Shocking how many people ask about the FREE PART C plans, and even more shocking the response when I tell Agents & Customers alike IT IS NOT FREE! It may not cost them out of their pocket, but nothing is FREE.
BEST FREE MEDICARE ADVANTAGE PLANJeff Cline Founder of 1-800-MEDIGAP
I do tell them I am very well versed and share with them the information I can gleen from Medicare.gov, related carriers, and Senior Sites, and the over 20 years of experience, but as always. CHECK WITH MEDICARE.gov
I DO NOT SELL ALL PLANS, If you want a list of all plans or to speak directly to medicare here is their site>>
With that said, here is some interesting info I have put together from data collected (AGAIN SEE MEDICARE.gov for all/full details). This is just a condensed version of the most frequently asked questions I get:
What is a Medicare Supplement Plan?
Medicare Supplement Insurance, also known as Medigap, is private health insurance that helps cover some of the out-of-pocket costs that Original Medicare (Part A and Part B) does not cover, such as deductibles, copayments, and coinsurance. Medigap policies are sold by private insurance companies, and the coverage options are standardized by the federal government. There are ten standardized Medigap plans, labeled with letters A through N, and each plan covers a different set of benefits.
The 1-800-MEDIGAP phone number is a service that helps beneficiaries find and compare Medigap policies offered by various insurance companies. This service is run by the National Medicare Supplement Insurance Association (NMSIA), a trade association that represents insurance companies that sell Medigap policies. By calling 1-800-MEDIGAP, beneficiaries can speak with licensed insurance agents who can provide information about different Medigap plans and help them enroll in a plan that meets their needs.
It’s important to note that Medigap policies can only be purchased by beneficiaries who are enrolled in Original Medicare, and that beneficiaries cannot have both a Medigap policy and a Medicare Advantage plan. Additionally, Medigap policies do not cover prescription drugs, so beneficiaries who want prescription drug coverage will need to enroll in a separate Medicare Part D plan.
Medicare Supplement plans, along with their phone numbers and addresses. Please note that the availability of Medicare Supplement plans can vary by location, and this chart is not exhaustive:
|Insurance Carrier||Phone Number||Address|
|Aetna||1-800-872-3862||151 Farmington Avenue, Hartford, CT 06156|
|Cigna||1-800-997-1654||900 Cottage Grove Road, Bloomfield, CT 06002|
|Humana||1-800-833-6917||500 West Main Street, Louisville, KY 40202|
|Mutual of Omaha||1-800-775-1000||Mutual of Omaha Plaza, Omaha, NE 68175|
|UnitedHealthcare||1-800-523-5800||9700 Health Care Lane, Minnetonka, MN 55343|
Again, please note that this is not an exhaustive list, and that the availability of Medicare Supplement plans can vary by location. It’s a good idea to compare plans and speak with a qualified professional to determine which plan is best for you.
Medicare advantage vs medicare?
Medicare Advantage (MA) and Original Medicare are both health insurance options available to individuals who are eligible for Medicare. Here are the top 10 differences between Medicare Advantage and Medicare:
- Coverage: Medicare Advantage plans are required to offer at least the same coverage as Original Medicare (Parts A and B), but many MA plans offer additional benefits such as prescription drug coverage, dental, vision, and hearing services, and wellness programs that are not covered by Original Medicare.
- Cost-sharing: Medicare Advantage plans may have lower premiums than Original Medicare, but may require copays, coinsurance, and deductibles for certain services. With Original Medicare, beneficiaries may have to pay for Part B premiums, as well as coinsurance and deductibles.
- Provider network: Medicare Advantage plans often have a provider network, which means that beneficiaries may be limited to seeing certain doctors and hospitals. With Original Medicare, beneficiaries can generally see any doctor or hospital that accepts Medicare.
- Referrals: Medicare Advantage plans may require beneficiaries to get a referral from their primary care physician before seeing a specialist. With Original Medicare, beneficiaries do not need a referral to see a specialist.
- Prescription drug coverage: Many Medicare Advantage plans include prescription drug coverage, while Original Medicare does not. Beneficiaries who want prescription drug coverage with Original Medicare must enroll in a separate Medicare Part D plan.
- Out-of-pocket maximum: Medicare Advantage plans have an out-of-pocket maximum, which limits the amount of cost-sharing that beneficiaries have to pay each year. Original Medicare does not have an out-of-pocket maximum.
- Plan changes: Medicare Advantage plans can change their benefits and coverage each year, which may require beneficiaries to switch plans if their needs change. Original Medicare benefits and coverage remain the same each year.
- Enrollment: Medicare Advantage plans have specific enrollment periods during which beneficiaries can enroll or switch plans. Original Medicare beneficiaries can enroll or switch plans during the annual open enrollment period.
- Availability: Medicare Advantage plans are not available in all areas, while Original Medicare is available nationwide.
- Coordination of care: Medicare Advantage plans often have care coordination programs that help beneficiaries manage their health care and coordinate services with their doctors. Original Medicare does not offer this type of program.
It’s important to note that there may be other differences between Medicare Advantage and Original Medicare depending on the specific plan and beneficiary needs. It’s a good idea to compare plans and speak with a qualified professional to determine which option is best for you.
What allows me to change my Medicare Advantage out of the Annual Enrollment Period?
