met the requirements for cataract surgery, so your glasses or contacts must be covered.
What Is the Average Cost of Cataract Surgery?
Cataract surgery can range from $3,800 to $7,000 per eye without a health insurance plan. For standard cataract surgery, the average cost is $3,700.
However, the average cost of astigmatism-correcting surgery is $5,000, and presbyopia-correcting is about $7,000.
What does Medicare pay toward cataract surgery? It depends on the Medicare plan you are enrolled in. If you are only enrolled in Original Medicare, you will need to pay a 20% coinsurance and your Medicare Part B deductible, which is $185 in 2019.
You may be able to get even more coverage through a Medicare Supplement plan (Medigap) or Medicare Advantage plan. Additionally, because cataracts cloud the eye lens, eye surgery is classified as a medical condition.
This means that Medicaid could also pay some of your cataract surgery costs.
How to Find a Cataract Surgeon Who Accepts Medicare
Ophthalmologists are eye doctors who specialize in vision correction and care. Many times your ophthalmologist will perform your cataract surgery.
Since not every ophthalmologist will accept Medicare Advantage and you may not want to go through the trouble of finding another healthcare provider, then ask your health insurance provider to give you a Medicare eye doctor list.
However, it may be a little more difficult to find a cataract surgeon who accepts Medicare in 2020 because the physician fee schedule has changed since last year. Eye surgeons have had to take a 15% cut in reimbursement compared to Medicare coverage for cataract surgery in 2019.
So another option is to use the Medicare.gov’s physician compare tool to help you find an eye surgeon who accepts Medicare.
Click here to get started. First you’ll come to the physician finder tool. Enter your zip code in the search bar beside the red arrow. We used 37209, which is our corporate offices’ zip code in Nashville, TN.
Then type “ophthalmology” in the search bar above the green arrow. Then click “Search” beside the yellow arrow.
Then you’ll come to a list of ophthalmologists who currently accept Medicare. Use the contact info to call different doctors to find the right fit.
Medicare Requirements for Cataract Surgery
Your vision must be 20/40 or worse to qualify for surgery. Your doctor will need to document that your vision is at this level or lower.
You also need to have difficulty completing daily living activities like reading, sewing, watching television, or driving.
It’s important to remember that the cloudiness in your eye is not directly correlated to the severeness of your cataracts. If you are unsure of your vision level or whether or not you qualify, visit your eye doctor.
Cataract Surgery and Medicare Supplements
Medicare Supplements work alongside Original Medicare and are a great way to add financial benefits to your current coverage. They can help cover your 20% coinsurance and your Medicare Part B deductible.
Plan F is currently the only plan that covers your Part B deductible.
However, Plan F was discontinued in 2020. If you enrolled in it before the start of 2020 you are locked into this plan and will maintain coverage. If you are interested in enrolling in Medicare Supplement Plans, fill out this form or give us a call at 1-855-783-1189 (TTY 711).
Cataract Surgery and Medicare Advantage
Medicare Advantage plans are required to cover, at a minimum, the same as Original Medicare. However, MA plans offer several additional benefits like prescription drug coverage, hearing and dental coverage, group fitness classes like SilverSneakers, and additional vision coverage.
Benefits will vary by plan but can include routine eye exams, eyeglasses, contacts, frames, and fittings. These benefits allow you to check your vision each year and update your prescription, lenses, and frames as needed.
If you are only enrolled in Original Medicare, you will need to pay for these expenses out of your own pocket.
What Are Cataracts?
Our eyes have a lens that works much like a camera. The lens bends light so you can see your surroundings.
A cataract makes that clear lens cloudy, and it can be more difficult to read or drive a car.
What Causes Cataracts?
Most of the time, cataracts develop with age, or when an injury changes your eye’s lens. As you age, the lens can become stiffer, thicker, and less transparent.
Sometimes genetic disorders, other eye conditions, medical conditions such as diabetes, or past eye surgery can contribute to cataract development. Other causes can be long-term steroid medication use.
