Does Medicare Cover Blood Tests?
Seniors, Medicare

Does Medicare Cover Blood Tests?

As you age, it's natural to start worrying about your health a bit more. One good way to keep track is through blood tests, which can provide insight into your body in many ways, including checking for diseases or conditions like diabetes, heart disease or thyroid problems. If caught early, many of them are manageable with treatment.

And while lab tests can be expensive thanks to the Federal Government-funded Medicare program, Americans over the age of 65 or those with certain disabilities are able to receive health insurance coverage that many would otherwise find it difficult to afford. But the question is: does Medicare cover blood tests?

What Is Original Medicare

Before we talk about blood test coverage, let us walk through some basic terminology about Medicare. The program is divided into four parts, with Part A and Part B also known as Original Medicare. And here's what they cover:

  • Medicare Part A: Covers hospital stays and care. This includes expenses like a semi-private hospital room, meals, nursing, and prescription drugs. After you've paid the deductible, Part A is free for most Americans since you likely paid for it with payroll taxes during your working years.
  • Medicare Part B: Covers medically necessary doctors' services, outpatient care, home health care, durable medical equipment, and many preventive services. You have to pay a monthly premium for Part B coverage, but this plan is optional. The standard Part B premium amount changes each year. It also has an annual deductible ($226 for 2023) and coinsurance, meaning you pay 20% of the amount approved by Medicare for most doctor services.

Medicare Part A Coverage of Blood Tests

When it comes to blood tests, Medicare Part A typically covers the costs if the tests are deemed medically necessary for diagnosis or treatment. Since it also covers hospital care, blood tests performed during an inpatient hospital stay or as an outpatient at a hospital facility should be fully covered.

Inpatient Hospital Care

If you are admitted to the hospital as an inpatient, Medicare Part A will cover any blood tests ordered by your doctor during your stay. These could include common tests like a complete blood count (CBC), electrolyte, kidney function tests, or more specialized tests if needed for diagnosis or monitoring of a medical condition. As long as the blood tests are directly related to the reason for your inpatient admission, there should be no out-of-pocket cost to you.

Outpatient Hospital Care

Even if you are not admitted for an overnight hospital stay, blood tests performed at a hospital outpatient clinic or emergency department should still be covered under Part A. This includes tests done to investigate symptoms or monitor an ongoing health issue. Depending on your condition or circumstances, this may include:

  • Kidney function tests (BUN, creatinine)
  • Liver function tests (AST, ALT, bilirubin)
  • Cholesterol tests (total cholesterol, LDL, HDL, triglycerides)
  • Blood sugar tests (fasting glucose, HbA1c)

While Part A provides some coverage for these medically necessary blood tests in a hospital setting, there are exceptions. Routine physical exams, diagnostic laboratory tests, tissue specimen tests, health screenings and blood work for monitoring stable conditions may not qualify.

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Blood Tests Covered With Medicare Part B

Medicare Part B also covers a variety of blood tests to help diagnose and monitor health conditions, though just like Part A, they are dependent on your medical needs and risk factors. Here are some of the common ones covered by Medicare Part B:

  • Complete Blood Count (CBC): Measures several components of your blood, including red blood cells, white blood cells, and platelets. It helps check for anemia or infection. Medicare covers this test once every 3 years, or more often if medically necessary.
  • Basic Metabolic Panel: Measures blood sugar, electrolyte and fluid balance, kidney function, and liver function. It provides an overview of your body’s chemical balance and is often used as a first-line test for general health screening. Medicare covers this test once every year.
  • Lipid Panel Test: A lipid panel measures cholesterol levels, including HDL (good cholesterol), LDL (bad cholesterol), and triglycerides. High cholesterol is a risk factor for heart disease, so Medicare covers this test once every 5 years, or more frequently if you have heart disease or high cholesterol.
  • Thyroid: Medicare covers blood tests to check thyroid hormone levels, including TSH, T3, and T4. These tests help diagnose thyroid disorders like hypothyroidism or hyperthyroidism. The frequency of coverage depends on your medical needs and risk factors.

Blood Tests for Diagnosing a Medical Condition

When diagnosing a medical condition, your doctor may order blood tests to help determine the cause of your symptoms or abnormal findings. Medicare Part B covers most medically necessary blood tests.

  • Blood Chemistry Tests: These tests analyze the levels of substances like glucose, electrolytes, proteins, and enzymes in your blood. They are often used to check for diabetes, liver or kidney disease, and other disorders. Basic blood chemistry tests, like a metabolic panel, are typically covered under Medicare Part B with no out-of-pocket costs.
  • Tumor Marker Tests: Certain blood tests can detect high levels of proteins that may indicate the presence of cancer. Prostate-specific antigen (PSA) tests, for example, are used to screen for prostate cancer in men. While Medicare Part B covers PSA tests once every 12 months, they will only cover additional tests if you have symptoms or a diagnosis of cancer.
  • Thyroid Function Tests: Checks levels of thyroid hormones TSH, T3 and T4. Used to diagnose hyperthyroidism or hypothyroidism.
  • Hepatitis: Screens for hepatitis A, B and C infections which can lead to liver disease.
  • HIV: Detects antibodies and antigens to determine if you have the human immunodeficiency virus (HIV).
Does Medicare Cover Routine Blood Testing?

Does Medicare Cover Routine Blood Testing?

In addition, Medicare Part B covers some routine blood testing to check for health issues or monitor a known medical condition, though again, the coverage and out-of-pocket costs for these tests will depend on whether they are medically necessary.

The following are examples of routine or preventive blood testing that’s not medically necessary hence may not be covered by Medicare. 

  • Comprehensive metabolic panels and cardiac risk panels.
  • Vitamin, mineral and nutrient level testing without a known deficiency.
  • Heavy metal toxicity testing without symptoms or exposure risks.
  • Baseline tests for “wellness” or health optimization purposes.

If Medicare denies coverage for a blood test, you'll have to pay the full cost out of pocket. The exact prices will depend on the specific tests ordered by your doctor. Make sure to check with your provider about potential costs before agreeing to any testing not medically necessary.

Do Medicare Advantage Plans Cover Blood Tests?

Now that we've discussed coverage for Original Medicare, let's look at Medicare Advantage Plans (Medicare Part C). Most Medicare Advantage plans cover diagnostic blood tests as they are crucial for detecting health issues, managing chronic conditions, and monitoring treatment plans.

Many Medicare Advantage plans require prior authorization from your doctor for certain blood tests. While diagnostic tests are typically covered, some plans may charge for elective or preventive screening tests. If cost is a concern, be sure to compare Medicare Advantage plans in your area to find one with affordable blood test coverage. Every Medicare Advantage plan is different, meaning there is something for everyone.

How do I Join a Medicare Advantage Plan?

When you first become eligible for Medicare, you can join a Medicare Advantage plan during your Initial Enrollment Period. This is a window (exactly 7 months) that includes the 3 months before you turn 65, the month you turn 65, and the 3 months after you turn 65. If you enroll during this time, your coverage will start the first of the month after you sign up.

If you don't join during your Initial Enrollment Period, you'll have to wait for the Annual Enrollment Period which runs from October 15th to December 7th each year. During this time, you can switch from Original Medicare to a Medicare Advantage plan, switch between Medicare Advantage plans, or drop your Medicare Advantage plan and go back to Original Medicare. Changes made during this time will take effect on January 1st of the following year.

What to Consider With Medicare Advantage Plans

What to Consider With Medicare Advantage Plans

When choosing Medicare Advantage Plans in your area, compare factors like cost, coverage, networks, prescription drug coverage and additional benefits. You can compare plans on Medicare.gov or work with a medical insurance broker. When you find a plan you want to join, you can enroll on the plan's website, over the phone, or sometimes even in person.

Need Blood Test Coverage With Your Medicare Plan?

Like we mentioned before, every Medicare Advantage plan is different, so they can be difficult to navigate. If blood testing coverage is important to you but your current plan doesn't cover it, we'll not only find you a plan that does, but one that meets all of your needs and wants! 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 Medicare plan that best suits your needs. Whether you need an Original Medicare plan or a Medicare Advantage plan, we're happy to take the time to help you out.

We're here for you and can't wait to help you live an EASY life!

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Does Medicare Cover Hearing Aids
Medicare

Does Medicare Cover Hearing Aids

So you've started to notice your hearing isn't quite as sharp as it used to be. The TV volume seems to creep up higher and higher. You find yourself asking people to repeat themselves. Your loved ones complain you're not listening like you used to. These are all signs pointing to age-related hearing loss. And worst of all: you're worried about the costs of getting treatment.

The big question on your mind is likely: Does Medicare cover hearing aids? Unfortunately, there isn't a yes or no answer as it's different for every Medicare plan. Below you will not only find out if your Medicare plan covers hearing aids in 2023, but also how else you can get them in case they're not covered by your plan. 

What Is Original Medicare

Before we get into hearing aid coverage, we need to understand what Original Medicare means. Original Medicare is a federal health insurance program and is typically what most Medicare participants are enrolled in. It is also sometimes referred to as Medicare Parts A and B. 

