Does Medicare Cover the Cost of Hip Replacement Surgery?
An estimated 2.5 million Americans have undergone total hip replacements. Conditions such as osteoarthritis and rheumatoid arthritis can cause the hip joint to wear down so much that a hip replacement may be the only course of action to improve your mobility.
The total cost of hip replacement surgery can be staggering if you don’t have help from insurance. How much does a hip replacement cost with insurance?
A total hip replacement costs anywhere from $32,000 to $45,000, based on general coverage guidance from healthcare.gov. The total cost usually includes everything from the surgeon’s initial evaluation to post-operation hospital care.
Increases in year-to-year costs are small under stable economic conditions. There was only a small increase in hip replacement 2019 costs compared to medicare hip replacement 2018 costs.
If you’re one of the millions of Americans who needs a hip replacement, you may wonder, “Does Medicare cover hip replacements?” Yes, but you have to meet certain eligibility requirements, and you may still have some out-of-pocket costs even with Original Medicare.
You may also be asking, “How much does Medicare pay for hip replacement surgery?” The good news is that it will cover at least some of all types of costs.
How Much Does Medicare Pay for Hip Replacement Surgery?
The likelihood of needing hip replacement surgery increases with age. Seniors 65 and older, people with ALS or ESRD, or people who have received SSDI for at least 25 months qualify for Medicare.
Original Medicare (Parts A and B) will help cover the cost of hip replacement surgery if your doctor determines it’s medically necessary because other treatments have failed. The answer to how much Medicare pays for hip replacement surgery will depend on whether it is medically necessary and what types of coverage you have.
Medicare Hip Replacement Costs With Medicare Part A
Medicare Part A is hospital insurance. This Medicare coverage helps pay for a semi-private room, meals and nursing care during your stay.
Part A will only cover a private room if your doctor says it’s medically necessary or it’s the only room available.
Medicare hip replacement reimbursement includes skilled nursing care after your surgery. Part A helps cover the first 100 days of in-patient care including physical therapy.
The Medicare Part A deductible can apply, and you may be responsible for copays or coinsurance.
Part B Coverage for Hip Replacement Surgery
Medicare Part B will help cover medical expenses such as doctor’s fees for the initial evaluation and post-op visits, surgery in an outpatient surgical facility, and outpatient physical therapy.
You may be responsible for paying the Part B deductible, which was $185 in 2019, and 20% of the Medicare-approved costs. Medicare Part B may also cover your post-operative durable medical equipment (DME) such as a cane or in-home grab bars.
Medicare Part D Coverage
Original Medicare does not cover post-op prescription drugs, but Medicare Part D includes prescription drug coverage. Your doctor may prescribe blood thinners to prevent clotting or painkillers to take during your recovery.
You can use Medicare Part D or private health insurance plans to cover prescription drugs.
Will Medicare Help Pay for a Knee Replacement?
Medicare Part A and Medicare Part B each cover a different aspect of joint replacement surgery. Medicare Part C will cover knee replacement, including both knees at once, only if your doctor considers it necessary.
Medicare Part D prescription drug program will cover the cost of painkillers, antibiotics, and anticoagulants required for the surgery.
What Medicare Advantage and Medicare Supplements Cover
Private insurance plans offer Medicare Advantage (MA) plans, and they are a great way to get all of the Part A and Part B benefits along with some unexpected offerings such as meal delivery, non-emergency transportation, vision and dental insurance.
Certain MA plans even cover prescription drugs! You will pay a monthly premium with MA plans, but some are as low as $0. Coverage varies depending on your location and the plans available, so look for a qualified professional to help you sort through the plans in your area and find the right one.
The difference is that Medigap Plans only cover your financial responsibilities such as coinsurance and deductibles. You cannot have both a Medicare Supplement and a Medicare Advantage plan at the same time, so it’s important to find out which one is best for you.
Medicare Supplement Insurance plans work with Medicare Part A and Medicare Part B to cover out-of-pocket costs for Medicare hip replacements.
Post-Hip Replacement Surgery Costs
Does medicare cover rehab after hip replacement? Yes. Sometimes, after hip replacement surgery, you may need some help.
For example, throughout your recovery, you might need orthotic devices or other equipment to help you get around. Medicare may cover those devices if your doctor says that they are medically necessary.
Some Medicare Advantage plans may provide extra coverage, and Medicare Supplement plans may cover your copayments for devices.
You also might be interested in Medicare Advantage plans that have an OTC or over-the-counter benefit. This can help offset some of your costs related to pain medication and other items you need to pick up from your pharmacy for your recovery.
Additionally, some people may need physical therapy to recover from surgery or other hip injuries. Medicare Part B may cover your physical therapy by as much as 80%, as long as it is deemed medically necessary.
Why You Might Need a Hip Replacement
Several conditions can cause the hip to deteriorate to the point of needing surgery including:
Hip replacement surgery can restore the hip joint and full range of motion. The type of replacement you receive depends on the doctor’s recommendation and your general health.
The surgery may use a cemented or uncemented prosthesis to connect the replacement parts to the healthy bone after the unhealthy cartilage is removed. The entire recovery process can take three to six months.
Understanding the Hip Replacement Procedure (Orthopedic Hip Arthroplasty)
Hip arthroplasty, also known as total hip replacement, is a common orthopedic procedure. During the surgery, your damaged bones and some soft tissue are removed.
The hip joint is replaced with an implant, which can be ceramic, plastic, or metal.
