Finding out you need a transplant of any type can be overwhelming and worrisome. Not only does it come with the need for life-changing surgical procedures, but for many people, the cost is concerning. Does Medicare cover transplants? The answer is yes, for the most part.
One key thing that you need to know is that Medicare coverage is based on a person’s specific health needs. Transplants are considered, in most cases, the last resort to care. Organ transplants for livers, hearts, kidneys, lungs, and other organs are a life-saving procedure that comes with ample risk. Medicare pays for transplant care when it is the most necessary level of help for your needs, often after every other applicable treatment is exhausted.
How Does Medicare Cover Transplant Needs?
The type of Medicare coverage you have ultimately determines what Medicare will cover in terms of overall medical costs associated with a transplant. For most people with Original Medicare, the coverage will involve:
Medicare Part A: This component of your Medicare coverage will cover hospital stay costs, which is typical of most transplants.
Medicare Part B: This will cover your pre- and post-transplant doctor’s visits. It may also provide coverage for your screenings and diagnostics that are necessary to determine if you are a candidate for transplant, including both physical and mental health care.
If Medicare determines that an organ transplant is the necessary and likely best care option for you, it will cover costs related to the pre- and post-transplant care you will have. However, there are limitations to this policy that you need to know about, and that often means you should have supplemental coverage to extend your financial protections.
Medications with Transplant and Medicare Coverage
One of the most important reasons to have health insurance in place heading into your transplant is that you will likely need highly expensive, very important medications for the rest of your life to help prevent your body from rejecting the organ. These medications are not covered directly under Medicare Part A and B, though some may receive medication for a limited amount of time through the plan.
Most people will need to have Medicare Part D or prescription drug coverage in place. Part D prescription drug coverage is not a component of Original Medicare. Rather, it is a separate policy you need to have in place typically before your Medicare coverage kicks in to cover those very important medications.
When will Medicare pay for immunosuppressive drugs?
Immunosuppressive drugs, also called transplant drugs, are critical to sustaining life after a transplant. Medicare Part B covers this when Medicare pays for the transplant itself. That means that you must have Part A in place at the time of the transplant, and it must have covered the transplant costs. Part B will then cover the immunosuppressive drugs.
What Will Medicare Pay for in a Transplant?
Typically, Medicare Part A will provide for some of the costs you have during a hospital stay. This includes all of the necessary tests, lab work, and exams needed in the lead-up to the transplant. Then, it will likely cover the costs for:
Heart transplant
Lung transplant
Kidney transplant
Pancreas transplant
Intestine transplant
Liver transplant
In addition to this, Medicare also provides coverage for stem cell transplants when it is deemed the best type of care for your condition.
Medicare Part B will likely provide coverage related to the doctor-specific care you receive for your transplant. This includes your ongoing care and drug needs for immunosuppressant care.
Your Expected Transplant Costs with Medicare
Review your transplant costs with your social worker and insurance provider to make sure you know exactly what to expect. Typically, you will still need to pay for some costs, including:
20% of your Medicare-approved amount for all of the doctor’s services considered necessary leading up to and after your transplant once you meet the deductible for Part B.
Various costs charged to you by the transplant facility and hospital
You do not have to pay anything to the living donor for a kidney transplant. You do not pay for any Medicare certified laboratory tests.
What About a Medicare Advantage Plan?
Medicare covers most of the costs associated with transplants because it is considered a life-saving treatment. However, if you need a kidney transplant, heart transplant, or other organ transplant and you have a Medicare Advantage Plan, you need to check with that provider to know what your specific coverage and limitations are.
The same applies to Medigap plans. This type of medical insurance will cover your costs as long as the transplant is considered necessary and life-saving. The covered transplant coverage amount will differ based on the Medigap plans themselves as well as the coverage limitations in place. You can check with your insurance company before you move forward to know what your Medicare supplement plan or advantage plan will and will not cover.
Other Factors to Know About a Medicare Covered Transplant
Consider the following details of coverage. Keep in mind that you should learn about this coverage in depth if you believe you may need to meet these needs.
Ensure you follow all rules required by Medicare
There are several things to keep in mind in this area:
You must be eligible for care through a Medicare approved facility.
Medicare covers organ transplants based on the plan’s coverage rules. When joining a Medicare Advantage plan, then, research coverage for the specific type of condition you have and the qualifications based on that plan.
Choose healthcare providers that are approved by Medicare, not just a Medicare approved hospital.
Know the rules for prior authorization. This could differ based on the plan you have. However, to ensure you get the transplant surgery covered, you must ensure you have met all of the coverage rules for prior authorization the plan puts in place.
Organ transplant programs differ across the country. One facility may tell you that you need a double lung transplant, while another does not. The key here is that Medicare will likely need to approve the coverage based on medical tests and lab work itself.
