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.
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How Much Does Medicare Pay for Hip Replacement Surgery?
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.
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.
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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 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:
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.
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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 844-431-1832 or contact us here today.
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This post was originally published on May 15, 2019, and updated on March 24, 2020.
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
Difficulty reading
Trouble judging distances
Struggling with vocabulary
Misplacing things around the home
Paying less attention to hygiene needs
Avoiding social activities
Changing personality
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.
Alzheimer’s Test
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.
Alzheimer’s Prevention
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.
Alzheimer’s Care
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.
Medicare Advantage plans are great options for coverage beyond Original Medicare.
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 844-431-1832.
Does Medicare Cover Cancer Treatment? (Updated for 2020)
The good news is that Medicare does cover cancer treatment, prescriptions, and screenings and might even cover genetic testing, depending on your plan.
Medicare Cancer Coverage: What you Need to Know
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.
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
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
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
We Can Help You Get Covered
A cancer diagnosis can be overwhelming, but the right medical coverage can help give you the chance to get the quality care you need.
If you have cancer and need to enroll in a C-SNP, we will assist you with finding the best insurance plan for you. Call us at 844-431-1832 or contact us here today.
This post was originally published on 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
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
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
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.”
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
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
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
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
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
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.
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
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.
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
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
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:
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 844-431-1832 to speak with one of our licensed agents about finding the right plan for you!
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 at the Medicare office near you. Your local Medicare office may be able to help you enroll in Medicare, get a replacement Medicare card, and answer many other important questions.
Medicare offices are located within Social Security offices. Here are the simple steps to locate a Medicare office near you.
Visit the SSA website and use their field office locator tool.
Click on “Locate An Office By Zip.”
Enter your zip code and click “locate”
You’ll now see a list of the Medicare offices in your area. You’ll see each Medicare office’s address, phone number, office hours, and any other additional notes. Take a look at the screen shots below.
Why and How to Contact a Medicare Office
Calling 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 near you 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 or your insurance company directly.
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.
Senior stylish woman taking notes in notebook while using laptop at home. Old freelancer writing details on book while working on laptop in living room. Focused cool lady writing notary in notepad.
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.
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:
1-877-772-5772 (TTY 1-312-751-4701, M-F, 9 AM to 3:30 PM)
Your local RRB office
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.
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.
Does Medicare Cover Dental Implants?
Sometimes plaque and tartar can build up to the point where the accumulation irritates the gums and cause damage to your teeth. The irritation and damage can even 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 your jaw. About 450,000 people have dental implants every year.
Does Medicare Cover Dental Implants? | Medicare Plan Finder
Original Medicare and Medicare Advantage Dental Coverage
Does original Medicare cover dental implants?
No. Original Medicare (Part A and Part B) does not cover dental implants or routine dental care.
Are dental implants covered by Medicare advantage plans?
Sometimes. This means some plans do and some plans don’t.
Private insurance policies called Medicare Advantage (MA) plans can offer coverage for additional services Original Medicare does not, including dental services. Sometimes the dental services offered include implants and sometimes they only include routine cleanings and x-rays.
If you need dental insurance, an agent with Medicare Plan Finder can work with you to find a Medicare Advantage plan in your area that offers dental implants. 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.
How to check if your Medicare Advantage plan covers dental implants.
In order to determine if your current plans covers dental implants, you’ll need to check the summary of benefits you received when you first enrolled in your plan.
There should be a section in your summary of benefits that will specifically address the dental benefits included as well as specifically covered benefits such as implants, dentures, cleanings, and x-rays.
As mentioned, every plan offers different benefits, so you should always verify with your plan summary benefits to be sure. If you do not know how to find your summary of benefits, you should call your insurance company or speak to a licensed agent.
Does Medicare Supplement Cover Dental Implants?
No. Medicare supplement plans do not 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.
A licensed agent with Medicare Plan Finder can help you determine what you need, and what’s available in your area. To learn more, call 1-844-431-1832 or click here to use our Medicare Plan Finder tool!
Does Medicaid Pay for Dental Implants?
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.
Dry Mouth
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.
Gum Disease
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
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?
Dental Exams | Medicare Plan Finder
Some people may not be able to receive dental implants. For example, if your jaw cannot support a dental implant, a dental specialist will have to find an alternative.
Dental Implant Alternatives
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, tooth loss, and ultimately avoid needing assistance with dental implants. 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 844-431-1832 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.
Does Medicare Cover Physical Therapy?
Does Medicare cover physical therapy? It depends. Medicare can help pay for physical therapy, which may be a crucial part of injury or surgery recovery. However, Medicare’s coverage has limits.
Every Medicare beneficiary begins with Original Medicare, which includes Part A, hospital coverage, and Part B, medical coverage. Most physical therapy services will fall under Medicare Part B – however, there are specific Medicare guidelines for physical therapy in-home health services and doctor services.
