Medicare’s Annual Enrollment Period (AEP) is here, so don’t worry if you missed your initial enrollment period, you’ve got time! You’ve probably seen all the ads urging anyone eligible to enroll or make changes, but what is the AEP, and how can you make sure you’re enrolling in the right plan? Well, you’re in the right place for those answers. This guide will show you how, when, and what changes you can make to your current Medicare health plan or prescription drug plan for 2024. You’ll get answers to all the important Medicare AEP questions so you can make the best choices.
What Is The Annual Enrollment Period?
For Medicare, this happens every year from October 15 to December 7. People might also call AEP “Open Enrollment” or “Fall Enrollment Period.” All people who are eligible for Medicare can sign up or make changes during this time, and your new coverage will start on January 1 of the next year.
What Can I Do During The Annual Enrollment Period?
You can use the AEP to initially enroll in Medicare. You can also use the AEP to sign up for a Medicare Supplement Plan or Advantage Plan if you already have Medicare Parts A and B. On the other hand, you can also drop your current Medicare Supplement Plan or drop your Medicare Advantage Plan and go back to Original Medicare if you choose.
Enrolling in Medicare
Medicare is a government program that helps pay for health care for people 65 and older or younger people with certain disabilities or health problems. The 4 Different parts of Medicare cover different kinds of medical treatments.
Medicare Part A – Medicare Part A pays for short-term inpatient care in a hospital, skilled nursing center, or nursing home, as well as hospice care and some home healthcare.
Medicare Part B – Medicare Part B pays for doctor visits and other outpatient services, as well as mental health care, ambulance transfers, durable medical equipment, lab tests, and preventive screenings. Parts A and B are sometimes called “original Medicare” to set them apart from Medicare Advantage plans that are run by private companies.
Medicare Advantage (Part C) – Medicare Advantage plans are an option to replace original Medicare. They are offered by private insurance companies in accordance with Medicare rules. Participants usually pay less out of pocket, but service is usually limited to providers in the network.
Medicare Part D – Coverage for prescription drugs. To sign up for Medicare Part D, you need to have either standard Medicare or a Medicare Advantage plan.
Medicare Supplement – Medicare Supplement Insurance is sold by private companies. It pays for some of the costs that original Medicare doesn’t cover, like deductibles, coinsurance, and copays.
Comparing
During the Annual Enrollment Period, one of your biggest decisions is whether it’s better to go with Original Medicare with a Medicare Supplement plan or a Medicare Advantage plan. Knowing the different types of coverage can help you decide which one makes the most sense for you. Here’s a look at how they compare.
Original Medicare
Allows you to use any doctor, hospital, or other health care provider who accepts Medicare and is taking on new patients.
Coverage for Parts A and B of Medicare.
There’s no need to pick a primary care doctor, and most of the time, you don’t need a referral to see a specialist.
Most of the time, you pay a deductible, co-pays or co-insurance, and Part B premiums.
Medicare Part D is not included.
Most people who have Medicare Part A benefits do not have to pay a premium. In 2024, the standard monthly premium for Medicare Part B is $179.80, but if you make more, your payment may be higher. The Part B deductible in 2023 was $226 and should be close to the same for 2024. There are deductibles and charges for both Parts A and B. The 2024 prices have not been announced yet but they should be close to the 2023 amounts. Part A charges in 2023:
Benefit period deductible was $1,600.
Hospital stay days 1-60 had no coinsurance per benefit period.
Days 61-90 has a $400 per day coinsurance per benefit period.
Days 91 and over had $800 coinsurance per lifetime reserve day used (up to 60)
Once you’ve used all of your lifetime reserve days the patient pays all costs
Medicare Supplement
Fills in the coverage gaps left by Original Medicare
Medicare is billed first for health care services, and the Supplement Plan is billed second.
Out-of-pocket costs will be based on what’s left after Medicare and the Supplement Plan pay their share.
Medicare Supplement plans vary based on the insurer and the plan you choose and where you live. To find out more about Medicare Supplement costs click here for our state-by-state Medicare Supplement Guide.
Medicare Advantage
Usually, you have to use doctors, hospitals, or other health care workers that are part of the plan’s network. There may be a fee if you go to a service that is not in your network.
Required to cover the same essential services Original Medicare does.
Depending on plan and provider, you may need a referral for specialists.
Plans have different out-of-pocket costs, but some may limit how much you have to pay each year.
Most plans cover medications through Medicare Part D.
How much you pay for a Medicare Advantage plan (Medicare Part C) depends on the plan you choose. Members of Medicare Advantage are still responsible for paying their Medicare Part B payments, but some plans may pay some or all of them on their behalf. This is called a “Medicare giveback benefit” in the insurance world. Some Medicare Advantage plans may have a monthly fee on top of what you already pay, but most don’t. Deductibles, copayments, and coinsurance costs can also be different.
AEP Tips
Your Medicare plan will automatically continue at the start of each year unless you change it, but you might not get the same benefits. Every year, insurance companies look at the perks of their Medicare plans and make changes. Instead of just letting your plan keep going, you should make sure it still meets your wants. During the Medicare Annual Enrollment Period (AEP), you can change your plan if you want. Here are some tips to help you make decisions about your Medicare coverage during AEP that are based on accurate information.
Check Your Current Plan Changes
Each year, your Medicare Advantage plan (Part C) or Medicare prescription drug plan (Part D) may change how much it covers or how much it costs. Changes go into action on January 1, so you need to be aware of them when making decisions during AEP. Changes to a plan may include adding new benefits, taking away benefits that were previously offered, updating the list of drugs that are covered, and lowering or raising prices. Plans will send you a letter called an Annual Notice of Change (ANOC) that explains any changes to your benefits or costs for the next year. Plan members usually get ANOC letters in September. Read it carefully and get in touch with your plan provider if you don’t get one.
Review Your Handbook
“Medicare & You” is the government’s official guide to Medicare. It covers coverage, costs, enrollment, and more. Every year, it’s changed. The guide shows what’s new with Medicare and what, if any, big changes are coming in the next year. Changes to Medicare rules or policies could affect your benefits, costs, or other parts of your health care, so it’s important to stay up to date.
Review Your Plan
Now that you’ve looked at plan changes and gone over what your plan covers it’s time to look at your present plan more closely. Start by figuring out how well your current Medicare plan will work for you in the coming year. If your plan still seems like the right choice, you don’t have to do anything during AEP to keep it. You’ll stay on the plan as long as you keep paying your fees and other costs.