According to the Mayo Clinic, signs and symptoms of cataracts can include:
Cloudy, blurry or dim vision
Increasing difficulty seeing at night
Sensitivity to light and glare
Need for brighter light for reading and other activities
Seeing “halos” around lights
Frequent changes in glasses or contact lens prescription
Fading or yellowing of colors
Double vision in one eye
How Do You Know If You Need Cataract Surgery?
Talk to your doctor if you experience any changes to your vision such as cloudiness or halos around lights. According to Harvard University, you should have an eye exam every year if you’re 65 or older.
Dr. Laura Fine, an ophthalmologist with Massachusetts General Hospital, says you don’t need cataract surgery until you think you need to see better.
Learn More About Medicare and Cataract Surgery
A licensed agent with Medicare Plan Finder may be able to find plans in your area that fit your budget and lifestyle needs.
Are you interested in learning about available plans in your area? Fill out this form or give us a call at 1-855-783-1189 (TTY 711) to schedule a no-cost, no obligation appointment with a licensed agent.
Does Medicare Cover Genetic Testing for Cancer?
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.
2020 Assistive Devices for the Elderly: Feel Comfortable With Independent Living
As you age, simple tasks like buttoning your shirt, getting out of your chair, and putting on your shoes can become increasingly difficult. Assistive devices can help restore your confidence, improve mobility, and increase safety in your home.
The first step in making your day-to-day life easier is understanding assistive technology, durable medical equipment, and the role of Medicare.
What Is Assistive Technology?
Assistive technology (AT) covers a wide platform of devices for older adults who may need just a little bit of help. Assistive, adaptive, and rehabilitative devices all fall under the assistive technology umbrella.
Assistive devices help seniors maintain their functional independence. This, in turn, promotes their well-being. Communication aids, pill organizers, spectacles, memory aids, prostheses, or wheelchairs assist family members with cognitive decline or physical challenges with their daily activities.
Caregivers can improve an elderly person’s range of activities of daily living by carefully selecting the most appropriate assistive devices for safe, independent living.
For instance, encouraging the use of personal care products for good hygiene, grooming, and dressing can help older people maintain their dignity, raise their self-esteem, and improve their mobility by allowing them to take care of themselves.
Assistive technology can be used in various settings, such as living at home, in a nursing home, or in an assisted living facility.
Common Assistive Devices
High-tech mobility devices, such as walking canes, stairlifts, power wheelchairs, and scooters, can help seniors maintain their mobility. Mobility aids may also include low-tech assistive devices like transfer benches and bed rails because they reduce the risk of falls.
Meanwhile, adaptive devices are designed to make an available technology more accessible. For example, adaptive switches will allow an elderly person to activate switch-adapted electronics.
There are also assistive listening devices, called Frequency Modulation systems, that connect hearing aids to media such as tablets, smartphones, computers, and music players. Additionally, screen magnifiers are software products that interface with the graphical output of a computer to enlarge content on a screen.
We’ll split assistive technologies into health, home, and comfort categories. You can purchase these products online and in-store from companies like Amazon, Walmart, and Target. Some health devices can be priced as low as five dollars.
Health devices act as an extra layer of protection and are a great way to prevent falls and accidents. For example, grab bars in the bathroom can help you get in and out of the shower and keep you stabilized and balanced. Consider purchasing:
Activator poles to keep you stabilized and balanced.
Grab bars to keep your balance in hallways, stairwells, bathrooms, etc.
A bed cane to help you get in and out of bed.
A shower bench so you can sit and avoid falling in the shower.
Toilet rails to help you sit down and keep your balance.
Stairlifts so you can go up or down stairs with ease.
Wheelchair ramps so you can easily get into and out of your home.
Slip-free stair strips to keep you from slipping on slick surfaces.
