Durable Medical Equipment: What Medicare Beneficiaries Should Know
According to the American Association for Homecare, about 15.5 million people use Durable Medical Equipment (DME) every day. Not every piece of medical equipment is considered DME, however. Did you know that in most cases, for Medicare to cover your medical equipment, the equipment has to be considered DME?
What is Durable Medical Equipment?
Durable Medical Equipment is any medical device that can be used repeatedly (for a duration of at least three years), can be used at home, and is medically necessary for the patient.
Examples of Durable Medical Equipment
Hospital beds
Canes, walkers, crutches, wheelchairs, etc.
Oxygen equipment
Nebulizers and the related medications
Sleep apnea devices
Infusion pumps and related supplies
Catheters and commode chairs
Glucose monitors and diabetes test strips
Some Medicare Advantage plans can now cover home modifications like handrails and wheelchair ramps. However, they are not normally considered DME.
Plans may not necessarily cover these items, but you may see them referred to as durable medical equipment:
Bedding protection and adult diapers
Cleansers and cloths
Bath lifts, shower seats, and grab bars
Ostomy supplies
Mobility tools
Something to keep in mind about durable medical equipment is that it does not necessarily refer to items used in nursing homes, hospitals, and doctors office – it actually more commonly refers to common home medical equipment.
Medicare Medical Supplies in Stores
If you’re looking for Medicare durable medical equipment or other home medical supplies, you should check with your plan details to see if there are any requirements for where you buy your materials if you want coverage.
You can probably buy a lot of these items from Amazon, Target, or Walmart, but a pharmacy like CVS, Walgreens, or other form of Medicare medical supplies store may be the best way to go so you can make sure you are receiving coverage. If you’re unsure what stores carry DME in your area, Google “DME near me.”
You may need to start by getting a prescription from your in-network doctor.
DME Medicare Coverage
Hospitalized clients will receive DME coverage through Medicare Part A, but others will fall under Part B. Under Part B, Medicare will pay 80% of the cost (after you’ve met your deductible).
If you need special items like blood testers and oxygen equipment, you’ll need to purchase them outright. Some equipment, like wheelchairs and other large items that you may not need forever, can be rented.
The first step to purchasing or renting DME with Medicare coverage is seeing a doctor. Most DME will require a prescription to prove that the DME is medically necessary. You must get this prescription or official doctor’s note within six months of the day that you rent or purchase your equipment.
How to Get Medicare DME Coverage
Some Medicare plans will have their own DME suppliers. Check with your plan’s website to see if there’s a special place where you can buy your equipment to make sure you get coverage for it. If you need help, your agent can help you figure it out. If you don’t currently have an agent, we can set you up with a free appointment.
We’ll send a licensed agent in your area to your home to help you find the coverage you need. Click here to set up an appointment or call 1-844-431-1832.
This post was originally published on April 12, 2018, and updated on November 8, 2019.
How to Switch From Medicare Advantage to Medigap
Medicare Advantage and Medigap are similar in some ways but very different in others. If you’ve enrolled in a Medicare Advantage plan and you don’t like it, you may think switching Medicare plans and enrolling in Medigap is a great idea. It’s important to understand the differences between the two, so you can make the best choice.
What is Medicare Advantage?
Medicare Advantage, also called Medicare Part C, is a type of private Medicare plan. When you first enroll in Medicare, you’ll start with Medicare Part A (the part that covers hospital care), and then most people will enroll in Medicare Part B (the part that covers doctor’s appointments).
Medicare parts A and B are limited, so adding Part C can give you additional benefits like:
Long-term care
Specialized care
Dental
Vision
Hearing
Physical fitness
Prescription drugs
No two Medicare Advantage plans are the same. In fact, there are several different types. You’ll have to look at what you’re eligible for and decide which benefits you need most and how much you’re willing to spend.
Medicare Part C doesn’t always mean spending more money, though. Some plans might even have $0 premiums!*
*Even with a $0 Medicare Advantage premium, you’d have to continue paying your Part B premium.
What is a Medigap plan?
Medicare Advantage plans sound fantastic, but some people will find that Medigap plans work best for them. Medigap coverage is what can “fill the gap” between what Medicare covers and what you owe out of pocket. These plans are also called “Medicare Supplement” plans because they supplement your existing Medicare Part A and Medicare Part B coverage.
Some Medigap plans may provide a few extra “perks,” but generally speaking, they do not provide additional health benefits in the same way that Medicare Advantage plans do. Instead, supplemental insurance covers your Medicare Part A and Medicare Part B deductibles, copayments, coinsurance, etc.
You’re probably thinking, “great!” I’ll just go ahead and get Medigap and Medicare Advantage. However, you can’t have both. That decision can be tough, but it all comes down to how much you’re able to spend each month and whether or not you can afford a medical emergency. For example, Medigap premiums tend to be a bit higher than Medicare Advantage, but if you’re in the hospital all the time, it might pay off.
Can I switch from Medicare Advantage to Medigap?
If you enroll in a Medicare Advantage plan and decide that a Medigap plan might be better, you can switch – but there are a few things you’ll need to keep in mind.
Mainly, Medigap plans come with medical underwriting. In other words, you can be denied for pre-existing conditions. Meanwhile, you will never be denied or charged more for a Medicare Advantage plan based on your preexisting conditions. There are two times when your preexisting conditions won’t affect your Medigap enrollment: when you’re enrolling in Medicare for the first time, and if you are forced out of your current plan and need to find a new one quickly. That rule is called “guaranteed issue rights.”
You’ll also have to keep in mind that if you had a Medicare Advantage plan with prescription drug coverage and you want to switch to Medigap, you will lose your prescription drug coverage. The only way to have a prescription benefit with Medicare Supplements is to also invest in a Part D (prescription drug) plan.
One of the many benefits to Medicare Advantage is that most of your benefits will be rolled into one plan, whereas if you have Medigap, you may have to seek alternative plans for your prescription drugs, dental, vision, etc.
Can I switch from a Medigap plan to an Advantage plan?
Just like switching from Medicare Advantage to Medigap, switching from Medigap to Medicare Advantage is possible, but there are some things to be aware of.
One of the first things you’ll notice when you switch plans from Medigap to Medicare Advantage is that your copayments might rise. This will all depend on what plans you have. For example, if you had Medigap Plan G (which covers Part B copayments), and then you switched to a Medicare Advantage PPO plan that had a $20 copayment for doctor visits, you might feel like your costs are rising. However, your Medicare Advantage plan might have a lower premium than your Medigap plan did, making your overall costs lower.
Confused? Your insurance agent can walk through these numbers with you before you switch plans to help you decide which type of plan is truly best for you.
Is it better to have Medicare Advantage or Medigap?
The question should read, “Is it better for ME to have Medicare Advantage or Medigap?” That may not be the answer you were looking for, but it is different for every person. What you may see as disadvantages of Medicare Advantage might be great for someone else. Common Medicare Advantage disenrollment reasons, like trouble finding a doctor in-network or the lack of one very specific benefit, may not apply to you.
While Medicare Advantage usually provides more covered benefits, Medigap can result in lower hospital bills and lower overall out-of-pocket costs.
Your decision should be based on your health history, your budget, and the quality of plans available in your area. Try sitting down and writing a pros/cons list for Medicare Advantage vs. Medigap, like this:
Medicare Advantage:
Pros: Prescription drug coverage can be included
Cons: Stricter network
Medicare Supplements:
Pros: Copayments can be covered
Cons: Higher premiums
Add in any items specific to you, like a specific benefit that you need or a specific cost that you are worried about. Then, circle the items that are most important to you. Whichever column has the most circled items is likely the best option for you.
