Category: Medicare

How Much Does an MRI Cost

How Much Does an MRI Cost

How Much Does an MRI Cost?

how much does an mri cost

There is nothing worse than getting a hospital bill with an unexpected number on it. So, if your doctor says you need an MRI, you might be wondering, just how much does an MRI cost?

First, MRI stands for Magnetic Resonance Imaging. An MRI machine can scan the inside parts of your body and create pictures for medical professionals to use for diagnostics. Moreover, it is considered “noninvasive” as it uses magnetic fields, radio waves, and computer technology to create images.

MRI’s are commonly used to discover issues in your brain, neck, arteries and spine. (Among many other uses.)

So, let’s look at cost estimates for an MRI with and without insurance, including Medicare options.

How Much Does an MRI Cost Without Insurance?

There is not a national “set price” for an MRI. The U.S.A. has a private healthcare system, so costs vary state-to-state and even facility-to-facility. For this reason, you will see estimates varying on the question of how much does an MRI cost in the United States.

Estimates for How Much does an MRI Scan Cost

  • According to Money.com, the average MRI cost is $2,611.

Cost Estimates for MRI as an Inpatient vs an Outpatient

  • However, MRI costs also vary significantly between inpatient and outpatient facilities.
    • According to this website, the national average for an MRI is $1,325, but the outpatient average is $650, while the inpatient average is $2,250.
    • That is over a $1,500 difference in price if you have the procedure done while you are admitted as an inpatient, versus being an outpatient.

The Cost to Get an MRI Scan Varies by State

  • As mentioned, the estimated cost of a MRI also varies across the country. The United States uses private hospital systems and they can set their own prices based on their expenses.
    • According to American Health Imaging, the most expensive state for an MRI is Alaska (at $3,200).
    • And the least expensive state for an MRI is Mississippi (at $97).

What is the Cost on an MRI with Private Insurance?

Private insurance may reduce the cost of your MRI if it is considered a covered service. It may reduce the cost of your service more if you get your procedure done at an in-network facility vs an out-of-network facility.

According to Money.com, insurance companies, on average negotiate MRI costs down to $511 to $2,815. After that, your costs for an MRI will depend on your insurance co-pays, deductibles and max out-of-pocket expenses.

How Much Does an MRI Cost with Medicare?

Depending on what type of Medicare Plan you have, and it your MRI is considered a “covered service,” you may have different costs associated with getting an MRI. Let’s look at each Medicare option and what costs might be associated with each.

Original Medicare

Medicare is a national healthcare system that negotiates with facilities to accept Medicare Beneficiaries as patients, and it negotiates prices. You just have Original Medicare and not a Medicare Advantage Plan or a Supplement on top of Medicare, then you can find the price of your MRI scan on the Procedure Price Look-up page on Medicare.gov.

This page lists off 54 different MRI procedures that are covered by Medicare and how much they may cost you and Medicare. For example,

  • A simple “MRI Scan” (Code: 76498) is listed at a total cost of $32 (patient pays $6, Medicare pays $25) at ambulatory surgical center or $62 (patient pays $12, Medicare pays $49) at a hospital’s outpatient center.
  • While a “MRI of heart before and after contrast with stress imaging” (Code: 75563) can have a total cost of $356 (patient pays $71, Medicare pays $285) at ambulatory surgical center or $691 (patient pays $138, Medicare pays $553) at a hospital’s outpatient center.

However, most people on Medicare do not just have Original Medicare. They also have a Supplement (which is also called a Medigap plan) or a Part C, Medicare Advantage Plan to help them cover the costs that Medicare does not pick up.

Medicare Supplement (Medigap) Plans

If you have a Medicare Supplement plan, then an MRI might not cost you any additional money, depending on your supplement. Plans like F (or G after the Part B deductible) cover all expenses that Medicare does not pick up.

There are different Medigap Plans available listed out by letter names, and Medicare Beneficiaries get to choose which one fits their needs best. To learn more about Medigap plans, click here.

Medicare Advantage

Medicare Advantage Plans (also called MA or Medicare Part C) are bundled plans that replace Original Medicare and offer more coverage than what Original Medicare offers. They often have co-pays or a co-insurance for listed covered services.

For example, a plan might have a set price co-pay for an outpatient service or an inpatient hospital service. If you have an MA Part C, you will need to consult your plan information to see how much an MRI costs with Medicare Advantage.

To learn more about how to pick a Medicare Advantage or Medigap Plan:

Why are MRI’s so Expensive?

Here is why MRI Scans are Expensive:

  • Research and Development Costs: MRI Machines have life-saving technologies that took years to develop. The development costs alone makes them expensive.
  • Little Competition: In addition, there are only 5 companies that make MRI machines.
  • More Power = More Money: MRI machines come in different sizes and strengths. Scientists measure their imaging power in “Teslas”. The more Teslas, the more power, the more the machines cost. Each machine can cost from $150,000 to $3,000,000.
  • Expensive Housing: Finally, the rooms that hold the MRI machines are also expensive because they must be safety proofed and large.

