Understanding Medicare Part B – Coverage and Costs for 2020

What Is Medicare Part B?

Medicare is a federal government health insurance program for seniors 65 and older and others who meet qualifying conditions.

Medicare consists of four parts, labeled A, B, C, and D. Parts A and B make up the government-funded “Original Medicare” program. Part C refers to “Medicare Advantage” plans, which provide additional medical insurance. Part D refers to separate prescription drug Medicare plans. 

Part A covers costs associated with hospitals and other inpatient services. It’s complemented by Part B, which covers outpatient services, preventative care, and durable medical devices.

Some people are automatically enrolled in Parts A and B while others must enroll on their own. 

What is the difference between Part A and Part B Medicare?

Part A is often referred to as Medicare “hospital insurance,” while Part B Medicare coverage is often referred to as “medical insurance.” What this means is that while Part A can cover hospital stay charges, Part B can cover your doctor’s appointments and preventative care. If you had Part A only, you would have coverage for hospital care, but not any of your doctor’s appointments, so it’s important to enroll in both. 

Medicare Part B Coverage

At this point, you’re probably wondering, “what does Part B of Medicare pay for?” 

Medicare Part B covers ambulance services, doctor visits, preventative services, mental health, women’s health services (like mammograms), lab tests and X-rays, some medical equipment, and more. It does NOT cover hospital stays or most prescription drugs. The only time that Part B will cover drugs is if the drug is administered by a medical professional.

Medicare Part B Drugs

Here is a list of drugs covered by Medicare Part B:

  • Drugs used with durable medical equipment, like nebulizer supplies
  • Antigens, when prepared and administered by a doctor
  • Injectable osteoporosis drugs if medically necessary 
  • Erythropoiesis-stimulating agents for those with ESRD or anemia related to other conditions
  • Oral ESRD drugs
  • Blood clotting factors for those with hemophilia
  • Other injectable and infused drugs when given by a medical professional

Preventative Services and the Annual Wellness Visit

Medicare Part B includes 100% coverage for several preventative services.

For example, when you first enroll in Part B, you can make a “Welcome to Medicare” appointment with your doctor. This will be a comprehensive overview conversation with your doctor about your healthcare needs and concerns.

You will also be eligible for an Annual Wellness Visit. This is more in-depth and includes a health risk assessment, a review of your and your family’s medical history, measurements (height, weight, BMI, blood pressure, etc.), mental health screenings, and a general conversation about your daily health concerns.

Also included under Part B at 100% coverage are your preventative vaccines, such as annual flu shots. However, some vaccines that are not considered preventative measures are not included under Part B coverage.

For example, the Shingles vaccine would be covered under Part D coverage instead of Part B.

Preventative services are also covered for:

  • high blood pressure
  • high blood sugar
  • abnormal cholesterol
  • obesity
  • glaucoma
  • depression
  • cardiovascular disease
  • HIV
  • smoking and alcohol cessation
  • various cancers

Women are covered at 100% for pap smears, pelvic exams, and breast exams every two years. If you are diagnosed as at-risk for gynecological conditions, you may be able to receive screenings every year instead.

Mental Health

Medicare Part A covers inpatient mental health care. Part B covers outpatient mental health services, including:

  • No-cost yearly depression screenings
  • Both individual and group psychotherapy (including family counseling)
  • Psychiatric evaluations and diagnostic tests
  • Certain prescriptions
  • Medication management
  • Limited partial hospitalization
  • Partial hospitalization refers to psychiatric hospital treatments that don’t require an overnight stay. Items like meals, transportation, and support groups are not included.

You will only receive coverage when you see a doctor or specialist who accepts Medicare. You will be responsible for 20% of most of these services. There may be additional co-payments or coinsurance for partial hospitalization.

IMPORTANT: If you or a loved one is in immediate crisis, call the National Suicide Prevention Lifeline immediately at 1-800-273-8255 (TTY 1-800-799-4889). Help is available 24-7.

Laboratory Tests and X-Rays

When your doctor orders a lab test to help diagnose a condition or as part of your annual checkup, you are covered under Part B. Medically necessary blood tests and other diagnostics sent to a lab are covered.

They include blood work, urine tests, tissue lab work, and some screenings at no cost to you.

Blood for transfusions is handled differently. If you get a transfusion through a blood donation, you may not have to pay anything. Otherwise, you may have to pay 20% of the Medicare-approved amount.

X-rays are also covered but at 80% of the Medicare-approved amount. You are responsible for the other 20%.

Emergency Transportation

Part B can cover emergency transportation if other transportation could put you in danger or you are having a medical emergency and need immediate assistance. It will only cover an ambulance ride to the nearest medical facility that can give you the type of care you need.

You cannot request to visit a hospital that is further away.

Air transportation is covered only if you need to get to a facility quickly and cannot do so by ground transportation (heavy traffic, inaccessible road conditions, etc.)

Transportation is covered at 80% of the Medicare-approved amount, and your Part B deductible will apply.

In some cases, Part B may cover non-emergency ambulance transportation if there is no other safe way for you to get to a hospital or other provider office for medically necessary services.

You will need to schedule your ambulance transportation in advance by reaching out to a non-emergency ambulance transportation company like ACC Medlink and Lifeguard.

The company you select may charge a fee and can contact Medicare to request authorization for coverage.

Durable Medical Equipment

Part B will only cover durable medical equipment.

For an item to be considered durable medical equipment (DME), it must be able to withstand repeated use for at least three years, must be usable at home, and must be used for a medical purpose only. Medicare will cover 80% of the cost.

In some cases, you may be able to choose whether you want to rent or purchase the equipment you need.

Some examples of DME include:

  • Blood sugar test strips and monitors/glucose control
  • Canes, crutches, scooters, walkers, and wheelchairs
  • Continuous passive motion machines
  • Continuous positive airway pressure devices (CPAP)
  • Commode chairs
  • Hospital beds
  • Infusion supplies
  • Lancets and lancet devices
  • Nebulizers and related medication
  • Nutrition supplies/equipment

Check with your doctor or Medicare to see if an item is considered a DME or not.

Long-Term Care

Part B covers some home health care, but only that which is relatively short-term and related to a limited period of recovery due to an illness, injury, or condition. Part B does not cover long-term care, either at home on in a nursing facility, that people may need due to frailty or because they need help with daily activities (bathing, grooming, eating, etc.)

What isn’t covered by Medicare Part B

Medicare Part A and Part B are structured to work together to provide maximum coverage at an affordable cost for most Americans.

This coverage is enhanced by adding optional Part C Medicare Advantage or Medicare Part D drug plan coverage.

In general terms, Part A covers in-hospital expenses, and Part B only covers outpatient expenses, durable medical equipment, and wellness activities.

Medicare does not cover anything not considered medically necessary. That includes elective and cosmetic surgery and several forms of alternative medicine such as homeopathy, acupuncture, and acupressure. Chiropractors are covered on a limited basis.

Other than flu and pneumonia shots, Medicare does not cover vaccinations and immunizations. The exception is if there is a health emergency, and vaccinations are required to stem the risk of infection through a contagious disease.

Part B also only covers drugs you can’t self-administer. Coverage is only provided if you receive medications in a hospital, doctor’s office, or health clinic. This is where Part D coverage can come in handy. All nonprescription drugs and remedies are also not covered under Part B.

General dental work is also not covered, unless it would need to be performed by a physician, meaning the treatment would be considered medical vs. dental

Part B also does not cover vision care, hearing aids, or contact lenses, except those required after cataract surgery. But if your eyes are affected by an illness or injury other than a routine loss of vision, you will be covered for ophthalmological services.

Routine foot care is also not covered unless a foot condition is the result of conditions such as diabetes, cancer, multiple sclerosis, inflammation due to blood clots, chronic kidney disease, malnutrition. Care must be diagnosed as medically necessary.

