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Senior Benefit’s Cumberland Office

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309 Willowbrook Road, Suite 1
Cumberland, MD 21502

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Monday – Firday : 9am – 5pm EST
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How Do I Get Medicare To Pay For Home Care Near MD, PA, WV?

How Do I Get Medicare To Pay For Home Care?

A recent analysis found that most Maryland seniors who need Medicare to pay for home care either don’t know Medicare covers it or think they don’t qualify when they actually do.

This is why that’s devastating: the average cost of private home health care in Maryland runs thousands per month, which means missing out on Medicare coverage could cost you massive amounts annually for just basic nursing visits.

Medicare To Pay For Home Care - Senior Benefit Services Hagerstown, MD

What You Will Learn About Medicare To Pay For Home Care

Medicare covers way more home services than people realize

One missing requirement kills your entire claim instantly

Hidden eligibility rules could unlock thousands in benefits

Maryland offers programs that work with Medicare coverage

Most denials happen from easily avoidable mistakes

We’ve been helping families navigate Medicare for decades, and we’ve seen too many people pay out of pocket for services Medicare would have covered completely.

The good news? Once you understand how Medicare To Pay For Home Care coverage actually works, you can access skilled nursing care, therapy services, and medical equipment at zero cost when you meet the requirements.

Table of Contents

The Hidden Truth About Medicare Home Health Coverage

After decades in this business, nobody wants to tell you about Medicare home health coverage:

Medicare covers eligible home health services at zero cost when you meet all the requirements. That’s right. Zero cost for covered services.

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What trips up most people about Medicare To Pay For Home Care

Medicare only covers skilled nursing care, therapy services, and medical social services when they’re medically necessary and ordered by your doctor.

They don’t cover someone to help you shower, cook meals, or do laundry unless you’re also getting skilled medical care.

Think of it like ordering a combo meal where you can’t just get the fries. You need the medical “burger” to get the personal care “fries.”

Most people assume Medicare To Pay For Home Care is just for people leaving the hospital. Wrong. You can qualify for Medicare home health services whether or not you’ve been hospitalized, as long as you meet the other requirements.

Hear From one of Our Happy Clients

“I started my search for Medicare with Senior Benefit Services. I knew nothing, and they got me started. I researched all options available to me, from multiple online sources, but in the end, for the same price, I got the personalized assistance of a professional with decades of experience.” – Kenny Bohrer, Maryland Resident

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What Medicare Actually Covers for Home Health in Maryland

Medicare covers skilled nursing care for things like wound care, medication management, and monitoring serious health conditions. This isn’t your typical “check on grandma” visit.

We’re talking about medical professionals providing hospital-level care in your living room.
Physical therapy, occupational therapy, and speech therapy are covered when medically necessary.

If you’re recovering from a stroke, hip replacement, or other condition that affects your mobility or daily functioning, these services can be lifesavers.

More Community Resources for Medicare To Pay For Home Care

Medical social services help coordinate your care and connect you with community resources. This often overlooked benefit can be huge for families dealing with complex medical situations.

Home health aide services are covered, but only when you’re also receiving skilled nursing or therapy services. This is where people get confused. You can get help with bathing and personal care, but only as part of a broader medical treatment plan.

Medicare specifically doesn’t cover: custodial care that helps with daily living activities like bathing, dressing, or using the bathroom when this is the only care you need.

The Four Requirements That Make or Break Your Coverage

Getting Medicare home health coverage requires meeting four specific criteria, and missing even one kills your entire claim.

1st Requirement

The very first requirement is you must be homebound. This means you have trouble leaving your home without help like using a cane, wheelchair, walker, crutches, special transportation, or help from another person because of illness or injury.

4 Requirements That Make or Break Your Coverage - Senior Benefit Services Hagerstown, Maryland

You can still leave home for medical treatment or short, infrequent absences for non-medical reasons like attending religious services. You can even attend adult day care and still qualify as homebound.

2nd Requirement

Second, your doctor must order the care. A healthcare provider must assess you face to face before certifying that you need home health services. No doctor’s order means no coverage, period.

3rd Requirement

Third, you need skilled care. You must need part-time or intermittent skilled nursing care, physical therapy, or speech therapy services. The care has to require a medical professional, not just someone to help around the house.

4th Requirement

Fourth, you must use a Medicare-certified agency. A Medicare-certified home health agency must provide the services. Using a non-certified provider means you pay everything out of pocket.

How Much Medicare Pays and for How Long

Medicare home health gets really good: for all covered home health services, you pay nothing.

There’s no limit on the number of visits as long as you continue to meet eligibility requirements and your doctor continues to certify your need for care.

Each certification period lasts up to sixty days, and your doctor can recertify you for additional periods if medically necessary.

The only cost you might face? You pay twenty percent of the Medicare-approved amount for durable medical equipment like wheelchairs or walkers used at home.

Let me put this in perspective. Private nursing visits in Maryland cost significant amounts per hour.

Physical therapy runs substantial costs per session. If you need twice-weekly nursing visits and physical therapy for three months, you’re looking at thousands in costs that Medicare covers completely when you qualify.

Maryland’s Secret Weapon: Dual Coverage Strategy

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Maryland residents have access to both Medicare and Medicaid home care programs, and understanding how they work together can save you thousands while keeping you in your home longer.

Medicare focuses on skilled medical services. Medicaid provides coverage for low-income seniors who are also enrolled in Medicare.

When you qualify for both programs (called dual eligibility), Medicaid can pick up services Medicare doesn’t cover. Medicaid covers additional services beyond those provided under Medicare.

How it works in practice: Medicare covers your skilled nursing visits for wound care. Maryland Medicaid might help with personal care services, like help with bathing or meal preparation, that Medicare won’t cover alone.

Services covered by both programs are first paid by Medicare, with Medicaid filling in the difference up to the state’s payment limit.

What if you do not qualify for dual eligibility? If your current household income levels do allow you to qualify for Medicaid benefits, then you should be considering a stand-alone home health care plan.

These plans are more affordable than a traditional long-term care insurance plan and provide benefits to allow you to recover in the comfort of your own home.

It is important to keep in mind that Medicare does not cover your typical custodial home health care services, such as general supervision, homemaker services, or help with activities of daily living, such as eating, bathing, dressing, and mobility.

This is where a stand-alone home health care insurance plan or a long-term care insurance plan will come into play. Want to learn more about home health care expenses, be sure to read our post here.

Finding Quality Providers in Maryland

Not all home health agencies are created equal, and Medicare only pays for services from certified providers.

Look for agencies with four or five-star ratings and read their detailed quality measures.

Ask about their experience with your specific medical conditions.

Seniors talking about Medicare To Pay For Home Care and Eligible For Medicare in 2025 in Maryland?

Some agencies specialize in wound care, others in cardiac rehabilitation or diabetes management. Make sure they have staff available when you need them and can coordinate effectively with your doctors.

The agency should explain exactly what Medicare will and won’t cover before starting services. Before you start getting your home health care, the home health agency should tell you how much Medicare will pay and tell you both verbally and in writing if Medicare won’t pay for any items or services. Start your search using the Medicare’s Medicare Compare website to begin your search.

Common Mistakes That Kill Claims

Most Medicare home health denials happen because of easily preventable errors, not because people don’t qualify.

The biggest mistake? Not getting proper physician certification. Your doctor needs to create a detailed plan of care that explains why you need skilled services and why you’re homebound.
Second biggest mistake?

Assuming you don’t qualify because you can still get around sometimes. The homebound requirement allows for occasional outings as long as leaving home requires considerable and taxing effort.

Third mistake? Waiting too long to apply. Start the process as soon as you realize you might need home health services. Getting everything approved and coordinated takes time.

Your Next Steps

When you’re having trouble getting around safely or managing medical care at home, talk to your doctor about Medicare home health services. Don’t wait until you’re in crisis mode.

You might find yourself dealing with a chronic condition that requires ongoing medical management, but ask your physician if home health services might be appropriate for your situation.

Sometimes, you can think you automatically qualify if you have been denied Medicare home health coverage, but don’t assume you don’t qualify. Many denials get overturned on appeal when the paperwork is done correctly

Understanding Medicare home health coverage isn’t just about getting care at home. It’s about maintaining your independence and avoiding unnecessary nursing home placement that could cost you everything you’ve worked to build.

Free Personalized Medicare Quote With Senior Benefit Client Near

At Senior Benefit Services, we’ve spent decades helping Maryland families understand their Medicare benefits and coordinate care that keeps them healthy and independent.

We know which home health agencies provide the best care, how to appeal wrongful denials, and how to coordinate Medicare with other programs to maximize your benefits.

If you’re facing decisions about home health care, don’t navigate this complex system alone.
The key to successful Medicare home health coverage is understanding the rules before you need the services. The families who plan ahead get better care at lower costs.

The ones who wait until emergencies end up paying unnecessarily or going without needed care.

Your health and independence are too important to leave to chance. Don’t go through this process alone when you have questions about Medicare home health coverage. Senior Benefit Services has helped thousands of Maryland families understand their Medicare benefits. Get your free consultation today at (800) 924-4727.

Senior Benefit’s Hagerstown Office

We are here to help. Contact us today!

(301)733-0085
(800) 924-4727

580 Northern Ave
Hagerstown, MD 21742

Hours :

Monday – Firday : 9am – 5pm EST
Sat & Sun: Closed

Senior Benefit’s Thurmont Office

We are here to help. Contact us today!

Hours :

Monday – Firday : 8am – 4pm EST
Sat & Sun: Closed

Senior Benefit’s Cumberland Office

We are here to help. Contact us today!

309 Willowbrook Road, Suite 1
Cumberland, MD 21502

Hours :

Monday – Firday : 9am – 5pm EST
Sat & Sun: Closed

Medicare vs Medicaid: Don’t Make This Expensive Mistake

Most Americans approaching retirement age don’t understand the Medicare vs Medicaid difference.

Medicare vs Medicaid: What’s the Difference?

Making the wrong assumption about understanding Medicare’s real advantages, and how these programs could cost you thousands in uncovered medical expenses.

This could leave you completely unprotected when a health crisis hits.

Medicare vs Medicaid - Senior Benefit Serivces Hagerstown MD

We’ve been in this industry for decades, and we’ve seen families lose their homes because they didn’t understand these differences.

The good news? Once you grasp how Medicare vs Medicaid coverage actually works, you can create a healthcare safety net that protects both your health and your life savings.

Some people even discover they qualify for both programs, essentially getting premium healthcare coverage for a fraction of the cost.

Let’s explore how you can benefit from getting this right before it’s too late.

What You Will Learn

Most people completely miss these eligibility requirements

One program has secret lifetime penalties that compound forever

There’s a hidden dual coverage strategy worth thousands annually

Your state determines if you save money

Missing one deadline could cost you more in life

Table of Contents

The Truth About These Programs

After decades in this business, we’ve learned that the biggest source of confusion comes from people assuming these programs work similarly because they’re both government health insurance. They don’t work similarly at all.

But here’s where it gets wild. Most people think Medicare is complicated and expensive. Wrong. Medicare actually provides predictable, comprehensive coverage that you can build a retirement plan around.

Then they assume Medicaid is easier because it’s “free.” Also wrong. Medicaid requires you to be broke first and offers zero geographic flexibility.

See the problem? People are making life-altering financial decisions based on misconceptions instead of facts that could save them thousands.

Hear From One of Our Happy Customers!

