Category Archives: medicare

Medicare Coverage After a Stroke

Yearly, more than 795,000 people in the United States have a stroke. The significant problems resulting from a stroke can include problems with balance, hearing or vision, paralysis, decreased mobility, and more. To fully understand what Medicare covers during recovery, read on.

Rehabilitation Services
Medicare will cover hospital, rehabilitation center, or skilled nursing facility care for those who have suffered from a stroke.

Medicare Part A will cover any inpatient rehabilitation necessary, as long as the patient’s doctor deemed it necessary. Stroke recovery care is factored into the requirements and costs associated with a typical skilled-nursing-facility. 

Medicare Part B will cover any needed outpatient rehabilitation such as physical therapy as long as the patient’s doctor noted it is necessary.

Medical Equipment
Medicare Part B will cover durable medical equipment as long as it is medically necessary for stroke survivors. Items on this list include wheelchairs, walkers, lifts, canes, etc.

If you have high risk factors for stroke, be vigilant and discuss your Medicare coverage with your provider. It is crucial to understand your costs fully, should you suffer from a stroke in the future. Take note of equipment, charges, services, and more in the event you will need to utilize your coverage.

To speak with one of our expert representatives regarding Medicare and coverage for stroke victims, contact Senior Health Medicare today.

Senior Health Medicare is a superior resource for Medicare guidance, information, and ongoing client support. Selecting a Medicare plan is not a flippant decision. It requires annual revisiting and evaluation in order for the member to retain the most cost-effective plan. Senior Health Medicare is here to serve as your resource through all the years to come. Contact us today at 888-404-5049 or visit us on the web at www.seniorhealthmedicare.com.

Written by the digital marketing staff at Creative Programs & Systems: www.cpsmi.com.

Will Medicare Cover the COVID-19 Vaccine?

As new COVID-19 vaccines are approved in the United States, health departments in all 50 states received their first round of vaccines. Frontline healthcare workers and residents of long-term care facilities were the first ones to receive doses.

Medicare will cover the coronavirus vaccine, thanks to the CARES Act, which was passed by Congress in March 2020. Medicare Part B is required by the CARES Act to 100 percent cover FDA-Approved COVID-19 vaccines. This means if you are a Medicare beneficiary, you will have no out-of-pocket costs for the COVID-19 vaccine.

The COVID-19 vaccine was developed with $10 billion in funding from the federal government. Under the CARES Act, the vaccine is free to all. The Medicare Trust Fund covers 100 percent of the vaccine’s cost for those Medicare and/or Medicaid beneficiaries. Private insurers are required to offer the vaccine for free to plan members. No money is allowed to be collected from vaccine patients by providers who administer the vaccine. Even if the insurance company (or Medicare) doesn’t reimburse the provider, they still are banned from billing the patient for the balance.

Those without insurance can get the vaccine for free under the CARES Act. Providers who administer the vaccine to people who do not have health insurance can submit a reimbursement request.

If you get the COVID-19 vaccine and receive a bill, it might have been for other services not related to the shot. If your only reason for an office/doctor visit is due to COVID-19, you should not receive a bill. If you received other services in the same visit, your regular Medicare cost-sharing would apply.

Currently, the CARES Act specifies only two Federal Drug Administration (FDA)-approved vaccines for COVID-19: the Pfizer/BioNTech vaccine and the Moderna vaccine. Several other vaccines are in development and testing stages; if they are approved for use by the FDA, Medicare will cover those also. Both approved vaccines require two doses (or shots) for complete immunity. Depending on the shot you obtained, you should receive a second dose three or four weeks later.

The chances of getting COVID-19 from the vaccine are impossible. Most vaccines introduce a live virus into the body to provoke an immune response. The Pfizer/BioNTech and Moderna vaccines do not include any actual coronavirus. Instead, they use messenger RNA (mRNA) technology. This process provides genetic coded cells needed to produce proteins that stimulate the immune system. It is a novel implication in vaccines; however, this has been used in cancer immunotherapy for years and is rigorously tested.

For more information about the COVID-19 vaccine related to Medicare, contact the experts at Senior Health Medicare today.