Why should I switch Medicare plans?
There are plenty of reasons to switch Medicare plans. Everything from network size to costs and benefits can be a factor.
You may want to switch Medicare plans if:
Your plan doesn’t cover all of your healthcare needs.
The premiums are too high.
Your favorite doctors are not in-network.
The costs are not worth the benefits you’re receiving.
A better plan becomes available in your area.
You become eligible for a cheaper or more specialized plan.
When can I switch from Medicare Advantage to Medicare Supplement?
Unfortunately, switching Medicare plans is not always easy. If you have a Medigap plan, you can switch to another Medigap plan at any time. However, if you already have Medicare Advantage and want a new Medicare Advantage plan, or if you have Medigap but want to switch to Medicare Advantage, you’ll have to wait for one of three* Medicare Advantage enrollment periods:
Annual Enrollment Period: October 15 – December 7 of every year, applies to all Medicare beneficiaries, any change is allowed
Special Enrollment Period: Applies only to those with specific circumstances, such as a special medical or financial need, and allows enrollments at specific times outside of AEP and OEP
Open Enrollment Period: January 1 – March 31 of every year, allows those with Medicare Advantage to make one switch to a different Medicare Advantage plan or drop coverage
*The fourth Medicare Advantage enrollment period is when you first become eligible for Medicare and is called the Initial Enrollment Period. This is when you would enroll in Medicare Part A and Part B for the first time and can choose to also enroll in Medicare Advantage (or Medicare Supplements and Part D).
When can I switch from Medicare Advantage to Medigap without losing guaranteed issue rights?
When you lose your current coverage for reasons beyond your control
Additionally, Medicare.gov identifies a few specific circumstances that can grant you guaranteed issue rights, including:
Your Medicare Advantage plan leaves your service area, or you move out of the plan’s service area.
You have Part A and Part B, and now your employer coverage is ending.
You joined either a Medicare Advantage plan of PACE (Programs of All-Inclusive Care for the Elderly) upon turning 65 and decided to switch within the first year.
You switched from Medigap to Medicare Advantage and want to switch back within less than one year.
Your policy’s company mislead you or broke a rule.
When You Can Change Medicare Advantage Plans
If you don’t want to switch between Medigap and Medicare Advantage and you simply want to disenroll from a Medicare Advantage plan or switch to another, you can do that during one of the Medicare Advantage enrollment periods.
CMS added the Medicare Advantage disenrollment period in 2020 to give beneficiaries another chance to switch without having to wait a full calendar year. This Medicare disenrollment period is actually the “Open Enrollment Period” lasting from January 1 through March 31. You are only eligible if you already have Medicare Advantage.
If you’d prefer to switch from Medigap to Medicare Advantage or make any other types of changes, you can do that during the annual election period in the fall, which is sometimes referred to as “Medicare open enrollment,” though it should not be confused with the Open Enrollment Period.
If you qualify for a Special Enrollment Period (SEP), you can make changes outside of the traditional enrollment periods. Common reasons that you might qualify are if you moved to a new plan service area (or your plan leaves your service area, you move into or out of a long-term care facility, you are also eligible for Medicaid, or you have a medical condition that qualifies you for a Special Needs Plan.
Can I Change my Medicare Advantage Plan If I Move?
You can (and may have to) change your Medicare Advantage plan if you move. Medicare Advantage plans are confined to specific service areas. Some are confined to specific counties or zip codes, while others are state-wide. If you leave that service area, you will need to change plans.
Additionally, moving to a new service area grants you a Special Enrollment Period. That means that from the date that you are officially living in the new area, you will have 60 days to switch Medicare Advantage plans. If you wait too long, you will have to wait until the Annual Enrollment Period rolls around again.
Switching Medicare Advantage Plans with Pre-existing Conditions
If you have preexisting conditions and want to switch into a new Medicare Advantage plan, you do not have to worry about medical underwriting. Medicare Supplement (Medigap) plans are the only type of Medicare plan that may require medical underwriting. Original Medicare (parts A and B), Prescription Drug Plans (Part D), and Medicare Advantage plans (Part C) all cannot deny you coverage based on your health history.
How to Switch Medicare Plans: Step by Step
When you think you’re ready to switch Medicare plans, follow these steps to ensure a successful switch:
Review your current benefits and make notes about what you like and what you don’t like about your current plan.
Meet with an insurance agent who can help you fill out your application correctly and answer all your questions (for no additional fees).
Tips for choosing a Medicare plan
Choosing a Medicare plan is a very personal process. Your Medicare coverage goes beyond copayments and deductibles. It can determine how prepared you are for emergencies, it can affect the quality of care you receive, and it can alter your lifestyle based on the benefits included.
Some people might find that traditional Medicare (parts A and B alone) is all they need, but most people will likely want to look for a prescription drug plan or some other benefits as well. No two health plans are the same. Some are very simple, covering basic needs and prevention, and others are complex, offering unique benefits like gym memberships and meal delivery.
When choosing your Medicare coverage, keep the following tips in mind:
What works for your spouse or friend may not work for you.
Always make sure your favorite doctors are in the plan network before you enroll.
Before selecting a prescription drug plan, verify that the prescriptions you need are covered.
Remember to look at all costs: premiums, copayments, deductibles, and coinsurance. It’s easy to get excited when you see one low number, but everything together can add up.
It doesn’t cost you anything to meet with an insurance agent who already understands the plans. They might even be able to help you save money.
We Can Help You Decide Which Coverage You Need
Changing your Medicare plan from Medicare Advantage to a Medicare Supplement is a big decision. Our licensed agents are highly trained, and they can help you find the plans available in your area. Your agent can discuss the pros and cons of MA and Medigap and help you make the decision that best fits your needs. To set up a no-cost, no-obligation meeting with an agent, call 1-844-431-1832 or contact us here today.
Hematologic Diseases & Common Blood Disorders in the Elderly
Blood has a number of important functions that include supplying your cells with oxygen and nutrients, fighting off infection, and removing waste such as carbon dioxide and lactic acid.
Hematologic diseases or blood disorders can impact your blood’s ability to function like it should. As you age, common blood disorders such as anemia and blood cancers may become more likely.
If you are age 65 and older, have ALS or ESRD, or have been receiving Social Security Disability Income for at least 25 months, you may be eligible for Medicare insurance. Medicare may cover some treatments and testing for common blood disorders.
List of Common Blood Disorders in the Elderly
As you age, you may become more susceptible to blood disorders. Common blood disorders in the elderly range from conditions that can be treated with diet and supplements to chronic diseases. The most common blood disorders include:
Anemia
Blood clots
Hemophilia
Leukemia
Lymphoma
Myeloma
Medicare Chronic Special Needs Plans for Blood Disorders
Original Medicare (Part A and Part B) may cover certain medical services for blood disorders. Medicare Part A is hospital insurance, and it can cover inpatient services such as surgeries that take place in the hospital. Medicare Part B is medical insurance, and it can cover outpatient services such as doctor visits and treatment, and emergency transportation.
For the most part, Original Medicare does not cover prescription drugs you take at home. Prescription drug coverage falls under Medicare Part D or certain Medicare Advantage plans.
Medicare Advantage plans are private health insurance plans that can offer supplemental benefits that Original Medicare does not such as prescription drug coverage, non-emergency medical transportation, and meal delivery.
Some chronic blood diseases may qualify you for a special type of Medicare Advantage plan called a Chronic Special Needs Plan (CSNP).
If you’re eligible for a CSNP, you may also qualify for a Special Enrollment Period (SEP) that allows you to make changes to your coverage as your medical needs change. Most people on Medicare have to wait for certain times of year to make changes.
