Does Medicare Cover Transplants?
Health Insurance

Does Medicare Cover Transplants?

Finding out you need a transplant of any type can be overwhelming and worrisome. Not only does it come with the need for life-changing surgical procedures, but for many people, the cost is concerning. Does Medicare cover transplants? The answer is yes, for the most part.

One key thing that you need to know is that Medicare coverage is based on a person’s specific health needs. Transplants are considered, in most cases, the last resort to care. Organ transplants for livers, hearts, kidneys, lungs, and other organs are a life-saving procedure that comes with ample risk. Medicare pays for transplant care when it is the most necessary level of help for your needs, often after every other applicable treatment is exhausted.

How Does Medicare Cover Transplant Needs?

How Does Medicare Cover Transplant Needs?

The type of Medicare coverage you have ultimately determines what Medicare will cover in terms of overall medical costs associated with a transplant. For most people with Original Medicare, the coverage will involve:

  • Medicare Part A: This component of your Medicare coverage will cover hospital stay costs, which is typical of most transplants.
  • Medicare Part B: This will cover your pre- and post-transplant doctor’s visits. It may also provide coverage for your screenings and diagnostics that are necessary to determine if you are a candidate for transplant, including both physical and mental health care.

If Medicare determines that an organ transplant is the necessary and likely best care option for you, it will cover costs related to the pre- and post-transplant care you will have. However, there are limitations to this policy that you need to know about, and that often means you should have supplemental coverage to extend your financial protections.

Medications with Transplant and Medicare Coverage

One of the most important reasons to have health insurance in place heading into your transplant is that you will likely need highly expensive, very important medications for the rest of your life to help prevent your body from rejecting the organ. These medications are not covered directly under Medicare Part A and B, though some may receive medication for a limited amount of time through the plan.

Most people will need to have Medicare Part D or prescription drug coverage in place. Part D prescription drug coverage is not a component of Original Medicare. Rather, it is a separate policy you need to have in place typically before your Medicare coverage kicks in to cover those very important medications.

Get a personalized Health Insurance quote now.

Click to speak with a licensed Insurance Agent

Or dial toll free

888-212-7991

When will Medicare pay for immunosuppressive drugs?

Immunosuppressive drugs, also called transplant drugs, are critical to sustaining life after a transplant. Medicare Part B covers this when Medicare pays for the transplant itself. That means that you must have Part A in place at the time of the transplant, and it must have covered the transplant costs. Part B will then cover the immunosuppressive drugs.

What Will Medicare Pay for in a Transplant?                    

Typically, Medicare Part A will provide for some of the costs you have during a hospital stay. This includes all of the necessary tests, lab work, and exams needed in the lead-up to the transplant. Then, it will likely cover the costs for:

  • Heart transplant
  • Lung transplant
  • Kidney transplant
  • Pancreas transplant
  • Intestine transplant
  • Liver transplant

In addition to this, Medicare also provides coverage for stem cell transplants when it is deemed the best type of care for your condition.

Medicare Part B will likely provide coverage related to the doctor-specific care you receive for your transplant. This includes your ongoing care and drug needs for immunosuppressant care.

Your Expected Transplant Costs with Medicare

Review your transplant costs with your social worker and insurance provider to make sure you know exactly what to expect. Typically, you will still need to pay for some costs, including:

  • 20% of your Medicare-approved amount for all of the doctor’s services considered necessary leading up to and after your transplant once you meet the deductible for Part B.
  • Various costs charged to you by the transplant facility and hospital

You do not have to pay anything to the living donor for a kidney transplant. You do not pay for any Medicare certified laboratory tests.

What About a Medicare Advantage Plan?

Medicare covers most of the costs associated with transplants because it is considered a life-saving treatment. However, if you need a kidney transplant, heart transplant, or other organ transplant and you have a Medicare Advantage Plan, you need to check with that provider to know what your specific coverage and limitations are.

The same applies to Medigap plans. This type of medical insurance will cover your costs as long as the transplant is considered necessary and life-saving. The covered transplant coverage amount will differ based on the Medigap plans themselves as well as the coverage limitations in place. You can check with your insurance company before you move forward to know what your Medicare supplement plan or advantage plan will and will not cover.

Other Factors to Know About a Medicare Covered Transplant

Other Factors to Know About a Medicare Covered Transplant

Consider the following details of coverage. Keep in mind that you should learn about this coverage in depth if you believe you may need to meet these needs.

Ensure you follow all rules required by Medicare

There are several things to keep in mind in this area:

  • You must be eligible for care through a Medicare approved facility.
  • Medicare covers organ transplants based on the plan’s coverage rules. When joining a Medicare Advantage plan, then, research coverage for the specific type of condition you have and the qualifications based on that plan.
  • Choose healthcare providers that are approved by Medicare, not just a Medicare approved hospital.
  • Know the rules for prior authorization. This could differ based on the plan you have. However, to ensure you get the transplant surgery covered, you must ensure you have met all of the coverage rules for prior authorization the plan puts in place.
  • Organ transplant programs differ across the country. One facility may tell you that you need a double lung transplant, while another does not. The key here is that Medicare will likely need to approve the coverage based on medical tests and lab work itself.

End Stage Renal Disease and Medicare

If you have been diagnosed with end stage renal disease and need a kidney transplant. End stage renal disease ESRD, is a condition that may qualify you for Medicare immediately without the delay that is typical of Medical eligibility. Your Medicare coverage will include immunosuppressive drug coverage, which will continue for 36 months after a successful kidney transplant. You may need to seek immunosuppressive drug coverage beyond this.

What If You Are Not Eligible for Medicare?

Some people need organ transplants and are not Medicare beneficiaries, and it can take some time to qualify for coverage. As a result of that, you may need to explore other options for care in order to get on the transplant waiting list and receive coverage. If you do not qualify for Original Medicare or Medicare Advantage Plans, you may still be able to receive care through Medicaid services. Medicaid services may cover the out of pocket costs associated with the surgery. It also covers immunosuppressive drugs and doctor services you need.

If you are unsure if you will have coverage for the transplant surgery you need, work with the social worker to find out what additional options may be available to you.

Get a personalized Health Insurance quote now.

Click to speak with a licensed Insurance Agent

Or dial toll free

888-212-7991

Read More
Medicaid for Immigrants Over 65: Unlocking Health Benefits for a Healthy Future
Health Insurance, Seniors

Medicaid for Immigrants Over 65: Unlocking Health Benefits for a Healthy Future

The healthcare landscape can be complex, especially when it comes to understanding the eligibility of Medicaid for immigrants over 65. With the aging immigrant population, it's essential to shed light on the available health coverage options and how to navigate the system. In this article, we will explore Medicaid, its coverage for immigrants over 65, and how to access its benefits.

Understanding Medicaid and its Importance for Immigrants Over 65

Medicaid, a joint federal and state program, is designed to help with medical costs for some people with limited income and resources. It provides free or low-cost health coverage to some low-income people, families and children, pregnant women, the elderly, and people with disabilities. Medicaid programs must follow federal guidelines, but they vary somewhat from state to state.

For immigrants over 65, Medicaid plays a critical role in providing access to essential healthcare services, especially as they are at a higher risk of experiencing health issues due to age. However, the eligibility for immigrants to access Medicaid benefits depends on several factors including their immigration status, residency duration in the U.S, and state-specific regulations.

Medicaid Eligibility Based on Your Immigration Status

Medicaid Eligibility Based on Your Immigration Status

The Affordable Care Act (ACA) extended Medicaid coverage to many low-income individuals, but for immigrants, eligibility is not straightforward. Certain 'qualified' immigrants - including lawful permanent residents, refugees, asylum seekers, and others - are eligible for Medicaid, but many face a five-year waiting period from the time they attain qualified status.

In some states, Medicaid coverage is available to lawfully present immigrants without a five-year wait, including those who are lawfully present but not in a 'qualified' status, such as people with temporary protected status or nonimmigrant visa holders. However, unauthorized immigrants are generally ineligible for Medicaid, although states have the option to provide coverage to undocumented immigrants for emergency services.

Additional Eligibility Factors

Medicaid will also check your financial situation as part of its eligibility criteria using MAGI, modified adjusted gross income.

It's important to note that the rules for some immigrant families' eligibility for Medicaid are complex and vary by state, so it's essential to check specific state regulations.

Learn what your state requires at Medicaid.gov

Medicaid Benefits for Immigrants Over 65

For eligible immigrants over 65, Medicaid can provide a range of benefits that are crucial for maintaining health in later life. These benefits typically include hospital and doctor visits, prescription drugs, preventative care, and other services like home health care and long-term care.

The specifics of what Medicaid covers can vary from state to state, and there may be some costs (like copayments for some services), but for many immigrants over 65, Medicaid provides vital access to healthcare that they might not otherwise be able to afford.

