Medicare Supplement Plans Archives - Page 7 of 17

Medicare Will Now Cover Aduhelm Only for Those Enrolled in Clinical Trials

Last year, there was new hope in the fight against Alzheimer’s disease when a new drug, Aduhelm, was approved for use to combat the disease. But now Medicare officials have announced their final decision to cover this drug only for people who receive it as participants in a clinical trial. This is good and bad news: while the drug won’t be as widely available, Medicare officials are considering cutting premiums for all beneficiaries, since the new drug was the reason for the $22 increase in Medicare’s Part B premiums this year.

The Price of Aduhelm

Aduhelm hit the market as the first new Alzheimer’s medication in nearly two decades, and many hoped it would be a breakthrough in fighting the disease. It was first priced at $56,000 a year, and was expected to generate billions for the company that developed it, Biogen. This astronomical price did eventually come down to $28,000 a year, but this price tag is still too high for Medicare. illustration of a green price tag in an orange circle

The high price of Aduhelm has meant that:

Doctors have been hesitant to prescribe it, given the lack of coverage and weak evidence that the drug slows the progression of Alzheimer’s.
Insurance companies have blocked or restricted coverage.
Medicare Part B premiums have gone up $22 a month, the largest increase ever.

The Future Of Aduhelm

After all the concerns from insurers, doctors, and advocacy groups, Medicare decided to restrict the new drug, and only allow coverage for it for people involved in clinical trials. Dr. Lee Fleisher, the chief medical officer at the Medicare agency, explained this decision by saying that this way of dealing with the fast-developing field of Alzheimer’s therapies, a program called Coverage with Evidence Development, “is meant to be nimble and really respond to any new drugs in this class that are in the pipeline, and do demonstrate clinical benefit.”

But Medicare is also trying to make the trials accessible to more people: instead of requiring randomized controlled trials to be approved by C.M.S., Medicare will cover participants in any trial approved by the F.D.A. or the National Institutes of Health. This will allow the trials to be done in more locations, not just in hospital settings, and to include people with other neurological conditions like Down syndrome, many of whom develop Alzheimer’s but were not included in earlier trials.

money sign in an orange circle with a blue arrow pointing down beneath it — *Officials are hoping to lower Medicare Part B Premiums since the cost of Aduhelm has gone down.*

In the trials, “the manufacturers will have to come to us with how are they going to include all patients that represent the Medicare population, and how are they going to ensure that all of these patients are getting appropriate medical treatment and monitoring of their treatment while they’re in each of these studies,” Tamara Syrek Jensen, the director of coverage and analysis for the Medicare agency’s Center for Clinical Standards and Quality, said in an interview.

Medicare Premiums

In the meantime, Medicare officials are in talks to hopefully lower Medicare Part B premiums now that they will not be covering Aduhelm for all Medicare beneficiaries, and now that the drug is coming down in price.

If you are one of the millions of Medicare beneficiaries who are living on a fixed income, saving as much money as possible is a top priority. The best way to save money on healthcare is to find an affordable Medicare Supplement Plan – and the best way to do that? Speak to an EZ agent! We work with the top-rated insurance companies in the nation and can help find a plan that will save you money this year – maybe even hundreds of dollars. Let our agents take the stress off you by comparing plans and finding ways to help you save money. And because we want to help you save as much money as possible, our services are completely free- no-obligation or hassle. To get free instant quotes for plans that cover your current doctors, simply enter your zip code in the bar on the side, or to speak to a licensed agent, call 888-753-7207.

Does Medicare Cover Heart Transplants?

Heart transplants patients are getting older: 1 in 50 people who receive a heart transplant are aged 70 or older. And while heart transplants sound scary, recent studies show that survival rates continue to improve despite an increase in older and higher-risk heart transplant recipients. In fact, approximately 85 to 90% of heart transplant patients are still alive one year after their surgery, with an annual death rate of approximately 4% thereafter, and a three-year survival rate of almost 75%. This is all good news, but if you have to undergo a heart transplant, you are probably concerned about many things, including the cost of the surgery and whether Medicare will cover it.