Senior Health Medicare is a superior resource for Medicare guidance, information, and ongoing client support. Selecting a Medicare plan is not a flippant decision. It requires annual revisiting and re-evaluating in order for the client to stay in the most cost-effective coverage. Senior Health Medicare is here to serve as your resource through all the years to come. Contact us today at 888-404-5049 or visit us on the web at www.seniorhealthmedicare.com.

Written by the digital marketing staff at Creative Programs & Systems: www.cpsmi.com.

Will Medicare Cover Prescription Lenses, Glasses, or Sunglasses?

If eyeglasses or other corrective lenses are deemed “medically necessary” (after cataract surgery, for example), they might be covered by Medicare. Otherwise, Parts A and B of Original Medicare will not assist with prescription sunglasses, contact lenses, or eyeglass costs.

Medicare Advantage Plan (Part C) might offer eyeglass, contact, and prescription sunglass vision coverage. Vision benefits such as routine eye exams might also be covered. Each plan is different, so make sure to talk to your provider regarding eye health items offered within your plan and how they are covered.

Medicare Part B will help pay for corrective lenses following cataract (implanting an intraocular lens) surgery. One pair of standard-frame eyeglasses or a single set of contact lenses, along with 20 percent of the Medicare-approved amount for the lenses after each surgery, will be covered. In these cases, the Part B deductible will apply, and you will also pay 20 percent of the Medicare-approved amount. Any additional costs for upgraded frames will also be your responsibility.

Talk to your healthcare provider to determine the price of your item, service, or test. The exact amount you will owe depends on factors such as other insurance you have, how much your doctor charges, whether your doctor accepts assignment, the type of facility, and the location of your test, item, or service.

Oftentimes, your doctor or medical provider might recommend you receive services more often than what Medicare covers. They might also suggest services that Medicare doesn’t cover. In this case, you might have to pay some (or all) of the expenses. To understand why your doctor recommends certain services and whether Medicare will pay for them, ask questions and gather information.

Contact lens and glasses coverage is limited outside of a Medicare Advantage plan. Make sure you consider your eye health needs when you select the Medicare coverage for you.

For more information, refer to the full article on Medicare.gov.

Senior Health Medicare is a superior resource for Medicare guidance, information, and ongoing client support. Selecting a Medicare plan is not a flippant decision. It requires annual revisiting and re-evaluating in order for the client to stay in the most cost-effective coverage. Senior Health Medicare is here to serve as your resource through all the years to come. Contact us today at 888-404-5049 or visit us on the web at www.seniorhealthmedicare.com.

Written by the digital marketing staff at Creative Programs & Systems: www.cpsmi.com.

New Medicare Coverage? Put It to Good Use in 2021!

If you have new Medicare coverage, now is a great time to learn about your revised benefits and see how they can work best for you. Check out your basic costs to learn about tests covered under Medicare, items, and other services to see whether they have changed. For cost-specific information, create a Medicare account.

Medicare can assist you in taking better care of yourself this year through preventative services such as yearly wellness visits and screenings for breast cancer, diabetes, and heart disease. Most of these services are free for beneficiaries and are vital to maintaining your overall health. By targeting issues early, these programs help keep you from getting sick and slow disease progression.

To discuss preventative services, contact your doctor, who will also tell you the best time to schedule them. Understanding your coverage and taking advantage of these preventive services is an excellent way to jump-start 2021. Before you leap, be confident in your plan choice. If you have questions, contact your Medicare provider, who can help answer questions and ensure that you are getting the most out of your benefits.  

For more information about Medicare or to schedule an appointment with a specialist who can guide you through the process, contact Senior Health Medicare today.

Senior Health Medicare is a superior resource for Medicare guidance, information, and ongoing client support. Selecting a Medicare plan is not a flippant decision. It requires annual revisiting and re-evaluating in order for the client to stay in the most cost-effective coverage. Senior Health Medicare is here to serve as your resource through all the years to come. Contact us today at 888-404-5049 or visit us on the web at www.seniorhealthmedicare.com.

Written by the digital marketing staff at Creative Programs & Systems: www.cpsmi.com.

Three Ways to Save on Medicare Expenses

Medicare expenses can pile up. If you need assistance paying for health or prescription costs, check out these three resources that might help cover your expenditures:

Medicare Savings Programs: There are four savings programs run by every state. They can help you pay for your premiums and other expenses. To see whether you qualify, contact your state Medicaid program.