Some types of physical and mental health services are mandatory and are covered by Medicaid in every state. These include:

  1. Hospital services: Both inpatient and outpatient hospital services are covered.
  2. Nursing facility services: Medicaid covers services provided in a nursing home, including room and board, nursing care, and other related services.
  3. Home health services: If a person is eligible for nursing facility services, they are also eligible for home health services, which can include part-time nursing, home health aide services, and medical supplies and equipment.
  4. Physician services: Services provided by a doctor are covered. This includes visits to a doctor's office, as well as any treatments or procedures performed by a doctor.
  5. Rural health clinic services: Services provided in a rural health clinic are covered.
  6. Laboratory and X-ray services: This coverage includes any necessary diagnostic services.
  7. Family planning services: While this may not be relevant for most individuals over 65, Medicaid is required to cover family planning services.
  8. Transportation to medical care: Non-emergency, but necessary, transportation to and from providers of Medicaid services is covered.

Optional Medicaid Health Coverage for Over 65

In addition to the mandatory services, states can choose to provide other "optional" services. These can include:

  1. Prescription drugs: While not required, all states currently provide coverage for prescription drugs.
  2. Physical therapy: If deemed medically necessary, physical therapy services can be covered.
  3. Occupational therapy: Similar to physical therapy, occupational therapy services can be covered if they are considered medically necessary.
  4. Speech, hearing, and language disorder services: These services can be covered if they are considered medically necessary.
  5. Respiratory care services: This type of care can be covered for individuals who are ventilator-dependent.
  6. Other diagnostic, screening, preventative, and rehabilitative services: Services intended to prevent, diagnose, or treat conditions could potentially be covered, depending on the state.
Medicaid and Telehealth

Medicaid and Telehealth

Medicaid also covers telehealth services, although the specifics can vary by state. Telehealth can include a range of services, from online doctor consultations to digital transmission of medical images. Telehealth services have the potential to significantly improve access to healthcare for individuals over 65, particularly for those who are housebound or live in rural areas.

Navigating the Complexity: Accessing Medicaid as an Immigrant

Accessing Medicaid as an immigrant involves several steps. First, it's necessary to understand your immigration status and how it relates to Medicaid eligibility. This may involve seeking advice from an immigration expert or attorney.

Next, it's important to understand the specific rules in your state, as some states have expanded Medicaid coverage to more formerly uninsured undocumented immigrants, than others. The application process for Medicaid also varies by state, so it's important to follow the correct procedure.

Finally, it's important to understand what Medicaid covers and what costs you might be responsible for.

The Impact of Medicaid Expansion Under the Affordable Care Act

The Affordable Care Act has significantly expanded Medicaid eligibility, including for many immigrants. However, not all states have chosen to expand Medicaid. In states that have not expanded, many immigrants fall into a 'coverage gap' where they earn too much to qualify for Medicaid but not enough to qualify for Marketplace coverage.

The Role of Private Health Insurance and Telehealth Services

The Role of Private Health Insurance and Telehealth Services

While Medicaid is a vital source of coverage for many immigrants over 65, it's not the only option to obtain health insurance. Private insurance can also play a role, particularly for immigrants who may not be eligible for Medicaid or who want additional coverage.

Telehealth services are increasingly being used to provide healthcare, especially in the wake of the COVID-19 pandemic. While not all telehealth services are covered by Medicaid, many are, and they can provide a convenient way to access healthcare, especially for older adults who may have difficulty getting to a healthcare provider.

DSNPS - Medicare Advantage Plans for Immigrant Seniors

Dual Eligible Special Needs Plans (D-SNPs) can be a great option for immigrant seniors who qualify for both Medicaid and Medicare. These Medicare Advantage plans are designed to cater to the needs of individuals who are eligible for both programs, combining benefits and coordinating care for more efficient healthcare management.

These plans often have extra benefits such as debit-style cards to purchase essentials, additional dental and vision benefits and more. Each insurance carrier's plan is different. It's best to speak with a licensed insurance agent that can provide free consultation on the plans available to you.

Get a personalized Health Insurance quote now.

Click to speak with a licensed Insurance Agent

Or dial toll free

888-212-7991

Cost Savings Through the Healthcare Marketplace

For immigrant seniors over 65 who don't qualify for Medicare, the ACA Health Marketplace can be a viable option for finding affordable health insurance coverage. The Marketplace offers various health plan options and provides cost-saving subsidies based on income. Cost-Sharing Reductions (CSRs) and Advanced Premium Tax Credits can help lower the cost of health insurance premiums and reduce out-of-pocket costs for eligible individuals.

Marketplace Silver Plans allow these tax credits premium subsidies to be used for plans significantly reducing the deductibles, premiums and copays needed.

Get a personalized Health Insurance quote now.

Click to speak with a licensed Insurance Agent

Or dial toll free

888-212-7991

Navigating the healthcare landscape as an immigrant over 65 can be challenging, but understanding the role of Medicaid and other various health insurance options and coverage options can make a big difference. With the right knowledge and resources, it's possible to access the healthcare needed to live a healthy life in the U.S.

Read More
What Is a Virtual Appointment: How to get Medical Treatment From Home
Health Insurance

What Is a Virtual Appointment: How to get Medical Treatment From Home

As a direct aftermath of COVID, virtual doctor's appointments are becoming more and more popular. And for good reasons. While for most of us it helps save time and money on traveling, the ability to see a doctor for a checkup without leaving one's home can be significant for people with a disability that limits their mobility. 

No traffic, no waiting rooms, just you and your doctor face to face on your device screen. If that seems helpful, this blog post is for you. Below we're going to go through how you can use virtual appointments to get treatment from the comfort and convenience of your own home!

How do Virtual Appointments Work?

Virtual care services, known to some as telemedicine or telehealth services, allow a patient to schedule and attend an appointment and get health care remotely using technology like video chatting. Instead of an in-person appointment, you can simply visit your doctor or healthcare provider from your home using a phone, tablet or computer. Other than the device, all you need is internet connection!

What are the Benefits of Virtual Appointments?

Now that you have an idea what telemedicine is, here are the main reasons people chose virtual appointments over traditional primary care physician visits:

Access Care From Anywhere

Virtual visits allow you to connect with your doctor from anywhere using your mobile device or a computer. Whether you’re at home, work, or even traveling, you can log in for your appointment. This makes it much easier to make time for medical care when you lead a busy life.

Save Time and Energy

By eliminating the need to travel to and wait at the doctor’s office, virtual appointments can save you hours of time. The actual visit itself is also usually more efficient since the doctor can focus on you without interruptions. Many routine issues like medication refills, test and screening results, chronic condition management, etc, can often be handled in just 5 to 10 minutes.

Lower Exposure Risk

If you are at higher risk of exposure to illnesses like the flu, colds, or even Covid-19, telemedicine helps limit contact with contagions that may be present in a doctor’s waiting room or clinic. Virtual visits are a safer option, especially if you have a weakened immune system or deal with chronic health conditions.

When Is a Virtual Appointment Right for You?

When Is a Virtual Appointment Right for You?

Telemedicine allows doctors to evaluate symptoms, examine photos or videos, review medical records and test results, diagnose conditions, and recommend treatment plans from a distance.

While many common illnesses and injuries can be managed virtually, some may still require an in-person visit for further evaluation or testing. So the question is: when could a virtual visit be right for you?

  • Minor Illnesses or Infections: Minor illnesses like colds, flu, sinus or urinary tract infections, and stomach viruses can often be diagnosed and effectively treated via telemedicine. Doctors can evaluate your symptoms, your medical history, and in some cases, photos to determine if antibiotics or other medications are needed.
  • Chronic conditions and Illnesses: Things like high blood pressure, diabetes, depression, and anxiety can also be managed remotely using telemedicine. Doctors can monitor health stats, adjust medications, and provide counseling and therapy during virtual visits.
  • Pediatric: Children's illnesses and behavior or developmental concerns can frequently be addressed through remote sessions as well. Checkups and monitoring of long-term conditions are also possible in some situations.
  • Dermatology: Issues like rashes, acne, and mild skin infections can sometimes be assessed and treated via telemedicine using photos and video. Doctors can examine the skin, determine if any testing is needed, and prescribe medication if appropriate.
  • Muscle or Skeletal injuries: Injuries such as sprains, strains, and minor fractures may be evaluated via a quick virtual appointment using images and a description of symptoms. Doctors can determine severity, recommend things like resting, icing, physical therapy or other treatments, and advise if an in-person follow up is necessary.

Get a personalized Health Insurance quote now.

Click to speak with a licensed Insurance Agent

Or dial toll free

888-212-7991

What Kinds of Care Can Be Provided Virtually?

Primary or Basic Care

Virtual appointments are ideal for routine primary care needs, such as medication refills, chronic condition management, and general checkups. Your doctor can review your medical history and symptoms with you over a video call to determine if your condition requires an in-person visit or remote consultation. For minor illnesses like colds, allergies, and rashes, a virtual visit may be all you need to get a diagnosis and prescription.

Behavioral and Mental Health

Virtual behavioral health visits with a therapist or counselor provide discreet, convenient access to services like counseling for anxiety, depression, trauma, or relationship issues. Speaking with a professional counselor over video allows for personal interaction and evaluation to determine a diagnosis and recommend a treatment plan. There's also an added benefit: Many people find online therapy helps lower barriers to seeking mental health support.

Nutrition and Wellness

Dietitians, health coaches, and wellness experts commonly offer virtual consultations. Advice on things like nutrition guidance, exercise plan, and making lifestyle changes can often be given remotely with phone or video calls. 

