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Prescription Discount Cards 101

Do you have a high deductible or copayment for your prescription drugs? Did you get a new prescription that is not covered by your insurance? Well, great news! A discounted prescriptions network may help cover some of those costs.

Rx Discount Card | Medicare Plan Finder
Prescription Discount Card | Medicare Plan Finder

What is a discounted prescriptions network?

A discounted prescriptions network provides prescription discount cards. These discount cards for prescriptions are available to everyone and can prove to be an easy way to save on your prescriptions.

Many top-rated prescription discount cards can be emailed or texted directly to you for immediate use.

You may be able to enjoy prescription savings in the long run by understanding the truth about these cards and knowing the best prescription discount cards available. Visit websites that offer the best prescription discount card reviews to choose the right one for your particular needs.

Your free prescription card could be a Walgreens prescription discount card, a GoodRX discount coupon, a SingleCare discount card, and so on.

Sometimes generic drugs provide the same value as the original drug at the lowest price. Brand name prescription drugs don’t cost more because they are better, but because companies have to pay for safety, effectiveness, animal, and clinical studies.

What is a pharmacy benefit manager?

A pharmacy benefit manager (PBM) is the middleman between the pharmaceutical company and the pharmacy. They negotiate drug pricing from the pharmaceutical company for the pharmacy.

This means that there may be a significant cost difference for the same drug in different stores and locations.

Pharmacies will negotiate prices depending on their customer base. If one pharmacy has many older adult customers, they may charge less for heart medication.

However, they might charge more for another drug that has a lower demand to make up the price difference. This is why comparing drug prices and utilizing prescription discount cards is important.

The Truth About Prescription Discount Cards

A prescription discount card can be useful to many people, but as Medicare scams continue to rise, it’s understandable why you may be hesitant to use them.

Some prescription discount cards can be misleading and claim higher savings. However, a large portion of free prescription discount cards are credible, can be used at thousands of pharmacies across the US, and don’t require your personal information.

Are prescription discount cards legitimate? A legitimate prescription drug discount card program has the following signs:

  • The website offers an easy pricing tool for brand and generic medications.
  • Pharmacies near you accept the card.
  • The website offers a home delivery option via a trusted website.
  • The discounted amounts are comparable to other discount program card program websites.

What are the best prescription discount cards?

Don’t confuse a health insurance card with prescription drug discount cards. A health insurance ID card is proof of insurance to use when you visit a health care provider, physician, or hospital while a drug card helps you fill a prescription at a discounted price.

Not all prescription discount cards are created equal.

Some prescriptions may be covered by one discounted prescription network and not the other. The best prescription discount card is the one — or combination of several cards — that can save you the most on the medications you take every day.

The amount of savings, number of eligible pharmacies, and number of prescriptions available will vary by the discounted prescriptions network. You may want to consider these cards:

Rx Discount Card | Medicare Plan Finder
Prescription Discount Card | Medicare Plan Finder

GoodRx

With the GoodRx app, prescription drug price comparison is available right at your fingertips. GoodRx compares prices for every FDA-approved drug at more than 70,000 pharmacies across the US.

Coupons can be printed, emailed, or texted to you and all you need to do is show the pharmacist your coupon to save up to 80% on your prescriptions.

US Pharmacy Card

This card is completely free and does not require any personal information. The US Pharmacy Card is accepted at roughly 59,000 pharmacies nationwide. You can have your card printed, emailed, or texted to you. Fun fact: this card can also be used on prescriptions for your pets!

Discount Drug Network

The Discount Drug Network card can save you up to 85% on your prescriptions with or without insurance. The only personal information you need to supply is your name, email, and address.

Your free prescription discount card will be mailed to you. Plus, the drug pricing tool on their website makes comparing prices a breeze.

SingleCare

A SingleCare prescription discount card is a savings card honored by a network of pharmacies across the country. Choose a pharmacy near you and present your card to the pharmacist at the counter.

If one of the participating pharmacies is Walmart, then show your prescription discount card at Walmart. Or if one of the participating pharmacies is CVS, then show your prescription discount card at CVS.

How to Use Your Drug Discount Card

When you want your prescription filled, go to one of U.S. pharmacies contractually obligated to honor your card. Visit participating pharmacies, such as Walmart, CVS, Walgreens, or Rite Aid, to get your discount.

A drug discount card mobile app may also be available for iPhone and Android.

If you haven’t already, click here to download your free prescription discount card. Then you can browse local pharmacies’ prices for your prescribed medications.

Prescription Drug Price Finder

Once you’ve downloaded your discount card, click here. Then type in your prescribed drug. For our purposes, we’re using rosuvastatin (Crestor), which is one of the best-selling drugs in the United States. Then enter your zip code. We used 37209, which the zip code of our headquarters in Nashville, Tennessee.

Prescription Finder Step 1 - Medicare Plan Finder

Then select your dosage and amount. We chose 20 mg and 30 tablets.

According to GoodRx, the average price without insurance for a 30-day supply of 20 mg is $161.64 as of March 2020. As you can see, you will pay just $8.44 at Walmart for the same thing with your free prescription discount card.

*Prices may vary. Always check with your pharmacist to find out the exact discounted price of your prescription.

Prescription Discount Cards and Medicare

Medicare and prescription drug coverage can be confusing. Fortunately, a licensed agent can help explain your prescription coverage options. If you’re interested in arranging a no-cost, no-obligation appointment with an agent, fill out this form or call us at 844-431-1832.

Contact Us | Medicare Plan Finder
Contact Us | Medicare Plan Finder

This post was originally published on November 27, 2018, by Kelsey Davis. It was last updated on April 9, 2020, by Troy Frink.

Medicare for Veterans with VA Benefits

As a veteran, you might have access to free or almost-free health care through the Department of Veterans Affairs (VA) – but veterans over the age of 65 can still benefit from enrolling in Medicare.

VA care is limited to providers who accept VA treatment, and having Medicare coverage will expand your doctor network as well as provide supplemental coverage opportunities.

If you’re nearing Medicare eligibility, you should decide whether or not to add to your VA coverage by enrolling in Medicare. Medicare and VA coverage together may provide more services than VA benefits alone.

Who qualifies for VA benefits?

Medicare for Veterans | Medicare Plan Finder
Medicare for Veterans | Medicare Plan Finder

Almost everyone who has served in active military duty is eligible for VA benefits. Since 1980, you must have served for 24 continuous months or for the full time for which you were called to active duty or you must have been honorably discharged to be eligible.

The VA encourages all servicemen and women to apply as there are many exceptions that may leave you eligible for benefits you didn’t even know you were eligible for. The VA states that some veterans can receive “enhanced eligibility” if they:

  • Are a former POW (prisoner of war)
  • Received the Purple Heart Medal or the Medal of Honor
  • Have a service-connected disability of 10% or more
  • Hold a VA pension
  • Were discharged from service for a disability
  • Served in a Theater of Operations for 5 years after discharge
  • Served in Vietnam (1962-1975)
  • Service in the Persian Gulf (1990-1998)
  • Were stationed at Camp Lejeune for 30 days or more (1953-1987)
  • Are catastrophically disabled
  • Have a household income below the VA’s National Income

Do you think you qualify? You can apply for VA coverage by completing this form!

