Medicare

Medicare

Medicare
Medicare is the federal health insurance plan for people over age 65 or who are long-term disabled. Eligibility and enrollment is through the Social Security Administration. Medicare has changed over the years, offering additional options for healthcare insurance. Traditional Medicare includes Part A for hospital insurance and Part B for medical coverage, meaning it covers doctor visits and other medical bills. Part C, also called Medicare Advantage, allows private health insurance companies to provide Medicare benefits. Part D is a prescription drug plan. It's important to carefully assess your healthcare needs and which plan is right for you. Learn more about Medicare benefits with expert advice from Sharecare.

Recently Answered

  • 1 Answer
    A
    Most people with diabetes are aware of the benefits of continuous glucose monitoring (CGM). A CGM helps track and monitor trends in blood sugar patterns. Currently, CGM is not covered under Medicare. As a result, millions of seniors with diabetes continue to face unnecessary hospitalizations from hypoglycemia. The Medicare CGM Access Act of 2015 (H.R.1427 / S.804) is a bill that would ensure access to CGM for eligible Medicare patients and help seniors achieve better glucose control and fewer complications.
  • 1 Answer
    A
    Medicare will cover 80% of the cost of three immunosuppressant medications after a transplant.

    If you receive Social Security Disability Income or are over the age of 65, your 80% Medicare coverage for these specific medications will be for the life of your transplanted organ.

    If you receive Medicare benefits primarily due to your end-stage renal disease, the 80% Medicare coverage for these medications will be expected to terminate at the end of three years after transplant.

    If you have another disabling condition that is documented and validated by Social Security and Medicare, it is likely your Medicare benefits will remain intact. 
  • 1 Answer
    A
    For transplant recipients the reality of utilizing Medicare Part D to maximize benefits is not simple, but rather complicated. The intricacies of Medicare Part D involve not only understanding premium costs and benefit stages, but formularies, and particularly for people having transplants, deciphering how Medicare Part B immunosuppressant coverage influences Part D coverage.

    Medicare Part D plans are voluntary prescription drug coverage options offered by private insurance companies who meet standards established by Medicare. Everyone entitled to Medicare Part A (which covers inpatient care in hospitals, skilled nursing facilities, hospice care and some home health care) or enrolled in Medicare Part B (recipients pay a monthly premium for Part B, which helps cover doctor and specified outpatient care and some outpatient medications such as immunosuppressants for qualifying people) qualifies to enroll in a Part D plan.

    Most Medicare recipients will pay a premium to participate in Part D, with premiums varying from plan to plan in each state. Part D plans’ monthly premiums range from less than $20 to greater than $60; however average premiums range from $32.20 to $37 for the average standard plan (Medicare defines standard plan as the minimum coverage that a drug plan most provide).

    If you did not have Medicare Part A when you got your transplant or if you did not have your transplant in a Medicare approved transplant program, your anti-rejection drugs have not been covered by Part B, but may be covered under Part D. 
  • 1 Answer
    A
    Questions you should ask about Medicare for a transplant include:
    • How do I apply for Medicare?
    • Is there a waiting period before I receive benefits?
    • What happens if I’m denied Medicare?
    • Will having savings accounts effect my qualifying for Medicare?
    In order to appropriately answer your questions or concerns regarding these benefits, contact your local Social Security Administration. It is through this office you will be assessed, reviewed and provided your Medicare benefits.

    If you receive disability benefits (i.e., a Social Security disability benefits) you will automatically be enrolled in Medicare two years later.