End Stage Renal Disease and Medicare
If you have been diagnosed with end stage renal disease and need a kidney transplant. End stage renal disease ESRD, is a condition that may qualify you for Medicare immediately without the delay that is typical of Medical eligibility. Your Medicare coverage will include immunosuppressive drug coverage, which will continue for 36 months after a successful kidney transplant. You may need to seek immunosuppressive drug coverage beyond this.
What If You Are Not Eligible for Medicare?
Some people need organ transplants and are not Medicare beneficiaries, and it can take some time to qualify for coverage. As a result of that, you may need to explore other options for care in order to get on the transplant waiting list and receive coverage. If you do not qualify for Original Medicare or Medicare Advantage Plans, you may still be able to receive care through Medicaid services. Medicaid services may cover the out of pocket costs associated with the surgery. It also covers immunosuppressive drugs and doctor services you need.
If you are unsure if you will have coverage for the transplant surgery you need, work with the social worker to find out what additional options may be available to you.
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:
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.
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?
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
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!
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
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
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.
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?
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!
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?
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?
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.
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?
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
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.
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.
The healthcare landscape can be complex, especially when it comes to understanding the eligibility of Medicaid for immigrants over 65. With the aging immigrant population, it's essential to shed light on the available health coverage options and how to navigate the system. In this article, we will explore Medicaid, its coverage for immigrants over 65, and how to access its benefits.
Understanding Medicaid and its Importance for Immigrants Over 65
Medicaid, a joint federal and state program, is designed to help with medical costs for some people with limited income and resources. It provides free or low-cost health coverage to some low-income people, families and children, pregnant women, the elderly, and people with disabilities. Medicaid programs must follow federal guidelines, but they vary somewhat from state to state.
For immigrants over 65, Medicaid plays a critical role in providing access to essential healthcare services, especially as they are at a higher risk of experiencing health issues due to age. However, the eligibility for immigrants to access Medicaid benefits depends on several factors including their immigration status, residency duration in the U.S, and state-specific regulations.
Medicaid Eligibility Based on Your Immigration Status
The Affordable Care Act (ACA) extended Medicaid coverage to many low-income individuals, but for immigrants, eligibility is not straightforward. Certain 'qualified' immigrants - including lawful permanent residents, refugees, asylum seekers, and others - are eligible for Medicaid, but many face a five-year waiting period from the time they attain qualified status.
In some states, Medicaid coverage is available to lawfully present immigrants without a five-year wait, including those who are lawfully present but not in a 'qualified' status, such as people with temporary protected status or nonimmigrant visa holders. However, unauthorized immigrants are generally ineligible for Medicaid, although states have the option to provide coverage to undocumented immigrants for emergency services.
Additional Eligibility Factors
Medicaid will also check your financial situation as part of its eligibility criteria using MAGI, modified adjusted gross income.
It's important to note that the rules for some immigrant families' eligibility for Medicaid are complex and vary by state, so it's essential to check specific state regulations.
For eligible immigrants over 65, Medicaid can provide a range of benefits that are crucial for maintaining health in later life. These benefits typically include hospital and doctor visits, prescription drugs, preventative care, and other services like home health care and long-term care.
The specifics of what Medicaid covers can vary from state to state, and there may be some costs (like copayments for some services), but for many immigrants over 65, Medicaid provides vital access to healthcare that they might not otherwise be able to afford.
Some types of physical and mental health services are mandatory and are covered by Medicaid in every state. These include:
Hospital services: Both inpatient and outpatient hospital services are covered.
Nursing facility services: Medicaid covers services provided in a nursing home, including room and board, nursing care, and other related services.
Home health services: If a person is eligible for nursing facility services, they are also eligible for home health services, which can include part-time nursing, home health aide services, and medical supplies and equipment.
Physician services: Services provided by a doctor are covered. This includes visits to a doctor's office, as well as any treatments or procedures performed by a doctor.
Rural health clinic services: Services provided in a rural health clinic are covered.
Laboratory and X-ray services: This coverage includes any necessary diagnostic services.
Family planning services: While this may not be relevant for most individuals over 65, Medicaid is required to cover family planning services.
Transportation to medical care: Non-emergency, but necessary, transportation to and from providers of Medicaid services is covered.
Optional Medicaid Health Coverage for Over 65
In addition to the mandatory services, states can choose to provide other "optional" services. These can include:
Prescription drugs: While not required, all states currently provide coverage for prescription drugs.
Physical therapy: If deemed medically necessary, physical therapy services can be covered.
Occupational therapy: Similar to physical therapy, occupational therapy services can be covered if they are considered medically necessary.