Shop Around
If you think your plan won’t meet your requirements anymore, you should look for one that will. Even if you think your current plan will still meet your needs, you may want to look around to see if you can find one with better features or lower costs. Every year, on October 1, insurance companies release new information about their Medicare plans. They are competing for your business, so don’t be afraid to look at all of your choices.
What If I Miss The Annual Enrollment Period?
During the Medicare Annual Enrollment, you can change your Medicare Parts A or B coverage. From October 15 to December 7, anyone can sign up. People who have private Medicare Advantage plans have their own open enrollment time, which runs from January 1 to March 31. If you miss your open enrollment time, you usually have to wait until the next year to make changes. However, there are some cases where you can make changes before the next year. Special Enrollment Periods (SEPs) are times when you can make changes to your benefits. You might be able to get an SEP if you:
Move to a place that isn’t in the service area of your present plan.
Move to a new area that gives your current plan new coverage choices
Are let out of prison
Move into or out of a nursing home with skilled care
Move back to the United States after living abroad
Leave coverage through a company or COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage
Stop being covered by the Program of All-Inclusive Care for the Elderly.
Used to be able to get Medicaid, but now you’re not.
Are registered in a Medicare Advantage plan or Part D plan that hasn’t been renewed
Both Medicaid and Medicare are available to you.
These are just some of the times when you might be able to change your Medicare plan outside of the Annual Enrollment Period. On the Medicare page, you can find out more about these times.
Getting Medicare With EZ
EZ can assist you in enrolling in Medicare, purchasing a Medicare Supplement Plan, or simply weighing your options. Our agents work with the best insurance companies in the country. They can provide you with a free comparison of all available plans in your area. We will go over your medical and financial needs and help you find a plan that meets your needs. To get started, simply enter your zip code in the bar below or give one of our licensed agents a call at 877-670-3602.
If you have Medicare or will soon have it, you probably know what it covers on a basic level. But do you know about the less common perks that come with Medicare coverage? These perks aren’t technically free, since Medicare itself isn’t free. However, many Medicare recipients don’t have to pay anything out of their own pocket for these benefits.
There are a few exceptions. For example, there may be limits on how often you can see a doctor, and your doctor must agree to Medicare’s billing rules. Still, it’s good to know that you can get these benefits if you have Original Medicare or Medicare Advantage.Medicare advantage plans come with their own set of benefits in addition to the services that Original Medicare requires. Below are the “free” services that Medicare beneficiaries can access. They all help you save money and stay in good health.
Part A Premiums
Part A mainly covers hospital stays and inpatient care. While Part B mainly covers services in outpatient centers and doctor’s offices. Most people don’t have to pay a monthly fee for Part A coverage as long as they or their spouse paid Medicare taxes when they worked. Usually, you need to work and pay Medicare taxes for at least 10 years to avoid paying a premium for Part A.
Welcome to Medicare Visit
After you sign up for Medicare Part B, which pays for doctor visits and other outpatient services, you can get one free “Welcome to Medicare” checkup at any time during the first 12 months. This checkup is not a full physical test, but it gives your doctor a chance to look at your health and make a plan for your future care. You don’t have to get the “Welcome to Medicare” checkup, but if you do, it will help your doctor create a baseline to keep track of your health with your future annual wellness visits. However, Medicare will not pay for a wellness visit in your first year of Part B.
Annual Wellness Visits
Medicare beneficiaries are also able to get a free wellness visit once a year. This visit is meant to help you update your personalized health plan depending on how your health has changed year to year. It helps your doctor find new symptoms or possible health concerns early. The visit includes:
Reviewing your medical history as well as family medical history
Updating or changing your prescriptions
Recording your height, weight, and blood pressure
Checking your cognitive impairment
Creating a care plan based on any findings
It’s important to note that while the visit itself is free, if you get any additional testing or treatments that aren’t considered covered preventative care there may be a copay.
Vaccines
Medicare Part B covers a number of vaccines for free without any copayments. Starting in 2011 the Affordable Care Act got rid of cost sharing for many types of tests and vaccines that help people stay healthy. Here are the shots that Part B pays for. Depending on your age, risk, and when you get the vaccine or series of vaccines, you may have to meet certain requirements:
COVID-19 – Even though the public health emergency stopped on May 11, 2023, Medicare still pays for COVID-19 vaccines. Providers who are part of Medicare can’t charge Medicare recipients for the shot.
Flu – Most people of all ages get flu shots every year during flu season, which usually lasts from October to May, with most people getting sick from December to February. For extra protection, the Centers for Disease Control and Prevention (CDC) advises that people 65 and older get the high-dose version.
Hepatitis B – Part B covers the hepatitis B vaccine as a preventive benefit for people with diabetes, end-stage kidney disease, or hemophilia, who are at medium or high risk for getting the virus.
Pneumonia – Medicare pays for the pneumonia vaccine, which can help protect you from pneumococcal disease, which can lead to pneumonia, meningitis, and other illnesses. Medicare pays either a single dose of the vaccine or a two-dose series, with the second dose needed at least a year later for most people 65 and older. People who don’t have strong immune systems may get the second dose sooner.
Cancer Screenings
Medicare pays for several cancer screenings. Although some have requirements or are only covered in certain time frames.
Breast Cancer
Medicare Part B covers one mammogram test every 12 months for all women 40 and over. If you are between 35 and 39 years old and are eligible for Medicare, you get one free baseline mammogram. If your doctor accepts Medicare assignment the mammograms are free. Accepting assignment means that your doctor agrees to accept the Medicare-approved amount for the test as full payment rather than charging more.
Colorectal Cancer
Medicare will cover several screenings for colorectal cancer with specific guidelines for each;
Colonoscopy – If you have Medicare and are at high risk for colorectal cancer, you can get a screening colonoscopy every two years. If you don’t have a high chance of getting colon cancer, the test is covered once every 10 years, or 120 months. There is no minimum age, and if your doctor agrees, these tests won’t cost you anything.
Fecal occult blood tests – If you are 50 or older and have Medicare, you may be able to get one fecal occult blood test every 12 months to check for colon cancer. If your doctor agrees to do the tests, you won’t have to pay for them.