With many CSNPs, you get coordination of care between multiple providers to ensure that your medical needs are met.. For example, a CSNP for leukemia, a type of blood cancer, may help pay for treatment by a blood specialist called a hematologist and/or a cancer specialist called an oncologist. Other team members may include surgeons and oncology nurses.
Another coverage option is a Medicare Supplement (Medigap) plan. Medigap plans can help cover certain fees associated with Original Medicare such as Part A and Part B coinsurance and copays, but they don’t usually include additional health benefits.
You cannot have both Medicare Advantage and Medicare Supplements. A licensed insurance agent can be an important resource for deciding which type of plan would best suit your needs.
Anemia in the Elderly
Anemia is a condition that happens when you have a lack of healthy red blood cells or a lack of hemoglobin (a main component of red blood cells). It can be caused by blood loss, decreased red blood cell production, and/or destruction of red blood cells. Symptoms include:
Dizziness
Fast or unusual heartbeat
Headache
Pain in your bones, chest, belly, and/or joints
Shortness of breath
Pale or yellow skin
Swollen or cold hands and feet
Feeling tired or weak
Vision problems
Medicare Coverage for Anemia
Medicare may cover a specific type of screening called a blood count for anemia if your doctor recommends one. The blood count can determine how much hemoglobin, white blood cells, and platelets your body has.
Medicare coverage for anemia treatment depends on the treatment. For example, a vitamin B12 deficiency can cause certain types of anemia, and they can be treated with oral vitamins and supplements. Neither Original Medicare nor Medicare Part D covers over-the-counter (OTC) vitamin supplements, however, some Medicare Advantage plans have an OTC benefit.
Original Medicare will help pay for vitamin B12 injections for certain types of anemia, as long as the injections are “reasonable and necessary to the treatment” of your hematologic disorder.
If your anemia is due to an iron deficiency, your doctor may recommend OTC supplements and/or changes to your diet.
If your body can’t produce enough red blood cells, your doctor may recommend blood transfusions as part of your anemia treatment. In that case, Medicare may help cover blood transfusions. You may have to pay coinsurance, copays, or deductibles depending on your plan and how your healthcare facility gets the blood.
Sometimes underlying chronic diseases such as cancer, kidney disease, and HIV/AIDS can cause anemia. In those cases, your treatment will depend on your condition and what your doctor recommends.
Blood Cancer
The most common types of blood cancer include leukemia, lymphoma, and myeloma.
Leukemia
Leukemia is cancer of the tissues that form blood, such as bone marrow and the lymphatic system. The cancer forms when mutated genes form in your DNA. According to the Mayo Clinic, symptoms include:
Fever or chills
Persistent fatigue, weakness
Frequent or severe infections
Losing weight without trying
Swollen lymph nodes, enlarged liver or spleen
Bleeding or bruising easily
Frequent nosebleeds
Tiny red spots on your skin
Excessive sweating, especially at night
Pain in your bones
Lymphoma
According to the Mayo Clinic, lymphoma is a blood cancer that occurs in the lymphatic system — part of the body’s “germ-fighting network.” Lymphoma has two main subtypes, which are Hodgkin’s and non-Hodgkin’s. Symptoms include:
Painless swelling of the lymph nodes in your neck, armpits, or groin
Chronic fatigue
Night sweats
Shortness of breath
Unintentional weight loss
Itchy skin
Myeloma
Myeloma is a cancer that forms in a type of white blood cell called a plasma cell. Your plasma cells help fight infection by making antibodies that attack germs. The cancer forms in your bone marrow, where the cancer cells can eventually outnumber healthy plasma cells. When that happens, your plasma cells can no longer produce antibodies. The cancer cells begin to produce proteins that can cause serious complications. Symptoms include:
Bone pain, especially in your spine or chest
Nausea
Constipation
Loss of appetite
Mental fogginess or confusion
Fatigue
Frequent infections
Unexplained weight loss
Weakness or numbness in your legs
Excessive thirst
Medicare Coverage for Blood Cancer
Your healthcare providers will create and execute your treatment plan depending on your type of blood cancer.
Medicare may cover diagnostic testing and screenings or blood cancer. Part B may cover treatments including outpatient radiation and intravenous chemotherapy. Medicare Part B may also cover CAR T-cell therapy for leukemia and lymphoma. Part A may cover hospital stays and inpatient surgeries as well as limited home healthcare services and skilled nursing care.
Medicare Part D may cover oral chemotherapy medications, painkillers, and/or anti-nausea drugs.
If you have blood cancer, you may qualify for a CSNP. After your initial diagnosis, you have 30 days to enroll in new coverage. If you need help selecting a CSNP*, talk to your agent. If you have a CSNP, your SEP will allow you to change your coverage as you need to. Your agent may be a valuable resource for finding the right plans.
*CSNPs may not be available in every location.
Hemophilia
Hemophilia is a hematologic disorder in which the blood can’t easily clot. If you have hemophilia, even a slight injury can cause severe bleeding. According to the Centers for Disease Control and Prevention (CDC), hemophilia is caused by a mutation in the gene that provides clotting instructions. The mutation can stop the “clotting protein from working properly.” Hemophilia can result in:
Bleeding in the joints that can lead to joint pain and disease
Bleeding in the brain which can cause long-term issues including paralysis and seizures
Bleeding in vital organs which can lead to death if the issue is severe
Medicare Coverage for Hemophilia
According to the National Hemophilia Foundation, Medicare Part B helps cover “clotting factors,” which are concentrated forms of clotting proteins. The CDC separates clotting factor products into two groups: plasma-derived and recombinant. Plasma-derived products come from donors. The clotting factors are separated from the blood plasma, tested for viruses, and freeze-dried. Recombinant products are genetically engineered in a laboratory. They do not contain any plasma or albumin.
Blood Clots
If you get a cut or scrape, blood cells called platelets and certain clotting proteins in your plasma work together to create clot over the injury. Usually, your body will dissolve the blood clot after you’ve healed. According to the American Society of Hematology, sometimes clots do not dissolve naturally, or they form on the inside of blood vessels without an injury.
Blood clots may be extremely dangerous. For example, blood clots in the brain can lead to a stroke, clots in the coronary artery can cause a heart attack, and clots in the pulmonary artery can cause pulmonary embolisms.
According to Medical News Today, the legs are the most common place for a blood clot to develop. Symptoms of a clot in the leg may include:
Pain
Swelling
A feeling of warmth
Tenderness
Redness
Pain in your calf when you stretch your toes upward
Medicare Coverage for Blood Clots
Medicare covers medically necessary diagnostic tests such as pulmonary angiograms or ultrasounds to look for blood clots.
Treatment for blood clots may include prescription anticoagulants (blood thinners). Medicare Part D or certain Medicare Advantage plans may cover blood thinners such as Xarelto.
Get Coverage for Common Blood Disorders Today
If you need coverage for the most common blood disorders in the elderly, a licensed agent with Medicare Plan Finder may be able to help. Our agents can see what plans are available in your area and help you decide which one works best for your needs, whether you need a CSNP, Medicare Advantage plan, or a Medicare Part D plan. To arrange a meeting with an agent, call 1-844-431-1832 or contact us here now.
7 Types of Exercises for Seniors (with Pictures!)
Exercising is not just for weight loss. As you get older, it becomes increasingly important to keep your body active in order to keep your strength and stability. However, it also becomes harder to exercise as you age.
Your exercise routine doesn’t have to be intense. You’re not expected to run marathons at 80 years old (though some have done it), but your doctor might recommend that you spend some time on your feet. Exercise for you can mean something as simple as taking a walk around the block.