Medicare Advantage (MA) plans have an Annual Enrollment Period (AEP) each year during which beneficiaries can switch plans or enroll in a new plan. However, there are also several other circumstances under which beneficiaries may be eligible to make changes to their MA plan outside of the AEP. Here are the top 15 reasons someone on Medicare Advantage can change their plan outside of AEP:
- Moving out of the plan’s service area: If a beneficiary moves out of the geographic area that their MA plan serves, they may be eligible to switch plans outside of the AEP. Source: Medicare.gov – Special circumstances (https://www.medicare.gov/sign-up-change-plans/joining-a-health-or-drug-plan/special-circumstances)
- Loss of current coverage: If a beneficiary loses their current coverage, such as if their employer stops offering health coverage, they may be eligible to enroll in an MA plan outside of the AEP. Source: Medicare.gov – Special circumstances (https://www.medicare.gov/sign-up-change-plans/joining-a-health-or-drug-plan/special-circumstances)
- Change in Medicaid eligibility: If a beneficiary becomes eligible for Medicaid, they may be able to switch to an MA plan with a five-star rating outside of the AEP. Source: Centers for Medicare & Medicaid Services (CMS) – Medicare Marketing Guidelines (https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/Downloads/CY-2021-Medicare-Marketing-Guidelines_Final07232020.pdf)
- Dual-eligible status: If a beneficiary becomes eligible for both Medicare and Medicaid, they may be able to enroll in a dual-eligible Special Needs Plan (SNP) outside of the AEP. Source: CMS – Medicare Managed Care Manual (https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/mc86c13.pdf)
- Plan non-renewal: If a beneficiary’s MA plan is not renewed for the following year, they may be eligible to enroll in a new plan outside of the AEP. Source: Medicare.gov – Special circumstances (https://www.medicare.gov/sign-up-change-plans/joining-a-health-or-drug-plan/special-circumstances)
- Plan termination: If a beneficiary’s MA plan is terminated, they may be eligible to enroll in a new plan outside of the AEP. Source: Medicare.gov – Special circumstances (https://www.medicare.gov/sign-up-change-plans/joining-a-health-or-drug-plan/special-circumstances)
- CMS sanctions against plan: If CMS imposes sanctions against a beneficiary’s MA plan, they may be eligible to enroll in a new plan outside of the AEP. Source: CMS – Medicare Managed Care Manual (https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/mc86c13.pdf)
- Entitlement to other coverage: If a beneficiary becomes entitled to other coverage, such as employer-sponsored coverage, they may be able to disenroll from their MA plan outside of the AEP. Source: CMS – Medicare Managed Care Manual (https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/mc86c13.pdf)
- Misrepresentation or plan error: If a beneficiary is enrolled in an MA plan due to a misrepresentation or plan error, they may be able to switch plans outside of the AEP. Source: CMS – Medicare Managed Care Manual (https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/mc86c13.pdf)
- Involuntary plan termination:
What Are Dule Eligible SNP’s
Dual-eligible SNPs are a type of Medicare Advantage plan designed for individuals who are eligible for both Medicare and Medicaid, also known as “dual eligibles.” These plans are intended to provide comprehensive and coordinated care for individuals with complex medical needs.
The two main reasons for dual eligibility are low income and disability. Individuals who meet certain income and asset limits and are enrolled in Medicaid may also be eligible for Medicare. Additionally, individuals who are under 65 years old and have certain disabilities may also be eligible for Medicare.
The date of eligibility for dual eligible SNPs can vary depending on individual circumstances. Generally, individuals can enroll in a dual eligible SNP during the annual Medicare Open Enrollment period, which runs from October 15 to December 7 each year. However, individuals who become newly eligible for Medicare and Medicaid outside of the Open Enrollment period may be able to enroll at any time.
For more information on dual eligible SNPs and eligibility requirements, you can visit the official Medicare website at www.medicare.gov. Here are the top ten reasons why a dual eligible SNP may be a good option for individuals:
- Comprehensive coverage for both medical and prescription drug costs
- Coordinated care from a team of healthcare providers
- Access to additional benefits such as dental, vision, and hearing services
- Low or no monthly premiums for those who qualify
- Reduced out-of-pocket costs for medical services
- Protection against high healthcare costs
- Simplified healthcare management through a single plan
- Increased access to preventive care services
- Assistance with care transitions and coordination between healthcare providers
- Greater flexibility in choosing healthcare providers and specialists.
- Medicare.gov: https://www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices/types-of-medicare-health-plans/special-needs-plans-snp
- Centers for Medicare & Medicaid Services: https://www.cms.gov/Medicare/Eligibility-and-Enrollment/Medicare-and-Medicaid-Plans/Special-Needs-Plans
SNP’s By State:
Dual eligible Special Needs Plans (SNPs) are offered by private insurance companies that are approved by Medicare. The availability of SNP plans and the insurance companies that offer them can vary by state. Here are some resources you can use to find SNP plans and insurers in your state:
- Medicare.gov: The official Medicare website offers a plan finder tool that can help you search for SNP plans in your area. You can enter your zip code and other information to see a list of plans available to you. The website also provides information on the insurance companies that offer SNP plans.
- State Health Insurance Assistance Program (SHIP): The SHIP program offers free counseling and assistance to Medicare beneficiaries. You can contact your state’s SHIP program to get help finding and enrolling in SNP plans. You can find contact information for your state’s SHIP program at https://www.shiptacenter.org/.
- Insurance company websites: Many insurance companies that offer SNP plans have websites that provide information on their plans and coverage. You can search for insurance companies in your state and visit their websites to learn more about their SNP plans. Some examples of insurance companies that offer SNP plans include UnitedHealthcare, Humana, and Aetna.
- State Medicaid agency: Since SNP plans are designed for individuals who are eligible for both Medicare and Medicaid, you may be able to find information on SNP plans through your state’s Medicaid agency. You can visit your state’s Medicaid website or contact the agency directly to learn more.