Extra Help: Those with limited revenue or resources can qualify for Extra Help for Part D drug costs. If you have applied for Medicaid or one of the Medicare Savings Programs, Extra Help will automatically be enacted for drug costs. You can apply for free online through the US Social Security Administration.

Medicaid: A joint federal and state program that is tailored to help those with limited income and resources, aiding with medical costs. Medicaid offers benefits not typically covered by Medicare, such as nursing home and personal care services. Every state has its own guidelines.

The most efficient way to save money is to choose the right health and drug coverage. The Medicare Plan Finder compares Medicare coverage options. You can also reduce your Medicare premiums by enrolling on time, reporting changes in income, and shopping around for plans.

To learn more about Medicare costs and lower them with help from professionals, contact Senior Health Medicare today. Our experts are ready to assist you with all your Medicare questions, concerns, and needs.

Senior Health Medicare is a superior resource for Medicare guidance, information, and ongoing client support. Selecting a Medicare plan is not a flippant decision. It requires annual revisiting and re-evaluating in order for the client to stay in the most cost-effective coverage. Senior Health Medicare is here to serve as your resource through all the years to come. Contact us today at 888-404-5049 or visit us on the web at www.seniorhealthmedicare.com.

Written by the digital marketing staff at Creative Programs & Systems: www.cpsmi.com.

Medicare Advantage VS Medicare Supplement Plans

Entering Medicare can be confusing, intimidating, and might leave you feeling vulnerable. There are countless predatory insurance companies and salespeople trying to win you over. It’s crucial for those 65 years old or over to stay informed regarding all options and make the best decisions possible in order to get the most bang for your buck. Navigating through the Medicare Advantage versus Medicare Supplement (also known as Medigap) plans is easier than you think. Read on for our pro- and con- list.

Medicare Advantage plans are cheap, but they automatically un-enroll you from original Medicare.

Pros:

  • Monthly premiums are relatively inexpensive, with some costing $0 per month.
  • Part D drug plans are usually included (for convenience, not efficiency.)
  • Fitness memberships or other incentives are sometimes included.

Cons:

  • Small and intricate medical networks determine your available medical providers. You most likely will have to change your doctor to become “in-network” before claims are covered.
  • Extremely high out-of-pocket costs (OPCs) if you aren’t in perfect health.
  • If OPCs rise due to illness or injury, you cannot revert to original Medicare, thereby paying the high OPCs eternally.
  • Network restrictions equal limited nationwide coverage. Insurance is usually not applicable in remote medical facilities, so traveling is an issue. For example, The Mayo Clinic will not take Medicare Advantage plans.

Medicare Supplement (Medigap) plans cost more, but the coverage they provide is exemplary.

Pros:

  • Almost everything is covered, depending on your plan. OPCs are relatively low/non-existent.
  • Eligibility allows you to enroll in a supplement plan, not only during the Annual Election Period.
  • Coverage is easier to comprehend and predictable.
  • Doctors usually accept original Medicare and your corresponding supplement plan.
  • Is almost always accepted nationwide.

Cons:

  • Medicare supplement plans are more expensive than Medicare Advantage plans.

With either choice, you can continue to pay a monthly Part B premium to Medicare. The main things to consider are:

  1. Do you want the choice of any provider or are you willing to choose a provider from within a network?
  2. Would you rather buy a separate prescription drug plan or get drug coverage included in one plan?
  3. Would you rather pay higher monthly premiums and have lower out-of-pocket costs for services or pay a low monthly premium and co-pays for services as you use them?

Your Medicare needs are personal. Navigating through the options can be confusing and misleading. To talk to a professional and learn more about Medicare, contact the experts at Senior Health Medicare today. Our agents are ready and available to help you make the best decision possible…for your health and wellbeing.

Senior Health Medicare is a superior resource for Medicare guidance, information, and ongoing client support. Selecting a Medicare plan is not a flippant decision. It requires annual revisiting and re-evaluating in order for the client to stay in the most cost-effective coverage. Senior Health Medicare is here to serve as your resource through all the years to come. Contact us today at 888-404-5049 or visit us on the web at www.seniorhealthmedicare.com.

