Category: Medicare

Medicare Category Information

The Medicare Category covers all parts including Part A (Hospital), Part B (Doctor), Part C (Medicare Advantage), Part D (Drugs) and Medigap (Supplements).

MedicareLifeHealth.com covers Medicare information extensively. It is our goal to help you make the best healthcare decisions possible for your unique situation. For this reason, this Category focuses on all parts of our national healthcare system and answers the most frequently asked questions.

Original Medicare is made up of:

  • Part A – Hospital Insurance
  • Part B – Doctor & Provider Insurance

The Federal Government administers these two parts.

Part D Prescription Drug Coverage

  • Part D Prescription Drug Coverage is also a part of Original Medicare, but unlike Parts A and B, it is administered by Private Insurance Companies.
  • The government sets rules and regulations for the private insurance companies, but they have the ability to differentiate in specific drugs covered (in regulated categories) and in prices (drugs and premiums).
  • One frequent question on Part D plans we hear is “What is the Donut Hole?” You can read about the doughnut hole here.

 

This Category also covers the Supplemental Options…

Part C Medicare Advantage (MA/MAPD) Plans

MA/MAPD plans are bundled plans that include Parts A & B (and usually D). They replace Original Medicare and offer additional services and benefits.

Supplement Plans – also known as Medigap

In addition, this Category includes Medigap Plan information. Medigap Plans cover the additional expenses that are not covered by Parts A & B such as co-pays, deductibles and coinsurance.

How to Know What Plan You Need

Finally, this Category explores how to pick a plan that is right for you.

A good place to start is with this article about the differences in Medigap Plans and MA/MAPD.

Please enjoy browsing all of our healthcare articles. In addition, if there is a question you need answered that you cannot find on our website, please contact us and let us know! We are happy to help.

Does Medicare Pay for Dentures

Does Medicare Pay for Dentures

Does Medicare Pay for Dentures?

One frequently asked question we get is “Does Medicare pay for dentures?” The short answer is NO.

Teeth are important part of your health. However, dental care is not a covered benefit in Original Medicare. As a result, Medicare does not pay for dentures.

Read on to find out how to get your dentures covered in other ways.

does Medicare pay for dentures

What Dental Services Does Medicare Cover?

Not much at all. In fact, the only time dental work may be covered by Medicare is in an emergency setting such as a hospital. For example, if you were in a car accident that affected your teeth, the emergency doctors and health care providers may need to provide emergency dental care.

In this instance, these services would be covered under Original Medicare Part A. (More at Medicare.gov.)

Options for Dental Insurance for Medicare Beneficiaries

Medicare beneficiaries looking for dental coverages, will need to look for benefits outside of Medicare insurance.

Other than paying for dentures and dental work with cash, there are two options for insurance:

  1. Medicare Advantage
  2. Dental Insurance

Medicare Advantage Plans (MA/MAPD Plans)

There are select Medicare Advantage (MA or MAPD) Plans that have dental benefits. Most of them have a network of dental offices that participate in their plan. Often, this is a reimbursement based plan.

You can read more about MA/MAPD plans (also called Medicare Part C) in this article.

Dental Insurance

Dental Insurance is especially worth purchasing if you have big ticket dental items or procedures coming up (i.e. dentures). Make sure when you are researching plans that you pick one that has denture coverage included. Plans and premiums can differ dramatically, so take the time to make sure the plan meets your needs.

Conclusions on Medicare Denture Coverage

If you are a Medicare user in need of dentures, I suggest your first step is to look into either a Medicare Advantage plan with dental benefits, or a stand alone dental plan.

Independent Insurance Agents for Dental Benefit Coverage

To find a plan in your area, I also suggest talking to an independent insurance agent that will be able to help you compare the options in your neck of the woods.

what does medicare cover - FAQ's to Medicare coverage questions

Is Acupuncture Covered by Medicare

Is Acupuncture Covered by Medicare

Is Acupuncture Covered by Medicare

Is acupuncture covered by Medicare? Only if you have chronic low back pain as defined by Medicare.

Let’s look at what that means and what treatments are available.

This article is part of our series “What Does Medicare Cover?” Click the link to read about more frequently asked coverage questions in that article.

Is acupuncture covered by Medicare

Medicare Acupuncture Coverage for Lower Back Pain

If you have chronic lower back pain, Medicare will cover a certain amount of acupuncture visits for you. It is covered under Medicare Part B.

What is considered “Chronic Lower Back Pain?”

According to the CMS, chronic lower back pain is defined as

– Lasting 12 weeks or longer

– Having no known cause (not related to cancer that has spread, inflammatory, or infectious disease)

– Pain not associated with surgery or pregnancy

https://www.medicare.gov/coverage/acupuncture

What is Acupuncture?

Acupuncture is a healing technique first introduced by ancient Chinese Medicine. According to the U.S. Department of Health and Human Services’ National Center for Complementary and Integrative Health,

“Acupuncture is a technique in which practitioners stimulate specific points on the body—most often by inserting thin needles through the skin.”

According to the NIH, researchers have completed enough studies to conclude that acupuncture can be helpful to treat chronic back pain. Scientists need to complete more research on how acupuncture can benefit other conditions before Medicare will consider extending coverages.

How Many Acupuncture Sessions are Covered by Medicare?

If you are diagnosed with chronic lower back pain, you can receive up to 12 acupuncture visits in 90 days under Medicare Part B.

What Does Acupuncture Cost with Medicare?

Remember, there are still costs involved with Original Medicare under Part B.

  • If you only have Original Medicare, then you will be responsible for a Part B co-insurance of 20%.
  • Medicare pays 80% of the cost of services.

Medicare Co-Insurance Coverage Options

For the 20% you are responsible for, you can either:

  • First, cover the cost of the co-insurance yourself “out-of-pocket”.
  • Finally, if you have a Medicare Advantage (MA/MAPD) Plan, then your plan may include benefits for acupuncture visits.
    • MA/MAPD plans all structure their benefits differently. However, they are all required to provide AT LEAST what Original Medicare covers.
    • Some may pay for a certain amount of visits or have co-pays for each visit.