Ways to keep your MRI costs down:

  1. Have the MRI done in an outpatient facility. This is the #1 way to keep your costs down as the price difference (on average, up to $1,500) is significant between in and out patient MRI procedures.
  2. Use insurance and stay in network. Learn what and how your insurance covers an MRI. In addition, if you have a network of medical providers and facilities provided by your insurance, then use them. It is much cheaper to use “in-network” providers because your insurance company has contracted with them and negotiated with them lower prices.
  3. You might also wonder, how much is an MRI if you pay cash? Is there a discount? Sometimes, yes! If you do not have insurance, pay in cash and negotiate your price upfront when possible. We know some MRI’s are done in emergency settings, but when possible, see if you can negotiate your price.
  4. Even if you are not paying cash, see if you can negotiate the price down. The insurance companies do the same thing with hospitals. You can also attempt this after the fact, but it is easier to do upfront.
  5. Call around. Shop your procedure to see where your least expensive options exist. Call all your “in-network” options if you have insurance, or call all your local options if you are uninsured. As mentioned, private healthcare systems set their own costs, so not every facility will be the same.

Healthcare Further Reading

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What is Medicare Plan F?

What is Medicare Plan F?

What is Medicare Plan F?

What is Medicare Plan F - simple answers to medigap questions

You may have heard, but there have been changes with who can get what Medicare Supplement Plans (aka Medigap Plans) now. Plan F and Plan C are not available to people turning 65 on or after 2020. So, you might be wondering, what is Medicare Plan F?

In this quick article, let’s look at what are Medicare Supplements and then specifically, what is Medicare Supplement Plan F.

Medicare Supplement Plans Explained

What are Medicare Supplements_

Medicare Supplement plans are supplemental policies that people can purchase to cover the costs that Original Medicare does not pick up.

There are many different plans to choose from, and they are all labeled with a Plan Letter. In addition, there are many different insurance companies that offer these plans, but they all over the exact same services as what is listed in the letter plan benefits. The only difference from private insurance company to company is the price they can offer in each specific market (area of the country).

Here is a Chart of What Supplement Letter Covers What Services

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

Why People Like Supplements (Medigap)

what is medicare Plan F Pin medigap made easy

People like Medicare Supplement Plans because of their flexibility and their routine costs. First, these plans offer flexibility because they allow beneficiaries to see any providers that accept Medicare in the whole country. Second, Medigap Plans have the same premium charged each month, and plans like F, have no costs other than that for covered services. As a result, Medigap Plans are good for budgeting and knowing what your costs are going to be each month.

Remember, the other option for supplementing Original Medicare covered services is a Medicare Advantage Plan. That is a plan you have INSTEAD OF a supplement (Medigap) plan.

Who is Eligible for a Supplement?

Anyone with Medicare Benefits can apply for a supplement. When you first age into Medicare, you have a window of “Guaranteed Enrollment Eligibility” to get the supplement of your choosing. After that, you will either need a special enrollment option to get into another one, or go through medical underwriting to get a supplement.

You can read more about Medicare Supplements here.

Medicare Supplement Plan F Explained

Medigap Plan F (aka Medicare Supplement Plan F) covers the most amount of services out of all the supplemental plans. So, this means if you have Plan F, you pay your monthly plan premium for the supplement, and then you pay no other costs for Medicare covered services.

As a result, it has been one of the most popular plans. If you take a look at the Medigap Plan chart above, you will see that…

Plan F Covers:

  • Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used
  • Part B coinsurance or copayment
  • Blood (first 3 pints)
  • Part A hospice care coinsurance or copayment
  • Skilled nursing facility care coinsurance
  • Part A deductible
  • Part B deductible
  • Part B excess charges
  • Foreign travel exchange (up to plan limits – 80%)

People like Plan F for its full coverage and it’s travel coverage both in the states and internationally.

Who Can get Medicare Plan F and Who Cannot?

A while back., the U.S. government passed MACRA bill, or “The Medicare Access and CHIP Reauthorization Act of 2015”, that made changes to who could sign-up for Medicare Supplement Policies that covered the Medicare Part B Deductible. These plans are not “going away,” but not everyone can get them as of January 1, 2020.

Here is who CAN get Plan F still:

  • You CAN get Medicare Supplement Plan F (or keep Plan F) is you turn 65 before January 1, 2020. (Same applies to Plan C.)
  • In addition, you CAN get Medicare Plan F (or C) if you turn 65 on or after January 1 2020, BUT ALSO you have a Medicare Part A Effective Date that started before the year 2020. (One example of this might be someone who was on Medicare prior to turning 65 because of a disability.)
  • You can KEEP your Plan F if you are already on one. It is not going away. However, there might be reasons for you to switch to a Plan G, or another plan that does not have the Part B Deductible covered. The main reason people switch is because the plans that can accept younger people into their pool, often have lower cost increases over time. You can read more about switching to a Plan G here.

Who CANNOT Get Plan F Now:

  • If you turn 65 on or after January 1, 2020, you cannot get Medigap Plan F or C. (Unless you fall into the Medicare Part A Effective Date Category explained above.)