  • Part A helps pay for inpatient care in hospitals, skilled nursing facilities, hospice, and home health care. Most people automatically get Part A coverage without paying a monthly premium.
  • Part B helps pay for doctors' services, outpatient care, durable medical equipment, and other medical services. To enroll in Part B you have to pay a monthly premium, but this plan is optional.

Does Original Medicare Cover Hearing Aids in 2023?

Unfortunately, Original Medicare (Parts A and B) does not cover hearing aids or exams for hearing aids. This can be frustrating news if you're experiencing hearing loss and these two are your only medical insurance coverage. Yet the good news is there are many other Medicare coverage plans apart from Original Medicare that offer extra benefits like hearing aids. These are called Medicare Part C plans (or Medicare Advantage Plans). 

What Is Medicare Part C (Medicare Advantage Plans)

Medicare Advantage Plans, also known as Medicare Part C, are health plans offered by private companies but are approved by Medicare. These plans provide an alternative way to get your Medicare benefits. Unlike Original Medicare (Parts A and B), Medicare Advantage Plans bundle Part A (Hospital Insurance) and Part B (Medical Insurance) together in one plan.

Medicare Advantage Plans must cover medically necessary services that Original Medicare covers except for hospice care. But, they can charge different out-of-pocket costs and have different rules for how you can get services. Most plans offer extra benefits that Original Medicare doesn’t cover, like vision, dental, and prescription drug coverage.

Types of Medicare Advantage Plans

Types of Medicare Advantage Plans

There are many different types of Medicare advantage plans. But here are a few of the most popular:

  • Health Maintenance Organization (HMO) Plans: You generally must get your care from doctors and hospitals in the plan’s network.
  • Preferred Provider Organization (PPO) Plans: You pay less if you use doctors and hospitals in the plan's network. You can use out-of-network providers for covered services, usually at a higher cost.
  • Private Fee-for-Service (PFFS) Plans: You can go to any Medicare-approved doctor or hospital that accepts the plan's payment terms. The plan determines how much it will pay doctors and hospitals as well as how much you must pay for co-insurance and deductibles.
  • Special Needs Plans (SNPs): Only people with special health care needs or institutional conditions can enroll for this one. Plans tailor their benefits to best meet the specific needs of groups they cover.

Do Medicare Advantage Plans Cover Hearing Aids?

When it comes to Medicare Advantage plans, hearing aid benefits vary depending on the specific plan. Some Medicare Advantage plans offer additional benefits like routine hearing care and hearing aid coverage. The way to find out if a Medicare Advantage plan covers hearing aids is to check with the plan's provider directly. Some plans may cover certain hearing aid costs such as:

  • Routine hearing exams to test your hearing and see if hearing aids are needed.
  • Coverage for some or all hearing aid device expenses.
  • Follow up appointments for adjusting and fitting hearing aids.

Some Medicare Advantage plans cover specific name brand hearing aids, while others allow you to choose from a selection. Certain plans may require you to stick to hearing care providers and services in their network.

Compare Medicare Advantage Plans

If your current Medicare Advantage plan does not cover hearing aids, you have the option to switch. Compare plans in your area to find one that offers hearing health benefits that meet your needs. Things to consider when comparing plans include:

•Premiums, deductibles, and out-of-pocket maximum costs

•Covered hearing aid brands and models

•In-network vs. out-of-network coverage

•Coverage for hearing tests, fittings, repairs, and follow up care

•Additional benefits like dental, vision, transportation, etc.

Medicare Advantage plans that cover hearing aids and related services can provide savings and make hearing care more affordable and accessible for those with hearing loss. With the variety of plans available, you have many options to choose from to find coverage that suits your needs and budget.

What To Consider With Medicare Advantage Plans

What To Consider With Medicare Advantage Plans

When considering a Medicare Advantage plan, there are a few important things to keep in mind. These private insurance plans offer coverage that replaces original Medicare Part A and Part B. While they may provide some additional benefits, you'll want to weigh the pros and cons carefully based on your needs and priorities.

Limited Provider Choice

With a Medicare Advantage plan, you can only get coverage with certain doctors and at healthcare facilities in the network of the insurance company. The insurance company also has to approve any treatment before you can receive it, which could cause delays. With original Medicare, all of your healthcare decisions stay between you and your doctor. If having flexibility and control over provider choice is important to you, Medicare Advantage may not be the best choice.

Out-of-Pocket Costs

Medicare Advantage plans typically have lower out-of-pocket costs like deductibles and copays, though they often charge higher monthly premiums. You'll need to calculate whether the lower cost-sharing offsets the higher premiums based on your expected medical needs for the year. Plans can also change benefits, providers, and costs each year.

Extra Benefits

Many Medicare Advantage plans provide extra benefits not covered under Original Medicare like dental, vision, hearing, and wellness programs. If these additional benefits are appealing to you, an Advantage plan could save you money. But, again, benefits can change each year with the plan.

Travel Considerations

Most Medicare Advantage plans only provide coverage for emergency and urgent care when you travel outside the U.S, while Original Medicare covers you in any hospital or healthcare provider that accepts Medicare around the world. So if you travel frequently or live part of the year abroad, the latter may suit you better.

When it comes time to choose between the two, think about what matters most in your retirement health coverage. Weigh all of the factors carefully and determine what combination of plans and supplemental insurance will provide you the benefits you need at a cost you can afford. The choice is personal for each Medicare recipient.

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How to Enroll or Switch to a Medicare Advantage Plan

You can join or switch Medicare Advantage plans during the Medicare open enrollment period from October 15 to December 7 each year. Changes you make during open enrollment take effect on January 1 of the following year. Some exceptions apply if you're newly eligible for Medicare or meet certain special needs.

How to Find and Apply to Medicare Advantage Plans

The easiest way to compare Medicare Advantage plans and enroll is on Medicare.gov. Just enter your zip code and the site will show you all of the plans available in your area along with details about costs, benefits, and coverage. You can also call 1-800-MEDICARE or your State Health Insurance Assistance Program (SHIP) for help.

Once you choose a plan, you enroll directly with the insurance company that offers it. They will have instructions on their website for how to join, usually involving filling out an online or paper application and providing information like your Medicare number. The company will then send you plan details including a membership card, summary of benefits, and information on accessing care.

  • Premiums, copays, deductibles, and other costs will vary based on the plan you choose. Compare carefully.
  • You must continue to pay your Medicare Part B premium. Some plans may have an additional monthly premium.
  • Not all doctors, hospitals and providers may be in the plan's network. Check that your doctors participate before joining.
  • You can leave a Medicare Advantage plan and switch back to Original Medicare during the Medicare Advantage Open Enrollment Period from January 1 to March 31 each year.

Following these steps will help ensure you find and enroll in a Medicare Advantage plan that suits your needs and budget. Once joined, be sure to use your plan coverage for all medical services to avoid unexpected costs. Let your doctors know you have a Medicare Advantage plan so they can properly bill for your care.

How Much Do Hearing Aids Cost Without Medicare?

How Much Do Hearing Aids Cost Without Medicare?

Now, you may be wondering if you can just pay for your hearing aid up front. Let's take a look at how much it would cost to buy out-of-pocket. Hearing aid costs can vary greatly depending on the type and technology. But the average cost of a pair of basic hearing aids in the U.S. is around $4,500. High-end devices with advanced features like Bluetooth connectivity or rechargeability can cost $6,000 per year or more.

  • Behind-the-ear (BTE) hearing aids are the most common and typically range from $1,000 to $3,500 per ear.
  • In-the-ear (ITE) hearing aids that fit completely in the ear are usually a bit more expensive, from $2,500 to $4,000 per ear.
  • The smaller, nearly invisible in-the-canal (ITC) and completely-in-the-canal (CIC) hearing aids tend to cost the most, from $2,500 up to $5,000 per ear or higher due to their small size and high-tech components.

What About Additional Fees?

The total cost for a pair of hearing aids also includes the audiologist’s fees for testing and fittings, which can add another $500 to $1,000 or more to the total bill. The good news is that most audiologists offer payment plans to make hearing aids more affordable, with the option to pay over 6 to 24 months with no interest. Some even offer discounts if you pay for the hearing aids in full upfront.

Shopping around at different audiologists and hearing clinics in your area is the best way to compare prices and find affordable options. Popular stores like Costco, Sam’s Club and Walmart also provide quality hearing aids at lower prices. You can often save thousands of dollars for the exact same hearing aid models sold by private audiologists. Also, non-profit organizations like the Hearing Loss Association of America offer ways to get discounted or donated refurbished hearing aids for those on fixed incomes or with limited means.

Do You Need Hearing Aid Coverage?

If hearing aid coverage 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 your needs. Whether you need a plan offered by the government or a private insurance company, we are always happy to take the time to sit down and discuss.

We're here for you and can't wait to help you live an EASY and stress-free life!

