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.

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:

Estimated reading time: 4 minutes

  • 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 vision service unless it’s medically necessary. For example, you can get eye exams when you have diabetes or glaucoma tests if 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.

Thank you for reading this article. We publish new articles every week. Share your email and choose the Medicare topics you what to read, and we will send you new articles.

Medicare Reader Survey - senior couple reads article on ipad
Senior Couple On Shore in Front of Cruise Ship

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.

Estimated reading time: 3 minutes

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. 

Thank you for reading this article. We publish new articles every week. Share your email and choose the Medicare topics you what to read, and we will send you new articles.

Medicare Reader Survey - senior couple reads article on ipad
Seated Squats for Seniors man rises from a chair

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. A third COVID-19 vaccine from Johnson and Johnson was approved by CDC on February 28, 2021.

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.

Special Enrollment Period california wildfires

Special Enrollment Period

Special Enrollment Period COVID-19

To qualify for a Special Enrollment Period (SEP) outside of Open Enrollment Periods, you need special circumstances. For example, you could change your Medicare Advantage or Part D plan if COVID-19 impacted you. Special COVID-19 circumstances include: (Healthcare.gov)

  • You or a family member was sick with COVID-19
  • The national emergency affected your job and employer-based coverage 

Estimated reading time: 4 minutes

Furthermore, you may need to submit documentation to confirm your loss of coverage. These documents must show you lost coverage within the last 60 days or later (not before January 1, 2020).

In addition to COVID-19, the Special Enrollment Period includes other national emergencies, such as hurricanes or wildfires.

Special Enrollment Period senior man in hospital COVID-19 test
Senior man get COVID-19 swap in hospital

To qualify for this special circumstance, you must live (or have lived during the event) in a county of a natural disaster. Moreover, this county must be eligible for assistance by FEMA.

Open Enrollment Periods

Medicare open enrollment periods include the following:

If you are outside of any of the above open enrollment periods, you may qualify for a Special Enrollment Period. Otherwise, you must wait for the next open enrollment period.

Open Enrollment Periods - senior ladies birthday cake
Senior women celebrate turning 65

Qualifying Events for Special Enrollment Period (SEP)

You can qualify for SEP if the following applies to you:

  • Qualifying Life Event such as marriage, baby, or losing health coverage
  • Exceptional circumstance such as unexpected hospitalization, temporary cognitive disability, or you were otherwise incapacitated
  • Natural disasters, such as earthquake, flood, hurricane, or wildfire
  • You experienced domestic abuse/violence or spousal abandonment
  • Qualifying for Extra Help paying for Medicare Part D
Special Enrollment Period (SEP) california wildfires

Change of Address

Senior man and woman moving boxes

Furthermore, you also qualify for SEP when you change where you live. For example, you move to a new address that is not in your plan’s service area. Other reasons for address changes include:

  • Moving back to the U.S. after living outside the country
  • You moved in or out of an institution such as a skilled nursing facility
  • Getting released from jail

Losing Your Credible Coverage

You may qualify for SEP when you lose your current coverage. For example, you left or lost your employer’s group health coverage. When you lose credible insurance coverage, you may qualify for SEP. In this case, you will have 60 days after you lost coverage to join a Medicare Plan.

Lastly, you can qualify for SEP “if you believe you made the wrong plan choice because of inaccurate or misleading information.” (Medicare.gov) If you made the wrong plan choice because of inaccurate information, call 1-800-MEDICARE, and explain your situation.

Senior African American Speaking on Phone

2021 Special Election Period

For people not yet eligible for Medicare, you can get affordable healthcare through the 2021 Special Enrollment Period. Discover how to lower your monthly premium and save money

Thank you for reading this article. We publish new articles every week. Share your email and choose the Medicare topics you what to read, and we will send you new articles.

Medicare Reader Survey african american man
4 parts of medicare

Medicare Parts coverage and cost in 2021

What do Medicare Parts cover and cost in 2021?

There are 4 parts of Medicare: Part A, Part B, Part C, and Part D.

  • Part A covers inpatient hospital services.
  • Part B covers outpatient medical services.
  • Part C is Medicare Advantage plan offered by private companies approved by Medicare.
  • Part D provides prescription drug coverage to lower the cost you pay for medications.

Estimated reading time: 9 minutes

Before you receive inpatient hospital benefits, you must first pay Part A deductible of $1484 in 2021. However, you can avoid paying this cost by having a Medicare Supplement plan.

