medicare coverage Archives - Page 7 of 8

4 Vaccines That Medicare Covers

When people think of the word vaccines, they often think of babies and young kids. While immunizations are important for children, they are just as important for seniors. Older adults should get vaccines in order to prevent diseases as they get older. Certain diseases can lead to complications in seniors, and possibly death. Luckily, Medicare offers many free preventive care services, including vaccines.

middle aged caucasian woman blowing her nose into a tissue. — *Older adults are more at risk of dying from the flu than any other age group due to weaker immune systems.*

1. Flu Vaccine

Influenza, also known as the flu, is responsible for many deaths every year. Older adults are more at risk of dying from the flu than any other age group due to weaker immune systems. It is especially important for people with asthma, diabetes, or heart disease to receive the flu shot. Studies have shown that vaccinated seniors reduced their risk of flu hospitalization by 50%. There is also a stronger shot that is high-dose, Fluzone High-Dose, if you require more protection.

Medicare Part B covers one flu shot for seniors every fall/winter season.

2. Pneumonia Vaccine

Pneumococcal disease is another disease that seniors are at a higher risk for contracting. It causes severe infections of the bloodstream (bacteremia) and organs, and can result in pneumonia or meningitis. It kills almost 20,000 adults 65+ each year, so it is very important that you get vaccinated against it. It is recommended that people get two different types of vaccines, PCV13 and PPSV23, for more protection.

Medicare Part B covers both pneumococcal vaccines after the age of 65. PCV13 is given first, with the second PPSV23 recommended 6-12 months after.

needle going into a persons upper arm by a medical professional's ahnd with a glove on. — *Medicare Part B covers the tetanus vaccine in specific cases.*

3. Tetanus Vaccine

Tetanus, also known as lockjaw, is an infection that is not common in the U.S. If you contract tetanus, the bacteria gets under your skin, causing muscle spasms and affecting the muscles that control breathing. A person can get tetanus usually when traveling to a different country or from someone who has it.

Medicare Part B covers the tetanus vaccine in specific cases. For example, if a person has diabetes or neuropathy, then they are at greater risk of getting tetanus due to the open sores that can occur. So, you are more likely to get 100% coverage for the shot, as long as the shot is administered as a treatment for either of these illnesses or an injury caused by them.

4. Hepatitis B Vaccine

Hepatitis B, or hep B, is a contagious virus that causes an infection of the liver. There are two types of Hepatitis B: Acute, which mimics the flu, and Chronic, which is a long-term condition with no symptoms that can cause extreme liver damage or even death. If a senior has hemophilia, diabetes, or other conditions that lower resistance to infection, then their risk of getting Hep B is increased.

If a doctor feels like a person is at high or even medium risk of contracting hep B, then Medicare will cover the vaccine.

Getting vaccinated as you age is an important part of staying healthy. If you are at high risk for any of the diseases mentioned, then it would be smart to take advantage of the free vaccinations covered by Medicare.

Does Medicare Cover Adjustable Beds?

When dealing with an illness or disability that leads to the assistance of durable medical equipment such as an adjustable bed. Questions come up, mainly how much they are, and if the costs of these beds are covered by Medicare Insurance.

black and white picture of a hospital bed — *Adjustable beds will be covered under Medicare if they are deemed medically necessary.*

Doctors can prescribe these beds for many conditions, such as sleep disorders, respiratory problems, restless leg syndrome, and more. If you do require an adjustable bed, then it must be deemed “medically necessary” by your doctor in order to be covered. Will it be completely covered? Well, it depends.

What Is Durable Medical Equipment (DME)?

Durable medical equipment is medical equipment that is reusable, such as crutches, wheelchairs, and adjustable beds. In order for a DME to be covered, it has to be used for medical reasons, durable, andused at home.

If you are staying in a nursing home, that does not qualify as your home. Therefore, it will not be covered. However, a long term care facility can give you DME, because they are responsible for your health.

Is it Medically Necessary?

Even though your doctor might determine that there is a medical purpose for DME, it does not mean it will be approved by Medicare. Once the doctor recommends it, it must be considered and reviewed by Medicare before it will pay. Not all DME is created equal. In other words, there might be a specific type of bed that is approved, while others are not.

Adjustable beds are usually prescribed to patients to help cure, relieve, and minimize circulatory and respiratory health issues. These beds help people get in and out of bed with more comfort and ease.