VA Aid & Attendance Payment

The Department of Veterans Affairs offers compensation for caregivers and aid & attendance pension for housebound veterans. If you’re a caregiver and you don’t qualify for VA payment, you may qualify for additional compensation from your state’s Medicaid program.

Click here for more information about how to get paid as a caregiver.

Veterans Health Insurance

Veterans health insurance applies to active service members and their families as well as retired or injured service members and their family members. In many cases, family members of deceased veterans can receive veteran health insurance as well.

Some veterans may have to pay a copay for doctor visits and prescription drugs, but others may receive free appointments. VA care is not limited to service-related illnesses and injuries.

VA Prescription Drug List

Not sure if the VA covers your prescription drugs? You can download this official VA prescription drug list from the VA. The VA prescription drug list can tell you all generic drugs that the VA covers and what dosage form or other restrictions there are. This is is from July 2018, but the list is subject to change.

Free Prescription Discount Card
Free Prescription Discount Card

What are the VA hospitals near me?

There are 1,921 VA facilities across the country. If you’re looking for a VA hospital or VA clinic near you, you can use the VA’s official guide to search by your address or zip code.

What are the VA wait times in my area?

Wait times at VA facilities have been a problem for years. The U.S. Department of Veterans Affairs has conveniently created a tool that allows you to search VA wait times in your area, so you can know before you go.

Use the tool to search your address and find VA hospitals or VA clinics near you. Select what type of facility or doctor you are looking for and how far you are willing to travel, and you can find out what your best option is to avoid wait times.

One of the biggest problems with VA facilities, which you will see when you use the search tool, is that you may have to wait a few weeks to get an appointment.

That’s fine if all you need is a yearly checkup, but if you have a serious health issue that you’re worried about, you may find yourself needing to visit another facility that is not covered by Veterans Affairs just so that you can get the care you need. That’s where Medicare may be able to help (if you are eligible).

Does VA coverage include VA dental (VADIP)?

VA dental can be purchased through the VADIP (VA Dental Insurance Program). Services include diagnostic and preventative services (like cleanings), oral surgeries, emergency dental treatments, and restorative treatment. Depending on the plan selected, you may be responsible for a monthly premium and copayments for services.

You can apply for VA Dental right now by clicking here.

Does VA coverage include VA eye glasses?

VA coverage does include routine eye exams and testing, like for glaucoma. It only covers eye glasses in certain circumstances. To qualify for VA eye glasses, you must:

  • Have a service-related disability
  • Be a former Prisoner of War
  • Have been awarded a Purple Heart
  • Receive Title 38 benefits
  • Receive increased pension due to being housebound or needing regular aid

If you do not qualify based on the above, you may still qualify if you suffer from stroke, diabetes, multiple sclerosis, vascular disease, or geriatric chronic illness.

Additionally, if while receiving VA care for other symptoms you have a negative reaction to a prescription or you require cataract surgery or brain surgery that interferes with your vision, you may qualify for VA eye glasses.

If you’re blind or have low-vision already, you may qualify for extra vision services.

Does VA coverage include VA hearing aids?

Once you have VA coverage, there are a few ways you can get VA hearing aids. You’ll need to start by visiting a VA Audiology and Speech Pathology Clinic for a hearing evaluation. If a doctor recommends hearing aids for you, your VA coverage will cover your hearing aids, any necessary repairs, and batteries.

To order VA hearing aids batteries, use the blue VA Form 2346, “Request for Batteries and Accessories.” You should have received this with your last battery order. You can send it to “VA Denver Acquisition and Logistics Center, P.O. Box 25166, Denver, CO 80225-0166.”

If you do not have this form or would prefer to use the phone, you can call the Denver Acquisition & Logistics Center (DALC) at 303-273-6200 and press “one.” You can also press “two” to speak with a customer service agent or “three” for hearing aid repair concerns.

If you have a Premium Account with eBenefits, you can also request hearing aid batteries from ebenefits.va.gov. You’ll need your last name, last four digits of your SSN, and date of birth.

Tricare Coverage

Medicare and Veterans | Medicare Plan Finder
Medicare and Veterans | Medicare Plan Finder

Similar to VA, Tricare is available to retired service members and those who are discharged for disease or disability. Some Veterans are eligible for both VA benefits and Tricare. Generally, the VA provides more coverage but Tricare provides more flexibility.

Tricare coverage can include care received in a VA facility. This comparison sheet from Tricare shows the differences. To enroll in Tricare, you must already have Medicare Part A and B.

Tricare Appointment

Since you do not have to go to a VA hospital or VA clinic to receive TriCare covered care, you can use the TriCare website to search for a TriCare provider near you. However, your network can be expanded even further if you add Medicare coverage.

Tricare Dental Program

There are six classifications for TriCare Dental Programs:

  • Active Duty Service Members
  • Active Duty Family Members
  • Guard/Reserve Members
  • Guard/Reserve Family Members
  • Retired Service Members and Families
  • Survivors

Each plan comes at a different cost with a different level of coverage. Generally, TriCare dental plans can cover:

  • Preventative care (cleanings, exams, x-rays)
  • Fillings
  • Root canals
  • Gum and oral surgery
  • Crowns & dentures
  • Orthodontics

Do veterans need Medicare?

Technically, veterans do not need Medicare because many veterans qualify for VA benefits and TRICARE. However, a private insurance plan called a Medicare Advantage (MA) plan may offer supplemental benefits that you can’t receive with just VA benefits.

For example, some Medicare Advantage plans have a $0 monthly premium (like this Humana plan) and some even come with a fitness benefit. That could mean that your Medicare Advantage plan provides a gym membership. VA benefits and TRICARE do not.

VA Benefits and Medicare Advantage Together

Even if you already have veterans benefits through the VA, Medicare can help you expand your provider network (more doctors and pharmacies, shorter wait times) and potentially provide more financial coverage.

Medicare Advantage comprises of Medicare Part A (hospital coverage), Medicare Part B (medical coverage – doctor visits), and can include other benefits like dental, vision, hearing, fitness, transportation, etc.

If your VA coverage does not include enough prescription drug coverage for you, you can also get a Medicare Advantage plan with prescription drug coverage.

The good news is that we can help you find a Medicare Advantage plan that will help fill in the gaps in your VA coverage and get you the care and coverage you deserve. Some plans even have $0 premiums, so you may be able to get Medicare Advantage’s supplemental benefits at no additional cost! Click here to get in touch with a licensed agent or give us a call at 844-431-1832.

Find Medicare Advantage Plans | Medicare Plan Finder
Find Medicare Advantage Plans | Medicare Plan Finder

This post was originally published on October 5, 2017, and updated on January 13, 2020. 

7 Popular Senior Instagram Accounts You Need to Follow

Seniors on Instagram are helping to change age-related stereotypes and they’re having fun doing it. Are you on Instagram? All you need to join these influencers is a smartphone and to download the Instagram app. The best part? The app is free, and you can use it to connect with your grandkids.

Social media influencers over 50 have become style icons, entrepreneurs, and they’ve even shown up at events such as music festivals and red carpets. Check out this list of popular senior Instagram accounts and give them a follow. Use these accounts as ideas for your own posts. Who knows? You might end up going viral just like some of the people below!

