Fibromyalgia, a medical illness that causes musculoskeletal pain throughout the body, affects approximately 4 million people in the United States. While it is not an age-related disease, the symptoms are more severe in seniors. It can cause severe pain and make daily tasks difficult. There is still a lot of mystery surrounding this condition, but there’s been a lot of headway in the diagnosis and treatment process. So, if you have fibromyalgia, you may be asking what treatments are available to you and whether Medicare will pay for them.
What is Fibromyalgia?
Fibromyalgia is a chronic (long-term) condition. It causes symptoms such as soreness, fatigue, muscle tenderness, and even difficulty sleeping. The condition is very complex and shows in a variety of ways, so much so that even healthcare specialists struggle to completely understand the disorder. This is because its symptoms all mimic symptoms of other illnesses and there is currently no definitive test to confirm a diagnosis. So, Fibromyalgia is often misdiagnosed for years before being found.
In the past, some doctors even questioned if fibromyalgia was real. This resulted in widespread “lazy” and “dramatic” stereotypes of those suffering from fibromyalgia. However, as the disease has been examined more thoroughly, some of the stigmas that once surrounded it have faded. Doctors have been able to find medication, therapy, and lifestyle changes that can all help you manage your symptoms and live a better life.
Fibromyalgia Symptoms
Fibromyalgia has a long list of symptoms including:
Fatigue
Trouble sleeping
Nonrestorative sleeping (sleep without feeling rested)
Headaches
Difficulty focusing (called Fibro Fog)
Dry eyes
Rash
Itching
Pain in the lower abdomen
Bladder problems
Depression
Anxiety
The most noticeable sign of fibromyalgia is pain. Most fibromyalgia patients have small tender spots around but not in the joints. When pressure is applied to these spots they can cause anything from a dull ache to severe pain. These areas, known as the 18 fibromyalgia trigger points, are symmetrical, appearing on both sides of your body with 9 spots on each side.
Since there is no specific test for fibromyalgia doctors used to diagnose fibromyalgia based on the above symptoms combined with pain in at least 11 of the 18 trigger points. However, the American College of Rheumatology (ACR) modified clinical practice recommendations and removed the minimum trigger point limit from the diagnosis criteria.
18 Trigger Points
Behind the Neck
Fibromyalgia patients frequently have two trigger points in the back of their neck where their skull meets the neck. Fibromyalgia may also cause a stiff neck, cramping, and limited range of motion. However, keep in mind that neck pain and stiffness is not limited to fibromyalgia. As we noted most symptoms will mimic other conditions. Neck pain can be caused by arthritis, trauma, over-exertion, bad posture, or even sleeping on it at an odd angle.
Front of Neck
The trigger points on the front of the neck are above the collarbone on either side of your larynx. Pain in the front of the neck can also be caused by arthritis, injury or swollen glands. So before diagnosing fibromyalgia, your doctor will most likely order blood tests to rule out any rheumatological causes first.
Shoulders
Shoulder trigger points are around midway between the edge of your shoulder and the bottom of the neck, where the supraspinatus muscles attach to the shoulder blades. People with fibromyalgia may suffer scorching or throbbing pain in this area, as well as shoulder stiffness, in addition to pain when pressure is applied. Tendonitis, rotator cuff tears, and adhesive capsulitis (commonly known as frozen shoulder) can all produce pain in the supraspinatus muscles, which form part of the rotator cuff.
Chest
Fibromyalgia pain spots on the chest are found near the second rib on either side of the sternum (also known as the breast bone). That sore point is felt at the costochondral junction, the cartilage that links the rib to the sternum, a few inches below the collarbone. Some fibromyalgia patients may feel significant pain that begins at the tender point and radiates over the chest, a condition known as costochondritis.
Upper Back
Fibromyalgia pain points in the upper back are positioned immediately below the shoulder blades, where the trapezius muscles meet the scapula. In addition to the tenderness, you may experience discomfort across the trapezius. In fact, a 2013 study found that people with fibromyalgia have much higher trapezius muscle tension when exposed to mental stress than others. A spinal disk condition, arthritis, or an injury can also all cause pain in that area.
Elbows
Tender spots on the forearms associated with fibromyalgia are right below the elbow crease toward the outside of the arm. These trigger spots might appear on either one or both elbows. Fibromyalgia is often linked to lateral epicondylitis (tennis elbow) and medial epicondylitis (golfer’s elbow), both of which are forms of tendinitis. Both can result in discomfort and tingling down the forearm to the hands and fingers. Elbow discomfort can also be caused by injuries or illnesses unrelated to fibromyalgia, such as arthritis, gout, and lupus.
Lower Back
Lower back fibromyalgia pain sites are located towards the top of the buttocks, where the gluteus maximus and gluteus medius muscles connect. Fibromyalgia can also produce muscle pain, spasms, and stiffness across your entire back and buttocks. This type of pain is also common in people who do not have fibromyalgia. In the United States, one out of every four adults suffers from low back discomfort. It can be caused by problems with the vertebral disks, spinal misalignment, repeated stress injury, or an inflammatory condition.
