Medicare is an essential program for seniors over 65, however, many of its benefits are underutilized or misunderstood. Consider the annual “wellness” visit. During which a physician will assess your health risks, take your blood pressure and other routine measurements, test for cognitive impairment, and provide personalized health advice. It’s Free! Nonetheless, a surprising number of people do not take advantage of this benefit. This isn’t the only benefit that has gone under the radar. Many healthy seniors ignore a variety of free preventive services, ranging from bone density screening to cancer detection. Other benefits such as home health care, are also frequently unused due to their strict eligibility requirements. Below you’ll find all the ways to make sure you’re using all of your benefits and getting your money’s worth.
Choose The Right Doctor
It is important to choose a doctor who accepts Medicare assignments in order to save money. If a doctor accepts a Medicare assignment, they accept Medicare-approved amounts as full payment, and you cannot be charged more. Most physicians who treat Medicare patients will accept Medicare assignments. Providers who don’t participate fall into two categories:
Non participating providers – These providers can charge up to 15% more than the Medicare approved amount for covered services and leave you responsible for the additional costs
Opt-out providers – These providers can charge whatever they want which is outlined in a private contract with the patient.
To locate physicians in your area who accept assignment, visit Medicare.gov to find doctors and other health professionals section. The search tool displays which physicians accept Medicare payments.
If you have a Medicare Advantage plan, check your plan’s provider directory or website to ensure you’re choosing doctors in the network. Keeping in mind that doctors may be added or removed at any time. Generally, you will pay more to see non-network providers. Make sure that you research different doctors. Confirm that they accept Medicare and are willing to educate you on what is and is not covered so that you are not overcharged.
Understand Your Policy
Medicare provides coverage for skilled services such as nursing, speech therapy, and physical therapy, but there are eligibility requirements. To qualify for these services, you must be homebound. Meaning you are unable to leave your home without assistance or because of a medical condition. Many seniors mistakenly believe that they are covered for these services, only to receive a hefty bill in the end. Before assuming something is covered, carefully read your policy’s guidelines.
Look Into Medicare Advantage
Medicare Advantage plans are offered by private insurance companies and offer the convenience of having Part A, Part B, and Part D services all bundled into one plan. Whereas traditional Medicare has you sign up for each plan individually. Medicare advantage plans may also include coverage for routine dental, vision, and hearing exams. Which are not available under Original Medicare. However, the biggest benefit of Medicare Advantage is the annual out-of-pocket maximums for seniors excluding
prescription drug plans. Which as of 2023 is $8,300. With Original Medicare, there are no annual out-of-pocket maximums.
However, you should also be aware of the disadvantages of Medicare Advantage. Original Medicare is widely accepted by physicians and hospitals all over the country. Whereas a Medicare Advantage plan will have a smaller network of providers. So, it’s possible that your doctor isn’t in their network. Next, you may be required to get a referral before seeing a specialist. Which is not the case for Original Medicare enrollees. There are also certain covered services that Parts A and B that may have a high copayment under a Medicare Advantage plan. Meaning you would have higher out-of-pocket costs with Medicare Advantage than you would with Original Medicare.
If you have a chronic or serious health condition and will likely visit the doctor frequently, you may want to consider a Medicare Supplement Plan. Medicare covers the majority of eligible medical expenses for seniors, but you are still responsible for 20%-25% of the total cost of care. Medicare Supplement Plans were designed to help cover a substantial portion of the medical expenses that come from having Medicare Part A and B, that you would otherwise be responsible for.
As with Part D, private insurers offer Medicare Supplement Plans and with Part D, there are a variety of plans to choose from. So you should shop around carefully to find the plan that fits you best. While yes, Medicare Supplement Plans do have premiums and can increase your monthly expenses, the additional coverage could give you peace of mind and eliminate some of the uncertainty that comes with your out-of-pocket Medicare costs.
Save On Medications
Even if you have Medicare Part D prescription drug coverage, your out-of-pocket costs can be astronomical, in part because Part D does not have a limit for out-of-pocket expenses. After you reach the catastrophic coverage threshold of $7,400 (as of 2023), the majority of people will continue to have to pay 5% of the cost of covered drugs. In certain instances, you can reduce drug costs by forgoing your Part D plan and paying cash. Big-box stores such as Costco and Target offer a variety of generic prescriptions for much cheaper, whereas many Part D plans have a high standard copay to fill a prescription. The only problem with paying in cash and not using your coverage is that the expense won’t count towards your deductible.