It’s important to note that the availability of SNP plans and insurers can change from year to year, so it’s a good idea to check for updates annually during the Medicare Open Enrollment period.
Do I qualify for both Medicare and Medicaid?
To be eligible for both Medicare and Medicaid, also known as “dual eligibility,” individuals must meet certain income and asset requirements as well as certain health criteria.
Generally, individuals who are eligible for Medicare and Medicaid are those who are:
- Age 65 or older and meet the income and asset requirements for both programs
- Under age 65 with certain disabilities and meet the income and asset requirements for both programs
- Living in a nursing home or other long-term care facility and meet the income and asset requirements for both programs
The income and asset requirements for Medicaid eligibility vary by state, so it’s important to check your state’s guidelines to determine your eligibility.
Here is a chart of the income limits for Medicaid eligibility for adults in each state in 2022, according to the Kaiser Family Foundation:
|District of Columbia||$1,253|
To determine your eligibility for Medicare and Medicaid, you can contact your state’s Medicaid agency. Here are some resources you can use to find your state’s Medicaid agency website and phone number:
- Medicaid.gov: The official Medicaid website provides a list of state Medicaid agencies and their contact information. You can visit https://www.medicaid.gov/state-overviews/index.html to find your state’s agency.
- State Health Insurance Assistance Program (SHIP): The SHIP program offers free counseling and assistance to Medicare beneficiaries. You can contact your state’s SHIP program to get help determining your eligibility for Medicaid. You can find contact information for your state’s SHIP program at https://www.shiptacenter.org/.
It’s important to note that Medicaid eligibility rules can be complex and vary by state, so it’s a good idea to seek guidance from a qualified professional if you have any questions about your eligibility.
Top Medicare Insurance Companies
I can not say who is top (it is against the law…call me and I can tell you who I put my mother with when she was alive), but below is a listing of the major players in the space that most customers buy from!Jeff Cline Founder 1-800-MEDIGAP
Here is a chart of some of the largest insurance companies that offer Medicare Advantage plans, along with their website, phone number, and address:
|Insurance Company||Website||Phone Number||Address|
|Aetna||https://www.aetnamedicare.com/||1-855-335-1407||151 Farmington Avenue, Hartford, CT 06156|
|Anthem||https://www.anthem.com/medicare/||1-855-766-1487||4361 Irwin Simpson Road, Mason, OH 45040|
|Blue Cross Blue Shield||https://www.bcbs.com/medicare/medicare-advantage||Varies by state||Varies by state|
|Cigna||https://www.cigna.com/medicare/||1-800-668-3813||900 Cottage Grove Road, Bloomfield, CT 06002|
|Humana||https://www.humana.com/medicare/||1-800-833-6917||500 West Main Street, Louisville, KY 40202|
|Kaiser Permanente||https://medicare.kaiserpermanente.org/wps/portal/medicare/plans||Varies by region||Varies by region|
|UnitedHealthcare||https://www.uhcmedicareplans.com/||1-800-721-0627||9700 Health Care Lane, Minnetonka, MN 55343|
It’s important to note that this list is not exhaustive and that the availability of Medicare Advantage plans can vary by location. You can visit the websites of individual insurance companies or contact their customer service departments for more information on Medicare Advantage plans in your area. Additionally, you can visit Medicare.gov’s plan finder tool at https://www.medicare.gov/plan-compare/ to search for Medicare Advantage plans available in your area.
What Does Medicare Part A cover?
Medicare Part A is the part of Original Medicare that covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care. Here is an overview of what Medicare Part A covers:
- Inpatient hospital stays: Part A covers inpatient hospital stays, which includes room and board, nursing care, and meals. It also covers necessary tests, medications, and other services provided during the hospital stay.
- Skilled nursing facility care: Part A covers care in a skilled nursing facility (SNF) for up to 100 days per benefit period. To be eligible, the beneficiary must have been in the hospital for at least three consecutive days and require skilled nursing care.
- Hospice care: Part A covers hospice care for beneficiaries who are terminally ill and have a life expectancy of six months or less. Hospice care can be provided in the home or in an inpatient setting.
- Home health care: Part A covers medically necessary home health care services, including skilled nursing care, physical therapy, and speech-language pathology services. To be eligible, the beneficiary must be homebound and require intermittent skilled care.
- Blood: Part A covers the cost of blood transfusions received as an inpatient or outpatient.
It’s important to note that while Part A covers many services related to hospital and skilled nursing facility care, there may be limits and restrictions on coverage. Additionally, beneficiaries may be responsible for paying deductibles, coinsurance, and copayments for certain services covered under Part A.
What does Medicare Part C cover?
Medicare Part C, also known as Medicare Advantage, is an alternative to Original Medicare (Part A and Part B) that is offered by private insurance companies approved by Medicare. Medicare Advantage plans are required to offer at least the same coverage as Original Medicare, but many plans offer additional benefits such as prescription drug coverage, dental, vision, and hearing services, and wellness programs. Here are some examples of what Medicare Part C may cover:
- Medical services: Medicare Advantage plans cover all services covered by Original Medicare, including hospital care, doctor visits, and medical equipment such as wheelchairs and walkers.
- Prescription drug coverage: Many Medicare Advantage plans include prescription drug coverage, which is not included in Original Medicare.
- Dental care: Some Medicare Advantage plans offer coverage for dental services, such as routine cleanings, fillings, and extractions.
- Vision care: Some Medicare Advantage plans offer coverage for routine eye exams, eyeglasses, and contact lenses.
- Hearing care: Some Medicare Advantage plans offer coverage for hearing exams, hearing aids, and other hearing services.
