Mental Health and Medicare

mental health and medicare text overlaying image of a brain with a stethoscope on it

Medicare enrollees are generally more likely to experience mental health issues. In fact, about 1 in 5 elderly citizens suffer from some form of mental disorder. Thankfully, Medicare provides coverage for counseling which can make support more accessible. Mental health programs and services exist to diagnose and treat mental health needs. As a Medicare beneficiary, you have access to screenings for depression, counseling sessions, medications, and partial hospitalizations. The amount you pay for these services all depends on where you receive care, your doctor’s fees, and any supplemental insurance you might have. Below we’ll look at all of the ways Medicare provides coverage for treatments and what is and isn’t covered.

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Medicare Plans with Mental Health Services

Medicare is made up of a few parts. Original Medicare includes Part A (hospital coverage) and Part B (medical coverage), both of which are offered by the federal government. Whereas private insurance companies’ contract with Medicare to provide Part C (Medicare Advantage) and Part D (prescription drug coverage). The government mandates that all of these plans cover certain mental health services for enrollees.

Medicare Part A

Medicare Part A covers mental health services for patients that are admitted to the hospital, regardless of whether they are in a general or psychiatric hospital. The coverage and cost-sharing are typically the same as any other type of hospitalization. For each benefit period you’ll pay the Part A hospital deductible which in 2023 is currently $1,600. As well as $400 a day for hospital coinsurance for days 61-90 of your hospital stay. If you stay longer than 90 days you can use your lifetime reserve days, which come with an $800 per day coinsurance. Keep in mind you only get 60 reserve days in your lifetime; they will not regenerate. Your benefit period begins the day you are admitted as an inpatient to the hospital or skilled nursing facility. It ends after you have been out of the hospital for 60 consecutive days. 

 

Medicare Part A does treat billing for mental health in one way. It will only cover 190 days in a psychiatric hospital that specializes in mental health treatment during your lifetime. However, if you are admitted to a general hospital, even if it’s for a mental health condition, the days spent in the general hospital will not count toward that 190 day limit.

Medicare Part B

While Part A has the hospital side covered, Medicare Part B covers mental health services you get outside of a hospital. Such as in a doctor’s office, therapist’s office, hospital outpatient department, or community health center. Medicare Part B covers mental health services and visits to psychiatrists, clinical psychologists, clinical social workers, nurse practitioners, and physician assistants. As long as the provider accepts Medicare assignment, which means they agree to provide the services for the price that Medicare approves. Be aware that not every mental health professional will accept Medicare.

 

After you’ve met your Part B deductible ($226 in 2023), you will pay 20% of the Medicare-approved amount for the service. However, Part B does fully cover preventative services such as depression screenings for free. That is as long as they are provided by a primary care provider, physician assistant, or nurse practitioner who accepts Medicare Assignment. The screening must also be done in a primary care setting such as a doctor’s office where you’re able to receive follow up treatment and referrals. However, aside from the preventative screening, follow up treatment and referrals to see other specialists are not free. 

 

Medicare Part B will also cover partial hospitalizations if you need more intensive care than your doctor or therapist can provide. Typically this partial hospitalization will happen in an outpatient hospital department or a mental health center, where patients do not stay overnight. Part B pays for these services, but you have to meet certain requirements, including having your doctor certify that without these services you would need to be hospitalized.

 

For partial hospitalizations you will be responsible for 20% of each service you receive. You may also have to pay for coinsurance for each day of outpatient hospital or mental health center treatment.

Medicare Advantage

Medicare Advantage is an alternative option to Original Medicare (Parts A and B), and as such, it generally covers all the same benefits combined into one plan. These plans may also offer additional coverages for telehealth care, grief counseling, and conflict resolution. However, Medicare Advantage plans may have smaller limited provider networks for mental health providers. So, before enrolling make sure your plan covers what you need and the doctors you prefer.