Home devices are a fantastic way to increase independence and confidence in your home and make it easier for you to be home alone. For example, if you need a walker or cane to get around comfortably, an automatic swing door opener allows you to open the door hands-free. Common home devices include:
Video doorbells so you can see who’s at the door before you get up.
Fall detectors to alert your friends and family if you take a tumble.
A power failure alarm to alert you of lost power and provide emergency lighting.
An automatic swing door opener so you can open doors hands-free.
A talking thermostat so you can hear the temperature settings.
Voice-activated lights to turn your lights on and off without getting up.
Sometimes the smallest tasks can cause the largest frustrations. For example, you may be easily annoyed if you can’t button your shirt yourself or hear the television well. Common comfort devices include:
A buttoning hook to help you button shirts and pants.
A zipper pull so you don’t have to fumble with small zippers.
A modified keyboard so you can see the letters on the keys more clearly.
Robotic vacuums so you can have clean floors without lifting a finger.
A table tray so you can eat anywhere in your home.
A mattress lift so you can get in and out of your bed with ease.
A sound amplifier to help you hear conversations, television shows, etc.
Assistive Technology Devices
Georgia Tech describes high-tech assistive technology gadgets for seniors who want to remain independent as complex devices with digital or electronic parts that can be computerized.
They point out that these devices are often expensive, usually require training, and take some effort to learn. Some examples of helpful things for elderly people that have a small learning curve are power wheelchairs, digital hearing aids, and voice-activated telephones.
Durable Medical Equipment
Durable Medical Equipment (DME) includes equipment like hospital beds, oxygen equipment, sleep apnea devices, glucose monitors, and some of the assistive devices mentioned above. DME devices are covered under Medicare Part B. You will be responsible for 20%.
The equipment must be durable, used for a medical reason in your home, and have an expected lifetime of at least three years for Part B to cover it.
Medicare Advantage (MA) plans can also cover DME and assistive devices. The difference is that MA plans are able to offer additional benefits that Original Medicare does not. This includes benefits like hearing, dental, and vision coverage.
With so many products for elderly people living alone, it can often be difficult for a caregiver or senior to make a decision on what to buy. For instance, a senior who asks, “How do I choose a walking aid?” has to select between wheeled frames, walking frames without wheels, folding frames, indoor trolleys, and outdoor trolleys.
Consequently, the right decision requires a clear assessment of needs and then matching those needs with available features.
If deciding on a walking aid is complex, imagine how much more bewildering it must be for caregivers to select the best smart device for elderly patients? For instance, when it comes to smartphones, GreatCall offers a variety of options, such as the Jitterbug Smart 2 and the Jitterbug Flip.
Again, it’s about matching needs with features. Some expert advice from someone familiar with technology is helpful.
What to Consider Before Purchasing
A family caregiver helping a loved one decide what assistive device to purchase must consider factors like independence, specific needs, personal goals, simplicity, and so on. Before making a purchase, it’s useful to talk to a professional or people who have purchased the device, consider the cost, and ask if a trial is available.
Implementing assistive technology in the home may require some structural modifications to a room. When considering interior home modifications, such as relocating switches, installing emergency alarms, or lowering bench heights, it’s usually practical and cost-effective to only modify necessary areas in an apartment or house.
Assistive technology devices for elderly people can be classified into two broad groups, high-tech AT, such as smartphone systems and sensors, and low-tech AT, such as pill organizers and canes. Usually, people who need assistive devices require both kinds.
In addition to mobility AT, personal care AT, and communication AT, there are a number of assistive technology devices for seniors with cognitive decline. For instance, seniors with Alzheimer’s or Parkinson’s disease with significant memory loss can benefit from wearable timers that have set and forget features for managing things like turning off the stove after cooking or running water in a bath.
They will also benefit from smartphone apps that remind them of to-do lists or appointments.