1. @magdalife57 (Magda Llohis de Gutierrez)

Followers: 21.9 thousand

Bio: “Age is an illusion. People call me fashionista, I call myself an artist. I 💜 life, laughter, music & color!”

Profile: https://www.instagram.com/magdalife57/

Magda Llohis de Gutierrez, 76, is living her best life and documenting it for everyone to see. She smiles in almost every photo she posts.

Llohis de Gutierrez’s Instagram initiation was about as free-spirited and spontaneous as her approach to life. According to the BBC, fashion blogger Ari Seth Cohen took photographs of Llohis de Guttierez and told her she “had to have an Instagram account.” She had “no clue what she was talking about.” She must’ve figured it out quickly — the self-proclaimed artist now has more than 20 thousand followers.

2. @baddiewinkle (Hellen Ruth Elam Van Winkle)

Followers: 3.8 million

Bio: “stealing ur man since 1928!!”

Profile: https://www.instagram.com/baddiewinkle/

Helen Ruth Elam Van Winkle worked in a factory for 28 years before rising to Instagram fame. The 91-year-old woman’s daughter posted a photo in cut-off denim shorts and a tie-dyed T-shirt while holding up a peace sign. Van Winkle told NPR that she thought people “saw a great-grandmother that didn’t care what anybody thought about her.”

Those rebellious vibes quickly went viral. Van Winkle now has nearly 4 million followers. “Being age-appropriate” is not a concern for the Insta-famous star — she’s often posting selfies from music festivals and red carpet events. She’s even been photographed lip-syncing with the rapper Drake.

Van Winkle also talks candidly about her challenges in life like her hip replacement surgery and the loss of her husband and son. She appreciates her Instagram community. “Thank you guys for always wanting to support me. I’m so undeniably grateful,” she wrote in one post.

3. @irvinrandle (Irvin Randle)

Followers: 315 thousand

Bio: “too grown”

Profile: https://www.instagram.com/irvinrandle/

Irvin Randle, 57, is an elementary school teacher from Houston, TX. He is a self-described “sharp-dresser,” and his Instagram posts back up his claims. Randle is a grandfather of two, and he even inspired his own hashtag — #MrStealYourGrandma. However, Randle was upset at the hashtag at first. “I don’t want anybody’s grandma,” he said.

Randle’s daughter sparked his Insta-fame flame. He became a social media celebrity seemingly overnight when his daughter took photos of him wearing a stylish outfit in 2016. He told Voyage Houston that he thought he was in trouble when his daughter told him he was trending.

Now Randle’s feed is full of him sporting tailored suits and urban wear. You can find him on Fashion Week runways, walking brides down the aisle, or exercising. “I exercise five days a week,” he said. “ I feel better now than I did at 27.”

Medicare Fitness Programs

4. @saramaijewels (Sarah Jane Adams)

Followers: 185 thousand

Bio: “Priceline Ambassador”

Profile: https://www.instagram.com/saramaijewels/

Sarah Jane Adams, 63, started her Instagram account to promote her jewelry business. Now her feed features an age-positive and feminist message. For example, she hashtags most of her posts with #MyWrinklesAreMyStripes. She said, “I have no desire to get rid of them,” after a makeup artist asked if Adams wanted to cover her wrinkles. “It’s ridiculous that we’re living in a world where showing an unfilled, make-up free face is considered ‘brave!’”

Adams was born in the United Kingdom and now lives in Sydney, Australia. She is on a mission to create diversity. “I don’t think people are following me because of my clothes or my jewelry,” she said. “It’s my attitude.”

5. @kimiko_nishimoto (Kimiko Nishimoto)

Followers: 223 thousand

Bio: “西本喜美子” (Translation: “Kimiko Nishimoto”)

Profile: https://www.instagram.com/kimiko_nishimoto/

Kimiko Nishimoto, 90, shows her followers that you’re never too old to learn something new. She joined her son for a photography class when she was 72, and she’s been snapping humorous photos ever since. 

“I just want to do something funny,” Nishimoto explained to the Japan Times. “Life is all about being playful.” Nishimoto’s sense of humor skews toward slapstick or physical comedy. She’s also a skilled photo editor. Her Instagram feed shows edited photos of her flying on a broomstick, crashing scooters, and slamming doors on people. 

Nishimoto credits photography with helping her cope with the loss of her husband in 2012. “Taking photos is my happiness,” she said. “I’ll keep doing it for as long as I’m alive.” 

6. @dinneranddance (Lance Walsh)

Followers: 56 thousand

Bio: None

Profile: https://www.instagram.com/dinneranddance/

Lance Walsh, 58, sells fruit in London, England. He’s best-known for his streetwear fashion sense on social media, however. Walsh has dressed in colorful clothing and worked his fruit stand for more than 30 years. One day, a photographer named Ben Awin noticed him, posted photos on the internet, and later Walsh started an Instagram account. 

Walsh can often be seen wearing hoodies, colorful T-shirts, camouflage pants, or colored shorts. His Instagram feed has caught the attention of followers all over the world. According to Walsh, some fans from Asia even “cry” when they see him. 

7. @moonlin0106 (Linzhuang Yueli)

Followers: 108 thousand

Bio: “91歲的月光仙子” (Translation: “91-year-old moonlit fairy”)

Profile: https://www.instagram.com/moonlin0106/

Linzhuang Yueli, also known as Moon Lin, is 91 years old and from Taiwan. Lin is another Instagrammer who’s known for her streetwear style. She has more than 100 thousand fans, and it doesn’t seem like she’ll be slowing down any time soon. 

Her feed shows her wearing colorful hats, sports gear, and even wearing a bunny costume as she goes on with her day-to-day life. 

Find Your Next Favorite Social Media Influencers Over 50

We hope these senior social media influencers give you some ideas about what popular senior Instagram accounts to follow. This list is not exhaustive, and it doesn’t cover everyone. Do some exploring to find more inspiration and and accounts to follow!

Pro tip: After you’ve “liked” or commented on a few posts, click on the magnifying glass at the bottom of your app. Instagram will start suggesting accounts and posts similar to the ones you’ve engaged with. In other words, the more you use Instagram, the more likely you are to find your next favorite influencer.

Does Medicare Cover Your Migraines?

Most of the 4 million Americans who suffer from migraines are between the ages of 18 and 44. These severe headaches usually diminish in later life but can still be a cause for concern for seniors. Migraines are reported in 17% of those over age 65 and may indicate a more serious underlying condition. 

If you experience migraines, consult with your doctor for diagnosis and treatment. You may even be able to use your Medicare benefits to cover some of the cost!

Migraine symptoms and treatment

A migraine is defined as a severe, recurring headache that can last for hours or even days. Those who have these headaches chronically can show symptoms for around 15 days out of the month. If you are experiencing these symptoms, check with your physician as soon as you can. The most common symptoms are:

  • Throbbing pain on one or both sides of the head
  • Blurred vision or sensitivity to light
  • Nausea or dizziness
  • Confusion

Treatment Options

The primary treatment method for migraines is medication, both for relief and prevention. Your doctor may prescribe one or more of these medications depending on your diagnosis and symptoms. 