Why Heart Transplants Become More Necessary With Age

Heart failure develops when your heart can no longer pump enough blood to provide your body with oxygen and nutrients. This can be caused by chronic conditions that you might have; if you reach heart failure, you could come to a point where medication cannot help, and the only option is to receive a heart transplant.

Medicare Coverage

One of the great things about Medicare is that it covers a wide variety of medical services, since there are different parts that cover different things. Part B covers general medical services that you would get from your doctor, and Part A covers services you receive while you’re in the hospital, as well as follow-up care and prescriptions. When it comes to receiving a transplant, Medicare Part A will pay for the surgery, as well as for finding the organ that you will receive during the surgery.

If it is not possible to receive a heart from a donor in time, you can consider receiving an artificial heart, but you should know that Medicare does not cover artificial hearts, whether permanent or temporary.

How Much Will You Pay?

Although Medicare does cover a lot of medical services and treatments, it does not cover everything 100%. Once Medicare approves the surgery, they will cover:

Services provided to prepare for the transplant, including finding the organ
The actual surgery
Follow-up services to ensure the transplant is successful
Any immunosuppressive drugs and other transplant-related prescriptions, if needed

All of the above will be covered at 100%, but you will have out-of-pocket costs, including your:

Medicare Part A deductible
Medicare Part B deductible, which must be fully paid if you receive any services following the surgery, such as rehabilitation.
Medicare Part B coinsurance- Medicare will only cover 80% of any necessary outpatient treatment and therapy sessions you receive, leaving you to pay 20% out-of-pocket

Extra Coverage

As we pointed out above, Medicare Part B will only cover the cost of services or treatment received at 80%, leaving you to pay for the other 20% out-of-pocket. If you have to have major surgery, like a heart transplant, this can be quite expensive, especially if you are living on a fixed income, as many Medicare beneficiaries are. Fortunately, though, you can save money on all your medical expenses and get extra coverage by purchasing a Medicare Supplement Plan.

There are 10 different Medicare Supplement Plans to choose from, each offering different coverage options and rates. It’s worth looking into a Medicare Supplement Plan to save as much money as you can, so speak to an EZ agent for all of your options. EZ’s agents work with the top-rated insurance companies in the nation and can compare plans for you in minutes at no cost to you. To get free instant quotes for plans that cover your current doctors, simply enter your zip code in the bar on the side, or to speak to a licensed agent, call 888-753-7207.

Almost Done With Your Medicare “Trial Right”? Want A Different Plan? EZ Can Help

Making the switch from private health insurance to Medicare can be confusing, and even a bit anxiety-inducing. Sure, Medicare is great, but it’s not always easy to navigate if you’re not used to it. There are a lot of little things that people are unaware of when they enroll in Medicare and purchase a Medicare Supplement Plan. For example, did you know that you have a Medicare “trial right”? This right gives you the ability to test out the Medicare Supplement Plan that you’ve purchased, and if you don’t like the plan or it doesn’t work for your needs, you can switch it for another one. But remember, you only have a limited amount of time to do so!

How Long Is Your Medicare Trial Right?

calendar — *You will have 63 days to decide if you want to purchase a Medicare Supplement plan once you’ve switched to Original Medicare.*

You can technically purchase a Medicare Supplement Plan whenever you want, but if you purchase it when you first turn 65, you can avoid the underwriting process. The underwriting process is when the insurer issuing your Medicare Supplement Plan reviews your medical history; they can charge you more for your premiums or deny you coverage based on your health status.

And if you do choose to purchase a Medicare Supplement Plan or even a Medicare Advantage Plan, you have time to try out the plan, known as your trial right. For a Medicare Advantage Plan, you have a full 12 months to try out the plan, and if you think it isn’t right for you, you can switch to Original Medicare and even purchase a Medicare Supplement Plan, as well. The great thing about this trial time is that, even if you choose to switch plans, you can still bypass the underwriting process, and continue to have what is known as a guaranteed issue. You will have 63 days to decide if you want to purchase a Medicare Supplement plan once you’ve switched to Original Medicare.

Now let’s say you purchased a Medicare Supplement Plan when you enrolled in Medicare, but you feel like the plan you chose is not working for you. You will have 30 days to change your plan to a different Medicare Supplement Plan. There are 10 different plans that you can choose from that offer different coverage and premium prices.