If you stick with your Medicare Part D plan’s list of “preferred” pharmacies you will typically pay less for your prescriptions. Also most Part D plans separate their drug formularies (list of covered drugs) into 5 tiers: preferred generic, generic, preferred brands, non preferred, and specialty. With preferred generics being the lowest cost-sharing tier and the most affordable for enrollees. If you find a drug that is approved for your condition on a lower tier than the one you currently take, ask your doctor if you can switch to the more affordable one.
Review Your Quarterly Summary
Your quarterly Medicare summary displays services and supplies for which Medicare was billed. This summary will also indicate whether or not any claims have been denied; if so it is important to contact the provider of the denied claim. If you believe the claim is unjust, you can appeal the claim denial by following the instructions on the summary’s final page. When admitted to the hospital, for instance, you will receive a notice outlining your Medicare rights. You may request an appeal of the decision and a review of your case if you believe you were discharged prematurely.
Use Your Preventative Care
Many Medicare recipients don’t realize that there is a long list of services that they can get for free. Medicare provides numerous screenings and annual wellness visits at no cost to you. These free preventative measures are important for detecting serious illnesses early. The screenings may include depression, cardiovascular disease, and other conditions. There are free counseling sessions for tobacco and alcohol abuse, as well as free vaccinations for flu and pneumonia. Additionally, you are eligible for a free “welcome to Medicare” preventive visit within the first 12 months of receiving Medicare Part B. During this initial appointment, you can also receive free assistance planning for end-of-life care. And your physician can help you draft an advance directive that outlines all of your wishes.
Utilizing these freebies can aid doctors in detecting major health problems before they worsen, thereby preserving your health. You might also have access to free wellness benefits if you have a Medicare Advantage plan. Some Advantage plans, for instance, include SilverSneakers membership at no extra charge. This program provides a basic gym membership and access to senior-specific group exercise classes.
Plan Yearly Expenses With The Out-Of-Pocket Maximum In Mind
Individuals’ Medicare costs can vary widely based on their circumstances and the type of coverage they have. Original Medicare typically covers 80% of a beneficiary’s Part A and Part B expenses. Such as doctor visits, hospital stays, and lab work. Individuals are responsible for remaining 20% of out-of-pocket costs, with no annual cap. Medicare Advantage plans offer predictable copayments and an annual limit on out-of-pocket costs. Once you reach your plan’s out-of-pocket maximum, all Medicare-covered services for the remainder of the year are covered in full. This cap can provide peace of mind if you have a sudden illness or are preparing for a major medical procedure.
Shop Around Every Year
Original Medicare, which includes Part A (hospital insurance) and Part B (medical insurance), is relatively simple. There is no need to shop around for Parts A or B because they come in a universal package. Where you should shop around is your Medicare Part D plan and your Medicare Supplement Plans. Medicare contracts with private insurance companies that offer Part D and Medicare Supplement Plans to provide seniors with a variety of coverage options. Moreover, these coverage options and their costs can change from year to year. This means that the plan you have this year might not be the best for you next year. The worst thing you can do is automatically enroll in your previous year’s plan without comparing options. This could result in higher out-of-pocket costs and for Part D could mean less coverage for prescription medications.
Get Help From EZ
If you’re looking for a Medicare Supplement Plan or Medicare Advantage Plan, you must compare the costs and benefits of each. This requires extensive research. Which can be time-consuming, as you will need to contact multiple insurance companies to obtain rate quotes. However, if you work with one of EZ’s agents, you can compare prices in half the time. Working with a licensed agent provides you with access to a variety of carriers and plans.
In addition to providing price comparisons, your agent can explain the differences between each plan. And explain the differences between each plan. In addition, your agent can assist you in determining which plan will be the most cost-effective for you in the long run by comparing out-of-pocket costs and premium costs. Call us today at 877-670-3601 or enter your zip code in the bar below to begin comparing.