Now, if you are someone who turns 65 after the cut-off, don’t fear. Plan G is the same as Plan F with only one difference: Plan G does not cover the Medicare Part B deductible.

Conclusions

In summary, Medicare Plan F is a robust, comprehensive Medicare Supplement Plan (aka Medigap Plan) that picks up all of the extra costs that Original Medicare does not cover.

Plan F is only available to people who already turned 65 before January 1, 2020. However, this plan is not going away at this time. It is still a popular plan and will continue offer full coverage and service flexibility to its beneficiaries.

Further Reading

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Medicare Easy Pay

Medicare Easy Pay

Medicare Easy Pay – What is it & How do I get it?

Medicare Easy Pay

Medicare Easy Pay is the automatic payment system set up by CMS to pay your Medicare Premiums.

CMS (The Centers for Medicare & Medicaid Services) offers Medicare Easy Pay for Part A and Part B Premium Payments from a checking account or a savings account. (Most people get Part A at no cost, so people typically use Easy Pay for just Part B premiums.)

If you sign-up for Easy Pay, then your premiums will be automatically deducted from the account you specify.

How Do You Sign-up for Medicare Easy Pay?

Well, I wish I could send you straight to a website with a secure enrollment option, all done online. However, it does not exist at this time. Instead, you will have to fill out a paper enrollment form and mail it in.

Enroll By Mail

Mail a completed Authorization Agreement for Pre-authorized Payments form [PDF, 117 KB] (SF-5510) to:

Medicare Premium Collection Center
PO Box 979098
St. Louis, MO  63197-9000

From Medicare.gov

In addition, if you are already signed-up for Easy Pay, but you want to make a change, this is also the address you will send the same form into. Just add the changes you want to make on that same form you would send in for new Easy Pay Enrollment.

Enroll in Person

Alternatively, you can also go to your local Medicare / Social Security office and make an appointment to submit your information through the office.

Railroad Benefits Differences

Railroad Medicare Benefits and Choices at MedicareLifeHealth.com

If you are with the Railroad, your options are different. You will need to send your payments in by mail, or set-up a “bill-pay” option with your bank for them to monthly mail the money into this address:

RRB, Medicare Premium Payments
PO Box 979024
St. Louis, MO 63197-9000


If you are retiring with Railroad Retirement, please read our about your benefits and choices with Medicare here.

How Does Medicare Easy Pay Work?

What is Medicare Easy Pay and How do you sign-up?

After you sign-up for Medicare Easy Pay by sending in your enrollment application, then the Center for Medicare and Medicaid Services (CMS) will take 6 – 8 weeks to process your application.

Remember, it is important to pay any billed premiums in the mean time.

Then, when you are set-up, CMS will monthly send you a Monthly Statement, called a “Medicare Premium Bill.” However, this is just for your reference, and you will not have to pay it when you are set-up for Easy Pay as it will be deducted from your account monthly now. CMS has a diagram to help you read this document here.

Medicare.gov also states that premiums typically come out of your checking or savings account around the 20th of the month.

Further Reading

Finally, to learn more about Medicare Insurance, here are some of our most useful articles:

How to Choose A Medicare Plan
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Medicare and Medicaid Difference Guide

Medicare and Medicaid Difference Guide

Medicare and Medicaid Difference Guide

medicare and medicaid difference guide

The Medicare and Medicaid Difference Guide helps you understanding both services, so you can make the best decisions for yourself and your loved ones.

The United States has two separate national health care systems: Medicare and Medicaid. The government created the two programs for two different kinds of people. However, they often overlap. Let’s look at both programs, including their similarities and difference. We will also look at who needs or qualifies for each program.

Let’s Start with Medicare vs Medicaid.

What is Medicare?

Medicare is the U.S. national health care program that provides seniors age 65 and older, and some disabled people, with health insurance.

The U.S. government started the program in 1966. The Centers for Medicare and Medicaid Services runs these programs. Medicare also covers people with end stage renal disease and amyotrophic lateral sclerosis.

Medicare does not cover all of the costs associated with health care. As a result, people with Medicare will also use a Medicare Supplement Insurance Plan (Medigap Plan) or a Medicare Advantage Insurance Plan to round out their care coverage.

Please read our Ultimate Guide article on “What is Medicare.

https://medicarelifehealth.com/glossary/medicare

What is Medicaid?

Medicaid is the United States National Health Care System that provides health coverage to over 64.7 Million People.

The program was created for people with low-incomes that cannot afford, or do not have access to, private healthcare insurance.

https://medicarelifehealth.com/glossary/medicaid

How are the programs similar?

Medicare vs Medicaid Pin

The programs are both National Health Care Systems. In fact, they are the only two nationalized heath care systems the United States has. Many other countries around the world have much more extensive national coverage for their citizens. The U.S. has a limited program for specific age, income, and health groups, and the rest of the country relies on private health insurance.

In addition, both programs cover specific hospital services, doctor services, and other health care related services.

Medicare has four parts. First, Medicare Part A, also known as “Hospital Insurance,” helps with coverage regarding: inpatient care, home health care, nursing facilities, and hospice.

