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Does Medicare Cover Knee Replacement Surgery?

With age comes wear and tear to your body. Knees are especially vulnerable to damage because of how much use they get over the years. As you age, the cartilage in your knees wears down, and can become almost non-existent, causing arthritis and leaving bone to painfully rub on bone as you move. Cartilage loss in your knees can often only be treated with knee replacement surgery. This type of surgery is very common, especially for people over 60: there are over 750,000 knee replacement surgeries performed annually in the United States, and over 3 million Americans have knees that have been replaced. If your doctor recommends knee surgery, it is important to know just how much Medicare will cover.

What The Surgery Involves

x-ray of a knee with plates in it — *During knee surgery, you can receive metal implants or plates between the bones.*

Knee replacement surgery, also called knee arthroplasty or total knee replacement, is done to resurface any damage caused by arthritis. During this surgery, doctors:

Remove all damaged cartilage.
Use metal and plastic parts to cap the ends of the bones that form the knee joint along the kneecap, so that the two bones are not rubbing against each other when in use.
Put metal replacement implants into the knee.
Resurface the kneecap.

Most patients are able to resume normal daily activities within 6 weeks after surgery, and drive within 3 to 6 weeks. Depending on the surgery, though, it can take as long as 6 months or up to a year to fully recover. Even with the long recovery time, most patients who have had the surgery say that it was worth it. According to the American Academy of Orthopedic Surgeons, 90% of people who have had knee replacement surgery experience significantly reduced pain and stiffness, and an increase in vitality.

What Does Medicare Cover?

Medicare Parts A and B will cover knee replacement surgery as long as your doctor considers it medically necessary. Part A will cover in-hospital treatment, including the surgery and any inpatient recovery time, after you have met your Part A deductible of $1,408. If you are in the hospital for less than 60 days, then you will not have to pay a copay for your stay. Part B will cover medical costs before the surgery, any follow-up appointments, and outpatient visits. If you need physical therapy afterwards, Medicare Part B will cover the sessions at 80%. In addition, if you need any durable medical equipment, such as a walker or a cane after your surgery, Medicare Part B will cover the cost, again at 80%. You will be responsible for your part B deductible of $198 and 20% coinsurance.

Can A Medicare Supplement Plan Help?

Medicare Supplement Plans help you pay for your 20% coinsurance, co-payments, and, in some cases, your Medicare Part A and Part B deductibles. Different plans offer different coverage and price points, but having a Medicare Supplement Plan will most likely save you hundreds of dollars a year, if not more. There are 10 different Medicare Supplement Plans to choose from, so you are sure to find the right plan for your specific needs. If you do not have a Medicare Supplement Plan, then you should consider signing up for one to save money on medical costs, and to have more services covered than are generally covered by Original Medicare.

If you have any questions about Medicare coverage options, or about the Medicare Supplement Plans available in your area, EZ can help. One of our licensed insurance agents will compare all available Medicare Supplement Plans in your area, and will find the one that best fits your medical and financial needs. To explore your Medicare Supplement Plan options, simply enter your zip code in the bar above, or to speak directly to a Medicare agent, call 888-753-7207.

Questions To Ask Your Medicare Agent

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

What You Will Need

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

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

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

Questions To Ask

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

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

Why Use An EZ Medicare Agent

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

Preparing For Medicare Open Enrollment: 2021 Medicare Costs

The Centers for Medicare & Medicaid Services (CMS) has finally released Medicare costs for 2021. Knowing these costs will help you decide whether to stick with Original Medicare or buy a Medicare Supplement Plan to help pay for your Part B premiums and costs. Medicare Open Enrollment is still going on, but not for long! It will be over December 7, so read on to find out how you can be better prepared for next year.

Medicare Part A Premiums/Deductibles

money bills spread out on a table with a stethoscope on top of it. — *Medicare Part A (hospital insurance) deductible has one up $76 dollars.*

Medicare Part A is hospital insurance, and covers things like skilled nursing facilities, inpatient hospital stays, and some home healthcare services. If you are 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years, then you will be eligible for premium-free Part A.