“Kayla was brilliant! I could not have done any of this Medicare stuff without her help. She walked me through every step in a way that I could understand, helping me make the right decisions for my needs. Any time that I had a question or concern, she was always there to help me. I am extremely grateful for everything that she has done for me and continues to do.” – Kelli

Dental Care For Seniors Free Quote Senior Benefit Services Maryland

The Medicare vs Medicaid Reality Nobody Talks About

Let’s start with Medicaid since most people have it completely backwards. Medicaid isn’t about age. It’s about being broke. Your income and assets must fall below strict state limits, and here’s the kicker: those limits change every time you cross a state line.

Move from Maryland to Florida? Your Medicaid benefits could disappear overnight. Relocate to be closer to grandchildren? You might lose prescription coverage entirely because your new state runs Medicaid differently.

Here’s what people don’t realize about Medicaid: it only kicks in AFTER you’ve spent down your life savings to poverty levels. Sure, Medicaid services cost nothing if you qualify. No premiums. No deductibles. No co-pays.

But qualifying means you’ve already lost your financial independence. Think about that for a moment. Medicaid helps you after you’re broke. That’s not retirement planning. That’s emergency assistance.

Here’s What People Are Doing Instead

The savvy retirees who maintain their wealth and dignity don’t wait around hoping they’ll qualify for Medicaid.

They take control of their healthcare future by understanding Medicare’s real advantages.

Medicare vs Medicaid Senior Benefit Services Hagerstown, MD

These smart planners recognize that Medicare is more than just basic government insurance. It’s a comprehensive healthcare foundation that you can build upon to create bulletproof retirement protection.

They know that with the right Medicare strategy, you can get excellent care while keeping every dollar you’ve worked decades to save.

While others are crossing their fingers, hoping Medicaid will be there when they need it, Medicare-smart families are locking in predictable healthcare costs that follow them anywhere in America.

They’re choosing Medicare Advantage plans with extras like dental and vision, or pairing original Medicare with Medigap policies that eliminate surprise medical bills.

The difference is night and day. Medicaid hopefuls spend their golden years worrying about qualifying for poverty assistance. Medicare planners spend their retirement enjoying the security that comes from having earned benefits that can’t be taken away based on where they live or how their state’s politics change.

Most importantly, they understand that Medicare planning isn’t just about healthcare coverage. It’s about maintaining the independence and choice that comes from keeping your assets while getting the care you deserve.

Why Medicare Destroys Medicaid for Retirement Planning

Now let’s talk about Medicare, the program that actually makes sense for people who want to retire with dignity. Medicare works exactly the same whether you live in California or Alabama. Same rules, same benefits, same costs.

This consistency lets you plan your retirement without worrying about state politics.

Medicare Part A covers hospital stays and comes “free” if you worked long enough. You’ve earned this benefit through decades of payroll taxes. It’s not charity. It’s your money.
Medicare Part B handles doctor visits and outpatient care.

Yes, it costs money every month, but it provides predictable, nationwide coverage that travels anywhere you want to retire.

Medicare Part C (Medicare Advantage) lets private companies enhance your benefits with extras like dental, vision, and prescription coverage that original Medicare doesn’t include. Medicare Part D covers prescriptions, filling the biggest gap in original Medicare.

Here’s the game changer: you can buy Medigap insurance to eliminate almost all out-of-pocket costs while keeping your assets intact. Try doing that with Medicaid. You can’t because you have to be broke to qualify.

Medicare vs Medicaid: The Numbers Don’t Lie

Let’s talk real money without sugarcoating anything. Average nursing home costs in our region are staggering monthly expenses.

Medicaid covers this cost, but only after you’ve spent your life savings down to almost nothing in most states.

We’ve seen families save their entire inheritance by understanding this difference.

Families who plan around Medicare tend to maintain their wealth. The ones who hope for Medicaid lose everything first.

Contact Senior Benefit Services today to learn how to maximize your Medicare benefits and avoid the Medicaid poverty trap.

The Double Coverage Secret

Here’s where things get interesting for people with limited income.

Some people qualify for both Medicare and Medicaid simultaneously.

We call this “dual eligible,” and it’s like winning the healthcare lottery.

We’ve watched dual-eligible people get comprehensive healthcare, including dental, vision, and prescription coverage, for basically nothing.

But here’s the crucial point most people miss: even with dual eligibility, Medicare is your primary coverage. It’s the foundation that makes everything else possible.

The Geographic Advantage That Changes Everything

Here’s a Medicare vs Medicaid difference that smart retirement planners obsess over. Medicare follows you anywhere in America.

Move to any state and your benefits stay identical. Want to winter in Florida and summer in Maryland?

Medicare doesn’t care. Thinking about retiring to a lower-cost state? Medicare makes that possible.

Medicaid doesn’t travel. At all. We’ve seen retirees lose prescription coverage entirely because they moved from a generous Medicaid state to a restrictive one.

Medicare’s portability gives you retirement freedom that Medicaid destroys.

The Asset Protection Strategy

Let’s get down to what really matters: protecting your money. Medicaid requires you to spend down your assets before it helps.

It’s financial protection after you’ve lost your wealth.
Medicare lets you keep your assets while getting excellent care. You can budget for predictable monthly costs and protect against catastrophic expenses with supplemental coverage.

Here’s the math that matters: A Couple with substantial retirement savings needs long-term care.

Medicaid path: Spend down to almost nothing, then get “free” care. Result: lose almost everything. Medicare path: Use proper planning to protect assets while paying for care. Result: keep wealth and get excellent treatment.

The difference isn’t just money. It’s dignity, choice, and leaving something for your family.

Your Medicare Action Plan

Here’s exactly what you need to do right now: If you’re approaching retirement age, start researching Medicare enrollment deadlines well before your birthday.

Missing these deadlines costs you money forever, but proper planning gets you the coverage you’ve earned.

If your income is limited, investigate Medicare Savings Programs that help pay Medicare premiums without requiring you to become impoverished like Medicaid does.

If you think you might qualify for both programs, understand that Medicare remains your primary coverage and the foundation of your healthcare plan.

Most importantly, stop thinking about Medicaid as retirement planning. It’s not. It’s poverty assistance.

Ready to secure your Medicare future? Call Senior Benefit Services at (800) 924-4727 for a consultation that will help you maximize your Medicare benefits and protect your retirement security.

The Bottom Line: Medicare Wins Every Time

Look, we’ve been doing this for decades, and the math is simple. Medicare protects your assets while providing excellent care. Medicaid provides care after you’ve lost your assets.

One is retirement planning. The other is emergency assistance. The families who understand this difference retire with dignity and leave inheritances for their children.

The ones who ignore Medicare planning end up broke and dependent on government assistance.

You’ve been paying into Medicare your entire working life. It’s not charity. It’s your earned benefit that deserves to be maximized.

At Senior Benefit Services, we’ve built our reputation over decades by helping people understand one simple truth: Medicare is the foundation of smart retirement healthcare planning. We serve families throughout Maryland, Virginia, and West Virginia because we are deeply familiar with these markets.

We know which Medicare plans provide the best value, which insurance companies pay claims, and how to coordinate Medicare benefits to create comprehensive coverage that protects your wealth.

Most importantly, we understand that choosing Medicare over hoping for Medicaid is the difference between retiring with dignity and spending your golden years worrying about money.

Because understanding Medicare vs Medicaid isn’t just about healthcare. It’s about protecting everything you’ve worked your entire life to achieve while ensuring you get the excellent coverage you deserve.

Your Medicare benefits are too valuable to leave to chance. Let us help you turn them into a retirement healthcare strategy that works.

Don’t wait until you’re broke to get help. Plan with Medicare now and keep your wealth forever.

Senior Benefit’s Hagerstown Office

We are here to help. Contact us today!

(301)733-0085
(800) 924-4727

580 Northern Ave
Hagerstown, MD 21742

Hours :

Monday – Firday : 9am – 5pm EST
Sat & Sun: Closed

Senior Benefit’s Thurmont Office

We are here to help. Contact us today!

Hours :

Monday – Firday : 8am – 4pm EST
Sat & Sun: Closed

Senior Benefit’s Cumberland Office

We are here to help. Contact us today!

309 Willowbrook Road, Suite 1
Cumberland, MD 21502

Hours :

Monday – Firday : 9am – 5pm EST
Sat & Sun: Closed

Does Medicare Cover Hearing Tests in MD, PA, WV?

Does Medicare cover hearing tests in Maryland, Pennsylvania, Virginia, and West Virginia?

Here’s what you need to know about how Medicare covers hearing tests and hearing test coverage in these states.

As we age, clear hearing becomes vital, yet many older adults struggle to access affordable screenings.

The good news? If your doctor orders a diagnostic exam, certain benefits may apply.
Original plans don’t include routine checks or devices like hearing aids, but Medicare Advantage plans sometimes offer extra perks.

Need clarity? We guide residents across multiple states to maximize their benefits.

Table of Contents

Key Takeaways

Diagnostic exams are covered if medically necessary.

Routine tests and hearing aids aren’t included.

Part B requires meeting the annual deductible plus 20% coinsurance.

Approximately 98% of hearing loss cases can be treated with hearing aids.

We help decode policies for MD, PA, and WV residents.
Understanding Medicare Coverage for Hearing Tests

Navigating hearing health benefits can be confusing under federal health plans. We simplify the rules so you know exactly what to expect.

What Original Medicare Covers (And Doesn’t Cover)

Original Medicare pays for diagnostic exams if a doctor orders them to investigate symptoms like sudden hearing loss. After meeting the annual Part B deductible, Original Medicare covers 80% of costs.

However, routine check-ups or devices like hearing aids aren’t included. Approximately 48 million Americans (nearly 15% of the population) experience some form of hearing loss, yet Medicare provides no coverage for the estimated $900-$6,000 cost of quality hearing aids.

One client, Melody Poniatowski, wrote:

“Sharon Sass has been a great help to my mom!!!! She has been helping us for a few years. I don’t know what we would do without her assistance!!! I highly recommend Sharon to everyone who needs help finding the right plan for their elderly loved ones.”

Diagnostic vs. Routine Hearing Exams

A diagnostic exam addresses specific concerns, such as infections or balance issues. These qualify for coverage. Annual screenings, though helpful, fall under routine care and aren’t paid for.
Without supplemental insurance, you’ll pay 20% of approved costs out-of-pocket. We helped Linda access VA benefits after her claim was denied, saving her approximately $1,500.
Always verify your plan’s services before scheduling tests. State programs or Medicaid might offer alternative paths.

Medicare Advantage Plans: Expanded Hearing Benefits

Hearing care shouldn’t be a luxury, yet many health plans treat it that way. Medicare Advantage changes this by offering annual exams and device coverage that Original Medicare excludes. For Pennsylvania and West Virginia residents, partnerships like Humana and TruHearing unlock significant savings of up to 70% off retail prices.

How Advantage Plans Differ from Original Medicare

Unlike Original Medicare, Advantage plans often include routine hearing exams and partial coverage for devices. Humana’s plans, for example, offer $0 copay annual checks and hearing aids starting at $399, compared to the retail price averaging $2,300 per ear. One satisfied client shared:

State-Specific Hearing Care in MD, PA, and WV

Access to quality hearing care varies by state, and here’s how residents in MD, PA, and WV can benefit. Local partnerships and specialized programs bridge gaps left by federal plans. We’ll explore top options in each region.

Local Medicare Advantage Offerings

Pennsylvania’s UPMC Health Plan members can combine benefits with Lions Club subsidies for extra savings of up to 80%.