Medicare is the nation’s health insurance program for seniors 65 and older. It also provides coverage for younger people who meet specific eligibility criteria. Medicare Parts A, B, C, and D cover a large variety of your major medical expenses. It’s a great program but it can be difficult to read through all of the plans, options, and rules. This can make it difficult to choose the right plan on time. Below we’ve outlined some of the most common Medicare mistakes so you know what to avoid and not wind up with penalties, coverage delays or gaps.
Signing Up Late
Medicare has specific deadlines to enroll. Your Initial Enrollment Period (IEP) happens when you first become eligible for Medicare. It starts 3 months before your 65th birthday, including your birth month, and then ends 3 months after you turn 65. This gives you 7 months to enroll. If you’re receiving Social Security benefits then you will be automatically enrolled and you don’t have to do anything or worry about the deadlines, Social Security handles enrollment for you. However, if you are not automatically enrolled you have to apply yourself during your IEP. If you miss the IEP you do have another opportunity between January 1st and March 31st called the General Enrollment Period (GEP).
Missing these enrollment periods is one of the most common and costly mistakes people make. If you miss both enrollment periods you can face late enrollment penalties for Medicare Parts A, B, and D. It’s important to note that there is a way to avoid these penalties. If you qualify for a Special Enrollment Period (SEP) then you will be able to enroll in Medicare penalty free with all the same benefits as when others enroll during the IEP.
SEP Types
Qualifying life event – If you have a qualifying life event then you qualify for a 2-month SEP where you have 2 months to enroll in Medicare. The most common qualifying events are:
You moved out of your current plan’s service area
Your plan no longer serves the area you are in
If you decide to switch from Medicare Advantage to Original Medicare within 12 months of enrolling in the Medicare Advantage plan.
You move into or out of a facility such as a nursing home
If you’ve lost Medicaid eligibility
Working past 65 – If you decide to continue working past 65 and have creditable coverage through your or your spouse’s employer’s health plan then once you leave your job you will open an 8-month SEP. This SEP does have a stipulation, if you want Part D you have to enroll in it within the first 2 months of your 8 month SEP, otherwise you still face penalties. Your 8 months begin the day you no longer have credible health coverage.
Medicare Part A Penalty
Some people qualify for Part A premium-free. If you’ve worked and paid into Social Security and Medicare taxes for at least 40 calendar quarters, then you are eligible for Railroad Retirement benefits (RRB), or have a spouse that qualifies for premium-free Part A then you will get Part A for free. However, if you don’t and have to pay for Part A, then you can face a 10% increase on your premium for missing the IEP. This penalty stays with you for twice the number of years that you were eligible and didn’t sign up. For instance, if you were eligible for Part A for 3 years and did not enroll, you’ll have the penalty for 6 years.
Medicare Part B Penalty
If you miss your enrollment period and don’t qualify for an SEP, you will face a Part B penalty. This penalty is a 10% increase for every year you did not sign up. For example, say you waited 2 years to enroll. You’re looking at a 20% increase in your premium, 10% for each of the 2 years you delayed. The standard Part B premium for 2023 is $164.90, plus adding the 20% will bring your premium up to $197.88 which will be rounded up to the nearest $.10, making it $197.90 for part B. That’s $32.98 extra every month that you could have saved by enrolling on time. Now that might not seem like a lot, but if you look at it on a yearly basis that is $395.76 a year!
Medicare Part D Penalty
The amount of the penalty depends on the length of time that you did not have Part D or a creditable prescription drug plan. Medicare determines the penalty amount by multiplying 1% of the national base beneficiary premium ($32.74 in 2023) by the number of full months you went without drug coverage. The penalty amount is then rounded to the nearest $.10 and added to your monthly premium. The national base beneficiary premium can vary from year to year, so your penalty will change with it.
For example, say you waited 14 months to enroll in Part D and didn’t have creditable drug coverage for any of that time. You’ll have to pay a 14% penalty. For 2023 that would be $4.58 rounded up is $4.60 extra on your premium.