Medicare Part D

So far we have hospitalization and outpatient mental health services covered in Parts A, B, and C, so all that’s left is your prescriptions. That’s where Part D prescriptions coverage comes in. You can either buy a separate Medicare Part D or enroll in a private Medicare Advantage plan that includes prescription drug coverage. Both types of plans will list covered medications on their drug formularies. Part D plans have to cover, with limited exceptions, all anticonvulsant, antidepressant, and antipsychotic medications. During Open Enrollment, when you’re selecting a Part D or Medicare Advantage plan, make sure the plan will cover your medications and find out exactly how much you would pay in copayments or coinsurance. Since these plans are offered by private insurance companies your out-of-pocket costs can vary from one plan to another. So, comparing is key.

Coverage For Other Types of Mental Health Counseling

Medicare isn’t limited to only helping you with depression and anxiety. Plans also cover substance use disorders and other mental illnesses as well. However, Medicare will only cover counseling services that directly address your mental health condition. We’ve detailed these services below.

Substance Use Disorders

Substance use disorder is considered a chronic mental illness. Medicare plans treat substance use disorders just like they would diabetes or cardiovascular disease. Medicare Part B covers the following substance use disorder treatments:

 

  • Monthly care management
  • Drug testing
  • Tobacco counseling
  • Opioid use disorder treatments
  • Alcohol use disorder screenings
  • Individual therapy
  • Group therapy
  • Medications
  • Drug withdrawal treatment

Opioid Treatment

Original Medicare covers the total costs of opioid use disorder treatment as long as it’s administered by a Medicare-enrolled program. You may have to pay an additional copayment or coinsurance for any opioid treatment services you receive in an outpatient hospital setting.

Alcohol Use Disorder

Medicare provides screening and therapy for alcohol use disorder to people who drink but are not dependent on alcohol. Medicare may cover up to 4 counseling sessions per year for alcohol abusers. It also pays for:

  • Detox
  • Rehab
  • Advance care planning
  • Behavioral health integration into primary care for monitoring

As long as your healthcare provider accepts Medicare assignment, you pay nothing for these services.

Marriage and Family

Medicare Part B plans will also help cover family counseling. However, the family counseling services must be medically necessary for your mental health treatment. Medicare typically will not cover marriage counseling or couple counseling though.

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Specific Mental Health Services

Medicare provides access to specific mental health care in a variety of ways. Here we will go more into detail about each of these services.

Inpatient Care

Medicare will cover inpatient care if you need intensive care that can only be provided in an inpatient setting. These plans will help with treatment costs and inpatient psychiatric facilities, critical access hospitals, and hospital psychiatric units. Medicare Part A covers up to 190 days of hospitalization in a psychiatric facility. Part B helps cover a portion of doctor or specialist fees that come with mental health inpatient care.

Outpatient Care

If your doctor accepts Medicare assignment, your yearly depression screening is free. However, for any doctor visits to diagnose and treat your mental illness you’ll have to pay the Part B deductible and 20% of the Medicare-approved amount. Medicare covers the costs of the outpatient psychiatric hospital services and supplies as long as they are:

 

  • Medically necessary for diagnostic studies 
  • You are expected to improve with treatment
  • The service is given under a care plan, which is a written plan that your provider writes and includes a list of the types of services you need, how long you need them, and how much they’re predicted to cost.
  • The prescribing doctor supervises and monitors the services.

Partial Hospitalization Programs (PHPs)

PHPs are structured outpatient mental health treatment programs. Medicare will cover these programs for patients who receive care from hospital outpatient centers and community mental health centers. PHPs give less than 24 hours of mental health care a day to people who have been recently discharged from an inpatient hospital program but need continued support, or people who are at risk of being hospitalized due to their mental illness. If your providers accept Medicare assignment, you may be responsible for a portion of the Medicare-approved amount for each service. You may also have to pay coinsurance for each day you receive PHP services.

Community Mental Health Centers

In addition to the services that you get from PHPs, community mental health centers offer hospitalization alternatives. These facilities offer 24-hour emergency care with follow-ups, and screenings for admission to a state mental health facility. They also provide day treatment, partial hospitalization, or rehab that line up with your mental health needs.

Telehealth

Telehealth visits, consultations, and psychotherapy are all covered by Medicare Part B. You will have to pay both the Part B deductible and 20% of the Medicare-approved amount for these services though. In most cases, telehealth costs are generally the same as costs for in-person visits.

The Bottom Line 

Medicare plans cover an extensive array of outpatient services, such as individual and group therapy, prescription medications, and diagnostic testing for depression, substance abuse, and other psychiatric disorders. In-person and virtual meetings are also covered.