Abortive migraine medications are used to relieve the symptoms of severe headaches as they occur.  Some of these target serotonin in the brain to treat migraines directly, while others are used to treat individual symptoms. Some are available over-the-counter. 

These abortive medications include:

  • Almotriptan (Axert)
  • Sumatriptan (Alsuma, Imitrex)
  • Zolmitriptan (Zomig)
  • Acetaminophen
  • Chlorpromazine (for treating nausea)

In cases of severe or frequent symptoms, your doctor may prescribe preventive migraine medications. These are meant to diminish the regularity and intensity of migraines before they happen. 

Antidepressants and high blood pressure medications are commonly used for preventive treatment, as are some new injectables like Aimovig. Recently, doctors have even been using botox to treat migraines!

Migraine coverage with Medicare

Seniors who suffer from migraines might be wondering if their treatment will be covered by Medicare. The answer is sort of complicated: different parts of Medicare will cover certain migraine treatments, but only if your doctor confirms that you need it. For instance, Medicare Part B may cover injections, whereas Part D might cover prescription drugs.

What does Medicare Part B cover?

Part B can cover up to 80% of eligible expenses like doctor’s visits, labwork, or injections given by your physician. This means that after you meet your deductible, you will only have to pay 20% of the total cost. If you have a Medicare Supplement plan however, you may use it to cover that remaining coinsurance.

For more information on finding a Supplement plan to cover your medical expenses, use our Plan Finder tool or call 844-431-1832 to speak to a licensed agent today!

Does Medicare cover botox for migraines?

The FDA has approved the use of botox as a form of chronic migraine medication. It works by blocking certain chemicals that cause muscle pain. The primary botox injection sites for migraines are the muscle fibers in the forehead and neck, where migraine pain usually occurs. These injections are usually given every 10-12 weeks to remain effective.

In order for you to receive this coverage, your doctor may need to perform diagnostic tests to confirm to Medicare that migraine therapy is needed. Additionally, Medicare may require your physician to attempt other treatment options before it will cover botox injections. 

Be sure to check with your doctor to ensure that your botox injections will be covered by Medicare!

What does Medicare Part D cover?

Medicare Part D mostly covers prescription medications in the form of pills, ointments, inhalers etc. While many prescription migraine medications may be covered by your Part D benefits, it’s always better to be safe than sorry. Before getting your medication, check the formulary for your Part D plan and make sure that your prescription is covered.

We know that Part B will pay for injections administered by a medical professional, but there are some injectable migraine medications meant for home use. This is another area where Part D can help cover the cost!

Does Medicare cover Aimovig?

A new form of preventive medication has recently emerged, called calcitonin gene-related peptide (CGRP) antagonists. Name brands like Aimovig come in prefilled autoinjector pens and are usually prescribed on a monthly basis. 

Your Part D benefits may cover a prescription for Aimovig, but the actual amount you pay out-of-pocket can vary depending on if you’ve met your deductible. Don’t forget to check with your Part D plan provider to see if your Aimovig prescription will be covered and how much you will pay in coinsurance.

Treatments not covered by Medicare

There are many forms of alternative treatment for migraines that Medicare will not cover. Acupuncture has been suggested a way of treating migraines, as has massage therapy. Unfortunately, these methods have not been approved by the FDA and, as a general rule, Medicare will only cover FDA-approved treatments.

Chiropractic treatments have also been indicated as a method for natural migraine prevention and pain relief. Medicare however does not cover chiropractic care, except as part of subluxation correction.

If you are suffering from migraines, talk with your doctor about finding a form of migraine therapy that works for you and can be covered by your Medicare benefits!

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

Home Health Care | Medicare Plan Finder

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.

Medicare Part A is hospital insurance. Covered services include:

Medicare Part B is medical insurance. Part B covers medically necessary and preventive services such as:

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.

Medicare Part A covers inpatient hospital stays, but Part B covers outpatient stays. If you need more care after leaving the hospital, you must have been an inpatient for at least three days for Medicare to cover a skilled nursing facility.

How much does Medicare hospital coverage cost?

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.

2020 Medicare Supplement Comparison Chart
2020 Medicare Supplement Comparison Chart

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.

Medicare Supplement plans only cover financial items, but Medicare Advantage plans can cover additional healthcare benefits such as meal delivery, non-emergency medical transportation, and even fitness classes! Medicare Advantage plans can also cover additional home health care services.

Get the Medicare Coverage You Need

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.

The 9 Best Christmas Gifts for Seniors in 2019

Finding Christmas gifts for seniors may seem difficult. You may not know what to get, and you may run into the seniors in your life saying, “I don’t want anything.” That doesn’t make matters easier. We’ve put together a list of fun and useful gifts that the seniors in your life are sure to love.

1. Electric Tea Kettle

Electric Tea Kettle - Medicare Plan Finder

Electric tea kettles are easy-to-use and they can come with safety features such as automatic shut-off and cool handles. Automatic shut-off makes it so your favorite senior doesn’t need to remember to turn the kettle off after the water boils — the kettle does that for you. A cool handle means that you don’t have to worry about using hot pads when you’re pouring a cup.

Pro tip: Arthritic hands will do better with a small tea kettle. Large tea kettles are too heavy when they’re full of hot water.

2. Autobiographical Journals

Writing in a Journal - Medicare Plan Finder

Journals are a great way to preserve memories. With some journals, your loved one doesn’t have to worry about formatting. Some journals have questions that are organized into life sections such as past, present, and family history. The questions serve as a way to jog your loved one’s memory. 

A journal is also a gift for you because you get to learn about your loved one’s experiences if they choose to share.

3. Book of the Month Subscriptions

Reading a Book With a Cup of Coffee - Medicare Plan Finder

This is the perfect gift for bookworms. With subscription services like bookofthemonth.com, your loved one gets to choose what books they want to read, and how often they want to receive new reading material. 

When you log onto the website, you can browse the books of the month, which are separated by genre. The best part? You don’t have to ask a bookstore employee or browse online reviews for recommendations. The subscription service puts it all together and gives a synopsis of each title.

4. Smart Speakers

Smart Speaker and Smartphone - Medicare Plan Finder

A smart speaker is a voice-activated device that can play music, answer questions, and give recipes. Many smart speakers such as the Amazon Echo, Apple HomePod, and Sonos One are easy-to-use and your loved one may enjoy the added sense of security that a smart speaker can bring. You can also use many smart speakers to make emergency calls.

5. Phone Case

Phone Cases - Medicare Plan Finder

According to PEW Research, 42 percent of seniors 65 and older have smartphones, and it makes sense. Smartphones are a great way to communicate with your friends and family, navigate to new locations, and take pictures & videos of grandchildren. 

Mobile apps can even make your loved one’s life easier. You can find pill reminder apps, tools for dementia support, and even to monitor blood glucose levels

With all of the great features smartphones have, you’ll probably want to keep it in good shape. It can be extremely expensive to replace damaged parts if you drop your phone. For example, it can cost $279 to replace an iPhone 11 screen. A durable, protective case can help protect your loved one’s phone from damage. Look for a case with your loved one’s favorite pattern (camouflage, hound’s tooth, etc.) or their favorite sports team for a personalized touch.