The following are seven different types of safe exercises for seniors with pictures included.
Senior Swimming Workouts
If you have a pool available to you, either at home or at a local fitness center, swimming exercises can be kind to older bodies. Experts especially recommend swimming exercises for those with joint pain or arthritis.
Some fitness centers may offer swimming classes that you can join. If there aren’t any available, consider taking the time yourself to jog through the water, swim laps, or use the resistance of the water to practice leg lifts.
In fact, certain private Medicare plans might come with a fitness program benefit. These benefits often include memberships to local fitness centers that can allow you access to free or very low-cost exercise classes.
Seniors at a swimming class | Senior exercises | Medicare Plan Finder
Simple Yoga for Seniors
Yoga can help improve your balance, stability, and flexibility and can even reduce stress. Yoga poses don’t have to be complicated, either.
Check out these examples of gentle yoga poses:
gentle yoga poses | Medicare Plan Finder
You also might be able to find yoga classes offered at your local fitness center. Look for beginner-level classes or classes specifically designed for senior groups (unless you think you’re ready for advanced yoga – do what you feel comfortable with!).
Pilates for the Elderly
Pilates exercises focus on your core strength, which can also improve your balance and stability. Pilates exercises can be easily performed at home. It includes poses like planks and sit-ups.
You can do Pilates from a mat in your local gym, or you can set up on your carpet or on your personal yoga mat at home. It does not require additional equipment!
Senior Man Doing Press Ups In Gym | Medicare Plan Finder
Senior Walking & Biking Exercises
Walking or biking for as little as 30 minutes per day can result in weight loss, improved cardiovascular health, reduced blood pressure, stronger bones, better balance, and more!
If you feel safe walking around your neighborhood, you don’t even have to go anywhere. Otherwise, you can find a pretty park, a school running track, or even a shopping mall to get your steps in.
You could also get your daily walk in by walking your dog or strolling with your grandkids!
If you feel comfortable, you can also try running – but don’t push yourself.
Seniors jogging with their dog outside | Medicare Plan Finder
Chair Exercises for Seniors
Sometimes standing up for long periods of time is NOT healthy. Some people can’t walk or move too much, and that’s ok. There are still ways to exercise and safely keep your body moving.
For example, try the “seated row.” Sit in a dining chair or any chair without arms, and repeat a “rowing” motion with your arms at least 8-10 times. Repeat as many times as you feel comfortable. This repeated motion will work your upper back and chest muscles.
You could also do knee lifts from a chair. Simply lift your knees one at a time towards your chest. Lift each leg individually at least 8-10 times. As you get stronger, you can increase the number of lifts and work on bringing your legs higher.
Prefer an even more sedentary routine? These yoga poses can be done from your chair:
Chair Yoga Poses | Medicare Plan Finder
Stretching Exercises for Seniors
Regular stretches are important as your joints age. As you age, your muscles gradually shorten and lose elasticity. While you can’t necessarily stop the aging process, you can certainly make yourself more comfortable by performing daily stretches.
“Static” stretching lengthens your muscles and improves your range of motion. Static stretching means holding a position for 10 to 30 seconds (or even longer, if you have the patience). Static stretches can be as simple as sitting down and touching your toes for 30 seconds straight.
Try to remember to spend a few minutes on static stretching exercises at least three to five times per week.
Keep in mind that you should feel the stretch a little, but it shouldn’t hurt. If you find yourself in pain after a stretch, you may have pushed yourself too far, or something could be wrong. Always see your doctor if you find yourself in pain.
Happy senior women stretching while out on a run | Medicare Plan Finder
Senior Dance Classes
Not only are dance workouts more fun, but they usually work several different areas of the body. If you feel comfortable with it, finding a local dance class for seniors is a great way to move your body.
You can join a “Zumba” class, a dance class designed for full-body workouts, or you can join a class that teaches you how to dance, like a salsa class. Even though a salsa class may not be designed as an exercise program, it certainly keeps your body moving and can still result in positive fitness results.
Senior couple dancing | Medicare Plan Finder
Medicare Fitness Coverage
If you’d like to do your workouts in group settings or would prefer to use the equipment at a gym, you might actually be able to get insurance for that.
That’s right – private Medicare plans (Medicare Advantage) can sometimes include Medicare fitness programs. These programs can pay for your gym membership and can provide unique classes designed just for the Medicare-eligible population.
Some programs even include home fitness products, like workout DVDs and small exercise equipment.
To find out what plans in your area include a Medicare fitness benefit, call Medicare Plan Finder at 844-431-1832 or click here to send us a message.
We can’t wait to help you!
Medicare Fitness Programs Guide
Home Health Tests Seniors Should Try
We’re all aware we should make an effort to regularly see our physicians. But we also know that life tends to get in the way.
Especially for seniors, transportation and cost can often prevent routine doctor visits. However, just because you can’t get to your doctor’s office, doesn’t mean you have to stay in the dark about your health. There are quite a number of tests that you can perform without ever leaving home!
Tests You Can Do At Home Today
The range of at-home tests and testing methods varies widely. Some require expensive medical equipment only available through a supplier and with a prescription, while others require only a pen and paper. Here are some tests that you can do today with little to no supplies
SAGE Test for Dementia
The Self-Administered Gerocognitive Exam, or SAGE, was devised by researchers from the Wexner Medical Center at Ohio State University. SAGE can help detect early warning signs of cognitive impairment and memory loss in less than 15 minutes.
The test has several components and several forms, all of which can be viewed and downloaded at the Wexner Medical Center’s website. These include sections on orientation, language, memory and visuospatial awareness.
The most well-known element of the SAGE is known as the clock drawing test. All you need to do is get out a pen and paper and draw a picture of a clock, with the hands reading 3:40. Then compare your drawing to a real clock to see how you scored.
If your circle is closed, give yourself a point. If all twelve numbers are accounted for and in the right place, you get two more points. If your hands are in the correct position as well, you passed with flying colors. A score of any less than three points, however, might be an indication that you should see your physician for further screening. This test is sometimes performed without the rest of the exam, though it is usually recommended to perform the entire SAGE test for dementia detection.
Free Medicare 101 Course
Window Test for Vision Loss
Our eyes take a lot of abuse these days from the onslaught of screens and artificial lighting. It’s even more severe as we get older and the natural, age-related loss of vision begins to take effect. If you experience some trouble reading, give yourself this informal at-home eye exam to judge whether or not you should seek an eye care professional.
First, sit across the room from a large window or door so that you can see all the lines of the frame around it. Cover one eye and focus on the window or door frame with your open one for 30 seconds. Then repeat with the opposite eye. The horizontal and vertical lines of the frame should be clearly visible with no missing or hazy areas. If the edges of the frame seem distorted or warped, this may indicate macular degeneration, a disease that is currently the leading cause of irreversible vision loss in people over 60.
Cushion Test for Peripheral Arterial Disease
The cushion test can be performed without even getting out of bed! It can help detect blocked arteries in your legs and feet, a condition known as PAD, or peripheral arterial disease. Those with high blood pressure or diabetes, both common among seniors, are especially at-risk for this disease.
To perform this test, lie on a bed and elevate your legs with pillows or cushions until they are resting at a comfortable 45-degree angle. Keep them there for one minute, then sit up and swing your legs over the side of the bed so that they hang at an angle of 90 degrees. If either or both of your legs turn pale when elevated and take several minutes to return to their normal shade after sitting up, you may need to consult your physician with the results from this peripheral artery disease test.
