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    Wegovy Covered by Medicare: A Possible Game-Changer in Weight Loss for Seniors

    Is Wegovy covered by Medicare?

    It’s official, Medicare has approved the weight loss drug Wegovy to now be covered under Part D of Medicare with certain restrictions.

    Weight management becomes increasingly challenging as we age, and for those navigating the golden years, effective solutions can seem elusive. However, the recent landmark approval of Wegovy, a revolutionary prescription weight loss medication, by Medicare has sparked a glimmer of hope for countless seniors nationwide. This comprehensive guide will enlighten you on the drug Wegovy, its Medicare approval, and how you or your loved ones might be eligible to benefit from this groundbreaking treatment.

    Wegovy covered by Medicare

    Understanding Wegovy: A Beacon of Hope in Obesity Management

    Wegovy, also known by its generic name Semaglutide, has emerged as a beacon of hope for individuals struggling with obesity. A sister to the widely acclaimed medication Ozempic, it has been found to induce significant weight loss, making it a groundbreaking advancement in the world of prescription weight loss drugs. Semaglutide, initially developed for diabetes management, demonstrated remarkable weight loss results during clinical trials, leading to its re-purposing and optimization for obesity treatment.

    How Wegovy Works

    Wegovy works by mimicking a hormone that regulates appetite, leading to a decreased craving for food. It also slows down the process of emptying the stomach, which contributes to a feeling of fullness. The combination of these effects has shown to result in notable weight loss for those participating in the studies.

    The Road to Approval

    Getting Wegovy covered by Medicare

    On June 30, 2021, the U.S. Food and Drug Administration (FDA) granted approval for Wegovy as a chronic weight management treatment in adults with obesity or overweight with at least one weight-related condition. This decision marked a pivotal moment in the approach to obesity treatment, providing a pharmaceutical option that significantly augments traditional methods such as diet and exercise.  In March 2024 the U.S. Food and Drug Administration (FDA) approved an additional indication that Wegovy can be used to reduce the risk of major cardiovascular events such as death, heart attack, or stroke in adults with heart disease and obesity. This approval is what opened the door to Medicare now approving coverage for Wegovy.

    Medicare’s Monumental Decision To Cover Wegovy

    While this decision does not change current regulations barring Medicare from paying for obesity drugs, it does provide benefits for those who are obese and are at risk for a cardiovascular event.

    What Medicare’s Approval Means for Seniors

    Medicare’s endorsement of Wegovy gives seniors access to a potentially life-changing medication that was previously out of reach for many due to cost considerations. The coverage under Medicare Part D Prescription Drug plans significantly lowers the financial barrier, potentially expanding the reach of this therapy to those who could benefit most from it.

    Eligibility Criteria and Cost Coverage

    Are you eligible to have Medicare cover Wygovy

    Here is where things get a bit murky.

    To qualify for coverage under Medicare, individuals need to meet specific eligibility criteria.

    • Medical Necessity – the treatment using Wegovy must be medically necessary due to cardiovascular disease.  Your physician must first deem it necessary as a suitable treatment.
    • BMI Requirements – your Body Mass Index (BMI) must be classified as obese, and you are being treated for heart disease and/or at risk for stroke.
    • Prior Authorization – some Medicare Part D prescription drug plans may require your physician to submit for prior authorization and provide supporting details on why you should qualify.

    It is important to understand that Medicare did not approve Wegovy for weight loss.  If you are wanting to take Wegovy solely for weight loss, then you will be required to pay all costs.

    Navigating Medicare Approval for Wegovy

    Securing Medicare approval for a prescription drug can be a complex process, but with the right knowledge, it becomes a more navigable terrain. Here’s what you need to know to ensure the successful navigation of Medicare’s approval process for Wegovy.

    Consulting Your Healthcare Provider

    The first step is to consult with your healthcare provider to determine if Wegovy is a suitable option for your weight management goals. Your physician will assess your medical history and current health status to provide personalized advice and support in your decision to pursue Wegovy as part of your treatment plan.

    Verify With Your Medicare Part D Plan

    The reality is that not all Medicare Part D Prescription Drug plans are going to cover this expensive prescription.  Those that do may have varying costs associated with this particular drug, so it is important for you to know what kind of financial exposure you are opening yourself up to.

    Recording Your Efforts

    Consistent record keeping of your weight loss efforts is crucial for Medicare approval. Documentation of dietary changes, exercise regimens, and participation in weight management programs establishes a history of effort that fulfills Medicare’s stringent criteria for drug coverage.

    Filing for Prior Authorization

    For most Medicare drug plans, prior authorization is a prerequisite for coverage of Wegovy. This entails your healthcare provider submitting a request to Medicare, justifying the medical necessity and appropriateness of the medication for your particular case. Once approved, this step paves the way for access to Wegovy through your Medicare Part D plan.

    The Impact of Wegovy on Senior Health

    The introduction of Wegovy into the arsenal of treatments for seniors with obesity could have a profound impact on their health and quality of life. With obesity being a significant risk factor for many chronic diseases prevalent in the elderly population, the potential for substantial weight loss through Wegovy offers a pathway to better health outcomes. It is important to remember that Wegovy should be used in conjunction with a reduced calorie diet and exercise.

    Frequently Asked Questions About Medicare’s Approval of Wegovy

    Understanding the nuances of Medicare’s coverage of Wegovy can be fraught with questions. Here, we address some of the common queries that may arise for seniors and their caregivers.

    Did Medicare Approve Wegovy for Weight Loss?

    No.  Medicare is prohibited from covering weight-loss medications.  Medicare’s approval of Wegovy is based on the approval of the FDA’s expanded use of the drug to reduce the risk of heart attacks and strokes.  The bonus side effect is that it reduces appetite, which will help many folks lose weight.

    Are Medicare Part D Plans Already Covering Wegovy?

    No.  As of this time of this article, only the approval by The Centers for Medicare & Medicaid Services has taken place.  There is a chance that later in the year we could start seeing Part D plans begin to offer coverage for Wegovy.

    Will Medicare Advantage Plans Cover Wegovy?

    Maybe.  Once again when we talk about Medicare Part D coverage, this is provided both by stand-alone Part D Prescription plans (PDP) and thru Medicare Advantage plans that have a built-in prescription drug benefit (MAPD).  The Part D prescription component in a MAPD plan will have its own formulary list (just like a stand-alone PDP plan). 

    How Do I Start the Process to Get Wegovy Covered Through Medicare?

    The process typically begins with a discussion with your healthcare provider, followed by documentation of treatment for cardiovascular disease and a request for prior authorization from your Medicare drug plan after it has added Wegovy to its formulary list.

    It is important to follow the recommendations of your healthcare provider. There are reasons why you hear all the medical disclosures (including side effects) during a prescription television commercial.

    Will Medicare Cover the Full Cost of Wegovy?