Except in rare circumstances, medical services outside of the United States and its territories are not covered as well. You will need to enroll in a Medicare Advantage plan for international coverage.

Medicare Part B costs in 2020/2021

Medicare premiums, copayments, and deductibles are adjusted annually according to the Social Security Act. What will Medicare Part B cost 2020 enrollees?

In 2020, the standard monthly premium is rising by about 7% due to increased program costs, up to $144.60. If you already get Social Security or Railroad Retirement benefits, your premium can be deducted from those. Social Security Medicare Part B payments will be automatic for most people. 

The standard deductible is $198. After you pay your deductible, you’ll have to pay 20% for most Medicare Part B services, other than preventative and wellness services detailed above.

There is no income limit for Medicare Part B, but if you have a high gross income, you could be required to pay an Income-Related Monthly Adjustment Amount (IRMAA).

Some people may purchase a Part C plan that offers low deductibles and copays. You will pay a Part C premium, but you could wind up with more comprehensive coverage that will significantly augment existing Part A and B coverage and provide Part D prescription drug coverage as well.

Who qualifies for free Medicare B?

Unlike Medicare Part A, the amount of time you’ve worked does not affect your Part B premiums. Most people will have to pay a premium for Medicare Part B. To qualify for free Part B, you’ll have to qualify for one of the following programs:

  • The Qualified Medicare Beneficiary Program (QMB) helps pay premiums for Part A and Part B, as well as copays, deductibles, and coinsurance.
    • Individual monthly income limit = $1,060
    • Married couple monthly income limit = $1,430
    • Individual resource limit = $7,730
    • Married couple resource limit = $11,600
  • The Specified Low-Income Medicare Beneficiary Program (SLMB) offers premium assistance for Part B. If you are eligible for an SLMB, you also are automatically eligible for an Extra Help program to assist in Part D prescription drug coverage.
    • Individual monthly income limit = $1,269
    • Married couple monthly income limit = $1,711
    • Individual resource limit = $7,730
    • Married couple resource limit = $11,600
  • The Qualified Individual Program (QI) also helps pay Part B premiums. To apply, which you must do every year, contact your state Medicaid program. Enrollments are on a first-come, first-served basis.
    • Individual monthly income limit = $1,426
    • Married couple monthly income limit = $1,923
    • Individual resource limit = $7,730
    • Married couple resource limit = $11,600

Eligibility for Medicare Part B

Medicare Part B eligibility is based on age, citizenship, retirement benefits, and qualifying illnesses. You are eligible for Medicare Part B if:

  • You are 65 or older and a U.S. citizen or permanent legal resident.
  • You are younger than 65 and have qualifying disabilities or suffer from End-Stage Renal Disease or Amyotrophic Lateral Sclerosis (ALS, Lou Gehrig’s disease).
  • You are eligible to receive, or you’re currently receiving Social Security or Railroad Retirement Board benefits.

Check your eligibility by going to the Medicare Eligibility and Premium Calculator.

Medicare Part B Enrollment

If you are aging into the Medicare program, you should enroll in Part B any time between three months before your 65th birthday to three months after. 

One question we hear a lot is, “I already have Part A, can I add Medicare Part B anytime?” Unfortunately, it’s not that simple. If you choose to forgo Medicare Part B when you first became eligible, you could face a late enrollment penalty fee later. Additionally, if you don’t enroll when you first become eligible, you’ll have to wait for the open enrollment period from January 1 through March 31 to enroll.

If you get Social Security or Railroad Retirement Board benefits for at least four months before your 65th birthday, you’ll automatically be enrolled in Part A and Part B coverage. Coverage starts the first day of the month you turn 65.

When you’re under 65, you have a disability, and you have been getting SSDI benefits for at least 24 months, you are automatically enrolled in Part A and Part B. If you suffer from Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s disease), you are automatically enrolled in Part A and Part B the month your disability benefits begin.

If you have been diagnosed with End-Stage Renal Disease (ESRD), you can enroll in Part A and Part B. To get full benefits that cover dialysis and kidney transplant benefits, you’ll need to be covered by both.

Check with Medicare.gov, because there are several stipulations regarding coverage for ESRD.

You can enroll in Part B during your Initial Enrollment Period (IEP), the General Enrollment Period (GEP), or during Special Enrollment Periods (SEP) if you qualify.

You can sign up for Part B benefits the following ways:

  • Apply online at Social Security.
  • Enrolling at your local Social Security office.
  • Call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778).
  • If you worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772.

Medicare Part B phone number: For questions about Medicare Part B billing, call 1-800-833-4455.

What happens if you don’t sign up for Medicare Part B?

While you are technically not required to sign up for Medicare Part B, you may face a late enrollment penalty fee if you wait too long to enroll. This will come in the form of a premium increase of as much as 10%. 

Can I delay Medicare Part B coverage?

You can delay signing up for Part B coverage, but if you enroll at a later date, you may have to pay an enrollment penalty. This penalty will be in force for the entire time you have Part B coverage.

When you delay Part B coverage, it also means you can’t sign up for a Part C Medicare Advantage plan. One of the requirements for Part C is that you must currently be enrolled in Parts A and B.

Additionally, if you miss your initial enrollment period for enrolling in Part B, you’ll have to wait until the enrollment period from January 1 through March 31 to enroll. 

Can I decline Medicare Part B coverage?

Is it mandatory to have Medicare Part B? No. But make sure you do your homework first and take into consideration your long-term health needs.

Although you have to pay a premium in many cases for Part B coverage, it still makes sense to enroll for a vast majority of people.

Spouse Medicare 101

Spouse Medicare 101

Medicare is different from other forms of insurance in a lot of ways. One of the biggest differences is that there are no family plans in Medicare. All Medicare coverage is individual-based. 

However, even though Medicare and marriage are not directly related, your marital status can impact your Medicare costs in a few special ways. 

Does Medicare Offer Spouse Coverage?

Medicare does not offer health coverage for spouses. You would have to be eligible on your own to qualify for Medicare – your spouse’s eligibility does not affect yours. 

According to the rules set in place by the Centers for Medicare & Medicaid Services, marriage can affect your Medicare in the following ways:

  1. Eligibility for Medicare cost savings can change due to your spouse’s income
  2. Your Part D (prescription drug plan) premiums can be higher due to your spouse’s income
  3. Premium-free Part A eligibility can be determined based on your spouse’s work history if they worked more than you.

So, can you get Medicare through your spouse? Not technically, no – but your marital status is not irrelevant.

Medicare if Spouse is Disabled

If one spouse is 65 and begins receiving Medicare and the other is not yet 65, there may be other ways to qualify. If you are diagnosed with ESRD or ALS or if you have been receiving SSDI (Social Security Disability Insurance) for at least two years, you can qualify for Medicare regardless of your age. 

The good news is that if you do qualify for Medicare based on a disability, you may also qualify for a Medicare Special Needs Plan at a low cost.

Medicare Eligibility Requirements

The “main” Medicare program is called “Original Medicare.” You can qualify for Original Medicare by:

Unlike Medicaid, income does not impact Medicare eligibility. Additionally, unlike ACA plans, pre-existing conditions do not affect your Medicare costs or coverage. The only exception to this is in private Medigap (or Medicare Supplement) plans. If you do not enroll in a Medigap plan when you first become eligible for Medicare, you can be charged more based on your health history. Medigap plans are completely optional and are there for additional financial protection.

You can qualify for additional health and drug coverage through Medicare Advantage plans or Medicare prescription drug plans after you’ve enrolled in Original Medicare. Those plans cannot charge more based on your age or preexisting conditions. 

Spouse Social Security Benefits

Even though the Social Security Administration manages Medicare enrollments, Social Security and Medicare are two vastly different things. There are a few differences in how your marital status affects your benefits. 