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Does Medicare Cover Cancer Treatment? Exploring Coverage and Benefits
Medicare

Does Medicare Cover Cancer Treatment? Exploring Coverage and Benefits

Cancer is a life-altering diagnosis that requires comprehensive treatment, often leading to significant financial burdens. For those enrolled in Medicare, understanding the coverage and benefits related to cancer treatment is crucial.

We will explore the different aspects of coverage, including screenings, treatment options, providing insights into the benefits and out-of-pocket costs involved.

By gaining a clear understanding of how Medicare will cover cancer treatment, individuals can make informed decisions about their healthcare options and financial well-being.

Coverage for Cancer Screenings

Prevention and early detection play a vital role in effectively managing cancer. Medicare recognizes the importance of cancer screenings and offers coverage for various preventive screenings. These screenings include breast cancer, cervical cancer, prostate cancer, lung cancer, and colorectal cancer.

Medicare covers mammograms, Pap smears, pelvic exams, PSA blood tests, and low-dose computed tomography (LDCT) for lung cancer. The frequency and coverage may vary depending on specific conditions and risk factors. Understanding these screenings and their coverage can help you to prioritize your health and take advantage of preventive measures.

What are the Types of Cancer Treatment Services?

What are the Types of Cancer Treatment Services?

Surgery

Surgery involves the removal of cancerous tumors or masses from the body. It is often used for solid tumors that are localized and haven't spread to other parts of the body. Surgery aims to remove the cancerous cells completely.

Radiation Therapy

Radiation therapy uses high-energy radiation to kill cancer cells and shrink tumors. It can be administered externally (external beam radiation) or internally (brachytherapy) depending on the type and location of the cancer. The radiation damages the DNA of these cells, preventing them from multiplying and causing further harm.

Chemotherapy

Chemotherapy involves the use of powerful medications (chemo drugs) to kill cancer cells. These drugs can be given intravenously or orally, and they work by targeting rapidly dividing cells, including cancer cells. Chemotherapy can be used to treat cancer that has spread throughout the body.

Immunotherapy

Immunotherapy is a type of cancer treatment that boosts the body's immune system to fight against cancer cells. It uses substances, such as immune checkpoint inhibitors and monoclonal antibodies, to stimulate the immune response and help the body recognize and attack cancer cells.

Targeted Therapy

Targeted therapy uses drugs that specifically target certain molecules or genes in cancer cells that are involved in their growth and survival. By blocking or inhibiting these specific targets, targeted therapy aims to disrupt the growth and spread of cancer cells while minimizing damage to healthy cells.

Hormone Therapy

Hormone therapy is used to treat cancers that are hormone-sensitive, such as breast and prostate cancers. It involves the use of medications that either block the production of hormones or interfere with their action, thereby slowing down or inhibiting the growth of hormone-dependent cancer cells.

Does Medicare Cover Surgery Treatments for Cancer?

Does Medicare Cover Surgery Treatments for Cancer?

Yes, Medicare does cover surgery treatments for cancer. The coverage for surgery and most cancer treatments is provided through both Medicare Part A (hospital insurance) and Medicare Part B (outpatient medical care).

Medicare Part A covers hospital care, including inpatient surgery for cancer treatment. If you require surgery to remove a tumor or treat cancer and are admitted as an inpatient hospital stay, Medicare Part A will generally cover the costs associated with the surgery. This includes the fees for the surgeon, anesthesiologist, operating room, prescription medications administered during your stay, and any necessary hospital stays.

Medicare Part B covers medically necessary outpatient care, and outpatient cancer services which include various cancer treatment options. Under Part B, coverage for surgery treatments may include consultations with surgeons, second opinions, and outpatient surgical procedures.

If you need surgery as an outpatient for cancer treatment, Medicare Part B will typically cover the costs of the procedure. This can involve surgeries performed in an outpatient clinic or a doctor's office, such as oral chemotherapy outpatient surgery.

It is important to note that Medicare Part A and Part B have different coverage rules and cost-sharing requirements. For Part A, there is a deductible for each benefit period, and additional costs may apply based on the length of the hospital stay. Under Part B, there is an annual deductible, and you are responsible for paying 20% of the Medicare-approved amount for outpatient surgeries and related services.

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Is There Medicare Coverage for Radiation Therapy?

Radiation therapy is another commonly used treatment for cancer for which Medicare provides coverage, ensuring that beneficiaries have access to this crucial treatment option.

Medicare Part A or Part B may cover radiation therapy, depending on whether the treatment is received as an inpatient or outpatient.

Part A covers therapy for a hospital inpatient or at a skilled nursing facility, with the individual responsible for the Part A deductible and coinsurance. Part B covers radiation therapy for outpatients or patients of freestanding clinics, with beneficiaries responsible for 20% cost sharing and the Part B deductible.

Does Medicare Cover Chemotherapy for Cancer Treatment?

Chemotherapy is a common treatment modality for cancer patients. Medicare provides coverage for chemotherapy, ensuring access to this critical treatment option. The coverage for chemotherapy under Medicare depends on the specific circumstances and treatment settings of cancer patients.

Medicare Part A Covers In-Patient Chemotherapy

For hospital inpatients, Medicare Part A covers chemotherapy.

If you receive chemotherapy in a hospital outpatient setting, doctor's office, or freestanding clinic, Medicare Part B will provide coverage. It's important to note that the location where chemotherapy is administered can impact the costs. In a hospital outpatient setting, copayments may apply, while in other settings, you will be responsible for 20% cost sharing along with the Part B deductible.

Medicare Part B for Out-Patient Chemotherapy

Additionally, Medicare Part D plans may cover certain chemotherapy treatments and related prescription drugs, including anti-nausea medications, oral chemotherapy drugs, pain medications, and other drugs necessary for cancer treatment.

Additionally, Medicare Part D options can help individuals manage the costs associated with oral prescription drugs used with chemotherapy.

Will Medicare Cover Immunotherapy?

Will Medicare Cover Immunotherapy?

Yes, Medicare can cover immunotherapy for eligible individuals. Immunotherapy is a type of cancer treatment that uses drugs to boost the body's immune system and help it recognize and destroy cancer cells. Medicare Part B, which covers medically necessary outpatient services, typically provides coverage for immunotherapy when it is deemed medically necessary for the treatment of cancer.

It's important to note that coverage for immunotherapy may depend on factors such as the specific type of cancer being treated, the stage of cancer, and the specific immunotherapy drug being used. Medicare will generally cover immunotherapy drugs that are approved by the U.S. Food and Drug Administration (FDA) and considered medically necessary for the treatment of cancer.

Can Medicare Cover Targeted Therapy for Cancer?

Medicare can cover targeted therapy for cancer in certain situations. Medicare Part B, which covers medically necessary outpatient services, typically provides coverage for targeted therapy drugs when they are deemed medically necessary for the treatment of cancer. Medicare will generally cover targeted therapy cancer drugs only that are approved by the U.S. Food and Drug Administration (FDA) and considered appropriate for the individual's specific type of cancer.

Coverage determinations are made on a case-by-case basis, taking into account medical necessity and evidence-based guidelines.

Does Medicare Cover Hormone Cancer Treatment?

Medicare can cover hormone cancer treatment in certain cases. Hormone therapy is a type of cancer treatment that involves the use of medications or procedures to block or interfere with the hormones that fuel the growth of certain cancers, such as breast or prostate cancer.

Medicare Part B, which covers medically necessary outpatient services, generally provides coverage for hormone therapy drugs and procedures that are considered medically necessary and prescribed by a healthcare provider.

Know Your Financial Responsibilities

Know Your Financial Responsibilities

Each of these cancer treatments has its own specific purpose and can be used alone or in combination with other treatments depending on the type and stage of cancer.

Medicare provides coverage for these treatments based on the specific guidelines and eligibility criteria associated with each part of Medicare (A, B, and D).

Remember traditional Medicare has a 20% co-insurance and no limit on Max Out of Pocket. With some cancer treatments costing between $10,000 to $200,000, you could be liable for a huge financial burden.

It's important for individuals to consult with their healthcare providers and understand their Medicare coverage to make informed decisions about their cancer treatment options.

Can I get Health Insurance Coverage for Cancer with a Medicare Advantage Plan?

Medicare Advantage plans, also known as Medicare Part C, offer an alternative way to receive Medicare benefits. These plans must provide at least the same coverage as Original Medicare (Parts A and B).

Different plan options offer different premiums and yearly maximum out-of-pocket amounts (MOOP). Once MOOP is reached, the plan pays 100%.

Certain plans may offer additional benefits not available to traditional Medicare Part A and B coverage.

There are also special Medicare Plans (DSNPs for those on Medicaid) or CSNPs (for individuals suffering from chronic conditions).

It is essential for individuals with cancer who have enrolled in a Medicare Advantage plan to understand the coverage, rules, and costs associated with prescription drug plans along with cancer screenings, chemotherapy, surgery, and other related services.

