How to Protect Yourself from Medicare Scams, Fraud, and Abuse

The Annual Enrollment Period (AEP) will be here before you know it. AEP is the most popular time of year for beneficiaries to change or enroll in a new plan. However, this means Medicare scams, fraud, and abuse are at all all-time high. Medicare Plan Finder makes understanding these risks easy, so you feel protected year-around.

Medicare Fraud and Abuse

The government loses millions of dollars each year due to Medicare fraud and abuse. This causes Medicare prices to increase. The government has created laws to protect all parties involved in Medicare and Medicaid.

These laws promote healthy relationships between agents, carriers, and clients to prevent the insurance industry from becoming profit-based, instead of care-based. Your coverage should be more important than profits.

Medicare fraud includes:

• Knowingly making false claims or misrepresenting data
• Intentionally giving or receiving rewards for goods and services
• Promoting one health service over another
• Billing Medicare for appointments that never happened or for more than what actually happened

Medicare abuse includes:

• Billing for unnecessary services
• Excessive supply purchases
• Misusing codes

Medicare Fraud and Abuse Laws

The government has implemented the following:

• False Claims Act (FCA) – Protects the government from being overcharged on goods or services. No proof of intent is required.
• Anti-Kickback Statute (AKS) – Agents cannot knowingly reward referrals for health care programs.
• Physician Self-Referral Law (Stark Law) – Doctors cannot make referrals to health care companies in which they have an interest.
• Criminal Health Care Fraud Statute – Cannot defraud; bill for unnecessary medical goods and services (like drugs that are not needed or wheelchairs for those who are not impaired).

What Can You Do?

Don’t become a victim! If you aren’t sure about a health agent’s validity, ask for licensing information or work with Medicare Plan Finder. To help fight Medicare fraud and abuse, report any suspicious activity to 1-800-HHS-TIPS (1-800-447-8477). You can also report the activity online.

Common Medicare Scams

A licensed Medicare agent is required to abide by strict rules when contacting seniors and Medicare beneficiaries. It is illegal for anyone (including an authorized Medicare agent) to show up at your front door without permission.

Also, keep in mind that no one associated with Medicare will ever call you to update your information. The following are common Medicare scams you need to look out for:

Grandparent Scam

One recent scam involves adults calling the elderly and pretending to be their grandchildren asking for money. They’ll say that they are in some form of trouble and need money.

To avoid this grandparent scam, be sure to ask for a personal detail that only your real grandchild would know the answer to. It is easy to assume you would recognize their voice, but if someone calls in a panic, your adrenaline may kick in, and their voice is the last thing you’re worried about.

Medicare Coverage Helpline Scam

In recent years, there has been a television commercial targeting current Medicare beneficiaries. The advertisement is from the “Medicare Coverage Helpline” and claims that if you have parts A and B, you are eligible for vision, dental, and prescription drug plans due to a recent Medicare health reform.

The commercial will provide a 1-800 number. Do not call that number. If you are interested in vision, dental, or prescription drug coverage, one of our licensed agents can discuss plans that are specific to your area. To get started, click here.

Medicareplans.com Scam

Medicareplans.com is an out-dated link that was a fake marketplace for those searching for a Medicare plan. While this link is no longer active, it is important to be careful when reviewing different companies and websites.

Look for websites that start with “https” instead of “http.” The “s” indicates a secure website. If you have doubts, a simple google search like “[Insert Company Name Here] Scam” can show any potential scam information.

Medicare Phone Scams

Medicare phone scams are probably the most common way that seniors and other Medicare beneficiaries are taken advantage of. In some cases, a scammer may call you and pretend to be from Medicare and offer you free services if you provide your Medicare number or Social Security number.

In other cases, a scammer who claims to be from Medicare may say that they need to validate your information to keep you from losing your benefits. The real Medicare program will never ask for this information. Never give these numbers away over the phone.

One phone scam in particular, the “can you hear me” scam, is easy to fall victim to.  The scammers use this question to get a “yes” answer from people, which they would then edit to make it seem as though they were agreeing to purchase a product or submit information. If you answer the phone and someone you don’t know asks, “Can you hear me?” hang up right away.

Medicare Refunds

Scammers will often try to catch your attention by saying you have Medicare refunds. The scammer’s goal is to get your bank information. Common reasons for Medicare refunds include changes or enhancements to Medicare or lawsuits with private insurance companies.

If for some reason you are entitled to a Medicare refund, a check will be mailed to you directly. No one will ever call asking for your bank information.

How to Avoid Medicare Scams

Medicare scams can be easily avoided. CMS (Centers for Medicare and Medicaid Services) suggests the following tips for avoiding scams and fraud:

• Treat your Medicare card like a credit card. Keep it in a safe spot and never give out your number to anyone other than your doctors.
• Do not accept an offer for free gifts or money in exchange for your Medicare information.
• Don’t accept services that aren’t usually covered by Medicare unless a doctor that you trust tells you that it is necessary.

Will Medicare Ever Call You?

Medicare will never call you randomly and ask personal questions. If you are already covered by Medicare, they have all the information they need. If someone from Medicare needs to contact you, they will find a more official communication route.

If you have any additional questions about Medicare communication, or if who is contacting you is legitimate, contact a Medicare customer service representative at 1-800-MEDICARE (1-800-633-4227).

Free Stuff for Seniors From the Government

Seniors and Medicare beneficiaries can fall into specific categories that scammers will use to their benefit. Scammers will sometimes call pretending to be from the government and offer free health checkups or free medical supplies.

During these fake calls, they will use common senior health conditions to act like they know specific details about your health. The scammer has no idea you have diabetes or high blood pressure; all they know is that a handful of seniors have those conditions. Scammers are hoping you will also fall into that category.

Some scammers have been known to give names and addresses of your doctor. It is unknown how they receive this information. Even if the caller ID looks reputable, don’t trust them so quickly.

Technology has continued to evolve and faking caller ID has become easier and easier. Don’t trust if someone says they are providing free products or services from the government. Scammers will say all you have to pay for is shipping costs, then get access to your credit card information.

How to Stop Medicare Phone Calls

As we mentioned, Medicare will not call you without your permission. If you receive a phone call about your Medicare plan, but did not consent to a call, it is likely a scam.

To help prevent calls from unknown numbers, don’t answer unknown numbers unless you’re expecting a call from a legitimate company (like us!). You will receive a voicemail if the call is legitimate.

If you have a smartphone, you can download apps that detect scam calls and block the calls instantly. You can also put your number on the National Do Not Call Registry.

How to Block Specific Numbers

Both iPhone and Android users can block specific numbers from calling. This is a useful tool because many scam callers will cycle through phone numbers. Once you block a number, you will not receive calls from that number unless you unblock it.

How to Block Phone Numbers on an iPhone

First go to you to your most recent calls. Then find the number you want to block and tap the “i” icon. That will lead you to the contact information associated with that phone number.

That will lead you to your most recent calls. Then find the number you want to block and tap the “i” icon. That will lead you to the contact information associated with that phone number.

Then scroll down to where you see “Block this Caller” and tap on the words.

The final step is verifying that you want to block the caller.

How to Block Phone Numbers on an Android

First, go to your most recent calls. Then tap the “i” icon under the phone number you want to block.

Then tap the three dots as shown below.

Then select “Block.”

Medicare Helpline

Protecting yourself from Medicare scams may seem like an impossible task. Now that you understand the common Medicare scams you will know what to watch out for.

If you are ever suspicious or have questions regarding Medicare fraud, call the Medicare Helpline. They can answer any questions you may have. The Medicare Helpline is a 24-hour toll-free line and can be reached at 1-800-MEDICARE.

Also, you can help eliminate Medicare fraud by reporting suspicious activity. Call the Medicare fraud line at 1-800-447-8477 or report the incident online.

Enroll in Medicare

The risks of Medicare scams does not lower the importance of proper Medicare coverage. We are dedicated to helping you choose the best plan from all of the options available in your area. Why do we need your information?

• Zip Code: We need this because Medicare plans are different in every zip code.
• County: We ask for your county because sometimes zip codes fall into more than one county.
• Email and Phone Number: We ask for your contact information because we want to have a conversation with you about helping you find a great health plan.
• Birthday: Sometimes we’ll ask for your birthday to help us ensure that you qualify for Medicare benefits.

Medicare Plan Finder and other legitimate resources will not ask for your Social Security Number or Medicare number before speaking with you. If someone who you do not know asks for your SSN or Medicare number, do not give out that information until you know that it is safe to do so.

We are here to discuss the best Medicare coverage for your needs and budget. If you’re interested in speaking with a licensed Medicare agent or scheduling a free no-obligation appointment, fill out this form or call us at 844-431-1832.

This blog was originally published on 10/1/18, and was updated on 8/21/19.

A Guide to Medicare Chronic Lung Disease Coverage

Chronic lung diseases affect millions of people in the United States. It falls under the fourth leading cause of death. Thankfully, the Centers for Medicare & Medicaid Services (CMS) considers chronic lung disorders to be one of the qualifications for a Medicare Special Needs Plan.

As you age, it’s easy to brush off symptoms as “part of the aging process.” You might even purposely ignore certain symptoms because they “aren’t that bad,” and you don’t want to pay for treatment – but your symptoms could be indicative of a bigger problem and should not be taken lightly. 

