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.
Your Medicare Summary Notice (MSN)
Your Medicare Summary Notice (MSN) shows Medicare Part A and Part B covered services for people with Original Medicare. It is not a bill. If you receive an MSN, it will list all the Medicare-billed services and supplies from the last 3-month period. Furthermore, it summarizes what Medicare paid and the maximum amount you may owe.
How often do I get an MSN?
If you received Medicare services or supplies during the last 3-month period, you would get an MSN. Furthermore, your mailed MSN will have the DHHS logo. Otherwise, you will not receive a Medicare Summary Notice.
Thus, Medicare can mail you up to 4 MSNs per year, once every three months. By default, Medicare sends you these printed notices. However, you can go paperless and get an electronic version called eMSN. Then, instead of getting paper copies, you will get an email every month with a link to your MSN. Thus, you don’t have to wait three months.
In addition to getting notified sooner, Medicare.gov saves your MSNs for future reference. You can avoid misplacing or losing your MSNs. So how can you sign-up for an eMSNs?
Go Paperless eMSN
First, log in to (or create) your secure Medicare account. Then select “Get your Medicare Summary Notices (MSNs) electronically.” Look under the “My messages” section at the top of your account homepage. When you arrive at the “My communication preferences” page, please select “Yes” under “Change eMSN preference.”
Now that you can access monthly eMSNs, how do I use them?
How to Use Your MSN
The MSN shows your Part A and Part B deductible status. Before Medicare begins to pay, you must cover your deductible amount (unless you have a Medigap Plan). Furthermore, the MSN shows if Medicare approved all claims and the amount you may be billed. It also names the facilities and dates of service.
For example, your Part A MSN may show a particular hospital and service date. You can compare your hospital bill with your MSN. Do the service dates and bill amounts match?
Moreover, your MSN Part A and Part B claims will show a “Maximum You May Be Billed” amount. It also notes the items and supplies you got. Use the MSN to check the maximum amount to pay, and make sure you received all the services, supplies, or equipment listed.
If you are billed for Medicare services you did not receive, please report fraud to 1-800-MEDICARE (633-4227).
What to do about denied claims?
Denial of Claim
When MSN approves your claim and a facility denies it, please take the following action: Review the facility’s itemized claim statement and make sure they sent in the correct information. When you change your Medicare Plan, the facility may bill the wrong insurance.
For example, you upgraded from Original Medicare to Medicare Supplement plan. The facility may say you owe Part A deductible because it does not have your Medigap Plan information.
What to do when you disagree with the coverage or payment decision on the MSN?
Appealing the MSN
If you disagree with the MSN, you can appeal. You have 120 days to appeal your claims. Furthermore, you must file the appeal in writing. Please use the form provided on page 4 of the MSN to file your appeal. Then mail the MSN and supporting documents to the Medicare Claims Office address provided.
Medicare may provide coverage for Parkinson’s Disease, including medications, treatments, and the following therapies: occupational, physical, and speech. We recommend you have Medicare Part D prescription drug coverage in addition to Original Medicare. Furthermore, if you have a Medicare Advantage plan, please choose a plan that includes Part D drug coverage.
You can shop for Medicare Plans during the Annual Election Period. Outside of Medicare Open Enrollment and under special circumstances, you may be able to switch Medicare Plans during a Special Election Period.
Do you or someone you know have Parkinson’s Disease? Discover who is at risk.
Risk Factors for Parkinson’s Disease
The Mayo Clinic says Parkinson’s Disease usually starts in “middle or late life.” Furthermore, your risk increases with age. Consequently, “people usually develop the disease around age 60 or older.” Thus, seniors are at risk for developing Parkinson’s Disease.
Moreover, you have a higher risk when many family relatives have had the disease. Men are more likely to develop it than women. Therefore, senior men, especially with a family history, have a higher risk of the disease.
Now you know who is at risk. What are the signs and symptoms?
What are the Signs and Symptoms?
Parkinson’s disease is a neurological disorder that progressively affects movement. For example, an early sign can be a barely noticeable tremor in one hand. The condition also can cause symptoms such as stiffness or slowing of movement.
