Even if you have Medicare Parts A and B coverage, you may still need extra coverage for your prescription drugs. So, like a lot of people with Medicare, you might be looking at Medicare Part D, especially Medicare Silverscript, which is the cheapest way to cover prescription drugs on the market. It’s not surprising that many Medicare recipients are choosing a Silverscript plan as a way to save money. Could one fit your needs?
Part D of Medicare is the plan for prescription drugs. Some of a Medicare recipient’s medicine costs are covered by these drug plans. Medication costs can add up quickly, and if you don’t have insurance, you may have to pay a lot out of pocket. Medicare Part D plans help pay for the prices of prescription drugs so that people who need them can get them.
Medicare is made up of different parts, or sections, that cover different types of health care. Part A and Part B are the parts of Original Medicare. Prescription drugs are not covered by either of these plans. On the other hand, there are Medicare Advantage Plans, also called Medicare Part C, that are given by private insurance companies. Some of these plans may cover Part D, but not all of them do. If someone with Original Medicare or a Medicare Advantage Plan without a Part D plan wants coverage for prescription drugs, they would need to sign up for a different Medicare Part D plan, like SilverScript.
SilverScript
SilverScript is a private insurance company that merged with Aetna in January of 2020 and offers Medicare Part D plans. It covers prescription drugs for people with Original Medicare. Coverage choices are available in all 50 states and Washington, D.C. People who are qualified for Medicare Part D can choose from three different plans from SilverScript. Each plan has a different fee and covers prescription drugs in a different way. To figure out which plan is best for you, you should make a list of the prescription drugs you take and compare it to the formularies of each plan.
Depending on the plan you choose and the medicines you need, SilverScript’s Medicare Part D plans offer a range of fees and copays that can fit almost any budget. Also, these plans cover you at thousands of pharmacies across the country. Even though the SilverScript formulary changes every year, this provider’s prescription drug plans offer full coverage and reasonable prices.
A formulary is a list of all the prescription drugs that a certain insurance will pay for. When looking for coverage for your prescription drugs, you should know what drugs you take and how the Medicare Part D plans in your area cover them. So, you can sign up for a plan that will cover your medicines. There are times when a Medicare Part D plan might not cover the medicine you need. There could be a formulaic option, though. Your doctor may think about a change if they think it would be a good idea. If not, you could ask for a list exception, which means that the plan may cover your drug if it is approved.
SilverScript may change its formularies from time to time, so it’s important to check your prescription drug benefits every year during the Annual Enrollment Period. This will make sure that you get the right coverage every year. There are five tiers of drugs, and each tier may have its own fees or copayments for coverage. Here’s how the tiers are broken up:
Tier 2 – Generic drugs that usually cost more than tier 1 drugs
Tier 3 – Preferred brand-name drugs with no generic version
Tier 4 – Less commonly prescribed non-preferred drugs
Tier 5 – Expensive specialty drugs that may require monitoring
In the formulary you will also see information about any restrictions or terms for coverage that apply to each drug. These rules are listed at the beginning of the formulary. They can include things like needing Aetna’s authorization first or limits on how many drugs can be covered at once. There’s a chance that a SilverScript formulary might be a little different based on where the plan is sold.