Chronic Condition Monitoring

For people with ongoing health conditions like diabetes, heart disease, or COPD, virtual care plays an important role in disease management. Remote patient monitoring with connected devices allows doctors to track health metrics and symptoms to better manage medications and treatment plans without frequent office visits. Patients can stay on top of chronic illnesses using virtual check-ins, health coaching, and monitoring programs.

Apps for Virtual Doctor Visits and Telemedicine

FaceTime

If you have a smart device, FaceTime is a convenient option for a virtual doctor visit. To connect with your doctor’s office, you just provide them with your Apple ID or phone number and FaceTime audio or video call to start the appointment. 

Zoom

The popular video conferencing app, Zoom, can also be used for telemedicine. In fact, many doctor’s offices are already using it for meetings and online events, so they may prefer sticking with it even for scheduling virtual visits. This platform also works on smartphones, tablets, laptops and desktop computers.

Doxy.me

Doxy.me is a telemedicine-specific app that many healthcare providers use for virtual appointments. Your doctor's office will provide you a link to enter your virtual waiting room, where you'll provide some basic information like your name and the doctor you're waiting for. Your doctor or a nurse will then start the video call for your appointment. Doxy.me does not require you to download an app or create an account.

Amwell

Amwell is another popular telemedicine app used by many major health systems and some insurance providers. Once you create an Amwell account, you can schedule virtual urgent care, therapy, or specialist visits with doctors using the app. Appointments are available 24 hours, so Amwell is a good option for after-hours care or if your doctor's office uses the platform.

Teladoc

Teladoc is one of the most prominent telemedicine providers, partnering with many employers, health care plans, and hospital systems to offer virtual care. Just like Amwell, you'll set up an account, provide your insurance info, and schedule a visit with a doctor either by video or phone. Teladoc doctors are also available 24 hours for non-emergency care to diagnose and treat many common health issues.

Is Telehealth Included in Medicare?

Is Telehealth Included in Medicare?

If you're enrolled in Medicare, you're probably wondering about telehealth coverage. Here's your answer: Some Medicare Advantage (Medicare Part C) plans offer coverage for telehealth services like virtual doctor visits. These Medicare plans, offered by private insurance companies, provide the same coverage as Original Medicare (Parts A and B) as well as additional benefits like telehealth.

Do You Need Telehealth Coverage in Your Medicare Plan?

If telehealth is important to you but your current plan doesn't cover it, it's never too late to switch! Not all Medicare plans are created equal, That's why we're here to help you find a plan that's perfect for you ---

EASY Insurance is a team of experienced agents that are dedicated to helping you find the health plans that best suit you. Whether your need is best served by a government assistance program or a plan offered by a private insurance company, we will guide you through the entire process.

Remember: we're here to help you live an EASY and stress-free life!

Get a personalized Health Insurance quote now.

Click to speak with a licensed Insurance Agent

Or dial toll free

888-212-7991

Read More
Does Medicare Cover Physical Therapy? A Comprehensive Comparison of Benefits
Health Insurance, Medicare

Does Medicare Cover Physical Therapy? A Comprehensive Comparison of Benefits

When it comes to accessing healthcare services, particularly physical therapy, understanding what your insurance plan covers is crucial. In this blog post, we will delve into the topic of whether Medicare covers physical therapy and explore the benefits and costs associated with Medicare.

Additionally, we will compare it to Medicare Advantage plans and the potential additional coverage they may provide for physical and occupational therapy. By the end, you'll have a clearer understanding of your options and how to make informed decisions regarding your healthcare needs.

What Does Standard Medicare Cover?

Medicare, the federal health insurance program for individuals with certain disabilities and those aged 65 and older, offers coverage for a wide range of medical services. However, when determining if your insurance will cover physical therapy sessions, it's important to understand the limitations of standard Medicare coverage.

Does Medicare Part A Cover Physical Therapy?

Inpatient Physical Therapy Sessions

Medicare Part A primarily covers inpatient hospital care, some skilled nursing facilities, facility care, and some home health services. While it may cover physical therapy during an inpatient stay, such as rehabilitation following a hospitalization, it does not typically cover outpatient physical therapy on its own.

Does Medicare Part B Cover Physical Therapy?

Outpatient Physical Therapy

Medicare Part B covers medically necessary outpatient services, including doctor visits, preventive care, and certain therapies. Physical therapy falls under this category, making it eligible for coverage under Part B.

There are specific requirements and limitations to keep in mind. Medicare Part B covers physical therapy services that are deemed medically necessary to diagnose or treat a medical condition. It typically covers up to 80% of the approved amount for outpatient physical therapy, leaving you responsible for the remaining 20% through coinsurance or supplemental insurance.

Important Note: There is no max out-of-pocket limit for expenses with standard Medicare.

Get a personalized Health Insurance quote now.

Click to speak with a licensed Insurance Agent

Or dial toll free

888-212-7991

What Are the Common Types of Physical Therapy for Seniors?

Physical therapy plays a crucial role in helping seniors regain their mobility, manage pain, and improve their overall quality of life. There are various types of physical therapy available, each tailored to address specific needs and conditions. Let's explore some of the common types of physical therapy recommended for seniors.

Orthopedic Physical Therapy

Orthopedic physical therapy focuses on treating injuries and conditions related to the bones, muscles, ligaments, and tendons. It aims to restore function, reduce pain, and improve mobility, making it an effective approach for seniors recovering from fractures, joint replacements, or sports injuries.

Geriatric Physical Therapy

Geriatric physical therapy is specifically designed to address age-related conditions that affect older adults. These types of physical therapy treatments targets issues such as arthritis, Alzheimer's disease, hip replacement recovery, and other age-related challenges. It focuses on enhancing mobility, flexibility, and overall physical well-being.

Neurological Physical Therapy

Seniors living with neurological disorders can benefit greatly from neurological physical therapy. This specialized therapy aids in the management of conditions like brain injuries, strokes, Parkinson's disease, multiple sclerosis, cerebral palsy, and Alzheimer's. It focuses on improving coordination, balance, and mobility while helping individuals regain independence in their daily activities.

Cardiovascular or Pulmonary Rehabilitation

Cardiovascular or Pulmonary Rehabilitation

Cardiovascular or pulmonary rehabilitation is essential for seniors with heart and lung disorders. This type of therapy includes exercises and interventions that improve cardiovascular endurance, lung capacity, and overall respiratory function. It aims to enhance the senior's ability to perform daily activities and improve their overall cardiovascular health.

Wound Care Therapy

Wound care therapy is instrumental in facilitating the proper healing of wounds in seniors. By promoting adequate oxygenation and blood flow to the affected area, this therapy helps wounds heal more efficiently. It also focuses on preventing infections and minimizing scarring, ensuring optimal recovery.

Vestibular Therapy

Vestibular therapy is designed to address balance problems that can arise from inner ear infections or other issues affecting one's equilibrium. Seniors experiencing dizziness, vertigo, or unsteadiness can benefit from this specialized therapy, which aims to improve balance, reduce falls, and enhance overall stability.

Decongestive Therapy

Decongestive therapy is a valuable option for seniors with conditions such as lymphedema, which involves fluid build-up and swelling. This therapy focuses on reducing swelling, improving circulation, and promoting lymphatic drainage. By managing these conditions effectively, seniors can experience improved comfort and better mobility.

Pelvic Floor Rehabilitation

Pelvic floor rehabilitation aims to address complications in the digestive system and pelvic pain resulting from injuries, surgery, or other underlying conditions. It focuses on strengthening the pelvic floor muscles, improving bladder and bowel control, and reducing discomfort. This therapy can be beneficial for seniors experiencing issues such as urinary incontinence or pelvic organ prolapse.

Beware the Limitations of Medicare Part B Coverage

Beware the Limitations of Medicare Part B Coverage

While Medicare Part B covers physical therapy services, there are certain limitations to be aware of. For instance, there may be caps on the number of therapy visits covered per year and restrictions on the duration of each session.

Additionally, Medicare may require prior authorization for physical therapy services, and the physical therapist providing the services must be Medicare-approved.

Exploring Physical Therapy Services with a Medicare Advantage Plan

Medicare Advantage plans (MA plans), also known as Medicare Part C, are offered by private insurance companies approved by Medicare. These plans provide an alternative to traditional Medicare and often offer additional benefits beyond what original Medicare covers.

One potential advantage of MA plans is the potential for enhanced coverage of physical therapy services.

Additional Physical Therapy Coverage in Medicare Advantage Plans

Medicare Advantage plans may offer additional physical therapy coverage beyond what original Medicare provides. These plans can include options such as lower co-payments or coinsurance for physical therapy visits, coverage for a higher number of therapy sessions, or even coverage for alternative therapies like acupuncture or chiropractic services.

It's important to review the specific details of each MA plan with your licensed agent to understand the extent of the physical therapy coverage by your plan.

Find a Plan with the Benefits Most Valuable to You

If you're seeking comprehensive coverage for physical therapy and want to explore your Medicare options, the licensed agents at EASY Insurance are here to assist you.