In West Virginia, WVU Medicine collaborates with Charleston VA Hospital to provide free ear exams for veterans. These networks make hearing care more accessible.
Additional Resources for Hearing Health

Beyond insurance, state programs help:

Maryland Medicaid covers hearing aids for low-income adults (serving approximately 65,000 eligible residents)

Pennsylvania Lions Clubs offer refurbished devices at 80% off retail prices

West Virginia VA hospitals provide free annual screenings to over 145,000 veterans
We partner with 23 clinics across these states. For a full list, download our free Tri-State Hearing

What Our Clients Say About Their Hearing Care Journey

Real stories often reveal the true impact of quality hearing care. For older adults, finding the right support can transform daily life. Here’s how we’ve helped clients across three states.

Success Stories from Maryland

A Baltimore resident saved $2,100 yearly after switching to an Aetna Advantage plan we recommended. “I finally joined family dinners without straining,” they shared. Their diagnostic exam uncovered hearing loss linked to chronic ear infections, which is now fully managed.

A Harrisburg couple accessed Bluetooth-enabled aids through UPMC health insurance.

“We stream music directly to our devices, which is a game-changer!” The Harrisons, PA
Their plan covered 80% of the costs, making advanced tech affordable.

West Virginia Testimonials

A Morgantown veteran combined VA benefits with a Humana plan for zero out-of-pocket expenses. “The team navigated every part of the process,” he said. Now, he attends grandkids’ soccer games without missing a cheer.

Join 428 satisfied patients. Schedule your free consultation today. Let’s write your success story next.

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Frequently Asked Questions About Medicare Coverage For Hearing Tests

Does Original Medicare pay for hearing tests?

Original Medicare (Part B) may cover diagnostic exams if ordered by a doctor for medical reasons. Routine check-ups are not included.

Can Medicare Advantage help with hearing aid costs?

Many Advantage plans offer extra benefits like annual exams and partial coverage for devices. Check your plan details for specifics.

Are there differences in coverage between states?

While federal rules apply nationwide, local Advantage plans in Maryland, Pennsylvania, and West Virginia may offer unique hearing care options.

How often can I get a hearing test with Medicare?

Under Original Medicare, only medically necessary tests are covered. Advantage plans often include one annual exam as part of their benefits.

What if I need hearing aids but can’t afford them?

Some state programs, nonprofits, and Advantage plans provide financial assistance. We can help explore options based on your location.

Time is running out to secure the best hearing care options. The Annual Enrollment Period ends December 7, lock in benefits before plan changes take effect.

Our free quotes compare up to 12+ Medicare Advantage plans with hearing aid perks in your area. No obligation, just expert guidance.

Call 800-924-4727 now or click below for a personalized analysis. Plus, check out our article on Does Medicare Cover an Audiologist?

Your satisfaction is guaranteed. Don’t wait, better coverage starts today.

Senior Benefit’s Hagerstown Office

We are here to help. Contact us today!

(301)733-0085
(800) 924-4727

580 Northern Ave
Hagerstown, MD 21742

Hours :

Monday – Firday : 9am – 5pm EST
Sat & Sun: Closed

Senior Benefit’s Thurmont Office

We are here to help. Contact us today!

Hours :

Monday – Firday : 8am – 4pm EST
Sat & Sun: Closed

Senior Benefit’s Cumberland Office

We are here to help. Contact us today!

309 Willowbrook Road, Suite 1
Cumberland, MD 21502

Hours :

Monday – Firday : 9am – 5pm EST
Sat & Sun: Closed

Medicare Telehealth Coverage Guide For Seniors 2025

Medicare Telehealth Coverage Guide for Seniors | Senior Benefit Services

Imagine having a doctor’s appointment while still in your pajamas, or getting medication adjusted without the hassle of parking, waiting rooms, or exposure to illness. Telehealth makes all this possible, providing convenient access to healthcare from the comfort of your home.

These services are revolutionizing how seniors receive healthcare – but many beneficiaries aren’t taking full advantage of this convenient option simply because they don’t understand what’s covered.

For countless seniors across Maryland and beyond, telehealth has become a lifeline – providing access to quality care without transportation barriers, mobility challenges, or concerns about infection exposure.

At Senior Benefit Services, we’ve helped hundreds of Medicare beneficiaries navigate these benefits, and we’ve seen firsthand how virtual care can transform lives when patients understand their coverage.

This service is currently extended through September 30, 2025, and now is the perfect time to understand your options before significant changes take effect.

Let us walk you through everything you need to know about this coverage, helping you maximize your benefits while they’re at their most expansive.

Key Takeaways

Coverage: Telehealth anywhere? Only until this crucial date

Changes: The rural restriction you didn’t expect

Cost: The truth about telehealth vs. in-person pricing

Advantage: Why some Medicare plans win the telehealth game

Planning: Act now before policies transform

What is Medicare Telehealth Coverage?

This refers to healthcare services delivered remotely using telecommunications technology. Instead of visiting a doctor’s office in person, you connect with healthcare providers through video calls, phone calls, or other digital platforms.

Types of Services

Medicare covers a variety of telehealth services, allowing you to receive care without leaving your home. These include:

Virtual doctor visits: Real-time video consultations with physicians

Mental health counseling: Individual and group therapy sessions

Urgent care consultations: For non-emergency health concerns

Medication management: Discussing and adjusting prescriptions

Preventive health screenings: Annual wellness visits and health risk assessments

Specialist consultations: Access to specialists who might not be available locally

Through September 30, 2025, Medicare beneficiaries can access this services from any location in the U.S., including their homes. However, starting October 1, 2025, most services will require patients to be in a healthcare facility located in a rural area.

How Telehealth Differs from Traditional In-Person Care

This service provides many of the same benefits as in-person appointments but with added convenience. Key differences include:

Location flexibility: Receive care from home or another comfortable setting

Reduced travel time: No need to commute to medical facilities

Lower infection risk: Avoid exposure to contagious illnesses in waiting rooms

Access to specialists: Connect with healthcare providers regardless of geographic limitations

Caregiver involvement: Family members can more easily participate in appointments

Does Medicare Cover Telehealth?

Yes, Medicare does cover services, though coverage varies depending on whether you have Original Medicare or a Medicare Advantage plan.

Original Medicare (Parts A & B) Telehealth Coverage

Under Original Medicare, Part B (Medical Insurance) covers approved telehealth services. Recent legislation has extended this service through September 30, 2025, including the ability to receive telehealth services from any location, including your home, regardless of whether you live in a rural or urban area.

Key coverage details include:

Provider eligibility: Must be Medicare-approved provider

Technology requirements: Most services require two-way, real-time audio and video communication

Audio-only options: Some services can be provided via telephone if video isn’t possible

Covered services: Includes doctor visits, mental health counseling, preventive screenings, and more

Medicare Advantage (Part C) Telehealth Coverage

Medicare Advantage plans typically offer more extensive benefits than Original Medicare. Many Medicare Advantage plans include:

Expanded Telehealth service: Coverage for services beyond what Original Medicare covers

24/7 virtual care options: Access to healthcare professionals around the clock

Lower out-of-pocket costs: Some plans offer reduced or waived copays

Built-in technology solutions: Dedicated apps or platforms for connecting with providers

Since Medicare Advantage plans are offered by private insurance companies, telehealth coverage varies by plan. It’s essential to check your specific plan’s details to understand what’s covered.

Which Services Are Covered by Medicare?

Medicare covers a wide range of services, making it possible to address many healthcare needs virtually.

Covered Services Under Medicare

Medicare-covered services include:

Office visits: Routine check-ups and consultations with primary care physicians

Mental health services: Therapy, counseling, and psychiatric evaluations

Preventive care: Annual wellness visits and health risk assessments

Specialist consultations: Appointments with specialists like cardiologists or neurologists

Chronic care management: Ongoing care for conditions like diabetes or heart disease

Emergency care assessments: Evaluation of urgent but non-life-threatening conditions

Physical therapy: Some rehabilitation services can be delivered virtually

Speech therapy: Sessions for speech and language disorders

Occupational therapy: Help with performing daily activities

Nutritional counseling: Guidance on diet and nutrition

Special Provisions for Mental Health Services

Mental health services have special provisions that extend beyond the September 2025 deadline. For mental health services, the requirement for an in-person visit within six months of initial telehealth service, and annually thereafter, remains waived through September 30, 2025. Hhs

This makes telehealth particularly valuable for ongoing mental health care, allowing consistent therapy without interruption.

Coverage Costs Under Medicare

Understanding what you’ll pay for helps you budget for virtual healthcare.

For Original Medicare beneficiaries:

You’ll pay the Part B deductible if you haven’t met it yet

After meeting the deductible, you pay 20% of the Medicare-approved amount

The cost is typically the same as what you would pay for in-person services

For Medicare Advantage beneficiaries:

Costs vary by plan

Many plans offer reduced copays or coinsurance

Some plans may waive costs entirely for certain services

Comparing Costs:

While the Medicare coverage percentage remains the same (80% after deductible), telehealth may still offer cost advantages:

Eliminated travel expenses: No costs for gas, parking, or public transportation

Reduced time costs: Less time away from work or other responsibilities

Fewer incidental expenses: No need for meals out or other expenses that often accompany medical appointments

How to Access Service

Getting started with telehealth is straightforward once you understand the process.

Steps to Begin

Confirm coverage: Verify that your specific Medicare plan covers the service you need

Choose a provider: Select a Medicare-approved telehealth provider

Schedule an appointment: Book your virtual visit through your provider’s office

Prepare technology: Ensure you have the necessary device (smartphone, tablet, or computer) and internet connection

Join the visit: Log in to your appointment at the scheduled time using the provided link or app

Technology Requirements

To participate you’ll need:

Device: Smartphone, tablet, or computer with a camera and microphone

Internet connection: Reliable broadband or cellular data connection

Software/apps: Any required platforms or applications

Private space: A quiet, well-lit area for your appointment

If you don’t have access to video technology, Medicare allows audio-only through September 30, 2025, for non-behavioral/mental health services when video isn’t possible. Hhs

Important Changes to Coverage in 2025

Medicare telehealth coverage is currently in a transitional period, with significant changes on the horizon.

Current Medicare Telehealth Flexibilities

On March 15, 2025, Congress passed a federal government spending bill that extended essential provisions through September 30, 2025. ATA These flexibilities include:

Location flexibility: Receive services from any location, including your home

Provider eligibility: Expanded list of eligible providers

Technology options: Audio-only services when video isn’t available

Rural requirements waived: No geographic restrictions

What Happens After September 30, 2025?

After September 30, 2025, without further extensions, Medicare coverage will change significantly. Most telehealth services will require patients to be in a healthcare facility located in a rural area.

However, there will be important exceptions, including:

Mental health services: Continue to be available at home regardless of location

End-Stage Renal Disease (ESRD) services: Monthly home dialysis visits

Stroke treatment: Services for acute stroke diagnosis and treatment

Medicare Advantage plans: May continue to offer broader benefits

Medicare Advantage and Telehealth: Enhanced Benefits

Medicare Advantage plans typically offer more comprehensive telehealth coverage than Original Medicare.

How Medicare Advantage Plans Enhance Telehealth Options

Many Medicare Advantage plans provide:

Broader service coverage: More types of virtual care services covered

More provider options: Larger networks of telehealth providers

Integrated platforms: Easy-to-use telehealth platforms or apps

Continued flexibility: Some plans may maintain telehealth benefits beyond the September 2025 deadline

Additional virtual services: Remote monitoring, virtual check-ins, and other digital health tools

Finding the Right Medicare Advantage Plan for Telehealth

If telehealth is important to you, consider these factors when choosing a Medicare Advantage plan:

Telehealth network: Ensure your preferred providers are in-network for telehealth

Service coverage: Check which specific telehealth services are covered

Technology support: Look for plans that offer assistance with telehealth technology

Cost-sharing: Compare copays and coinsurance for telehealth services

Long-term commitments: Consider how the plan will handle telehealth after September 2025

Preparing for the October 2025 Telehealth Changes

Planning ahead is crucial to ensure continuity of care when Medicare telehealth coverage changes.