- Wellness programs: Many Medicare Advantage plans offer wellness programs, such as gym memberships and health coaching, to help beneficiaries maintain their health.
- Transportation: Some Medicare Advantage plans offer transportation services to and from medical appointments.
It’s important to note that the specific benefits and coverage of Medicare Advantage plans can vary by plan and location. It’s a good idea to compare plans and speak with a qualified professional to determine which plan is best for you.
Does Medicare cover cataract surgery?
Yes, Medicare generally covers cataract surgery, which is a common procedure used to treat cataracts, a condition that causes clouding of the eye’s natural lens. Medicare Part B, which covers medically necessary services and procedures, includes coverage for cataract surgery performed by an ophthalmologist who accepts Medicare assignment.
Medicare Part B covers the cost of the following services related to cataract surgery:
- Preoperative exams and evaluations
- Surgeon’s fees for the cataract removal and insertion of an intraocular lens (IOL)
- Facility fees for the surgical center or hospital outpatient department where the surgery is performed
However, beneficiaries may be responsible for paying deductibles, coinsurance, and copayments for these services. Additionally, if a beneficiary chooses to have an upgraded or premium IOL, they may be responsible for paying the difference in cost between the standard IOL covered by Medicare and the upgraded or premium IOL.
It’s important to note that Medicare only covers medically necessary cataract surgery, and that any additional procedures or services related to vision correction or cosmetic changes are not covered.
Does Medicare cover shingles vaccine?
Yes, Medicare covers the shingles vaccine, which is recommended for individuals aged 50 and older to help prevent shingles, a painful rash caused by the same virus that causes chickenpox. The shingles vaccine is covered under Medicare Part D, which provides coverage for prescription drugs.
There are two FDA-approved shingles vaccines available: Shingrix and Zostavax. Shingrix is the preferred vaccine, and it is covered by Medicare Part D. Zostavax is an older vaccine that is no longer recommended, but it may still be covered by some Medicare Part D plans.
Beneficiaries can receive the shingles vaccine from a doctor or other healthcare provider who accepts Medicare assignment. The cost of the vaccine may vary depending on the specific Medicare Part D plan, but beneficiaries can expect to pay little or no out-of-pocket costs if they receive the vaccine from a provider that accepts Medicare assignment.
It’s important to note that Medicare Part D plans may have specific rules regarding the timing and frequency of shingles vaccine coverage. Beneficiaries should check with their plan to determine when they are eligible to receive the vaccine and how often it is covered.
Here is a chart of important Medicare enrollment periods and dates, along with other relevant information:
|Enrollment Period||Dates||Other Important Dates||Information|
|Initial Enrollment Period (IEP)||3 months before to 3 months after 65th birthday||N/A||If you do not enroll during this period, you may be subject to a late enrollment penalty.|
|General Enrollment Period (GEP)||January 1 to March 31||N/A||If you did not enroll in Medicare during your IEP, you can enroll during the GEP. However, you may be subject to a late enrollment penalty.|
|Annual Enrollment Period (AEP)||October 15 to December 7||N/A||During this period, you can switch from Original Medicare to Medicare Advantage, or vice versa. You can also switch between Medicare Advantage plans or between Part D plans.|
|Medicare Advantage Open Enrollment Period (OEP)||January 1 to March 31||N/A||During this period, beneficiaries enrolled in Medicare Advantage can switch to another Medicare Advantage plan or switch back to Original Medicare with or without a Part D plan.|
|Special Enrollment Period (SEP)||Varies by situation||N/A||Beneficiaries may qualify for a SEP if they experience certain life events, such as moving or losing other health coverage.|
|Turning 65||Varies by individual||N/A||If you are turning 65 and are eligible for Medicare, you can enroll during your IEP.|
|Late Enrollment Penalty||Applies if you do not enroll when first eligible||N/A||The penalty is added to your Part B premium for as long as you have Part B coverage. The amount of the penalty depends on how long you waited to enroll.|
|Automatic Enrollment in Part A||If you are already receiving Social Security benefits||N/A||Most beneficiaries are automatically enrolled in Part A, but they may need to manually enroll in Part B.|
|Medicare Part A Costs for 2023||$0 for most beneficiaries||Part A premium of up to $490/month for those with less than 30 quarters of Medicare-covered employment||The cost of Part A can vary depending on the individual’s work history and whether they are eligible for premium-free Part A based on their work history.|
- “Medicare & You 2022,” Centers for Medicare & Medicaid Services, https://www.medicare.gov/Pubs/pdf/10050-Medicare-and-You.pdf
- “Medicare costs at a glance,” Medicare.gov, https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance
- “Late Enrollment Penalty,” Medicare.gov, https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/late-enrollment-penalty
- “Enrollment Periods,” Medicare.gov, https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/enrollment-periods-medicare-advantage-and-medicare-drug-plans
- “Special Circumstances (Special Enrollment Periods),” Medicare.gov, https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/special-circumstances-special-enrollment-periods
What is Medicare For All?
Medicare for All is a proposal to create a single, national health insurance program that would cover all U.S. residents, regardless of income, age, or health status. The proposal would expand the existing Medicare program, which currently provides health insurance for individuals aged 65 and older, to cover all U.S. residents, including children and non-elderly adults.
Under a Medicare for All system, all healthcare services, including doctor visits, hospital stays, prescription drugs, and preventive care, would be covered by the government-funded insurance program. Private insurance would be eliminated, and healthcare providers would be paid by the government for their services. The proposal aims to simplify the healthcare system, reduce administrative costs, and ensure that all U.S. residents have access to affordable, high-quality healthcare.