In a traditional replacement, a 10-12 inch incision is made on the side of the hip. In less-invasive procedures, the incision may only be three to six inches.
Some people may not be eligible for a minimally invasive procedure. Be sure to ask your doctor if you aren’t sure what your procedure will be like.
Medicare Hip Replacement Scenario
To better understand how everything works together, let’s take the real-world example of a 75-year-old man who has osteoarthritis.
He’s been working with his doctor to manage his symptoms, and things have been going well. One day, the man takes a nasty fall and breaks his hip. This man’s Medicare hip replacement process involves several steps:
He doesn’t go to the hospital right away because the bruising around his hip looks like one of his routine injuries. The man makes another doctor’s appointment, and his doctor takes X-rays and determines the man will need a hip replacement.
His doctor will determine if the man is healthy enough for surgery, and then the doctor refers the man to an orthopedic surgeon. Until this point, everything falls under Medicare Part B.
The man decides to have his surgery in an outpatient facility. He’s responsible for his deductible if he hasn’t met it, or the out-of-pocket maximum for his plan.
The surgery is successful, so he has physical therapy appointments so he can recover as quickly as possible. The man has a Medicare Advantage Prescription Drug plan, so he collects his blood thinners and painkillers for only a small copayment at the pharmacy.
Along with prescription drugs, the man’s surgeon prescribes a cane and grab bars to help the man perform daily tasks. The man’s MA plan also covers those items, because his doctor determined they are medically necessary.
Contact Us Today
A comprehensive Medicare plan can help cover the cost of hip replacement surgery. If you need help finding coverage, we can help! Call us at 833-438-3676 or contact us here today.
This post was originally published on May 15, 2019, and updated on March 24, 2020.
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 Alcohol Rehab and Substance Abuse? (Updated for 2020)
Substance abuse costs the US more than $740 billion every year. Those costs are related to crime, healthcare, and lost productivity at work.
Overcoming addiction is a lot of work, and it takes a team of mental health and medical professionals to keep you on the right path. You might know that Medicare will pay for doctor visits for illness and injuries, but what you want to know is, “Does Medicare cover alcohol rehab?”
Medicare does cover many of the costs related to alcohol rehab and treatment if your provider says those services are medically necessary. You must get treatment at a Medicare-approved facility or from a Medicare-approved provider, and that provider must create a care plan.
Addiction Treatment for Seniors and Medicare Eligibles
Treatment for addiction is a lot like treatment for any other disease. It starts small, often with preventive measures, and will progress according to the doctor’s recommendations.
Medicare pays for alcohol and substance abuse treatment for both inpatients and outpatients. Substance use disorders are drug addictions that influence a person’s thoughts, feelings, and behaviors.
These disorders aren’t just limited to illicit drugs, such as Cocaine, Ecstasy, GHB, Hallucinogens, and Heroin, among others. They can also include misuse of legal drugs like nicotine, marijuana, or alcohol as well as legal medications like fentanyl (Duragesic), hydrocodone (Vicodin), or oxycodone (OxyContin).
Level 0.5, Early Intervention Education and prevention for people who are at risk of developing an addiction fall under this level. Medicare can cover a conversation with your doctor about a prescription drug that may be habit-forming.
Level 1, Outpatient Treatment This level of addiction treatment refers to nine hours or less of weekly counseling services or recovery. Outpatient mental health services fall under Medicare Part B and certain Medicare Advantage (MA or Part C) plans.
Level 2, Intensive Outpatient and Partial Hospitalization
These treatment programs are categorized as having more than nine hours of counseling services a week, and/or short inpatient hospital care. Medicare Part A pays for hospital stays of up to 60 days. After 60 days, you will owe coinsurance.
According to the American Addiction Centers, “Part B covers partial hospitalization (PHP), which is an outpatient treatment” that a hospital or mental health center provides. A PHP provides more intensive treatment than standard outpatient programs.
A doctor must say that PHP is medically necessary, and your treatment plan must include at least 20 hours of treatment per week.
PHP services can include:
Individual and group therapy
Activity therapies that are not chiefly recreational
Therapeutic drugs that can’t be self-administered
Medically necessary diagnostic services for mental health
Level 3, Inpatient Treatment
The next level involves up to 90 days in a rehab facility with a focus on behavioral therapy and staying away from substances. Medicare Part A covers the first 60 days of psychiatric hospital stays.
Days 61-90 will cost most people $335/day.
According to the American Addiction Centers, you can receive up to 190 days of treatment at a specialty psychiatric hospital, but no more. That is a lifetime limit. You may be able to receive treatment under Medicare Part A at:
Acute care hospitals
Critical access hospitals
Inpatient rehab centers
Long-term care hospitals
Inpatient care as part of a qualifying research study
People whose long-term addictions have caused them physical harm need this level of care. It not only involves drug and alcohol counseling but also access to nursing care, prescription drugs, and other medical services
In the event that you or someone you love suffers an overdose, Medicare covers some treatments. For example, most Medicare Part D plans cover Narcan, the drug used to reverse the effects of an opioid overdose.
Typical co-pays for most people with Part D and certain Part C plans for Narcan range from $19-$144.
Medicare Part A is hospital insurance, and it will cover your hospital stay, but not all services fall under Part A. Ambulance transportation is under Part B, and so is doctor observation until you are “officially admitted” into the hospital.
The Centers for Medicare & Medicaid Services (CMS) cover mental health treatment. Medicaid is a federal and state program to help you with your medical costs if you have limited income.