    The extent of coverage for Wegovy varies by Medicare Part D plan. Some plans may offer full coverage, while others may require a copayment or coinsurance.

    Final Verdict of Wegovy Now Being Covered By Medicare

    The approval of Wegovy by Medicare marks a significant step forward in the battle against obesity, for seniors who are at risk for cardiovascular events. By understanding the criteria for Medicare coverage and proactively engaging with the process, seniors can now possibly access a cutting-edge treatment that may transform their efforts in weight management.

    While we all anxiously await to find out how many Part D plans will start covering Wegovy, take the time to find out if you are paying too much for your current Medicare insurance plan.

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    This article is for informational purposes only and is not intended to provide any medical advice.  All medical advice should be sought from your current healthcare provider.

    Sources for Quoted Information

    Are Dental Implants Covered by Medicare?

    When it comes to dental coverage, one of the major areas of concern for seniors on Medicare is whether or not Medicare will cover dental implants. As we age, we tend to face different types of health challenges, including dental issues. Many seniors struggle with the consequences of tooth loss and the problems that come with it. Dental implants are a popular and effective solution to replace missing teeth, but they can be expensive. If you are a retiree on Medicare and considering dental implants, you may wonder if your insurance covers the cost. In this blog post, we will answer some common questions about dental implants and Medicare coverage for seniors.

    Does Medicare cover dental implant

    Medicare and Dental Implants

    Is it true that Medicare now pays for dental implants? Unfortunately, no. Original Medicare (Part A and Part B) does not cover routine dental care or dental implants. However, some Medicare Advantage plans (Part C) might offer dental benefits, including coverage for dental implants. To find out if your Medicare Advantage plan covers dental implants, check your plan summary of benefits or call your plan provider. Keep in mind that even if your plan covers dental implants, you might still have to pay a portion of the cost as a copayment, coinsurance, or deductible.

    Dental Insurance for Seniors

    Private Dental Insurance Plans

    Some stand-alone dental insurance plans for seniors on Medicare actually provide benefits for dental implants. These benefits typically range anywhere from $1,000 – $5,000 per year. The cost for these plans are very affordable, but the pricing will be directly related to the amount of annual benefits the plan will pay out each year. In other words, the higher the annual maximum of benefits equates to a higher monthly plan premium.

    Read more about Dental, Vision, and Hearing plans.

    Frequently Asked Questions (FAQs)

    • What is the best dental plan for seniors on Medicare?
      • There is no one-size-fits-all answer to this question, as the best dental plan for seniors depends on various factors, such as your budget, oral health needs, and personal preferences. Before choosing a dental plan, do your research, compare costs and review benefits.
    • Can I get additional dental coverage if I have a Medicare Advantage plan?
      • Yes! Many times the amount of coverage a person may have with a Medicare Advantage plan is less than what they desire. An example of this would be a person who has dental benefits with their Medicare Advantage plan, but it only provides up to $1,000 in annual benefits. This individual could purchase a stand-alone dental plan that provides them with an additional $1,000 of benefits each year for a minimal monthly expense. Of course they could also choose to add up to an additional $5,000 per year in benefits if it is affordable to them.
    • Are dental implants worth the expense?
      • The answer to this question depends on individual circumstances and preferences. While dental implants are usually more expensive than other tooth replacement options, such as dentures or bridges, they also offer several advantages, such as improved comfort, function, and aesthetics. In addition, some seniors on Medicare do not like the feeling of dentures. Moreover, dental implants can last for decades, which can make them a cost-effective long-term investment.
    • Why do full mouth dental implants cost so much?
      • Full mouth dental implants refer to the replacement of all teeth with implants. This procedure is more complex and time-consuming than single tooth implants and may require additional treatments, such as bone grafting or sinus lift. The cost of full mouth dental implants can vary depending on many factors, such as the number and type of implants, the surgeon’s skill and experience, the geographic location, and any associated fees. It’s important to ask for a detailed treatment plan and cost estimate from your dentist.

    Final Thoughts

    In conclusion, original Medicare does not currently cover dental implants, but retirees can opt to purchase a stand-alone dental plan. While some Medicare Advantage plans offer dental benefits, they might not be enough for your individual needs. Call us today at (800)924-4727 to see how affordable dental coverage can be.

    Dental Insurance for Seniors

    Are Medicare Premiums Tax Deductible?

    Is Medicare tax deductible? This is one of the biggest questions those who are retired or getting ready to retire ask us.

    The Internal Revenue Service (IRS) provides American citizens with the opportunity to deduct various personal expenses from their taxable income each year. However, it is important to understand that not all regularly incurred expenses are eligible for deduction, as the Internal Revenue Code specifies certain criteria for deductibility.

    Federal deductions play a crucial role in reducing the amount of income subject to federal income tax, which ultimately lightens the tax burden during tax season. Consequently, many American citizens, including Medicare beneficiaries, seek out suitable tax deductions to maximize their tax returns.

    For Medicare beneficiaries, it is natural to wonder which Medicare-related costs can qualify for a tax break.Optimize your Medicare-related tax deductions and maximize your tax return by staying well-informed.

    Are Medicare premiums tax deductible?

    So, is Medicare tax deductible?

    The answer is a resounding yes! Medicare premiums are indeed tax-deductible, but there is a threshold to consider.

    In order to deduct your Medicare expenses from your taxes, the total amount of your deductible medical and dental expenses must exceed 7.5% of your adjusted gross income (AGI). If you meet this requirement, you will need to complete Schedule A of Form 1040.

    The deductible amount is subtracted from your gross income, ultimately determining your taxable income and guiding your tax obligations.

    Tax Deductible

    Medicare premium tax deductions extend beyond Original Medicare, importantly. If your total medical and dental deductions exceed 7.5% of your gross income, you can also deduct premiums for Medicare Part A (if applicable), Part B, Part D, Medicare Advantage, and Medicare Supplement (Medigap) plans.

    Tax Deductible for the self-employed?

    Now, let’s talk about tax-deductible Medicare premiums for the self-employed. If you earn income from self-employment and are enrolled in Medicare, you have the opportunity to deduct the entire cost of your Medicare premiums from your taxable income. Additionally, if your spouse is also a Medicare beneficiary, you can deduct their Medicare premium costs as well.

    To qualify as self-employed according to IRS standards, you must fall into one of the following categories:

    • Sole proprietor or independent contractor engaged in a trade or business
    • Member of a partnership involved in a trade or business
    • Otherwise operating as a self-employed individual

    By following these guidelines, you can ensure that you are maximizing your Medicare-related tax deductions while staying compliant with IRS regulations.

    Deductible Medicare Expenses: Understanding What You Can Claim

    Deductible Medicare Expenses

    When it comes to tax deductions, not all Medicare expenses are eligible. But don’t worry, we’re here to shed light on what you can and can’t claim, helping you navigate the world of medical expenditures.