The Medicare for All proposal has been a topic of debate in the United States, with some supporters arguing that it would improve access to healthcare and reduce overall healthcare costs, while opponents argue that it would be too expensive and would lead to longer wait times for medical services.
It’s important to note that while several versions of the Medicare for All proposal have been introduced in Congress, the proposal has not yet been enacted into law.
What is MEDIGAP for All?
As far as I know, there is no official proposal or policy called “Medigap for All.” However, there have been discussions and proposals to expand access to Medicare Supplement Insurance (Medigap) to more individuals, particularly those who are under 65 and eligible for Medicare due to a disability.
Currently, Medigap policies are only available to beneficiaries who are 65 or older and enrolled in Original Medicare. However, some states offer limited Medigap coverage to beneficiaries under 65, while others do not offer any coverage at all. This has left many disabled individuals with limited options for covering the out-of-pocket costs associated with Medicare.
Some advocates have proposed expanding access to Medigap policies to all beneficiaries, regardless of age or disability status. This would help ensure that all beneficiaries have access to affordable healthcare and are not burdened with high out-of-pocket costs.
It’s important to note that any proposals to expand Medigap coverage would likely face opposition from insurance companies and other stakeholders who may be concerned about the potential costs and impact on the insurance market. Additionally, any changes to the Medicare program would require congressional action and could face significant political and policy hurdles.
Many of my doctor friends ask:
Medicare credit balance report due dates 2023?
The Medicare Credit Balance Report is a report that providers and suppliers who receive Medicare overpayments must submit to the Centers for Medicare & Medicaid Services (CMS) on a regular basis. The report provides information on any credit balances that the provider or supplier owes to Medicare.
The due dates for the Medicare Credit Balance Report in 2022 are as follows:
- Q1 Report (January 1 – March 31, 2022): Due May 31, 2022
- Q2 Report (April 1 – June 30, 2022): Due August 31, 2022
- Q3 Report (July 1 – September 30, 2022): Due November 30, 2022
- Q4 Report (October 1 – December 31, 2022): Due February 28, 2023
It’s important to note that these dates are subject to change, and providers and suppliers should check with CMS or their Medicare Administrative Contractor (MAC) to confirm the exact due dates for their reports. Providers and suppliers who fail to submit the Medicare Credit Balance Report on time may face penalties or other consequences.
Does Medicare cover eye exams?
This is near to me as I owned Eyecyte and this question is confusing to most even not on Medicare.
Medicare generally does not cover routine eye exams for eyeglasses or contact lenses, but it does cover some eye exams and other eye care services in certain situations. Here is a chart outlining some of the eye care benefits that Medicare may cover:
|Eye Care Benefit||Description||Information|
|Annual Eye Exam||Covered for beneficiaries with diabetes||Source: Medicare & You 2022, p. 46 (https://www.medicare.gov/Pubs/pdf/10050-Medicare-and-You.pdf)|
|Glaucoma Tests||Covered for beneficiaries at high risk for glaucoma, as well as those with a family history of glaucoma or African Americans aged 50 or older||Source: Medicare & You 2022, p. 46 (https://www.medicare.gov/Pubs/pdf/10050-Medicare-and-You.pdf)|
|Cataract Surgery||Covered by Medicare Part B, including pre- and post-operative exams, surgeon’s fees, anesthesia, and facility fees||Source: Medicare & You 2022, p. 47 (https://www.medicare.gov/Pubs/pdf/10050-Medicare-and-You.pdf)|
|Corrective Lenses||Covered following cataract surgery with an intraocular lens (IOL), or for beneficiaries with aphakia or high myopia||Source: Medicare & You 2022, p. 48 (https://www.medicare.gov/Pubs/pdf/10050-Medicare-and-You.pdf)|
It’s important to note that the above chart is not exhaustive, and that coverage may vary depending on the individual’s specific situation and the provider’s participation in Medicare. Additionally, beneficiaries may have to pay deductibles, coinsurance, and copayments for these services.
Beneficiaries should also check with their Medicare Advantage plan (if they have one) for additional eye care benefits that may be covered under the plan. Some Medicare Advantage plans may offer additional coverage for routine eye exams, eyeglasses, and other eye care services.
Medicare prescription drug plans (Medicare Part C)
Medicare prescription drug plans, also known as Medicare Part D, are available to all Medicare beneficiaries, including those enrolled in Original Medicare, Medicare Advantage plans, and certain other Medicare plans. Here is a chart outlining some key information about Medicare prescription drug plans:
|Medicare Prescription Drug Plans||Information|
|What are they?||Insurance plans that provide coverage for prescription drugs|
|What does Medicare charge?||Premiums, deductibles, coinsurance, and copayments vary depending on the plan and the individual’s income|
|When can you enroll?||Initial Enrollment Period (IEP), Annual Enrollment Period (AEP), Special Enrollment Periods (SEPs), and other circumstances|
|When can you disenroll?||During the AEP or during certain SEPs|
|List of Providers||Available at Medicare.gov (https://www.medicare.gov/part-d-plans)|
It’s important to note that Medicare prescription drug plans are provided by private insurance companies that are approved by Medicare, and that coverage and costs may vary depending on the specific plan and the individual’s circumstances. Additionally, beneficiaries should consider their medication needs and compare plans to find one that best meets their needs and budget.
- “Medicare & You 2022,” Centers for Medicare & Medicaid Services, https://www.medicare.gov/Pubs/pdf/10050-Medicare-and-You.pdf
- “Medicare Prescription Drug Plans,” Medicare.gov, https://www.medicare.gov/part-d-plans
What is medicare easy pay?