If you are diagnosed with chronic lung disease, you may qualify for a Medicare Special Needs Plan that can save you thousands of dollars in doctor visits and treatment costs. Qualifying for a Special Needs Plan means you will also qualify for a Special Enrollment Period, which allows you to change plans more often.

Let’s take a look at what all of this might mean for you.

What Is Chronic Lung Disease?

Chronic lung disease refers to any condition that causes long-term obstructions to a person’s airways. They can cause the following symptoms:

• Shortness of breath after little or no physical exertion, or shortness of breath after normal exercise plus a brief rest period
• A persistent cough – one that lasts longer than a month
• Mucus or sputum production lasting a month or longer
• Labored breathing
• Swollen feet, ankles or legs
• Blue lips

If you experience any of these symptoms, you should talk to your doctor immediately. Chronic lung disease can severely impact your quality of life and shorten your lifespan considerably. The faster you get started on treatment, the better.

SEP-Qualifying Disabilities

To qualify for a SEP (Special Enrollment Period) due to a disability or disease, your condition must be “severe or disabling.” The list of chronic lung diseases below would automatically qualify you for a SEP because you would be eligible for a Medicare Special Needs Plan, or SNP. 

Once you qualify for a Special Enrollment Period, you won’t be restricted to the Annual Enrollment Period (AEP) anymore. 

Usually, AEP is the only time of year that Medicare beneficiaries can switch Medicare Advantage plans. It only lasts from October 15 through December 7. Those with a SEP are eligible to make one change per quarter (January – March, April – June, July – September). The fourth quarter is excluded because you’ll be able to switch like everyone else from October 15 through December 7 (the Annual Enrollment Period). 

Chronic Lung Diseases List

The Centers for Medicare & Medicaid Services (CMS) specifically defines the following lung disorders as chronic lung diseases that could make you eligible for a Medicare Special Needs Plan:

• Asthma
• Chronic bronchitis
• Emphysema
• Pulmonary fibrosis (PF)
• Pulmonary hypertension

Lung cancer is a qualifier as well (though it is listed in the “cancer” category instead of “chronic lung disorders.”

Severe COPD as a Qualifying Disease

You might be wondering, “what about severe COPD? Does Medicare cover COPD?” Medicare Part B can cover COPD diagnosis and treatment. 

To begin, Medicare Part B covers your doctor’s visits at 80%. Start by asking your doctor about COPD and getting tested. Then, Part B also will cover a comprehensive pulmonary rehabilitation program for moderate to severe COPD (chronic obstructive pulmonary disease). If your doctor offers this treatment, you will only owe 20% of the Medicare-approved amount with Part B (after the Part B deductible). If you are hospitalized, your treatment will fall under Part A, and you may owe a hospital copayment.

Emphysema and bronchitis are forms of COPD, so a COPD diagnosis may mean that you also qualify for a Special Needs Plan (SNP) and a Special Enrollment Period. In that case, you may be able to get even more coverage. 

SNP plans often come with care coordination. That means no more confusing phone calls and mixed messages between all your different doctors!f

What Chronic Lung Disease Treatments Will Medicare Cover for COPD?

Two main diseases fall under the term COPD: chronic bronchitis and emphysema. There currently is no cure for COPD. Early detection can help you manage your symptoms and continue to live a “normal” life with COPD. 

One of the main things to keep in mind when living with COPD is that seemingly small things like seasonal allergies or air pollution can cause serious exacerbations. It’s important to take every small infection or symptom seriously. 

COPD Oxygen Therapy

People with COPD may have low blood oxygen levels, which is called hypoxia. Supplemental oxygen, or oxygen therapy, can help prevent heart failure and improve quality of life in COPD patients. 

Some people may need long-term oxygen therapy 24 hours per day. Others may only need supplemental oxygen during exercise, sleep, or air travel.

You can get oxygen therapy in three ways:

• Oxygen concentrators
• Oxygen-gas cylinders
• Liquid-oxygen devices

Remember that you cannot smoke or stay near an open flame while using any of these devices.

Medicare Part B will cover your device as well as any accessories (like mouthpieces or tubing), maintenance, repairs, and the oxygen itself. You will only be responsible for 20% of the costs with Part B. 

Uniquely, Medicare requires a five-year obligation with whichever company you use to rent your oxygen equipment. After five years, you will be able to rent new oxygen equipment from a separate provider.

COPD Prescription Drugs with Medicare Health Insurance

While no prescription can cure COPD, there are several that can help you manage your discomfort. Some examples may include:

• Bronchodilators (in an inhaler; relaxes the airway muscles)
• Inhaled steroids (reduce inflammation)
• Phosphodiesterase-4 inhibitors (reduces inflammation and relaxes the airway muscles)
• Theophylline (eases breathing)

To get coverage for these drugs, you’ll need either a Medicare Part D plan or a Medicare Advantage plan with prescription drug coverage. 

COPD Surgery

Sometimes, when patients have severe emphysema or severe COPD, doctors may recommend surgery. There are three COPD surgeries:

1. Lung Volume Reduction: Small portions of damaged tissue are removed from the upper lungs, creating extra space so that your diaphragm is more productive. The procedure is minimally invasive. A small valve is placed in the lung.
2. Bullectomy: Bullae (large air spaces) are removed from the lungs to improve airflow.
3. Lung Transplant: A lung transplant comes with huge risks, but can also have huge rewards. This procedure requires that you meet specific criteria outlined by your doctor. After a lung transplant, you’ll need to take immune-suppressing medications for the rest of your life.

Medicare coverage for your surgery would fall under Part A, but you’ll still have copayments and a deductible. Some Medicare Advantage plans might provide more coverage.

COPD and Medicare Supplement

A Medicare Supplement (also called Medigap) plan can be a great way to cover the extra costs associated with COPD. However, most people will find that a Medicare Advantage plan is better for COPD than a Medicare Supplement. That’s because you cannot be denied for Medicare Advantage based on preexisting conditions. However, you can be denied Medicare Supplement coverage. 

There are two times when you can get a Medicare Supplement plan without medical underwriting. One is when you’re signing up for Medicare health insurance for the first time, and the other is if you lose your current coverage due to no fault of your own and need a new plan.

Lung Cancer Screenings

If you’ve been diagnosed with COPD, your doctor may recommend annual lung cancer screenings, because about one percent of COPD patients develop lung cancer. Medicare Part B covers yearly lung cancer screenings with Low-Dose Computed Tomography (LDCT) if you meet one or more of the following conditions:

• You’re 55-77 years old
• You don’t display any lung cancer symptoms
• You smoke currently or quit smoking within the past 15 years
• In the past, you smoked at least one pack per day for 30 years
• A doctor orders the screening

Inhalers Medicare Will Cover

In many cases, inhalers will fall under prescription coverage (meaning you will need either a Part D prescription drug plan or a Medicare Advantage plan that includes prescription benefits). However, your inhaler may be considered “durable medical equipment,” which is covered by Part B. There are two COPD inhalers covered by Medicare Part B: controllers and rescue relievers.

Controllers: A doctor may prescribe this type of inhaler to help keep your symptoms from worsening. Different types of controllers are:

• Short-acting Anticholinergic Bronchodilators
• Long-acting Anticholinergic Bronchodilators
• Corticosteroids
• Phosphodiesterase-4 Inhibitor (PDE-4 Inhibitor)
• Combinations of Corticosteroids and Long-acting Beta-agonists
• Combinations of Long-Anticholinergic Bronchodilators and Corticosteroids

Rescue Relievers: These inhalers are reserved for emergencies for fast, short-term symptom relief. Different types of rescue relievers are:

• Short-acting Beta-agonist Bronchodilators
• Combinations of Short-acting Anticholinergic and Short-acting Beta-agonist

The right inhalers can help keep your day-to-day symptoms at bay and step in when a flare-up occurs. Your doctor will be able to help you get the right prescription medications and inhalers for you.

Does Medicare Part D Cover COPD Inhalers?

Medicare Part D plans can cover COPD inhalers (bronchodilators and steroids), but there may be some cost-sharing required. One study found that out-of-pocket annual costs for inhalers with a Part D benefit ranged from $494 to $1,197 in 2015. 

It’s important to speak to an insurance agent before you invest in Medicare Part D because there may be cheaper plans out there, or you may qualify for savings that you don’t even know about. You can get in touch with an agent by calling 844-431-1832.

What Treatments Will Medicare Cover if I Have Lung Cancer?

Along with initial lung cancer screening, Medicare will cover certain cancer treatments. Different Original Medicare treatments and services fall under Parts A and B.

Part A:

• Hospital visits and stays, including the treatment you receive while staying at the hospital while you’re considered an inpatient. Note: You can still be considered an outpatient while you stay at the hospital if you’re considered to be on “observation status.”
• Care at skilled nursing facilities following a three-day hospital stay
• Limited home health care
• Hospice

Part B:

• Visits to doctors’ offices
• Many chemotherapy drugs administered intravenously in a doctor’s office or outpatient clinic
• Some oral chemotherapy drugs
• In some cases, Medicare will cover second opinions for non-emergency surgeries, and even third opinions if the first two opinions differ.

Medicare can help cover your lung cancer screening and treatment so you can be in the best health possible. A qualified professional can help you determine which plan will cover what you need while taking your budget and lifestyle into consideration.