Mental health treatment services are based on screening, brief intervention, and referral to treatment (SBIRT). This is an evidence-based approach used in public health for early interventions and treatment services.
It’s designed to help someone at risk for a substance abuse disorder or who already has a substance abuse disorder.
For instance, after this comprehensive evaluation protocol, someone addicted to heroin might be administered methadone to reduce the intensity of withdrawal symptoms. If this patient does not benefit from outpatient treatment, then inpatient psychiatric care is another option. Such residential treatments provide a space for treatment, sleeping, bathing, recreation, and dining.
Addiction is a disease, and with the right treatment plan, it can be managed. A qualified professional can guide you through the thousands of Medicare plans out there and help you find one that will suit your needs.
Does Medicare Cover Opioid Treatment?
In 2020, the Medicare program includes paying for Opioid Treatment Programs (OTP). The Medicare-enrolled opioid treatment program is comprehensive, consisting of periodic assessments, intake procedures, toxicology testing, individual therapy, group therapy, and counseling for substance use.
It also includes FDA approved opioid treatments and medication-assisted treatment (MAT) medications as well as the dispensation and management of MAT medications. A search for “opioid treatment programs near me” will show you a map of addiction treatment centers in your neighborhood.
SAMHSA Helpline to Find Treatment
The Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline is a free, confidential service you can use 24 hours a day, seven days a week to find treatment for substance abuse disorders. You reach the helpline at 1-800-662-HELP (4357) or use SAMHSA’s online treatment finder tools.
What Is the SAMHSA Helpline?
The SAMHSA National Helpline offers assistance in finding local treatment facilities, support groups, and community-based organizations. You can also request free publications and other information.
Will My Medicare Plan Cover This Service?
The referral service is free. When you call, ask the representative to refer you to a facility that accepts Medicare. If you have a Medicare Advantage plan, ask your health insurance carrier for a list of participating healthcare providers.
How to Find Approved Medicare Alcohol Treatment and Drug Rehab Providers
Medicare’s Physician Compare website is a great resource for finding addiction treatment in your area. Click here to get started.
You’ll reach a page that allows you to enter your zip code and what type of medical practice you want to find. We chose 37209, which is the zip code for our corporate offices in Nashville, TN.
For the practice type, we chose “addiction medicine.” Once you’ve entered that information, click “search.”
That will lead you to a list of local practices that specialize in addiction treatment. You can use the contact information to call the facilities and compare their services, or you can use Medicare.gov’s tool.
To use the tool, click on the practices you want to compare. For our purposes, we only chose the top three practices on the list.
Then click “Compare” at the bottom of the page.
Then you will come to a page that allows you to view practice contact information on one screen. You can also look at the practices’ full profiles and get directions to each location.
Prevalence of Substance Abuse in Older Adults
Older adults (defined as 65 and older in the United States) most commonly abuse alcohol, but many also abuse prescription and illegal drugs. The percentage of older adults who met the criteria for having an addiction problem was 11.7 percent.
Drug abuse in adults older than 65 years is mainly limited to alcohol despite the prevalence of so many illicit drugs and mood-altering prescription drugs.
Substance Abuse in the Elderly: Unique Issues and Concerns
The elderly population accounts for 25% of the prescription drugs sold in the US, and this population faces unique issues when it comes to substance abuse. Because addiction symptoms look like other common senior health disorders such as dementia, diabetes, and depression, addiction often goes ignored.
If you or someone you love struggles with drug or alcohol addiction, you don’t have to face it alone. A licensed agent with Medicare Plan Finder may be able to help you find a Medicare plan with the right care team to lead your or your loved one’s recovery.
To set up a no-cost, no-obligation appointment with an agent call 844-431-1832 or contact us here today.
This post was originally published on April 22, 2019, and updated on March 6, 2020.
Does Medicare Cover Dental Implants?
Sometimes plaque and tartar can build up to the point where the accumulation irritates the gums. The irritation can result in tooth loss. A dentist might recommend a dental implant to solve the problem.
If you’re one of the many people who need dental implants and you have Medicare insurance, you probably have a lot of questions such as, “What are dental implants,” and, “Does Medicare cover dental implants?”
What Are Dental Implants?
A dental implant is an artificial tooth with a titanium post that’s surgically attached to the jaw. About 450,000 people have dental implants every year.
Original Medicare and Medicare Advantage Dental Coverage
Original Medicare (Part A and Part B) does not cover dental implants or routine dental care. However, private insurance policies called Medicare Advantage (MA) plans can offer coverage for additional services Original Medicare does not, including dental services.
If you need dental insurance, an agent with Medicare Plan Finder can work with you to find a MA plan in your area that offers dental coverage. Some plans also offer coverage for vision, hearing and even fitness classes along with all of the services that Original Medicare covers.
Some people may find that their Medicare Advantage plan does not cover all of their dental needs. Those people may need additional dental coverage from private policies called commercial dental insurance plans to cover major procedures such as dental implants.
Does Medicare Supplement Cover Dental Implants?
Medicare Supplement (Medigap) plans can help pay for financial items such as copays and coinsurance that can come with Original Medicare.
Unlike Medicare Advantage plans, Medigap policies do not offer additional benefits. That means that a Medicare Supplement plan will not pay for routine dental care or dental implants. You cannot have both a Medicare Advantage policy and a Medigap plan at the same time, so it’s a great choice to learn the difference between the two.
