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.

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.

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Does Medicare Pay for Stem Cell Therapy?

Does Medicare Pay for Stem Cell Therapy?

Does Medicare Pay for Stem Cell Therapy?

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

When does Medicare pay for stem cell therapy? The answer is: in a limited amount of cases.

Stem cell therapy is still controversial and expensive. Moreover, there are limited amounts of studies available on specific therapies and procedures. As a result, Medicare’s coverage of stem cell therapies, including transplants, is minimal.

If you have a sick loved one, or if you yourself are sick, it makes sense to want to research every option available for quick healing. During your search, you may run into “stem cell therapy” as a treatment option. Sometimes, stem cell news can bring up confusing and conflicting stories. Let’s start with the basics of stem cell therapy and then discover what Medicare covers for treatments.

What is a Stem Cell?

To start, according to the Mayo Clinic, a stem cell is a “master cell” that forms a base for the creation of all the body’s other cells. (For example, brain cells, organ cells, blood cells or bone cells.) That is a simple way to look at a complex body function.

However, the main take away is, stem cells are the ONLY cells that naturally have the ability to generate new cells.

Because of their generative ability, the study of stem cells holds great possibilities for healing diseases. As a result, researchers call stem cell therapy “the next chapter” in healing our organs, blood and tissues. Effectively, reducing the need for organ transplants.

What is Stem Cell Therapy?

Doctors and researchers are creating and studying new procedures every year that will help heal organs, but the science is still new, and the verified and approved procedures and treatments are few and expensive.

Stem Cell Therapy is also called regenerative medicine. According to the Mayo Clinic it, “promotes the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives.”

Stem Cell Therapy is a fascinating subject for anyone needing an organ transplant or experiencing organ dysfunction / organ failure. Organ donors are few and transplant lists are long. The possibility of stem cell therapy being able to be a solution is promising and exciting.

In addition, there is also hope that stem cells will be able to offer treatments in spinal cord injuries, diabetes, Parkinson’s, and heart disease.

However, not only is research expensive, it is also controversial.

So, What is the Controversy Behind Stem Cell Therapy?

The controversy behind stem cell therapy lies within where the studied stem cells are harvested. You can get stem cells from embryos, adult tissues, or even, as more recently discovered, in amniotic fluid as well as umbilical cord blood.

However, the best, more versatile stem cells are embryonic stem cells. Not only do these cells have more regenerative potential, but they also are not changed or affected by any environmental factors (like adult cells would be.)

Harvesting stem cells leads to strong ethical debates on “personhood” and whether or not researchers should be using embryos for stem cells. You can read more on that debate here.

What Does Medicare Cover for Stem Cell Therapy?

As mentioned, because the science is new and studies on procedures and their affects are limited, Medicare has a very limited coverage of Stem Cell Therapies. The CMS (Centers for Medicare and Medicaid Services) closely follow the recommendations of the FDA (Federal Drug Administration) on what procedures are considered necessary and effective.

According to the CMS, Medicare Part A covers stem cell transplants under “certain conditions”. (Part A is also responsible for transplant coverage.) Usually, these conditions start with having you try other Medicare-approved options first if stem cell therapy is not the charted first course of action.

First, know that coverage can be different in each state. However, when procedures are standardized, CMS will release new information on what is Medicare-approved nationally.

Examples of Medicare-Approved Stem Cell Therapies

The CMS has a page on “Coverage with Evidence Development,” and on this page you can find new information on coverage and research. For example, on this page, you can see information on “Allogeneic Hematopoietic Stem Cell Transplant for Multiple Myeloma.” In regards to this specific disease, stem cell therapy was approved by CMS for Medicare coverage in this specific way:

“CMS will cover items and services necessary for research under §1862(a)(1)(E) for a allogeneic hematopoietic stem cell transplant (HSCT) for certain Medicare beneficiaries with multiple myeloma (MM) using the Coverage with Evidence Development (CED) paradigm. “

https://www.cms.gov/Medicare/Coverage/Coverage-with-Evidence-Development/allo-MM

You will also find additional information on the CMS website for the following stem cell therapies:

Another example, is AuSCT or Stem Cell Therapy/Transplantation for Amyloidosis

According to CMS, AuSCT can treat AL Amyloidosis, a “rare blood disorder” affecting your heart, kidneys, nervous and gastrointestinal systems.

