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Medicare Telemedicine & Mental Health

Medicare has been a hot topic lately: the H.R. 3 bill, which would allow Medicare to negotiate prescription drug prices, is currently in the Senate waiting to be passed, and talks surrounding expanding coverage to more older Americans continue on both sides. Not only that, but there have also been changes to Medicare brought on by the coronavirus pandemic, including the expansion of access to telemedicine. New guidance was recently issued by Congress and the Center for Medicare and Medicaid Services (CMS) on the delivery of psychology care services through the use of telemedicine, allowing psychologists to treat seniors through audio-only calls. But there are now new restrictions to mental health services provided through telemedicine that Medicare beneficiaries need to be aware of.

Background: The Coronavirus Preparedness & Response Supplemental Appropriations Act 2020

Under the Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020, which went into effect on April 30, 2020, CMS is now waiving telehealth requirements for Medicare beneficiaries in order to make it easier for them to access mental health services. Psychologists can now provide many of their typical services through audio-only calls, and can:

Provide telemedicine services from their home.
Provide services to new and established Medicare patients.
Offer Medicare patients telemedicine services in their homes.

In addition, telehealth services are now reimbursed for the same dollar amount as in-person visits.

The New Restrictions

a man with his hands on his head sitting across from a man in a suit with his hand on his chin — *Medicare beneficiaries will now have to see a psychologist in person first before getting telemedicine coverage for mental health services.*

While this step towards greater access to mental health care through telehealth has been good news for Medicare beneficiaries, there is now a new restriction on reimbursement for these services that threatens to put patients back to where they started. The Consolidated Appropriations Act of 2021 states that “Payment may not be made…for telehealth services furnished by a physician or practitioner to an eligible telehealth individual for purposes of diagnosis, evaluation, or treatment of a mental health disorder unless such physician or practitioner furnishes an item or service in-person, without the use of telehealth…” within the 6-month period prior to the first time the telehealth services are furnished.

In other words, under this new Act, a Medicare patient must first have an in-person examination before they can seek mental health services through telehealth. This is a change from previous laws surrounding telehealth, which in most states allowed doctor-patient relationships to be created through telemedicine without an in-person examination.

The coronavirus pandemic paved the way for telemedicine to become a more popular and widely used way to get medical care, including mental health care. Most government action surrounding telehealth has moved in the direction of expanding access to it, but unfortunately this new restriction is a step backwards, and will mean that Medicare patients will now need to see a doctor in-person before using telemedicine to get mental health care.

It is unclear what the next step is going to be for telemedicine and mental health care, but if you are a Medicare beneficiary in need of mental health services, remember that they are still covered: Medicare Part B covers mental health services, as well as counseling services, and if you need help covering the 20% coinsurance that Medicare Part B does not cover, a Medicare Supplement Plan can help. If you are curious, or want to compare Medicare Supplement Plans in your area, EZ can help. To get free instant quotes, enter your zip code in the bar, or to speak to a licensed agent, call 888-753-7207.

Chronic Fatigue Syndrome Is A Real Thing

Have you been feeling more tired than usual? Sure, getting older sometimes means lower energy levels, but if you are excessively fatigued, what you are experiencing might actually be more than just tiredness: it could be a medical condition. Chronic fatigue syndrome (CFS), which was once the subject of controversy, is now recognized as a real disorder that is characterized by extreme fatigue or exhaustion that doesn’t go away even after resting. So, if you are one of the up to 2.5 million Americans who suffer from chronic fatigue, know that it is not “all in your head”; it is a serious and complex condition, and if you are experiencing symptoms of it, you should speak to your doctor so you can find ways to deal with it and live a normal life.

Chronic Fatigue Syndrome Explained

Chronic fatigue syndrome is not the same as simple tiredness, which is short-term and goes away after resting. CFS is a more long-term condition, which makes you feel sleepy, as well as lacking in energy and motivation, even after getting more sleep. CFS can affect anyone, but it is 2-4 times more common among older women. There is no exact known cause of chronic fatigue syndrome, but experts believe it could be triggered by viruses, a weak immune system, stress, or other factors. However the fatigue presents itself, whether it is physical, mental, or both, CFS requires treatment.