Phalen’s Maneuver for Carpal Tunnel
We are an increasingly computer-savvy society and people of all ages are typing more than they used to. Extended periods of typing are strongly associated with carpal tunnel syndrome, a painful condition caused by a pinched median nerve in the wrist, but many other activities like driving can bring on these symptoms as well. Furthermore, people over 55 years old are at a much higher risk and those over 65 are more likely to have cases that are severe.
Phalen’s maneuver is a test devised to diagnose carpal tunnel at home and has been shown to be surprisingly effective. To see for yourself, press the tops of your hands together with your fingers pointing toward the floor and your elbows extended. If you can, hold this position for a full minute. If you feel an unpleasant sensation, such as prickling, tingling, or burning, you may likely have carpal tunnel and should consider preventive measures.
Check out this video from Physiotutors on YouTube that explains how to perform the Phalen test:
Testing With Medical Equipment
Some at-home health tests will require special instruments to fully gauge the results. While many of these items can be freely obtained from online and brick-and-mortar retailers, some require ordering through a medical supplier with a doctor’s prescription. Below, we will detail some of the testing you can do at home with the help of specially-designed medical equipment.
Blood Sugar Test
For the 12 million seniors living with diabetes* (about 25% of those over the age of 65), monitoring blood sugar levels is an near-constant concern. Luckily, this is something that can be checked at home or on-the-go using a blood glucose monitor, or glucometer. These can be found online or in pharmacies in the form of kits, which include testing strips, needles (called lancets), and the glucometer itself.
To test blood sugar at home, you will need to insert a test strip into the electronic monitor and prick the side of your finger with the provided lancet. Gently apply pressure to that finger until you see a drop of blood form, then touch it to the edge of the test strip. In just a few seconds, you will have an accurate metering of your current blood sugar levels, no matter where you are.
Blood Pressure Test
Along with heart rate, breathing rate, and body temperature, blood pressure is one of the four most significant vital signs that our bodies produce. High blood pressure can be caused by countless factors like high cholesterol, stress, and even fear, and affects almost 70% of adults between the ages of 65 to 74. Monitoring blood pressure accurately is vitally important, as symptoms may not manifest until these levels are dangerously high. Doctors maintain accuracy by using large, costly machines but there are ways to test blood pressure at home with minimal equipment.
The quickest and most accurate results will come from automated, electronic blood pressure monitors that come with an upper arm cuff. Many different brands of at-home blood pressure cuff exist and can be found at pharmacies or similar retailers. The directions for use may change from model to model but there are certain rules that apply no matter what brand you use, including placing the cuff directly on the skin, placing the feet flat on the floor, elevating the arm to chest height, and avoiding smoking or drinking for 30 minutes before testing.
At-Home Lab Tests
Another popular method of in-home health testing comes in the form of test kits that can be ordered right to your door. These vary widely, not only in terms of what is being tested, but also in the method of sample collection. Some services will send a team of professionals to administer and retrieve your test, while others will only send instructions and require you to send your samples back in the mail for results. These can be purchased to test for a wide range of conditions, including food sensitivity, hormone testing, DNA testing, and other at-home blood tests.
Medicare DME Coverage
Medical equipment may be needed for certain tests.
Durable medical equipment, or DME, is a designation that Medicare uses to classify coverable medical equipment that can be used in the home. This benefit might be used to cover the cost of equipment to aid in the at-home testing we have already covered. The covered equipment can range from crutches and canes to CPAP devices and hospital beds, though it all must come from a Medicare-approved medical supplier.
Medicare-Approved Glucose Meters
Blood sugar monitors and test strips are usually covered under Medicare Part B as durable medical equipment for home use with a doctor’s prescription. You may be able to rent or buy a glucometer but Medicare will only provide coverage if both your physician and the supplier are both enrolled and participating in Medicare. Be sure to clarify this with your doctor and equipment supplier, as some may be enrolled but not “participating” and may not accept the cost of assignment.
Medicare Part B may cover the cost of a blood pressure monitor or ambulatory blood pressure monitoring (ABPM) device but only under very specific circumstances. Part B will cover a blood pressure monitor and stethoscope for those who receive blood dialysis treatment in their home and will pay for the rental of an ABPM device for patients who have exhibited “white coat hypertension,” a phenomenon where nervousness in clinical settings causes artificially high blood pressure readings.
For those with Medicare Part C, or Medicare Advantage, all the benefits of Parts A & B will be covered but may also include additional benefits and expanded coverage. Contact your insurance company to find out if your Part C plan covers blood pressure monitors or glucometers.
If you don’t have a Medicare Advantage plan, give us a call at 844-431-1832 or contact us online to speak with a licensed agent and find a plan that can address your healthcare needs!
Ultimate Guide to Railroad Retirement Medicare Benefits
According to the US Railroad Retirement Board, more than 500 thousand people receive railroad retirement benefits, which include “retirement, survivor, unemployment, and sickness insurance benefits for railroad workers and their families.”
Many railroad retirees can also receive Medicare health insurance benefits. Railroad Retirement Medicare benefits work much the same way as regular Medicare benefits. The difference lies in what organization administers the benefits. The Railroad Retirement board administers railroad Medicare benefits for most eligible people, and the Social Security Administration administers regular Medicare benefits.
Who Is Eligible for Railroad Retirement Benefits and Medicare?
Railroad Retirement benefits do not include health insurance, but many retirees are also eligible for Medicare. Each program has different eligibility requirements.
According to Union Pacific, one of the major railroad companies in the United States, the earliest that Railroad Retirement benefits begin is “either age 60 with 30 years of qualifying service, or age 62.”
If you have less than 30 years of service, you must wait until full retirement age to receive full benefits. You may be eligible for reduced benefits if you’re at least 62, but haven’t reached full retirement age, which ranges from 65-67 depending on when you were born. For example, full retirement age is 67 for anyone born after 1960.A
Another way you can qualify for Railroad Retirement Board benefits is through disability insurance. You must have at least 10 years of service to qualify for RRB disability insurance.
Medicare Eligibility Requirements
Many people are eligible for Railroad Retirement Board Medicare benefits when they turn 65. You can also qualify if you have ALS, ESRD*, or SSDI**.
If you are already receiving Railroad Retirement or Social Security benefits when you turn 65, you’ll automatically be enrolled. You’ll receive information about it a few months before your birthday. You will “have the option of turning Part B coverage down” because you have to pay a monthly premium for Part B.
*The Social Security Administration handles benefits for enrollees with ESRD.
**Must have had SSDI for at least 24 months to qualify.
What Does Medicare Cover?
Original Medicare (Parts A and B) covers many medical expenses, but it doesn’t cover everything. Here’s a breakdown of what Medicare covers:
Medicare Part A
Medicare Part A covers inpatient care, skilled nursing facility care, hospice, and home health services. You may be responsible for copays, coinsurance, and/or deductibles.
Medicare Part B
Medicare Part B helps pay for outpatient care including doctor’s appointments and preventive services. Part B also helps pay for emergency medical transportation, durable medical equipment (DME), mental health services, and partial hospitalization. You may be responsible for paying deductibles, copays, coinsurance, and/or monthly premiums.
Medicare Part C (Medicare Advantage)
Medicare Part C, or Medicare Advantage plans are private insurance policies that can offer additional benefits to Original Medicare. Those supplemental benefits can include hearing, vision, dental, meal delivery, and even fitness classes. Some Medicare Advantage plans offer prescription drug benefits.
Medicare Part D
Another way to get prescription drug coverage is through a standalone Medicare Part D plan. You may be responsible for premiums, copays, coinsurance, and/or deductibles with a Part D plan.
What Is a Railroad Retirement Medicare Supplement?
It’s important to understand the difference between Medigap and Medicare Advantage because you can’t have both types of plans. While Medicare Advantage plans cover additional health benefits, Medicare Supplement (Medigap) plans cover financial items such as copays and coinsurance.
