medicare part A Archives

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.

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!

Are Plastic Surgeries Covered by Medicare?

When you think of plastic surgery, the Kardashians or a Real Housewife of some random city probably come to mind, but what they’ve actually had is cosmetic surgery. There is a difference between the 2 and if you have Medicare, the good news is one of them may be covered.

Plastic Surgery vs. Cosmetic Surgery

bare back — Medicare will cover breast reconstruction after breast cancer surgery.

Plastic surgery is a procedure performed because it’s medically necessary. That means you need it for medical reasons to improve the health or function of your body. Plastic surgery is sometimes referred to as reconstructive surgery. You may need plastic surgery for medical reasons after an accident, infection, tumor, malformation of a body party or other disease, such as breast cancer. Some examples of medically necessary plastic surgery covered by Medicare include treatment for severe burns, facial reconstruction following a car accident, or a breast reconstruction after a partial or full mastectomy. Cosmetic surgery is a type of plastic surgery used to enhance the natural features of the body. Surgeons generally perform cosmetic surgery to reshape normal structures of the body to improve your appearance or enhance your self-esteem. These are generally not covered by Medicare. If you’re looking to get a breast lift, facelift, neck lift, or chemical peels covered, you’re out of luck because those are considered cosmetic and are not medically necessary.

Cosmetic Surgery for Medical Reasons

Medicare may pay for a cosmetic surgery if you need it for medical reasons but you must obtain prior authorization. This means your doctor must send a prior authorization request to Medicare for approval before performing the procedure. If Medicare approves the request, you’ll pay your Medicare Part A and/or B deductible and coinsurance costs, depending on the setting of your plastic surgery, such as inpatient or outpatient. Some examples of cosmetic surgeries that may be considered medically necessary are botox to treat muscle disorders or a nose job to correct structural nose defects that affect your breathing. An eyelid surgery to remove excess tissue around your eye that may be impairing your peripheral vision would probably qualify as medically necessary as well. Only your doctor can determine whether your procedure is medically necessary so be sure to have a thorough conversation with them before going through with a procedure.

Find a Medicare Supplement Plan

eye surgery — Medicare Supplement Plans may help cover costs of certain types of plastic surgeries.

There are many reasons why you might need or want plastic surgery. Luckily Medicare Parts A and B may cover plastic surgery if you need it for medical reasons. If your plastic surgery is covered by Medicare, you may be able to find a Medicare Supplement Insurance plan that helps pay for some of your Medicare copays, deductibles and more and EZ can help. Our agents work with the top-rated insurance companies in the nation, which makes comparing plans easy, quick, and free. To get free instant quotes on plans that cover your doctors, simply enter your zip code in the bar above, or to speak to a local licensed agent, call 888-753-7207.

Do You Need a Referral With a Medicare Supplement Plan?

If you’ve had private health insurance, you’ve probably had to get referrals before seeing certain doctors. These referrals are pre-approvals that you need to get from your primary care physician before seeing a specialist within the same network; we often associate them with certain types of private insurance plans. But now that you’re on Medicare, or are about to enroll, you might be wondering: do you need referrals to see specialists if you’re on Medicare?

Are Referrals Necessary?

The good news is that Original Medicare (Parts A and B) doesn’t require referrals for specialist care. However, if you have Part A or Part B coverage through a Medicare Advantage (Part C) Plan, you might need a referral before seeing a specialist.

In addition, if you have a Medicare Supplement Plan, you will not need a referral to see a specialist: you will be able to go to any doctor, hospital, or other provider in the country who accepts Medicare. This means that Medicare Supplement Plans offer some of the best coverage out there: all you have to pay is your monthly premium and you get all the benefits of Original Medicare, plus a lot of extras. For example, your plan will cover what Original Medicare does not, including the 20% coinsurance that you need to pay when you receive medical treatment.

What Medicare Supplement Plans Have to Offer

In addition to the ability to see a specialist without a referral, all Medicare Supplement Plans also offer coverage for at least part of:

Medicare Parts A and B deductibles
Skilled nursing facility costs (after you run out of Medicare-covered days)
Medicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used up)
Medicare Part B coinsurance or copayment
Part B excess charges
Part A hospice care coinsurance or copayment
Blood (first 3 pints)

Two Medicare Supplement Plans (Plans K and L) include an out-of-pocket limit. This means that once you have reached a certain amount spent on Medicare-covered services, the plan will cover 100% of Medicare-covered costs for the rest of the year.

Looking For A Medicare Supplement Plan?

