Medicare General Information

This blog section contains general information about Medicare. For example, we answer general Medicare question and update you on Medicare changes. Amid the COVID-19 pandemic, you can get Coronavirus tips to stay safe and apply for Medicare Part B from the safety of your home.

Diabetes Self Management Education

Diabetes Self Management Education

The American Diabetes Association reports Diabetes Self Management Education (DSME) improves hemoglobin A1c by up to 1% in people with type 2 diabetes. Furthermore, DSME reduces the onset and advancement of diabetes complications. Moreover, it empowers you to eat healthier, exercise more regularly, and better cope with and manage your diabetes. Medicare.gov calls this education Diabetes Self Management Training (DSMT).

Nutrition is the foundation for better health. Eating foods with little starch such as broccoli, cauliflower, and asparagus keeps your blood sugar levels low. However, eating starchy foods such as potatoes, white rice, and refined carbs increases your blood glucose levels.

What are refined carbs?

Refined carbs include sugars and refined grains. For example, sucrose (table sugar) and high fructose corn syrup are refined sugars. Likewise, white flour is a refined grain in foods such as bread, pasta, and pastry. Refined carbohydrates such as white spaghetti have a high glycemic load of 21 that causes a sharp increase in blood sugar levels.

Avoid starchy food such as french fries
Avoid refined grains such as white spaghetti

What is the glycemic load?

According to the global diabetes community at Diabetes.co.uk, Glycemic load is defined as follows:

Glycemic load is a measure that takes into account the amount of carbohydrate in a portion of food together with how quickly it raises blood glucose levels.

For example, you can reduce the portion size to decrease the number of carbohydrates and lower the glycemic load. You can calculate glycemic load by using the formula below:

Glycemic Load (GL) = Glycemic Index (GI) x carbohydrates / 100

Every food has a GI, which you can look up. Nutrition labels have the amount of carbohydrates per serving. If white spaghetti has 43 grams of carbs per serving and a glycemic index of 49, then glycemic load is 21. The University of Sydney defines a high glycemic load at 20 and over. However, you can reduce your spaghetti glycemic load by eating less than 1 cup (the serving size).

You can lower your glycemic load by serving food on a salad plate. The smaller portion fills the plate. As a result, you feel more satisfied with less food. Conversely, you would feel less satisfied with a larger plate that’s half empty.

Lower Glycemic Load with smaller portions
Lower glycemic load with smaller portions

Diabetes Self Management Education

When a doctor diagnoses you with diabetes, Medicare Part B pays for Diabetes Self Management Training (DSMT). Then Medicare may cover up to ten hours of initial DSMT. This diabetes self-management education consists of one hour of individual training and nine hours of group training. Furthermore, you may qualify for up to two hours of follow-up training each year. Moreover, you may be able to get DSMT services from a Registered Dietitian through Medicare Telehealth.

When you participate in Diabetes Self Management Training, you pay 20% of the Medicare-approved amount. Furthermore, the Part B deductible of $198 in 2020 applies. Finally, you must have a written order from your doctor or a qualified non-doctor practitioner to get DSMT.

Diabetes Self Management Training group
Medicare covers 9 hours of DSMT group training

What else does Medicare cover for diabetes?

In addition to Diabetes Self-Management Education, Medicare covers the following:

To help you decide what Medicare services are most relevant to you, read an informative summary of what Medicare covers for diabetes.

Diabetes Self Management Education - happy senior couple

Medicare Diabetes Prevention Program

You can prevent type 2 diabetes with the Medicare diabetes prevention program. If your diabetes screening result is pre-diabetes, you qualify for this proven health behavior-changing program. According to Medicare.gov, this program is free if you meet the following conditions:

  • Pre-diabetes test results: A1C 5.7% to 6.4%, fasting plasma glucose 110-125mg/dL, or 2-hour glucose tolerance 140-199mg/dL within 12 months of your first core session
  • Overweight: BMI of 25 or more (23 if Asian)
  • Never diagnosed with type 1 or 2 diabetes or ESRD
  • Never participated in the Medicare Diabetes Prevention Program
Medicare Diabetes Prevention Program - blood drawn
Senior gets blood drawn for diabetes screening