If any of this is confusing to you, please see our article on How to Choose a Medicare Plan for help.

How to Choose A Medicare Plan

Where Can you Get Acupuncture Covered by Medicare?

Medicare will only cover an acupuncture treatment at select facilities with certain providers. (You can’t just go to any person advertising needle services.)

According to Medicare.gov,

Acupuncture must be given by a doctor, or by another health care provider (like a nurse practitioner or physician assistant) who has both of these:

– A masters or doctoral level degree in acupuncture or Oriental Medicine from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine

– A current, full, active, and unrestricted license to practice acupuncture in the state where care is being provided

https://www.medicare.gov/coverage/acupuncture

There are programs on acupuncture created specifically for doctors and medical providers. If you want Medicare to cover your visit, you will need to find one of these trained providers that actively accept Medicare. (In addition, if you are on a Medicare Advantage Plan, make sure your provider is a part of your network.)

Conclusions

At this time, coverage of acupuncture treatments by Medicare is limited to chronic lower back pain.

If you are looking for Medicare covered treatment for back pain, make sure you find a medical provider that is properly trained and accepts Medicare as payment.

Your full cost for the service will depend on what supplemental Medicare plans you also have in addition to Medicare Part B.

Other Related Coverage Questions:

does medicare cover Chiropractic Care
What Does Medicare Cover?

What Does Medicare Cover?

What Does Medicare Cover?

The Most Frequently Asked Medicare Coverage Questions

what does medicare cover - FAQ's to Medicare coverage questions
  • This is a quick directory answering what Medicare will and will not cover.
  • We will list out frequently asked questions, brief answers, and links to more in depth articles if we have them.

Medicare Ambulance Coverage

Medicare does cover ambulance coverage for approved emergency situations. Original Medicare covers 80% of the cost of service. You additional plans will cover all or part of the rest.

Does Medicare Cover Ambulances medicare FAQs

Medicare and Hearing Aids

Does Medicare cover hearing aids? While there might be some Medicare Advantage Plans that have hearing benefits, in general, Original Medicare does not cover hearing aids. Read here for your answers.

Does medicare cover hearing aids doctor examining patient

Medicare Chiropractic Coverage

In regards to Chiropractic Coverage, what does Medicare cover, if anything? According to our article on Medicare Chiropractic Coverage,

Yes, when deemed medically necessary, Medicare does cover chiropractic services. Original Medicare Part B pays for 80% of the cost of chiropractic services. You will pay the other 20% is the co-insurance – unless you have supplemental insurance.

https://medicarelifehealth.com/does-medicare-cover-chiropractic
does medicare cover Chiropractic Care

Medicare Cataract Coverage

Does Medicare cover cataract surgery? Yes, Medicare Part B covers cataract surgery. Please read more here.

does medicare cover cataract surgery

Does Medicare Cover Rehab?

How Long Does Medicare Pay for Rehab? It depends on what Medicare Plan you have.

Medicare often pays for at least part of medically necessary rehab.

However, how it pays, and how much it pays, for your rehab is dependent on what type of care you need and what kind of Medicare plan you have.

https://medicarelifehealth.com/how-long-does-medicare-pay-for-rehab
How Long Does Medicare Pay for Rehab

Medicare Denture Coverage

Does Medicare cover dentures? No, as a rule, dental services are not covered by Original Medicare – including dentures. As an exception, if dental work is preformed in a hospital emergency setting, it may be covered under Original Medicare Part A. (More at Medicare.gov.)

There are select Medicare Advantage (MA or MAPD) Plans that have dental benefits. You can read more about these plans (also called Medicare Part C) in this article.

Stem Cell Therapy Coverage

Does Medicare Pay for Stem Cell Therapy? Sometimes, yes. However, the cases in which it does pay are very limited. Stem Cell Therapy is expensive and controversial. As a result, Medicare’s list of approved cases is short.

does medicare pay for stem cell therapy article from medicarelifehealth.com

Medicare MRI Coverage

Does Medicare Cover MRI’s and how much do they cost? Read our article on MRI’s coverage and cost here.

how much does an mri cost

Original Medicare Coverages

Original Medicare refers to the basic coverages put in place by the Federal Medicare Program. The Center for Medicare and Medicaid Services breaks down the coverages into four parts. (Although Part C and D are provided by private insurance companies.)

In addition to the four parts of Medicare, beneficiaries also have the opportunity to add a Medigap Plan. (Also called Medicare Supplement Plans, these plans pick up the extra costs and co-pays that Original Medicare does not.)

Medicare Parts A B C D Explained
Click here for our infographic on the 4 parts of Medicare.

For more information, here are our detailed articles about each part.

Does Medicare Cover Chiropractic Care?

Does Medicare Cover Chiropractic Care?

does medicare cover Chiropractic Care

Does Medicare Cover Chiropractic Care / Services?

Yes, when deemed medically necessary, Medicare does cover chiropractic services. Original Medicare Part B pays for 80% of the cost of chiropractic services. You will pay the other 20% is the co-insurance – unless you have supplemental insurance.

“Medically necessary” chiropractic care is defined as manual manipulation of the spine to correct a subluxation by a qualified provider such as a chiropractor. (Medicare.gov source info).

What is a Subluxation?

A subluxation is when one or more of your bones moves out of position. In other words, your spinal vertebrae are out of position or misaligned. According to experts, this can cause back or neck pain, headaches and immobility.

Chiropractors can manipulate the spine to correct these misalignments and alleviate pain. This is Medicare’s expected use of chiropractic care.

How Much Does Medicare Pay for Chiropractic Adjustment?

When used for a Medicare approved reason, Medicare will pay for 80% of the cost of your chiropractic care. However, since it is part of Original Medicare Part B (Doctor / Professional Services), the Medicare Part B Deductible will apply.