Steps to Take Before the 2025 Deadline

Healthcare organizations and patients should prepare for potential changes by identifying which telehealth services may no longer be covered, developing transition plans for affected patients, and considering alternative care options. Telehealthresourcecenter

For Medicare beneficiaries, recommended actions include:

Talk to your healthcare providers: Discuss how your care will continue after the deadline

Review your Medicare coverage: Understand what telehealth benefits you’ll maintain

Consider Medicare Advantage: Explore plans with robust telehealth benefits

Identify in-person alternatives: Locate accessible healthcare facilities for necessary in-person care

Explore transportation options: Research services that can help you reach in-person appointments

Stay informed: Watch for potential further extensions or permanent telehealth provisions

Telehealth Success Stories: How Seniors Benefit

Real-world examples demonstrate the positive impact of telehealth for Medicare beneficiaries.

Case Studies: Telehealth Transforming Senior Healthcare

Case Study 1: Rural Access to Specialists
Martha, 78, lives in rural Maryland and needs regular cardiology follow-ups. Before telehealth, she traveled three hours each way to see her specialist. Now, she connects virtually for most appointments, saving time and reducing physical strain.

Case Study 2: Chronic Condition Management
James, 70, manages diabetes and uses telehealth for monthly check-ins with his healthcare team. Virtual visits have improved his medication adherence and allowed for more frequent monitoring without the burden of frequent office visits.

Case Study 3: Mental Health Support
Eleanor, 82, began experiencing depression after her husband’s passing. Through Medicare-covered telehealth therapy sessions, she receives weekly counseling from her home, removing transportation barriers that would have otherwise prevented consistent care.

Tips for Successful Medicare Telehealth Visits

Maximize the value of your virtual healthcare appointments with these practical strategies.

Before Your Telehealth Appointment

Test your technology: Ensure your device, internet, camera, and microphone work properly

Gather medical information: Have your medication list, recent symptoms, and health history ready Prepare questions: Write down concerns you want to address

Set up your space: Find a quiet, private area with good lighting

Check your coverage: Verify your telehealth visit is covered by Medicare

During Your Telehealth Visit

Be ready early: Log in 5-10 minutes before your scheduled appointment

Take notes: Document important information and instructions

Be specific: Clearly describe symptoms or concerns

Ask for clarification: Don’t hesitate to request explanations if something is unclear

Discuss follow-up: Understand next steps, including any necessary in-person care

Medicare Telehealth Coverage for Specific Conditions

Telehealth can be particularly valuable for managing certain health conditions common among seniors.

Chronic Disease Management via Telehealth

Medicare covers telehealth services for managing many chronic conditions, including:

Diabetes: Virtual check-ins for blood sugar monitoring, medication adjustments, and lifestyle coaching

Heart disease: Remote monitoring of vital signs, medication management, and symptom assessment

COPD and asthma: Virtual pulmonary rehabilitation and breathing assessments

Hypertension: Blood pressure monitoring and medication adjustments

Arthritis: Pain management consultations and exercise guidance

Mental Health Services via Telehealth

Mental health care is especially well-suited to telehealth delivery. Medicare-covered telehealth mental health services include:

Individual therapy: One-on-one counseling sessions

Psychiatric consultations: Medication management and treatment planning

Group therapy: Virtual support groups

Cognitive behavioral therapy: Structured therapeutic approaches

Depression and anxiety screening: Assessment and monitoring

The Future of Medicare Telehealth Coverage

The landscape of Medicare telehealth coverage continues to evolve.

Advocacy for Permanent Telehealth Expansion

Healthcare organizations are advocating for permanent telehealth authority beyond the temporary extensions. The American Speech-Language-Hearing Association (ASHA) and other groups continue to push for legislation that would make telehealth a permanent part of Medicare coverage. Asha

Potential Legislative Developments

Several bills and initiatives are under consideration that could impact the future of Medicare telehealth:

Permanent telehealth expansion: Legislation to maintain current flexibilities beyond September 2025

Rural access improvements: Enhanced coverage for rural beneficiaries

Technology accessibility: Programs to help seniors access necessary telehealth technology

Provider reimbursement: Standardized payment models for virtual care

Interstate licensing: Simplified processes for providers to offer telehealth across state lines

How Senior Benefit Services Can Help

Navigating Medicare telehealth benefits can be complex, but you don’t have to do it alone.

Our Medicare Telehealth Expertise

At Senior Benefit Services, our advisors specialize in helping seniors understand and maximize their Medicare benefits, including telehealth coverage. We can:

Explain your current telehealth benefits: Clarify what’s covered under your specific Medicare plan

Help you prepare for 2025 changes: Develop strategies to maintain access to care

Compare Medicare Advantage options: Identify plans with robust telehealth benefits

Answer your telehealth questions: Provide guidance on using virtual healthcare effectively

Advocate for your needs: Help resolve coverage issues or denials

Connect with Our Medicare Telehealth Specialists

Our experienced advisors are ready to help you navigate Medicare telehealth coverage:

Frequently Asked Questions About Medicare Telehealth Coverage

Does Medicare cover telephone calls with doctors?

Yes, Medicare currently covers audio-only telehealth services (telephone calls) through September 30, 2025, for non-behavioral/mental health services when video capability isn’t available or the patient doesn’t consent to video. Hhs

What if I live in an urban area?

Yes, through September 30, 2025, there are no geographic restrictions for Medicare telehealth services. You can receive care regardless of where you live. Hhs After that date, restrictions will apply for most services except mental health care.

How much does a visit cost?

With Original Medicare, after meeting your Part B deductible ($249 in 2025), you typically pay 20% of the Medicare-approved amount, which is the same as in-person visits. Medicare Advantage costs vary by plan.

Can I see any doctor for a visit?

You must see a Medicare-enrolled provider who offers these services. Not all providers offer telehealth, so check with your healthcare providers to confirm their telehealth capabilities.

Will Medicare Advantage plans still cover telehealth after September 2025?

Many Medicare Advantage plans are likely to continue offering these benefits beyond September 2025, as they often provide coverage beyond Original Medicare requirements. However, specific benefits will vary by plan.

Can I get prescriptions through telehealth?

Yes, Medicare-approved telehealth providers can prescribe medications during virtual visits, with some limitations on controlled substances. The provider must determine if the prescription is appropriate based on the telehealth evaluation.

Conclusion: Maximizing Your Benefits

Telehealth has revolutionized healthcare access for Medicare beneficiaries, offering convenience, continuity of care, and reduced barriers to treatment.

With the current flexibilities extended through September 30, 2025, now is the ideal time to incorporate virtual care into your healthcare routine.

Understanding your coverage, and preparing for upcoming changes—will help ensure you continue receiving the care you need in the most convenient way possible. Whether you have Original Medicare or a Medicare Advantage plan, telehealth offers valuable options for connecting with healthcare providers.

At Senior Benefit Services, we’re committed to helping you navigate your Medicare benefits. Our advisors can guide you through the complexities of Medicare, helping you make informed decisions about your healthcare.

Contact us today at (800) 924-4727 to speak with a Medicare specialist about your telehealth coverage options. We’re here to help you make the most of your Medicare benefits, now and in the future.

Senior Benefit’s Hagerstown Office

We are here to help. Contact us today!

(301)733-0085
(800) 924-4727

580 Northern Ave
Hagerstown, MD 21742

Hours :

Monday – Firday : 9am – 5pm EST
Sat & Sun: Closed

Senior Benefit’s Thurmont Office

We are here to help. Contact us today!

Hours :

Monday – Firday : 8am – 4pm EST
Sat & Sun: Closed

Senior Benefit’s Cumberland Office

We are here to help. Contact us today!

309 Willowbrook Road, Suite 1
Cumberland, MD 21502

Hours :

Monday – Firday : 9am – 5pm EST
Sat & Sun: Closed

Who Is Eligible for Medicare in Maryland for 2025?

Have You Ever Wondered if You’re Eligible for Medicare?

Are you approaching retirement age or dealing with a disability and wondering if you qualify for Medicare? You’re not alone. Every day, thousands of Americans search for clear answers about Medicare eligibility.

I’m David Kurtz, President of Senior Benefit Services, and my team and I have spent years helping people navigate the Medicare system. I can tell you that understanding your eligibility is the critical first step.

Who is Eligible For Medicare in 2025 in Maryland?

Without this knowledge, you might miss enrollment deadlines, face unnecessary penalties, or go without coverage you’re entitled to receive.

Medicare Eligibility Key Takeaways

Age Surprise: Turning 65 doesn’t always mean what you think for Medicare – there’s a critical detail about retirement most people miss.

Disability Shortcut: The “hidden bypass” for disability patients that few advisors mention (plus the one condition that gets you immediate coverage).

Residency Trap: Why citizenship alone isn’t enough – the 5-year rule that catches thousands off guard every year.

Cost Saver: The work history loophole that could save you $518 monthly (or cost you if you’re not careful).

Enrollment Danger: Automatic enrollment might be a myth for your situation – the deadline mistake that can’t be undone.

2025 Benefit: The 2025 rule change that caps your costs at $2,000 and expands a program most beneficiaries never hear about.

Family Advantage: Why the spouse connection matters more than ever – even if you’re divorced or widowed.

Confused by all the literature you get about Medicare Supplements and Medicare Advantage plans? At Senior Benefit Services, we stop the confusion!

Free Personalized Medicare Quote With Senior Benefit Client in Maryland

At Senior Benefit Services, we specialize in finding the most cost-effective Medicare options for our clients. Many people overpay for Medicare simply because they don’t know all their options. Our advisors help you understand all your costs and identify savings opportunities.

As one of our clients mentioned in a Google review: “Karen from Senior Benefit Services was so patient at sifting through all my information and helping me select the most cost-effective Medicare package. Her understanding of the Medicare system was exceptional.”

Call us at (800) 924-4727 to discuss your specific situation and learn what your actual Medicare costs would be.

Medicare Eligibility by Age

The most common path to Medicare eligibility is reaching age 65. I’ve seen too many clients assume they need to be retired to qualify, but that’s not the case at all.

Here’s the truth: If you’re 65 or older and a U.S. citizen or permanent resident who’s lived in the United States legally for at least five consecutive years, you qualify for Medicare. Period.

But here’s where it gets interesting. Your eligibility for premium-free Part A (hospital insurance) depends on your work history. If you or your spouse paid Medicare taxes for at least 10 years (40 quarters), you’ll get Part A without paying a monthly premium.

One of our clients at Senior Benefit Services shared this with me: “I was so confused about Medicare until I realized I could enroll at 65 even though I was still working full-time. Knowing I qualified based on my age alone took a huge weight off my shoulders. Thanks to your team for explaining everything so clearly!

Medicare Eligibility Through Disability

Not yet 65? You might still qualify for Medicare if you have a qualifying disability.

The standard pathway is receiving Social Security Disability Insurance (SSDI) benefits for 24 months. This two-year waiting period is one of the most challenging aspects of disability-based Medicare eligibility.
During my time working with disability advocates, I’ve seen the struggles people face during this waiting period. The good news is that once you reach the 24-month mark, your Medicare enrollment happens automatically.

Railroad workers receiving disability benefits from the Railroad Retirement Board follow similar rules, with eligibility typically starting after 24 months of disability benefits.

Mark, a former construction worker and client of Senior Benefit Services, told me: “After my accident, navigating the disability system was overwhelming. I wasn’t aware that Medicare would kick in after 24 months on SSDI. When it did, it opened up so many more treatment options for me. Your advisors made a world of difference in helping me understand my benefits.”

