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Health Line
3 days ago
- Business
- Health Line
Does Medicare Cover Blood Tests for Cholesterol and How Often?
Key takeaways Medicare covers cholesterol testing as part of cardiovascular screening blood tests, including tests for lipid and triglyceride levels, which are covered once every 5 years. For those diagnosed with high cholesterol, Medicare Part B covers continuing blood work to monitor the condition and response to prescribed medication. Cholesterol-lowering medication is typically covered by Medicare Part D (prescription drug coverage) and Medicare Advantage (Part C) plans. Medicare covers cholesterol testing as part of the cardiovascular screening blood tests. It also includes tests for lipid and triglyceride levels, which are covered once every 5 years. However, if you have a diagnosis of high cholesterol, Medicare Part B will usually cover continuing blood work to monitor your condition and response to prescribed medication. If you need cholesterol-lowering medication, it's usually covered by Medicare Part D (prescription drug coverage) and Medicare Part C (Medicare Advantage) plans. Keep reading to learn more about what Medicare covers to help diagnose and prevent cardiovascular disease. What else does Medicare cover to help diagnose and prevent cardiovascular disease? Cholesterol testing isn't the only thing Medicare covers to help identify, prevent, and treat cardiovascular disease. Medicare Part B will also cover an annual visit with your primary care doctor for behavioral therapy, which may include suggestions for a heart-healthy diet. Additional preventive services covered by Medicare Medicare covers other prevention and early detection services — many at no charge — to help identify health issues early. Diagnosing health conditions early can maximize the success of treatment. These tests include: Preventive services Coverage abdominal aortic aneurysm screening 1 screening for people with risk factors alcohol misuse screening and counseling 1 screen and 4 brief counseling sessions per year bone mass measurement 1 every 2 years for people with risk factors colorectal cancer screenings how often is determined by the test and your risk factors depression screening 1 per year diabetes screening 1 for those at high risk; based on test results, up to 2 per year diabetes self-management training if you have diabetes and a written doctor's order flu shots 1 per flu season glaucoma tests 1 per year for people with risk factors hepatitis B shots series of shots for people at medium or high risk hepatitis B virus infection screening for high risk, 1 per year for continued high risk; for pregnant women, 1st prenatal visit and at time of delivery hepatitis C screening for those born 1945 to 1965; 1 per year for high risk HIV screening for certain age and risk groups, 1 per year; 3 during pregnancy lung cancer screening test 1 per year for qualified patients mammogram screening (breast cancer screening) 1 for women ages 35 to 49 years; 1 per year for women ages 40 years and older medical nutrition therapy services for qualified patients (diabetes, kidney disease, kidney transplant) Medicare diabetes prevention program for qualified patients obesity screening and counseling for qualified patients (BMI of 30 or more) Pap test and pelvic exam (also includes a breast exam) 1 every 2 years; 1 per year for those at high risk prostate cancer screenings 1 per year for men over age 50 years pneumococcal (pneumonia) vaccine covered; specific vaccine as recommended by your doctor tobacco use counseling and tobacco-caused disease 8 per year for tobacco users wellness visit 1 per year If you register at you can get direct access to your preventive health information. This includes a 2-year calendar of the Medicare-covered tests and screenings you're eligible for. What to expect from cholesterol testing The cholesterol test is used to estimate your risk of heart disease and blood vessel disease. The test will help your doctor evaluate your total cholesterol and your: Low-density lipoprotein (LDL) cholesterol: Also known as 'bad' cholesterol, LDL in high quantities can cause the buildup of plaques (fatty deposits) in your arteries. These deposits can reduce blood flow and can sometimes rupture, leading to a heart attack or stroke. High-density lipoprotein (HDL) cholesterol: Also known as 'good' cholesterol, HDL helps carry away LDL cholesterol and other 'bad' lipids to be flushed from the body. Triglycerides: Triglycerides are a type of fat in your blood that is stored in fat cells. At high enough levels, triglycerides may increase the risk of heart disease or diabetes. Lipoprotein(a): Your doctor may order this test to check your Lp(a), a type of LDL (bad) cholesterol. Medicare doesn't cover this test. Takeaway Medicare covers the costs of testing your cholesterol, lipid, and triglyceride levels every 5 years. These tests can help determine your risk level for cardiovascular disease, stroke, or heart attack. Medicare also covers other preventive services, including wellness visits, mammogram screenings, colorectal cancer screenings, flu shots, and more. The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.