Can You Have More Than One Trial Right Period?

Unfortunately, once you exercise your trial right to switch from Medicare Advantage to Original Medicare and a Medicare Supplement Plan, or vice versa, you will not get another chance to switch. If you want to change plans again, you will have to enroll in a Medicare Supplement Plan and go through medical underwriting. However, that does not mean you won’t still be able to find a great, affordable plan! illustration of two people talking

You can work with a Medicare agent to figure out your best option when it comes to your Medicare Supplement Plan, so you can find a plan that covers everything you need covered, and that fits in your budget.

To save as much money as you can, speak to an EZ agent for all of your options. EZ’s agents work with the top-rated insurance companies in the nation and can compare plans for you in minutes at no cost. To get free instant quotes for plans that cover your current doctors, simply enter your zip code in the bar on the side, or to speak to a licensed agent, call 888-753-7207.

What’s the Difference Between a Preferred and Standard Pharmacy?

When you transition to Medicare from private insurance, figuring out how much your prescriptions will cost with your new healthcare plan might feel confusing, or even overwhelming. But there are ways to navigate this new world: one of the first, and most important things you’ll need to know when purchasing your prescriptions, is whether the pharmacy where you fill your prescriptions is considered by Medicare as preferred, standard, or out-of-network.

Knowing the difference between a preferred, standard, and out-of-network pharmacy is important because if you don’t choose the right pharmacy, you’ll end up paying a lot out-of-pocket for your prescriptions. So, before you tell your doctor where to send your prescriptions, or switch pharmacies, be sure to check which of the following classifications Medicare applies to your pharmacy.

Preferred Pharmacy

Preferred pharmacies have negotiated rates, so they can offer the lowest copays and coinsurance, meaning you’ll pay the least for your medications at one of these pharmacies. In addition to getting lower prices, you’ll also often be allowed to get 90-day supplies of your medications when you choose a preferred pharmacy.

Standard Pharmacy

gold money sign — *If you get medicine from an out-of-network pharmacy, you might have to pay for the medicine at full price out of pocket.*

You will pay a little bit more for your prescriptions at a standard pharmacy than at other pharmacies, but you will still not pay full price out-of-pocket, because Medicare will cover some of the costs. Unlike at a preferred pharmacy, a 90-day supply of your medication is not guaranteed at a standard pharmacy, which can be a problem for many people.

Out-of-Network Pharmacy

The last option where you can get your medications is an out-of-network pharmacy. Because these pharmacies are not in Medicare’s network, you can expect to pay full price for any medications that you purchase here.

Need Help?

Before having any prescriptions sent to a pharmacy, talk to the pharmacist to see if they know how your plan works with that specific pharmacy. Remember also to evaluate your Medicare options during your Medicare Open Enrollment Period, so you know what plan is right for you and will give you the lowest out-of-pocket costs. Last but not least, you can work with a Medicare agent to figure out your best option when it comes to your Medicare Plan, so you can get all of your medications and any other necessities you need covered.

To save as much money as possible, speak to an EZ agent for all of your options. EZ’s agents work with the top-rated insurance companies in the nation and can compare plans for you in minutes at no cost. To get free instant quotes for plans that cover your current doctors, simply enter your zip code in the bar on the side, or to speak to a licensed agent, call 888-753-7207.

How You Can Manage Sarcoidosis

This National Sarcoidosis Awareness Month, we want to shed light on this little-understood inflammatory disease. Sarcoidosis remains difficult to diagnose, with limited treatment options and no known cure. It most commonly affects the lungs and lymph glands, and eventually, the inflammation will change the normal structure and possibly the function of all of the affected organs. But how do you know if you have sarcoidosis, and what will it mean for your body if you do?

What Is Sarcoidosis?

two skeletons with organs showing — *Sarcoidosis is an inflammatory disease that causes inflammation and the failure of your body’s organs.*

It’s estimated that between 150,000 and 200,000 people in the U.S. have sarcoidosis, and around 1.2 million individuals are living with it worldwide. Sarcoidosis is an inflammatory disease that is characterized by the formation of granuloma, or tiny clumps of inflammatory cells, on one or more organs in the body. When a person’s immune system goes into overdrive, and too much cell clumping happens, it interferes with how the organ functions. If sarcoidosis is left unchecked, chronic inflammation can lead to fibrosis, or permanent scarring of the organ tissue. It will affect the lungs in about 90% of cases. For some, the disease will go away on its own, while for others it can progress in life-altering ways.

