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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.

Does Medicare Cover Chiropractic Care?

Many people visit the chiropractor to treat a variety of conditions including back pain and headaches. Chiropractic care may be an alternative to prescription drugs.

The idea is that chiropractic care will treat the root cause of the problem, rather than just treating the symptoms. If you have Medicare insurance, you may want to know, “Does Medicare cover chiropractic care?” Yes, but according to the official notice of Medicare coverage for chiropractic care, Medicare has non-covered, always-covered, and perhaps-covered categories.

So it is only applicable in limited circumstances when chiropractic care treatments meet specific rules.

Medicare Chiropractic Coverage

Medicare will not cover the X-rays, massage therapy, or acupuncture treatments your chiropractor may recommend. However, Medicare does cover chiropractic care (spinal manipulation) to correct subluxations, which describes the condition when one or more spinal vertebrae move out of position.

Original Medicare consists of hospital insurance (Part A) and medical insurance (Part B). Medicare Part B will help pay for chiropractic services if your doctor says they’re medically necessary.

If your chiropractor is Medicare-approved, Part B will pay for 80% of your adjustment. You will still owe 20% coinsurance, and the Part B deductible applies.

Original Medicare does not cover many services people want. Private insurance plans called Medicare Advantage (MA) plans can offer coverage for additional chiropractic services.

MA plans vary by location and carrier, and choosing a plan may seem overwhelming. A licensed agent with Medicare Plan Finder can help you find a health insurance plan in your area that fits your needs.

Here is how Medicare Part A, B, C, and D apply to Chiropractic coverage:

  • Medicare Part A will not cover a visit to a chiropractor because it only applies to hospital care. Chiropractic care is classified as a non-emergency medical service provided in a chiropractic doctor’s office.
  • Medicare Part B covers manipulation of the spine if a chiropractor believes treatment of a subluxation, which is a misalignment of the spine, to be medically necessary. Part B also provides coverage for physical therapy, since this is another outpatient treatment.
  • Medicare Part C, the Medicare Advantage plan part, will also cover medically necessary chiropractic services.
  • Medicare Part D, the Medicare prescription drug benefit, does not apply to chiropractic care at all because Chiropractors are not typically permitted to prescribe medicines legally.
Medicare Advantage | Medicare Plan Finder
Medicare Advantage | Medicare Plan Finder

How Many Chiropractic Treatments Does Medicare Cover?

Medicare provides five paid chiropractic visits annually. This can be arranged by your physician through either the Chronic Disease Management plan (CDM) or the Team Care Arrangement (TCA). Medicare chiropractic coverage will save you more than $250 in your healthcare costs.

How Much Does Chiropractic Care Cost With Medicare?

Medicare beneficiaries are United States residents enrolled in Medicare Part A or Part B benefits, or enrolled in both Part A and Part B. They are entitled to receive most medical services after paying their deductibles and a 20% coinsurance.

As a Medicare beneficiary, several factors affect the exact amount you pay with Medicare, for example:

  • Your health insurance plan
  • How much your chiropractor charges
  • Whether your doctor takes Medicare and accepts the assignment
  • The type of facility
  • The location of your test or service

What Leads to the Need for Chiropractic Adjustments?

Chiropractor Explaining X-Ray Results to Man | Medicare Plan Finder

Many common conditions can lead to spinal subluxations. For example, let’s say you bend over to pick something up, and when you stand up, your back doesn’t feel right. It hurts, feels tight, and you can’t stand up straight.

You visit your doctor right away, and your doctor determines that your spine is out of alignment. Your doctor might refer you to a chiropractor.

Before your chiropractor creates a treatment plan you will have X-rays and tests to assess your range of motion.

Improper lifting is one cause of spinal subluxations. Other common causes include:

  • A vertebra going out of place due to slips, trips or falls
  • The entire spine slipping out of place because of poor posture
  • Damage to intervertebral joints (joints between the vertebrae) resulting in joint swelling
  • Osteoporosis or degenerative spine disease
  • Tight back muscles that can move the vertebrae out of place

Why Good Posture Is Important

Many people sit down for 6-8 hours a day, and that sedentary lifestyle may be more dangerous than smoking. You may spend hours looking at your phone or laptop while hunched over. That puts unnecessary strain on your neck.

For every inch that your head strays from its natural position, you put an extra 20-30 pounds of pressure on your neck (according to Rene Cailliet, MD, former Director of the Department of Physical Medicine and Rehabilitation at the University of Southern California).

While you sit, don’t slouch. Sit with a straight back and keep your head squarely above your shoulders. If you sit for an extended period of time, be sure to get up and walk around for a while. Develop healthy habits such as stretching your entire body every day.

Benefits of Chiropractic Care for Seniors and Medicare Eligibles

A Chiropractic Adjustment | Medicare Plan Finder

Even though Medicare does not cover chiropractic care unless it’s part of subluxation correction, you may still benefit from chiropractic care. Along with correcting subluxations, chiropractic care may provide relief from headaches, low back and neck pain, and sciatica.

Headaches

Many people may not want to take prescription drugs for headache relief, and they may want to pursue an approach that doesn’t require an abundance of OTC meds either. Many studies suggest that chiropractic care helps treat both tension and migraine headaches.

Lower Back Pain

Chiropractic treatment may be a cost-effective approach to successfully treating lower back pain. Some patients may find that spinal manipulation is more effective for providing pain relief in the long term.