Medicaid is both federally and state-funded. The program helps people who qualify to pay for their health insurance. Every state has different rules about dental coverage. While most states provide at least emergency dental services for adults, not all states provide comprehensive dental coverage.
If you qualify for Medicaid and have questions about what services your state covers, contact your local Medicaid office.
Elderly Dental Problems and Their Solutions
Tooth loss is not an inevitable part of aging, but many seniors can develop diseases which can make dental implants or other solutions a necessity. Conditions that affect older adults include dry mouth, gum disease, and oral cancer.
Many medications that treat common senior conditions have dry mouth as a side effect. Dry mouth can lead to cavities, which ultimately lead to gum disease. If you have dry mouth as a medication side effect, talk to your doctor about what drugs you take and the dosages.
Your doctor may change your prescriptions or recommend over-the-counter oral moisturizers or drinking more water. In order to further prevent cavities, your dentist may apply fluoride treatments.
Periodontal, or gum disease results from bacteria in plaque irritating the gums. The gums become swollen and are more likely to bleed. Periodontal disease is widespread among older adults because it’s often painless until it becomes severe and many people don’t have regular dental exams.
If gum disease goes untreated, the gums can recede from the teeth and form spaces that can collect food particles and more plaque. Advanced periodontal disease can destroy the gums and the bones and ligaments that support the teeth. Your dentist can treat or help you prevent gum disease, so it’s important that you have regular check-ups.
Oral cancer is an uncontrollable growth of invasive cells that causes damage to the mouth, tongue, and throat. It can be life-threatening if it’s not treated early. Along with regular dental visits, you can prevent oral cancer by avoiding tobacco or heavy alcohol use.
Other risk factors include a family history of cancer, excessive sun exposure and having HPV. About 25 percent of oral cancer cases are people who don’t smoke or who only drink occasionally. Treatment for oral cancer involves surgery to remove the cancerous cells, or radiation and chemotherapy.
Does Medicare Cover Dentures or Other Alternatives to Traditional Dental Implants?
Some people may not be able to receive dental implants. For example, if your jaw cannot support an implant, a dental specialist will have to find an alternative. Dental implant alternatives include:
Bridges: This alternative uses artificial teeth supported by crowns that attach to the natural teeth to solve the dental issue.
Full or Partial Dentures: Full dentures are a dental implant alternative for people who have lost most of their natural teeth. They are removable artificial teeth secured to a support piece in the mouth. Partial dentures are for people who have most of their natural teeth still, and they attach to natural teeth with metal clasps.
“Teeth in a Day”: Traditional dental implants require a lengthy recovery period that can last up to two years. “Teeth in a Day” is a procedure that uses computer-guided technology to find the best placement for implants and accurately insert new posts in an hour.
If you take care of your teeth, you can avoid many of the issues that contribute to tooth decay, gum disease and tooth loss. A strong oral hygiene routine includes:
Brushing twice daily with fluoride toothpaste
Flossing between your teeth every day to remove plaque
Limiting alcoholic beverages
Refraining from smoking or chewing tobacco
Regular dental visits even if you have no natural teeth or you have dentures
Visiting your doctor or dentist if you experience abrupt changes in taste or smell
Working to control diabetes, which will decrease the risk of gum disease and other conditions
Many older adults will need assistance with everyday grooming and self-care. If you’re a caregiver, you can help the people you care for avoid gum disease by flossing and brushing their teeth every day and bringing them to their dentist visits.
Let Us Help You Find Dental Plans That Cover Dental Implants
Even though Medicare does not cover dental implants, the right Medicare Advantage plan or commercial dental insurance plan can help pay for the treatments your dentist recommends. Call 833-438-3676 or contact us here to arrange an appointment with a licensed agent.
This post was originally published on June 12, 2019, and updated on January 7, 2020.
While this is probably the easiest way to explain Medicare, most people don’t know how complicated it can be once you dive below the surface. Here we’ve broken down the 7 most important facts about Medicare that you may have never heard before!
1. There are multiple parts of Medicare
Perhaps the biggest misconception about Medicare is that it’s one gigantic program. In truth, what we refer to as Medicare actually has four distinct components, or “parts.” You might hear some different names used but usually these parts will be designated as A, B, C, or D.
The Original Medicare program consists of Part A and Part B. Part A primarily covers inpatient hospital care, while Part B handles outpatient services like doctor visits. These two components of Original Medicare represent the basic coverage that is available to you when you turn 65.
Part C, often called Medicare Advantage plans, are offered by private health insurance companies. These allow recipients of parts A and B to also receive benefits like dental, vision, and prescription drug coverage depending on the plan they choose.
Part D, sometimes called a prescription drug plan (PDP), offers prescription drug coverage to beneficiaries enrolled in Medicare. These are offered by private insurance companies as an addition to the Original Medicare benefits, as Original Medicare does not include any drug coverage.
To see these different Medicare plans explained in even more detail, check out our more in-depth blog here on finding the best types of Medicare plans for you in 2020!
2. You can’t enroll whenever you want
Unfortunately, Medicare is not a program you can just enroll in at any time. It’s true that you are eligible for Medicare when you turn 65, but unless you qualify for automatic enrollment, you will need to sign up during one of the five designated enrollment periods.
The Initial Enrollment Period (IEP) is usually your primary opportunity for Medicare enrollment. If you are aging into the program, this IEP begins three months before your 65th birthday and extends to three months after, giving you seven months in total to enroll.