Furthermore, during the early stages of Parkinson’s disease, you may see the following:
- Little or no facial expression
- Arms that do not swing while walking
- Feet that drag when you walk
- Soft or slurred speech
- Posture and balance problems
Your symptoms can change over time. For example, Michael J. Fox, who had early-stage Parkinson’s at age 29, now has hand tremors and speech impediments at age 59.
Medicare Prescription Coverage for Parkinson’s
Your Medicare prescription coverage may include drugs that treat the neurological disorders of Parkinson’s Disease (PD). Medicare Part D may cover medically necessary medications used to treat PD. For example, your doctor may prescribe the following PD drugs: (WebMD)
- Levodopa and carbidopa (also called L-dopa): it helps you control symptoms. Mainly, it helps with slow movement and stiff, rigid body parts.
- Dopamine agonists. These drugs act like dopamine in the brain.
- Mao-B inhibitors. These drugs block the brain chemicals that break down dopamine.
- COMT inhibitors. It helps the brain use levodopa more effectively to ease Parkinson’s symptoms.
Treatments for PD
Medicare may cover medically necessary treatments for Parkinson’s Disease (PD). To reduce tremors, “doctors use ultrasound beams to destroy brain cells that cause movement problems.” (MichealJFox.org) This non-invasive treatment helps improve motor function.
When the oral medication Levodopa becomes less effective, your doctor may recommend a Duopa pump. Parkinson’s Foundation says the procedure requires a surgeon to make a small hole (stoma) in your stomach wall. Then a tube delivers Duopa directly into your intestine.
Finally, when medication is non-effective, your doctor may recommend deep brain stimulation (DBS). Parkinson’s Foundation explains DBS surgery: surgeons insert electrodes into targeted areas of your brain while using MRI (magnetic resonance imaging). Then an IPG (impulse generator battery) is implanted, producing electrical impulses to your brain. You get a controller to turn the device on or off.
In addition to these treatments for PD, Medicare may provide coverage for different types of therapies.
Therapies for PD
Medicare coverage for Parkinson’s may include occupational, physical, and speech therapies. For example, walking barefoot on a sandy beach is a safe place to challenge your balance. If you fall, the sand is much softer than hard ground.
Medicare Part B may pay for occupational therapy when your doctor certifies you need it. People with Parkinson’s Disease (PD) who have trouble with daily living activities can get occupational therapy (OT). For example, OT can help improve the following skills: (WedMD.com)
- Computer use
Part B may cover 80% of occupational therapy costs after you pay the Part B deductible. However, most Medicare Supplements cover 100% of your Part B coinsurance costs. You can shop for a Medigap Plan with Senior Healthcare Direct. Call 1-855-368-4717 or get a quote.
In addition to occupational therapy, Medicare also may provide coverage for physical therapy.
Physical Therapy for PD
Medicare Part B may cover 80% of medically necessary outpatient physical therapy. After paying the Part B deductible, you pay 20% of the Medicare-approved amount. Furthermore, there is no limit to how much Medicare pays for outpatient therapy services in a calendar year.
What form of physical therapy can help with Parkinson’s Disease (PD)? According to Johns Hopkins Medicine, Amplitude Training has you perform exaggerated physical movements. For example, high steps and arm swings. It helps you retrain the muscles and slows down hypokinesia (the increasingly smaller, more shuffling movements of Parkinson’s).
Physical therapist, Padilla-Davidson, says, “Practice walking, keeping in mind the swinging of your arms. It may help to chant or sing to keep the rhythm.”
In addition to physical therapy, Medicare also may provide coverage for speech-language pathology services.
Speech Therapy for PD
If you need speech therapy because of Parkinson’s Disease (PD), Medicare Part B may cover 80% of the cost. People with Parkinson’s can lose control of muscles in the face, mouth, and throat. Consequently, a person’s voice may change as well as making it difficult to speak or swallow.
PD can cause a person’s speech to become slurred, mumbled, rapid, and voice softer. The speech therapy you need will depend on your stage of Parkinson’s. Speech therapists recommend you make eye contact while speaking.