Speech, hearing, and language disorder services: These services can be covered if they are considered medically necessary.
Respiratory care services: This type of care can be covered for individuals who are ventilator-dependent.
Other diagnostic, screening, preventative, and rehabilitative services: Services intended to prevent, diagnose, or treat conditions could potentially be covered, depending on the state.
Medicaid and Telehealth
Medicaid also covers telehealth services, although the specifics can vary by state. Telehealth can include a range of services, from online doctor consultations to digital transmission of medical images. Telehealth services have the potential to significantly improve access to healthcare for individuals over 65, particularly for those who are housebound or live in rural areas.
Navigating the Complexity: Accessing Medicaid as an Immigrant
Accessing Medicaid as an immigrant involves several steps. First, it's necessary to understand your immigration status and how it relates to Medicaid eligibility. This may involve seeking advice from an immigration expert or attorney.
Next, it's important to understand the specific rules in your state, as some states have expanded Medicaid coverage to more formerly uninsured undocumented immigrants, than others. The application process for Medicaid also varies by state, so it's important to follow the correct procedure.
Finally, it's important to understand what Medicaid covers and what costs you might be responsible for.
The Impact of Medicaid Expansion Under the Affordable Care Act
The Affordable Care Act has significantly expanded Medicaid eligibility, including for many immigrants. However, not all states have chosen to expand Medicaid. In states that have not expanded, many immigrants fall into a 'coverage gap' where they earn too much to qualify for Medicaid but not enough to qualify for Marketplace coverage.
The Role of Private Health Insurance and Telehealth Services
While Medicaid is a vital source of coverage for many immigrants over 65, it's not the only option to obtain health insurance. Private insurance can also play a role, particularly for immigrants who may not be eligible for Medicaid or who want additional coverage.
Telehealth services are increasingly being used to provide healthcare, especially in the wake of the COVID-19 pandemic. While not all telehealth services are covered by Medicaid, many are, and they can provide a convenient way to access healthcare, especially for older adults who may have difficulty getting to a healthcare provider.
DSNPS - Medicare Advantage Plans for Immigrant Seniors
Dual Eligible Special Needs Plans (D-SNPs) can be a great option for immigrant seniors who qualify for both Medicaid and Medicare. These Medicare Advantage plans are designed to cater to the needs of individuals who are eligible for both programs, combining benefits and coordinating care for more efficient healthcare management.
These plans often have extra benefits such as debit-style cards to purchase essentials, additional dental and vision benefits and more. Each insurance carrier's plan is different. It's best to speak with a licensed insurance agent that can provide free consultation on the plans available to you.
For immigrant seniors over 65 who don't qualify for Medicare, the ACA Health Marketplace can be a viable option for finding affordable health insurance coverage. The Marketplace offers various health plan options and provides cost-saving subsidies based on income. Cost-Sharing Reductions (CSRs) and Advanced Premium Tax Credits can help lower the cost of health insurance premiums and reduce out-of-pocket costs for eligible individuals.
Marketplace Silver Plans allow these tax credits premium subsidies to be used for plans significantly reducing the deductibles, premiums and copays needed.
Navigating the healthcare landscape as an immigrant over 65 can be challenging, but understanding the role of Medicaid and other various health insurance options and coverage options can make a big difference. With the right knowledge and resources, it's possible to access the healthcare needed to live a healthy life in the U.S.
As a direct aftermath of COVID, virtual doctor's appointments are becoming more and more popular. And for good reasons. While for most of us it helps save time and money on traveling, the ability to see a doctor for a checkup without leaving one's home can be significant for people with a disability that limits their mobility.
No traffic, no waiting rooms, just you and your doctor face to face on your device screen. If that seems helpful, this blog post is for you. Below we're going to go through how you can use virtual appointments to get treatment from the comfort and convenience of your own home!
How do Virtual Appointments Work?
Virtual care services, known to some as telemedicine or telehealth services, allow a patient to schedule and attend an appointment and get health care remotely using technology like video chatting. Instead of an in-person appointment, you can simply visit your doctor or healthcare provider from your home using a phone, tablet or computer. Other than the device, all you need is internet connection!
What are the Benefits of Virtual Appointments?
Now that you have an idea what telemedicine is, here are the main reasons people chose virtual appointments over traditional primary care physician visits:
Access Care From Anywhere
Virtual visits allow you to connect with your doctor from anywhere using your mobile device or a computer. Whether you’re at home, work, or even traveling, you can log in for your appointment. This makes it much easier to make time for medical care when you lead a busy life.
Save Time and Energy
By eliminating the need to travel to and wait at the doctor’s office, virtual appointments can save you hours of time. The actual visit itself is also usually more efficient since the doctor can focus on you without interruptions. Many routine issues like medication refills, test and screening results, chronic condition management, etc, can often be handled in just 5 to 10 minutes.