Contact us today for a free consultation to discuss your healthcare needs and find the right insurance plan that fits your requirements. Don't wait to protect your health and well-being – reach out to EASY Insurance and secure the coverage you deserve.

Get a personalized Health Insurance quote now.

Click to speak with a licensed Insurance Agent

Or dial toll free

888-212-7991

Knowledge is Power and a Potential Money Saver

Understanding whether Medicare covers physical therapy is crucial for making informed decisions about your healthcare needs. While standard Medicare provides some coverage for outpatient physical therapy under Medicare Part B, it's important to be aware of the limitations and potential costs.

Exploring Medicare Advantage plans can offer additional options and enhanced coverage for physical therapy services. By evaluating your options and considering your individual needs, you can make an informed decision that ensures you have the right coverage to meet your physical therapy requirements.

Contact EASY Insurance today to start exploring your healthcare insurance options and get the coverage you need.

Read More
Why Is It Important to Know Your Family Health History?
Health Insurance

Why Is It Important to Know Your Family Health History?

When it comes to safeguarding your health and ensuring the well-being of your loved ones, knowledge is power. Understanding your family health history can provide invaluable insights into potential health risks, hereditary conditions, and predispositions that may affect you and your family members.

By looking into your family's medical past, you gain a deeper understanding of your genetic makeup, potential areas of higher risk, and any major medical conditions you should know allowing you to make informed decisions about your healthcare.

Let's learn why it is crucial to know your family health history, how it can help during doctor visits, and why protecting yourself and your family with health insurance is extremely important.

What is Family Health History?

Your family health history refers to a record of diseases, conditions, and health-related information within your immediate and extended family. It includes details about illnesses that your parents, grandparents, siblings, and other close relatives have experienced throughout their lives.

Gathering this information helps create a comprehensive picture of your family's health background, identifying patterns and potential genetic risks that may impact your well-being.

A Few Suggestions to Find Out Your Family Medical History

A Few Suggestions to Find Out Your Family Medical History

Not sure where or how to start gathering information on your family medical history? Try these suggestions:

  1. Talk to your relatives: Start by having open and honest conversations with your immediate and extended family members. Ask about any known medical conditions, chronic illnesses, or hereditary diseases that run in your family. Use family gatherings to gather health information and let your relatives know why you are asking these questions as it may help them too.
  2. Gather medical records: Collect family medical records, including hospital discharge summaries, old prescriptions, and laboratory test results of family members. These records can provide valuable insights into past diagnoses and medical conditions.
  3. Create a family health tree: Develop a visual representation of your family history. Include information about each family member and relative's medical conditions and age of onset. This can help identify patterns and potential risk factors.
  4. Consult with older family members: Reach out to older relatives who may have a deeper understanding of the family's medical history. They may recall details about relatives who have passed away or have limited communication.
  5. Utilize online resources: Take advantage of online tools and resources that can assist in documenting and tracking your family medical history. Websites and mobile applications specifically designed for this purpose can help organize and store information in a convenient and accessible manner.

Get a personalized Health Insurance quote now.

Click to speak with a licensed Insurance Agent

Or dial toll free

888-212-7991

How Can Knowing Your Family History Help During Doctor Visits?

When you visit a doctor, having knowledge of your family medical history can significantly influence the quality of care you receive. Healthcare professionals consider your family health history as an essential tool for assessing your risk factors and making accurate diagnoses.

By understanding your genetic predispositions and any hereditary conditions present in your family, doctors can tailor their approach, recommend appropriate screening tests, and suggest preventive measures to mitigate potential health risks.

Knowing your full family health history information enables doctors to:

Identify Potential Red Flags

If certain diseases or conditions run in your family, it raises your risk of developing them as well. By knowing this information, doctors can monitor your health more closely, conduct early screenings, and implement preventive measures to catch any potential issues before they worsen.

Some health problems and issues that may be common across a family include:

  • Breast Cancer
  • High Blood Pressure
  • Developing Heart Disease

Just because one of your other family members may have certain health conditions, it doesn't mean you are also guaranteed to have them, but you may be at an increased risk.

By knowing your other family members share a medical history you can pre-emptively take part in genetic testing to look for the same issues or proactively make lifestyle changes to reduce your risk.

Determine Suitable Treatment Plans

Certain medications or treatment methods may be more effective or suitable for individuals with specific genetic characteristics or ethnic background.

Using genetic testing and understanding your family health history, doctors can choose appropriate treatment options tailored to your genetic makeup, improving the chances of successful outcomes.

Offer Personalized Advice

Your family health history provides insights into lifestyle modifications and preventive measures that can help reduce your risk of developing certain conditions. By discussing your family health history with your doctor, you can receive personalized advice on diet, exercise, and other habits that may positively impact your overall health and well-being.

The Role of Health Insurance in Protecting Your Family Members' Health

The Role of Health Insurance in Protecting Your Family Members' Health

While knowing your family health history is essential, it's equally crucial to have health insurance to protect yourself and your loved ones from unexpected medical expenses. Health insurance acts as a safety net, ensuring access to quality healthcare services and mitigating the financial burden associated with medical treatments.

With health insurance, you can:

Receive regular check-ups and preventive care

Many health insurance plans cover preventive services such as vaccinations, screenings, and annual check-ups. These proactive measures can detect potential health issues early on, allowing for timely interventions and better health outcomes.

Access a wide network of healthcare providers

Health insurance plans often include a network of doctors, hospitals, and specialists. This network ensures that you have access to a diverse range of healthcare professionals, enabling you to choose providers who align with your specific healthcare needs.

Obtain financial protection

Medical emergencies or unexpected illnesses can result in substantial healthcare expenses. Health insurance provides financial protection by covering a significant portion of the medical costs, reducing the burden on you and your family.

Enjoy peace of mind

Having health insurance gives you peace of mind knowing that you and your family are protected against unforeseen, major medical issues and challenges. It allows you to focus on your health without worrying about the financial consequences of medical treatments and services.

Understanding your family health history empowers you to make informed decisions about your healthcare. It helps doctors assess your risk factors, tailor treatment plans, and provide personalized advice.

Additionally, securing health insurance ensures that you and your family have access to quality healthcare services while protecting you from the financial burden associated with medical expenses. By prioritizing your family's health and being proactive in managing your healthcare needs, you can take proactive steps towards a healthier future.

Ready to Invest in Your Future Health?

Ready to Invest in Your Future Health?

If you would like to explore health insurance options that can protect you and your other family member's health, EASY Insurance Plan agents are here to guide you every step of the way. Contact us today for a free consultation and let us help you find the perfect insurance plan that best fits your needs.

Remember, your own health history and the well-being of your loved ones are invaluable assets. Take charge of your healthcare journey by understanding your family health history and securing reliable health insurance coverage today.

Get a personalized Health Insurance quote now.

Click to speak with a licensed Insurance Agent

Or dial toll free

888-212-7991


Read More
How to Find a Good Doctor: A Complete Guide
Health Insurance

How to Find a Good Doctor: A Complete Guide

Finding a good doctor is a crucial step in maintaining your health and well-being. A reliable and competent healthcare provider can make a significant difference in your overall medical experience. However, with countless options available, it can be overwhelming to determine who is the right doctor and fit for you.

In this guide, we will walk you through the process of finding a good doctor, ensuring that you make an informed decision. Let's explore the steps you can take to find a healthcare professional who meets your needs and provides excellent care.

How Can You Gather Recommendations?

When beginning your search for a good doctor, start by reaching out to your trusted network of friends, family, and colleagues. Ask them about their experiences with their healthcare and primary care providers, and inquire about any recommendations they may have. Personal referrals can provide valuable insights into a doctor's competence, bedside manner, and overall patient satisfaction.

Research Online Platforms and Review Websites

In this digital age, online platforms and review websites have become go-to resources for finding reputable doctors. Websites like Healthgrades, RateMDs, and Zocdoc offer comprehensive information about doctors, including patient reviews, ratings, and contact details. Reading patient reviews can give you a sense of the new doctor who's communication skills, professionalism, and quality of care.

Seek Advice from Your Insurance Provider

If you have health insurance, consult your insurance provider for a list of in-network doctors. Insurance companies maintain networks of healthcare professionals who have agreed to provide services at negotiated rates. By choosing a doctor within your health insurance companies' network, you can maximize your benefits and minimize out-of-pocket expenses.

Contacting your insurance provider can help narrow down your options and ensure that you find a doctor who accepts your insurance plan. Many of them provide a database and rating system for many doctors and specialists in your area.

Get a personalized Health Insurance quote now.

Click to speak with a licensed Insurance Agent

Or dial toll free

888-212-7991

What Credentials and Qualifications Should You Consider?

Board certification is an important credential to consider when evaluating doctors. It indicates that the physician has undergone rigorous training and passed specialized exams in their respective medical fields.

Organizations such as the American Board of Medical Specialties (ABMS) and the American Osteopathic Association (AOA) certify doctors in various specialties. Verifying a doctor's board certification assures you that they have the necessary expertise to provide quality health care throughout.

Review medical school and residency training

Another aspect to consider is the doctor's educational background and residency training. Reputable medical schools and well-regarded residency programs often produce highly skilled and knowledgeable physicians. Researching a doctor's alma mater and residency training can provide insight into their training and qualifications.