 

Help is available if you experience an emotional crisis requiring medical attention. Medicare can also cover a significant portion of inpatient care costs. If you require assistance with Medicare in general, EZ is also available to assist you. EZ can help you enroll in Medicare, purchase a Medicare Supplement Plan, or evaluate your options. Our agents work with the nation’s top insurance providers. They can provide you with a complimentary comparison of all local plans. We will assess your medical and financial needs and assist you in locating a plan that meets them. Simply call one of our licensed agents at 877-670-3602 to get started.

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Medicare Myths Debunked

medicare myths debunked text overlaying image of wooden blocks spelling out the words myths and factsYour Initial Enrollment Period (IEP) is an important time if you’re considering your Medicare options. It’s natural that everyone has their own opinions regarding Medicare and the best coverage. While advice from family and friends can be helpful, when it comes to Medicare, there are a lot of myths passed around. Maybe you’ve come across information on social media or in conversation and wondered “Is that really true?”. You deserve accurate information about your coverage options so we’ve compiled a list of 10 common myths that we’d like to debunk for you.

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Medicare Myths

1.Medicare is free.

There’s a misconception that since Medicare is a government benefit, seniors don’t have to pay for it because it has already come out of their taxes. While that would be great, it’s unfortunately not entirely true. Medicare Part A, or hospital coverage, doesn’t have any premiums. That is as long as you have paid your Medicare taxes for at least 40 calendar quarters. Even so, you still have a deductible and copays. So that part of the myth is kind of true. 

 

However, Part A is the only Medicare product with no premium. Part B, medical coverage, has a monthly premium of $164.90 as of 2023. It’s important to note that the premiums are adjusted annually, meaning some years they increase and some years they’ll decrease. These premiums might also be higher for enrollees with higher income. The good news is that if you’re on Social Security, your Part B premium can be paid directly from those benefits, so while you may not be paying directly out of pocket, you are still paying for it. Additionally, if you choose the Medicare Advantage route you may also have to pay a monthly premium.

2. Medicare covers all healthcare costs.

Medicare does cover a large portion of your healthcare but not everything. Between Part A and Part B most of your hospital and basic medical expenses are covered. 

This includes:

 

  • Hospital care
  • Skilled nursing facilities 
  • Hospice
  • Lab tests
  • Surgeries
  • Home health care
  • Doctor visits
  • Outpatient care
  • Durable medical equipment
  • Some preventative services

 Even with the services it does cover you are still responsible for deductibles, coinsurance, and copays. As you can see there are still several services that you may need that aren’t covered. Such as hearing, vision, and dental care. There is also no prescription drug coverage in Original Medicare (Part A and B). Typically to get those things covered most people will enroll in Medicare Advantage, Medicare Part D (prescription drug coverage), or a Medicare Supplement Plan. Any of those options do provide coverage for the gaps in your Medicare coverage.

3. You are automatically enrolled in Medicare.

This is another myth that is only partially true. If you have been receiving Social Security benefits or Railroad Retirement Board Benefits (RRB) for at least 24 months after you turn 65, then you will automatically be enrolled in Medicare Part A and B. Be aware that even after automatic enrollment, you are responsible for enrolling yourself in either Medicare Advantage, Medicare Part D or any Medicare Supplement Plans. 

 

Now, if you’re not receiving Social Security or RRB, then enrolling is entirely up to you. The best thing to do is to enroll during your IEP, which will begin 3 months before you turn 65 and will end 6 months after your 65th birthday. 

4. I can enroll in Medicare at any time.

This is completely false and can be one of the most detrimental myths to believe. If you don’t enroll during your IEP, you can face enrollment restrictions as well as a penalty. You will then have to wait for the next eligible enrollment period, which is known as the General Enrollment Period (GEP). The GEP lasts from October 15th to December 7th every year. The penalty for waiting is a premium increase of 10% for twice as many years that you were eligible and did not enroll. To make that simpler, If you did not enroll in Part A for 2 years after your IEP then the penalty would apply to your premium for the next 4 years. For Part B, the increase only lasts for the amount of time you did not enroll, so it would only apply for those first 2 years.

