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.

Johnson and Johnson COVID-19 Vaccine

Johnson and Johnson COVID-19 vaccine senior man shot arm needle face mask

Johnson and Johnson COVID-19 Vaccine

Sunday, February 28, 2021, the CDC recommended and endorsed the Johnson and Johnson COVID-19 vaccine’s safety and effectiveness. Furthermore, it authorized the emergency use of the vaccine for people age 18 and older. Consequently, CNN reports today, “US begins distribution of a third Covid-19 vaccine.” 

Estimated reading time: 3 minutes

COVID-19 Vaccinations in US

Up to 4 million doses of the Johnson and Johnson COVID-19 vaccine are ready to roll out this week. This new COVID-19 vaccine only requires one dose. Whereas the other COVID-19 vaccines (Pfizer and Moderna) require two doses. 

In other words, you only need to get a single shot in the arm with this new COVID-19 vaccine. However, Pfizer and Moderna COVID-19 vaccines require three-week immunity (waiting) period between shots. Thus, Pfizer and Moderna vaccines take twice as long for a person to become fully vaccinated. 

US COVID-19 Vaccinations

The United States has administered 75 million COVID-19 vaccinations from December 14, 2020, to February 28, 2021. However, the percentage of Americans fully vaccinated is only 7.6%. To be fully vaccinated, you have to receive two shots of either Pfizer or Moderna COVID-19 vaccines.

Most of these 75 million vaccinated Americans have received only one shot. Furthermore, some people who had their first shot may choose not to get a second shot. Since the new Johnson and Johnson COVID-19 vaccine only requires a single shot, we can expect the rate of fully vaccinated Americans to increase much faster. In other words, the pace to end the COVID-19 pandemic will quicken starting in March 2021.

COVID-19 Vaccine Effectiveness

The two-shot COVID-19 vaccines (Pfizer and Moderna) are about 95% effective. However, the one-shot Johnson and Johnson vaccine is only 72% effective against moderate to severe COVID-19 infection. Furthermore, it’s nearly 86% effective against severe forms of the disease.

Vaccine Storage and Transport

Unlike the Pfizer and Moderna vaccines that require subzero storage and transport, the Johnson and Johnson vaccine only requires refrigeration. It’s much easier to transport and store the new Johnson and Johnson COVID-19 vaccine. This difference will make the new vaccine widely available to many communities, including mobile sites.

Johnson and Johnson COVID-19 Vaccine seniors woman gets vaccination shot

Takeaway

The easier to distribute, one-shot Johnson and Johnson’s vaccine will quicken the pace of vaccinations. With this new vaccine, we can end the COVID-19 pandemic. Learn more about COVID-19 and other vaccines for seniors covered by Medicare.

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Medicare Kidney Transplant

Medicare Kidney Transplant

Does Medicare pay for a Kidney Transplant?

Original Medicare Part A and Part B pay for kidney transplants. Furthermore, Medicare Advantage (Part C) also covers kidney transplants. So what exactly is a kidney transplant?

Estimated reading time: 5 minutes

Kidney Transplant Surgery

Kidney transplant surgery is a medical procedure to remove a healthy kidney from a donor and transplant it into the receiver. The receiver’s non-functioning kidney remains in place, and the surgeon adds the new kidney to the receiver’s abdomen. Kidney donors can live with only one kidney. So what services does Medicare cover?

Medicare Part A Kidney Transplant Services

Medicare Part A covers kidney transplant services for you and your donor. Medicare pays for your inpatient hospital services, the kidney registry fees, blood, and the cost of finding a kidney donor. Furthermore, Part A covers laboratory tests and exams to evaluate your medical condition and potential kidney donors’ condition. 

Kidney Donor Coverage

Medicare covers the full cost of care for your kidney donor. Specifically, Medicare covers donor care before, during, and after surgery. Furthermore, should your donor need additional hospital care after surgery, Medicare covers this care as well. 

Medicare Kidney Transplant surgery
Medicare Part A covers kidney transplant surgery.

When you enrolled in a Medicare Advantage plan, did you check if a transplant specialist was in your plan’s network?

Medicare Advantage Kidney Transplant Specialist

Kidney Transplant Specialist doctors

If your Medicare Advantage plan does not include a kidney transplant specialist, you currently have time to change your plan. Between January 1 and March 31, you can switch Medicare Advantage plans. However, if it’s past March 31, you will have to wait until the Annual Election Period starting October 15. 