Stool DNA labs – Medicare will pay for a multi-target stool DNA lab test once every 3 years if you are 50 to 85 years old. You must meet certain requirements, such as having a normal chance of getting colorectal cancer and not having any signs of colorectal disease. If your doctor agrees to do the tests, you won’t have to pay for them.
Cervical Cancer
Part B of Medicare pays for a Pap test and pelvic exam every 24 months if you have Medicare. As part of the pelvic exam, the breasts are looked at to see if there are any signs of breast cancer. You might be able to get a screening test once a year if:
You have a high risk for vaginal or cervical cancer
You’re at childbearing age and had an abnormal pap in the last 36 months
If you are between the ages of 30 and 65, your Pap test every 5 years also includes an HPV test. If your doctor agrees to do the tests, you won’t have to pay for them.
Prostate Cancer
Medicare Part B pays for blood tests for prostate-specific antigen (PSA) and digital rectal exams (DRE) once a year for people 50 and older. The yearly PSA tests are free and won’t cost you anything if your doctor agrees to do them. The Part B deductible applies to the DRE, and Medicare will pay 80% of the allowed amount.
Medicare Part B will pay for a low-dose computed tomography (LDCT) lung cancer test once a year if you are between 55 and 77 years old. If your doctor accepts Medicare assignment, the tests will cost nothing. You do have to meet certain requirements such as:
You have no lung cancer symptoms
You smoke, or quit within the last 15 years
Your smoking history had an average of a pack a day
Medicare Part B pays for a yearly screening for depression. To be screened for depression, you don’t have to show any signs or symptoms, but the screening has to happen in a place where people get basic care, like a doctor’s office. This means that Medicare won’t pay for your screening if it happens in a hospital, skilled nursing facility (SNF), or emergency room. The annual depression check is done with the help of a questionnaire that you or your doctor fills out. This quiz is meant to show if you are at risk for depression or have signs of it. If your test results show that you might be at risk for depression, your provider will do a full evaluation and, if necessary, refer you for more mental health care.
Most of the time, you should get a depression test when you already have an appointment with your doctor. But your provider can choose to do the screening on a different visit. Original Medicare pays 100% of the Medicare-approved amount for depression screenings when they are done by a qualified provider. This means you don’t have to pay anything (no deductible or share). Medicare Advantage Plans are required to cover depression screenings without deductibles, copayments, or coinsurance if you see a provider in their network and meet Medicare’s standards for the service.
Diabetes Screenings
When diabetes is treated early, it can help people avoid problems. Depending on how likely you are to get diabetes, Medicare will pay for up to two diabetes tests per year. Medicare will also help you learn how to take care of your diabetes, but you’ll have to pay for it. Medicare also has a program to help people who are at risk of getting diabetes, but haven’t been officially diagnosed. This program is free of charge.
Working With EZ
Using the free services Medicare gives is a good way to stay as healthy as possible. If you’re new to Medicare, you should learn how it works so you can take advantage of all the services it offers. EZ can help you sign up for Medicare, buy a Medicare Supplement Plan, or just figure out what your best choices are. Our insurance brokers work with the best firms in the country. You can get a free review of all the plans in your area from them. We’ll talk about your physical and financial needs and help you choose a plan that fits them. To get started, just call 877-670-3602 and talk to one of our certified agents.
Fraudsters can make a lot of money off of Medicare fraud, which poses a big problem for Medicare enrollees and taxpayers alike. If thieves get their hands on your Medicare number, they can be worth a lot of money. With these numbers Medicare can be billed for services that never even happened. Then the thieves keep the money for themselves. And taxpayers are the ones that pay. The more money that goes towards false health care claims, the less money there is for real health care needs. In the long run, this can lead to higher premiums and stricter rules for Medicare enrollees. So, to help you avoid these scams let’s look at the most common scams and how to avoid them.
Billing Scams
These scammers network with crooked medical professionals who will bill Medicare for services or medical equipment that they never gave. Scammers can also pretend to be a hospital or medical office and send you a fake bill. They count on the chance that you will pay any bill you get without double checking it against your medical records. So, it’s important to keep track of how you use your Medicare. If you have Original Medicare (Parts A and B), every 3 months you will receive a Medicare Summary Notice (MSN). Or if you have Medicare Advantage, you will get a monthly Explanation of Benefits (EOB).
The MSN and EOB are not bills, instead they are an itemized list with information about Medicare services charged under your Medicare number during those time periods. Specifically, they include how much Medicare paid for your care and how much you owe. If you get a bill that doesn’t match your MSN or EOB, or if the MSN and EOB show services you didn’t receive it could be a scam and you need to contact Medicare to report it.
In-Person Scams
Sometimes these scammers will come directly to your home pretending to be from Medicare or a healthcare company working for Medicare. Be wary! They might try to sell you a service or offer “free” services to get your attention. This is just an attempt to get your personal information. Medicare will never send someone to your house to sell you anything.
Any home health services covered by Medicare will be scheduled ahead of time. Things like nursing care and physical therapy will always be scheduled, you will be expecting them. They will also never ask you about your finances or any personal information as their company will already have all of your information on file.
Phone Scams
Medicare will never call you unless you’ve specifically requested a phone call. If the Social Security Administration needs more information to process your Medicare application they will first send you a letter to set up a time to talk to you on the phone. Other than that the only calls you can expect from Medicare are ones you have personally set up by either requesting a call in writing or by calling 1-800-MEDICARE (1-800-633-4227).
Even when you do get a formal Medicare call (which is rare), they will never ask for credit card or banking information. Scammers will typically try to get you to share this information, as well as your Social Security and Medicare numbers. Don’t share this information with anyone. To keep yourself safe, make sure you know who is calling you. To be extra sure, you can tell the caller that you will call Medicare directly to handle whatever the problem is. This way when you call you know the number is actually Medicare.
Marketing Scams
Medicare Open Enrollment runs from October 15th to December 7th every year. Seniors will get a lot of mail about different Medicare plans at this time of year. Some of this information may be legitimate, but some can also be scams. It’s important to separate fact from fiction. If you are new to Medicare, the best way to make sure that you’re getting real information is to use the Medicare Plan Finder. This is the official government site that has all the information about available MEdicare plans.
An even better way to confirm all the information is real is by working with a licensed agent, such as EZ. You can make sure they are real by checking credentials with the National Association of Insurance Commissioners, and remember, never give out information to anyone calling unsolicited.