Medigap plans offer eight different levels of coverage in 2020, and each level is assigned a letter. Note: People who enrolled prior to 2020 might have Plan C or Plan F. Plans that cover the Part B deductible (like Plan C and Plan F) will not be available to anyone newly eligible for Medicare in 2020.
Learn More About Railroad Medicare Benefits
If you need help finding the right Medicare plan, a licensed agent with Medicare Plan Finder may be able to help. Every location has different plans, and it may be difficult to determine what plan would work best. Our agents are highly trained and they can help you determine what kind of plan you need for additional coverage — Part D, Medicare Advantage, or Medigap. Call 844-431-1832 or contact us here to set up a no-cost, no-obligation appointment today.
Help for Seniors Living Alone
Living alone is scary, no matter how old you are, but it gets scarier as you age and develop more health and safety concerns.
Concerned family members may start to lovingly imply that it “might be best” for you to move into an assisted living home, or start to ask questions.
You can share this blog with them to give them a sense of security that you are thinking about this and making the right moves. Living alone can be scary, but it’s not impossible.
Advantages of Elderly Living Alone and at Home
There are more benefits to living alone than your family members may realize. Living alone and at home can cost much less than moving into a retirement home or nursing facility. Of course, this can change depending on whether you have specific healthcare needs or require an in-home aide.
Living at home can also be much more comfortable. High-tier, expensive nursing homes, and retirement facilities can certainly be nice, but they often come at a cost.
Sometimes, more reasonably-priced facilities are not as comfortable as being home. Plus, there’s a sense of security and happiness that comes with staying in the home that you’ve worked for.
Tips for Living Alone
The following tips will not only provide you with a safer, healthier living situation but will also provide your friends and family members with peace of mind.
Attend your annual doctor visits, even if you feel fine.
Keep your social life as active as possible and get to know your neighbors.
Set reminders on your phone or calendar to refill your medication, or schedule automatic medication reminders.
Have a first-aid and a disaster preparedness kit easily assessable in case of emergency.
Make all necessary home repairs as soon as possible.
Always lock your doors and windows, and consider installing an alarm system.
Keep a list of emergency contacts pinned in a visible location in case of an emergency.
Consider purchasing useful devices for your home (see below)
Devices for Seniors Living Alone
Technology has made living at home by yourself much easier than it was for your grandparents. Everything from automatic vacuums to alarm systems makes home life safer, healthier, and more possible. We searched the internet, and these are some of our favorite devices that you can buy to improve your life at home.
Housekeeping Devices
Smart Vacuum – One of the hardest things about living alone as an older adult is finding ways to keep your house clean. Simple tasks like vacuuming will start to get harder, but smart vacuums can solve that problem for you. All you have to do is press a button on your phone to get a Roomba vacuum to do it for you!
Voice Assistants – Devices like Amazon’s “Alexa” and Google’s “Home” platform can save you from things turning off the light before you walk to bed, or having to get up and walk around too often.
Kitchen & Bath
Bath Mats, Chairs, and Bars –Slips and falls are one of the most dangerous parts of living alone because it’s hard to say how long it will be before someone can help you up. Be sure to buy grip bath mats for your shower or tub (or even for any tiled and slippery areas). Also, consider investing in a chair for the shower so that you don’t have to stand on the slippery tub.
Automatic Kitchen Appliances – Kitchen fires are another major concern for adults living alone. As symptoms of dementia start to appear, leaving appliances on can become a common occurrence. Consider appliances that have automatic “off” functions and cordless devices like this electric kettle.
Life Alert Devices for Seniors Living Alone
Life Alert is just one brand of medical alert device, which is a device you wear that can alert emergency personnel if you need help. Other brands include Medical Guardian and Philips Lifeline.
Life Alert – Life alert can be a lifesaver if you fall and can’t get up, or if you have a medical emergency and can’t reach for the phone. All you have to do is hit a button on your device (which you can wear around your neck), and help will arrive.
Medical Guardian – This company has a few different types of products for medical alerts and home safety. Their devices are capable of detecting falls and alerting authorities of any emergency instantly.
Philips Lifeline – Their products include wearable pieces like watches and necklaces as well as home bases that you can keep in your living room. Like other services, Philips Lifeline products will alert authorities. Uniquely, they focus on unique, individualized care plans, and there is two-way communication available so that you can request a specific type of emergency help.
How Medicare Covers Home Care
You can alleviate a lot of your and your family’s concerns about you living alone at home by taking charge of your in-home care. Medicare Part A covers part-time or intermittent home health services when ordered by a doctor.
It does NOT cover 24-hour care, meal delivery, or homemaker/custodial services, but you may be able to get those other items through select Medicare Advantage plans.
Home Care Services That Accept Medicare
To find home care services near you that accept Medicare, use Medicare.gov’s “Find a home health agency” tool. Type in your zip code and click “search” for a list of the providers in your area.
Home Health Services That Accept Medicare
Remember that if you have a Medicare Advantage plan, you’ll need to use your plan’s search tool or list of providers to make sure that the agency or service you want to use accepts your Medicare Advantage coverage.
Organizations That Offer Help for Elderly Living Alone
Living independently does not mean that you are completely alone. Even if you don’t have friends and family members close by, there are several organizations you can reach out to for help.
AARP & the AARP Foundation: AARP is a nonprofit organization with a goal to help people aged 50 and older improve their lives through better nutrition, housing, income, social activities, and more.
Area Agencies on Aging (AAA): The AAA is a nationwide program offering education, meal programs, transportation, and more for aging adults. Each of its programs is localized.
National Council on Aging: Works with nonprofits, governments, and businesses to provide programs and services for seniors in regards to health, finances, and legal concerns.
National Institute on Aging (NIA): The NIA conducts research on the well-being of older adults and is a great source for health topics. They also operate “Go4Life,” an exercise and physical activity program for seniors.
Meals on Wheels: The Meals on Wheels program is a localized program for meal delivery for people who have a hard time leaving their homes and cooking their own food. Click here to read more about Medicare meal delivery.
PACE (Programs of All-Inclusive Care for the Elderly): PACE helps eligible people over the age of 55 with medical, personal, and social care while they live at home. That can include medication delivery, transportation, etc.
Becoming a Caregiver
If you are reading this with another person in mind, maybe it’s time for you to become a caregiver. Keeping your loved ones at home instead of moving them to a facility is a tough decision to make.
Some older adults will truly be better off living in a medical facility, while others don’t need that level of attention and will be more comfortable at home. Have the discussion not only with your loved one but also with their doctors.
If you decide that your loved one is going to stay at home, and you would like to become their primary caregiver, there are a few steps you should take:
Learn everything you can about your loved one’s medical conditions so that you can provide the best possible care.
Reach out to the senior advocacy groups listed above for help with managing your loved one’s in-home care.
Talk to your loved one about Medicare, Medicaid, and private health insurance options and find out if you are eligible to be paid as a caregiver through their plan (click here to speak with a licensed agent).
This post was originally published on July 31, 2019, and updated on October 29, 2019.
A Guide to Medicare Insulin Coverage
According to the Kaiser Family Foundation (KFF), a non profit healthcare organization, Medicare Part D (prescription drug) spending increased from $1.4 billion to $13.3 billion from 2007 to 2017.
The huge increase in drug costs ultimately gets passed to the consumer. KFF also said that insulin out-of-pocket costs have “quadrupled.” That may be the case, but Medicare insulin coverage may help lower costs if you qualify.
How Does Medicare Insulin Coverage Work?
Original Medicare is the public health insurance that helps beneficiaries pay for medical expenses. It does not cover prescription drugs, with one exception — insulin.