If your doctor recommends chiropractic care for your lower back pain, then it may be a viable option for relieving pain symptoms.

Sciatica

Sciatica refers to a pinched sciatic nerve. It usually starts with a herniated spinal disk. The pain runs from the base of the spine into your legs, and it can range from a mild ache to severe pain.

Your foot might also go numb or feel weak. According to the European Spine Journal, chiropractic adjustments may be more effective than corticosteroid treatment for sciatica.

Common Chiropractic Care Questions

What chiropractic codes does Medicare cover?

Here are the most common chiropractic codes:

  • CPT Code 98940 Chiropractic manipulative treatment (CMT); Spinal, 1-2 regions
  • CPT Code 98941 Chiropractic manipulative treatment (CMT); Spinal, 3-4 regions
  • CPT Code 98942 Chiropractic manipulative treatment (CMT); Spinal, 5 regions

Does Medicare cover chiropractic care in 2020?

Medicare chiropractic coverage in 2020 continues to cover the Medicare guidelines for chiropractic documentation.

Where can I find the latest Medicare fee schedule for 2020?

Medicare.gov is where you will find all the information you need about Medicare’s chiropractic coverage, including the latest Medicare chiropractic fee schedule.

Does AARP United Healthcare cover chiropractic?

Most plans in the AARP secondary Medicare insurance offer a chiropractic benefit.

Let Us Help You Find Medicare Coverage for Chiropractic Care

If you’re one of the many people who rely on chiropractic care for pain relief, you may want to consider a Medicare Advantage plan to help cover costs.

The licensed agents at Medicare Plan Finder are highly trained and they can help you find a MA plan in your area with additional chiropractic coverage. Call 833-438-3676 or contact us here to learn more.

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

This post was originally published on June 24, 2019, and updated on April 9, 2020.

Does Medicare Cover Genetic Testing for Cancer?

Cancer is the leading cause of death worldwide and impacts millions of patients and families each year. Fortunately, genetic testing for cancer, which is growing in popularity, can be a great tool for understanding your risk of developing cancer.

Does insurance pay for genetic testing of cancer? Yes, but coverage determination depends on certain circumstances.

The Food and Drug Administration (FDA) and the Centers for Medicare and Medicaid Services (CMS), are actively working to make sure these tools are effective and accessible.

What Are My Chances of Getting Cancer?

Cancer Patient | Medicare Plan Finder
Cancer Patient | Medicare Plan Finder

The American Cancer Society estimates that 1 in 3 people in the United States will develop cancer at some point in their life. Data and research show that cancer risk is highest for those between the ages of 65 to 74 years and accounts for the largest portion of new cancer cases found each year.

While you may have a smaller chance of developing cancer if you are under the age of 65, it is still a good idea to get tested as early as possible so that you can make smart decisions about health insurance and your future.

Is Cancer Hereditary?

About 10% of cancers occur in someone who has inherited gene mutations. Hereditary cancer syndromes are caused by mutations in certain genes passed from parents to children.

Researchers have found mutations in more than 50 hereditary cancer syndromes.

These mutations are found in the genetic code of DNA and are represented by the letters A, T, C, and G. These codes can be long – for example, the BRCA 1 code is over 10,000 letters long.

However, not every mistake in the “code” should raise concern for cancer.

Reasons to Consider Genetic Testing for Cancer

If you have an inherited gene mutation, that doesn’t necessarily mean you’ll get cancer. It only means that you’re at a higher risk of developing certain types of cancer.

If your personal history or family history of cancer suggests you are at risk, find out how genetic counseling and genetic testing can help you understand and manage your concerns.

The following populations should also ask for specific types of genetic testing:

  • Those whose family members have had gynecologic cancer should get tested for fallopian tube cancer. This very rare cancer only affects about 1,500 to 2,000 women worldwide and only about 300 to 400 women are diagnosed with it every year in the United States.
  • Those with Ashkenazi Jewish ancestry have a higher risk for specific hereditary diseases and genetic disorders.
  • Those with a family history of pancreatic cancer can get tested for inherited conditions that can increase the risk of getting this type of cancer.
  • Those with a personal history of breast cancer can take the BRCA gene test to see if they have an inherited mutation.

You may want to tell your family about your test results whether the results are positive or not.

Risk Factors for Hereditary Cancer

When cancers are linked to an inherited gene mutation, that’s called a family cancer syndrome.

Certain factors may make it more likely that you and your family members can pass cancer on to your loved ones including:

  • Many cases of the same kind of cancer (especially if the type of cancer is rare) — like ovarian cancer caused by BRCA1 and BRCA2 gene mutations
  • Cancers that occur much sooner than usual – like breast cancer in a teenager
  • One person who has multiple types of cancer (like a man who has both colon and prostate cancer)
  • Cancers that occur in pairs of organs (both kidneys or both breasts, for example)
  • Siblings who have childhood cancers
  • Cancer that occurs in the opposite sex of the one usually affected (breast cancer in a man, for example)
  • Cancer that occurs in several generations (like in a grandmother, mother, and daughter)

Hereditary Genetic Testing for Cancer

The estimated number of new cancer cases in 2018 was 1,735,350. If you are curious about your risk of developing cancer, consider hereditary cancer testing.

Hereditary testing kits can help you understand any mutations you may have and allow you to better prepare for any issues that may arise in the future. Plus, knowing about an inherited mutation gives you the power to take the necessary steps to reduce your risk of cancer or to help detect it at an early stage.

