Surgeons perform more than 3.8 million cataract procedures every year in the United States. As you age, your risk of developing cataracts increases. Approximately half of all Americans will develop cataracts by age 75.
Before factoring in health care coverage, cataract surgery can cost $3,700 to $7,000 per eye. If you have one of the millions of cases of cataracts, you may wonder, “Does Medicare cover cataract surgery and implants?” Yes. Medicare covers these costs for qualified Medicare beneficiaries.
How Much Does Medicare Pay for Cataract Surgery?
Original Medicare (Part A or Part B) generally* does not include vision coverage. However, cataract surgery is an exception. Medicare Part B covers basic lens implants and cataract removal.
If your provider recommends an advanced lens implant, you may need to pay some or all of the additional costs. It’s essential to talk with your doctor to get a clear understanding of the necessary procedure.
*Medicare Part A may cover emergency services in a hospital.
Medicare Part D, which is the prescription drug plan, may cover any prescription medications you need after you have had your cataract surgery.
Incidentally, any medications you need before surgery, such as prescription eye drops, will be covered by Medicare Part B. Part B will also cover eyeglasses or a set of contact lenses for cataract surgery that implants monofocal intraocular lenses (IOL).
Since Part D has no deductibles, you may be responsible for a specified copayment amount that you must pay when you get your prescription drugs.
What Type of Cataract Surgery Does Medicare Cover?
Medicare covers two types of surgery: manual blade surgery and laser surgery.
Medicare will also pay for an intraocular lens (IOL), which corrects presbyopia or astigmatism, but only if these lenses should be replaced because of cataracts.
Does Medicare Pay for Laser Cataract Surgery?
Medicare coverage for cataract surgery doesn’t depend on the surgical method. Medicare will cover 80% of the cataract removal and basic lens whether the procedure is conventional or bladeless with a computer-controlled laser. Similar to conventional surgery, laser surgery requires you to pay the additional costs if you require an advanced lens.
Does Medicare Pay for Cataract Surgery With Astigmatism?
Since you can correct astigmatism with glasses, Medicare will only cover a cataract surgery with astigmatism if the cataract surgery itself is considered necessary. If this is the case, Medicare will pay for the cataract surgery.
Does Medicare Cover Glasses or Contacts?
For the most part, Medicare does not cover routine vision care, glasses, or contact lenses. However, Medicare can make an exception
You may be wondering, “How much does Medicare pay for glasses after cataract surgery?” After your surgery, Medicare will cover 80% of the costs for prescription glasses or contacts, but you must purchase them through a provider who accepts Medicare assignment.
You will be responsible for the remaining 20%. Some beneficiaries have trouble getting Medicare to cover the pair of glasses or contacts.
If you are denied coverage, you can appeal the decision and request that they are covered. If you already paid for them out of your own pocket, you can request reimbursement.
You and your health provider can write a letter to add to your appeal, just be sure to state that you had met the requirements for cataract surgery, so your glasses or contacts must be covered.
What Is the Average Cost of Cataract Surgery?
Cataract surgery can range from $3,800 to $7,000 per eye without a health insurance plan. For standard cataract surgery, the average cost is $3,700.
However, the average cost of astigmatism-correcting surgery is $5,000, and presbyopia-correcting is about $7,000.
What does Medicare pay toward cataract surgery? It depends on the Medicare plan you are enrolled in. If you are only enrolled in Original Medicare, you will need to pay a 20% coinsurance and your Medicare Part B deductible, which is $185 in 2019.
You may be able to get even more coverage through a Medicare Supplement plan (Medigap) or Medicare Advantage plan. Additionally, because cataracts cloud the eye lens, eye surgery is classified as a medical condition.
This means that Medicaid could also pay some of your cataract surgery costs.
How to Find a Cataract Surgeon Who Accepts Medicare
Ophthalmologists are eye doctors who specialize in vision correction and care. Many times your ophthalmologist will perform your cataract surgery.
Since not every ophthalmologist will accept Medicare Advantage and you may not want to go through the trouble of finding another healthcare provider, then ask your health insurance provider to give you a Medicare eye doctor list.
However, it may be a little more difficult to find a cataract surgeon who accepts Medicare in 2020 because the physician fee schedule has changed since last year. Eye surgeons have had to take a 15% cut in reimbursement compared to Medicare coverage for cataract surgery in 2019.
So another option is to use the Medicare.gov’s physician compare tool to help you find an eye surgeon who accepts Medicare.
Click here to get started. First you’ll come to the physician finder tool. Enter your zip code in the search bar beside the red arrow. We used 37209, which is our corporate offices’ zip code in Nashville, TN.
Then type “ophthalmology” in the search bar above the green arrow. Then click “Search” beside the yellow arrow.
Then you’ll come to a list of ophthalmologists who currently accept Medicare. Use the contact info to call different doctors to find the right fit.
Medicare Requirements for Cataract Surgery
Your vision must be 20/40 or worse to qualify for surgery. Your doctor will need to document that your vision is at this level or lower.
You also need to have difficulty completing daily living activities like reading, sewing, watching television, or driving.
It’s important to remember that the cloudiness in your eye is not directly correlated to the severeness of your cataracts. If you are unsure of your vision level or whether or not you qualify, visit your eye doctor.
Cataract Surgery and Medicare Supplements
Medicare Supplements work alongside Original Medicare and are a great way to add financial benefits to your current coverage. They can help cover your 20% coinsurance and your Medicare Part B deductible.
Plan F is currently the only plan that covers your Part B deductible.
However, Plan F was discontinued in 2020. If you enrolled in it before the start of 2020 you are locked into this plan and will maintain coverage. If you are interested in enrolling in Medicare Supplement Plans, fill out this form or give us a call at 833-438-3676.
Cataract Surgery and Medicare Advantage
Medicare Advantage plans are required to cover, at a minimum, the same as Original Medicare. However, MA plans offer several additional benefits like prescription drug coverage, hearing and dental coverage, group fitness classes like SilverSneakers, and additional vision coverage.