Medicare Easy Pay is a free, electronic payment option that allows Medicare beneficiaries to have their Medicare premiums automatically deducted from their bank account each month. Here is a chart outlining some key information about Medicare Easy Pay:
|Medicare Easy Pay||Information|
|What is it?||A free, electronic payment option for Medicare premiums|
|How do I enroll?||Complete the Medicare Easy Pay Authorization Form (CMS-588) and mail it to your Medicare Administrative Contractor (MAC)|
|Where do I get the form?||Available at Medicare.gov (https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS588.pdf)|
|Benefits||Automatic payment of Medicare premiums, no need to write checks or send payments|
|Enrollment Deadline||Must enroll at least 15 days before the premium due date|
|Contact Numbers||Medicare Easy Pay Hotline: 1-800-633-4227; TTY: 1-877-486-2048|
It’s important to note that beneficiaries must have a bank account to enroll in Medicare Easy Pay, and that they must continue to pay their premiums by other means until they receive confirmation that their enrollment has been processed.
- “Medicare Easy Pay,” Medicare.gov, https://www.medicare.gov/manage-your-health/pay-premiums/medicare-easy-pay
- “Medicare Easy Pay Authorization Form (CMS-588),” Centers for Medicare & Medicaid Services, https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS588.pdf
Does medicare pay for assisted living?
I had to deal withthis with my mother, so call me if you have questions. I will tell you start 2 years before you think you need toJeff Cline founder 1-800-MEDIGAP or check out my blogs on ESTEMEED LIVING
Medicare generally does not cover the costs of assisted living facilities or long-term care in a nursing home. However, there are other options available for individuals who need help paying for these services. Here is a chart outlining some key information about paying for assisted living and long-term care:
|Paying for Assisted Living and Long-Term Care||Information|
|Does Medicare pay?||No, Medicare does not typically cover the costs of assisted living or long-term care|
|Medicaid||A joint federal and state program that helps individuals with limited income and resources pay for healthcare, including long-term care|
|How much can I have or own?||Medicaid has asset and income limits that vary by state. In 2022, the asset limit for a single individual is $2,000 in most states|
|Steps to avoid losing savings||Options may include long-term care insurance, setting up a trust, or transferring assets to a spouse or family member|
|Assistance numbers by state||Medicaid contacts by state available at Medicaid.gov (https://www.medicaid.gov/state-overviews/index.html)|
It’s important to note that the rules and regulations around Medicaid and long-term care can be complex, and beneficiaries should consult with a financial advisor or elder law attorney to determine the best options for their situation.
- “Paying for Care,” Medicare.gov, https://www.medicare.gov/coverage/paying-for-care
- “Medicaid,” Medicaid.gov, https://www.medicaid.gov/
- “Medicaid Eligibility: 2022 Income and Asset Limits,” The Balance, https://www.thebalance.com/medicaid-eligibility-2022-income-and-asset-limits-4589590
Does medicare cover acupuncture?
Medicare may cover acupuncture in certain situations. In 2021, Medicare began covering acupuncture for chronic low back pain that is:
- Chronic, meaning it has lasted 12 weeks or longer;
- Nonspecific, meaning it is not associated with a recognizable systemic or spinal cause (such as infection, tumor, osteoporosis, rheumatoid arthritis, fracture, structural deformity, inflammatory disorder, or radiculopathy); and
- Not associated with surgery.
To receive Medicare coverage for acupuncture, the beneficiary must have a face-to-face evaluation and a written treatment plan from a doctor or other qualified healthcare provider that demonstrates the medical necessity of the acupuncture. The provider must also be enrolled in Medicare and meet certain other requirements.
It’s important to note that Medicare does not cover acupuncture for other conditions or for general wellness. Additionally, coverage and costs may vary depending on the specific situation and the provider’s participation in Medicare.
- “Acupuncture for Chronic Low Back Pain,” Centers for Medicare & Medicaid Services, https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=295
- “Acupuncture,” Medicare.gov, https://www.medicare.gov/coverage/acupuncture
Does Medicare Cover chiropractic services?
Medicare may cover chiropractic services in certain situations. Medicare Part B (Medical Insurance) covers manual manipulation of the spine to correct a subluxation (a joint that’s out of position) when provided by a chiropractor or other qualified healthcare provider.
Medicare covers up to 80% of the Medicare-approved amount for chiropractic services. Beneficiaries are responsible for the remaining 20% of the cost, plus any deductible that applies.
It’s important to note that Medicare does not cover other services provided by chiropractors, such as acupuncture, massage therapy, or X-rays. Additionally, coverage and costs may vary depending on the specific situation and the provider’s participation in Medicare.
- “Chiropractic Services,” Medicare.gov, https://www.medicare.gov/coverage/chiropractic-services
- “Medicare & Chiropractic Care,” Medicare Interactive, https://www.medicareinteractive.org/get-answers/medicare-covered-services/preventive-care-services/medicare-chiropractic-care
What is the medicare 8-minute rule?