Kits often include a saliva collection kit and a prepaid return label. The testing kits analyze over 30 genes that can contribute to the most common hereditary cancers.

A certified medical professional will review your sample and provide clear results of the absence or presence of any cancer-causing mutations. This information is personalized to you and provides information on how your genetic makeup can impact your family.

Medicare Cancer Test Kits

Fortunately, you can complete a cancer genetic test in the comfort of your own home. This can help alleviate any stress that may come from testing in a doctor’s office.

Most at-home test companies provide return labels so the entire process is convenient and stress-free. However, if you prefer to go into a doctor’s office for your genetic testing, that is also an option.

If you decide to use a Medicare cancer test kit to screen for covered screenings, be sure to follow the test’s directions to the letter. This helps ensure that your test results will be accurate.

Breast Cancer Genetic Testing & the BRCA Testing Cost

It is easy to learn your genetic risk of the most common hereditary cancers, including BRCA 1 and BRCA 2 genes. BRCA stands for BReast CAncer genes. BRCA 1 is on chromosome 17 and BRCA 2 is on chromosome 13.

All it takes is a small DNA sample through saliva.

Plus, the test can be conveniently mailed to you and completed in the comfort of your home. The cost of a hereditary cancer testing kit can range from $100 to $200.

There are multiple genetic testing companies, including Color and 23andMe, but not all are approved by the FDA.

Aging and Cancer

The risk of cancer increases with age, but it’s never too early to start screening. According to the Dana-Farber Cancer Institute, the average age for a breast cancer diagnosis is 61 years.

The average age for a prostate cancer diagnosis is 66 years.

There is no single explanation as to why age and cancer correlate, but researchers believe sunlight, radiation, environmental chemicals, and ingredients in our food are large factors.

Physical exercise, a healthy diet, and adequate sleep can help lower the risk of cancer as you age.

Medicare Coverage and Genetic Testing for Cancer

Doctor and Nurse Discussing Cancer Risk With Patient | Medicare Plan Finder
Doctor and Nurse Discussing Cancer Risk With Patient | Medicare Plan Finder

Medicare beneficiaries who need genetic counseling can get it covered under Medicare Part A and Part B only if it has been ordered by a physician before starting medication covered under Part D or if it is medically necessary in a skilled nursing facility.

Medicare covers certain genetic cancer tests if they’re medically necessary. In 2020, Medicare will cover genetic testing if:

  • You have recurring, relapsed, refractory, metastatic, or advanced stage III or IV cancer
  • You have not used the same genetic test for the same cancer diagnosis previously
  • You have decided to seek further cancer treatment such as chemotherapy and radiation
  • You have signs or symptoms of a cancer like colorectal cancer that can be clarified or verified with diagnostic testing
  • You have a first-degree relative who has a known mutation such as Lynch syndrome

Does Medicare Cover BRCA Testing?

How much does the BRCA test cost? The price ranges from $475 to $4,000. Fortunately, Medicare covers FDA-approved genetic testing for BRCA 1 and 2 for those with a personal or family history.

So, it covers hereditary breast, tubal, epithelial ovarian, or primary peritoneal cancer tests as well.

Does Medicare Cover Genetic Testing for Melanoma?

Medicare currently covers the Myriad Genetics myPath and Castle Biosciences DecisionDx genetic tests for melanoma.

Medicare also covers screenings for lung, breast, prostate, and cervical cancer. Screenings are used to detect potential disease and a diagnostic test establishes the presence or absence of the disease.

Does Medicare Cover Genetic Testing for Prostate Cancer?

Medicare covers prostate cancer screening for men over 50 every 12 months. If cancer is detected, Medicare Part B coverage includes a variety of options, including genetic testing to help physicians distinguish between an aggressive and a non-aggressive tumor.

This essential information helps physicians design an optimal treatment plan for their patients.

What Happens During a Genetic Test for Cancer?

A genetic test for cancer may provide some insight into your medical history and the possibility of passing mutated genes on to your loved ones.

A Medicare genetic test for cancer may involve several steps:

1. Risk Assessment

Your doctor will first ask you questions about your personal and family medical history such as, “Have you or an immediate family member been diagnosed with cancer?” Based on your answers, your doctor may refer you to a genetic counselor. (A genetic counselor is someone who has advanced training in medical genetics and counseling.)

2. Informed Consent

Before your test, you must give informed consent, which means that you’re aware of and that you agree to the following items:

  • The genetic test’s purpose
  • The type and nature of the genetic condition being tested
  • The test’s accuracy
  • The pros and cons of testing (including the limits of the results and what they might tell you)
  • Other testing options
  • Possible screening or treatment options depending on the test results
  • Further decisions you might need to make once the results are back
  • The possible consent to use the results for research purposes
  • Availability of counseling and support services
  • Your right to refuse testing

3. Collecting the Sample

Depending on the test, you may need to provide a saliva, blood, hair, cheek cells (usually a swab from inside your mouth), urine, or stool sample. Once your healthcare professional collects your sample, he or she will send it to the lab for testing.

4. Getting the Results

Once the results are in, your genetic counselor or healthcare provider will tell you about your test results and the next steps you should take.

Questions to Ask Yourself About Medicare DNA Cancer Screening

Does Medicare pay for DNA cancer screening? Yes, because the Centers for Medicare & Medicaid Services (CMS) covers a broad range of FDA approved diagnostic tests, CMS cancer screening is available to detect many types of DNA cancers.