For people with Original Medicare, you have access to all transplant specialists who accept Medicare-assignment. Specifically, Medicare Part B covers doctor services for kidney transplants. What are other medical services covered by Part B?

Medicare Part B Kidney Transplant Service

In addition to doctor services during kidney transplant surgery, Part B covers care before and after surgery. Furthermore, Part B covers doctor services for your kidney donor. You may also be eligible for transplant drugs.

Kidney Transplant Drugs

Kidney transplant drugs are immunosuppressants that help prevent rejection of your new kidney. Furthermore, you will need to take these drugs for the rest of your life. If you are not age 65 but were eligible for Medicare because of an End-Stage Renal Disease (ESRD), please do the following:

  • Enroll in Part A before your kidney transplant
  • Have your kidney transplant surgery at a Medicare-approved facility

According to Medicare.gov, Part B will only cover your transplant drugs when you meet the above conditions. Furthermore, ESRD Medicare coverage expires 36 months after the month of your transplant. If you happen to turn 65 during these 36 months, please enroll in Medicare again to avoid losing coverage. Moreover, if you were eligible for Medicare because you were 65 before you got ESRD, your transplant drug coverage has no time limit. 

Kidney Transplant Drug pharmaist hands over prescription bottle

Now that you know the hospital (Part A) and medical (Part B) services covered by Medicare, what do these services cost?

Medicare Kidney Transplant Costs

According to an NPR.org article, the costs of kidney and related care costs about $100,000 per patient. Furthermore, people who lost Medicare coverage after 36 months bear the monthly cost of transplant drugs. If such a person loses their health insurance, these drug costs thousands per month! 

However, if you have Medicare, Part B pays for your transplant drugs, and you pay the Part B premium. If you take other prescriptions, your Medicare Part D or Medicare Advantage plan pays these costs. Furthermore, most drug plans charge you a monthly fee. So Medicare Part B pays for your kidney transplant medical costs, do you pay any donor costs?

Kidney Donor Costs

Medicare pays for all your kidney donor costs. Thus, neither you nor the donor pays any deductible, coinsurance, or other costs. However, you pay your share of hospital and medical costs.

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Donating a healthy kidney is FREE! Learn more about donating your kidney. You can save a life!

Your Kidney Transplant Costs

Happy african american senior couple
ESRD prevalence is 3.7 times greater in African Americans.

When you get your kidney transplant surgery in a hospital, you pay the Part A deductible $1484 in 2021. However, you do not pay hospital coinsurance as long as your stay is 60 days or less. Furthermore, you can receive up to 20 days in a skilled nursing facility at no cost.

For Part B medical services, you pay the Part B deductible $203 in 2021 kideand 20% coinsurance costs. However, you do not pay for Medicare-approved laboratory tests. If a hospital can not procure blood from a blood bank, you pay for the first three blood units.

If you have a Medicare Advantage plan, what you pay may be different.

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Seniors seated lifting weights in Ger-Fit class

Senior Fitness Programs

Senior Fitness Programs woman dumbells in park at sunset
Healthy and fit mature woman exercises in park.

What is a Senior Fitness Program?

Senior Fitness Programs (SFP) are for people age 65 and older, and may be available through your Medicare plan. For example, your Medicare Advantage Plan may include Silver Sneakers

Estimated reading time: 5 minutes

Fitness programs vary based on your Medicare insurance provider. For instance, United Healthcare has a new and exclusive program called Renew Active. However, your Medicare plans may not have a fitness program. In this case, you can choose a stand-alone fitness program.

New Fitness Program for Seniors

If you are a current client of Senior Healthcare Direct, you can purchase a stand-alone fitness program. Discover Active&Fit Direct, a new fitness program exclusively for our senior clients. Find out how this gym membership can save you money.

Evidence-based Senior Fitness Programs

If you do not have a Medicare fitness program, please consider the following “evidence-based physical activity programs.” These fitness programs have been proven to produce measurable health benefits for seniors.” (ncoa.org)

Enhance Fitness

Enhance Fitness is a “low-cost ongoing evidence-based group exercise and falls prevention program.” It helps seniors of all fitness levels become “more active, energized, and empowered to sustain independent lives.” 