Does Medicare Cover Pulmonary Rehabilitation?

People with COPD, pulmonary hypertension, interstitial lung disease, cystic fibrosis, and those who have had a lung transplant can all benefit from pulmonary rehabilitation, also called respiratory therapy. 

A pulmonary rehabilitation program includes both education and exercise to help you manage your breathing and increase your stamina. It may also include testing to find out if oxygen supplements would help you. 

You’ll meet with a medical professional two or three times per week for a few months in a hospital outpatient setting. During that time, you’ll complete exercises like stretching, weight lifting, walking, and cycling. The staff member assisting you will walk you through each step of the process. Since the goal is pulmonary rehabilitation (not weight loss), everything will be focused on your breathing and stamina. 

Since pulmonary rehabilitation programs usually occur in hospital outpatient settings, your Medicare coverage will fall under Part A. You will likely owe the hospital a copayment for each session. In some cases, your rehabilitation might occur in a doctor’s office instead, in which case it would fall under Part B, and you would owe 20%. To get your Medicare coverage for this service, you will need a direct referral from a doctor. If you qualify for both Medicare and Medicaid, this service might fall under your state’s Medicaid physical therapy coverage. 

How many visits does Medicare cover for pulmonary rehab?

The CMS Medicare guidelines for pulmonary rehab state that “Medicare will pay for up to two (2) one-hour sessions per day, for up to 36 lifetime sessions (in some cases, up to 72 lifetime sessions) of PR.” To qualify, your care must take place within one of the qualified pulmonary rehab centers that your doctor refers you to.

Does Medicare Cover COPD Prevention?

The number one cause of COPD is overexposure to lung irritants like cigarette smoke, pipes, cigars, air pollution, and chemical fumes. It is possible to achieve overexposure purely from second-hand smoke.

In some rare cases, COPD can also come from a genetic condition called “alpha-1 antitrypsin deficiency.” The condition refers to low blood levels of alpha-1 antitrypsin, a protein from the liver. Additionally, some people with asthma develop COPD.

The best way to prevent COPD is to avoid smoke and harmful chemicals. However, if you fear you may have already been exposed, some Medicare-covered services may help you prevent further damage. 

To begin, you may wonder what tests are covered by Medicare. You can ask your doctor for a pulmonary function test. Your doctor will use either spirometry or plethysmography, both of which are noninvasive. Both tests have a mouthpiece that will measure your breathing; the difference is that a plethysmography can test for lung residual volume and total lung capacity, while spirometries cannot. Since these tests are not medically necessary, Original Medicare does not cover spirometry, but your private plan may. Regardless, spirometries can cost less than $100 out of pocket. Medicare will cover a plethysmograph when your doctor deems it necessary.

No matter what your test results are, you can prevent COPD exacerbation by getting your annual flu shot, which would be covered at your doctor’s office under Part B.

COPD Services, Medications, and Treatments That Medicare Does Not Cover

It’s important to recognize that Original Medicare (Parts A and B) does not cover prescription drugs. While some of your inhalers may be covered under Part B, any other drugs related to your COPD treatment will not be covered. For prescriptions, you’ll need to choose between either a Medicare Advantage plan that includes a prescription benefit or a Part D prescription drug plan. You cannot have both a Medicare Advantage plan and a Part D plan at the same time, so you’ll have to choose one or the other. 

One exception is that if you have a lung transplant, Medicare Part B will continue to cover your immunosuppressant drugs as long as you had Medicare Part A at the time of transplant. If you did not yet have Medicare when you received your transplant, you may need to seek alternative drug coverage through a Part D plan or certain Medicare Advantage plan to get coverage for your immunosuppressants. 

Additionally, Medicare will not cover experimental treatments or drugs.

What to Do if Medicare Won’t Cover the COPD Drugs, Treatments, and Services You Need

If you’re finding that Medicare either does not cover the COPD services you need or does not cover them enough, it might be time to look into a form of Medicare extended coverage. COPD patients and anyone with chronic lung disease symptoms may find that Medicare Advantage Prescription Drug plans and Medicare Supplements (two types of private Medicare plans) are worth the investment – but you can’t have both types. 

Remember that if you are diagnosed with chronic lung disease, you may be eligible for a Special Needs Plan. In turn, you’d be eligible for a Special Enrollment Period (meaning you don’t have to wait until the fall to change plans).

A Medicare Supplement plan (Medigap) can help you by covering those pesky deductibles, copayments, and other charges related to your Medicare coverage. For example, Medigap Plan G covers hospital coinsurance and copayments. It’s a great plan choice for anyone preparing for surgery or an extended hospital stay.

A Medicare Advantage Prescription Drug plan can help you with your COPD by providing the prescription drug coverage you need. Some of these plans might also cover additional therapy sessions, extra surgery coverage, etc. Each plan is different, so it’s a good idea to speak with an insurance agent who understands all of your available options. 

COPD patients might also qualify for a Medicare Advantage Special Needs Plan, a type of Medicare Advantage that is specifically designed for your needs and may provide additional benefits.

To speak with an insurance agent in your area for free, call 844-431-1832. You can also start by using our Medicare plan search tool.

Get Coverage for Your Condition

Chronic lung disease is not something that should be taken lightly. If you think you might qualify for a Special Enrollment Period with your condition, call Medicare Plan Finder at 844-431-1832 or contact us here today. We can help you determine your Medicare status and find the right plan to suit your budget and lifestyle.

Medicare Hearing Aids Coverage

Hearing aids can turn your entire life around, but you may need a private Medicare plan to be able to afford it. Original Medicare (Part A and Part B) will only cover hearing tests under limited circumstances. That means no ear treatments, no hearing aids, or anything else.

Not every Medicare-eligible person needs ear treatments, which is why Medicare does not consider it an “essential benefit”.

Does Medicare Cover Hearing Aids Costs?

Hearing aids can cost anywhere from $400 per ear to $4,000 or more per ear. Even if the initial device is not too expensive, you’ll have to remember that you’ll need to pay the costs of a hearing aid fitting, hearing aid exams, cleanings, and replacement hearing aids every five years or so.

Some providers may offer free cleanings and fittings with your hearing aid. When you add everything together, you could be paying thousands upon thousands over your lifetime for your ear care. Luckily, there is a solution that can help you out financially.

You may be able to get cheaper hearing aids by ordering online. However, by ordering a hearing aid online, you miss out on the doctor consultation and fitting.

Even if you think you don’t need the doctor consultation, remember that an experienced doctor can give you the medical advice you need to determine what kind of hearing aid you need and help you get the right fit.

Does Medicare Cover Hearing Tests?

Medicare does not cover hearing aid tests, fittings, or routine hearing exams. Medicare Part B will only cover hearing and balance tests if your doctor orders them to diagnose medical conditions. 

Medicare Advantage Plans that Cover Hearing Aids

The easiest way to get Medicare coverage for audiology appointments, treatments, hearing aids is to enroll in a Medicare Advantage plan. While some separate hearing benefit plans are available, it’s often not as cost-effective.

Medicare Advantage is a plan offered by private insurers that covers hospital visits, doctor visits, and other benefits like prescription drugs, vision, dental, and hearing.

Every year, you have the chance to enroll in a Medicare Advantage plan between October 15 and December 7. You should start thinking about your needs now so you can be ready to switch in the fall!

Not all Medicare Advantage plans cover hearing benefits, so make sure you read everything carefully before you buy. Some plans will require that you buy a hearing aid from a specific provider.

Our agents can help make sure you get into a plan with all of the benefits you need. You can set up a no-cost, no-obligation appointment to review your benefits by calling 844-431-1832.

Senior Hearing Loss: An Epidemic

Hearing loss affects more than just your hearing. Your hearing is directly connected to your sense of balance, so hearing loss can lead to more trips and falls, leading to higher medical bills.

Additionally, people who experience hearing loss or more likely to also experience high blood pressure, depression, and even dementia. Hearing aids can reduce all of these symptoms and side effects.

Signs of Hearing Loss

Some signs of hearing loss might include:

• Trouble focusing on a person’s speech, especially when there is background noise
• Tinnitus (ringing in the ears)
• Finding yourself constantly raising the volume on your television or radio
• Having a harder time hearing extremely high or extremely low pitches
• Missing certain consonant sounds like “sh,” “th,” and “p.”
• Leaving your car’s turn signal on because you don’t hear it
• Not hearing your alarm clock in the morning

Hearing Loss Prevention

Some hearing loss prevention is purely the result of old age, but there are certain ways you can prevent the development of this ailment. The best way is to avoid circumstances where you will be surrounded by loud noises. Wear earplugs when attending concerts or events with big crowds, pay attention to the volume on your radio and TV, don’t sit too close to the speakers, etc.

You should also be sure to attend your yearly wellness exams. Your doctor may or may not check your hearing during these appointments (you may face an extra co-payment for audiology). Medicare Advantage plans often including a hearing benefit so that you can get coverage for regular hearing exams.

About Medicare Hearing Aids

While hearing aids can’t give a deaf person the ability to hear, they can help people with minimal to moderate hearing loss regain some hearing ability. Hearing aids effectively make sounds louder. There are a handful of ways to lose hearing ability, but hearing aids help those who have sensory cell damage in the inner ear.