Written by the digital marketing staff at Creative Programs & Systems: www.cpsmi.com.

Difference Between Medicare and Medicaid

Sharing the same prefix makes Medicare and Medicaid easily interchangeable, but in reality, they are entirely different. To add to the confusion, both are structured by the government to assist people with healthcare costs. Beyond sharing prefixes and the healthcare realm, the two programs have nothing else in common.

Medicare: an insurance program paid from trust funds which those covered have paid into.

  • For seniors 65+ or those with a qualifying disability
  • Federal government sets standard benefits and costs
  • Private plans might provide additional (varying) coverage and costs
  • Parts A and B provided by the government; Parts C and D provided by insurance companies

Medicaid: an insurance assistance program serving low-income people.

  • For individuals, families, and children with limited income and resources
  • State sets Medicaid programs based on federal guidelines
  • Different programs exist for specific populations
  • Both mandatory and optional benefits available

Both Medicare and Medicaid include premiums, deductibles, copays, and insurance costs. Specific Medicaid groups are exempt from out-of-pocket expenses, and there are four different Medicare savings programs available. Some people can have both Medicare and Medicaid; these people are called “dual eligible.”

To enroll for Medicare, enroll with either Social Security directly (Parts A and B) or a private insurance company (Parts C and D) to choose the coverage you need. To enroll for Medicaid in Michigan, visit their website.

Both Medicare and Medicaid are two very different healthcare programs. It is imperative to understand the differences. If you are dual-eligible, learn how they can work together for your benefit.

For more information about the differences between Medicare and Medicaid, visit the U.S. Department of Health and Human Services website. To enroll in Medicare Parts C and D, contact Senior Health Medicare today.

Senior Health Medicare is a superior resource for Medicare guidance, information, and ongoing client support. Selecting a plan is not a flippant decision. It requires annual revisiting and re-evaluating in order for the client to stay in the most cost-effective coverage. Senior Health Medicare is here to serve as your resource through all the years to come. Contact us today at 888-404-5049 or visit us on the web at www.seniorhealthmedicare.com.

Written by the digital marketing staff at Creative Programs & Systems: www.cpsmi.com.

7 Costly Medicare Mistakes Seniors Should Avoid Making

There are many parts to Medicare, and with that comes confusion and a good chance at missing something. It is essential for everyone approaching age 65 to get informed on Medicare and sign up for the right plan at the right time. Neglecting the chance to act at making the best Medicare decisions could cost you. Here’s how to avoid these seven common mistakes so you can get the right coverage without overpaying on premiums and deductibles, experiencing gaps in coverage, or getting hit with high penalty fees.

  1. Deciding without fully understanding each Medicare plan.

Medicare has many plan options making it very confusing and hard to decide which plan is best. It is essential for new enrollees to do their homework on Medicare before their enrollment period, so they know precisely the action they need to take. It’s necessary to become familiar with the differences between Original Medicare with a Medicare Supplement or “Medigap” plan, and Medicare Advantage plans, also known as “Part C.” Not knowing what your final choice has to offer could leave you with a plan that doesn’t fully cover your specific healthcare needs.  

  1. Going out of your plan’s network.

It is essential to realize when you sign up for Medicare, not every health provider will accept your specific plan and that this could change every year. Most places accept original Medicare and therefore, any Medicare supplement plan, but if you have a Medicare Advantage plan, you might not be covered if the provider is out of network. Always make sure to check if the doctor or hospital you are going to is in your network or it could mean an expensive bill. One more thing to be wary of here is that doctors and hospitals can stop taking Medicare Advantage plans ANY TIME, even though you have to wait until fall to change your plan. We see doctors jumping out mid-year, and that puts people at a crossroads: either I see my current doctor and pay for visits/procedures out of pocket, or, I find a new doctor who is in my network (for now). One more thing – if you think that your plan covers emergencies out-of-network, we want to kindly remind you that the insurance companies dictate what is considered an “emergency.” What you find emergency room-worthy actually isn’t up to you.