    Let’s start with the good news – Medicare premiums are indeed tax-deductible. According to the IRS, these premiums fall under the category of medical expenses, making them eligible for deduction. However, it’s important to note that only itemized deductions on personal income tax returns qualify for this benefit.

    But wait, there’s more! The scope of deductible expenses extends beyond premiums. You can also claim costs related to the treatment, diagnosis, and prevention of medical conditions or injuries. This includes the expenses for necessary medical equipment, supplies, and even preventive care.

    For a full list of medical and dental expenses that are approved in 2022 by the IRS for deductions can be found here. Feel free to review the draft of 2023 approved medical and dental expenses.

    What is a deductible expense?

    Now, you might be wondering, what exactly qualifies as a deductible medical expense? To make things crystal clear, the IRS has provided a comprehensive list for reference. It’s always a good idea to consult their list to ensure you’re making the most of available deductions.

    Here’s an interesting tidbit – there are often overlooked items on the medical expenses list. You can also claim the cost of modifying your home to accommodate medical equipment. Yes, it’s true! Transportation costs can also be eligible for deduction, so keep that in mind.

    Honorable Mention

    Most Medicare beneficiaries, often retirees, are 65 years of age or older. Consequently, their adjusted gross incomes (AGIs) tend to be lower. This means that deducting Medicare premiums from taxes can be particularly advantageous for the average recipient.

    So, as you prepare your taxes, keep these deductible Medicare expenses in mind. Ensure to maximize your benefits and take advantage of all entitled deductions. The information provided above is not tax advice but rather suggestions of areas you should speak with your tax preparer about to see if you can qualify for any deductions.

    Takeaway

    While deductions are always great, it is very important to make sure you have the right Medicare coverage for your health and budget needs. Call Senior Benefit Services, Inc. at (800)924-48727 to speak to one of our advisors to make sure you are in the correct plan that offers the lowest premiums, and the correct benefits for your needs.

    Prefer us to contact you? Simply click on the button below and give us a little bit of information and we will have an advisor reach out to you ASAP!

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    Medicare Advantage Open Enrollment Period

    Many folks think the Medicare Advantage Open Enrollment Period runs from October 15th – December 7th. This is actually incorrect. The term Open Enrollment has been thrown around over the years to somehow cover different enrollment periods. This is actually wrong! The dates listed above are actually for the Medicare Advantage Annual Election Period.

    The Medicare Advantage Open Enrollment Period runs from January 1st – March 31st and limits the choices and changes that a Medicare beneficiary can make. During the Annual Election Period, those on Medicare have access to make changes to just about everything related to Medicare such as switching from one Medicare Advantage plan to another, switching their stand-alone Part D prescription drug plan, leaving original Medicare to enroll in a Medicare Advantage plan, or leaving a Medicare Advantage plan to go back to original Medicare.

    What is the Medicare Advantage Open Enrollment Period?

    The Medicare Advantage Open Enrollment Period starts on January 1st and ends on March 31st each year. During this period, you are allowed to make changes to your Medicare Advantage plan. This means you can switch from one Medicare Advantage plan to another or go back to Original Medicare.

    Medicare Advantage Open Enrollment Period

    Can I switch from original Medicare to a Medicare Advantage plan during the Open Enrollment Period?

    No! Let’s say that you currently have original Medicare along with a stand-alone Part D prescription drug plan. In addition to this coverage you also have a Medicare Supplement Plan G. If you had wanted to make the change to a Medicare Advantage plan, you would have had to complete this during the Annual Enrollment Period (Oct 15th – Dec 7th).

    Can I switch from a Medicare Advantage plan to original Medicare?

    Yes! If you are enrolled in a Medicare Advantage plan and find that it simply is not working for your healthcare needs, then you can use this enrollment period to make a switch back to original Medicare. Keep in mind that you will need to enroll in a stand-alone Part D prescription drug plan so that you do not face any future penalties.

    Is it a good idea to switch Medicare Advantage plans during Open Enrollment?

    When deciding to switch from one Medicare Advantage plan to another, consider factors such as the participation of all your providers in the new plan’s network. If they do, then you need to determine what benefits do you gain by switching. Are your co-payments going to be lowered? Are you getting additional benefits in the new plan that are not available in your current plan? All of these items and more should be weighed before making a switch.

    Should I switch from a Medicare Advantage plan back to original Medicare during the Open Enrollment Period?

    While this is actually a common event that takes place, it is important to keep in mind several things. If you have always been on a Medicare Advantage plan for more than 12 months and decide to switch back to original Medicare and get a Medicare Supplement plan, you will need to qualify for the Medicare Supplement plan by answering a list of health questions. Qualifying for the Medicare Supplement plan is not a guarantee during the Medicare Advantage Open Enrollment period.

    If you left original Medicare and a Medicare Supplement plan during the annual election period (and it is your first time enrolling in a Medicare Advantage plan), then you would be within your 12 month trial period where you could return back to original Medicare and have your existing Medicare Supplement issued with no health questions. You would also be able to sign up for a stand-alone Part D prescription drug plan.

    Why are people leaving Medicare Advantage plans?

    People commonly leave Medicare Advantage plans due to health status changes, network alterations such as providers no longer participating, or the requirement of prior authorization before consulting a specialist or undergoing a test. Another common reason that a beneficiary might leave a Medicare Advantage plan could be due to their prescription coverage offered within the plan. Such things as a certain prescription no longer being on the plan’s formulary or that same prescription now is a higher tier that requires the member to pay a higher amount out of pocket can have a negative impact.

    What is the scandal about Medicare Advantage plans?

    Medicare Advantage scandals

    There are a couple of issues that have made Medicare Advantage plans look tarnished in recent years. The Centers for Medicare and Medicaid Services (CMS) have accused some Medicare Advantage plans of overcharging the government for medical services. This is simply a nice way of saying that they committed fraud.

    Another issue is that complaints regarding Medicare Advantage plans increased dramatically over the last couple of years. Many folks who called into the 800#s they saw on television ads made switches into Medicare Advantage plans who didn’t completely understand the restrictions such as networks, referrals, and having to be responsible for co-pays and co-insurance out of their own pocket. According to CMS the amount of complaints rose from 16,000 in 2020 to nearly 40,000 in 2021.

    New regulations have transformed the display of Medicare Advantage ads on TV, yet out-of-country rogue call centers continue to plague seniors. These call centers blatantly disregard the Federal Do Not Call List, cold call seniors multiple times a day with such bogus claims as:

    • Saying they are with Medicare (CMS)
    • Scammers falsely claim that a Medicare beneficiary’s current card is invalid and needs replacement with a new plastic card. Once the senior provides their Medicare ID to these callers, the scammers transfer them to a licensed US call center. Unbeknownst to the senior, the call center switches them into a Medicare Advantage plan without their knowledge or consent.

    Is being enrolled in a Medicare Advantage plan the same as having a Medicare Supplement?