There is no cap on the amount of times you can see the chiropractor in a year with Original Medicare. However, you have a Medicare Advantage Plan or a supplement plan, there may be different rules.

Let’s look at each of those extra insurances to see how they work with Medicare Part B.

Does Medicare Advantage Pay for Chiropractic Care?

The US Government and CMS (the Center for Medicare / Medicaid Services) requires Medicare Advantage Plans to cover at least what Original Medicare covers. So yes, Medicare Advantage plans will have some benefit for chiropractic care.

It will depend on each individual plan what that looks like. Some plans have a co-pay or co-insurance due each time you use the chiropractor. Also, some may have a cap on fully covered care. Finally, some plans may require a referral from a PCP (Primary Care Physician), so make sure to check with your plan for coverages and options.

Does Medigap Pay for Chiropractic Care?

Medigap (which is also called Medicare Supplement) Plans help to cover costs where Original Medicare leaves off. Some of them cover all extra costs and co-insurances not paid by Original Medicare.

As mentioned earlier, chiropractic services are covered with Medicare Part B. To see what a particular supplement will cover, you will need to look at how they cover the uncovered costs of Part B. For example:

  • Medigap Plan F covers all costs that Medicare does not. (This includes the Part B yearly deductible.) So, if you have Plan F, you will not pay any co-pays or co-insurances to see a chiropractor for approved care.
  • Also, read “Is Medicare Plan F Going Away?”
What is Medicare Plan F - simple answers to medigap questions
  • Medicare Plan G also covers all costs that Medicare does not – except for the Medicare Part B yearly deductible. So, if you have Plan G, you would first pay the Part B deductible for rendered and approved services. Then, once that deductible was satisfied, you would not pay anything else for your services.
What is Medicare Plan G - medigap plans made clear
Medigap Plan Letter Policy Chart - what supplements cover what services
CLICK HERE to see more about the various Medigap plans and what they offer.

A note of warning from Medicare.gov:

“Medicare doesn’t cover other services or tests ordered by a chiropractor, including X-rays, massage therapy, and acupuncture (except for low back pain). If you think your chiropractor is billing Medicare for services that aren’t covered, you can report suspected Medicare fraud by calling 1-800-MEDICARE (1-800-633-4227). TTY: 1‑877‑486‑2048.”

https://www.medicare.gov/coverage/chiropractic-services#

Conclusions on Medicare Coverages of Chiropractic Care

  • Yes, if you have Medicare Part B, you are entitled to 80% coverage of your Medicare approved uses of the chiropractor (after your yearly Part B Deductible applies).
  • If you have additional coverage, through a supplement or a Medicare Advantage Plan, you may have additional coverage for the remaining 20%.
  • If you have questions on whether or not your care will be considered a covered service, you can talk with your primary care physician, directly to Medicare, or if you have additional insurance, to your private insurance company. They can also give you a better idea of your actual costs – including any co-pays, deductibles or co-insurances.
Does Medicare Cover Cataract Surgery

Does Medicare Cover Cataract Surgery

Does Medicare Cover Cataract Surgery?

does medicare cover cataract surgery

Yes, Medicare covers cataract surgery.

Medicare Part B covers the costs associated with cataract surgery. This includes if you need corrective lenses as a result from surgery. (Such as glasses or contact lenses.)

Let’s get into the necessary details you will want to know before cataract surgery. (Such as, how much will I pay?) But first, what is a Cataract? And second, why would you need cataract surgery?

What is a Cataract?

According to the National Health Institute:

  • Cataracts are a cloudy area in the eye’s lens that affects vision.
  • To start, cataracts are a very common eye problem in older people.

“When you’re young, the lens in your eye is clear. Around age 40, the proteins in the lens of your eye start to break down and clump together. This clump makes a cloudy area on your lens — or a cataract. Over time, the cataract gets more severe and clouds more of the lens.”

National Health Institute
  • Interestingly, over half of Americans over the age of 80 have either had cataracts (and just lived with them) or have had surgery to remove them.

What is Cataract Surgery?

Cataract surgery is the removal of your cloudy eye lens, and then the replacement of your original lens with a new, artificial lens. It is done in an outpatient setting in a hospital or an ambulatory surgical center. This means, you are in and out without an overnight hospital stay.

Why Would You Have Cataract Surgery?

Some people’s cataracts do not bother them enough to do anything about them. If you are trying to stave off surgery, you can try

  • getting stronger glasses,
  • or a magnifying device or lenses,
  • reducing glare with your glasses or sunglasses,
  • or just increasing the amount of light in your living areas.

However, if it gets to the point where you are having trouble seeing, you may need surgery. According to the National Health Institute, people who have cataracts may notice:

  • Blurry Vision
  • Hazy/Halo Vision
  • Seeing Dulled Colors
  • Trouble Reading
  • Poor Night Vision
  • Seeing Double

Some people just get cataracts naturally with age. While others will develop them after another eye surgery, eye trauma or glaucoma issues. Source NHI.

How Much Does Cataract Surgery Cost on Medicare?

The CMS Medicare.gov website has a “Procedure Price Lookup” page where you can see the average costs of medical procedures.

Remember, this is not an exact price of what you will pay. It is just an estimate, but it can be very helpful. (Your actual costs will depend on if you have extra insurance, what your doctor charges, any facility charges, where you live, and any other variable medical costs involved with your care.)

How to Look Up Your Cost Estimate on Medicare.gov

If you want to know how much Cataract Surgery costs on average, you can visit their website. Then, type in “Complex removal of cataract with insertion of lens.” (This is under code: 66982.)

When we looked up this procedure at the end of 2020, the average cost was:

  • Ambulatory Surgical Centers Total Cost of $1,777
    • Patient Pays $355
    • Medicare Pays $1,422
  • Hospital Outpatient Surgery Total Cost of $2,786
    • Patient Pays $557
    • Medicare Pays $2,229

Here is a screenshot from the date we looked it up. (However, prices change, so please use the tool for an up to date estimate.)

cataract surgery cost estimate on medicare, screenshot from medicare.gov December 2020

How Much Does Cataract Surgery Cost with Medigap?