Where to Buy Assistive Devices
A caregiver or senior can buy assistive technology from online tech stores. In 5 Assistive Technology Stores for your Techie with Special Needs, author Lauren Lewis recommends five top online stores that sell assistive devices: EnablingDevices.com, Boundless Assistive Technology, Enable Mart, Infogrip, and Able Net. Her article covers each store’s specialty.
Assistive Technology and Devices Coverage
Assistive technology and devices can improve your life in several areas. If you are interested in learning more about things to help at home, such as increasing your independence, improving your quality of life, supporting your health, and restoring your confidence, let us help you!
We have licensed agents across 38 states that are contracted with all of the major carriers and can help you find a plan that makes it easier for you to afford assistive devices for elderly parents or patients. To get started, call 833-438-3676 or click here.
Alzheimer’s Care Guide: Symptoms, Stages, Prevention, and Treatment
There are more than 5.7 million Americans living with Alzheimer’s. This number is expected to reach 14 million by 2050.
The complications from this disease make Alzheimer’s the sixth leading cause of death in the United States, so it’s important to educate yourself on the symptoms, signs, stages, prevention, and treatment.
Difference Between Alzheimer’s and Dementia
Dementia is a syndrome and used to describe symptoms that include memory loss, difficulty problem solving, and struggling with thoughts and language. Alzheimer’s is a disease and is a type of dementia.
In fact, there are over 100 types of dementia. Some forms of dementia can be temporary, reversed, or cured, however, Alzheimer’s disease cannot.
Alzheimer’s Symptoms and Stages
Alzheimer’s can cause changes in the brain long before any symptoms or signs start to show. Understanding the symptoms can help you detect Alzheimer’s early on and increase your chance of benefiting from treatment.
The risk of developing Alzheimer’s will vary per individual, but the following are the largest risk factors.
Age: Alzheimer’s is not a normal part of aging, however, your risk increases with age. Most people with Alzheimer’s are diagnosed after the age of 65. After 65, your risk doubles every five years.
Family History: If your parent or sibling was diagnosed with Alzheimer’s, you are more likely to develop the disease. This risk increases with the number of diagnosed family members.
Other Risks: There is a strong connection between our hearts and our brain. If you have heart disease, are overweight, or lack regular exercise, you’re at a higher risk of developing Alzheimer’s.
What Are the Very First Signs of Alzheimer’s?
Alzheimer’s is a slow progressing brain disease. If you notice any of the following warning signs, contact your doctor:
Forgetting recently learned information (dates, appointments, events, etc.)
Trouble following a recipe
Difficulty driving to a familiar location
Losing track of dates, seasons, and times
Trouble judging distances
Struggling with vocabulary
Misplacing things around the home
Paying less attention to hygiene needs
Avoiding social activities
What Are the 7 Stages of Alzheimer’s?
There are three general stages of Alzheimer’s – mild (early stage), moderate (middle stage), and severe (late stage). However, these stages can be broken down into seven more specific stages.
Keep in mind that the seven stages can overlap, and placing someone into a specific stage can be difficult.
Stage 1 – No Impairment: Alzheimer’s is not detectable in this stage. There are no signs of memory problems or other symptoms.
Stage 2 – Very Mild Decline: Minor memory problems may begin to surface. You would still perform well on memory tests, and Alzheimer’s will be difficult to detect.
Stage 3 – Mild Decline: At this stage, you or family members may start to notice small symptoms. Memory tests may be affected and doctors can detect impaired function. Someone in this stage may be unable to find the right words in conversation or remember new names.
Stage 4 – Moderate Decline: This stage is much more clear-cut. Someone in this stage may have difficulty with basic math problems, have short-term memory loss, be unable to manage bills, and may forget details of the past.
Stage 5 – Moderately Severe Decline: Those in this stage may begin to require assistance in day-to-day life. They may be unable to get dressed appropriately, be unable to recall details like their phone number, and demonstrate significant confusion.
Stage 6 – Severe Decline: People in this stage need constant supervision and may require professional care. They may be unaware of their environment, unable to recognize faces, and unable to remember most of their personal history. Loss of bladder control, personality changes, and wandering are also common in this stage.