Types of Hearing Aids

Medicare Hearing aids can work in two different ways: analog and digital. Analog hearing aids convert sound waves into amplified electrical signals. Digital hearing aids convert sound waves into numerical codes, then amplify them.

There are six different types of analog and digital hearing aids: IIC, CIC, ITC, ITE, RIC, and BTE. Your doctor may recommend one type over another based on your specific hearing needs and your budget.

1. IIC (Invisible n Canal) – Fitted for your ear canal and invisible when worn. For mild to moderate hearing loss.
2. CIC (Completely in Canal) – Fitted for your ear canal, small handle may be visible; for mild to moderate hearing loss
3. ITC (In the Canal) – Fitted to your ear canal, small portion will show; for mild to mildly severe hearing loss
4. ITE (In the Ear) – Fitted to your outer ear; for mild to severe hearing loss
5. RIC (Reciever in Canal) – Barely visible, open and comfortable fit; uses electrical wires (as opposed to a plastic tube). For mild to moderate hearing loss
6. BTE (Behind the Ear) – Fitted behind the ear, directs sound into a mold inside the ear; for moderate to severe hearing loss

Best Hearing Aids on the Market

Your doctor may recommend one hearing aid brand over another, and we recommend listening to your doctor’s opinion. However, we can tell you that some of the most highly-rated hearing aid brands are Resound, Phonak, Starkey, Widex, and Oticon.

If you’re getting coverage for your hearing aid from a Medicare Advantage plan, be careful. Your plan may require that you select from specific Medicare hearing aids. You should also consider that some hearing aid companies will offer trial periods.

Get Your Medicare Hearing Aids

Before you select and purchase a hearing aid, be sure to speak to a Medicare agent about finding coverage for your ear care. We recommend Medicare Advantage for most seniors and other Medicare-eligible people with hearing deficiencies.

Most people who are eligible for Medicare are eligible for several different Medicare Advantage plans. Our agents are licensed to sell most of those plans and can help you select the best one for your needs. To set up your free appointment, send us a note or call us at 844-431-1832.

*This post was originally published on February 22, 2018, and updated on August 19, 2019.

How do I Check my Benefits for Medicare and Other Programs?

Have you recently performed a healthcare benefits check up? Are you missing out on the benefits that you qualify for? They can be hard to keep track of when there are so many out there. There are benefits available for everything from your health to the food on your table, and they all have different eligibility requirements. Thankfully, there are tools out there that can help you keep track. One of our favorites is benefitscheckup.org.

What is My Benefits Checkup?

BenefitsCheckUp is a free financial and healthcare benefits check up tool offered by the National Council on Aging. They scan over 2,500 federal, state, and private benefits programs for eligibility standards to keep their tool up-to-date. When you visit benefitscheckup.org and click on “Find My Benefits,” you’ll get results for all the programs that you might be eligible for based on your:

• Zipcode
• Gender
• Birth year and month
• Monthly gross income (including your spouse, if applicable)
• Marital status
• Veteran status
• Race/ethnicity (optional)

Your report will reveal what programs you may be eligible for, which can include (but is not limited to):

• Adult daycare
• Adult education
• An Alliance for Accessible Hearing Care (AUDIENT)
• Donated Dental Services (DDS)
• Elderly Nutrition Program/Home delivered meals
• Foreclosure prevention
• HUD Public Housing or Section 8
• Legal assistance
• Low Income Home Energy Assistance Program (LIHEAP)
• Medicaid
• Medicare
• Medicare Savings Programs
• Program of All-Inclusive Care for the Elderly (PACE)
• Retirement benefits
• Social Security
• State Children’s Health Insurance Program (SCHIP)
• Supplemental Nutrition Assistance Program (SNAP)
• TRICARE
• Tax credits
• Transportation benefits

Who is the National Council on Aging?

The NCOA, or National Council on Aging, partners with governments, businesses, and nonprofit organizations to support aging adults. NCOA’s mission is to “improve the lives of millions of older adults, especially those who are struggling.” They accomplish this by finding ways to help seniors make more money, save more money, participate in healthy social programs, remain in their communities, and fight fraud, waste, and abuse.

How to Check my Health Benefits

You can check your health benefits online, but there are a few different ways to do that depending on what health benefits you have. If you have marketplace health insurance, go to healthcare.gov, then complete these steps: 

1. Log into your account 
2. Click on your name in the top right corner
3. Select “My applications & coverage”
4. Under “Your existing applications,” select your completed application

Once you get there, you’ll see a summary of your health benefits. If you need more information, you can also call your health insurance company.

How do I Check My Medicare Status?

To check your Medicare enrollment status online, visit Medicare.gov at this link. Enter your information, then click “continue.” You will need your Medicare card for your Medicare number. You won’t be able to continue until you’ve answered all the questions.

How to Check Medicare Eligibility Online

You can qualify for Medicare by:

• Turning 65
• Getting diagnosed with ALS
• Getting diagnosed with ESRD
• Entering your 25th month of SSDI

To check your Medicare eligibility online, go to Medicare.gov at this link and complete the series of questions. It is important that you answer them accurately to find out if you are eligible. 

When you’re done, you can click on the button that says “Eligibility & Premium Calculator Home” at the bottom, and then click on “Calculate my premium” to find out what your Part B premium will most likely be.

Check Medicaid Status Online

Checking your Medicaid status online isn’t quite as easy as Medicare because Medicaid is different in every state. Your state might have its own application portal where you can track the status of your application and find out more about your benefits. You can also visit your local Medicaid office (usually a Social Security building or another government office) or call to check your application status, but know that it could take a few weeks. 

How do I Check Medicaid Eligibility?

Checking your Medicaid eligibility will be different in each state as well. Medicaid eligibility is based on your income and ability to pay for your healthcare services, but each state’s income limits are slightly different due to the cost of living and other factors. Check with your state’s page, here, to find out if you might be eligible.

How to Check my Financial Benefits

Checking your financial benefits is easy with today’s online tools. Health benefits aside, the major welfare benefits are TANF, SNAP, EITC, Supplemental Security Income, and housing assistance. 

Social Security benefits can begin when you retire. To be eligible for Social Security retirement benefits, you must have worked for at least ten years. The longer you’ve worked, the higher your benefit can be. For example, if you wait until you are age 70 to retire, your benefit may be higher than if you retire at age 62.

If you don’t qualify for Social Security retirement benefits, you might instead qualify for SSI, or Social Security Income. To qualify for SSI, you must be either blind, disabled, or over the age of 65, and you must have limited income and resources. Qualifying for SSDI (Social Security Disability Income) is different. SSDI eligibility is based on means, severity, and work. That means you must have low income due to your disability/inability to work substantially, a severe disability, and must be incapable of working and earning a livable income. If you receive SSDI for at least 25 months, you may also qualify for Medicare (even if you re under 65).

What Tax Benefits do I Qualify for?

There are lots of different types of tax benefits out there. The best way to make sure you’re not missing out on any tax benefits is to meet with a tax accountant before you file each year. Retirees might qualify for the tax credit for the elderly and disabled. To qualify, you must be:

• Age 65 or older at the end of the tax year
• A legal U.S. citizen or resident alien (or married to one)
• Earning less than:
  • $17,500 if single
  • $20,000 if married but only one spouse qualifies
  • $25,000 if married
  • $12,500 if married but living and filing separately

How do I get Income Assistance Through TANF?

TANF stands for Temporary Assistance for Needy Families. TANF is not a government handout. It promotes job preparation and job hunting, helps to reduce unprepared pregnancies, and encourages healthy marriages. TANF is both federal and state-based, similar to Medicaid. 

The government has a TANF budget every year that is divided among the states. Each state then has the ability to determine how much each state is allowed to give out and can adjust the eligibility standards. 

Check with your state’s Health and Human Services office to find out if you’re eligible. Many states have TANF applications built into their Medicaid applications, so you can apply for both programs at the same time.

Collecting Unemployment After Retirement

Some states have different requirements. For the most part, if you are not retired and lose your job after age 62, you can apply for unemployment. You may be able to receive Social Security and unemployment at the same time. However, if you are retired/over 65, you may not be able to collect unemployment. You’ll have to rely on your senior tax break and your Social Security retirement benefits instead.

Other Benefits you Might be Eligible for

Government assistance can extend far beyond healthcare and income. You may be eligible for meal assistance, free or low-cost housing, and more!

What Veterans Benefits am I Eligible for?

You can qualify for VA (Veteran’s Affairs) healthcare benefits as long as you served the full period for which you were called to active duty or at least 24 continuous months. If you served prior to September 7, 1980, the time period limit may not apply to you. It also may not apply if you were honorably discharged.

You can qualify for TRICARE if you are a uniformed or retired uniformed Service member or family member, a National Guard/Reserve member or family member, a survivor, a former spouse, a Medal of Honor recipient, or otherwise registered in the Defense Enrollment Eligibility Reporting System (DEERS).

You may also be able to qualify for disability compensation, memorial benefits, pension, home loans, education, job training, life insurance, and more.

What Housing Benefits am I Eligible for?

Public housing options tend to be a bit limited, so the eligibility standards can be strict. Eligibility depends not only on your income and citizenship status but also on whether you are elderly or disabled or if you have dependent kids. Eligibility can change based on where you live, so it’s best to contact your local PHA (Public Housing Agency) and fill out an application.