Second, there is Medicare Part B, also known as “Medical Insurance.” Part B helps with coverage related to doctor and other provider services, including: doctors visits, health care providers, outpatient, prevention services, and medical equipment. Medicare Beneficiaries pay for Part B.

Finally, Medicare has a Prescription Drug Program that is administered by private insurance carriers. Click here to lean more about What Medicare Covers and Medicare Parts A, B, C and D are.

How are the programs different?

One of the biggest differences between the two programs is who runs them. Medicare is run on a national level, by the Federal government. On the other hand, Medicaid is run by each state individually.

Of course, the biggest difference is the the different populations the programs serve:

  • Medicare – For Seniors over age 65, and some disabled people
  • Medicaid – For people with low income and few resources

Medicare and Medicaid Differences in Beneficiaries – Who Gets What Program?

The U.S. government created Medicare and Medicaid to take care of different “vulnerable” populations – the poor, the disabled, and the elderly. Let’s look at each program and population.

Who should get Medicare?

Anyone who is a citizen or qualified resident of the U.S. can enroll in Medicare when they turn 65 years old. There is a seven month window of time starting three months before turning 65, the month of your birthday, and then three months after your birthday month.

How do I Sign-up for Medicare?

First, you may be automatically signed-up if you are already receiving Social Security (SS) or Railroad Retirement (RRB).

Second, if you are not already receiving SS or RRB benefits, you must sign up for it when you turn 65 years old.

Conversely, if you are not ready for Medicare when you turn 65, you must notify the government that you want to delay your benefits. If you do delay, it must be because you have credible coverage in place. An example of this would be an employer plan.

Click here to read more about Medicare, including where to go to enroll.

From Our Article What is Medicare? A Guide to All Medicare Basics

Supplemental Medicare Insurance Options

Medicare picks up about 80% of the health care costs for its beneficiaries. For the other 20%, seniors turn to either Medicare Supplements (aka Medigap Plans) or Medicare Advantage Plans. Click here to read our article on Medicare Advantage vs. Medigap, or see the informational articles below.

What is Medicare Advantage?
What are Medicare Supplements_

Who should get Medicaid?

Medicaid is for people with limited income and resources. Medicaid is run on a state level, not on a federal level. As a result, in order to qualify for Medicaid, you will need to determine what your state defines as a qualifying income level.

How Do You Enroll in Medicaid?

Again, since Medicaid is run by State Governments, you will need to contact your state’s agency to start see if you qualify to enroll.

You can find a list of State Agencies here on the Medicaid.gov website.

Who Can Get Both Medicare and Medicaid?

People of any age who have certain qualified disabilities and people over 65, who are also below their states Medicaid income levels, can qualify for both Medicare and Medicaid.

For example, Henry is a 55 year-old disabled man who is also unemployed and living below the poverty level set by his state. Consequently, he would most likely qualify for both Medicaid (because of his income level) and Medicare (because of his qualified disability).

People that qualify for both programs are called “Dual Eligible.”

Who Can Help?

Navigating one (let alone both) of these systems can be confusing. But there is help available.

  • If you need help enrolling in Medicare, then you can contact CMS and Social Security in the following ways:
  • Finally, if you need help finding a Medicare Supplement or Medicare Insurance Plan, or if you are dual eligible for both Medicare and Medicaid, then please contact an Insurance Agent. An Independent Medicare Insurance Agent will help you explore your options, and help you make the right choice for your unique situation.

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Is Medicare Plan F Going Away?

Is Medicare Plan F Going Away?

Is Medicare Plan F Going Away?

Is Medicare Plan F Going Away?

As a Medicare Health Insurance Agent I hear this question over and over: “Is Medicare Plan F Going Away?” The simple answer is, no, Plan F is not going away. However, not everyone can sign-up for it as of January 2020.

Who Can Still Get a Medigap Plan F?

Medicare Beneficiaries who turned 65 prior to January 2020, are eligible to purchase a Plan F Medicare Supplement. They will either have to have a special enrollment period for guaranteed acceptance, or go through Medical Underwriting to get into a plan.

Who Cannot Get a Medigap Plan F?

Beneficiaries who turn 65 after January 2020, are not eligible to purchase a Plan F Medicare Supplement.

Why Can’t Some People Purchase a Plan F?

Well, the government set a new rule that says anyone that turns 65, on January 1, 2020, or after, cannot purchase any supplement policy that covers the Medicare Part B deductible. This includes Plan F and Plan C.

2020 Part B Deductible

In 2020, the Medicare Part B Deductible is $198.

Click here to read all the 2020 Changes and Updates to Medicare Part B.

Medicare Supplement (Medigap) Plan Chart

Wondering what the difference is in Plan G vs Plan F? Here is a Medicare Supplement (Medigap) Plan Chart to remind you of what letter Plan covers what.

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

Plan G is More Competitive

Is Medicare Plan F Going Away Pin

The good news is that Plan G Medigap Plans are typically much more competitively priced than Plan F’s. Moreover, the only difference between the two plans is Plan F covers the Medicare Part B deductible, while Plan G does not.