Lower Exposure Risk
If you are at higher risk of exposure to illnesses like the flu, colds, or even Covid-19, telemedicine helps limit contact with contagions that may be present in a doctor’s waiting room or clinic. Virtual visits are a safer option, especially if you have a weakened immune system or deal with chronic health conditions.
When Is a Virtual Appointment Right for You?
Telemedicine allows doctors to evaluate symptoms, examine photos or videos, review medical records and test results, diagnose conditions, and recommend treatment plans from a distance.
While many common illnesses and injuries can be managed virtually, some may still require an in-person visit for further evaluation or testing. So the question is: when could a virtual visit be right for you?
Minor Illnesses or Infections: Minor illnesses like colds, flu, sinus or urinary tract infections, and stomach viruses can often be diagnosed and effectively treated via telemedicine. Doctors can evaluate your symptoms, your medical history, and in some cases, photos to determine if antibiotics or other medications are needed.
Chronic conditions and Illnesses: Things like high blood pressure, diabetes, depression, and anxiety can also be managed remotely using telemedicine. Doctors can monitor health stats, adjust medications, and provide counseling and therapy during virtual visits.
Pediatric: Children's illnesses and behavior or developmental concerns can frequently be addressed through remote sessions as well. Checkups and monitoring of long-term conditions are also possible in some situations.
Dermatology: Issues like rashes, acne, and mild skin infections can sometimes be assessed and treated via telemedicine using photos and video. Doctors can examine the skin, determine if any testing is needed, and prescribe medication if appropriate.
Muscle or Skeletal injuries: Injuries such as sprains, strains, and minor fractures may be evaluated via a quick virtual appointment using images and a description of symptoms. Doctors can determine severity, recommend things like resting, icing, physical therapy or other treatments, and advise if an in-person follow up is necessary.
Virtual appointments are ideal for routine primary care needs, such as medication refills, chronic condition management, and general checkups. Your doctor can review your medical history and symptoms with you over a video call to determine if your condition requires an in-person visit or remote consultation. For minor illnesses like colds, allergies, and rashes, a virtual visit may be all you need to get a diagnosis and prescription.
Behavioral and Mental Health
Virtual behavioral health visits with a therapist or counselor provide discreet, convenient access to services like counseling for anxiety, depression, trauma, or relationship issues. Speaking with a professional counselor over video allows for personal interaction and evaluation to determine a diagnosis and recommend a treatment plan. There's also an added benefit: Many people find online therapy helps lower barriers to seeking mental health support.
Nutrition and Wellness
Dietitians, health coaches, and wellness experts commonly offer virtual consultations. Advice on things like nutrition guidance, exercise plan, and making lifestyle changes can often be given remotely with phone or video calls.
Chronic Condition Monitoring
For people with ongoing health conditions like diabetes, heart disease, or COPD, virtual care plays an important role in disease management. Remote patient monitoring with connected devices allows doctors to track health metrics and symptoms to better manage medications and treatment plans without frequent office visits. Patients can stay on top of chronic illnesses using virtual check-ins, health coaching, and monitoring programs.
Apps for Virtual Doctor Visits and Telemedicine
FaceTime
If you have a smart device, FaceTime is a convenient option for a virtual doctor visit. To connect with your doctor’s office, you just provide them with your Apple ID or phone number and FaceTime audio or video call to start the appointment.
Zoom
The popular video conferencing app, Zoom, can also be used for telemedicine. In fact, many doctor’s offices are already using it for meetings and online events, so they may prefer sticking with it even for scheduling virtual visits. This platform also works on smartphones, tablets, laptops and desktop computers.
Doxy.me
Doxy.me is a telemedicine-specific app that many healthcare providers use for virtual appointments. Your doctor's office will provide you a link to enter your virtual waiting room, where you'll provide some basic information like your name and the doctor you're waiting for. Your doctor or a nurse will then start the video call for your appointment. Doxy.me does not require you to download an app or create an account.
Amwell
Amwell is another popular telemedicine app used by many major health systems and some insurance providers. Once you create an Amwell account, you can schedule virtual urgent care, therapy, or specialist visits with doctors using the app. Appointments are available 24 hours, so Amwell is a good option for after-hours care or if your doctor's office uses the platform.
Teladoc
Teladoc is one of the most prominent telemedicine providers, partnering with many employers, health care plans, and hospital systems to offer virtual care. Just like Amwell, you'll set up an account, provide your insurance info, and schedule a visit with a doctor either by video or phone. Teladoc doctors are also available 24 hours for non-emergency care to diagnose and treat many common health issues.