Consider Affiliations with Reputable Medical Associations

Doctors who are affiliated with reputable medical associations and organizations demonstrate a commitment to their profession. These affiliations can include memberships in professional societies, hospital affiliations, participation in medical research, or involvement in local healthcare initiatives.

A doctor's active engagement in these organizations can reflect their dedication to staying updated with the latest advancements and best practices in their field.

How Can You Evaluate a Doctor's Communication Skills and Bedside Manner?

How Can You Evaluate a Doctor's Communication Skills and Bedside Manner?

Effective communication is paramount in a doctor-patient relationship. A good doctor should actively listen to your concerns, ask pertinent questions, and provide clear explanations about your health condition and treatment options. They should create a comfortable environment that encourages open dialogue and addresses any anxieties or uncertainties you may have.

How are the Doctor's Listening Skills and Responsiveness?

During your initial consultation with a new physician, observe how the doctor interacts with you.

  • Do they attentively listen to your current symptoms?
  • Are they empathetic and responsive to your questions and concerns?
  • Do they treat the office staff in a courteous manner?

A doctor who values open communication and prioritizes patient-centered care will make you feel heard and respected.

Does the Doctor Ask About Your Medical History?

When it comes to finding a good doctor, one crucial aspect to consider is whether they take the time to ask about your medical history. Your medical history plays a vital role in your overall healthcare management, as it provides valuable insights into your past and current health conditions, medications, allergies, and previous treatments.

A doctor who genuinely cares about your well-being will make it a priority to understand your medical background thoroughly. By asking detailed questions about your history, they can find specialists who can better assess your healthcare needs, identify potential risks, and tailor a personalized treatment plan that takes into account your unique circumstances.

So, when selecting a doctor, ensure that they prioritize getting to know your medical history, as this will lay the foundation for effective and personalized healthcare.

Can the Doctor Explain Medical Information Clearly?

Medical jargon and complex information can be overwhelming for patients. A good doctor should be able to explain medical concepts and treatment plans in a way that is easy to understand. They should use clear and concise language, avoid excessive technical terms, and provide visual aids or written materials, if necessary.

What Role Does Specialization Play in Finding a Doctor?

What Role Does Specialization Play in Finding a Doctor?

Medical specialties exist to address specific areas of healthcare, and doctors often specialize in particular fields. While general practitioners provide primary care, specialists focus on specific organ systems, diseases, or age groups. Depending on your health condition, you may need a doctor with specialized knowledge and expertise. Understanding the importance of specialization will help you identify the right type of doctor for your specific needs.

Helpful Tip: If you suffer from chronic conditions, you may be eligible for special needs plans which are a type of insurance with extra benefits and managed care teams to better treat your conditions.

Primary Care Doctor vs. Specialist

It's also important to note that depending on your insurance plan (both health insurance and Medicare recipients) you may be required to see a primary care doctor (also known as a primary care physician) before you are able to see a specialist. Most HMO plans require a referral to a specialist by a primary care doctor first.

Make sure you confirm with your insurance company first or your specialist visit may not be covered by the health plan.

Helpful Tip: If you wish to be able to see specialists without first visiting your primary care doctor, consider a PPO based insurance plan. Many of these plans allow you to see a specialist directly.

How Can You Assess a Doctor's Experience?

When dealing with a specific medical condition, seeking a doctor with experience in that area of practice can be advantageous. Doctors who have treated a high volume of patients with similar conditions tend to possess in-depth knowledge and skills specific to that ailment. Researching a doctor's experience and patient outcomes can give you confidence in their ability to provide effective care.

Assessing a Doctor's Track Record and Patient Outcomes

It is essential to assess a doctor's track record and patient outcomes when considering their services as primary care providers. Does the doctor have a history of successful treatments and positive patient experiences? Are there any red flags or malpractice claims associated with the doctor? Websites like the National Practitioner Data Bank and state medical boards can provide information regarding a doctor's disciplinary actions, malpractice claims, or licensure status.

How Can you Ensure Accessibility and Convenience?

Accessibility is a crucial factor when selecting a doctor. Consider the doctor's office location and its proximity to your home or workplace. Long travel times and inconvenient office locations can discourage regular visits, particularly for routine check-ups or follow-up appointments. Choosing a doctor within a reasonable distance can make healthcare more convenient and encourage better continuity of care.

Another option to check is if the doctor does TeleHealth visits. Telehealth can save you time and money for routine checkups.

Check Office Hours and Appointment Flexibility

Flexible office hours and appointment availability are vital, especially for individuals with busy schedules. Find out if the doctor offers early morning, evening, or weekend appointments to accommodate your needs. Additionally, inquire about their policy for urgent care or same-day appointments. A doctor who can accommodate your schedule will help ensure that you receive timely and convenient medical attention.

Does the Doctor Accept Your Insurance Plan?

Finances are an essential aspect of healthcare. To prevent unexpected expenses, confirm whether the doctor accepts your insurance plan. Contact both the doctor's office and your insurance provider to verify network participation and coverage details.

Working with an in-network doctor and health plan will help minimize out-of-pocket costs, ensuring that you receive the maximum benefits offered by your insurance plan.

What if Your Current Doctor Leaves Your Insurance Network?

What if Your Current Doctor Leaves Your Insurance Network?

If your current doctor leaves your insurance network you have two options.

  1. Find out if there is a new plan available to you that still covers your doctor and has the benefits you want and a premium within your budget.
  2. Keep your existing policy and find other primary care doctors in the area you can see. If you need help finding one in network, reach out to your insurance agent as they can provide a list for you.

Is it important to seek a second opinion?

Seeking a second opinion can be a prudent step, particularly when dealing with complex or serious medical conditions. A second opinion provides an opportunity to gain additional perspectives on chronic conditions, explore alternative treatment options, and confirm the initial diagnosis and proposed treatment plan. It can empower you to make well-informed decisions about your health.

How to approach seeking a second opinion

To seek a second opinion, start by discussing it with your new primary care physician. Be open and transparent about your intentions, as a good doctor will support your decision and respect your autonomy. Your primary doctor can often provide referrals to other specialists or recommend reputable colleagues who can offer a fresh perspective.

Finding doctors who specialize in providing second opinions

Certain doctors specialize in internal medicine, providing second opinions, and are well-versed in reviewing and reevaluating medical cases. These specialists offer unbiased assessments and can provide valuable insights and alternative treatment options. Consulting these specialists can be particularly beneficial if you require a comprehensive evaluation of your health condition.

Have Peace of Mind When Selecting Your Primary Care Physician

Finding a good doctor is a critical step in managing your healthcare needs. By following the steps outlined in this guide, you can navigate the process with confidence and make an informed decision. Remember to gather recommendations, assess credentials and qualifications, evaluate communication and bedside manner, consider specializations and experience, assess accessibility and convenience, and be open to seeking second opinions. By prioritizing these factors, you can find a good doctor who will provide excellent care and support you on your health journey.

Remember, your health is your most valuable asset, and finding a trusted doctor is an investment in your well-being. Take the time to research, ask questions, and trust your instincts. With a good doctor by your side, you can proactively manage your health and enjoy peace of mind knowing that you are in capable hands.

If you would like to look at your insurance plan options with an agency focused on getting you the benefits you deserve, EASY Insurance Plan agents are here to guide you every step of the way. Contact us today and let us help you find the perfect insurance plan that best fits your needs.

Get a personalized Health Insurance quote now.

Click to speak with a licensed Insurance Agent

Or dial toll free

888-212-7991


Read More
What Is Family Practice vs General Practice: Understanding the Differences
Health Insurance

What Is Family Practice vs General Practice: Understanding the Differences

Family practice and general practice are two common terms used in the medical field, often interchangeably. However, there are distinct differences between the two. If you're confused about what sets family practice apart from general practice, you've come to the right place

Learn the key differences between these medical specialties, exploring their unique features, the scope of practice, and the benefits they offer. Whether you're seeking medical care for yourself or your family, understanding the differences between family practice and general practice will empower you to make informed decisions about your healthcare needs.

Defining Family Practice (aka a Family Doctor)

Family practice, also known as family medicine, is a medical specialty that focuses on providing comprehensive healthcare for individuals of all ages, from infants to seniors. Family practitioners, also called family doctors, family physicians or primary care physicians, are trained to diagnose, treat, and manage a wide range of medical conditions across various organ systems.

Get a personalized Health Insurance quote now.

Click to speak with a licensed Insurance Agent

Or dial toll free

888-212-7991

What Does Family Medicine Cover?