Additionally, the Medicare Plan G Supplements are usually still less expensive than Plan F’s even after adding back in the Part B deductible.

Even if you are 65 years old before January 1, 2020, it is a good idea to see if you could save money by switching to a Plan G if you now have a Plan F.

Just know, You will have to pass medical underwriting to switch plans. Plan F’s will not have the ability to add younger (potentially healthier) beneficiaries to their pool. As a result, these plan prices will most likely rise at a faster rate than plans that can add younger people.

Plan F vs Plan G – How do They Work Differently?

Again, the only difference between Medigap Plan F and Plan G, is that Plan F pays the Medicare Part B Deductible and Plan G does not.

Part B pays for Medical Insurance. This includes:

  • Outpatient
  • Home Health
  • Doctors
  • Health Care Providers
  • Durable Medical Equipment
  • Prevention

Each year, when you use these types of services, you will pay the Part B Deductible ($198 in 2020) first. Then, you will pay no other costs as everything else will be picked up by your supplement.

With Plan G Supplements sometimes being up to $900 a year cheaper, it makes a lot of sense to see if you are eligible to switch to one or start on one.

Medicare Parts A B C D Explained
Click here for our infographic on the 4 parts of Medicare.
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Renew Active vs Silver Sneakers

Renew Active vs Silver Sneakers

Renew Active vs Silver Sneakers

Renew Active vs Silver Sneakers

Does it sometimes seem like Medicare and Insurance companies are trying to make things as complicated as they possibly can? Just when you think you have Medicare Advantage down, something else comes up! For example: Renew Active vs Silver Sneakers.

Not so very long ago, there was one main senior fitness program when you joined a Medicare Advantage Plan: SilverSneakers®. Then, in January 2019, Unitedhealthcare dropped SilverSneakers and replaced it with Renew Active™. Many people were concerned when this first happened. However, it now seems like Renew Active is a reasonable replacement.

Who is Affected?

The people affected by the change to Renew Active are those that are a part of an AARP® Unitedhealthcare Medicare Advantage Plan. (In addition to those people considering whether or not to join their plan.) The majority of the other Medicare Advantage plans still use Silver Sneakers as their main plan.

How to Make a Decision?

If you are trying to decide on a Medicare Advantage Plan in your area, Renew Active vs Silver Sneakers may play a part in your decision.

Let’s take a quick look at the two programs, how they are similar or different, and whether or not there are advantages to either one.

What is Silver Sneakers?

what is Silver Sneakers Senior Fitness

SilverSneakers® is a fitness and wellness program for seniors age 65 and up. It includes free gym memberships across the country, and it is included with many Medicare Advantage Plans.

Click here to read our article: What is Silver Sneakers?

What does a SilverSneakers Membership Include?

  • LOCAL GYM MEMBERSHIPS: Silver Sneakers has an extensive list of gyms that participate in their program that offers free gym memberships to seniors. Their website boasts having more gym facilities than there are Starbucks locations in the U.S. (at over 16,000).
    • If you are a part of a Medicare Advantage (MA) program that uses Silver Sneakers, then you can access the gyms in their network at no cost. You can use as many of these facilities as you like while you are a part of your MA plan.
  • ONLINE FITNESS CLASSES: If you prefer to workout at home, or do not have a physical location close to you, SilverSneakers offers online fitness classes.
  • APP: They also have an app to help you track your fitness goals and schedule your fitness plans. The app can also help you locate participating locations.

What is Renew Active?

Renew Active™ is the AARP® Unitedhealthcare’s Version of Silver Sneakers.

Renew Active™ from UnitedHealthcare, available with select Medicare Advantage plans. Designed around you and your goals, Renew Active offers access to participating fitness locations, both local and national options and group fitness classes, as well as online brain exercises to help keep both your body and your mind active — all at no additional cost.

From Renew Active Member Website.

What does a Renew Active Membership Include?

  • GYM ACCESS: When we looked into all the benefits offered by Renew Active, we found the standard access to local gyms.
  • BRAIN TRAINING: Interestingly, they also offered a unique feature of online brain training. The company partnered with BrainHQ to offer an app to keep your brain sharp with games and tools available on a PC or mobile device.
    • The BrainHQ service is available for purchase from $8-$14 a month, so getting this included with your Renew membership does seem like a good deal.

Renew Active vs Silver Sneakers: How are they Similar?

renew active vs silver sneakers pin

When comparing Renew Active vs Silver Sneakers, you will find they are very similar in their main functions.

  • To start, both programs offer free gym memberships at local fitness facilities.
  • In addition, you can sign-up for multiple fitness locations with both memberships.
  • Both plans offer at-home options for people that are too far away from any participating facilities.
    • For at home options with Renew Active you must call their customer service phone number. According to Unitedhealthcare, you can find this on the back of your health plan member ID.
    • You can find SiliverSneakers at home programming information online here.
  • Finally, Medicare Advantage Plans include one of these programs at no additional cost to plan members.
    • (Some Medigap plans in certain states may have access to some sort of fitness benefit, but that is all dependent on the insurance company and the service area. This is not near as common. Mostly fitness plans are an extra benefit of Medicare Advantage plans.)