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Research Your Options and the Financial Requirements of Each Plan Option

Receiving a cancer diagnosis is challenging both emotionally and financially. Medicare plays a critical role in ensuring that individuals have access to cancer treatment options. From preventative screenings to various treatment options, Medicare Plans offers coverage choices to suit your financial situation.

However, it is essential to understand coverage specifics, including out-of-pocket costs and potential limitations, to make informed decisions about healthcare and financial well-being. By having a clear understanding of your plan's coverage for cancer treatment, Medicare beneficiaries can navigate the complex landscape of cancer care with confidence and peace of mind.

Get a personalized Health Insurance quote now.

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Does Medicare Cover Telehealth? Unlocking Convenient Healthcare for Seniors and Individuals with Disabilities
Medicare

Does Medicare Cover Telehealth? Unlocking Convenient Healthcare for Seniors and Individuals with Disabilities

Telehealth services have gained immense popularity in recent years, revolutionizing the way healthcare is delivered. For senior citizens and individuals with disabilities on Medicare, telehealth brings a new level of convenience and accessibility.

You too can receive the telehealth benefits of increased access to your primary health care professional and specialists and reduced fees from Federally qualified health centers when accessing services.

What Are the Basics of Medicare Coverage for Telehealth Services?

Before we dive into the world of telehealth, it's essential to understand the basics of Medicare coverage. Medicare consists of Parts A, B, C, and D, each with its own set of benefits. While Parts A and B primarily cover in-person medical visits, the landscape is evolving to incorporate telehealth services and extend coverage to more convenient healthcare options. Part C (also known as Medicare Advantage) and Part D prescription drug plans are also incorporating Telehealth services.

What Telehealth Services Are Covered by Medicare?

Telehealth, also known as telemedicine, refers to the remote delivery of healthcare services through technology. Medicare has recognized the potential of telehealth in enhancing access to health care providers and has expanded its coverage to include various telehealth services.

This opens up a world of possibilities for senior citizens and individuals with disabilities who may face challenges in accessing traditional healthcare.

Who Is Eligible for Telehealth Services Under Medicare?

To use telehealth services under Medicare, certain eligibility criteria and requirements must be met. Medicare beneficiaries who meet specific conditions are eligible for telehealth services, which are delivered through audio and video technology. Through December 2024 beneficiaries are able to access the same in-person services remotely. The standard cost sharing of 80% covered by Medicare and 20% by the beneficiary applies.

To reduce the 20% co-payment, beneficiaries need to be enrolled in a Medigap or Medicare Advantage plan. Per Medicare.gov, some Medicare Advantage plans may offer more telehealth benefits than Original Medicare.

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What Are the Cost and Billing Considerations for Medicare Telehealth Services?

When it comes to telehealth services, cost and billing are important factors to consider. Original Medicare and Medicare Advantage plans may have different cost structures for telehealth visits.

It's essential to understand copayments, deductibles, and coinsurance for telehealth services to make informed decisions. It's worth noting that certain copayments for telehealth services may be waived under specific circumstances, further reducing financial barriers.

Check with your insurance provider or licensed agent to check what kinds of telehealth care services your plan covers.

How Does Telehealth Improve Accessibility for Seniors and Individuals with Disabilities?

  1. Improved Accessibility: Telehealth eliminates geographical barriers, allowing individuals to receive healthcare services from the comfort of their homes. This is particularly beneficial for seniors and those with disabilities who may have limited mobility or face challenges in traveling to healthcare facilities (i.e. those that previously had to travel long distances to rural health clinics).
  2. Transportation Convenience: Telehealth eliminates the need for transportation to medical appointments, saving time, energy, and expenses associated with commuting.
  3. Flexible Appointment Scheduling: With telehealth, individuals have greater flexibility in scheduling appointments, reducing wait times and accommodating busy lifestyles.
  4. Specialized Care Delivery: Telehealth enables seniors and individuals with disabilities to access specialized care remotely. They can connect with specialists and receive expert guidance without the need for extensive travel.
  5. Chronic Condition Management: Telehealth allows for enhanced monitoring and management of chronic conditions. Regular check-ins and remote monitoring help individuals maintain their health and well-being more effectively.
What Are the Limitations and Restrictions of Telehealth Services under Medicare?

What Are the Limitations and Restrictions of Telehealth Services under Medicare?

While telehealth offers numerous advantages, it's important to be aware of its limitations and restrictions within the Medicare framework.

Geographic limitations and originating site requirements may impact the availability and coverage of telehealth services in certain areas. It's also crucial to understand the specific services that may not be covered under Medicare telehealth.

You'll also need to check if your doctor is in-network and is available for telehealth services.

Lastly confirm what health services are covered and the copays associated with these services.

How Do Medicare Advantage Plans Embrace Telehealth Services?

Telehealth services have gained significant momentum in recent years, and Medicare Advantage plans have recognized the value they bring to the healthcare landscape. These plans, also known as Medicare Part C, are offered by private insurance companies approved by Medicare.

One of the key advantages of Medicare Advantage plans is their flexibility in providing additional benefits beyond what Original Medicare covers. Many Medicare Advantage plans now include telehealth services as part of their comprehensive coverage. This means that beneficiaries can access virtual medical consultations, remote monitoring, physical and occupational therapy, and other telehealth services conveniently from their own homes.

Get Access to Doctors Through TeleHealth Apps from Your Chosen Insurance Provider

Many insurance companies have their own telehealth app and online patient portal you can put on your smartphone or tablet. Using these devices, you will have access to your primary care provider or specialists from the comfort of your own home. It's important to check your chosen doctor is in-network or you may be responsible for out-of-network copayments.

Helpful tip: Many Medicare beneficiaries may qualify for the Lifeline and ACP program that offers free cell phone and data service, further reducing their monthly expenses through participation in certain government programs (i.e. Medicaid services or through your monthly income level.

By embracing telehealth, Medicare Advantage plans aim to enhance access to healthcare services, improve patient outcomes, and promote overall well-being for individuals seeking the convenience and flexibility of virtual health care providers.

How Can EASY Insurance Help You Explore Medicare Coverage for Telehealth Service?

How Can EASY Insurance Help You Explore Medicare Coverage for Telehealth Service?

Medicare's coverage of telehealth services opens up a world of convenient healthcare options for senior citizens and individuals with disabilities. The benefits of telehealth, such as improved accessibility, flexible scheduling, and specialized care, empower individuals to take control of their health and well-being.

If you have any questions or need assistance exploring your Medicare coverage for telehealth services, contact EASY Insurance today. Our knowledgeable agents are here to guide you and help you find the best healthcare solutions that suit your needs.

Remember, convenient, low-cost and often zero-premium healthcare is just a click away with Medicare and telehealth!

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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.

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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.

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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.

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What Disabilities Qualify for Medicare Under 65?
Medicare

What Disabilities Qualify for Medicare Under 65?

Medicare is a health insurance product typically reserved for those who are over the age of 65 and who have contributed to the Social Security Administration throughout their lifetime through payroll deductions. Medicare benefits like this include coverage for many health needs, including preventative care and hospitalization. However, some people may qualify for Medicare coverage before age 65. Typically, this is reserved for those who have a qualifying disability.

The key here is that not all disabilities qualify for Medicare coverage, but that Social Security Disability benefits must be applied for. You must meet the guidelines set by the Social Security Administration for that disability to qualify for coverage. Even if your doctor says you cannot work or that you have a disability, you must meet Medicare rules in this area – and that can be challenging, especially if you don’t know what health insurance coverage is available.

When Do People Under 65 Get Medicare Benefits?

In order to obtain Medicare benefits, you must first qualify for Social Security Disability Insurance. Then, you must have SSDI, as it is often called, for a full 24 months (in most cases). However, to obtain SSDI benefits, a person must wait five months, during which time they must show that they are not able to work. That means that:

  • You need to apply for SSDI and prove you cannot work.
  • Qualify for SSDI for 5 months.
  • Once you qualify for SSDI, then wait 24 more months to obtain Medicare benefits as long as you still cannot work.

There are some conditions that do not have this waiting period. That includes those who are diagnosed with end-stage renal disease (ESRD) as well as amyotrophic lateral sclerosis (ALS). In these situations, you may automatically qualify for Medicare at the time of your diagnosis and not have to wait.

What Disabilities Qualify for SSDI?

Medicare beneficiaries typically have to first work through the Social Security Disability Insurance requirements before they can obtain disabled Medicare benefits. The list of conditions that may help you qualify for SSDI is quite extensive, but every one of them has very specific requirements that must be met. Let’s take a look at some of them.

Heart-related Medical Conditions

There are a number of heart-related conditions that may allow you to meet the needs for SSDI. Most often, the impairment must be severe enough that you cannot work. This may include:

  • Chronic heart failure
  • Ventricular dysfunction
  • Myocardial ischemia with pain with or within necrosis of the muscle
  • Syncope due to cerebral perfusion from some type of cardiac cause, such as rhythm or conduction problems
  • Vein or artery disorders, including rupture, obstruction, or aneurysm

To qualify, SSDI considers your symptoms, lab tests, testing and diagnosis, treatment response, and functional limitations.