Classes meet three times per week for a full hour of physical activity lead by a certified instructor. The fitness program provides seniors with the following activities:

  • Warm-up (5 min)
  • Cardiovascular workout (20 min)
Senior fitness class stretching
Seniors stretch during an Enhance Fitness class.
  • Cool-down (5 min)
  • Upper and lower body strength training with weights (20 min)
  • Stretching to keep your body flexible (10 min)

Enhance Fitness classes also include dynamic and static balance exercises.

Geri-Fit

Geri-Fit is a “highest tier level III evidence-based” strength-training exercise program for seniors. It’s for “older adults who want to improve their strength, balance, flexibility and cardiovascular endurance.” 

In a Geri-Fit class, you work out at your own pace. The instructor provides “one-on-one assistance” to help you lift weights correctly. New participants start with 2-lbs dumbells. As your strength increases, you can use heavier dumbells to build strength and balance. 

You perform most of the Geri-Fit exercises while seated in a chair. Classes are 45-minutes and meet 2 or 3 times per week. Alternatively, you can enroll in a Ger-Fit course for 12 weeks (24 classes). 

Seniors seated lifting weights in Ger-Fit class
Seniors lifting weights in a Geri-Fit class.

Lifting weights can help prevent bone loss. Please read the article, Does Medicare Cover Prolia? and learn about this injectable osteoporosis drug.

Weekly Workout for Seniors

Dr. Stuart McGill’s article, Seven-Day Workout Cycle, provides seniors with a structure for staying fit into old age. The following is a 7-day weekly fitness program for seniors:

  • Strength training for two days
  • Mobility training for two days
  • “Something else”: two days
  • Rest: one day

For example, a sample week may look like the following:

  • Monday strength training
  • Tuesday “something else”
  • Wednesday mobility training
  • Thursday “something else”
  • Friday strength training
  • Saturday mobility training
  • Sunday rest day
Senior Fitness Program man workout TRX straps
Dr. McGill recommends functional exercises such as pulling yourself up with TRX straps.

Please avoid three consecutive training days. Instead, put your rest day after two consecutive training days. On “Something else” days, you could bicycle ride, walk, hike, or swim. Do whatever you like that gets your heart pumping. However, please abstain from exercise on your rest day. 

Senior Workout Recommendations

Dr. McGill recommends the following guidelines to ensure your workout best suits your capabilities:

First, lightly challenge your capabilities without exceeding them. When the going gets tough, lower your intensity by slowing down or lifting less weight. Otherwise, you will need an extra day to recover. Dr. McGill says, “It’s better to have two moderately easy days of activity than one hard day and then two days off.” 

If you feel sore after a workout or the next day, McGill recommends reducing the workout load (weight) or duration (time). For example, cut your exercise time in half and spread the training over two days. Then slowly increase training time. 

Dr. McGill recommends you limit each incremental step to 10 percent. For example, if your workout is 15 minutes, gradually increase this duration by 1.5 minutes to 16.5 minutes.

Senior Fitness Program group of seniors hiking on trail
Hiking challenges and tests your balance.

According to McGill, any “well-rounded fitness program for seniors” has four components: mobility, strength, and endurance. Dr. McGill recommends you focus on different components throughout the week. For a fitness framework, please follow McGill’s Seven-Day Workout Cycle.

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BMI for Seniors

Body Mass Index, BMI, is a screening tool for seniors used by Medicare to assess if you are at risk for weight-related health issues. For example, Medicare obesity counseling can help you lose weight when you have a 30 or higher BMI. 

Estimated reading time: 2 minutes

During your Annual Wellness Visit, your doctor will measure your height and weight to assess your BMI. Furthermore, anytime you apply for Medicare Supplement Plan outside your initial Open Enrollment Period, you will have to answer underwriting questions. Based on your BMI, a supplement insurance company could charge you more or deny your Medigap policy. 

BMI for Seniors - feet on a weight scale
How much do you weigh? Calculate your BMI.

BMI Calculator for Seniors

The BMI calculator is for seniors and any adults age 20 and over. You can enter your height and weight in metric (cm and kg) or imperial (in and lbs). Press the submit button to calculate your BMI.

How is BMI calculated? The metric system’s BMI formula is your weight (kg) divided by your height (cm) squared. For example, 74.38 kg / (1.83 m * 1.83 m) = 22.2 BMI. Alternatively, the BMI formula in the imperial system is your weight (lbs) divided by your height (in) squared. Then this quotient multiplied by 703. For example, 164 lbs / (72 in * 72 in) = .03164 x 703 = 22.2 BMI.