6. Supplies for Your Loved One’s Favorite Hobby

Art Supplies - Medicare Plan Finder

Whether your loved one loves gardening, painting, or yoga, you can find supplies so they can keep up with their favorite activities. If your loved one enjoys spending time in the garden, look for gardening tool kits with trowels, spades, and clippers in a sturdy carrying case. See if you can locate brushes and paints for the artist in your life or a yoga mat for your favorite senior yogi.

These are just examples. Today’s seniors are active and they enjoy taking fitness classes, attending dance classes at their local senior centers, and traveling. The best Christmas gifts for seniors can be just about anything, depending on what they’re into!

7. A Tablet or E-Reader

Woman Reading on a Tablet - Medicare Plan Finder

An e-reader is a device that allows you to have an entire library of reading material in one spot. When you give your loved one an e-reader, you give them the opportunity to subscribe to their favorite periodicals and purchase new books from the comfort of their home.

Some seniors will want more features than e-readers provide such as browsing the internet, playing games, and watching videos. Those people will be better off with a tablet like an iPad. You can still purchase and store books and periodicals with a tablet, but you also get additional features.

8. Jigsaw Puzzles & Puzzle Books

Jigsaw Puzzle - Medicare Plan Finder

Puzzles are a great hobby for seniors, especially for those who live alone. Not only are puzzle books and jigsaw puzzles a great way to pass the time, but mental games like sudoku and crossword puzzles can help delay the onset of dementia symptoms.

Your loved one may enjoy the challenge of completing a daily puzzle from a book or they might want to frame their favorite 1000-piece jigsaw puzzle. You can even buy a custom photo puzzle with pictures of their grandkids or pets!

Crossword Puzzle & Word Search - Medicare Plan Finder

9. Great Experiences

Audience at a Show - Medicare Plan Finder

Your favorite senior may have every material thing they could ever want or need. If that’s the case, get them tickets to a show, a sporting event, or a gift certificate to their favorite restaurant. 

Alternatively, you can book a spa day so your loved one can relax. Some spas even offer geriatric massages! If you live close, go to the event with your loved one. Quality time can be worth much more than the price of admission.

The Best Christmas Gifts for Seniors Come From the Heart

Sometimes it really is the thought behind a gift that means the most. Your loved one will appreciate the time and effort you spent making sure that their Christmas is special. Check out our blog for more holiday health tips including healthy recipes and meal tips.

Medicare Transportation Solutions

As ridesharing services like Uber and Lyft grow in popularity, more and more Medicare Advantage plans are including transportation services as a benefit. In 2018, CMS (Centers for Medicare and Medicaid Services) announced that in 2019, Medicare Advantage plans will have more freedom to provide coverage for services such as food delivery and transportation.

Does Medicare cover transportation for medical services?

Medicare Part B may cover emergency ambulance transportation to a hospital or skilled nursing facility if transporting in a different vehicle would put your health at risk. Medicare may cover non-emergency transportation in an ambulance if you have a written doctor’s note explaining why an ambulance is medically necessary.

Medicare generally covers up to 80% of the transportation associated costs, but you are responsible for the remaining 20%. If you don’t want to pay for these out-of-pocket costs, a Medicare Supplement plan can help you get full coverage.

Sometimes, Medicare Advantage plans cover non-emergency transportation through third-party vendors. As long as the vendor works with your health plan, you may be able to receive rides to and from doctor’s appointments, pharmacies, and hospitals.

Medicare Transportation | Medicare Plan Finder
Medicare Transportation | Medicare Plan Finder

Medicare Transportation Services

Ground medical Transportation services can cost hundreds or even thousands of dollars (depending on distance), and air medical transportation can cost well over $10,000.

In an emergency, you should always call 911. If you’re not in an emergency, you can shop around and compare prices with different ambulance and medical transportation services in your area.

Medicare Transportation | Medicare Plan Finder
Medicare Transportation | Medicare Plan Finder

Medicare Transportation By State:

While there are a handful of national players, there are several local medical transportation companies in each state.

Medicare Transportation Arizona

The most popular private transportation services in Arizona include:

  • ABC Ambulance
  • Arizona Ambulance Transport

ABC Ambulance covers the greater Phoenix region. They provide rapid response times alongside basic patient transportation services.

Arizona Ambulance Transport transports patients from the Southeastern Arizona Medical Center to Bisbee, Sierra Vista, and Tucson.

Medicare Transportation Kentucky, Indiana, and Ohio

The most popular private transportation services in Kentucky, Indiana, and Ohio include:

  • Yellow Ambulance (KY, IN)
  • MTS Ambulance Services (KY, IN, and OH)
  • Rural/Metro Corporation (20 states)
  • Heartland Ambulance Service (IN)
  • TransCare (IN)

Yellow Ambulance is the preferred transportation provider for Louisville and Bullitt County in Kentucky and Floyd and Marion County in Indiana. They provide basic and advanced life support, specialty care transport (dialysis, ventilator, chemotherapy), long-distance transportation, and bariatric transport.

MTS has 24-hour paramedic crews and offers emergency and non-emergency transportation. This includes rides to hospitals, dialysis treatments, and cancer treatments. They also offer wheelchair van service in KY, IN, and OH.

Rural/Metro is a semi-national company that provides emergency and non-emergency transportation. They also have a community fire protection program and offer personal emergency response systems.

Heartland Ambulance Service offers emergency transportation, basic and advanced life support, and a fixed wing air ambulance. They are available in several central Indiana locations.

TransCare serves Terre Haute, Indianapolis, Vincennes, and Columbus. They offer transportation to and from hospitals, dialysis treatments, doctor appointments, and radiation therapy.

Medicare Transportation | Medicare Plan Finder
Medicare Transportation | Medicare Plan Finder

Medicare Transportation Louisiana

The most popular private transportation services in Louisiana include:

  • Acadian Ambulance Service (LA, MS, TX, and TN)
  • A-Med Ambulance Service

Acadian serves 70 counties/parishes in Louisiana, Texas, Mississippi, and Tennessee. Their largest state is Louisiana. They offer emergency transportation, air services, non-emergency transportation, and bariatric transport.

A-Med serves the greater New Orleans region including Metairie, New Orleans, Kenner, Jefferson Parish, Orleans Parish, Saint Bernard Parish, and Plaquemines Parish. They offer medical transportation to hospitals, nursing homes, and critical care facilities. They also offer wheelchair van transportation.

Medicare Transportation Northeast

The most popular private transportation services in the Northeast include:

  • Citywide Ambulance (NY)
  • Lifeline Ambulance (NY)
  • Northeast Community Ambulance (PA)

Citywide Ambulance provides basic and advanced life support, bariatric transports, airport transfers, long-distance transport, and luxury transportation options. They serve the greater New York area.

Lifeline provides basic and advanced life support and transportation to and from nursing homes, rehab hospitals, dialysis, radiation, assisted living centers, and retirement centers.

Northeast Community Alliance provides 24/7 emergency transportation. Plus, they offer non-emergency transportation to and from doctor’s appointments, dialysis treatments, and hospital discharges.