Medical News Today
6 days ago
- Business
- Medical News Today
Omeprazole and Medicare coverage
Many Medicare Part D or Part C plans with drug coverage cover omeprazole when a doctor prescribes it. Some Part C plans may even allow a person to buy it over the counter. Omeprazole can be purchased over the counter or with a prescription. However, over-the-counter (OTC) purchases typically cannot be made through a health insurance plan. This article explores how people can use their Medicare Part D prescription plan or Medicare Advantage (Part C) plan with drug coverage to purchase prescription omeprazole and the potential out-of-pocket expenses individuals might encounter. Is omeprazole covered by Medicare Part B? However, Part B only covers medications a person cannot take themselves, such as IV drugs . For this reason, omeprazole coverage falls under Part D. Studies indicate that many Part D plans cover this medication in its prescribed form. In addition, some Part D plans may cover OTC omeprazole if a person has a doctor's prescription. What tier level is omeprazole? Whether a person's specific plan covers the generic omeprazole or Prilosec brand depends on its inclusion in the plan's specific formulary. Within this formulary, every Part D plan categorizes drugs into tiers. Generally, the higher the tier, the more a person will pay out of pocket even after Part D coverage kicks in. While each Part D plan may place omeprazole in a different tier, more commonly prescribed or preferred drugs tend to feature in lower tiers. In addition, formularies are more likely to rank generic omeprazole lower than Prilosec. However, it is essential to understand that certain Part D plans may require individuals to try the OTC version of a medication before approving coverage for the prescription form. This process is known as step therapy. Medicare Advantage However, what is different about such Part C plans is that some may provide an additional benefit for OTC medications, allowing a person to buy the drug over the counter using their plan. How much does omeprazole cost with Medicare? The cost for thirty 40-milligram capsules of generic omeprazole fluctuates between $10 and $48, depending on the pharmacy dispensing it. In contrast, the brand-name drug Prilosec, when a person acquires it under prescription, costs between $448 and $476, making it considerably more expensive than its OTC or generic alternatives. The amount someone pays for prescription Prilosec or non-OTC generic versions after Medicare coverage takes effect depends on the drug's tier classification in their plan's formulary. Drugs in higher tiers typically incur higher costs. Furthermore, Medicare Part C and D plans generally require meeting a deductible and paying a monthly premium, which varies by plan. In 2025, the national base beneficiary premium for Part D is $36.78, while the average monthly premium for Part C is around $17. In addition, a person must still pay the Part B premium to enroll in a Part C plan. However, some plans may cover this cost. What is the best alternative to omeprazole under Medicare? Omeprazole falls into the drug category of proton pump inhibitors (PPIs) and is among the top ten prescribed medications in the United States. That said, there are other PPIs, including: Which of these drugs works best depends on the person, their specific health needs, and the doctor's recommendations. It is also essential to know that not every PPI has approval for treating the same medical conditions. Medicare may not approve coverage if a doctor prescribes a drug off-label or for a reason the insurance does not consider medically necessary.
Health Line
23-05-2025
- Business
- Health Line
Why Are Some Medicare Advantage Plans Free?
Medicare Advantage plans aren't free. Sometimes called Medicare Part C, private insurers administer these plans, and they may offer $0 premium options. However, plans may have other out-of-pocket costs. Private insurance companies administer Medicare Advantage plans. They're available to anyone eligible for Medicare. Plans include all of the benefits of Original Medicare but typically also include prescription drug coverage and additional benefits, such as: dental vision hearing fitness How can a Medicare Advantage plan be free? If you shop around for a Medicare Advantage plan, you may notice that private insurers advertise some plans as 'free.' Some insurers may refer to Medicare Advantage plans as free because the plans offer a $0 monthly enrollment premium. This offer makes them attractive for people looking to save money on monthly Medicare costs, but other costs exist. A free Medicare Advantage plan means the insurer offers a $0 monthly premium. However, there may be other costs, such as deductibles, coinsurances, and copayments, and you must still pay the Medicare Part B premium to Medicare, which in 2025 is $185. When a private insurance company contracts with Medicare, it receives a set amount of money to cover parts A and B insurance. The company could save money elsewhere by using in-network doctors and facilities. In that case, it could pass those extra savings to members, resulting in a 'free' monthly premium. These 'free' Medicare Advantage plans are also great for companies to advertise attractive savings to potential beneficiaries. Are $0 premium Medicare Advantage plans really free? Even though private insurers advertise $0 premium Medicare Advantage plans as free, you still have to pay some out-of-pocket costs for coverage, such as: Medicare Advantage plan monthly premium: If a Medicare Advantage plan is truly free, you don't have to pay a monthly premium to enroll. Part B monthly premium: You still need to pay the Part B premium to Medicare. In 2025, the Part B premium is $185 per month for most people, although it may be higher depending on your income. Deductibles: Most Medicare Advantage plans have two types of annual deductibles. One is for the bundles of inpatient and outpatient coverage for Part A and Part B, and the other is for prescription drug coverage if the plan includes it. Coinsurance/copayments: Most Medicare Advantage plans charge copayments. A copayment is the out-of-pocket fee you pay every time you receive medical services. Some plans may also charge coinsurance, which is a percentage cost toward billed services. Medicare Advantage plan costs can also differ based on their structure. For example, Preferred Provider Organization (PPO) plans charge different out-of-pocket costs based on whether you use a provider that's in or out of your network. Do you qualify for $0 premium Medicare Advantage plans? There are no qualifications for free Medicare Advantage plans. When searching for a Medicare Advantage plan online, you can usually sort the search results page by 'lowest monthly premium' to see $0 premium Medicare Advantage plans in your area. Another way to keep track of your Medicare Advantage