medicare Archives - Page 23 of 44

Biden Aims To Lower Medicare Eligibility Age To 60

Throughout the 2020 campaign and after his election, President Biden put forward many proposals related to healthcare, including one to lower the Medicare eligibility age from 65 to 60. If this were to happen, over 23 million more Americans would be able to enroll in Medicare. Avalere Health experts estimate that 59%, or 13.4 million, of the new beneficiaries would shift into Medicare after being previously covered by an employer-based plan. While hospitals are hoping that this proposal doesn’t become a reality, lowering the eligibility age does have advantages for many.

doctors in teal scrubs in a hospital operating room looking at a patient — *Hospitals are not happy that the Medicare age could be pushed to 60 years old.*

Hospitals Pushing Back

If the Medicare eligibility age were to be lowered to 60, hospitals could end up losing a lot of their revenue. The Kaiser Family Foundation has found that, on average, private insurers pay nearly double (199%) Medicare’s rates for hospital services. So if 23 million individuals suddenly switched from employer-based plans to Medicare, hospitals would need to find ways to make up for the loss.

Hospitals could be right to worry about Medicare’s ability to pay for so many new beneficiaries. Critics of the proposal say that the Hospital Insurance Trust Fund is in a deficit and will not have enough money by 2024 to pay hospitals and nursing homes in full for inpatient care.

Popularity With Older Adults

While hospitals are unhappy with the proposal, a survey conducted by GoHealth has found that more than 3,000 Americans aged 55 and older support the lowering of the Medicare eligibility age. According to the survey, approximately 64% of non-Medicare respondents and 49% of Medicare beneficiaries are in favor of the change. The main reason changing the Medicare eligibility age is so popular is that it would allow people to retire earlier. In addition, the change would bring relief to the 23% of older Americans who have lost their jobs due to the COVID-19 pandemic.

“Generally, working Americans and seniors 65 and over have affordable health insurance options, either in the form of their employer’s plan or Medicare, respectively,” Clint Jones, GoHealth co-founder and CEO told McKnight’s Business Daily. “However, there’s a gap for middle-aged people who are currently unemployed or choosing early retirement, and some lack reliability if their health insurance is through their spouse’s employer’s plan. Lowering the Medicare eligibility age would help fill the health insurance gaps for middle-aged Americans that need affordable, quality healthcare options.”

Advantages For Employers

Lowering the Medicare eligibility age could also be beneficial to employers. Employees who continued working after age 60 could switch to Medicare instead of staying on their employer’s plan. They would save money by switching to Medicare and pairing it with a Medicare Supplement Plan, and their employers would also see significant savings, since they would no longer have to contribute to these employees’ premium payments. It would be a win-win situation.

Reducing the Medicare eligibility age could mean great things for people who are working into their 60s, are older and unemployed, or who want to retire early, as well as for employers. The only downside is that, according to some projections, there may not be enough money to pay hospitals at the rates that they are used to. Over time we can assess the issue of funding for hospitals, but the majority of older adults approve of and are ready for this change.

Prevent Heart Disease With Medicare Screenings

According to the Centers for Medicare and Medicaid Services (CMS), heart disease has been the leading cause of death for Americans ages 65 and over for the past several decades. One in four deaths is contributed to some form of heart disease, meaning any kind of condition, such as heart rhythm disorders, coronary heart disease, and congestive heart failure, that can lead to heart attack or stroke. The best way to prevent heart disease is to know your risk. Fortunately, because heart disease is so common – and deadly – in people aged 65 and older, Medicare offers multiple free screenings to help prevent it.

Medicare Coverage

Medicare Part B covers an annual cardiovascular disease risk reduction visit with your primary care physician. You do not need to show any signs or symptoms of heart disease in order to get screened. As long as your doctor or other health care provider accepts Medicare assignment, you will not pay anything for this screening. During the screening, your physician might:

Encourage aspirin use if the benefits outweigh the risks and:
- You are a man age 45-79
- You are a woman age 55-79
Check your blood pressure
Encourage a healthy diet

Once you get the initial screening, your doctor may advise further screenings, tests, and treatments. Medicare Part B also covers:

Aneurysm Screenings- Aortic aneurysms thin out areas in your arteries, which can weaken them. Medicare pays for a free screening for aneurysms as long you meet the following conditions: you have a family history of aortic aneurysm, or are a man between the ages of 65 and 75 who has smoked 100 or more cigarettes in his lifetime
Cholesterol Screenings- Having high cholesterol leads to build up in your arteries, which can restrict blood flow to the heart. Medicare covers one free cholesterol screening every 5 years. Any additional tests will not be free.
Medicare will only cover a cardiac stress test for people with known heart disease and symptoms.
Cardiac Stress Testing- During this test, your doctor will monitor your heart while you run or walk on a treadmill. They will also examine your heart with an electrocardiogram (EKG), echocardiogram (ultrasound of the heart), or imaging (pictures of your heart taken after you are injected with a radioactive tracer). **Medicare will only pay for the stress test for those with known heart disease and symptoms of chest pain, shortness of breath, etc. You will pay 20% coinsurance for this test.

