Medigap Mondays

This blog section contains information about Medicare supplement plans. You can learn more about the following:

Medicare Summary Notice MSN senior couple documents

Medicare Summary Notice MSN

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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?

Medicare Summary Notice MSN every 90 days
Your Medicare Summary Notice (MSN) every 90 days.

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?

Medicare Summary Notice MSN senior man computer and phone

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. 

Medicare Summary Notice MSN senior couple documents
Senior couple checks their MSN claims and amounts.

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?

Senior woman reading bad news document
A facility denies your Medicare-approved claim.

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. 

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Senior couple walking outside sunny day wearing sunglasses

Does Medicare cover cataract surgery?

Does Medicare cover cataract surgery - senior women with eye bandage

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)

Does Medicare cover cataract surgery senior woman

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

Senior woman takes pill with glass of water

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. 

Risk Factors

Other factors that increase your risk for cataracts include:

  • Excessive exposure to sunlight
  • Smoking
  • Obesity – discover if you’re obese (BMI calculator)
  • High blood pressure
  • Drinking excessive amounts of alcohol

Cataract Prevention

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)
Senior couple walking outside sunny day wearing sunglasses
Seniors wear sunglasses to protect their eyes from harmful UV rays.

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. 

Vitamin C

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)

Senior man holds oranges over eyes
Eating oranges can help prevent cataracts.

Vitamin E

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 
  • Almonds
  • Sunflower oil
  • Hazelnuts
  • Peanut butter and peanuts
Peanuts in a senior hand
Eat peanuts to help prevent cataracts.

The recommended dietary allowance of vitamin E (alpha-tocopherol) is 15 mg (22.4 IU) for males and females.

Takeaways

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.

Best Medicare Supplement Plan 2021 - get quote button
Get a Medigap Plan for full cataract coverage.

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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.

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. 

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Medicare 2021 October Stories

Medicare Stories

Medicare stories published in October 2020 about Medicare changes in 2021.

Medicare Underwriting - Advantage vs. Supplement - Happy Seniors

Medicare Advantage vs Medicare Supplement

Compare Advantage Vs Medicare Supplement

The Medicare 2021 chart below compares Medicare Advantage vs Medicare Supplement. This chart shows positive (green), negative (red), and equal value (black). Medicare Supplement works with Original Medicare, so it provides you with nationwide coverage and access to any doctor and hospital without referrals.

However, Medicare Advantage provides you with local (HMO) or regional (PPO) coverage for doctors and hospitals in-network. For example, doctors outside an HMO network are not covered and require referrals. Furthermore, doctors outside of a PPO network are allowed but will cost you more. The 2021 chart below shows you several differences between Medicare Advantage vs Medicare Supplement.

Medicare Advantage vs Medicare Supplement - happy seniors
Medicare 2021 Chart - Advantage vs Supplement infographic
Embed and download Medicare Advantage vs Medicare Supplement Infographic

MedicareBob Video

In this MedicareBob video, Robert Bache “talks about the most important decision” people new to Medicare will make. Should you choose a Medicare Advantage or Medicare Supplement? Watch this video to help determine the right Medicare plan for you. 

Medicare Advantage vs Supplement Cost Differences

Part B Premium

Medicare Advantage and Medicare Supplement require you to have Medicare Part B. There is no Medigap Plan that pays your Medicare Part B premium. However, some Medicare Advantage Plans pay all or part of your Part B premium.

Copays and Coinsurance

Medicare Advantage charges you copays for each doctor visit or medical service. However, Advantage Plans do not charge you coinsurance.

Medicare Supplement Plans have no copays, except plans K (50%), L (75%), and N. You are charged copays for diagnostic tests, hospital outpatient, and ER visits. For Plan N, you pay up to $50 for outpatient emergency room visits and up to $20 for outpatient doctor visits.

Furthermore, Supplement Plans K and L only pay 50% and 75% respectively for Part B, Part A Hospice, and Skilled Nursing Facility coinsurance. In other words, you pay the remaining balance. For example, Medigap Plan K will cover 50% of your outpatient medicare service.

Advantage vs Supplement Plan Premiums

Medicare Advantage Plan premiums will vary based on coverage and the insurance carrier. However, CMS.gov reports, “historically low premiums in Medicare Advantage.” Furthermore, you have more than 1,600 prescription drug plans from which to choose. We can help you find the right Medicare Advantage Plan with our Advantage Plan Finder.

Medicare Supplements pay Part A and Part B coinsurance. For example, Medigap Plan G covers 100% of your hospital and medical services after you pay a $203 Part B deductible in 2021. Plan G is the most comprehensive coverage available for people new to Medicare since 2020. You can shop Medigap Plans by calling Senior Healthcare Direct at 1-855-368-4717 or get your quote.