Medicare Transportation Northwest

The most popular private transportation services in the Northwest include:

  • Olympic Ambulance (WA)
  • Northwest Ambulance Transport (WA)
  • Tri-Med Ambulance (WA)

Olympic Ambulance offers 911 response, basic and advanced life support, and bariatric transports. They also provide wheelchair van transportation to those who need it.

Northwest Ambulance Transport provides advanced and basic life support in a mobile hospital setting. They also provide standby coverage for several cities in the area.

Tri-Med Ambulance offers ambulance services and critical care transport. They also provide wheelchair accessible transportation for medical treatments or doctor visits.

Contact Us | Medicare Plan Finder
Contact Us | Medicare Plan Finder

Medicare Transportation Tennessee

The most popular private transportation services in Tennessee include:

  • Lifeguard Ambulance Service (IL, TN, OK, TX, AL, GA, SC, and FL)
  • BlueShield EMS
  • American Medical Response

Lifeguard serves several states and provides EMS solutions to rural and urban locations. They offer emergency and non-emergency transportation, health system partnerships, and mobile integrated healthcare.

BlueShield EMS provides ambulatory cars, wheelchair vans, stretcher vans, and ambulances for basic and advanced life support.

American Medical Response provides basic and advanced life support, ventilators, and bariatric transportation services to the greater Nashville and Davidson County area.

Medicare 101 Course
Free, quick, and easy: Medicare 101 Course

Medicare Transportation Texas

The most popular private transportation services in Texas include:

  • City Ambulance Service
  • First Medical Response of Texas
  • BestCare

City Ambulance Service serves the entire states of Texas. They provide basic and advanced life support, and wheelchair, dialysis, and chemotherapy transportation.

First Medical Response of Texas provides a mobile intensive care unit providing advanced life support. They also provide EMT basics, bike medical teams, and medical gators.

BestCare offers non-emergency, emergency, and critical care medical transportation. They also offer air ambulance, wheelchair service, dialysis transports, and long-distance transfers.

How to Use Medicare Transportation Services

Medicare transportation can be used for emergencies and non-emergencies. This can help ensure transportation to and from providers, doctor offices, pharmacies, therapy, critical care units, nursing homes, assisted living facilities, etc.

Medicare Transportation | Medicare Plan Finder
Medicare Transportation | Medicare Plan Finder

Medicare Transportation to Doctor’s Appointments

Medicare Advantage plans can help cover the costs of utilizing private transportation companies like the ones above. You can request a ride just before you need to leave your home, or you can schedule a pick-up in advance.

Medicare Transportation to Dialysis

If you have End-Stage Renal Disease (ESRD) and require dialysis, Medicare may cover non-emergency transportation to and from a dialysis facility. However, they will only cover the closest facility.

If you choose to be transported to a facility further away, Medicare will not cover it. If there are no facilities within your local area, Medicare will pay for the nearest facility outside of your area.

Ambulance Transportation

Medicare Part B covers ambulance services, but only when necessary. For example, if you are bleeding heavily, unconscious, or need immediate treatment and can’t wait until you get to the hospital, Part B can cover your ambulance transportation. This is only covered if the ambulance is taking you to the nearest facility – you can’t make a special request.

Air ambulance transportation may be covered if your location can’t be reached easily by ground or if obstacles like heavy traffic can stop you from getting the care you need in a timely fashion.

Non-Emergency Medical Transportation

If you need a ride to a doctor’s appointment or a hospital that does not warrant an ambulance, you may have options.

You may want to start by calling your local Office on Aging. They may have a program in place to help you out regardless of your healthcare plan. Some Medicare allow transportation benefits through Uber, Lyft, and other ridesharing services.

These plans will require that you have a specific need for transportation, and you would only be able to use your coverage for healthcare-related transportation. This can include rides to doctor’s appointments, pharmacies, and other healthcare providers.

The Future of Medicare Transportation

Ride-sharing companies have grown significantly in recent years. Uber and Lyft have dominated the industry. There are 75 million Uber users and 23 million Lyft users. Medicare Advantage plans are capitalizing on this market and providing new benefits to MA enrollees.

Medicare and Lyft

Medicare Transportation | Medicare Plan Finder
Medicare Transportation | Medicare Plan Finder

Some carriers are quickly forming partnerships with Lyft to provide enrollees transportation to and from Walgreens and CVS pharmacies. They have plans to create a “no-cost” service that provides insured transportation to and from health appointments.

This is not intended to be a replacement for emergency transportation, but an extra alternative for non-emergency situations. Lyft Concierge is a website that allows you to schedule or book a ride from a computer alongside your plan’s coverage.

Medicare and Uber

Medicare Transportation | Medicare Plan Finder
Medicare Transportation | Medicare Plan Finder

Uber has plans to partner with several organizations nationwide. They will provide transportation to patients traveling to and from their medical appointments.

Uber will allow parents, caregivers, and medical staff to schedule transportation on your behalf. Plus, Uber has created “Uber Health” which is a HIPAA-compliant and cost-effective way for you to book rides with your plan’s coverage.

Medicare and Roundtrip

Roundtrip, a digital NEMT marketplace for the betterment of health, is offering transportation as a benefit for 2020 Medicare plans. Roundtrip works with hospitals, health systems, paratransit, and health plans nationally to remove transportation as a barrier to health and wellness. 

With Roundtrip, members can efficiently book all levels of transport: rideshare, Medical Sedans, Wheelchair Van, and Non-Emergency Ambulances (BLS, ALS, SCT, Bariatric Ambulance with our easy-to-use platform. The Roundtrip software is HIPAA compliant and verifies member eligibility. Roundtrip uses real-time GPS tracking and automatically sends text and call notifications to the members about their rides. 

Talk to your insurance agent to find out if Roundtrip is included in your plan.

Pick a Plan With Medical Transportation Coverage

If your plan does not offer transportation and you would like to have that benefit, we may be able to find a better plan for you. It all depends on your location and eligibility. We can send one of our agents to your home for a free appointment to figure out what your plan options are.

Just complete this form to request a call or call us at 833-438-3676.

Contact Us | Medicare Plan Finder
Contact Us | Medicare Plan Finder

This post was originally published on May 31, 2018, by Anastasia Iliou, and updated on December 4, 2019, by Troy Frink.

Does Medicare Cover Weight Loss Programs [2020]?

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

Does Medicare Cover Weight Loss Programs? | Medicare Plan Finder
Medicare Weight Loss Programs | Medicare Plan Finder

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.

Find a Medicare Plan | Medicare Plan Finder

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.

Grocery List for Seniors
Free, Printable Grocery List

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.

Gym Memberships

Medicare Fitness Programs
Medicare Fitness Programs

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.

Silver and Fit vs SilverSneakers

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:

Gastric Bypass

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.

Sleeve Gastrectomy

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

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.

To join Optifast, start by finding a clinic near you.

Jenny Craig

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

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)

Click here for a full guide on Medicare diabetes coverage.

*There may be some coverage limitations.

What Else Does Medicare Cover, and Do I Qualify?

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.

Call Medicare Plan Finder

This post was originally posted on June 22, 2017, and was last updated on December 3, 2019.