What Causes CFS?

Getting older does not mean that being fatigued everyday is normal. Experts do not know what causes CFS, but there are some potential triggers that have been linked to it, such as:

Viral infections– The Epstein-Barr virus, human herpes virus 6, Ross River virus (RRV), and rubella virus are all linked to CFS.
Hormonal imbalances– People who have experienced CFS have sometimes also experienced abnormal levels of hormones produced in the hypothalamus, pituitary glands or adrenal glands.
Physical or emotional trauma– Some people report that they experienced an injury, surgery or significant emotional stress before their symptoms began.
Weakened immune system
Medications– If you are experiencing more fatigue than normal, certain medications you are taking might be the culprit.

Other factors that could increase your risk for CFS include:

caucasian woman blowing her nose into a tissue — *Allergies can increase your risk of chronic fatigue syndrome.*

Genetic predisposition

Allergies

Stress

Environmental factors

Symptoms of Chronic Fatigue Syndrome

Symptoms of CFS can be classified in two different ways: physical symptoms and mental symptoms. Physical fatigue means not having enough physical strength to perform an activity, while mental fatigue is when you do not have enough mental energy to perform an activity.

Some of the physical symptoms include:

Muscle weakness
Sleepiness
Vision problems
Bloating
Constipation
Frequent headaches
Muscle pain
Weight loss
Diarrhea
Frequent sore throat

Mental symptoms of fatigue include:

a caucasian man with his hand on his head with a question mark and exclamation mark next to him — *Memory problems and reduced concentration are mental symptoms of fatigue.*

Memory problems
Lack of motivation
Anxiety
Mood swings
Irritability
Slowed response times
Reduced concentration
Depression

Diagnosing Chronic Fatigue Syndrome

According to the Institute of Medicine, CFS affects anywhere from 836,000 to 2.5 million Americans, but it is estimated that 84 to 91% have yet to receive a diagnosis, possibly because there are no tests to screen for the condition. According to a 2015 Institute of Medicine report, doctors usually give a CFS diagnosis if you experience:

A decrease in your ability to do activities at previous levels which lasts for more than 6 months, and doesn’t improve with rest.
Worsening of symptoms after any type of activity.
Difficulty thinking.
Dizziness that hits when you stand up, but that is relieved by lying back down.
Sleep that does not refresh you.

There is no specific cure for CFS, so if your doctor diagnoses you based on the above criteria, they will treat you based on your specific symptoms.

Preventing CFS

two older adults riding bicycles next to each othercyc — *Exercising, drinking water, and eating nutritious foods can help prevent CFS.*

One of the best ways to prevent fatigue is to make some lifestyle changes. This includes:

Eating nutritious foods, and focusing on eating smaller meals throughout the day to have a constant source of energy.
Drinking enough water.
Exercising, which can help you feel less fatigued by preventing muscle loss, providing energy, and improving your mood. Always talk to your doctor before beginning an exercise program, so you can discuss with them what type of movement is right for you.
Practice yoga, tai chi, or pick up a new hobby that will help to reduce stress.

Being tired is normal, especially as you age, but being extremely fatigued even after getting enough sleep is not normal; this is a red flag that you should consider speaking to your doctor about. Chronic fatigue is real, and can progress, leading to a decline in your physical and mental health – but it can be treated and prevented. Seek help from your doctor, and rest assured that Medicare will cover your medical expenses for this visit, or for any further visits with specialists or therapists. Be aware, though, that you will have some out-of-pocket expenses, including your deductible and coinsurance, so you should consider a Medicare Supplement Plan to help you, because the last thing you want to do is worry about money while dealing with a condition that takes a lot out of you, like CFS. A Medicare Supplement Plan will cover your out-of-pocket expenses and help you save money.

To get free Medicare Supplement Plan quotes, simply enter your zip code in the bar above, or to speak to a trained EZ agent in your area, call 888-753-7207. No obligation, no hassle.