For Social Security, your benefit is calculated based on your total household income according to your tax returns. That includes both your and your spouse’s income. Both you and your spouse can benefit from Social Security, even after one spouse has passed away

Medicare does not work like that. Your marital status and income do not impact your eligibility, and there are no additional Medicare benefits given to a spouse after a Medicare beneficiary passes. 

Medicare & Health Insurance Options for Spouse of a Medicare Recipient

If one spouse is ineligible for Medicare and needs to find a different health plan, don’t panic – there are plenty of options for health insurance for the spouse of a Medicare recipient. You might want to start by checking to see if that spouse is eligible for Medicaid based on your total household income. If the answer is no, you’ll want to start looking at individual health plans in your area, which you can do through healthcare.gov/

If the Medicare spouse has insurance through an employer when they become eligible for Medicare, the non-Medicare eligible spouse can also try getting COBRA until they are also eligible for Medicare. COBRA allows an individual, couple, or family to continue health coverage after leaving a job. However, keep in mind that even if you’re able to keep your health plan through COBRA, your costs may go up because your employer won’t be sponsoring the plan for you anymore. 

Can my Wife get Medicare at 62?

To get Medicare, you have to either be 65 or have a qualifying disability. 

If your husband or wife is just a few years short of Medicare eligibility, they can select an ACA plan or enroll in a short-term health plan. Short-term medical insurance can be renewed for up to 36 months, so it’s a good option if you’re within 36 months of becoming eligible for Medicare. Since these plans are designed for such short periods of time, they tend to be a bit cheaper than long-term plans, like the ones offered by your employer or the ACA. 

Can a Non-Working Spouse Qualify for Medicare?

People often wonder if Medicare is available for their non-working spouse. In short: yes, as long as they meet the age or disability requirements. However, your spouse’s costs may be different from yours. Your employment status does not determine your Medicare eligibility – but it can determine your Medicare costs as such:

  • If you or your spouse has worked and paid Medicare taxes for at least 40 quarters, you can qualify for premium-free Medicare Part A
  • If you or your spouse has worked and paid Medicare taxes for 30-39 quarters, you can qualify for a discounted Medicare Part A premium of $252/month in 2020
  • If you and your spouse have worked and paid Medicare taxes for less than 30 quarters (or have not worked at all), your Medicare Part A premium will be $458/month in 2020

Can my Wife get Medicare if she Never Worked?

Employment and marital status do not impact Medicare eligibility. Even someone who has never worked a day in their life can get Medicare, but their costs may be higher than someone who has been paying Medicare taxes.

Medicare vs. Medicaid

Unlike Medicare, your Medicaid coverage can be impacted by your marital status. While each state has somewhat different regulations, most of Medicaid eligibility is based on the Federal Poverty Line. Your income is calculated using your total household income, which is verified with your tax returns. Both your and your spouse’s income are included. That means that even if you qualify for Medicaid based on your income, you won’t be eligible if you and your spouse’s total income together is higher than your state’s limits.

How to Apply for Medicare Through a Spouse

You cannot apply for Medicare through your spouse. You’ll have to wait until you are eligible and then apply during your Initial Enrollment Period. If you qualify by turning 65, this period begins three months before your 65th birthday and ends three months after. If you miss that period, you can apply during the Open Enrollment Period from January 1 through March 31. To apply for Medicare online, visit the Social Security website, not medicare.gov. 

How do I Apply for Spousal Medicare Benefits?

There are no spousal Medicare benefits – but you can apply for spousal Social Security benefits, here.

What is Not Covered Through Your Spouse’s Medicare?

Your spouse’s Medicare plan won’t provide health coverage for you. If you’re looking for Medicare for spouses, you’ll have to wait until the other spouse is eligible. Then, you can talk to an agent about finding separate plans that work for both of you and both fit into your household monthly budget. 

Medicare Family Coverage

In general, Medicare is not available to non-qualifying spouses or dependants. However, if your child has a qualifying disability, they may be eligible for a Medicare plan of their own. Note that except for in the cases of ALS and ESRD, you will have to receive disability benefits for at least two years before you can enroll in Medicare. 

How Does Getting Married Affect Medicare?

Getting married? Congrats! A new marriage often involves complicated discussions about finances, and you might be wondering, “will getting married affect my Medicare benefits?” The good news is that no, marriage does not affect your current Medicare benefits – but it CAN impact your eligibility for Medicare cost savings programs. For example, Medicare Savings Programs and Low-Income Subsidies for Medicare prescription coverage base eligibility on total household income. If your new spouse causes your household income to increase, you could become ineligible for these programs. 

If you’re not yet 65, you might be wondering, “will I lose my disability Medicare if I get married?” No! Even if you are qualifying for Medicare based on disability and not age, your Medicare coverage won’t change based on your marital status. 

Medicare Premium Payments: How Much Does Medicare cost for a Married Couple?

How much does a married couple pay for Medicare? Medicare is 100% individual, so each spouse will have to pay their own premium. There are no joint plans with joint costs.

Your Medicare Part A monthly premium will depend on your and your spouse’s work history and will range between $0 and $458 per month in 2020. Your Medicare Part B premium will be $144.60 in 2020 (unless you qualify for savings programs or have your premium covered by a Medigap plan). If you have Medicare Part D prescription drug coverage or either a Medicare Supplement or Medicare Advantage plan, you’ll pay a separate premium for those plans.

Do Husband and Wife pay Separate Medicare Premiums?

Yes – families and spouses cannot have joint Medicare plans. All premiums will be separate. Some people will have their premiums automatically deducted from their Social Security benefits. 

How Your Spouse Might Affect how Much you Pay

Your spouse can reduce your Part A premium amount if they have worked more than you. Additionally, your spouse’s income can affect your eligibility for assistance programs such as Medicare Savings Programs, Medicaid, and Medicare Extra Help.

Medicare Plan Spousal Discounts

While Medicare does not provide spousal benefits, there are some plans that offer household discounts for plan premiums. You should always confirm with your agent whether or not a household discount exists as some companies may have specific requirements regarding spousal discounts.

Medicare Extra Help and Income Limits

The one thing that marriage will affect when it comes to Medicare is whether or not you qualify for the Extra Help Program, otherwise known as Low-Income Subsidy (LIS). LIS exists to help people with limited income pay for their prescription drugs. Those who qualify for the program pay less in drug premiums, copayments, and coinsurances.

Single and married beneficiaries have different requirements for what constitutes a low-income level. For example, to qualify for LIS (a prescription drug savings program) in 2020, single beneficiaries must make less than approximately $19,000 per year, but married couples must make less than approximately $26,000 per year.

Meet with one of our agents to find out if you qualify for savings.

Joint Meeting with a Licensed Agent

Even if you and your spouse have different Medicare plans, you can still share an agent! Sharing an agent will make your enrollment process easier and help you build a relationship with someone who knows everything about Medicare plan options and can help you find savings.

Do you have a licensed agent? Have more questions about spouse Medicare? Give us a call today to set up a free meeting. Our agents are licensed to sell several different insurance plans, so they can offer you an unbiased opinion and help you find the plan that truly works best for your needs. Call us at 1-844-431-1832.

How to Find a Medicare Office Near You

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

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

Find a Medicare Office

Why and How to Contact Medicare

Calling 1-800-MEDICARE allows you to:

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

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

Medicare Office Hours

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

Medicare Phone Number

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

Medicare Mailing Address

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

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

Medicare Contact Center Operations

PO Box 1270

Lawrence, KS 66044

____________________________

Regional offices are as follows: 

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

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

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

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

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

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

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

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

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

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

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

Can you get Medicare Online?