Email Scams
Spam emails are another way that people try to get your Medicare number or other personal information. The email might say it comes from a doctor’s office, a state or local health agency, a hospital, or the Centers for Medicare and Medicaid Services. The email scam could come in many different forms, such as a request for personal information because you need a new Medicare card or because changes to Medicare mean you should get money back.
No matter what the reason, it’s not right. Nobody from the government, a service provider, or an insurance company will ever send you an email asking for your Medicare number, bank account information, or other personal information. Again, the best thing to do is to close the email without replying or clicking on any of the enclosed links. If you want to know if the email is legitimate, you can call 1-800-MEDICARE or the number on the back of your card.
Tips To Avoid Medicare Scams
There are a handful of ways to avoid Medicare scams. We’ve briefly mentioned them above but here’s a full look at tips to keep you safe.
1.Protect Your Medicare Card
Your Medicare card is just as important as your Social Security Card. Just like you’d never keep your SS card out, do the same with your Medicare Card. Never give your Medicare number out to anyone who isn’t your doctor or an authorized Medicare agent.
2. Be Wary Of Phone Calls
If a government agency or insurance company needs to confirm information, especially sensitive information like a social security or Medicare number, they will send you a letter. Uncle Sam doesn’t make phone calls to people who haven’t asked for them. The Social Security Administration, the IRS, or Medicare will only call you if you have already talked to them and given them permission to call you again. And if Medicare really does call you back, they already have your Medicare number and other personal information on file.
3. You Don’t Need To Activate Your Medicare Card
Scammers often pretend to be from Medicare to get you to “activate” your Medicare card for a fee. Your Medicare card is not a debit card. There is no activation needed to use it and you’ll never have to pay to use your Medicare card.
4. Medicare Reps Are Not Salesmen
Medicare will never contact you trying to sell your services or plans. Your Medicare is something you seek out on your own; they do not try to sell you specific services. The only people that should recommend medical services or products is your doctor.
5. Analyze Medicare Statements
Medicare or your private insurance company sends you claims summary statements with information about the health care you have received. Pay close attention. It’s important to make sure you get all the services and goods that are provided. Report anything you think might be a mistake.
Reporting Medicare Fraud
If you think something is wrong with a Medicare bill, you should first call your doctor, provider, or the facility to see if there was a mistake. You might also want to talk to the people in charge of billing. If you have Original Medicare and are still worried, you can talk to the Medicare Administrative Contractor (MAC). Your Medicare Summary Notice (MSN) has information about the MAC, which is the company that handled your Medicare claim. You can also call 1-800-MEDICARE (1-800-633-4227).
If you are still worried and have a Medicare Advantage Plan, you can talk to your plan directly. The phone number for your plan should be on the back of your benefit card and on your EOB (Explanation of Benefits. To report fraud, call 1-800-MEDICARE (633-4227), the Senior Medicare Patrol (SMP) Resource Center (877-808-2468), or the Inspector General’s fraud hotline at 1-800-HHS-TIPS (447-8477). If you don’t want to, Medicare won’t use your name in an investigation.
Let EZ Help
Medicare is great, but sometimes it can be hard to understand. Even after signing up, you’ll still have to make some decisions about your health care. Don’t worry. Talk to an EZ agent who can tell you what you need to do to sign up and explain everything to you. EZ can help you enroll, buy a Medicare Supplement Plan, or just think about your options. Our insurance agents work with the best firms in the country. You can get a free comparison of all the plans in your area from them. We’ll talk with you about your medical and financial needs and help you find a plan that meets them all. Call one of our licensed agents at 877-670-3602 to get started.
As you age, you’ll start to face new health problems, and old ones become harder to treat. Thankfully, according to the Center for Disease Control and Prevention (CDC), seniors today can expect to live longer and healthier than ever before. That doesn’t mean you don’t have to be careful with your health though. Taking steps like quitting smoking, losing weight, and eating healthier can help you avoid the most common health issues that seniors face.
Heart Disease
Heart disease is one of the most common health problems that seniors have to deal with. There are a range of conditions that fall into the heart disease category:
Blood vessel diseases
Arrhythmias (irregular heartbeat)
Congenital heart defects
Heart muscle disease
Heart valve disease
Heart diseases are also called “silent killers” because they don’t always have obvious outward signs. You have a higher risk of heart disease if you have diabetes, high blood pressure, or high cholesterol.
Heart Disease Symptoms
Heart disease symptoms vary depending on what types of disease it is:
Blood Vessel Disease Symptoms
Coronary artery disease is a common heart problem that affects the main blood vessels that bring blood to the heart muscle. Most of the time, coronary artery disease is caused by cholesterol buildup (plaque) in the heart’s vessels. This plaque build up can lead to the heart and other parts of your body getting less blood. Which can lead to heart attacks, angina, or stroke. Men and women can have different signs of coronary artery disease. For example, men more commonly experience chest pain while women are more likely to have nausea, fatigue, and shortness of breath. Other symptoms include:
Chest tightness
Chest pressure
Pain in the neck, jaw, throat, upper abdomen, or back
Numbness, pain, weakness in your legs or arms
Coronary artery disease might not be found until you have a heart attack or stroke. It’s important to keep an eye out for any of these symptoms and talk to your doctor about them. If you mention it early enough the disease can be found and treated early.
Arrhythmia Symptoms
Arrhythmia is when your heart is beating too fast or slow in an abnormal way. In general, heart arrhythmias can lead to problems like stroke, sudden death, and heart failure. Blood clots are more likely to happen in people with heart problems. If a clot breaks free, it can move from your heart to your brain and cause a stroke. Some signs of arrhythmia are:
Chest pain or discomfort
Dizziness
Fainting
Chest flutters
Lightheadedness
Racing heartbeat
Shortness of breath
Slow heartbeat
Congenital Heart Defect Symptoms
Adult congenital heart disease (ACHD) is a group of disorders that affect the structure of your heart and are present at birth. “Congenital” means that the problem was there when the baby was born. It happened while the baby was still in the womb. These diseases can change how your heart pumps blood. They are also called birth defects of the heart.