PERSONAL OPINION: I think this is crazy, and my doctor friends feel it rushes them into not providing the level of care they wish that more time would provideJeff CLine founder 1-800-MEDIGAP
The Medicare 8 Minute Rule applies to physical and occupational therapy services provided to Medicare beneficiaries in outpatient settings. The rule requires that providers bill for therapy services in 15-minute increments, and that at least 8 minutes of each 15-minute increment must be spent providing direct, one-on-one therapy to the patient. Here is a chart outlining some of the things that count towards the Medicare 8 Minute Rule, and a checklist that beneficiaries can use to monitor their therapy sessions:
|Medicare 8 Minute Rule Checklist||Things that count toward the rule|
|Time spent providing direct, one-on-one therapy||Therapeutic exercises, manual therapy, neuromuscular reeducation, gait training, functional training, modalities (such as ultrasound or electrical stimulation), and other skilled interventions|
|Time spent on non-therapy activities||Time spent on activities that are not directly related to therapy, such as paperwork or waiting for equipment, does not count towards the rule|
|Time spent with other patients||Time spent treating other patients at the same time as the beneficiary does not count towards the rule|
|Time spent with assistants or aides||Time spent with therapy assistants or aides does not count towards the rule|
|Beneficiary’s role in therapy||Beneficiaries should actively participate in therapy, communicate their goals and concerns with the therapist, and report any changes or improvements in their condition|
Beneficiaries can use the following checklist to monitor their therapy sessions:
- Did the therapist spend at least 8 minutes of each 15-minute increment providing direct, one-on-one therapy?
- Did the therapist provide a variety of skilled interventions, such as therapeutic exercises, manual therapy, or neuromuscular reeducation?
- Did the therapist avoid spending time on non-therapy activities, such as paperwork?
- Did the therapist provide one-on-one therapy, without treating other patients at the same time?
- Did the therapist spend the entire session with the beneficiary, without using assistants or aides?
- Did the beneficiary actively participate in therapy and report any changes or improvements in their condition?
It’s important for beneficiaries to be aware of the Medicare 8 Minute Rule and to monitor their therapy sessions to ensure that they are receiving appropriate and effective therapy.
- “Medicare Benefit Policy Manual: Chapter 15 – Covered Medical and Other Health Services,” Centers for Medicare & Medicaid Services, https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf
- “Medicare 8 Minute Rule,” WebPT, https://www.webpt.com/glossary/medicare-8-minute-rule/
Does Medicare Cover Hospice
|Medicare Hospice Coverage||Information|
|What is hospice?||A type of palliative care that provides comfort and support to individuals with a life-limiting illness or condition|
|Does Medicare cover hospice?||Yes, Medicare covers hospice care for beneficiaries who meet certain criteria|
|What does Medicare cover?||Hospice services, including medical care, nursing care, social services, counseling, and medications related to the terminal illness|
|What costs does Medicare cover?||Most hospice care is covered with no out-of-pocket costs for beneficiaries, although there may be a small copayment for some medications|
|What are the eligibility criteria?||Beneficiary must have a life-limiting illness or condition and a life expectancy of 6 months or less, as certified by a doctor|
|What are the rules for hospice care?||Beneficiary must elect hospice care and agree to forgo curative treatment for their terminal illness. The beneficiary’s care must be provided by a Medicare-approved hospice provider|
|Assistance helplines by state||Available at Hospice Foundation of America (https://hospicefoundation.org/Hospice-Care/State-by-State-Hospice-Resources)|
It’s important to note that beneficiaries should carefully consider their options and consult with their healthcare providers and family members before electing hospice care.
- “Hospice Care,” Medicare.gov, https://www.medicare.gov/coverage/hospice-care
- “Medicare Hospice Benefits,” Centers for Medicare & Medicaid Services, https://www.medicare.gov/Pubs/pdf/02154-Medicare-Hospice-Benefits.PDF
- “State-by-State Hospice Resources,” Hospice Foundation of America, https://hospicefoundation.org/Hospice-Care/State-by-State-Hospice-Resources
What age does Medicare Start?
Here is a chart outlining the age requirements and options for Medicare enrollment:
|What age does Medicare start?||Most individuals become eligible for Medicare at age 65|
|Can you start early?||Individuals who are receiving Social Security or Railroad Retirement Board benefits before age 65 will automatically be enrolled in Medicare Parts A and B|
|Can you start early?||Individuals who are not receiving Social Security or Railroad Retirement Board benefits may choose to enroll in Medicare during their Initial Enrollment Period (IEP), which begins three months before their 65th birthday month and ends three months after their 65th birthday month|
|Can you start early?||Individuals who have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) may be eligible for Medicare before age 65|
|Can you start late with benefits?||Individuals who do not enroll during their IEP may be subject to a late enrollment penalty and may have to wait until the next General Enrollment Period (January 1 – March 31 each year) to enroll|
|Citation links||Medicare.gov (https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/when-sign-up-parts-a-and-b/when-sign-up-parts-a-and-b.html)|
It’s important for individuals to understand their options for enrolling in Medicare and to enroll during the appropriate enrollment period to avoid penalties and gaps in coverage.
- “When to Sign Up for Medicare Parts A and B,” Medicare.gov, https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/when-sign-up-parts-a-and-b/when-sign-up-parts-a-and-b.html
Welcome to Medicare Visit Checklist
When you first enroll in Medicare, you are entitled to a one-time “Welcome to Medicare” preventive visit. During this visit, your doctor will review your medical history, provide education on preventive services, and recommend screenings and vaccinations that are appropriate for you based on your age, gender, and health status.
Here is a chart outlining some of the tests and procedures that may be recommended during your “Welcome to Medicare” visit, as well as some of the annual screenings and preventive services that are required to stay 5-star rated:
|Medicare Preventive Services||Recommended during Welcome to Medicare visit||Required annually for 5-star rating|
|Cardiovascular screenings||Blood pressure screening, lipid panel||Blood pressure screening|
|Cancer screenings||Colorectal cancer screening, prostate cancer screening, mammogram||Colorectal cancer screening, mammogram|
|Immunizations||Influenza vaccine, pneumococcal vaccine, hepatitis B vaccine||Influenza vaccine, pneumococcal vaccine|
|Other preventive services||Diabetes screening, bone density test, depression screening||Diabetes screening, depression screening|
It’s important to note that the specific tests and procedures recommended for you may vary depending on your individual health needs and risk factors. You should discuss your preventive care options with your doctor and follow their recommendations for maintaining your health and well-being.