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

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

Senior stylish woman taking notes in notebook while using laptop at home. Old freelancer writing details on book while working on laptop in living room. Focused cool lady writing notary in notepad.

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

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

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

Does Medicare Cover Physical Therapy?

Does Medicare cover physical therapy? It depends. Medicare can help pay for physical therapy, which may be a crucial part of injury or surgery recovery. However, Medicare’s coverage has limits.

Every Medicare beneficiary begins with Original Medicare, which includes Part A, hospital coverage, and Part B, medical coverage. Most physical therapy services will fall under Medicare Part B – however, there are specific Medicare guidelines for physical therapy in-home health services and doctor services.

It can be confusing to navigate the different coverage caps and figure out what Medicare therapy coverage you have. Let’s break it down.  

Does Medicare Cover Physical Therapy for Back Pain?

Back pain is one of the most common symptoms that leads to physical therapy. As you age, back pain is almost inevitable. It’s easy to fall into bad habits and poor posture. If you have back pain that lasts for a few weeks or longer, most doctors will recommend physical therapy.

A licensed and professional physical therapist will not only help you decrease pain but also educate you on how to prevent back pain in the future. He or she may even teach you some physical therapy exercises to perform at home.

Alternatively, seniors and Medicare eligibles who have a hard time getting to a doctor’s office may opt for a home nurse who is licensed to assist with physical therapy. In most cases, if your home nurse happens to double as a physical therapist, you will be covered under Part B.

Unfortunately, these services are not free.

Medicare Physical Therapy Cap 2020 | Medicare Plan Finder
Medicare Physical Therapy Cap | Medicare Plan Finder

How Much Does Medicare Pay for Physical Therapy?

Medicare Part B will cover your medically necessary outpatient therapy (physical, speech-language pathology, occupational) at 80 percent, you will likely be responsible for 20 percent of all Medicare-approved costs. 

The Physical Therapy Cap

The Medicare physical therapy cap was eliminated by the Bipartisan Budget Act of 2018.

Previously, Medicare only covered up to 80 percent of $2,040 ($1,608) for physical and speech-language therapy services and another 80 percent of $2,040 ($1,608) for occupational therapy services. That meant that, for example, if your physical therapy appointments cost you $100, Medicare would have only covered about 20 visits per year.

Beneficiaries were receiving notices titled, “Advance Beneficiary Notice of Noncoverage.” The notice will tell you what Medicare will can or cannot continue to cover so that you can make informed choices about whether or not you want to continue your physical therapy.

Thankfully, physical, occupational, and speech therapy patients with Medicare won’t have that problem in 2019.

Medicare Physical Therapy Billing

Medicare Physical Therapy Caps 2020 | Medicare Plan Finder
Medicare Physical Therapy Caps | Medicare Plan Finder

When it comes to paying the bills for your physical therapy, you may want to consider adding either a Medicare Advantage plan or a Medicare Supplement plan. Even though Original Medicare Part B covers physical therapy, the cap will hold you back. Adding Medicare Advantage or Medicare Supplements may give you the coverage you need to pay the bills.

The good news is that everyone who is eligible for Original Medicare is also eligible for Medicare Advantage and Medicare Supplement plans. You can’t have both, so you’ll have to choose one.

Medicare Advantage plans are offered by private insurance companies and are designed to add additional covered services like dental, vision, hearing, fitness.

Alternatively, Medicare Supplement plans do not provide coverage for additional services but instead provide additional financial coverage. These plans are designed to help you pay for your coinsurance, copayments, and deductibles. You’ll have to decide what makes the most sense for you and your needs: more financial coverage, or more covered services?

Common Conditions That Physical Therapy Can Treat

Physical therapists can help treat a wide variety of medical conditions, depending on their specialty.

Some conditions that can benefit from physical therapy are:

Other conditions that may benefit include burns, wound treatment, and diabetic ulcers.

What Are the Benefits of Physical Therapy?

Depending on the your reason for treatment, physical therapy benefits can include:

Your physical therapist can discuss the physical therapy benefits specific to your condition and personal medical history.

Does Medicare Cover Transportation to Physical Therapy Appointments?

Original Medicare does not cover non-emergency medical transportation. Some Medicare Advantage plans can cover Medicare transportation benefits including travel to and from doctor’s appointments.

How to Find a Physical Therapist Who Accepts Medicare

Finding a local physical therapy practice that takes Medicare may be easier than you think. If you’re looking for physical therapy near you, click here to get started. Medicare.gov’s Physician Compare website allows you to find providers who specialize in the services you need including physical therapy.

Enter your zip code beside the red arrow. We used our home office’s zip code in Nashville, Tennessee, which is 37209. Then type “physical therapy” in above the yellow arrow. After that, click “Search” beside the orange arrow.

How to Find a Physical Therapist Who Takes Medicare Step 1 - Medicare Plan Finder

You confirm the service you need on the next page. If the boxes beside “Physical Therapy” and “Select all specialties related to ‘physical therapy'” are white, click in them to make both boxes have check marks. Then click “View results.”

The last step is scrolling through the list of providers and making some calls. You may have to call more than one physical therapy practice to find one that fits your medical and budget needs.

How to Find a Physical Therapist Who Takes Medicare Step 3 - Medicare Plan Finder

Need a New Medicare Plan?

Our agents can help you decide if Medicare Advantage or Medicare Supplements are right for you. We have agents in 38 states and we’re constantly growing!

Plus, our agents are licensed to sell plans from many of the major insurance carriers in your area, which means we are NOT biased. We can help you set up an appointment with an agent who can show you how to choose the right Medicare plan for your needs.

Most seniors and Medicare beneficiaries will have to wait until AEP (October 15 to December 7) to change plans. Check out our post about Special Election Periods to see if you qualify for a SEP. Not sure if you qualify? That’s OK. Your licensed agent can help you find out if you qualify. Give us a call at 1-844-431-1832 or click here to have Medicare Plan Finder call you.

This post was originally published on January 4, 2018, by Anastasia Iliou, and was most recently updated on January 6, 2020, by Troy Frink.

How to Find a Home Chair Lift You Can Afford

A chair lift (also called a stair lift or lift chair) is an assistive device that helps users go up and down stairs without having to climb. The user rides in a seat attached to a track, and the device glides up the staircase. Chair lifts can help people be more independent

Purchasing a lift chair for your home doesn’t have to be extremely expensive. Here are some ways to get financial assistance for home stair lifts.

How to Find Home Chair Lift Assistance

You may be eligible for federal and/or state financial assistance for purchasing and installing a lift chair. The best way to find out if you qualify for assistance is to apply for the various programs and ask what’s available. If you think you’re eligible, you can apply for Medicare, Medicaid, Social Security, and veterans benefits.

Does Medicare cover stair lifts?

Original Medicare does not cover stair lifts*. However, certain private plans called Medicare Advantage (Part C) plans might. There are hundreds of Medicare Advantage plans available throughout the country, but they can all offer slightly different coverage. Additionally, not all plans will be available in your area. 

Medicare Part C plans can cover supplemental benefits that Original Medicare does not, including meal delivery, non-emergency medical transportation, and home health care

*Original Medicare may help pay for an elevating seat to help the rider sit and stand safely. The coverage may only cover the seat, which is considered to be durable medical equipment. According to Medicare, home chair lifts fall under home modifications, not durable medical equipment. 

Medicare Durable Medical Equipment

Will Medicaid pay for a lift chair?

Medicaid is a state and federal program that helps eligible people receive healthcare coverage. Your state’s Medicaid program may help pay for a lift chair if you qualify.

If you’re eligible for both Medicare and Medicaid, you may qualify for a Dual Special Needs Plan (DSNP), which is a special type of Medicare Advantage plan that may have discounted premiums, copays, and/or coinsurance. 