How do I Check Eligibility for SNAP Benefits?

SNAP eligibility depends on your location and household income. You must apply for SNAP in the state that you legally reside in. Use this website to find your local office (click on your state) to apply for SNAP.

Can I get Meals on Wheels?

Meals on Wheels operates through different local programs throughout the nation. Each programs’ eligibility requirements are slightly different, but for the most part, you will need to be homebound and over the age of 60 (some people under 60 may be able to qualify). Some people may be able to get Medicare Advantage plans that offer Medicare meal delivery services through Meals on Wheels.

How else can I Check my Benefits?

There are several ways to check on your current benefits and to see what you’re eligible for. We encourage anyone who is receiving benefits to check with a licensed agent who understands health insurance programs. You can also visit your local Social Security or other government offices to ask about benefits in person.

We also recommend that you find a great lawyer and a great accountant. Benefitscheckup.org can tell you if you might qualify for free or low-cost legal assistance.

These websites offer benefits checks:: 

• Benefitscheckup.org
• Eligibility.com
• Benefits.gov
• SSA Best
• Unemployment Benefits Finder

Why Should I use a Licensed Agent?

Using a licensed agent to check your benefits and find out what you’re eligible for can prove to be extremely useful. Licensed agents are often familiar with the rules and regulations set in place by both the federal government and your state. Additionally, they are often able to help walk you through the application process for benefits. 

We have licensed agents available who can sell Medicare Advantage, Medicare Supplements, Medicare Part D, and sometimes more. To get started, click here or call 844-431-1832.

Guide to Medicare Mental Health Coverage

Mental illnesses, even though you can’t always see them, are just as real and treatable as physical diseases. Depression and anxiety can affect you physically in the same way that an illness can. In fact, depression IS an illness.

It can cause extreme fatigue and lethargy to the point where getting out of bed seems impossible. It can also lead to oversleeping or insomnia, as well as overeating or starving. It’s important to take care of your mental health just as you would your physical health.

Does Medicare Cover Mental Health?

Seniors and Medicare eligibles may have an increased risk of developing depression for both physical and mental reasons. Weakened immune systems and other ailments make the brain more susceptible to mental illnesses, which are most often the result of a chemical imbalance in the brain.

The anti-socialization that retirement can bring can easily affect one’s mood and lead to depression. Managing your mental health can relieve stress, improve memory, help you sleep better, and boost your overall mood.

With those circumstances in mind, you may wonder, “Does Medicare cover mental health?” Yes, but only under certain conditions.

Medicare Mental Health Benefits for Inpatient Care

Medicare Part A covers mental health services that you receive in an inpatient hospital setting. The out-of-pocket costs are the same regardless if you receive treatment in a general or psychiatric hospital.

You can only receive coverage in a psychiatric hospital for 190 days per your lifetime. If you are already hospitalized when you enroll in Medicare, you can be reimbursed for up to 150 hospital days.

Part A hospital coverage is broken into 60-day periods. First, you must pay your deductible, which is $1,408 in 2020, but after this is met, your first 60 days are completely covered.

If you are still in the hospital after 60 days, you will need to pay $352/day for days 61-90, and $704/day for days 91-150. Your Part A coverage will end after this time. However, once you have been out of the hospital for 60 days, your “day count” resets to 0 and this cycle can start over.

Medicare Outpatient Mental Health Coverage

Medicare Part B covers all doctor visits related to mental health. That means any psychiatrists, psychologists, social workers, nurses, therapists, and addiction center visits are covered by your Medicare.

Counseling or therapy sessions are slightly more limited because they are only covered under Medicare if you see a doctor who accepts Medicare assignment. More specifically, this includes:

• Individual and group therapy
• Substance use disorder treatment
• Occupational therapy
• Active therapy (art, dance, music therapy)
• Family counseling
• Lab tests
• Annual depression screening
• Prescription drugs you cannot administer yourself

Original Medicare will cover these services at 80% of the Medicare-approved amount. This means you will likely pay 20% coinsurance after you meet your Part B deductible. However, keep in mind that your provider must take Medicare assignment, otherwise, Medicare will not pay for the services.

How to Find a Medicare Therapist

Psychology Today has a tool that can help you find a local therapist who takes Medicare. To get started, click here. Then enter your zip code. We used 37209, which is the zip code for our corporate offices in Nashville, Tennessee.

That will lead you to a page that lists the therapists in your area. From there, you can further filter your search results by therapist specialties and the qualities that matter most to you, such as gender, age, and faith.

Medicare Mental Health Costs

Medicare mental health costs will vary based on your unique situation and personal needs. Treatment can range as low as $1,000 or as high as $9,000. Thankfully, Part D, Medicare Supplements, and Medicare Advantage plans can help lower your out-of-pocket costs.

Mental Health and Part D

Original Medicare does not cover prescription drugs. A Part D prescription drug plan is a great alternative to help cover the costs of any antidepressants or other health-related drugs.

Part D plans have an annual deductible of $435 for 2020. This means that every year, you will need to spend $435 before your coverage starts. Since Part D plans are sold by private insurance companies, each plan may be a little different. Some plans may waive, reduce, or charge the deductible up front.

Once you’ve reached your Part D deductible, you will enter the initial coverage phase. You’ll stay in this phase until you spend $3,820 in 2019. During this time, you will need to pay a copay for every prescription based on the plan’s drug formulary (list of drugs that are covered).

Drug formularies are organized by tiers according to co-payments. For example, a generic, tier-one antidepressant may only cost you $32, whereas a tier three, brand-name antidepressant can cost you $133.

Any drug labeled as “preferred” will be cheaper. Plus, you may be eligible for extra prescription drug cost savings through Medicare Extra Help. To learn more, or to schedule an appointment to discuss the best Part D plans in your area, fill out this form, or give us a call at 844-431-1832.

Mental Health and Medicare Supplements

Medicare Supplement plans can add financial benefits and help you save in the long run on mental health coverage and other health-related costs. These plans help pay for things like copayments, coinsurance, and deductibles.

There are ten different plan types (A, B, C, D, F, G, K, L, M, N) and each plan offers different coverage and pricing. Your best bet is to speak with a licensed agent. If you’re interested in arranging a no-cost, no-obligation appointment, fill out this form or give us a call at 844-431-1832.

Mental Health and Medicare Advantage

Medicare Advantage plans must cover, at a minimum, the same as Original Medicare. However, they generally often several more benefits such as prescription drug coverage, hearing, dental, or vision coverage, OTC pharmacy allowance, non-emergency transportation, and group fitness classes like SilverSneakers®.

A licensed agent can help you find the best plan at the best rate that is specific to your needs and budget. Fill out this form or give us a call at 844-431-1832 to get in contact with a licensed agent.

Improving Your Mental Health With Medicare

Did you know that stress and depression can weaken your immune system? Your mental health affects you physically as well as emotionally. Thankfully, Medicare provides benefits that can serve as “mood boosters” to help keep you both physically and emotionally healthy. Learn how emotions affect the body and how you can stay healthy.

Depression is all-too-common among seniors and Medicare eligibles, and it can often come from the stress of aging or physical health conditions. The feeling of stress is triggered by the release of the hormone cortisol, which slows down motivation and metabolism.

This means that stress can cause you to not only lose the motivation to eat healthily and exercise, but also lose the metabolism to break down fatty foods, ultimately leading to unhealthy weight gain. Aside from weight gain, the influx of cortisol can inflame the immune system, weakening it and making it easier for you to catch infections and get sick.

On the same side of the token, a positive mood will allow you to heal more quickly. If you take a positive attitude with your illness or injury, your immune system will stay stronger and you’ll have less cortisol holding you down.

Medicare Mood Boosters

What makes you happy? All the little small things that you enjoy can help you heal emotionally and physically, as the two are connected. Consider starting with your senses – do you have a scent that makes you happy? Light a candle or spray a fragrance. Do you have a sound that makes you happy? Play some music.

A lot of people find that physical activity is a great mood booster. Medicare’s SilverSneakers® program promotes healthy social and physical behaviors for people like you. The program revolves around group exercise programs hosted within gyms and YMCAs including activities like strength, flexibility, walking, and yoga classes.

The group setting gives you an opportunity to socialize with other seniors in your area, and the activities will help strengthen your physical health.

If SilverSneakers® is a benefit included in your Medicare plan, you should receive a list of participating facilities. Then, all you’ll need to do is bring your SilverSneakers® card with its 16-digit member number to the facility.

Get Medicare Mental Health Benefits

To enroll in a Medicare Advantage plan or to find answers to any questions you have about your mental health coverage, click here or call 844-431-1832.

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This blog was originally published on May 18, 2017, by Anastasia Iliou, and was updated on August 9, 2019, by Troy Frink.

Why Medicare Advantage Plans Are Bad

Someone may have told you a million reasons why Medicare Advantage plans are bad. The truth is they’re just misunderstood. More than 34 percent of Medicare beneficiaries are enrolled in Medicare Advantage (MA) plans, so they can’t be all bad.

What Is Wrong With Medicare Advantage Plans?

Medicare Advantage plans have pros and cons like any other type of health insurance plan. They may not make sense for some people, but they can be extremely beneficial for others, and here’s why.