Medicare Diabetes Prevention Program

Medicare Part B pays for this program when you meet all of the conditions above. It includes 16 core sessions in a group setting for six months. Furthermore, you get the following benefits:

  • Training to make realistic, lasting behavior changes
  • Tips on how to get more exercise
  • Strategies for controlling your weight
  • A behavior coach, specially trained to help keep you motivated
  • Support from people with similar goals
Medicare Diabetes Prevention Program - seniors walking
Walking helps prevent type 2 diabetes

Program Goals

The goal of the Medicare Diabetes Prevention Program is to prevent type 2 diabetes in individuals with pre-diabetes. According to CMS.gov, the 16 intensive “core” sessions of a CDC approved curriculum provides the following:

  • Practical training in long-term dietary change
  • Increased physical activity
  • Behavior change strategies for weight control

The primary goal is at least 5 percent weight loss by participants. 

Medicare Diabetes Prevention Program - senior weightloss goal

Lifestyle Coach and Program Details

The program includes a lifestyle coach to help you set and achieve realistic goals, keep you motivated, and manage stress. You can meet group members and the lifestyle coach in-person or online. During the first six months, you meet once a week, and you can talk privately with your lifestyle coach.

As a group, you will discuss the challenges you face in losing weight, eating healthy, and increasing your physical activity. Moreover, your coach will help you overcome obstacles in the way to your success. Finally, this program is proven to work with thousands of people.

Medicare Diabetes Prevention Program - lifestyle coach in classroom
Lifestyle coach in-person classroom setting

What else does Medicare cover for diabetes?

In addition to the Diabetes Prevention Program, Medicare covers the following:

To help you decide what Medicare services are most relevant to you, read the informative summary of what Medicare covers for diabetes.

Medicare Diabetes Prevention Program - happy senior couple

What does Medicare cover for diabetes?

Medicare does cover diabetes prevention, treatment, and supplies. The 2020 National Diabetes Report published by the CDC estimates the prevalence of diabetes. Among the US population in 2018, 34.2 million people of all ages (10.5%) had diabetes. However, adults with diabetes increased with age. The prevalence of seniors age 65 or older with diabetes is 26.8%. In other words, 1 out of 4 seniors has diabetes.

What does Medicare cover for diabetes - 1 in 4 seniors have diabetes in us

Type 2 Diabetes Prevention

You can prevent type 2 diabetes. The Havard school of public health says, “prediabetes and type 2 diabetes is largely preventable.” Moreover, lifestyle changes can lower your risk of developing type 2 diabetes. The Medicare Diabetes Prevention Program provides seniors with health behavior changes to help you prevent type 2 diabetes.

Diabetes Prevention Program

Medicare Part B covers a once in a lifetime diabetes prevention program. To qualify, you must meet all of the following conditions:

  • Test positive for Prediabetes within 12 months of your first meeting
  • Overweight: BMI of 25 or more (23 if Asian)
  • Never diagnosed with type 1 or 2 diabetes or ESRD
  • Never participated in the Medicare Diabetes Prevention Program

If you meet all of the above conditions, Medicare will pay for the diabetes prevention program. According to Medicare.gov, it “is a proven health behavior change program to help you prevent type 2 diabetes.” Moreover, the program includes 16 core sessions in a group setting for six months. Learn more about the benefits of this program.

Walking can reduce your risk of diabetes

Type 2 Diabetes Screening

Type 2 diabetes is a metabolic disease that results in high blood glucose levels. When your body does not produce enough insulin – a hormone that regulates sugar into your cells – or your body resists the effects of insulin, you have type 2 diabetes.

Since 1 in 4 seniors have type 2 diabetes and “often there are no symptoms” (WebMD), diabetes screening can help you avoid serious complications. Medicare pays for diabetes screening when you meet certain risk factors. Learn more about Medicare diabetes screening.

Type 2 Diabetes Screening - blood glucose meter
Blood glucose meter tests your blood sugar levels

Diabetes Self Management Education

Medicare Part B pays for Diabetes Self-Management Training (DSMT) when a doctor diagnoses you with diabetes. This diabetes self-management education includes one hour of individual training and nine hours of group training. Furthermore, you may be able to get DSMT services from a Registered Dietitian through Medicare Telehealth.