Hips
The hip trigger points are located directly below the hip bone, roughly where the buttock muscles bend and connect the thigh muscles. In addition to the trigger points, people with fibromyalgia may have muscle soreness and limited range of motion in the hip area. Hip discomfort can be caused by osteoarthritis, muscular strains, and other injuries. When attempting to narrow down a diagnosis, X-rays and other imaging studies can sometimes rule out alternative illnesses. Imaging scans can assist distinguish between pain caused by joint degeneration, osteoarthritis, and myalgia (muscle pain).
Knees
Tender spots in the knee are found on the inside of the leg. The specific pain site lies directly above the side of the knee near the bottom of the vastus medialis muscle. Fibromyalgia-related knee pain may be accompanied by joint stiffness and cracking. Joint swelling, on the other hand, is not typical of fibromyalgia. If your knee is also swollen, it could be caused by another ailment such as knee osteoarthritis, a meniscus injury, bursitis, or an inflammatory disease.
Fibromyalgia Treatment
Unfortunately, there is currently no cure for fibromyalgia. Instead, medications, self-care practices, and lifestyle changes are used to reduce symptoms and improve quality of life.
Medications
Medications can help you sleep better and decrease pain. Pain relievers, anti-seizure medicines, and antidepressants are common fibromyalgia medications.
Pain Relievers
Fibromyalgia pain can be unpleasant and persistent enough to disrupt your everyday routine. If your discomfort is minor, you can take over-the-counter pain medicines such Tylenol, Aspirin, Motrin, or Aleve. These drugs can help you manage your disease by reducing your pain and discomfort. They may even help with your sleep.
Many of them also reduce inflammation. Inflammation is not a prominent symptom of fibromyalgia, although it may occur if you have a linked disorder such as rheumatoid arthritis (RA). Opioids have also been prescribed to treat fibromyalgia pain. However, research has revealed that they are ineffective over time. Furthermore, the dosage of narcotics is often increased rapidly, posing a health danger to those administered these prescriptions.
Anti Seizure Medication
Pregabalin (Lyrica), an anti seizure medication, was the first medication approved by the Food and Drug Administration (FDA) for fibromyalgia. It prevents nerve cells from delivering pain signals. Gabapentin (Neurontin) was developed to treat epilepsy, but it may also aid with fibromyalgia symptoms. Gabapentin is an off-label medicine that has not been approved by the FDA to treat fibromyalgia. Off-label drug use is when a medicine licensed by the FDA for one purpose is also used for a second, unapproved purpose.
A doctor can continue to prescribe the medicine for that unapproved purpose. This is due to the fact that the FDA regulates drug testing and ensures that the drug is safe to take but they don’t regulate what the drug can be used for. As a result, your doctor can prescribe a medicine in whatever way they believe is best for your treatment.
Antidepressants
Antidepressants such as duloxetine (Cymbalta) and milnacipran (Savella) are sometimes used to alleviate fibromyalgia pain and fatigue. These drugs may also assist to restore neurotransmitter balance and promote sleep. Both duloxetine and milnacipran have been approved by the FDA for the treatment of fibromyalgia.
Fibromyalgia Diet Changes
Some fibromyalgia patients claim to feel better when they follow a specific diet plan or avoid particular foods. There is no evidence that any specific diet changes will improve or cure fibromyalgia entirely but there are changes that are known to help some of the symptoms associated with fibromyalgia.
If you have fibromyalgia, aim to eat a well-balanced diet in general. Nutritious foods give you a steady amount of energy and help you keep your body healthy. They may also help to keep symptoms from worsening. Doing simple things like eating more fruit and lean proteins, and lowering sugar intake can all help balance your diet. Certain foods or substances, such as gluten or monosodium glutamate (MSG), may aggravate your symptoms. Keep a food diary to note what you eat and how you feel after each meal if this is the case. Share this journal with your doctor so they can assist you in determining which meals worsen your symptoms.
Natural Remedies
If drugs and dietary modifications do not completely improve your symptoms, you can explore other options. Many natural cures focus on stress reduction and pain relief, and they can help you feel better both psychologically and physically. They can be used alone or in conjunction with established medical treatments. Natural fibromyalgia treatments include:
Physical therapy
Acupuncture
Massage therapy
Meditation
Yoga
Tai Chi
General exercise
Therapy
Cognitive Behavioral Therapy
It’s worth noting that most alternative remedies for fibromyalgia haven’t been properly researched or confirmed to be effective. Before attempting some of these methods, consult with a healthcare practitioner about the advantages and dangers.
Medicare Coverage For Fibromyalgia
Medicare may cover some of the costs of your fibromyalgia treatment. Part B (Medical Insurance) can help pay the price of medical visits and diagnostic tests. If you are hospitalized for your disease, Medicare Part A may cover the costs of your hospital stay as well as any medicine you receive while in the hospital.
Part D, or prescription drug coverage, might help you save money on prescriptions you need. If you’ve been diagnosed with fibromyalgia in the last year and your current coverage isn’t meeting your needs, think about your alternatives during the Annual Election Period, which runs from October 15 to December 7. Pricing tiers will be established for each plan, based on generic, brand-name, and mail-order medications.
