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

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

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

What Dental Services Does Medicare Cover?

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

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

Options for Dental Insurance for Medicare Beneficiaries

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

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

1. Medicare Advantage
2. Dental Insurance

Medicare Advantage Plans (MA/MAPD Plans)

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

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

Dental Insurance

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

Conclusions on Medicare Denture Coverage

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

Independent Insurance Agents for Dental Benefit Coverage

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

• You can find one here.

• Additionally, if you have never worked with an agent before, please read this article on the benefits of working with an agent.

The post Does Medicare Pay for Dentures appeared first on Medicare Life Health.

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

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

Medicare Cost Sharing Chart

2021 Medicare Part A Premiums

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

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

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

2021 Medicare Part B Premiums

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

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

Medicare Coverages

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

The post Medicare Part B Premium 2021 Changes appeared first on Medicare Life Health.

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.

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

• Click here to learn more about Medigap Plan F
• Click here to learn more about Medigap Plan G

Medicare Advantage Rehab Coverage

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.

• You can learn more about Medicare Advantage here.
• In addition, you can learn about the differences between Medicare Advantage and Medigap Plans here.

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.

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.

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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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:

• Allogeneic Hematopoietic Stem Cell Transplant for MDS
• Allogeneic Hematopoietic Stem Cell Transplant for Multiple Myeloma
• Allogeneic Hematopoietic Stem Cell Transplant for Myelofibrosis
• Allogeneic Hematopoietic Stem Cell Transplant for Sickle Cell Disease

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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Applying For Medicare Overview Infographic

Applying for Medicare – Parts A & B

Let’s get right to it! If you are ready to enroll in Medicare, there are three ways to do it: in person, online, or by phone. Alternatively, if you are already on Social Security before you turn 65, your enrollment will be automatic.

(Read our FAQ’s below if you still need to determine if you are ready to enroll, or to see if you enrollment is automatic.)

Medicare Enrollment Preparation

Before you head over to apply in person, online or by phone, you might want to gather the necessary documents needed to apply.

The SSA has created a helpful checklist of what you will need to apply for Medicare. You can find it here.

How to Apply for Medicare in Person

For those that are not automatically enrolled (still working or not taking social security yet on your 65th birthday) you will need to enroll yourself. Your first option is to do this in person.

While appointment wait times in the SSA lobby can make this a longer application process, it is often the fastest way to get your benefits started. For example, I will have clients that walk into the SSA office needing their Part B instated, and leave the office that same day with their benefits active. If you are in a time crunch (i.e. sudden retirement via layoff!) this is the fastest way to get your benefits in place.

In addition, if you run into any problems or concerns with your enrollment process, visiting Social Security in person might also be the fastest way to resolve any issues.

Click here to find a Social Security Office Near You
to Apply for Medicare in Person.

How to Apply for Medicare Online

The Social Security Administration (SSA) has partnered with CMS (The Centers for Medicare and Medicaid Services) to offer you an online enrollment option. It is a fast process (about ten minutes) and is safe and secure.

____________________

Click here to be directed to the Social Security Website for Online Medicare Enrollment.

If you are retiring and need both Social Security Benefits and Medicare, you can complete one application for both here.

____________________

According to the Social Security Administration, when you apply for benefits online, you will get a receipt. Moreover, you will have the ability to check the status of your application with the confirmation number on your receipt. This is a big benefit to applying online, but if you prefer, you have one more enrollment option: phone.

How to Apply for Medicare by Phone

Finally, you can apply for Medicare by phone. However, this is the slowest option, as you will likely have to use “snail mail,” the U.S. postal system that is, to receive and send paperwork.

If you decide to enroll by phone, just understand that it will take a while. Confirm with the SSA representative you are talking with that you will have enough time to complete enrollment this way. It is important to have your benefits in place in time for when you need them so you are not without coverage.

To apply for Medicare by phone, call
1-800-772-1213. (TTY 1-800-325-0778)
from 7 AM to 7 PM Monday through Friday.
(Source: SSA website.)

Enrollment in Medicare Part D

Next, you may be wondering, how do I enroll in Medicare Part D – Prescription Drug Coverage?

Part D is actually run by Private Insurance Companies, not the CMS (Center for Medicare and Medicaid Services). For this reason, you will need to enroll in a Prescription Drug Plan (Part D) separately from your enrollment in Original Medicare Parts A and/or B.

You can only enroll in a Part D plan if:
– You are in your Initial Enrollment Period (IEP)
– Have a Special Enrollment Period (SEP)
– Or are in the Annual Enrollment Period (AEP) – Oct. 15 – Dec 7

How to Apply for Medicare Part D

To enroll in a Part D, Drug Plan, we highly suggest working with an agency, either online, by phone or in person, instead of just doing this on your own.

The main reasons we suggest using an agent, is…

1. First, if you ever have a problem with your policy, you can call your agent for support and they can talk to the carriers with you and for you.
2. Second, the Part D drug plans change often, and your agent will have the ability to stay on top of changes and premium rates. They can make sure you always have the best coverage and costs for your unique situation.
3. Finally, like we saw in 2019, there are sometimes issues with policy comparison technologies. An independent agent can help you compare plan information correctly.

How to Apply for Medicare Advantage & Medigap Plans

After you enroll in Original Medicare, you will need to decide if you want:

• Original Medicare + A Supplement + Part D Drug Plan
• Or a Part C Medicare Advantage Plan (includes Parts A, B, & D)

There are benefits to going both routes, and you will need to decide which plan fits your needs the best. We do advise seeking the help of a licensed, independent insurance agent to help you in your decision making process. Moreover, your agent can then help you to enroll in your plan and be your support into the future.