Durable Medical Equipment: What Medicare Beneficiaries Should Know

According to the American Association for Homecare, about 15.5 million people use Durable Medical Equipment (DME) every day. Not every piece of medical equipment is considered DME, however. Did you know that in most cases, for Medicare to cover your medical equipment, the equipment has to be considered DME?

What is Durable Medical Equipment?

Durable Medical Equipment is any medical device that can be used repeatedly (for a duration of at least three years), can be used at home, and is medically necessary for the patient.

Examples of Durable Medical Equipment

  • Hospital beds
  • Canes, walkers, crutches, wheelchairs, etc.
  • Oxygen equipment
  • Nebulizers and the related medications
  • Sleep apnea devices
  • Infusion pumps and related supplies
  • Catheters and commode chairs
  • Glucose monitors and diabetes test strips
  • Some Medicare Advantage plans can now cover home modifications like handrails and wheelchair ramps. However, they are not normally considered DME.

Click here for a more comprehensive list.

Medicare Durable Medical Equipment List
Medicare Durable Medical Equipment List

Home Medical Equipment

Plans may not necessarily cover these items, but you may see them referred to as durable medical equipment:

  • Bedding protection and adult diapers
  • Cleansers and cloths
  • Bath lifts, shower seats, and grab bars
  • Ostomy supplies
  • Mobility tools

Something to keep in mind about durable medical equipment is that it does not necessarily refer to items used in nursing homes, hospitals, and doctors office – it actually more commonly refers to common home medical equipment.

Medicare Durable Medical Equipment

Medicare Medical Supplies in Stores

If you’re looking for Medicare durable medical equipment or other home medical supplies, you should check with your plan details to see if there are any requirements for where you buy your materials if you want coverage.

You can probably buy a lot of these items from Amazon, Target, or Walmart, but a pharmacy like CVS, Walgreens, or other form of Medicare medical supplies store may be the best way to go so you can make sure you are receiving coverage. If you’re unsure what stores carry DME in your area, Google “DME near me.”

You may need to start by getting a prescription from your in-network doctor.

DME Medicare Coverage

Hospitalized clients will receive DME coverage through Medicare Part A, but others will fall under Part B. Under Part B, Medicare will pay 80% of the cost (after you’ve met your deductible).

If you need special items like blood testers and oxygen equipment, you’ll need to purchase them outright. Some equipment, like wheelchairs and other large items that you may not need forever, can be rented.

The first step to purchasing or renting DME with Medicare coverage is seeing a doctor. Most DME will require a prescription to prove that the DME is medically necessary. You must get this prescription or official doctor’s note within six months of the day that you rent or purchase your equipment.

How to Get Medicare DME Coverage

Some Medicare plans will have their own DME suppliers. Check with your plan’s website to see if there’s a special place where you can buy your equipment to make sure you get coverage for it. If you need help, your agent can help you figure it out. If you don’t currently have an agent, we can set you up with a free appointment.

We’ll send a licensed agent in your area to your home to help you find the coverage you need. Click here to set up an appointment or call 1-844-431-1832.

This post was originally published on April 12, 2018, and updated on November 8, 2019. 

How to Switch From Medicare Advantage to Medigap

Medicare Advantage and Medigap are similar in some ways but very different in others. If you’ve enrolled in a Medicare Advantage plan and you don’t like it, you may think switching Medicare plans and enrolling in Medigap is a great idea. It’s important to understand the differences between the two, so you can make the best choice. 

What is Medicare Advantage?

Medicare Advantage, also called Medicare Part C, is a type of private Medicare plan. When you first enroll in Medicare, you’ll start with Medicare Part A (the part that covers hospital care), and then most people will enroll in Medicare Part B (the part that covers doctor’s appointments). 

Medicare parts A and B are limited, so adding Part C can give you additional benefits like:

  • Long-term care
  • Specialized care
  • Dental
  • Vision
  • Hearing
  • Physical fitness
  • Prescription drugs

No two Medicare Advantage plans are the same. In fact, there are several different types. You’ll have to look at what you’re eligible for and decide which benefits you need most and how much you’re willing to spend.

Medicare Part C doesn’t always mean spending more money, though. Some plans might even have $0 premiums!*

*Even with a $0 Medicare Advantage premium, you’d have to continue paying your Part B premium.

What is a Medigap plan?

Medicare Advantage plans sound fantastic, but some people will find that Medigap plans work best for them. Medigap coverage is what can “fill the gap” between what Medicare covers and what you owe out of pocket. These plans are also called “Medicare Supplement” plans because they supplement your existing Medicare Part A and Medicare Part B coverage.

Some Medigap plans may provide a few extra “perks,” but generally speaking, they do not provide additional health benefits in the same way that Medicare Advantage plans do. Instead, supplemental insurance covers your Medicare Part A and Medicare Part B deductibles, copayments, coinsurance, etc.

You’re probably thinking, “great!” I’ll just go ahead and get Medigap and Medicare Advantage. However, you can’t have both. That decision can be tough, but it all comes down to how much you’re able to spend each month and whether or not you can afford a medical emergency. For example, Medigap premiums tend to be a bit higher than Medicare Advantage, but if you’re in the hospital all the time, it might pay off. 

Can I switch from Medicare Advantage to Medigap?

If you enroll in a Medicare Advantage plan and decide that a Medigap plan might be better, you can switch – but there are a few things you’ll need to keep in mind.

Mainly, Medigap plans come with medical underwriting. In other words, you can be denied for pre-existing conditions. Meanwhile, you will never be denied or charged more for a Medicare Advantage plan based on your preexisting conditions. There are two times when your preexisting conditions won’t affect your Medigap enrollment: when you’re enrolling in Medicare for the first time, and if you are forced out of your current plan and need to find a new one quickly. That rule is called “guaranteed issue rights.”

You’ll also have to keep in mind that if you had a Medicare Advantage plan with prescription drug coverage and you want to switch to Medigap, you will lose your prescription drug coverage. The only way to have a prescription benefit with Medicare Supplements is to also invest in a Part D (prescription drug) plan. 

One of the many benefits to Medicare Advantage is that most of your benefits will be rolled into one plan, whereas if you have Medigap, you may have to seek alternative plans for your prescription drugs, dental, vision, etc. 

Can I switch from a Medigap plan to an Advantage plan?

Just like switching from Medicare Advantage to Medigap, switching from Medigap to Medicare Advantage is possible, but there are some things to be aware of. 

One of the first things you’ll notice when you switch plans from Medigap to Medicare Advantage is that your copayments might rise. This will all depend on what plans you have. For example, if you had Medigap Plan G (which covers Part B copayments), and then you switched to a Medicare Advantage PPO plan that had a $20 copayment for doctor visits, you might feel like your costs are rising. However, your Medicare Advantage plan might have a lower premium than your Medigap plan did, making your overall costs lower.

Confused? Your insurance agent can walk through these numbers with you before you switch plans to help you decide which type of plan is truly best for you. 

Is it better to have Medicare Advantage or Medigap?

The question should read, “Is it better for ME to have Medicare Advantage or Medigap?” That may not be the answer you were looking for, but it is different for every person. What you may see as disadvantages of Medicare Advantage might be great for someone else. Common Medicare Advantage disenrollment reasons, like trouble finding a doctor in-network or the lack of one very specific benefit, may not apply to you. 