Symptoms & Causes

Researchers believe that sarcoidosis is caused by an abnormal immune response. The latest research indicates that sarcoidosis could be caused by a genetic susceptibility to the disease.

The disease affects more African-Americans in the country than it does any other ethnicity. For Caucasians, the disease appears suddenly, which means it tends to be milder in this group, while African-Americans and Latinos tend to develop a more long-term and severe form of sarcoidosis.

Sudden onset of general symptoms, such as weight loss, fatigue, fever, or just an overall feeling of ill health, usually means that the course of sarcoidosis will be relatively short and mild in severity. Shortness of breath and some types of skin involvement mean that sarcoidosis will be more long-lasting and severe: the disease is considered chronic in people for whom the disease remains active for more than 2 to 5 years.

Common symptoms of sarcoidosis include:

Shortness of breath
Wheezing
Chronic cough
Fatigue
Irregular heartbeat
Swollen legs
Headaches
Joint pain
Vision problems
Red eyes
Weakness or numbness of an arm, leg, or part of the face
Blurry vision
Arthritis

Diagnosis & Testing

Around a third of people diagnosed with sarcoidosis will require long-term treatment. Common tests used to diagnose sarcoidosis include:

Chest X-ray– This allows your doctor to completely see your lungs and airways. More than 90% of people with sarcoidosis will have abnormal X-rays.
CT scans– A certain type of CT scan that requires a special diet will help show things more clearly to your doctor. During a CT scan, you will be asked to hold your breath so the machine can take pictures of your muscles, bones, and lungs.
Lung function test- Your doctor will have you breathe into a mouthpiece that is attached to a spirometer, which is a device that measures the amount and speed of air that you blow out.
Lung biopsy– After conducting X-rays and lung function tests, your doctor might take a sample of lung tissue for testing.
Blood test– Your doctor might give you a blood test to check for an excess amount of vitamin D and/or a chemical called angiotensin-converting enzyme.
Heart rhythm monitoring– Your doctor might use an electrocardiograph to get information on the function of your heart. Around 50% of people with sarcoidosis will have an abnormal EKG.

Managing Sarcoidosis

There is no cure for sarcoidosis, but the disease can get better on its own over time. In some cases, you will need medication to relieve symptoms and reduce inflammation of the affected tissue. Corticosteroids can help control disease, and if you cannot tolerate steroids, there are other medications available.

You can also make some lifestyle changes to help manage the disease, such as:

Eating a well-balanced diet with fresh fruits and vegetables
Getting 6 to 8 hours of sleep each night
Quitting smoking
Drinking 8 to 10 8-oz glasses of water each day
Getting regular checkups with your doctor
Avoiding excessive amounts of calcium-rich foods, such as dairy products and oranges.
Avoiding excessive amounts of vitamin D in sunlight

In addition, being insured will give you peace of mind, and the coverage you need to make sure you can see your doctor regularly, and get any treatments you might need. If you’re looking for an insurance plan, EZ can help: we offer a wide range of health insurance plans from top-rated insurance companies in every state. And because we work with so many companies and can offer all of the plans available in your area, we can find you a plan that saves you a lot of money – even hundreds of dollars – even if you don’t qualify for a subsidy. There is no obligation, or hassle, just free quotes on all available plans in your area. To get free instant quotes for plans that cover your current doctors, simply enter your zip code in the bar on the side, or to speak to a licensed agent, call 888-753-7207.

Does Medicare Cover Occupational Therapy?

As you get older, you might find that it takes a little longer to heal from an injury or recover from an illness and get back on your feet. This is especially true if your injury or illness was so bad that it required you to be hospitalized: in this case, you could need extra help, like occupational therapy to get you back to your old self. But while Medicare will cover your hospital costs, will occupational therapy also be covered? If it isn’t, you could end up with a huge medical bill, so it’s important to know what Medicare will cover, and what you might need a Medicare Supplement Plan to help with.