In this transplantation, stem cells are retrieved from a patient’s bone marrow or blood, stored, and then transplanted back into the patient following high dose chemotherapy used to treat various cancers.

Read more here.

National Coverage Listings are Not All-Inclusive

Of course, that list does not cover all the potential uses for stem cell therapy, but it is a place to start. Additionally, since each state’s Medicare coverage can be different, your medical providers and doctors are good places to go for Medicare coverage questions.

Where Can You Receive Medicare Covered Stem Cell Treatments?

Very few medical facilities have the equipment or expertise for specific stem cell therapies. For this reason, approved stem cell transplants (and cornea transplants) are not limited to just Medicare-approved facilities.

This flexibility can be good news for Medicare beneficiaries looking to schedule these unique procedures. On the other hand, according to Medicare.gov, all other transplants, must be done at Medicare-approved centers and facilities.

Does Medicare Cover Stem Cell Therapy for Knees?

One popular use for stem cell therapy is repairing injured knees. Unfortunately, it is not covered by Medicare at this time. In addition, stem cell therapy is not Medicare-approved for other stem cell treatments for arthritis and joint connection issues (i.e. tears and pain in ligaments and tissues).

You can certainly go outside of your Medicare coverage to have these treatments done, but be careful of clinics using non-FDA-approved techniques and making unsubstantiated claims. You can read the FDA’s warning here.

Conclusions

In Summary, if you are wondering “is stem cell therapy covered by Medicare?”

  • Your best first step is to consult with your doctor and medical providers to get information on what specific therapies would be applicable to your unique situation.
  • Then, specifically ask them about stem cell therapies available.
  • Remember, each area of the country might have different rules and treatments available.
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What is MAPD?

What is MAPD?

What is MAPD?

What is MAPD + PDP+ Medicare Jargon Made simple

There are a lot of acronyms in Medicare, and even more in insurance. We know, it can get very confusing when you are not hip to the “Medicare/ insurance world” lingo. As a result, one of the most repeated acronym questions we hear is: What is MAPD?

Medicare MAPD plans are private insurance plans offered by Insurance Carriers to replace Original Medicare. Also called Medicare Part C, they offer a single payer option to beneficiaries. In addition, they offer extra benefits to members above and beyond what is covered in Medicare Part A and Part B. Finally, they also include a Part D drug plan.

What does MAPD Stand for?

MAPD Stands for: Medicare Advantage Prescription Drug.

If the plan does not offer drug coverage, then it is just called a MA (Medicare Advantage) Plan. As mentioned, these plans are also called Medicare Part C, and insurance companies offer Medicare MAPD plans with extra benefits to take the place of Original Medicare.

What Do Medicare Advantage Plans Cover?

Medicare Advantage Plans are regulated by the CMS (Centers for Medicare and Medicaid Services). This agency makes sure that every plan offers at least the same standards of care and coverage that Original Medicare offers. Most plans offer additional benefits, not covered by Original Medicare, such as vision, dental, hearing and even gym memberships such through organizations like SilverSneakers or Renew Active.

Costs of MAPD

Medicare Advantage Plans often come with lower premium costs than Supplement Plans. Some of them even offer “zero premium” options. They are not technically “free” because everyone still has to pay their Medicare Part B Premiums directly to the government each month.

However, they are low cost options because the government is paying the insurance company to take beneficiaries onto their books and off the government books. Essentially, the Medicare Advantage Insurance companies are replacing beneficiaries Original Medicare with their Part C plan and becoming a single-payer.

PDP vs MAPD

PDP is an acronym to Prescription Drug Plan. We also refer to it as Medicare Part D. You can read more about PDP Drug Plans here.