Embed or download 4 Parts of Medicare infographic

What does Medicare Part A cover and cost in 2021?

According to Medicare.gov, Part A covers the following:

  • Inpatient hospital care
  • Skilled Nursing Facility care
  • Long-term Care Hospitals
Medicare Part A - Hospital

Inpatient Hospitals Coverage and Cost in 2021

The first 60 days of inpatient care is covered by Medicare Part A. In other words, you pay $0 coinsurance for each 60 day benefit period. For example, you can be a hospital inpatient multiple times per year and each hospital stay will cost you nothing so long as each stay is 60 days or less. However, hospital stays between 61 days and 90 days will cost you $371 coinsurance per day in 2021.

Skilled Nursing Facility

Skilled Nursing Facility Coverage and Cost in 2021

Medicare Part A also covers 20 days of care in a Skilled Nursing Facility (SNF). Specifically, you pay $0 coinsurance for each 20 day benefit period. Some of the benefits of SNF include physical therapy, meals, and dietary counseling. Therefore, you can get short-term skilled nursing care multiple times per year for no cost so long as each stay is 20 days or less. However, SNF stays between 21 days and 100 days will cost you $185.50 per day in 2021.

Long-term Care Hospital Coverage and Cost in 2021

Medicare Part A covers the first 60 days in a Long-term Care Hospital (LTCH). In particular, the cost of LTCH is $0 for each 60 day benefit period under the following conditions.

  • You are transferred to a LTCH directly from an acute care hospital.
  • You are admitted to a LTCH within 60 days of being discharged from a hospital.

If the above conditions do not apply, then you must pay Part A $1484 deductible in 2021 before Medicare will pay anything. Furthermore, LTCH stays from 61 days to 90 days will cost you $371 coinsurance per day in 2021.

Medicare Part A - Long-Term Hospital Care

What does Medicare Part B cover and Cost in 2021?

Medicare Part B covers the following services:

  • Medical outpatient services for stays at any hospital or medical facility for less than 24 hours. For example, a stay that occurs overnight but for less than 24 hours is outpatient service.
  • Preventive services to prevent illness such as seasonal flu-shot and annual wellness visits.
first aid kit

Medicare Outpatient Coverage and Cost in 2021

Original Medicare covers 80% of medically necessary services and supplies. These Part B medical services include:

Before Medicare pays for these medical services and supplies, you must first pay Part B deductible of $203 in 2021. Furthermore, you are responsible to pay the 20% that Medicare does not cover. However, Medicare Supplement Plan C and Plan F pay Part B deductible and your 20% coinsurance.

Medicare Preventive Coverage and Cost

Medicare preventive services cover screening tests that help detect health conditions at early stages when treatment is most effective. In the tables below, we list 31 preventive tests covered by Medicare Part B. 

Medicare Part B preventive screening table 1
Click to view larger table size
Medicare Part B preventive screening table 2
Click to view larger table size

In the above tables, 71% of these screening tests are free after you pay the $203 Part B deductible. Furthermore, 19% of tests require payment of Part B deductible and 20% coinsurance. Finally, 10% of tests you pay absolutely nothing: neither Part B deductible nor 20% coinsurance. These preventive screening tests are completely FREE:

  • Nutrition Therapy Service – you pay nothing if you have diabetes or kidney disease.
  • “Welcome to Medicare” preventive visit – you pay nothing as long as the doctor does not perform additional tests or services.
  • Yearly Wellness Visit – is free every 12 months as long as the doctor does not perform additional tests or services.

To receive Part B coverage you need to pay a monthly premium. In 2021, the standard premium for Part B is $148.50.

What does Medicare Part C cover and cost in 2021?

Part C Medicare Advantage network
MA plans have a network of doctors, hospitals, and other medical services.

Medicare Part C is an alternative to Original Medicare and covers Part A (Hospital Insurance) and Part B (Medical Insurance). Part C is also known as Medicare Advantage (MA) Plan.

Medicare Advantage (MA) Coverage

MA plans often include Medicare Part D prescription drug coverage. Moreover, many MA plans include extra benefits not covered by Original Medicare. For example, MA plans may include dental, vision, and hearing. Some MA plans even include gym memberships such as Silver Sneakers! MA plans are offered through a network of healthcare providers HMO or PPO.