How They are Different: Renew Active vs Silver Sneakers

renew active vs silver sneakers infographic comparison chart
  • The first difference we see at this time is Silver Sneakers seems to be in more facilities.
    • SilverSneakers boasts over 16,000 locations.
    • At the start of 2019, Renew Active mentioned over 7,000. However, it seems like their program has grown since that mention.
    • Check the location searches for both programs to make sure your gym preference is covered.
  • The second difference is that Renew Active has an online brain training application included, and Silver Sneakers does not (at the time I am writing this article).
    • The BrainHQ app seems to retail at $8-$14 a month if you wanted to buy it separately, so that does suggest added value.
    • We have not tried this app, and could not find a lot of research or reviews on the platform at the moment. Please leave a comment if you find something useful!
  • In our Renew Active vs Silver Sneakers comparison, the third difference we see is that Silver Sneakers has an good list of online classes.

What’s Better About Silver Sneakers?

To start, if you are someone who likes to do workouts at home, and likes to stream different workouts online, Silver Sneakers has more to offer you in this area. Their online “on-demand” workout section boasts hundreds of online workouts available.

Also, Silver Sneakers seems to have the larger network of physical fitness facilities at this time.

Finally, multiple Medicare insurance company plans use SilverSneakers. This means your coverage might not change if you change Medicare plans.

What’s Better About Renew Active?

Renew Active is only associated with the Unitedhealthcare AARP Medicare Advantage Plans. It’s major advantage over SilverSneakers seems to be the access to BrainHQ training games. It’s network might be a bit smaller than SilverSneakers, but it is still impressive and very useful.

Should Renew Active vs Silver Sneakers be a Deciding Factor on Your MA Plan?

In my opinion, there are much more important factors to consider when choosing a Medicare Advantage Plan than Renew Active vs Silver Sneakers. Your network access to doctors and medical providers should be your first consideration. Your drug plan and hospital facilities and costs should also be more important.

However, if all your plans seem comparable, your decision might include the convenience of using a local wellness facility, streaming exercises at home, or participating in brain health activities.

In this case, it is a great idea to hop onto the facility location tools and online resources for both Renew Active and Silver Sneakers. You can then make sure the program you choose covers your gym or desired services.

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What is Silver Sneakers?

What is Silver Sneakers?

What is Silver Sneakers?

what is Silver Sneakers Senior Fitness

Maybe you just overhead your neighbor talking about his free gym membership, or maybe your doctor asked you if you are a SilverSneakers user. You might then be wondering, just what it Silver Sneakers?

SilverSneakers(r) is a fitness and wellness program for seniors age 65 and up. It includes free gym memberships across the country, and it is included with many Medicare Advantage Plans.

NOTE: If you are a part of AARP’s Unitedhealthcare’s Medicare Advantage Plans, then you will be a part of Renew Active. This is a similar program, but has several differences you can read about here.

Renew Active vs Silver Sneakers

What is Included in a Silver Sneakers Membership?

  • LOCAL GYM MEMBERSHIPS: Silver Sneakers has an extensive list of gyms that participate in their program that offers free gym memberships to seniors. Their website boasts having more gym facilities than there are Starbucks locations in the U.S. (at over 16,000).
    • If you are a part of a Medicare Advantage (MA) program that uses Silver Sneakers, then you can access the gyms in their network at no cost. You can use as many of these facilities as you like while you are a part of your MA plan.
  • ONLINE FITNESS CLASSES: If you prefer to workout at home, or do not have a physical location close to you, SilverSneakers offers online fitness classes.
  • APP: They also have an app to help you track your fitness goals and schedule your fitness plans. The app can also help you locate participating locations.

What you Need to Know About Silver Sneakers

First, there are a few things you need to know to get started. Here is an overview and some frequently asked questions about the program.

How do I know if I am a member of SilverSneakers?

Well, if you are part of a Medicare Advantage Plan, then there is a very good chance you are already a part of the program.

To check on your eligibility, click here.

Where can I find participating gyms and wellness facilities?

As an overview, SilverSneakers tries to be in as many convenient fitness facilities as possible. Moreover, they are doing an excellent job of reaching this goal! Right now, they are in over 16,000 fitness facilities.

Here is the official link to search for a participating fitness facility near you.

What if there are no facilities close to me?

If you are in a smaller town or rural area, there might not be a class or gym close to you. However, even if there is not a Silver Sneakers contracted location close to you, you can still participate. The program features online classes and workout kits.

Do I have to take the Silver Sneakers Classes?

what is silver sneakers?

Often, people will ask me if they have to attend the SilverSneakers branded classes at the gym. The answer is no. The program gives you access to the whole facility. This includes Silver Sneakers classes, but also all the other classes at the gym. You can also just go walk on the treadmill or lift weights.

