medicare coverage Archives - Page 2 of 8

Does Medicare Cover Cosmetic or Reconstructive Surgery?

It’s no secret that cosmetic surgery is popular in this country – and it’s been increasing in popularity with older adults in particular. Understandably, many older adults want to look good and feel good about themselves. Which is probably why Americans aged 55 and up accounted for nearly 4.2 million cosmetic procedures in 2020. And because most of the seniors getting this type of surgery are within Medicare age, the question is will Medicare cover any of these cosmetic surgeries? The answer to that question is generally no but is dependent on a few factors.

Medicare & Cosmetic Surgery

As we said, Medicare usually will not cover cosmetic surgery. But there are some exceptions: if the surgery will improve the function of deformities or abnormal body parts, or it is considered a reconstructive surgery, you might be able to get coverage.

illustration of a penguin in doctor's scrubs and a scalpal Medicare may cover the following surgeries with prior authorization:

Blepharoplasty – Eyelid surgery that Medicare might cover if it could functionally improve your vision. This can include the removal of droopy, fatty eyelids.
Botox – Medicare might cover this neurotoxin injection for the treatment of chronic migraines in adult patients, but botox to specifically treat skin wrinkles is not covered by Medicare.
Panniculectomy -Surgery to remove excess skin and tissue from your lower abdomen. Medicare does not cover panniculectomy for cosmetic purposes.
Rhinoplasty – Nasal surgery that Medicare might cover to improve nasal respiratory function. For example, they will cover it if it improves a nasal airway obstruction.
Vein ablation – The treatment of varicose veins of the lower extremities. Spider veins are most often treated for cosmetic purposes. So Medicare usually won’t cover vein ablation but can be in rare instances.

Medicare & Reconstructive Surgery

If you need reconstructive surgery due to one of the conditions above, or some other injury or disease, Medicare might cover it. Outpatient cosmetic services covered by Medicare Part B require prior authorization. And if medically approved, you will only have to meet your deductible and pay your 20% coinsurance.

Need Help?

If you do need reconstructive surgery, that 20% coinsurance might seem a bit daunting, but there is help available. A Medicare Supplement Plan can help cover the out-of-pocket costs that Original Medicare does not cover. 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.

Does Medicare Cover Dental Implants?

As you age, your teeth might require more care, and you might even lose some or all of your teeth. In fact, one in five adults 65 and older have lost all of their teeth, which can take a major toll on their overall health. Dental implants can help, but they can be quite expensive. If you are considering getting a dental implant, you are probably wondering how much it will cost and if Medicare will cover it.

Dental Implant Surgery Costs

green price tag — *The average price for a single implant can be around $3,500 to $6,000.*

Dental implant surgery is a procedure in which artificial teeth with metal posts are secured in your jawbone to replace damaged or missing teeth. The price of dental implants can vary depending on how many teeth you need to have replaced, but the average price for a single implant can be around $3,500 to $6,000. This can feel like an overwhelming amount of money if you need multiple implants, so is there any way to get them covered?

What Medicare Covers

Unfortunately, Medicare does not generally cover routine dental services, including implants. There are exceptions, though: for example, Medicare Part A will pay for some dental services if you are in an inpatient setting. And if you are in an accident and require dental services, Medicare will cover the costs.

In addition, there are several stand-alone dental plans available that will help cover the cost of dental implants. These plans often group dental coverage with additional coverage for vision and hearing, as Original Medicare doesn’t cover those services, either.

If you do choose to pay for dental surgery, and there are any health concerns or issues after the surgery, Original Medicare will cover the costs of treatment.

Extra Coverage

If you are looking for extra coverage apart from a dental and vision plan, a Medicare Supplement Plan is the way to go. Although Medicare Supplement Plans, like Original Medicare, do not provide dental coverage, if your procedure occurs in an inpatient setting or additional health issues arise after you get dental implants, your Medicare Supplement Plan will cover those related costs. This extra coverage can save you hundreds, even thousands of dollars each year.

There are 10 different types of 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 for you in minutes 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.

Ready To Travel? Make Sure You’re Insured!

Now that travel restrictions are finally being lifted, and people are getting back to traveling, you might be thinking that it’s time for you to get back out there, too. But before you do, you should check a few things off of your list: along with grabbing your passport, vaccination card, and itinerary, you need to make sure you are fully insured before you travel! This is especially important if you are older and on Medicare, because Medicare coverage for overseas travel is limited. If you travel to another country and get hurt, you’ll have to pay your medical bills out-of-pocket, unless you are properly insured.

person's hand holding a boarding pass — *Medicare will cover you anywhere in the U.S. but not when you travel outside of the U.S.*

Medicare Coverage For Travel

If you are a Medicare beneficiary and are traveling within the U.S., you will have coverage anywhere in the U.S. and its territories. This includes all 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. As long as the hospital and/or doctor that you visit accept Medicare assignment, you will be fully covered. If you are traveling abroad, however, it’s a different story.