Medicare Advantage (MA) Costs

To enroll in Medicare Advantage Plan (Part C) you must first be enrolled in Part A and Part B. Most Seniors pay no premium for Part A. However, you will have to pay Part B monthly premiums. In 2021, the standard premium for Part B is $148.50. Furthermore, you will need to pay a monthly Part C premium. According to The Kaiser Family Foundation, the average Medicare Advantage Plan premium is $36 in 2020.

When you add standard Part B and average MA premiums, the total monthly cost is $180.66 in 2020. Conversely, Original Medicare Part B and Part D premiums may only cost $177.34 in 2020. However, you may be thrilled to get a gym membership for only a few extra dollars per month!

You can choose a lower premium MA plan. As a result, you may be excited to pay less every month. However, these MA plans will have higher deductibles, copays, and larger out-of-pocket limits. Consequently, the cost to use your health insurance will be much higher. You can avoid these excessive costs by choosing an MA premium of $40 or more.

What does Medicare Part D cover and cost in 2021?

 Part D drug plan
Part D drug plans save you money

Part D saves you money on prescription drugs. Specifically, it reduces your cost for brand-name and generic drugs. For example, rather than paying the full retail price for medications, you only pay small copayments with Part D. To join a Part D drug plan, you must be enrollment in certain parts of Medicare.

How to Join a Drug Plan

You must have either Part A or Part B to join a stand-alone Part D drug plan with Original Medicare. However, you must have both Part A and Part B to join a Medicare Advantage plan.

Part D Costs for Original Medicare and MA Plans

To enroll in Part D with Original Medicare you need to have either Part A or Part B. However, most people have both Part A and Part B coverage. Since private health insurance companies such as Aetna, Mutual of Omaha, and AARP provide drug coverage, the price you pay will vary.

Part D drug costs in 2021 

All Part D drug plans have a monthly Part D premium. This amount will depend on the income reported on your 2019 tax return. Some Part D plans have an annual deductible which can not be more than $445 in 2021. However, other drug plans may have little or no deductible. 

After the out-of-pocket deductible, you pay either a copay or coinsurance for each prescription drug. For example, you pay less for drugs in tier 1 and more for drug in tier 2. Discover the differences in Medicare Part D tier costs. Furthermore, after you and your drug plan spend a certain amount, you enter a coverage gap called the donut hole.

Donut Hole Costs in 2021

In 2021, you will enter the donut hole and pay 25% coinsurance for both brand-name and generic drugs when your drug plan spends $4,130. After total out-of-pocket drug costs are $6,550 in 2021, you exit the donut hole. Learn more about the 4 stages of drug coverage and costs in 2021.

Want More Help with Medicare Parts?

You can speak with a licensed agent at 1-855-368-4717 and get more help with the 4 parts of Medicare: A, B, C, and D. Our team is very experienced at explaining Medicare parts and how they work. 

.

Medicare Prostate Cancer Screening Costs happy african american senior couple

Medicare Prostate Cancer Screening

According to Medicare.gov, men over 50 qualify for prostate cancer screenings every 12 months. You can get prostate screening as early as the day after your 50th birthday. Medicare covers two prostate screening options: 

  • Digital rectal exam – the doctor inserts a gloved, lubricated finger (“digit”) into your rectum. 
  • PSA blood test – measures the amount of prostate-specific antigen (PSA) in your blood.

Estimated reading time: 4 minutes

American Cancer Society recommends you talk with your doctor to “make an informed decision” before deciding to get tested for prostate cancer.

Medicare Prostate Cancer Screening african american gets PSA blood test
African-American men are more likely to develop prostate cancer. So screening may be more beneficial for this group.

Talk with Your Doctor Before Testing

Screening for prostate cancer has benefits and risks. Prostate cancer is the second leading cause of death in American men, behind lung cancer. Thus, screening and early treatment can prevent cancer from spreading and save your life! 

However, “most men diagnosed with prostate cancer do not die from it.” Furthermore, prostate screening has possible harms, such as:

  • False Positive – the test says you might have cancer, but you actually don’t. The chance of a false positive is higher.

Thus, discussing these benefits and risks with your doctor can help you decide whether to screen for prostate cancer.

African American Senior consults with doctor
African-American senior consults with doctor.

PSA Cancer Screening

The PSA blood test measures the amount of prostate-specific antigen (PSA) in your blood. The Mayo Clinic says, “high levels of PSA may indicate the presence of prostate cancer.” However, “many noncancerous conditions can increase PSA level.” Thus, PSA “doesn’t provide precise diagnostic information about the condition of the prostate.”