In the meantime, here are some articles to help you decide which Medicare Plan is best for you:

How to Choose a Medicare Plan	What is Medicare Advantage	What are Medicare Supplements

Medicare Enrollment Frequently Asked Questions (FAQ’s)

When Can I Apply for Medicare?

The Initial Enrollment Period (IEP): You will have a seven month window to apply for Medicare if you are not already on Social Security or Railroad Retirement Benefits. (Remember, if you are on Social Security/Railroad Benefits, you will be automatically enrolled.)

Your Seven Month Enrollment Window:

• Starts 3 Months Before Your 65th Birthday Month
• Continues Through Your Birthday Month
• And Then Lasts Until 3 Months After Your Birthday Month

During this time, you will need to apply for Parts A & B from the SSA or RRB (Social Security Administration or Railroad Retirement Board) and then decide if you want a stand alone Part D with a Supplement, or a Medicare Advantage Plan.

How Do I Enroll in Medicare Easy Pay?

Medicare Part B does cost money. You will pay a monthly premium for your Part B benefits. To see how to set up automated payments with Medicare Easy Pay, please click here.

How to Apply for Medicare Without Claiming Social Security?

You have access to Medicare at age 65, whether or not you decide to claim your social security benefits. You can do this in person, by phone, or online here.

How to Avoid Late Penalties

To read extensively about Medicare Late Enrollment Penalties, please read this article. In summary,

Part A – If you have to pay for Part A, and you don’t sign-up for it when you are first eligible, there is a late enrollment penalty: Premium price increase of 10% for “twice the number of years you could have had Part A, but didn’t sign up.” 

Part B – If you do not sign-up for Part B when you are first eligible, there is an even steeper late enrollment penalty: Standard premium price increase of “10% for each full 12-month period that you could have had Part B, but didn’t sign up for it,” for as long as you have Part B.

From https://medicarelifehealth.com/medicare-penalties-for-late-enrollment

To avoid these penalties, make sure you apply for Medicare during your Initial Enrollment Period (IEP) if you are not automatically enrolled through SS or RRB benefits.

What if you have health care with your employer at 65?

Make sure your employer’s insurance is considered “credible coverage.” Then, if it is you will let the government know you will be delaying your use of Medicare Part B until that coverage ends. (Part A does not cost you anything in most cases, so starting Part A when you are eligible is always a good practice, even with employer coverage. In this case, you would not have a penalty when you eventually begin Part B.

Dual Eligible? How to Apply for Medicare & Medicaid

People who meed the low income levels set by CMS may be eligible for both Medicare and Medicaid. If you are eligible for both programs, you have special plans that help to coordinate your care and make things easier to manage. Please contact an independent insurance agent to see what plans are available to you in your area.

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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.

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

• The Number One Thing you can do to keep your health care costs lower in the future.

The post How Much Does an MRI Cost? appeared first on Medicare Life Health.

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

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?

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:

• What is Medicare Advantage?

• Medigap vs Medicare Advantage

• What are Medicare Supplements?

• What are the 2020 Changes for Medicare and 2020 Part B Premiums

• How to Choose a Medicare Plan?

• What is Medicare Part D – Prescription Drug Plans?

The post Medicare Easy Pay appeared first on Medicare Life Health.

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.“

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.

How are the programs similar?

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.

Both Medicaid and Medicare Advantage Plans can be set up as managed care plans with networks of doctors and hospitals members have access to. If you would like to learn more about how these networks work, please read, HMO vs PPO – Which is Better?

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.

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 with Medicaid or need to enroll in Medicaid only, then contact your state agency directly.

• If you need help enrolling in Medicare, then you can contact CMS and Social Security in the following ways:
  • BY PHONE: If you need to sign-up for Medicare, you can call Social Security at 1-800-772-1213.
  • ONLINE: Additionally, you can also visit CMS online at ssa.gov/benefits/medicare if you need to sign yourself up.
  • RAILROAD: Finally, if you are on Railroad Retirement Benefits, you will need to notify the local Railroad Board (RRB) office before you turn 65 that you would like to sign-up for Medicare. You can sign-up 3 months before you turn 65 even if you are not planning on retiring at 65. You can read more about Railroad requirements in our article here.

• 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.
  • You can contact your author Carly Cummings here, for assistance if you live in Nebraska or Iowa.
  • Or, if you live in all other 48 states, you can find an agent in your area here.

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The post Medicare and Medicaid Difference Guide appeared first on Medicare Life Health.

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?

• If you have a specific procedure you want to look into, you can use the CMS’s government search tool here.

• Additionally, the Government has an app for coverage questions! You can find it on Google Play, or on the Apple App Store. “What’s Covered” is the name of the app in each store.

• Finally, you can use the Medicare and You Guidebook. CMS produces it every year. So, you can see what Part A covers and does not cover. In addition, you can see coverage for any other part of Medicare there too.

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:

• The Four Parts of Medicare Explained
• The Medicare and You User Guide
• Does Medicare Cover Hearing Aids?
• What is Medicare Advantage?
• What are Medicare Supplements (Medigap) Plans?

The post What Medicare Part A Covers appeared first on Medicare Life Health.

The 2021 changes for Medicare were released this month. The 2021 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. Let’s look at what is changing.

Part B Deductible for 2020

• In 2021, the Medicare Part B Deductible will be $203.
• In contrast, the deductible was 198 for 2020.
• This is an increase of $5.

Part B Premiums for 2021

• In 2021, the Medicare Part B Monthly Premium will be $148.50
• In 2020, the Medicare Part B Monthly Premium was $144.60.
• The premium was 135.50 for 2019.

Why are the Part B Deductible and Premiums Increasing in 2021?

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

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.

The post 2020 Part B Deductible / 2021 Part B Deductible appeared first on Medicare Life Health.