Musculoskeletal Disorders

Musculoskeletal Disorders

This type of qualification for disability may include disorders related specifically to the skeletal spine or those of the upper or lower extremities. The condition must impact the movement and function of those areas. This could include any bony structures, discs, or ligament related conditions.

Typically this includes conditions that do not heal or improve, including:

  • Spinal cord damage and dysfunction
  • Inflammatory arthritis
  • Curvatures of the skeletal spine that make it hard to breathe, limit heart function, or result in depression
  • Non-healing fractures due to cancer
  • Leg pain due to peripheral vascular and foot conditions

Diagnostic testing is through here and often involves a grading to determine how limited you may be from the condition.

Respiratory Disorders

The Social Security Administration considered respiratory disorders that make it hard for a person to work as well. This includes conditions related to the obstruction, restriction, or diffusion necessary for breathing. There are a wide range of conditions that are evaluated, including:

  • Pulmonary fibrosis
  • Chronic obstructive pulmonary disease, including chronic emphysema and bronchitis
  • Cystic fibrosis
  • Bronchiectasis
  • Asthma
  • Pneumoconiosis
  • Chronic pulmonary hypertension
  • Lung transplantation
  • Respiratory failure

Signs and symptoms are considered, as well as the impact that the condition has on a person’s overall functionality and health.

Digestive System Disorders

There are a number of digestive system disorders that qualify for Medicare benefits through disability qualifications. This includes disorders such as:

  • Hepatic (Liver) conditions
  • Gastrointestinal hemorrhage
  • Short bowel syndrome
  • Inflammatory bowel disease
  • Malnutrition

Factors including how well a person responds to treatment, the severity of their condition, and diagnostic information help to determine if a person qualifies for disability.

Genitourinary Disorders

These conditions are evaluated based on severity and are often based on overall function and lab tests. Some examples include:

  • Chronic obstructive uropathy
  • Chronic glomerulonephritis
  • Hypertensive nephropathy
  • Chronic kidney disease
  • Hereditary nephropathies
  • Kidney transplantation

As noted, those with end-stage renal disease may not have to wait for the full period of qualifying before receiving benefits. Because this is considered an end-of-life matter, individuals qualify right away.

Hematological Disorders

This may include conditions of various types that create impairment in function and pain. Some examples include:

  • Hemolytic anemias
  • Non-malignant hematological disorders
  • Disorders of thrombosis
  • Bone marrow failure
  • Dysfunction of white or red blood cells, platelets, and clotting factors
  • Lymphoma
  • Leukemia
  • Multiple myeloma
  • Human immunodeficiency virus (HIV)

Lab testing, treatment response, and definitive testing are all used to determine if a person qualifies for Medicare benefits.

Neurological Disorders

A number of neurological disorders may qualify for disability coverage based on their overall severity and the limitations they place on a person’s ability to work. Some examples of covered disability conditions include:

  • Epilepsy
  • Amyotrophic lateral sclerosis
  • Persistent vegetable state
  • Coma
  • Early-onset Alzheimer’s disease
  • Huntington’s disease
  • Parkinsonian syndrome
  • Myasthenia gravis

The severity of the symptoms, along with the likelihood that they will be long-term, are key factors here. Co-occurring mental health disorders may also be a consideration.

Special Senses and Speech

Special Senses and Speech

There are some conditions that relate to the senses, including blindness and visual disorders. The Social Security Administration advises on these individually based on the level and complexity of the situation. Things like visual acuity and visual fields are often used to better demonstrate a person’s ability to see and function.

Endocrine Disorders

Some endocrine disorders may qualify for disability benefits depending on their impact on a person’s ability to work. Most often, these are conditions that create severe hormonal imbalances due to endocrine gland malfunction. Some conditions that may fall into this area include:

  • Pituitary gland disorders
  • Thyroid gland disorders
  • Parathyroid gland disorders
  • Adrenal gland disorders
  • Diabetes mellitus
  • Pancreatic gland disorders
  • Hyperglycemia
  • Diabetic ketoacidosis
  • Chronic hyperglycemia

The severity and the person’s ability to respond to treatment may play a role in whether they can receive benefits for these conditions.

Skin Disorders

Skin disorders that impact a person’s ability to function and meet their needs could fall under disability qualification guidelines. Some examples may include the following:

  • Ichthyosis
  • Bullous diseases
  • Chronic infections
  • Genetic photosensitivity disorders
  • Burns

Diagnosis and testing are often requirements for obtaining this type of coverage. The severity of the disorders is often a big factor in determining if a person qualifies for benefits.

Immune System Disorders

Conditions that impact the immune system that makes work impossible or unsafe are considered as well. This includes:

  • Dysfunctions of antibody production, including impaired cell-mediated immunity or complement deficiency
  • Recurrent or unusual infections and inflammation-causing conditions
  • Autoimmune disorders
  • Immune deficiency disorders

The details of these conditions are important. If the condition makes it unsafe for a person to work, then coverage may be provided.

Cancer

The Social Security Administration will evaluate all types of cancer to determine if the condition warrants coverage. Factors that play a role in this decision include the origin of the cancer, how involved it is, how long it has been present, and the effects on a person after therapy is provided.

Mental Health Disorders

Some mental health disorders may qualify for coverage through Medicare. However, this is dependent on the severity and symptoms of the condition. Some people with a diagnosis of the following conditions may qualify:

  • Schizophrenia spectrum
  • Psychotic disorders
  • Bipolar and related disorders
  • Neurocognitive disorders
  • Depressive disorders
  • Anxiety disorders
  • Obsessive-compulsive disorders
  • Somatic symptoms
  • Intellectual disorders
  • Neurodevelopmental disorders
  • Trauma and stressor-related disorders
  • Autism spectrum disorders
  • Eating disorders

Diagnosis is often not enough. Treatment information and the response to medication and treatment are also considered.

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What Are the Steps to Qualify for Medicare Benefits to Get Started?

If you believe you have a condition that provides you with Medicare eligibility, the next step is to apply for Social Security Disability benefits. Here’s what to expect from this process if you are under the age of 65.

The Social Security Administration considered your condition. People with disabilities must first apply here to obtain any care. The agency then approves your disability as one that is covered.

You start to receive Social Security Disability Insurance payments after five months of having received the determination of your disability qualification.

You will then wait 24 more months until you reach Medicare eligibility under age 65.

What If You Apply and Are Denied Coverage?

There are some situations in which a person may not qualify for disability benefits right away. For example, you may not have proven to the Social Security Administration that you meet the requirement to be considered for this coverage. In that case, you can reapply with more information or documentation.

If you then meet eligibility requirements and are qualified disabled, you can then backdate your application to the first month you would have received SSDI. That would allow you to begin waiting for the 24 months necessary to reach Medicare eligibility. You may also receive compensation for that length of time.

Keep in mind that through this time you must be unable to maintain substantial gainful activity, meaning you cannot work. If you are able to go back to work, some younger Medicare beneficiaries may no longer qualify for health care services.

Does This Mean Health Care Services Are Free?

No. When you qualify for Medicare coverage that means you qualify. It does not mean that your health insurance is free to you. There are a few things to understand when it comes to being under age 65 and having a disability.

First, healthcare services do become available to you as Medicare beneficiaries under age 65. The health insurance program you select, though, may be a bit different.

Here is a look at Medicare costs and what you can expect.

Original Medicare

Medicare beneficiaries receive Original Medicare coverage right away. This is the same for those over age 65 as it is for those under the age of 65. If you have a disabling impairment, you may expect to have access to the very best level of care. That is not always the case, even with chronic conditions. Parts A and B are the components of Original Medicare.

Medicare Supplement policies, called Medigap policies, are often necessary. These allow you to get more of the coverage you need to meet your ongoing health needs and goals. Your monthly Part B premium, for example, may not provide you with the full coverage you need, including prescription drug coverage. You can purchase Medicare Advantage Plans to replace Original Medicare, or you can choose to cover more of your medical costs through Medigap plans which extend your coverage further, providing gap coverage.

Medigap policies are expansive for disabled Medicare beneficiaries under 65. They tend to provide more options for those who need a Medigap policy and who qualify for Medicare early.

Medicare Part A

Also known as hospital insurance, you do not pay any premiums for this type of coverage. It covers the inpatient care you need, such as being admitted to the hospital. Hospital insurance covers the care you receive only in a medical facility like this. You will have a deductible to pay, which renews each year, and you may have to pay coinsurance costs at a specific rate if you are in the hospital for 61 to 90 days per calendar year.

Medicare Part B

Medicare Part B is a bit different. It covers your preventative care, such as going to your doctor for checkups. You pay a Medicare Part B premium each month. This typically is deducted from the SSDI payment you receive. In addition, there is a deductible to pay, though it is lower than that for hospital stays. You also have coinsurance to pay, which can be 20% of the medical costs you pay. If you have a Medigap plan, this may help to cover some of these added costs.

