medicare coverage Archives - Page 6 of 8

Questions To Ask Your Medicare Agent

When it is time to enroll in Medicare, change your Medicare plan, or purchase a Medicare Supplement Plan, speaking to an agent is a great idea. But before you do, make sure you have all of your information ready and available; you should also have an understanding of exactly what your needs are and what you’re looking for so your Medicare agent can better assist you. Because the details that you give an agent will determine which plan is right for you, EZ has provided you with what information you should have prepared, as well as what questions to consider asking one of our Medicare agents.

What You Will Need

medicare insurance card — *Be prepared with your Medicare Insurance Card, a list of health conditions, and your budget.*

Before speaking to your agent, be prepared to provide the following information:

Personal information- Your agent will ask you what zip code you live in so that they can research and compare plans in your area.
Health conditions– Prepare a list of all your health conditions, concerns, and/or medical records. Providing an agent with your specific healthcare needs can help them decide what plans might be best for you, since each Medicare Supplement Plan provides different coverage options.
Your Medicare Card– You will need to provide your agent with your card number so they can verify coverage.
Your budget- If you live on a fixed income, or have a specific budget in mind, have that information ready so you can discuss it with your agent.

Questions To Ask

There are different Medicare plan routes that you can take. When enrolling in Medicare, you have the option to enroll in a Medicare Supplement Plan at the same time. There are 10 different plans to choose from that offer different coverage options at different price points. Here are some questions to ask your agent if you’re considering a Medicare Supplement Plan:

Popular plans– Premiums can sometimes be lower for policies that are more popular, because more people are enrolled in those plans. Ask your agent which plans are the most popular in your area so you can compare their costs and benefits with those of other plans.
Waiting Periods– If you enroll in Medicare when you first turn 65, and you enroll into a Medicare Supplement Plan at the same time, then you have guaranteed issue rights. This means that you won’t have to pay extra for any pre-existing health conditions. It also protects you from having to go through a waiting period. But if you are enrolling in a Medicare Supplement Plan outside of your Initial Enrollment Period, then there might be a waiting period while you undergo the Medicare underwriting process, and you may have to pay more because of pre-existing conditions.
Using EZ’s Medicare agent will save you time, money, while providing you with a quality Medicare plan for your needs.
When Medicare Supplement Plan Coverage Begins- When you buy your Medicare Supplement Plan determines when coverage will begin for the plan. Ask your agent for a timeline, so you are aware of when you can start using your plan.
Out-of-Pocket Costs– This is a very important question to ask, especially if you are living on a fixed income. Ask about the out-of-pocket costs you are responsible for so that you can prepare for what your medical costs could be for the year.

Why Use An EZ Medicare Agent

When signing up for Medicare or a Medicare Supplement Plan, you need to have the right agent by your side. EZ.Insure will offer you an agent who cares, listens, and truly has your best interest at heart. What sets us aside from other companies is that our services are completely free. Our main goal is to help you, so our trained licensed agent will do all the work for you and compare all plans to find you the best plan at the best price. We are ready to answer all of your questions and get you covered. To get started, simply enter your zip code in the bar above, or to speak to an agent call 888-753-7207.

Does Medicare Cover a CPAP Machine?

Over 18 million Americans have some form of sleep apnea, and some need a Continuous Positive Airway Pressure (CPAP) machine. If you are enrolled in Medicare and are one of these millions of people with sleep apnea, you might be wondering if a CPAP machine is covered under the Durable Medical Equipment benefits of Part B. The simple answer to this question is yes, but with some caveats. In some cases, Medicare only covers a three month trial for CPAP therapy, but you can get it covered for longer as long as you meet certain criteria.

What Is A CPAP Machine?

Obstructive sleep apnea (OSA) that is left untreated can lead to high blood pressure and possibly even congestive heart failure. If you are suffering from this dangerous condition, you will be evaluated to see whether you need a CPAP machine to help you breathe more easily while sleeping. This machine, which has an attached mask that you wear while sleeping, produces air pressure in your throat. The air pressure it produces is higher than that of the room’s air, which will help to keep your upper airway open. Before prescribing a CPAP machine, your doctor will speak to you about how long you’ve had symptoms of sleep apnea, and will assess your symptoms to see if you are a good candidate for this type of therapy.