Benefits will vary by plan but can include routine eye exams, eyeglasses, contacts, frames, and fittings. These benefits allow you to check your vision each year and update your prescription, lenses, and frames as needed.
If you are only enrolled in Original Medicare, you will need to pay for these expenses out of your own pocket.
What Are Cataracts?
Our eyes have a lens that works much like a camera. The lens bends light so you can see your surroundings.
A cataract makes that clear lens cloudy, and it can be more difficult to read or drive a car.
What Causes Cataracts?
Most of the time, cataracts develop with age, or when an injury changes your eye’s lens. As you age, the lens can become stiffer, thicker, and less transparent.
Sometimes genetic disorders, other eye conditions, medical conditions such as diabetes, or past eye surgery can contribute to cataract development. Other causes can be long-term steroid medication use.
According to the Mayo Clinic, signs and symptoms of cataracts can include:
Cloudy, blurry or dim vision
Increasing difficulty seeing at night
Sensitivity to light and glare
Need for brighter light for reading and other activities
Seeing “halos” around lights
Frequent changes in glasses or contact lens prescription
Fading or yellowing of colors
Double vision in one eye
How Do You Know If You Need Cataract Surgery?
Talk to your doctor if you experience any changes to your vision such as cloudiness or halos around lights. According to Harvard University, you should have an eye exam every year if you’re 65 or older.
Dr. Laura Fine, an ophthalmologist with Massachusetts General Hospital, says you don’t need cataract surgery until you think you need to see better.
Learn More About Medicare and Cataract Surgery
A licensed agent with Medicare Plan Finder may be able to find plans in your area that fit your budget and lifestyle needs.
Are you interested in learning about available plans in your area? Fill out this form or give us a call at 844-431-1832 to schedule a no-cost, no obligation appointment with a licensed agent.
Does Medicare Cover Genetic Testing for Cancer?
Cancer is the leading cause of death worldwide and impacts millions of patients and families each year. Fortunately, genetic testing for cancer, which is growing in popularity, can be a great tool for understanding your risk of developing cancer.
Does insurance pay for genetic testing of cancer? Yes, but coverage determination depends on certain circumstances.
The American Cancer Society estimates that 1 in 3 people in the United States will develop cancer at some point in their life. Data and research show that cancer risk is highest for those between the ages of 65 to 74 years and accounts for the largest portion of new cancer cases found each year.
While you may have a smaller chance of developing cancer if you are under the age of 65, it is still a good idea to get tested as early as possible so that you can make smart decisions about health insurance and your future.
Is Cancer Hereditary?
About 10% of cancers occur in someone who has inherited gene mutations. Hereditary cancer syndromes are caused by mutations in certain genes passed from parents to children.
Researchers have found mutations in more than 50 hereditary cancer syndromes.
These mutations are found in the genetic code of DNA and are represented by the letters A, T, C, and G. These codes can be long – for example, the BRCA 1 code is over 10,000 letters long.
However, not every mistake in the “code” should raise concern for cancer.
Reasons to Consider Genetic Testing for Cancer
If you have an inherited gene mutation, that doesn’t necessarily mean you’ll get cancer. It only means that you’re at a higher risk of developing certain types of cancer.
If your personal history or family history of cancer suggests you are at risk, find out how genetic counseling and genetic testing can help you understand and manage your concerns.
The following populations should also ask for specific types of genetic testing:
Those whose family members have had gynecologic cancer should get tested for fallopian tube cancer. This very rare cancer only affects about 1,500 to 2,000 women worldwide and only about 300 to 400 women are diagnosed with it every year in the United States.
Certain factors may make it more likely that you and your family members can pass cancer on to your loved ones including:
Many cases of the same kind of cancer (especially if the type of cancer is rare) — like ovarian cancer caused by BRCA1 and BRCA2 gene mutations
Cancers that occur much sooner than usual – like breast cancer in a teenager
One person who has multiple types of cancer (like a man who has both colon and prostate cancer)
Cancers that occur in pairs of organs (both kidneys or both breasts, for example)
Siblings who have childhood cancers
Cancer that occurs in the opposite sex of the one usually affected (breast cancer in a man, for example)
Cancer that occurs in several generations (like in a grandmother, mother, and daughter)
Hereditary Genetic Testing for Cancer
The estimated number of new cancer cases in 2018 was 1,735,350. If you are curious about your risk of developing cancer, consider hereditary cancer testing.
Hereditary testing kits can help you understand any mutations you may have and allow you to better prepare for any issues that may arise in the future. Plus, knowing about an inherited mutation gives you the power to take the necessary steps to reduce your risk of cancer or to help detect it at an early stage.
Kits often include a saliva collection kit and a prepaid return label. The testing kits analyze over 30 genes that can contribute to the most common hereditary cancers.
A certified medical professional will review your sample and provide clear results of the absence or presence of any cancer-causing mutations. This information is personalized to you and provides information on how your genetic makeup can impact your family.
Medicare Cancer Test Kits
Fortunately, you can complete a cancer genetic test in the comfort of your own home. This can help alleviate any stress that may come from testing in a doctor’s office.
Most at-home test companies provide return labels so the entire process is convenient and stress-free. However, if you prefer to go into a doctor’s office for your genetic testing, that is also an option.
If you decide to use a Medicare cancer test kit to screen for covered screenings, be sure to follow the test’s directions to the letter. This helps ensure that your test results will be accurate.
Breast Cancer Genetic Testing & the BRCA Testing Cost
It is easy to learn your genetic risk of the most common hereditary cancers, including BRCA 1 and BRCA 2 genes. BRCA stands for BReast CAncer genes. BRCA 1 is on chromosome 17 and BRCA 2 is on chromosome 13.
All it takes is a small DNA sample through saliva.
Plus, the test can be conveniently mailed to you and completed in the comfort of your home. The cost of a hereditary cancer testing kit can range from $100 to $200.
There are multiple genetic testing companies, including Color and 23andMe, but not all are approved by the FDA.
Aging and Cancer
The risk of cancer increases with age, but it’s never too early to start screening. According to the Dana-Farber Cancer Institute, the average age for a breast cancer diagnosis is 61 years.
