Your Initial Enrollment Period (IEP) is an important time if you’re considering your Medicare options. It’s natural that everyone has their own opinions regarding Medicare and the best coverage. While advice from family and friends can be helpful, when it comes to Medicare, there are a lot of myths passed around. Maybe you’ve come across information on social media or in conversation and wondered “Is that really true?”. You deserve accurate information about your coverage options so we’ve compiled a list of 10 common myths that we’d like to debunk for you.
There’s a misconception that since Medicare is a government benefit, seniors don’t have to pay for it because it has already come out of their taxes. While that would be great, it’s unfortunately not entirely true. Medicare Part A, or hospital coverage, doesn’t have any premiums. That is as long as you have paid your Medicare taxes for at least 40 calendar quarters. Even so, you still have a deductible and copays. So that part of the myth is kind of true.
However, Part A is the only Medicare product with no premium. Part B, medical coverage, has a monthly premium of $164.90 as of 2023. It’s important to note that the premiums are adjusted annually, meaning some years they increase and some years they’ll decrease. These premiums might also be higher for enrollees with higher income. The good news is that if you’re on Social Security, your Part B premium can be paid directly from those benefits, so while you may not be paying directly out of pocket, you are still paying for it. Additionally, if you choose the Medicare Advantage route you may also have to pay a monthly premium.
2. Medicare covers all healthcare costs.
Medicare does cover a large portion of your healthcare but not everything. Between Part A and Part B most of your hospital and basic medical expenses are covered.
Even with the services it does cover you are still responsible for deductibles, coinsurance, and copays. As you can see there are still several services that you may need that aren’t covered. Such as hearing, vision, and dental care. There is also no prescription drug coverage in Original Medicare (Part A and B). Typically to get those things covered most people will enroll in Medicare Advantage, Medicare Part D (prescription drug coverage), or a Medicare Supplement Plan. Any of those options do provide coverage for the gaps in your Medicare coverage.
3. You are automatically enrolled in Medicare.
This is another myth that is only partially true. If you have been receiving Social Security benefits or Railroad Retirement Board Benefits (RRB) for at least 24 months after you turn 65, then you will automatically be enrolled in Medicare Part A and B. Be aware that even after automatic enrollment, you are responsible for enrolling yourself in either Medicare Advantage, Medicare Part D or any Medicare Supplement Plans.
Now, if you’re not receiving Social Security or RRB, then enrolling is entirely up to you. The best thing to do is to enroll during your IEP, which will begin 3 months before you turn 65 and will end 6 months after your 65th birthday.
4. I can enroll in Medicare at any time.
This is completely false and can be one of the most detrimental myths to believe. If you don’t enroll during your IEP, you can face enrollment restrictions as well as a penalty. You will then have to wait for the next eligible enrollment period, which is known as the General Enrollment Period (GEP). The GEP lasts from October 15th to December 7th every year. The penalty for waiting is a premium increase of 10% for twice as many years that you were eligible and did not enroll. To make that simpler, If you did not enroll in Part A for 2 years after your IEP then the penalty would apply to your premium for the next 4 years. For Part B, the increase only lasts for the amount of time you did not enroll, so it would only apply for those first 2 years.
Now having said that, another way that you can avoid these penalties, aside from applying on time, is if you qualify for a Special Enrollment Period (SEP). To trigger an SEP you would have had to still be working and have credible health coverage through your employer or through your spouse’s employer during your IEP. Once you leave your job or lose the group plan coverage, you then have 8 months to enroll without penalty. Another way you can get an SEP is if you are under 65 and eligible for Medicare due to illness or disability, but have health insurance through a caregiver or spouse’s employer-sponsored health insurance. However, this only applies if their company has at least 100 employees.
5. Medicare costs the same for everyone.
While Medicare offers the same benefits to everyone, the cost is not universal. How long you worked and paid Medicare taxes, as well as your gross income determine your premiums and deductibles. The more you make, the more you will end up paying just like with regular health insurance. Additionally enrolling in Medicare Advantage, or Part D, or any Medicare Supplement Plans will change how much you pay for Medicare. So it varies greatly from person to person depending on their specific circumstances.
6. I can only enroll if I’m healthy.
This is a huge myth, Original Medicare cannot deny your coverage due to illness or a pre-existing condition due to implementation of the Affordable Care Act. If you have certain medical conditions like End-Stage Renal Disease (ESRD) or ALS, you are eligible for Medicare even if you aren’t 65 yet. Once you turn 65 or retire you are eligible for Medicare Parts A and B, period. Also,there are no penalties or premium increases for pre-existing conditions. If you have certain medical conditions like End-Stage Renal Disease (ESRD) or ALS, you are eligible for Medicare even if you aren’t 65 yet.
