Category: Part B

Does Medicare Cover Chiropractic Care?

Does Medicare Cover Chiropractic Care?

does medicare cover Chiropractic Care

Does Medicare Cover Chiropractic Care / Services?

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

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

What is a Subluxation?

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

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

How Much Does Medicare Pay for Chiropractic Adjustment?

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

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

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

Does Medicare Advantage Pay for Chiropractic Care?

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

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

Does Medigap Pay for Chiropractic Care?

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

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

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

A note of warning from Medicare.gov:

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

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

Conclusions on Medicare Coverages of Chiropractic Care

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

Does Medicare Cover Cataract Surgery

Does Medicare Cover Cataract Surgery?

does medicare cover cataract surgery

Yes, Medicare covers cataract surgery.

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

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

What is a Cataract?

According to the National Health Institute:

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

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

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

What is Cataract Surgery?

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

Why Would You Have Cataract Surgery?

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

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

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

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

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

How Much Does Cataract Surgery Cost on Medicare?

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

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

How to Look Up Your Cost Estimate on Medicare.gov

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

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

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

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

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

How Much Does Cataract Surgery Cost with Medigap?

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

How Much Does Cataract Surgery Cost with Medicare Advantage?

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

Are Eyeglasses Covered by Medicare with Cataract Surgery?

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

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

Does Medicare Cover Eyeglasses or Contacts in General?

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

Conclusions

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

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

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

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

Medicare Part B Premium 2021 Changes

Medicare Part B Premium 2021 Changes

Medicare Part B Premium 2021

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

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

Medicare Cost Sharing Chart

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

2021 Medicare Part A Premiums

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

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

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

2021 Medicare Part B Premiums

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

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

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

Medicare Coverages

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

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

Does Medicare Cover Ambulance Services?

Does Medicare Cover Ambulances medicare FAQs

Does Medicare Cover Ambulance Services?

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

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

Does Medicare Pay for Ambulance Services?

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

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

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

Does Medicare Cover Non-Emergency Transportation?

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

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

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

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

What are My Costs with Medicare Ambulance Coverage?

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

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

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

Medigap Ambulance Coverage

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

Coverage By Specific Medicare Supplement Letter Plan

Ambulance Medicare coverage

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

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

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

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

Medicare Advantage Ambulance Coverage

What is Medicare Advantage?

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

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

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

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

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

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

Other FAQ’s

Here are a few other frequently asked questions:

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

Conclusions

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

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.

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.
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.

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:

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