Medical Underwriting – Advantage vs Supplement

Medicare Underwriting - Advantage vs. Supplement - Happy Seniors
Happy seniors avoid medical underwriting.

Starting in 2021, Medicare Advantage Plans accept all health conditions, including End-Stage Renal Disease (ESRD). Likewise, you can enroll in Medicare Supplement Plan without medical underwriting during your initial Open Enrollment Period (OEP). In other words, there is no medical underwriting when you are first eligible for Medicare, which includes:

  • Three months before you turn 65
  • The month you turn 65
  • Three months after you turn 65

However, anytime after your initial Open Enrollment Period, medical underwriting is required. For example, you switch to a different Medigap Plan after your initial OEP. Discover some of the most common underwriting questions and find out whether or not you can qualify.

Prescription Drugs – Advantage vs Supplement

Medicare Advantage Plans such as HMO and PPO most often include prescription drug coverage. However, Advantage Plans are not required to cover prescription drugs. If your HMO or PPO does not provide drug coverage and you enroll in a separate Medicare Prescription Drug Plan, you will be disenrolled from your Medicare Advantage Plan.

Medicare Supplement Plans fills in the coinsurance and deductible coverage gaps of Original Medicare, which does not cover prescription drugs. To get drug coverage, you need to enroll in a separate Part D drug plan. Senior Healthcare Direct can help you find the right drug plan that includes all your prescriptions.

Max Out-of-Pocket Limits – Advantage vs Supplement

Forbes reports Medicare Advantage maximum out-of-pocket (MOOP) limits will increase to $7,550 in 2021. In other words, your max out-of-pocket cost will be $850 more for in-network services in 2021. Once you reach this MOOP limit, your Medicare Advantage plan will cover all costs until the end of the year.

All Medicare Supplement Plans cover most or all of your out-of-pocket costs except plans K and L. Thus, CMS.gov put the following out-of-pocket 2021 limits on plans K and L.

  • $6,220 for Plan K ($740 increase from 2020)
  • $3,110 for Plan L ($170 increase from 2020)

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best medicare supplement plan 2021

Best Medicare Supplement Plan 2021

What is the Best Medicare Supplement Plan for 2021?

With 2021 fast approaching, Robert Bache gives his recommendation for the best Medicare Supplement Plan. Medicare Open Enrollment, also called Annual Election Period (AEP), begins October 15 and ends December 7, 2020. Watch the video to discover which Medicare Plan Robert Bache recommends for the upcoming AEP. In the video, you will learn:

  • Historically, his Medigap Plan recommendations have been “right on” since 2012.
  • How this most comprehensive Medigap Plan works.
  • Discover how this plan saves you on monthly premiums and is a better value than Plan F.

Furthermore, Robert compares Plan N to the best Medicare Supplement Plan he recommends in 2021. Watch the video and find out how Plan N compares. 

Medigap Plans F, N, and G

best medicare supplement plan 2021
Which Medigap Plan is best for you in 2021?

Which Medigap Plan F, N, or G is best for you in 2021? To determine the best plan for you, we will consider the following three factors:

  • Eligibility – who is and who is not eligible?
  • Coverage – what are the benefit differences?
  • Costs – what are the cost difference?

For Medicare Plans F, N, and G, we will determine whether you are eligible or not and compare plan benefits and costs.

Medigap Plan F Eligibility

Suppose you have Medigap Plan F before January 1, 2020. In that case, you can continue to buy Plan F. However, anyone new to Medicare in 2020 is not eligible and can not enroll in Plan F. In other words, if you turn age 65 in 2020, you can not buy Plan F.

However, if you turned 65 before January 1, 2020, and enrolled in Plan F, you can keep it! (Medicare.gov eligibility restrictions applies to Medigap Plans C and F.)

Medigap Plan F Eligibility - senior ladies birthday cake
Best Medicare Supplement Plan 2021 Plan N and Plan G Eligibility

Medigap Plan N and Plan G Eligibility

To be eligible for any Medicare Supplement Plan, you must have Part A and Part B. Moreover, anyone eligible for a Medigap Plan is also eligible for Plan G and Plan N. Unlike Plan F, you are eligible to enroll in Plan N or Plan G whenever you turn 65 in 2020. 

You can enroll in a Medigap Plan during your initial 7-month open enrollment period. It begins three months before you turn 65, continues the month of your birthday, and ends three months after your birthday. During this period, you have guaranteed issue rights!