The scope of coverage for a family medicine doctor is broad, covering preventive care, acute illnesses, chronic diseases primary medical care, and routine medical check-ups. They are equipped to address a wide range of health concerns, including but not limited to:

  1. Preventive Care: Family practitioners emphasize preventive care by promoting regular check-ups, immunizations, and screenings. They work closely with patients to develop personalized wellness plans to maintain optimal health.
  2. Diagnosis and Treatment: Family doctors are skilled in diagnosing and treating common illnesses and injuries such as infections, minor injuries, and respiratory conditions. They can also manage chronic diseases like diabetes, hypertension, and asthma.
  3. Management of Chronic Conditions: Family practice physicians provide ongoing care and management for chronic conditions, helping patients understand their conditions, develop treatment plans, and make necessary lifestyle adjustments.
  4. Mental Health: Family practice doctors are attuned to the emotional well-being of their patients. They can address mental health concerns, provide counseling, and refer patients to specialists if needed.
  5. Referrals and Coordination: If specialized care is required, family physicians coordinate referrals to specialists and ensure seamless communication among healthcare providers.
Benefits of Family Practice

Benefits of Family Practice

Family practice offers several benefits to patients seeking comprehensive and continuous healthcare:

  1. Continuity of Care: Family practitioners build long-term relationships with their patients, providing consistent and personalized care throughout their lives. This familiarity enables better understanding of a patient's medical history, family dynamics, and individual needs.
  2. Convenience for Families: Having a family practitioner means that individuals of all ages, from infants to seniors, can receive care from a single healthcare provider. This streamlines the healthcare process and simplifies scheduling appointments for the entire family.
  3. Holistic Approach: Family practice doctors take a holistic approach to healthcare, considering not only physical health but also the emotional, social, and environmental factors that can impact well-being. They focus on preventive care services and wellness promotion, emphasizing the importance of overall health.
  4. Comprehensive Healthcare Services: Family practitioners offer a wide range of services, reducing the need for multiple specialists for routine care. They serve as the first point of contact for medical concerns and can address various health issues effectively.

What Does General Practice Mean?

General practice, also known as general medicine, is another branch of primary care that provides a broad range of medical services. General practitioners, often referred to as GPs or general physicians, are trained to offer initial evaluations, diagnoses, and treatment for a wide array of medical conditions.

What is Covered in a General Practice?

A General practitioner provides medical care for patients of all ages and are trained to handle urgent care for a variety of health concerns, including:

  1. Diagnosis and Treatment: a General practitioner diagnoses and treats common acute illnesses, such as respiratory infections, gastrointestinal issues, and musculoskeletal injuries.
  2. Chronic Disease Management: They are skilled in managing chronic conditions like diabetes, hypertension, arthritis, and asthma. They work with patients to develop treatment plans, monitor progress, and make necessary adjustments to improve health outcomes.
  3. Routine Check-ups and Screenings: Perform routine check-ups and preventive screenings to detect potential health issues early on. This includes monitoring vital signs, conducting physical examinations, and ordering laboratory tests.
  4. Referrals and Coordination: When specialized care is required, a general practitioner can refer patients to appropriate specialists and coordinate their care. They ensure that all healthcare providers are aligned in managing the patient's health.

Benefits of General Practice Doctors

General practice doctors offers several advantages for individuals seeking primary care:

  1. Versatility: General practice physicians are equipped to handle a wide range of medical conditions, making them a one-stop destination for most healthcare needs. They provide comprehensive and integrated care, reducing the need for multiple specialists for routine issues.
  2. Accessibility: General practitioners are typically available in various healthcare settings, including clinics, hospitals, and private practices. Their accessibility ensures that patients can seek prompt medical attention without lengthy waiting periods.
  3. Continuity of Care: Similar to family practice, general practitioners emphasize long-term relationships with their patients. They provide continuity of care, getting to know their patients' medical history, preferences, and individual needs over time.
  4. Cost-Effective Care: General practitioners offer cost-effective healthcare by providing initial evaluations, diagnoses, perform medical testing, and treatment for a broad range of conditions. This reduces the need for unnecessary referrals and specialist visits, resulting in potential cost savings.
Choosing the Right Approach for Your Healthcare Needs

Choosing the Right Approach for Your Healthcare Needs

When deciding between family practice and general practice doctors, it's essential to consider your specific healthcare requirements. Here are some factors to consider:

  1. Family Dynamics: If you're seeking healthcare for your entire family, including infants, children, and elderly members, family practice may be more suitable as it caters to patients of all ages.
  2. Complexity of Medical Conditions: If you have complex or chronic medical conditions that require specialized care, you may benefit from the comprehensive approach of a family practitioner who can coordinate your overall healthcare.
  3. Convenience and Accessibility: Consider the availability and proximity of family practice and general practice providers in your area. Choose a healthcare provider that offers convenience and easy access to timely care.
  4. Personal Preference: Reflect on your preference for continuity of care and the development of long-term relationships with your healthcare provider. This may play a significant role in your decision-making process.

Ultimately, both a family practice doctor and general practice one play vital roles in primary care, providing essential medical services to patients of all ages. By understanding the differences between these two specialties and evaluating your healthcare needs, you can make an informed decision about the approach that best aligns with your personal preferences and requirements.

Is Your Doctor Covered By Your Insurance?

No matter if you choose a family doctor or a general practitioner as your primary care physician you need to check if they are covered by your insurance. If they are not covered, you could be paying "out of network" fees that could very costly.

If you're unsure about whether your family or general practice doctor is covered by your insurance or if you're looking for insurance that best fits your needs, our licensed agents at EASY Insurance Plans are here to help.

We understand that finding the right coverage for you and your family can be overwhelming, but we're here to make it easy. Our knowledgeable agents can assist you in determining the best options for you and your family, and the best part is, our services come at no cost to you.

Don't hesitate to reach out to us for guidance and support in finding the insurance coverage that suits your unique needs.

Get a personalized Health Insurance quote now.

Click to speak with a licensed Insurance Agent

Or dial toll free

888-212-7991


Read More
dental and vision insurance for seniors on medicare
Health Insurance

Dental and Vision Insurance for Seniors on Medicare: Learn What is Covered

As we age, it becomes increasingly important to take care of our health, including our dental and vision needs. For seniors on Medicare, however, it can be challenging to find adequate coverage for these essential services.

In this blog, we will explore Dental and Vision Insurance for Seniors what is covered under standard Medicare, the types of additional insurance people need, and how some carriers and plans provide extra benefits through Medicare Advantage to help cover dental and vision expenses.

What is Covered Under Standard Medicare

What is Covered Under Standard Medicare?

Medicare is a federal health insurance program that provides coverage for people who are 65 or older, as well as some younger people with disabilities. Original Medicare is made up of two parts: Part A, which covers hospital stays, and Part B, which covers doctor visits and other outpatient services. While Medicare covers a wide range of healthcare services, it does not cover routine dental care and vision checkups.

Medigap Policies Don't Cover Dental Services and Vision

It's important for seniors to understand that while Medicare Supplement Plans, also known as Medigap policies, provide additional health insurance coverage beyond what Original Medicare offers, they do not typically cover dental or vision care. Medigap policies are designed to cover gaps in Original Medicare coverage, such as coinsurance, copayments, and deductibles.

However, dental and vision care are considered separate services under Medicare and are not included in Medigap policies.

How to Get Dental and Vision Insurance for Seniors Coverage?

To get coverage for dental and vision care, seniors on Medicare can purchase additional insurance. Some people may choose to enroll in a standalone dental or vision insurance plan from private insurance companies.

When it comes to getting coverage for dental and vision care, everyone has different preferences on what they consider to be the "best coverage." That's why it's important to carefully review the options available and choose a plan that meets your unique healthcare needs.

When looking for your best dental insurance plan, consider the following factors:

  1. Coverage: Look for a plan that covers the dental services you need, such as cleanings, fillings, root canals, and additional preventative care services.
  2. Cost: Review the plan's premiums, deductibles, and copayments to determine your out of pocket costs.
  3. Network: Check to see if your preferred dental provider is in the plan's network, or if you're willing to switch to an in-network provider.
  4. Limitations: Some dental plans may have limitations on certain major services, procedures, and long waiting periods so make sure to review the plan's limitations before enrolling.
  5. Reputation: Look for a dental insurance provider with a good reputation and high customer satisfaction ratings.

When looking for a vision insurance plan, consider the following factors:

  1. Coverage: Look for a plan that covers the vision services you need, such as eye exams, glasses, or contact lenses.
  2. Cost: Review the plan's premiums, deductibles, and copayments to determine how much you'll pay out of pocket.
  3. Network: Check to see if your preferred eye doctor or eyewear provider is in the plan's network, or if you're willing to switch to an in-network provider.
  4. Limitations: Some plan's vision coverage may have limitations on certain diagnostic services, types of eyewear, and long waiting periods so make sure to review the plan's limitations before enrolling.
  5. Reputation: Look for a vision insurance provider with a good reputation and high customer satisfaction ratings.

By taking these factors into consideration, you can find a dental or vision insurance plan that fits your budget and healthcare needs.

Have You Considered Medicare Advantage Plans

Have You Considered Medicare Advantage Plans?

Many Medicare Advantage plans can be a great option for seniors who want more comprehensive healthcare coverage, including dental and vision benefits. These plans may offer services like routine dental checkups, teeth cleaning, X-rays, and fillings, as well as coverage for vision care such as eye exams, glasses, and contact lenses.

By enrolling in a Medicare Advantage plan, seniors can potentially save time and money by having all their healthcare needs covered under one policy, rather than managing multiple stand-alone dental and vision plans with separate expenses. This can also help to reduce the hassle of keeping track of multiple premiums, deductibles, and copayments.