A DSNP qualifies you for a Special Enrollment Period (SEP) that allows you to make one change per quarter for the first three quarters of the year (January – September). You can make a change in your coverage during the fourth quarter (October – December), but only during the Annual Enrollment Period (AEP), which is from October 15 – December 7. The change you make during AEP will take effect on January 1 of the following year. 

Stair Lifts for Disabled Veterans

The Department of Veterans Affairs (VA) may help disabled veterans who cannot safely navigate stairs pay for a stair lift. The benefit applies to veterans whose disabilities are the result of their military service. You may need a home visit and skills evaluation before the VA approves your stair lift.

You may also qualify for VA benefits if you or your spouse is disabled and the disability is not the result of military service. Some veterans qualify for the VA Aid and Attendance benefit, which may help pay for “care-related services.”

If you aren’t eligible for a lift chair due to service-related injuries, and you don’t qualify for the VA Aid and Attendance benefit, local assistance programs called Veterans Directed Home and Community Based Services may help. These are specific to local VA medical centers, and they help veterans live at home, rather than at nursing homes

Other Financial Assistance Options

Some states have assistance programs that help seniors and Medicare-eligibles stay at home, which may include home modifications. For example, you may qualify for low-interest or conditional loans from state assistive technology programs.  Note: not all states offer loans for assistive devices. You can also check with your local National Council on Aging (NCOA) office for information about assistive technology programs. 

Some long-term care insurance policies may cover stair lifts if it means that you can live at home, rather than transitioning to a long-term care facility. 

In addition, you may be able to save by looking for used stair lifts. Some manufacturers may offer financing so you don’t have to pay all at once.

Chair Lifts for Stairs With Landings

Chair lifts for stairs with landings come in a variety of configurations to accommodate different types of stairs. Most chair lifts fall into two categories: straight or curved. 

Straight Chair Lifts

Straight chair lifts only work on straight staircases without curves or corners. However, you can use multiple straight chair lifts on straight portions of your staircase with landings or turns. 

For example, one chair lift can go from the floor to the first landing. Then another can go from the first landing to the top of the stairs. 

The advantage to installing multiple chair lifts is that it can be less expensive than one curved lift chair. The disadvantage is that once you reach the first landing, you must get up and transfer to the second chair. The transfer may be unsafe for some people.

Curved Chair Lifts

Every staircase can be different, and to work, most curved chair lifts must be custom-fit to accommodate your home’s twists and turns. However, there are some common configurations that include: 

Top or Bottom Overrun: An overrun can be at the top, bottom, both ends of a staircase. The “overrun” is where the stair lift track extends past the staircase and onto the landing and/or the floor at the bottom of the stairs. This feature may make it easier for the user to sit into or stand up from the chair.

Intermediate Landing: An “intermediate landing” is a landing before the top of the stairs. Curved stair lifts can rise with the staircase, become level at the intermediate landing, then continue rising to the top of the stairs. 

90° Flat Landing: This is a type of staircase with a landing that has right-angle change of direction in the staircase. Like with the intermediate landing, the lift chair’s track travels up the staircase, levels out at the landing, then travels up again.

180° Flat Landing: The same as the 90° flat landing but the turn is 180° at the landing.

Spiral Stair Lift: These chair lifts feature tracks that curve around the entire length of a spiral or curved staircase.

The Best Stair Lift Brands

According to PayingForSeniorCare.com, some popular stair lift brands are: 

Get Coverage for Home Chair Lifts

Original Medicare does not offer coverage for home chair lifts. If you want help finding assistance for a home stair lift, one of our licensed agents may be able to help you find a Medicare Advantage plan, a long-term care policy, or other financial assistance. Our agents are highly trained and they can help you determine the right fit for your budget and medical needs. To schedule a no-cost, no-obligation appointment, call 1-844-431-1832 or contact us here today.

What is Medicare Part B Buy Back/Give Back?

Are Medicare Buy Back plans too good to be true? No! There are some legitimate Medicare plans out there that can “buy back” your Part B premiums. These plans are effectively paying you instead of the other way around! Let me explain. 

Medicare Part B Premiums in 2020

When you enroll in a Medicare Advantage plan, whatever your Medicare Advantage premium is, you’re still going to have to pay your Medicare Part B premium. In 2020, the standard Medicare Part B premium will be $144.60. Your premium may be a bit higher if you have a high income. . 

2020 Medicare Part B Premiums
2020 Medicare Part B Premiums

The reason you have to keep paying this premium is that while Medicare Part B is a part of the government Medicare program, Medicare Advantage plans are privately owned. To have Medicare Advantage, you have to be enrolled in the government program. To stay enrolled, you have to continue paying your premiums! 

So, What are Medicare Advantage Part B Buy Back Plans?

Medicare Advantage plans are additions to your existing Medicare coverage. They can vary greatly in coverage amounts and premium prices. Some Medicare Advantage plans can come with a $0 premium or a low premium in addition to a Part B buy back (or give back, as some plans call it). 

If you pay your Part B premium automatically out of your Social Security check, this could feel like a bonus added to your monthly checks! You’ll start seeing a bit more coming in, which is nice. 

Premium Give Back Plan? What’s the Catch? 

You’re probably skeptical about the idea of an insurance carrier wanting to give YOU money. However, there’s not really a catch. According to Quality Health Plans of New York, Medicare Advantage plans “may choose to use some of the funding it receives” to “reduce its members Medicare Part B premium.” What these plans are doing is providing you an incentive to sign up for their plans

 Even if they give you some of that money back for your Part B premiums, they still get paid from your copayments, deductibles, etc.

As you’re looking into available Part B buy back plans in your area, be sure to consider what you might be giving up. Remember, all plans are different, but it is possible that a plan with a Part B buy back option will have higher copayments and deductibles – which may not matter to you if you don’t spend a lot of time in the doctor’s office!

I guess you could say the only true “catch” to these plans is that you have to stay enrolled in Medicare parts A and B – but that’s true of any Medicare Advantage plan. You’ll have to continue paying your A and B premiums, even if you do get some of that money back. 

Additionally, it may be a few months after you sign up for your premium give back plan before you receive your first Part B reimbursement. 

How do I Get a Part B Buy Back (Give Back) Plan?

Great question! As you can imagine, these plans might be harder to find than more standard Medicare Advantage plans, and there may or may not be one available in your area. 

Unfortunately, CMS (Centers for Medicare and Medicaid Services) does have certain rules in place that forbid us from sharing the plan details with you publically. However, we have licensed agents across the nation who can meet with you either in person or by phone to help you choose a plan. 

If you’re interested, call us at 844-431-1832. Let us know that you’re interested in Part B buy back plans, and we’ll do all we can to help!
You can also leave us a message here, and we’ll get back to you.

2020 Medicare Changes & Trump’s Executive Order

Every year, CMS (Centers for Medicare and Medicaid Services) reserves the right to make changes to the Medicare program. Rules and regulations around enrollment periods, penalty fees, marketing, and plan benefits are released in late summer and early fall for the following year. Costs can rise, and brand new plans can enter or leave the market.

Medicare is confusing as it is. When you add these yearly changes into the mix, choosing the right plan can be stressful. Our goal is to make all of this less stressful for you. Our website is a great educational tool, and our licensed agents can provide free assistance!

Here are the changes you need to know about for Medicare in 2020.

Contents:

Trump’s Executive Order – October 3, 2019

On October 3, 2019, President Donald Trump signed an executive order “protecting” the Medicare program. What does this mean?

Alex Azar, Health and Human Services (HHS) Secretary, said that Trump told HHS to take “specific, significant steps” towards improving Medicare funding and improving healthcare for American seniors. These steps include lowering Medicare Advantage costs, allowing savings accounts, and improving access to new medical technology. It also leaves room for more plan options, more telehealth, more wellness benefits, and a stronger financial model.