The Medicare Part A inpatient deductible that you must pay when admitted to the hospital will be $1,484 for each benefit period in 2021, which is an increase of $76 from $1,408 in 2020. The breakdown for 2021 is:

Days 1-60- $0 coinsurance for each benefit period
Days 61-90– $371 coinsurance per day of each benefit period
Days 91 and beyond- $742 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime)
Beyond lifetime reserve days- you pay all costs

Medicare Part B Premiums/Deductibles

Medicare Part B is medical insurance and covers such things as doctor visits, outpatient hospital services, durable medical equipment (DME), and certain home health services. The government had indicated that Medicare Part B premiums would not increase by more than 25% in 2021. CMS’ announcement has now given us the exact amount they will increase by: Medicare Part B premiums for 2021 will be $148.50, which is an increase of $3.90 from $144.60 in 2020. Your premium amount may be higher depending on your income:

CMS also announced that the annual deductible for Medicare Part B will be $203 in 2021, which is an increase of $5 from $198 in 2020. You will continue to pay 20% of the Medicare-approved amount for most doctor services, outpatient therapy, and durable medical equipment after this $203 deductible is met.

Considering A Medicare Supplement Plan

Although the costs are not going up by too much next year, for some who are on a fixed income or a tight budget, an almost $4 a month rise in premiums can be a lot. On top of that, the 20% coinsurance you will have to pay could increase with the rising costs of healthcare. Luckily there are ways to help pay for coinsurance and save money.

Medicare Supplement Plans are perfect for beneficiaries looking to save money and have more of their medical care covered. There are 10 different Medicare Supplement Plans to choose from, each with different price points and coverage options. If you are interested in looking into these plans but do not know where to start, allow an EZ.Insure agent to help. Our licensed agents work with the top-rated insurance companies in the country and can compare plans in your area in minutes. We will assign you one and only one agent who will go over your budget and medical needs. They will compare Medicare Supplement Plans to find the one that is best for your needs. What’s even better is that all of our services are free! To get instant free quotes, simply enter your zip code in the bar above, or to speak directly to an agent, call 888-753-7207.

Medicare Advantage Vs. Medicare

You’re probably already familiar with Original Medicare, especially if you’re nearing the age of 65 and getting ready to enroll. You may not be aware, though, that there are some gaps in Original Medicare’s coverage, which lead many people to either add a Medicare Supplement Plan or choose a Medicare Advantage Plan. Medicare Advantage Plans, also known as Medicare Part C, are very similar to Original Medicare. However, there is a slight difference between the two, mainly that Medicare Advantage Plans offer more coverage than Original Medicare.

caucasian hand over an older caucasian hand bringing it towards blocks — *Medicare Part B covers physical therapy, doctor visits, and more.*

Original Medicare Overview

Medicare is a government health insurance program consisting of:

Part A– Hospital insurance that covers hospital stays, skilled nursing care facilities, hospice care, and limited home healthcare services.
Part B– Medical insurance that covers preventive services, doctors’ office visits, flu shots, physical therapy, durable medical equipment, diabetes screening and supplies, and mental health care.

In most cases, you will not pay a monthly premium for Medicare Part A; the Medicare taxes that you paid while you were working are what pay for Part A. However, Part A does have a deductible, coinsurance, and co-payments.

Part B, on the other hand, does have a monthly premium: the Medicare Part B premium for 2020 is $144.60, but could be higher depending on your income. Like Part A, Part B also has a deductible, coinsurance, and co-payments for most services. Medicare Part B covers 80% of your costs, meaning you will need to pay the remaining 20% of any bills.

Medicare Advantage Overview

Medicare Advantage is an “all-in-one” alternative to Original Medicare. Private insurance companies approved by Medicare can offer Medicare Advantage Plans. Unlike Original Medicare, most Medicare Advantage Plans include prescription drug coverage, and some plans offer more benefits, like routine dental or hearing care. In order to be eligible for Medicare Advantage, you have to be enrolled in Medicare Part A and Part B. You must also live in the plan’s service area, and you cannot have end-stage renal disease.Medicare Advantage Plan premiums differ from plan to plan. Many Medicare Advantage Plans have low-cost, or even $0, premiums. The average Medicare Advantage premium is only $30 a month. Remember, you will still have to pay your monthly Medicare Part B premiums in addition to any Medicare Advantage premium.