When Medicare Will Cover You Abroad

There are very few scenarios in which Original Medicare will actually cover you when you are in a foreign country. These include:

If you live in the United States and have a medical emergency, but the nearest foreign hospital is closer to you than the nearest U.S. hospital.
If you have a medical emergency while you’re traveling to Canada, without unreasonable delay, between Alaska and another U.S. state, and the closest hospital that can treat you is in Canada. Medicare will determine on a case-by-case basis what qualifies as “without unreasonable delay.”
If you live in the United States and the foreign hospital is closer to your home than the nearest U.S. hospital, you can get coverage for certain healthcare services, whether it is an emergency or not.
If you are on a cruise ship and you need to receive medically necessary care while the ship is in U.S. waters or a U.S. port (or within six hours of arrival or departure from a U.S. port).

Extra Coverage

a hand with a bubble over it with an airplane and suitcase in the bubble — *If you want extra coverage when traveling, then a Medicare Supplement Plan can offer you that at an affordable price.*

All of this means that you won’t be fully covered by Original Medicare when traveling abroad, so the best option for getting adequate coverage is a Medicare Supplement Plan. These plans work alongside Original Medicare to provide you with coverage for things, like foreign travel, that Medicare does not cover. Medicare Supplement Plans C, D, F, G, M, and N all provide some sort of foreign travel coverage.

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.

Does Medicare Cover Heart Transplants?

Heart transplants patients are getting older: 1 in 50 people who receive a heart transplant are aged 70 or older. And while heart transplants sound scary, recent studies show that survival rates continue to improve despite an increase in older and higher-risk heart transplant recipients. In fact, approximately 85 to 90% of heart transplant patients are still alive one year after their surgery, with an annual death rate of approximately 4% thereafter, and a three-year survival rate of almost 75%. This is all good news, but if you have to undergo a heart transplant, you are probably concerned about many things, including the cost of the surgery and whether Medicare will cover it.

Why Heart Transplants Become More Necessary With Age

Heart failure develops when your heart can no longer pump enough blood to provide your body with oxygen and nutrients. This can be caused by chronic conditions that you might have; if you reach heart failure, you could come to a point where medication cannot help, and the only option is to receive a heart transplant.

Medicare Coverage

One of the great things about Medicare is that it covers a wide variety of medical services, since there are different parts that cover different things. Part B covers general medical services that you would get from your doctor, and Part A covers services you receive while you’re in the hospital, as well as follow-up care and prescriptions. When it comes to receiving a transplant, Medicare Part A will pay for the surgery, as well as for finding the organ that you will receive during the surgery.

If it is not possible to receive a heart from a donor in time, you can consider receiving an artificial heart, but you should know that Medicare does not cover artificial hearts, whether permanent or temporary.

How Much Will You Pay?

Although Medicare does cover a lot of medical services and treatments, it does not cover everything 100%. Once Medicare approves the surgery, they will cover:

Services provided to prepare for the transplant, including finding the organ
The actual surgery
Follow-up services to ensure the transplant is successful
Any immunosuppressive drugs and other transplant-related prescriptions, if needed

All of the above will be covered at 100%, but you will have out-of-pocket costs, including your:

Medicare Part A deductible
Medicare Part B deductible, which must be fully paid if you receive any services following the surgery, such as rehabilitation.
Medicare Part B coinsurance- Medicare will only cover 80% of any necessary outpatient treatment and therapy sessions you receive, leaving you to pay 20% out-of-pocket

Extra Coverage

As we pointed out above, Medicare Part B will only cover the cost of services or treatment received at 80%, leaving you to pay for the other 20% out-of-pocket. If you have to have major surgery, like a heart transplant, this can be quite expensive, especially if you are living on a fixed income, as many Medicare beneficiaries are. Fortunately, though, you can save money on all your medical expenses and get extra coverage by purchasing a Medicare Supplement Plan.

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 for you in minutes at no cost to you. 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.

Almost Done With Your Medicare “Trial Right”? Want A Different Plan? EZ Can Help

Making the switch from private health insurance to Medicare can be confusing, and even a bit anxiety-inducing. Sure, Medicare is great, but it’s not always easy to navigate if you’re not used to it. There are a lot of little things that people are unaware of when they enroll in Medicare and purchase a Medicare Supplement Plan. For example, did you know that you have a Medicare “trial right”? This right gives you the ability to test out the Medicare Supplement Plan that you’ve purchased, and if you don’t like the plan or it doesn’t work for your needs, you can switch it for another one. But remember, you only have a limited amount of time to do so!