SilverScript Plans
There are three different SilverScript coverage choices for Medicare beneficiaries:
SilverScript SmartSaver
This choice is for people who are active, prefer generic drugs, and are generally healthy. It has the lowest national average of monthly premiums at $5.92. It includes $0 deductibles for Tier 1 drugs, and $505 deductible for Tiers 2-5. The copays for preferred pharmacies by tier are:
Tier 1 – $2 copay for 30-day prescriptions and $6 for 90-day prescriptions
Tier 2 – $15 for 30-days’ worth and $45 for 90-days
Tier 3 – 25% coinsurance
Tier 4 – 50% coinsurance
Tier 5 – 25% coinsurance for 30-day prescriptions
SilverScript Choice
This plan covers more than the SmartSaver plan, but it has a $505 deductible and a $33.60 monthly premium. If you qualify for the Extra Help program, you can get a $0 monthly premium instead. The copays for preferred pharmacies are:
Tier 1 – $2 copay for 30-day prescriptions and $6 for 90-day prescriptions
Tier 2 – $7 for 30-days’ worth and $21 for 90-days
Tier 3 – 17% coinsurance for a 30-day supply; 22% for 90
Tier 4 – 30%-40% coinsurance
Tier 5 – 25% coinsurance for 30-day prescriptions
SilverScript Plus
This plan has even better coverage than the first 2, with a $75.58 monthly fee, a $0 deductible on all tiers, and a coverage gap for Tier 1 and 2 drugs. I also has$0 copays on Tier 1 and 2 drugs for the other tiers the copays are:
Tier 3 – $47 copay for a 30 day supply; $141 for 90
Tier 4 – 50%-40% coinsurance for both supply amounts
Tier 5 – 33% coinsurance for 30-day prescriptions
What Pharmacies Accept SilverScript?
SilverScript lets you get your prescription drugs from thousands of pharmacies across the country. There are more than 65,000 pharmacies in the United States that are part of the SilverScript drugstore network. Your SilverScript Medicare Part D plan will be accepted at most chain pharmacies. But not all shops are in the “preferred category”. With a preferred pharmacy, you can get the drugs for the least amount of money. These pharmacies include:
Walmart
CVS
Wegmans
Kroger
Publix
Even though they cost a little more than preferred pharmacies, standard network pharmacies still offer service. These pharmacies include:
Walgreens (for most SilverScript plans)
Sam’s Club
There are also many local pharmacies that fall into either of those categories so be sure to check your plan for your area’s local pharmacies.
How To Choose
There are a few things to think about when choosing the right Part D plan, whether it’s SilverScript or any other plan, for you. The major things you should think about are cost, coverage, and how flexible the plan is. Cost is always a factor when choosing a Part D plan. Different plans come with different costs. Coverage gaps, fees, deductibles, copayments or coinsurance, and premiums all affect your overall cost. If you are in good health and prefer to take generic drugs, you may want to choose a plan with a lower premium and benefits for tier 1 or tier 2 drugs. You can choose a plan with a higher cost and more benefits to help with your health care needs if you need specific drugs, have serious health problems, or need more specific coverage.
You also need to know how much coverage you need. If you don’t need a lot of coverage, you may want to save money by getting a plan with less coverage. But if you need more coverage because of your health or for your own peace of mind, you may want to look into plans with more coverage that cost more. Choosing the best Part D plan will also depend on how flexible you are about the drugs and pharmacies you want to use. If you don’t mind taking generic or recommended generic drugs, you may have more plan choices. Also, if you are willing to get your drugs from different pharmacies you will have more plans to choose from. However, if you have specific drug plans or pharmacies in mind, you may need to look at better coverage plans to see what works best for you.
Call EZ
If you want to compare SilverScript drug plans, you should think about the prescription drugs you take and how much of them you take. You should also think about how much you are willing to pay for premiums and a yearly deductible. As we’ve already said, if the cost of your medicines is getting too high for you, a SilverScript plan could help you by putting all of your monthly costs into one payment.
You should also look into a Medicare Supplement Plan if you want to save even more money. There are 10 Medicare Supplement Plans to choose from, and each one has different rates and coverage choices. Talk to an EZ agent about all of your choices. The agents at EZ work with the best insurance companies in the country, and they can review plans for you for free in just a few minutes. Enter your zip code in the box below to get free instant quotes for plans that cover your present doctors, or call 877-670-3602 to talk to a licensed agent.
The Medicare Annual Enrollment Period (AEP) is a set period of time where you can change your Medicare benefits. Every year, the AEP lasts from October 15 to December 7. If you didn’t sign up for a Medicare Advantage plan or a Medicare prescription drug plan when you first became eligible for Medicare (during your Initial Enrollment Period), the AEP is usually your chance to do so, unless you apply for a Special Election Period (SEP). It also allows you to make any changes you need to tailor your Medicare coverage to your specific needs.