The Similarities

All Medicare Advantage Plans have to offer at least the same benefits as Medicare Parts A and B do. This means that if Original Medicare covers hospital care at a certain level, then so will a Medicare Advantage Plan.

The Differences

The benefit of Medicare Advantage Plans is that they offer more coverage than Original Medicare. The following chart breaks down the differences between the two:

Does Medicare Cover a CPAP Machine?

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

What Is A CPAP Machine?

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

When Medicare Will Cover CPAP

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

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

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

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

How Much Is Covered By Medicare?

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

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

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

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

Medicare Supplement Plan

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

Preparing For Medicare Open Enrollment: Important Documents

September is here, and with it will come important documents for Medicare’s fall Open Enrollment. Medicare Open Enrollment, which is also referred to as the Annual Election Period (AEP), occurs every year from October 15th to December 7th. During this period, you have the option to change your Medicare plan for 2021. In order to be better prepared, it is important to review the information that you will be receiving this month. Check your mailbox for the following important documents:

Medicare And You Handbook

the word medicare with words pertaining to medicare insurance around it — *You will receive a “Medicare and You” handbook that will explain the benefits, your rights, and available plans.*

If you are already enrolled in Medicare, you will receive a free 2021 Medicare And You handbook in the mail this month. The handbook will provide you with:

A summary of Medicare benefits
Your Medicare rights
Answers to frequently asked questions
Lists of available health and drug plans in your area. All plans have to cover the same benefits listed in the handbook, but costs and coverage rules will vary based on your area.

If you did not receive your handbook, you can call 1-800-MEDICARE and request a copy with information for your region to be mailed to you. You can also view the handbook online at medicare.gov.

Annual Notice Of Change

If you have a Part D prescription drug plan or a Medicare Advantage plan, then you should receive a notice called the Annual Notice of Change (ANOC) this month. The ANOC will list any changes that will be made to your plan in 2021 regarding your:

Rates What you can expect to pay for your copays, annual deductibles, and drug costs for 2021.
Covered Drugs- You will be able to look through the plan’s formulary and see what drugs are being added or removed from Part D formularies.
Provider Network– Check to see which doctors, hospitals, and other providers and pharmacies will be in your plan’s network next year. Be sure to pay attention to this as networks do change from time to time, and you might find that some providers have been added or removed.

The EOC along with he ANOC are 2 very important documents that will notify you of any changes in your plans and if your plan is leaving Medicare.

Evidence Of Coverage

The Evidence of Coverage (EOC) document that you will receive will give you an in-depth explanation of the benefits and out-of-pocket costs for your plan. Your EOC should come in the mail with your ANOC, or you can look at the document on your plan’s website. Your EOC will notify you of:

Plans that are leaving the Medicare program, so you can start searching for another plan for the new year.
The quality of performance of your current plan, if your current plan has received a low rating for 3 or more years in a row. This is so you can begin to look at other, better-rated plan options in your area.

Notice of Creditable Coverage

If you get your health insurance and drug coverage through an employer, then you will receive a notice of creditable coverage. This will inform you if your coverage is still credible, and if it is as good as or better than Medicare coverage. You will need this document as proof that you had credible employer-based health insurance, so that you do not get hit with a late enrollment penalty when you decide to switch to a Medicare Advantage or a Part D plan.

the word important in written on a purple paper with a red thumbnail on it Review these notices so that you are aware of any changes being made to your Medicare plan. If you find that there are changes that you are unhappy with, then you can start searching for a new plan before Open Enrollment begins.

Once you receive these important documents in the mail and begin reviewing your coverage, you might find that your current plan will no longer fit your needs. If it is time to change your coverage, then it is time to call EZ.Insure. Our agents are highly trained in Medicare and help you compare all of the options available for your financial and medical needs. We want to make sure that you have the best coverage and care, especially during these times. To get free, instant quotes, enter your zip code in the bar above. Or to speak directly to one of our licensed agents, call 888-753-7207.

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