    Medicare Advantage vs Medicare Supplement

    Absolutely NOT!! When it comes to Medicare, there are a lot of terms to keep straight. One question many people have is whether being enrolled in a Medicare Advantage plan is the same as having a Medicare Supplement, also known as Medigap. The short answer is no. While both types of plans can help cover costs that original Medicare doesn’t, they work in different ways. Private insurance companies offer Medicare Advantage plans, typically replacing original Medicare altogether. In contrast, Medicare Supplements actively fill in the gaps while working alongside original Medicare. It’s important to understand the differences between the two so you can choose the plan that’s right for you.

    Is there a simple list of what I can and can’t do during the Medicare Advantage Open Enrollment Period?

    Yes! Below is a list of everything you can do during the Open Enrollment Period.

    • Change from one Medicare Advantage Plan to another Medicare Advantage Plan.
    • Drop your current Medicare Advantage Plan and return to Original Medicare and get a stand-alone Medicare Part D prescription drug plan.
    • Make a one-time-change

    What you can’t do during the Open Enrollment Period

    • Enroll in a Medicare Advantage plan for the first time.
    • Switch your current stand-alone Part D prescription drug plan to another stand-alone Part D plan.
    • Make changes more than once

    Remember, the Medicare Advantage Open Enrollment Period doesn’t offer options to switch Medicare Supplement carriers without medical underwriting.

    Conclusion

    Review your current Medicare Advantage coverage during the Open Enrollment Period to ensure it meets your specific health care needs. If you are not sure, then you can simply contact Senior Benefit Services, Inc for a non-bias and free review. Give us a call today at (800)924-4727 or use the contact form below.

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    Is Medicare FREE at Age 65?

    We would all love to hear that Medicare is free at age 65, but that is really not the case. Turning 65 is a significant milestone for many Americans. As you approach this milestone, you may be wondering about Medicare and how much it will cost you. There are many misconceptions about Medicare, but one of the most frequently asked questions is, “Do I have to pay for Medicare?” The answer is yes, but the amount you pay depends on your income, the type of Medicare coverage you choose, and when you enroll. This article will cover everything you need to know about paying for Medicare.

    Is Medicare Free at Age 65

    Is There A Monthly Fee To Have Medicare?

    Yes, there is a monthly fee for Medicare Part B, which covers doctor visits, outpatient care, and medical equipment. In 2024, the standard monthly premium for Part B is $174.70. However, the amount you pay may be higher based on your income. If you have a high income, you may be subject to an Income-Related Monthly Adjustment Amount (IRMAA). If you are single and making above $103,000 or married filing jointly and making above $206,000 be sure to check out our IRMAA chart for additional premiums owed in 2024.

    Is Medicare Free for US Citizens?

    Medicare is not free for US citizens. While you may not have to pay a premium for Part A, which covers hospitalizations, Part B requires a monthly premium. Additionally, Medicare does not cover all expenses, and you may still be responsible for copayments, deductibles, and coinsurance.

    Do You Have to Pay for Medicare at Age 65?

    If you or your spouse paid Medicare taxes while working, you will be eligible for premium-free Part A when you turn 65. Now keep in mind that if you or your spouse happened to only work a part-time job for a year or so, that will not qualify you to receive premium-free Part A. To qualify for premium-free Medicare Part A you must have worked for 40+ quarters (10 years) and paid Medicare taxes. See the chart below for Part A monthly premium costs for 2024 below.

    Quarters Paid In2024 Monthly Premium
    0-29$505.00
    30-39$278.00
    40+ (10 years)$0.00
    Part A Monthly Premiums

    However, you will still need to pay a monthly premium for Part B. If you do not enroll in Part B when you are first eligible, you may be subject to a late enrollment penalty.

    How Much Do I Have To Pay for Medicare When I Turn 65?

    The amount you will pay for Medicare when you turn 65 depends on a few factors. If you or your spouse paid enough Medicare taxes while working, you will not have to pay a premium for Part A. The standard monthly premium for Part B in 2024 is going to be $174.70, but the amount you pay may be higher based on your income (IRMAA).

    What Happens If You Don’t Enroll in Medicare Part A at 65?

    Medicare Penalties

    If you are eligible for premium-free Part A and do not enroll in it when you turn 65, you may have to pay a penalty. The penalty is 10% of the Part A premium for every 12-month period you could have been enrolled but were not. The penalty lasts for twice the number of years you could have been enrolled but were not.

    How Do You Pay for Medicare If You Are Not On Social Security Already?

    If you are not receiving Social Security benefits when you become eligible for Medicare, you will need to pay your premiums directly. You can pay your Medicare premiums online, by mail, or by phone. If you are enrolled in Medicare Advantage, a Medicare Supplement or a Medicare prescription drug plan, you may have additional costs.

    How Much Will Social Security Take Out For Medicare in 2024?

    In 2023, the standard monthly premium for Part B is $1640.90. Social Security withholds this premium from your benefit payments each month. Social Security will withhold for Medicare in 2024, but it will be about 3.5% ($5.80) higher at $174.70 per month.

    How Do You Qualify For Free Part B Premium?

    Some people may qualify for free Part B from Medicare if they meet certain income and asset requirements. The program is called Extra Help, and it is available to people who have limited income and resources. You can apply for Extra Help online, by mail, or by phone.

    Is Medicare Part B Giveback the Same As Free Part B?

    No! Medicare Part B giveback is found in certain states/counties where the reimbursement rates from Medicare to the private insurance companies offering those plans is higher. Some plans will credit the full Part B premium back to you and others might only credit a portion of the Medicare Part B premiums back to you.

    It is important to understand that these plans are not available everywhere. In addition, you would need to be enrolled in a Medicare Advantage plan and not original Medicare.

    Are Medicare Advantage Plans Free?

    No! This is a huge misconception that many folks have. While some Medicare Part C plans may be $0 premium each month, you must continue to pay your Part B monthly premium. It is also very important to understand that Medicare Advantage plans ‘share’ the costs with you. This means that you will have co-payments and co-insurance to pay out of your pocket for each service. Now the good news is that Medicare Advantage plans must have an annual maximum out of pocket that sets a yearly cap on how much you would have to pay out of pocket. Some plans may have a $3,000 maximum whereas others may have a maximum of $7,500.

    Conclusion

    Medicare can be confusing, and the cost is an important factor to consider when deciding which coverage to choose. While Medicare is not free, it provides essential coverage and protection against high medical costs. Understanding the costs and requirements of Medicare will help you make informed decisions and plan for your future. There is no need to go at this alone! Call Senior Benefit Services, Inc. today at (800)924-4727 to get the help you deserve.