The average age for a prostate cancer diagnosis is 66 years.
There is no single explanation as to why age and cancer correlate, but researchers believe sunlight, radiation, environmental chemicals, and ingredients in our food are large factors.
Physical exercise, a healthy diet, and adequate sleep can help lower the risk of cancer as you age.
Medicare Coverage and Genetic Testing for Cancer
Medicare beneficiaries who need genetic counseling can get it covered under Medicare Part A and Part B only if it has been ordered by a physician before starting medication covered under Part D or if it is medically necessary in a skilled nursing facility.
Medicare covers certain genetic cancer tests if they’re medically necessary. In 2020, Medicare will cover genetic testing if:
You have recurring, relapsed, refractory, metastatic, or advanced stage III or IV cancer
You have not used the same genetic test for the same cancer diagnosis previously
You have decided to seek further cancer treatment such as chemotherapy and radiation
You have signs or symptoms of a cancer like colorectal cancer that can be clarified or verified with diagnostic testing
You have a first-degree relative who has a known mutation such as Lynch syndrome
Does Medicare Cover BRCA Testing?
How much does the BRCA test cost? The price ranges from $475 to $4,000. Fortunately, Medicare covers FDA-approved genetic testing for BRCA 1 and 2 for those with a personal or family history.
So, it covers hereditary breast, tubal, epithelial ovarian, or primary peritoneal cancer tests as well.
Does Medicare Cover Genetic Testing for Melanoma?
Medicare currently covers the Myriad Genetics myPath and Castle Biosciences DecisionDx genetic tests for melanoma.
Medicare also covers screenings for lung, breast, prostate, and cervical cancer. Screenings are used to detect potential disease and a diagnostic test establishes the presence or absence of the disease.
Does Medicare Cover Genetic Testing for Prostate Cancer?
Medicare covers prostate cancer screening for men over 50 every 12 months. If cancer is detected, Medicare Part B coverage includes a variety of options, including genetic testing to help physicians distinguish between an aggressive and a non-aggressive tumor.
This essential information helps physicians design an optimal treatment plan for their patients.
What Happens During a Genetic Test for Cancer?
A genetic test for cancer may provide some insight into your medical history and the possibility of passing mutated genes on to your loved ones.
Your doctor will first ask you questions about your personal and family medical history such as, “Have you or an immediate family member been diagnosed with cancer?” Based on your answers, your doctor may refer you to a genetic counselor. (A genetic counselor is someone who has advanced training in medical genetics and counseling.)
2. Informed Consent
Before your test, you must give informed consent, which means that you’re aware of and that you agree to the following items:
The genetic test’s purpose
The type and nature of the genetic condition being tested
Possible screening or treatment options depending on the test results
Further decisions you might need to make once the results are back
The possible consent to use the results for research purposes
Availability of counseling and support services
Your right to refuse testing
3. Collecting the Sample
Depending on the test, you may need to provide a saliva, blood, hair, cheek cells (usually a swab from inside your mouth), urine, or stool sample. Once your healthcare professional collects your sample, he or she will send it to the lab for testing.
4. Getting the Results
Once the results are in, your genetic counselor or healthcare provider will tell you about your test results and the next steps you should take.
Questions to Ask Yourself About Medicare DNA Cancer Screening
Does Medicare pay for DNA cancer screening? Yes, because the Centers for Medicare & Medicaid Services (CMS) covers a broad range of FDA approved diagnostic tests, CMS cancer screening is available to detect many types of DNA cancers.
However, as with any type of medical screening, you should know what you’re getting into before you take the test. Before you take a Medicare cancer swab test, ask yourself:
Is this test legitimate? Unfortunately, genetic kits including Medicare cancer swab tests are the latest trend in Medicare fraud, according to many state and federal agencies. Your doctor can tell you what type of test to buy.
Is this test FDA-approved? Medicare will only cover FDA-approved tests.
How will this information benefit future generations? You may not want to know if you have genetic mutations that could lead to cancer. However, that information could help your children and grandchildren. If you have gene mutations associated with cancer, you can have Medicare cancer screening. Many forms of cancer can be treated if they’re detected early.
We Can Help You Find the Best Medicare Plans for Cancer Patients
A Medicare Advantage (MA) plan is a great option if you are looking for additional benefits like genetic testing beyond BRCA 1 and 2 and myPath.
Some may even offer fitness classes like SilverSneakers®, which can help promote a healthy, physically active lifestyle and help lower your risk of cancer.
If you’re diagnosed with cancer, you may be eligible for a type of MA plan called a Chronic Special Needs Plan (C-SNP). These plans are specially designed for people with certain chronic illnesses and conditions. Your C-SNP will involve a network of healthcare providers that will coordinate your treatment plan with each other.
If you are interested in arranging a no-cost, no-obligation appointment with a licensed agent to discuss your options for MA plans including C-SNPs, call us at 833-438-3676 or fill out this form.
This post was originally published on November 29, 2018, by Kelsey Davis and updated on March 24, 2020, by Troy Frink.
Alzheimer’s Care Guide: Symptoms, Stages, Prevention, and Treatment
There are more than 5.7 million Americans living with Alzheimer’s. This number is expected to reach 14 million by 2050.
The complications from this disease make Alzheimer’s the sixth leading cause of death in the United States, so it’s important to educate yourself on the symptoms, signs, stages, prevention, and treatment.
Difference Between Alzheimer’s and Dementia
Dementia is a syndrome and used to describe symptoms that include memory loss, difficulty problem solving, and struggling with thoughts and language. Alzheimer’s is a disease and is a type of dementia.
In fact, there are over 100 types of dementia. Some forms of dementia can be temporary, reversed, or cured, however, Alzheimer’s disease cannot.
Alzheimer’s Symptoms and Stages
Alzheimer’s can cause changes in the brain long before any symptoms or signs start to show. Understanding the symptoms can help you detect Alzheimer’s early on and increase your chance of benefiting from treatment.