In his post-executive order speech given in Florida yesterday morning, Trump stated, “In my campaign for president, I made you a sacred pledge that I would strengthen, protect and defend Medicare for all of our senior citizens.” That was the intent of the executive order.

Is Medicare Going Up in 2020?

New 2020 Medicare premiums and costs for 2020 have not been released yet. The new numbers are usually released in early fall of the year prior, so we are expecting to see them over the coming months. The Wall Street Journal reported in April that 2020 Medicare Part B premiums are likely to increase by $8.80/month to a total of $144.30, but this is not final.

We will continue to update this post with new 2020 costs as they are released. Thank you for your patience!

2020 Medigap Changes

Just like the Original Medicare program, private plans like Medicare Advantage, Medicare Supplements, and standalone benefit plans can change every year.

What Medigap Plans will be Available in 2020?

Plans A, B, D, G, K, L, M, and N will be available in different areas across the nation in 2020. Plans F and C are being discontinued.

Plan availability may not be the same for everyone. Medigap eligibility, in particular, can depend on your age when you enroll, preexisting conditions, and where you live. Plans can be different not only in every state but also in every county and zip code.

Medigap Plan Comparison
Medigap Plan Comparison

Use our plan finder tool to find out what Medigap plans are available in your area for 2020.

Medicare Plan Finder

Is Medicare Supplement Plan F Going Away in 2020?

Starting in 2020, you will no longer be able to purchase Medigap Plan F or Medigap Plan C. Plan F was one of the most popular plans, and Plan C was fairly similar. The plans are going away because they include coverage for the Part B deductible (only $185 in 2019).

You might here plans C and F referred to as “first-dollar” plans because they virtually eliminate out-of-pocket costs. CMS decided that taking away the Part B deductible coverage was a smart move to discourage people from overusing their primary physician offices and costing the Medicare program a lot of money for unnecessary doctor’s visits.

If you already have Medigap Plan F or Medigap Plan C, you can be grandfathered in. That means that you will not lose your coverage in 2020. However, if you leave your Plan F or Plan C in favor of a different Medigap plan, you won’t be able to re-enroll in F or C.

Will Plan F Premiums Rise After 2020?

As Plan F sees less and less enrollees, Plan F premiums will likely begin to rise. We can’t say this for sure and we will certainly have to wait and see what happens, but generally less enrollees means higher costs for the companies, resulting in higher premiums.

Will There be a High Deductible Plan G in 2020?

Since people will not be able to purchase Plan F or Plan C in 2020, CMS did want there to be another option with similar benefits. Plan G was already that option, given that the only difference is that Plan G does not cover the Part B deductible.

The other difference is that previously, Plan G was not offered with a high-deductible. If you typically have low medical costs, you may prefer a high-deductible option. Having a high deductible often means that your premiums will be lower. This way, you don’t have to pay as much until you start experiencing health concerns. The high deductible Plan G option can replace the high deductible F option.

Donut Hole Closing in 2020

In addition to all of these plan changes, the infamous “Donut Hole” will be effectively closing in 2020. The Bipartisan Budget Act of 2019 closed the coverage gap for brand-name drugs in 2019, and the generic drug coverage gap will be eliminated in 2020. This basically means that, if you have a Medicare Part D plan, you will only be responsible for 25% of your covered prescription drug costs instead of 44%.

2020 Medicare Advantage Changes

There may be more Medicare Advantage plan changes to come in 2020, but we wanted to make sure you had heard about the changes from last year.

On October 12, 2018, the Centers for Medicare and Medicaid (CMS) announced the 2019 Original Medicare premium and deductible increase, but what about Medicare Advantage (MA) plans? Unlike Medicare Part A and B, beneficiaries enrolled in MA plans may see a decrease in their premiums in 2019 and 2020 compared to 2018.

2020 Medicare Advantage Cost Changes and 2020 Premiums

In September of 2018, CMS announced that on average, Medicare Advantage premiums will decrease by 6%. This is great for beneficiaries interested in affordable vision, dental, and hearing coverage or even fitness classes like SilverSneakers®!

CMS estimated that 83% of beneficiaries would have equal or lower premiums for 2019 and 46% will have a $0 premium! Premiums for MA plans have steadily declined, and this is the lowest premium we’ve seen in three years. This is a perfect example of a private and public collaboration that allows beneficiaries to drive and define the value. The 2019 Medicare Advantage changes are a quick glance of what you can expect to continue in the future.

2020 cost changes for Part A and B premiums and deductibles have not officially been released yet but are not expected to increase by very much. We will continue to monitor this information and will update as soon as the cost changes are officially announced.

Free Prescription Discount Card
Free Prescription Discount Card

New Medicare Benefits 2020

Early in 2018, CMS (Centers for Medicare and Medicaid Services) released new rules that allow Medicare Advantage plans to offer a few benefits, like “daily maintenance,” transportation, telehealth, and durable medical equipment.

Some plans in 2020* are really going above and beyond, offering benefits like new air conditioners and pest control!

*These benefits are not included in all MA plans. Your agent may be able to help you find a plan that includes more.

Daily Maintenance

The addition of the “daily maintenance” benefit means that Medicare Advantage plans are now able to offer at-home care items, such as wheelchair ramps and other home modifications. Tied in with that benefit are other forms of durable medical equipment, like hospital beds, oxygen equipment, blood sugar monitors, etc, as well as “non-skilled” services. Non-skilled refers to items that do not require a licensed doctor or nurse, such as aides who can assist with bathing and dressing or homemakers who can help with cleaning and cooking.

Non-Emergency Medical Transportation Coverage

CMS has also added the ability for MA plans to provide non-emergency transportation coverage, a service that several Medicaid plans provide. This benefit (if your plan covers it) will allow you to receive free or low-cost rides to medical appointments and pharmacies. In most cases, you can only qualify for this benefit if you do not have another adequate means of transportation. The appointment that you are requesting a ride to must be for a Medicare-covered service.

Telemedicine and Telehealth

MA plans can now provide coverage for telehealth. That means you can have live video interaction with your doctor through digital clinics like HealthTap, Teladoc, and MDLive. Telehealth can also include health alerts delivered to your phone, health education apps, electronic medical data transfers, mail-order prescriptions, digital appointment scheduling and exam reminders, and more.

New Enrollment Period (OEP)

Before 2019, most people were only able to switch into new Medicare Advantage plans during the Annual Enrollment Period in the fall. Now, if you already have a Medicare Advantage plan, you may be eligible to make a change during OEP. OEP, or the Open Enrollment Period, takes place from January 1 through March 31. During this time, you can switch from one Medicare Advantage plan to another or drop your Medicare Advantage plan in favor of Original Medicare (Part A and Part B only).

Future of Medicare Advantage Plans

According to the Henry J Kaiser Family Foundation, enrollment has tripled to 19 million beneficiaries since 2003 and continues to grow each year. CMS estimates that MA enrollment will hit an all-time high of 22.6 million beneficiaries in 2019 (an 11.5% increase)! 

As enrollment continues to increase, plan selection and variety increase too, with approximately 600 new plans offered in 2019! 99% of seniors and Medicare-eligibles have access to a MA plan – and 91% can choose from 10 or more plan options. Beneficiaries will not only see more plans to choose from, but also new supplemental Medicare benefits!

Enroll in a Medicare Advantage Plan in 2020

Are you interested in getting coverage beyond Original Medicare? Along with the new benefits, many Medicare Advantage plans offer dental, hearing, and vision coverage. 

Our agents at Medicare Plan Finder can contract with nearly every carrier in your state! This means that you can enroll in the MA plan that best fits your needs and budget.

The Annual Enrollment Period runs from October 15 through December 7. Start looking over your plan benefits now so that you’re ready to enroll before December 7!

