Medicare Policies

Medicare Part D Coverage and the Coverage Gap in 2012

Medications are vital to the long term and short term health of many sick and elderly people and when those medications are not available it can cause big problems.  When Medicare created a large coverage gap in Medicare Part D Coverage years ago it left many people holding the bag when it came to staying healthy.  Though the coverage gap continues, it does continue to get better as it nears on the ability to close out in the not so near future. Read more…

What Counts Towards the Medicare Part D Coverage Gap?

To get out of the coverage gap that is associated with Medicare Part D
it is important to know what expenses are a part of this gap and what
isn’t.  The smarter you are about your choices of what to pay for the
better off you will be when it comes time to reach the gap.  Here is a
brief description of what is and what is not covered with the Medicare
Part D Coverage Gap: Read more…

Stopping Medicare Supplier Fraud: Random Phone Calls from Unknown People

When you start receiving any kind of random phone calls it can be disturbing to think about what is happening and what people are trying to do to you. Phone calls that are from unknown callers can be scary because you don’t understand the motive behind it, but they are even stranger when you don’t know how the information was obtained by the caller. People calling you randomly and asking you about your Medicare supplies should not be trusted in any way. Read more…

Foot Exams for Diabetes Could be Covered by Medicare

The effect of diabetes can extend throughout your body because of the nature of the condition and this could cause some financial trouble for those afflicted.  Thankfully, insurance can absorb much of this expense if you are lucky enough to have the coverage and if you have Medicare, you are covered.  One of the experiences that many with diabetes have is painful foot issues that require exams to determine if treatment is necessary. Read more…

Flexible Sigmoidoscopy is Covered by Medicare

Another potential test to diagnose colon cancer is flexible sigmoidoscopy and it can be covered by Medicare in some instances when necessary.  This isn’t the most well known test to the public, though it is used regularly in the industry to diagnose and eventually treat colon cancer.  Flexible sigmoidoscopy is not always covered completely by Medicare, but you are covered in most instances for a good portion of the test. Read more…

Does Medicare Pay Anything for Bone Mass Measurement?

You are charged for insurance based on the risk that an insurance company believes you pose to them in relation to money. Regardless of the type of insurance coverage that you have this is true and insurance through Medicare is no different. It is this reason that causes Medicare to approve certain screenings and deny others for certain conditions. Read more…

Is the Pneumococcal Shot Covered by Medicare?

Certain illnesses and sicknesses have the potential of being much worse when they happen to someone that is already sick or elderly.  The human body isn’t quite as apt to battling off the issues when these things happen and for this reason it is good to be prepared.  The way that you prepare your body for such a situation is to get vaccinated and help your body build up its defenses with things like the pneumococcal shot. Read more…

Glaucoma Tests and Medicare

The eye disease of glaucoma is a serious situation that afflicts many people as they get older in their lives.  It is important to test for this regularly but it is also important to know what your insurance covers to avoid unexpected medical bills.  If you are on Medicare there is a period of once every twelve months that screening for glaucoma is covered under your benefits. Read more…

Medicare Part D: Help with the Donut Hole on Brand Name Medications

With the health care reform instituted by President Obama there has been a lot of talk in the media about the infamous Medicare Part D “Donut Hole”.  This hole is caused by a gap in coverage that previously caused those enrolled to have to pay full price for medications after reaching a certain dollar amount of coverage.  Talk in the media has centered around the rebate given to people in the donut hole this year and how it will go away completely by 2012, but there is more to it than that.

Many people who currently use Medicare Part D and will be using it in the future should be happy to know that in 2011 when you are in the donut hole you will be significantly better off.  This is due to the fact that Medicare has negotiated a 50% discount on medications while in the gap in 2011.  While this doesn’t offer you everything, it certainly is a better deal than before.

While this new healthcare law has caused anger, confusion and concern from some people it has definitely worked well for those on Medicare.  The options for coverage are getting better and the cost of service has become much more affordable.