Stage 7 – Very Severe Decline: This is the final stage of Alzheimer’s. People at this stage are unable to communicate and respond to their environment. Their speech may be limited to less than six words and they are unable to sit up independently.
How Quickly Does Alzheimer’s Progress?
The rate that Alzheimer’s symptoms progress can vary, but the average person lives four to eight years after diagnosis. However, early detection and a healthy lifestyle can help someone with Alzheimer’s live 20+ years after diagnosis.
There is no single test that can diagnose someone with Alzheimer’s. Doctors use a combination of medical history, physical exams, neurological exams, mental status tests, and brain imaging when diagnosing.
Neurological exams address reflexes, coordination, eye movement, speech, and sensation. Mental status tests give an overall sense if a person is able to understand dates, times, locations, and simple instructions or calculations.
The Main Cause of Alzheimer’s
Although scientists don’t fully understand all the causes of Alzheimer’s, research suggests that this progressive disease is related to aging, genetics, and underlying health conditions.
Environmental and lifestyle factors may also contribute. Often the disease could be a combination of these factors.
Complex factors like age, genetics, environment, lifestyle, and existing medical conditions play a role in developing Alzheimer’s. However, while you can’t change your genes or your age, there are plenty of steps you can take to help prevent Alzheimer’s.
Can Alzheimer’s Be Prevented?
There is strong evidence that shows changing your lifestyle promotes a healthy heart and lowers your risk of Alzheimer’s.
Prevention tips include:
Healthy Heart: There are several connections between our heart and brain. Studies have shown that about 80% of people with Alzheimer’s also have some form of heart disease. Manage your blood pressure, diabetes, and cholesterol levels to lower the risk of developing any heart conditions.
Exercise and Diet: Regular exercise and a healthy diet directly benefit your brain cells. Exercise increases blood flow and oxygen to the brain and a healthy diet limits your intake of sugars and saturated fats.
Social Activities: Staying social helps build and maintain strong connections. This can keep you mentally active. Researchers believe these connections can lower your risk of Alzheimer’s by increasing mental stimulation and reinforcing connections between nerve cells and your brain.
Alzheimer’s Disease Treatment
There is no cure for Alzheimer’s and no way to stop its progression. However, there are drug and non-drug options to help treat the symptoms. These include:
Medications for Memory: Cholinesterase inhibitors and memantine are common drugs used to treat memory loss and confusion. A doctor can prescribe these medications, so be sure to contact your health care provider.
Behavior Treatments: Some doctors may prescribe antidepressants, anxiolytics, or antipsychotic medications for people who demonstrate drastic behavior.
Alternative Treatments: 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. To see an extended list, click here.
Are you a caregiver? There are several options available to help a loved one diagnosed with Alzheimer’s. These options include:
Minor Assistance: You can help your loved one with simple tasks like removing objects that could cause injury, maintaining smoke alarms and fire extinguishers, and keeping dark areas, like stairwells, well lit.
Home Care: Home health services and adult day centers are two options that can help with more intensive health and well-being tasks, while the patient is still living in the home.
Residential Care: Residential care is common in the later stages of Alzheimer’s. Residential care can include assisted living, nursing homes, and Alzheimer’s special care units. These options can help with tasks like meal preparation, dressing, bathing, and other everyday tasks.
Alzheimer’s, like other forms of dementia, will often require long-term care. The type of care someone will need will change as the disease progresses; so, at some point, outside care will probably be necessary.
Outside care options include nursing home care, assisted living, adult care services, and respite care. Caring for Alzheimer’s patients in a nursing home is necessary when caring for your loved one at home has become overwhelming.
Alzheimer’s and Dementia Care: Tips for Daily Tasks
The Mayo Clinic organizes tips for caring for some with Alzheimer’s into two groups: things to do to reduce frustration and guidelines to follow to ensure a safe environment.