There is actually a second IEP, sometimes called IEP2, available for those who are eligible for Medicare before they turn 65, such as those with disabilities. This period also lasts seven months and gives these beneficiaries an opportunity to make changes to their plan.
The General Enrollment Period (GEP) is offered for first-time Medicare enrollees who did not join during their IEP. This period occurs every year from January 1 to March 31. Coverage applied for during this period begins on July 1st.
The AEP, or Annual Enrollment Period, starts every October 15 and runs until December 7. This period provides an opportunity for those already enrolled in Medicare to make changes to their coverage, such as adding a Part D plan or converting your Original Medicare to a Medicare Advantage plan.
Special Enrollment Periods (SEPs) allow Medicare beneficiaries to make changes to their coverage outside of AEP. During these periods, people who are enrolled in a Special Needs Plan or who have recently lost a job can add to or switch their coverage. Check out the handy graphic below to see if you qualify for one of these SEPs.
In 2019, a new enrollment period was introduced, called the Open Enrollment Period, or OEP. This period lasts from January 1 to March 30, and lets those who enrolled in Medicare Advantage during AEP make changes in their coverage without having to wait for the next AEP.
3. You may have to pay if you delay
If you do miss your IEP, you may have to pay penalties when you finally do enroll. The amount you will pay and the duration you will have to pay depends on which part of Medicare you enroll in and how long you waited.
The Part A penalty is incurred if you do not qualify for free, automatic enrollment and you fail to sign up for it when you are eligible. This penalty will be added to your premium to the tune of 10%, which you will have to pay for twice the number of years that you neglected to sign up.
If you enroll late in Part B, your premium will go up by about 10% for every year you were eligible but didn’t sign up. You will then have to pay this increased premium for the entire time you have Medicare Part B. You may also have to pay a penalty if you do not enroll in a Part D plan within the first three months that your Parts A & B are active. However, some of these penalties may be avoided if you qualify for a Special Enrollment Period.
4. Original Medicare only covers 80%
Once you are finally enrolled, you might wonder: “How much does Medicare cover?” The unfortunate truth is that it will not fully cover your medical expenses. Parts A & B will only cover up to 80% of the cost of Medicare-covered services, leaving you to pay the remaining 20% coinsurance.
This might not be too much trouble for routine doctor visits, but in the case of a medical emergency or hospital stay, the amount you pay out-of-pocket can skyrocket quickly. To cover that last 20%, consider purchasing a Medicare Supplement plan to add on to your Original Medicare coverage.
5. Original Medicare doesn’t cover dental, hearing, or vision
Many people might not realize that Medicare covers very little in the way of dental and hearing expenses, and virtually nothing when it comes to vision. Part A will sometimes pay for specific dental services if you have to get them while you are staying in a hospital, but will not pay for cleanings, fillings, dentures etc.
Medicare will sometimes cover diagnostic hearing exams if your physician orders it as part of their treatment, but will not cover hearing aids under any circumstances. For vision coverage, your options with Original Medicare are even more limited, as it will not pay for eye exams, glasses, or contact lenses.
There are some options that can provide vision, hearing, and dental coverage for seniors. A DVH (or Dental, Vision, Hearing) plan can be purchased to add to your Original Medicare benefits, or you might look to a Medicare Advantage policy to consolidate all of that coverage into one plan.
If you think Part C might be the best coverage option for you, click here or give us a call at 844-431-1832 to have a licensed agent help you compare Medicare Advantage plans!
6. Original Medicare will not cover you abroad
Aside from a few very specific circumstances, Medicare Parts A and B will not cover your health care while you are traveling outside the United States. Medicare Part D plans are also invalid once you are more than 6 hours away from a U.S. port.
But there are some Medicare coverage options available for foreign travel, primarily in the form of Medicare Supplement (Medigap) plans.
7. Supplement plans have the same coverage, different cost
Medicare Supplement, or Medigap, insurance can be used to cover the out-of-pocket costs you may have to pay with Parts A and B. Insurance carriers offer many different types of Medigap plans, often sorted alphabetically, but they all must follow the same government regulations.
This means that Plan F from one carrier must provide the same benefits as Plan F from another carrier. Below is a quick breakdown of all the benefits covered by the different Medigap plan types.
Once you have found a Medigap plan type that meets your needs, you must consider the price. Insurance carriers must cover what is mandated by the government guidelines, but may charge very different rates for that coverage.
To find the best price, reach out to one of our licensed agents here or at 844-431-1832 to have them run a personalized quote, or use our Medicare Plan Finder Tool to compare all the plans offered in your state and county!
3 Easy Steps to Making New Friends After Retirement
It’s always tough adjusting to big life changes and, as we get older, those changes seem to come faster and faster. Retiring, moving to a new city, or the death of a spouse can all be overwhelming and foster social withdrawal and isolation.
In fact, a recent survey of retirees showed that 11% of those questioned said they felt lonely and isolated, and almost half of those had recently moved to a new home. The AARP estimates that 42.6 million Americans over age 45 suffer from loneliness, which has been established as a risk factor for early illness and death, especially among seniors.
Fortunately, staying social is easier than ever in our modern age. Read on and learn some awesome methods for making and maintaining new friendships!
1. Follow Your Passions To Find Friends
It’s not easy knowing how to make friends when you are older. Stanford researchers have even suggested that baby boomers are withdrawing from social relationships more than any other group.