Does Medicare Cover Home Health Aides?

People who are relegated to the home for a variety of different medical issues often have to get help around the house to live a normal life.  In these instances it is not just the hard things like leaving the house or having a job that are the problems, doing normal routine things are hard too.  For people that are struggling in this manner there is help from Medicare in the form of a home health aide. Read more…

Mental Health Services can be Covered by Medicare Part B

Medicare is about helping you and those around you deal with the conditions that you have so you can enjoy your life.  There is a big part of the coverage that has to do with your physical well-being, but Medicare also covers the mental side of things.  Medicare Part B, as a matter of fact, will pay for services to treat your mental health condition so you can live a normal life.

Medicare Part B will cover a psychiatric evaluation that may be necessary to diagnose your treatment so that you may seek assistance.  This is a great service that can help you understand what your situation is and how you can deal with it on your own terms.

Medication management is also offered by Medicare Part B as a way of helping you understand what drugs you should use and why.  This is a great way to learn about the effects that certain types of medication can have on you and can be beneficial for family as well.

Occupational therapy that’s part of your mental health treatment is covered by Medicare Part B so that you can function as close to normal as possible.  The better you can get around in your normal life, the better your quality of life will be and that is the entire point of Medicare.

When do you have to pay your Medicare Premium?

When you get any kind of insurance coverage, including that of Medicare coverage of any kind, you will be required to pay a premium for the payment.  Premium is just a fancy word for a monthly bill that will be required to be paid in order to keep your coverage valid.  You will not always get a bill for your Medicare premium, but if you do it is very easy to pay.
First, understand that you will always receive a bill for your Medicare Part A insurance premiums, regardless of your situation.  If you are receiving checks from the Railroad Retirement Board (RRB), Civil Services, or SSA (Social Security Administration) the Part B premium will be deducted from your check.  If not you will receive a bill for your Part B and Part A premiums that you must pay on time.
All you have to do when you are ready to make your payment is to send the check to the Medicare payment processing center.  You can mail your premium payments to the Medicare Premium Collection Center, P.O. Box 790355, St. Louis, MO 63179-0355. If you get a bill from the RRB, mail your premium payments to RRB, Medicare Premium Payments, P.O. Box 9024, St. Louis, MO 63197-9024.

Are there any Drugs Excluded in Medicare Part D?

Any type of coverage of anything at all that is offered by the government will have its fair share of exclusions.  These exclusions generally exclude things that are not completely vital for a human being to function from day to day.  Sure, they may help you live a happier and enjoyable, more care-free life but they are not completely necessary to life itself.

Generally, weight loss drugs are excluded under Medicare Part D because they are not completely necessary to day-to-day functioning.  These drugs could help you lose weight which may indirectly cause happiness to be more attainable, but they are not completely necessary.  Weight loss can generally be attained through other means, though it may not be as quick and painless.

Erectile dysfunction drugs are also not usually covered under Medicare Part D because everyone can agree they don’t sustain your life.  They can improve your enjoyment of life and may give you something to look forward to, but that is not what health insurance is about.  There are a few other excluded drugs under Part D, including benzodiazepines and barbiturates, but none are as discussed as these two.

Medicare Part A and Your Hospital Stay

There is nothing scarier in our mortal human lives than going to the hospital for the simple reason that the consequences will be unknown.  The consequences or repercussions could be on the medical end of things, or it could be that your finances have been thrown a massive curveball.  If you are a subscriber to Medicare Part A you should know what will be paid for with your hospital stay in 2010. Read more…

Medicare Part D: How Much is Covered for One Year?