If you are eligible or already enrolled in any Medicare product you can use the AEP to move to a different Medicare plan, sign up for an entirely new plan, or drop out of a plan. This includes the ability to move from Original Medicare to Medicare Advantage, switch between different Medicare Advantage plans, and sign up for or change Medicare prescription drug coverage.
Your AEP Options
During the Medicare AEP, you can move from Original Medicare (Parts A and B) to Medicare Advantage (Part C), or vice versa, if you already have Medicare. However, if you want to switch, you may also have to make some other choices. Depending on what kind of plan you’re switching to and from, you’ll have to make different decisions.
In this case, you have Original Medicare and want to move to a Medicare Advantage plan. You may also have a separate Part D plan for prescription drugs. Most Medicare Advantage plans include everything that you need. They pay for your Medicare Part A and Part B benefits, as well as Part D prescription drugs and other health services and things that Original Medicare doesn’t cover. Some of these other things are dental, vision, and hearing care, as well as gym memberships. There is also an annual out-of-pocket limit on Medicare Advantage plans to keep you from paying too much.
During the AEP you can move from Original Medicare to a Medicare Advantage plan. Depending on the Medicare Advantage plan you choose, you may no longer need a separate Part D plan if you already have one. With Medicare Advantage, you usually don’t need a separate Part D prescription drug plan because drug coverage is built in.
If you switch to a Medicare Advantage plan, the plan will work with Medicare to move your benefits over. You don’t have to get in touch with Medicare on your own. On January 1, your new plan will start to cover you. If you have a stand-alone Part D prescription drug plan or another private Medicare plan, you’ll need to call the plan provider directly to drop out. Just call the number on the back of your member ID card. During the Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31, you can choose a different Medicare Advantage plan or switch back to Original Medicare.
Medicare Advantage To Original Medicare
Original Medicare only has Part A (coverage for hospital stays) and Part B (coverage for medical care). It doesn’t give you some of the things your Medicare Advantage plan might have, like coverage for prescription drugs, dental, vision, or fitness. Original Medicare also doesn’t have an annual out-of-pocket cap, so there is no built-in financial protection.
If you still want these things, you will need to buy extra coverage. For example, if you want coverage for prescription drugs, you will now have to find a stand-alone Part D plan and sign up for it. If you decide you need more coverage, you will need to choose a Medicare Supplement Plan and sign up directly with the plan provider. To make the switch to Original Medicare, you will need to call your Medicare Advantage plan provider or Medicare directly.
Medicare advantage plans are pretty comprehensive, but there are still times you may want to switch to a different plan. Such as:
Moving to a plan that offers drug coverage
Moving to a plan without drug coverage
Switching to a plan that has dental or vision coverage
Aside from the AEP there are other times you can change your Medicare Advantage plan. During the Medicare Advantage open enrollment period, which runs from January 1 to March 31 every year, you can make changes to your plan at any time. The changes you make will go into action on the first of the month after you make them. You can also change your Medicare Advantage plan during a Special Enrollment Period if you have a big change in your life. Medicare may give you a special enrollment period if you move to a new place, if your coverage choices change, or if certain other things happen in your life.
You can apply for a Medicare Supplement Plan at any time of the year, not just during the AEP. However, unlike Part D and Medicare Advantage plans, Medicare Supplement Plans don’t have to offer a yearly enrollment period like Part D and Medicare Advantage plans do. If you apply for a Medicare Supplement Plan after your six-month initial enrollment time has ended, the insurer is likely to use a process called “medical underwriting” to decide if you are eligible and how much you will have to pay. Some states have passed laws that make it easier for seniors to switch from one Medicare Supplement Plan to another by applying birthday rules or guaranteed issue rights. Both allow a specific amount of time where you can change your Medicare Supplement Plan without going through underwriting.
Guaranteed Issue Rights
New York and Connecticut – Medicare Supplement Plans are guaranteed issue all year.
Massachusetts – There is a 2 month period every year between February and March where plans are guaranteed issue
Maine – Participants can move to a different Medicare Supplement plan with the same or less benefits at any time during the year, and all carriers must set aside one month each year when Medicare Supplement Plan A is guaranteed to be available to all participants.