The risk of developing Alzheimer’s will vary per individual, but the following are the largest risk factors.
Age: Alzheimer’s is not a normal part of aging, however, your risk increases with age. Most people with Alzheimer’s are diagnosed after the age of 65. After 65, your risk doubles every five years.
Family History: If your parent or sibling was diagnosed with Alzheimer’s, you are more likely to develop the disease. This risk increases with the number of diagnosed family members.
Other Risks: There is a strong connection between our hearts and our brain. If you have heart disease, are overweight, or lack regular exercise, you’re at a higher risk of developing Alzheimer’s.
What Are the Very First Signs of Alzheimer’s?
Alzheimer’s is a slow progressing brain disease. If you notice any of the following warning signs, contact your doctor:
Forgetting recently learned information (dates, appointments, events, etc.)
Trouble following a recipe
Difficulty driving to a familiar location
Losing track of dates, seasons, and times
Trouble judging distances
Struggling with vocabulary
Misplacing things around the home
Paying less attention to hygiene needs
Avoiding social activities
What Are the 7 Stages of Alzheimer’s?
There are three general stages of Alzheimer’s – mild (early stage), moderate (middle stage), and severe (late stage). However, these stages can be broken down into seven more specific stages.
Keep in mind that the seven stages can overlap, and placing someone into a specific stage can be difficult.
Stage 1 – No Impairment: Alzheimer’s is not detectable in this stage. There are no signs of memory problems or other symptoms.
Stage 2 – Very Mild Decline: Minor memory problems may begin to surface. You would still perform well on memory tests, and Alzheimer’s will be difficult to detect.
Stage 3 – Mild Decline: At this stage, you or family members may start to notice small symptoms. Memory tests may be affected and doctors can detect impaired function. Someone in this stage may be unable to find the right words in conversation or remember new names.
Stage 4 – Moderate Decline: This stage is much more clear-cut. Someone in this stage may have difficulty with basic math problems, have short-term memory loss, be unable to manage bills, and may forget details of the past.
Stage 5 – Moderately Severe Decline: Those in this stage may begin to require assistance in day-to-day life. They may be unable to get dressed appropriately, be unable to recall details like their phone number, and demonstrate significant confusion.
Stage 6 – Severe Decline: People in this stage need constant supervision and may require professional care. They may be unaware of their environment, unable to recognize faces, and unable to remember most of their personal history. Loss of bladder control, personality changes, and wandering are also common in this stage.
Stage 7 – Very Severe Decline: This is the final stage of Alzheimer’s. People at this stage are unable to communicate and respond to their environment. Their speech may be limited to less than six words and they are unable to sit up independently.
How Quickly Does Alzheimer’s Progress?
The rate that Alzheimer’s symptoms progress can vary, but the average person lives four to eight years after diagnosis. However, early detection and a healthy lifestyle can help someone with Alzheimer’s live 20+ years after diagnosis.
There is no single test that can diagnose someone with Alzheimer’s. Doctors use a combination of medical history, physical exams, neurological exams, mental status tests, and brain imaging when diagnosing.
Neurological exams address reflexes, coordination, eye movement, speech, and sensation. Mental status tests give an overall sense if a person is able to understand dates, times, locations, and simple instructions or calculations.
The Main Cause of Alzheimer’s
Although scientists don’t fully understand all the causes of Alzheimer’s, research suggests that this progressive disease is related to aging, genetics, and underlying health conditions.
Environmental and lifestyle factors may also contribute. Often the disease could be a combination of these factors.
Complex factors like age, genetics, environment, lifestyle, and existing medical conditions play a role in developing Alzheimer’s. However, while you can’t change your genes or your age, there are plenty of steps you can take to help prevent Alzheimer’s.
Can Alzheimer’s Be Prevented?
There is strong evidence that shows changing your lifestyle promotes a healthy heart and lowers your risk of Alzheimer’s.
Prevention tips include:
Healthy Heart: There are several connections between our heart and brain. Studies have shown that about 80% of people with Alzheimer’s also have some form of heart disease. Manage your blood pressure, diabetes, and cholesterol levels to lower the risk of developing any heart conditions.
Exercise and Diet: Regular exercise and a healthy diet directly benefit your brain cells. Exercise increases blood flow and oxygen to the brain and a healthy diet limits your intake of sugars and saturated fats.
Social Activities: Staying social helps build and maintain strong connections. This can keep you mentally active. Researchers believe these connections can lower your risk of Alzheimer’s by increasing mental stimulation and reinforcing connections between nerve cells and your brain.
Alzheimer’s Disease Treatment
There is no cure for Alzheimer’s and no way to stop its progression. However, there are drug and non-drug options to help treat the symptoms. These include:
Medications for Memory: Cholinesterase inhibitors and memantine are common drugs used to treat memory loss and confusion. A doctor can prescribe these medications, so be sure to contact your health care provider.
Behavior Treatments: Some doctors may prescribe antidepressants, anxiolytics, or antipsychotic medications for people who demonstrate drastic behavior.
Alternative Treatments: Researchers believe that herbal remedies, dietary supplements, and certain foods can enhance memory and prevent Alzheimer’s. Some examples include coconut oil, coral calcium, and omega-3 fatty acids. To see an extended list, click here.
Are you a caregiver? There are several options available to help a loved one diagnosed with Alzheimer’s. These options include:
Minor Assistance: You can help your loved one with simple tasks like removing objects that could cause injury, maintaining smoke alarms and fire extinguishers, and keeping dark areas, like stairwells, well lit.
Home Care: Home health services and adult day centers are two options that can help with more intensive health and well-being tasks, while the patient is still living in the home.
Residential Care: Residential care is common in the later stages of Alzheimer’s. Residential care can include assisted living, nursing homes, and Alzheimer’s special care units. These options can help with tasks like meal preparation, dressing, bathing, and other everyday tasks.
Alzheimer’s, like other forms of dementia, will often require long-term care. The type of care someone will need will change as the disease progresses; so, at some point, outside care will probably be necessary.