Depending on what Medigap Plan you have, you may have all the extra costs covered through your supplement. (However, some plans have you pay the Medicare Part B Deductible. Please read this article to understand what Supplements cover what costs.)

How Much Does Cataract Surgery Cost with Medicare Advantage?

If you have a Medicare Advantage Plan, you most likely will have a co-pay, deductible or coinsurance. You can read more about Medicare Advantage Plan costs here.

Are Eyeglasses Covered by Medicare with Cataract Surgery?

According to Medicare.gov, the only time that Medicare covers eyeglasses or contact lenses is if you need them after cataract surgery for corrective purposes. In this case, you would still be responsible for 20% of the cost.

In addition, the corrective lenses would be under Medicare Part B, so the Part B Deductible would also apply. This is unless you have supplemental coverage (for example, Medigap or Medicare Advantage).

Does Medicare Cover Eyeglasses or Contacts in General?

Typically, Original Medicare will not cover contact lenses or eyeglasses outside of cataract surgery. However, there are Medicare Advantage Plans that have an eyeglass or contact benefit included. The amount varies from plan to plan and from year to year. These are outside of, or in addition to, cataract surgery corrective lenses needs.

Conclusions

Cataract surgery is covered by Medicare Part B. If you are considering cataract surgery, the first thing to do is to talk with your medical providers.

Then, consult with your insurance provider’s information or personnel on cost. Ask them what your financial responsibility is for the costs Original Medicare Part B does not cover (the 20% coinsurance).

Depending on what kind of plan you have, you may be responsible for all, some, or none of the co-insurance costs.

Disclaimer:
This information isn’t intended to replace professional medical advice, diagnosis, or treatment.

Medicare Part B Premium 2021 Changes

Medicare Part B Premium 2021 Changes

Medicare Part B Premium 2021

The Center for Medicare Services has announced the costs of Medicare Part B Premium 2021. In addition, they have announced the changes to Part A Premiums and Part A and B Deductibles for 2021.

We have included a helpful chart so you can see the premium and deductible differences from 2020 to 2021.

Medicare Cost Sharing Chart

medicare part b costs 2021 chart - Medicare Part A Costs Chart
Medicare Part B Premium Changes

2021 Medicare Part A Premiums

Most people do not pay a Part A Premium, unless they paid into Medicare taxes for less than 30 quarters. However, if you have worked less than 30 quarters paying into the Medicare insurance program, then you will owe a monthly premium if you want Medicare Part A (Hospital Insurance).

  • In 2021, the Medicare Part A Premium is $471 per month.
  • Medicare Part A was $458 per month in 2020.

For more information, please visit the Medicare.gov page.

2021 Medicare Part B Premiums

  • In 2021, the Medicare Part B Monthly Premium will be $148.50
  • In 2020, the Medicare Part B Monthly Premium was $144.60.

Medicare Part B Deductible 2021 / Medicare Part A Deductible & Co-Insurances

Medicare Part A & B Deductibles & Co-Insurances20202021
Part B Deductible$198$203
Part A Deductible$1,408$1,484
Part A Inpatient Hospital Co-insurance
Days 0-60$0 per day$0 per day
Days 61-90$352 per day$371 per day
Lifetime Reserve Days 91-150$704 per day$742 per day
Skilled Nursing Facility Coinsurance from 21-100 days$176 per day$185.50 per day
2021 out-of-pocket (OOP) limits for Medigap Plan K is $6,220 and L is $3,110.
2021 Medigap High-Deductible Options F, G, & J have a $2,370 Deductible.

Medicare Coverages

For a in-depth look at each what each part of Medicare covers, take a look at this article: Medicare Parts A B C D.

Medicare Parts A B C D Explained
Click here for our infographic on the 4 parts of Medicare.
Does Medicare Cover Ambulance Services?

Does Medicare Cover Ambulance Services?

Does Medicare Cover Ambulances medicare FAQs

Does Medicare Cover Ambulance Services?

Yes, Medicare covers ambulance services in approved emergency situations. As with all Medicare covered costs, you will pay 20% of the cost of service, unless you have additional coverage.

Let’s break down in more detail – what is covered and how it gets paid for.

Does Medicare Pay for Ambulance Services?

Medicare Part B covers ambulance services. (Part B is medical insurance. To learn more about what Part A and Part B offers, visit this page.)

What does the government describe as covered ambulance services? Well, they include:

  • Emergency ground transportation to a hospital (including critical access and skilled nursing facilities)
  • Emergency air transportation (via helicopter or airplane) when ground transportation is not available or is not adequate

Does Medicare Cover Non-Emergency Transportation?

No, Medicare does not typically cover non-emergency transportation. For example, you will not be able to get an ambulance to a doctors appointment.

However, there are certain Medicare / Medicaid programs that do offer non-emergency transportation to people who need it. Also, according to CMS (Center for Medicare Services), there are a few instances where Medicare may provide non-emergency ambulance services:

“In some cases, Medicare may pay for limited, medically necessary, nonemergency ambulance transportation if you have a written order from your doctor stating that ambulance transportation is medically necessary. For example, you may need a medically necessary ambulance transport to a dialysis facility if you have End-Stage Renal Disease.”

https://www.medicare.gov/coverage/ambulance-services

What are My Costs with Medicare Ambulance Coverage?

First, it is good to remember that the reason for your ambulance ride must be considered a “Medicare approved” service. Otherwise, your ride might not be covered at all. Also, CMS states that the ambulance can only take you to the nearest medical facility considered appropriate for your needs. (You can read more about it here.)

Next, if you only have Original Medicare Part B, then you will pay the 20% of the ambulance bill that Medicare does not pay. (If you only have Medicare Part A, then ambulance services are not covered. You will need to enroll in Part B to have them covered.)