However, as with any type of medical screening, you should know what you’re getting into before you take the test. Before you take a Medicare cancer swab test, ask yourself:

  1. Is this test legitimate? Unfortunately, genetic kits including Medicare cancer swab tests are the latest trend in Medicare fraud, according to many state and federal agencies. Your doctor can tell you what type of test to buy.
  2. Is this test FDA-approved? Medicare will only cover FDA-approved tests.
  3. How will this information benefit future generations? You may not want to know if you have genetic mutations that could lead to cancer. However, that information could help your children and grandchildren. If you have gene mutations associated with cancer, you can have Medicare cancer screening. Many forms of cancer can be treated if they’re detected early.

We Can Help You Find the Best Medicare Plans for Cancer Patients

A Medicare Advantage (MA) plan is a great option if you are looking for additional benefits like genetic testing beyond BRCA 1 and 2 and myPath.

Some may even offer fitness classes like SilverSneakers®, which can help promote a healthy, physically active lifestyle and help lower your risk of cancer.

If you’re diagnosed with cancer, you may be eligible for a type of MA plan called a Chronic Special Needs Plan (C-SNP). These plans are specially designed for people with certain chronic illnesses and conditions. Your C-SNP will involve a network of healthcare providers that will coordinate your treatment plan with each other.

If you are interested in arranging a no-cost, no-obligation appointment with a licensed agent to discuss your options for MA plans including C-SNPs, call us at 833-438-3676 or fill out this form.

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

This post was originally published on November 29, 2018, by Kelsey Davis and updated on March 24, 2020, by Troy Frink.

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.

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

How Much Does Medicare Pay for Hip Replacement Surgery?

Cost of Hip Replacement Surgery | Medicare Plan Finder
Cost of Hip Replacement Surgery with Medicare | Medicare Plan Finder

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 Durable Medical Equipment
Medicare Durable Medical Equipment

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.

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

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.

Medicare Supplement (Medigap) plans pick up where Original Medicare leaves off. Like MA plans, private insurance companies offer Medigap plans.

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.

Man Discussing the Cost of Hip Replacement Surgery With His Doctor | Medicare Plan Finder
Man Discussing the Cost of Hip Replacement Surgery With Medicare With His Doctor | Medicare Plan Finder

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:

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.

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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.

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

This post was originally published on May 15, 2019, and updated on March 24, 2020.

Does Medicare Cover Cancer Treatment? (Updated for 2020)

Cancer is the second-most common cause of death in the US, right behind heart disease. A cancer diagnosis comes with a lot of uncertainty.

You might be unsure of how to tell your friends and family, or you might not know how you’ll pay for treatment.

After all, cancer treatment can be expensive. The average cost for cancer treatment is about $150,000, according to the American Association of Retired Persons (AARP).

The good news is that Medicare does cover cancer treatment, prescriptions, and screenings and might even cover genetic testing, depending on your plan.

Medicare Cancer Coverage: What you Need to Know

Man Discussing Cancer Treatment With His Doctor | Medicare Plan Finder
Man Discussing Cancer Treatment With His Doctor | Medicare Plan Finder

Cancer treatment usually involves a combination of treatments that can include chemotherapy, radiation, and surgery. Medicare plans can cover a lot of the costs associated with these treatment options.

What Cancer Treatment Does Medicare Cover?

In order for your treatment to be covered, your doctor must accept Medicare. Outpatient care (including intravenous chemotherapy, certain screenings, and outpatient radiation) falls under Part B.

You may have to pay a copayment, coinsurance and a deductible for each service.

Cancer treatment under Part A (hospital insurance) covers inpatient surgeries and hospital stays. Part A will also cover limited skilled nursing care and home health care services.

Original Medicare Coverage (Medicare Part A and Medicare Part B)

After you qualify at age 65, you’re enrolled in Medicare Part A and Part B, the Original Medicare. Medicare Part A covers inpatient hospital stays, which includes skilled nursing facility care, hospice care, and home health care.

Medicare Part B covers doctor visits, lab tests, and medical equipment and supplies.

Both Part A and Part B cover high-dose radiation treatments to shrink tumors and destroy cancer cells, but in different ways. Part A covers it for inpatients in hospitals.

Part B covers it for outpatients at independent (freestanding) clinics.

Medicare Advantage Plan Coverage

Medicare Advantage Plans are a health care plan offered by private health insurance companies that contract with Medicare and offer the full spectrum of Part A and Part B benefits.

Since these companies are legally expected to provide “equal or better” coverage than the original Medicare, a Medical Advantage Plan is sometimes also known as Medicare Part C.

Medicare Part D Coverage

Medicare Part D Coverage is an optional federal prescription drug plan for Medicare beneficiaries to pay for prescription drug coverage. You can get it as part of your original Medicare (Part A and Part B).

The annual premium for coverage in 2020 is $435, up from $415 last year.

Medicare Supplement Insurance (Medigap) Coverage

Medicare Supplement Insurance (Medigap) is worth buying to lower out-of-pocket costs if you want lower monthly premiums. Medigap plans cover many original Medicare costs, like copayments, coinsurance, or deductibles.

Does Medicare Cover Chemotherapy?

Medicare Part B covers chemotherapy drugs, radiation, and chemotherapy treatment for cancer patients in a doctor’s office, a clinic, a hospital, or even chemotherapy in a skilled nursing facility.