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    Can I Switch From A Medicare Advantage Plan Back To Original Medicare?

    switch from Medicare Advantage to Original Medicare

    Switching from a Medicare Advantage Plan back to Original Medicare might not be something you read about often, but it actually happens quite a bit. Medicare Advantage Plans have become increasingly popular among seniors over the years because of their affordability and additional benefits like vision, hearing, and dental coverage. However, some seniors may find themselves unsatisfied with their Medicare Advantage Plan or may want to switch back to Original Medicare. If you’re one of these seniors, you may be wondering if switching from a Medicare Advantage Plan back to Original Medicare is possible. This blog post will help answer your questions and guide you through the process.

    When Can You Return Back to Original Medicare?

    If you find yourself wondering if or when you can return back to original Medicare, it’s important to understand that there are specific times during the year when you can make changes to your Medicare coverage. The Annual Enrollment Period (AEP) runs from October 15th to December 7th each year, during which you can enroll in or switch your Medicare Advantage or prescription drug coverage. Additionally, if you’re already enrolled in a Medicare Advantage Plan, there is a separate enrollment period called the Medicare Advantage Open Enrollment Period (OEP) that runs from January 1st to March 31st each year. This period allows you to make changes to your Medicare Advantage Plan, including switching to a different Medicare Advantage Plan or switching back to Original Medicare. You can generally only switch outside these enrollment periods if you qualify for a Special Enrollment Period, which certain circumstances such as relocating to a new area may trigger.

    Things To Consider When Leaving Your Medicare Advantage Plan

    If you’re considering switching back to Original Medicare, it’s important to understand the differences between Original Medicare and Medicare Advantage. Original Medicare consists of Part A (hospital insurance) and Part B (medical insurance), which are offered by the federal government. Medicare Advantage, on the other hand, is a private insurance option that covers the same services as Original Medicare, but may offer additional benefits like vision, hearing, and dental coverage. Original Medicare may have higher out-of-pocket costs, but it allows you the freedom to choose your own healthcare providers. Learn more about Medicare Supplement plans and stand-alone dental, vision, and hearing plans.

    How To Switch From Your Medicare Advantage Plan back to Original Medicare?

    To switch from a Medicare Advantage Plan back to Original Medicare, you’ll need to contact your Medicare Advantage Plan provider or call Medicare directly at 1 (800) MEDICARE. You can also enroll in a Part D prescription drug plan at this time if you’d like and it should automatically end the Medicare Advantage plan (as long as the plan has prescription drug coverage integrated into it). Once you’re back on Original Medicare, you’ll have the option to enroll in a Medicare Supplemental Insurance (Medigap) Plan, which can help cover your out-of-pocket costs like deductibles, coinsurance, and copayments. If you are switching out of a Medicare Advantage plan that has prescription drug coverage, you most definitely will want to enroll in a stand-alone Part D prescription plan.

    Can I Get A Medicare Supplement Plan After Switching Back To Original Medicare?

    Medicare Supplement

    If you decide to switch from a Medicare Advantage Plan back to Original Medicare and wish to enroll in a Medicare Supplemental Insurance plan, note that you might need to respond to health-related questions for eligibility. Keep in mind that if you turned 65 and initially enrolled into a Medicare Advantage plan and have been on that plan for less than 12 months then you can qualify for a special enrollment period (SEP). This SEP allows you to return to original Medicare and enroll in a Medicare Supplement plan with no underwriting. Your Trial Right is the name of this specific SEP. Learn more about other Special Enrollment Periods and how to qualify.

    Final Thoughts

    Switching from a Medicare Advantage Plan back to Original Medicare is possible, but it’s important to understand the enrollment periods and differences between the two options. If you’re thinking about making the switch, be sure to contact your Medicare Advantage Plan provider or call Medicare directly at 1 (800) MEDICARE. And if you decide to enroll in a Medigap plan, be sure to do so during your open enrollment period to ensure you get the best coverage and pricing. By understanding the process and timing, you can make an informed decision that best meets your healthcare needs and budget. If all of this still sounds confusing, then let one of our advisors help. Simply give us a call at (800)924-4727 and experience why Senior Benefit Services, Inc has so many satisfied clients. Remember, “We Make Medicare Easy!”

    Medicare Costs 2024

    What Medicare Cost

    The Centers for Medicare & Medicaid Services (CMS) released the Medicare costs for 2024. Find out more about what Medicare costs for you in the new year.

    Medicare Part A Costs 2024

    Medicare Part A is designed to help cover the costs of such things as inpatient hospital care and skilled nursing facility care. So lets take a look at what Medicare Part A costs in 2024.

    • Medicare Part A Deductible will rise to $1632 which is an increase of $32
    • Medicare Part A coinsurance for inpatient hospital stays that last more than 60 days will have a daily co-payment amount of $408 beginning on day 61 thru day 90 which is an increase of $8 per day.
    • Medicare Part A coinsurance for inpatient hospital stays that last more than 90 days will have a daily co-payment amount of $816 beginning on day 91 thru day 150 which is an increase of $16 per day.
    • Skilled Nursing Facility daily coinsurance will be $204 per day beginning on day 21 thru day 100. The daily co-payment is an increase of $4 per day.

    The Medicare Part A premium has risen as well. Keep in mind that the majority of American retirees do not pay a Part A premium since they have worked at least 40 quarters of Medicare covered employment. For those who did not work enough quarters for premium-free Part A, their costs are as follows:

    Quarters Paid In2024 Monthly Premium
    0-29$505.00
    30-39$278.00
    40+ (10 years)$0.00

    Common Part A Questions

    1. Is the Medicare Part A deductible an annual deductible? No, the Part A deductible can be charged more than once per year. You will be responsible for the Part A deductible for each benefit period (per occurrence) of inpatient hospital care. The benefit period restarts after you have not received any inpatient hospital care for at least 60 days in a row.
    2. Is there a limit as to how benefit periods a person can have in one year? No.
    3. Are there benefit periods for Skilled Nursing Facility (SNF)? Yes, a benefit period begins the day you are admitted as an inpatient and ends after you have not received any skilled care in a SNF for at least 60 days in a row.
    4. Want to view more commonly asked questions about Medicare Part A? Click here.

    Medicare Part B Costs 2024

    Medicare Part B is designed to help cover medical costs such as doctors, surgeons, outpatient surgery some prescription drugs, and so much more. So lets take a look at what Medicare Part B costs in 2024.

    • Medicare Part B deductible will rise to $240 which is an increase of $14
    • Medicare Part B coinsurance will remain at 20%

    The Medicare Part B premium has risen as well. For those individuals who are not classified as high income earners, the Medicare Part B premium will rise to $170.70 per month which is an increase of $5.80 per month.