"20%" written in silver and enlarged — *Medicare Part B will cover 80% of the adjustable bed expense, leaving you to pay the rest (20%).*

Will Medicare Cover Adjustable Beds?

Under Medicare Part B, in the DME section, it states that they might cover adjustable beds. But there are some requirements that a person must meet first before qualifying. First, a doctor must prescribe the bed for use at home. Afterwards, the bed must be sourced by an accredited Medicare supplier. Then, Medicare Part B will cover 80% of the expense, leaving you to pay the rest (20%).

Thankfully, if you are in need of an adjustable bed in your home due to chronic pain, or certain conditions, Medicare will cover it. As long as the bed is prescribed as medically necessary, and acquired from an accredited supplier, then you will be good to go. Make sure you contact Medicare to make sure the bed is accredited before purchasing it, because some bed suppliers will mislead patients into buying unaccredited beds.

Does Medicare Cover Life Alert?

Medical life alert systems were created to help older adults in the unfortunate event of a fall, or a medical emergency. Generally, these alert devices are worn around the neck or on the wrist, so that seniors can have easy access to help 24/7. This can be life saving in dire situations. So how much do these life alerts cost? And does Medicare cover the cost?

different emergency vehicles parked next to each other. — *Medical alert systems can help direct emergency respondents when and where they need to go to help you.*

Is A Medical Alert System Necessary?

According to the Center for Disease Control and Prevention, CDC, approximately 1 in 4 Americans over the age of 65 experience a fall every year. These falls result in broken hips, bones, and more. If you are living alone, then these devices would be extremely beneficial. Especially if you experience physical weakness, poor vision or balance, medication side effects, or chronic conditions.

The Different Types

There are all kinds of medical life alert systems. If you do not want to wear one, you can have one on your phone, or activity tracker. You have the ability to choose the one that best suits your lifestyle.

Bracelets, lanyards, or pendant– These are the usual alert systems that have an emergency button to push. You can wear it around your neck, and wrist. With some you have to push a button, while others sense a fall and call help for you.
Cell phone alert system– These systems are self explanatory. You can contact your alert monitoring center through the push of a button on your phone. They can use GPS on your phone with these systems so medical assistance will know exactly where you are when needed.
Activity tracker– These kinds of systems track your daily activity. If something is off, then the company will raise a red flag and check on you to make sure you are okay. These kinds of systems will help you improve your overall health by tracking sleep cycles, and more.

The Cost

The cost of an alert system is different among companies. For some, you will have to pay a one-time fee for rental, and then a monthly monitoring fee. Other companies will have you just pay the monitoring services, and ship the device for free. The monthly fees range for these systems range from $50 to $90.

So, Is It Covered By Medicare?

Unfortunately Medicare does not cover medical life alert systems. But don’t worry, there are some ways to get a discount on them. Some Medicare Supplement Plans might provide discounts, as well as organizations like AARP, AMAC, and USAA.

calculator and paper with hands pointing at both — *Unfortunately Medicare does not cover medical life alert systems, but there are some ways to get a discount.*

If you are not a part of any of these organizations, don’t lose hope. You can contact the local Department of Human Resources, or Department of Aging Services in your area, and they can help. Also, consider looking into Medicare Supplement Plans, since they can offer discounts towards alert systems.

If you need assistance searching and comparing Medicare Supplement plans, EZ.Insure can help! There are roughly 10 different types of medicare supplement plans on the market, and they all vary in coverage and cost. We will offer you a personal agent who will go over all the different kinds, and which one will suit you best, and offers a discount on alert systems. You can start by simply entering your zip code in the bar above to get a quote, or you can contact us by email at replies@ez.insure or call 855-220-1144. There is no hassle and no obligation.

Does Medicare Cover Dental?

Medicare provides seniors with the necessary care they need. However, this is not the case when it comes to dental coverage. People 60 years old, and older often face dental issues. At least 20% of them deal with untreated decay.

Why such a high rate? Medicare does not cover dental examinations, dentures, annual cleanings, crowns, or fillings. This can leave you in a penny-pinch, because these procedures can get expensive. There are a few exceptions though!

Accidents Happen

Medicare Part A can pay for inpatient hospital care if you need to have emergency or complicated dental procedures–even though dental care isn’t covered. This means while they don’t exactly cover “dental” work, if your teeth are involved in an emergency procedure, it can be included in the overall payment.