For ESRD patients, Medicare coverage typically begins on the first day of the fourth month of dialysis treatments. However, there are two ways to get coverage earlier:

If you participate in a home dialysis training program through a Medicare-certified training facility during the first three months of dialysis

If you’re admitted to a hospital for a kidney transplant or for health services you need before the transplant.

Jennifer came to Senior Benefit Services right after her husband developed ESRD at 52, shared: “After my husband’s kidneys failed, we were terrified about the costs. Your advisor explained he qualified for Medicare before 65 because of ESRD, which was life-changing information.

Medicare Eligibility for ESRD Patients

End-Stage Renal Disease (ESRD) creates a special eligibility pathway to Medicare at any age.

If you have ESRD requiring regular dialysis or if you’ve had a kidney transplant, you may qualify for Medicare regardless of your age.

However, you must also meet one of these conditions:

Medicare Eligibility for ESRD Patients in Maryland

You’ve worked the required time under Social Security, the Railroad Retirement Board, or as a government employee

You’re already receiving or are eligible for Social Security or Railroad Retirement benefits

You’re the spouse or dependent child of someone who meets either of the above requirements

You’ve worked the required time under Social Security, the Railroad Retirement Board, or as a government employee

You’re already receiving or are eligible for Social Security or Railroad Retirement benefits
You’re the spouse or dependent child of someone who meets either of the above requirements

For ESRD patients, Medicare coverage typically begins on the first day of the fourth month of dialysis treatments. However, there are two ways to get coverage earlier:

If you participate in a home dialysis training program through a Medicare-certified training facility during the first three months of dialysis

If you’re admitted to a hospital for a kidney transplant or for health services you need before the transplant.

Free-Personalized-Medicare-Quote-With-Senior-Benefit-Client-Near-Maryland-Pennsylvania-West-Virginia-Smiling-Couple-Red-Side

Medicare Eligibility for ALS Patients

If you have Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig’s disease), Medicare eligibility works differently.
You qualify for Medicare immediately upon being approved for Social Security Disability benefits. There’s no 24-month waiting period like there is for other disabilities.
This expedited eligibility recognizes the rapid progression and serious nature of ALS. It ensures that patients can access needed medical care without delay.

Citizenship and Residency Requirements

Medicare eligibility has specific citizenship and residency requirements.
U.S. citizens and permanent residents who have lived in the United States legally for at least five consecutive years typically qualify for Medicare at age 65.

For non-citizens, the rules can get complicated. Generally, lawful permanent residents (green card holders) must meet the five-year residency requirement unless they have enough work history (40 quarters/10 years) paying Medicare taxes.

Citizenship and Residency Requirements in Maryland

Carlos, who moved to the U.S. from Mexico and gained permanent residency, explained after meeting with a Senior Benefit Services advisor: “I was worried about healthcare after turning 65 since I’d only had my green card for three years. Your Medicare specialist helped me understand that I needed to wait two more years to reach the five-year residency requirement before I could enroll. They even scheduled a follow-up appointment for when I’d be eligible.”

Work History Requirements

Your work history directly affects your Medicare Part A costs.
To get premium-free Part A (hospital insurance), you generally need 40 quarters (10 years) of Medicare-covered employment where you paid Medicare taxes.

If you have fewer quarters, you can still get Part A, but you’ll pay a monthly premium:

Robert, a freelancer with inconsistent tax contributions who visited our Cumberland office, told me: “I was shocked to learn I’d have to pay over $500 monthly for Part A because I only had 25 quarters of Medicare tax payments. Thanks to your team at Senior Benefit Services, I now have a plan to manage these costs. I just wish I’d come to you earlier in my career to understand the importance of those contributions.”

Qualifying Through a Spouse

Here’s something many people miss:
You can qualify for Medicare through your spouse’s work record.

You might be eligible for premium-free Part A based on your spouse’s work history if:

Your spouse has at least 40 quarters (10 years) of Medicare-covered employment

You’ve been legally married for at least one year

Your spouse is at least 62 (even if not taking Social Security yet)

This provision is especially important for those who worked in jobs not covered by Medicare taxes or who took time away from the workforce.

Divorced individuals can even qualify based on an ex-spouse’s work record if:

The marriage lasted at least 10 years

You’re currently unmarried

You’re at least 62 years old

Widows and widowers may qualify based on a deceased spouse’s work record if:

The marriage lasted at least 9 months before the spouse’s death

You’re currently unmarried

Maria, who primarily worked as a homemaker and visited our Thurmont office, shared: “After 40 years of marriage, I worried about healthcare costs when turning 65. My advisor at Senior Benefit Services explained I could get premium-free Medicare Part A based on my husband’s work history, which was a tremendous relief. Your team made the whole enrollment process so easy.”

How Senior Benefit Services Can Help Check Your Eligibility

Wondering if you qualify for Medicare? At Senior Benefit Services, we provide free eligibility verification and Medicare guidance:

Schedule a free consultation with our Medicare specialists:
- Call our main number: (800) 924-4727
- Visit one of our four convenient office locations
- Contact us through our website at seniorbenefitclient.com

Our experts will verify your eligibility:
- We’ll review your age, work history, and other qualifying factors
- We’ll explain when you can enroll and what plans are available
- We’ll help you understand all your coverage options with no obligation

We can confirm your existing Medicare coverage:
- We’ll help you understand what parts of Medicare you already have
- We’ll look for coverage gaps or areas where you might save money
- We’ll provide clear, personalized recommendations based on your needs

Our Senior Benefit Services team makes checking your Medicare eligibility simple and stress-free. Unlike calling government agencies and waiting on hold, our experts provide personalized assistance to verify your status and guide you through your options.

Betty from Cumberland told us: “Senior Benefit Services helped explain the benefits and helped me choose a plan that was right for me. I was turning 65 and did not understand what to expect with Medicare. John was very helpful and walked me through everything.”

Free-Personalized-Medicare-Quote-With-Senior-Benefit-Client-Near-Maryland-Pennsylvania-West-Virginia-Walking-Seniors-Blue

Medicare Enrollment Periods

Even if you’re eligible for Medicare, you need to know when to enroll to avoid penalties.
Initial Enrollment Period (IEP): This is your first chance to sign up for Medicare. It’s a 7-month period that includes:

The 3 months before you turn 65

The month you turn 65

The 3 months after you turn 65

Special Enrollment Period (SEP): If you delayed Medicare enrollment because you had creditable employer coverage, you qualify for an SEP when that coverage ends. This gives you 8 months to enroll without penalty.

General Enrollment Period (GEP): If you miss your IEP and don’t qualify for an SEP, you can sign up during the General Enrollment Period from January 1-March 31 each year, with coverage starting July 1.

⚠️ Important: Missing your enrollment period can result in permanent late enrollment penalties and gaps in coverage.

Medicare Costs

Understanding Medicare costs helps you budget effectively for healthcare in retirement.

Part A (Hospital Insurance):

$0 monthly premium if you or your spouse paid Medicare taxes for 40+ quarters

$285/month with 30-39 quarters of work (Estimated Costs)

$518/month with fewer than 30 quarters of work (Estimated Costs)

Part B (Medical Insurance):

$185.00/month standard premium (Estimated Costs)

Higher premiums for those with income above $103,000 (single) or $206,000 (married)

Part D (Prescription Drug Coverage):

Varies by plan, averaging $55/month

New (estimated cost) $2,000 annual out-of-pocket cap

Income-related surcharges may apply

⭐⭐⭐⭐⭐ Google Review “Senior Benefit Services was the best decision I made in choosing someone to help me navigate my retirement options! Karen was amazing! She really knew her stuff and gave me several avenues to choose from but also she carried thru with all the details of completing my application. It was a stress-free experience!” — Deborah R., Maryland

Don’t navigate Medicare alone! Our team of licensed advisors at Senior Benefit Services can verify your eligibility for free and help you understand all your coverage options.

Call (800) 924-4727 today for your free Medicare consultation. Or visit one of our offices:

Requirements For Medicare Eligibility

The three fundamental requirements for Medicare eligibility are:

Age or qualifying condition:
- Being 65+ OR
- Having a qualifying disability for at least 24 months OR
- Having End-Stage Renal Disease (ESRD) OR
- Having Amyotrophic Lateral Sclerosis (ALS)

Citizenship/residency status:
- Being a U.S. citizen OR
- Being a legal permanent resident with at least 5 years of continuous residency in the United States

Work history requirements:
- Having sufficient work credits (40 quarters/10 years) for premium-free Part A, OR
- Being willing to pay a premium if you have fewer credits, OR
- Qualifying through a spouse’s work history

At Senior Benefit Services, we handle these requirements for you. Our advisors will review your situation and clearly explain which requirements you meet and what options are available to you. Call us at (800) 924-4727 to speak with an experienced Medicare specialist who can walk you through your specific eligibility status.

Is Anyone Eligible for Medicare?

Not everyone is eligible for Medicare. Eligibility is specifically limited to:

U.S. citizens and legal permanent residents with at least 5 years of continuous residency

People aged 65 or older, OR

People under 65 with qualifying disabilities who’ve received SSDI for 24 months, OR

People of any age with End-Stage Renal Disease or ALS (with specific requirements)

Undocumented immigrants and people who don’t meet the residency requirements are not eligible for Medicare.

If you’re unsure about your eligibility status, the team at Senior Benefit Services can help. Many of our clients come to us confused about whether they qualify.

Our advisors can quickly assess your situation and explain your eligibility options. We have experience with complex cases including green card holders, those with non-traditional work histories, and people with specific medical conditions.

During your consultation, we’ll explain exactly which Medicare benefits you’re eligible for and when you can enroll. Call us at (800) 924-4727 to schedule your free eligibility check.

Free Consultation: We’ll explain your Medicare options and when to apply

10-Minute Application: We handle the paperwork to get you enrolled quickly

Ongoing Support: We’re here to help even after your coverage begins

Does Everyone Have to Pay $170 a Month for Medicare?

No, not everyone pays the same amount for Medicare:

Part A (Hospital Insurance):
- Most people get this premium-free based on their work history (or a spouse’s)
- If you have 30-39 quarters of work credits, you’ll pay $285/month (estimate cost)
- If you have fewer than 30 quarters, you’ll pay $518/month (estimate cost)

Part B (Medical Insurance):
- The standard premium is $185/month (estimate cost) for most beneficiaries
- Higher-income individuals pay more through Income-Related Monthly Adjustment Amounts (IRMAA)
- Low-income beneficiaries may qualify for assistance programs that reduce or eliminate these costs

Additional Coverage:
- Part D (prescription drug coverage): Varies by plan, averaging $55/month
- Medicare Supplement (Medigap): Varies by plan, location, and age, typically $50-$300+/month
- Medicare Advantage: Many $0 premium plans available, though costs vary widely

Do I Automatically Get Medicare When I Turn 65?

You only get Medicare automatically at 65 if you’re already receiving Social Security or Railroad Retirement Board benefits at least 4 months before your 65th birthday.

If you’re not receiving these benefits (which is increasingly common as many people work past age 65), you must actively apply for Medicare. This is a crucial point that many people misunderstand and can lead to costly penalties if you miss your enrollment window.

At Senior Benefit Services, we’ve helped thousands of clients navigate this transition. Our “3 Steps And You’re Done” approach makes enrollment simple:

We’ve seen many clients confused about automatic enrollment. One client, Mike from Hagerstown, told us: “I thought Medicare was automatic at 65, but my neighbor mentioned I needed to sign up.

I was just three months away from my birthday! The team at Senior Benefit Services guided me through enrollment and helped me avoid late penalties.”