    If you are classified as a high income earner you will pay a Medicare Income-Related Monthly Adjustment Amount (IRMAA). It is important to keep in mind that this classification is based off of your IRS tax return from 2 years ago (which may be unknown to many that are new to Medicare). The additional premium you would pay each month for Medicare Part B in 2024 based on your yearly income in 2022 would be as follows:

    File Individual Tax ReturnFile Joint Tax ReturnFile Married & Separate Tax ReturnYou Pay Each Month in 2024
    $103,000 or less$206,000 or less$103,000 or less$174.70
    above $103,000 up to $129,000above $206,000 up to $258,000Not applicable$244.60
    above 129,000 up to $161,000above $258,000 up to $322,000Not applicable$349.40
    above $161,000 up to $193,000above $322,000 up to $386,000Not applicable$454.20
    above $193,000 and less than $500,000above $386,000 and less than $750,000above $103,000 and less than $397,000$559.00
    $500,000 or above$750,000 or above$397,000 or above$594.00

    Common Part B Questions

    1. Is the Medicare Part B deductible an annual deductible? Yes.
    2. What are Medicare approved amounts? This is the payment amount that original Medicare sets for a specific covered service or item.
    3. If I am classified as a high income earner due to my tax returns but I don’t make that much income anymore, can I file an appeal? If you had a life changing event such as death of a spouse, marriage, divorce or annulment, work reduction, work stoppage, loss of income from producing property, loss or reduction of certain kinds of pension income then you can file an appeal. Other situations that would warrant an appeal would be such things as there being an error in the IRS data, the IRS provided older data and you have newer information available that shows lower income, or you filed an amended tax return for the year that the Social Security Administration (SSA) is using to make their classification of you being a higher income earner.

    Takeaway

    The overall increases released for 2024 are not the worst we have seen, but still will affect the net income a retiree will have each month. The Medicare Part B monthly cost for 2024 will be about 3.5% higher which will basically mirror the 2024 Social Security increase for 2024 of 3.2%. Call us at (800)924-4727 to check if you can reduce your current Medicare Supplement plan premium or to explore if a Medicare Advantage plan suits you better. One of our knowledgeable advisors will assist you. Prefer to have us call you, then simply click on the box below and provide us with your contact information.

    Get Help From Senior Benefit Services

    Does Medicare Cover Audiologist?

    Does Medicare Cover Audiologist?

    First let’s dive into exactly what an audiologist is and does.

    Audiologists are health care professionals who specialize in disorders dealing with hearing, balance, and other neural systems.   Once a disorder is diagnosed these healthcare providers fit and dispense hearing aids and other types of listening devices if appropriate.  Keep in mind that an audiologist does not perform surgery.  If you suffer from a hearing issue that requires surgery, then you will need to see an ENT doctor.Audiologist conducting diagnostic test

    Types of Hearing Loss

    While hearing loss can come in many forms that can range from minimal to total loss of hearing.  There are two broad categories of hearing loss:

    • Sensorineural hearing loss – which is when there is usually permanent damage to the inner ear or auditory nerve.
    • Conductive hearing loss – occurs when sound waves cannot reach the inner ear.  Typically medical treatment or surgery can correct the hearing loss.

    As we age, the odds of hearing loss increase.  It is estimated that 1 in 3 people between the ages of 65 and 74 suffers from a certain degree of hearing loss.  For those older than 75 nearly half has difficulty hearing clearly.  This type of hearing loss is often times called Age-Related Hearing Loss but is medically diagnosed as Presbycusis.  This type of hearing loss comes on gradually as we get older and it seems to run in families.  Additionally this type of hearing loss usually (but not always) occurs in both ears.  Once the hearing loss has progressed substantially, many older adults will look to hearing aids as a solution.

    Woman hard of hearing

    What Does Medicare Cover?

    So…does Medicare cover audiologist? Medicare will cover diagnostic exams with an audiologist when a healthcare professional such as a physician, clinical nurse specialist, nurse practitioner, physician’s assistant or other approved provider refers you to an Audiologist to determine appropriate medical care for your hearing issue.  If this criteria is met then Medicare Part B will generally cover 80% of the approved charges (after the annual Part B deductible has been met) leaving you or your Medicare Supplement to pay the other 20%.

    So does this mean that a healthcare professional can refer you to an audiologist for a routine hearing test and Medicare will cover it?  No.  Medicare does not cover routine hearing tests, hearing aids, or the exams for fitting of hearing aids.Picture of hearing aid

    Does a Medicare Advantage plan cover hearing aids?

    If you are covered by a Medicare Advantage plan you could possibly have some coverage for hearing aids.  While not all plans provide this additional coverage, some do.  Many times there are strict limitations on the actual benefits and coverage limits for hearing aids.  Some plans may cap out a certain dollar amount they will pay, while other plans may pay a higher amount towards hearing aids, but will limit the purchase to once every few years.

    Keep in mind that most Medicare Advantage plans use a network, such as a PPO or HMO.  This means that if your plan does actually provide benefits toward hearing aids, you will need to see an audiologist that is part of that plan’s network.

    How Else Can You Get Benefits For Hearing Aids?

    If you are on traditional Medicare Parts A & B (whether you have a Medicare Supplement or not) you can always purchase stand-alone coverage for hearing benefits.  While these plans are not usually sold with just hearing benefits, you actually get 3 areas of coverage with them.  This includes dental, vision, and hearing.  To find out more about these plans click here.

    Get A Quote Now for Medicare Coverage

    Takeaway

    If you are having hearing issues, your first step should be to schedule a visit with your primary care physician to discuss your concerns.  If you have questions about obtaining coverage for possible future hearing issues, then feel free to call us at (800)924-4727 or click on the Get A Quote Now button above.

    Medicare Open Enrollment 2023

    Medicare Open Enrollment Period 2023…Get Ready…Get Set…GO!

    Let the craziness begin!  The Medicare Open Enrollment 2023 period is upon us and everyone is having to suffer.  Personally, I think having to watch commercial after commercial on the television about Medicare Advantage plans is about as fun as listening to nails on a chalkboard!!  You know the commercials…Joe Namath and JJ Walker talking about ‘getting the benefits you are entitled to’.  Of course, these commercials are not all they seem to be.  Too learn more about the Medicare Advantage commercials check out our article found here.Joe Namath Medicare Advantage Commercial

    So Why Is It Called The Open Enrollment Period?

    That is a fantastic question, since the enrollment period from October 15th – December 7th was actually the Annual Election Period.  For some reason years back, Medicare started running commercials themselves and kept referring to this period as the Open Enrollment period.

    The reality is that the Open Enrollment period for Medicare Advantage plans starts on January 1st of each year and runs until March 31st.  Of course, this just adds more confusion to an already confusing time.  Well, enough complaining, let’s move on to what you should be doing to make the enrollment periods easier to navigate.

    Medicare Open Enrollment 2023 Made Easy

    Keep in mind that no matter what the commercials say, or all of the junk mail pieces you get in your mailbox, you do not have to make changes during the Annual Enrollment Period or the Open Enrollment Period.  If your Medicare Advantage or stand-alone Part D Prescription plan works great for you, and you did not notice any major changes in your Annual Notice of Change letter, then you can simply stay where you are.  If you find that your plan isn’t working for you or there are major changes coming for the following year that will negatively impact you, then a change will likely be needed.