Discover what you pay for Diabetes Self Management Training and what you need from your doctor. Moreover, learn how diabetes self-management education can improve your blood glucose levels so you can reduce the onset and advancement of diabetes complications.

Diabetes Self Management Education

Medicare Diabetes Screening

Type 2 Diabetes

In this MedicareBob video, Robert Bache shows you diabetes type 2 warning signs and how Medicare diabetes screenings can help you avoid serious health issues. For example, screening may help people avoid long-term damage to the eyes, kidneys, nerves, heart, and blood vessels. Furthermore, webmd.com says, “people with undiagnosed type 2 diabetes have a significantly higher risk for stroke, coronary heart disease, and peripheral vascular disease.”

Robert says you can get the diabetes screenings every two years. However, Robert misspoke. The video’s graphic shows, “you may be eligible for two diabetes screenings each year.”

What is Type 2 Diabetes?

Type 2 diabetes is a metabolic disease and the most common form of diabetes. According to Medicinenet.com, people with type 2 diabetes have high blood sugar (glucose). In a healthy person, insulin controls your blood glucose levels. For example, you eat carbohydrates, and your blood glucose levels rise. Then your pancreas releases insulin to normalize your blood’s glucose level. 

However, a person with type 2 diabetes eats carbohydrates, and their pancreas produces an inadequate amount of insulin to normalize glucose levels. Consequently, the person gets high blood sugar, also called hyperglycemia. Alternatively, the Mayoclinic.org says, “with type 2 diabetes, the body resists the effects of insulin – a hormone that regulates sugar’s movement into your cells.” 

Medicare Diabetes Screening - blood glucose meter

Blood Glucose Meter tests your blood sugar levels

Free Medicare Diabetes Screening

According to Medicare.gov, it costs you nothing for Medicare diabetes screening when your doctor determines you are at risk for diabetes or diagnosed with pre-diabetes. You can get free lab tests two times per year if you have any of the following diabetes risk factors:

  • High blood pressure (hypertension)
  • History of abnormal cholesterol and triglyceride levels (dyslipidemia)
  • Obesity: BMI of 30 or greater
  • A history of high blood sugar (glucose)

Furthermore, Medicare pays for two diabetes screenings per calendar year if two or more of the following pre-diabetes conditions apply to you:

  • Age: 65 or older
  • Overweight: BMI over 25 and less than 30
  • Family History: your parents or siblings have diabetes
  • Pregnancy History: you have a history of diabetes during pregnancy, also called gestational diabetes
  • Heavy Baby: you delivered a baby weighing more than 9 pounds

Moreover, according to CMS, if a doctor diagnoses you with pre-diabetes, your screenings must be at least six months apart. However, if you were previously tested but not diagnosed with pre-diabetes, or this is your first test, you are eligible for one diabetes screening test per year. 

Diabetes Screening Tests

The most common Medicare diabetes screening is a fasting plasma glucose test (FPG) followed by a 2-hour glucose tolerance test. The FPG test measures your blood sugar level after fasting, not eating or drinking (except water, tea, black coffee – no sugar) for at least 8 hours. According to CMS definitions, you have pre-diabetes when your fasting blood glucose is 100 to 125 mg/dL. Moreover, you have diabetes when your fasting blood glucose is 126 mg/dL or greater on two different occasions.

After the doctor takes a sample of your blood to measure your fasting blood glucose level, you drink a glucose solution that contains 75 grams of sugar. Then after two hours, your blood is tested. According to Mayoclinic.org, a normal blood glucose level is lower than 140 mg/dL. You have pre-diabetes with a blood glucose level between 140 and 199 mg/dL. Finally, you have diabetes with a blood glucose level of 200 mg/dL or higher.

If you test positive for diabetes, Medicare pays for a second screening to confirm the diagnosis.

Medicare Diabetes Screening - Glucose Tolerance Drink

What else does Medicare cover for diabetes?