Ready to learn more? Call us at 833-438-3676 or fill out this form to arrange a no-cost, no-obligation appointment with an agent in your area.


*This post was originally posted on November 8, 2018, and was last updated on October 4, 2019.

BREAKING NEWS: Tennessee SilverSneakers® Program Splits from YMCA

SilverSneakers® announced on Tuesday, September 17, that the Tennessee State Alliance of YMCAs decided to leave the SilverSneakers® network effective January 1, 2020, citing financial disagreement. 

The alliance apologized, stating, “Seniors are a vital part of our membership, and we apologize for any inconvenience this decision may cause. Tennessee Ys are committed to continuing to  serve seniors in our community.”

SilverSneakers® is a Medicare fitness program that allows eligible Medicare beneficiaries access to gyms, fitness centers, and classes. Many of these often take place within YMCAs, offering not only physical fitness benefits but also a social atmosphere.

Eligibility for the program is simple – anyone who is age 65 or older and has a private Medicare plan that includes the SilverSneakers® benefit can join.

Watch this brief video to learn more about Medicare fitness programs:

The news that SilverSneakers® may not cooperate with Tennessee YMCAs anymore may be detrimental to seniors who made use of that benefit. If you’re one of those people, what should you do next?

What to do if You’re Losing Your YMCA SilverSneakers® Benefit

If you have SilverSneakers® but are no longer going to be able to visit a YMCA with your membership, all hope is not lost! There are a few steps you can take: 

Silver and Fit vs SilverSneakers
Silver & Fit vs. SilverSneakers

Other Gyms You can Visit with SilverSneakers ®

Tivity Healthcare, the company that operates the SilverSneakers® program, wants to make it clear that there are still over 350 facilities in the state of Tennessee that SilverSneakers® members can use. Planet Fitness, Gold’s Gym, Anytime Fitness, and Workout Anytime as well as a variety of community centers are still part of the SilverSneakers® network in Tennessee and may be a great option for you. 

Planet Fitness

Planet Fitness locations across the state of Tennessee offer benefits like massages, tanning, and even discounts on travel and Reebok products. Most locations have long hours, and some are open 24-7. Many of them also have free WiFi!

Gold’s Gym

Gold’s gym locations offer group exercise classes, personal training, and more. Group exercise classes include Yoga, Zumba, Mixed Martial Arts, Group Cycle, and High-Intensity Interval Training.

Anytime Fitness

Different Anytime Fitness locations offer different equipment such as treadmills, ellipticals, cycles, stair climbers, rowing machines, weights, kettlebells, etc. They also offer different classes like Zumba, cardio, yoga, and additional services like tanning, private showers, wellness programs, and personal training.

Workout Anytime

Workout Anytime locations have high-quality equipment from Matrix Fitness, which has received rewards for innovation. They also have high-quality polypropylene, antimicrobial flooring that is beautiful, comfortable, and clean.

Medicare Plan Finder Tool
Search for Medicare Plans with fitness benefits

How to Switch to Silver & Fit ®

If you decide that you would rather stick to a YMCA membership and do not want to try out some of the other SilverSneakers® locations options, a licensed agent can help you find a plan that includes Silver & Fit® instead. 

Silver & Fit® is similar to SilverSneakers® and includes a digital resource library, home fitness kits, community activities, and several different fitness classes at various fitness centers in Tennessee.

Silver & Fit® locations across major cities in Tennessee are listed below:

To find a plan that includes Silver & Fit®, call 833-438-3676 or send us a message. We’ll connect you with a licensed agent in your area who may be able to help you make the switch.

Medicare Fitness Programs
Free Medicare Fitness Programs Guide

The Do’s and Don’ts of Medicare AEP

Watch this brief video first!

One minute and 30-second overview of the Annual Enrollment Period

The Medicare AEP (Annual Enrollment Period) is the time when anyone who is enrolled in Medicare can make changes to their coverage. That can mean: 

  • Enrolling in Medicare Advantage OR Part D for the first time
  • Switching between Medicare Advantage plans
  • Switching between Part D plans
  • Dropping Medicare Advantage OR Part D coverage

However, the Medicare AEP only lasts from October 15 through December 7 of each year. Some people may qualify for a Special Enrollment Period and may be able to change plans outside of the AEP, but for many, this will be the only time to change plans!

What you Should do During Medicare AEP

Even if you think you have the best Medicare plan in the world, here are a few things you should definitely do during or leading up to Medicare AEP (October 15 – December 7):

1. Check Eligibility for Savings.

Apply for LIS (Extra Help prescription drug savings program) and other Medicare Savings Programs to see if you could be saving money. If you have low income, you may even want to try applying for Medicaid! The results could influence what coverage you are eligible for this AEP.

Review Your Medicare Plan
Contact a licensed agent

2. Analyze your Current Coverage.

What insurance do you have now? Do you have Original Medicare only, or do you have a private plan as well? Do you have enough coverage? Does your plan fit into your budget, or could you be saving more money? Are all of your doctors and prescriptions covered by your current plan? Did you receive your ANOC (Annual Notice of Change), and is anything in your plan changing? Ask yourself these questions and take notes, because there may be something better out there.

3. Notate your Life Changes.

Did you start seeing a new doctor this year, or do you have a problem with your current doctor? Did you gain or lose a job, or suddenly develop financial stress? Were you diagnosed with a new health condition that requires expensive treatments? Think about not only your past year but what you expect to happen over the next year. Think about what type of coverage you might need to get yourself through it all.

4. See What Medicare Plans are Available this Year.

Every year, new Medicare plans may come to the market, and old plans may change what they are offering. It’s important to look at the new information instead of just assuming that your old plan will stay the same. If your plan does change what they are offering, you will be notified – but it is important to look at other changes in your area as well. 

Maybe there’s a great new doctor you’ve wanted to see, but she doesn’t accept your current plan! Or, maybe you suddenly have access to a plan with a five-star rating, when previously you only had access to four-star plans!

*Click here to read about some Medicare changes in 2020.

5. Schedule an Appointment with a Licensed Agent. 

We know it’s nice to think that you can do it all yourself and that with the internet, you don’t need an insurance agent anymore! But, that’s not always true. The benefits of meeting with a licensed insurance agent are simple: it’s free, it’s easy, and it can’t hurt!

Our agents are licensed and able to sell from a variety of different insurance carriers, meaning they are not all biased towards one plan option. Your plan won’t cost any more money whether you meet with an agent or not, so meeting an agent can only help you. A licensed agent can walk you through everything that is available in your area and help you select the best option based on your needs. Plus, let us repeat – the meeting is free!

Medicare Plan Finder Tool
Search for Medicare Plans

What you Should not do During AEP

We’re here to help, so we don’t want to only talk about the positives. Here are some things that you should NOT do during the Medicare AEP:

1. Don’t Jump into a new Medicare Plan Too Fast.

Do you understand how to choose a Medicare plan? Sometimes good deals are tempting, and it’s easy to jump into a shiny new plan because the costs are lower or there’s an added benefit. Make sure you’ve considered everything before you switch because it might not be easy to switch back. Make sure that your doctors work with the new plan, it covers your prescriptions, and there aren’t any hidden costs. Also, make sure the new benefit is something that will actually be useful to you!

2. Don’t Misunderstand Medigap.

Medigap, or Medicare Supplements work differently from Medicare Advantage and other types of Medicare plans. Technically, Medigap enrollment is not limited to the AEP. However, that does not mean that you should just change back and forth between different Medigap plans any time.

If you enroll in Medigap outside of your Initial Enrollment Period (when you first become eligible for and enroll in Medicare), you may be put through an underwriting process and may have higher fees based on your age and any preexisting conditions. Medicare Advantage and Part D plans do NOT take age and preexisting conditions into account, but Medigap plans if you wait too long to enroll.