7. Medicare Advantage and Medicare Supplement Plans are the same thing.
This is not true at all. They are similar in that private companies offer them but they are entirely different. Medicare Advantage is an alternative to Original Medicare. It may include prescription drug coverage. Medicare Supplement Plans are additional coverage you can buy to fill in the gaps left by your Original Medicare. Additionally, you can buy one or the other but not both.
8. Medicare doesn’t have as many options.
You may believe that Medicare is a one-size-fits-all program because it’s a government program. However, this is another one of those pesky Medicare myths. Medicare typically provides significantly more health insurance options than your employer’s group coverage. Whereas you may have had only a few plan options to choose from when enrolling in employer coverage, Medicare provides you with dozens of options. Medicare allows you to tailor your coverage to your specific needs.
9. Medicare will notify me when it’s time to enroll.
Obviously you don’t want to be late enrolling in Medicare. Nobody wants to have a penalty added to their premium. Unfortunately, Medicare does not give you an enrollment reminder when it’s time for you to enroll. The good news is that if you have Social Security Benefits or RRB before you’re 65, you will automatically enroll in Medicare Parts A and B. On the other hand, if you don’t have those benefits you have to remember to enroll on your own. So, it’s important that you note the specific times when you can enroll.
10. I am on COBRA so I don’t need to sign up for Medicare Part B.
COBRA does not count as active employment. To delay Part B enrollment without incurring a penalty, you or your spouse must be actively employed and covered by a group health plan. Additionally, if you are already on COBRA and your Medicare begins, your COBRA status will change when you turn 65. Meaning your COBRA coverage will end. You won’t be eligible to delay Part B without incurring a penalty. You may even experience a delay in the start of your Part B coverage, which could result in a serious coverage gap.
EZ Can Help
Now that you have all the facts it’s time to enroll with the help of EZ. EZ is able to help you enroll in Medicare, purchase a Medicare Supplement Plan, or just help you weigh your options. Our insurance agents collaborate with some of the most reputable insurance providers in the country. They are able to provide you with a free analysis that compares all of the plans that are available in your region. We will discuss your medical and financial needs and then assist you in locating a plan that is tailored to meet those requirements. To start, enter your zip code into the box below. Or give one of our licensed agents a call at 877-670-3602 and we’ll get the ball rolling for you.
Turning 65 can feel like hitting a milestone. At this point in your life, you’ve lived a long life and made a lot of memories and are looking forward to making more! And one of the best ways to keep going strong is to have a good insurance plan that will protect your health. Fortunately, turning 65 also means you can finally benefit from Medicare, which you’ve been paying into your whole working life, so you will have some pretty good coverage to help you do this. But Medicare alone is not enough. You’ll also need something, like a Medicare Supplement Plan, to fill the gaps in your coverage.
You might be seeing a lot of commercials about different Medicare plans available to adults 65 and older to help you fill those gaps. And it can all be confusing as to what direction you should go, but this is where EZ can help you. We will go over everything you need to know and provide you with quotes for all the plans in your area at no cost to you, so you can get fully covered and get back to living your life!
So why do you need an insurance plan if you already have Medicare? Well, while Medicare Part B covers outpatient medical services, including durable medical equipment, there are quite a few out-of-pocket expenses associated with it. You will have to pay a monthly premium and meet your annual deductible, as well as cover your 20% coinsurance for each service you receive, since Part B only covers 80% of costs.
To fill these gaps in Part B, you’ll need a Medicare Supplement Plan. For one low monthly premium payment, Medicare Supplement Plans cover things like deductibles, copays, and coinsurance, and can even offer extras like coverage for when you’re traveling.
Save Time
There are around 10 Medicare Supplement Plans available, meaning you have a lot of options. But it also means that looking into all the various plans available, and what each plan entails, while trying to figure out if these plans will suit your specific needs, can be very overwhelming. Working with one of our agents will save you the time and frustration of searching through all the different plans available in your area.
We will also save you time by sitting down with you and discussing your medical needs and your budget, to find only the plans that will work for you. We’ll show you which plans cover your current providers, and any other necessities you would like, such as travel insurance. Then we will go through all available options with you and explain each one so that you get a full understanding of the coverage options and the costs.