Is Telehealth Included in Medicare?
If you're enrolled in Medicare, you're probably wondering about telehealth coverage. Here's your answer: Some Medicare Advantage (Medicare Part C) plans offer coverage for telehealth services like virtual doctor visits. These Medicare plans, offered by private insurance companies, provide the same coverage as Original Medicare (Parts A and B) as well as additional benefits like telehealth.
Do You Need Telehealth Coverage in Your Medicare Plan?
If telehealth is important to you but your current plan doesn't cover it, it's never too late to switch! Not all Medicare plans are created equal, That's why we're here to help you find a plan that's perfect for you ---
EASY Insurance is a team of experienced agents that are dedicated to helping you find the health plans that best suit you. Whether your need is best served by a government assistance program or a plan offered by a private insurance company, we will guide you through the entire process.
Remember: we're here to help you live an EASY and stress-free life!
With inflation showing no signs of slowing, you may be noticing that the benefits you're receiving as a senior on social security aren't covering all your expenses. While your income may still be enough to meet some basic needs, affording housing can be a challenge. And depending on where you live, a competitive housing market can make it even more difficult to find a home.
But don't worry, in this blog post we will show you the ways that allow millions of seniors on social security to find affordable housing. We will explore practical strategies and resources to help you navigate the housing market and find options that offer both stability and comfort for you and your family.
Determine Your Budget and Needs.
There are a lot of factors to consider when looking for affordable senior housing when you are on limited income. The first and perhaps most important step is to determine your budget and needs, so you can decide what's the right type of home for you.
Budget
First you need to ask yourself a simple question: How much can you afford to spend on rent or mortgage payments each month? It's important to be realistic about what you can afford, as you don't want to end up not able to make your payments. Once you have an idea on budget, you can start looking for housing options within your price range.
Needs
Another important factor is your needs, such as what kind of features and amenities you want for your new home? For example, if you have mobility issues, you'll want to look into assisted living facilities or make sure the property has accessible features like ramps or elevator access. Alternatively, if you're looking for a sense of community, you might want to look for senior-focused developments that offer social activities and common areas. Take some time to think about your needs so that you can narrow down your search to properties that will best meet them.
After considering these factors, you'll be more prepared to identify the right housing option for you.
Affordable Housing Programs.
Once you've determined your budget and needs, it's time to start finding a suitable home. As we mentioned, with rising cost-of-living, the housing options available for low income families or individuals are somewhat limited in certain places. This is especially so if you have additional needs and wants outside of just a livable home.
But don't worry --- there is plenty of help available. Thanks to the many government programs out there, you may be able to get support for housing expenses, and being on Social Security or having a lower income may actually make qualifying for these programs easier for you.
The Section 8 Housing Choice Voucher Program is administered by the U.S. Department of Housing and Urban Development (HUD) with the aim of ensuring individuals and families with limited income can secure suitable housing. It can be a good option for seniors on social security who are struggling to find low-income housing. The best part of the program is the flexibility -- these vouchers can be used to help pay for rent in the home of your choice and not just limited to subsidized housing projects.
Who Is Eligible For Section 8 Housing?
The first requirement for Section 8 Housing is that you must be a U.S. citizen or have eligible immigration status. So if you're receiving Social Security benefits, it means you're already covered on that end.
Secondly, because the program is designed to assist low-income households, your annual income must fall below a certain threshold. This criteria is determined based on your area's median income level, so it may vary depending on where you are and the size of your household.
Note that the Section 8 Housing program often has long waiting lists due to high demand. Yet local housing authorities prioritize individuals with disabilities, seniors, and families with children, which may help speed up the process for you as a senior.
Does Social Security Affect Section 8 Housing Eligibility?
Yes and no. Your status as a senior on Social Security may impact your eligibility. Social Security benefits, including retirement, disability, or survivor benefits, are counted as income for the purposes of determining if you qualify.
But, HUD provides certain deductions to accommodate the financial situations of seniors, such as medical expenses and allowances for dependents. Also, as we mentioned, being on Social Security may help you qualify. Because even though your benefits are counted as income, if you are reading this blog because you're struggling to afford housing on your own, chances are you'll likely fall below the threshold.
How Do I Apply For Section 8 Housing?
Now that you have an idea of whether you qualify for the program, to properly determine your eligibility, you will need to contact your local public housing agency (PHA) or the housing authority overseeing your area. They will provide you with the necessary forms, explain the documentation required, and help you apply for Section 8 Housing.
What About The Section 202 Program? (Specifically For Seniors)
Besides Section 8 Housing, the HUD also offers other affordable housing programs specifically designed for seniors. One example is Section 202 Supportive Housing for the Elderly. This is another program that provides affordable housing options for seniors with limited income or who may have physical challenges. In addition to support on rents, it also provides services such as meal preparation, transportation, and affordable housing maintenance, etc.