Missouri – There is an Anniversary Guaranteed Issue Period. Anyone with a Medicare Supplement plan has 60 days around the anniversary of their plan each year to switch to the same plan from a different insurance company.
Birthday Rules
California – The rule goes into effect 30 days before their birthday and stays in place for 60 days after. During this time, customers in The Golden State can switch to any plan with the insurance company of their choice that has the same or less benefits.
Oregon – The birthday rule starts on your birthday and lasts for 30 days after that. This gives you 31 days to change plans. It works like California’s and lets customers switch to any insurance company or plan with the same or less benefits.
Idaho – This rule goes into effect on your birthday and lasts for 63 days. You will be able to sign up for any plan with the same or less benefits. Also, the plan could be with any provider.
Illinois – This birthday rule only applies to people who are 65 to 75 years old. During this time, you can switch plans with your current insurance company. But the benefits of your new plan can’t be better than those of your old plan. This open registration period starts on your birthday and goes on for 45 days.
Louisiana – The time for the birthday rule starts 30 days before your birthday and ends 63 days after it. So, you have 93 days to change the plan you have now. During this time, you can switch to a policy with the same or less benefits through your present provider.
Maryland – The birthday rule for Medicare Supplement starts on your birthday and ends 30 days after that. Giving residents 31 days to sign up for a plan with the same or less worth.
Nevada – For at least 61 days, you can make changes to your plan. This window opens on the first of your birthday month. You can switch carriers or plans during this time, but the benefits of the new plan must be the same or less than what you get from your present plan.
Oklahoma – The 60-day window for the birthday rule starts on your birthday. During the 60 days, you can change your plan or provider. However, you can only switch to a plan with the same or less value than the one you have now.
Need Help?
Medicare is great, but sometimes it can be hard to understand. Even after you sign up during the AEP, you’ll still have to make some decisions about your health care. Don’t worry about asking questions. Talk to an EZ person 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 certified agents at 877-670-3602 to get started.
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.
Does Medicare cover assisted living? The simple answer is no. Medicare does not fund assisted living, which provides housing and custodial services including laundry, cooking, medication management, and other daily living activities for older people or those with disabilities eligible for Medicare. However, it will cover some services such as skilled nursing facilities and some home health care services.
As you get older, you may need help doing things like taking a shower or getting ready. A study showed that 1 in 5 people over the age of 85 in the U.S. need or get extra help with everyday chores. If you find it hard to live on your own, you might want to look into an assisted living center. Different from nursing homes, these facilities give older people the personalized care they need and let them keep their own living area. If you have Medicare, it’s important to know what your plan covers and how much money you may have to pay out of pocket.
What Is Assisted Living?
Assisted living is a place to live for older people or people with disabilities, such as amyotrophic lateral sclerosis (ALS) or end stage renal disease(ESRD), who need help with some daily tasks and access to medical care when they need it. People in this situation or their families may choose assisted living homes so that they can get help from professionals. People who live in assisted living may need ongoing medical care and skilled nursing services.
Assisted living is a step below a nursing home or skilled nursing facility in terms of the amount of care it offers. State rules, which vary from state to state, govern them. Assisted living usually gives people more freedom and costs less than care in a nursing home, but it is more expensive than a place for independent living. Assisted living is more like a home than a hospital, while a nursing home is more like a hospital. People who can’t live on their own but want to keep as much freedom as possible can benefit from assisted living.
The Difference Between Assisted Living and Skilled Nursing
Assisted living communities are more like homes, whereas skilled nursing facilities and nursing homes are more clinical like hospitals. Skilled nursing facilities provide a higher level of medical care and, in some cases, may be covered by Medicare. Most assisted living communities focus on giving personal care rather than medical care like helping you bathe, eat, and get dressed.
As long-term care assisted living centers are not covered by Medicare because they are considered custodial care, but Medicare will pay for any health care costs that add up while the person is living in an assisted living home. These health care bills that can be covered include things like medicine and medical equipment. Most of the time, Medicare will only fully pay for skilled medical care or short stays in a skilled nursing facility. Hospital insurance is covered by Part A of Medicare. For example, if you need care while healing from surgery and it’s not the only thing you need, it will be covered.