Medicare Part C

Also known as Medicare Advantage Plan is designed to be a separate option that replaces the need for Original Medicare. If you are eligible for Medicare and need more coverage, you can choose to use these private insurance companies to cover your costs. Medicare Advantage Plans vary widely in what they cover. You will need to compare several options to determine which is best for you. Medicare Advantage Plans are available to those who are disabled and are called SNPs.

Medicare Part C Medicare Advantage Special Needs Plans

Medicare SNPS will vary based on the plan. These are designed for those who have special medical needs and qualify for early Medicare access prior to age 65. Costs vary significantly but tend to be more affordable than others.

Medicare Supplement Plans

Also known as a Medigap plan, this coverage is higher than what you can expect to pay for Original Medicare as a disabled individual. Both the deductible you pay and the coinsurance responsibility will differ between plans.

Medicare Part D

Medicare Part D is often a necessary component. It does not pay for medical services but rather prescription drug coverage. As a result, it tends to be very important for many people. There is a monthly premium for these though it tends to be more affordable than other health insurance plans.

Understanding Medicare Special Needs Plans

Understanding Medicare Special Needs Plans

While Medicare is the same for those under and over the age of 65, the specific type of coverage you have under age 65 is called a Special Needs Plan. These are beneficial because they help to coordinate care for people who have disabilities a bit better than what other coverage options offer.

There are several types of SNPs, including one that is designed for people who have chronic conditions. If you have the qualifying conditions for SSDI, then this is the type of coverage you are likely to need. When comparing policies and coverage options, then, you need to be sure you are looking specifically at this type of qualification and plan.

What about ALS?

Those who have Amyotrophic Lateral Sclerosis (ALS), which is also known as Lou Gehrig’s disease, do not have to wait to obtain Medicare. They are automatically enrolled in Original Medicare, Parts A and B at the time of diagnosis. There is no waiting period for SSDI or Medicare benefits.

What about End-Stage Renal Disease ESRD?

If you have been diagnosed with ESRD or permanent kidney failure, and you need either ongoing dialysis or a kidney transplant, you do not have to wait to obtain the benefits from Medicare. You qualify right away, but there is no automatic enrollment here.

Instead, you will need to sign up for coverage. Your benefits start based on your condition. For example, for those who need a kidney transplant, the coverage starts the month you go in for surgery. If you are receiving dialysis, your coverage will begin on the first day following your fourth full month of dialysis treatments.

Also, note that you do not always continue to qualify for Medicare with ESDR. Rather, if you have a transplant or your condition improves, you may no longer receive coverage. This typically occurs 12 months after you stop receiving dialysis treatment.

Is a Medigap Policy Right for You?

As noted, you have the ability to choose either Medicare Advantage Plans or Original Medicare. If you go with Original Medicare, you could use Medigap for coverage gaps. In some states, Medigap is not even available to those under age 65. In other states, these policies are very expensive and may not be enough to cover their needs. For that reason, it may be best to consider options with Medicare Advantage plans instead.

What Happens When You Go Back to Work?

There are some situations in which a person may go back to work. Their condition improves, or they receive a transplant. In these cases, if you are under 65, Medicare will evaluate your health and symptoms to determine if you can go back to work.

If you lose SSDI because you go back to work, you’ll need to consider a few additional factors. Medicare put in place a new law in October of 2000 that allows a person that has been receiving SSDI benefits to go back to work but continue to maintain their Medicare benefits for as long as 8 ½ years.

A Trial Work Period allows you to go back to work to see if you can handle doing so with your condition. During the first 9 months of that time, in a rolling 5 year period, you can continue to receive your Medicare benefits. During this time, your SSDI continues as well, no matter how much you earn. You will have to let Social Security know that you are doing this.

Once your Trial Work Period ends, that is when your Extended Period of Medicare Coverage begins. This is also called the continuation of Medicare Coverage. It allows most Medicare beneficiaries who have not improved medically to continue to receive coverage for up to 93 additional months, even if you are no longer getting SSDI payments.

Finding Coverage That Fits Your Needs

Medicare coverage for those who are disabled is often very valuable and may be critical to ensuring you get the health care you need. Working with a team to help you to select the best policy for your needs is critical. That can help you to keep your costs down while also helping to ensure you are getting the coverage necessary to maintain your health even if you have a disability. Don’t overlook the value and importance of a well-designed policy that meets all of your needs.

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Medicare Gym Memberships Is Fitness Covered
Medicare

Medicare Gym Memberships: Is Fitness Covered?

Being in good health and staying active is the best way to live a long and happy life. While some people enjoy getting their exercise in outdoor sports or other activities, many may prefer the more comfortable and stress-free environment of indoor gym to help them maintain a healthy mind and body. This is particularly common among the elderlies or people whose mobility are limited by certain conditions.

Yet with all its benefits, gym fees can be unaffordable to many people, especially to retirees who must watch their budget carefully. This brings us to the question of whether Medicare, the government program created to help older Americans or those with certain disabilities to get health insurance, cover gym memberships or fitness programs. And the answer to that is that it depends, and there's not a simple yes or no answer.

Every Medicare plan is different and may include its own unique benefits. So whether you are covered for fitness center membership or not depends on what Medicare program you currently have. In this blog post, we will go through the ways you can obtain Medicare Gym Memberships.

What is Original Medicare?

Before we get to gym membership coverage, we need to understand the basics of Medicare. Medicare is divided into four parts -- parts A to D. The first two, Part A and Part B, are also known as Original Medicare and together they form the basic or essential parts of the program. While Part A is mandatory for any Medicare plans, all others are optional.

Part A is essentially hospital insurance that covers your hospital bills and other inpatient expenses. It typically pays for the following: hospital stays, hospice care, skilled nursing facility care, and some home health care services. Most people get this coverage without any sort of premiums, as they would've paid into the system with payroll taxes during their working years.

Medicare Part B refers to medical insurance that covers outpatient services such as doctor visits, outpatient care, preventative services, and medical equipment. While Medicare part B usually requires you to pay a monthly premium, it's an optional plan.

So while Medicare Part A and Part B cover a lot of essential services, they do not give you free gym memberships directly. That said, they do sometimes offer things like physical therapy, group therapy for diabetes prevention, and nutrition therapy, though they only apply to people suffering certain conditions.

Is there any Medicare Plan that Covers Gym Memberships

Is there any Medicare Plan that Covers Gym Memberships?

As Original Medicare doesn't pay for gym memberships, what about other Medicare health plans? Medicare Advantage plans, which are the type of Medicare insurance plan offered by private insurance companies instead of the government, could be your answer. These plans typically offer additional benefits outside of what Part A and Part B include.

Medicare Advantage plans are also known as Medicare Part C. If you're looking for a Medicare plan with gym and fitness benefits, this may be the right choice for you.

Enrolling in Medicare Advantage plans?

If you don't have Medicare yet, and you're under 65, you can enroll directly into a Medicare Advantage plan during your initial enrollment period. This starts 3 months before you turn 65 and ends 3 months after your 65th birthday.

But let's say you're over the age of 65, you've have had Medicare for a while, and you want to switch to a plan that covers a gym membership. In that case, you can enroll during the open enrollment period, which is every year from October 15th - December 7th. When you enroll during this time, your coverage starts January 1st of the following year.

What To Consider With Medicare Advantage Plans

Medicare Advantage plans typically offer extra benefits such as prescription drug coverage, dental and vision care, and wellness programs. But before you jump to switch to a Medicare Advantage Plan, there are a few things you need to think about. And the reason is that while many Medicare Advantage Plans cover gym memberships, there are some downsides to them.

For example, most Medicare Advantage Plans have a network of doctors and healthcare providers that members must use to receive coverage for medical services. So if you have a preferred doctor or healthcare provider, you should check to make sure they are covered by your insurance company.

Also, some plans may require authorization for certain preventive services or medications. This can sometimes cause delays in your treatment, and also allows your insurance company to refuse the medicine you may need.

With Original Medicare, all of your healthcare decisions stay between you and your doctor, not an insurance company. In addition, you also have the flexibility to visit any doctor, hospital, or skilled nursing facility in the country, without having worry about whether they're covered by your plans.

Medicare Supplement Insurance

Medicare Supplement Insurance

Medicare is a very helpful tool for those over 65, or with qualifying conditions. But for some people, it can get quite tiring to have to deal with tall he copays, coinsurance, or deductibles that come with Original Medicare. Medicare Advantage Plans, on the other hand, normally offer a variety of options when it comes to out-of-pocket expenses.

The Part A deductible for 2023 is $1,600 per benefit period. A benefit period starts when you are admitted to a hospital or skilled nursing facility and ends 60 days after you are discharged. That means that once you pay the first $1,600 of your hospital bills, you can get all the inpatient treatment you want, fully covered by Medicare.

The Part B deductible is a bit different. This one works on a yearly basis, and is $226 for 2023. So if you have Medicare, you typically will never have to pay more than that year's deductible for Part B covered services each year.