When you turn 65 and enroll in a Medigap Plan, you are guaranteed the following:

  • No medical underwriting questions
  • No medical disqualification – all medical conditions qualify
  • You pay the same premium as a healthy senior – even if you have health problems

However, if you do not enroll during your initial open enrollment period, you must answer medical underwriting questions. Furthermore, you can be medically disqualified or pay more for health problems. To get your Medigap Plan quote, call Senior Healthcare Direct at 1-855-368-4717.

Best Medicare Supplement Plans in 2021

The best Medigap Plans in 2021 recommended by Robert Bache is Plan G because it has the greatest value. It provides the same comprehensive coverage as Plan F at a much lower monthly premium. If you are eligible for Plan F, it has the highest monthly premium.

Plan F is a “first-dollar” plan because Medicare pays the first dollar once you pay the expensive monthly premium. With Plan F, you do not pay the Part B deductible.

However, with Plan G, you pay the $198 Part B deductible in 2020, and you save several hundred in premiums per year. As MedicareBob says in his video, “You come out ahead” with Plan G coverage.

Best Medicare Supplement Plan 2021 - MedicareBob why plan G is a greater value than Plan F

Best Medigap Plans Coverage and Costs

The Best Medigap Plans chart compares the coverage and costs of plans F, N, and G. The green checkbox covers that benefit 100%. The red checkbox does not cover that benefit. Use this chart to compare Medigap benefits and the differences in coverage and costs.

Why Plan G is the best Medigap Plan

When you compare Medigap benefits of Plan F and G, the only difference is the Part B deductible. If you have Plan G, you pay a one-time annual Part B deductible. Since Plan G has lower premiums, you will save much more than the Part B deductible throughout the year.

So why pay more for Plan F when Plan G has the same coverage benefits? There is absolutely no reason to pay more for Plan F. Therefore, the best Medicare Supplement Plan for 2021 is Plan G.

Medigap Plan N coverage and costs

Medigap Plan N is a lower-cost alternative to Plan G. It has the same comprehensive coverage benefits as Plan G, except for Part B excess charges. Consequently, any medical provider who does not accept Medicare assignment can charge you up to 15% more than the Medicare-approved price. 

Furthermore, anytime you have an outpatient doctor’s office visit, you owe $15 copayment with Plan N. Moreover, you have up to a $50 copayment for every outpatient visit to the emergency room.

Medigap Plan N coverage and cost - Hospital Outpatient

Shop the Best Medigap Plans

As a Medicare insurance broker, Senior Healthcare Direct can shop the best Medigap Plans with all the top A-rated carriers. We save you money by comparing prices with many insurance providers. You can shop for the best 2021 Medicare Supplement Plans by calling Senior Healthcare Direct at 1-855-368-4717 or click the button to get your free quote!

Best Medicare Supplement Plan 2021 - get quote button

Switch Medigap Plans

Get a Medigap Plan for less money

In this MedicareBob video, Robert Bache explains when you can switch Medigap Plans and save money. Watch the video and find out when you can shop for Medicare Supplement insurance. Moreover, discover how Medicare standardized lettered plans make it easy for you to compare prices. For example, you could get the same Medigap Plan for less money.

Switching Medigap Plans

Alternatively, you could switch to a different Medicare Supplement plan. For example, you could save hundreds in monthly premiums by switching from Plan F to Plan G. Senior Healthcare direct makes it easy for you to shop and save on Medigap plans. Whether you want to shop for a lower price and keep your Medigap Plan or switch to a different Medicare Supplement Plan, Senior Healthcare Direct can find you the best price. 

Call 1-855-368-4717 or click the get quote button. Learn more about when you can shop for Medicare Supplement Plans.

Switch Medigap Plans get quote button

Medigap Underwriting Questions

Happy seniors can switch Medigap Plans with no underwriting questions.

You can switch Medigap Plans without answering medical underwriting questions during your initial Open Enrollment Period. The first three months before you turn 65, the month you turn 65, and three months after you turn 65, you can switch Medigap Plans. For example, two months before your turn 65, you may choose Plan F. Then, a month after you turn 65, you can switch to Plan G.

However, after your initial Open Enrollment Period, you will have to answer medical underwriting questions unless you live in a State with a birthday rule. The states of Oregon and California have Medigap Birthday Rules.

A licensed agent will ask you for your current height and weight. Anyone who is severely underweight or overweight will be denied. Another underwriting question is, “Do you require assistance for activities of daily living?” If you are unable to perform certain daily activities, you will not pass underwriting. Certain chronic, incurable health conditions may also disqualify you. Learn more about Medicare Supplement Insurance Underwriting.

In the Coffee with MedicareBob video, Robert Bache asks with customer support team member Tammy Hess questions about your insurance application. Watch the video to discover mistakes that can cause application delays.