However, most people have a supplement or a Part C (Medicare Advantage) Plan in addition to Medicare Part A and Part B. Original Medicare works together with your private insurance options to pay for ambulance services. Let’s look at both options and how they cover ambulance rides.

Medigap Ambulance Coverage

Remember that with Original Medicare Part B, the government pays for 80% of the cost of a Medicare covered ambulance ride. You are responsible for the rest, unless you have a Medigap plan. Also known as Medicare Supplement plans, these plans help you pay for the co-insurances, deductibles, and co-pays that Original Medicare does not pay for.

Coverage By Specific Medicare Supplement Letter Plan

Ambulance Medicare coverage

In exchange for a monthly premium, Medigap plans will help you pay for some or all of your personal costs of Medicare approved services. The Part B Co-insurances or co-payments are

  • Paid in full by Medigap Plans A, B, C, D, F, G and M.
  • Plan K pays for 50%;
  • L pays for 75%,
  • And N pays for all minus a co-pay.

You can read more about the supplement coverage chart in our article: What are Medicare Supplements here.

Medigap Plan Letter Policy Chart - what supplements cover what services
CLICK HERE to see more about the various Medigap plans and what they offer.

Medicare Advantage Ambulance Coverage

What is Medicare Advantage?

Medicare Advantage (Part C) plans are private insurance options that “replace” Original Medicare as your only Medicare coverage. They offer everything that Original Medicare offers, and also offer extra benefits are services on top of what is covered in Part A and Part B.

Medicare Advantage plans cover at least what Part B covers for ambulance rides. In addition, they also may cover the 20% that Part B doesn’t cover, but they way they do that is specific to each individual private insurance company.

For example, some Medicare Advantage plans will have a set co-pay for ambulance use, or they may have a percentage they cover. They may also distinguish between air and ground emergency transportation in how they cover costs.

It is important to know that every Medicare Advantage plan has a set max out-of-pocket cost that you can never go above each year. So, for example, if your MA plan had you pay 10% of the cost for air transportation, then you would be responsible for that cost only up to the max out-of-pocket limit set for your plan.

Remember, each Medicare Advantage plan is different, and if you are a MA plan beneficiary, you will need to look at your plan information or “Summary of Benefits” to see how your costs will be covered.

If you want to compare Medicare Advantage vs Medigap plans, you can read more here.

Other FAQ’s

Here are a few other frequently asked questions:

  • Does Medicare cover air ambulances?
    Yes, as long as it is a “Medicare approved” service, then it is covered. If you need an emergency air transportation and it is considered a necessary, approved situation, then Medicare will pay for it. Remember, you will be responsible for a 20% co-insurance payment unless you have additional coverage (like with a Medigap or Medicare Advantage plan).
  • Does Medicare cover life flight?
    Life Flight or LifeFlight is just a branded name of a company that provides emergency air transportation services. If you use their services for a Medicare approved expense, then it will be covered accordingly.

Conclusions

Yes, Medicare will cover ambulance service for approved and necessary emergency transportation needs. You will still have co-insurance unless you also have a Medicare Supplement Plan or a Medicare Advantage Plan. Do you need help finding coverage in addition to what you receive through Original Medicare (Part A and Part B)? Then please reach out to us.

Best Hearing Aid Alternatives

Best Hearing Aid Alternatives

Best Hearing Aid Alternatives

hearing aid alternatives with medicare life health - what is a psap

Hearing aids are expensive. We are talking thousands of dollars, sometimes even with insurance. In addition, they may be overkill for the amount of hearing support you require.

Fortunately, there are hearing aid alternatives. You just need to know where to look and what to look for.

Hearing Aids are Not Covered by Medicare

Does medicare cover hearing aids doctor examining patient

One of the main problems is that hearing aids are not covered by Original Medicare. (Read this article to learn more, and how they are sometimes “covered” or subsidized by select Medicare Advantage plans.

Just as a refresher, Medicare Advantage Plans are private insurance plans (Medicare Part C) that are available to Medicare Beneficiaries in certain geographic areas. Some of them do have hearing care benefits.

So, What is a Low Cost Hearing Aid Alternative?

Before 2009, the only solution for procuring a hearing aid was through a doctor. In addition, to make matters worse, these solutions were (and still are) thousands of dollars.

Enter the PSAP…

What is a PSAP?

However, in 2009, a court decision finally allowed sales of OTC (over the counter) hearing aids. They changed the name of these “hearing aid alternatives” to Personal Sound Amplifier Products or PSAP.

What is the Difference Between a Hearing Aid and an Amplifier?

To be frank, the main difference between a hearing aid and a hearing amplifier is FDA regulation. To get a hearing aid, you will

To get an amplifier (PSAP), you just need to purchase one online. No doctor or prescription required. However, you may want to see a hearing specialist just to be sure your hearing loss is not connected to another condition.

How do Amplifiers Work?

Personal Sound Amplifiers are basically over-the-counter hearing aids. They “manage” noise around you and help you hear what is important, like the sound of voices directed at you. Some of them even have noise cancelling technologies. (Affiliate Link)

Our PSAP Brand Recommendation

One of the first, and still very popular, brands of PSAP’s is Otofonix. We recommend this brand, and our links for them are affiliate links. The company was started by an ENT (ear, nose and throat) doctor and the company has many different options and price points.

Otofonix has some limited time offers for our readers. They are listed here:

Otofonix is known for having great customer service, a 1 year warranty and a up to 45 day return window.

Hearing Health Tips for Improving and Protecting Hearing

Finally, we are ending our hearing aid alternatives article with a few tips for naturally improving hearing. They might not be a substitute for an amplifier or hearing aid, but they might make a difference.

To Start, Keep Your Ears Unclogged

There are multiple ways your ears can get plugged up. You could have an infection, allergies, pressure build-up (like from a plane ride), or even too much war wax.

I remember when my mom spent months not being able to hear and thinking she needed hearing aids. However, when she went to the doctor, they found out she just had a prolific amount of ear wax! After they drained her wax out, she could hear again.