Heart problems that are present at birth can be mild or very dangerous. Depending on the type of heart disease and how bad it is, signs may not show up until a person is an adult. Some people never feel anything at all. And some people were treated for these conditions when they were kids, only to have long-term effects as adults. Symptoms include:
Blue tints to fingernails, lips, and skin
Dizziness
Fatigue
Heart murmur
Heart palpitations
Irregular heartbeat
Shortness of breath
Swelling in your ankles, feet, or hands
Heart Muscle Disease Symptoms
Heart muscle disease, or cardiomyopathy, makes it harder for senior’s heart to pump blood to the rest of your body. Cardiomyopathy can cause the heart to stop working. There are 3 types of cardiomyopathy: dilated, hypertrophic, and restrictive. Depending on the type of cardiomyopathy and how bad it is, treatment might include medicines, device implants, surgery or in the worst case heart transplant. Symptoms include:
Breathlessness
Swelling in your legs, ankles, and feet
Bloating
Coughing
Difficulty lying down
Fatigue
Chest discomfort
Dizziness
Fainting
Heart Valve Condition Symptoms
The aorta, mitral, pulmonary, and tricuspid valves are the four valves in the heart. They open and close to help the heart pump blood. Many things can hurt the valves in the heart. A heart valve can become narrowed (stenosis), leaky (regurgitation or weakness), or not close properly (prolapse).
Heart valve disease is another name for valve heart disease. Depending on which valve isn’t working right, the signs of heart valve disease are usually:
Chest pain
Fainting (syncope)
Fatigue
Irregular heartbeat
Shortness of breath
Swollen feet or ankles
Medicare And Heart Disease
Medicare Part B pays for heart disease blood tests every 5 years if your doctor orders them. You don’t necessarily have to have any signs of heart disease to get these tests done, you can have them just as a precaution if you’d like. Original Medicare pays 100% of the Medicare-approved amount for screening blood tests for heart disease. This means you don’t have to pay anything. Medicare Advantage plans have to cover heart disease screenings without deductibles, copayments, or coinsurance if you see a provider in their network.
During your heart disease check, your doctor may find something new or old that needs to be looked into or fixed. This extra care is diagnostic, which means that your doctor is treating you because of some signs or risk factors. During a preventive visit, Medicare may charge you for any medical care you get.
Obesity
As the number of seniors in the U.S grows, so does the obesity rate. According to the National Health and Nutrition Examination Survey, more than one-third of seniors were considered obese. Research has shown that obesity puts older people at risk for a wide range of health problems. When a person is overweight, their organs are put under extra stress, which makes it hard for them to work properly. If you are obese as a senior, you are more likely to have health problems like:
Diabetes
Hypertension
Respiratory problems
Arthritis
Osteoarthritis
Cardiovascular disease
Cancer
Mobility issues
Body pain
Gallbladder disease
Additionally, obesity has been shown to cause depression and a low quality of life. Depression in old age can put you at a higher risk for heart disease and other serious health complications.
Medicare and Obesity
Recent changes to Medicare Part B are a big step toward getting doctors and patients alike to see obesity as a serious health problem. So, beneficiaries with a BMI (body mass index) of 30 or more can get free obesity screenings and behavioral therapy through the Intensive Behavioral Therapy for Obesity program. Their services must be given by a doctor, nurse practitioner, physician’s assistant, or clinical nurse specialist. Covered services include:
Initial BMI assessment
Nutritional evaluation
Ongoing weight loss and dietary counseling
Medicare only pays for visits that take place in a primary care setting as part of the Intensive Behavioral Therapy program. If your doctor tells you to see someone else, like a chef, you’ll have to pay for those services yourself. Some Medicare Advantage (Part C) plans give you more benefits, which can help you lose weight. These plans may cover gym memberships and subscriptions to exercise programs like SilverSneakers, an app for older people that helps them stay fit. For a short time, some Medicare Advantage plans may also cover the delivery of healthy meals to your home.
Medicare will pay for bariatric surgery if your doctor says you need it because you are very overweight (BMI of 35 or higher). In most cases, you’ll need a certain BMI and at least one health problem connected to your weight, like diabetes or heart disease, in order to get coverage. You must also show that you have tried and failed to lose weight in the past by dieting or working out.
Diabetes
Diabetes affects about 33% of adults ages 65 and up. People in this age group are more likely than younger people with diabetes to get problems like hypoglycemia (low blood sugar), kidney failure, and heart disease. There is new knowledge that can help us better understand and treat diabetes in older people. Special things should be taken into account to help people’s general health and quality of life. Many older people have more than one condition at the same time, such as cognitive impairment, heart disease, and others that affect how they learn about and take care of their diabetes.
Diabetes Symptoms
Diabetes can cause you to feel tired, hungry, or thirsty more often, to lose weight without trying, to urinate a lot, or to have trouble seeing clearly. You could also get skin diseases or take a long time to recover from cuts and bruises. Some people with diabetes may not know they have it because the signs usually come on slowly and are easy to miss. Seniors sometimes brush off these signs as “getting old,” but they could be signs of a major problem. If you have any of these signs, you should talk to your doctor.
Medicare And Diabetes
If you have been diagnosed with diabetes or have certain risk factors, you can rest easy knowing that Medicare Part B covers free diabetes screenings, prevention programs, supplies and nutrition therapy. So you won’t have to pay your deductible or the copayment for Part B, which is usually 20% of the cost of services paid by Medicare. Part B also pays for lessons on how to take care of your diabetes on your own, but you may have to pay the Part B deductible and copay.
Screenings
You can get up to two diabetes checks a year for free if your doctor thinks you might get diabetes and you have any of the following risk factors:
High blood pressure
Abnormal cholesterol history
High blood sugar
Obesity
Or if you have 2 of more of these:
Are 65 or older
Had gestational diabetes during a pregnancy
BMI of 25-29.9
Parents or siblings with diabetes
Prevention
One Medicare-covered diabetes prevention program can help you avoid type 2 diabetes, which often happens to people because of what they eat, how little they exercise, or how they live their lives. The program includes weekly group meetings for six months to help you change your diet, move more, and keep your weight in check, as well as six monthly follow-up meetings.
To be eligible, you must have certain amounts of glucose in your blood or plasma, a BMI of 25 or more, and no history of type 1 or type 2 diabetes. Part B needs you to go to a program put on by a Medicare Diabetes Prevention Program provider that has been approved.