When insurance is such a big part of taking care of you for a year of your life it is important to pick the right policy.  What is even more important than picking the right policy is knowing what is covered under the policy that you choose.  With Medicare Part D drug coverage you should know just how much is covered during one plan year. Read more…

Medicare Supplement Insurance Changes Coming in June 2010

Thanks to the constant attention given to Medicare and Medicare supplement insurance by legislators there are always improvements being made to the process.  The Medicare Improvements for Patients and Providers Act that was passed in July 2008 will go into effect on June 1st, 2010 and includes some things that you should know.  If you like the Medicare supplement insurance plan that you have now and you have no desire to change you do not have to.

The at-home recovery benefit that has been a part of Medicare Plans D and G will be eliminated as a part of this new amendment.  If you get Medicare Plan G your coverage will increase from 80% to 100%, but if you already have Plan G your coverage will not change.  A hospice benefit will be a part of all new plans starting in June and could make your Medicare supplement insurance much stronger.

If you have any questions about the changes to Medicare supplement insurance in June 2010 then contact your Medicare supplement insurance provider.  Be sure to follow up with questions about your rates as this could change the rates that you have been charged in the past.  Medicare supplement insurance will continue to change as the Federal government continues to try to find ways to help consumers pay for healthcare costs.

Medicare Part A: Are Preventive Services Covered?

The health insurance industry as a whole is being pushed these days to coverage preventive services and Medicare Part A is already on board.  With Medicare Part A you will be automatically covered for certain services that will help maintain your overall health.  These types of services will help you as well as the general society by stopping certain illnesses that could be passed around.

Here are a few of the common preventive services covered by Medicare Part A:

Cardiovascular screenings are covered as a preventive service by Medicare Part A.  This will help with your general good health by requiring your doctor or hospital to assess your body’s general health.

Diabetes screenings are covered as a preventive service by Medicare Part A.  This is a service that doesn’t generally help society by stopping a possible communicable disease, but it does help detect a very common personal health issue.

Flu shots are covered as a preventive service by Medicare Part A.  The flu causes a scare almost every year as it has caused such damage to the world as a whole in the past.  You can do your best to protect yourself by getting a flu shot covered by Medicare Part A.

Glaucoma tests are covered also as a preventive service by Medicare Part A.  As this is a common issue among Medicare patients it is covered.

What is the Medicare Part B Cost of Living Adjustment (COLA)

In 1973 the United States passed a law to assist those who didn’t have the funds to keep up with rising healthcare costs by passing the Medicare Cost of Living Adjustment in association with Medicare Part B.  With the passing of this provision in Medicare the people who may be left behind by rising healthcare costs and inflation were able to keep up.  The Medicare Part B Cost of Living Adjustment is designed to change every year with the expected change in healthcare and consumer prices.

Here is what Medicare wants you to know about the Medicare Part B Cost of Living Adjustment in 2010:  “In 2010, social security benefits won’t have cost of living adjustments. This is due to the decline in consumer prices and the expected low inflation.”

This leads to the following information as to how Medicare Part B will be assessed in 2010.  This is straight from the horse’s mouth in relation to Medicare Part B:

“Most Medicare beneficiaries will continue to pay the same $96.40 Part B premium amount in 2010. Beneficiaries who currently have the Social Security Administration (SSA) withhold their Part B premium and have incomes of $85,000 or less ($170,000 or less for joint filers) will not have an increase in their Part B premium for 2010.

For all others, the standard Medicare Part B monthly premium will be $110.50 in 2010, which is a 15% increase over the 2009 premium. The Medicare Part B premium is increasing in 2010 due to possible increases in Part B costs.  If your income is above $85,000 (single) or $170,000 (married couple), then your Medicare Part B premium may be higher than $110.50 per month.”

Do You Automatically Get Medicare Part A?

Medicare Part A is a coverage that helps the covered in a situation that requires the covered individual to go to the hospital.  This is one of the more popular coverage choices for those that are enrolling in Medicare and paying for the premiums themselves.  However, did you know that it is possible that you automatically qualify for Medicare Part A without having to enroll? 