There are ways to “irrigate” your own ear canal, but that also might be something to consult your doctor about. It is always a good idea to be safe and gentle your ears. (And stay away from putting things in your ears like cotton swabs.)

Finally, Prevent Further Hearing Loss

Hearing Loss Prevention is the Key to hearing health! Make sure you are protecting your hearing by:

  • Wearing ear plugs when you know you will be experiencing loud sounds. For example, at a concert or fireworks show.
  • Give yourself some quiet time. Your ears and brain work hard together to interpret sounds. Make sure to give them a break every once-and-a-while.
  • Turn down the volume on the TV and on your music.
  • Take care of your whole self. Exercise and a healthy diet will help to keep all your body’s systems in proper working order, including your ears.
  • In addition, foods rich in magnesium may help bolster hearing health. Studies have been inconclusive in how other vitamins and minerals help hearing health.

HMO vs PPO Which is Better?

HMO vs PPO Which is Better?

HMO vs PPO Which is Better?

HMO vs PPO Which is better in regards to health insurance, Medicare Advantage Plans and dental insurance

Insurance has changed a lot over the last 20 years, and there is no better example than the way we define and use provider networks. When you are looking at insurance plans, it’s important to compare HMO vs PPO. Which is better for you?

We are here to clear up the confusion, and quickly answer the most frequently asked questions in regards to what is HMO and PPO insurance, how the plans work, and where you will find HMO and PPO insurance plans.

If you are a Medicare user, you will run into HMO vs PPO in regards to choosing a Medicare Advantage Plan. You can learn more about Medicare Advantage Plans here.

What is an HMO?

To start, what is HMO health insurance? A HMO is a network of health care providers, set-up by a health insurance company, to offer services and benefits to its customers. (More at Healthcare.gov.)

What does HMO stand for? Health Maintenance Organization

How does an HMO work?

  • To start, when you are a beneficiary/member of an HMO, you have access to a specific set of healthcare providers in a specified geographical area. (For example, a city, counties or defined state(s).) These providers include doctors, healthcare professionals, specialists and hospitals.
  • You must use the HMO’s contracted providers to have your care paid for by your insurance plan. Moreover, if you go outside the plan for care, you will often have to pay the full cost of your care.
  • You can only go outside of your plan’s provider list in the case of an emergency.
  • With most HMO’s you need to have a Primary Care Physician (called a PCP). Your PCP takes care of your general health care and then refers you to specialists as needed.
  • So then, as a member of an HMO, if you need to see a specialist, your PCP with often have to refer you, to use one. However, in some states, and with some plans, the insurance companies have take away this requirement. As a result, it is important to check your specific plan’s requirements for seeing a specialist.
  • Finally, HMO’s are often concerned about prevention and keeping their member’s as healthy as possible to keep everyone’s costs down. For this reason, health maintenance organizations will often provide prevention based benefits and services to encourage safe and healthy behaviors among their members.

What is a PPO?

So, in regards to insurance, what is a PPO? A PPO is a type of insurance plan that uses a defined network of medical providers to meet your health care needs.

You pay a contracted rate (less than full price) to see network providers. However, unlike an HMO, with a PPO you can use doctors, clinics and hospitals outside the network at a higher cost. (More at healthcare.gov.)

What does PPO stand for? Preferred Provider Organization.

How Does a PPO Work?

  • First, with a PPO, you still have a network of providers to use that offer contracted prices to members of the PPO.
  • In contrast, you have more flexibility to go outside the network if needed to use uncontracted providers. You will most likely have to pay a higher percentage of the costs to use these providers, but the insurance companies will still pay something.
  • You can use any provider when the circumstance is deemed an emergency.
  • With most PPO’s, you do not have to have a referral to see a specialist.

What is the Difference Between HMO and PPO Insurance Plans

Both HMO’s and PPO’s have contracted networks of healthcare providers, clinics and hospitals where they will pay for some or all of your care. However, there are differences to consider:

  • First, HMO’s and PPO’s treat their out of network costs differently.
    • With an HMO, if you go “out-of-network” to see a provider, they may not cover any of your costs. Unless, it is an emergency situation.
    • With a PPO, the plan will most likely cover “out-of-network” provider/hospital visits, but at a lower percentage rate than their “in-network” providers/hospitals.
  • Second, the networks treat visits to healthcare specialists differently.
    • With an HMO, you will often need a referral to see a specialist.
    • With a PPO, you can most often just choose a specialist from the network provider list and make an appointment to see them without a referral.
  • Third, the PCP is usually the person making referrals in an HMO network. As a result,
    • The HMO’s often require having a primary care physician (PCP) on file for its members.
    • While the PPO’s usually do not have a requirement to name a PCP.

So, HMO vs PPO Which is Better?

After reading about the differences between HMO’s and PPO’s, it may seem like the PPO sounds hands down better than the HMO. Regarding, its freedom to see both in-network and out-of-network providers, and its options to see specialists without a referral, it does seem more flexible.

So then, why do people like HMO’s as well as PPO’s, and which one is right for you?

  • To start, HMO’s have changed a lot over the last years. Their networks have become more robust and their requirements less strict. In certain geographical areas, the HMO might include all the major hospital systems and the majority of providers. As a result, it may not matter to a person if they have a PPO or HMO, in regards to providers available.
  • Second, in some states, it is not necessary to get a provider referral to see a specialist in an HMO’s network. State laws often dictate how HMO’s work in this capacity, so it is important to learn how your area’s plans work.
  • Third, their may be a cost difference paid by members between an insurance company’s HMO and PPO plans. These costs include monthly premiums, max out of pocket costs, deductibles, and co-pays/co-insurances. When picking a plan, it often comes down to what is the more affordable option.
  • Finally, since HMO’s are often more focused on the wellness of their members, they might have other prevention benefits and services available to their members. PPO’s can sometimes have these services too, you will just need to do your homework to see what is included when shopping for a plan.

Going Deeper: HMO vs PPO Which is Better FAQ’s.

For those of you that have further questions, here are the most asked questions in regards to HMO and PPO insurance.