They Can Be Expensive

Medicare Advantage plans all come with monthly premiums. Some of them have $0-premiums, but the average monthly premium in 2019 is $28. Some people may think, “free,” when they hear “$0 premium,” but that’s not necessarily the case. Even if you enroll in a MA plan, you may still be responsible for paying your Medicare Part B premium and other costs, like copayments.

Along with monthly premiums, MA plans can come with high out-of-pocket maximums. An out-of-pocket limit is designed to protect you. Once you reach your limit, the insurance company pays for your covered services. However, some plans’ out-of-pocket limits can be as high as $6700. 

The out-of-pocket limit resets at the beginning of the year, but you could end up paying $13,400 if you have two major procedures within a few months. 

For example, if you have hip replacement surgery in November, you might reach the $6700 limit just from that. Then,after your out-of-pocket maximum resets in January, you need knee replacement surgery. You would owe another $6700, just a few months later. You would then be covered for the rest of the year, but that total of $13,400 within a few months can certainly hurt.

Medicare Advantage Plans Have Smaller Networks

Most MA plans have provider networks you have to stay within. You can go out-of-network to find a doctor, but you may have to pay significantly more than if you stayed in your network.

You may even go to your favorite doctor and get turned away because your doctor isn’t in your plan’s coverage network.

Many people don’t realize that MA plans have networks when they enroll, and that may be why Medicare Advantage plans are bad according to some people. 

Specific Coverage Areas

Most MA plans have coverage specific to one location. That’s great if you’re close to home and you need medical treatment, but that means your plan may not cover a doctor’s appointment if you get sick when you’re out of town. Original Medicare is a federal program, so it is likely that you’ll be able to find a doctor when you’re on vacation in another part of the country. 

Your Plan Could Change Every Year

Many Medicare Advantage plans change their benefits every year. Sometimes they add or remove providers, covered services, and/or prescription drugs on the plan’s formulary. 

Plans can also change how much you pay in monthly premiums, copays, and/or deductibles. 

That means you’ll have to change plans if your current plan drops vision coverage, and you signed up for your plan specifically because you wanted the annual eye exam benefit. The problem is that you can only change plans during certain parts of the year. 

Most people have to wait until the Annual Enrollment Period (AEP), which is from October 15 – December 7 to enroll in new plans or make changes to existing ones. Exceptions to that rule include people who are about to turn 65, or who just had their 65th birthday. 

The Initial Enrollment Period (IEP) for people aging into the program is the three months before you turn 65, and the three months after. During that seven-month period you can choose a new Medicare health insurance plan. If you are eligible due to ALS or ESRD, your IEP is the week after your diagnosis. If you are eligible due to receiving SSDI for at least 25 months, your IEP is your 25th month of benefits.

You may qualify for a Special Enrollment Period (SEP) if you meet certain conditions. Your SEP may be lifelong or temporary, but it will allow you to make changes to your plan outside of the other enrollment periods.

Some Plans Require Doctor Referrals

Many Medicare Advantage plans are HMOs, which require you to select a primary care provider (PCP). In most cases, your PCP will need to give you a referral before you can see a specialist. 

To illustrate what this looks like, let’s take the example of a man* who has a MA HMO. The man notices a mole that’s changed in size and shape. He knows he needs to see a dermatologist because he’s had skin cancer before, and the new mole likes like his previous carcinoma.

The man can’t just go to a dermatologist, however. He needs to first make an appointment with his PCP, and the PCP can then refer him to a dermatologist. The man will owe a copay to see his PCP, and then he’ll need to pay the dermatologist a copay, too. Specialist copays are usually higher than PCP copays. You may pay $10 for a PCP visit, but $40 for a specialist.

On the flip side, because the man went to his primary physician first, he got a really good recommendation and was able to see one of the best dermatologists in his town on short notice. That doctor referral requirement may have brought more help than harm.**

*This example is not real and only represents a possible circumstance.

**Not all doctors will be able to see you on short notice, regardless of your plan.

Benefits of Medicare Advantage Plans

The reasons why MA plans are good may outnumber why Medicare Advantage plans are bad. The truth is everyone has different healthcare and financial needs. MA plans make sense for people who want coverage for a variety of health services.

Medicare Advantage Plans May Actually Cost Less

Even though you may still owe the Part B monthly premium, you could end up paying less overall if you have Medicare Advantage. 

Your cost-sharing may also be less with a MA plan. If you only have Original Medicare, you will owe 20 percent of covered services, and Original Medicare will pay 80 percent of approved costs.

To illustrate what this looks like, let’s say you see your doctor because you have the flu. Your doctor charges Medicare $100. Medicare approves the charge and you owe $20. 

Many MA plans have copays of $10 or less for doctor’s appointments. That $10 savings for one doctor’s visit may not seem like much, but it adds up over time.

Plans Can Be a “One-Stop-Shop” for Covered Services

Many Medicare Advantage plans are designed to provide the beneficiary with comprehensive healthcare coverage. MA plans can offer coverage for services Original Medicare does not, including vision, hearing, dental, and fitness classes.

Many MA plans even include prescription drug coverage, which Original Medicare does not. 

That also means that you may have access to doctors with a variety of specialties, provided they’re in-network. All of your providers can coordinate with each other to provide a complete health plan to keep you in optimal health.

Find out Why Medicare Advantage Plans Are Bad (or Good) for You

A Medicare Advantage plan may be a good fit if you need coverage for a variety of services and you want to have a whole care team creating your treatment plan. A licensed agent with Medicare Plan Finder can help you determine if a MA plan is right for your budget and lifestyle needs. To get started, call us at 844-431-1832 or contact us here today.

Medicare Long Term Care Coverage

More than half of adults aged 65 and older will need long-term support and services in their lifetimes according to the American Association of Retired Persons (AARP).

As you age, it can become difficult to perform everyday tasks such as bathing or getting dressed, and you may need assistance to do those things.

Long term care may consist of skilled nursing services or physical therapy immediately following an illness or injury, or it may consist of someone coming to your house to help you with day-to-day tasks.

Does Medicare Cover Long Term Care?

Original Medicare does not cover long term care unless it follows a hospital stay or is for necessary medical treatment.

However, you can use certain Medicare Advantage (Part C) or Medigap (Medicare Supplement) insurance plans to help pay for non-medically necessary long term care. Here’s what Original Medicare will cover:

Medicare Skilled Nursing Coverage

Medicare Part A will cover short stays (100 days or less) in skilled nursing facilities if you meet these qualifications:

• You’ve been admitted to the hospital for at least three days
• A Medicare-certified skilled nursing facility admits you within 30 days of the initial hospital stay
• Your treatment plan involves skilled care such as physical therapy or skilled nursing services.

Medicare will cover 100 percent of the costs for the first 20 days. In 2019, your copay for days 21-100 is $170.50.

For Medical Treatment

In order for Medicare to cover long term care for medical treatment, your doctor must first deem it medically necessary. Medicare Part B will cover the following services:

• Intermittent and part-time skilled nursing care
• Physical therapy
• Occupational Therapy
• Speech pathology

Your durable medical equipment (DME) can be covered if your doctor prescribes it and it will be used for at least three years. Medicare Part B also covers mental health services to help manage the psychological and cultural issues that come with having an illness.

There is no limit on how long you can receive the above services if your doctor reorders them every 60 days.

For Chronic Illnesses

Chronic Special Needs Plans (C-SNP) will cover long term care services for people with chronic illnesses. The covered services for conditions such as Parkinson’s and ALS are to help prevent and slow the progression of the symptoms.

Original Medicare will NOT cover prescription drugs for chronic illnesses, however. Prescription coverage falls under Medicare Part D and certain Part C plans.

Medicare Hospice Coverage

If you have a terminal illness with no chance of improvement, are expected to live less than six months, and are looking for peace instead of a cure, Medicare will cover hospice care.

In order for Medicare to cover drugs to control the symptoms and to relieve pain, you must be receiving care from a Medicare-approved hospice provider.

You can receive hospice care at your home, in a nursing home, or in a hospice care facility. When you enter hospice care, you will have an entire team of people focused on your overall comfort and well-being including your spiritual and emotional needs, not just your physical needs.

Long Term Care Coverage With Medicare Supplement Vs. Medicare Advantage

Private insurance companies offer plans that can go beyond what Medicare Parts A and B will cover. For non-medically necessary long term care, you won’t be able to use Original Medicare, and, for the most part, you won’t be able to use Medicare Supplements, either. If you want long term care coverage, a Medicare Advantage plan may be your best option.

Long Term Care Medicare Supplement

Medicare Supplements (Medigap) plans are designed to fill in the financial gaps Original Medicare creates. For example, you are financially responsible for that $170.50 copay. You can use a Medicare Supplement to help make those payments easier.

Medicare Advantage

Medicare Advantage (MA) plans are insurance plans that can cover medical services Original Medicare does not. While Medigap plans are strictly for help paying for out-of-pocket costs, MA plans are for additional medical coverage. Certain Part C plans can include coverage for DME and non-medical long term care, so it’s critical you know what your options are.

Note: You cannot have both a Medicare Supplement and a Medicare Advantage plan, so having someone help you sift through the thousands of plans out there and find the right one for you is extremely important to your overall health and well-being.