In some cases, the same company might run both an assisted living community and skilled nursing facility in the same building or on the same property. How Medicare pays for your care depends on what kind of care you are receiving in one of the hybrid facilities and if you meet certain criteria.
Skilled Nursing Criteria
For Medicare to cover skilled nursing care:
You must have just come out of a hospital stay of at least 3 days and still have covered hospital days left in your benefit period.
Your doctor has to prescribe this level of care.
The reason you are in skilled nursing is because of the same condition you were in the hospital for or the condition stems from being in the hospital, such as you picked up an infection while in the hospital.
The skilled nursing care has to be considered medically necessary.
If you meet all of these criteria, Medicare will fully cover your first 20 days of residential care. From days 21 to 100, you would have to pay up to $200 a day in coinsurance. If you have Medicare Supplement, your share of the costs could be covered for up to 100 days instead of 20. Either way Medicare will not cover any part of this care after 100 days.
Will Medicare Advantage Cover Assisted Living?
Medicare Advantage has to cover at least as much as Original Medicare. However, Medicare Advantage is bought through private health insurance companies so any extra policy benefits will vary. Some Medicare Advantage plans do include benefits for home care services, but they don’t usually cover assisted living or other long-term custodial care. However, if you move to an assisted living community, Medicare Advantage will continue to pay for eligible medical costs like medications, surgeries, and appointments, just as it would if you were living at home.
Cost Of Assisted Living
In 2023, the average cost of living in an assisted living home is $4,774 per month or $57,288 for the year. The total cost of assisted living can be different based on the following:
How many hours of care you need, such as 24/7 or just a few hours a day.
What time of day you need care
Where the assisted living community is located
Which facility you choose
If you need additional services depending on your health
Generally, assisted living communities have varying levels of care. The more independent you are and the less care you need the cheaper it will be. Depending on the facility here are the costs associated with assisted living communities:
Rent
Medication management, or nursing care services
Special meal plans
Transportation
Events or activities
Move-in fees
Housekeeping
Laundry services
Unless you have long-term care insurance, you will have to pay for all of the costs of assisted living out-of-pocket. If you have long-term care insurance your policy may cover some assisted living costs if you meet certain requirements. Additionally, if you have access to Veterans Affairs benefits, check your plan to see if long term custodial care is covered and for how long.
Other Care Options
Medicare Part A pays for skilled nursing care, but only under certain circumstances and for a short time. With a few cases, it must be given less than seven days a week or less than eight hours a day for no more than 21 days. Some of the other types of care that Medicare might pay for are:
Home Care – Such as part-time or occasional help from a home health worker. Medicare does not, however, pay for care at home 24 hours a day, 7 days a week. It also doesn’t pay for maid or custodial services like cleaning, bathing, or putting on clothes if those are the only things you need.
Hospice or respite care – Both of which Medicare pays for. Hospice cares for and supports people who are nearing the end of their lives. Respite care is a short stay in a hospital for hospice patients that gives their nurses a break.
PACE – Also known as programs of all inclusive care for the elderly. It is a Medicare/Medicaid program that helps people get the health care they need in their own communities so they don’t have to go to a care center. It pays for prescription drugs, doctor visits, help getting to and from the doctor’s office, home care, and if needed, stays in a nursing home.
Working With EZ
As you get older, you need to be able to take care of yourself. An assisted living center may be a good choice if you need extra help with everyday tasks. The cost of assisted living varies on many things, like the type of care you get, how long you need care, and where you live. Original Medicare and Medigap (supplemental insurance) does not pay for personal care in an assisted living facility, but they may pay for other medically required services. A Medicare Advantage plan may cover more services, such as personal care, than a regular Medicare plan.
Since Medicare won’t usually cover the costs, you should think ahead and find other ways to pay for assisted living. Medicare is great, but sometimes it can be hard to understand. After you sign up, you’ll still have to make some decisions about your health care. Don’t worry about asking questions. Talk to an EZ person who can tell you what you need to do 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 certified agents at 877-670-3602 to get started.