Overweight? Medicare Can Help With Obesity Counseling

Millions of Americans of all ages are overweight or obese, but weight issues can be a particular problem for older adults. In fact, almost 35% of adults 65 and older are considered obese, which also means that they are at higher risk of developing other medical conditions, like heart disease, stroke, diabetes, high cholesterol, and more. So, if you are one of the many older adults dealing with obesity, it is important to try and lose weight – fortunately, there are ways that you can do so with the help of Medicare.

Are You Obese?

In order to determine whether you are overweight or obese, you will need to calculate your body mass index (BMI). Your doctor will usually check your BMI during your Medicare Annual Wellness Visit, or you can calculate it yourself by plugging your height and weight into an online BMI calculator. A BMI of 30 or more is considered obese.

Health Problems Associated With Obesity

The sad reality of getting older is that it becomes much easier for you to gain weight. Your metabolism slows down; in addition, your joints might ache or you could develop a chronic condition, both of which could prevent you from getting enough exercise. Add to this the fact that our fat-stores tend to increase with age, and it becomes clear why older adults have such a high risk of obesity – and with obesity can come other dangerous medical conditions, including:

blood pressure monitor in the red zone. — *Obesity will lead to other health problems, such as hypertension.*

Diabetes- Obesity is a major cause of type 2 diabetes
Hypertension
Cardiovascular disease
Gallbladder disease
High cholesterol
Heart disease
Certain cancers including breast, uterine, colon, and leukemia.
Arthritis and mobility impairment- Every pound of excess weight exerts about 4 pounds of extra pressure on the knees
Cognitive decline

Research shows that obesity is linked to a shorter life expectancy, mainly because of all the health risks associated with it. To lower your risk of developing medical conditions associated with obesity, you’ll have to lower your body mass index; in order to do this, you will have to put in some work. But Medicare can help!

Obesity Counseling

In order to help you lose weight and improve your health, Medicare Part B will cover obesity counseling services, both in-person and virtually through telehealth counseling. If you take advantage of this benefit, you will have access to a licensed psychologist, who will assess your diet and lifestyle, and then offer you a detailed dietary and physical activity plan to help you lose weight. This counseling is completely free to Medicare beneficiaries.

Medicare Supplement Plans

While obesity counseling is completely covered by Medicare, many of your medical expenses will not be fully covered, so if you’re looking for a way to help pay for the 20% of medical expenses that Medicare Part B doesn’t cover, you should look into a Medicare Supplement Plan. You can sign up for one of these plans at any time, but the best time to purchase one is during your 7-month Medicare Initial Enrollment Period (the 3 months before you turn 65, the month of your birthday, and the 3 months after you turn 65). If you sign up after your Initial Enrollment Period, you’ll face medical underwriting, and if you have a risky health condition like obesity, you could end up paying more or even getting denied for a plan. But don’t worry if you’re past your Initial Enrollment Period and are in the process of trying to lose weight – you can still find an affordable plan with the help of an EZ agent!

If you are interested in learning more about Medicare Supplement Plans, and the many different coverage options that they offer, EZ can compare every plan available to you, for free. Our agent will find one that fits your specific needs, so you can save as much money as possible. To compare plans for free, simply enter your zip code in the bar above, or to speak to a licensed agent, call 888-753-7207. No obligation.

Medicare Outpatient VS Inpatient (& Why Its Important)

When you go to the hospital in an emergency situation, the last thing on your mind is probably your patient status. But whether you are classified as an “outpatient” or as an “inpatient” can make a huge difference in what you are expected to pay for your visit, especially as a Medicare beneficiary, since it will determine whether Part A or Part B will help pay the costs. Knowing the rules of these classifications, though, can help you to avoid getting a large and unexpected bill in the mail.

Outpatient Status Explained

x-ray of a person's head — *You might go to the hospital and get an X-ray or MRI and be considered an outpatient.*

In some cases, you might go to the emergency room, get lab tests, an X-ray, MRI, or other procedures, but not get admitted to the hospital. If this happens, you will be considered an outpatient, or as an observation stay. You can be considered an outpatient even if you stay overnight at the hospital; for example, if you have an outpatient procedure and are kept overnight to be monitored, you are still under outpatient care, unless you are admitted under a doctor’s orders.