costs is to pay attention to the Evidence of Coverage (EOC) form and annual notice of change (ANOC). Your plan sends them each year, and they can help you stay on top of any price changes or fee increases. Resources to help cover Medicare costs One of the most important ways to manage your Medicare costs is to use the resources available to help cover or lower your costs. These resources include: Medicare savings programs: These programs can help low income beneficiaries pay Medicare Advantage premiums, deductibles, copayments, and coinsurance. Supplemental Social Security: This benefit offers a monthly payment to people who are disabled, blind, or above 65 years old. This payment can help cover Medicare costs. Extra Help: This program can help with prescription drug costs and is available to people with low income and limited resources. Programs of All-Inclusive Care for the Elderly (PACE): This program can help you manage your healthcare needs from within your community. The takeaway Free Medicare Advantage plans mean private insurance companies don't charge a monthly premium. While private insurers advertise these plans as free, you still have to pay the standard out-of-pocket costs, including premiums, deductibles, and copayments. You also still need to pay the Part B premium directly to Medicare. If you qualify for Medicare and are a part A and B enrollee, you can search for $0 premium Medicare Advantage plans in your area. The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.
Health Line
09-05-2025
- Health
- Health Line
How to Switch from Original Medicare to Medicare Advantage
There are set times during the year when people can change their Medicare coverage. You can switch from Original Medicare to Medicare Advantage during one of these Medicare enrollment periods. Original Medicare refers to Part A (hospital insurance) and Part B (medical insurance). It is administered by the federal government and provides coverage for a wide range of services with healthcare providers across the United States. Medicare Advantage (Part C) is an alternative to Original Medicare. Private insurance companies offer these plans. They offer the same level of coverage as Original Medicare but include expanded benefits, such as drug coverage and dental, hearing, and vision care. If you're currently enrolled in Original Medicare, you may switch to a Medicare Advantage during the Medicare open enrollment period (OEP). This article discusses when and how to switch from Original Medicare to Medicare Advantage, along with the potential benefits and drawbacks of Medicare Advantage plans. When to switch to Medicare Advantage Medicare open enrollment is the primary period when someone with Original Medicare can switch to Medicare Advantage. The OEP runs from October 15 to December 7 each year. During the OEP, Medicare beneficiaries can make a wide range of changes to their coverage, including joining, dropping, or switching Original Medicare, Medicare Advantage, and Part D prescription drug plans. The Medicare Advantage open enrollment period (MA OEP) is a separate period that runs from January 1 to March 31 each year. During MA OEP, people who already have Medicare Advantage plans can switch plans or return to Original Medicare. However, people with Original Medicare cannot join Medicare Advantage during the MA OEP. Enrollment procedure and considerations The first step in switching from Original Medicare to Medicare Advantage is finding the right plan for you. Plan options vary by location, so you'll need to search by ZIP code to learn what's available. You could also speak with a licensed insurance agent or your local State Health Insurance Assistance Program (SHIP) for guidance. Consider both your health needs and financial resources when selecting a plan. Do you take specific medications? Do you need coverage benefits for things like dental and vision care? How do the plan's costs align with your financial needs and expected healthcare costs? Once you've found a plan you like, you have a couple of options for how to join it. If you've searched for the plan on you can click the 'Enroll' button and follow the steps to get started. Alternatively, you may reach out to the insurance carrier directly. You can typically do so online or by phone, and a representative will help you through the process. Pros and cons of Medicare Advantage plans There are benefits and drawbacks to Medicare Advantage plans. These plans won't make sense for all individuals. Consider the following pros and cons when deciding whether to switch from Original Medicare to Medicare Advantage. However, note that different plans may have different benefits, so these factors may not apply in all situations. Potential pros of Medicare Advantage plans include: additional coverage, such as vision, dental, and hearing care extra benefits, such as fitness plans, over-the-counter (OTC) cards, transportation assistance, telehealth services prescription drug coverage out-of-pocket spending limits Potential cons of Medicare Advantage plans include: limited provider networks no option for supplemental coverage (Medigap) requiring prior authorization before procedures Frequently asked questions about switching to Medicare Advantage Can you switch between Original Medicare and Medicare Advantage? Yes, you can switch from Original Medicare to Medicare Advantage and vice versa. To do so, you'll need to wait for the correct Medicare enrollment period unless you qualify for a special enrollment period (SEP). SEPs allow people who have experienced life changes that affect their insurance coverage to enroll in Medicare in a timely fashion. Yes, you can switch from Original Medicare to Medicare Advantage and vice versa. To do so, you'll need to wait for the correct Medicare enrollment period unless you qualify for a special enrollment period (SEP). SEPs allow people who have experienced life changes that affect their insurance coverage to enroll in Medicare in a timely fashion. Is there a penalty to switch from Original Medicare to Medicare Advantage? No, there is no penalty for switching from Original Medicare to Medicare Advantage. Medicare has certain penalties for late enrollment, but these do not apply when switching between Original Medicare and Medicare Advantage. No, there is no penalty for switching from Original Medicare to Medicare Advantage. Medicare has certain penalties for late enrollment, but these do not apply when switching between Original Medicare and Medicare Advantage. Summary You can switch from Original Medicare to Medicare Advantage during the open enrollment period (OEP), which is from October 15 to December 7 each year. Prior to switching, it's important to consider your health and financial needs and search for a plan that meets your requirements. For free, unbiased health insurance counseling, consider speaking with a representative from your local SHIP.