How EZ Can Help
If you need additional coverage, you can purchase an affordable Medicare Supplement Plan. Medicare Part B covers a lot, however it only covers 80% of your expenses, leaving you to pay the other 20% out of pocket. This can be rather costly, especially if you are on a fixed income, as many Medicare recipients are. However, by obtaining a Medicare Supplement Plan, you can save money on medical expenses while also receiving additional coverage.
There are ten Medicare Supplement Plans to choose from, each with its own set of coverage options and pricing. To save as much money as possible, it’s recommended looking into a Medicare Supplement Plan, so talk to an EZ agent about all of your alternatives. EZ’s agents work with the best insurance carriers in the country and can compare plans for you in minutes at no cost. Simply enter your zip code in the box below to get free instant quotes, or call 877-670-3602 to speak with an agent directly.
While shopping for Medicare Supplement Plans you might see something called a Part B excess charge. You’ll specifically see this term in the discontinued Medicare Supplement Plans C and F. Providers who take Medicare usually also take Medicare assignment, which is the amount Medicare will pay for certain services. So, thankfully, excess charges don’t happen very often for most Medicare recipients. However, a doctor may choose to accept Medicare insurance, but not Medicare assignment which means they can charge more in some cases. The difference between the higher charge and the Medicare-approved amount for medical services, supplies, or equipment is the excess charge.
Medicare Assignment
There’s no guarantee that a doctor or hospital will only charge Medicare-approved amounts for their patients just because they take Medicare patients. All of the services and procedures that Medicare agrees to pay for have set prices that they will pay. In other words, the medical service provider must “accept Medicare assignment”. Which means they agree to take the Medicare-approved amount as payment for the service or equipment. After that, the provider sends a bill for the amount owed straight to Medicare. Medicare usually pays 80% of the bill, leaving the patient to pay the last 20%. If a provider doesn’t “accept assignment,” they can charge up to 15% more than the Medicare-approved amount for Part B.
If you go to a participating provider, all you have to pay for approved services is your Medicare deductible and coinsurance. This is the case even if the provider charges people with other types of health insurance more. Your participating provider will also send your bills to Medicare.
There are also providers who won’t take Medicare assignment. These are called “nonparticipating providers.” If your provider doesn’t participate, they might or might not agree to accept Medicare assignment for specific services. There are usually limits on how much doctors and other medical workers can charge when they don’t accept Medicare assignment. However, there is usually a limit on how much more they can charge for the service.
Part B of Medicare usually pays for care and services given in clinics and other outpatient settings. Medicare Part B pays for a range of medically necessary outpatient services and care. The Centers for Medicare & Medicaid Services say that medically necessary services are “services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.”
The Part B deductible must be paid before Part B will pay for most medically necessary treatments during the year. For most covered services, you have to pay 20% of the cost out of pocket through Part B. Part B of Medicare also covers services and care that keep you from getting sick. Such as cancer and some other diseases’ screenings, tests, shots, and guidance. For most preventive services, you don’t have to pay anything, but for most medically important services, you have to pay 20% of the cost.
How Much Is The Excess Charge?
“The limiting charge” is the most that non-participating providers can charge you for some medical services and products that Medicare covers. This limit says that Medicare-accepting providers who are not participating can charge you up to 15% more than Medicare’s amount for the same services. This is an example: Medicare has agreed to pay providers $300 for a service you need. Your provider won’t work with Medicare, and they’ll charge you the full legal amount, which is 15%. In this case, the extra charge for you would be $45.
In another instance, Medicare pays $100 for another service you receive. Your provider doesn’t take Medicare assignments, but they’ll only charge you an extra 6%. In this case, the extra charge is $6. It’s important to note that not all services have a limit and there is no cap on how much non-participating suppliers of durable medical equipment can charge you for goods and equipment. Make sure your doctor accepts assignments before you get any durable medical equipment.
How Common Are Excess Charges
A 2020 issue report from the Kaiser Family Foundation says that 99% of doctors who aren’t pediatricians accept Medicare. Also, 98% of doctors who take Medicare are participating providers, which means that most Medicare-approved visits shouldn’t have an excess charge. Although there are many medical providers in the United States, even a small number of providers who don’t accept assignments can add up. This is why you should always check with your provider to see if they take assignments before making appointments or buying medical supplies and equipment.
Does Every State Allow Excess Charges?
It can be a pain to deal with Part B extra charges, but luckily some states are against them. The state has to allow excess charges to happen. If they don’t, Medicare recipients in those places won’t be charged more than the Medicare approved amount. Because Part B excess charges are different in each state, it’s important to know what’s going on if you don’t want to have extra Medicare charges added to your bill. Some states either don’t allow extra charges or put some kind of cap on them, but not all of them do.
Connecticut – People who are in the Medicare Savings Program at the Qualified Medicare Beneficiary (QMB) level are the only ones who can’t be charged extra. Everyone else in Connecticut who has Medicare Part B can face excess charges.
Massachusetts – Balance billing is illegal in the state, so doctors who take Medicare can’t charge their patients more than the approved amount.
Minnesota – Under Minnesota law, Medicare excess charges are not allowed. However, there is an exception that ambulance services and medical equipment are able to have excess charges.