Your BMI is

Your BMI Weight Categories

Your Body Mass Index, BMI, is associated with one of four weight status categories. You are underweight if your BMI is under 18.5. A healthy weight status has a BMI between 18.5 and 24.9. Seniors with a BMI between 25 and 29.9 are overweight. A BMI of 30 and higher has a weight status category of obese.

For example, a senior with a BMI of 22 has a healthy weight. However, seniors with a BMI of 28 are overweight. If you are overweight or obese, please join a fitness program of seniors. Furthermore, to help you safely lose weight, please read the article, Weight Loss for Seniors.

BMIWeight Status
Below 18.5Underweight
18.5 – 24.9Healthy Weight
25.0 – 29.9Overweight
30.0 and upObese
BMI table for seniors to determine your weight status

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What does Medicare not cover dressing a senior woman in assisted living

What Does Medicare Not Cover

Medicare does not cover services or supplies that are medically unreasonable or unnecessary to diagnose and treat a patient’s condition. (CMS.gov page 5) For example, Medicare does not cover:

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  • Long-term care – the daily living and medical care you get in an assisted-living or nursing home.
  • More than 20 days in a Skilled Nursing Facility – however, your Medigap Plan may pay for up to 100 days.
  • Greater than 90 days in a hospital if no lifetime reserve days – otherwise, add your remaining reserve days out of 60.
  • More than six months of hospice care
What does Medicare not cover dressing a senior woman in assisted living
Dressing a senior woman in an assisted-living home.

Medicare Coverage Outside the United States

Medicare Foreign Travel Coverage cruise ship Sydeny Opera House
Cruise ship sails by the Sydney Opera House.

There are particular cases when Medicare does provide foreign travel coverage outside the United States. If you do not meet these specific circumstances, Medicare will not pay for services outside the US. However, you can get foreign travel emergency benefits with a Medicare Supplement Plan, such as Medigap Plan G. 

Personal Comfort Items and Services

Senior man haircut

Medicare does not cover personal comfort items such as radios and televisions. Furthermore, Medicare does not provide comfort services such as beauty and barber services. However, you can request such items and services, and the charge may not exceed the typical cost.

When you can not perform these services yourself, Medicare may cover shaves, haircuts, and shampoos.

Annual Physical Checkups

Medicare does not cover annual physical checkups. However, Medicare does cover Annual Wellness Visits. A physical exam is more comprehensive than a wellness visit and could cost you $400 or more! 

Dental, Fitness, Hearing, Vision, and Transportation

Medicare doesn’t provide dental, fitness programs, hearing, vision, and transportation (non-emergency) services. However, you can get these Medicare Advantage Benefits with a MA Plan. If you need eyeglasses, hearing aids, or dental care, consider changing your MA Plan.

Medicare doesn’t provide eye exams unless you have diabetes or glaucoma tests unless you are at high risk for glaucoma

Medicare does not cover vision -senior man eye exam for new glasses
Medicare does not cover glaucoma Testing

Cosmetic Surgery

Medicare does not cover cosmetic surgery - senior with stitches after brain surgery
Senior with stitches after brain surgery

Medicare doesn’t cover cosmetic surgery, which includes any procedure to improve the patient’s appearance. However, Medicare may cover cosmetic surgery to make repairs on an accidental injury. Furthermore, Medicare may also cover surgery to improve the functioning of a malformed body member. Examples of covered cosmetic surgery:

  • Treatment of severe burns
  • Repairing the face after a serious accident
  •  Surgery for therapeutic purposes that incidentally has cosmetic appeal

Medicare May Not Cover

Medicare may not cover services or supplies when a doctor or other health care practitioner deems them not medically necessary. Services that Medicare may not cover:

  • Allergy Shots – immunotherapy that desensitizes you of particular allergens such as grasses, pollens, and trees
  • Acupuncture – only covers chronic lower back pain
  • Chiropractic Services – limits coverage to adjustment of the spine to correct a subluxation
  • Foot care – many exceptions apply – such as diabetic foot care, which may cover therapeutic shoes or inserts
Chiropractic service on senior man
Senior man gets chiropractic service.