- “Welcome to Medicare Visit,” Medicare.gov, https://www.medicare.gov/coverage/welcome-to-medicare-visit
- “Medicare Preventive Services,” Medicare.gov, https://www.medicare.gov/coverage/preventive-and-screening-services
Medicare Part C costs?
This will change every year, this data is for 2022 based on my research….check with medicare.govJeff CLine Founder 1-800-MEDIGAP
Medicare Part C, also known as Medicare Advantage, is an alternative to Original Medicare that is offered by private insurance companies. Here is a chart outlining the costs that beneficiaries may incur with Medicare Part C, broken down by medical need:
|Medicare Part C Costs||What the customer pays out-of-pocket|
|Monthly premium||Varies by plan and location; may be $0 or more|
|Annual deductible||Varies by plan; may be $0 or more|
|Copayments/coinsurance||Varies by plan and medical service; may be $0 or more|
|Out-of-pocket maximum||Varies by plan; may be $3,400 or more|
|Medical needs||Preventive care: Often $0 out-of-pocket costs; services such as annual physicals and cancer screenings are typically covered<br>Primary care: May require a copayment or coinsurance<br>Specialty care: May require a copayment or coinsurance<br>Hospital care: May require a copayment or coinsurance<br>Prescription drugs: May be included in the plan or require a separate premium; may require a copayment or coinsurance|
It’s important to note that the costs and coverage may vary depending on the specific plan and the beneficiary’s medical needs. Beneficiaries should review plan details carefully and compare plans to find one that meets their needs and budget.
- “Medicare Advantage Costs,” Medicare.gov, https://www.medicare.gov/your-medicare-costs/medicare-advantage-costs
- “Medicare Advantage 2022 Spotlight: First Look,” Kaiser Family Foundation, https://www.kff.org/medicare/issue-brief/medicare-advantage-2022-spotlight-first-look/
additional medicare tax
The Additional Medicare Tax is a tax that was introduced as part of the Affordable Care Act (ACA) to help fund Medicare. It applies to individuals who earn more than a certain amount per year, and is an additional 0.9% tax on top of the standard Medicare payroll tax of 1.45%.
Here are some key facts about the Additional Medicare Tax:
- Who pays it: The tax applies to individuals who earn more than $200,000 per year ($250,000 for married couples filing jointly).
- How it’s calculated: The tax is calculated at a rate of 0.9% on any earnings above the threshold amount.
- How it’s paid: The tax is withheld from your paycheck by your employer, just like the standard Medicare payroll tax.
- When it starts: The tax went into effect in 2013 and has been in place ever since.
- Self-employed individuals: Self-employed individuals are responsible for paying both the employer and employee portions of the Medicare payroll tax, including the Additional Medicare Tax.
It’s important to note that the Additional Medicare Tax only applies to earned income (such as wages and salaries), and does not apply to investment income (such as interest, dividends, and capital gains).
- “Questions and Answers for the Additional Medicare Tax,” IRS.gov, https://www.irs.gov/affordable-care-act/questions-and-answers-for-the-additional-medicare-tax
- “What Is the Additional Medicare Tax?” The Balance, https://www.thebalance.com/additional-medicare-tax-what-you-need-to-know-4173687
Life alert cost covered by medicare?
Life Alert is a personal emergency response system that is designed to provide assistance in the event of a medical emergency or other urgent situation. While Medicare does not typically cover the cost of Life Alert or other personal emergency response systems, there are some Medicare Advantage plans that may offer this type of service as an additional benefit.
If you are interested in finding a Medicare Advantage plan that offers personal emergency response services, you can use the Medicare Plan Finder tool on the Medicare website (https://www.medicare.gov/plan-compare/) or contact a licensed insurance agent who can provide personalized assistance in finding plans that meet your needs and preferences.
It’s important to carefully review the plan details and costs before enrolling in a Medicare Advantage plan that offers personal emergency response services, as the costs and coverage may vary depending on the specific plan and location.
does medicare cover ambulance
Here is a chart outlining some of the Medicare coverage related to transportation and personal assistance:
|Ambulance services||Medicare Part B covers emergency ambulance services to the nearest appropriate medical facility when transportation by any other means would endanger your health. Non-emergency ambulance services may be covered in certain cases.|
|Transportation to hospital||Medicare generally does not cover transportation to and from the hospital for non-medical reasons, such as transportation to visit a hospitalized family member. However, some Medicare Advantage plans may offer transportation benefits as an additional benefit.|
|Getting groceries||Medicare does not cover the cost of groceries or other household items. However, some Medicare Advantage plans may offer personal assistance benefits as an additional benefit, such as assistance with meal preparation or errands.|
|Seeing doctor||Medicare Part B covers medically necessary doctor visits, including outpatient services such as office visits, lab tests, and diagnostic tests. Medicare Part A covers inpatient hospital stays and related services.|
It’s important to note that the specific coverage and costs may vary depending on the beneficiary’s medical needs, the type of Medicare plan they have, and their location. Beneficiaries should review plan details carefully and contact Medicare or their plan provider with any questions.
- “Ambulance services,” Medicare.gov, https://www.medicare.gov/coverage/ambulance-services
- “Transportation,” Medicare.gov, https://www.medicare.gov/coverage/transportation
- “Does Medicare cover groceries?” MedicareFAQ, https://www.medicarefaq.com/faqs/does-medicare-cover-groceries/
- “What’s Medicare?” Medicare.gov, https://www.medicare.gov/what-medicare-covers/what-medicare-covers