Outside care options include nursing home care, assisted living, adult care services, and respite care. Caring for Alzheimer’s patients in a nursing home is necessary when caring for your loved one at home has become overwhelming.
Alzheimer’s and Dementia Care: Tips for Daily Tasks
The Mayo Clinic organizes tips for caring for some with Alzheimer’s into two groups: things to do to reduce frustration and guidelines to follow to ensure a safe environment.
A care plan to reduce frustration could include the following:
Creating a daily routine for the patient.
Allowing the patient to take their time.
Doing tasks that involve the patient.
Offering the patient choices, such as offering finger foods if it’s time to eat but they are not hungry.
Providing instructions that are easy to understand and simple to follow. Establish eye contact to make sure the patient understands what has been said.
Reducing napping time so that the patient remains aware of whether it is day or night.
Reducing distractions when they are eating, such as turning off the television during mealtime to make it easier to focus on eating.
Some safety tips on dealing with Alzheimer’s patients could include the following:
Preventing falls by avoiding things that could trip a patient up, like extension cords, and installing handrails in places like bathrooms.
Putting locks on all cabinets that could contain dangerous equipment or materials, such as guns, power tools, utensils, cleaning detergents, and so on.
Checking water temperature before showers or baths to avoid scalding.
Avoid accidental fires by supervising smoking.
Making sure all carbon monoxide detectors and smoke alarms have charged batteries.
When applying these dementia caregiver tips, the caregiver needs to be patient and flexible and be open to changing routines as the symptoms of the disease progress.
Caring for the Caregiver
Family caregivers, such as a son or daughter caring for an Alzheimer’s parent, must prepare for a series of distressing experiences as they watch their mother or father forget favorite family memories and lose practical self-care skills.
It’s often challenging dealing with an Alzheimer’s parent because of the overwhelming emotions, the fatigue, the isolation, and the financial complications. Still, it’s rewarding to bond with a parent by providing them with care and service and solving their problems.
There are also new relationships with others they meet in a similar situation through support groups.
Getting Help With Caregiving
Initially, family caregivers can reduce stress by sharing their caregiving challenges with their support groups.
However, caregiver stress will increase as the disease progresses. While medications used for Alzheimer’s will control some symptoms, they can only provide a limited amount of memory care support before a patient experiences significant memory loss.
Eventually, it will become necessary to consider outside care options, such as respite care, senior care, or moving the patient to a skilled nursing senior center.
For information or support on what to do when caregiving for an Alzheimer patient becomes difficult, visit the Alzheimer’s Association at www.alz.org.
Coping With the Last Stages of Alzheimer’s
Alzheimer’s disease and related dementias affecting older adults get severe during the last stages of the disease. Patients will need considerable support because they will lose touch with what is going on around them.
It can be difficult to figure out how to talk to someone with Alzheimer’s when they don’t respond to what is happening in their environment, can’t communicate any discomfort or pain, and have difficulty controlling their movements.
Legal and Financial Planning
Legal and financial planning for someone with Alzheimer’s requires a specialized lawyer because any general powers of attorney will not work for asset protection planning. A skilled and experienced lawyer is also necessary if the patient needs a health care power of attorney document.
Role of Medicare and Alzheimer’s
Original Medicare (Parts A and B) cover inpatient hospital care and some doctor’s fees associated with Alzheimer’s. Plus, Medicare will pay up to 100 days of skilled nursing home care in certain circumstances.
Long-term custodial care, like a nursing home, is not covered. Medicare will pay for hospice care in-home or at a hospice facility.
Some people with Alzheimer’s may be eligible for a Medicare Special Needs Plan. SNPs are a different type of Medicare Advantage plan and generally provide coverage for doctor visits, hospital services, and prescription drugs. Some of these plans can coordinate care services to help you better understand your condition and your doctor’s plan.
If you qualify for a Medicare Special Needs Plan, you may also qualify for a Special Enrollment Period. This means you can enroll or change Medicare plans throughout the year!
If you have any questions about Medicare Special Needs Plans or Special Enrollment Periods do not hesitate to contact us. Our licensed agents are contracted with all the major carriers across 38 states and can help you enroll in a plan that fits your needs and budget.
To schedule a no-cost, no-obligation appointment, click here or call us at 833-438-3676.
Medigap and Pre-Existing Conditions (& How it Impacts You)
A pre-existing condition is a medical condition that started before a person’s health benefits went into effect (like diabetes, COPD, cancer, sleep apnea, etc.) Some of the most common questions we get are, “Do pre-existing conditions impact your Original Medicare coverage? What is considered a pre-existing condition? How do Medigap and pre-existing conditions work?”
Original Medicare and Pre-Existing Conditions
Before we dive into Medigap and pre-existing conditions, let’s discuss the role of Original Medicare. A pre-existing condition cannot stop you from enrolling in parts A and B, and you will not be charged more due to your condition. This is great news for those who have been previously diagnosed with asthma, diabetes, cancer, or some other chronic health condition. However, your out-of-pocket costs can quickly add up if you’re only enrolled in Original Medicare. Fortunately, Medicare Supplements can help!
What are Medicare Supplements?
Medicare Advantage and Medicare Supplements are two very different types of plans. Medicare Advantage plans are stand-alone plans that offer the same benefits as Original Medicare. These plans often include extra health benefits like hearing, vision, dental, or group fitness classes (like SilverSneakers® and Silver & Fit®). Medicare Supplement (Medigap) plans offer financial protection but usually do not include additional health benefits.
You cannot be enrolled in a Medicare Advantage and Medicare Supplement plan at the same time. If you aren’t sure which type of plan is best for you, one of our licensed agents can help! To get started, click here or call 833-438-3676.
The average beneficiary enrolled in Original Medicare spends roughly $4,300 each year on premiums, deductibles, copayments, and other Medicare-related costs. Medicare Supplement (Medigap) plans can be purchased to work alongside Original Medicare to help cover these costs and provide financial protection through a range of benefits. These benefits include:
Blood work copays (up to three pints)
Foreign emergency travel
Hospice coinsurance and copayments
Part A coinsurance and hospital costs
Part A deductible
Part B coinsurance and copayments
Part B deductible
Part B excess charges
Skilled nursing facility coinsurance
There are ten different types of Medigap plans that you can choose from, and each plan offers a different combination of benefits. Generally, the more benefits a plan has, the higher the monthly premium will be. Medigap plans do not replace Original Medicare, and you must be enrolled in parts A and B first.