In addition to diabetes screening, Medicare covers the following:

To help you decide which Medicare services are most relevant to you, read the informative summary of what Medicare covers for diabetes.

Medicare Diabetes Screening - happy senior couple
Hepatitis B Symptom - yellow eyes

Does Medicare pay for Hepatitis B vaccine?

Does Medicare pay for Hepatitis B vaccine

If you are at medium or high risk for Hepatitis B, Medicare Part B does pay for your Hepatitis B vaccine. Please check with your doctor to see if you are at high or medium risk for Hepatitis B. Therefore, if you are at risk, you pay nothing for Hepatitis B shots.

Please read this article to learn about Hepatitis B and how it spreads. Moreover, discover the symptoms and the difference between acute and chronic Hepatitis B.

What is Hepatitis B?

In this Medicare & You Hepatitis video, Denise Sieron from CMS defines Hepatitis as follows:

Hepatitis is a medical condition defined by the inflammation of the liver and characterized by the presence of inflammatory cells in the organ tissue.

Furthermore, Denise says, “Hepatitis may occur with few or no symptoms.” However, it “can lead to jaundice, nausea, and in some rare cases, death.” Moreover, “some forms of Hepatitis may eventually cause cirrhosis and liver cancer.”

Hepatitis B Transmission

Medicare does pay for the Hepatitis B vaccine, which prevents liver infection by the Hepatitis B virus (HBV). According to the CDC, “Hepatitis is spread when blood, semen, or other body fluids from a person infected with the virus enters the body of someone who is not infected.” So how do people transmit the HBV virus? 

Hepatitis B Transmission occurs through the following methods:

  • Sexual contact with an infected person
  • Sharing needles, syringes, or other drug-injection equipment
  • Exposure to an infected person’s blood

You can become infected with HBV when in direct contact with the blood of an infected person. For example, unsterilized needle at a tattoo parlor, body piercing, or blood transfusion. If you become infected with Hepatitis B, you may or may not show symptoms.

Hepatitis B Transmission - senior man has blood transfusion
Senior man has blood transfusion

Hepatitis B Symptoms

You may be infected with Hepatitis B and not show any symptoms. However, for those who do, symptoms may include the following:

  • Fatigue
  • Poor appetite
  • Stomach pain
  • Nausea
  • Jaundice

Jaundice is when your skin and the whites of your eyes turn yellow. A build-up of bilirubin causes the yellow color of the skin and eyes.

Most adults and seniors can clear the HBV virus from their system. However, other people continue to have a life-long illness. 

Hepatitis B Symptom - yellow skin
Hepatitis B Symptom - yellow eyes

Acute Hepatitis B

According to the CDC, Acute Hepatitis B is a short-term illness where the Hepatitis B virus leaves the body within six months. You may have an “acute” infection for only a few weeks. Some people may have no symptoms or only mild illness. For other people, the Hepatitis virus may cause serious health problems and hospitalization. 

Chronic Hepatitis B

Suppose you cannot clear the HBV virus from your system. In that case, you can have a life-long infection called chronic Hepatitis B. The CDC says, “almost all adults infected with the Hepatitis B virus recover completely and do not develop chronic infection.” 

Medicare does pay for the Hepatitis B vaccine

When you are at risk for Hepatitis B, Medicare Part B pays for the Hepatitis B vaccine. Thus, it costs you nothing! If you do not have Medicare Part B, you can apply for Part B.

You may have Hepatitis B and show no symptoms. Consequently, you could unknowingly pass the HBV virus to someone through sexual contact or sharing needles. However, if you show Hepatitis B symptoms, your skin and the whites of your eyes may turn yellow. Almost all infected seniors recover entirely and do not develop chronic infection.

Other Medicare Vaccine Coverage

In addition to the Hepatitis B vaccine, Medicare does pay for other vaccine coverage. For example, Medicare Part B provides seniors with Flu Shot and Pneumococcal vaccines. Furthermore, Medicare Part D or Medicare Advantage Plan with drug coverage pays for the Shingles vaccine.