Similarities between PDP and MAPD Plans

  • Just like Medicare Advantage (Part C), PDP plans are not administered by the U.S. government, but instead by private insurance companies. Just like MAPD Insurance plans, you can shop to find the best PDP plan for your needs each year.
  • And also, just like Medicare Advantage Insurance plans, you do not have to go through medical underwriting to be accepted into a Part D plan.

Differences Between Medicare Advantage and Part D Plans

  • First, if you have Original Medicare, you will need a PDP plan in addition to Parts A & B to cover your prescription drugs needs. They are not included.
  • Additionally, beneficiaries on Original Medicare + a PDP Part D Drug Plan often also have a Medigap Plan (Supplement) to cover the 20% of costs, co-pays and co-insurances that Medicare does not cover.
  • MAPD Healthcare Insurance Plans, on the other hand, include all three of these options in one (Parts A + B + D).
  • As a result, you will not need a standalone PDP plan or a Medigap Plan in addition. All you need is your MAPD Plan (aka Medicare C).

Further Medicare Reading

How to Choose A Medicare Plan
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Attained Age vs Issue Age

Attained Age vs Issue Age

attained age vs issue age in medigap pricing

Attained Age vs Issue Age

Medicare Supplement Insurance Companies all price their plans differently. One of the biggest differences between plan prices is whether or not an insurance company uses attained age vs issue age to price their Medigap plans.

Background Information: What is a Medicare Supplement?

Medicare Supplement plans, also called Medigap Plans since they cover the gaps in Original Medicare coverage, are issued by private insurance companies.

Click here to read a simple, but comprehensive introduction to Medicare Supplement (aka Medigap) Plans.

Standard Coverages from Each Medicare Supplement Plan

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

The government tells each company what should be included/covered in each Medigap Letter Plan. As a result, they are standard in coverage. However, the insurance companies can price each plan differently, and each company does so according to its needs in each market (part of the country) they sell in.

Medigap Costs & Pricing Considerations

The way each private insurance company prices its plans has an effect on what the plan will cost you now, and then again down the road as premiums are re-evaluated each year.

Medigap Plans do tend to increase in price each year (some more than others if new people cannot enroll in them, such as Plan F or C).

Shop Your Plan, While You are Healthy

As a result, it is a good idea to shop your Medigap Plan year to year if you are still healthy enough to get medically underwritten into a new plan. (What this means is, switching Medigap plans, when you are not guaranteed to be issued one, is dependent on you being healthy enough for an insurance company to accept you into the new plan.)

Attained Age vs Issue Age vs Community Rated Pricing

what is attained age vs issued age in medigap plans (medicare supplement pricing) pin

Remember, when you are comparing private insurance companies plans, pricing is the only difference between letter plans. The coverage is the same for each letter plan, and set by the government, so pricing is your biggest consideration.

Additionally, you need to consider HOW the plan is priced, not just WHAT each plan costs. The way each plan is priced will affect how the price changes year-to-year.

There are three ways that insurance companies can price their Medigap Plans: Attained Age, Issue Age, and Community Rated Pricing.

Attained Age Pricing of Medigap (Medicare Supplement) Insurance Plans

Attained Age Plans are priced (or rated) based on your current age.

Medigap plans that use this pricing are based on your attained age. Your plan price rises as you get older. Premiums might start lower for younger beneficiaries on these plans, but when they hit certain ages set by the plan, their premiums will increase.

Attained age plans can also go up because of other factors (such as inflation or company actuarial assessments.)

Issue Age Pricing of Medigap Plans

Issue Age Rated Policies (or “entry age-rated”) have premiums based on the age you are when you purchase your plan. Or, as CMS puts it, when you are “issued” the plan. For example, when buying a new plan, a 70-year-old beneficiary will pay more for the same plans as a 65-year-old beneficiary.

This means that the younger you are when you buy this kind of policy, the less you will pay for it. In addition, the policy will not go up in price as you age, because of your age. It may go up for other reasons, but not because of your age.

Community Rated Pricing of Medigap Plans

The CMS (Centers for Medicare and Medicaid Services) and private insurance companies sometimes call Community Rated Plans “no-age-rated” plans, as their pricing has nothing to do with the age of their beneficiaries.