 

Now having said that, another way that you can avoid these penalties, aside from applying on time, is if you qualify for a Special Enrollment Period (SEP). To trigger an SEP you would have had to still be working and have credible health coverage through your employer or through your spouse’s employer during your IEP. Once you leave your job or lose the group plan coverage, you then have 8 months to enroll without penalty. Another way you can get an SEP is if you are under 65 and eligible for Medicare due to illness or disability, but have health insurance through a caregiver or spouse’s employer-sponsored health insurance. However, this only applies if their company has at least 100 employees.

 

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5. Medicare costs the same for everyone.

While Medicare offers the same benefits to everyone, the cost is not universal. How long you worked and paid Medicare taxes, as well as your gross income determine your premiums and deductibles. The more you make, the more you will end up paying just like with regular health insurance. Additionally enrolling in Medicare Advantage, or Part D, or any Medicare Supplement Plans will change how much you pay for Medicare. So it varies greatly from person to person depending on their specific circumstances.

6. I can only enroll if I’m healthy.

This is a huge myth, Original Medicare cannot deny your coverage due to illness or a pre-existing condition due to implementation of the Affordable Care Act. If you have certain medical conditions like End-Stage Renal Disease (ESRD) or ALS, you are eligible for Medicare even if you aren’t 65 yet. Once you turn 65 or retire you are eligible for Medicare Parts A and B, period. Also,there are no penalties or premium increases for pre-existing conditions. If you have certain medical conditions like End-Stage Renal Disease (ESRD) or ALS, you are eligible for Medicare even if you aren’t 65 yet. 

7. Medicare Advantage and Medicare Supplement Plans are the same thing.

This is not true at all. They are similar in that private companies offer them but they are entirely different. Medicare Advantage is an alternative to Original Medicare. It may include prescription drug coverage. Medicare Supplement Plans are additional coverage you can buy to fill in the gaps left by your Original Medicare. Additionally, you can buy one or the other but not both. 

8. Medicare doesn’t have as many options.

You may believe that Medicare is a one-size-fits-all program because it’s a government program. However, this is another one of those pesky Medicare myths. Medicare typically provides significantly more health insurance options than your employer’s group coverage. Whereas you may have had only a few plan options to choose from when enrolling in employer coverage, Medicare provides you with dozens of options. Medicare allows you to tailor your coverage to your specific needs.

9. Medicare will notify me when it’s time to enroll.

Obviously you don’t want to be late enrolling in Medicare. Nobody wants to have a penalty added to their premium. Unfortunately, Medicare does not give you an enrollment reminder when it’s time for you to enroll. The good news is that if you have Social Security Benefits or RRB before you’re 65, you will automatically enroll in Medicare Parts A and B. On the other hand, if you don’t have those benefits you have to remember to enroll on your own. So, it’s important that you note the specific times when you can enroll. 

10. I am on COBRA so I don’t need to sign up for Medicare Part B.

COBRA does not count as active employment. To delay Part B enrollment without incurring a penalty, you or your spouse must be actively employed and covered by a group health plan. Additionally, if you are already on COBRA and your Medicare begins, your COBRA status will change when you turn 65. Meaning your COBRA coverage will end. You won’t be eligible to delay Part B without incurring a penalty. You may even experience a delay in the start of your Part B coverage, which could result in a serious coverage gap.

EZ Can Help

Now that you have all the facts it’s time to enroll with the help of EZ. EZ is able to help you enroll in Medicare, purchase a Medicare Supplement Plan, or just help you weigh your options. Our insurance agents collaborate with some of the most reputable insurance providers in the country. They are able to provide you with a free analysis that compares all of the plans that are available in your region. We will discuss your medical and financial needs and then assist you in locating a plan that is tailored to meet those requirements. To start, enter your zip code into the box below. Or give one of our licensed agents a call at 877-670-3602 and we’ll get the ball rolling for you.

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Medicare Part B Premiums to Drop 3% Next Year

The government has finally announced the new standard monthly premiums for Medicare Part B. And after all the speculation about rate hikes, rates will actually be decreasing a little bit next year. Not only that, but the annual deductible for Medicare Part B will also be lower next year. With many Medicare beneficiaries struggling with increased healthcare costs, this decrease in rates should be helpful. So what will you be paying for Medicare Part B in 2023?piggy bank on a calendar with money sticking out of it and article title written across

Medicare Part B Premium

The new standard monthly premium for Part B will be $164.90 next year, which is about 3% lower than it is this year.  