What does HMO POS mean? / What is HMO POS Medicare Advantage?

An HMO POS is a type of HMO network that allows more flexibility in seeing providers outside of the specified HMO provider list. POS stands for Point of Service.

According to Healthcare.gov, with an HMO POS, you will still need to choose a PCP (primary care physician) and they will still make specialist referrals for you. However, with a POS, if they want to refer you to a specialist outside of the HMO network, they can do so with the POS designation. Keep in mind, specialists and providers outside of the HMO network may still have higher out-of-pocket costs than in-network providers.

In a HMO POS Medicare Advantage Plan, you also have this ability to use providers who are “out-of-network,” but they may incur an increased cost.

What is Medicare PPO? / What is Medicare HMO?

PPO’s and HMO’s come into play in Medicare when you are using Medicare Part C – aka Medicare Advantage Plans.

Medicare Advantage (MA & MAPD) Plans are alternative plans offered by private insurance companies to take the place of Original Medicare. They often include drug coverage or Part D coverage (MAPD plans). They are approved by the Federal Government and cover everything that Original Medicare covers. In addition, they often offer benefits and services beyond what Medicare offers such as dental, vision and hearing benefits.

So then, what is a Medicare Advantage PPO plan or HMO plan?

What is Medicare Advantage?

Medicare Advantage plans are often HMO, PPO, or PFFS plans. (Additionally, they have special plans set up for people with special needs.) When you are choosing a Medicare Advantage Plan, you will need to consider everything we discussed about HMO’s and PPO’s as they will apply to these private insurance plans and how they set-up their provider networks.

Ok, then what is a PFFS Plan?

PFFS is a Private Fee-for-Service Plan. These plans also have networks that include a list of providers that have agreed to accept the plan. Moreover, you can see other providers, not on the list, as long as they agree to the plan’s terms and conditions and bill the plan directly. Original Medicare is an example of a PFFS plan.

What is HMO Medicaid?

Medicaid is provided to its recipients at a state level. Each state has to decide how to manage their Medicaid programs. These “managed care” options include choosing an insurance administrator to deliver healthcare services to Medicaid beneficiaries in a way that will “manage cost, utilization, and quality.” Often times the contracted insurance company will use an HMO model to structure their network of providers.

medicare and medicaid difference guide

In addition, if you are a “Dual Eligible” beneficiary – meaning that you qualify for both Medicaid and Medicare – then you have the option of finding a private insurer to manage your health care insurance. Each state has DSNP Medicare Part C (Medicare Advantage) providers that offer plans to dual eligible beneficiaries to help them manage the care between Medicare and Medicaid. These plans can also be HMOs or PPOs.

What is an EPO?

An EPO is an Exclusive Provider Organization. According to Healthcare.gov, “EPOs generally limit coverage to care from providers in
the EPO’s network (except in an emergency).”

What is PPO Dental Insurance? / What is HMO Dental Insurance?

Dental Insurance Carriers (aka Insurance Companies) set-up their provider networks similar to how medical companies set-up their networks. They have both DHMO and DPPO plans.

Just like in medical insurance, both DPPO’s and DHMO’s have provider networks, but HMO’s will typically only pay for services rendered by providers in the network. In addition, PPO’s will pay more of the costs for services provided by network providers, but will pay some percentage of costs out-of-network. For this reason, Dental HMO’s are usually less expensive than PPOs.

What is Better HMO or PPO Dental Insurance?

There are other differences between Dental PPO’s and HMO’s including deductible costs, and co-pays/co-insurances. When you are looking at dental plans in your area, you will need to decide what type of plan most affordably meets your dental care needs.

Sometimes this will be an DHMO and other times, this will be a DPPO, so compare costs, provider networks and types of dental services covered before buying a policy. Here is a good article for more detail on dental insurance network types to help you decide what is best for you.

What is Preferred Provider Organization?

Also known as a PPO, a Preferred Provider Organization is a type of insurance plan that provides a network of healthcare providers, offices and hospitals for its members to use at contracted costs. In addition, it provides the flexibility to use providers outside of its networks if needed, but at a higher cost to the members.

Then, what does preferred provider mean?

Preferred provider means that a particular doctor, specialist, clinic, hospital or other healthcare professional or facility is a part of your insurance provider’s network. They will offer a contracted (most likely discounted) rate for you to use their services while on your PPO insurance plan.

What is the largest PPO network?

The largest PPO Network in the United States is MultiPlan.

What is MultiPlan PPO?

Multiplan is not a “type” of healthcare insurance. They are a third party company that helps insurance companies “manage the cost of care, improve their competitiveness and inspire positive change.” You do not have a Multiplan PPO, you have a PPO that uses Multiplan.

What is a Regional PPO?

We often hear the questions, “what is a Regional PPO?” and “what is a Regional PPO Medicare Advantage Plan?” Regional just refers to the service area for the PPO. Members will have access to providers in the PPO’s specified region.

What is Health Maintenance?

“Health Maintenance” refers to a system of prevention. In insurance terms, it refers to an insurance network plan with a focus on keeping medical costs down by keeping members healthy with lower cost preventative care options.

The thought is “an ounce of prevention” will lead to significant cost savings on unused healthcare dollars down the road.

So then, what are the benefits for providers who use HMO model?

Providers who are a part of the HMO model have benefits of being a part of a network that pays them based on a contracted fee. Each network will arrange the contracts differently. However, the providers will know that they have access to the insurance carrier’s pool of members to service for their healthcare needs.

HMO vs PPO Which is Better Summary

In conclusion, whether a PPO or a HMO is “better” all depends on your needs and the plans available in your area.

If we missed any questions in “HMO vs PPO Which is Better” you may have, please drop us a note in the comments and we will do the best to answer them!

All the best. Carly and the MLH Team

How Long Does Medicare Pay for Rehab?

How Long Does Medicare Pay for Rehab?

How Long Does Medicare Pay for Rehab?