The price of the plan is not dependent on your age. If the plan goes up, it is not because your age went up. The increase in price may have been dependent on other factors (such as inflation).

Other Pricing Considerations

Insurance companies have other ways to raise or lower their Medigap Plan prices. According to CMS, these include:

  • Plan discounts like household discounts, smokers ratings, or payment processing discounts.
  • Discounts for people that apply through medical underwriting versus being a guarenteed issue.
  • Using “Medicare Select” network providers in certain types of plans.
  • Choosing “high-deductible” versions of specific Medigap letter plans.

Conclusions and Actions

In conclusion, since each private insurance company can price their plans differently, it is important to ask how your current supplement is priced or supplements you are considering are priced.

The pricing structure affects not only what you are paying now for your Medigap plan, but what you will also be paying in future years.

Again, call Carly, your Medicare Author and Independent Insurance Agent if you life in Nebraska or Iowa. Or if you live elsewhere, find an agent here.

Further Reading

  • Read this article, if you need guidance on deciding what Medicare Plan type is right for you.
  • Start here, if you need to learn the basics of Medicare, who can get it, and what it covers.
  • Need to know how to apply for Original Medicare? Read this.
  • Finally, start with this article, if you want to read the differences between the two paths of Medicare: Medicare Advantage vs Medigap.
How to Choose A Medicare Plan
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What is Medicare Plan G?

What is Medicare Plan G?

What is Medicare Plan G?

What is Medicare Plan G - medigap plans made clear

When people talk about Medicare Plan G, they are referring to the Medicare Supplement Plan G. It can also be called a Medigap Plan G. Plan G is on its way to becoming the most popular Supplement Plan.

2020, is the first year that people newly aging into Medicare cannot choose a supplement that covers the Medicare Part B Deductible. This included Plans F and Plan C. However, people who have already turned 65 before January 1, 2020 can still choose a plan F or C at any point going forward. They are considered “grandfathered in.”

Although, people age 65 before January 1, 2020 can still choose a Plan F or Plan C, it doesn’t mean that they should. These plans may get more expensive at a faster rate since they cannot enroll younger beneficiaries into them going forward. It makes sense then for everyone to learn about Plan G and all the other plans that are still available to everyone in Medicare.

What Does Medicare Plan G Cover?

Medicare Plan G is a Medigap Plan. This means it picks up the charges and fees that original Medicare does not cover.

Medicare Supplemental Options

Traditionally, Medicare covers about 80% of Medicare approved services. As a result, Medicare Beneficiaries are either left to cover the other 20% by themselves, or to supplement their Medicare insurance with an additional plan.

What is Medicare Plan G? Comparing Plan F vs Plan G

Here is a list of the charges and fees that Plan G 100% covers, where Original Medicare leaves off:

  • Part A Coinsurance
  • Medicare Part A Deductible
  • All Part B Co-payments and Coinsurance
  • Medicare Part B Excess Charges
  • The First 3 Pints of Blood
  • Foreign Travel Emergencies (up to plan limit)
  • Hospice Care Coinsurance
  • Skilled Nursing Facilities Coinsurance

What Does Medicare Plan G Not Cover?

Why? Well, the U.S. Legistlature passed a bill called the MACRA bill, or “The Medicare Access and CHIP Reauthorization Act of 2015”, that said so. It is a small attempt to keep Medicare costs lower for tax payers and assure our system is sustainable for future generations. Will it be enough? Who knows, that is beyond this article.

Plan G vs Plan F

The only difference in coverage between Medigap Plan F vs Plan G is the Part B Deductible. (Click here to learn more about 2020 Fees and Changes to Medicare Part B.)

Plan F and Plan G both have the most extensive coverage out of all the Medigap Plans. They cover 100% of the costs that Medicare leaves behind (minus the Part B Deductible for Plan G).

Even though this is the only difference between these two plans, Plan G’s will often be much less expensive to buy than Plan F’s – even after you take the Part B Deductible into consideration.

Why? The reason for this is mostly due to the fact that Plan G’s can enroll newer, younger (and hopefully, healthier) Medicare Beneficiaries into their plans. In contrast, Plan F’s will now have a shrinking pool of people to choose from as people age.