Outpatient Medicare Coverage

Medicare Part B will pay for any medical care that is performed under outpatient status, including diagnostic imaging tests, emergency room visits, medical observation, outpatient surgery, lab tests, x-rays, and colonoscopies. Remember, though, that Medicare Part B will only cover 80% of the cost of these qualified expenses, leaving you to pay your 20% coinsurance after meeting your Part B deductible.

Inpatient Status Explained

person's hand with wires all around it — *If you are admitted to the hospital, then you are considered an inpatient.*

After getting assessed as an outpatient at the hospital, you could get admitted to the hospital under a doctor’s order – then, and only then, will your status change to that of an inpatient. Any care you continue to get after this will be considered on an inpatient basis until you are discharged.

Inpatient Medicare Coverage

Medicare Part A completely covers any medical care that is on an inpatient basis, so you will not have to pay any coinsurance (as long as your stay is under 60 days). The only thing you will be responsible for is your Medicare Part A deductible and a daily coinsurance if your hospital stay goes beyond 60 days. In addition, if your stay lasts longer than 90 days, you will have an even higher coinsurance to pay.

Skilled Nursing Facility Coverage

These two classifications can become confusing, and even problematic, if you get transferred to a skilled nursing facility directly from the hospital. If you are still considered an outpatient, or under an observation stay, when you are transferred, Medicare will not cover your stay at the facility. In order for Medicare to cover a stay at a skilled nursing facility, you will have to be admitted to the hospital and considered an inpatient for 3 days prior to the transfer. house outline with silhouette of two people inside of it with canes This is where knowing your status can make all the difference in what care gets covered, and what care you will be responsible for paying for. If you are being transferred to a skilled nursing facility, be sure to ask how you have been classified; you can ask to have your status changed from outpatient to inpatient, but you have to do so while still in the hospital. Once you are transferred without having been an inpatient for 3 days, you will be left with a bill for the skilled nursing facility stay.

How to Save on Medical Expenses

If you’d like to save money on your medical expenses, the best way to do so is by considering a Medicare Supplement Plan. Part A might cover inpatient hospital care almost completely, but you’ll probably find that you’ll end up using Medicare Part B far more, since it covers most everyday and outpatient services – and Part B only covers 80% of medical expenses! That remaining 20% can really add up, but a Medicare Supplement Plan can help cover these costs. Each plan offers different coverage at different price points, so you’re sure to find one that meets your individual needs. Not sure where to begin? EZ can compare the 10 different Medicare Supplement Plans and provide you with quotes as well as guidance as to which will provide you the most coverage with the most savings. To get free quotes, simply enter your zip code in the bar above, or to speak to a licensed agent, call 888-753-7207. No obligation.

Will Medicare Be Able To Negotiate Lower Drug Prices?

It’s no secret that the cost of prescription drugs has been steadily rising, with prices going up each year for the past two decades. In fact, people in the U.S. pay significantly more than people in other countries for the same drugs, leading many Americans to shop abroad for necessary medications like insulin. In an attempt to keep drug prices under control for seniors, the House of Representatives passed the Elijah E. Cummings Lower Drug Costs Now Act in 2019, which if passed by the Senate will give Medicare the power to negotiate drug prices. The bill has recently been reintroduced in Congress, and President Biden has signaled his support for lowering prescription drug prices for seniors through Medicare negotiation, but so far it is unclear whether it will become law.

The Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3 Bill)

In 2019, the U.S. House of Representatives passed the H.R. 3 bill, which includes a provision that would allow Medicare to directly negotiate drug prices with drugmakers in order to keep prices under control. The bill has been stalled in the Senate since passing in the House, but it has now been reintroduced.

H.R. 3 would:

Authorize the Secretary of Health and Human Services (HHS) to negotiate directly with drugmakers in the Medicare program in order to lower prices for up to 250 prescription drugs each year.
Limit the annual out-of-pocket costs for Medicare beneficiaries to no more than $2,000.
Require manufacturers to give the federal government a rebate for any drug prices that increase faster than the rate of inflation.
Establish a top negotiated price for drugs of no more than 120% of the average of 5 other wealthy nations.
Support research and development for new drugs by investing some of the savings into the National Institutes of Health.