Occupational Therapy

Occupational therapy is a form of treatment that helps people recover skills that are needed for everyday work and life after going through an injury or illness; it is also useful for people living with a disability. The goal of occupational therapy is to try and get you back to the way you were before your injury or illness, or to help you navigate life with your disability.

When you begin an occupational therapy program, your therapist will make a custom plan for your sessions, and will also provide you with information so you can continue the therapy at home on your own. Your therapist will measure your progress to be sure that you are on track to meet the goals they have set for you; if you are not, they will help you find ways to quickly get back on track.

Studies show that this type of therapy has a high success rate: for example, according to a 2016 study, 77 of 95 clients in a general occupational rehabilitation program were successful in regaining mobility.

Occupational Therapy Coverage

In the past, there was a yearly cap of $1,840 on total Medicare payments for occupational therapy provided in any setting other than a hospital outpatient department, but now Medicare does not impose any limits on how much it will pay for medically necessary occupational therapy services in a calendar year. Medicare will cover occupational therapy as long as it is deemed medically necessary by a physician or healthcare provider.

Medicare Part A

Medicare Part A will cover any medically necessary occupational therapy given in a hospital or rehab facility.

Two-Midnight Rule

Under the ”two-midnight rule,” Medicare Part A can be used to pay for services that you receive if you are expected to stay in the hospital through two midnights. However, Part A should not be used if your hospital stay is not expected to last that long.

Medicare Part B

Medicare Part B will cover occupational therapy when it is received outside of the hospital on an outpatient basis, such as at a doctor’s office, outpatient rehab facility, skilled nursing facility, or at your home. Medicare will cover occupational therapy, physical therapy, and speech-language therapy. With that being said, though, Medicare Part B will only cover 80% of the cost when you go to a Medicare-approved therapist.

Your Out-of-Pocket Expenses

While Medicare will cover a lot of the cost of your occupational therapy, there will still be some out-of-pocket costs that you will be responsible for. You will still be responsible for:

Medicare Part A deductible
Medicare Part B annual deductible before coverage of your occupational therapy begins
Medicare Part B coinsurance of 20% of each treatment

Extra Coverage

Again, Medicare Part B will only cover the cost of your occupational therapy sessions at 80%, leaving you to pay for the other 20% out-of-pocket. This can be quite expensive, especially if you are living on a fixed income, as many Medicare beneficiaries are. Fortunately, though, you can save money on all your medical expenses and get extra coverage by purchasing a Medicare Supplement Plan.

There are 10 different Medicare Supplement Plans to choose from, each offering different coverage options and rates. It’s worth looking into a Medicare Supplement Plan to save as much money as you can, so speak to an EZ agent for all of your options. EZ’s agents work with the top-rated insurance companies in the nation and can compare plans for you in minutes at no cost. To get free instant quotes for plans that cover your current doctors, simply enter your zip code in the bar on the side, or to speak to a licensed agent, call 888-753-7207.

Tag: Medicare Supplement Plans

Medicare Will Now Cover Aduhelm Only for Those Enrolled in Clinical Trials

The Price of Aduhelm

The Future Of Aduhelm

Medicare Premiums

Does Medicare Cover Heart Transplants?

Why Heart Transplants Become More Necessary With Age

Medicare Coverage

How Much Will You Pay?

Extra Coverage

Almost Done With Your Medicare “Trial Right”? Want A Different Plan? EZ Can Help

How Long Is Your Medicare Trial Right?

Can You Have More Than One Trial Right Period?

What’s the Difference Between a Preferred and Standard Pharmacy?

Preferred Pharmacy

Standard Pharmacy

Out-of-Network Pharmacy

Need Help?

How You Can Manage Sarcoidosis

What Is Sarcoidosis?

Symptoms & Causes

Common symptoms of sarcoidosis include:

Diagnosis & Testing

Managing Sarcoidosis

Does Medicare Cover Occupational Therapy?

Occupational Therapy

Occupational Therapy Coverage

Medicare Part A

Two-Midnight Rule

Medicare Part B

Your Out-of-Pocket Expenses

Extra Coverage

Business

About Us

Individual

Insurance News