Latest news with #Medigap
Health Line
3 days ago
- Business
- Health Line
Understanding Medicare Plan G Supplemental Coverage
Key takeaways Plan G is a Medicare Supplement Insurance (Medigap) policy that helps cover out-of-pocket costs associated with Original Medicare (parts A and B), including copayments, coinsurance, and deductibles (except for the Medicare Part B deductible). Medigap Plan G provides 100% coverage for Part A coinsurance, hospital costs, Part A deductible, hospice care coinsurance, blood (first 3 pints), and skilled nursing facility care coinsurance, plus 80% coverage for foreign travel emergencies up to plan limits. Medigap Plan G does not cover prescription drugs, the Part B annual deductible, or benefits like dental, hearing, and vision that are not covered under Original Medicare. 'Medigap' is another term for Medicare supplement insurance. Medicare Supplement Plan G is extra insurance you can buy to help cover your portion of costs for medical services with Original Medicare, such as: copayments coinsurance deductibles (with the exception of the Medicare Part B deductible) Original Medicare includes Part A (hospital insurance) and Part B (medical insurance). Medigap Plan G is one of the most popular of the 10 Medigap policies because of its broad coverage, including coverage for Part B excess charges. Keep reading to learn more about Medicare Part G and what it covers. What are Medicare Part B excess charges? Medicare Part B only covers services from healthcare professionals who participate in Medicare. If you choose a doctor who doesn't participate in Medicare, they may charge up to 15% more than the standard Medicare rate. If your Medigap plan does not cover Part B excess charges, you will pay these charges — known as excess charges — out of pocket.
Health Line
3 days ago
- Business
- Health Line
5 Things To Do When You Turn 65
By age 65, you may wish to take some important medical and financial steps. These involve Medicare, preventive health screenings, Social Security, taxes, and other legal considerations. Usually, if you're 65 years or older or younger and living with specific disabilities or conditions, you qualify for Medicare. If you're living with a qualifying disability, you'll be automatically enrolled in Original Medicare. However, if you're eligible because of your age, you'll need to sign up yourself. In addition, if you haven't already, you may wish to take this time to consider various social security and other legal decisions. Follow this guide for five things to do about Medicare, Social Security, and more when you reach 65. 1. Understand and enroll in Medicare To know which part or plan to enroll in, you'll need to understand the various benefits and costs. Generally, your Medicare enrollment options are: Original Medicare (parts A and B) Medicare Advantage (Part C) stand-alone Medicare Part D Medigap Both Healthline and this guide from the Centers for Medicare & Medicaid Services (CMS) go into detail about the benefits of each part of Medicare. In most cases, you won't pay a premium for Part A, but you must meet a deductible. Part B does have a premium and covers 80% of eligible expenses after you meet the deductible. Note that Original Medicare costs will change in 2026. Medigap can help you with your remaining out-of-pocket costs, but this requires paying an additional premium, and you can't use the plan with Part C. Private insurers manage Parts C and D, which means their costs vary by plan. Your out-of-pocket drug costs also depend on the specific plan's formulary. To cut your costs further, consider looking into whether you might be dually eligible for Medicaid or if you're eligible for Medicare Savings Program (MSP) or Extra Help. After enrollment, be aware that Medicare Part B covers a one‐time ' Welcome to Medicare ' preventive visit if you schedule it within 12 months of enrolling. You're also eligible for an annual wellness visit every 12 months. It's a good idea to take advantage of both of these visits and schedule any other preventive tests your doctor recommends. Long-term care insurance Long-term care insurance can help you manage your daily routines if you can no longer do so yourself at home, in a nursing home, or in an assisted living facility. But Medicare usually doesn't cover this. If you need this now or think you or a spouse may need this in the future, you may consult with a broker, look into State Partnership Programs, or check out your employer benefits if you're still working. 