However, Medicare insulin coverage is limited. Medicare Part B (medical insurance) only covers insulin if it’s administered with an insulin pump. The pump is considered to be durable medical equipment (DME), which Medicare helps cover when medically necessary.
That means that while Original Medicare may help pay for insulin pumps, diabetes screening/treatment, and even orthotics for diabetics, Original Medicare does not cover insulin by itself.
If you’re eligible for Medicare and want insulin coverage, you have two options. One option is through a Medicare Part D plan that only helps cover drugs. The other option is through a private insurance plan called a Medicare Advantage Prescription Drug (MAPD) plan.
Many Part D and MAPD plans use a formulary to determine how much you pay at the pharmacy. A formulary is a list of the drugs your plan covers. The list divides prescriptions into tiers. Each tier has a different copay or coinsurance amount. According to GoodRx, Lantus, the most popular insulin has “a copay of $37.50-$67.50.” That’s a significant savings when you consider that the estimated Walmart pharmacy retail price is $507.
How Can I Get Insulin at a Lower Price?
If you have a limited income, you may be able to receive help for Part D premiums and drug costs with a Low Income Subsidy (LIS), also called Extra Help. LIS eligibility is based on your income, assets, and the Federal Poverty Level. According to the Social Security Administration (SSA), Extra Help can save you almost $5 thousand per year. If you’re eligible for LIS, you won’t pay more than $8.50 for covered name brand drugs or $3.40 for covered generic prescription drugs.
If you qualify for LIS, you may also qualify for Medicaid. If you qualify for both Medicare and Medicaid, you may qualify for a Medicare Advantage plan called a Dual Special Needs Plan (DSNP). Many DSNPs offer prescription drug coverage with low copays. DSNPs may also offer additional benefits such as fitness classes, vision coverage, and meal delivery.
If you have LIS or a DSNP, you are eligible for a Special Enrollment Period (SEP), which allows you to enroll in new coverage or change existing plans at different parts of the year.
Many people have to wait until the Annual Enrollment Period (AEP), which is from October 15 to December 7 to make changes. With a LIS or DSNP SEP, you can make one change per quarter from January to September. Those changes will take effect on the first of the month following your change. You can make changes during AEP as well, however, those changes won’t take effect until January 1 the following year.
SEPs can be long-term or temporary. For example, in the case of a DSNP, you have a SEP for as long as you qualify for both Medicare and Medicaid. If you gain or lose Medicaid coverage, you have a temporary SEP, which allows you 30 days to enroll in a new plan.
To illustrate how a DSNP SEP works, let’s take the hypothetical example of a 70-year-old man who’s recently qualified for Medicaid. In this example, it’s January 12 and the man qualified on the 10th. The man has until February 9 to enroll in a DSNP. Let’s say he enrolls on February 9. The new coverage will take effect on March 1.
If the man decides he’s not satisfied with his new plan, he can make one change on April 1, which is the start of the second quarter of the year. The man won’t be allowed to make any more changes until July 1. He won’t be allowed to make any changes after September 30 with his DSNP SEP.
Why Is Insulin So Expensive?
According to NPR, many different factors affect insulin’s price. The most important factor is that there’s no generic equivalent to insulin.
With many drugs, other manufacturers cannot legally create generic versions because of patent laws
Once a patent expires, manufacturers have license to create generic versions of brand-name drugs. Generic drugs are often much cheaper than their name brand counterparts. According to the World Health Organization, current insulin patents won’t expire until 2030.
What Is Insulin?
Insulin is a hormone produced in the pancreas that regulates blood sugar. Your body will store glucose in your liver if there’s more sugar than it needs. Insulin will trigger your body to release that sugar when you need it.
If your blood sugar is too high, you can develop diabetes, which is when your body can’t use insulin efficiently or make its own insulin. Type 1 diabetes is when the pancreas can’t make insulin. Type 2 diabetes is when the pancreas makes insulin, but the body doesn’t respond well to it.
The drug insulin dates back to the early 1920s. Researchers conducted a clinical trial with diabetes patients. The trial used insulin from cattle pancreases, and “most patients recovered.” After the trial, insulin was “produced and sold on a massive scale around the world.” Both type 1 and type 2 diabetes need insulin shots to use glucose from food.
Types of Insulin
According to the American Diabetes Association, there are different types of insulin. The type of insulin your doctor prescribes depends on how quickly it works and how long it lasts. Insulin may have a peak blood-sugar lowering capacity and length of total time it works. Injectable insulin is the most common, and it can be divided into five types:
Rapid-acting insulin: Starts to work about 15 minutes after injection, peaks in about one hour, and continues to work for two to four hours.
Regular or short-acting insulin: Typically reaches the bloodstream within half an hour of injection, peaks anywhere from two to three hours after injection, and is effective for approximately three to six hours.
Intermediate-acting insulin: Usually reaches the bloodstream about two to four hours after injection, peaks four to 12 hours later, and is effective for about 12 to 18 hours.
Long-acting insulin: Reaches the bloodstream several hours after injection and can lower glucose levels for 24 hours or longer.
Ultra long-acting insulin: Reaches the bloodstream in six hours, does not peak, and lasts about 36 hours.
Another way to take insulin is inhaled insulin. According to the American Diabetes Association, it begins working in 12-15 minutes, peaks by about 30 minutes, and leaves the body in about three hours.
No matter what type of insulin your doctor prescribes, be sure to follow the instructions for taking and storing the insulin. For example, all insulin comes in liquid form. You may have to refrigerate insulin so it doesn’t expire too soon.
Get Medicare Coverage for Insulin
If you need insulin coverage, a licensed agent with Medicare Plan Finder may be able to help. Our agents are highly trained. They can find what Part D and/or Medicare Advantage plans are in your area, and they can even help you apply for LIS. To set up a no-cost, no-obligation appointment call 844-431-1832 or contact us here today.
Medicare Coverage for Diagnostic Colonoscopy
A colonoscopy is a test that uses a small camera to scan your entire colon to detect disease before it becomes a catastrophic health issue.
Colorectal cancer, also called colon cancer, is the third most common cancer among adults in the United States, according to the Centers for Disease Control.
Does Medicare Cover Colonoscopy?
Medicare can cover some or all of the costs surrounding your colonoscopy. How much you pay depends on what the test finds and whether the test is considered to be a screening colonoscopy or a diagnostic colonoscopy.
Screening Colonoscopies
Medicare Part B covers preventive screenings, tests, and x-rays, including screening colonoscopies. Original Medicare covers screening colonoscopies in full if your doctor or health care provider agrees to perform the test. The coverage you get depends on your risk for developing cancer.
If you have a high risk for developing colon cancer, you get coverage for:
One screening colonoscopy every two years
If you have an average risk of developing colon cancer, you get coverage for:
One screening colonoscopy every 10 years
Or one screening colonoscopy four years after a flexible sigmoidoscopy (a similar test to a colonoscopy, however, it only examines the lower part of the colon
Diagnostic Colonoscopies
If the screening colonoscopy reveals a polyp or other cancer tissue and your doctor removes it, then the test becomes a diagnostic colonoscopy.
Medicare coverage for a diagnostic colonoscopy differs from a screening colonoscopy. You might be responsible for paying 20 percent of the Medicare-approved total cost of the procedure along with the Medicare Part B deductible, which is $185 in 2019.
Does Medicare Pay for Colonoscopy Anesthesia?
How much you’ll pay for anesthesia depends on whether your colonoscopy is for screening or diagnostic purposes. Medicare coverage for diagnostic colonoscopy anesthesia comes with both a 20 percent coinsurance fee and the Part B deductible. S
ince a screening colonoscopy is considered preventive care, Medicare waives any coinsurance fees and the Part B deductible that normally goes with anesthesia.