    In this post I will explain how these periods of enrollment differ, and how they can be used.  Just sit back, relax and know that by the end of this article you will have an idea of exactly what you need to do.

    Medicare Open Enrollment 2023

    What Can I Do During the Annual Election Period?

    As we stated earlier this is also now called the Medicare Open Enrollment Period on most commercials that you see.  During the period of October 15th – December 7th you can:

    • Stay in your current plan if it works well for you
    • Change from one Medicare Advantage plan to another Medicare Advantage plan
    • Change from one stand-alone Part D Prescription plan to another stand-alone Part D Prescription plan
    • Change from Original Medicare (Parts A & B) to a Medicare Advantage plan (Part C)
    • Change from a Medicare Advantage plan to Original Medicare and enroll in a stand-alone Part D Prescription plan.

    What Are Some of the Reasons Why I Would Change My Plan?

    • Your Annual Notice of Change letter shows that your prescriptions will either not be on next year’s formulary (list of approved medications) or moves to a higher tier which will cost you more in either co-payments or co-insurance. A prescription moving from a Tier 1 to a Tier 2 is not going to be outrageous, but a Tier 2 prescription moving to a Tier 4 will be.  You will actually go from making a flat co-payment to paying a percentage of the actual prescription cost.
    • The Medicare Advantage plan you have will have a change in the provider network. This means that maybe a hospital you like to use or your favorite doctor has decided to no longer be part of the plan’s network.
    • The Medicare Advantage plan is no longer available in your resident county. When this happens, you will either need to choose another Medicare Advantage plan or return to Original Medicare and enroll in a stand-alone Part D Prescription plan.
    • The Medicare Advantage plan has a premium increase for next year that makes it unaffordable, and you want to enroll in a less expensive plan.

    The key thing to remember is that our advisors here at Senior Benefit Services, Inc can help you navigate thru these rough waters.  If you really need to make a change, they will advise you on your best options.  If you don’t need to make a change, then they will advise you to remain in your current plan and just ignore all the junk mail, television, and radio commercials.Contact Senior Benefit Services

    What Should I Do If I Have a Medicare Supplement plan?

    The great news is that the Annual Election Period (Medicare Open Enrollment Period) does not apply to Medicare Supplements.  The reason why is that each year your Medicare Supplement core benefits will not change.  If you have a plan that covers the Part A deductible, then your plan each year will continue to cover that cost.  It doesn’t matter that the Part A deductible goes up every year, because your Medicare Supplement plan will still cover it.

    This means that you do not have to make any changes to your Medicare Supplement plan during this period of time.

    What If My Medicare Supplement Premium Went Up This Year?

    Sorry to say, but Medicare Supplement plans are health insurance policies and due to rising medical costs and claims being paid out, these plans will typically go up each year.

    While your premium may go up, your benefits don’t go down.

    You are free to shop your Medicare Supplement plan during the Medicare Open Enrollment 2023 Annual Enrollment Period, the same as you are free to shop your plan any other time of the year.

    One point that I want to make very clear is that the Annual Election Period (Open Enrollment Period) does NOT provide any special provisions to guarantee you to get another Medicare Supplement.

    Wait A Minute…the Medicare Commercials All Say Now Is the Time to Make Changes and I Can’t Be Turned Down!

    This is 100% true for Medicare Advantage and stand-alone Part D Prescription plans.  Keep in mind that Medicare Advantage plans typically only have 1 health question on their application and that asks whether or not you have End Stage Renal Disease (ESRD).  The stand-alone Part D prescription plans have no health questions at all.  This is the reason why you can easily change these plans.

    Since this enrollment period has never applied to Medicare Supplement plan (since it originated in 2006) you would have to answer the health questions and qualify to get a new Medicare Supplement plan.

    To see if you can lower your Medicare Supplement plan premiums, simply click on the button below.  It is easy, fast, and there is absolutely no obligation.

    Medicare Supplement Quote Request

    What Can I Do During the Medicare Advantage Open Enrollment Period?

    This period which runs from January 1st – March 31st allows you to:

    • Switch to a different Medicare Advantage plan (if you are already enrolled in a Medicare Advantage plan to begin with).
    • Switch from a Medicare Advantage plan to Original Medicare. You will also now need to enroll in a stand-alone Part D Prescription plan so that you do not incur a penalty.

    IMPORTANT REMINDER:  This is for Original Medicare only and does not pertain to Medicare Supplements.

    What Are My Next Steps?

    To make this easier, lets break it down into three categories:

    Category 1 – You are an existing client of Senior Benefit Services, Inc.  The first thing you should do is review your Annual Notice Change Letter to see if there are any plan changes that will negative effect you.  The next step would be to also take note if you had any new prescriptions added this year that are in a higher Tier pricing.  While your current plan may cover it, another plan may cover the prescription at a lower Tier pricing which saves you more money.  If there are notable changes to your coverage or changes in your prescription costs, then you should contact your Senior Benefit Services advisor to schedule a review.  Many of our clients simply prefer to have a standing annual review each year for peace of mind.

    Category 2 – You are not an existing client of Senior Benefit Services, Inc. but feel that our well-known top shelf service would be of great value, then feel free to call (800)924-4727 and we will have an advisor assigned to you.

    Contact Senior Benefit Services

    Category 3 – You are someone who enjoys doing everything yourself.  While this path is filled with lots of confusing information to digest and understand, you can opt to do this.  Keep in mind that you will not be saving any money since premiums are set by the plans and approved by CMS, but you can call Medicare directly at 1-800-MEDICARE for help or go to Medicare.gov and use the Plan Finder on their website.

    We would enjoy having the opportunity to show you why so many Medicare beneficiaries love working with our company and have been with us for decades.  You will always receive straightforward, honest advice that benefits you and not the insurance company.  Contact us to make the Medicare Open Enrollment 2023 season relaxing.  Remember…We Make Medicare Easy!

    What Does Medicare Cost Me in 2022?

    So How Much is Medicare Going To Cost Me in 2022?

    Medicare cost for 2022 showed an increase not only for Part A but also for the Part B deductible over 2021.

    As always, your basic costs change each year in both premiums you pay for Part B coverage and the additional amounts that you will pay for deductibles and co-payments under Original Medicare.  To see the current Medicare cost for 2022 please refer to the image below.Chart of Basic Medicare Costs 2022

    If you worked 40 quarters during your lifetime, you will not be charged the Part A premium listed above.  During your working years, the Part A premium was paid thru you Medicare taxes from each pay period.  The deductible for Part A increased from $1484 in 2021 to $1556 in 2022.   For days 61-90 as an inpatient the daily copayment rose from $371 per day in 2021 to $389 per day in 2022.  The lifetime reserve days which begin on day 91 as an inpatient rose from $742 per day in 2021 to $778 per day in 2022.  The daily co-payment for skilled nursing facility care increased from $185.50 per day in 2021 to $194.50 per day in 2022.