Nutritional Therapy
If you have diabetes or kidney disease and your doctor tells you to go to nutrition therapy, you don’t have to worry. This service may include an initial nutrition and lifestyle exam, individual and group nutritional therapy, help with managing lifestyle factors that affect your diabetes, and follow-up visits. The nutrition therapy services must be given by a registered dietitian or another qualified nutrition worker.
Diabetes Supplies
Medicare covers a lot of products for seniors with diabetes, like blood sugar monitors, glucose test strips, glucose solutions, and lancets used to draw blood. It also pays for constant glucose monitors for seniors who take insulin or who have had trouble with low blood sugar in the past. Part B says that these items are covered as long-lasting medical tools. After you’ve paid your Part B payment for the year, you’ll pay 20% of Medicare-approved costs.
You must buy the equipment from a Medicare-enrolled supplier or order it through Medicare’s mail-order program using a Medicare national contract provider. A Part D prescription plan pays for things like alcohol swabs, bandages, inhaled insulin devices, needles, and syringes that are used to give insulin.
Dementia
Dementia isn’t just one illness. It’s actually a general term for a group of signs that people with different diseases, like Alzheimer’s, may have. Diseases that are called “dementia” are caused by changes in your brain that make it not work properly. The symptoms of dementia cause a decline in cognitive abilities that is serious enough to make it hard to live on your own or do daily tasks. Dementia also changes how you act, feel, and relate to others.
60-80% of dementia cases are caused by Alzheimer’s disease. Vascular dementia is the second most common cause. It is caused by tiny blood clots and blocked blood vessels in your brain. People with mixed dementia have brain changes that stem from more than one type of dementia at the same time. Most people call dementia “senility” which is wrong because that term comes from the belief that mental decline is a normal part of aging, which it’s not.
Medicare And Dementia
Medicare covers dementia care, providing much-needed assistance throughout the condition. Alzheimer’s, vascular dementia, and other dementias require comprehensive care across multiple healthcare providers. However, Medicare addresses many of these needs, thankfully.
First, Medicare Part B covers cognitive tests. These are essential for senior dementia tracking. Doctors can adapt treatment plans based on cognitive changes in you or your loved one through regular cognitive exams. They can also identify the patient’s dementia stage. Medicare Part B provides cognitive and home safety tests. These examinations can detect household hazards that could injure or complicate dementia patients. The evaluations suggest ways to make living safer and dementia-friendly. Medicare Part B also covers care planning. The advancement of dementia requires care modifications. Medicare care planning helps address medical, social, and mental needs as dementia progresses.
Medicare Part A covers hospital stays for complications or severe dementia progression. Inpatient care at general or mental hospitals is included. Dementia care requires pharmaceutical management, which Medicare Part D provides. This prescription drug coverage covers doctor-prescribed dementia drugs. This coverage can greatly minimize senior drug expenditures, which can add up. While Medicare provides extensive coverage, it’s crucial to understand your plan’s deductibles, copayments, and other out-of-pocket charges. Remember that knowing what to expect might make dementia care easier.
How EZ Can Help
EZ can help you enroll in Medicare, buy a Medicare Supplement Plan, or compare options. Our representatives deal with top insurance companies. They can compare all local plans for free. We will assess your medical and financial needs and recommend a plan. Simply call one of our qualified agents at 877-670-3602 or enter your zip code in the bar below to begin.
Medicare enrollees are generally more likely to experience mental health issues. In fact, about 1 in 5 elderly citizens suffer from some form of mental disorder. Thankfully, Medicare provides coverage for counseling which can make support more accessible. Mental health programs and services exist to diagnose and treat mental health needs. As a Medicare beneficiary, you have access to screenings for depression, counseling sessions, medications, and partial hospitalizations. The amount you pay for these services all depends on where you receive care, your doctor’s fees, and any supplemental insurance you might have. Below we’ll look at all of the ways Medicare provides coverage for treatments and what is and isn’t covered.
Medicare Plans with Mental Health Services
Medicare is made up of a few parts. Original Medicare includes Part A (hospital coverage) and Part B (medical coverage), both of which are offered by the federal government. Whereas private insurance companies’ contract with Medicare to provide Part C (Medicare Advantage) and Part D (prescription drug coverage). The government mandates that all of these plans cover certain mental health services for enrollees.
Medicare Part A covers mental health services for patients that are admitted to the hospital, regardless of whether they are in a general or psychiatric hospital. The coverage and cost-sharing are typically the same as any other type of hospitalization. For each benefit period you’ll pay the Part A hospital deductible which in 2023 is currently $1,600. As well as $400 a day for hospital coinsurance for days 61-90 of your hospital stay. If you stay longer than 90 days you can use your lifetime reserve days, which come with an $800 per day coinsurance. Keep in mind you only get 60 reserve days in your lifetime; they will not regenerate. Your benefit period begins the day you are admitted as an inpatient to the hospital or skilled nursing facility. It ends after you have been out of the hospital for 60 consecutive days.
Medicare Part A does treat billing for mental health in one way. It will only cover 190 days in a psychiatric hospital that specializes in mental health treatment during your lifetime. However, if you are admitted to a general hospital, even if it’s for a mental health condition, the days spent in the general hospital will not count toward that 190 day limit.
While Part A has the hospital side covered, Medicare Part B covers mental health services you get outside of a hospital. Such as in a doctor’s office, therapist’s office, hospital outpatient department, or community health center. Medicare Part B covers mental health services and visits to psychiatrists, clinical psychologists, clinical social workers, nurse practitioners, and physician assistants. As long as the provider accepts Medicare assignment, which means they agree to provide the services for the price that Medicare approves. Be aware that not every mental health professional will accept Medicare.
After you’ve met your Part B deductible ($226 in 2023), you will pay 20% of the Medicare-approved amount for the service. However, Part B does fully cover preventative services such as depression screenings for free. That is as long as they are provided by a primary care provider, physician assistant, or nurse practitioner who accepts Medicare Assignment. The screening must also be done in a primary care setting such as a doctor’s office where you’re able to receive follow up treatment and referrals. However, aside from the preventative screening, follow up treatment and referrals to see other specialists are not free.
Medicare Part B will also cover partial hospitalizations if you need more intensive care than your doctor or therapist can provide. Typically this partial hospitalization will happen in an outpatient hospital department or a mental health center, where patients do not stay overnight. Part B pays for these services, but you have to meet certain requirements, including having your doctor certify that without these services you would need to be hospitalized.