Medicare Pneumococcal Vaccine Coverage

Medicare Part B provides pneumococcal vaccine coverage. Furthermore, Medicare will pay for two different pneumococcal shots. Each shot protects against different strains of bacteria. You can talk with your doctor or healthcare provider to determine if you need one or both shots.

Moreover, Part B will cover your first pneumococcal shot(s) at any time. Then you can get a different, second shot(s) at least one year after the first shot. To emphasize, you pay nothing for the pneumococcal vaccine when your doctor or other qualified health care provider accepts Medicare assignment.

Please read this article to learn about the pneumococcal disease, transmission, symptoms, and possible vaccine side effects.

Medicare Pneumococcal Vaccine Coverage - Senior Male

Pneumococcal Disease

Pneumococcal disease is an illness caused by Streptococcus pneumoniae bacteria. These illnesses include the following:

  • Pneumonia, infection of the lungs
  • Ear and sinus infections
  • Meningitis, infection of tissues covering the brain and spinal cord
  • Bacteremia, bloodstream infection

These illnesses can become severe, requiring hospital treatment, and may cause death in some cases. According to the CDC, seniors are at increased risk of pneumococcal disease.

Pneumococcal disease bacteria

Pneumococcal Transmission

A kiss on the cheek is safer than the lips.

Similar to COVID-19, pneumococcal bacteria spread from person-to-person by direct contact with respiratory particles. For example, an infected person coughs or sneezes, releasing particles into the air near you. Then these respiratory secretions enter your nose or mouth, and you become infected by the bacteria. 

Moreover, people, especially children, can have the bacteria in their nose or throat without being ill. For example, you can kiss your seemingly healthy grandchild and become infected with pneumococcal bacteria. 

Pneumococcal Symptoms

Pneumococcal symptoms depend on the part of the body infected. The most severe form of pneumococcal disease infects the lungs and include the following symptoms:

  • Fever and chills
  • Cough
  • Rapid breathing or difficulty breathing
  • Chest pain

According to the CDC, seniors “may experience confusion or low alertness, rather than the more common symptoms above.”

Pneumococcal Symptoms - Senior Man
Senior man with pneumococcal symptoms

Meningitis, Bacteremia, and Ear Infections

Pneumococcal meningitis infects your brain and spinal cord, and symptoms include:

  • Stiff neck
  • Fever
  • Headache
  • Photophobia (eye sensitivity to light)
  • Confusion

Pneumococcal bacteremia infects your blood and causes symptoms of fever, chills, and low alertness. The pneumococcus bacteria can also cause middle ear infections with the following symptoms:

  • Ear pain
  • A red, swollen eardrum
  • Fever
  • Sleepiness
Pneumococcal Meningitis - Senior Man Headache

Medicare Pneumococcal Vaccine Coverage

Medicare Pneumococcal Vaccine Coverage - doctor gives senior man a vaccine shot
Doctor gives senior man pneumococcal vaccine

Medicare Part B provides seniors with CDC recommended Pneumococcal Polysaccharide vaccine PPSV23. This vaccine is also called Pneumovax23 and protects seniors “against serious infections caused by 23 pneumococcal bacteria types.” Polysaccharide vaccines look like the surface of certain bacteria to help your body build immunity. So how effective is this vaccine?

Vaccine Effectiveness

CDC reports studies showing that “1 dose of pneumococcal polysaccharide vaccine protects between 50% to 85% of healthy seniors against invasive pneumococcal disease.” For example, the vaccine protects most seniors from pneumococcal meningitis, bacteremia, and ear infections. So what are the possible vaccine side effects?

Possible Vaccine Side Effects

Most seniors who get the Pneumococcal Polysaccharide vaccine do not have any serious problems. However, you may experience the following mild side effects: redness or pain where the shot location, fever, or muscle aches. If these side effects occur, they usually go away within two days.

Other Medicare Vaccine Coverage

In addition to the pneumococcal vaccine, Medicare provides other Medicare vaccine coverage. For example, Medicare Part B provides seniors with Flu Shot and Hepatitis B vaccines. Furthermore, Medicare Part D or Medicare Advantage Plan with drug coverage pays for the Shingles vaccine

Medicare Flu Shot Coverage

Medicare Flu Shot Coverage - Senior Female

Medicare Part B provides flu shot coverage. You can get one FREE flu shot per flu season! The CDC recommends seniors get a flu shot in September or October. Read about the flu vaccine and discover the following:

What is Influenza?