But finding new friends doesn’t have to be a guessing game. Just ask yourself a few simple questions: what do you like to do? What are you passionate about? What would you like to learn more about? Finding people with mutual interests and passions is the best place to start forging new friendships.
Social Networking for Seniors
More than ever, technology is helping us form and sustain new friendships. A quick Google search will bring you to senior friendship sites like Silversurfers or Buzz50, which feature forums and chat rooms tailored to older adults.
You can also find countless senior social media groups on platforms like Facebook, which have an increasingly large userbase over the age of 55. Here you can get connected with people online or even find a group that meets in real life. You can look for clubs, classes, or other hobby groups in your area and you’re sure to meet other like-minded social seniors.
2. Getting Out and About
In the social media age, congregating with people who have shared interests can be done from the comfort of your own home. But if you’re feeling cooped up, there are countless ways to meet new senior friends while staying active!
A senior meetup is a great place to meet seniors in your area that share your interests or passions. You may find these meetups at churches, gyms, retirement communities, or other places senior citizens hang out. There are even dedicated websites like Meetup.com, which connect you to in-person events based on your location and preferred activity. This helps provide a built-in ice breaker, as you can discuss your common interests.
If you are into photography or arts & crafts, find a workshop at a senior community center where you can advance your skills. If you enjoy cooking but are getting bored of the same old recipes, join a cooking class like the ones offered at Sur La Table. If you’re more of an outdoorsy type, there are groups that go for nature outings. Or you may prefer to find a group that gets together simply to eat, drink, and socialize.
Volunteer Opportunities for Seniors
Another great solution for the social isolation elderly people face is volunteering. This can be a great way to form social connections and do something good for others at the same time.
Organizations like Senior Corps offer programs that allow retirees to mentor young people, be a companion to other seniors who are less mobile, or share their expertise in community projects like building housing.
The AARP also has a program called the AARP Foundation Experience Corps, where those over the age of 50 can tutor young children to help improve their reading comprehension. This mentoring has an impressive impact on the students, improving their literacy skills by up to 60%.
Senior Fitness Classes
Working up a sweat is a tried-and-true strategy for staving off some of the side effects of isolation, such as depression and anxiety. But it can also be a terrific way to meet new people!
Active older adults can join a senior fitness program to help keep an exercise routine and chat with other seniors looking to stay in shape. Many of these programs, like Silversneakers®, may be covered by your insurance. If you have Medicare and are considering purchasing a Medicare Advantage plan to cover fitness programs, click here or give us a call at 844-431-1832 to speak with a licensed agent.
3. Get To Know Your New Friends
Once you have made some new acquaintances, it can be difficult to form a closer bond. Plus, as we get older, we usually have less interest in maintaining superficial or casual relationships. Getting organized and keeping to a routine can help tremendously in developing old and new friendships alike.
Keep A Schedule To Stay In Touch
The best way to uphold and develop a relationship is to keep in contact on a regular basis. As your social group grows, start a calendar.
A well-organized calendar can ensure you never miss a meetup or social event that you want to attend. You can also use your calendar to keep track of birthdays and anniversaries. A simple “happy birthday” can go a long way in strengthening a burgeoning friendship.
Just as modern technology can help us meet new people, it can also help us stay in touch with friends and family alike. On social media platforms like Facebook, you can stay engaged with your social groups, old and new, by liking or commenting on statuses and pictures, as well as posting a few of your own! Emails and phone calls can also keep you in the loop with new friends.
Whichever way you choose to find your new social group, remember that forming long-lasting bonds takes time. If a new acquaintance does not respond to your efforts, try not to take it personally. There are plenty more people out there looking for the same connections you are. Keep searching and don’t get discouraged!
5 Common Types of Mental Illness In The Elderly
Most of today’s senior citizens grew up in a time when mental illness was almost never discussed in public. Over the years though, the stigma around mental health has largely eroded and conversations about mental health often dominate the national discourse.
As mental illness becomes less taboo, its far-reaching impact on society is coming more into focus. For example, the effects of mental illness in seniors are studied much more closely than ever before.
Common Types of Mental Illness In Seniors
With this more extensive research, it’s easier to see what mental health issues are common in the elderly population. The most prominent issues in senior mental health are:
Depression is often cited as the most endemic mental illness in the elderly population today. Many older adults may shrug depression symptoms off as simply “feeling down,” meaning it often goes undiagnosed and may be even more pervasive than the research suggests.
There are many risk factors that specifically contribute to depression in the elderly. Retiring from work can cause strong feelings of boredom or listlessness, and the death or illness of a spouse can leave many stressed and sorrowful.
Not only can depression exacerbate the symptoms of other chronic health issues, it is also noted as a symptom of more severe mental disorders like dementia. This means seniors and their loved ones must be vigilant in watching for these depression symptoms:
Feelings of sadness, hopelessness, or emptiness
Lack of motivation or interest in previously enjoyed activities
Trouble concentrating and decision making
Thoughts of suicide or self-harm
Anxiety disorders can take many different forms, such as obsessive-compulsive disorder (OCD), panic disorder, or generalized anxiety disorder. These are usually characterized by intense fear or nervousness over issues most would consider normal, routine aspects of everyday life – locking doors or finding a parking spot, for example.
Like depression, anxiety in older adults is extraordinarily common and is often underdiagnosed. Older adults are especially prone to ignoring this illness, perhaps because the conventional medical wisdom of previous decades downplayed psychiatric symptoms if no physical issues existed.