While Medicare Advantage usually provides more covered benefits, Medigap can result in lower hospital bills and lower overall out-of-pocket costs.

Your decision should be based on your health history, your budget, and the quality of plans available in your area. Try sitting down and writing a pros/cons list for Medicare Advantage vs. Medigap, like this: 

Medicare Advantage: 

Pros: Prescription drug coverage can be included

Cons: Stricter network

Medicare Supplements:

Pros: Copayments can be covered

Cons: Higher premiums

Add in any items specific to you, like a specific benefit that you need or a specific cost that you are worried about. Then, circle the items that are most important to you. Whichever column has the most circled items is likely the best option for you. 

Why should I switch Medicare plans?

There are plenty of reasons to switch Medicare plans. Everything from network size to costs and benefits can be a factor. 

You may want to switch Medicare plans if:

  • Your plan doesn’t cover all of your healthcare needs.
  • The premiums are too high.
  • Your favorite doctors are not in-network.
  • The costs are not worth the benefits you’re receiving.
  • A better plan becomes available in your area.
  • You become eligible for a cheaper or more specialized plan.

When can I switch from Medicare Advantage to Medicare Supplement?

Unfortunately, switching Medicare plans is not always easy. If you have a Medigap plan, you can switch to another Medigap plan at any time. However, if you already have Medicare Advantage and want a new Medicare Advantage plan, or if you have Medigap but want to switch to Medicare Advantage, you’ll have to wait for one of three* Medicare Advantage enrollment periods:

  • Annual Enrollment Period: October 15 – December 7 of every year, applies to all Medicare beneficiaries, any change is allowed
  • Special Enrollment Period: Applies only to those with specific circumstances, such as a special medical or financial need, and allows enrollments at specific times outside of AEP and OEP
  • Open Enrollment Period: January 1 – March 31 of every year, allows those with Medicare Advantage to make one switch to a different Medicare Advantage plan or drop coverage

*The fourth Medicare Advantage enrollment period is when you first become eligible for Medicare and is called the Initial Enrollment Period. This is when you would enroll in Medicare Part A and Part B for the first time and can choose to also enroll in Medicare Advantage (or Medicare Supplements and Part D). 

When can I switch from Medicare Advantage to Medigap without losing guaranteed issue rights?

The guaranteed-issue rights for Medigap state that you cannot be denied coverage based on a preexisting condition if you enroll:

  1. When you first become eligible for Medicare, or
  2. When you lose your current coverage for reasons beyond your control

Additionally, Medicare.gov identifies a few specific circumstances that can grant you guaranteed issue rights, including:

  1. Your Medicare Advantage plan leaves your service area, or you move out of the plan’s service area.
  2. You have Part A and Part B, and now your employer coverage is ending.
  3. You joined either a Medicare Advantage plan of PACE (Programs of All-Inclusive Care for the Elderly) upon turning 65 and decided to switch within the first year.
  4. You switched from Medigap to Medicare Advantage and want to switch back within less than one year.
  5. Your policy’s company mislead you or broke a rule.

When You Can Change Medicare Advantage Plans

If you don’t want to switch between Medigap and Medicare Advantage and you simply want to disenroll from a Medicare Advantage plan or switch to another, you can do that during one of the Medicare Advantage enrollment periods. 

CMS added the Medicare Advantage disenrollment period in 2020 to give beneficiaries another chance to switch without having to wait a full calendar year. This Medicare disenrollment period is actually the “Open Enrollment Period” lasting from January 1 through March 31. You are only eligible if you already have Medicare Advantage.

If you’d prefer to switch from Medigap to Medicare Advantage or make any other types of changes, you can do that during the annual election period in the fall, which is sometimes referred to as “Medicare open enrollment,” though it should not be confused with the Open Enrollment Period. 

If you qualify for a Special Enrollment Period (SEP), you can make changes outside of the traditional enrollment periods. Common reasons that you might qualify are if you moved to a new plan service area (or your plan leaves your service area, you move into or out of a long-term care facility, you are also eligible for Medicaid, or you have a medical condition that qualifies you for a Special Needs Plan.

Can I Change my Medicare Advantage Plan If I Move?

You can (and may have to) change your Medicare Advantage plan if you move. Medicare Advantage plans are confined to specific service areas. Some are confined to specific counties or zip codes, while others are state-wide. If you leave that service area, you will need to change plans. 

Additionally, moving to a new service area grants you a Special Enrollment Period. That means that from the date that you are officially living in the new area, you will have 60 days to switch Medicare Advantage plans. If you wait too long, you will have to wait until the Annual Enrollment Period rolls around again. 

Switching Medicare Advantage Plans with Pre-existing Conditions

If you have preexisting conditions and want to switch into a new Medicare Advantage plan, you do not have to worry about medical underwriting. Medicare Supplement (Medigap) plans are the only type of Medicare plan that may require medical underwriting. Original Medicare (parts A and B), Prescription Drug Plans (Part D), and Medicare Advantage plans (Part C) all cannot deny you coverage based on your health history. 

How to Switch Medicare Plans: Step by Step

When you think you’re ready to switch Medicare plans, follow these steps to ensure a successful switch: 

  1. Review your current benefits and make notes about what you like and what you don’t like about your current plan.
  2. Find out if you qualify for Medicaid, Social Security Disability Income, Medicare Savings Programs, or Low-Income Subsidies (all things that can help you save money on your Medicare coverage).
  3. Use this Medicare plan finder tool to find out what plans are available in your area that meet what you’re looking for.
  4. Meet with an insurance agent who can help you fill out your application correctly and answer all your questions (for no additional fees).

Tips for choosing a Medicare plan

Choosing a Medicare plan is a very personal process. Your Medicare coverage goes beyond copayments and deductibles. It can determine how prepared you are for emergencies, it can affect the quality of care you receive, and it can alter your lifestyle based on the benefits included.

Some people might find that traditional Medicare (parts A and B alone) is all they need, but most people will likely want to look for a prescription drug plan or some other benefits as well. No two health plans are the same. Some are very simple, covering basic needs and prevention, and others are complex, offering unique benefits like gym memberships and meal delivery. 

When choosing your Medicare coverage, keep the following tips in mind:

  1. What works for your spouse or friend may not work for you.
  2. Always make sure your favorite doctors are in the plan network before you enroll.
  3. Before selecting a prescription drug plan, verify that the prescriptions you need are covered.
  4. Remember to look at all costs: premiums, copayments, deductibles, and coinsurance. It’s easy to get excited when you see one low number, but everything together can add up.
  5. It doesn’t cost you anything to meet with an insurance agent who already understands the plans. They might even be able to help you save money.

We Can Help You Decide Which Coverage You Need

Changing your Medicare plan from Medicare Advantage to a Medicare Supplement is a big decision. Our licensed agents are highly trained, and they can help you find the plans available in your area. Your agent can discuss the pros and cons of MA and Medigap and help you make the decision that best fits your needs. To set up a no-cost, no-obligation meeting with an agent, call 1-844-431-1832 or contact us here today. 

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