Medicare Part D plans cover cancer drugs like oral chemotherapy medications, anti-nausea drugs, and painkillers. Many people buy Medicare Supplement Plans (Medigap) plans to cover any dollar amount that Medicare does not cover.

Does Medicare Cover Immunotherapy for Cancer?

Immunotherapy is a cancer treatment that triggers your own immune system to fight off cancer cells. If immunotherapy is medically necessary, Medicare may cover many types of specialized treatments, for instance, immunotherapy for lung cancer.

Is CAR T-Cell Cancer Therapy Available to Medicare Beneficiaries?

The Centers for Medicare and Medicaid (CMS) approved Medicare coverage for FDA-approved Chimeric Antigen Receptor T-cell (CAR T-cell) to treat specific types of cancer, such as non-Hodgkin lymphoma and B-cell precursor acute lymphoblastic leukemia.

According to the Leukemia and Lymphoma Society (LLS), CAR T-cell therapy works by re-engineering a patient’s T-cells (disease-fighting cells), multiplying the cells, and re-introducing the “new” cells to the body.

Medicare Cancer Screening

Catching cancer in its early stages can make a huge difference in your treatment’s success.

That’s why Medicare offers coverage for preventive screenings for most cancers, including but not limited to:

  • Breast cancer: Medicare will cover one annual mammogram, and one clinical breast exam (CBE) every two years for all women 40 and older who have an average risk of developing breast cancer. Women who are at a high risk of developing breast cancer can receive one CBE every year.
  • Cervical cancer: Medicare pays for one pelvic exam and Pap test every two years. If you have a high risk of cancer, Medicare covers those tests once yearly.
  • Colorectal cancer: Medicare covers certain colorectal cancer screenings looking for pre-cancer polyps for people 50 and older.
  • Prostate cancer: Medicare covers one digital rectal exam (DRE) and one prostate-specific antigen (PSA) for men 50 and older. Medicare will cover 80% of the DRE and 100% of the PSA.
  • Lung cancer: If you’re a smoker or have a long history of tobacco use, Medicare will cover low-dose CT scans for lung cancer.

Does Medicare Cover Wigs for Cancer Patients?

Hair loss is a common side effect of certain cancer treatments. Original Medicare and Medicare Supplements do not cover wigs. However, some Medicare Advantage plans may offer coverage for wigs.

Medicare Genetic Testing

Some people are at a higher genetic risk for cancer than others, meaning that they have specific gene mutations. Medicare will cover BRCA1 and BRCA2 genetic testing to find those mutations if you have a personal history of cancer.

Medicare also covers certain genetic tests for melanoma and colon cancer. Depending on where you live, that coverage extends to multigene testing if the initial test indicates multiple mutations.

Which Medicare Plan Is Best for Cancer Patients?

Americans spend $74 billion on cancer treatments each year, and Medicare covers almost half of that cost.

Medicare Part A, Part B, and Part D cover cancer treatment. Part A will cover up to 150 days stay in the hospital.

Part B will cover 80% of outpatient treatment, such as diagnostic imaging, injectable drugs, chemotherapy, radiation, and surgery. Part D will cover retail prescription drugs from a local pharmacy.

Medicare Special Enrollment Period and How to Qualify for Medicare Cancer Coverage

Open enrollment is a window of time from November 1, 2020, to December 15, 2020, to buy a healthcare insurance plan that is on the Federal Health Insurance Marketplace.

A cancer diagnosis means you qualify for the Medicare Special Enrollment Period (SEP). The SEP allows you to enroll in or change your plan as your treatment or other needs change.

Most people have to wait for the Annual Enrollment Period (AEP), which is from October 15 to December 7, to change coverage, but you can take advantage of the SEP.

Medicare Chronic Special Needs Plan (C-SNP)

If you are diagnosed with cancer, you may be eligible for a Chronic Special Needs Plan (C-SNP). C-SNPs are a form of Medicare Advantage designed specifically for those with certain chronic illnesses and conditions.

They go above and beyond the coverage that Original Medicare provides. For example, C-SNPs provide coverage for prescription drugs.

Your C-SNP will involve a network of providers that will communicate with each other about your treatment plan.

When to Enroll in a C-SNP

You can enroll in coverage as soon as you receive your cancer diagnosis, but you must get confirmation from your doctor that you have cancer. While you are allowed to enroll in a C-SNP before your doctor verifies the diagnosis, your doctor must verify the diagnosis before you can keep the coverage.

Does Medicare Cover Cancer Treatment After Age 76?

Medicare covers cancer treatment for those enrolled, including medicare coverage over 70 years of age, but there may be a deductible or a copay. It also covers beneficiaries after they turn 76.

Can You Get Medicare Before 65 If You Have Cancer?

If you’re under 65 and get cancer, you are eligible for Medicare if you’ve been receiving Social Security Disability Insurance (SSDI) checks for 24 months or longer or if you have a diagnosis of End-Stage Renal Disease (ESRD).

How to Find an Oncology Doctor Who Takes Medicare

An oncology doctor, or oncologist, is a doctor who specializes in cancer treatment. Oncologists can have one of three different sub-specialties: medical, surgical, and radiation.

Medicare.gov has a tool for finding local oncologists who accept Medicare.

To get started, click here. First, enter your zip code beside the red arrow. We used 37209, because that’s the zip code for our corporate headquarters in Nashville, TN.

Then enter “oncology” in the box above the green arrow. Once you do that, click “Search” beside the yellow arrow.