For partial hospitalizations you will be responsible for 20% of each service you receive. You may also have to pay for coinsurance for each day of outpatient hospital or mental health center treatment.
Medicare Advantage is an alternative option to Original Medicare (Parts A and B), and as such, it generally covers all the same benefits combined into one plan. These plans may also offer additional coverages for telehealth care, grief counseling, and conflict resolution. However, Medicare Advantage plans may have smaller limited provider networks for mental health providers. So, before enrolling make sure your plan covers what you need and the doctors you prefer.
So far we have hospitalization and outpatient mental health services covered in Parts A, B, and C, so all that’s left is your prescriptions. That’s where Part D prescriptions coverage comes in. You can either buy a separate Medicare Part D or enroll in a private Medicare Advantage plan that includes prescription drug coverage. Both types of plans will list covered medications on their drug formularies. Part D plans have to cover, with limited exceptions, all anticonvulsant, antidepressant, and antipsychotic medications. During Open Enrollment, when you’re selecting a Part D or Medicare Advantage plan, make sure the plan will cover your medications and find out exactly how much you would pay in copayments or coinsurance. Since these plans are offered by private insurance companies your out-of-pocket costs can vary from one plan to another. So, comparing is key.
Coverage For Other Types of Mental Health Counseling
Medicare isn’t limited to only helping you with depression and anxiety. Plans also cover substance use disorders and other mental illnesses as well. However, Medicare will only cover counseling services that directly address your mental health condition. We’ve detailed these services below.
Substance Use Disorders
Substance use disorder is considered a chronic mental illness. Medicare plans treat substance use disorders just like they would diabetes or cardiovascular disease. Medicare Part B covers the following substance use disorder treatments:
Monthly care management
Drug testing
Tobacco counseling
Opioid use disorder treatments
Alcohol use disorder screenings
Individual therapy
Group therapy
Medications
Drug withdrawal treatment
Opioid Treatment
Original Medicare covers the total costs of opioid use disorder treatment as long as it’s administered by a Medicare-enrolled program. You may have to pay an additional copayment or coinsurance for any opioid treatment services you receive in an outpatient hospital setting.
Alcohol Use Disorder
Medicare provides screening and therapy for alcohol use disorder to people who drink but are not dependent on alcohol. Medicare may cover up to 4 counseling sessions per year for alcohol abusers. It also pays for:
Detox
Rehab
Advance care planning
Behavioral health integration into primary care for monitoring
As long as your healthcare provider accepts Medicare assignment, you pay nothing for these services.
Marriage and Family
Medicare Part B plans will also help cover family counseling. However, the family counseling services must be medically necessary for your mental health treatment. Medicare typically will not cover marriage counseling or couple counseling though.
Specific Mental Health Services
Medicare provides access to specific mental health care in a variety of ways. Here we will go more into detail about each of these services.
Inpatient Care
Medicare will cover inpatient care if you need intensive care that can only be provided in an inpatient setting. These plans will help with treatment costs and inpatient psychiatric facilities, critical access hospitals, and hospital psychiatric units. Medicare Part A covers up to 190 days of hospitalization in a psychiatric facility. Part B helps cover a portion of doctor or specialist fees that come with mental health inpatient care.
Outpatient Care
If your doctor accepts Medicare assignment, your yearly depression screening is free. However, for any doctor visits to diagnose and treat your mental illness you’ll have to pay the Part B deductible and 20% of the Medicare-approved amount. Medicare covers the costs of the outpatient psychiatric hospital services and supplies as long as they are:
Medically necessary for diagnostic studies
You are expected to improve with treatment
The service is given under a care plan, which is a written plan that your provider writes and includes a list of the types of services you need, how long you need them, and how much they’re predicted to cost.
The prescribing doctor supervises and monitors the services.
Partial Hospitalization Programs (PHPs)
PHPs are structured outpatient mental health treatment programs. Medicare will cover these programs for patients who receive care from hospital outpatient centers and community mental health centers. PHPs give less than 24 hours of mental health care a day to people who have been recently discharged from an inpatient hospital program but need continued support, or people who are at risk of being hospitalized due to their mental illness. If your providers accept Medicare assignment, you may be responsible for a portion of the Medicare-approved amount for each service. You may also have to pay coinsurance for each day you receive PHP services.
Community Mental Health Centers
In addition to the services that you get from PHPs, community mental health centers offer hospitalization alternatives. These facilities offer 24-hour emergency care with follow-ups, and screenings for admission to a state mental health facility. They also provide day treatment, partial hospitalization, or rehab that line up with your mental health needs.
Telehealth visits, consultations, and psychotherapy are all covered by Medicare Part B. You will have to pay both the Part B deductible and 20% of the Medicare-approved amount for these services though. In most cases, telehealth costs are generally the same as costs for in-person visits.
The Bottom Line
Medicare plans cover an extensive array of outpatient services, such as individual and group therapy, prescription medications, and diagnostic testing for depression, substance abuse, and other psychiatric disorders. In-person and virtual meetings are also covered.
Help is available if you experience an emotional crisis requiring medical attention. Medicare can also cover a significant portion of inpatient care costs. If you require assistance with Medicare in general, EZ is also available to assist you. EZ can help you enroll in Medicare, purchase a Medicare Supplement Plan, or evaluate your options. Our agents work with the nation’s top insurance providers. They can provide you with a complimentary comparison of all local plans. We will assess your medical and financial needs and assist you in locating a plan that meets them. Simply call one of our licensed agents at 877-670-3602 to get started.
The National Cancer Institute defines gynecology as a field of medicine that focuses on diagnosing and treating diseases of the female reproductive organs. It is often grouped with obstetrics. Gynecology also focuses on other issues related to women’s health, like menopause, hormone problems, birth control, and infertility. Gynecology is not just for younger women, you still need it as you age. That’s why a number of important gynecology treatments are covered by Medicare.
As long as you have an OB/GYN who takes Medicare, you can get preventive women’s health care through Medicare Part B.There are no exceptions; all women who have Medicare Part B have benefits for gynecology. You should make use of these advantages! Remember that Medicare isn’t just meant to help you when you’re sick or hurt; it’s also meant to keep you from getting sick in the first place.