When Medicare Will Cover CPAP

doctor room with machines and cords — *You have to complete a sleep test in a laboratory before getting a CPAP machine.*

If you are diagnosed with obstructive sleep apnea, Medicare will cover a 3-month trial of CPAP therapy as long as you:

Meet face-to-face with a treating physician to receive a clinical evaluation prior to a sleep test assessment.
Complete a sleep test in a laboratory, or use an approved at-home test.
Have a prescription for a CPAP machine from your doctor.
Get a CPAP machine from a participating Medicare supplier and receive instruction from the CPAP supplier about the proper use and care of the CPAP machine

In order for your machine to be covered for longer than the 3-month trial period, you have to use the machine more than 4 hours a night for at least 70% of nights within a consecutive 30-day period. Once you are successful with a 3-month trial of the CPAP, Medicare might continue coverage as long as you meet in person with your doctor, and your doctor documents in your medical records that the CPAP is helping you. Once that is in your medical records, Medicare will cover an additional 10 months of the machine rental.

How Much Is Covered By Medicare?

stop watch with a checklist next to it — *After meeting some requirements of 13 months and meeting your deductible, then Medicare will cover your CPAP machines cost.*

Medicare will help pay for your rental of a CPAP machine for a total of 13 months as long as you use it continuously for that time. After you are done renting it for a total of 13 months, you will own the CPAP machine.

You will need to meet your Medicare Part B deductible before Medicare pays its share of your CPAP equipment. Medicare Part B (which covers durable medical equipment) will then cover 80% of the cost, meaning you will have to pay a 20% coinsurance for the CPAP machine. Tubing, face masks, filters, and other supplies for the machine are also covered at 80%.

If your CPAP supplies get dirty or lose effectiveness, Medicare will cover replacement supplies. Depending on the part, you might need to replace it every two weeks to every six months.

Medicare Supplement Plan

If you have a Medicare Supplement Plan, your plan might cover your CPAP coinsurance payment. It will also help pay for the coinsurance of your CPAP supplies. Each plan has its own cost and coverage options. If you do not have a Medicare Supplement Plan already, EZ can help you to find a plan that covers a CPAP machine and equipment. Our agents can compare all available Medicare Supplement Plans in your area, including all the plans that cover CPAP machines. They will provide you with quotes within minutes, and help sign you up for the plan that fits your budget and coverage needs. To get started, enter your zip code in the bar above, or to speak directly to an agent, call 888-753-7207.

Medicare Coverage For Mammograms

Breast cancer. Those two words can be terrifying, especially for older women. The median age for a breast cancer diagnosis is 61 years old, with 41% of breast cancer cases diagnosed in women age 65 and older. In addition, the median age of death from breast cancer is 68 years old. These are scary statistics for older women, but there is one simple thing you can do to minimize your risk. This Breast Cancer Awareness Month, we want older women with Medicare to understand how mammograms can help detect (and successfully treat) breast cancer, as well as how they are covered under Medicare.

The Different Types Of Mammograms

A mammogram is generally scheduled every year for women aged 50 and older to help with early detection of breast cancer. It is a simple procedure: once you remove your clothing from the waist up, you will place each breast between two specialized plates on the machine. The breast is then compressed for imaging. It might be uncomfortable and there might be some pain involved, but the compression does not last longer than a few seconds each time. The 3 types of mammograms are:

Film Mammograms– Conventional 2-D X-rays record black and white images on large sheets of film.
Digital Mammograms– 2-D black and white images of the breast are taken and then recorded into a computer. This allows the doctor to zoom in and enlarge the picture to take a closer look.
3-D Mammograms– 3-D images of the breast are taken in thin slices. This type of mammogram has been shown to improve the diagnosis of cancer in dense breast tissues.