2. Set up a healthcare proxy If you haven't already, you might want to consider setting up a healthcare proxy. This will allow someone you trust to make medical decisions for you if you're ever unable to do so yourself. In addition, you can fill out a form to give the person access to your Medicare records and allow them to speak with providers on your behalf. Both of these can be really important if you have significant health issues that might affect your ability to make decisions or you're concerned that you might in the future. If you're married, it's a good idea to designate one another as proxies. Alternatively, or in addition, it may be a good idea to create or refresh your estate plan or issue a power of attorney to someone on your behalf. Depending on your goals, these legal moves could also replace designating a healthcare proxy while allowing the person you choose to manage your financial affairs. To decide on the best path for you, you may wish to consult with an attorney. 3. Make your home safer As you age, your physical needs may increase, and mobility around your home can become more challenging. You may prefer to stay in your home for as long as possible, but you may also have concerns about your safety. That said, there are things you can do to help make your home safer and protect yourself from injury in your home. These include: Adding grab bars or handrails on stairs, in bathrooms and showers, or anywhere you might need more support. Making sure your lighting is good and up to date in every room. Putting nonslip strips on stairs or fitting carpet on other slippery surfaces. Durable Medicare Equipment (DME) If you need it, you may be able to get mobility devices like walkers, wheelchairs, or scooters for use at home through Medicare Part B. 3. Understand retirement benefits You can begin receiving Social Security benefits as early as age 62, although you'll only get the full benefits once you reach the designated full retirement age. You can check when you're eligible for full benefits on Note that if you wait to get full benefits past full eligibility, your payments could increase by up to 8%. In addition, if you've been married for at least 10 years, you might be eligible for spousal benefits, which can also boost your payments. That said, depending on your situation, you may need your retirement benefits sooner. That's why it's important to know when you're eligible and how much you'll be able to get. 4. Review retirement savings Whether you're retiring this year or not, it's wise to review your retirement accounts to ensure your portfolio aligns with your retirement objectives. If you're currently still working and your employer provides a retirement savings option like a 401(k), make sure you're making the maximum possible contributions. Additionally, you can invest up to $7,000 annually into an Individual Retirement Account (IRA). Each of these retirement account types has its own benefits and drawbacks, and you might have one or both. There are also different rules on when and how you can withdraw money from these accounts. For this reason, consulting a financial advisor can be beneficial to ensure you're managing these correctly and contributing the right amounts. 5. Check your taxes Filing tax returns can be complex. When you're working on your tax return, it's important to pay extra attention to avoid losing out on deductions that you're owed due to errors. Be especially aware that once you turn 65 years old, you can get a larger deduction on your federal tax returns. If you or your spouse has a visual impairment, you may qualify for a bigger standard deduction. In addition, you might be able to get additional state deductions based on the specific rules in your state. If you need to, consider speaking with a tax consultant to make sure you're filing your taxes correctly and getting the right deductions. Takeaway Generally, people who are 65 years or older, as well as younger individuals with certain disabilities, qualify for Medicare. If you live with an eligible disability, you'll be automatically enrolled in Original Medicare, but if you qualify by age, you need to enroll on your own. Before you enroll in Medicare, consider the program's structure, the plans that best suit your needs and their associated costs, and the key enrollment periods. Other things to consider around age 64 are your plans for your future healthcare needs, your Social Security benefits, the status of your retirement benefits, changes in tax exemptions, home safety, essential legal documents, and more.
Health Line
3 days ago
- Business
- Health Line
What Happens After Enrolling in Medicare?