Medicare Supplement Insurance (or MediGap) is a supplemental program that essentially helps you pay for these deductibles, as well as copays and coinsurance. So if you qualify for MediGap, you can cut some costs that come with Original Medicare. Note that while MediGap plans may have higher monthly premiums, if you expect a lot of medical expenses, it could still be a money-saving program for you.

What About The SilverSneakers Fitness programs?

There is another option that would allow you to keep the Medicare Original plan and go to the gym for free. The SilverSneakers fitness program offers completely free access to gym memberships and fitness benefits for qualifying seniors who are enrolled in qualified Medicare Advantage plans or MediGap. They are available in thousands of locations including gyms, fitness centers, and senior living communities.

SilverSneackers will pay for things like sports equipment, saunas, swimming pools, free weights and machines, fitness classes, and more. The program was created to promote health and fun activities among senior individuals. You can check if you qualify from the SilverSneakers website in a matter of seconds.

We Are Here to Make it EASY for You?

Are you finding these information a bit hard to navigate? Don't worry, we are here to help

At EASY Insurance, we have a team of experienced agents that are dedicated to helping you find the health plans that best suit your needs. Whether your interest is best served by options offered by the government or private insurance providers, they are always happy to take the time to sit down and discuss them.

We're here to get you on the right track to living a healthy and EASY life.

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Does Medicaid Cover Dentures
Medicare

Does Medicaid Cover Dentures?

When it comes to dental care, Medicaid coverage for adults can be a bit of a mystery. One question that many Medicaid recipients have is whether or not their Medicaid benefits will cover dentures. The answer is not simple, as individual state Medicaid programs vary greatly in coverage. Because of this complexity, many people choose to ignore the need for dentures or dental coverage.

However, it's important to understand the benefits of dentures on overall health, the cost of paying for dentures out of pocket, what standard Medicare covers for different types of dentures, and why additional insurance is often needed to cover these costs. In this article, we will explore these topics and more.

The Benefits of Dentures on Your Health

The Benefits of Dentures on Your Health

Dentures can have a significant impact on overall health and well-being. Missing teeth can make it difficult to eat, speak, and even smile. Dentures can help to restore these functions and improve self-confidence. Additionally, missing teeth can lead to bone loss in the jaw, which can cause further dental problems and greater future expenses. Dentures or partial dentures help to prevent this by providing support for the jawbone.

The Expense of Paying for Dentures Out of Pocket

The cost of dentures can vary depending on a number of factors, including the type of dentures medically needed, the materials used, and the dentist's fees. In general, dentures can be quite expensive, with costs ranging from a few hundred to several thousand dollars. For many people, paying for dentures out of pocket isn't an option.

However, there may be ways to reduce your out-of-pocket expenses to pay for denture costs through Medicaid or in combination with Medicare.

Are You Eligible for Medicaid Coverage?

Medicaid is a program that provides health coverage to millions of Americans with low incomes. Eligibility for Medicaid varies by state, and each state has its own specific rules and requirements. In general, eligibility for Medicaid is based on income, household size, and other factors such as age, disability status, and pregnancy.

To determine if you are eligible for Medicaid, you can start by visiting the website of your state's Medicaid program. There, you can find information on the eligibility requirements, the application process, and what Medicaid covers.

How to Apply for Medicaid

How to Apply for Medicaid?

You may also be able to apply for Medicaid online, by mail, or in person at a local office. Additionally, you can speak with a representative from your state's Medicaid program to get answers to any questions you may have about eligibility and the application process. It's important to note that even if you have been denied Medicaid in the past, you may still be eligible based on changes in your income or other circumstances.

How to check does Medicaid Cover Dentures or Partial Dentures in your State?

If you are wondering whether Medicaid will pay for dentures or partial dentures in your state, the first step is to check your state's Medicaid website or contact your local Medicaid office. Each state's Medicaid program is different in terms of coverage, so it's important to review the information specific to your state.

Is Medicare Available to You?

Medicare is a federal health insurance program that provides coverage to eligible individuals in the United States. To be eligible for Medicare, you must be a US citizen or a legal resident who has lived in the country for at least five years. You also need to have worked and paid into the Medicare system for a minimum of 10 years, or 40 quarters, through payroll taxes.

It's important to note that Medicare is not just available to senior citizens. Individuals with certain disabilities, such as Lou Gehrig's disease, end-stage renal disease, and permanent disabilities, are also eligible for Medicare. If you think you may be eligible to qualify for Medicare, you can check your eligibility by visiting the Social Security website or contacting your local Social Security office for more information.

What Standard Medicare Covers for Different Types of Dentures

Unfortunately, standard Medicare does not typically cover the cost of dentures. However, there are some exceptions. If you need dentures due to a medical condition, such as cancer or a traumatic injury, Medicare may cover the dentures cost however

Why Additional Insurance is Often Needed to Cover Dental Costs

Since standard Medicare does not cover most dental services, including dentures, many people turn to additional insurance to help cover these costs. Dental insurance plans are available to help cover the cost of dentures and other dental services. However, it's important to note that these plans often have limitations and may not cover the full cost of dentures.

How Medicare Advantage Plans Can Help Cover These Costs

How Medicare Advantage Plans Can Help Cover These Costs

Medicare Advantage plans are an alternative to standard Medicare that are offered by private insurance companies. These plans provide all of the benefits of Medicare Parts A and B, and often include additional benefits such as dental, vision, and hearing coverage. Some Medicare Advantage plans even provide coverage for dentures.

If you are in need of dentures and are a Medicaid recipient, it's important to understand your state's denture coverage, as well as your insurance coverage options. Often new Medicare plans may provide additional benefits your existing plan does not. It's important to make sure you have the best plan available. Medicaid recipients may have special enrollment periods for Medicare providing more flexibility in changing plans.

Have You Considered a Medicare Advantage D-SNP Plan?

If you are on Medicaid and want to explore your options for getting additional benefits and support to stay healthy, consider a Dual Special Needs Plan (DSNP). At EASY Insurance Plans, we can help you find the right DSNP plan that fits your needs and budget. Our agents can assist you in navigating the complex world of Medicare and Medicaid and finding a plan that provides you with the coverage and benefits you need.

Contact us today to learn more about DSNP plans and how we can help you get started.

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Does Medicaid Cover Chiropractic Services A Complete Guide
Medicare

Does Medicaid Cover Chiropractic Services? A Complete Guide

If you're considering chiropractic care but have limited financial resources, you may be wondering "Does Medicaid cover chiropractic services?"

Yes, it does cover some services.

Medicaid is a joint Federal and state program that provides healthcare coverage to eligible individuals with low incomes and limited resources. However, whether or not Medicaid covers chiropractic services depends on several factors, including the state in which you live and the specific Medicaid program you're enrolled in.

While some states do cover chiropractic services under their Medicaid programs, others do not. In some cases, chiropractic services may be covered only for certain conditions or providers may have limitations on the number of visits allowed. It's important to understand the benefits and limitations of Medicaid coverage for chiropractic care before making a decision about your healthcare options.

Benefits of Chiropractic Care

Benefits of Chiropractic Care

Chiropractic care is a type of complementary and alternative medicine that focuses on the musculoskeletal system and the nervous system. Chiropractors use manual techniques, such as spinal manipulation, to help alleviate pain and improve overall health and wellness.

Chiropractic care is generally safe and non-invasive, which makes it an attractive treatment option for many patients. It can also be less expensive than other types of healthcare services, such as surgery or prescription medications. For patients who are looking for a natural approach to healthcare, chiropractic care can be an excellent option.

Limitations of Medicaid Coverage for Chiropractic Treatments

As mentioned earlier, whether or not Medicaid covers chiropractic care depends on the state in which you live and the specific Medicaid program you're enrolled in. In some states, chiropractic care is not covered under Medicaid at all. In others, coverage is limited to certain conditions or has a cap on the number of visits allowed (for state-by-state information visit the Medicaid.gov site).

Even in states where chiropractic care is covered under Medicaid, there may be other limitations to consider. For example, some Medicaid programs require prior authorization before chiropractic services can be provided. Others may limit the types of services that are covered or the Medicaid fee that the chiropractor can charge for their services.

It's also important to note that not all chiropractors accept or pay by Medicaid. Before seeking chiropractic care under Medicaid, it's important to verify that the chiropractor you're considering accepts Medicaid and is enrolled as a Medicaid provider.

Chiropractic Services - What if You Have Medicare

Chiropractic Services - What if You Have Medicare?

Medicare Part B is a component of the federal health insurance program for individuals who are 65 or older, disabled, or have certain chronic conditions. Medicare Part B does cover some chiropractic services, but the reimbursement is with limitations.

Medicare Part B covers manual manipulation of the spine to correct spinal subluxation (a misalignment of the vertebrae), but only when performed by a chiropractor or other qualified healthcare professional who is legally authorized to perform the service under state law. The service must also be deemed a medical necessity and must be provided in an office setting by a Medicare-approved chiropractor.