How to Find an Oncology Doctor Step 1 | Medicare Plan Finder
How to Find an Oncology Doctor Step 1 | Medicare Plan Finder

The next page will let you select what subspecialty you want your oncologist to have. You can select more than one, but for demonstration purposes, we only chose “Medical oncology” (below beside the red arrow).

Then click “View results” beside the blue arrow.

How to Find an Oncology Doctor Step 2 | Medicare Plan Finder
How to Find an Oncology Doctor Step 2 | Medicare Plan Finder

The next page features a list of medical oncologists complete with contact information. Call the doctors to get an idea of what services they provide and if they can treat you.

You may have to call multiple oncology doctors to find the right one.

How to Find an Oncology Doctor Step 3| Medicare Plan Finder
How to Find an Oncology Doctor Step 3| Medicare Plan Finder

We Can Help You Get Covered

A cancer diagnosis can be overwhelming, but the right medical coverage can help give you the chance to get the quality care you need.

If you have cancer and need to enroll in a C-SNP, we will assist you with finding the best insurance plan for you. Call us at 844-431-1832 or contact us here today.

Find Medicare Advantage Plans | Medicare Plan Finder
This post was originally published on May 28, 2019, and updated on March 6, 2020. Find Medicare Advantage Plans | Medicare Plan Finder

This post was originally published on April 19, 2019, and updated on March 6, 2020.

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

Outpatient Addiction Counseling | Medicare Plan Finder
Outpatient Addiction Counseling | Medicare Plan Finder

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).

The American Society of Addiction Medicine (ASAM) divides treatment into five levels of care. Here’s how they relate to Medicare:

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
  • Occupational therapy
  • Family therapy
  • Patient education
  • 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
  • Mental health care

Level 4, Medically-Managed Intensive Inpatient Services

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

Medicare Part A covers limited home health care, and Medicare Part D and certain Medicare Advantage (Part C) plans cover prescription drugs.

Medicare Coverage and Overdoses

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.”

How to Find Approved Medicare Alcohol Treatment and Drug Rehab Step 1 | Medicare Plan Finder
How to Find Approved Medicare Alcohol Treatment and Drug Rehab Step 1 | Medicare Plan Finder

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.

How to Find Approved Medicare Alcohol Treatment and Drug Rehab Step 2 | Medicare Plan Finder
How to Find Approved Medicare Alcohol Treatment and Drug Rehab Step 2 | Medicare Plan Finder

Then click “Compare” at the bottom of the page.

How to Find Approved Medicare Alcohol Treatment and Drug Rehab Step 3 | Medicare Plan Finder

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.

How to Find Approved Medicare Alcohol Treatment and Drug Rehab Step 4 | Medicare Plan Finder
How to Find Approved Medicare Alcohol Treatment and Drug Rehab Step 4 | Medicare Plan Finder

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.

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), drug addiction in adults over 60 years primarily arises from alcohol and prescription drugs. This creates a risk of harmful interactions between the two.

Medicare Help for You or Someone You Love

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.

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

This post was originally published on April 22, 2019, and updated on March 6, 2020.

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. 

Is Genetic Testing a Good Idea for Seniors?

Around 60% of adults ages 50-64 say they are interested in genetic testing, but less than 10% have actually gone through with taking one, according to a national poll done by the University of Michigan and the AARP in 2018.

Seniors have tended to stay away from genetic testing and there are a few reasons why. You may have seen the headlines about DNA testing scams, or you may feel that knowing the likelihood of future diseases would make you worry too much. It’s always best to get informed before you start swabbing anything!

How is genetic testing done?

Genetic tests can be done with a variety of biological samples, including hair, skin, blood, or saliva. Most commercial DNA tests will either have you spit into a sterile tube or use a cotton swab to collect samples from the inside of your cheek. 

Your genetic information is sent back to a laboratory, where technicians examine the DNA, chromosomes and proteins to look for variations associated with certain traits or diseases. The results are then sent to your home or doctor’s office, depending on what sort of genetic test you received.

Types of genetic tests

Genetic testing is actually a very broad term, covering everything from newborn screenings to forensic testing. But for health or ancestry information, the test will likely be predictive or diagnostic.

Many of the popular online genetic testing services offer predictive testing. These look for signs of potential disorders of which you have no symptoms at the time. If a physician orders your genetic test to confirm a condition based on your symptoms, it can be considered diagnostic testing.

Pros and cons of genetic testing

Genetic testing can provide a great insight into your health and family history, but there are still risks to consider. These should be weighed against the benefits before you decide to get a genetic test done.

Ancestry and health information

60% of the seniors polled by the AARP reported they would be interested in genetic ancestry testing. These tests are usually performed by looking for variations in the Y chromosome, which can be used to determine ancestry along the male lineage, or the mitochondrial DNA, which is only passed down from the mother.

The level of detail in your ancestry results will depend on which service you choose. Some services break down the globe into 500 geographic regions, where others separate it further into over 1,500 regions, giving you more detailed results. 

An equal amount of seniors have expressed interest in genetic testing to learn more about their health. They may get tested to see a clearer view of their general wellness, or to know their future risk of disease. But like the regional breakdown of ancestry, not all health tests on the market will test for the same conditions.

What diseases can be detected through genetic testing?