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Medicare Foreign Travel Coverage

Medicare may provide foreign travel coverage outside the United States. To qualify for coverage, special circumstances apply. Otherwise, Medicare will not cover your health care outside the US.

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Medicare Foreign Travel Coverage

Medicare may pay for services you get on board a ship within the US’s territorial waters. For example, you take a vacation aboard a cruise ship to the US Virgin Islands. Medicare may pay for medical services while you are in these territorial waters.

Senior Couple On Shore in Front of Cruise Ship
Senior couple on shore in front of cruise ship while on vacation in the Eastern Caribbean.

Foreign Hospital and Medical Services

Medicare may pay for inpatient hospital, doctor, ambulance service, or dialysis in a foreign country in the following cases: (Medicare.gov)

  • While in the US, you require immediate medical attention, and the nearest hospital that can treat your medical condition is a foreign hospital. 
  • For example, you are traveling in Canada, and you have a medical emergency. Medicare may cover your medical services at a Canadian hospital when it is closer than a US hospital. 
  • Your US home is closer to a foreign hospital than a US hospital. Regardless of any emergency, the foreign hospital can treat your medical condition. 
Medicare Foreign Travel Coverage cruise ship Sydeny Opera House
Medicare will not cover foreign travel on a cruise ship in Sydney Harbor Australia. Find out what else Medicare does not cover.

Furthermore, Medicare will not cover health care services on a ship that is more than 6 hours away from a US port.

Senior man at the airport in times of pandemic
Senior man traveling during the coronavirus pandemic.

Medigap Foreign Travel Coverage

Your Medicare Supplement Plan may cover foreign travel emergency care. When you travel outside the US, the following Medigap Plans provide you with foreign travel emergency coverage: plans C, D, E, F, G, H, I, J, M, and N. 

By the way, you can not currently buy Medigap Plans E, H, I, and J. However, you could have purchased one of these plans before June 1, 2010, and kept it. (Medicare.gov)

Medicare Supplement Plan Foreign Travel Coverage

If Medicare does not cover your care, these Medigap Plans pay for foreign travel emergency care within the first 60 days of your trip. Medicare Supplement Plans pay 80% of medically necessary care outside the US after you pay a $250 deductible for the year. Furthermore, this foreign travel emergency coverage has a lifetime limit of $50,000. 

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Weight Loss for Seniors

Weight loss for seniors can be risky for many obese older adults. As you age, you lose muscle mass – called sarcopenia. Recent scientific research shows obese seniors on a weight loss diet who do not perform resistance exercises often lose muscle mass. Consequently, adverse health outcomes of sarcopenia include: 

  • Higher rate of mortality (death)
  • Functional decline
  • More frequent falls
  • Higher incidence of hospitalizations

Estimated reading time: 4 minutes

However, resistance training during dieting preserves your muscles, so you avoid these adverse health outcomes. If you think you might be obese, you can check your BMI and get Medicare obesity counseling.

Weight Loss for Seniors physical activity woman squats outdoors
Senior woman squats using her body weight to strengthen the muscles in her legs, glutes, and abs.

To maintain muscle strength, you need to get regular physical activity.

Physical Activities for Seniors

During COVID-19 Pandemic, seniors can safely get physical activity at home. Otherwise, seniors who receive the Coronavirus vaccines (1st and 2nd shots) can safely workout at a fitness center. Find out about Senior Healthcare Direct’s new fitness program for seniors.

New Fitness Program for Seniors

If you have COVID-19 immunity, we recommend you join the new fitness program for seniors called Active&Fit Direct. Membership benefits include access to over 11,000 fitness centers nationwide and online classes with workout videos. Learn more about the Active&Fit Direct program.

Weight Loss for Seniors - woman takes an online exercise class at home
Senior woman takes an online exercise class at home.

Bodyweight Strength Training

Training Prep Guidelines senior man ties sport shoes at home

You can use your body weight for strength training. If you exercise at home, make sure you perform these muscle resistance activities correctly to avoid injury. Before you start strength training, review the Training Prep Guidelines.

Training Prep Guidelines

Get your gear and your environment ready for physical activity, so you can safely perform your training.

  • Wear shoes with a rubber outsole so the shoe bottoms can grip the floor. 
  • Secure your shoes – tighten shoelaces and tie them.
  • Ensure the training space is clean, dry, and adequately illuminated.

It’s best not to train alone. If possible, exercise when your spouse or other family member is present. Then if something goes wrong, they can help. Otherwise, put your mobile phone in your pocket so you can call for help if you need it. 