For follow-ups after your free screenings or any outpatient services, Medicare will pay 80%, and you will pay the remaining 20% coinsurance out-of-pocket. If you are hospitalized or need surgery, Medicare Part A will cover your inpatient hospital stay as well as any skilled nursing care.

Paying The Medicare Coinsurance

If you are experiencing any symptoms that could be related to heart disease, or would simply like to get screened for heart disease, get yourself checked! Medicare will pay for one free screening related to heart disease. If there is an issue, or you have to seek further care for heart disease, Medicare will only pay 80% of the costs for visits, tests, and more. These costs can add up. Fortunately, Medicare Supplement Plans help pay for the 20% out-of-pocket costs that Original Medicare does not cover. Having one of these plans can help you better budget for and save money on medical expenses.

There are 10 different Medicare Supplement Plans. Each offers their own added coverage at different price points. They all help pay for any unexpected costs, and any further care management costs. EZ.Insure wants to protect your heart and your wallet by helping you find the right Medicare Supplement Plan for your needs. We will compare plans and guide you through the whole process, while answering any questions you might have. To get instant free quotes, simply enter your zip code in the bar above, or to speak directly with a licensed agent, call 888-753-7207.

Medicare & COPD

Chronic obstructive pulmonary disease, or COPD, is most common among individuals 65 and older. It is especially common among women age 65 to 74 years old. This disease is the third leading cause of death in the United States, and anyone with COPD has a significantly increased risk of severe illness or death from complications from the flu or respiratory illnesses like COVID-19.

When it comes to those suffering from COPD, life expectancy is determined by multiple factors such as history of smoking, and other conditions that might add further complications. While most patients with COPD can live with the disease for many years, they will need to constantly manage and treat this chronic condition. For older Americans, this continuous management can be costly, but fortunately, Medicare covers screenings and treatment up to a certain point.

What Is COPD?

For the over 30 million Americans who are living with COPD, every day can mean a struggle to breathe. COPD, a group of progressive lung diseases, such as emphysema, slowly destroys air sacs in the lung, causing air flow blockage and breathing-related problems. The disease develops over a long time, and the most common cause of it is smoking tobacco.

Because the disease is progressive, there is unfortunately no cure for COPD. However, treatments can help ease the symptoms and lower the chances of complications, while improving quality of life. If not treated, COPD can cause heart problems and worsening respiratory infection.

COPD Symptoms

caucasian woman with short blonde hair holding her chest with one hand. — *Some COPD symptoms include shortness of breath and tightness in the chest.*

The symptoms of COPD come in stages. Early symptoms include occasional shortness of breath, a mild recurrent cough, and a frequent need to clear the throat. But if the symptoms are not treated, they can get progressively worse. Worsening symptoms include:

Shortness of breath with little exertion, such as from going up a flight of stairs
Tightness in the chest
Wheezing
Frequent colds, flu, or other respiratory infections
Chronic cough
Lack of energy

In the later stages of the disease, symptoms include weight loss, and swelling of the feet, ankles, or legs. If you are suffering from COPD, it is important to seek immediate medical care if you have trouble catching your breath, feel confused or faint, or have bluish or gray fingernails or lips.

Medicare COPD Coverage

There is no single test for COPD. Diagnosis is based on assessing the symptoms mentioned earlier, a physical exam, and diagnostic test results. To help diagnose you, Medicare Part B will cover a lung cancer screening with Low Dose Computed Tomography (LDCT). Medicare will cover this screening once a year if you:

Are 55 to 77 years old
Have a history of smoking at least 1 pack of cigarettes a day for 30 years
Are a current smoker or have quit smoking in the last 15 years
Are asymptomatic (don’t have signs or symptoms) of lung cancer
Get a written order from your doctor

As long as you meet all of the above criteria and your doctor accepts Medicare assignment, Medicare Part B will cover 100% of the screening.

If you have already been diagnosed with COPD, Medicare Part B will cover a pulmonary rehabilitation program to help manage your COPD. This program should help you breathe better and improve your quality of life. Medicare Part B will completely cover the pulmonary rehabilitation program as long as you have a referral from your doctor.

pink piggy bank — *Medicare Supplement Plans will help pay for the 20% Medicare does not cover, which will help you save more money.*

Getting More Coverage

Other expenses related to COPD treatment and management might only be covered 80% by Medicare, leaving you with 20% coinsurance to pay out-of-pocket. But you can save money on these expenses with a Medicare Supplement Plan, which will pay your 20% coinsurance for COPD coverage, as well as all other Medicare-covered conditions.