Don’t leave your Medicare enrollment to chance. Call Senior Benefit Services at (800) 924-4727 to ensure you don’t miss important deadlines.

Senior Benefit’s Hagerstown Office

We are here to help. Contact us today!

(301)733-0085
(800) 924-4727

580 Northern Ave
Hagerstown, MD 21742

Hours :

Monday – Firday : 9am – 5pm EST
Sat & Sun: Closed

Senior Benefit’s Thurmont Office

We are here to help. Contact us today!

Hours :

Monday – Firday : 8am – 4pm EST
Sat & Sun: Closed

Senior Benefit’s Cumberland Office

We are here to help. Contact us today!

309 Willowbrook Road, Suite 1
Cumberland, MD 21502

Hours :

Monday – Firday : 9am – 5pm EST
Sat & Sun: Closed

Medicare Part B Calculator : Are you paying too much for your Medicare Part B Premium?

Medicare Part B Premium Calculator

Tax Filing Status (from 2023 return):

What was your Modified Adjusted Gross Income (MAGI) on your 2023 tax return?:

FAQs We Get About Medicare Part B Premiums

What is IRMAA and how does that apply to Medicare Part B?

IRMAA stands for Income-Related Monthly Adjustment Amount. Think of it as an extra charge that some people have to pay in addition to their standard monthly premiums for Medicare Part B (which covers doctor visits and outpatient care) and Medicare Part D (which covers prescription drugs).

It’s basically the government saying that if your income is above a certain level, you need to contribute a bit more towards your Medicare costs. It’s not a penalty, just a way the cost is adjusted based on income.

Want to know how you may be able to save more on your Medicare? Contact us for more details.

How does IRMAA work?

It works like this:

The Social Security Administration (SSA) gets income information from your federal tax return filed two years ago. For example, the IRMAA you might pay in 2025 is based on the income reported on your 2023 tax return.

They look at your Modified Adjusted Gross Income (MAGI). This is basically your Adjusted Gross Income (AGI) from your tax form plus some other tax-exempt income sources, like tax-exempt interest.

They compare your MAGI from two years ago to the income brackets set for the current year.

If your MAGI is above the starting threshold, you will be notified by SSA that you owe IRMAA.

There are several income tiers or brackets. The higher your income was two years ago, the higher your IRMAA amount will be for both Part B and Part D. This extra amount is added directly to your monthly premium bills.

Need help sorting out how this may impact you or how you may be able to save more? Reach out to us for a customized quote.

How Do I Find My Modified Adjusted Gross Income (MAGI) Amount?

You need to calculate it based on your federal tax return from the relevant year. Crucially, for this year’s Medicare premiums (IRMAA), they look at your tax return from two years prior.

Here’s how to find your MAGI relevant for Medicare costs:

Get Your Federal Tax Return From Two Years Ago: You’ll need your completed Form 1040 for that year.

Find Your Adjusted Gross Income (AGI): Look for the line labeled “Adjusted Gross Income” on your Form 1040. Note the amount on that line.

Identify Items to Add Back: Review your tax return and any related schedules to see if you had any of the specific income types listed above that need to be added back. The most common one to look for is tax-exempt interest (check Line 2a of your Form 1040 or your Schedule B if you filed one). Also check if you excluded foreign earned income or had the other less common items mentioned.

Calculate:
- Start with your AGI (from Step 2).
- Add the total amount of any tax-exempt interest you found (from Step 3).
- Add any other specific excluded income amounts identified in Step 3.
- The result is your MAGI, which is the figure used to determine your 2025 Medicare IRMAA.

If you are unsure, especially if your tax situation is complex, reach out to us and we’ll be happy to help.

Which Medicare costs besides Part B does IRMAA affect?

IRMAA specifically increases the monthly premiums for two parts of Medicare:

Medicare Part B: This is the part that covers things like doctor visits, outpatient procedures, lab tests, and durable medical equipment. Everyone pays a standard Part B premium, but if IRMAA applies to you, you’ll pay the standard amount plus the IRMAA surcharge.

Medicare Part D: This is the part that covers prescription drugs. If you have a Part D plan and your income triggers IRMAA, you will pay your plan’s regular monthly premium plus a separate Part D IRMAA amount. This Part D IRMAA is a fixed extra amount based on your income tier, regardless of which specific Part D plan you have.

IRMAA does not directly affect costs for Medicare Part A (hospital insurance) premiums (though most people don’t pay a Part A premium anyway) or costs for Medicare Supplement (Medigap) plans.

Wondering how IRMAA could impact your total Medicare spending? Get a free customized quote to see the potential costs.

How have Medicare Part B Premiums changed over the years?

Understanding Medicare Part B Premium Changes

Thank you for asking about Medicare Part B premium changes over the years. I understand this is an important topic for seniors who need to budget for healthcare costs. I’ll explain the historical trends, reasons for changes, and what to expect.

Historical Premium Changes

Looking at the information provided, Medicare Part B premiums have generally followed an upward trend over the years, though with some interesting fluctuations:

In 2012, there was actually good news when Medicare Part B premiums decreased by $15.50 to $99.90 per month from their 2011 levels of $115.40.

From 2013-2015, premiums first rose to $104.90 per month and then remained stable at that level for three years.

In 2016, there was a significant jump of $16.90, increasing premiums to $121.80 per month, though many beneficiaries were protected from this increase.

From 2017-2018, premiums rose again to $134.00 per month (about a 10% increase).

In 2019, there was a minimal $1.50 increase to $135.50 per month.

For 2020, premiums increased by $9.10 (about 6%) to $144.60 per month.

In 2021, the increase moderated to $3.90, bringing rates to $148.50 monthly, but 2022 saw one of the largest increases of about $21.60, raising the premium to $170.10 per month for most enrollees.

Why Do Premiums Change?

Several factors influence these premium changes:

The Hold Harmless Provision: This important protection prevents Medicare premium increases from reducing a beneficiary’s Social Security check when the premium increase would exceed their Social Security cost-of-living adjustment (COLA). However, this provision doesn’t apply to those newly enrolling in Medicare, who must pay the current year’s rate.

Income-Based Adjustments: Higher-income beneficiaries pay significantly more than the standard premium. This applies to single filers with adjusted gross incomes above $91,000 or joint filers above $182,000.

New Treatments: One major factor in the large 2022 premium increase was anticipation of covering a new Alzheimer’s treatment that was initially expected to cost around $56,000 per patient. This single factor accounted for about 50% of the premium increase. When the drug manufacturer later reduced the price to around $28,000 and questions arose about the treatment’s effectiveness, it created a situation where premiums had been unnecessarily increased.

Inflation and Healthcare Costs: General increases in healthcare costs and overall inflation also drive premium changes.

Take Action Today

Ready to understand exactly what your Medicare Part B premium might be?

Senior Benefit Services is here to help. Click here to contact Senior Benefit Services.

Don’t navigate Medicare alone – let our experienced team help you make informed decisions about your healthcare coverage!

Why is understanding IRMAA important for seniors?

Understanding IRMAA is crucial for seniors, especially when planning for retirement finances. Healthcare is already a significant expense in retirement, and IRMAA can add hundreds or even thousands of dollars per year per person to your Medicare costs if your income is above the thresholds.

Knowing about IRMAA helps you:

Budget accurately: You can anticipate potential extra costs and plan your retirement spending accordingly.

Make informed decisions: Understanding how withdrawals from retirement accounts (like traditional IRAs or 401(k)s) impact your MAGI can help you plan distributions more strategically to potentially manage or avoid IRMAA in future years.

Take action if your situation changes: Knowing about the life-changing events’ appeal process empowers you to lower your premiums if your income drops significantly after retirement.

Ignoring IRMAA can lead to unexpected and potentially stressful increases in your healthcare expenses during retirement.

Don’t end up overpaying by not planning. Contact us and we’ll help you find the best plan for you.

Senior Benefit’s Hagerstown Office

We are here to help. Contact us today!

(301)733-0085
(800) 924-4727

580 Northern Ave
Hagerstown, MD 21742

Hours :

Monday – Firday : 9am – 5pm EST
Sat & Sun: Closed

Senior Benefit’s Thurmont Office

We are here to help. Contact us today!

Hours :

Monday – Firday : 8am – 4pm EST
Sat & Sun: Closed

Senior Benefit’s Cumberland Office

We are here to help. Contact us today!

309 Willowbrook Road, Suite 1
Cumberland, MD 21502

Hours :

Monday – Firday : 9am – 5pm EST
Sat & Sun: Closed

Medicare Costs 2025

The Centers for Medicare & Medicaid Services (CMS) released the Medicare costs for 2025. Find out more about what Medicare costs for you in the new year

Medicare Part A Costs 2025

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 2025.

Medicare Part A Deductible will rise to $1676 which is an increase of $44

Medicare Part A coinsurance for inpatient hospital stays that last more than 60 days will have a daily co-payment amount of $419 beginning on day 61 thru day 90 which is an increase of $11 per day.

Medicare Part A coinsurance for inpatient hospital stays that last more than 90 days will have a daily co-payment amount of $838 beginning on day 91 thru day 150 which is an increase of $22 per day.

Skilled Nursing Facility daily coinsurance will be $209.50 per day beginning on day 21 thru day 100. The daily co-payment is an increase of $5.50 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:

Medicare premiums and deductibles for 2025

Quarters Paid In		2025 Monthly Premium
0-29		$518.00
30-39		$278.00
40+ (10 years)		$0.00

Common Part A Questions

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.

Is there a limit as to how benefit periods a person can have in one year? No.

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.

Want to view more commonly asked questions about Medicare Part A? Click here.

Medicare Part B Costs 2025

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 $257 which is an increase of $17

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 $185 per month which is an increase of $10.30 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 2025 based on your yearly income in 2023 would be as follows:

File Individual Tax Return	File Joint Tax Return	File Married & Separate Tax Return	You Pay Each Month in 2025
$106,000 or less	$212,000 or less	$106,000 or less	$185.00
above $106,000 up to $133,000	above $212,000 up to $266,000	Not applicable	$259.00
above 133,000 up to $167,000	above $266,000 up to $334,000	Not applicable	$370.00
above $167,000 up to $200,000	above $334,000 up to $400,000	Not applicable	$480.90
above $200,000 and up to $500,000	above $400,000 up to $750,000	above $97,000 up to $403,000	$591.90
$500,001 or above	$750,001 or above	$403,000 or above	$628.90

Common Part B Questions

Is the Medicare Part B deductible an annual deductible? Yes.

What are Medicare approved amounts? This is the payment amount that original Medicare sets for a specific covered service or item.

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 2025 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 2025 will be about 5.90% higher which is higher than the Social Security increase of 2.50%. 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.

How to Disenroll from Medicare Advantage Plan in 2025

What is the Medicare Advantage Open Enrollment Period?

Learn the step-by-step process on how to disenroll from your Medicare Advantage plan during enrollment periods.

Expert guidance on timing, options, and securing new coverage.

Understanding how to disenroll from medicare advantage can seem overwhelming, but with proper guidance, you can navigate the process successfully

What is the Medicare Advantage Open Enrollment Period?

See How We Help Our Clients!

As Sharon Sass of Senior Benefit Services explains-

“I have been helping seniors navigate the complexities of Medicare for over 10 years. The most important thing is understanding your timeline and options.” The Medicare Advantage disenrollment process requires careful attention to timing and available options to ensure continuous coverage.

FREE! NO OBLIGATION Quote

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When Can I Disenroll from My Medicare Advantage Plan?

The Medicare Advantage Open Enrollment Period runs from January 1 through March 31, 2025, offering beneficiaries a strategic “second chance” to evaluate and adjust their healthcare coverage.