Screening Vs Diagnostic Mammograms

The mammograms you get at your doctors office are classified in two different ways: screening and diagnostic. Screening mammograms are administered as part of a routine checkup to detect breast cancer in women who have no apparent symptoms. Diagnostic mammograms, on the other hand, are used after abnormal results on a screening mammogram, or if there are signs of breast cancer, such as a lump, that alerts a physician that there may be a problem.

Doctors use the same machines for both screening mammograms and diagnostic mammograms. Screening mammograms usually consists of taking two or more images of each breast while diagnostic mammograms involve taking a higher number of images from different angles.

Medicare Part B

If you have Medicare Part B, both screening and diagnostic mammograms are covered, but there are different coverage levels and out-of-pocket costs depending on your situation. Medicare will pay for:

One screening mammogram every 12 months if you’re 40 or older.

Medicare will pay for one screening mammogram every 12 months if you’re 40 or older.
One or more diagnostic mammograms, if necessary, to diagnose breast cancer
Both conventional and 3-D mammogram costs, if the provider offers 3-D mammograms.
Transportation costs if you need to get to your mammogram appointment

You will pay nothing for a screening mammogram as long as your doctor accepts Medicare assignment. However, if your doctor recommends more frequent tests or additional services, you might have to pay co-pays and other out-of-pocket costs. For example, as with many services, Medicare will cover 80% of the costs of diagnostic mammograms and you will pay the other 20% of the medicare-approved amount. You can avoid these out-of-pocket costs if you have a Medicare Supplement Plan. As long as you pay your monthly premium, many of these plans will cover your share of the costs.

If you are looking for ways to help pay for mammograms or any other Medicare costs, a Medicare Supplement Plan is a great option for you. There are 10 different types of Medicare supplement plans to choose from, so it can be a lot of work trying to determine which one is best for your needs. EZ is here to help make the process as painless as possible: we will provide you with a personal agent who will compare all available plans in your area, and sign you up with a Medicare Supplement Plan that is within your budget. To get started simply enter your zip code in the bar above or to speak to one of our highly-trained licensed agents, call 888-753-7207.

What Medicare Covers After A Stroke

According to the National Institute of Neurological Disorders and Stroke, over half a million people over the age of 65 suffer from a stroke every year. A stroke can be very serious, and can have long lasting effects on balance, hearing, and vision. It can also cause decreased mobility or even paralysis. Recovery after a stroke can be a long and difficult process, especially if you don’t have the proper insurance coverage. Thankfully, Medicare covers a lot of the aftercare related to recovery from a stroke, including both inpatient and outpatient care, as well as some medical equipment. There are gaps, however, which can be filled by a Medicare Supplement Plan.

Medicare Part A Coverage

If you suffer a stroke, you might need to go to an Inpatient Rehab Facility afterwards to recover and get the therapy that you need. As long as your doctor deems your stay medically necessary, Medicare Part A will cover this inpatient rehabilitation. Medicare will cover the cost of treatment in an inpatient facility for a limited time; if you need to stay longer than 60 days you will have to pay $352 per day for days 61-90. For days 91 and beyond, you will pay $704 in coinsurance per “lifetime reserve day.” You have 60 reserve days over your whole lifetime; after that, you will need to pay the full cost of your stay.

Medicare Part B Coverage

Medicare Part B will cover any outpatient rehabilitation needed, such as physical therapy, at 80%. You will be responsible for the other 20% coinsurance. As with any service, your doctor must deem your rehab medically necessary in order for it to be covered. If there is any durable medical equipment that is medically necessary, then Part B will also cover the cost of that at 80%. This includes equipment such as wheelchairs, walkers, or canes. Any of this equipment will need a prescription from your doctor.

Skilled Nursing Facilities

If you are moved into a skilled nursing facility from the hospital or from an inpatient rehab facility, Medicare will only pay for your stay if you have satisfied the “3-day rule.” This means that you need to have been admitted as an inpatient into the hospital for three days, and not classified as an “observation care” patient. With Medicare, staying at one of these facilities is free to you for the first 20 days, and $176 per day for the next 80 days after that.