The Lee Silverman voice technique (LSVT) significantly improves speech after one month. Furthermore, results last up to two years following treatment. The LSVT method is easy to learn. However, it must be practiced four days a week for four consecutive weeks to be effective. (ParkinsonNewsToday.com)
On March 23, 2021, CMS.gov announced a 2021 Special Enrollment Period (SEP). Americans (not on Medicare) can get extended access to new savings through the American Rescue Plan. Your family members will have until August 15 to enroll or re-evaluate their coverage on HealthCare.gov.
For seniors on Medicare, you can qualify for a SEP due to COVID-19 and other qualifying events.
Starting April 1, 2021, Americans will have over four-and-a-half months to find an affordable health care plan. “The American Rescue Plan will bring costs down for millions of Americans,” says HHS Secretary Xavier Bacerra. To save on your health insurance, visit HealthCare.gov.
You can save money on your health care insurance. The average person can save $50 per month! Furthermore, 25% of enrollees who upgrade to a better plan will see fewer out-of-pocket costs or lower premiums.
2021 Special Enrollment Period Eligibility
Discover if you are eligible for the 2021 Special Enrollment Period (SEP). Eligible Americans who enroll under SEP can select a plan with coverage starting as soon as the following month. To take advantage of SEP savings, please review and update, if needed, your application information. Then submit your application to check SEP eligibility.
Beginning in July, Americans eligible for SEP who have received unemployment compensation in 2021 may be able to increase savings. You could get these additional savings on HealthCare.gov as follows:
- Enrolling in new Marketplace coverage
- Updating your existing Marketplace application and enrollment
Furthermore, these July savings are in addition to the increased savings available to Americans on April 1.
SEP Availability and Costs
The 2021 Special Enrollment Period (SEP) is available to Americans in 36 states on HealthCare.gov. If your state is not available, you can access State-based Marketplaces on your state’s website. How many Americans have signed up for coverage during SEP?
On March 12, 2021, the American Rescue Plan fact sheet reported: (HHS.gov)
“More than 200,000 people signed up for Marketplace coverage through HealthCare.gov in the first two weeks.”
Furthermore, the 2021 enrollment rate has increased “three-fold year over year.” Over 14.9 million Americans who lack health insurance will receive affordable coverage.
So how much money will the American Rescue Plan save you?
Reducing Your Healthcare Costs
The American Rescue Plan reduces your health insurance costs by lowering your monthly premiums. How much could you save?
- An uninsured couple earning over $70,000 per year could save over $1,000 per month on premiums
- Families of four making $90,000 will see lower premium reductions by $200 per month
- Individuals making $19,000 will find health coverage for zero monthly premiums, saving you $66 per month on average
Please read this article to discover what diabetic retinopathy is and what Medicare covers. You will learn the following:
Estimated reading time: 6 minutes
Medicare and Diabetic Retinopathy
If you have diabetes, Medicare Part B covers eye exams for diabetic retinopathy. Medicare will cover a state-licensed eye doctor to test your eyes once a year. After you pay Part B deductible, Medicare will pay 80% of the eye exam costs. Thus, you pay 20% with Original Medicare.
However, some Medicare Supplement plans cover your 20% Part B coinsurance. Furthermore, Medigap plans also cover copayments for eye exams in a hospital outpatient setting. Please call Senior Healthcare Direct at 1-855-368-4717 to shop for Medigap Plans.
What is Diabetic Retinopathy?
Diabetic retinopathy is an eye disease that causes vision loss and blindness in people who have diabetes. High blood sugar levels cause damage to blood vessels in your retina. For example, blood vessels in your retina can swell, leak, or close. Furthermore, abnormal new blood vessels can grow on the retina. Any of these changes can cause vision loss. (AAO.org)
This diabetic eye disease has the following two stages:
Two Stages of Diabetic Eye Disease
Two stages of diabetic eye disease are early-stage NPDR and advanced stage PDR.
Early Stage NPDR
The early stage of diabetic eye disease is Non-Proliferative Diabetic Retinopathy (NPDR). During NPDR, blood vessels leak fluid, making your macula (center of your retina) swell. Vision loss from early-stage diabetic retinopathy is similar to age-related dry macular degeneration.
Furthermore, blood vessels in the retina can close off with NPDR, causing macular ischemia. Consequently, this results in extensive damage to the retina and vision loss. (NIH.gov)
Moreover, sometimes deposits of fats can leak into your retina. These deposits are called hard exudates. People with Diabetes who have NPDR will have blurry vision.