During this period, you can make one coverage change if your current plan isn’t meeting your needs.

The Annual Election Period (October 15 – December 7) provides another opportunity to switch plans, with changes taking effect January 1.

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What Steps Do I Need to Take to Disenroll From Medicare Advantage?

To start the disenrollment from Medicare Advantage process, you have several options:

Online Disenroll From Medicare Advantage:

The online disenrollment from Medicare Advantage process can be guided through one of our representatives to ensure the process goes smoothly.

Whether it’s a disenroll from Medicare Advantage notice or a form to switch to Original Medicare, the rep can make sure the paperwork is filled out correctly.

After logging into your Medicare account, you’ll access the plan comparison tool to view and evaluate available options in your area.

The system guides you through each step, ensuring all necessary information is provided.
You’ll need your Medicare number, current plan details, and information about any new coverage you’re selecting.

Working with an Agent

“I started my search for Medicare with Senior Benefit Services. I knew nothing, and Andy got me started. I researched all options available to me, from multiple online sources, but in the end, I got the personalized assistance of a professional with decades of experience,” shares Kenny Bohrer.s.

FREE! NO OBLIGATION Quote

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What Happens After I Disenroll From Medicare Advantage?

After you start the disenrollment from Medicare Advantage, there are several important steps that need to be taken:

Coverage Transition:

The coverage transition begins on the first day of the month following when you disenroll from Medicare Advantage and receive your confirmation.

Insurance cards and welcome materials from your new plan typically arrive before the coverage start date.

Senior Benefit Services, Inc. helps ensure all transitions proceed smoothly.

“We make sure there are no gaps in coverage and that all your doctors and prescriptions transfer correctly,” explains Karen Simundson, Senior Insurance Advisor.

Financial Considerations:

Budget for any new premiums or out-of-pocket costs

Understand new deductibles and copayments

Plan for potential gaps in coverage

Prescription Drug Coverage:

If returning to Original Medicare, you’ll need to enroll in a standalone Medicare Part D plan to maintain prescription drug coverage. This step is crucial to avoid late enrollment penalties.

What Special Circumstances Allow Disenrollment From Medicare Advantage?

Special circumstances that permit you to disenroll from Medicare Advantage outside standard periods include:

Moving Outside Service Area

Permanent relocation beyond plan coverage area

Temporary absence exceeding plan allowances

International moves

Plan Changes:

Medicare Advantage plans can modify their benefits, costs, and provider networks annually. Significant changes may qualify you for a Special Enrollment Period to select new coverage.

Monitor annual plan notices for changes affecting your care. Pay particular attention to provider network changes, prescription drug coverage, and cost modifications.

5-Star Special Enrollment Period:

Medicare offers a unique opportunity to switch to a 5-star rated plan once during the year.

This SEP runs from December 8 through November 30 and allows enrollment in the highest-rated plans.

How Do I Choose New Coverage?

When selecting new coverage, consider these factors:

Understanding Provider Networks

Network coverage forms a crucial part of your Medicare Advantage plan selection. When evaluating networks, start by verifying that your current healthcare providers participate in the new plan’s network.

The depth of specialist networks also requires careful consideration. Evaluate not just current specialist relationships but potential future needs based on your health conditions.

Senior Benefit Services advisor Sharon Sass notes, “Many seniors don’t realize their long-time doctor might not be in a new plan’s network. We help verify provider participation before making any changes.”

Certain specialists may only practice at specific hospitals, so understanding facility affiliations helps ensure comprehensive coverage.

Review the geographic distribution of providers – some plans offer broader networks but may require longer travel times for certain specialists.

Cost Analysis:

Compare monthly premiums

Evaluate deductibles and copayments

Calculate total annual out-of-pocket costs

Additional Benefits:

Dental and vision coverage

Fitness memberships

Over-the-counter allowances

What Are Common Mistakes to Avoid?

Missing Enrollment Deadlines:

Missing enrollment deadlines can have serious consequences for your Medicare coverage and potentially result in gaps or penalties.

It’s essential to mark all relevant enrollment dates on your calendar, including the Medicare Advantage Open Enrollment Period (January 1 – March 31) and Annual Election Period (October 15 – December 7), while allowing sufficient time for application processing.

Karen at Senior Benefit Services emphasizes, “We guide clients through enrollment timing to prevent missed deadlines. Processing can take up to several weeks, so planning ahead is crucial for continuous coverage.”

Overlooking Coverage Gaps:

When transitioning between Medicare plans, it’s critical to verify continuous prescription drug coverage to avoid late enrollment penalties and ensure access to needed medications without interruption.

Carefully document all coverage effective dates and keep copies of enrollment confirmations, plan acceptance letters, and any correspondence regarding your coverage changes.

“Maintaining meticulous records protects you during the transition,” advises Senior Benefit Services advisor Sharon Sass. “We help clients track their documentation and effective dates to ensure seamless coverage transitions.”

Insufficient Research:

Thorough research is crucial before making Medicare coverage decisions.
Take time to compare available plans’ benefits, costs, network coverage, and prescription drug formularies while carefully reviewing performance ratings and member satisfaction scores.

“Healthcare needs often change as we age,” explains Karen Simundson of Senior Benefit Services. “We help clients evaluate plans not just for current health situations but also considering potential future medical needs to avoid unexpected coverage issues down the road.”

How Can I Get Help with Disenrollment From Medicare Advantage?

Experienced agents from Senior Benefit Services, Inc. can provide personalized guidance through the disenrollment Medicare Advantage process and help you find the best coverage options for your needs.

To disenroll from a Medicare Advantage plan requires careful consideration of timing, options, and potential implications for your healthcare coverage.

Remember that when you disenroll from a Medicare Advantage plan, this is a significant decision that affects your healthcare coverage and costs.

Take time to understand your options and seek professional guidance to make the best choice for your situation.

Whether you’re switching to another Medicare Advantage plan or returning to Original Medicare with a supplement plan, careful planning ensures continuous coverage that meets your healthcare needs and budget.

For personalized assistance with your Medicare decisions, contact Senior Benefit Services today to speak with an experienced Medicare advisor who can help guide you through the process and ensure you make informed decisions about your healthcare coverage.

With over 50 years of combined experience, their team is dedicated to helping seniors navigate the complexities of Medicare with confidence and peace of mind.

For immediate assistance or to schedule a free consultation, call Senior Benefit Services at (800) 924-4727 or visit one of their convenient locations in Hagerstown, Thurmont, or Cumberland. Their experienced advisors are ready to help you understand your options and make the best decision for your healthcare needs.

Want a Medicare Supplement or Medicare Advantage Plan Today?

FREE! NO OBLIGATION Quote

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You Can Also Contact our local offices for a free consultation:

Senior Benefit’s Hagerstown Office

We are here to help. Contact us today!

(301)733-0085
(800) 924-4727

580 Northern Ave
Hagerstown, MD 21742

Hours :

Monday – Firday : 9am – 5pm EST
Sat & Sun: Closed

Senior Benefit’s Thurmont Office

We are here to help. Contact us today!

Hours :

Monday – Firday : 8am – 4pm EST
Sat & Sun: Closed

Senior Benefit’s Cumberland Office

We are here to help. Contact us today!

309 Willowbrook Road, Suite 1
Cumberland, MD 21502

Hours :

Monday – Firday : 9am – 5pm EST
Sat & Sun: Closed

Medicare Advantage Open Enrollment Period 2025

What is the Medicare Advantage Open Enrollment Period?

Making changes to your Medicare coverage requires understanding specific enrollment periods. Watch our video to see the Medicare Advantage Open Enrollment Secrets Revealed!

Take advantage of the Medicare Advantage Open Enrollment Period to reassess your plan and make adjustments that better fit your needs.

See How We Help Our Clients!

“When my husband turned 65, we didn’t know what to do. Karen helped us understand everything, including deadlines that could result in lifetime penalties if missed!” – Allison R.

Timing and Purpose

The Medicare Advantage Open Enrollment Period, from January 1 through March 31, 2025, offers beneficiaries a strategic “second chance” to evaluate and adjust their healthcare coverage.

This unique 90-day window allows individuals to make one coverage change based on their experience with their initial plan selection.

By allowing a focused reassessment, the enrollment window empowers individuals to make informed adjustments based on unexpected healthcare requirements, network satisfaction, or financial considerations discovered in the early months of the year.

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Eligibility Requirements

Medicare Advantage enrollees have specific eligibility criteria for this special advantage open enrollment Period.

Participants must currently have a Medicare Advantage plan and cannot use this advantage open enrollment period to join Medicare Advantage for the first time.

The enrollment opportunity is open to all existing Medicare Advantage enrollees, regardless of their current plan’s tenure.

Special considerations may exist for dual-eligible beneficiaries, though specific provisions require further detailed examination.

How Does This Differ from Other Enrollment Periods?

Medicare offers several distinct open enrollment periods throughout the year. Understanding the differences helps ensure you make changes at the right time.

Annual Election Period

The Annual Election Period occurs from October 15 to December 7, offering Medicare beneficiaries a comprehensive window for coverage adjustments.

Participants can join, switch, or drop prescription drug coverage, with multiple changes permitted throughout the period.

All selected changes will take effect on January 1, providing a strategic opportunity for beneficiaries to optimize their healthcare coverage for the upcoming year.

Initial Coverage Election Period

The Initial Coverage Election Period spans three months before and three months after an individual’s Medicare eligibility, representing their first opportunity to choose a Medicare Advantage plan.

During this period, participants can make multiple coverage changes with greater flexibility.
Beneficiaries enjoy guaranteed issue rights for Medicare Supplement plans during this time, with special rules accommodating those who continue working past age 65.

This period provides a critical window for new Medicare-eligible individuals to carefully select and adjust their healthcare coverage.

Karen Simundson, Senior Medicare Specialist

“Our industry is littered with misleading information. We work hard to explain all options so consumers make informed decisions rather than panic choices.”

What Changes Can I Make During Open Enrollment?

Your healthcare journey begins with one important question: what are my options, and which one is right for me?

With the MA OEP, you’ll find a clear trade-off: specific benefits come with corresponding limitations.

Allowed Changes

The special advantage open enrollment period allows Medicare Advantage enrollees to switch between any plans within their service area.

Participants can choose plans with or without prescription drug coverage, and even return to Original Medicare with optional Part D coverage.

During this advantage open enrollment period, enrollees can make one change, with modifications taking effect the first of the month following their request.

This provides a structured yet flexible approach to adjusting healthcare coverage based on individual needs.

Restricted Actions

The Special advantage open enrollment period has strict restrictions on plan changes and enrollments.

Participants cannot enroll in Medicare Advantage for the first time, switch between standalone Part D plans, or make multiple plan changes during this advantage open enrollment period.

By confining the scope, the focus stays squarely on fine-tuning performance for existing Medicare Advantage members.

Enrollment boundaries are in place to prevent any mistakes or misinformation – and as a bonus, they give users a chance to make essential changes to their plans before it’s too late. See how this applies for open enrollment in Maryland.

What’s Different About the MA OEP this year?

Medicare rules continue to evolve to better serve beneficiaries.

This year’s medicare advantage open enrollment period introduces important changes affecting certain Medicare recipients.

New Dual-Eligible Benefits

Dual-eligible beneficiaries receive special monthly enrollment opportunities with enhanced coverage flexibility.

Low-income individuals eligible for Extra Help receive extra protections and a smoother transition experience, alleviating some of the burden.

Those eligible for both Medicare and Medicaid get a double bonus: more complete and flexible healthcare coverage that actually addresses their needs.

Simplifying plan selection and breaking down barriers – that’s the goal of special provisions designed to support vulnerable beneficiary groups.