New York – The Balance Billing Law of New York says that excess charges can’t be more than 5% above what Medicare allows.
Pennsylvania – Pennsylvania does not allow excess charges.
Rhode Island – This is another state that does not allow excess charges.
Vermont – This state also prohibits excess charges entirely.
How Excess Charges Can Affect You
Say you go to a doctor who isn’t a participant to get a few moles removed that look odd. Medicare will only pay $400 for this treatment, so the dermatologist could charge you $460. If you’ve already met your Part B deductible, the treatment would cost you $140 out of pocket. This includes your $80 coinsurance payment of 20% plus the $60 Part B extra charge. With a participating provider, the most you would have to pay out of pocket is $80. It’s important to remember that excess charges do not count toward your Part B payment.
However, a doctor who isn’t participating can add extra charges to your bill as many times as they want. If you often see a provider who doesn’t take assignments, you could end up paying hundreds of dollars more each year than you should.
Medicare Supplement Plans That Cover Excess Charges
There are only two Medicare Supplement plans that protect you from Medicare Part B extra charges– Plans F and G are those plans. In the past, Medicare Plan F gave the most benefits of all the Medicare Supplement plans. Many people thought it was worth the extra cost because it filled in some of the holes in Medicare Parts A and B.
The main thing that makes Plan F better than other Medicare Supplement plans is that it pays for the yearly Medicare Part B deductible. However, in 2015, this changed. People who became eligible for Medicare after January 1, 2020, can no longer get Plan F. People who already had Plan F before the change have the option of keeping it. If you could have gotten Medicare before January 1, 2020, but chose not to, you might also still be able to sign up for Plan F.
Plan G is now the most popular Medicare Supplement Insurance plan that anyone, regardless of when you enroll in Medicare, can get. Plan G pays for the “gaps” in Medicare benefits, which are the costs you have to pay for yourself after Medicare pays its share of the bill. More of these costs are covered by Plan G than by any other Medicare Supplement Insurance plan for new Medicare users.
Why Is Plan F Discontinued?
The Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law in 2015. This law made it illegal to sell any Medicare Supplement plans that covered Part B deductibles for people who became eligible after January 1, 2020. There are only 2 of 10 Medicare Supplement Plans that have this benefit, Plan F and Plan C. The new law did not change anything about the plans themselves. If you had or were eligible for one of these plans before January 2020 then the coverage is still the same. The only thing that changed was that new enrollees can no longer purchase the plans and eventually the plans will be entirely phased out once nobody on Medicare is eligible or has one of these plans.
Working With EZ
It is very important to compare the pros and cons of each Medicare Supplement Plan before choosing one. That takes a lot of work because you have to call a lot of insurance companies to get rate quotes, which can take a long time. You can check prices in half the time if you work with an EZ agent. When you work with a qualified agent, you can compare Medicare Supplement Plans from a number of different companies and plans all in one place.
Your agent can tell you about the changes between each plan and compare prices for you. Your adviser can also help you compare out-of-pocket costs and premium costs to find the plan that will save you the most money in the long run. Call us at 877-670-3602 right now to start looking for a Medicare Supplement Plan. To see online quotes you can also type your zip code into the box below.
The National Cancer Institute defines gynecology as a field of medicine that focuses on diagnosing and treating diseases of the female reproductive organs. It is often grouped with obstetrics. Gynecology also focuses on other issues related to women’s health, like menopause, hormone problems, birth control, and infertility. Gynecology is not just for younger women, you still need it as you age. That’s why a number of important gynecology treatments are covered by Medicare.
As long as you have an OB/GYN who takes Medicare, you can get preventive women’s health care through Medicare Part B.There are no exceptions; all women who have Medicare Part B have benefits for gynecology. You should make use of these advantages! Remember that Medicare isn’t just meant to help you when you’re sick or hurt; it’s also meant to keep you from getting sick in the first place.
Preventative Screenings
Medicare pays for Pap smears, pelvic checks, STI testing, and HPV screenings. Your medical history and any risk factors will determine how often you can get these preventive treatments. For women with no symptoms and low risk pap smears and pelvic exams are recommended once every 2 years. While women with a higher risk of cervical cancer, or women with a history of abnormal pelvic exams should go annually. Johns Hopkins University says that cervical cancer is more likely to be cured if it is found and treated early. Screening tests, like Pap smears and pelvic checks, can help find cells that aren’t working right and could lead to cancer.
Pelvic Exams
During a pelvic exam, the reproductive systems, including the vagina, vulva, cervix, ovaries, uterus, rectum, and pelvis, are examined physically. During a pelvic exam, your doctor may look for problems, do a Pap and/or HPV test, and look at your medical history.
Pap smears look for signs of cancer in the cervix. The doctor takes a few cells from your cervix with a small tool that looks like a spatula. The sample is then sent to a lab where it is checked for precancerous cells or other problems. If the doctor can find pre-cancerous cells early, you can get treatment before the cancer gets worse. Medicare Part B pays for Pap tests and pelvic exams once every 2 years to check for vaginal and cervical cancers. If you are at high risk, Medicare will pay for these tests once every 12 months. If you do any of the following, you may be in the high-risk group:
If you have had an abnormal pap smear result in the last 3 years
Were sexually active before your turned 16
Have had more than 5 sexual partners throughout your life
Have a history of or currently have an STD
As long as you meet the standards to get these services and get the annual checks, they are free. All of the tests, including the Pap check, lab work, a pelvic exam, and a breast exam, are free. Only if you go to a doctor who does not accept Medicare assignment will you have to pay for these services.