These covered services have to specifically be “emergency or complicated dental procedures.” Once they are deemed as such by a medical professional, Medicare Part A will assist in payments.

dental care with two toothbrushes in a cup — *Dental health starts at home. Make sure you’re brushing and flossing twice a day, and use mouthwash!*

For example, if you were in an accident and needed to have your jaw reconstructed, then Medicare will cover it because it is within your hospital stay. It’s still dental work but under a different umbrella.

The same goes for if a disease causes issues with your teeth or your entire mouth. As long as it is approved by a hospital or doctor as “medically necessary,” then Medicare Part A will cover the costs. More example services that are covered include:

Oral exams in the hospital before a kidney transplant.
Dental splints and wiring after jaw surgery.
Dental services for radiation treatment for certain jaw-related diseases, such as oral cancer.
Jaw reconstruction when a facial tumor is removed.
Surgery to treat fractures of the jaw or face.
Oral exam in a rural clinic or Federally Qualified Health Care Center before a heart valve replacement.

People don’t take into account how important dental care is. Not only does it play a huge part in your overall digestive health, but it can also lead to serious problems if you don’t brush and floss.

Why Dental Care Is So Necessary

Irreversible diseases are your biggest worry. Not taking care of your teeth can lead to serious illness because bacteria will build up, and find its way into your bloodstream. This includes heart disease, dementia, diabetes, cancer, rheumatoid arthritis, and respiratory infections.

Worse yet, studies have linked gingivitis to Dementia and Alzheimer’s. The bacteria from the gum disease can enter your brain through nerve channels, or your bloodstream. The brain is then exposed to the bacteria which can lead to nerve cell damage and brain cell loss. When your brain nerves are damaged or die, memory loss and early dementia can occur.

Dental Options To Consider

Just because Medicare does not cover dental work, does not mean you are out of luck or have to suffer. Instead of paying for expensive dental work out of pocket (routine dental exams can cost you anywhere from $400-$500), these are the options you can consider:

dentist performing oral surgery on patient for dental care — *By taking care of your teeth, you can avoid expensive dentistry bills. If you have to pay them though, make sure your coverage can help.*

Medicare Advantage Plan– There are several advantage plans, like Part C, which cover preventative services. This includes cleanings, fillings, extractions, X-rays, root canals, and crowns.
Dental Insurance– There are stand-alone dental insurances that you can purchase. You would pay a monthly premium, and you would have to see an in-network dentist.
Discount Dental Plan– This plan requires a membership fee. It is usually cheaper than insurance and will give you discounted rates at certain dentists. The discounts normally range anywhere from 25-50%.

Your dental health is connected to your mental and physical health. If you do not take care of your teeth and gums, dire issues can arise. Dental issues aren’t given enough attention, and they can be just as bad as other diseases.

You can develop dementia and Alzheimer’s due to bad oral hygiene. It is linked to heart issues, cancer, and more. Make sure you brush and floss every day. Just because Medicare does not cover dental, does not mean you can not seek other options to make sure your oral hygiene is up to par.

Can Hearing Aids Reduce Your Risk Of Dementia?

Hearing loss affects one-third of people over the age of 65, and two-thirds of those over 70. Many people who deal with hearing loss refuse a hearing aid, even when their insurance helps pay for it.

A road with the words dementia on it, and the wky in puzzle pieces with pieces missing. — *The risk of dementa can be reduced by using a hearing aid.*

Hearing aids do more than just help with hearing loss. Most people are unaware that hearing loss increases the likelihood of dementia, depression, balance issues, and anxiety. Therefore, by using hearing aids, you can improve your quality of life and lower your risk of dementia.

Understanding the Research

A University of Michigan team used data from nearly 115,000 people over age 66 with hearing loss. From 2008 to 2016, Elham Mahmoudi, MBA, Ph.D and her colleagues looked at the data for each person with hearing loss. They gathered this info one year before their diagnosis and then again three years later.

The study shows that men were more likely to get hearing aids than women. It also showed almost 37% of people with hearing loss in the north-central part of the US used hearing aids compared to the people in mountain states.

Those with hearing aids within the three years were 18% less likely to get diagnosed with dementia and Alzheimer’s. Hearing aid users had an 11% lower risk of being diagnosed with depression, and a 13% lower risk of fall-related injuries.

Because of Dr. Mahmoudi and her colleagues, we see that hearing aids can help in other areas.