  1. Missing your enrollment periods.

There are enrollment periods that vary from person to person, depending on when an individual turns 65 or when they decide to leave their current job that provides them with healthcare benefits. When turning 65, eligibility to sign up for Medicare begins three months before your birthday month and continues for three months after. If you turn 65 and still have healthcare coverage through your job, you may want to delay your Part B enrollment until you seek full benefits from Medicare. This depends on the situation, size of the company, and the cost comparison, so you definitely want to discuss this with an expert to be sure you make the right moves. The Annual Enrollment Period (AEP) is the same for everyone, every year, which begins October 15th and goes until December 7th. This is the only time frame for current Medicare beneficiaries to change Part D prescription plans or Medicare Advantage plans. You can change a Medicare Supplement plan any time you want, however. It’s important to become familiar with these time frames, so you aren’t left without coverage at any time or hit with late-enrollment fees or penalties.

  1. Ignoring your Annual Notice of Change (ANOC).

The Annual Notice of Change (ANOC) is sent out to all Medicare beneficiaries before the Annual Enrollment Period stating any changes to plans and costs that will take place the following January. If you don’t read your NAOC, you might not know if your plan details or costs have changed, and it could leave you without coverage in certain areas and/or more expensive bills. You might learn it is in your best interest to keep the plan you have, but ignoring this critical update from your insurance company could result in getting stuck in a plan that costs way too much or doesn’t take care of your needs.

  1. Improperly signing up for Medicare Part B.

Once you turn 65, you are automatically enrolled in Medicare Part A (which covers your facility costs at the hospital) because you worked more than 40 quarters (10 years) and it does NOT come with a premium. Medicare Part B, however, not only comes with a premium (income-based, starting at $135.50 per month for 2019) but also comes with huge penalties and expenses if you enroll or delay enrollment improperly. If you are still working and you plan to continue working after your 65th birthday, you will need to find out the answers to a few critical questions. First off, is your company larger than 20 employees? If so, they MUST offer you health coverage while you are still employed. However, this does not mean you have to or should take this. It’s best at that point to compare your predicted costs with your employer plan versus your options under Medicare. About 50% of the time, it makes sense to leave your employer plan for Medicare. Definitely something you want to discuss with an expert. Okay, here is another common situation, let’s say you decide not to take Medicare Part B, and your employer is found to be less than 20 employees, otherwise known as not-credible coverage. If your plan is found to be not-credible coverage then when you go to take Medicare Part B, Medicare charges you a 10% penalty of the premium (about $13.50 per month at the lowest income bracket) for the rest of your life. That penalty can really add up. Lastly, let’s say that you take your Medicare Part B while you are still working and your employer has over 20 employees, so you stay on this insurance, too. The problem people run into with this is that when you take your Medicare Part B, not only are you paying a premium for coverage you aren’t using, but you run the risk of lapsing your Open Enrollment window. This is the time that lasts for six months (three months before and three months after your 65th birthday) in which you can choose any Medicare Supplement plan you want, with no medical questions asked. When you lapse this window while it’s sitting as your secondary insurance to employer coverage, when you retire, you will have to be reasonably healthy to get supplemental coverage.

  1. Missing your opportunity to switch plans.

There are many reasons a beneficiary might want to change Medicare plans, but it is easy to miss the chance to do so when it comes to prescription and Medicare Advantage plans. Just like enrollment, there are only specific periods where switching is possible. You can make changes to your prescription and Medicare Advantage plans during AEP. With Medicare Advantage plans, you have a 1-year trial period from the first date active, which allows you to switch to Original Medicare anytime within that timeframe if necessary. There are other unique opportunities to change, including life events like moving to a new area where your current plan doesn’t exist. The most common reason to switch plans is to save money, so make sure you understand your enrollment windows.

  1. Signing up for the same plan as your spouse.

When you get health insurance through an employer, often you can choose a plan that covers you and your spouse. With Medicare, you each need an individual plan, and it isn’t always the best option to go with the same insurance company, let alone plan. As you age, the chances of having different healthcare needs than your spouse become higher, so it is significant for beneficiaries to pick a plan that is specific to you and your personal needs. Often, healthy couples can and should take the same plan, because some insurance companies offer household discounts. Comparing companies and rates is the best way to decide what’s most cost-effective for you and your spouse.

Medicare is confusing, and finding a helpful resource isn’t always easy. Here at Senior Health Medicare, we aim to be that helping hand that you can rely on so you can avoid making these mistakes and navigate Medicare with ease. If you have any further questions about this blog or anything Medicare-related, please feel free to comment on this post or contact one of our helpful experts by phone.