Mammograms
Mammograms are the best way to detect breast cancer. Original Medicare Part B pays for some preventive services, like mammograms, but there are rules you need to know before you schedule one.
Types of Mammograms Covered By Medicare
First of all, Medicare covers 3 types of mammograms:
Baseline mammogram – The first mammogram you get is called a baseline mammogram. It is used to look for early signs of breast cancer and will be compared to other scans in the future.
Screening mammogram – Mammograms used for screening are preventive tests that look for new signs of breast cancer. They are usually done once a year on women over 40 who have no symptoms or signs of breast cancer and are thought to have an average risk of getting it.
Diagnostic mammogram – A diagnostic mammogram is used to find out more about something wrong with the breast tissue, like a lump or a growth. To check for breast cancer, an x-ray of the breast will be taken. Diagnostic mammograms can also be used to find out more about a possible risk that was found during a screening mammogram.
How Often Medicare Covers Mammograms
The next thing you need to know is how often Medicare will cover a mammogram. Medicare will pay for one baseline mammogram for a woman between the ages of 35 and 39. Women over 40 are covered for a screening mammogram once every 12 months. Medicare will pay for as many screening mammograms as you need if they are deemed medically necessary.
Cost Of Medicare Covered Mammograms
Part B pays 100% of the Medicare-approved amount for baseline and yearly screening mammograms if your doctor or health care provider accepts assignment. That means you pay nothing (no deductible or coinsurance) for one baseline mammogram between the ages of 35 and 39, and you pay nothing for one screening mammogram every year if you are 40 or later.
If you get your mammogram from a participating provider, Medicare will pay 80% of the Medicare-approved amount. After you pay your Part B copay, you pay a 20% coinsurance fee ($164.90 in 2023). What you pay out of pocket can depend on how much your doctor charges and what other insurance you may have.
Do You Need A Pap Smear, Pelvic Exam, Or Mammogram After You Turn 65?
Even for older adults, Pap tests are an important way to check for cervical and vaginal cancers. Even if you are 65 years old, you may still be at risk for cervical cancer or vaginal cancer, so you should keep getting Pap tests until your doctor tells you to stop. Pap tests are no longer necessary after age 65 if:
You’ve have 3 consecutive negative pap results
You’ve have 2 negative pap-HPV tests in a row
On the other hand you definitely need to continue Pap smears if:
You have a medical history of lesions of cervical cancer
You were given DES, a synthetic estrogen hormone, during a pregnancy
If you have a weakened immune system
Even if you don’t need Pap smears anymore, gynecology exams are still a good way to check for health problems, especially if you are still sexually active. Regular pelvic checks in older people can help find more than just vaginal cancer. They can also help find sexually transmitted infections (STIs) and other changes in the vagina, rectum, or abdomen that aren’t normal. Also, the CDC says that most cases of breast cancer are found after the age of 50. Since Medicare covers both a breast exam and a pelvic exam, it is very important that you make sure your doctor gives you regular breast checks after you turn 65.
Which Parts Of Medicare Cover Gynecology?
Medicare will pay for appointments with an OB-GYN. But that’s not always the case. As is usually the case with Medicare, you have to meet certain requirements for Medicare to pay for your trips to the OB-GYN. We’ll explain what these are below so you know what to expect.
Gynecology exams are covered by Original Medicare, which is made up of Medicare Parts A and B cove. Medicare Part B covers the cost of a visit to an OB-GYN. Medicare Part B pays for OB-GYN treatments like pap smears, pelvic exams, and breast exams. Once every 24 months, Medicare Part B pays for the above-mentioned services,ut Medicare Part B may pay for these tests once a year if you are at high risk of cervical or vaginal cancer or if you are of childbearing age and have had a negative pap smear in the last 3 years. During the tests, if your doctor finds a new or existing problem and has to treat it, that care would is diagnostic care, and Medicare Part B could send you a bill for it.
Medicare Advantage plans (Medicare Part C) also covers OB-GYN visits. By law, they must pay for everything Original Medicare pays for. But these plans also cover a wider range of health care treatments. Different plans will cover different services and charge different amounts for these services and the plan itself.
EZ Can Help
Original Medicare covers most of the health care needs of women, which is good news. But Medicare Advantage and Medicare Supplements can add to the benefits you get from Original Medicare. Our licensed agents can help you find more health benefits through Medicare Advantage or more cash benefits through Medicare Supplements. Talk to an EZ agent who can tell you what you need to do to sign up and explain everything to you.
EZ can help you sign up, buy a Medicare Supplement Plan, or just think about your choices. Our insurance brokers work with the best firms in the country. You can get a free review of all the plans in your area from them. We’ll talk with you about your medical and financial needs and help you find a plan that meets them all. Call one of our agents at 877-670-3602 or enter your zip code in the bar below to start.