As stated, Medicare Part B, which covers the costs of most medical services, only covers 80% of these costs. This will leave you with the remaining 20% to pay out-of-pocket, but a Medicare Supplement Plan can help you pay for the medical expenses that aren’t covered by Medicare Part B. One of these plans can help you save hundreds, or maybe even thousands of dollars each year.

There are 10 different plans to choose from, and depending on which plan you choose, you could get anywhere from 75% coverage of your medical expenses up to 100%. Each plan offers a range of coverage at different price points, and can help save you money and keep you from stressing over medical bills, leaving you with more time and energy to focus on your health.

EZ can compare all 10 Medicare Supplement Plans and find the one that will meet your financial and medical needs. Our agents work with the top-rated insurance companies in the nation, which makes comparing plans easy, quick, and free – our services come at no cost to you because we just want to help you save money so you can focus on your health. To get free instant quotes on plans that cover your doctors, simply enter your zip code in the bar above, or to speak to a local licensed agent, call 888-753-7207.

Medicare Reimbursement: How It Works

If you’re on Medicare, you know by now that Medicare doesn’t cover everything. You have to meet your deductibles each year, and pay your copays and coinsurance for your doctor visits. There are also some doctors who will charge more than the Medicare-approved amount for services, meaning you’ll have to pay more out-of-pocket to see them. But did you know that you can submit a claim to Medicare to receive some of your money back for some of the care that you receive? So how does Medicare reimbursement work?

Medicare Payment Process

Medicare billing works pretty similarly to that of private health insurance, except that you can see any medical provider, as long as they accept Medicare assignment. As long as they accept Medicare, your medical provider will bill Medicare, who will then pay the agreed-upon rate to the medical provider. You’ll then be left to pay the remaining out-of-pocket costs, or the coinsurance/copay.

But if you see a non-participating provider who does not agree to accept Medicare rates, they can choose to charge more than the Medicare reimbursement amount for services. Medicare allows out-of-network providers to charge up to 15% more than the approved amount for their services, also known as the limiting charge. Whatever rate they charge, you will need to pay the bill out-of-pocket and then file a claim for Medicare reimbursement.

Original Medicare

If you ever find yourself needing to pay for services upfront, you will need to file a claim with Medicare to get reimbursed. Here’s what you need to know:

The provider has 1 year to submit a bill for their services to a Medicare Administrative Contractor.
If the provider does not file within the time limit, you must complete Patient Request for Medical Payment Form 1490S.
You will have to provide itemized bills and a letter explaining why you are submitting a claim.
You will receive a Medicare Summary Notice (MSN) in the mail every 3 months, which will outline any claims for reimbursements.
Medicare Part B will reimburse 80% of the Medicare-approved amount for the healthcare services you received.

Medicare Supplement Plans

gold piggy bank — *A Medicare Supplement Plan can help you save hundreds of dollars a year on medical expenses.*

If you want to avoid having to pay for medical services out-of-pocket, you should consider a Medicare Supplement Plan. These plans work with Original Medicare to provide extra coverage for what Medicare doesn’t cover. 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.

Are Medicare Parts A & B Enough?

If you’re enrolled in Medicare, you have the ability to change your plan once a year during the Medicare Annual Enrollment Period (AEP). The AEP is less than 2 months long, lasting from October 15 to December 7, and is the time to review your Medicare options and find ways to save money on medical expenses: for example, if you only have Medicare Parts A and B, you could be missing out on hundreds of dollars of savings. EZ can help you save money by assessing your financial and medical needs during the AEP.

Medicare Parts A & B Coverage

stethoscope — *Medicare Parts A & B will cover hospital and medical insurance, but will not cover anything.*

If you’ve been enrolled in Medicare for a while, you probably have a good understanding of how it works, but it’s always helpful to have a refresher, because Medicare can get complicated. So, Medicare Part A is hospital insurance, and Part B covers other medical expenses; both allow you to use almost any hospital or doctor within the United States that accepts Medicare assignment.

As far as out-of-pocket costs go, generally there is no monthly premium for Part A, but there is a deductible for each benefit period. Part B has an annual deductible, a monthly premium based on your income, and a 20% coinsurance, meaning you will have to pay 20% of your medical expenses, which can add up to quite a lot, especially if you have a chronic condition or illness.