It is important to note however, that some physical symptoms such as restlessness or fatigue may accompany anxiety, further confusing a potential diagnosis. Be on the lookout for these symptoms of anxiety in the elderly:
Irrational, obsessive, or catastrophic thoughts
Isolating behavior and withdrawal from others
Irritability or agitated moods
Fatigue and muscle soreness
3. Bipolar Disorder
Bipolar disorder is usually diagnosed in younger people, whose moods can swing quickly from elation to depression. If this diagnosis is made when the person is an older adult, it is referred to as late onset bipolar disorder and it is more likely to manifest as agitation.
Diagnosing bipolar disorder in seniors is made even more difficult by the misinterpretation of symptoms. Many of the warning signs of late onset bipolar disorder might be dismissed as simply the natural effects of aging. Furthermore, some symptoms may resemble the side effects of certain medications, like antidepressants and corticosteroids.
As the population steadily increases, the number of cases of late onset bipolar disorder is expected to rise along with it. Professional help should thus be sought if you or those close to you observe any of these bipolar symptoms in adults:
Agitation and irritability
Hyperactivity or distractibility
Loss of memory, judgment, or perception
Similar to bipolar disorder, schizophrenia is a condition usually diagnosed in younger individuals. Late onset schizophrenia is the terminology used when this disorder is observed in patients over the age of 45.
Schizophrenia is characterized by a broad range of symptoms, from the so-called “negative” symptoms, like loss of interest or enthusiasm in activities, all the way to delusions and hallucinations. While late onset schizophrenia is less common than the early onset variety, older sufferers are more likely to experience these severe symptoms.
Currently, doctors are unsure what causes late onset schizophrenia and why it is different from its other forms. Some have theorized that it is a subtype of the disorder which is triggered by life events. Regardless, it is vitally important that seniors and their loved ones keep an eye out for these late onset schizophrenia symptoms:
Delusions or hallucinations
Disorganized speech or behavior
“Negative” symptoms (absence or lack of interest in normal behaviors)
Though it is classified separately from mental illnesses by the medical community, dementia is still a disorder that severely affects mental health. There are many different stages and forms of dementia but the most common incarnation is Alzheimer’s disease, which affects around 3 million people over age 65.
Alzheimer’s and other forms of dementia can develop from the natural cognitive decline that happens as we age, drawing a startling link between aging and mental health. All demographics should make mental health a priority but seniors especially should watch for these dementia symptoms:
Disorientation or confusion (forgetting dates, years etc.)
Decrease in memory
Decline in ability to communicate
Mood swings and emotional issues
Treatment & Medication
Mental illness treatment can be a tricky process and it begins with a proper diagnosis of the condition’s type and cause. To do this, your doctor may administer several different types of tests, from cognitive and psychiatric evaluations to brain scans and lab tests.
Several different mental conditions have symptoms that overlap and make them difficult to diagnose without extensive medical experience. Once the condition is properly diagnosed, a doctor may suggest one of these common forms of mental illness treatment.
The most common forms of outpatient mental illness treatment are based around medication or psychotherapy, often used in conjunction. The efficacy of these treatments varies from person to person and sometimes multiple treatment options must be attempted before an effective one is found.
For depression and anxiety disorders, pharmacological methods of treatment usually utilize antidepressants. These can be prescribed in addition or as an alternative to psychotherapeutic approaches like “talk therapy.” The Anxiety and Depression Association of America (ADAA) also suggestsregular exercise and a balanced diet as ways of staving off these common mental illnesses, stressing the link between brain and gut health.
The primary medications used in treating bipolar disorder and schizophrenia in seniors are classified as antipsychotics, usually prescribed at a lower dosage than people diagnosed at a younger age. For non-drug treatments of more severe cases, inpatient care is often required for proper rehabilitation.
For the treatment of dementia in the elderly, no cure is currently known. But the symptoms can be managed and the Alzheimer’s Association recommends a non-drug approach before attempting medication. These can begin with something as simple as changing the environment of those with dementia to remove obstacles and promote a general ease of mind.
If these non-drug approaches are not effective, certain types of medications like cholinesterase inhibitors and memantine may be prescribed to temporarily relieve some symptoms. Other approaches may include the use of antidepressants or anxiolytics, depending on the specific behaviors and symptoms that manifest.
With the more serious mental illnesses widely seen among seniors, outpatient care may not be an option. Those suffering from bipolar disorder or dementia may not be able to maintain their daily functions on their own and must turn to medical services that can attend to their needs 24 hours a day.
For example, the most common form of therapy for conditions like schizophrenia is a psychosocial approach, where a team of doctors, nurses, social workers and other professionals work in close contact with the patient to monitor their symptoms, both mental and physical, and help them maintain social skills and daily activities.
In these severe cases of mental illness, the accessibility of quality inpatient care has been shown to be a determining factor in recovery. The psychosocial interactions common in inpatient care are now considered to play a necessary role in a comprehensive intervention plan, as isolation can intensify many of the symptoms of these conditions.
What mental health services does Medicare cover?
When faced with one of these potentially life-changing illnesses, it is important to know what exactly is covered by your health insurance. Depending on the condition and its severity, some patients may need an extended stay in a hospital, which can quickly skyrocket the cost of care. Fortunately, Medicare covers many mental health services.