It's important to note that Medicare Advantage plans may vary in terms of the dental and vision benefits they offer, so seniors should carefully review the plan options available in their area and choose the one that best fits their healthcare needs and budget.

Special Medicare Advantage Plans (DSNPs)

If you are a Medicare recipient who has both Medicare and Medicaid, you may be eligible for Dual Eligible Special Needs Plans (DSNPs). These plans can offer specialized healthcare services and additional benefits, such as dental, vision, and hearing coverage, transportation to medical appointments, and gym memberships. DSNPs also have additional special enrollment periods throughout the year, which allow eligible individuals to enroll in the plan outside of the standard enrollment period. If you have complex healthcare needs and require more specialized care, DSNPs can be a great option for you.

However, it's important to note that not all Medicare Advantage plans offer DSNP options, so you should check with a knowledgeable Medicare insurance provider to determine your eligibility and the plan options available in your area.

Learn More About Your Options for Dental and Vision Insurance

If you or someone you know is on Medicare and is in need of dental and vision coverage, there are options available. At EASY Insurance Plans, we offer zero-cost, zero-obligation consultations to help seniors understand their options and make informed decisions about their healthcare coverage.

Whether you are interested in standalone dental or vision insurance or a Medicare Advantage plan that includes dental and vision coverage, our team of licensed insurance agents can help you find the right plan for your needs and budget. Contact us today to learn more.

Get a personalized Health Insurance quote now.

Click to speak with a licensed Insurance Agent

Or dial toll free

888-212-7991

Read More
To Shop at the Health Insurance Marketplace What You Need To Know
Health Insurance

To Shop at the Health Insurance Marketplace: What You Need To Know

Are you, like many Americans, having difficulties finding the right health insurance plan for yourself and your family?

From looking through the offers by different providers, to obtaining coverage details and quotes, to working out the estimated costs, you can easily be overwhelmed by all the terms and options that are available to you. The truth is, the entire decision-making process can be complicated and lengthy. At some point, you may even find yourself having to make decisions within a very limited time frame, making the already frustrating process even more challenging.

The Health Insurance Marketplace is the platform set up by the Federal government to help you access the information you need to make informed decisions on your healthcare coverage. You can also enroll in the plans through the platform. To ensure a seamless process, contact agents such as EASY Insurance Plans to walk you through the entire process.

What Is the Health Insurance Marketplace

What Is the Health Insurance Marketplace?

The Federal Health Insurance Marketplace (also known as the "Marketplace" or "Exchange") is a website where American individuals, families, and small businesses can shop and enroll in health insurance plans.

The Marketplace is a convenient one-stop-shop platform for insurance plan shoppers. Through online or in-person approach, you will be able to:

  • Browse and compare insurance plans and prices
  • Choose the benefits and plan that best suits your individual needs
  • Find the most affordable benefits package
  • Get answers to questions about your health care insurance
  • Find out your eligibility for tax credits
  • Enroll in a health insurance plan that meets your needs

The Marketplace was created as part of the Affordable Care Act (ACA) in 2010 (commonly known as "Obamacare") so that all U.S. consumers could afford quality healthcare coverage regardless of their income or pre-existing conditions.

Who Is Eligible For Health Insurance Marketplace?

To be eligible to enroll in Health Insurance Marketplace, you must live in the U.S., be a U.S. citizen or national (or be lawfully present), and not be incarcerated.

Your household income level will determine whether and how much premium subsidy you are entitled to. Check out this link for more details.

If you have Medicare coverage, you’re not eligible to use the Marketplace to buy a health or dental plan.

The purpose of the Marketplace is to provide subsidies to uninsured populations with a place to purchase health insurance. Uninsured populations include:

  • People who lost their jobs and access to health coverage
  • Workers whose employers do not offer health insurance as a benefit option
  • People who are self-employed, freelancers, or early retirees who are not yet eligible for Medicare.

Things You Need To Know Before Picking A Marketplace Plan

Choosing a health insurance plan for yourself and your family can be a complicated process.
Knowing the following information before you start comparing plans can make the process easier:

1. The 5 categories of health insurance plans

Bronze, Silver, Gold, Platinum and Catastrophic. These categories show how you and your plan share costs. The categories have nothing to do with the quality of care.

2. Your Total Costs For Health Care

It is important to understand the kind of costs you need to pay. You pay a monthly fee to your insurance company (a "premium") even if you don’t use medical services that month. When you get healthcare services, you pay out-of-pocket costs, including a deductible.

3. Plans and Network Types (HMO, PPQ, POS, EPO)

You will see terms like HMO, PPQ, POA, EPO. Each represents the network types of your health care plan. Some plan types allow you to use almost any doctor or healthcare facility. Others limit your choices or charge you more if you use providers outside their network. Check out the definition of each type of health care plan before deciding which plan fits you best.

What Plans Does The Marketplace Offer

What Plans Does The Marketplace Offer?

The available plans in the Marketplace are offered in 4 categories - Bronze, Silver, Gold, and Platinum. "Catastrophic Plans" are also available to some people.

Again, the plan categories are classified based on how you and the insurance company split the cost. They have nothing to do with the quality of the benefit you receive. All plans provide free preventive care.

Bronze (Insurance pays 60%, You pay 40%)

  • Lowest monthly premiums
  • Highest out-of-pocket costs
  • Higher deductible
  • More for those who are looking for affordable health coverage.
  • Recommendation:
    • Good choice if you are looking for low-cost coverage to protect you from serious sickness or injury.
    • If you do not need to visit a doctor on a regular basis, you may benefit from this plan as you would save money on lower premiums over time but you will have to pay for most routine care yourself.

Silver (Insurance pays 70%, You pay 30%)

  • Moderate monthly premiums
  • Moderate out-of-pocket costs
  • Lower deductible than those in the Bronze plan
  • Get extra savings with a silver plan. If you are qualified for Cost-Sharing Reductions (CSR), you must select a silver plan to get your discount savings. If you’re enrolled in a silver plan and lose your cost-sharing reductions, you’ll qualify for a Special Enrollment Period. If you want to change plans, you can enroll in a Bronze, Silver or Gold plan according to your budget.
  • Recommendation:
    • Good for those who qualify for the extra savings options.
    • If you are willing to pay a slightly higher monthly premium than Bronze to have more of your routine care covered.
    • If you need frequent medical care per year, the extra saving can go up to a few hundred or even thousands of dollars per year.

Gold (Insurance pays 80%, You pay 20%)

  • Higher monthly premium
  • Lower out-of-pocket costs
  • Lower deductible
  • Recommendation: If you are willing to pay more each month to have more costs covered when you get medical treatment. You would benefit from Gold if you need medical attention regularly.

Platinum (Insurance pays 90%, You pay 10%)

  • Highest monthly premium
  • Lowest out-of-pocket costs
  • Lowest deductible
  • Recommendation:
    • If you need a lot of medical care per year.
    • You can afford higher monthly premiums in exchange for lower out-of-pocket costs.

Catastrophic Plans

  • Very low monthly premiums
  • Very high deductible
  • Recommendation: An affordable way to protect yourself from serious sicknesses or injuries. But you pay most routine medical expenses yourself.

In order to qualify for catastrophic plans, you have to be either:

Catastrophic plans cover the same health benefits as other Marketplace plans with all preventive services covered at no cost. However, this option is excluded from the premium tax credit and you may consider if it is the best financial option for you.

Get a personalized Health Insurance quote now.

Click to speak with a licensed Insurance Agent

Or dial toll free

888-212-7991

Save Money On Health Insurance Premium

No matter which health plan category you choose, you can save a lot of money on your monthly premium based on your income.

When you fill out a Marketplace insurance application, you will find out if you qualify for a Marketplace plan with a lower monthly premium plus extra savings, including lower deductibles and copayments. You may also be eligible for the premium tax credits.

You can do a quick check here to see if your income is within the range to qualify.

Health Insurance Marketplace Requirements

Health Insurance Marketplace Requirements

Health benefits may vary based on each state's requirements on Marketplace. However, all Marketplace plans must cover the below 10 essential health benefits as minimum requirements:

10 essential health benefits

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Laboratory services
  • Prescription drugs
  • Preventive and wellness services and chronic disease management
  • Rehabilitative and habilitative services and devices
  • Mental health and substance use disorder services, such as behavioral health counseling
  • Pregnancy, maternity, and newborn care
  • Pediatric services, including oral and vision care

Additional benefits

Plans may also include the follows benefits:

  • Birth control coverage
  • Breastfeeding coverage, such as lactation specialists, counseling, and equipment

Specific services and benefits may be covered by some states, which may include:

  • Dental coverage
  • Vision coverage
  • Medical management programs (for specific needs like weight management, back pain, and diabetes)

How to Choose a Plan From the Health Insurance Marketplace

Below are some of the factors to consider before deciding which insurance plan is the best for you and your family:

  • Frequency of healthcare you need
  • Your health condition based on your history
  • Any planned healthcare needs, such as surgical procedures scheduled, regular monitoring of certain medical conditions
  • Your budget, long-term finances and affordability

Gold or Platinum might be the best options if you predict you will need frequent doctor’s visits, hospital stays, or medical procedures.