Pushups for Seniors

Weight Loss for Seniors - man does wall pushups

Pushups help strengthen muscles in your chest and arms. The following pushups for seniors provide you with three modified versions. The order of difficulty is from least difficult to most difficult. 

  • Standing Wall Pushups: put the palms of your hands on a wall and take a step back. Next, you bend your arms and bring your head close to the wall. Then you push against the wall and straighten your arms. 
  • Countertop Pushups: you do the same thing as standing wall pushups, except you put your hands on the edge of a countertop.
  • Chair Pushups: place your hands on the edge of a chair seat and perform the same pushup movement.

Another bodyweight strength training activity for seniors is seated squats.

Seated Squats for Seniors

Seated Squats for Seniors man rises from a chair

A seated squat is a functional movement that trains the muscles you need to sit up from a seated position. This strength training activity works the muscles in your legs, glutes, and abs. Modified versions also work your arms and back muscles. 

The following three modifications of seated squats will progress from least difficult to most difficult. With all versions, you begin in the seated position.

  • Pole-Assisted seated squat: while holding on to a pole or cane, pull yourself out of the seat and into a standing position.
  • Armchair seated squat: with your hands on the arms of a chair, push yourself up and stand.
  • No Assist seated squat: with your arms extended out in front, stand up out of your chair.

Physical Activity and Weight Loss for Seniors

Strength training helps seniors maintain muscle mass while on a weight loss diet. Using your body weight for resistance training allows you to strengthen your muscles at home. By following the Training Prep Guidelines, you can workout safely and lose weight.

Obese Senior on phone

Medicare Obesity Counseling

Medicare Obesity Counseling - American Flag and Obese Person

Medicare obesity counseling can help you lose weight. With over 100 million obese adults, America needs all the help it can get. The latest CDC obesity facts show 42.4% of adults are obese. Moreover, CDC reports 9.2% of adults are severely obese. 

Estimated reading time: 3 minutes

Find out if you are one of the many obese Americans.

Are You Obese?

You can calculate your Body Mass Index (BMI) to determine if you are obese. Enter your height and weight into the calculator to determine your BMI. An obese BMI equals 30 or greater.

Does your BMI indicate obesity? You can get referrals for obesity counseling during your Medicare Annual Wellness Visit.

Medicare Obesity Counseling - feet on scale

Medicare Telehealth Counseling

Due to Coronavirus (COVID-19), Medicare Part B covers telehealth counseling. You can communicate with a licensed psychologist and get Medicare obesity counseling at home using the Internet. For example, you can do a video call using a smartphone or computer.

During your AWV, your doctor does a health risk assessment. It may identify cognitive impairments such as Alzheimer’s and physiological risks such as obesity. 

Many life events can lead to weight gain, such as:

  • Senior retirement
  • Losing a spouse
  • Depression
Coronavirus Medicare Telehealth protecting senior

Counseling can help you make healthy lifestyle changes. So what exactly is Medicare Obesity Counseling?

Annual Wellness Visit doctor exam room senior woman

Medicare Obesity Counseling

Medicare Part B covers obesity screening and behavioral counseling when you have a body mass index (BMI) of 30 or higher. Moreover, Medicare pays for your obesity behavioral therapy, so it’s FREE to you! The screening measures your height and weight to determine your BMI and includes a dietary assessment. Counseling helps you lose weight through diet and physical activity. 

Furthermore, losing weight can qualify you for a Medicare Supplement (Medigap) Plan.

Medigap Insurance Underwriting

Obese Senior on phone

After your initial Open Enrollment Period (OEP), Medicare Supplement insurance companies can deny you coverage. OEP ends three months after your 65th birthday month. Anytime after this period, you could be denied Medigap coverage.

For example, you want to switch to a different Medigap Plan or switch from Medicare Advantage to Medicare Supplement Plan. In these cases, underwriting must ask you health questions, which include your height and weight. Read Medicare Supplement Insurance Underwriting to discover the BMIs that may disqualify you. 

Vaccines for Seniors woman gets vaccination shot

Vaccines for Seniors

Medicare covers many vaccines for seniors. In 2021, seniors need the COVID-19 vaccine. CDC confirms a new COVID-19 variant “seems to spread more easily and quickly than other variants.” Thus, putting seniors at greater risk for viral infection.