Under Medicare Part B, there is a limit on the number of chiropractic treatments that are covered in a calendar year. In 2023, Medicare covers up to 20 chiropractic visits per year. The beneficiary is responsible for paying the Part B deductible and 20% of the Medicare-approved amount for each service.

It is important to note that Medicare does not cover other services provided by chiropractors, such as an X-ray, massage therapy, or acupuncture. These services may be covered under Medicare Part B if they are deemed medically necessary and are provided by a healthcare professional who is authorized to provide them under state law.

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Can You Combine Medicaid and Medicare?

Yes, it is possible for beneficiaries to combine Medicaid and Medicare to obtain additional healthcare coverage. This is known as "dual eligibility" and occurs when an individual qualifies for both Medicaid, a state-run program for low-income individuals, and Medicare, a federal program for individuals aged 65 or older, certain younger people with disabilities, and those with End-Stage Renal Disease (ESRD).

It's important to note that the specific benefits and eligibility requirements of dual-eligible individuals vary by state and may change from year to year, so it's important to stay informed about your options and coverage.

Have You Considered a Medicare Advantage D-SNP Plan

Have You Considered a Medicare Advantage D-SNP Plan?

If you are on Medicaid, you may be eligible for a Dual Special Needs Plan (DSNP) – a type of Medicare Advantage plan designed for individuals who have both Medicare and Medicaid coverage. DSNP plans can provide you with many additional benefits beyond what Original Medicare and Medicaid provide, these may include routine chiropractic care, dental, vision, and hearing coverage, prescription drug coverage, and transportation services to medical appointments.

Some DSNP plans may also offer gym memberships, wellness programs, and over-the-counter allowances. If you're on Medicaid, it's definitely worth checking if you're eligible for a DSNP plan to see if you can get additional benefits and support to help you stay healthy.

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Final Thoughts on Chiropractic Services Coverage with Medicaid and Medicare

Chiropractic care can be an effective and affordable option for many patients, but whether or not it's covered by Medicaid depends on several factors. If you're considering chiropractic care under Medicaid, it's important to understand the benefits and limitations of coverage before making a decision. To learn more about Medicaid coverage for chiropractic care in your state, contact your state's Medicaid agency or speak with a healthcare professional who is familiar with your Medicaid program work.

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What is a DSNP - Dual Eligible Special Needs Plan
Medicare

What is a DSNP – Dual Eligible Special Needs Plan?

Medicare was set up by the federal government with the goal of helping older Americans and those with certain disabilities and conditions get coverage for most of their medical expenses. Today, the program benefits over 63 million people in our country by providing them with access to the care they need.

The Medicare program is divided into four parts, with Part A (hospital insurance) and Part B (medical insurance) -- also known as Original Medicare -- being the two most basic and important components. These two parts must be included in the coverage of every eligible Medicare beneficiary. Part C, known as Medicare Advantage plans, refers to medical coverage offered by private insurance companies that can be used as alternatives to Original Medicare. If you are to enroll in a Medicare Advantage plan, it would replace your original Medicare coverage. At the same time, these plans may include additional benefits outside of what Part A and Part B cover.

But even if you are eligible for Medicare, you may also be entitled to another type of Medicare Advantage plans called the Dual Eligible Special Needs Plans (D-SNPs), with the condition that you fulfil certain state-specific criteria under Medicaid. Put it another way, D-SNPs are for individuals who qualify for both Medicare and Medicaid.

In this blog post, we will cover what a D-SNP is, how you may qualify, and all the information you'll need to make an informed decision on whether it's right for you.

What Does It Mean To be Dual Eligible?

While Medicare have over the years provided healthcare assistance to many eligible Americans, the program is available only to individuals over the age of 65, or those with certain disabilities. This means there is still a huge healthcare coverage gap in our society - in 2022, it was estimated that 44% of working-aged adults struggle to pay for health insurance as well as other out-of-pocket healthcare expenses.

To those who don't meet the conditions to qualify for Medicare, they may still be eligible for Medicaid. This program was designed to help people over the country whose income are below certain threshold with their Medical bills. While the criteria may vary between states, it is generally available to those whose annual income is below the federal poverty level (FPL), which is $14,580 for single adults without children and $24,860 for a three person household.

To be considered dual eligible, you would need to be eligible for both Medicare and Medicaid.

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What is the Benefit of Dual Special Needs Plans

What is the Benefit of Dual Special Needs Plans?

Dual Eligible Special Needs plans (D-SNPs) is a special type of Medicare Advantage plan that packages your Medicare/Medicaid benefits and prescription drug coverage together to offer you a complete and easy healthcare experience. Because D-SNPs include all the benefits of both Medicare and Medicaid programs, you're typically getting the most out of your plan if you qualify for one.

Compared to Original Medicare, these plans usually offer more benefits since they are offered by private insurance companies. But it's important to note that all D-SNPs are jointly funded by the federal government and your state government. This means that your state may have some control over the type, amount, and duration of your benefits, provided they meet certain guidelines.

A typical D-SNP may include benefits such as personalized care coordination, chronic condition management, home health services, over-the-counter benefits, telehealth services, inpatient procedures, outpatient procedures, mental health services, preventative services, medical equipment, dental, vision, hearing, transportation, caregiver support, etc. But as we mentioned, every D-SNP is different, so it's important to check the benefits of the individual plan you're interested in before making a decision.

Who Qualifies for Dual Special Needs Plans?

D-SNPs are available to dual-eligible beneficiaries, meaning you first must qualify for both Medicare and Medicaid. Eligibility is mainly determined by a number of factors such as household income, marital status, etc.

To qualify for a D-SNP you must be a US citizen or permanent legal resident and a resident of the state in which you are receiving benefits. Depending on your state, there may be other criteria you must meet. For more details on eligibility, you can refer to the Centers for Medicare & Medicaid Services website.

What Is Partial Dual Eligible?

A person who is partially dual-eligible is someone who qualifies for the Medicare Savings Program (MSP), which was designed to help low-income individuals with their Medicare costs. There are four types of Medicare savings programs.

Qualified Medicare Beneficiary (QMB): The QMB program covers Part A and B premiums, deductibles, coinsurance, and copayments.

Specified Low-Income Medicare Beneficiary (SLMB): The SLMB program simply pays for Part B Premiums.

Qualifying Individual (QI): The QI program covers Part B Premiums for Medicaid Beneficiaries.

Qualified Disabled and Working Individual (QDWI). The QDWI program helps pay Part A premiums for working individuals under the age of 65, those who lost Part A premium coverage after returning to work, those who do not receive state medical assistance, and those who do not meet the income and resource limit based on their state.

To enroll in a Medicare savings program, you must meet the eligibility requirements based on income and resource level. If you meet certain conditions, you may also be automatically qualified for the Extra Help program, which is a federal program that covers Medicare beneficiaries for prescription drugs (Part D).

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What Is a Medically Needy Program

What Is a Medically Needy Program?

Many states also offer what is called a Medically Needy Program, or spenddown program. It is made for those who would not typically qualify for dual-eligibility because of their income, but have large healthcare bills due to extensive medical needs.

With this program, individuals may deduct medical expense from their income so that they qualify for Medicaid spend down for aged, blind, and disable (ABD). This is usually for people whose medical expense take up a significant portion of their income. The coverage provided under a Medically Needy program is similar to that of Medicaid, and it typically includes Medicaid services such as doctor visits, hospital stays, prescription drugs, and other medically necessary services.

Is a D-SNP Right for me?

While Medicare Advantage plans typically come with more benefits than original Medicare, there is also downside to them. Since Original Medicare is designed to give you freedom over your healthcare, with this program, you can visit any doctor or hospital in the country..

On the other hand, Medicare Advantage plans may restrict you to doctors, hospitals, or facilities within their network. You may also be required to obtain pre-approval on procedures, prescriptions, or treatments a doctor recommends, before you are allowed to move forward with certain treatment. This can sometimes lead to delays in your care and even allows your insurance company to refuse the treatment you need.

How Much Does a D-SNP Cost?

The cost of a D-SNP also varies depending on a few factors, such as the state you live in, the insurance company offering the plan, and the specific benefits and coverage options included.

In general, if you are eligible for both Medicare and Medicaid, you may be able to enroll in a D-SNP at no additional cost beyond what you already pay for your Medicare and Medicaid premiums. However, some D-SNPs may have additional costs such as copays, deductibles, or coinsurance for certain services or medications.

How Do I Enroll In a D-SNP?

Because dual eligible special needs plans are offered by private insurance companies, you may not have covered access to doctors outside the company's network. If you have a preferred doctor or hospital, you will first want to make sure they are covered by the insurance plan you are interested in.

To enroll in a D-SNP, you will first want choose a plan that is right for you. It's difficult and time-consuming to consider all of your needs and options on your own, and this is an important decision that could lead to you getting stuck in a plan that isn't a fit. As such, it is important that you engage with a professional that will connect you to the best plan available.

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

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