Until the last few years, the FDA had forbidden any direct-to-consumer (DTC) genetic testing service to give their customers information about health and potential disease. This changed in 2017 when they approved one of the biggest DTC services for testing these 10 conditions:

  • Alpha-1 antitrypsin deficiency
  • Celiac disease
  • Early-onset primary dystonia
  • Factor XI deficiency
  • Gaucher disease type 1
  • Glucose-6-Phosphate Dehydrogenase deficiency
  • Hereditary hemochromatosis
  • Hereditary thrombophilia
  • Late-onset Alzheimer’s disease
  • Parkinson’s disease

Several other DNA testing services are seeking the same FDA approval and the scope of at-home genetic testing for disease will only grow larger from there. Tests are available for other conditions such as cancer, but they must be ordered by a physician.

Privacy concerns

Seniors expressed several concerns about genetic testing in the AARP’s study, but genetic privacy was not one of them. The sensitivity of genetic information is part of the reason the Health Insurance Portability and Accountability Act (HIPAA) was passed in 1996. But the legislation included a loophole, allowing companies to sell genetic data as long as it was not tied to your name or other information.

This loophole has been a windfall for the genetic testing industry. Testing services are partnering with pharmaceutical firms and granting them access to a backlog of genetic samples for use in research. Some services allow you to opt out of having your information sold, but be sure to read their Informed Consent paperwork carefully before you sign!

Genetic Discrimination

Another danger of having your genetic information sold and distributed is something called genetic discrimination. This occurs when you are treated negatively by an insurance company or even employer because of your genetic test results.

Luckily, the Genetic Information nondiscrimination Act (GINA) was passed in 2008 to help safeguard you from such discrimination. The two sections of that bill went into effect in 2009 and make it illegal for employers or insurers to use your genetic information against you.

Does Medicare cover genetic testing?

In the AARP’s study, roughly 68% of seniors said they would be more interested in genetic testing if it was fully covered by their insurance. Several questionable DTC testing services have taken advantage of this by claiming their tests are covered by Medicare, then fraudulently billing the program thousands of dollars. 

In truth, Medicare will only cover the cost of genetic testing if it is ordered by a doctor. Your physician may order a genetic test to confirm a cancer diagnosis, or to assess how you will metabolize certain drugs. For more information on receiving Medicare genetic testing reimbursement for cancer screening, see our full article on the subject.

If you have a Medicare Advantage plan, you may also be covered for certain diagnostic tests and could be entitled to additional benefits. Click here or call us at 833-438-3676 to speak with one of our licensed agents about finding the right plan for you!

Medicare Advantage | Medicare Plan Finder
Medicare Advantage | Medicare Plan Finder

How to Find a Medicare Office Near You

While you can handle most of your healthcare online, some things are better handled in person. Your local Medicare office may be able to help you enroll in Medicare, get a replacement Medicare card, and more. 

Medicare offices are usually Social Security offices. If you want to visit a Social Security office near you, visit the SSA website and use their field office locator tool. Click on “Locate An Office By Zip.” Once you enter your zip code and click “locate,” you’ll see a list of the offices in your area. You’ll see each office’s address, phone number, office hours, and any other additional notes.

Find a Medicare Office

Why and How to Contact Medicare

Calling 1-800-MEDICARE allows you to:

  • Check your claim status
  • Find out if your medical service or product is covered
  • Ask your billing questions
  • Check your account balance for Part A or B
  • Report fraud
  • Report a lost or stolen Medicare card

Keep in mind that the Medicare office can’t help you with your private plan (like Medicare Advantage, Medicare Supplement, etc.). For questions with your private plan, you can contact your insurance agent. 

Medicare Office Hours

Social Security hours will vary by location. When you use the office locator tool, you’ll be able to see their hours and their phone number. 

Medicare Phone Number

The main Medicare helpline number that you can call with billing, claims, medical records, or expenses questions is 1-800 MEDICARE (1-800-633-4227)/TTY 1-877-486-2048.

Medicare Mailing Address

The main Medicare office (CMS office, Centers for Medicare and Medicaid Services) is located in Woodlawn, Maryland. There are additional regional Medicare offices in D.C., Boston, New York, Philadelphia, Atlanta, Chicago, Dallas, Kansas City, Denver, San Francisco, and Seattle. 

If you need to mail something to Medicare, use the following address:

Medicare Contact Center Operations

PO Box 1270

Lawrence, KS 66044

____________________________

Regional offices are as follows: 

Washington, D.C.
The Hubert H. Humphrey Building
200 Independence Ave., S.W.
Washington, DC 20001

Boston, MA
John F. Kennedy Federal Building
15 New Sudbury St., Room 2325
Boston, MA 02203-0003

New York, NY
26 Federal Plaza, Room 3811
New York, NY 10278-0063

Philadelphia, PA
801 Market Street
Suite 9400
Philadelphia, PA 19107-3134

Atlanta, GA
Atlanta Federal Center, 4th Floor
61 Forsyth Street, SW, Suite 4T20
Atlanta, GA 30303-8909

Chicago, IL
233 North Michigan Ave, Suite 600
Chicago, IL 60601

Dallas, TX
1301 Young Street, Room 714
Dallas, TX 75202

Kansas City, MO
Richard Bolling Federal Building
601 East 12th Street, Room 355
Kansas City, MO 64106-2808

Denver, CO
1961 Stout Street, Room 08-148
Denver, CO 80202

San Francisco, CA
90 7th Street, #5-300 (W)
San Francisco, CA 94103-6706

Seattle, WA
701 Fifth Avenue, Suite 1600
Seattle, WA 98104

Can you get Medicare Online?