What You Can Do To Save More

During the AEP, you have the option to make changes to your Medicare coverage: for example, you can change from Original Medicare to a Medicare Advantage Plan, switch Medicare Advantage Plans, enroll in a Part D plan, or change prescription drug plans. But what if you’re not interested in switching to a Medicare Advantage Plan and want to stick with Original Medicare, but want to save money on your out-of-pocket expenses? Well, what a lot of Medicare beneficiaries do not know is that they can buy a Medicare Supplement Plan during the AEP. These plans help fill the gaps in Original Medicare and can save you hundreds of dollars each year because they cover some or all of your:

Part B coinsurance
First three pints of blood
Part A hospice coinsurance

Some plans will offer additional benefits, including covering your:

Part A deductible
Part B excess charges
Skilled nursing facility coinsurance
Foreign travel emergencies that do not qualify for Medicare reimbursement from Medicare Parts A or B

These plans are a great way to save on medical expenses, but be aware that if you are signing up for a Medicare Supplement Plan outside of your Open Enrollment window (the month you turn 65 and the 5 months after that), you might be subject to underwriting, meaning that the insurer might ask you some health questions in order to determine the price of your premiums.

Work With An Agent

There are 10 different Medicare Supplement Plans to choose from, which means there’s sure to be a plan that’s right for you – but that also means it can be confusing and time-consuming to compare them and figure out which one you should choose. To make the process easier for you, work with a licensed EZ agent. Our agents are highly trained, and work with the top-rated insurance companies in the nation; your dedicated agent will assess your medical needs and help you find a plan that will save you as much money as possible, which is important if you are living on a fixed income.

Our services are free, because we just want to help you find an affordable plan with the coverage you need – no obligation, just free quotes. 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.

Medicare Vs Medicaid: Know The Difference

Medicare and Medicaid. These two words are so much alike that many people get them confused. They are both government-sponsored health insurance programs, but that is where the similarities end. One of these programs is for adults 65 and older, while the other is for low-income individuals. It is important to understand the difference between the two, so when it is time to enroll in Medicare, you do not miss the opportunity and end up facing a penalty.

red medical bag in a blue circle — *Medicare Part A and B will help pay for medical services including hospital insurance and medical insurance.*

What is Medicare?

Medicare is a federally-funded program run by the federal government. It is funded by taxpayer dollars as well as by premiums that are paid by beneficiaries. It covers all adults 65 or older; unlike Medicaid, Medicare eligibility is not determined by your income. When you turn 65, you are eligible for Medicare coverage that is broken down into 2 parts: Part A and Part B.

Part A is hospital insurance that covers inpatient medical services and supplies. You can receive premium-free Part A as long as you or your spouse worked and paid Medicare taxes for at least 10 years.
Part B is medical insurance and covers outpatient medical services and supplies. It has monthly premiums that you must pay in order to receive coverage.

When You Can Enroll

You can enroll in Medicare during the 7 month window around your 65th birthday, which includes the 3 months before your birth month, the month of your birth date, and the 3 months after your birth month. If you miss your Initial Enrollment Period, you can enroll during the General Enrollment Period (January through March), but you will have to pay a penalty fee. Your monthly premium may go up 10% for each 12-month period you could’ve had Part B, but didn’t sign up. In most cases, you’ll have to pay this penalty for as long as you have Part B.

The only exception to the Part B late penalty fee is if you or your spouse is still working and you have group coverage through your employer or union. Then you can qualify to enroll in Medicare Part B during an 8-month Special Enrollment Period after losing your employer-based coverage.

Medicare Supplement Plans

Medicare Part B generally covers 80% of your medical expenses, meaning you will have to pay the other 20% coinsurance out of pocket. Depending on your situation, these expenses can add up to a lot of money throughout the year. In order to help with these expenses, you can choose to purchase a Medicare Supplement Plan when you enroll in Medicare. These plans will pay the 20% coinsurance that Original Medicare does not pay, as well as other healthcare expenses, like deductibles and copays.

What Is Medicaid?

black and white picture of a pregnant woman's belly with a little girl laying her head against the belly. — Medicaid qualifications are dependent on family status, pregnancy, and more.

Medicaid is a health insurance program that is jointly funded by states and the federal government. It is voluntary and is offered based on income, generally to low-income individuals or families. Medicaid qualifications are broadly based on:

Income
Disability
Pregnancy
Age
Household size
Family status

Medicaid covers major medical expenses and is required to cover certain care. Medicaid beneficiaries pay premiums, deductibles, copays and coinsurance.

Medicare and Medicaid may sound the same, but when it comes to coverage and eligibility, they are not the same at all. When you are approaching age 65, it is important to know how to enroll in Medicare, because the longer you push it off, the more you will pay. In order to get properly insured, contact an EZ.Insure agent. We will provide you with expert Medicare help, and even compare Medicare Supplement Plans for free. We want to make the transition from regular health insurance to Medicare as smooth as possible. In order to do this, we will go over your needs and compare all Medicare Supplement Plans to find a plan that will save you hundreds of dollars each year.

To compare quotes within minutes, simply enter your zip code in the bar above, or to speak directly with an agent, call 888-753-7207.