On the other hand, Bronze or Silver might suit you better if you have minimal healthcare needs. You can save on the monthly premiums since you seldom need health care services.

There should also consider carefully your budget and financial strength. You need to strike a balance between how much coverage you need and what fits within your budget.

When Can You Enroll In Health Insurance Marketplace?

The next open enrollment period will be from November 2023 until January 2024. If you are currently having Marketplace coverage, you will need to renew your enrollment during the open enrollment period.

You can enroll in a plan during the open enrollment period each fall (around Nov) for coverage the following year.

If you wish to enroll in or make changes to your health plan outside the open enrollment period, you need to qualify for a Special Enrollment Period which has to be triggered by a qualifying life event (QLE).

A life event is generally a significant change that occurs in your life. Such as a change to your family, your residence, your previous health coverage, loss of employer-provided coverage, and other reasons. Note that you usually have 60 days from that event to enroll.

How To Apply For 2024 Health Insurance Marketplace

How To Apply For 2024 Health Insurance Marketplace?

Having read all the basic information about Marketplace we listed above, it's now time to decide on the right plan for you and your family.

Don't know where and how to start? Don't worry, as we mentioned, our team of licensed agents at EASY Insurance Plans will walk you through the entire sign-up process. We will break down and compare the offers from different providers and their plans, and answer whatever questions you have, such as the deductibles and copayment of each plans.

We are here to help you find the plan that best suit your needs.

Get a personalized Health Insurance quote now.

Click to speak with a licensed Insurance Agent

Or dial toll free

888-212-7991

What Other Government Healthcare Benefits Are There?

While the ACA and the Marketplace have helped bring affordable healthcare coverage to many who were uninsured, there are other options out there when it comes to public medical assistance program.

When you approach the age of 65, you will be eligible for Medicare, which is another national health care program offered by the U.S. government. Medicare is also available to people with certain types of disabilities or medical conditions.

There are many different insurance companies, agents and brokers offering Medicare policies.

If you are looking for an experienced Medicare agent that has your best interest in mind, EASY Insurance Plans will be happy to take the time and discuss your Medicare options.

Not turning 65 but looking for an independent agent to help determine what the best coverage health plans are available for you and your family?

We can compare your current health insurance coverage with other plans in your area to help you find the best fit. {link to health insurance landing page}

Read More
What Is Health Insurance Open Enrollment Why Is It So Important
Health Insurance

What Is Health Insurance Open Enrollment? Why Is It So Important?

When you sign up for health plans, it is important to bear in mind the dates when you can enroll in or make changes to your coverage. This time period is generally known as the open enrollment period. And the dates can be different between those looking for health insurance plans via the individual market, and government programs like Medicare.

For Health Insurance Marketplace plans and individual plans, the enrollment period usually takes place once a year from November till January the following year. During this time, you can compare health plans, switch from a current plan to a different plan or insurer, add or remove dependents, and make other changes to your health insurance coverage. It is important to take advantage of open enrollment to make sure you are enrolled in the best possible health insurance plan for your needs and budget.

This blog post will explain to you all the details about the open enrollment period.

When Is The Open Enrollment for 2024

When Is The Open Enrollment for 2024?

Health Insurance Open Enrollment for 2024 starts in November. Here are the important dates to remember:

  • Wednesday, November 1, 2023. Open Enrollment begins.
  • Monday, January 15, 2023: Open Enrollment ends (extensions may be granted).
  • Monday, January 1, 2023: The earliest a plan purchased during open enrollment can start.

Some states may or may not extend their open enrollment dates in response to their residents' needs. It is important that you check with your own state's insurance department for detailed information.

What Types of Insurance Use Open Enrollment?

Open enrollment is commonly used for health insurance, including employer-sponsored health insurance plans, and individual health insurance plans purchased through the Health Insurance Marketplace.

Dental and vision insurance plans may also use open enrollment periods. Additionally, some employers may offer open enrollment periods for life insurance, disability insurance, and other forms of voluntary employee benefits.

Get a personalized Health Insurance quote now.

Click to speak with a licensed Insurance Agent

Or dial toll free

888-212-7991

What is Health Insurance Marketplace

The Health Insurance Marketplace, commonly known as the Marketplace, is an online platform that offers health insurance options to individuals, families, and small businesses in the United States. It was created as part of the Affordable Care Act (ACA) and is also known as the Obamacare marketplace.

The Marketplace allows consumers to compare and purchase health insurance plans from different insurance companies, while also providing financial assistance to those who qualify. You can shop for and compare plans based on income, family size, and location, and get personalized help from trained professionals to find the best coverage options to fit your needs.

What To Do If You Missed The Open Enrollment Deadline?

If you have missed the health insurance open enrollment deadline, there are still some options available to you. If you are required to enroll in a new plan for 2023 or make any changes to your existing plan for the year, you can choose one of the below options:

1. Special Enrollment Period

In certain circumstances, you may be eligible for a Special Enrollment Period outside of the open enrollment period. Qualifying events may include losing your job, getting married or divorced, having a child, or moving to a new state.

Depending on your Special Enrollment Period type, you may have 60 days before or 60 days following the event to enroll in a plan.

Later in this article, you will see a list of examples of qualified life events that trigger a special enrollment period. Contact your licensed insurance agent if you experienced a similar situation and find out whether you qualify for a special enrollment.

2. Short-Term Health Insurance

Short-term health insurance plans are an option if you need coverage for a limited time, usually up to 12 months. However, these plans are not compliant with the Affordable Care Act (ACA) and do not offer all the same benefits as standard plans.

3. Medicaid or CHIP

If you have a low income, you may be eligible for Medicaid or the Children's Health Insurance Program (CHIP), which provides free or low-cost health coverage to those who qualify.

4. COBRA - Continuation of Health Coverage under the Consolidated Omnibus Budget Reconciliation Act

If you have lost your job or had your working hours reduced, you may be eligible for COBRA , which allows you to continue your employer-sponsored health coverage for up to 18 months after you leave your job. However, you will need to pay the full premium.

5. Private Insurance

You can always purchase a private health insurance plan outside of the open enrollment period. Keep in mind that these plans may be more expensive, and you may have to go through a medical underwriting process.

What is a Qualifying Life Event

What is a Qualifying Life Event?

There are 4 basic types of qualifying life events. Below are EXAMPLES of life event commonly experienced by consumers:

1. Loss of health coverage

  • Losing existing health coverage, including job-based, individual, and student plans
  • Losing eligibility for Medicare, Medicaid, or CHIP
  • Turning 26 and losing coverage through a parent’s plan

2. Changes in household

  • Getting married or divorced
  • Having a baby or adopting a child
  • Death in the family

3. Changes in residence

  • Moving to a different ZIP code or county
  • A student moving to or from the place they attend school
  • A seasonal worker moving to or from the place they both live and work
  • Moving to or from a shelter or other transitional housing

4. Other qualifying events

  • Changes in your income that affect the coverage you qualify for
  • Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
  • Becoming a U.S. citizen
  • Leaving incarceration (jail or prison)
  • AmeriCorps members starting or ending their service

Get a personalized Health Insurance quote now.

Click to speak with a licensed Insurance Agent

Or dial toll free

888-212-7991

What are the Enrollment Periods for Medicare

What are the Enrollment Periods for Medicare?

This enrollment period for Medicare is from October 15 through December 7 each year.

Coverage begins the following January 1. For people who are new to Medicare, the Initial Enrollment Period (IEP) - is the very first chance you sign up Medicare. IEP last for 7 months long, starting 3 months before you turn 65, and ending 3 months after the month you turn 65.

Avoid the penalty - If you miss your 7-month Initial Enrollment Period, you may have to wait to sign up and pay a monthly late enrollment penalty for as long as you have Part B coverage. The penalty goes up the longer you wait. You may also have to pay a penalty if you have to pay a Part A premium, also called “Premium-Part A.” Check with your licensed insurance agent to understand more and avoid any unnecessary penalties.

It's important to remember that going without health insurance can be costly in the long run, as you may be responsible for paying for all of your medical expenses out of pocket.

If you are unsure of your options or need assistance, reach out to a licensed insurance agent at EASY Insurance Plans and we will provide you with all information you need for comparing plans and prices, find you the plans that best suit you and your family, and guide you through the enrollment process.

Get Yourself Ready For Open Enrollment for 2024

Similarly, if you need assistance navigating the Health Insurance Marketplace, or a licensed insurance agent to explain to you details of the plans and their benefits, as well as toher government healthcare benefits available for your current and future needs, EASY Insurance Plans can also help to answer all these questions.

An example is if you or someone in your family is approaching the age of 65, you or they will be eligible for Medicare, Medicare is also available to people with certain types of disabilities or medical conditions.

In some cases, you may want to purchase secondary insurance for some items not covered by your Medicare benefits. There are many different insurance companies offering Medicare policies. If you are looking for an experienced Medicare agent that has your best interest in mind, our agents will be happy to take the time and discuss your Medicare options.

So whether you are looking to buy in the individual insurance market or are looking for the best Medicare insurance plans, we will bring you all the best options and help you make the right choice.

Read More