How Long Does Medicare Pay for Rehab

How Long Does Medicare Pay for Rehab? It depends on what Medicare Plan you have.

Medicare often pays for at least part of medically necessary rehab.

However, how it pays, and how much it pays, for your rehab is dependent on what type of care you need and what kind of Medicare plan you have.

Let’s look at the various types of rehab and how:

  • Original Medicare,
  • Medigap, and
  • Medicare Advantage address coverage.

Original Medicare Rehabilitation

Rehab, or Inpatient Rehabilitation Care, is part of Medicare Part A or “Hospital Insurance.” To learn more about what Part A covers, click here.

Rehab administered in an outpatient setting or by doctors / medical providers can be covered by Part B when considered necessary by Medicare Standards. One example of a covered program is Cardiac Rehabilitation Programs.

“Medically Necessary”

Original Medicare will pay for part of your rehab in most cases if your care is considered “medically necessary” by CMS (Center for Medicare and Medicaid Services) standards.

According to CMS, medically necessary rehabilitation requires:

  • certification by a doctor that you have a medical condition that requires rehab
  • continued professional medical supervision
  • coordinated care from doctors and therapists

How Many Days does Medicare Pay for Rehab?

If you only have Original Medicare, you will have costs associated with rehab for each benefit period.

  • For the first sixty days, a deductible will apply (in 2020, $1,364).
  • After that, a $341 coinsurance will apply to days 61-90, and $682 coinsurance from day 91 and beyond.
  • Finally, if you are going beyond 91 days in rehab, you will only have 60 more “lifetime reserve days” for coverage. What this means is that Medicare will only cover 60 rehab days total in your lifetime after you hit the 90 benefit period limit. These lifetime days do not start over each year. As a result, if you run out of lifetime reserve days, you will be paying 100% of all costs for rehab when you run out.

For more information on inpatient rehab, please visit this medicare.gov page.

Medicare Supplements (Medigap)

Medicare Supplements are designed to pick up the costs that Original Medicare does not cover (such as deductibles, coinsurance and co-pays.)

Click here to read more about Medicare Supplements.

There are some Medicare Supplements that pick up just about all costs that Medicare does not pay. (As long as they are “covered services.”) You can consult this chart to see what plan pays what.

Medigap Plan Letter Policy Chart - what supplements cover what services
CLICK HERE to see more about the various Medigap plans and what they offer.

Medicare Plan F and Plan G offer the most extensive coverage and among the most popular plans.

Medicare Advantage Rehab Coverage

how to apply for medicare article - medicare enrollment questions and answers

Private insurance companies run Medicare Advantage plans. They are designed to “replace” Original Medicare. They cover at least what Original Medicare covers plus they offer additional coverage and extra benefits and services to their beneficiaries.

Each Medicare Advantage Plan will be different in regard to their Medicare rehab coverage. However, they most often offer additional coverage or a different structure as to how they cover rehab days – both inpatient and outpatient.

Additionally, all Medicare Advantage Plans (also called MA / MAPD plans) are required to have a “max-out-of-pocket” limit for each annual benefit period. This means that you will not pay more than that predetermined amount each year for your covered health services.

the most frequently asked medicare questions or faqs

Now that we have looked at the various plans and how long they cover rehab, let’s look at a few specific examples that Medicare addresses.

Does Medicare Pay for Physical Therapy?

Sometimes, when people ask if Medicare pays for rehab, they are referring to outpatient physical therapy.

Medicare covers some costs for outpatient physical therapy when it is considered “medically necessary” as we defined earlier in this article.

Medicare Part B helps pay for physical therapy, and if you only have Original Medicare, you will pay 20% of your medical costs.

How Long Does Medicare Pay for Physical Therapy?

According to CMS, “Medicare law no longer limits how much it pays for your medically necessary outpatient therapy services in one calendar year.”

Finally, always remember to make sure that your physical therapy is considered both medically necessary and a Medicare covered service. If it is not, you may end up paying for all of it.

Need more info? Allow us to direct you to the correct pages on the government website for information on:

How Long Does Medicare Pay for Cardiac Rehab?

If you have recently had a heart attack or some other cardiac event (see here for more information on what “events CMS covers), Medicare will cover most costs for Cardiac rehabilitation programs. These programs usually are covered for as long as they are needed.

Medicare covered costs can include both regular cardiac rehab and “Intensive Cardiac Rehabilitation” Programs (ICR).

According to CMS, programs can address exercise, education and counseling in some form, and can either be held in an outpatient hospital setting or at a doctor’s office.

In regards to costs, just remember…

  • Original Medicare will cover 80% of approved medical bill amounts under Part B. (Part B deductibles may apply).
  • If you have a Medigap Plan (aka Medicare Supplement) then that plan will pick up additional costs according to your plan’s letter specifications. (See the Medigap chart above or visit our Medigap Page for more information.)
  • Or, if you have a Medicare Advantage Plan, your plan will list out how it covers cardiac rehab costs and what your copayments will be, if any.

How Long Will Medicare Pay for Nursing Home Rehab?

If you need rehab that extends beyond a stay as an inpatient at a regular hospital, your doctors may transfer you to a “Long-Term Care Hospital” (LTCH). Long-Term Care Hospital stays are different than living in a Long-Term Care facility (also called a nursing home). They are still considered a hospital setting, so they are covered by Medicare Part A.

Under Original Medicare, your coverage lengths and payment amounts are the same as the inpatient rehab amounts we detailed out above in the section, “How Many Days does Medicare Pay for Rehab?.” Or, you can find them on the government website here.

However, your benefit period does not start over if you are transferred from one hospital to another (including a LTCH). So, you will not have to pay another deductible.

Conclusions

We understand that Medicare rules and costs are often confusing. This is especially true when you are confronted with rehab options. Your coverage lengths and costs will often be different depending on how you have your Medicare coverage set-up.

If you need more help in answering questions regarding your specific plan, you can reach out to your insurance agent or plan directly. If you are looking for an agent, you can contact us for help.