Medicare Supplement Insurance fills in the “gaps” left by Original Medicare by paying for things such as copayments, deductibles, and coinsurance. A high deductible choice is available with some Medicare Supplement policies. The premiums for high-deductible Medicare Supplement Plans are lower than those for regular plans, but the coverage threshold is higher. If the premium difference between the high-deductible and the standard plan is small, then the high-deductible plan may be more cost-effective.
Which High Deductible Medicare Supplement Plans Are Available?
Both Plan F and Plan G have a version with a high deductible. Beneficiaries who became eligible for Medicare after 2020 will no longer be able to get Plan F, or its high deductible option. But anyone can sign up for Plan G with a high deductible.
The only exception is in Massachusetts. Massachusetts is one of 3 states who standardize their Medicare Supplement Plans differently than the rest of the country but they do have the same benefits. In Massachusetts there are only 3 plans available and none of them are high deductible plans.
How Do High Deductible Medicare Supplement Plans Work?
In the majority of states, residents can choose from one of 10 different Medicare Supplement Plans designated by letters. The government sets the benefits for each type of plan. High-deductible options are limited to Plans F and G. The only difference between the standard and high-deductible versions of these Medicare Supplement Plans is the date on which coverage will begin. While standard plans pay for their benefits right away, high deductible plans don’t begin paying for them until the annual deductible is met.
What Do High Deductible Medicare Supplement Plans Cover?
The high deductible versions of Plan F and Plan G cover the same things as their standard counterparts. Plan F is the most popular Medicare Supplement plan and has been for a long time, even though it is unfortunately discontinued. Your only out-of-pocket expense with this plan is the monthly premium for Plan F, as it covers everything else. It covers:
Deductibles for Medicare Part A and Part B
Medicare Part A and Part B coinsurance or copayments
Medicare Part B excess charges
Skilled nursing facility coinsurance
Foreign travel emergency expenses up to plan limits
Since Plan F was discontinued, Plan G has become extremely popular among Medicare beneficiaries and is now among the most widely selected Medicare Supplement Plans. Plan G is the most affordable Medicare Supplement plan and helps fill in the gaps that Original Medicare doesn’t cover. Plan G covers:
Medicare Part A deductible
100% of hospice copayments and coinsurance
Additional foreign travel emergency benefits
100% of Medicare Part B excess charges
How Much Do High Deductible Medicare Supplement Plans Cost?
With a high-deductible Medicare Supplement Plan, you are responsible for both the premiums and the deductible. In 2023, the deductible for high-deductible Plan G and Plan F is $2,700, however it changes yearly. The plan’s premiums vary from person to person. According to Medicare.gov, the premiums for Medicare Supplement Plans are determined by private health insurance providers and can vary depending on a person’s age, gender, geographic location, tobacco use, and health history.
The premiums for high-deductible Medicare Supplement Plans are lower than those for standard Medicare Supplement Plans because members are responsible for paying the deductible before the plan begins paying for covered services. A new Medicare beneficiary of age 65, for instance, may be charged $105 per month for the standard version of Medicare Supplement Plan G, while the high-deductible version may cost only $35 per month from the same insurer. As you get older, the premium gap between the regular and high deductible plans can widen. A Medicare recipient who is 85 might pay $195 per month for Medicare Supplement Plan G, with a low deductible and $60 per month for a high deductible version of the same plan.
Advantages and Disadvantages of High Deductible Plan G
The best thing about a high-deductible health plan is the low monthly premium. People who think they will only need preventive care can save a lot of money. Also, once the deductible is paid, the benefits are the same as with plan G.
A disadvantage of the High-deductible Plan G is that you have to pay the Part B deductible for Medicare for non-hospital care. Also, you don’t get insurance benefits until you’ve paid your annual deductible. Every year, these deductibles start over and usually go up. And, you’ll have to pay the Part B coinsurances until your deductible is met.
Advantages and Disadvantages of High Deductible Plan F
Unfortunately Plan F is no longer available to anyone you became eligible for Medicare on or after January 1st 2020. This is because the Medicare Access and CHIP Reauthorization Act of 2025 included a change that says Medicare Supplement Plans can not cover the Part B deductible. However, if you were eligible before that date or already had Plan F you are still able to keep or purchase it.
As with any option with a high deductible, the main benefit of a high deductible is a lower premium. Once the deductible is paid, the benefits are the same as Plan F. The biggest problem is that if health problems worsen, they can lead to an increase in medical bills. Also, the deductible can change every year, which makes it hard to plan for medical costs in the future.
Is A High Deductible Medicare Supplement Plan Worth It?
When the combined cost of your premiums and deductible is less than the premiums for a standard Medicare Supplement plan, the high-deductible plan makes more financial sense. There are three things you’ll need to consider.
1. If You Can Meet The Deductible
If you’ll spend enough on coinsurance, copayments, and deductibles to meet the Medicare Supplement deductible for a high-deductible Medicare Supplement plan, you should compare quotes to see which one is the most cost-effective. For the high-deductible version to cost less than the standard option, the lower premiums must be more than enough to cover the extra cost of meeting the deductible- remember you have a high deductible. In 2023, the deductible for Medicare Supplement plans will be $2,700, which equates to $207.50 per month. For you to spend less on a high-deductible plan overall, its monthly premiums would have to be at least $207.50 less than those of a standard plan.