After you enroll in Medicare, you receive a welcome packet with information such as your Medicare card. You also have some important decisions to make about additional coverage. It's a great idea for a new Medicare enrollee to learn how Medicare works and the interactions of its parts. Consider familiarizing yourself with the key parts of Medicare: Part A (hospital insurance) Part B (medical insurance) Part C (Medicare Advantage) Part D (prescription drug coverage) Medicare supplement insurance (Medigap) With a solid understanding of the Medicare system, you can make educated decisions and ensure that your coverage aligns with your health and financial goals. Medicare can be complex. If you want help understanding your options and deciding what's best for you, consider speaking with a professional. You can get free, unbiased Medicare counseling from your local State Health Insurance Assistance Program (SHIP). This article discusses what to expect in the weeks after signing up for Medicare and what steps you can take to get the best coverage. Look for your welcome packet Within a couple of weeks of signing up for Medicare, you receive a ' Welcome to Medicare ' packet that contains a: letter introducing you to the Medicare program booklet with your coverage details Medicare card Your Medicare number is on your Medicare card and account. Healthcare professionals, insurers, and certain government agencies require your Medicare number to identify you and ensure you get the appropriate care. You also need your number to join a Medicare plan and buy Medicare supplement insurance. Consider your coverage needs Once you sign up for Original Medicare (parts A and B), you can decide whether to add additional coverage. Your options include: switching to a Medicare Advantage plan adding Part D prescription drug coverage including Medicare supplement insurance (Medigap) Medicare Advantage plans are available from private insurance companies. These plans include the same benefits as Original Medicare but offer extra coverage for other medical necessities, such as dental, vision, and hearing care. Medicare Advantage plans vary by location and provider. You can search for and compare plans on If you want to keep Original Medicare, you have a few options for adding extra coverage. You can sign up for a stand-alone Part D plan to add coverage for prescription drugs. You can also sign up for a Medigap plan to help cover the out-of-pocket costs of Original Medicare. Consider signing up for a Medigap plan within 6 months after your Part B coverage begins to get the most plans at the best prices. Learn when your coverage begins Knowing when your coverage starts is critical after enrolling in Original Medicare. The timing of your coverage initiation depends on when you sign up. If you sign up for Medicare during your initial enrollment period but before the month of your 65th birthday, your coverage begins at the start of your birth month. If you sign up during or after the month you turn 65 years old, coverage begins at the start of the next month. Once your coverage begins, consider contacting your healthcare professionals and pharmacy to update them on your new insurance. Schedule your 'Welcome to Medicare' visit If you sign up for Medicare Part B, you qualify for a 'Welcome to Medicare' preventive visit during your first 12 months of coverage. It's a free, comprehensive visit that includes: a review of your health history educational material on vaccines and other preventive services body measurements necessary referrals a mental health evaluation a written medical plan However, the Welcome to Medicare visit isn't a physical. Get familiar with your coverage Review your policy documentation to understand all facets of your coverage when you finalize your plans. Look at what benefits you can receive, the costs you need to pay, and the coverage limitations. Doing so can help you get the most out of your Medicare coverage and prepare for costs ahead of time. Summary After enrolling in Medicare, you receive some vital information. You also have to make some decisions about your coverage. Watch for your Medicare welcome packet in the mail and review its documents. Read up on how Medicare works to help you make coverage choices that are right for you. Once you finalize your coverage, update your healthcare professionals on your new insurance details, and schedule your Welcome to Medicare preventive visit, if you have Part B. Contact your local SHIP for free Medicare counseling if you have questions.
Health Line
3 days ago
- Business
- Health Line
How Much Will Medicare Cover If I Need a CT Scan?
Key takeaways Medicare will cover any medically necessary diagnostic tests, including CT scans. Inpatient CT scans are typically covered by Part A, while outpatient CT scans are usually covered by Part B. Part C (also called Medicare Advantage) plans include at least the same level of coverage as parts A and B. Medigap plans can help decrease out-of-pocket costs associated with Original Medicare coverage for CT scans. Medicare will cover any medically necessary diagnostic tests you need. This includes computed tomography (CT) scans. Your exact coverage depends on where you have the test and which Medicare part covers it. Part A coverage for CT scans Part A is hospital insurance. It covers the care you receive during an inpatient stay at: a hospital a skilled nursing facility another inpatient facility This includes any tests your doctor orders during your stay. So, if you receive a