Coverage Transition Rules

Coverage transition rules introduce several key improvements for Medicare beneficiaries.
These rules focus on simplifying prescription drug coverage coordination and eligibility verification.

The new guidelines enhance beneficiary protections through improved communication requirements and clearer transition processes.

This approach aims to reduce complexity and uncertainty during plan changes, ensuring smoother healthcare coverage transitions.

How Do I Compare Medicare Advantage Plans?

Making an informed decision requires careful evaluation of multiple factors. Consider both current and potential future healthcare needs when comparing plans.

Network Considerations

Medicare beneficiaries must carefully evaluate network considerations when selecting or changing plans.

These aspects include critical factors like provider participation, specialist availability, and referral requirements.

The plan’s hospital and facility affiliations, pharmacy network options, and out-of-network coverage rules significantly impact healthcare accessibility.

Additionally, travel and emergency coverage provisions play a crucial role in comprehensive plan selection.

Cost Structure Analysis

Medicare beneficiaries should conduct a thorough cost structure analysis when evaluating plan options.

The analysis includes comparing monthly premiums, annual deductibles, and varying copayment and coinsurance levels.

Critical financial considerations encompass maximum out-of-pocket limits, prescription drug cost tiers, and additional benefit costs.

This comprehensive review helps individuals understand the total financial implications of their healthcare coverage.

Coverage Evaluation

Medicare beneficiaries should carefully evaluate coverage details, including pre-existing condition management programs and prescription drug formulary inclusion.

Critical aspects involve understanding prior authorization requirements and referral policies.
The evaluation encompasses emergency and urgent care coverage, along with additional benefits availability.

This comprehensive review ensures beneficiaries select plans that meet their specific healthcare needs and potential medical contingencies.

What About Pre-Existing Conditions?

While Medicare Advantage plans do not take into consideration pre-existing conditions to qualify for coverage, it is important to make sure that the plan does provide the most benefits for a particular chronic condition that you might have.

Managing chronic conditions requires careful consideration of plan benefits and restrictions. Each plan handles pre-existing conditions differently.

Medical Management Programs

Disease-specific care coordination

Specialist network availability

Prescription drug coverage details

Prior authorization policies

Care transition support

Health monitoring program

Cost Considerations

Medicare’s medical management programs offer comprehensive care coordination for specific diseases and health conditions.

These programs focus on specialist network availability, prescription drug coverage details, and prior authorization policies.

The programs provide critical care transition support and health monitoring initiatives.
By integrating these elements, beneficiaries receive more personalized and proactive healthcare management.

What Additional Benefits Should I Consider?

Medicare Advantage plans often include extra benefits beyond Original Medicare coverage. These additional services can provide significant value.

Wellness Benefits

The benefits extend to fitness membership programs, weight management services, and nutritional counseling. These offerings aim to support holistic health maintenance and proactive wellness strategies.

Support Services

Medicare support services offer comprehensive assistance beyond traditional medical care.
These services include transportation to medical appointments, meal delivery after hospital stays, and over-the-counter product allowances.

The benefits include in-home support services, telehealth options, and care coordination assistance.

These programs aim to provide holistic support for beneficiaries’ healthcare needs and quality of life.

How Do We Help You Make the Right Choice?

With over 50 years of Medicare experience, we provide comprehensive guidance throughout the decision process.

Expert Guidance

Free plan comparisons and analysis

Provider network verification

Prescription drug coverage review

Cost calculation assistance

Benefit explanations

Ongoing support services

Simple Process

3 Steps And You’re Done” approach

Easy Price Breakdown – Clear advice, no sales pitch

10-Minute Application Process

Automatic Approval for eligible individuals

Plus, every plan includes our “Love Your Plan” guarantee with a 30-day free look period.

Another Happy Customer !

Hear From Mary Ann –
“They cut through all the confusion when trying to get good coverage for the best price. I found great coverage with a much lower premium.” – Mary Ann B.

Ready to Review Your Medicare Options?

Contact our local offices for a free consultation:

Senior Benefit’s Hagerstown Office

We are here to help. Contact us today!

(301)733-0085
(800) 924-4727

580 Northern Ave
Hagerstown, MD 21742

Hours :

Monday – Firday : 9am – 5pm EST
Sat & Sun: Closed

Senior Benefit’s Thurmont Office

We are here to help. Contact us today!

Hours :

Monday – Firday : 8am – 4pm EST
Sat & Sun: Closed

Senior Benefit’s Cumberland Office

We are here to help. Contact us today!

309 Willowbrook Road, Suite 1
Cumberland, MD 21502

Hours :

Monday – Firday : 9am – 5pm EST
Sat & Sun: Closed

Medicare Advantage Open Enrollment Period in Maryland

If you’re one of the many Maryland residents with a Medicare Advantage plan, you might be wondering about your options for changing your coverage during the Medicare Advantage Open Enrollment Period.

The Medicare Advantage Open Enrollment Period (MA OEP) is a great chance to make sure your healthcare coverage is just right for you.

We had the privilege of helping thousands of seniors in the Hagerstown, Thurmont, and Cumberland areas fine-tune their plans.

Christina G. from Hagerstown recently shared about their experience:

“Transitioning to Medicare was so confusing and overwhelming! Thank goodness for Andy at Senior Benefit Services, he helped explain everything I needed to know about my benefits. He answered all my questions and told me how to apply for the extra help program for low-income people. I left there with a smile, and felt so much better about moving to Medicare.”

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What Exactly Is the Medicare Advantage Open Enrollment Period?

Think of the Medicare Advantage Open Enrollment Period as your “second chance” opportunity. Running from January 1st through March 31st.

This special period gives you the flexibility to make important adjustments to your Medicare Advantage coverage if your current plan isn’t meeting your needs.

As Karen, one of our experienced Medicare specialists at Senior Benefit Services, often explains to clients:

“Our industry is littered with misleading mail, email, and commercials. The result is that consumers make decisions out of panic rather than understanding. We work very hard to reassure each client that we’re working in their best interest by explaining all available options.”

Have questions about the Medicare Advantage Open Enrollment Period?
Call us at (800) 924-4727 to get answers.

Key Dates and Deadlines You Need to Know

The timing of the MA OEP is straightforward but crucial to understand:

January 1: First day to make changes

March 31: Last day to make changes

Changes typically take effect on the first day of the month following your enrollment

What Changes Can You Make During This Period?

Switch to a Different Medicare Advantage Plan

You can change from your current Medicare Advantage plan to another one that better suits your needs.

This might be particularly useful if you’ve discovered that your current plan’s network doesn’t include your preferred doctors or if you’ve found a plan with better coverage for your specific health needs.

Return to Original Medicare

You can choose to leave your Medicare Advantage plan and return to Original Medicare (Parts A and B). If you make this choice, you’ll also have the option to enroll in a standalone Medicare Part D prescription drug plan.

It is important to keep in mind that if you are wanting to get a Medicare Supplement plan (also known as a Medigap plan) you may be required to answer a number of health questions to qualify.

As Bill Kesecker shares:

“Nicole navigated me into understanding Medicare and giving me confidence in the choices I made. I believe she demonstrated interest in what I needed and through her knowledge, empathy, and clear explanations and examples helped me make a solid decision.”

Who Can Use the MA OEP?

It’s important to understand that the MA OEP isn’t available to everyone.
You’re eligible to use this period if:

You’re currently enrolled in a Medicare Advantage plan

You’re within the January 1 to March 31 timeframe

You haven’t already made a change during this period (you can only make one change)

Unsure if you’re eligible to make changes? Call us at (800) 924-4727 for a free consultation.

How Is This Different from the Annual Enrollment Period?

Many people confuse the MA OEP with the Annual Enrollment Period (AEP) that runs from October 15 to December 7.

Here’s the key difference: while the AEP is open to all Medicare beneficiaries and allows for various changes, the MA OEP is specifically for those already enrolled in Medicare Advantage plans.

Common Reasons to Consider Making Changes

Network Changes

Your preferred doctors or specialists may no longer be in your plan’s network. As Andrew Thomas, one of our Medicare specialists with 28 years of experience, notes: “You can turn Medicare into Rocket Science if you choose, but that’s not my approach. I take great pride in simplifying the specifics of Medicare putting them in layman’s terms for the benefit of my clients.”

Cost Concerns

You might have discovered unexpected costs or found that another plan offers better value for your specific situation. As Carmine Russo shares: “Thanks Mike for saving me expense on my supplement to Medicare insurance. I guess it is about $50 per month for the exact same insurance.”

Coverage Gaps

Your healthcare needs may have changed, and you’ve found that your current plan doesn’t provide adequate coverage for new medications or treatments.

Service Area Changes

If you’ve moved or spend significant time in different areas, you might need a plan with better coverage in your new location.
Want to evaluate if you should make changes to your coverage? Call (800) 924-4727 for a personalized review.

Making Changes: The Process

If you decide to make changes during the MA OEP, the process is straightforward, especially with proper guidance. Here’s what you’ll need:

Your Medicare card and number

A list of your current medications

Names of your preferred healthcare providers

Information about your current plan

As Doris Brady shares:

“This service is critical to me and many others because there are so many choices, it’s almost impossible to make a good decision. My advisor can distill everything down to what’s best for me.”

Important Considerations Before Making Changes

Provider Networks

Verify that your preferred doctors and hospitals are in the new plan’s network. Our team can help you check provider participation in various plans.

Prescription Drug Coverage

Review the plan’s drug formulary to ensure your medications are covered at a cost-effective level.

Total Costs

Look beyond just the monthly premium. Consider deductibles, copayments, and out-of-pocket maximums.

Additional Benefits

Many Medicare Advantage plans offer extra benefits like dental, vision, and fitness memberships. Compare these additional features when making your decision.

Getting Expert Help

Navigating Medicare choices can be overwhelming, but you don’t have to do it alone.

Our team at Senior Benefit Services has been helping seniors make informed Medicare decisions for over 50 years. With offices in Hagerstown, Thurmont, and Cumberland, we provide personalized guidance to help you understand your options and make the best choice for your situation.

As Sharon Womack puts it simply: “Detailed and informed help.” That’s exactly what we strive to provide every day.

Schedule your consultation today. Call (800) 924-4727 to speak with our Medicare experts.

The Bottom Line

The Medicare Advantage Open Enrollment Period provides a valuable opportunity to ensure your healthcare coverage truly meets your needs.

Whether you’re considering switching plans or have questions about your current coverage, our team of local Maryland Medicare specialists is here to help you navigate your options.

Remember, you can only make one change during this period, so it’s important to carefully consider your options and make an informed decision. We’re here to help you understand your choices and find the coverage that best meets your healthcare needs and budget.

Ready to explore your options during the Medicare Advantage Open Enrollment Period?

Contact our licensed Medicare specialists at Senior Benefit Services at (800) 924-4727, or visit one of our local offices in Hagerstown, Thurmont, or Cumberland. We’re here to help you make the most of this important opportunity to optimize your healthcare coverage.

Find a Location Near You!

Ready to get started? Contact any of our 3 Maryland offices in Hagerstown, Thurmont, and Cumberland, or fill out our simple online form below for a personalized consultation.

Senior Benefit’s Hagerstown Office

We are here to help. Contact us today!

(301)733-0085
(800) 924-4727

580 Northern Ave
Hagerstown, MD 21742

Hours :

Monday – Firday : 9am – 5pm EST
Sat & Sun: Closed

Senior Benefit’s Thurmont Office

We are here to help. Contact us today!

Hours :

Monday – Firday : 8am – 4pm EST
Sat & Sun: Closed

Senior Benefit’s Cumberland Office

We are here to help. Contact us today!