Plan F’s are not going away, as many millions of Medicare Beneficiaries still have them, but they may have steeper price increases each year – relative to other plans.

Conclusions and Actions

In summary, Medicare Plan G is a good replacement for Plan F, and offers the most comprehensive Medicare coverage available to people just now aging into Medicare.

Remember, Plan F is only available to people who already turned 65 before January 1, 2020. However, people in Plan F might benefit from seeing if they can get Medically underwritten into a Plan G as its premiums might be cheaper. In addition, Plan G’s premiums will most likely raise at a slower pace than Plan F’s as G can enroll new people.

How to Choose Which Supplement and Which Insurance Company

Each private insurance company will offer the same coverage for each letter plan. However, each company will offer different prices for different markets. For this reason, we recommend you speak to an independent insurance agent to discover what is available to you in your area of the country.

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What are Part B Excess Charges?

What are Part B Excess Charges?

What are Part B Excess Charges?

what are medicare part b excess charges

Medicare Part B Excess Charges are important to understand when you are deciding what Medigap Plan (Medicare Supplement) to get.

Every once-in-a-while, we hear from a client that is confused about a doctor’s bill. They are confused that there is a fee they need to pay that Medicare didn’t cover that they thought was covered by Medicare. Moreover, they have a supplement, that they believe should have also picked up the rest of the cost.

Often times, this fee turns out to be an “excess charge.” Let’s see what this means.

Excess Charges in Medicare Defined

what are medicare part b exciess charges PIN

Excess Charges are amounts of money charged by doctors or other healthcare providers above what Medicare has stated it will pay for a specific service. In other words, the amount of money charged above the Medicare approved amount is the excess charge.

Basically, your doctor or healthcare provider is more expensive for a particular service than the Medicare approved reimbursement. If this is the case, you either have to pay the excess fee out-of-pocket, or you might have the fee picked up by your Medigap (aka Supplement) plan.

Medicare Supplements and Excess Charges

Beneficiaries of the Medicare Healthcare System use Medicare Supplements to pick up the costs that Original Medicare does not pay. (Medicare picks up 80% and beneficiaries pick up 20%, unless they have a supplement or a Medicare Advantage Plan.) These costs include co-payments, co-insurance and deductibles. Medicare

Supplements pay some or all of these extra costs, depending on what plan you get.

What Medigap Plans Cover Excess Charges?

Plan F and Plan G Cover Excess Charges.

  • If you have aged into Medicare before 2020, you can pick either Plan F or Plan G. The only difference between Plan F vs Plan G, is G does not cover the Medicare Part B Deductible.
  • If you age into Medicare after 2020 (i.e. your 65th birthday is on or after January 1, 2020) then you cannot get Plan F. Plan G would then be your only option for a plan that covers Part B excess charges.
  • To read more about why this birthday cut off exists, please read this article.

All other plans do not cover excess charges. If you have any of the other Medicare Supplement (Medigap) Plans, you will be responsible for paying excess charges.

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

Is My Service or Procedure Covered by Medicare?

If you are trying to figure out if your needed service or procedure is part of Medicare’s covered services, and/or how much is covered, then start with the Medicare.gov web-page here.

Medicare Advantage & Excess Charges

If you have a “Part C” Medicare Advantage (MA / MAPD) Plan, then excess charges do not apply to you. Medicare Advantage Plans basically replace Original Medicare and cover all of the services they are required to, plus many have additional coverage and benefits.

Your specific Medicare Advantage plan costs will be outlined by your private insurance company. So, you will know exactly what is covered and what costs you are responsible for according to your plan. In addition, your plan may have a network of doctors that have negotiated rates with your plan, so excess charges may not even be relevant to your MA set-up.

Further Reading:

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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

Health Hacks to Save Money
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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.

For example, Medicare Supplement Plan F is one of only two Medigap plans that covers Part B Excess Charges (read more about this here.)

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:

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

Since every private insurance company offers the same coverage for each letter plan, it is important to understand and compare pricing. To learn how insurance companies price plans, read this article.

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.

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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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