Popular Medigap Plans
The most popular Medigap plans are generally the ones that offer the most comprehensive coverage. They typically have higher monthly premiums, but they help you save money in the long-run. These plans include:
Plan F and Plan C are going away in 2020. They are the only two plans that cover your Part B deductible. Congress believed that covering the Part B deductible made the plan too inclusive, and people were encouraged to visit the doctor too often because it was practically free. If this specific benefit is important to you, you need to enroll before 2020. To get started, click here or call 833-438-3676.
Do Medicare Supplements Cover Pre Existing Conditions?
In general, if you enroll in Medigap when you are 65, you may not be penalized for preexisting conditions. However, if you are not yet 65 or if you wait too long, you may be charged more or denied based on your preexisting conditions.
However, if you can’t get a reasonably priced Medigap plan, there are hundreds of disabilities that are automatic qualifiers for Medicare Advantage Chronic Special Needs Plans. You do not have to be 65 to qualify for these plans as long as your disability is a qualifier.
Medigap Plans Eligibility
To be eligible for a Medigap plan, you must be enrolled in parts A and B first. Medicare Supplements are sold through private insurance companies. However, states are not required to sell Medigap plans to beneficiaries under 65. This means if you qualified for Medicare through ESRD (end-stage renal disease), ALS (Lou Gehrig’s disease), or SSDI (Social Security Disability Income) and are not yet 65, you can be denied a Medigap plan.
Medicare Supplements for Beneficiaries Under 65
When Can I Buy Medigap?
If you apply for a Medigap plan, you have certain rights guaranteed by federal law. These are called “guaranteed issue rights,” and they protect you from being denied healthcare. During your Initial Enrollment Period (IEP), you cannot be overcharged or denied access to Medigap based on pre-existing conditions.
You can purchase a Medigap plan year-around, but if you do not purchase a Medigap plan during your IEP, you can be denied coverage or required to pay a higher premium. This occurs through medical underwriting where the insurer can consider your age, gender, and pre-existing conditions you have been diagnosed with or treated for in the last six months. Plus, some insurers can refuse to cover your pre-existing condition for up to six months. This is called your waiting period. This can be avoided or shortened if you have had creditable health coverage. Insurers classify creditable health coverage to be any form of healthcare that has been active for at least 63 consecutive days.
Medigap Plan Finder
If a Medigap plan is something that sounds interesting to you, your best Medigap plan finder tool is a licensed agent! Our licensed agents are contracted with all of the major plans and carriers to eliminate any bias when showing you plan availability and costs. If you’re interested in speaking with a licensed agent or setting up an appointment, click here or call 833-438-3676.
This blog was originally published on 10/28/18, but was updated on 6/14/19.
Medicare for Diabetics and Diabetes Management
Diabetes is one of the largest health issues facing America and affects over 12 million older adults. In fact, the World Health Organization estimates that diabetes will be the seventh leading cause of death by 2030. The risk of developing diabetes increases with age, so it’s important to understand the role of Medicare and diabetes management.
Medicare for Diabetics and Medications
If you are diabetic, or even pre-diabetic, your doctor may prescribe you medications like:
Original Medicare (Part A and B) does not cover prescription drugs. If you are diabetic, you could end up having a high out-of-pocket cost for your medications. A Part D plan is a great alternative to help you save money and get the coverage for medications you need.
You can enroll in a Part D plan on top of your Original Medicare or purchase a Medicare Advantage plan. Medicare Advantage plans can offer benefits like prescription drug coverage, hearing, vision, or dental coverage and even things like meal delivery and transportation to doctor appointments or the pharmacy.
Without insurance, the most popular form of insulin (Lantus) can cost over $500. According to GoodRx, the average copay for Lantus is $37.50-$67.70 with insurance.
Original Medicare does not cover other forms of insulin including pens, syringes, or needles. If you need other forms of insulin, a Part D plan or a Medicare Advantage plan with a prescription drug benefit can help!
What does Medicare cover for diabetics?
Medicare Part B covers diabetes self-management training (DSMT) for those who were recently diagnosed. Part B will also cover:
However, there may be limits on how much or how often you can get these supplies.
Medicare Part D covers diabetes supplies including:
Inhaled insulin devices
Diabetic Supplies Delivered Directly to Your Door
You can get your diabetic supplies delivered directly to your door. However, you have to use an approved Medicare mail-order supplier if you want to utilize your Medicare coverage. If you prefer to purchase your supplies in a store, Medicare will cover the costs if you buy them at a Medicare-enrolled store or pharmacy.
Types of Diabetes and Symptoms
If you are diagnosed with diabetes, it means that your body struggles to process the sugars in the foods you eat. As a result, your blood sugar levels rise. This means your body cannot produce enough insulin (or produce it in the right way) depending on which type of diabetes you have.
Type 1 occurs when your pancreas cannot produce insulin (a hormone produced in the pancreas which regulates the glucose in your blood). It is typically developed at a young age and accounts for less than 10% of cases. If you have type 1, you will need to balance your blood sugar with insulin doses through a shot, pen, or pump. You will also need to pay close attention to the foods you eat and your daily activity level
Warning signs and symptoms of type 1 diabetes include:
Going to the bathroom more frequently
Having mood changes
Struggling to see or other vision problems
Losing weight without a change in diet or exercise
Type 2 is the most common type of diabetes and accounts for 90% of diabetic patients. On the bright side, it is the most preventable and treatable form of diabetes. Unlike type 1, people with type 2 can produce insulin, just usually not enough. This means insulin shots, pens, or pumps may not be needed. Instead, you can monitor your blood sugar and manage insulin levels through medication.