Advanced Stage PDR
Proliferative Diabetic Retinopathy (PDR) is the advanced stage of diabetic eye disease. When many retinal blood vessels close, your retina does not get adequate blood flow. Consequently, your retina responds by growing new blood vessels, neovascularization.
As a result, these fragile new vessels often bleed. If vessels bleed a little, you see a few dark floaters. If vessels bleed a lot, you may lose your vision.
PDR can form scar tissue and cause problems with your macula (center of the retina). Complications may include a detached retina and glaucoma. PDR is a severe diabetic eye disease and can cause you to lose central and peripheral vision.
Now that you know the two stages of diabetic retinopathy, what are the symptoms?
Diabetic Retinopathy Risk Factors
Anyone with diabetes, including type 1, type 2, and gestational (pregnancy) diabetes, can get diabetic retinopathy. Furthermore, your risk increases the longer you have diabetes. However, you can lower your risk by controlling your diabetes. (MayoClinic.org)
The risk for developing diabetic eye disease increases as a result of:
- Poor control of your blood sugar level
- High blood pressure and cholesterol
- Tobacco use
Furthermore, people at higher risk include African-Americans, Hispanics, and Native Americans. Females can also be at higher risk during pregnancy.
Now that you know the risk factors, what can you do to prevent this eye disease?
Preventing Diabetic Retinopathy
Dr. Robert Lustig, M.D. and nutrition expert, says sugary drinks increase your risk for type 2 diabetes. Robert explains the scientific evidence in his video, The Bitter Truth. He recommends you eliminate all sugared liquids, including alcoholic beverages, and drink only water and milk.
Medicare Diabetes Prevention Program helps you with behavior changes to prevent type 2 diabetes. Discover what Medicare covers for Diabetes.
Regular annual eye exams can diagnose eye diseases early so that you can start treatment before severe vision loss. Furthermore, please keep your medical conditions under control:
- Manage Diabetes – if you have pre-diabetes, you can join a Medicare Diabetes Prevention program. If you have diabetes, please take your prescribed diabetes medications.
- Keep your blood pressure and cholesterol under control. Please eat healthy foods and exercise regularly. For example, eat more fruits and vegetables, and walk every day.
- If you smoke, Medicare can help you quit smoking.
You can not always prevent diabetic retinopathy. If you have this eye disease, what are your treatment options?
Your treatment options depend on whether you have early or advanced diabetic retinopathy. Furthermore, treatment will depend on the severity of your particular condition. (MayoClinic.org)
In the early stage, you may not need treatment. However, keeping your blood sugar under control can slow the progression of this diabetic eye disease.
For the advanced stage, you will need eye surgery immediately. Your surgical treatment options include:
- Focal laser treatment (photocoagulation) stops or slows the leakage of blood and fluid in your eye.
- Scatter laser treatment (panretinal photocoagulation) shrinks abnormal blood vessels.
- Vitrectomy removes blood from the middle of your eye as well as scar tissue on your retina.
- Injecting medication in your eye to help stop the growth of new blood vessels.
These surgical options slow or stop the progression of diabetic retinopathy. However, none of these treatments cure this diabetic eye disease.
Medicare Part B covers age-related macular degeneration (AMD) treatment. Furthermore, Medicare covers diagnostic tests for AMD. For people 50 years and older, it’s the leading cause of vision loss. So what is AMD?
What is Age-related Macular Degeneration (AMD)?
AMD is an eye disease that affects the macula (center part) of your retina. It causes the center of your vision to become blurry. Whether you look close or far, AMD causes the center of your vision to be out-of-focus. However, you can still see fine details in your peripheral (side) vision. (AAO.org)
For example, a clock’s hands will look blurry, and the numbers will be in focus. Age-related Macular Degeneration is also called Dry AMD.
Dry AMD is the most common, affecting 80% of those who have the disease. As you age, tiny clumps of protein (drusen) grow under the retina, causing you to lose central vision slowly. As a result, dry AMD breaks down or thins the macula. However, Wet AMD is less common and progresses much faster.