2. If You Can’t Meet The Deductible
When you are reasonably confident that you will not be able to meet the deductible, selecting a Medicare Supplement plan with a high deductible is not the best option for you. If you have expenses that are lower than the deductible, the plan will not pay for any of the services that you receive. You are, in all respects, not compensated in any way for the premiums that you pay.
3. If You’re Unsure If You Can Meet The Deductible
If this describes your situation, one way to figure out whether or not a high-deductible Medicare Supplement plan is right for you is to evaluate your current financial standing. Then determine how much money you have available to pay for out-of-pocket medical expenses. When you do not end up meeting the deductible, you will not only be responsible for the cost of the premiums, which are typically quite affordable. But you also run the risk of losing coverage that is available with a standard Medicare Supplement plan. If you are able to meet the deductible, you will be covered from that point. Which will help you limit the amount of money you will have to pay out of pocket in the event that you face unexpectedly high medical costs.
Alternative Options
Another choice for Medicare Supplement coverage that could help you save money on your monthly premiums is the Medicare Supplement Plans K and L. A cost-sharing benefit and out-of-pocket spending caps are included in these plans. A Plan N could be beneficial to you if you want more coverage than what is offered by those two options. In exchange for a few copayments, participants in Plan N pay a premium that is marginally lower than the standard Plan G or Plan F premium.
One more alternative to consider is enrolling in a Medicare Advantage plan. Because the monthly payments are so much more affordable. On the other hand, considering the ongoing out-of-pocket costs that come in the form of copayments and coinsurance, a Part C plan might end up being more expensive in the long run.
Sign Up With EZ
Whether you’re looking for a high-deductible plan or something else, we can help you choose the right policy. We’re here to make it easy for you to weigh your options and choose the most beneficial arrangement possible. Working with an EZ agent will cut down time spent shopping around. You can compare and contrast numerous Medicare Supplement Plan providers and plans by working with a licensed agent. In addition to providing you with cost comparisons, your agent can explain the nuances between the various plans. Furthermore, your agent can assist you in comparing premium costs to out-of-pocket expenses to help you choose the most economical plan. Get started on your search for a Medicare Supplement Plan by calling us at 877-670-3602 right away.
Many people think eating disorders only affect young or even middle-aged adults, but not older adults. Unfortunately, this is not the case: eating disorders don’t simply go away with age. But it is only in more recent times that there has been recognition of eating disorders in older adults, and now the National Eating Disorders Association (NEDA) reports that 20% of women aged 70 and older are trying to change the size of their bodies.
Eating disorders can affect anyone at any age, but social stigma keeps some older women from seeking help. So if you or someone you know is dealing with an eating disorder, you are probably wondering if you can get treatment with Medicare.
Medicare Coverage
If you or a loved one are dealing with an eating disorder, you will be happy to know that many hospitals and treatment centers accept Medicare for the treatment of these conditions. But when it comes to paying for treatment, Medicare will first require you to seek outpatient treatment before they will pay for more advanced treatment options.
But regardless of the level of care required, Medicare will agree to pay for a reasonable and necessary treatment for beneficiaries’ eating disorders. Generally, Medicare will cover medication, therapy, and patient education.
Medicare will also usually cover a portion of inpatient care if your physician provides documentation that inpatient treatment is medically necessary for your situation. It is essential to note that Medicare does not cover outpatient treatment services for ongoing therapy after inpatient care. And similar to inpatient coverage, your doctor has to recommend outpatient care and psychotherapy.
Inpatient Care Vs. Partial Hospitalization
While, as noted above, you can get coverage for inpatient care for eating disorders with Medicare, they often prefer to cover partial hospitalization (PHP). PHP is covered by Medicare Part B and provides a structured program of outpatient services as an alternative to inpatient care.
Medicare will help cover these services when provided by a hospital outpatient department or Community Mental Health Center. It will also cover any occupational therapy that is part of your mental health treatment. And although Medicare covers the cost of treatment, you will still be responsible for a percentage of the payment for each Medicare-approved service that you receive. Typically Medicare will cover 80% of costs, leaving you to pay the remaining 20% out-of-pocket. There also be a coinsurance payment for each day of PHP services, regardless of the setting.
Extra Coverage
If you need help paying for the things that Medicare doesn’t cover, like out-of-pocket costs for treating an eating disorder, you can purchase a Medicare Supplement Plan. Your plan can help pay for the things that Medicare does not, including the 20% coinsurance that you will have to pay out-of-pocket for every Part B expense. One of these plans could cover 100% of your Part A coinsurance and hospital costs, as well as 100% of Part B coinsurance and copayments, for one low monthly premium price.
There are 10 different Medicare Supplement Plans to choose from, each offering different coverage options and rates. It’s worth looking into a Medicare Supplement Plan to save as much money as you can, so speak to an EZ agent for all of your options. EZ’s agents work with the top-rated insurance companies in the nation and can compare plans in minutes for you at no cost. To get free instant quotes for plans that cover your current doctors, simply enter your zip code in the bar on the side, or to speak to a licensed agent, call 888-753-7207.