Agreement On The Negotiations

shopping cart on a computer screen. — *Drug prices have left many Americans to shop online and abroad, which can be dangerous.*

President Biden is supportive of legislation to lower drug prices, bringing the subject up in his speech announcing his American Families Plan. “Let’s give Medicare the power to save hundreds of billions of dollars by negotiating lower drug prescription prices,” he said. “Let’s do it now.”

Roughly 93% of Americans agree that Medicare should be able to negotiate with pharmaceutical companies for lower prices. This is not surprising, since some Americans are forced to look for cheaper ways to fill their prescriptions, including shopping for them abroad or buying questionable drugs online; others are being forced to forgo their medications altogether, which can be deadly, especially for older adults.

As of the writing of this, the bill has yet to pass in the Senate. The Democrats control the Senate by a 50-50 split (with the tie vote given to Vice President Harris), but so far it is unclear if enough Republicans will support the legislation to give it the 60 votes necessary to overcome a legislative filibuster.

What Is An Advance Directive?

There are some things in life that go without saying, and others that you need to be very clear about. For example, you can’t assume that your loved ones will know what your wishes are when it comes to your end-of-life care. It is important to have a written document that spells out exactly what your wishes are in the event that you can no longer communicate them for yourself. This document is known as an advance directive, and because it is a legal document, you might be wondering whether you have to pay to have one drafted, and whether Medicare covers it.

Advance Directive Explained

An advance directive is a legal document that is drafted to ensure that you get the medical care you want if you ever become incapable of communicating your wishes. Essentially, this document spells out what you would like to be done for you at the end of your life. The advance directive will be used by healthcare providers and your family to guide them in different scenarios.

Your advance directive will allow you to give power of attorney to someone, who will then be able to make medical decisions for you if you are not physically or mentally able to. It will also include a living will that details your specific wishes regarding your medical care and even your after-death wishes.

How To Get An Advance Directive

You can get an advance directive drafted by an attorney, who will create a living will or power of attorney form. You can also get an advance directive from your local Area Agency on Aging, state health department, or through your doctor.

The best time to make an advance directive is when you are well, so you can be sure that you are making decisions with a clear head. Bring up the subject with your doctor, and provide them with a copy after you have had one drafted. Remember, your advance directive is not set in stone; you can change it at any time and, if you are able to communicate your wishes, your verbal instructions will always override your written directive.

Why You Need One

caucasian doctor writing down something on paper with a caucasian man sitting down in front of him — *Your doctor can draft an advance directive on your behalf, as long as he or she accepts Medicare assignment.*

It’s never easy to talk about the end of your life or the possibility that you could end up incapable of communicating your wishes. But it is something that you should think about and be ready for in the event that it does happen. Having an advance directive will put your family at ease, because they will know they did what you would’ve wanted regarding your medical care.

Medicare Coverage

Medicare will cover advance care planning as part of your “Wellness” visit. During this appointment, you can talk about an advance directive with your doctor, and they might be able to help you fill out the forms if you’d like. As long as your doctor accepts Medicare assignment and talking about your advance directive is part of your “Wellness” visit, Medicare Part B will completely cover advance care planning. If you go to the doctor for something other than a “Wellness” visit, Medicare will still cover advance care planning as part of your medical treatment, but you’ll have to pay your coinsurance and your deductible.

In general, Medicare Part B covers 80% of qualified medical expenses, leaving you to pay the other 20% out-of-pocket. Medicare Supplement Plans help pay that remaining 20%, which will save you money in the long run, especially if you are being treated for a chronic condition. In fact, having a Medicare Supplement Plan could save you hundreds of dollars each year. There are 10 different Medicare Supplement Plans to choose from, each with different levels of coverage at different price points. One of our agents will go over each plan and find the one that meets your needs. To get free instant quotes, simply enter your zip code in the bar above, or to speak to a licensed agent, call 888-753-7207. No hassle. No obligation.

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