In addition to PSA, your doctor will usually do a digital rectal exam.

PSA Cancer Screening african american gets blood test

Digital Rectal Exam

During a digital rectal exam, your doctor inserts a lubricated, gloved finger into your rectum. Then the health care provider feels the prostate for any abnormal lumps or hard areas. According to Mayo Clinic, “Neither a PSA test nor digital rectal exam provides enough information for your doctor to diagnosis prostate cancer.” 

Thus, if you have positive test results, your doctor may recommend a biopsy to remove a sample of your prostate. The biopsy results may determine whether you have cancer or not. 

Medical Prostate Cancer Screening digital rectal exam

Medicare Prostate Cancer Screening Costs

Medicare Prostate Cancer Screening Costs happy african american senior couple

Medicare covers two prostate cancer screening tests: the PSA blood test and Digital Rectal Exam. Original Medicare pays 20% of the yearly digital rectal exam cost and 100% for the PSA test, as long as the doctor accepts Medicare assignment. Furthermore, you must pay the Part B deductible before Medicare covers the digital rectal exam. 

In addition to cancer screening, Medicare covers cancer treatment for hospital inpatient, outpatient, and chemotherapy drugs.

Thank you for reading this article. We publish new articles every week. Share your email and choose the Medicare topics you what to read, and we will send you new articles.

Medicare Reader Survey african american man
Woman wearing pink to celebrate Breast Cancer Awareness

Does Medicare cover cancer treatment?

Does Medicare cover cancer treatment senor woman chemotherapy
Medicare covers chemotherapy cancer treatment

Medicare does cover medically necessary cancer treatment supplies, services, and prescription drugs. Seniors are at greater risk of developing cancer. According to Cancer.net, “60% of people who have cancer are 65 or older.”

Estimated reading time: 3 minutes

Medicare provides cancer treatment coverage for the following:

Medicare Part A 

Woman wearing pink to celebrate Breast Cancer Awareness
Woman celebrate Breast Cancer Awareness

Medicare Part A hospital insurance covers inpatient hospital stays, including cancer treatments. For example, breast cancer may involve surgically-implanted breast prostheses after a mastectomy. If your surgery takes place in an inpatient setting, Medicare Part A covers 80% of the cost. Consequently, you pay the remaining 20% unless you have a Medicare Supplement Plan.

Senior Healthcare Direct recommends Medigap Plan G, which covers 100% of your Part A costs.

Medicare Part B

Medicare Part B medical insurance covers many cancer-related services and treatments provided on an outpatient basis. Furthermore, Part B includes preventive services. For example, you can get lung cancer and prostate cancer screenings. 

Medicare Part B cancer treatment coverage includes chemotherapy drugs administered through your vein in an outpatient clinic or doctor’s office. Part B also covers the following:

  • Some oral chemotherapy treatments
  • Radiation treatments in an outpatient clinic
  • Diagnostic tests such as X-rays and CT scans
  • Durable Medicare Equipment (DME) like wheelchairs and walkers

Furthermore, Part B covers outpatient surgeries. For example, cancer surgery to remove a tumor. It also covers mental health services to help you cope with these difficult times.

Medicare Lung Cancer Screening - senior man gets LDCT
Senior man has a low-dose CT lung cancer screening.

Patients with head, neck, or esophageal cancers, can get enteral nutrition equipment (feeding pump) as DME. If you have oral intake issues, your doctor can prescribe a feeding pump for use in your home to help you avoid malnutrition and recover for cancer treatment. Medicare covers 80% of feeding pump costs “under the prosthetic device benefit.”

Medicare Part D

Senior gets good news about her cancer treatment
Senior gets good news about her cancer treatment.

Medicare Part D covers chemotherapy and other cancer-related drug treatments. Original Medicare does not cover prescription drugs. To get drug coverage, you must enroll in either a Medicare Advantage Plan with drug coverage or a Part D plan. When you enroll in a drug plan, make sure your plan covers your list of drugs (formulary) and check the drug tiers.

You can learn more about Part D tier costs to minimize your out-of-pocket drug costs. Furthermore, Senior Healthcare Direct can help you choose a drug plan that saves you the most money per year. Please fill out our Part D Drug Finder form.

Thank you for reading this article. We publish new articles every week. Share your email and choose the Medicare topics you what to read, and we will send you new articles.

Medicare Reader Survey - senior couple reads article on ipad