Yes, you may not have to visit your local Medicare office or call Medicare at all. As long as you feel comfortable using your computer instead, you can apply for Medicare, manage your benefits, get answers to your questions, and even request a new Medicare card all online. 

If you do want to visit your local Medicare office in person instead, it may be a good idea to call ahead and make sure that they can help you with your question or concern.

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Why would you need to go to a Social Security Office?

Most things can be done online nowadays, but there are still a few non-Medicare related tasks that you may need to visit your local Social Security office for. For example, there are ten states that don’t allow you to get a replacement Social Security card online, though this may change in the future. The ten states are Alabama, Connecticut, Minnesota, Nevada, New Hampshire, Ohio, Oklahoma, Oregon, Utah, and West Virginia. 

Other services you may need to handle in-person are completing benefits applications with a translator, applying for survivor benefits, and getting a Social Security number for the first time if you didn’t get one as a baby.

How do I get a New Medicare Card?

When you first enroll a Medicare, you’ll receive a “Welcome to Medicare” packet in the mail with your Medicare card.

If your Medicare card is lost, stolen, or damaged, you’ll need to request a replacement card immediately through Social Security. Be sure to request a new card quickly so that you don’t have to wait for coverage at your next doctor’s appointment.

Your doctor might be able to look up your Medicare number, but it will be easier and faster if you can present your card.

How to get a New Medicare Card

You can request a new Medicare card by:

When you use the online service, you should receive your Medicare card in the mail within 30 days. It will be automatically shipped to the address on file with Social Security, so make sure the address in your account is correct.

If you get your Medicare benefits through the Railroad Retirement Board, you’ll want to contact them directly:

What to do if you Lose Your Medicare Card

Have you lost or misplaced your Medicare card? A lost Medicare card can be very dangerous as it contains your social security number. Losing your Medicare card is similar to losing your social security card. That’s why starting this year, new Medicare cards will be slightly different. We’ll discuss that and show you a new Medicare card image in a bit.

If you need to order a new Medicare card because of a lost Medicare card or changed information (like if you change your name or address), your first step should be to contact Social Security and let them know. You can also print a copy of your Medicare card by signing into My.Medicare.gov (you may need to create an account). If you still have your old Medicare card or if you find your lost Medicare card, be sure to cut it up and throw it away so that no one can steal your information.

What is a Medicare Card

When you enroll in Medicare for the first time, you’ll receive a red, white, and blue Medicare card in the mail. If you are automatically enrolled in Medicare Part A, you will receive your plastic Medicare card about three months before your 65th birthday so that you will already have it when your plan becomes active.

Your plastic Medicare card proves that you have Medicare health insurance and will tell providers (doctors, pharmacists, hospitals, etc.) what type of coverage you have and what day your coverage begins. You should keep your plastic Medicare card with you at all times so that if you have to see a doctor for any reason, you can prove that you have Medicare coverage and avoid being overcharged.

New Medicare Cards 2018

In 2017, CMS (Centers for Medicare and Medicaid Services) decided to launch a new version of the red, white, and blue Medicare card. The big change is that instead of having your Social Security number plastered on your card, you’ll be assigned a Medicare number.

You should treat your “MBI” or Medicare beneficiary identifier number the same way you treat your Social Security number – don’t give it out unless you know it’s necessary and you trust the person you’re giving it to. However, it is much safer to carry a card with your Medicare number than your Social Security number!

Everyone should have received a new Medicare card by early 2019. The last batch was reportedly shipped in October 2018. If you never received one, be sure to contact Social Security right away (or ask your insurance agent for help).

The new plastic Medicare cards will not affect your benefits – it will only protect your security.

Note that if you have a Medicare Advantage plan or a Part D prescription drug plan, your other plan cards will most likely not be changing. You should carry those with you everywhere you go as well.

Will the new Medicare cards be plastic?

Unlike the old plastic Medicare card you may have, new Medicare cards will not be plastic. They will be made of paper to make it easier for providers to use and make copies. We recommend purchasing a cheap plastic cover for your Medicare card. You can buy a pack of card covers  (like these) in bulk on Amazon or stop by your favorite local office supplies store, like Staples or Officemax.

If you have questions about your Medicare plan or these new Medicare cards, call your agent! If you don’t yet have an agent, call Senior Market Advisors at 1-844-431-1832.

Avoiding Medicare Card Scams

Scammers might try to get your Medicare number from you. Remember that Medicare will never call and ask you to verify your number – they already have that information. If someone calls you and asks for your Medicare number, and you weren’t expecting them to call, do not give it to them. The only people that should need your Medicare number are your doctors, your insurance agents, and your private health plan (if you have one).

Here are some tips for protecting your identity in regards to your new Medicare card:

  • A Medicare employee will never call and ask for your social security number or banking information. If someone does call you asking for that information, it may be a scam. Do NOT give out your social security number to someone who claims to be calling from Medicare unless you know you can trust the person on the line.
  • If someone asks you to pay for a Medicare card, it is a scam. Medicare cards are always free and you should receive one automatically when you enroll.
  • If someone tells you that your benefits will be revoked if you do not give information or money, it may be a scam. The only people that should ask you for money are your doctors or your plan’s billing department. Be sure to always know who you are talking to.

In fact, click through to our guide on Medicare scams to learn how to block unknown scam callers on your phone. Read about common scams to look out for so you can be as prepared as possible.

*This post was originally published on 9/7/17. It was last updated on 1/7/20.

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