How Long Is Your Medicare Trial Right?

calendar — *You will have 63 days to decide if you want to purchase a Medicare Supplement plan once you’ve switched to Original Medicare.*

You can technically purchase a Medicare Supplement Plan whenever you want, but if you purchase it when you first turn 65, you can avoid the underwriting process. The underwriting process is when the insurer issuing your Medicare Supplement Plan reviews your medical history; they can charge you more for your premiums or deny you coverage based on your health status.

And if you do choose to purchase a Medicare Supplement Plan or even a Medicare Advantage Plan, you have time to try out the plan, known as your trial right. For a Medicare Advantage Plan, you have a full 12 months to try out the plan, and if you think it isn’t right for you, you can switch to Original Medicare and even purchase a Medicare Supplement Plan, as well. The great thing about this trial time is that, even if you choose to switch plans, you can still bypass the underwriting process, and continue to have what is known as a guaranteed issue. You will have 63 days to decide if you want to purchase a Medicare Supplement plan once you’ve switched to Original Medicare.

Now let’s say you purchased a Medicare Supplement Plan when you enrolled in Medicare, but you feel like the plan you chose is not working for you. You will have 30 days to change your plan to a different Medicare Supplement Plan. There are 10 different plans that you can choose from that offer different coverage and premium prices.

Can You Have More Than One Trial Right Period?

Unfortunately, once you exercise your trial right to switch from Medicare Advantage to Original Medicare and a Medicare Supplement Plan, or vice versa, you will not get another chance to switch. If you want to change plans again, you will have to enroll in a Medicare Supplement Plan and go through medical underwriting. However, that does not mean you won’t still be able to find a great, affordable plan! illustration of two people talking

You can work with a Medicare agent to figure out your best option when it comes to your Medicare Supplement Plan, so you can find a plan that covers everything you need covered, and that fits in your budget.

To save as much money as you can, 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 for you in minutes 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.

Does Medicare Cover Occupational Therapy?

As you get older, you might find that it takes a little longer to heal from an injury or recover from an illness and get back on your feet. This is especially true if your injury or illness was so bad that it required you to be hospitalized: in this case, you could need extra help, like occupational therapy to get you back to your old self. But while Medicare will cover your hospital costs, will occupational therapy also be covered? If it isn’t, you could end up with a huge medical bill, so it’s important to know what Medicare will cover, and what you might need a Medicare Supplement Plan to help with.

Occupational Therapy

Occupational therapy is a form of treatment that helps people recover skills that are needed for everyday work and life after going through an injury or illness; it is also useful for people living with a disability. The goal of occupational therapy is to try and get you back to the way you were before your injury or illness, or to help you navigate life with your disability.

When you begin an occupational therapy program, your therapist will make a custom plan for your sessions, and will also provide you with information so you can continue the therapy at home on your own. Your therapist will measure your progress to be sure that you are on track to meet the goals they have set for you; if you are not, they will help you find ways to quickly get back on track.

Studies show that this type of therapy has a high success rate: for example, according to a 2016 study, 77 of 95 clients in a general occupational rehabilitation program were successful in regaining mobility.

Occupational Therapy Coverage

In the past, there was a yearly cap of $1,840 on total Medicare payments for occupational therapy provided in any setting other than a hospital outpatient department, but now Medicare does not impose any limits on how much it will pay for medically necessary occupational therapy services in a calendar year. Medicare will cover occupational therapy as long as it is deemed medically necessary by a physician or healthcare provider.

Medicare Part A

Medicare Part A will cover any medically necessary occupational therapy given in a hospital or rehab facility.

Two-Midnight Rule

Under the ”two-midnight rule,” Medicare Part A can be used to pay for services that you receive if you are expected to stay in the hospital through two midnights. However, Part A should not be used if your hospital stay is not expected to last that long.

Medicare Part B

Medicare Part B will cover occupational therapy when it is received outside of the hospital on an outpatient basis, such as at a doctor’s office, outpatient rehab facility, skilled nursing facility, or at your home. Medicare will cover occupational therapy, physical therapy, and speech-language therapy. With that being said, though, Medicare Part B will only cover 80% of the cost when you go to a Medicare-approved therapist.

Your Out-of-Pocket Expenses

While Medicare will cover a lot of the cost of your occupational therapy, there will still be some out-of-pocket costs that you will be responsible for. You will still be responsible for:

Medicare Part A deductible
Medicare Part B annual deductible before coverage of your occupational therapy begins
Medicare Part B coinsurance of 20% of each treatment

Extra Coverage

Again, Medicare Part B will only cover the cost of your occupational therapy sessions at 80%, leaving you to pay for the other 20% out-of-pocket. This can be quite expensive, especially if you are living on a fixed income, as many Medicare beneficiaries are. Fortunately, though, you can save money on all your medical expenses and get extra coverage by purchasing a Medicare Supplement Plan.

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 for you in minutes 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.