Does Medicare Cover Virtual Colonoscopy?
A virtual colonoscopy (CT colonoscopy) uses a computer rather than a camera to scan the large intestine. According to the American Cancer Society, Medicare “does not cover virtual colonoscopies at this time.”
What Other Colon Cancer Tests Does Medicare Cover?
Sometimes people will use other tests to screen for colon cancer. Medicare will cover the following preventive screening tests if you’re 50 or older:
Cologuard (stool DNA test): Once every three years for people ages 50 to 85 who do not display colon cancer symptoms and who have an average risk of colorectal cancer. A stool DNA test can show altered DNA and/or blood in the sample, and those results may mean you have cancer.
Fecal Occult Blood Test (FOBT) or Fecal Immunochemical Test (FIT): For people 50 and older once per year. The FOBT or FIT is a lab test that checks stool samples for occult (hidden) blood. The hidden blood may signify that the colon has polyps or cancer.
Screening Barium Enema: An X-ray that involves using a white liquid called barium to enhanced photos of the colon.
Your doctor may order a diagnostic colonoscopy if any of the above tests yield abnormal results. The diagnostic colonoscopy costs will apply.
Medicare Genetic Testing for Colon Cancer
Some people are more likely to develop cancer than others. The BRCA1 and BRCA2 gene mutations indicate a higher likelihood of developing cancer and passing the disease on to your children.
Medicare will pay for genetic testing for colon cancer if the test is medically necessary. In order for Medicare to pay for your genetic testing, you must have a high risk for developing the disease and have a personal history of cancer.
What Does Medicare Consider High Risk for Colon Cancer?
The Centers for Medicare and Medicaid Services (CMS) consider people to be high-risk if they have or have had any of the following:
A personal or family history of colon cancer
A personal history of inflammatory bowel disease such as Crohn’s Disease
A sibling, parent or child who’s had colon cancer or an adenomatous polyp
A personal or family history of adenomatous polyposis
A colon cancer diagnosis qualifies you for the Special Enrollment Period (SEP), which means you won’t have to wait for certain times of the year to change your coverage or enroll in new coverage. The SEP allows you to add or remove coverage as your needs change.
Find Medicare Coverage for Diagnostic Colonoscopy
Getting Medicare coverage for a screening or diagnostic colonoscopy might be a huge factor in finding colon cancer before it’s too late. If you need quality health insurance, Medicare Plan Finder can help. Call us at 844-431-1832 or fill out this form today.
Contact Us | Medicare Plan Finder
This post was originally published on May 2, 2019, and updated on October 28, 2019.
Good News: 2021 Medicare Advantage Plans Have Higher Ratings and Lower Premiums
It’s time to start making decisions for your healthcare coverage in 2021. The Annual Enrollment Period for Medicare beneficiaries is going on NOW and only lasts through December 7.
As you’re looking through your Medicare Advantage and Part D plan options for next year, you may notice that monthly premiums are shrinking and benefits are expanding!
CMS (The Centers for Medicare & Medicaid Services) released a statement earlier this fall that said the average monthly premium for a Medicare Advantage plan in 2021 will be the lowest it’s been in 14 years (since 2007!)
In fact, the average Medicare Advantage (MA) premium will see a decrease of 34.2% from 2017, while plan choice and benefits continue to expand. In some states like Alabama, Nevada, and Kentucky, the average premium decrease since 2017 will be closer to 50%.
Medicare Part D prescription drug plans (PDPs) will also have low premiums in 2021, with standard plans averaging around $30.50 a month. This marks a 12% decrease in PDP premiums since 2017.
Average monthly Medicare Advantage premiums
Average star ratings increasing
The average star ratings for Medicare Advantage and prescription drug plans in 2021 are set to increase significantly. About 77% of Medicare Advantage enrollees will have a plan with 4 or more stars, and 98% of those in a standalone PDP plan will have a rating of more than 3.5 stars.
There will also be more plans with a 5-star rating than were available in 2020, including UnitedHealthcare, Cigna, and Anthem BCBS. Even the lowest-rated plans have improved to at least 2.5 stars.
CMS uses this Medicare star rating system for Medicare Advantage and Part D plans to determine whether or not a plan is doing its job, and whether or not it can stay on the market. Plans that consistently receive poor ratings (one or two stars) will eventually be removed from the market.
Plans are given a star rating between one and five, with one being “poor” and five being “excellent.”
Medicare Advantage plans are rated on the following factors:
Level of access to preventive services (including annual physical exams and screenings)
Care coordination
How often members receive treatment for long-term conditions
Current member satisfaction
Plan performance in comparison to the previous year
Customer service quality
Part D plans are rated on the following:
Number of member issues with the plan
How many people left over one year
Patient safety while using prescriptions in the plan
Accuracy of pricing
Quality of care
Customer service quality
More and more Medicare Advantage and Part D plan carriers are entering the market every year, meaning there is more competition. More competition means that more plans are trying to be the most valuable to be able to compete. That’s why even though costs may be going down, plan ratings are still increasing.
If you plan on meeting with a licensed agent during this year’s Annual Enrollment Period, be sure to ask about four and five-star plans in your area!
3300Medicare Advantage star ratings increasing
Remind me: What is Medicare Advantage?
You can enroll in Medicare Advantage as an addition to your Original Medicare coverage. Since Medicare Advantage plans are owned and operated by private insurance companies and are not the same as the government Medicare program, the coverage is a bit different.
Medicare Advantage plans are able to cover things that Original Medicare is not, such as fitness programs, dental, vision, and prescription drugs.
Medicare Advantage plans might come with copayments, coinsurance, and deductibles, but the average premium for 2021 is expected to be $21/month.
If you can afford to add a Medicare Advantage premium, the benefits may save you from thousands of dollars in healthcare costs later on.
Expanded benefits for 2021
Earlier this year, CMS released the 2021 benefit and cost sharing information on Medicare.gov. In large part due to the coronavirus pandemic, they are offering expanded benefits in several key areas, and many health care providers are taking advantage of this flexibility.
There will be over 4,800 Medicare Advantage plans in 2021 for enrollees to choose from, a 76.6% increase since 2017. The number of MA plans per country is also growing in the new calendar year.
In response to the COVID-19 pandemic, 94% of all MA plans will provide added telehealth benefits. The current health crisis also drove CMS to develop the Part D Savings Model, which sets a $35 monthly copay rate for insulin. Over 1,750 MA and PDP plans are participating in this new model in 2021.Many health plans are also expanding their benefits for enrollees with chronic conditions. About 500 Medicare Advantage plans will feature either supplemental benefits or lower copays to those with specific chronic diseases or other conditions.
$0 Premiums and Special Needs Plans
Some people may even be eligible for a $0 premium Medicare Advantage plan. Others still may be eligible for low-cost Medicare Advantage Special Needs Plans.
CSNPs are Chronic Special Needs Plans and are for people who have certain chronic conditions and need additional coverage. ISNPs are Institutional Special Needs Plans and are for people who have been living in an institution such as an inpatient medical facility for 90 days or more. DSNPs are Dual Eligible Special Needs Plans and are for people who are dual-eligible for both Medicare and Medicaid.
How to Get a Low-Cost, Five-Star Medicare Advantage Plan in 2020
Our licensed agents across the nation are contracted and certified to sell a number of Medicare Advantage plans. An agent can sit down with you and show you all of the top-rated plans available in your area and help you select which one is best for you.
To get in touch with a licensed agent, call 844-431-1832 or click here.