Medicare Plan G Benefits

Does Medicare cover knee replacement?

Medicare Knee Replacement

In this Medigap Monday video, Robert Bache answers the question, “Does Medicare supplement plan G cover knee replacement?” Watch the video and discover how Medicare Supplement Plan G covers total knee replacement surgery. Then continue reading to learn how Medicare Plan G pays for your knee replacement recovery. Moreover, find out about surgical complications and inpatient costs.

Outpatient Knee Replacement

In most cases, knee replacement is an outpatient procedure. So, like every other outpatient procedure, Medicare covers 80% of your knee replacement costs.. If you have a Medicare supplement plan G, you pay $198 Part B deductible in 2020. Once you pay the annual one-time Part B deductible, the plan G supplement pays the remaining 20% of your outpatient procedures. Moreover, plan G covers your knee replacement recovery.

Knee Replacement Recovery

Recover from knee replacement often includes physical therapy rehab and doctor follow up visits. Since you already paid the Part B deductible and you have Medigap Plan G, you will not have any copays or follow up fees. As long as you go to a provider that accepts Medicare, 100% of all your outpatient medical services are covered. In some cases, knee replacement may result in surgical complications.

Does Medicare cover knee replacement - doctor and senior with knee condition
Doctor examines senior with a knee condition

Knee Replacement Complications

After outpatient knee replacement, you may have surgical complications. For example, according to Heathline, a small percentage of older adults may develop the following medical complications:

  • About 1 percent develop an infection
  • Less than 2 percent develop blood clots

 Moreover, anesthesia may cause the following adverse effects:

  • breathing difficulties
  • allergic reactions
  • nerve injury

If any of these medical conditions develop after knee surgery, a hospital may admit you as an impatient. 

Senior in a hospital bed after knee surgery

Inpatient Knee Replacement

Medicare Part A does cover 80% of your inpatient knee replacement cost after you pay the Part A deductible of $1408 in 2020. If you have Medigap Plan G, this Medicare supplement pays 100% of your Part A deductible. Furthermore, supplement plan G pays the 20% coinsurance not covered by Original Medicare. If you plan to have total knee replacement surgery, a Medicare Supplement Plan covers all the costs saving you lots of money.

How to Upgrade to a Medigap Plan

If you have Original Medicare, you can upgrade to a Medigap Plan by calling Senior Healthcare Direct at 1-855-368-4717 or get a quote. If you have Medicare Advantage, you have two Medigap Enrollment Periods.

Does Medicare cover knee replacement - before and after illustration
Knee replacement before and after illustration

Do Any Medigap Plans Cover Drugs?

Medigap plans do not cover maintenance medications, aka drugs that treat chronic health conditions. All lettered Medigap Plans: A, B, C, D, F, G, K, L, M, and N do not cover prescription drugs. However, your Medigap Plan will cover drugs while an inpatient in a hospital under Part A. Furthermore, your Medigap may pay for drugs administered in your doctor’s office under Part B.

For example, Medicare Part B covers Humira injections when administered by a licensed medical provider. Discover how MedicareBob’s advice results in a Medigap client getting FREE Humira injections.

Do Any Medigap Plans Cover Drugs

What are maintenance medications?

Maintenance medications are the everyday drugs you take to treat chronic health conditions. For example, Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory lung disease that obstructs airflow to your lungs. Most people with COPD use bronchodilator inhalers. This medication makes breathing easier by relaxing your airways. For people with Medigap Plans, you will need a separate Part D plan to cover maintenance medications.

A Brief History of Medicare Part D

The Medicare Prescription Drug, Improvement, and Modernization Act of 2013 adds a new Part D drug benefit program effective January 1, 2006. The act adds prescription drug coverage to Medicare Advantage plans. Furthermore, this public law allows beneficiaries with Part A or Part B to join Medicare Part D stand-alone Prescription Drug Plan (PDP). Thus, Medigap Plans sold after January 1, 2006, are not allowed to include prescription drug coverage. 

Brief History of Medicare Part D

Medicare Part D Plan

You can enroll or change your Medicare Part D Plan during the Annual Election Period (AEP) every year between October 15 and December 7. Furthermore, you can sign up for a Part D plan during your initial Medicare enrollment period. Moreover, you can avoid a late enrollment penalty by enrolling when you are first eligible.

Medicare Advantage Plan

You can enroll or change your Medicare Advantage Plan during the Annual Election Period (AEP) once a year between October 15 and December 7. Furthermore, you can switch Advantage plans or enroll in a Medigap plan during Medicare Advantage Open Enrollment.