A care plan to reduce frustration could include the following:
Creating a daily routine for the patient.
Allowing the patient to take their time.
Doing tasks that involve the patient.
Offering the patient choices, such as offering finger foods if it’s time to eat but they are not hungry.
Providing instructions that are easy to understand and simple to follow. Establish eye contact to make sure the patient understands what has been said.
Reducing napping time so that the patient remains aware of whether it is day or night.
Reducing distractions when they are eating, such as turning off the television during mealtime to make it easier to focus on eating.
Some safety tips on dealing with Alzheimer’s patients could include the following:
Preventing falls by avoiding things that could trip a patient up, like extension cords, and installing handrails in places like bathrooms.
Putting locks on all cabinets that could contain dangerous equipment or materials, such as guns, power tools, utensils, cleaning detergents, and so on.
Checking water temperature before showers or baths to avoid scalding.
Avoid accidental fires by supervising smoking.
Making sure all carbon monoxide detectors and smoke alarms have charged batteries.
When applying these dementia caregiver tips, the caregiver needs to be patient and flexible and be open to changing routines as the symptoms of the disease progress.
Caring for the Caregiver
Family caregivers, such as a son or daughter caring for an Alzheimer’s parent, must prepare for a series of distressing experiences as they watch their mother or father forget favorite family memories and lose practical self-care skills.
It’s often challenging dealing with an Alzheimer’s parent because of the overwhelming emotions, the fatigue, the isolation, and the financial complications. Still, it’s rewarding to bond with a parent by providing them with care and service and solving their problems.
There are also new relationships with others they meet in a similar situation through support groups.
Getting Help With Caregiving
Initially, family caregivers can reduce stress by sharing their caregiving challenges with their support groups.
However, caregiver stress will increase as the disease progresses. While medications used for Alzheimer’s will control some symptoms, they can only provide a limited amount of memory care support before a patient experiences significant memory loss.
Eventually, it will become necessary to consider outside care options, such as respite care, senior care, or moving the patient to a skilled nursing senior center.
For information or support on what to do when caregiving for an Alzheimer patient becomes difficult, visit the Alzheimer’s Association at www.alz.org.
Coping With the Last Stages of Alzheimer’s
Alzheimer’s disease and related dementias affecting older adults get severe during the last stages of the disease. Patients will need considerable support because they will lose touch with what is going on around them.
It can be difficult to figure out how to talk to someone with Alzheimer’s when they don’t respond to what is happening in their environment, can’t communicate any discomfort or pain, and have difficulty controlling their movements.
Legal and Financial Planning
Legal and financial planning for someone with Alzheimer’s requires a specialized lawyer because any general powers of attorney will not work for asset protection planning. A skilled and experienced lawyer is also necessary if the patient needs a health care power of attorney document.
Role of Medicare and Alzheimer’s
Original Medicare (Parts A and B) cover inpatient hospital care and some doctor’s fees associated with Alzheimer’s. Plus, Medicare will pay up to 100 days of skilled nursing home care in certain circumstances.
Long-term custodial care, like a nursing home, is not covered. Medicare will pay for hospice care in-home or at a hospice facility.
Some people with Alzheimer’s may be eligible for a Medicare Special Needs Plan. SNPs are a different type of Medicare Advantage plan and generally provide coverage for doctor visits, hospital services, and prescription drugs. Some of these plans can coordinate care services to help you better understand your condition and your doctor’s plan.
If you qualify for a Medicare Special Needs Plan, you may also qualify for a Special Enrollment Period. This means you can enroll or change Medicare plans throughout the year!
If you have any questions about Medicare Special Needs Plans or Special Enrollment Periods do not hesitate to contact us. Our licensed agents are contracted with all the major carriers across 38 states and can help you enroll in a plan that fits your needs and budget.
To schedule a no-cost, no-obligation appointment, click here or call us at 833-438-3676.
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.
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