Reducing Risk Factors

Hand holding a hearing aid. — *Because they are able to enjoy life more, people with hearing aids are less likely to develop dementia and depression.*

Because they are able to enjoy life more, people with hearing aids are less likely to develop dementia and depression. They are more social, which in turn boosts cognitive health.

“Older people with hearing loss who wear hearing aids may be better educated or may socialize more, factors which are also associated with a reduced risk of dementia,” said Dr. David Loughrey, a research psychologist specializing in hearing and cognition.

Social isolation can result in less brain stimulation, and hearing loss promotes cognitive decline because you don’t have as much auditory input. Over time, the brain’s auditory centers degenerate, which in turn makes the brain struggle to compensate. It has to use more sources to process this information. Studies and scans show that your brain shrinks as you lose hearing.

Payment

When it comes to payment, Medicare Part B will cover a hearing exam if your doctor finds it necessary. Only four states (New Hampshire, Connecticut, Rhode Island, and Arkansas) are required to cover hearing aid expenses, which probably contributes to their lack of popularity. Paying for hearing aids out-of-pocket can cost thousands of dollars.

However, there’s good news. The FDA has approved over-the-counter hearing aids for sale in 2020. They hope more people will purchase them with mild or moderate hearing loss.

From what Dr. Mahmoudi found, we can safely say that hearing loss affects your mental state. In order to stay on top of your overall well-being, invest in a hearing aid. You will be doing your mental, physical, and emotional health a favor. Just because hearing loss is an issue, does not mean you can not help promote a better life by getting a hearing aid. Hopefully, they will be available over-the-counter soon, or Medicare will offer more assistance in the future.

Medicare Does NOT Cover Annual Physicals

Many Medicare beneficiaries confuse a yearly physical with a yearly wellness exam. Medicare WILL cover an annual wellness visit, but WILL NOT cover an annual physical. If you do not clarify exactly which exam you are receiving, you will end up with an unexpected hefty bill. So what is the difference exactly? An annual physical is a more detailed

Cartoon man holding a long sheet of paper to the floor that says "bill" on it. — *If you do not clarify what the visit is with your doctor, you may end up paying an unexpected bill.*

exam than a Medicare Wellness Visit. Let’s examine the difference between the two exams, and what Medicare does and does not cover.

Annual Physical

An annual physical is an extensive exam that requires blood work and other tests. Any blood work or lab tests that need to be done will not be covered by Medicare. The doctor will:

- Measure height and weight

- - Perform lung exam
- - Perform head and neck exam
- - Check vital signs
- - Perform a neurological exam
- Test your reflexes

- Review medical and family history

- - Measure BMI
- Submit urine and/or blood samples

- Assess risk factors for preventable diseases

*Any work done at both visits is bold, and italicized.

Chart explaining what exams are done during medicare annual visit and medicare wellness visits. — *Medicare Wellness VS Medicare Annual Visits*

Annual Wellness Visit

Medicare will cover annual wellness visits, after the initial “Welcome to Medicare” visit is done with your doctor. During the initial visit, the doctor will establish your health and create a plan for future care. Your medical and social history is reviewed and you will receive free preventive services. The services include certain screenings, shots, and referrals if needed, a vision test, body mass index (BMI) calculation, height and weight measurements, blood pressure measurements, depression screening, a plan with knowledge of which future screenings, shots, and other preventive services you need. This is only covered one time and is not required to be covered by the annual “wellness” visits.

The annual wellness visit’s focus is on preventing disease and disability. This happens with a personalized plan for future medical issues based on your health and risk factors. During the annual wellness visit, the doctor will:

Measure height and weight

- - Measure blood pressure and other routine measurements.
- Listen to your heart through your clothes

Review medical and family history

- Review Health Risk Assessment questionnaire

Assess risk factors and treatment options

- Update list of providers and prescriptions

- Set up screening for appropriate preventive services such as diabetes and depression

Check that you are up to date with preventative tests such as cancer screenings, and flu shots (which are all free)

Generally, during a wellness visit, the doctor will not perform exams. The visit is mainly to catch up on your vitals, assess your risks, and provide a treatment plan. When you call your doctor to set up an appointment, make sure to tell them exactly which exam you want. If you simply say “physical” then you will be responsible for what the doctor charges you for the services, which will not be covered by Medicare. A simple mistake could end up costing you hundreds of dollars!

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