To prevent the influenza virus from causing a contagious respiratory illness, the CDC recommends getting the flu vaccine. The influenza virus causes mild to severe illness and can result in hospitalization and death. Seniors are at high risk for serious flu complications. Moreover, it’s more important than ever to get your flu vaccine during the COVID-19 pandemic. 

According to the CDC, the flu can cause the following symptoms:

  • Fever or chills
  • Cough
  • Sore throat
  • Runny or stuffy nose
  • Muscle or body aches
  • Headaches
  • Fatigue (tiredness)
Medicare Flu Shot Coverage - Senior Male 370x500

2 Human Influenza Viruses

The influenza virus has four antigenic types: A, B, C, and D. Human Influenza types A and B cause seasonal epidemics. Moreover, Influenza type A viruses cause flu pandemics. For example, the 2009 H1N1 (swine flu) pandemic lasted 19 months and killed 284,000 people. According to the CDC, “Influenza B viruses generally change more slowly in terms of their genetic and antigenic properties than Influenza A viruses.”

The photo shows the protein structure of the Influenza virus. The blue surface proteins are Hemagglutinin (H), and the red surface proteins are Neuraminidase (N). Inside is the Ribonucleoprotein (RNP) containing the viral RNA.

Medicare provides flu shot coverage to protect against two Influenza type A viruses (H1N1 and H3N2) and one or two Influenza type B viruses.

Medicare Flu Shot Coverage - Influenza virus

New Flu Vaccines for Seniors

According to the CDC, this year’s 2020-2021 flu season vaccines “were updated to better match viruses expected to be circulating in the United States.” Moreover, there are two new flu vaccines for seniors:

  • Quadrivalent high-dose vaccine
  • Quadrivalent adjuvanted vaccine

High Dose Flu Vaccine

Medicare Part B provides high dose flu shot coverage for seniors (brand name Fluzone High-Dose). It contains four times the amount of antigen as a regular shot. Consequently, you have a more robust immune response and higher antibody production. Results from a clinical trial of over 30,000 seniors who received the high dose vaccine had 24% less influenza illness than the standard dose flu vaccine. 

Medicare High Dose Flu Shot Coverage

Adjuvanted Flu Vaccine

The additive MF59 creates a more robust immune response in the adjuvanted flu vaccine. Trials show seniors have a “significantly higher immune response than those who received a standard flu vaccine.” CDC reports a study published in the Journal of Infectious Diseases among seniors. It found that trivalent FLUAD provided “greater protection against flu-related hospitalizations than the standard-dose, egg-based flu vaccine.”

FLUAD adjuvanted vaccine

Medicare Flu Shot Coverage

Medicare Flu Shot Coverage - Senior Female with Flu

In conclusion, Medicare Part B pays for senior flu shot coverage. The flu vaccine protects you from a contagious respiratory illness from two human influenza viruses, type A and B. Furthermore, Medicare Part B provides seniors with two new vaccines: Fluzone High-Dose and FLUAD adjuvanted flu vaccine.

In addition to flu vaccines, Medicare provides other vaccine coverage. For example, Medicare Part B provides seniors with Hepatitis B and Pneumococcal vaccine coverage. Furthermore, your Medicare Part D or Medicare Advantage Plan with drug coverage pays for the Shingles vaccine.

Medicare Vaccine Coverage

Medicare Part B and Part D drug plan provide you with vaccine coverage. Medicare Part B covers vaccinations from an outpatient medical provider, such as your doctor’s office. Part B vaccine coverage include:

Shingles Vaccine

Medicare Part D prescription drug plan covers the Shingles vaccine. You can receive a Shingles shot with a stand-alone Medicare Part D drug plan or Medicare Advantage Plan with drug coverage. Read this Shingles Vaccine article and discover the medical facts, such as:

  • If you ever had chickenpox, you can get shingles.
  • The older you get, the higher your risk of getting shingles.
  • Shingles produce a painful, blistering rash, and the vaccine reduces your risk of having Shingles.
Shingles Vaccine
Medicare Vaccine Coverage

Moreover, discover the differences between the two Shingles vaccines: Zostavax or Shingrix. Find out which vaccine is most effective in reducing the risk of developing shingles. Furthermore, get answers to the following Shingles vaccine questions:

  • How many Shingles shots for Zostavax vs. Shingrix vaccine?
  • Where and how to get the Shingles vaccine?
  • What does the Shingles vaccine cost?