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What Medicare Part A Covers

What Medicare Part A Covers

What Medicare Part A Covers

What Does Medicare Part A Cover

Here is what Medicare Part A Hospital Insurance covers:

  • Inpatient Hospital Care
  • Skilled Nursing Care
  • Stays at Skilled Nursing Facilities (short-term)
  • Home Health Care
  • Hospice Care

In addition:

  • Part A also includes inpatient care in a religious non-medical health care institution.
  • Blood is also a Part A covered service. You will have to pay for the first three units of blood that you use. However, if the blood is donated free to the hospital or donated to you, then you do not have to pay for it.

What Medicare Part A Will Not Cover

Medicare Part A or Part B will not cover custodial, long-term care, nursing home or assisted living facilities. Click here to read more about ways to cover these costs.

Will Medicare Cover My Costs?

How Do I Know if I am Signed-up for Medicare Part A?

Part A and B are separate in Original Medicare, and you can be signed-up for one and not the other. First, to see if you are signed-up for Part A, you can check your Medicare Card. If you are signed-up, it will say “Hospital” and then have an effective date listed right on the card.

In addition, if you are a part of a Medicare Advantage Program, they you are also already signed-up for Part A. This is a prerequisite for join a Medicare Advantage (aka Part C) plan.

For More on What Medicare Part A Covers & the Other Parts of Medicare

Please Read:

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What is the Medicare Donut Hole?

What is the Medicare Donut Hole?

What is the Medicare Donut Hole?

What is the Medicare Donut Hole or Doughnut Hole?

The Medicare Donut Hole (or Doughnut Hole) is a coverage gap in the Part D Prescription Drug Plan where beneficiaries could pay more for their drugs.

The Center for Medicare and Medicaid Services (CMS) calls the coverage gap a “temporary limit” on what their drug plan will cover.

Why Did My Drugs Get More Expensive this Month?

2020 Medicare Donut Hole Explained by MedicareLifeHealth.com

During Medicare’s Annual Enrollment Period (AEP) this year I was stationed at a pharmacy a few hours a week to answer people’s questions.

One gentleman came up to me and said, “The Pharmacist sent me over to you to ask you: Why did my drugs cost more this month? I get the same drugs each month, but this month, they cost me more!”

Yes sir, you have reached the Medicare Donut Hole in your Part D Prescription Drug Coverage. It was November, and this gentleman had been able to make it his other five years on Medicare without reaching the coverage gap.

However, this year, his drug costs were a little higher, and he hit the gap before the end of the year.

Will I hit the Coverage Gap?

The price changes in the coverage gap can be a shock if you have not experienced it before. So, let’s go over a little more information to prepare you for what might come.

When Does the Donut Hole Begin?

In 2020, the Part D Coverage Gap begins when you and your plan have spent $4,020 on prescription drugs. (In 2019, it was $3,820.) Thus, if you only spend $1,000 a year on drugs, the donut hole will not affect you.

Who Does the Coverage Gap Not Apply to?

  • People who pay less than $4,020 in drugs each year.
  • In addition, people who get extra help in paying for their drug plans (for example, low income subsidies and Medicaid beneficiaies) will not enter into the coverage gap.

When Does the Donut Hole End?

In addition, you may be wondering, when does medicare donut hole end? It ends once you and your drug plan have spent $6,350 in 2020 ($5,100 in 2019). You are then out of the coverage gap and have entered into Catastrophic Coverage.

During Catastrophic Coverage you will pay a much smaller amount of money for your drugs. This includes smaller co-insurances and smaller co-payments for the rest of the calendar year.

What am I Paying in the Coverage Gap (Medicare Doughnut Hole)?

As of 2020, Medicare will pay for 75% of BOTH brand name and generic drugs in the coverage gap. As a result, you will pay 25% of the cost of your drugs in the coverage gap.

However, there is a generic to brand name drug difference in what counts towards your out-of-pocket costs to get your out of the donut hole:

  • For generics, only your copayment counts towards getting you out of the coverage gap.
  • Conversely, with brand name drugs, 95% of the total price of the drug (your co-payment and what your plan pays) counts towards your out-of-pocket costs to help you reach the end of the gap.

There are some Medicare drug plans that includes coverage in the gap. According to CMS, ” you may get a discount after your plan’s coverage has been applied to the drug’s price. The discount for brand-name drugs will apply to the remaining amount that you owe.” You will need to speak to your plan to learn more.

What Costs Counts Towards the Coverage Gap?

Here are the costs that apply to your out-of-pocket expenses:

  • First, Your Annual Drug Plan Deductible
  • Second, Your Co-insurance and Co-Payments
  • Third, Your Discount on Brand-name Drugs in the Donut Hole Coverage Gap
  • Finally, Your Costs in the Coverage Gap

Here is what does not apply:

  • Your Plan Premiums
  • Any Pharmacy Dispensing Fees
  • Any Drugs Not-Covered by Medicare Part D

Need More Information on Part D Drug Coverage?

For Part D Sign-up Assistance

2020 Medicare Donut Hole Explained by MedicareLifeHealth.com
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2020 Part B Deductible

2020 Part B Deductible

2020 Part B Deductible for Medicare

2020 Part B Deductible

The 2020 changes for Medicare were released this month. The 2020 Part B Deductible is just one of the increases you will see.