Those who qualify for the program typically pay a rent fee of around 30% of their net income, with the government taking up the rest. So the lower your income is, the less you will have to pay.
Do You Qualify For The Section 202 Program?
Other than income, there are other criteria you will need to meet to qualify. For example, you must be at least 62 years old and making below 50% of the median income for your area. In addition, you need to be able to live independently, as the program does not offer daily assistance.
Some Section 202 communities may require you to meet other criteria, such as being disabled or a veteran. It's important to check with each community to understand their specific requirements.
How To Apply For Section 202 Program.
If you think you meet the requirement, you can fill out an application directly with your local public housing authority. Bear in mind that waiting lists may also apply for this program, so it's always a good idea to plan ahead.
Local non-profit organizations and senior centers may also have information on affordable housing options in the area.
Can My Children or Spouses Live in Senior Apartments?
Your spouse can live with you in your senior community, provided he or she is over the minimum age allowed. As for your children, if they are not over the community's minimum age, then they can also live with you. It's best to check with your community before applying. Most of these communities have rules against anyone under their minimum age living in the community, so you'll likely get a no. There are, however, some exceptions to these rules, such as caregivers for example.
What About Government Assistance For Other Basic Needs?
Now that we've covered housing for seniors on Social Security, let's take a look at what other government assistance programs are . Government support can range from housing to food to even WiFi and FREE cell phones, so let's get into what else you may be eligible for as a senior on Social Security:
Medicare
As we age, it becomes more and more important to have access to healthcare. Yet healthcare can be very expensive, especially to those already heavily dependent on Social Security benefits. Thanks to the federal government-funded Medicare program, when you reach 65, you'll be able to receive meaningful support in this area.
The goal of Medicare is to help older Americans and those with certain disabilities and conditions get coverage for most of their medical expenses. The program helps over 63 million people in the US by providing them with access to the care they need.
What Does Medicare Assist you With as a Senior?
When you enroll in Medicare, you get access to a lot of different healthcare benefits (covered under Medicare Part A&B, also known as Original Medicare). There are also certain types of alternative Medicare plans (Medicare Advantage Plans or Part C), but here we'll focus on the Original Medicare.
Part A --- 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. Many people get this coverage without any sort of premiums once they turn 65, as they would've paid into the system with payroll taxes during their working years.
Part B --- is responsible for 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.
When Can I Join a Medicare Program?
If you're currently under the age of 65, you can enroll directly into a Medicare plan during your initial enrollment period, which starts 3 months before you turn 65 and ends 3 months after your 65th birthday.
But if you're already over the age of 65, and you're looking to join a Medicare program, 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.
How Do I Enroll In Medicare?
You can apply for Medicare directly online at Medicare's Government Website. Simply answer some questions and find out exactly what you're eligible for. As we mentioned, you will automatically be enrolled in Part A when you join.
Medicare Savings Programs For Low-Income Seniors
Medicare offers a lot of help for seniors, but it does come with some fees and payments, such as deductibles, co-payments, etc. But if you meet certain criteria, you may be eligible for Medicare Savings Programs (MSPs), which are programs to help you pay for some of these out-of-pocket expenses that come with Medicare. Here are the 3 main MSPs:
Qualified Medicare Beneficiary (QMB): This helps pay for Medicare's Part A and B premiums. With this program, you shouldn't have to pay any medical bills when visiting a doctor or hospital, as long as it's within your Medicare Advantage Plan's network.
Specified Low-income Medicare Beneficiary (SLMB): This program is specifically for Medicare Part B premiums.
Qualifying Individual (QI) Program: The QI program also pays for Part B premiums.
If you enroll in one of the above MSPs, you will also automatically become a member of the Extra Help program that focuses on paying for some, or even all of the costs associated with Part D Medicare (prescription drug coverage).
How Do I Qualify For an MSP In 2023?
To join an MSP program, you must meet a certain income criteria to show that you need financial help with your Medicare expenses. Luckily, if you're on Social Security, you're likely to meet this criteria. Here are the monthly income limits for each program mentioned above:
QMB: $1,235 for a single person. $1,663 for a married couple.
SLMB: $1,478 for a single person. $1,992 for a married couple.
QI: $1,660 for a single person. $2,239 for a married couple.
Remember That FREE PHONE we Mentioned?