Here are the individuals that qualify for automatic enrollment into Medicare Part A:

  1. If you get Social Security or the Railroad Retirement Board benefits then you automatically qualify for Medicare Part A the first day after you turn 65.  Those who are disabled and get Social Security or Railroad Retirement Board benefits will get some or all benefits on the 25th month of the disability.
  2. If you have ALS (Amyotrophic Lateral Sclerosis, also called Lou Gehrig’s disease), you automatically get Part A the month your disability benefits begin. 

Those who do not qualify in the above categories do not automatically qualify for Medicare Part A but there is still hope for getting the coverage.  All you have to do to get Medicare Part A is sign up for the coverage, you may still even qualify to get the coverage premium free.

Do You Get Medicare Part D Extra Help?

Millions of people who use Medicare Part D assume that they are getting the best coverage possible and therefore make decisions that impact their health in such a manner.  Assuming that they have the best coverage that they can afford they make decisions to skip certain treatments to be able to save money.  These treatments that would be paid for by Medicare Part D could greatly impact their quality of life.

Many of these people don’t realize that they are eligible for help through a new Medicare Part D coverage known as “extra help”.  With this coverage Medicare is starting to change its opinion of what is income and resources and what is not.  After doing so you could be eligible to get more coverage.  It is assumed that this could help with up to around $3,900 per year in savings.

If you are a citizen of one of the 50 states or the District of Columbia you have passed the first test of being eligible.  If your resources are less than or equal to $12,510 for an individual or $25,010 for a married couple living together then you have passed the next portion of qualifications.  Resources are bank accounts, stocks and bonds and the like.  Resources are not things like your home and car.

Finally, your annual income must be less than or equal to $16,245 for an individual or $21,855 for a married couple living together.  Even if you earn more than this but support other family members, have earnings from work or live in Alaska or Hawaii you could still be eligible for support.

Medicare Part D: How to Avoid the Late Enrollment Penalty

Many people who use Medicare everyday as part of their main health insurance coverage are unaware that they can actually be penalized for not enrolling in Medicare Part D as soon as they are eligible.  This penalty is in play to try to discourage people from not paying when they have no prescription drugs to speak of and then enrolling in Medicare Part D when it becomes obvious that the coverage will be necessary.

If you enroll in Medicare Part D coverage as soon as you are eligible to get the coverage then you are reducing the possibility of being assessed a late enrollment penalty.  This will show that you aren’t trying to avoid paying the premium that everyone is required to pay and you are trying to play by the rules.

To avoid the late enrollment penalty for Medicare Part D it is a good idea to avoid going more than 63 consecutive days without coverage that would be considered credible by Medicare.  Creditable prescription drug coverage could include drug coverage from a current or former employer or union, TRICARE, or the Department of Veterans Affairs.

When you enroll in another creditable coverage it is a very good idea to let the Medicare Part D provider know that you have other creditable coverage right away.  To avoid this late enrollment penalty for Medicare Part D it is a good idea to get the contact information for anybody that you inform about this creditable coverage as soon as is possible.

Medicare Part B: Travel Coverage

Most people who are on Medicare insurance know the basics of what is covered through Medicare, but what about parts of Medicare Part B that you are unaware of?  Since you are paying for Medicare Part B it is only fair that you know exactly what is covered so you can get the biggest bang for your buck.  Here is one unknown area of Medicare Part B, travel coverage.

In general, Medicare Part B does not cover you when you are traveling outside the United States and its territories.  However, there are three exceptions:

1) If an emergency arose within the U.S. and the foreign hospital is closer than the nearest U.S. hospital that can treat your medical condition.

2) If you are traveling through Canada without unreasonable delay by the most direct route between Alaska and another state when a medical emergency occurs and the Canadian hospital is closer than the nearest U.S. hospital that can treat the emergency.

3) If you live in the U.S. and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition, regardless of whether an emergency exists.

The coverage in these situations would be applicable to your Medicare Part B deductible and you would be responsible for 20% of the amount approved by Medicare.