Finally, we will save you time by helping you enroll in the plan in a matter of minutes when you are ready.
One of the most nerve-wracking things is trying to find a plan that keeps your prescriptions affordable. It is no secret that many Americans, especially seniors, struggle to pay for medications, but working with an EZ agent will allow you to see all of your options for prescriptions coverage and save the most money.
If you’re retired and living on a fixed income, you’ll need to budget carefully for your daily expenses, and you’ll need a plan that fits into that budget. We can help you find a plan that will do just that, giving you the ability to save money for other things that matter in your life, such as traveling or your grandchildren.
No Need to Look Further
As we pointed out above, if you’re a Medicare beneficiary and need help paying for the things that Medicare doesn’t cover, you have the option of purchasing 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-covered service. 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.
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.
It’s no secret that cosmetic surgery is popular in this country – and it’s been increasing in popularity with older adults in particular. Understandably, many older adults want to look good and feel good about themselves. Which is probably why Americans aged 55 and up accounted for nearly 4.2 million cosmetic procedures in 2020. And because most of the seniors getting this type of surgery are within Medicare age, the question is will Medicare cover any of these cosmetic surgeries? The answer to that question is generally no but is dependent on a few factors.
As we said, Medicare usually will not cover cosmetic surgery. But there are some exceptions: if the surgery will improve the function of deformities or abnormal body parts, or it is considered a reconstructive surgery, you might be able to get coverage.
Medicare may cover the following surgeries with prior authorization:
Blepharoplasty – Eyelid surgery that Medicare might cover if it could functionally improve your vision. This can include the removal of droopy, fatty eyelids.
Botox – Medicare might cover this neurotoxin injection for the treatment of chronic migraines in adult patients, but botox to specifically treat skin wrinkles is not covered by Medicare.
Panniculectomy -Surgery to remove excess skin and tissue from your lower abdomen. Medicare does not cover panniculectomy for cosmetic purposes.
Rhinoplasty – Nasal surgery that Medicare might cover to improve nasal respiratory function. For example, they will cover it if it improves a nasal airway obstruction.
Vein ablation – The treatment of varicose veins of the lower extremities. Spider veins are most often treated for cosmetic purposes. So Medicare usually won’t cover vein ablation but can be in rare instances.
Medicare & Reconstructive Surgery
If you need reconstructive surgery due to one of the conditions above, or some other injury or disease, Medicare might cover it. Outpatient cosmetic services covered by Medicare Part B require prior authorization. And if medically approved, you will only have to meet your deductible and pay your 20% coinsurance.
Need Help?
If you do need reconstructive surgery, that 20% coinsurance might seem a bit daunting, but there is help available. A Medicare Supplement Plan can help cover the out-of-pocket costs that Original Medicare does not cover. 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.
The government has finally announced the new standard monthly premiums for Medicare Part B. And after all the speculation about rate hikes, rates will actually be decreasing a little bit next year. Not only that, but the annual deductible for Medicare Part B will also be lower next year. With many Medicare beneficiaries struggling with increased healthcare costs, this decrease in rates should be helpful. So what will you be paying for Medicare Part B in 2023?
Medicare Part B Premium
The new standard monthly premium for Part B will be $164.90 next year, which is about 3% lower than it is this year.
2022 saw a large increase in Medicare Part B premiums because of projected spending on Aduhelm, a new drug for treating Alzheimer’s disease. Now that spending on the drug, and other treatments and services, has gone down, Part B once again has more financial reserves. This is allowing Medicare to lower next year’s premiums for Medicare beneficiaries.
Medicare Deductibles
Medicare Part B premiums are not the only costs that are going down. The annual deductible for Part B will be $226 for 2023, which is a $7 decrease from $233 in 2022.
But while the Medicare Part B deductible is going down, the deductible for Medicare Part A will go up $44 from this year’s $1556, making it $1,600 in 2023. For the 61st through 90th day of hospitalization, coinsurance will be $400 per day, up from $389 this year. For lifetime reserve days, the charge will be $800 per day (up from $778 in 2022).
IRMAA Changes
Income-related adjustment amounts, or IRMAAs, will kick in for single beneficiaries at the modified adjusted gross income amount of more than $97,000, up from $91,000 this year. For married beneficiaries filing a joint tax return, the extra monthly charge will apply if income is above $194,000, up from $182,000 this year.
Want To Save More?
If you need help paying for the things that Medicare doesn’t cover, you have the option of purchasing 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.