Estimated reading time: 5 minutes

Seniors age 65 and older often have a weakened immune system, making it more difficult to fight infections. Thus, seniors who get infected are more likely to have complications, such as hospitalization and death. Since the new COVID-19 variant is accelerating the spread of the virus, seniors need vaccination ASAP. 

Vaccines For Seniors man get COVID-19 shot
Senior man gets the COVID-19 vaccine.

What vaccines do seniors need?

All vaccinations protect seniors from serious diseases (and related complications), so you can stay healthy. Medicare covers the following vaccines for seniors:

COVID-19 Vaccination

FDA issued Emergency Use Authorization (EUA) for Pfizer COVID-19 vaccine on December 11, 2020. A week later, the FDA issued EUA for the Moderna COVID-19 vaccine. As of January 2021, the supply of these COVID-19 vaccines is limited. To protect the most vulnerable, the CDC recommends the following get the vaccine first. 

CDC prioritization for COVID vaccine

  • 1a. Healthcare personnel and residents of long-term care facilities
  • 1b. Frontline essential workers and people aged 75 and older
  • 1c. People aged 65 – 74, those 16 – 64 with underlying medical conditions, and other essential workers.

To find a COVID-19 vaccination site near you, search for your state’s department of health. For example, search “Florida Department of Health.” Your state governor will determine who can administer the COVID-19 vaccine. 

Vaccines for Seniors woman is first to get COVID-19 shot
75 year old woman is first to get COVID-19 vaccine.

Hepatitis B Vaccine

Medicare Part B covers the Hepatitis B vaccine if you are at increased risk for Hepatitis B. Read the article, Does Medicare Pay for Hepatitis B vaccine? and discover how Hepatitis B spreads. Furthermore, learn the symptoms and the difference between acute and chronic Hepatitis B. 

You qualify for the Hepatitis B vaccine if you have one of the following:

Hepatitis B vaccine illustration
Hepatitis B is a virus that infects your liver.

Influenza Flu Vaccine for Seniors

To protect your health, the CDC says, “Flu vaccination is especially important for adults 65 years and older.” Seniors have a “high risk of developing serious complications from the flu.” For example, recent estimates show between 70 and 85 percent of seasonal flu-related deaths occur with seniors. Furthermore, seniors also account for 50 to 70 percent of flu-related hospitalizations. 

Flu vaccine for seniors reduces their risk of flu illness and severe outcomes. Moreover, flu vaccines for 2020-2021 are new from last season’s vaccine to better match circulating viruses. Studies show the flu vaccine effectively reduces medical visits and hospitalizations, particularly in seniors. 

Influenza virus

Medicare Part B provides flu shot coverage. Learn about the Influenza viruses and how the flu vaccine protects you from this contagious respiratory illness. Discover the most effective flu vaccines for seniors. 

Pneumococcal Vaccine for Seniors

Medicare Part B provides pneumococcal vaccine coverage for seniors. Furthermore, Medicare covers two different pneumococcal shots, which protects you against different strains of the bacteria. As long as your health provider accepts Medicare assignment, your pneumococcal vaccinations are FREE! 

The National Foundation for Infectious Diseases recommends pneumococcal vaccinations for all seniors. Pneumococcal infections cause an estimated 150,000 hospitalizations per year and about 5-7% of those hospitalized die. However, the death rate of seniors is even higher.

According to the CDC, seniors are at increased risk for pneumococcal disease.

Vaccines for Seniors woman gets vaccination shot

Read the Medicare Pneumococcal Vaccine Coverage article and discover the following:

  • What is pneumococcal disease?
  • How does it transmit from person-to-person?
  • What are the symptoms?
  • How effective is the vaccine for seniors?

Shingles (Zoster) Vaccine

Shingles is a painful, blistering rash, and the vaccine reduces your risk of having Shingles. According to the CDC, almost 1 out of 3 people in the United States will develop shingles in their lifetime. The incidence of adults having shingles has been increasing for decades. 

The graph shows people age 70 and older have the highest incidence of shingles. However, adults aged 50 – 59 have about the same incidence rate as adults aged 60 – 69. Thus, your risk of having shingles increases as you get older.

Unlike other vaccines, your Medicare Part D prescription drug plan covers the shingles vaccine. You can get Part D drug coverage in Medicare Advantage or stand-alone Part D Plan.