Medicare treatment for this type of macular degeneration (wet AMD) is eye injections. You lose vision much faster with wet AMD than dry AMD. Wet AMD is when new, abnormal blood vessels grow under the retina. Blood may leak from these vessels, causing scarring of the macula.
Medicare Macular Degeneration Treatments
Your Medicare-covered Macular Degeneration treatment will depend on your type of AMD. Doctors treat Age-related wet Macular Degeneration (wet AMD) using drugs. Thus, you will need a Part D plan or a Medicare Advantage plan with drug coverage. However, doctors treat dry AMD with vitamins and minerals.
Wet AMD Treatment
In 2005, anti-vascular endothelial growth factor (anti-VEGF) drugs helped save the sight of patients with wet AMD. These drugs stabilized or improved vision in many patients. However, patients had to take eye injections regularly. For example, many patients need eye injections every four to eight weeks to keep their vision. (AAO.org)
Dry AMD Treatment
There is no cure for dry AMD. However, you can slow this eye disease by taking a specific mix of vitamins and minerals. The following daily nutritional supplements may help lower your risk of getting wet AMD. (AAO.org)
- Vitamin C (500 mg)
- Vitamin E (400 IUs)
- Lutein (10mg)
- Zeaxanthin (2 mg)
- Zinc (as zinc oxide 80 mg)
- Copper (as cupric oxide 2 mg)
However, eating a healthy diet is more effective for preventing or delaying advanced AMG.
A Healthy Diet can Protect Your Vision
Eating a healthy diet can help protect your vision. You can lower your risk of age-related macular degeneration (AMD) and cataracts with a nutrient-rich diet. Please eat the following foods to protect your vision:
- Eat fruits and vegetables rich in vitamin c, such as sweet peppers, oranges, grapefruit, kiwi, and strawberries.
- Consume foods with vitamin E, including almonds, sunflower seeds, olive oil, and avocadoes.
- Cook and eat foods that contain zinc, such as beans, meat/seafood, and eggs.
Eating carotenoid-rich foods can help protect your vision. Carotenoid foods are colorful (yellow, orange, and red) vegetables and fruits, such as carrots, corn, and tomatoes.
Medicare Macular Degeneration Coverage
Medicare Part B covers 80% of your outpatient eye doctor visits when you have age-related macular degeneration. If you have service in a hospital outpatient setting, you pay a copayment. However, if you have a Medicare Supplement Plan such as Plan G, it covers your 20% coinsurance and copayments. Call Senior Healthcare Direct at 1-855-368-4717 to shop Medigap Plans or get your quote.
According to Medicare.gov, Medicare does cover cataract surgery “using traditional surgical techniques or using lasers.” Furthermore, if you have cataract surgery to implant an “intraocular lens,” Medicare helps you pay for corrective lenses. For example, Medicare part B pays 80% of the cost for corrective eyeglasses or contact lenses after cataract surgery. So what is cataract surgery?
Estimated reading time: 6 minutes
What is Cataract Surgery?
WebMD says a cataract is “a clouding of the eye lens that can make it hard for you to see.” As your cataract grows more cloudy, less light enters your eye, making your vision dim and blurred. It’s difficult for seniors with cataracts to see in low-light and increases glare from lights. For example, a cataract diminishes your night vision making driving at night difficult and dangerous.
During the surgery, the surgeon cuts your cornea and inserts a needle-thin probe. Ultrasound waves transmit from the probe to break up the cataract and suck out the fragments. Then the surgeon implants the intraocular lens (IOL), which focuses light on your retina. The IOL becomes a permanent part of your eye. (Mayoclinic.org)
Depending on your vision needs, your eye doctor will discuss different types of IOLs. What type of cataract surgery does Medicare Cover?
Medicare Cataract Surgery Coverage
Medicare traditionally covers cataract surgery using fixed-focus monofocal intraocular lens (IOL) implants. These IOL lenses have a single focus strength for distance vision. However, you may need eyeglasses for reading up close. Medicare covers 80% of your reading eyeglasses costs after cataract surgery.
Medicare may not cover other types of intraocular lens (IOL) such as:
- Accommodating-focus monofocal – you can shift focus using eye muscle movements to see objects near and far.
- Multifocal – similar to bifocal or progressive lenses
- Astigmatism correction (toric) – helps focus light on the retina to correct blurred vision at any distance.