Why It’s Important to Have a Plan

Long term care can easily cost hundreds or thousands of dollars a month, and those costs will only increase. By 2050 the baby boomer population in the US will be 80 million, and that means more competition for home health care and therefore steeper prices. Having a health insurance plan to help with those costs might not only help you stay in good health, but also give you peace of mind.

Get Medicare Long Term Care Coverage Today

Are you looking for Medicare long term care coverage? One of our licensed agents can answer your questions and help you find the right plan for you. Fill out this form or call us at 844-431-1832 for a no-obligation appointment today.

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Original Medicare vs. Medicare Advantage

The Annual Enrollment Period is quickly approaching and starting October 15, you will be able to switch Medicare Plans. Which do you favor in the battle of Medicare vs Medicare Advantage? If you’re not quite sure, we’re here to help! By understanding the basic principles of each, you will be better prepared to make that decision.

What is Medicare?

Medicare is operated under the federal government and covers a variety of health care expenses and provides benefits for seniors over 65 as well as those with Social Security benefits or certain health conditions. There are many parts, policies, and new standards associated with Medicare. We get it – it’s confusing! It’s important to understand the history of Medicare Part A B C D, because AEP is right around the corner!

Created in 1965, Original Medicare is a federally-regulated healthcare program designed largely for senior citizens. Original Medicare includes Part A (hospital coverage) and Part B (medical coverage).

Part A covers inpatient and outpatient care at hospitals, nursing homes, hospice care, and home health services. Part B covers doctor visits and ambulance rides. Most beneficiaries receive Part A for free. Most people pay the same rate for Part B coverage, but a small number of beneficiaries may have income-adjusted premiums.

Original Medicare allows beneficiaries to go to any provider that accepts Medicare, which is over 900,000 physicians nationwide! This means that no matter which Medicare provider you visit, the costs will stay the same. This is ideal for beneficiaries who travel often or want doctors in different locations.

If you are enrolled in Original Medicare, you are able to enroll in a Medigap plan. Medigap plans provide financial benefits for an extra monthly premium. This can include help paying your copayments, coinsurance, and deductibles. Additionally, some of these Medigap plans cover prescription drugs. However, if your plan does cover prescription drugs, you cannot purchase a separate drug plan.

History of Medicare

National health coverage wasn’t even discussed until President Roosevelt in 1912. He ran on a platform that included providing health coverage to anyone who needed it. Flash forward to 1945 when President Truman took office. Within seven months, he called for a national health fund that would be available to all Americans.

Truman fought hard, but it took another 25 years before anything went into effect. In 1965, Lyndon B Johnson signed legislation that provided benefits for seniors over 65. As of 2018, the Centers for Medicare and Medicaid Services (CMS) estimate that over 58.5 million people benefit from Medicare. As more policies and new standards go into effect and technology creates healthcare innovations in this industry, Medicare will continue to evolve.

Medicare Part A B C D

Medicare is broken into specific parts and each part is unique. Original Medicare consists of Parts A and B. Part A covers inpatient hospital fees, hospice care, and home health services. Part B covers doctor services, outpatient care, and physical therapy.

Most beneficiaries receive Part A for free and Part B is covered by a monthly Medicare premium. Beyond Original Medicare, there are Parts C and D. Part C is Medicare Advantage (MA).

MA plans combine Part A (hospital fees insurance) and Part B (medical insurance) and usually prescription drug coverage. Part D is a standalone plan that is purchased separately on top of Original Medicare. It can help cover the cost of prescription drugs.

What is Medigap?

If you are enrolled in Original Medicare, you are eligible to purchase a Medigap plan. What is Medigap? Medigap plans help pay some of the cost that Original Medicare does not cover. This can include copayments, coinsurance, and deductibles. Medigap plans generally don’t cover vision or dental care but may include prescription drug coverage. They are sold by private insurance companies. You cannot be enrolled in a Medicare Advantage plan and Medigap, so it’s important to compare and evaluate your budget and needs.

Pros and Cons of Medicare

Some people love Medicare, and others don’t care for it.

Why Medicare is Awesome

Premiums: If you worked for most of your life, you won’t have to pay any premium for Medicare Part A!

Healthcare Innovation: Medicare has increased healthcare innovations in the medical market tremendously. Thanks to Medicare, millions of Americans suddenly have access to health coverage they otherwise would be unable to afford. Millions of dollars have been invested in healthcare innovation and development!

Medicare “Rules:” CMS has steady Medicare rules that help prevent fraud, waste, and abuse. Without breaking the Medicare Rules, Medicare agents and plans can’t take advantage of you!

Why Some People Dislike Medicare

Hospital Fees: Even with the help of Medicare, hospital fees can still cost a pretty penny. Medicare beneficiaries typically pay 20% of the total fee. Additionally, Medicare typically does not have a cap. This means that if you have a series of health issues within a year, you may be spending more than you originally budgeted.

Prescription Drug Coverage: Medicare does not cover prescription drugs. If you are looking to purchase drug coverage, you will need to purchase separate prescription drug coverage through Medicare Advantage or Part D.

Limitations: Original Medicare provides the same health coverage for everyone. There is no personalization or choosing the exact benefits you want, unless you enroll in Medicare Advantage. If you are seeking more than basic health coverage, an MA plan could be perfect for you.

What is Medicare Advantage?

The history of MA plans is relatively short compared to Original Medicare. Just like Medicare, MA plans have benefits for seniors over 65 and certain disabled persons. These plans are rising in popularity and may be the best option for you!

Medicare Advantage plans can allow you to have a monthly premium for all your additional benefits, like dental, vision, and prescription drugs. There is no hassle with sending payments for multiple plans. Some MA plans may offer a lower deductible in exchange for a higher monthly premium. This is a great option for healthy seniors and other Medicare eligibles. With MA plans, you only pay for the services you use rather than paying a higher upfront cost.

The History of the Medicare Advantage Program

Medicare Advantage plans were not offered until 2003. Since then, enrollment has tripled to 19 million beneficiaries according to the Henry J Kaiser Family Foundation. Medicare Advantage plans are available through private insurance companies and must cover the same benefits as Original Medicare. However, many MA plans offer extra benefits like vision and dental coverage and even SilverSneakers®. These plans have a set network of providers you must choose from, but don’t worry! There are many different networks and plans available.

Medicare Advantage (Part C) Popularity

According to the Henry J Kaiser Family Foundation, enrollment has tripled to 19 million beneficiaries since 2003. Medicare Advantage plans are available through private insurance companies and must cover the same benefits as Original Medicare. However, many MA plans offer extra benefits like vision and dental coverage and even fitness programs like SilverSneakers®. These plans have a set network of Medicare providers you must choose from, but don’t worry! There are many different networks and plans available.

Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) are the most popular plans among Medicare Advantage.

HMOs:

An HMO, or Health Maintenance Organization, has a closed provider network. You’ll have to select one primary provider for most of your healthcare needs. HMOs may require you to get a referral for more severe injuries or illnesses.

PPOs:

PPOs, or Preferred Provider Organizations, allow you to see any doctor, but staying in your network you will save you money. Additionally, they don’t require referrals and like HMOs, they often cover Part D supplements.

Medicare Advantage plans have one monthly premium. There is no hassle with sending payments for multiple plans. Some MA plans may offer a lower deductible in exchange for a higher monthly premium. This is a great option for healthy seniors. With MA plans, you only pay for the services you use rather than paying a higher upfront cost.

Pros and Cons of Medicare Advantage

Why Medicare Advantage Plans are Awesome

Premiums: KFF reported that half of Medicare Advantage beneficiaries in 2019 pay no premium at all, and most others pay between $20 and $100.

Out-of-pocket Max: Although you pay a premium with both Original Medicare and Medicare Advantage, MA plans may offer a lower deductible in exchange for a higher monthly premium. Also, MA plans have a limit for your out-of-pocket costs, saving you even more in the long run!

Prescription Drugs: Prescription drug coverage is often included in Medicare Advantage plans. This allows you to bundle your health coverage – saving you money and creating more convenience for you!

Unexpected Benefits: Some Medicare Advantage plans even include cool benefits like gym memberships!

Flexibility: There is a broad range of Medicare Advantage plans out there, so you may be able to choose between a few options to get the one that’s right for you.

Why Some People Don’t Like Medicare Advantage Plans

Limited Networks: There is usually no nationwide coverage with Medicare Advantage plans. This can be an issue if you frequently travel within the US. Additionally, your network may require that you only see specialists that your doctor refers you to.

Price Fluctuation: The specifics of your Medicare Advantage plan varies per provider. You may still be required to pay copays and coinsurance fees. Additionally, your Medicare premiums and copayments may change each year.

Medicare Advantage vs. Medigap

When comparing Medicare Advantage vs Medigap, it’s easy to get confused. Medigap can only be purchased alongside Original Medicare. You cannot have a Medicare Advantage and Medigap plan at the same time. Medigap plans cost an additional monthly Medicare premium, but they help fill the cost gaps in coverage – this means less out of pocket costs for you.

Medicare Advantage vs Medigap prices can vary. If this is something you’re interested in, it’s important to compare policies.