The warning signs and symptoms of type 2 are very similar to type 1, they just take longer to develop. These symptoms include frequent urinating, thirst, mood changes, vision issues, fatigue, and unexplained weight loss. Some symptoms can take several years to surface which means regular check-ups and monitoring your blood sugar levels is crucial, especially if you are diagnosed with prediabetes.
Another sign of type 2 is prediabetes. If you are prediabetic, you probably have high blood sugar, and your body will start to reject insulin slowly. However, your blood sugar levels are not high enough to be considered type 2 diabetic just yet. Eating better, exercising, and losing weight can help prevent the development of type 2 diabetes in the future.
Effects of Diabetes
All types of diabetes should be taken seriously as they can have severe complications and effects on your body. Without proper treatment and management, diabetes can lead to the following health issues:
Diabetes can raise your blood pressure and cholesterol. Nearly 75% of people with diabetes suffer from some sort of heart-related condition. This can include heart attacks, stroke, coronary heart disease, and many more.
Your kidneys are full of small blood vessels. Diabetes can damage these vessels, which impacts your kidney’s overall function. According to the National Kidney Foundation, 30% of type 1 diabetes patients will experience kidney failure.
Hypoglycemia is when your blood sugar levels reach a dangerously low level. These low levels can result in falls, seizures, or even cause you to enter a coma.
High blood sugars can make it difficult for your blood vessels to take blood to certain parts of your body. If blood does not get to certain nerve endings, they can be partially or permanently damaged.
Blurry vision is a warning sign of diabetes. This is because the blood vessels attached to your retinas are getting damaged. If diabetes is left untreated, this condition could worsen.
How to Test for Diabetes
If you have a body mass index over 25, are older than 45, or have been diagnosed with prediabetes, you should be tested for diabetes annually. The most common tests are as follows:
Glycated Hemoglobin (A1C) Test
This blood test shows your average sugar levels for the past 2-3 months. It measures the percentage of sugars attached to hemoglobin (an oxygen-carrying protein in red blood cells). The higher level of blood sugars equates to the higher number of hemoglobin with attached sugars. Two A1C tests of levels greater than 6.5% indicate diabetes. One A1C test between 5.7% and 6.4% indicates prediabetes. Anything under 5.7% is normal.
Random Blood Sugar Test
A random blood sugar test is exactly that – random. There is no fasting and it does not matter when (or what) you last ate. A blood sugar level of 200 mg/dL or higher indicates diabetes.
Fasting Blood Sugar Test
This test requires you to fast overnight. The next morning you take a blood sugar test. Sugar levels less than 100 mg/dL is normal. Anything between 100 and 150 mg/dL indicates prediabetes. If you take two separate tests at different times, and the results are over 126 mg/dL, you may have diabetes.
Oral Glucose Tolerance Test
This test requires you to fast overnight and check your blood sugar levels the next morning. Directly after, you will drink a sugary liquid. Over the next two hours, you will check your levels again. A level of less than 140 mg/dL is normal. After two hours, a level between 140 and 199 mg/dL indicates prediabetes, and anything over 200 mg/dL indicates diabetes.
How to Prevent Diabetes
You can’t change your genes, age, or past behavior, but you can take control of other factors, including:
Exercise: Did you know losing 10 kg (about 22 pounds) over a ten year period can lower your risk of diabetes by 33%? You should aim to get 30 minutes of exercise at least five days a week. If you haven’t been active, start slowly and work towards an overall goal.
Diet: A diet that is high in nutrients and low in glycemic loads are great for preventing diabetes. Green vegetables, beans, nuts, seeds, and fruit can help maintain your blood sugar. However, foods with added sugars, refined grains, and trans fats can have the opposite effect. Avoid fried foods and red meats when possible. Try a healthy soup!
Stress Less/Sleep More: When you are sleep deprived or have unusual sleep patterns, you increase your risk of obesity. As we previously mentioned, obesity plays a large factor in developing diabetes. Stress can impact your sleep schedule and make you toss and turn in the night. Plus, stress releases several hormones that increase your blood sugar. Pay attention to your sleep patterns and stress levels and visit a doctor if you have continued issues.
Diabetes and Medicare Coverage
Diabetes costs America more than $327 billion every single year. If you are diagnosed with diabetes, you may have high out-of-pocket costs. As we mentioned, Part D and Medicare Advantage plans can help save you money and provide the benefits and coverage you need. If you have any questions, or interested in enrolling in a Part D or MA plan, fill out this form or call us at 844-431-1832.
Shingles in the Elderly: Signs & Prevention
According to the Centers for Disease Control and Prevention, nearly one-third of people in the United States will develop shingles at some point in their life. The risk of developing shingles increases as you age and is more likely in those who have had the chickenpox (Varicella) virus. Prepare yourself now by learning everything you need to know about shingles in the elderly.
Shingles is caused by the varicella-zoster virus and results in painful blisters on your body. This is the same virus that causes chickenpox. If you had chickenpox, the virus remains inactive in nerve tissue near your spinal cord and brain. Years later, this virus can reactivate as shingles. What causes the dormant virus to reactivate? The exact reason is unclear, but researchers suggest that weakened immune systems, certain diseases such as HIV/AIDS or cancer, radiation, chemotherapy, and certain medications, like steroids, can contribute to the development.
Shingles can result in severe complications, the most common being postherpetic neuralgia (PHN). Those with PHN continue to have pain on the surface of their skin even after the blisters have subsided. PHN can take weeks, months, or even years to resolve. Other shingles complications include vision loss, facial paralysis, balance problems, and bacterial skin infections.
How long does shingles last in the elderly?
The average case of shingles lasts between three to five weeks. According to the National Institute on Aging, shingles follows a pattern. The first sign of shingles is often an itching or burning sensation on the side of the body. About one to five days later, a red rash will start to develop. A few days after that, the rash will turn into blisters. These blisters will last for roughly ten days before drying up and scabbing. Within a couple of weeks, the scabs should clear up. In some cases, shingles can then lead to other conditions (like PHN, mentioned above) that can last longer, but the shingles virus should clear up after about five weeks. Most people only get shingles one time, if at all, but it is possible to develop shingles more than once.