CT scan in the hospital, Part A will cover it. In this situation, the cost of a CT scan will go toward your Part A deductible. In 2024, the Part A deductible is $1,632 for each benefit period, and in 2025, it is $1,676. Once you've met this deductible, Part A will cover all tests and procedures during your stay, with no coinsurance costs during the first 60 days of hospitalization. Part B coverage for CT scans Part B is medical insurance. It covers outpatient care at multiple types of healthcare facilities, such as: doctor's offices urgent care centers health centers outpatient clinics outpatient labs and testing facilities surgical centers Part B will cover your CT scan no matter which outpatient setting you have it in. You'll have coverage as long as the facility participates in Medicare and a doctor orders the scan. The Medicare website has a tool for checking which facilities and providers participate in Medicare in your area. After you meet your Part B deductible, Medicare will pay 80% of the approved cost of your CT scan. You'll be responsible for the other 20%. The Medicare Part B deductible is $240 in 2024 and $257 in 2025. Part C coverage for CT scans All Part C plans cover CT scans. However, many Part C plans have networks. You might pay much higher costs for leaving your plan's network. Sometimes, you may not have out-of-network coverage, even if the facility participates in Medicare. The deductible and any copayment or coinsurance amount depend on your specific plan. If possible, contact your insurance company ahead of time to get an estimate of how much this test will cost. Medigap coverage for CT scans Medigap is supplemental insurance that you can buy to cover your out-of-pocket costs from Medicare. Depending on your Medigap plan, you may be able to get coverage for your: Part A deductible Part B deductible Part A copays and coinsurance Part B copays and coinsurance That means that Medigap would cover any costs associated with your CT scan that would typically be your responsibility. Medigap plans have a monthly premium on top of your Medicare Part B premium. So, while you'll pay more each month, the costs will be covered when you need a service like a CT scan. The bottom line Part A will cover your CT scan if you have it during an inpatient hospital stay, and Part B will cover it when you have it as an outpatient. Part C will also cover a CT scan, but you'll typically need to stay within your plan's network. If Medicare doesn't cover your CT scan and you think it should, you can file an appeal. An appeal will give you several chances to explain why the CT scan was medically necessary and see whether Medicare will cover it.
Health Line
3 days ago
- Business
- Health Line
Does Medicare Cover Physical Therapy
Key takeaways Medicare Part B covers 80% of physical therapy costs that are considered medically necessary after meeting your Part B deductible. To be covered, physical therapy must involve skilled services from qualified professionals like physical therapists or doctors, and your therapist must document that services remain medically necessary after costs exceed $2,410 in 2025. Medicare Advantage (Part C) plans cover medically necessary physical therapy and may include additional services like dental, vision, and prescription drug coverage, while Medigap plans can help cover out-of-pocket costs of Original Medicare like deductibles and copayments. PT can be an important part of treatment or recovery for various conditions. It focuses on restoring functionality, relieving pain, and increasing mobility. Physical therapists work closely with you to treat or manage a variety of conditions, including but not limited to musculoskeletal injuries, stroke, and Parkinson's disease. Medicare covers some of the costs of PT. Keep reading to find out which parts of Medicare cover PT and when. When does Medicare cover physical therapy? Medicare Part B will help to pay for outpatient PT that's medically necessary. A service is considered medically necessary when it's needed to reasonably diagnose or treat a condition or illness. PT can be considered necessary to: improve your current condition maintain your current condition slow further deterioration of your condition For PT to be covered, it must involve skilled services from a qualified professional like a physical therapist or doctor. For example, something like providing general exercises for overall fitness wouldn't be covered as PT under Medicare. Your physical therapist should give you written notice before providing you with any services that wouldn't be covered under Medicare so you can decide whether to have them. Which parts of Medicare cover physical therapy? Let's further break down the different parts of Medicare and how the coverage provided relates to PT. Part A Medicare Part A is inpatient hospital insurance. It covers things like: inpatient stays at: hospitals mental health facilities rehabilitation centers skilled nursing facilities hospice care home healthcare Part A can cover inpatient rehabilitation and PT services when they're considered medically necessary to improve your condition after hospitalization. Part B Medicare Part B is outpatient medical insurance. It covers medically necessary outpatient services. Part B may also cover some preventive services. Medicare Part B covers medically necessary PT. This includes both the diagnosis and treatment of conditions or illnesses that affect your ability to function. You can receive this type of care at the following types