It can be confusing to navigate the different coverage caps and figure out what Medicare therapy coverage you have. Let’s break it down.
Does Medicare Cover Physical Therapy for Back Pain?
Back pain is one of the most common symptoms that leads to physical therapy. As you age, back pain is almost inevitable. It’s easy to fall into bad habits and poor posture. If you have back pain that lasts for a few weeks or longer, most doctors will recommend physical therapy.
A licensed and professional physical therapist will not only help you decrease pain but also educate you on how to prevent back pain in the future. He or she may even teach you some physical therapy exercises to perform at home.
Alternatively, seniors and Medicare eligibles who have a hard time getting to a doctor’s office may opt for a home nurse who is licensed to assist with physical therapy. In most cases, if your home nurse happens to double as a physical therapist, you will be covered under Part B.
Unfortunately, these services are not free.
Medicare Physical Therapy Cap | Medicare Plan Finder
How Much Does Medicare Pay for Physical Therapy?
Medicare Part B will cover your medically necessary outpatient therapy (physical, speech-language pathology, occupational) at 80 percent, you will likely be responsible for 20 percent of all Medicare-approved costs.
Previously, Medicare only covered up to 80 percent of $2,040 ($1,608) for physical and speech-language therapy services and another 80 percent of $2,040 ($1,608) for occupational therapy services. That meant that, for example, if your physical therapy appointments cost you $100, Medicare would have only covered about 20 visits per year.
Beneficiaries were receiving notices titled, “Advance Beneficiary Notice of Noncoverage.” The notice will tell you what Medicare will can or cannot continue to cover so that you can make informed choices about whether or not you want to continue your physical therapy.
Thankfully, physical, occupational, and speech therapy patients with Medicare won’t have that problem in 2019.
Medicare Physical Therapy Billing
Medicare Physical Therapy Caps | Medicare Plan Finder
When it comes to paying the bills for your physical therapy, you may want to consider adding either a Medicare Advantage plan or a Medicare Supplement plan. Even though Original Medicare Part B covers physical therapy, the cap will hold you back. Adding Medicare Advantage or Medicare Supplements may give you the coverage you need to pay the bills.
The good news is that everyone who is eligible for Original Medicare is also eligible for Medicare Advantage and Medicare Supplement plans. You can’t have both, so you’ll have to choose one.
Medicare Advantage plans are offered by private insurance companies and are designed to add additional covered services like dental, vision, hearing, fitness.
Alternatively, Medicare Supplement plans do not provide coverage for additional services but instead provide additional financial coverage. These plans are designed to help you pay for your coinsurance, copayments, and deductibles. You’ll have to decide what makes the most sense for you and your needs: more financial coverage, or more covered services?
Your physical therapist can discuss the physical therapy benefits specific to your condition and personal medical history.
Does Medicare Cover Transportation to Physical Therapy Appointments?
Original Medicare does not cover non-emergency medical transportation. Some Medicare Advantage plans can cover Medicare transportation benefits including travel to and from doctor’s appointments.
How to Find a Physical Therapist Who Accepts Medicare
Finding a local physical therapy practice that takes Medicare may be easier than you think. If you’re looking for physical therapy near you, click here to get started. Medicare.gov’s Physician Compare website allows you to find providers who specialize in the services you need including physical therapy.
Enter your zip code beside the red arrow. We used our home office’s zip code in Nashville, Tennessee, which is 37209. Then type “physical therapy” in above the yellow arrow. After that, click “Search” beside the orange arrow.
You confirm the service you need on the next page. If the boxes beside “Physical Therapy” and “Select all specialties related to ‘physical therapy'” are white, click in them to make both boxes have check marks. Then click “View results.”
The last step is scrolling through the list of providers and making some calls. You may have to call more than one physical therapy practice to find one that fits your medical and budget needs.
Need a New Medicare Plan?
Our agents can help you decide if Medicare Advantage or Medicare Supplements are right for you. We have agents in 38 states and we’re constantly growing!
Plus, our agents are licensed to sell plans from many of the major insurance carriers in your area, which means we are NOT biased. We can help you set up an appointment with an agent who can show you how to choose the right Medicare plan for your needs.
Most seniors and Medicare beneficiaries will have to wait until AEP (October 15 to December 7) to change plans. Check outour post about Special Election Periods to see if you qualify for a SEP. Not sure if you qualify? That’s OK. Your licensed agent can help you find out if you qualify. Give us a call at 1-844-431-1832 or click here to have Medicare Plan Finder call you.
This post was originally published on January 4, 2018, by Anastasia Iliou, and was most recently updated on January 6, 2020, by Troy Frink.