2022 saw a large increase in Medicare Part B premiums because of projected spending on Aduhelm, a new drug for treating Alzheimer’s disease. Now that spending on the drug, and other treatments and services, has gone down, Part B once again has more financial reserves. This is allowing Medicare to lower next year’s premiums for Medicare beneficiaries.

Medicare Deductiblesblack envelope filled with money

Medicare Part B premiums are not the only costs that are going down. The annual deductible for Part B will be $226 for 2023, which is a $7 decrease from $233 in 2022.

But while the Medicare Part B deductible is going down, the deductible for Medicare Part A will go up $44 from this year’s $1556, making it $1,600 in 2023. For the 61st through 90th day of hospitalization, coinsurance will be $400 per day, up from $389 this year. For lifetime reserve days, the charge will be $800 per day (up from $778 in 2022).

IRMAA Changes

Income-related adjustment amounts, or IRMAAs, will kick in for single beneficiaries at the modified adjusted gross income amount of more than $97,000, up from $91,000 this year. For married beneficiaries filing a joint tax return, the extra monthly charge will apply if income is above $194,000, up from $182,000 this year.

Want To Save More?

If you need help paying for the things that Medicare doesn’t cover, you have the option of purchasing a Medicare Supplement Plan. Your plan can help pay for the things that Medicare does not, including the 20% coinsurance that you will have to pay out-of-pocket for every Part B expense. One of these plans could cover 100% of your Part A coinsurance and hospital costs, as well as 100% of Part B coinsurance and copayments, for one low monthly premium price. 

 

There are 10 different Medicare Supplement Plans to choose from, each offering different coverage options and rates. It’s worth looking into a Medicare Supplement Plan to save as much money as you can, so speak to an EZ agent for all of your options. EZ’s agents work with the top-rated insurance companies in the nation and can compare plans in minutes for you at no cost. To get free instant quotes for plans that cover your current doctors, simply enter your zip code in the bar on the side, or to speak to a licensed agent, call 888-753-7207.

What Medicare Part A’s Belly-Up Date Means for You

According to the June 2022 Medicare trustees report, the Medicare Hospital Insurance trust fund will run out of money in 2028 if things continue at their current pace. If this trust fund is depleted, and Medicare does go “belly up”, the program will not have enough revenue to cover all of its operating costs. This would most likely result in a financial shock to hospitals that rely on Medicare revenues to operate. Find out just what all of this means for you. 

What Does the Part A Belly-Up Date Mean For Beneficiaries?

stethescope with a calculator behind it and money sign
If the Medicare insurance trust fund runs out of money, this could result in a backlog to payments, which will affect beneficiaries.

As stated, if the Medicare insurance trust fund runs out of money, this could result in a backlog to payments, and financial shock to the whole program. “This part of the Medicare program won’t be able to make payments to health care providers and health insurers that are due, and those payments will become increasingly delayed over time,” says Matthew Fiedler, a senior fellow with the USC-Brookings Schaeffer Initiative for Health Policy.

And what does this mean for Medicare beneficiaries? In short, costs would rise in order to help make up for some of the shortfall. But there are a number of different ways to address this problem being looked at, all of which will affect how much you will pay in the present for Medicare, if implemented.

How Can Medicare Be Fixed?

There are a few options that Medicare officials are looking at  to help with the situation, including tweaking service coverage in order to redirect revenues. This would mean, for example:

  • Moving some Medicare Part A services to Part B-  Some experts suggest moving post-acute services (such as physical therapy or nursing care after a hospital stay) from being covered by Part A to being covered by Part B. This solution might look good on paper, but other experts are concerned it wouldn’t make a real difference. 

“That makes the Part A trust fund look better, because you’ve taken some of the expenses off the books,” says Dr. Mark McClellan, the Robert J. Margolis professor of business, medicine and policy at Duke University, who holds a doctorate in economics. “But that’s not really changing the overall cost or sustainability of the program.”  