Long-Term Care Facilities

Medicare does not cover any long-term care facilities, even if your doctor deems it medically necessary. These services are not covered because care at these facilities includes things like bathing, feeding, and assisting with the bathroom, which Medicare does not consider medical care services.

Medicare Supplement Plans

There are obviously gaps in what Parts A and B cover when it comes to recovery from a stroke. A Medicare Supplement Plan can help to fill those gaps. Most plans will cover your Part A coinsurance and allow you to extend hospitalization days up to 365 days over your lifetime. A Medicare Supplement Plan will cover part or all of your Part A deductible, and approximately 8 out of 10 plans will cover the skilled nursing facilities coinsurance. Some also provide coverage for long-term care. There are 10 different types of plans to choose from, with different coverage and different price points. EZ’s highly trained, licensed agents can help you compare these plans, and can provide quotes to you within minutes.

We hope you never need to test the limits of Medicare’s coverage for stroke care. Speak to your doctor about your risk factors, such as high blood pressure, high cholesterol, diabetes, smoking, and drinking, and see if there are ways you might be able to lower your risk through healthy lifestyle changes. Suffering a stroke can be scary and life-changing, but if it does happen to you, Medicare will cover the majority of your costs for treatment and rehabilitation. And whatever it does not cover, you can always count on a Medicare Supplement Plan to help you pay your medical bills. To be better prepared and to save money, compare Medicare Supplement Plan quotes by entering your zip code in the bar above, or to speak directly to an agent call 888-753-7207.

Does Medicare Cover Ambulance Rides?

Ambulance rides are not cheap, they can range anywhere from hundreds to thousands of dollars. During a medical emergency, the last thing you want to worry about is if Medicare will cover the large ambulance bill. Thankfully, Medicare does cover ambulance rides so you don’t have to worry about anything but receiving the care you need. In fact, Medicare pays over $5 billion for ambulance service claims every year. However, to receive these benefits, there are stipulations you should be aware of first.

Eligibility Under Medicare Part B

Medicare Part B covers emergency ambulance services, and in some cases will also cover non-emergency services. An emergency is considered any situation in which your health is in serious danger. If you schedule your ambulance ride, then it is not considered an emergency. To receive coverage from Medicare:

The ambulance service must be medically necessary, and the only way to safely transport you to the hospital.
The transportation supplier (meaning nursing care facility or any provider asking for ambulance services) must meet Medicare ambulance requirements.
The reason for the trip must be to receive a Medicare-covered service during transportation or to return from receiving Medicare-covered care.
if it is not an emergency, then your doctor must provide a written order ahead of your scheduled trip.

If the situation is not an emergency, then ambulance services will only be covered if:

You are confined to your bed and unable to get up.
You need medical services during the trip that are only available in an ambulance.
You live in a skilled nursing facility and your doctor has written an order for an ambulance. You might be required to produce the order within 48 hours of the transport.
Your doctor deems that ambulance transport is medically necessary and provides a written order ahead of your scheduled trip.

Be aware that if you ask first-responders to take you to a hospital or facility other than the one that is closest to you, Medicare will only cover the cost of a ride to the nearest hospital or facility. You will be responsible for paying the rest of the bill out-of-pocket.

Ambulance Flights

Medicare will also cover other modes of emergency transportation, including ambulance flights. In order for Medicare to cover an ambulance flight, a ground ambulance must be unable to make it to your location. Medicare will also approve a flight if a ground ambulance can make it to the location but the situation is unsafe for the crew.

Your Costs

As with many services, Medicare Part B covers 80% of ambulance services, leaving you to pay 20% coinsurance out-of-pocket after you meet your Part B deductible ( $198 in 2020). It is illegal for ambulance companies to apply excess charges to your bill.

Some Medicare Supplement Plans will cover your coinsurance payments, so if you have certain letter plans, then ambulance rides will be covered 100%.