Medicare Part A Helps You Recover

There are many different parts of Medicare coverage and at times this can make it confusing, but the different parts of Medicare such as Medicare Part A can be pretty easy to understand.  Medicare Part A is the part of Medicare that deals with hospital stays, in home care and other types of care such as hospice. 

Here are a few highlights of Medicare Part A coverage:

  1. With Medicare Part A your hospital stays are covered as you will have a semi-private room along with meals and general nursing care.  This is great for following surgeries and other procedures that may cause a long hospital stay.
  2. Medicare Part A also covers some hospice care, specifically, drugs, medical and support services.  This part of the coverage includes the language that the hospice you choose must be approved by Medicare before beginning the billing process.
  3. Some home health care services are covered by Medicare Part A with more emphasis given to those that are in need of part time care.  This may be in a situation where a patient needs more one-on-one skill work like speech pathology, physical therapy and occupational therapy.

There are other benefits of Medicare Part A coverage but the general highlights are included above.  Just remember, if a procedure you are getting ready to have is covered by Medicare, it is likely covered under Medicare Part A.

Medicare Part D: When is it Not a Good Idea?

We are all looking for a way to save an extra buck, that is, unless you are the heir to some unknown fortune that has left you without a worry.  However, in this day in age we are all looking for a way to scrimp and save our way out of the “poor house”.  One way to do that is to eliminate unnecessary coverage on your insurance, in this case, the question is on Medicare Part D.

Many people are changing the amounts of deductibles with auto insurance and health insurance, while others are eliminating insurance altogether as a cost-cutting measure in difficult economic times.  The problem with that is, what happens if everything changes and you need that coverage tomorrow?  Can you survive without Medicare Part D?

Let’s play the game of “worst-case scenario” for a moment and pretend that you are suddenly diagnosed with cancer tomorrow.  Are you aware that the expensive medications you may have to purchase would be charged to you at full cost without the benefits of Medicare Part D?

Did you know that if you don’t enroll in Medicare Part D right now and you wait until later when the coverage is suddenly necessary that you could have to pay a penalty?  This is not a decision to take lightly, make sure you consider all possibilities when turning down Medicare Part D.

Out-of-Pocket Expenses in a Medicare Advantage Plan

A Medicare Advantage Plan is a privately run health plan, owned by private insurance companies, approved by (and working with) Medicare.  Medicare advantage plans, called MAs, or Part C, are required to follow rules set by Medicare and, in addition to your payments and fees, receive funding from Medicare.  

MA plans will provide beneficiaries with their Hospital Insurance (Part A) and Medical Insurance (Part B), all medically-necessary services covered by Original Medicare, and, in many cases, optional extra benefits such as vision, dental, hearing, and prescription drug coverage – for additional cost, of course.

In fact, many of your out-of-pocket costs in a Medicare Advantage Plan will vary significantly.  For instance, many MA plans will charge, on top of your Part B premium, another monthly premium.  Your costs will also vary depending on whether or not your MA plan has a yearly deductible or any other deductibles for certain health care services.  Costs can increase if your plan requires you to pay more for each doctor’s visit or health care service.  If you frequently require health care or if you need more costly services, this can also increase your out-of-pocket costs.  If you decide you want extra benefits, you can expect to pay more for these as well.   

There are, of course, some ways to reduce costs.  First – and perhaps most importantly – research available plans carefully.  Contact Medicare, at or at 1-800-MEDICARE – or call your local SHIP to find out more. Once you’ve selected a plan, be sure to familiarize yourself with your MA plan’s rules, and to follow them vigilantly. 

The right MA plan can allow you to receive the medical coverage you need.  However, unexpected costs can put a strain on your budget and, in some cases, even make receiving the care you need a significant hardship.  An awareness of the out-of-pocket costs involved in your Medicare Advantage plan can help you prepare for those expenses, and allow you to financially arrange for your future.