The Centers for Medicare & Medicaid Services (CMS) released their updates for the coming year in a press release – 2020 Medicare Parts A & B Premiums and Deductibles. Let’s look at what is changing.

Part B Deductible for 2020

  • In 2020, the Medicare Part B Deductible will be $198.
  • In contrast, the deductible was 185 for 2019.
  • This is an increase of $13.

Part B Premiums for 2020

  • In 2020, the Medicare Part B Monthly Premium will be $144.60.
  • In contrast, the premium was 135.50 for 2019.
  • Consequently, this is an increase of $9.10.

Why are the Part B Deductible and Premiums Increasing in 2020?

The CMS adjusts the deductibles yearly, in accordance to the Social Security Act. Moreover, the increase reflects national healthcare trends.

In addition, the CMS has stated that the rate hike is mostly due to the increased use and cost of physician- administered drugs. Part B covers Physician-administered drugs.

What Part B Covers

Medicare Parts A B C D Explained

As a reminder, Medicare Part B covers:

  • Physician and Provider Services
  • Outpatient Services
  • Home Health Services
  • Durable Medical Equipment
  • Other non-hospital health services

To learn even more about the parts of Medicare and what they cover, you can see our infographic and discussion here.

Who Pays the Part B Deductible?

  • If you have Original Medicare only, you will pay the Part B Deductible.
  • In addition, if you have a Medicare Supplement that does not cover the Part B Deductible, you will pay it.
  • Some Medicare Advantage Plans have you cover the Part B deductible. This will be stated in your Summary of Benefits. However, 2020 plans have already been released, so deductibles are already set for the new year and will not be affected by this increase.

As of 2020, new beneficiaries to Medicare will not be able to choose a Medicare Supplement Letter Plan that covers the Part B Deductible. For example, Plan F covers the deductible, so seniors new to Medicare in 2020 and beyond will not be able to pick Plan F. Seniors that are already on these letter plans can keep them. Read more about this topic here.

Will the Changes Affect Part C or Part D costs?

No, these deductible and premium increases will not affect Part D Drug Plans or Part C Medicare Advantage Plans. The premium costs and the deductibles have already been set for the coming year. As a result, they are not affected.

According to the CMS press release,

As previously announced, as a result of CMS actions to drive competition, on average for 2020, Medicare Advantage premiums are expected to decline by 23 percent from 2018, and will be the lowest in the last thirteen years while plan choices, benefits and enrollment continue to increase. Premiums and deductibles for Medicare Advantage and Medicare Part D Prescription Drug plans are already finalized and are unaffected by this announcement.

CMS Press Release, Nov 2019

That is extra good news for those on Medicare Advantage Plans that have their deductibles satisfied with their plan. Some Medicare Advantage plans have a zero dollar deductible for their whole plan. These plans bundle Parts A & B and have the option of including the Part B Original Medicare deductible or covering it themselves.

Income Adjustments to Part B Premiums

There are no income related adjustments to the Part B Medicare Deductible. However, there are income related adjustments to your Part B Premiums.

  • First, the standard 2020 Part B premium of $144.60 applies to those with income less than or equal to $87,000 a year ($174,000 joint income).
  • Second, if you claim income between $87,000 and $109,000 ($174k-$218k joint), you will pay $202.40 a month.
  • Third, if you claim income between $109,000 and $136,000 ($218k – $272k joint), you pay $289.20.
  • Fourth, if you claim income between $136,000 and $163,000 ($272k – $326k joint), you pay $376.00.
  • Fifth, if you claim income between $163,000 and $500,000 ($326k – $750k joint), you pay $462.70.
  • Finally, if you have income greather than or equal to $500,000 ($750k+ joint), then you pay 491.60.
  • Click here if you need to see a table for premiums for spouses that file separate returns.

Are there Changes to Part A?

Yes, there are also changes to Medicare Part A. If you have a Medicare Supplement Plan, depending on which Letter plan you have, your supplement will continue to pick up these costs.

If you have a Medicare Advantage Plan, your plans benefits will still apply to you instead of the Original Medicare benefit structure. 2020 plans have already been released, so you will not be affected by these changes.

However, if you have Original Medicare only, you will want to take a look at the Part A changes that affect you here.

Further Reading

If you would like to learn more about Medicare we Suggest the following articles:

This Tool Kit answers your questions regarding Medicare Information, Medicare Supplements, Medicare Advantage, and Prescription Drug Plans. Discover what products are right for you and how to sign-up for them. 

Medicare 101

Read about basic Medicare Information. What is Medicare Part A? Part B? Get answers to your basic Medicare questions.

Medicare Supplements

What is a Medicare Supplement and how do I choose the best one for me? 

Medicare Advantage

What is Medicare Advantage and when is it, and what plans are, best for my situation?

Prescription Drug Plans

When do I need a drug plan and what do I need to look for in a good plan?

Medicare Advantage vs Medicare Supplements

What plan type is best for my situation and what do I need to consider when choosing.

Most Asked Medicare ?s

Answers to your questions and answers to questions you should be asking.

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