When you are in retirement, chances are you will look at cutting as many extra costs as possible. Items like your WiFi and cell service bills can eat up a good chunk of your retirement. Yet in this day and age they are so important for many people to stay connected with families and friends. So are there any ways out there that can help you save money on your phone and mobile data plan? How about EASY Wireless? EASY Wireless is an established provider with a 20-year history of offering reliable communication services to thousands of satisfied wireless customers. The company has been helping Americans stay connected through two government assistance programs: Lifeline and Affordable Connectivity Program (ACP). When you qualify for either of these programs, you will have the chance to get a FREE data plan and even a FREE smartphone!
What are Lifeline and the Affordable Connectivity Program (ACP)?
Lifeline is a government program designed to make phone and internet connection more affordable for eligible low-income individuals and families, including seniors with a fixed-income. It offers a subsidy that reduces monthly costs for phone services. The Affordable Connectivity Program (ACP), on the other hand, aims to provide affordable internet access, helping eligible households overcome financial barriers to connectivity.
Using Other Assistance programs for Lifeline and ACP with EASY Wireless
An easy way to qualify for these programs is if you're already on a different government program. If you are, you will have the chance to receive the following benefits.
EASY Wireless Unlimited Plan
FREE Unlimited Data
FREE Unlimited Talk
FREE Unlimited Text
FREE Brand-new Smartphone
FREE SIM Card Kit and Activation
Choose to Keep Your Number or Get a New One
Are You Eligible For The ACP?
There are two ways you can qualify for ACP: either by your household income level or by taking part in certain government programs.
Qualify for ACP
You can qualify for the ACP if you participate in one of the following government assistance programs:
If you haven't taken part in one of these programs, you can also qualify with your income level.
Do I Qualify For Lifeline?
The eligibility criteria for Lifeline service is similar to ACP. You can qualify if you or a member of your household has participated in one of the following support programs:
Supplemental Nutrition Assistance Program (SNAP)
Medicaid
Federal Public Housing Assistance
Supplemental Security Income
Veterans and Survivors Pension Benefit
Certain Tribal Programs
You may also qualify if your household income is at 135% or less than the federal poverty guidelines. Visit the Lifeline website for more information
How do I Get My FREE GOVERNMENT PHONE?
When you come to one of EASY Wireless's retail stores, our customer service agent will help you apply for the benefits.
You will first have to provide identity proof with a government-issued ID. After that's done, you can confirm your participation in one of the qualifying programs or your household income amount.
EASY Wireless accepts the following ID for proof of identity:
You can show the following documents to prove that you are taking part in a government:
Statement of benefits from a qualifying Program.
Notice letter of participation, such as an award letter
Program participation documents, such as a screenshot from an online account.
In order to show income, you can provide any of the following proofs:
Unemployment Documentation
Copy of your State or Federal income tax return.
Three months' worth of current pay stubs.
Veterans Administration or SSI benefits letter.
A divorce decree or child support document that states income.
Retirement or pension statement.
To see if you qualify for ACP, you'll need to use the National Verifier process. Since we understand that the National Verifier can be a bit confusing, our in-store agents are available to assist you. Just sit back and wait for confirmation.
You'll be able to connect to the Internet right away and stay in touch with your loved ones. We can't wait to see you and help you get connected!
Need More Than Just One Line of Service or an Additional Phone?
EASY Wireless is a full-service cellular store that cares about all of your communication needs. We have a wide range of pre-paid plans for every budget and usage requirement. We also offer a selection of brand-name phones that combine quality, reliability, and the latest technology.
Not only that – but we also provide an array of amazing accessories to enhance your mobile experience. At EASY Wireless, we're dedicated to delivering exceptional service and ensuring you find the perfect plan, phone, and accessories to suit your lifestyle and preferences.
Visit us for all your cell phone and wireless service needs today!
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.
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?
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).
Transportation Convenience: Telehealth eliminates the need for transportation to medical appointments, saving time, energy, and expenses associated with commuting.
Flexible Appointment Scheduling: With telehealth, individuals have greater flexibility in scheduling appointments, reducing wait times and accommodating busy lifestyles.
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.
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?
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 offersfree 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?
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!
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.
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 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
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.
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.
When it comes to safeguarding your health and ensuring the well-being of your loved ones, knowledge is power. Understanding your family health history can provide invaluable insights into potential health risks, hereditary conditions, and predispositions that may affect you and your family members.
By looking into your family's medical past, you gain a deeper understanding of your genetic makeup, potential areas of higher risk, and any major medical conditions you should know allowing you to make informed decisions about your healthcare.
Let's learn why it is crucial to know your family health history, how it can help during doctor visits, and why protecting yourself and your family with health insurance is extremely important.
What is Family Health History?
Your family health history refers to a record of diseases, conditions, and health-related information within your immediate and extended family. It includes details about illnesses that your parents, grandparents, siblings, and other close relatives have experienced throughout their lives.