Influenza Flu Vaccine

The best way to prevent seasonal flu is by getting the flu vaccine. Seniors and other high-risk groups are advised by the CDC to get a flu shot. Read this Medicare Flu Shot Coverage article and learn more about Influenza, including:

  • What is Influenza?
  • Two human types of Influenza virus?
  • When to get your flu shot?

Moreover, learn about the new vaccines for seniors age 65 or older for the 2020-2021 flu season. 

Hepatitis B Vaccine

Medicare Part B provides Hepatitis B vaccine coverage. To qualify for a FREE Hepatitis vaccine, you need to be at medium or high risk. In particular, you qualify by having any one of the following:

  • Hemophilia
  • End-Stage Renal Disease (ESRD)
  • Diabetes
  • Live with someone who has Hepatitis B
  • Be a healthcare worker with frequent contact to blood or bodily fluids
Medicare Vaccine Coverage Hepatitis B

Read the article, ‘Does Medicare pay for Hepatitis B vaccine?‘ and discover how Hepatitis B spreads from person-to-person. Moreover, learn the symptoms and the difference between acute and chronic Hepatitis B.

Pneumococcal Shots

Medicare Part B provides pneumococcal vaccine coverage. It’s FREE to get your pneumococcal shots! You can get your first shot any time and a different, second shot at least one year after the first shot. The CDC recommends Pneumococcal polysaccharide vaccine PPSV23 for all adults 65 years or older. 

Some pneumococcal infections are invasive and can spread through the body resulting in severe illness and death. However, studies show PPSV23 protects between 50 and 85 in 100 adults with healthy immune systems against invasive pneumococcal disease. Read the Medicare Pneumococcal Vaccine Coverage article and learn about symptoms and possible vaccine side effects.

Medicare Vaccine Coverage pneumococcal shots
Medicare Part B provides FREE pneumococcal shots

Tdap Vaccine Not Covered by Medicare

Medicare does not have vaccine coverage for Tdap shots. According to Medicare.gov, Tdap is an adolescent and adult booster shot for tetanus, diphtheria, and pertussis (aka whooping cough). Medicare does not cover this childhood vaccination shot, also called DTaP.

Medicare Annual Election Period

When is the Medicare Annual Election Period (AEP), and what can you do? You can make changes to all your Medicare Plans during AEP from October 15 to December 7. For example, you can change your Medicare Advantage, Medicare Supplement, or Part D drug plan. In particular, you can switch insurance carriers, enroll or disenroll from any of these Medicare plans.

Drug Plan Changes

In this FAQ Friday video, Robert Bache advises you to look for changes to your drug plan. Moreover, Robert “encourages you to focus on any formulary changes.” Part D Formulary is a list of drugs covered by your plan. 

First, Robert advises you to check and make sure your plan covers all your prescriptions. If possible, you want most of your drugs under Tier 1 or 2. Otherwise, Tier 3 drugs will be more expensive. If the medications you take are not available or will be more expensive, you can change your drug plan. 

Annual Notice of Change (ANOC)

Medicare Annual Election Period ANOC

The month before starting the Medicare Annual Election Period, your insurance carrier sends you an ANOC notice. When you receive this Annual Notice of Change (ANOC) in September, you can review your plan changes. Then decide to keep or change your Medicare plan.

For example, you should receive ANOC notice by September 30 from your Medicare Advantage or Part D drug carrier. The changes you see to your Advantage or Drug plan will be effective in January of the next year. According to Medicare.gov, ANOC includes any changes in coverage, costs, or service. 