of facilities: medical offices privately practicing physical therapists hospital outpatient departments outpatient rehabilitation centers skilled nursing facilities (when Medicare Part A doesn't apply) at home (using a Medicare-approved service) Medicare Advantage (Part C) Medicare Part C plans are also known as Medicare Advantage. Unlike parts A and B, they're offered by private companies that Medicare has approved. Medicare Advantage plans must cover the same as Original Medicare's parts A and B, and this includes medically necessary PT. These plans can also cover additional services, like dental, vision, and prescription drugs. What's included in a Medicare Advantage plan varies by plan type, insurer, and location. If you have a Medicare Advantage plan, you should check for information regarding any plan-specific rules for therapy services. Part D Medicare Part D provides prescription drug coverage. Like Medicare Advantage, private companies approved by Medicare administer Part D plans. The medication covered can vary by plan. Part D plans don't cover PT. However, if prescription medications are a part of your treatment or recovery plan, Part D may cover them. Medigap Medigap is also called Medicare supplement insurance. Private companies administer these plans, and they can cover some of the out-of-pocket costs associated with Original Medicare, including: deductibles copayments coinsurance medical care when you're traveling outside the United States Although Medigap may not cover PT, some policies may help to cover the associated copayments or deductibles. How much does physical therapy cost? The cost of PT can vary greatly, and many factors can affect the cost, including: your insurance plan the specific type of PT services that you need the duration or number of sessions involved in your PT treatment how much your physical therapist charges your location the type of facility you're using Coinsurance can also be a big factor in Medicare PT costs. Medicare coinsurance is a percentage amount you must pay toward each visit. Medicare pays 80% of an approved fee for PT, and you must pay 20%. You may also have to pay anything your physical therapist charges over the Medicare-approved fee. If you need to have many PT sessions, this cost can quickly add up. A 2019 study found that the average outpatient PT expenditure per participant was $1,488 annually. This varied by diagnosis, with neurological conditions and joint replacement expenditures being higher while genitourinary conditions and vertigo were lower. Coverage and payments Once you've met your Part B deductible, which is $257 for 2025, Medicare will pay 80% of your PT costs. You'll be responsible for paying the remaining 20%. There's no longer a cap on the PT costs that Medicare will cover. After your total PT costs exceed a specific threshold, your physical therapist must confirm that the services provided remain medically necessary for your condition. For 2025, this threshold is $2,410. Your physical therapist will use documentation to show that your treatment is medically necessary. This includes evaluations of your condition and progress as well as a treatment plan with the following information: diagnosis the specific type of PT you'll be receiving the long-term PT treatment goals number of PT sessions you'll receive in a single day or single week total number of PT sessions needed Until 2028, when total PT costs exceed $3,000, a targeted medical review may be performed. However, not all claims are subject to this review process. Estimating your out-of-pocket costs Although you may not know exactly how much PT will cost, it's possible to come up with an estimate. Try the following: Speak with your physical therapist to know how much your treatment will cost. Check with your insurer to find out how much of this cost they will cover. Compare the two numbers to estimate the amount you'll need to pay out-of-pocket. Remember to include things like coinsurance and deductibles in your estimate. Which Medicare plans may be best if you need physical therapy? Original Medicare parts A and B cover medically necessary PT. If you know you'll need it in the coming year, having just these parts may meet your needs. If you're concerned about additional costs that aren't covered by parts A and B, you may consider adding a Medigap plan which can help pay for some of Original Medicare's out-of-pocket costs. Medicare Advantage (Part C) plans include the coverage from parts A and B. However, they may also cover additional services. If you'll need coverage of dental, vision, or fitness programs in addition to PT, consider a Medicare Advantage plan. Part D includes prescription drug coverage. It can be added to Original Medicare and is often already included in Medicare Advantage plans. If you already take prescription medications or know that they may be a part of your treatment plan, Part D may be right for you. The takeaway Medicare Part B covers outpatient PT when it's medically necessary, which means that the PT you receive is required to reasonably diagnose or treat your condition. There's no cap on the PT costs that Medicare will cover. However, after a certain threshold, your physical therapist must confirm that the services you're receiving are still medically required. Other Medicare plans, such as Medicare Advantage and Medigap, can also cover costs associated with PT. If you're looking at one of these, remember to compare several options before selecting one since coverage can vary by insurer.