Difference Between Medicare and Medicare Advantage

What is the difference between Medicare and Medicare Advantage? It is easy to confuse the two. The main difference is that while Original Medicare is the federal program, Medicare Advantage plans are privately owned. Medicare Advantage plans still have to follow all the rules determined by CMS (Centers for Medicare and Medicaid Services), but they are able to offer benefits that the federal program cannot. med

How to get Medicare Advantage

Does a Medicare Advantage plan look attractive to you? Did we grab your attention? AEP is coming soon!

From October 15 to December 7, anyone with Medicare can make changes to their plans. If you’re interested in purchasing a Medicare Advantage plan or hearing more about how to get covered, complete this form or call us at 844-431-1832 to arrange a free, no-obligation appointment with an agent and get covered today.

*This blog was originally published on September 20, 2018, and updated on July 28, 2019.

5 Medicare Enrollment Periods & What You Can Do During Each One

Did you know there are five different Medicare enrollment periods? You may qualify to enroll or make changes to your current coverage and have no idea! AEP is just a few months away, so we’d like to share with you what you can do during the various enrollment periods so you are properly prepared.

Initial Enrollment Period

Your Initial Enrollment Period (IEP) is typically your first opportunity to enroll in Medicare. Your IEP is three months before your 65th birthday and three months after. This gives you a seven-month window to enroll in your preferred coverage. 

In most cases, if you do not enroll in Part A and Part B (Original Medicare) during your IEP, you will be charged a late enrollment penalty fee that will be added to your monthly Part B premium. If you do not have prescription drug coverage, you should also consider enrolling in a Part D plan to avoid other penalties down the road. You are not required to enroll in a Medicare Advantage or Medicare Supplement plan, but you should consider enrolling to optimize your coverage.

During your IEP, you can:

• Enroll in Part A and Part B
• Enroll in a Medicare Advantage plan (must be enrolled in parts A and B first)
• Enroll in a Part D (prescription drug) plan (must be enrolled in parts A or B first)
• Enroll in a Medicare Supplement plan (can be done any time of year)

General Enrollment Period

The General Enrollment Period (GEP) is for those who are enrolling in Medicare for the first time but missed their IEP. The GEP runs from January 1 to March 31 each year, and coverage will begin in July. 

During the GEP, you can:

• Enroll in Original Medicare if you missed your IEP
• Enroll in a Part D (prescription drug) plan (must be enrolled in parts A or B first)
• Enroll in a Medicare Supplement plan (can be done any time of year)

*If you enroll for the first time during the GEP, you can follow up by enrolling in a Medicare Advantage plan during a period from April 1 through June 30.

Annual Enrollment Period

The Annual Enrollment Period (AEP) runs from October 15 to December 7 each year. During this time, all Medicare beneficiaries can make changes to their plans. You may not need to do anything during AEP. However, major insurance carriers can change the benefits that they offer every year. It’s possible that a change in your plan benefits or your provider network will change how you feel about your plan. Ultimately, it’s always a good idea to speak with an agent. Any changes you make during AEP become effective on January 1 of the following year.

During the AEP, you can:

• Switch from Original Medicare only to a Medicare Advantage plan 
• Add a Medicare Supplement plan
• Switch between Medicare Advantage and Medicare Supplements
• Switch into a new Medicare Advantage plan
• Add Part D (prescription drug) coverage

Special Enrollment Period

Most people can only make changes to their plans once a year (during AEP), but if you qualify for a Special Enrollment Period you can make those changes during different times of the year or even all year long. Lifelong SEPs allow you to change plans once every quarter for the first three quarters of the year. Circumstantial SEPS allow you to change plans once following a particular event. 

During a SEP, you can:

• Switch to a new Medicare Advantage plan in your area
• Move from one Medicare Advantage plan to another
• Add Medicare Advantage to your Part A and Part B
• Switch from Medicare Supplements to Medicare Advantage
• Change or add a form of prescription drug coverage

Open Enrollment Period

Starting in 2019, there will be a new “Medicare Open Enrollment Period”  that will run from January 1 through March 30. OEP was created for anyone who signs up for a Medicare Advantage plan during AEP to enroll in a different plan, without having to wait until the following fall. You do not have to do anything during OEP unless you are unhappy with the coverage you enrolled in during AEP.

During the OEP, you can:

• Change from one Medicare Advantage plan to another Medicare Advantage plan
• Change from a Medicare Advantage plan with prescription drug coverage to Original Medicare with Part D prescription drug coverage
• Change from Medicare Advantage to Original Medicare only, with the option to add a prescription drug plan

Contact Medicare Plan Finder

Are you looking to enroll in Medicare Advantage, Medicare Supplements, or Part D? Are you still confused on which Medicare enrollment periods you qualify for?

Our agents at Medicare Plan Finder can answer any of your questions and simplify the enrollment process. They are contracted with most of the major carriers in your state so the agent should not show bias when enrolling. To speak with a licensed agent and to learn about plans in your area, click here or call 844-431-1832.

This blog was originally published on 10/23/18 and was updated on 7/15/19.

OTC Medicare Drug Coverage

According to the Consumer Healthcare Products Association, the average American makes 26 trips per year to buy over-the-counter (OTC) products. As you age, this number may increase. This means you may be spending more on these products each year.

Every penny counts and understanding the products, drugs, and the role of a Medicare Advantage OTC pre-paid card can help you save in the long run.

What Are Over-the-Counter Medications?

These medications don’t require a doctor’s prescription to be purchased. They can help ease pains such as backaches, help prevent or treat illnesses such as athlete’s foot and allergic reactions, and help manage recurring issues such as migraines.

The most common over the counter medications are fever reducers, anti-inflammatories, allergy pills, and cold medicine.

Does Medicare Cover Over-the-Counter Drugs?

Original Medicare (Part A and Part B) does not cover over-the-counter products and medications. Some stand-alone Part D plans may cover the costs, but generally, a Medicare Advantage plan is your best option if this type of drug coverage is important to you.

Your Medicare Advantage plan provider should give clear instructions on how to utilize your allowance towards medications and products.

Oftentimes, your insurance carrier will provide a website or downloadable document that lists the eligible products/medications, instructions to purchase, and the details of the benefit. If you have any issues, feel free to contact a licensed agent here.

What Is Medicare Advantage OTC Card Coverage?

Certain Medicare Advantage plans offer beneficiaries a unique way to buy over the counter products: a pre-paid card! These cards can be used to purchase most OTC products and medications.

Once you exceed your allowance (average of $50-$100/month for most providers), the card is no longer valid until it is reloaded by your insurance provider. Most plans reload the cards to the set amount on a monthly basis and any previous balance will be lost.

What Can I Buy With My OTC Card?

Before you ask yourself, “What can I buy with my OTC card,” you should first look at your plan’s OTC catalog. Eligible products and medications may vary through your plan provider, but common eligible items include:

• Acne aids
• Cough, cold, and flu medications
• Antibiotic creams
• Bandages
• Denture products
• Digestive aids
• Ear care
• First-aid kits
• Orthopedic support
• Pain relievers
• Sleep aids
• Wart removal

Generally, these items are not covered:

• Chapstick
• Deodorant
• Dietary supplements
• Mouthwash
• Perfume
• Soaps
• Teeth whitening products

Where Can I Use My Medicare Advantage OTC Card?

Stores and locations that accept your card will vary by provider. However, the following stores are included in most plans:

• CVS
• Dollar General
• Family Dollar
• Kroger
• Rite Aid
• Target
• Walgreens
• Walmart

Medicare OTC Card Online Stores

Along with an extensive inventory of over-the-counter products in the stores, many of the major pharmacies listed above also have a mail-order feature so you can have many of your favorite OTC and even prescription items shipped straight to your door! You may be able to use your OTC card at the following online pharmacies*:

• Blink Health
• Health Warehouse
• Overstock Drugstore
• Planet Drugs Direct
• My OTC Store

*This is not an exhaustive list of online pharmacies.

Medicare OTC Card Activation

Your card should come with information about how to activate it. If you’re unsure how to activate your card, contact your plan’s customer service center and ask about OTC card activation.

How to Check Your OTC Card Balance

For information about how to check your OTC card balance, go to the website your plan gave you. If you’re not sure how to access it, call your plan’s customer service center for help.

How Do I Save on My Prescriptions?

While a Medicare Advantage OTC benefit can certainly be a great perk to have, you’re probably still wondering how you can cut down on your prescription costs.

You may want to start by finding out if you’re eligible for “Extra Help,” a Medicare savings program for prescription drugs. Then, look at your current coverage and make sure you have the right plans for your needs. A licensed agent can help you.

Then, download our free prescription drug savings card. It works in many major pharmacies and is sort of like a coupon. Just show the card when you pick up your prescriptions, and your pharmacist can tell you whether or not your prescriptions can be cheaper with the card. It’s worth a try!

How Do I Get Medicare Advantage OTC Coverage and Prescription Drug Coverage?

Are you interested in getting OTC Medicare coverage? Our licensed agents are contracted with most major carriers in your state. There are countless plans that can fit your personal needs and budget all while having the additional benefit of over-the-counter drug coverage.

Already enrolled in a Medicare Advantage plan? You may unknowingly have this benefit already, and we want to help you use it. Call us today at 844-431-1832 or fill out this form to get started.

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This post was originally published on January 17, 2019, by Kelsey Davis and updated on July 15, 2019, by Troy Frink, and November 12, 2020, by Anastasia Iliou.