Preventative Screenings
Medicare pays for Pap smears, pelvic checks, STI testing, and HPV screenings. Your medical history and any risk factors will determine how often you can get these preventive treatments. For women with no symptoms and low risk pap smears and pelvic exams are recommended once every 2 years. While women with a higher risk of cervical cancer, or women with a history of abnormal pelvic exams should go annually. Johns Hopkins University says that cervical cancer is more likely to be cured if it is found and treated early. Screening tests, like Pap smears and pelvic checks, can help find cells that aren’t working right and could lead to cancer.
Pelvic Exams
During a pelvic exam, the reproductive systems, including the vagina, vulva, cervix, ovaries, uterus, rectum, and pelvis, are examined physically. During a pelvic exam, your doctor may look for problems, do a Pap and/or HPV test, and look at your medical history.
Pap smears look for signs of cancer in the cervix. The doctor takes a few cells from your cervix with a small tool that looks like a spatula. The sample is then sent to a lab where it is checked for precancerous cells or other problems. If the doctor can find pre-cancerous cells early, you can get treatment before the cancer gets worse. Medicare Part B pays for Pap tests and pelvic exams once every 2 years to check for vaginal and cervical cancers. If you are at high risk, Medicare will pay for these tests once every 12 months. If you do any of the following, you may be in the high-risk group:
If you have had an abnormal pap smear result in the last 3 years
Were sexually active before your turned 16
Have had more than 5 sexual partners throughout your life
Have a history of or currently have an STD
As long as you meet the standards to get these services and get the annual checks, they are free. All of the tests, including the Pap check, lab work, a pelvic exam, and a breast exam, are free. Only if you go to a doctor who does not accept Medicare assignment will you have to pay for these services.
Mammograms
Mammograms are the best way to detect breast cancer. Original Medicare Part B pays for some preventive services, like mammograms, but there are rules you need to know before you schedule one.
Types of Mammograms Covered By Medicare
First of all, Medicare covers 3 types of mammograms:
Baseline mammogram – The first mammogram you get is called a baseline mammogram. It is used to look for early signs of breast cancer and will be compared to other scans in the future.
Screening mammogram – Mammograms used for screening are preventive tests that look for new signs of breast cancer. They are usually done once a year on women over 40 who have no symptoms or signs of breast cancer and are thought to have an average risk of getting it.
Diagnostic mammogram – A diagnostic mammogram is used to find out more about something wrong with the breast tissue, like a lump or a growth. To check for breast cancer, an x-ray of the breast will be taken. Diagnostic mammograms can also be used to find out more about a possible risk that was found during a screening mammogram.
How Often Medicare Covers Mammograms
The next thing you need to know is how often Medicare will cover a mammogram. Medicare will pay for one baseline mammogram for a woman between the ages of 35 and 39. Women over 40 are covered for a screening mammogram once every 12 months. Medicare will pay for as many screening mammograms as you need if they are deemed medically necessary.
Cost Of Medicare Covered Mammograms
Part B pays 100% of the Medicare-approved amount for baseline and yearly screening mammograms if your doctor or health care provider accepts assignment. That means you pay nothing (no deductible or coinsurance) for one baseline mammogram between the ages of 35 and 39, and you pay nothing for one screening mammogram every year if you are 40 or later.
If you get your mammogram from a participating provider, Medicare will pay 80% of the Medicare-approved amount. After you pay your Part B copay, you pay a 20% coinsurance fee ($164.90 in 2023). What you pay out of pocket can depend on how much your doctor charges and what other insurance you may have.
Do You Need A Pap Smear, Pelvic Exam, Or Mammogram After You Turn 65?
Even for older adults, Pap tests are an important way to check for cervical and vaginal cancers. Even if you are 65 years old, you may still be at risk for cervical cancer or vaginal cancer, so you should keep getting Pap tests until your doctor tells you to stop. Pap tests are no longer necessary after age 65 if:
You’ve have 3 consecutive negative pap results
You’ve have 2 negative pap-HPV tests in a row
On the other hand you definitely need to continue Pap smears if:
You have a medical history of lesions of cervical cancer
You were given DES, a synthetic estrogen hormone, during a pregnancy
If you have a weakened immune system
Even if you don’t need Pap smears anymore, gynecology exams are still a good way to check for health problems, especially if you are still sexually active. Regular pelvic checks in older people can help find more than just vaginal cancer. They can also help find sexually transmitted infections (STIs) and other changes in the vagina, rectum, or abdomen that aren’t normal. Also, the CDC says that most cases of breast cancer are found after the age of 50. Since Medicare covers both a breast exam and a pelvic exam, it is very important that you make sure your doctor gives you regular breast checks after you turn 65.
Which Parts Of Medicare Cover Gynecology?
Medicare will pay for appointments with an OB-GYN. But that’s not always the case. As is usually the case with Medicare, you have to meet certain requirements for Medicare to pay for your trips to the OB-GYN. We’ll explain what these are below so you know what to expect.
Gynecology exams are covered by Original Medicare, which is made up of Medicare Parts A and B cove. Medicare Part B covers the cost of a visit to an OB-GYN. Medicare Part B pays for OB-GYN treatments like pap smears, pelvic exams, and breast exams. Once every 24 months, Medicare Part B pays for the above-mentioned services,ut Medicare Part B may pay for these tests once a year if you are at high risk of cervical or vaginal cancer or if you are of childbearing age and have had a negative pap smear in the last 3 years. During the tests, if your doctor finds a new or existing problem and has to treat it, that care would is diagnostic care, and Medicare Part B could send you a bill for it.
Medicare Advantage plans (Medicare Part C) also covers OB-GYN visits. By law, they must pay for everything Original Medicare pays for. But these plans also cover a wider range of health care treatments. Different plans will cover different services and charge different amounts for these services and the plan itself.
EZ Can Help
Original Medicare covers most of the health care needs of women, which is good news. But Medicare Advantage and Medicare Supplements can add to the benefits you get from Original Medicare. Our licensed agents can help you find more health benefits through Medicare Advantage or more cash benefits through Medicare Supplements. Talk to an EZ agent who can tell you what you need to do to sign up and explain everything to you.
EZ can help you sign up, buy a Medicare Supplement Plan, or just think about your choices. Our insurance brokers work with the best firms in the country. You can get a free review of all the plans in your area from them. We’ll talk with you about your medical and financial needs and help you find a plan that meets them all. Call one of our agents at 877-670-3602 or enter your zip code in the bar below to start.