It can be overwhelming to review your options and go over all 10 different Medicare Supplement Plans, but that is what EZ.Insure is here for. EZ’s dedicated agent will compare all available plans in your area and review all of your options. We will provide you with quotes for free, and find a plan that fits your needs and budget, while helping you save hundreds of dollars a year. To get free instant quotes, simply enter your zip code in the bar above, or to speak directly with one of our agents, call 888-753-7207.

New Medicare Part D Rates

This year, Medicare Part B premiums rates are not the only rates on the rise. The Centers for Medicare and Medicaid (CMS) released the 2021 Medicare Part D rates back in October, and noted that, while there are more Part D plans being offered in 2021, plan rates have gone up slightly. Because prices for Medicare Parts A, B, and D continue to rise, there is no better time than now to look into Medicare Supplement Plans.

Part D Plans & Prices

The average Medicare beneficiary has a choice of almost 30 Medicare stand-alone drug plans. The following charts illustrate the costs of Part D plans and how income affects rates.

medicare part d benefit chart — *Medicare Part D Rates*

filing income medicare part d rates — *Medicare Part D Income Rates*

Part D Cost-Sharing

Cost-sharing amounts have also changed for medications in certain “tiers” in Part D plans. Each plan has a drug formulary, made up of tiers which determine the price of each drug. The typical five-tier formulary structure places medications into the following categories:

Preferred generics
Generics
Preferred brands
Non-preferred drugs
Specialty drugs

For all Part D Plans, the median standard cost sharing in 2021 is $0 for preferred generics, $5 for generics (up from $4 in 2020), $40 for preferred brands (down from $42 in 2020), 40% coinsurance for non-preferred drugs (up from 38% in 2020; the maximum allowed is 50%), and 25% coinsurance for specialty drugs (the same as in 2020; the maximum allowed is 33%).

Medicare Supplement Plans

Costs continue to increase yearly for Medicare beneficiaries, but that does not mean you have to live on a tight budget. Medicare Supplement Plans can help you pay for medical costs that Original Medicare does not cover. For example, Medicare Supplement Plans cover the 20% coinsurance that you usually pay for a medical service. There are 10 different types of Medicare Supplement Plans to choose, and each offers different coverage at different price points. To easily compare these plans within minutes, use an EZ agent. Our agents will compare prices, go over your financial and medical needs, and help you save hundreds a year – and we’ll do it all for free! Medicare rates are on the rise, but we will help you save! To get started, simply enter your zip code in the bar above, or to speak directly to a licensed agent, call 888-753-7207.

New Medicare Rule WIll Cut Emergency Doctors’ Pay During Pandemic

The coronavirus pandemic has hit the country hard. Many Americans have been affected financially, and now Medicare-accepting doctors are going to be among those suffering a pay cut. A new rule that is set to go into effect January 1st will lower the reimbursement rates that doctors receive for treating patients covered by Medicare. The new 2021 physician fee schedule final rule will affect many types of physicians, and now they are fighting back.

The Pay Cut

Doctors practicing general surgery, emergency medicine, anesthesiology, and critical care medicine will be affected by the new rule. They will see a 10% cut in the “conversion factor,” which is used to determine their fee-for-service Medicare payment. The conversion factor is a multiplier that Medicare uses in order to calculate reimbursement for a particular service or procedure done by doctors. The conversion factor is multiplied by the relative value unit, RVU, which depends on the amount of work and type of work done by the physician.

The 2021 conversion factor will be $32.41, a decrease of $3.68 — or 10.2% — from the 2020 conversion factor of $36.09.

Doctors Voice Their Concerns

caucasian man that appears to look mad with teal scrubs on, mask and hat, as well as a stethoscope around his neck. — *Doctors who have been working long hours to help Medicare patients through the pandemic are not happy about the pay cut.*

The Centers for Medicare and Medicaid Services (CMS) first proposed the pay cuts in the summer. When the rule was presented to the country, doctors immediately began to voice their concerns, pointing out that they put their lives on the line every day and shouldn’t be facing a cut in pay at this critical time.

“We come to work every day and we work long hours and we put our lives on the line and took risks on a daily basis and it’s a slap in the face to say here’s how we’re gonna reward you — we’re going to be paying you less,” Dr. Lisa Moreno, an emergency medicine physician and the president of the American Academy of Emergency Medicine (AAEM), said.

The American College of Emergency Physicians (ACEP) also joined the AAEM in criticizing the rule, saying they were disappointed and dismayed that CMS was cutting physicians’ pay simply because they were helping take care of Medicare patients. “Emergency physicians and other health care providers battling on the frontlines of the ongoing pandemic are already under unprecedented financial strain as they continue to bear the brunt of COVID-19,” ACEP President Mark Rosenberg, DO, said in a statement. “These cuts would have a devastating impact for the future of emergency medicine and could seriously impede patients’ access to emergency care when they need it most.”