    Medicare does not cover 100% of charges in most situations. It is important to consider your options related to obtaining a Medicare Supplement or Medi-Gap policy.
  • 1 Answer
    A
    Questions you should ask when looking into Medicare Supplements for a transplant:
    • Will this policy pay the hospital deductible?
    • How expensive is this policy?
    • Are there assistance programs to help purchase these plans?
    • Can I be denied a Medicare Supplement policy?
    It is important to consider your options related to obtaining a Medicare Supplement or Medi-Gap policy. Medicare does not cover 100% of charges in most transplant situations. Medicare usually pays hospitals and healthcare providers on a fixed fee schedule. You will have hospital deductibles and many other expenses not covered by Medicare.
  • 2 Answers
    A
    A , Internal Medicine, answered

    Most insurance plans cover second opinions because they care about you -- and because it makes good financial sense. They’d rather not pay $50,000 for that heart operation when there’s a chance that you need only a $3,500 preventive-medicine plus a statin drug regimen and lifestyle change.  For this reason, many insurers require you to get a second opinion before they’ll pay for certain major procedures.

    Not all insurance plans are so forward thinking, sadly. If you have an HMO or managed care plan, it may not cover a second opinion. Before you whip out your checkbook, though, read your entire policy carefully and check the laws in your state. Some states, including California and New York, have passed laws that guarantee members of HMOs the right to get a second opinion.
    See All 2 Answers
  • 2 Answers
    A
    A , Internal Medicine, answered

    Health insurance companies affect patient care indirectly by driving what tests, medications, and procedures doctors can use to diagnose and treat patients and even which patients doctors can care for. However, the details of these decisions vary greatly based on what type of insurance you have (if any) and whether your doctor (or a hospital) takes it.

    See All 2 Answers
  • 1 Answer
    A
    A , Cardiology (Cardiovascular Disease), answered
    Before you sign up for a health insurance plan, you should ask do some research on the insurance company and find out what the plan covers. As part of the latter, you need to know what kind of treatments the plan considers experimental. After all, if this health insurance plan won't cover an expensive, lifesaving procedure that most other plans will, you should know that up front.

    Generally, government approval for the treatment is the litmus test. That means U.S. Food and Drug Administration (FDA) and Centers for Medicare and Medicaid Services (CMS) have agreed that the procedure is worthy. But seeing if other major insurers in your area are covering a procedure is an excellent means to test the waters of eligibility, because our government agencies often take years to formally evaluate a new procedure. Surprised?
  • 8 Answers
    A
    A , Internal Medicine, answered

    Medicare is the USA’s federal insurance program that helps Americans who are age 65 or older, or who have specific disabilities, pay for hospital care, doctor visits, and some other medical costs. It’s very similar to the health insurance you likely have now, in that you’ll pay premiums, deductibles, and co-pays to use it -- though it won’t be nearly as expensive as the cost of totally private health insurance. (Don’t confuse Medicare with Medicaid, which is a supplemental insurance for persons who have very little or no income or savings, and is often used to pay for nursing-home costs.)

    For more information about Medicare, contact 1-800-633-4227 or www.medicare.gov.

    See All 8 Answers
  • 1 Answer
    A
    A , Cardiology (Cardiovascular Disease), answered
    There was always a big hole in Medicare—namely prescription drug coverage—that the government attempted to address by adding Medicare Part D. (We're still getting to know Part C!) Medicare Part D is a prescription drug benefit program (which went into effect in 2006) that helps pay for 146 different types of prescription drugs identified by US Pharmacopeia.

    Medicare Part D isn't free, it isn't perfect, and it generated a lot of flak nationwide when it was first laid out from people who thought it did far too little to help older Americans pay for incredibly expensive prescription drugs. But it's the plan we have, so let's learn to use it.

    The premium for Part D is about $35 per month, and enrollees have to pay a $250 deductible before Medicare will cover 75% of drug costs…until the total reaches $2,250 (and that can be reached in a blink given the cost of some common medications). After that, you'll have to pay the entire cost of all your prescriptions until you've shelled out another cool $2,850, making the combined total spent on drugs $5,100. After that, Medicare will cover 95% of drug costs approved by the plan.

    Whew. Keep your fingers crossed in hopes that Washington dreams up something simpler and more affordable before too long. Meanwhile, prescription drug cards are one of your best ways to reduce your medication expenses.