Americans spent more than $129.1 billion on home health services in 2022. With home health care being so expensive it’s important to have all of the facts. For example, if you’re on Medicare and the need arises for home health care, will you be covered? What services will be covered? What won’t be covered? All of these questions need to be answered so you can plan accordingly.
What Is Home Health Care?
Simply put, home health care is any medical care you receive inside your home. There are a variety of services you can receive at home, including skilled nursing care, therapy services, care from home health aides, and medical social services. All of these services help manage your health in different ways, and what you need will vary depending on your condition.
Will Medicare Cover Home Health Care?
Medicare Parts A and B cover home healthcare services, but you have to meet certain criteria:
You must be under the care of a physician who is regularly reviewing your plan of care.
Your doctor must certify that you are homebound. This usually means you require a wheelchair or walker to be able to leave the house.
Your doctor certifies that you need intermittent skilled nursing care, physical therapy, or ongoing occupational services.
You do not have to be confined to your home 24/7 to qualify as homebound. You can still leave your home to receive medical treatment. Additionally, you can also leave for non-medical events like family gatherings, religious services, and even visiting the barber or beauty salon without risking your homebound status.
Skilled nursing –This includes any service performed or supervised by a licensed nurse to treat your condition. Services may include receiving injections, catheter changes, tube feedings, and wound care. This type of care also includes management and evaluation of your healthcare plan. Medicare will cover these services on a part-time or intermittent basis. That means they cover up to seven days a week for typically no more than 8 hours a day, and a total of 28 hours a week. In some cases, Medicare will cover up to 35 hours per week, depending on the level of care recommended by your doctor.
Skilled therapy – There are a few different types of skilled therapy, including:
Physical therapy -This includes gait training and training exercises to regain movement and strength in a specific area of your body.
Occupational therapy –This helps you regain the ability to do daily activities like dressing or feeding yourself.
Speech-language therapy – This helps strengthen your speech or language skills.
Home health aides – Home health aides help you with personal care services like bathing, going to the bathroom, and dressing. Medicare will fully cover a home health aide only if you are also receiving skilled nursing care or skilled therapy, as well as personal care.
Medicare social services – These services help you with social or emotional concerns that can interfere with your care. They include counseling and finding resources in your community. As with coverage for home health aides, you have to also be receiving skilled care to have these services paid in full by Medicare.
Medical supplies – Medicare will cover the cost of medical supplies like wound dressings and catheters when they are provided by a home health agency (HHA). Medicare pays for durable medical equipment like wheelchairs and walkers separately. Typically, Medicare with cover 80% of the cost of durable medical equipment. They have to fall under certain guidelines and a doctor must order them.
All of these services have to be necessary for treating your illness and performed or supervised by a licensed therapist. The amount of coverage varies, and Medicare needs to consider the services reasonable for each condition they treat.
What isn’t covered?
While Medicare does cover a good number of services, there are limitations. Medicare will not cover:
24/7 home care
Meals delivered to the home
Household services like laundry, cleaning, and grocery shopping
Personal care if you are not also receiving skilled care
Medical social services if you are not also receiving skilled care
You’ll have to pay for some things out-of-pocket, but you will know what they are. Your HHA has to give you an “Advance Beneficiary Notice of Noncoverage” (ABN) for any services that Medicare won’t cover.
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What Is an Advance Beneficiary Notice of Noncoverage?
Your home HHA has to give verbal and written notice before giving you any supplies or care that Medicare will not cover. You will receive an ABN if Medicare won’t pay for services due to these circumstances:
The care is not reasonable or necessary
You’re only receiving non-skilled care
You are not homebound
You are not receiving your home care on an intermittent basis
Your ABN will have clear instructions and provide a reason why Medicare might not pay for the services. It will also detail exactly what service or supply is not covered. The ABN will also include directions to get an official decision from Medicare about the payment, and directions on how to file for an appeal. The HHA must also advise you how much the services will cost if Medicare decides they will not cover it.
While you are waiting for the official decision or appeal, you can opt to pay out-of-pocket to receive the care or supplies that are in question. If Medicare decides to pay for the care, they will reimburse you for all the payments you made during that time.
Understand that if Medicare denies your appeal, or decides they will not cover the services, you will not receive a refund. Talk to your doctor and family to help you decide if you should pay out-of-pocket, or if you should wait for the decision before having the HHA provide the care or medical supplies.
The Bottom Line
In short, Medicare will cover your home health care. Just be sure to communicate with your doctor and have them regularly review your plan and renew your orders. And if you need extra help paying for your out-of-pocket expenses, your best bet is to look into a Medicare Supplement Plan.
If the time has come for home health care, EZ.Insure can help you find the Medicare Supplement Plan that’s right for you. EZ’s agents are highly trained and can help answer any questions you may have. We work with the best insurance companies in the nation and can get you instant quotes at no cost to you. For a free instant quote simply put your zip code in the bar above. Or call a licensed agent directly at 888-753-7207.
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