In addition, the ACEP voiced their concerns that the new rule would have wide reaching effects, and would mean more than just a pay cut to some doctors. “CMS chose to finalize a cut that will reverberate beyond just Medicare to other payors including private insurance, which often structure their payments to emergency physicians and other providers based on these Medicare rates. This will result in significant reimbursement reductions as well as widespread uncertainty and disruption across the system.”

The Fight

two blue gloves facing each other with a black background and a light shining on the bottom middle of the picture. — *Doctors and organizations are fighting back against the new Medicare rule by lobbying for a new legislation to maintain reimbursement.*

After receiving backlash for cutting reimbursement pay, CMS responded by stating that they will be “increasing payments to physicians and other practitioners for additional time they spend with patients, especially those with chronic conditions.”

“We value the contributions of all providers caring for patients on the front-lines of this historic pandemic, but this action is designed to address fundamental problems in Medicare reimbursement that long predate the current public health emergency. It is also important to note that physicians that see a higher proportion of patients’ visits will see increases in payments compared to physicians that do fewer visits or more procedures,” CMS wrote.

The ACEP, along with other health care organizations, are lobbying to maintain reimbursement in Medicare at 2020 levels for the next 2 years.

“Emergency physicians have courageously faced a global pandemic that has shaken our healthcare system to its core, unwavering in their commitment to their patients despite potentially deadly exposure to the disease for themselves and their families,” said Rosenberg. “Congress must act now in order for them to continue playing this vital role in our communities.”

Are Glaucoma Screenings Covered By Medicare?

Glaucoma is the cause of approximately 10% of cases of total blindness in the U.S. It mainly affects people over the age of 65; in fact, the American Academy of Family Physicians notes that about 75% of those who are legally blind because of glaucoma are older adults. What’s worse is that doctors believe that about half of all people with glaucoma have yet to be diagnosed. In order to help save your sight, it is important to get screened for this disorder. If you have Medicare Part B, then you need to know how glaucoma screenings are covered.

illustration of an eye with it partially open showing the nerves and inside — *Glaucoma mainly affects people over 65 years old, and can cause blindness.*

What Is Glaucoma?

Glaucoma damages the optic nerve at the back of the eye and can lead to partial vision loss or blindness. It is often hereditary. There are three different types of glaucoma:

Primary open-angle glaucoma- causes gradual vision loss, and typically has no other signs or symptoms.
Normal tension glaucoma- the nerve is damaged even if there is no high fluid pressure in the eye. Eyesight changes in the center of the person’s vision.
Angle-closure glaucoma– a rarer type that develops quickly when fluid cannot drain from the eye. Symptoms include nausea, eye pain, headache, and sudden loss of vision.

Vision loss can happen gradually, so you may not notice anything until the damage is already done. This is why it is important to get screened for glaucoma regularly.

The Test

Glaucoma screenings are fairly simple. The doctor will put drops in your eyes to dilate them and then will use instruments to conduct the following tests:

Tonometry: measures fluid pressure behind your eye.
Ophthalmoscopy: examines your optic nerve.
Perimetry: tests your peripheral vision.
Gonioscopy: inspects the angle where your iris and cornea meet.
Pachymetry: measures the thickness of your cornea.

Medicare Coverage & Costs

Medicare part B will cover one glaucoma screening test every 12 months if you’re considered high-risk. High-risk individuals are those who:

Are over the age of 60
Have diabetes
Have a family history of glaucoma
Are African American and age 50 or older
Are Hispanic American and age 65 or older

Once you have met your deductible, Medicare will pay for 80% of the screening, and you will pay 20% of the Medicare-approved amount for the test. If the test is done in an outpatient setting, you might also be responsible for any facility charges. If you require surgery to treat the glaucoma, Medicare Part A will pay for it.

hundred dollar bill sticking out of a wallet. — *Medicare Supplement Plans will help pay for what Original Medicare does not cover, which puts more money back in your wallet.*

Medicare Supplement Plan

As with most medical services, Medicare only covers 80% of glaucoma screenings. The 20% that you have to pay out-of-pocket for services can start to add up, especially if you are living on a fixed income. Medicare Supplement Plans help cover the gaps in your Medicare coverage, including your 20% out-of-pocket payments. There are 10 different Medicare Supplement Plans to choose from, all with different coverage at different price points. This means that you will be sure to find one that suits your needs.

To easily compare Medicare Supplement Plans in minutes, and to find an affordable plan that helps you save hundreds of dollars, talk to an EZ agent. Our agent will do all the work for you, inform you of the differences between each plan, and help you figure out which one will best suit your financial and medical needs. There is no obligation, just free quotes. Start comparing quotes for free by entering 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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