For Medicare beneficiaries, doing this would mean services that used to be 100% covered under Part A would now be subject to the Part B deductible and 20% coinsurance.medications

  • Modernize the Medicare drug benefit– The government pays the majority of the bill for high-cost drugs. One option to cut costs is to cover less of these drug costs, and apply those savings to the Part A trust fund.
  • Cut payments to providers- If the government were to reduce Medicare payments to some or all Part A providers, it would save the program a lot of money. But while that would have less of a financial impact on beneficiaries, it would reduce access to some providers, or mean that some providers would offer services that weren’t covered by Medicare, to increase their revenues. 

Finding The Most Savings 

With all the talk of Medicare raising prices, you might feel a little overwhelmed, especially by the costs of Medicare Part B. Your best option to keep yourself financially on track? A Medicare Supplement Plan, which will cover most of your medical expenses for a low monthly price. 

At EZ.Insure, we are trained to be on your side and get you the best plan for your budget. Get an instant quote by typing your zip code in the bar above, or speak with someone now. To get free instant quotes on plans that cover your current doctors, simply enter your zip code in the bar on the side, or to speak to a local licensed agent, call 888-753-7207. We want to help you get coverage, not help insurance companies get right. We know how hard it is dealing with a ton of phone calls and agents hounding you, which is why we want to help – we work for you. Let us help you today!

The Top 6 Things Medicare Beneficiaries Pay For Out-Of-Pocket & How You Can Save More Next Year

Did you know that out-of-pocket costs top the list of considerations when picking a Medicare plan? In fact, based on a report by eHealth, around 29% of Medicare beneficiaries say finding a plan with affordable out-of-pocket costs is the most important thing to them, while 27% say affordable premiums are most important, and 26% cite coverage for their preferred doctors and hospitals. So, if you’re like most Medicare beneficiaries, and are living on a fixed income, you’re looking to save as much money as possible. Before the Medicare AEP is over (December 7), make sure to review the following top 6 out-of-pocket costs you can expect next year, so you can choose the plan that will save you the most money. 

1. Premiums

You will have a monthly Medicare premium to pay:

illustration of an invoice being handed to another hand tats holding money

  • Part B premiums for 2022 have not been released yet, but for 2021, they were $148.50/month, and you can expect next year to be slightly more. 
  • There generally is no monthly premium for Part A if you worked 40 quarters or 10 years. If you worked less than that, you can expect to pay a monthly premium ($471 per month for 2021).

2. Deductibles & Coinsurance

Deductibles are the amount  you will pay out-of-pocket before your coverage begins and Medicare starts paying for your medical services. For each benefit period, you will need to meet a Part A deductible (for 2021 it was $1,484); you will also need to meet a Medicare Part B deductible each year, which was $203 in 2021. 

You will also be responsible for Medicare coinsurance:

  • Part A: After 60 days in a hospital, Medicare charges a coinsurance per day for days 61-90. After 20 days in a skilled nursing facility, you will have to pay coinsurance each day for days 21-100. After 100 days, you pay all costs out-of-pocket.
  • Part B will only cover 80% of your medical expenses, after you meet your deductible. This leaves you to account for the other 20% out-of-pocket. 

3. Prescription Coverage

illustration of a white prescription bottle with a blue cross in the middle and blue circle around it
Prescriptions can cost a lot of money if you have chronic conditions, but you can save if you compare plans.

If you have a Part D plan, your monthly premiums will be based on which plan you purchased, and your prescription drug coverage costs will depend on which formulary your medication is in. Different prescription drug plans will place medications on different tiers, so your drugs might cost more or less depending on which plan you choose. 

4. Late-enrollment Penalties

You are supposed to enroll in Medicare when you turn 65, and if you miss the deadline to enroll,  you will face a late enrollment penalty. You can expect to pay:

  • Part A: You will pay 10% of your monthly premium for twice the number of years you were eligible but did not enroll in Medicare.
  • Part B: You will pay 10% of your monthly premium multiplied by the number of years you went without Medicare after you were initially eligible.

5. Non-covered Services

You need to budget for common medical needs that Medicare does not cover, such as routine eye care, dental care, and hearing aids. 