Shingles in the Elderly Symptoms
There is no cure for shingles, but early treatment can help fight the virus and limit the amount of pain you have. It’s important to understand the symptoms so you can talk to your doctor as soon as possible. Common shingles in the elderly symptoms include:
Burning, itching, or numbing area on the skin
Is shingles contagious to the elderly?
No. Shingles itself cannot be passed from one person to another. However, the virus that causes shingles can be spread through direct contact with the fluid from the blisters. A person with shingles is only contagious during the blistering phase. However, only those who have not had the chickenpox can contract the virus this way, and they would develop chickenpox as a result. Those who had chickenpox previously actually already have the virus, though it is inactive! If a person who has had chickenpox develops shingles, it will most likely be from the virus that is already in the body, not through contact with someone else who has shingles.
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Shingles in the Elderly Prevention
Preventing shingles can be difficult, especially since those who have had chickenpox already have the virus in their body! However, there is a vaccine that can drastically lower your risk of developing shingles. The vaccine is recommended for those over the age of 50 and it comes in two doses. The second dose should be administered between two to six months after the first. The shot doesn’t completely eliminate your risk for shingles, but it lowers your risk and can reduce the severity of the virus if it does surface.
Original Medicare (Part A and B) does not cover the shingles vaccine. However, a Medicare Advantage or Part D plan may cover it! These plans are great options that include coverage beyond Original Medicare and help you live the healthiest life possible! Our agents can help you understand all of your plan options and enroll you in a plan that fits your specific needs and budget. If you interested in arranging a no-cost, no-obligation appointment, fill out this form or call at us 833-438-3676.
Vitamin D for Seniors and Medicare Eligibles
Vitamin D, also known as the “sunshine vitamin,” is essential. It helps absorb calcium, which is necessary for bone health and strength. Over an extended period of time, vitamin D deficiency can result in obesity, diabetes, hypertension, depression, Osteoporosis, and more. Vitamin D for seniors and Medicare eligibles becomes increasingly important with age, so it is important to understand the recommended dosage and the symptoms of deficiency.
Why is Vitamin D Important in the Elderly?
If you are deficient in vitamin D, your body may start to lose bone tissue. This can lead to bone pain, muscle weakness, and even skeletal deformity. Seniors and Medicare eligibles who get the recommended dose of vitamin D every day are more likely to lower their risk of cardiovascular issues, cancers, bone disorders, and diabetes. Plus, it can lower the chance of early nursing home admission, encourage physical independence, and act as a form of fall prevention.
How Much Vitamin D Does a Senior Need?
It can be extremely difficult to get enough vitamin D through diet alone. Sunshine and vitamin D supplements are beneficial alternatives. The recommended dose of vitamin D for seniors age 70+ is, at a minimum, 800 IU* per day. For those less than 70 years old, the adequate intake is, at a minimum, 600 IU per day. Blood tests are a great way to see if you are getting the right amount of vitamin D. However, it’s important to understand that you can have too much vitamin D. An excess can cause vomiting, weakness, and excess urination. Your daily vitamin D intake should never exceed 4,000 IU per day.
*IU stands for international units and is used to measure fat-soluble vitamins. This includes vitamins A, D, and E. You will notice that these vitamins will use “IU” on their labels instead of MG.
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Typical D3 Dosage for Seniors and Medicare Beneficiaries
There are two main forms of vitamin D for seniors and Medicare eligibles – vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). D2 can be found in plant foods like mushrooms and D3 can be found in sunlight and animal foods like salmon or eggs. D2 does not occur naturally in your body, but D3 is produced in the skin when exposed to sunlight. Experts believe that D3 is at least three times more potent than D2 and is more stable, safe, and beneficial to the body.
Symptoms of Vitamin D Deficiency in Elderly People
Vitamin D Deficiency in elderly people is common due to smaller food intake, less exposure to sunlight, and reduced skin thickness. It’s important to listen to your body so you can take the proper steps to rectify the issue. Symptoms of vitamin D deficiency in elderly people include:
In general, adults often feel their muscles get heavier with age. This can actually be linked to a Vitamin D Deficiency. This means that if you have difficulty standing up or climbing the stairs, you may not be getting enough vitamin D.
Vitamin D makes sure your immune system is strong and helps fight off illness-causing viruses and bacteria. If you get sick easily and often, especially with colds or the flu, low vitamin D could be a contributing factor. Plus, researchers have found links between vitamin D deficiency and respiratory infections. Studies have shown that increasing your vitamin D intake can decrease your risk of infection.
Researchers claim that vitamin D and a hormone called leptin work together to regulate your weight. Leptin works by signaling your brain that you are full and to stop eating. If you are deficient in vitamin D, the leptin signaling process may not function properly. Overeating and weight gain can be an indicator that you need more vitamin D.
There are many reasons you may be feeling tired, but a vitamin D deficiency is often overlooked. There have been several observational studies that show correlations between low vitamin D levels and fatigue. When the vitamin D dosage was increased, the tiredness and fatigue subsided.
Since vitamin D is a fat-soluble vitamin, a deficiency can trigger digestive problems like inflammatory bowel disease. Digestion problems can be extremely uncomfortable and negatively impact the fat absorption process.
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Medicare Advantage and Part D Plans
If you think you may have a vitamin D deficiency, visit your doctor before taking corrective action. A blood test is the most accurate way to measure vitamin D in your body. Unfortunately, in most cases, Original Medicare only covers blood tests for at-risk individuals.
Medicare Advantage plans can provide additional coverage for bloodwork. In some cases, MA plans with prescription drug coverage will even include some coverage for over-the-counter medications like vitamin D supplements! Talk to a licensed agent about finding out whether a plan in your area offers these benefits. A great first step is to download our Part D checklist that can help you figure out what prescription coverage you need out of your health care plan.
Our licensed agents can help you understand all of your plan options and enroll you in a plan that fits your needs and budget. If you’re interested in arranging a no-cost, no-obligation appointment, fill out this form or call us at 833-438-3676.