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.
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.
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.
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.
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.
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.
Last year, there was new hope in the fight against Alzheimer’s disease when a new drug, Aduhelm, was approved for use to combat the disease. But now Medicare officials have announced their final decision to cover this drug only for people who receive it as participants in a clinical trial. This is good and bad news: while the drug won’t be as widely available, Medicare officials are considering cutting premiums for all beneficiaries, since the new drug was the reason for the $22 increase in Medicare’s Part B premiums this year.
The Price of Aduhelm
Aduhelm hit the market as the first new Alzheimer’s medication in nearly two decades, and many hoped it would be a breakthrough in fighting the disease. It was first priced at $56,000 a year, and was expected to generate billions for the company that developed it, Biogen. This astronomical price did eventually come down to $28,000 a year, but this price tag is still too high for Medicare.
Doctors have been hesitant to prescribe it, given the lack of coverage and weak evidence that the drug slows the progression of Alzheimer’s.
Insurance companies have blocked or restricted coverage.
Medicare Part B premiums have gone up $22 a month, the largest increase ever.
The Future Of Aduhelm
After all the concerns from insurers, doctors, and advocacy groups, Medicare decided to restrict the new drug, and only allow coverage for it for people involved in clinical trials. Dr. Lee Fleisher, the chief medical officer at the Medicare agency, explained this decision by saying that this way of dealing with the fast-developing field of Alzheimer’s therapies, a program called Coverage with Evidence Development, “is meant to be nimble and really respond to any new drugs in this class that are in the pipeline, and do demonstrate clinical benefit.”
But Medicare is also trying to make the trials accessible to more people: instead of requiring randomized controlled trials to be approved by C.M.S., Medicare will cover participants in any trial approved by the F.D.A. or the National Institutes of Health. This will allow the trials to be done in more locations, not just in hospital settings, and to include people with other neurological conditions like Down syndrome, many of whom develop Alzheimer’s but were not included in earlier trials.
Officials are hoping to lower Medicare Part B Premiums since the cost of Aduhelm has gone down.
In the trials, “the manufacturers will have to come to us with how are they going to include all patients that represent the Medicare population, and how are they going to ensure that all of these patients are getting appropriate medical treatment and monitoring of their treatment while they’re in each of these studies,” Tamara Syrek Jensen, the director of coverage and analysis for the Medicare agency’s Center for Clinical Standards and Quality, said in an interview.
Medicare Premiums
In the meantime, Medicare officials are in talks to hopefully lower Medicare Part B premiums now that they will not be covering Aduhelm for all Medicare beneficiaries, and now that the drug is coming down in price.
If you are one of the millions of Medicare beneficiaries who are living on a fixed income, saving as much money as possible is a top priority. The best way to save money on healthcare is to find an affordable Medicare Supplement Plan – and the best way to do that? Speak to an EZ agent! We work with the top-rated insurance companies in the nation and can help find a plan that will save you money this year – maybe even hundreds of dollars. Let our agents take the stress off you by comparing plans and finding ways to help you save money. And because we want to help you save as much money as possible, our services are completely free- no-obligation or hassle. 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.
Tax season is almost over, so as you’re getting everything squared away, you might also want to think about how your taxes will affect your Medicare premiums in the coming years. In fact, you should know that how you file your taxes this year can determine your premiums for 2023 and beyond, and if you’re married or upper-income, you might be in for some surprises. Find out exactly how your taxes this year will affect your future Medicare premiums.
Medicare Part B Premiums
When it comes to Medicare premiums, most individuals will pay the base Part B premium of $170.10 per covered person. Higher-income individuals, though, will not only pay the Part B premium, but will also pay a surcharge, or an income related monthly adjustment amount (IRMAA) on top of it.
How is this IRMAA determined? Your monthly premium depends on your modified adjusted gross income (MAGI) as reported on your 1040 form from two years ago. Your MAGI is your household’s adjusted gross income after any tax-exempt interest income and after factoring in certain tax deductions. So, that means your 2023 premiums will depend on the 2021 MAGI you reported on the 1040 form that you filed in 2021.