Gathering this information helps create a comprehensive picture of your family's health background, identifying patterns and potential genetic risks that may impact your well-being.
A Few Suggestions to Find Out Your Family Medical History
Not sure where or how to start gathering information on your family medical history? Try these suggestions:
Talk to your relatives: Start by having open and honest conversations with your immediate and extended family members. Ask about any known medical conditions, chronic illnesses, or hereditary diseases that run in your family. Use family gatherings to gather health information and let your relatives know why you are asking these questions as it may help them too.
Gather medical records: Collect family medical records, including hospital discharge summaries, old prescriptions, and laboratory test results of family members. These records can provide valuable insights into past diagnoses and medical conditions.
Create a family health tree: Develop a visual representation of your family history. Include information about each family member and relative's medical conditions and age of onset. This can help identify patterns and potential risk factors.
Consult with older family members: Reach out to older relatives who may have a deeper understanding of the family's medical history. They may recall details about relatives who have passed away or have limited communication.
Utilize online resources: Take advantage of online tools and resources that can assist in documenting and tracking your family medical history. Websites and mobile applications specifically designed for this purpose can help organize and store information in a convenient and accessible manner.
How Can Knowing Your Family History Help During Doctor Visits?
When you visit a doctor, having knowledge of your family medical history can significantly influence the quality of care you receive. Healthcare professionals consider your family health history as an essential tool for assessing your risk factors and making accurate diagnoses.
By understanding your genetic predispositions and any hereditary conditions present in your family, doctors can tailor their approach, recommend appropriate screening tests, and suggest preventive measures to mitigate potential health risks.
Knowing your full family health history information enables doctors to:
Identify Potential Red Flags
If certain diseases or conditions run in your family, it raises your risk of developing them as well. By knowing this information, doctors can monitor your health more closely, conduct early screenings, and implement preventive measures to catch any potential issues before they worsen.
Some health problems and issues that may be common across a family include:
Breast Cancer
High Blood Pressure
Developing Heart Disease
Just because one of your other family members may have certain health conditions, it doesn't mean you are also guaranteed to have them, but you may be at an increased risk.
By knowing your other family members share a medical history you can pre-emptively take part in genetic testing to look for the same issues or proactively make lifestyle changes to reduce your risk.
Determine Suitable Treatment Plans
Certain medications or treatment methods may be more effective or suitable for individuals with specific genetic characteristics or ethnic background.
Using genetic testing and understanding your family health history, doctors can choose appropriate treatment options tailored to your genetic makeup, improving the chances of successful outcomes.
Offer Personalized Advice
Your family health history provides insights into lifestyle modifications and preventive measures that can help reduce your risk of developing certain conditions. By discussing your family health history with your doctor, you can receive personalized advice on diet, exercise, and other habits that may positively impact your overall health and well-being.
The Role of Health Insurance in Protecting Your Family Members' Health
While knowing your family health history is essential, it's equally crucial to have health insurance to protect yourself and your loved ones from unexpected medical expenses. Health insurance acts as a safety net, ensuring access to quality healthcare services and mitigating the financial burden associated with medical treatments.
With health insurance, you can:
Receive regular check-ups and preventive care
Many health insurance plans cover preventive services such as vaccinations, screenings, and annual check-ups. These proactive measures can detect potential health issues early on, allowing for timely interventions and better health outcomes.
Access a wide network of healthcare providers
Health insurance plans often include a network of doctors, hospitals, and specialists. This network ensures that you have access to a diverse range of healthcare professionals, enabling you to choose providers who align with your specific healthcare needs.
Obtain financial protection
Medical emergencies or unexpected illnesses can result in substantial healthcare expenses. Health insurance provides financial protection by covering a significant portion of the medical costs, reducing the burden on you and your family.
Enjoy peace of mind
Having health insurance gives you peace of mind knowing that you and your family are protected against unforeseen, major medical issues and challenges. It allows you to focus on your health without worrying about the financial consequences of medical treatments and services.
Understanding your family health history empowers you to make informed decisions about your healthcare. It helps doctors assess your risk factors, tailor treatment plans, and provide personalized advice.
Additionally, securing health insurance ensures that you and your family have access to quality healthcare services while protecting you from the financial burden associated with medical expenses. By prioritizing your family's health and being proactive in managing your healthcare needs, you can take proactive steps towards a healthier future.
Ready to Invest in Your Future Health?
If you would like to explore health insurance options that can protect you and your other family member's health, EASY Insurance Plan agents are here to guide you every step of the way. Contact us today for a free consultation and let us help you find the perfect insurance plan that best fits your needs.
Remember, your own health history and the well-being of your loved ones are invaluable assets. Take charge of your healthcare journey by understanding your family health history and securing reliable health insurance coverage today.