6. Medicare Supplement Plan

Many Medicare beneficiaries  purchase a Medicare Supplement Plan because it covers the Part B coinsurance (the 20% of medical expenses you owe out-of-pocket), amongst other services. These plans are relatively affordable, saving you money on your out-of-pockets expenses for a low monthly premium. There are 10 different plans to choose from, so you can pick the one that meets your specific medical needs and budget. 

The Medicare Annual Enrollment Period is a very important time when you can look for a plan that better suits your needs, and save some money. The AEP is coming to an end, so now is the time to think about your budget, review the out-of-pocket costs mentioned, and find ways you can cut down on costs, such as by purchasing a Medicare Supplement Plan. If you need help comparing plans, EZ can help – we will provide you with an agent who will compare plans in your area for free. No obligation. To get free instant quotes for plans that cover your current doctors, simply enter your zip code in the bar on the side, or to speak to a local licensed agent, call 888-753-7207.

Are Glaucoma Screenings Covered By Medicare?

Glaucoma is the cause of approximately 10% of cases of total blindness in the U.S. It mainly affects people over the age of 65; in fact, the American Academy of Family Physicians notes that about 75% of those who are legally blind because of glaucoma are older adults. What’s worse is that doctors believe that about half of all people with glaucoma have yet to be diagnosed. In order to help save your sight, it is important to get screened for this disorder. If you have Medicare Part B, then you need to know how glaucoma screenings are covered.

illustration of an eye with it partially open showing the nerves and inside
Glaucoma mainly affects people over 65 years old, and can cause blindness.

What Is Glaucoma?

Glaucoma damages the optic nerve at the back of the eye and can lead to partial vision loss or blindness. It is often hereditary. There are three different types of glaucoma:

  • Primary open-angle glaucoma- causes gradual vision loss, and typically has no other signs or symptoms.
  • Normal tension glaucoma- the nerve is damaged even if there is no high fluid pressure in the eye. Eyesight changes in the center of the person’s vision.
  • Angle-closure glaucoma– a rarer type that develops quickly when fluid cannot drain from the eye. Symptoms include nausea, eye pain, headache, and sudden loss of vision.

Vision loss can happen gradually, so you may not notice anything until the damage is already done. This is why it is important to get screened for glaucoma regularly.

The Test

Glaucoma screenings are fairly simple. The doctor will put drops in your eyes to dilate them and then will use instruments to conduct the following tests:

caucasian woman looking into eye machine to look at an other womans eye that has a laser light on it

  • Tonometry: measures fluid pressure behind your eye.
  • Ophthalmoscopy: examines your optic nerve.
  • Perimetry: tests your peripheral vision.
  • Gonioscopy: inspects the angle where your iris and cornea meet.
  • Pachymetry: measures the thickness of your cornea.

Medicare Coverage & Costs

Medicare part B will cover one glaucoma screening test every 12 months if you’re considered high-risk. High-risk individuals are those who:

  • Are over the age of 60 
  • Have diabetes
  • Have a family history of glaucoma
  • Are African American and age 50 or older
  • Are Hispanic American and age 65 or older

Once you have met your deductible, Medicare will pay for 80% of the screening, and you will pay 20% of the Medicare-approved amount for the test. If the test is done in an outpatient setting, you might also be responsible for any facility charges. If you require surgery to treat the glaucoma,  Medicare Part A will pay for it.

hundred dollar bill sticking out of a wallet.
Medicare Supplement Plans will help pay for what Original Medicare does not cover, which puts more money back in your wallet.

Medicare Supplement Plan

As with most medical services, Medicare only covers 80% of glaucoma screenings. The 20% that you have to pay out-of-pocket for services can start to add up, especially if you are living on a fixed income. Medicare Supplement Plans help cover the gaps in your Medicare coverage, including your 20% out-of-pocket payments. There are 10 different Medicare Supplement Plans to choose from, all with different coverage at different price points. This means that you will be sure to find  one that suits your needs.

To easily compare Medicare Supplement Plans in minutes, and to find an affordable plan that helps you save hundreds of dollars, talk to an EZ agent. Our agent will do all the work for you, inform you of the differences between each plan, and help you figure out which one will best suit your financial and medical needs. There is no obligation, just free quotes. Start comparing quotes for free by entering your zip code in the bar above, or to speak directly to one of our licensed agents, call 888-753-7207.