Shingles Incidence Rates by age over time
Shingles Incidence Rates by age over time

Read the Shingles Vaccine article to get answers to the following questions:

  • Who can get shingles?
  • Which shingles vaccine is best for seniors?
  • Where to get the shingles vaccine?
  • What does the shingles vaccine cost?
Medicare Annual Wellness Equals Prevention

Medicare Annual Wellness Visit

Medicare Annual Wellness Visit

Medicare Annual Wellness Visit (AWV) is a yearly appointment with your primary care provider (PCP) to develop or update your personalized prevention plan. The AWV helps you prevent disease and disability based on your current health and risk factors. Does Medicare pay for your annual wellness visit?

Estimated reading time: 5 minutes

Your Annual Wellness Visit is FREE

Medicare will pay for your Annual Wellness Visit (AWV) when the following conditions are true:

  • Your “Welcome to Medicare” initial visit is within the first 12 month
  • It has been 12 months or longer since your last AWV
  • During these 12 months, you have had Medicare Part B

If you qualify, Medicare Part B covers your AWV at 100% of the Medicare-approved cost. Moreover, there is no deductible. So you do not pay the $203 Part B deductible in 2021.

Medicare Annual Wellness (AWV) equals prevention infographic
AWV helps to prevent disease and disability

When you meet these conditions, your AWV is FREE. Discover more FREE Medicare Part B preventive services.

However, if your AWV uncovers the need to investigate or treat a new or existing problem, Medicare may bill you for any diagnostic care.

Your First Annual Wellness Visit

Your first AWV maybe your Welcome to Medicare Visit if it occurs within the first 12 months of enrolling in Medicare Part B. During your initial visit, your primary care physician will cover the following:

Health Risk Assessment – you fill out the form shown on the right. The health assessment includes the following:

  1. General Health, Tobacco and Alcohol Use
  2. Nutrition
  3. Physical Activity
  4. Sleep
  5. Functional Status Assessment
  6. Pain Assessment
  7. Home/Safety
  8. Depression

Provider Consultation – reviews your Health Risk Assessment and addresses the following:

  • Psychosocial risks
  • Behavioral risks
  • Activities of Daily Living
  • Establish a list of current providers and suppliers
  • Establish your medical/social and family history
  • Physical Exam includes your height, weight, body mass index (BMI), blood pressure, visual acuity, and other factors based on your assessment
  • Establish or detect any cognitive impairment you may have

Personalized Prevention Plan – a list of risk factors and conditions for which primary, secondary, and tertiary interventions are recommended. Furthermore, you will be furnished personalized health advice and referrals, as appropriate, to health education or preventive counseling services or programs such as:

medicare annual wellness visit health risk assessment
visual acuity testing
medicare annual wellness visit AWV

What does an Annual Wellness Visit include?

Annual Wellness Visit doctor exam room senior woman

During your AWV, you can update your medical/family history. Based on these updates, your primary care doctor will revise your personalized prevention plan. Furthermore, you can update your list of health providers and suppliers.

Your Annual Wellness Visit includes the following: (Medicare.gov)

  • Check your weight (or waist circumference), blood pressure, and other routine measurements
  • Assessment of any cognitive impairment such as signs of Alzheimer’s disease or dementia
  • Receive personalized health advice and referrals to health education, preventive counseling, and programs
  • A screening schedule for preventive services, such as diabetes and vaccines

How to Make An Annual Wellness Appointment

The Washington Post published an article about a lady on Medicare named Beverly Dune. She “called her primary care doctor’s office to schedule an annual checkup, she assumed her Medicare coverage would pick up most of the tab. The appointment seemed like a routine physical, and she was pleased that the doctor spent a lot of time with her. Until she got the bill: $400.”

When you call your doctor to make an appointment, it is essential to use the words “annual wellness visit.” Otherwise, if you use the words “Annual Physical,” the visit can cost you $400! A physical exam is more comprehensive than a wellness visit. 

For example, a physical is a full-body examination where the doctor exams your head, neck, lungs, abs, reflexes, and neurological responses. Furthermore, physicals usually include blood and urine lab testing.

Doctor examines African American Woman during AWV
Doctor examines a senior woman

Therefore, make sure you use the words “annual wellness visit” when you schedule your doctor’s appointment. Otherwise, Medicare won’t cover it. Discover what else Medicare does not cover.