    The standard Medicare Part B premium had a substantial increase from $148.50 per month in 2021 to $170.10 in 2022.  To find out more about the changes in Medicare Part B premiums and why this occurred in 2022 listen to our short video below.

    For recently approved Medicare 2023 costs click here.  To compare our current chart to 2021 numbers click here.  To see the Medicare Fact Sheet click here.

    Wondering if you are paying too much for your current Medicare Supplement coverage or have questions about any type of other health insurance benefits you have?  Get a FREE, NO OBLIGATION quote by click below.Compare Medicare Plans

     

    Does Medicare Cover Vision, Eye Exams, Glasses, and Cataract Surgery

    Besides dental, one of the most asked questions is Does Medicare Cover Vision?  The first thing to remember is that vision care has a wide range.  It could be something as simple as getting glasses for reading to getting cataract surgery performed.

    Fortunately, Medicare provides coverage stronger coverage for vision care than dental benefits.

    While there are some stipulations and exceptions, Medicare’s vision coverage is pretty good when it comes to issues that are part of the aging process.  Does Medicare Cover Vision

    Inside you will find out how Medicare covers vision, eye exams, glasses and cataract surgery.   

    What Original Medicare Doesn’t Cover  

    Original Medicare will not cover things such as:

    • routine vision exams known as eye refractions
    • glasses (unless prescribed after a cataract surgery)
    • contact lenses.

    In addition, if you do get corrective lenses after cataract surgery, Medicare will not cover any costs for upgraded frames.

    Medicare Supplement Quote Request​

    What Original Medicare Does Cover

    Original Medicare will cover such things as:

    • Medically necessary treatment for eye problems including:
      • Cataracts
      • Macular Degeneration
    • Eye exams for diabetic retinopathy (if you have diabetes)
    • Glaucoma tests if you have diabetes or classified as high risk

      

    Free Medicare Supplement Quote Comparison

    What Medicare Medicare Supplements Will Cover  

    Medicare Supplement plans are designed to help cover the costs left over after Medicare approves a charge and covers their portion.  Since your Medicare approved vision services would be provided under Part B of Medicare, your supplement would typically cover the remaining 20% of approved charges.  If you were on Medicare prior to January 1, 2020 then you might have a Plan F or Plan C that would also cover the Part B annual deductible.  If you went on Medicare January 1, 2020 or after then Plan F and Plan C are not available to you so therefore you would have the Part B deductible to pay first before your plan would kick in.

    While Medicare Supplements were not designed to cover routine vision exams or corrective lenses, some Medicare Supplement insurance carriers offer a discounted vision benefit as a value add.  For more robust benefits you can purchase a private plan that could include not only vision benefits, but also dental and hearing.

    Do Medicare Advantage Plans Cover Vision Benefits?  

    Just like original Medicare, a Medicare Advantage plan will cover the same type of medically necessary benefits.

    In addition, Medicare Advantage plans typically do cover some of the routine services such as an eye exam and an allowance to use towards glasses. 

       

    Medicare Supplement Quote Request

    Not all Medicare Advantage plans offer the same additional vision benefits.  In addition, some require you to pay an additional amount to add benefits such as these and dental to their plans.  Always be sure to check your plan’s benefit disclosure.

    Free Medicare Supplement Quote Comparison

    Take Action!  

    Hopefully, this article helped to give you a better sense of how vision benefits are handled with Original Medicare, Medicare Supplements, and Medicare Advantage plans.

    Senior Benefit Services has been in the Medicare business for over 50 years and understands your concerns.   

    To make sure everything is understood correctly, give a Senior Benefit Services Expert a call today at (800)924-4727!   

    Does Medicare Cover Dental Care, Implants, and Dentures?

    Does Medicare cover dental?  That is a Yes & No question.

    Fortunately, Medicare provides coverage for quite a bit of our healthcare, and even some dental when it is truly health related.

    Does Medicare Cover Dental Care

    Inside you will find out how Medicare covers dental services such as routine dental care, emergency dental, dentures and much more.   

    Dental Medicare Coverage  

    Medicare Part A will cover emergency or complicated dental services you receive in the hospital.  An example of this would be that you were involved in an accident and the damage done requires surgery or teeth extraction, then it may be covered by Medicare Part A.

    The Medicare website  provides a good starting point to better understand dental coverage.

    ​

    If you receive any of the following, then Medicare will not cover these expenses: 

    1.  Dental cleanings
    2. Fillings
    3. Dentures
    4. Dental Plates
    5. Dental Devices
    6. Dental Implants

     

    Get Free Medicare Supplement Quote
    Get Help Now With Your Medicare Supplement Quote

    Besides dentures, dental implants are one of the other concerns that many retirees are concerned about.  While dental implants permanently anchor prosthetic teeth into the gum line, this procedure is also NOT covered by original Medicare

    Free Medicare Supplement Quote Comparison

    Does Medicare Part B cover any dental services? 

    Medicare Part B may pay for a dental exam if it is required to be completed before a procedure is able to be performed such as open heart surgery.  In addition, for these services to be covered you must have an underlying health condition.  Our advice is to always ask if the service will be covered by Medicare prior to having services performed. 

    What are my coverage options for dental care?

    Private dental plans are one of the most popular options that we see people use to cover dental care.  Many of these plans also offer additional benefits to help cover vision and hearing as well.

    Dental Insurance for Seniors

    If you are enrolled in a Medicare Advantage plan you can check your plan benefits to see if dental is a benefit, or if you can add additional coverage for these benefits.  Since Medicare Advantage plans typically are network driven you will most likely have to use a dental provider who is in that plan’s network.  Some other key points to keep in mind:

    • Most dental coverage under Medicare Advantage Plans have a coverage limit which may be lower than a private dental plan.
    • Most costs incurred will require you to pay a co-insurance rather than a small co-pay.
    • May restrict how often they cover a particular dental benefit.

    What Is A Discount Dental Plan?

    The key point to understand is that a discount dental plan is NOT insurance.  You are basically paying an annual fee to receive ‘discounted’ dental services.  You are required to use a dentist that is part of the discount plan’s network.  Before signing up for a discount dental plan it is wise to first make sure that your current dentist is in their network.​

    Do Veterans receive any dental benefits? 

    Veterans may be eligible for reduced cost dental care or insurance.  If you are a veteran, then you can start here to see if you qualify for those benefits.  The VA does have clinics that provide dental care and those locations can be found here.

    Free Medicare Supplement Quote Comparison

    Take Action!  

    Hopefully, this article helped to alleviate some of your fears about who would end up paying for dental care, implants, and dentures.

    Medicare coverage of dental services can sometimes be a bit confusing.

    Senior Benefit Services has been in the Medicare business for decades and understands your concerns.   

    To make sure everything is understood correctly, give a Senior Benefit Services Expert a call today at (800)924-4727.