Assuming Spouse Coverage
Assuming your spouse is covered by Medicare because you have it or vice versa is a big mistake. It could leave you or your spouse without insurance. Medicare doesn’t work the same as an employer group plan. Meaning it won’t cover your family, it only applies to the individual who enrolls. If you worked and paid your Medicare taxes for the last ten years then at most your spouse who is 65 will be eligible for premium-free Part A. If your spouse is under 65, they need to find their own coverage elsewhere, such as a plan from the Health Insurance Marketplace, their own group plan, or COBRA. Additionally, if your spouse is under 65 they still may be eligible under certain conditions. Medicare is available to anyone who receives Social Security Benefits for at least 24 months, has End-Stage Renal Disease (ESRD), or Amyotrophic Lateral Sclerosis (ALS).
Not Weighing Your Options
There are many options to choose from with Medicare. There’s Original Medicare, Medicare Advantage, and Medicare Supplement Plans. It’s important that you know the differences and their benefits. If you make the mistake of not weighing your options you can leave yourself with large gaps in your coverage or end up paying far more than you need. Below we’ve outlined these plans to give you a starting point.
Original Medicare
Original Medicare, also known as traditional Medicare, consists of only Parts A and B. Medicare Part A is hospital insurance, and it covers hospital inpatient care and skilled nursing facility care. Part A coverage typically includes the following:
Semi-private hospital rooms
Hospital meals
Inpatient lab tests and X-rays
Operating room and recovery room services
Drugs and medical equipment used while in the hospital or skilled nursing facility
ICU care
Skilled nursing services
Hospice care
Part B of Medicare covers your general medical expenses. Such as doctor’s visits, urgent care, and specialists. Typically Part B covers:
Doctor visits and services
Some preventative screenings and services
Ambulance services
Outpatient surgery services
Mental health care
Some durable medical equipment
Some medically necessary tests such as X-rays, MRIs, CT scans, and EKGs
Medicare Advantage
Medicare Advantage, commonly known as Part C, is a type of Medicare plan that is offered by private insurance companies. These companies have a contract with the Medicare program that ensures the plans they offer comply with Medicare’s regulations. Medicare pays a set amount to the insurers for each participant enrolled in the plan. Additionally, you will pay your medical bills directly to your insurance company while your insurance provider must follow Medicare’s regulations. They are allowed to set their own rules for out-of-pocket expenses as well as decide if you need a referral to see specialists.
Medicare Supplement Plans
Medicare Supplement Plans are plans that you can buy to supplement your Original Medicare. These plans fill in any gaps in coverage, ensuring you get the most coverage for all the medical needs you specifically have. You do have to pay a monthly premium for these plans, and you must enroll in both Part A and Part B to be eligible for a Medicare Supplement Plan. However you may end up paying less than you would overall with your Original Medicare because Medicare Supplement Plans all have benefits that cover a lot of the out-of-pocket costs for Part A and B. One of the biggest advantages with Medicare Supplement is the variety. There are 10 plans to choose from and all of them cover different benefits at different amounts. It’s important you look through these plans and compare to tailor your coverage specifically to what you need.
Working With EZ
In order to save as much as possible during your Medicare journey, it’s important to keep all of these mistakes in mind. You can rely on EZ if you have any questions or need help choosing your plans. Whether you’re looking for help enrolling, or just need some information. Give us a call today at 877-670-3608 to speak to your own Medicare Agent or you can get free instant quotes by entering your zip code in the box below.
Your Initial Enrollment Period (IEP) is an important time if you’re considering your Medicare options. It’s natural that everyone has their own opinions regarding Medicare and the best coverage. While advice from family and friends can be helpful, when it comes to Medicare, there are a lot of myths passed around. Maybe you’ve come across information on social media or in conversation and wondered “Is that really true?”. You deserve accurate information about your coverage options so we’ve compiled a list of 10 common myths that we’d like to debunk for you.
There’s a misconception that since Medicare is a government benefit, seniors don’t have to pay for it because it has already come out of their taxes. While that would be great, it’s unfortunately not entirely true. Medicare Part A, or hospital coverage, doesn’t have any premiums. That is as long as you have paid your Medicare taxes for at least 40 calendar quarters. Even so, you still have a deductible and copays. So that part of the myth is kind of true.
However, Part A is the only Medicare product with no premium. Part B, medical coverage, has a monthly premium of $164.90 as of 2023. It’s important to note that the premiums are adjusted annually, meaning some years they increase and some years they’ll decrease. These premiums might also be higher for enrollees with higher income. The good news is that if you’re on Social Security, your Part B premium can be paid directly from those benefits, so while you may not be paying directly out of pocket, you are still paying for it. Additionally, if you choose the Medicare Advantage route you may also have to pay a monthly premium.