 

How You Can Help Prevent Medicare Fraud

Medicare fraud is happening all the time, which results in higher taxes and healthcare costs for everyone. People and companies who get access can steal your Medicare number and personal information to scam the system for illegitimate products and services. It is important for beneficiaries to understand how to spot and protect from fraud to keep costs from rising even higher in the future. Not to mention, keeping your confidential information safe.

Doing Your Part

  • Keep your Medicare card, Medicare number, and Social Security number safe as you would protect a credit card. Only give this information to doctors, Medicare providers or someone you know should have it.
  • Keep records of all doctor’s visits and services provided. Always check your Medicare statements to ensure every detail is accurate.
  • Be sure to check you were given the right medications before leaving the pharmacy.
  • Never accept special offers on free or discounted Medicare.
  • Ask any questions about your Medicare or billing costs. It is your right to know.
  • Be aware of providers who claim they know how to bill Medicare even though they don’t usually offer that particular service.
  • Always report suspected incidences of Medicare fraud.
  • Never accept anything from a door-to-door salesperson claiming they are from Medicare. Medicare never sends representatives to your home.
  • Don’t let the media influence you about your health because they don’t always have your best interest in mind.

How to Spot & Report

If you have any suspicions whatsoever never hesitate to call Medicare. If you think a charge on your statement isn’t correct, call your provider and ask them about it. Always review your Medicare claims for any errors to stop fraud from happening early on. View your claims as soon as they are processed by logging into MyMedicare.gov or give them a call. When reporting Medicare fraud, make sure you have any records indicating possible existing errors and documents providing proof of services. To report any suspicious activity, you can call 1-800-MEDICARE (1-800-633-4227), report online at the Office of Inspector General or call them at 1 800 447 8477.

Medicare can be confusing for enrollees, which makes it easy for criminals to take advantage. If you have any questions or would like more general knowledge on Medicare, leave a comment, or give us a call. Here at Senior Health Medicare, we strive to educate beneficiaries on Medicare so that you and your loved ones stay protected and feel confident in your Medicare decisions.

Travel smart with Medicare

Before going on any trip, creating a checklist is always recommended. While you are updating your passport, checking the weather to prepare to pack, you should also make sure to check on your health coverage while traveling. Medicare can be great for travelers if the proper decisions are made.

Original Medicare covers you in the United States of America, including the District of Columbia, Guam, U.S. Virgins Islands, Puerto Rico, Northern Mariana Islands, and America Samoa. If you are going outside of these lands and/or overseas, for a majority of the time Medicare will not pay for the health services or supplies. There are some rare occasions where Medicare will cover your service or supplies.  An example of the rare occasions where Medicare will cover your service or supplies is as the following: If your emergency happens in the United States of America but nearest hospital to treat you is in Canada or Mexico.

According to Medicare.gov “In some cases, Medicare may cover medically necessary health care services you get on board a ship within the territorial waters adjoining the land areas of the U.S. Medicare won’t pay for health care services you get when a ship is more than 6 hours away from a U.S. port. “  As you can see, understanding the boundaries, the loop holes and the safety net created by Medicare is best left to an expert to fully understand.

Many experts advise their clients to invest in travel insurance as a “just to get home” safety net. when you have travel insurance you will have coverage for things that aren’t an emergency. It’s reasonably priced, and a great asset to have to in your back pocket if you are a frequent traveler, particularly an international traveler. If you have an emergency under $50,000, Medigap is a great option for you. With Medigap you can go anywhere in the U.S. that accepts Medicare . Also most Medigap plans include foreign travel emergency coverage up to  $50,000- but this coverage is meant to be reimbursed. For example, if you were hurt abroad, depending on the procedure needed you would either Medivac to the United States or receive treatment abroad. Either way, it would be your responsibility to pay for that procedure out of pocket, and then the insurance company will reimburse the claim. The Medigap covers 80% up to 50k, so you could still end up with a big bill.

So before setting sail, or boarding the plane, make sure you speak to your Medicare advisor and ask many questions. No one plans to have a medical emergency while on vacay, but it’s better to be proactive rather than reactive.