Medicare Part A Coverage
The types of mental health coverage offered differ depending on which elements of Medicare you are covered by. Medicare Part A covers inpatient care, or the medical services you receive while staying in a hospital. The out-of-pocket costs not covered are the same regardless of the type of hospital, general or psychiatric.
Medicare measures your use of hospital facilities using benefit periods. These benefit periods are tallied in increments of 60 days, beginning on the day you’re admitted to a hospital and ending when you haven’t used any hospital services for 60 consecutive days.
If your stay is in a general hospital, there is no limit to the amount of benefit periods Medicare will cover. In a specialized psychiatric facility though, Part A will only pay for up to 190 days of inpatient care during your lifetime.
For further information on how the co-payments break down, check out this handy graphic or see our more in-depth article here.
Medicare Part B Coverage
Medicare Part B will cover most of the cost associated with outpatient mental healthcare. This primarily includes any doctor visits that may relate to your mental health, including appointments with psychiatrists, psychologists, nurses, and social workers.
Therapy and counseling may or may not be covered depending on if the doctor accepts Medicare assignment. Finding a therapist who takes Medicare is now easier than ever, using tailored search tools like the one developed by Psychology Today, available here.
After you meet your Part B deductible, Medicare will cover 80% of their approved amount to the doctor or therapist. This leaves a 20% copay that will have to be paid out-of-pocket. For some, this may still be too expensive and that’s where Medicare Advantage, Supplement, and Part D plans can help!
Medicare Advantage, Supplement & Part D Coverage
There are several types of supplemental coverage that can help pay for Medicare mental health benefits.
Part D plans, for example, offer coverage for prescription drugs which are not covered by original Medicare. For the year of 2020, these plans will have an annual deductible of $435 but, since they are provided by private insurance, there is some variation in the deductible, which may be waived, reduced, or charged upfront.
Medicare Advantage plans, also referred to as Part C, can offer far more benefits than parts A and B alone, including prescription drugs, dental and vision coverage, and group fitness classes tailored to seniors.
Alternately, you may choose to apply for a Medicare Supplement plan, which provides additional financial benefits to help with mental health-related costs like copayments and deductibles. There are up to ten distinct types of Medicare Supplement plans (designated alphabetically from A – N). Each plan may differ in coverage and price.
Whatever supplemental coverage you are looking for, it is best to seek the help of a licensed agent who can fully explain the details of each plan and find one that works best for you or your loved one. To contact one of these professionals directly for free, no-strings-attached information, fill out this form or give us a call at 844-431-1832 and get covered today!
$0 Premium Humana Honor Plans for Veterans
Humana is one of the biggest Medicare Advantage carriers, with over 8.4 million members across all 50 states (plus D.C. and Puerto Rico). They’ve been active for over three decades! New this year, Humana is providing a “Humana Honor” Medicare Advantage plan.
Uniquely, though it is “available to anyone eligible for Medicare” who lives in the service area, this Medicare Advantage plan is designed to complement VA (Veteran’s Affairs) coverage. Many veterans think they have no use for Medicare Advantage (or even Medicare at all) due to their VA coverage, but a plan like this could be a game-changer.
Do you Need Medicare if you have VA Coverage?
For some people, the VA may provide all the coverage you need. But, if you can get additional coverage at no extra cost, why not take it?
Plus, even though there are 1,921 VA facilities across the country, wait times can be a problem. You can use this tool to find out what your local wait times are, but you might not need to if you have additional coverage. If you also have Medicare (and if you have Medicare Advantage), your network can be expanded to many more local doctors and other medical facilities, where you may have an easier time getting an appointment.
Plus, the VA does not automatically provide dental coverage to all veterans. You can purchase it through the VADIP (VA Dental Insurance Program), but you might not need to. If it makes sense for you and if it is available in your area, you can instead enroll in a Humana Honor or other Medicare Advantage plan that includes a dental benefit.
Humana Honor is available as 17 different plans available in 28 states:
How to get Humana Honor Medicare Advantage
There are a few ways you can enroll in Humana plans, but we recommend speaking with a licensed agent. An agent can help you sort through all your options and make sure that the plan you like is truly the best plan for you. It is free to speak with a licensed agent regarding your healthcare, so it can only help!
You can speak to a MedicarePlanFinder.com agent by calling 844-431-1832 during business hours or clicking here.
Humana Taking Care of Veterans
Humana has strong relationships with (and is the national Medicare plan carrier for) the VFW (Veterans of Foreign Wars) and AMVETS (American Veterans). Infact, Humana partnered with the VWF’s “Uniting to Combat Hunger” campaign and helped raise money for over 500,000 veteran meals.
Additionally, Humana’s administration has hired over 4,500 veterans and veteran spouses since 2011.
Whether you like Humana’s Medicare Advantage plans or not, you have to give them props for their work with veterans and veteran families!
We’re proud to offer Humana plans through our insurance brokers and are excited to be a part of providing veterans with the care they deserve.
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:
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:
Pros: Prescription drug coverage can be included
Cons: Stricter network
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?
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:
Your Medicare Advantage plan leaves your service area, or you move out of the plan’s service area.
You have Part A and Part B, and now your employer coverage is ending.
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.
You switched from Medigap to Medicare Advantage and want to switch back within less than one year.
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:
Review your current benefits and make notes about what you like and what you don’t like about your current 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:
What works for your spouse or friend may not work for you.
Always make sure your favorite doctors are in the plan network before you enroll.
Before selecting a prescription drug plan, verify that the prescriptions you need are covered.
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.
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.