Yahoo
29-04-2025
- General
- Yahoo
Amid federal turmoil, Hillsborough's Migrant Education Program soars
RIVERVIEW — As graduation season begins, Belzar Roblero-Pedro wanted people to know that his fellow graduates in Hillsborough County's Migrant Education Program were more than just an othered category. They were 'fighters, dreamers and survivors,' he said. Roblero-Pedro grew up between Florida, North Carolina and Michigan, with vivid memories of his parents regularly carrying pounds of strawberries, cucumbers, and blueberries in grueling temperatures. They wanted him and his siblings to be able to pursue their dreams, he said. But at school, he said, he was met at times with racial slurs, snickers when his name was called or other students asking if his parents had 'hopped the border to be here.' This month, the Armwood High School senior was one of 85 Hillsborough County students on track to graduate through the Migrant Education Program. For them, it's the end of a journey filled with added challenges that come with often moving between states several times within a school year. 'Not just across states,' Roblero-Pedro said, 'but across identities, and the dreams of our families and our own.' The Office of Migrant Education, the federal office in the Department of Education that runs the Migrant Education Program, was created in the 1960s, around the time a documentary about migrant workers created public outcry about the living conditions of agricultural and fishing workerswho often make several moves a year. Though the majority of participants in Florida's Migrant Education Program are Latino, in Hillsborough County, not all migrant students are immigrants, and the demographics of the program have shifted as the agricultural industry has shifted. According to agricultural worker surveys by the U.S. Department of Labor, data from 1989 to 1993 shows that almost three in five agricultural workers were white, compared to less than a third from 2019 to 2022 period. In Hillsborough County, the program serves more than 1,800 children aged 3 to 21 in schools. Its small staff of advocates seek out children of migrant workers, educating parents about their rights and responsibilities, bridging the gap between curriculum requirements in different states, offering tutoring services and sometimes helping address food insecurity. They often work nights and weekends, making home visits around work schedules. With President Donald Trump setting a goal of dismantling the Department of Education, and specifically targeting Title I, Part A funding that supports low-income students, little has been said about Title I, Part C, the program's federal source of funding Carol Mayo, who has supervised the program in Hillsborough County since 2013, said there is too much work to be done for the time being. 'I don't think anyone's really heard anything' about future funding, she said, though the program has seen less funding in recent years. 'We work really hard to make sure that (families) know school is the safest place for your child. It doesn't matter what's going on. That's always been the message.' But on an evening earlier this month celebrating their largest graduating class in recent years, it was a moment to celebrate the students and recognize their families' sacrifices, as a mariachi band played the national anthem and tears flowed from parents and teachers. Silvia Villegas said she was filled with pride to watch her daughter Jasmine graduate among the top of her class at Lennard High School. Olga Perez, a teacher and migrant advocate for more than 20 years, worked with Villegas' older daughter, who was Lennard's valedictorian in 2007. It was a full-circle moment for her, too. Perez said she hoped people thought about the invisible labor behind produce displays at grocery stores. 'There's a story behind those beautiful displays of vegetables, fruits,' she said. 'There's sweat, tears. Those kids have to go to schools in different districts. They have to leave people behind, leave friends behind. They have to follow the crops.' Araseli Martinez Pena, founder of an education equity firm and a doctoral candidate at the University of South Florida, was a former Migrant Education Program graduate. She told graduates they'd face challenges ahead. 'You will have many voices that tell you you cannot do what you dream of doing,' she said. 'You will have many voices that tell you you cannot dream at all. 'The only voice that's important is the one in your own head, because your worth, your value, is defined by who you are, and what you tell yourself you can do.'