2. Medicare covers all healthcare costs.
Medicare does cover a large portion of your healthcare but not everything. Between Part A and Part B most of your hospital and basic medical expenses are covered.
Even with the services it does cover you are still responsible for deductibles, coinsurance, and copays. As you can see there are still several services that you may need that aren’t covered. Such as hearing, vision, and dental care. There is also no prescription drug coverage in Original Medicare (Part A and B). Typically to get those things covered most people will enroll in Medicare Advantage, Medicare Part D (prescription drug coverage), or a Medicare Supplement Plan. Any of those options do provide coverage for the gaps in your Medicare coverage.
3. You are automatically enrolled in Medicare.
This is another myth that is only partially true. If you have been receiving Social Security benefits or Railroad Retirement Board Benefits (RRB) for at least 24 months after you turn 65, then you will automatically be enrolled in Medicare Part A and B. Be aware that even after automatic enrollment, you are responsible for enrolling yourself in either Medicare Advantage, Medicare Part D or any Medicare Supplement Plans.
Now, if you’re not receiving Social Security or RRB, then enrolling is entirely up to you. The best thing to do is to enroll during your IEP, which will begin 3 months before you turn 65 and will end 6 months after your 65th birthday.
4. I can enroll in Medicare at any time.
This is completely false and can be one of the most detrimental myths to believe. If you don’t enroll during your IEP, you can face enrollment restrictions as well as a penalty. You will then have to wait for the next eligible enrollment period, which is known as the General Enrollment Period (GEP). The GEP lasts from October 15th to December 7th every year. The penalty for waiting is a premium increase of 10% for twice as many years that you were eligible and did not enroll. To make that simpler, If you did not enroll in Part A for 2 years after your IEP then the penalty would apply to your premium for the next 4 years. For Part B, the increase only lasts for the amount of time you did not enroll, so it would only apply for those first 2 years.
Now having said that, another way that you can avoid these penalties, aside from applying on time, is if you qualify for a Special Enrollment Period (SEP). To trigger an SEP you would have had to still be working and have credible health coverage through your employer or through your spouse’s employer during your IEP. Once you leave your job or lose the group plan coverage, you then have 8 months to enroll without penalty. Another way you can get an SEP is if you are under 65 and eligible for Medicare due to illness or disability, but have health insurance through a caregiver or spouse’s employer-sponsored health insurance. However, this only applies if their company has at least 100 employees.
5. Medicare costs the same for everyone.
While Medicare offers the same benefits to everyone, the cost is not universal. How long you worked and paid Medicare taxes, as well as your gross income determine your premiums and deductibles. The more you make, the more you will end up paying just like with regular health insurance. Additionally enrolling in Medicare Advantage, or Part D, or any Medicare Supplement Plans will change how much you pay for Medicare. So it varies greatly from person to person depending on their specific circumstances.
6. I can only enroll if I’m healthy.
This is a huge myth, Original Medicare cannot deny your coverage due to illness or a pre-existing condition due to implementation of the Affordable Care Act. If you have certain medical conditions like End-Stage Renal Disease (ESRD) or ALS, you are eligible for Medicare even if you aren’t 65 yet. Once you turn 65 or retire you are eligible for Medicare Parts A and B, period. Also,there are no penalties or premium increases for pre-existing conditions. If you have certain medical conditions like End-Stage Renal Disease (ESRD) or ALS, you are eligible for Medicare even if you aren’t 65 yet.
7. Medicare Advantage and Medicare Supplement Plans are the same thing.
This is not true at all. They are similar in that private companies offer them but they are entirely different. Medicare Advantage is an alternative to Original Medicare. It may include prescription drug coverage. Medicare Supplement Plans are additional coverage you can buy to fill in the gaps left by your Original Medicare. Additionally, you can buy one or the other but not both.
8. Medicare doesn’t have as many options.
You may believe that Medicare is a one-size-fits-all program because it’s a government program. However, this is another one of those pesky Medicare myths. Medicare typically provides significantly more health insurance options than your employer’s group coverage. Whereas you may have had only a few plan options to choose from when enrolling in employer coverage, Medicare provides you with dozens of options. Medicare allows you to tailor your coverage to your specific needs.