However, paying for these upgraded IOLs can eliminate your need for reading glasses or other corrective lenses.
In the video above, Robert Bache says that Medicare does cover cataract surgery after you pay the Part B deductible. Furthermore, Medigap Supplements such as Plan G will pay your 20% coinsurance costs. Please watch the video to learn more.
Cataract Causes and Risk Factors
According to Mayo Clinic, cataracts develop when aging or injury to your eye’s lens (cornea). In some cases, genetics can increase your risk for cataracts. Furthermore, diabetes and long-term use of steroid medications can lead to cataracts. For example, the long-term use of Prednisone can cause osteoporosis and cataracts.
Other factors that increase your risk for cataracts include:
- Excessive exposure to sunlight
- Obesity – discover if you’re obese (BMI calculator)
- High blood pressure
- Drinking excessive amounts of alcohol
Removing the above risk factors can help prevent cataracts. Thus, doctors recommend the following:
- Annual eye exams – having your eyes examed every year can detect cataracts and other eye problems early
- Quit smoking – Medicare helps you quit smoking
- Avoid long-term corticosteroids use – to prevent cataracts and other side effects such a glaucoma
- Wear sunglasses – please wear sunglasses that block ultraviolet B (UVB) rays when you are outdoors
- Eye protection – please wear protective eyewear while playing sports or whenever projectiles may fly into your eyes
- Limit alcohol use – please limit alcohol intake to one drink for women and two drinks for men (DietaryGuidelines.gov)
Eating a healthy diet may prevent cataracts
You may also reduce your cataract risk by consuming a healthy diet. American Optometric Association reports that “adding antioxidants to your diet can improve your eye health.” Several research studies show vitamins C and E may protect you against the development and progression of cataracts.
Many fruits and vegetables are excellent sources of vitamin C. For example, two foods with the highest amounts of vitamin C are sweet red peppers and oranges. Please eat fruits and veggies to protect against cataracts. Furthermore, heat destroys ascorbic acid (vitamin C), so please consume your fruits and veggies raw.
The recommended daily intake of vitamin C for seniors is 90 mg for men and 75 mg for women. However, seniors who smoke require an additional 35 mg per day. (NIH.gov)
Some oils, seeds, and nuts are excellent sources of vitamin E. There are eight natural forms of vitamin E, but only alpha-tocopherol meets human requirements. Synthetic vitamin E found in fortified American foods and supplements is half as biologically potent as natural vitamin E sources. (NIH.gov)
Food labels list natural sources of vitamin E as “d-alpha-tocopherol.” In contrast, synthetic vitamin E made in a laboratory is “dl-alpha-tocopherol.” The best foods of natural alpha-tocopherol are as follows: (NIH.gov)
- Wheat germ oil
- Sunflower seeds
- Sunflower oil
- Peanut butter and peanuts
The recommended dietary allowance of vitamin E (alpha-tocopherol) is 15 mg (22.4 IU) for males and females.
Medicare does cover cataract surgery using traditional monofocal intraocular lens (IOL) implants. You can upgrade your IOL based on your vision needs. However, Medicare may not cover these other types of IOL lenses. Medicare does pay for 80% of your cataract surgery. Furthermore, Medigap Plans, such as Plan G, will cover the remaining 20% after paying the Part B deductible.
To avoid cataracts, please avoid behaviors that increase your risk for cataracts. For example, please avoid sunbathing, smoking, and drinking excessive amounts of alcohol. Moreover, please eat foods rich in vitamins C and D.
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
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.
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.
Does Medicare pay for a Kidney Transplant?
Original Medicare Part A and Part B pay for certain kidney transplant services. Furthermore, Medicare Advantage (Part C) plans also cover certain kidney transplant services. 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.
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
If your Medicare Advantage plan does not include a kidney transplant specialist, you may be able to change your Medicare Advantage plan. However, if it’s past March 31, you may 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 may cover care before and after surgery. Furthermore, Part B may cover 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 may 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 only covers 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.
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 drugs may cost 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 may pay 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.
Your Kidney Transplant Costs
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 may pay the Part B deductible $203 in 2021 and 20% coinsurance costs. Medicare may cover the cost of 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.