2021 Medicare Plans

October 1, 2020, Senior Healthcare Direct will have access to the new 2021 Medicare Plans. You can start shopping for a new Medicare Plan on or after October 1 by calling 1-855-368-4717 or get your quote. However, Robert says, “you can not actually change your plan until October 15.” So what plans can you change during the Medicare Annual Election Period?

2012 Medicare Plans get quote button
Medicare Annual Election Period

Change Any Medicare Plan during the Annual Election Period

You can change any Medicare plan during the Annual Election Period (AEP). However, you can change from one Medicare Supplement plan to a different Medigap plan anytime all year long. You can change Medicare Advantage plans or switch to Medigap plan during AEP or Medicare Advantage Open Enrollment. Furthermore, you can enroll, drop, or switch carriers on our Part D prescription drug coverage. 

AEP – Medicare Advantage Plan Changes

During AEP, you can make the following changes:

  • Original Medicare to Medicare Advantage
  • Medicare Advantage to Original Medicare
  • Switch from one Advantage plan to a different advantage plan

When you switch to a different Medicare Advantage plan, you can choose a plan that either does or does not include drug coverage. If you switch to Original Medicare, you can then enroll in Part D drug coverage and Medicare Supplement plan.

AEP – Part D Plan Changes

During the Medicare Annual Election Period, you can make the following Part D changes:

  • Enroll in Part D prescription drug plan
  • Switch from one Part D plan to a different Part D plan
  • Drop your Part D plan

Does Medicare cover Skilled Nursing Facility?

Medicare does cover a Skilled Nursing Facility (SNF). However, Medicare coverage is limited based on the following conditions:

In the Medigap Monday video, MedicareBob briefly mentions the 3-day qualifying hospital stay requirement and Plan G coverage benefits for SNF days 21 – 100. 

What is a Skilled Nursing Facility?

A Skilled Nursing Facility (SNF) is where you receive skilled nursing or therapy to treat a hospital-related medical condition. What does Medicare cover in a Skilled Nursing Facility? 

  • Semi-private room
  • Meals
  • Physical Therapy / Occupation Therapy
  • Speech-language pathology services
  • And more!
Does Medicare cover Skilled Nursing Facility

Skilled Nursing Facility benefit period

According to Medicare.gov, your benefit period begins when a Skilled Nursing Facility (SNF) admits you. After 60 consecutive days have passed without you receiving SNF benefits, your benefit period ends. The next time a hospital admits you, you must pay the hospital deductible $1408 in 2020.

However, during the COVID-19 pandemic, you may be able to get renewed SNF coverage without waiting 60 days for a new benefit period to begin.

Skilled Nursing Facility benefit period

Qualified Hospital Stay

Medicare does cover a Skilled Nursing Facility (SNF) after a qualifying 3-day admission to a hospital. First, you must have three or more days at a hospital. Then you can be transported to SNF, and Original Medicare covers the first 20 days.

Medicare.gov states your three days at a hospital must be as an inpatient (not outpatient). Furthermore, a qualifying hospital stay does not include inpatient observation services. Moreover, during the COVID-19 pandemic, you can get SNF coverage without a qualifying hospital stay.

Qualified Hospital Stay
You need at least 3 days as hospital inpatient to qualify for Skilled Nursing Facility care.

Care for a Hospital-Related medical condition

You must enter a Skilled Nursing Facility (SNF) care within a short time (30 days) of leaving the hospital and require skilled services related to your hospital stay. Moreover, you can leave SNF and reenter the same or another SNF within 30 days, and you will not need another 3-day qualifying hospital stay.

Skilled Nursing Facility care

Medigap Plan G – SNF Benefits

With Medigap Plan G, you do not have to pay $1408 hospital deductible every Skilled Nursing Facility benefit period. Moreover, Plan G covers SNF coinsurance costs $176 per day from days 21 – 100. Shop Medicare Supplement Plans, call Senior Healthcare Direct at 1-855-368-4717 or get your quote!

Change Your Medicare Plan

If you have Original Medicare and want to upgrade to a Medicare Supplement, discover when to shop Medigap Plans. If you have Medicare Advantage and want to switch to a Medigap Plan, find out when you can change.