Ambulance rides are mostly covered by Medicare, but if you are worried about coinsurance payments, then consider a Medicare Supplement Plan. These plans mean that you won’t have to face Medicare bills alone, allowing you peace of mind, while at the same time putting money back in your wallet. There are different types of plans to choose from, with different coverage options at different price points. If you’re unsure where to begin, EZ can give you free quotes and a breakdown of all the plans. One of our agents will compare all of your options and find the perfect plan for your budget and needs. To get your free Medicare Supplement Plan quotes, simply enter your zip code in the bar above, or to speak to an agent, call 888-753-7207.

Does Medicare Cover Colonoscopies?

Colorectal cancer is the second leading cause of cancer-related deaths in men and women in the U.S. It is estimated that about 1 in 20 people will be diagnosed with colorectal cancer in their lifetimes. This number is high in part because 1 in 3 people are not up-to-date on their colonoscopy screenings. Colonoscopy screenings are the most effective way to detect and prevent colorectal cancer. Getting regularly screened is especially important for older adults, because if you are 65 or older, you are at a greater risk of dying from colon cancer. Fortunately, Medicare covers colonoscopies at specific time intervals, based on a person’s risk for colon cancer.

doctor in blue gown holding a black tube with a light on the end of it. — *During a colonoscopy, a thin, tubed camera is inserted inside the body so that doctors can view the lining of the colon.*

What Is A Colonoscopy?

Colonoscopies are safe, common procedures. According to the CDC, over 25 million colonoscopies took place in 2012. During this procedure, a thin, tubed camera is inserted inside the body so that doctors can view the lining of the colon. There are two types of colonoscopy:

Screening colonoscopy– a routine procedure performed to see how healthy the colon is and to check if there are any polyps that need to be removed.
Diagnostic colonoscopy– performed to check for irregularities because a person is having intestinal issues.

When a colonoscopy is performed, the patient will normally be put under general anesthesia.

How Much Does It Cost?

Many factors go into determining the price of a colonoscopy. This includes the location where it is done, what kind of anesthesia is used, and whether any tissue samples have to be sent to a lab for testing. The average cost of a colonoscopy is almost $4,000. If you have private insurance, the procedure will be covered after you meet your deductible. Medicare also covers colonoscopies, but how they are covered depends on whether they are considered a screening or a diagnostic procedure.

What Medicare Covers

Because a screening colonoscopy is considered a preventive service, Medicare Part B will cover it. Medicare will cover all screening costs as long as the doctor accepts Medicare assignment. This means that your doctor agrees to accept the Medicare-approved amount as full payment for the procedure.

Medicare will cover the cost of screening colonoscopies:

Once every 24 months (2 years) if you are at high risk of colorectal cancer because of family history or history of colon polyps or inflammatory bowel disease.
Once every 120 months (10 years) for patients who are not considered high-risk.

Your screening will be covered in full whether or not you have met your deductible.

Only the screenings themselves are covered, so if your doctor finds a polyp or takes tissue samples during the colonoscopy, then you will have to pay a portion of the bill. You might owe:

20% of the Medicare-approved amount
A copay if you’re in a hospital getting the procedure done

Medicare Supplements can help pay for the additional 20% of out-of-pocket costs if a polyp is found or if you require more than just a screening. Before scheduling your colonoscopy, contact your Medicare Supplement Plan insurer and find out just how much they will cover if a polyp removal is necessary.

A colonoscopy is an important screening test that can help catch colorectal cancer early and possibly save your life. There’s no reason not to get one done if you are over 65, because Medicare covers the cost, and a Medicare Supplement Plan can help pay for any other costs associated with getting tested. If you are looking for a Medicare Supplement Plan, we will help compare the different plan types in your area. We will help you find one that meets your health and financial needs. To get free quotes, enter your zip code in the bar above, or to speak to an agent directly call 888-753-7207. No obligation. No hassle. Just free quotes.

Tag: medicare coverage