For 2022, an IRMAA will apply if you:
Filed individually in 2020, and reported modified adjusted gross income (MAGI) for that year in excess of $91,000.
Filed jointly for 2020 and reported MAGI for that year in excess of $182,000.
Deducting Medicare Premiums
If you’re paying a lot for your Medicare premiums, the good news is that you can write them off, as well as any other qualifying health care expenses from the year. In order to do this, you will have to itemize your deductions, and you can only include out-of-pocket medical expenses that exceed 7.5% of your adjusted gross income (AGI).
In addition, if you are self-employed, you can deduct your premiums on Schedule 1 of your 1040 form as an “above the line” deduction, which will lower your AGI. The IRS considers you to be self-employed if you own a business as either a sole proprietor (Schedule C), partner (Schedule E), limited liability company (LLC) member, or S corporation shareholder with at least 2% of company stock.
So remember: what you do with your 2021 1040 form can impact your 2023 Medicare premiums. If you do have a higher income, and are worried about what your premiums will look like in the next few years, try to itemize to get some money back, so you can hopefully offset some of your medical expenses.
A few weeks ago, Medicare announced the new Part B premiums for 2022. While the Centers for Medicare and Medicaid Services (CMS) had projected a rise in premiums of 6.7% earlier in 2021, the actual increase in Part B premiums for 2022 is 14.5%, the largest increase ever seen. The huge increase is partly based on the potential cost of covering Aduhelm, a new drug to treat Alzheimer’s disease.
This massive increase will take premiums for beneficiaries in the lowest income bracket from $148.50 a month to $170.10 a month, which could be difficult for many Medicare beneficiaries living on a fixed income to afford. But now there is a chance that Medicare Part B premiums might be reduced.
The Reason For The $21.60 Hike
Medicare Part B premiums were hiked up to cover the new Alzheimer’s drug that has been approved by the FDA.
By law, CMS is required to set each year’s Part B premium at 25% of the estimated costs that will be incurred by that part of the program. One of the main reasons CMS gave for the large spike in Medicare Part B premiums for 2022 was that it needed to set aside money to cover Adulhem, the new Alzheimer’s drug that has recently been approved by the FDA. It was estimated that the drug would cost $56,000 a year.
Now the medication’s manufacturer, Biogen, has estimated that the drug will actually cost $28,200 a year. Because of this projected change in price, the Department of Health and Human Services is asking for a re-assessment of Medicare Part B premiums.
The Push To Reduce Premiums
Department of Health and Human Services Secretary Xavier Becerra has ordered the Centers for Medicare & Medicaid Services to reassess this year’s standard premium. “With the 50% price drop of Aduhelm on Jan. 1, there is a compelling basis for CMS to reexamine the previous recommendation,” Becerra said.
Other organizations are also calling for a reduction in Part B premiums. “It is unconscionable for a single outrageously priced drug to drive up premiums for all Medicare beneficiaries – many of whom are already struggling to make ends meet,” said Nancy LeaMond, AARP executive vice president and chief advocacy and engagement officer. “Now that the drugmaker has cut the price in half, the Medicare Part B premium increase should be lowered as well.
“This also highlights the importance of giving Medicare the authority to negotiate drug prices. Without it, we’ll keep seeing sky-high drug prices leading to premium hikes and higher out-of-pocket expenses for older Americans.”
A CMS spokesperson said the agency is “reviewing the secretary’s statement to determine next steps.”
You can save hundreds of dollars with a Medicare Supplement Plan.
Save Money
If you are like one of the millions of Medicare beneficiaries who are living on a fixed income, saving as much money as possible is a top priority. The best way to save money on healthcare is to find an affordable Medicare Supplement Plan – and the best way to do that? Speak to an EZ agent! We work with the top-rated insurance companies in the nation and can help find a plan that will save you money this year – maybe even hundreds of dollars. Let our agents take the stress off you by comparing plans and finding ways to help you save money. And because we want to help you save as much money as possible, our services are completely free- no obligation or hassle. 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.
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
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.