9. Medicare will notify me when it’s time to enroll.
Obviously you don’t want to be late enrolling in Medicare. Nobody wants to have a penalty added to their premium. Unfortunately, Medicare does not give you an enrollment reminder when it’s time for you to enroll. The good news is that if you have Social Security Benefits or RRB before you’re 65, you will automatically enroll in Medicare Parts A and B. On the other hand, if you don’t have those benefits you have to remember to enroll on your own. So, it’s important that you note the specific times when you can enroll.
10. I am on COBRA so I don’t need to sign up for Medicare Part B.
COBRA does not count as active employment. To delay Part B enrollment without incurring a penalty, you or your spouse must be actively employed and covered by a group health plan. Additionally, if you are already on COBRA and your Medicare begins, your COBRA status will change when you turn 65. Meaning your COBRA coverage will end. You won’t be eligible to delay Part B without incurring a penalty. You may even experience a delay in the start of your Part B coverage, which could result in a serious coverage gap.
EZ Can Help
Now that you have all the facts it’s time to enroll with the help of EZ. EZ is able to help you enroll in Medicare, purchase a Medicare Supplement Plan, or just help you weigh your options. Our insurance agents collaborate with some of the most reputable insurance providers in the country. They are able to provide you with a free analysis that compares all of the plans that are available in your region. We will discuss your medical and financial needs and then assist you in locating a plan that is tailored to meet those requirements. To start, enter your zip code into the box below. Or give one of our licensed agents a call at 877-670-3602 and we’ll get the ball rolling for you.
Many people think eating disorders only affect young or even middle-aged adults, but not older adults. Unfortunately, this is not the case: eating disorders don’t simply go away with age. But it is only in more recent times that there has been recognition of eating disorders in older adults, and now the National Eating Disorders Association (NEDA) reports that 20% of women aged 70 and older are trying to change the size of their bodies.
Eating disorders can affect anyone at any age, but social stigma keeps some older women from seeking help. So if you or someone you know is dealing with an eating disorder, you are probably wondering if you can get treatment with Medicare.
Medicare Coverage
If you or a loved one are dealing with an eating disorder, you will be happy to know that many hospitals and treatment centers accept Medicare for the treatment of these conditions. But when it comes to paying for treatment, Medicare will first require you to seek outpatient treatment before they will pay for more advanced treatment options.
But regardless of the level of care required, Medicare will agree to pay for a reasonable and necessary treatment for beneficiaries’ eating disorders. Generally, Medicare will cover medication, therapy, and patient education.
Medicare will also usually cover a portion of inpatient care if your physician provides documentation that inpatient treatment is medically necessary for your situation. It is essential to note that Medicare does not cover outpatient treatment services for ongoing therapy after inpatient care. And similar to inpatient coverage, your doctor has to recommend outpatient care and psychotherapy.
Inpatient Care Vs. Partial Hospitalization
While, as noted above, you can get coverage for inpatient care for eating disorders with Medicare, they often prefer to cover partial hospitalization (PHP). PHP is covered by Medicare Part B and provides a structured program of outpatient services as an alternative to inpatient care.
Medicare will help cover these services when provided by a hospital outpatient department or Community Mental Health Center. It will also cover any occupational therapy that is part of your mental health treatment. And although Medicare covers the cost of treatment, you will still be responsible for a percentage of the payment for each Medicare-approved service that you receive. Typically Medicare will cover 80% of costs, leaving you to pay the remaining 20% out-of-pocket. There also be a coinsurance payment for each day of PHP services, regardless of the setting.
Extra Coverage
If you need help paying for the things that Medicare doesn’t cover, like out-of-pocket costs for treating an eating disorder, you can purchase a Medicare Supplement Plan. Your plan can help pay for the things that Medicare does not, including the 20% coinsurance that you will have to pay out-of-pocket for every Part B expense. One of these plans could cover 100% of your Part A coinsurance and hospital costs, as well as 100% of Part B coinsurance and copayments, for one low monthly premium price.
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 in minutes for you 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.