3. Don’t Avoid Researching Medicare Plan Options.

If you already know the name of a carrier, you might be tempted to go straight to their website and enroll in a plan that looks good online. However, there may be more than one carrier offering plans in your area. So, how do you look at all of them easily?

Start by using a plan comparison tool, like our free Medicare Plan Finder. Then, once you’ve compared a few options, consider taking that research to a licensed agent who can talk to you about what you’re looking at and why the differences matter.

Ready for AEP?

To schedule an appointment with one of our licensed agents, call 833-438-3676 or click here. We can’t wait to help you get the coverage you deserve!

Medicare AEP
Click to get in touch with a licensed agent

5 Ways to Boost Brain Health for Seniors

It’s perfectly natural to lose some mental “processing speed” as we age. This process is called cognitive aging and usually starts as soon as we reach adulthood. While certain brain functions like vocabulary might even improve as we get older, others will gradually decline. A common list of cognitive changes in elderly people typically includes slower problem solving, diminished spatial awareness, and a decline in perceptual speed and memory.

 Most of these aging brain symptoms are entirely normal but the rate of this decline may increase, leading to MCI (mild cognitive impairment) or even dementia. However, scientific research has uncovered several methods proven to help maintain elderly brain health and most of them are simple things you can do in your day-to-day life!

Staying Active At Any Age

The connection between exercise and brain health for seniors has long been established. But new studies are suggesting that staying active may be the best way to prevent memory loss in old age! While it might be most effective before severe memory loss begins, it also appears to benefit those with advanced conditions like Alzheimer’s or vascular dementia. 

Seniors who exercise regularly can experience reduced inflammation, improved blood flow, and even increased growth of new blood vessels in the brain. An active lifestyle can also improve the quality of sleep, which we will see later is another crucial factor in maintaining brain health. In fact, sustaining a moderate regimen of low impact exercises from six months to a year has even been associated with increased volume in the prefrontal and medial temporal cortices, the parts of the brain responsible for memory and critical thinking!

Medicare Fitness Programs

Unfortunately, the research also indicates that exercise must be a regular commitment in order to see some of these amazing benefits. But dedicating at least three hours a week can be difficult for seniors who don’t have access to a gym. This is where Medicare plans that include fitness programs can help. Plans can include Medicare fitness programs Programs like SilverSneakers® and Silver&Fit® that are designed specifically for seniors and can provide access to fitness and exercise centers. Some may supply their less mobile members with home fitness kits.

Medicare Fitness Programs
Click to get fit!

Food For Thought: Brain Healthy Foods For Seniors

Many of us probably remember our mothers extolling the virtues of “brain food.” Turns out she was right! A diet consisting of mostly fruits, vegetables, nuts, beans, and fish has been closely linked to brain health and a lower risk of dementia. This “Mediterranean diet” is also often touted for its positive effects on heart health and cardiovascular risk factors, which can indirectly influence the health of the brain.

Senior Healthy Eating Grocery List
Healthy Living Grocery List

Best Memory Supplements For Seniors

In addition to a more healthy diet, many seniors take supplements to get a higher dose of these crucial ingredients than can be found in the foods themselves. Some of the most popular include fish oils like omega-3 fatty acids, antioxidants such as resveratrol, as well as creatine and even caffeine.

Companies have begun producing memory supplements targeted at seniors. Some of these include:

  • Brainol (includes 19 ingredients for improved cognition, like B-Vitamins, Huperzine A, L-Theanine, and DMAE.
  • Neurofuse (includes B-Vitamins, L-Theanine, DMAE Bitartrate, and Huperzine A.)
  • True Focus (includes Horse Chestnut, Butcher’s Broom, Hesperidin, etc.)
  • Irwin Naturals Brain Awake (includes Vitamin B6 and L-Theanine)
  • BriteSmart (includes Huperzine A)

While memory supplements are not typically covered by Medicare, some Medicare Advantage plans might have an OTC (over the counter) allowance benefit which would allow you to purchase supplements. Click here to read more about OTC benefits in Medicare.

Free Prescription Discount Card
Free Prescription Discount Card

Training An Aging Brain

One of the easiest methods for seniors to maintain mental acuity is daily brain training. This interactive practice can take on many forms, from crossword puzzles to arts and crafts. And now more than ever, there are services and applications specifically designed to give you your daily dose of critical thinking.

Activities for Alzheimer’s Patients at Home

There are countless ways for seniors to get their brains engaged on a daily basis. Many are things you might already enjoy, including puzzles or card games. In the technological age, of course, many of these activities can be done on a computer or smartphone.

In addition to these traditional games, there are many apps that are designed specifically as activities for seniors with dementia and Alzheimer’s. Apps like Lumosity are great for challenging your brain on a daily basis and some, such as Mindmate, even include exercise and nutrition tips. A cursory Google search may also help you find other free brain games for seniors.

Medicare Crossword and Word Search
Free Medicare Crossword and Word Search

Seniors Staying Social

Some doctors suggest that one of the best ways to retain memory and cognitive functioning is to remain engaged with a social group. Many seniors use social media to stay in touch with family and friends and there are even apps like Timeless that are designed to help people with dementia or Alzheimer’s stay social.

Clear Your Mind (And The Rest Will Follow)

The importance of everyday factors like stress and sleep on brain health for seniors shouldn’t be overlooked, especially for the elderly. A good night’s sleep will clear the brain of toxins that accumulate throughout the day like beta-amyloid, a protein which is also commonly found in Alzheimer’s patients. Stress can also play a huge role in how the brain functions by introducing high levels of cortisol and even possibly reducing the size of the prefrontal cortex, the part of your brain that governs memory and learning.

Meditation and Aging

Meditation has been shown to increase the thickness of the hippocampus and decrease the volume of the amygdala, which is responsible for stress and anxiety. Research into mindfulness meditation has even indicated an effect on the process of aging itself. A 2017 UCLA study showed that the brains of people who meditate regularly actually declined at a slower rate than those who did not.

Natural Sleep Remedies For The Elderly

We know that sleep is essential for overall brain health for seniors, but many older adults experience trouble sleeping. Some practices for getting better sleep include turning off screens and lights, regular exercise, reducing sugar intake, and keeping a consistent sleep schedule with naps no longer than 20 minutes. If something more serious is causing you to lose sleep, you might need to consult a physician to test for sleep apnea or to evaluate any medications you might be taking.

Medicare Annual Wellness Visit

If the decline in cognitive functions persists or accelerates, you may need to seek professional help as a preventive measure. As part of your Medicare benefits, you may be entitled to a paid Annual Wellness Visit with your primary care provider to develop a personalized prevention plan that takes into account your lifestyle and risk factors.

In addition to checking physical factors like height, weight, and blood pressure, they can perform a cognitive assessment and screen for various forms of dementia or cognitive impairment. Additionally, a Special Needs Plan might be used to supplement your Medicare benefits. These plans are Medicare Advantage products specifically focused on providing care and coverage for patients with dementia.

Prescription Drug Plans for Alzheimer’s

If your condition or that of a loved one develops into Alzheimer’s or another form of dementia, Medicare Part D may cover the cost of prescription drugs to treat the symptoms. These medications include brands like Aricept and Exelon. Though they are not cures for the disease itself, they are effective at temporarily improving common symptoms of dementia, such as confusion or aggression.

Memory Care Through Medicare

Some severe cases of dementia and Alzheimer’s can make it nearly impossible to handle all the daily duties that come with living alone. In these cases, Medicare may help pay for nursing home care for a period of up to 100 days but will not cover such a solution in the long-term. However, some Medicare Part C plans may help cover the high costs of a nursing home or memory care facility.

For help enrolling in a Medicare plan that covers memory care and other brain health services, call us at 833-438-3676 or click here.

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