Chronic obstructive pulmonary disease, or COPD, is a scary diagnosis. It can mean a significant reduction in your quality of life, and there is unfortunately no cure for the condition. But there is some hope: elderly people who partake in pulmonary rehabilitation programs can see a significantly improved quality of life. The rehab program will not cure any lung disease, but it will help with breathing problems and give you more strength. Does Medicare cover pulmonary rehabilitation programs, and if so, what are the requirements?
What Is Pulmonary Rehabilitation?
Pulmonary rehabilitation is a nonpharmacologic treatment program targeting the symptoms of COPD. It’s a broad-based, outpatient program that provides exercises, peer support, and education for people who need it.
You can access pulmonary rehab services in your doctor’s office, a clinic, or in a hospital outpatient facility. During pulmonary rehabilitation, you will learn more about COPD, lung function, and exercises that can help you gain strength and breathe more efficiently. As we stated above, it can help improve your quality of life, even if it can’t cure your COPD.
Medicare Part B Coverage
Medicare Part B, medical insurance, covers a comprehensive pulmonary rehabilitation program if:
You have moderate to severe COPD
Your doctor gives you a referral for COPD treatment
You had a confirmed or suspected case of Covid-19 and have persistent systems, including respiratory dysfunction, for at least four weeks.
Medicare will typically cover up to 36 pulmonary rehab sessions. Your doctor can request a coverage be increase to 72 sessions if it is medically necessary.
How Much You Will Pay?
When it comes to your out-of-pocket costs for a pulmonary rehab program, you will first have to meet your annual Medicare Part B deductible. As well as pay your Medicare Part B monthly premiums. Once you have met your Part B deductible, you will be responsible for 20% of the Medicare-approved cost of your pulmonary rehabilitation services. If you receive the treatment at a doctor’s office, you will pay 20% of the Medicare-approved amount. If you get treated in a hospital outpatient setting, you will pay the hospital copay per session.
Extra Coverage
If the 20% coinsurance that you will be required to pay for pulmonary rehab seems daunting, know that a Medicare Supplement Plan can cover some of the out-of-pocket costs that Original Medicare does not cover. These plans can help keep out-of-pocket expenses down, especially if you have a chronic condition such as COPD.
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 in minutes for you 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.
If you’re a Medicare beneficiary, you have a few opportunities throughout the year to enroll in, change, or drop your Medicare plan. One of the opportunities to do so is the Medicare Annual Enrollment Period (AEP) which runs from October 15th to December 7th. Because this period is such a short amount of time, many people accidentally miss it. So what happens if you missed the Medicare Annual Enrollment Period, but would like to make changes to your current plan?
Research Other Medicare Enrollment Periods
Although you might have missed the AEP, there are other Medicare enrollment periods that you might qualify for, including:
Initial Enrollment Period – This is when you have just become or are about to become eligible for Medicare. It begins three months before your 65th birthday and continues through the three months following.
General Enrollment Period – This runs from January 1-March 31 each year, and is an opportunity for individuals who didn’t sign up for Original Medicare when they were first eligible to sign up. It’s important to note that you might have to pay a late enrollment fee if you enroll after your Initial Enrollment Period, and your coverage will not start until July 1 of that year.
Special Enrollment Period– Certain life events can make you eligible to enroll in Medicare, such as moving, losing employer coverage, being diagnosed with a qualifying chronic condition, or moving in or out of a skilled nursing facility or long-term hospital care.
Speak With Your Doctor
If you have missed this year’s AEP, and you don’t qualify to change your coverage or can’t wait for another enrollment period, there are still ways you can lessen the burden of healthcare costs. One of the best ways is to speak with your doctor. Talk to them about your medications, for example: they might be able to find a generic version that will help you save hundreds of dollars each year.
In addition, ask your doctor if certain medical services are required, and how you can save on those, particularly when it comes to how they are coded for billing.
Work With An EZ Agent
Missing the Medicare Annual Enrollment Period can cause a lot of stress. EZ.Insure offers agents in your region to help you and answer any questions you may have. Our agents are highly trained to provide you with the best option for your needs. Our agent will provide you with Medicare Supplement Plan quotes from top carriers in your area, and even help you sign up at no cost. To get free instant quotes on plans that cover your current doctors, simply enter your zip code in the bar on the side, or to speak to a local licensed agent, call 888-753-7207.
