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Health Line
a day 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.
Health Line
3 days ago
- Business
- Health Line
Does Medicare Cover Cancer Treatment?
Key takeaways Original Medicare covers cancer treatment, with Part A covering hospitalization and Part B covering outpatient treatment. Medicare Part C (Medicare Advantage) also offers the same coverage. Medicare Part B pays 80% of the costs for approved cancer treatments after you meet your annual deductible of $257. If you need surgery, Part B will pay for you to consult with a surgical oncologist and get a second opinion from another surgical oncologist. If those two doctors disagree, Part B will also pay for you to seek a third opinion. Part A will cover the costs of the surgery if it is an inpatient procedure. Medicare Part B pays 80% of your care provider's bills for prescribed, approved cancer treatments. You're responsible for 20% of the billed amount until you hit your annual deductible. However, some doctor's visits and procedures must meet unique criteria to be approved by Medicare. For example, if you need surgery, Part B will pay for you to consult with a surgical oncologist and to get a second opinion from another surgical oncologist. If those two doctors disagree, Part B will also pay for you to seek a third opinion. If you're enrolled in Medicare, it covers cancer treatment regardless of your age. Medicare Part D covers prescription drugs that are part of your cancer treatment. This article will answer basic questions about how to find out how much you'll owe for cancer treatment if you have Medicare. If you receive a serious cancer diagnosis, you may want to call the Medicare Health Line at 800-633-4227. This line is available 24/7 and can give you specific answers about anticipating your costs. What does Medicare cover for cancer treatment? Medicare is a federal program in the United States that is governed by several laws. The policies are the 'parts' of Medicare, and they cover different aspects of cancer treatment. Part A Part A covers cancer treatments that you receive as part of an inpatient hospital stay, such as surgery to remove cancerous masses. It also covers skilled nursing facility care, home healthcare (like physical therapy), blood transfusions, costs related to participation in certain cancer-focused clinical studies, and surgically implanted breast prostheses after a mastectomy. Part B Part B covers medically necessary outpatient care, including most types of cancer treatment, such as chemotherapy and radiation. It should also cover doctors' visits, diagnostic testing, outpatient surgery, durable medical equipment, mental health services, and certain preventive care screenings. Part C (Medicare Advantage) Medicare Advantage (Part C) plans are private health insurance plans that offer the same benefits as Original Medicare (Part A and Part B). Some plans may offer additional benefits. Part D Part D covers prescription drugs. Your plan may cover some oral chemotherapy drugs, anti-nausea medications, pain medications, and other medications your doctor prescribes as part of your cancer treatment. Different plans have different restrictions on which drugs they'll cover. How much does Medicare pay for cancer treatments? Before you visit any doctor for your cancer treatment, call their office and ask whether they ' accept assignment.' Doctors who accept assignment take the amount that Medicare pays, as well as your copayment, and consider that a 'full payment' for the services you receive. Doctors who have opted out of Medicare may bill more for your treatment than Medicare will cover, leaving you responsible for the remaining costs along with your copay. Here's what you need to know about Medicare costs. Part A Most people don't have to pay for Part A as long as they have worked and paid taxes in the United States for 10 years or longer. Those who must pay for Part A spend either $285 or $518 per month, depending on their work history. There's a deductible of $1,676, and once you've reached the deductible, Part A covers hospital and postsurgery rehab for 2 months. Beyond that, daily costs apply, and after 100 days, you must cover all expenses. For skilled nursing facility care, your extra daily costs start on day 21. Part B Monthly premiums for Part B start at $185 and increase depending on your income bracket. Once you meet the Part B deductible, which is $257 in 2025, Medicare will pay for 80% of any covered treatment or service. Part C Medicare Part C plans are provided by private insurance companies, and the premiums, deductibles, and coinsurance will vary depending on your specific plan. According to the Centers for Medicare & Medicaid Services, the average monthly premium for Part C plans is $17 in 2025. Part D Part D plans also come from private insurance companies. The national base beneficiary premium is $36.78 in 2025. In addition, the amount you pay out of pocket for prescriptions depends on the drug tier classified within the plan's formulary. The higher the tier, the more expensive the drug will be, even after coverage kicks in. How much will I pay out of pocket for my cancer treatment? The amount you'll pay out of pocket after your Medicare coverage kicks in depends on your plan as well as the type of cancer you have, how aggressive it is, and the treatment type your doctors prescribe. According to a 2021 research review, adults in the United States might pay anywhere from $180 to $2,600 per month for cancer care. And they might spend another $288 per month on cancer medications. If you enroll in Original Medicare, you can also sign up for a Medigap plan, which is another kind of insurance policy that can help cover your share of the cost after Original Medicare covers its share. But you'll have to pay a premium for Medigap, and that cost will vary depending on which of the 10 available plans you choose. According to a 2025 study, people with cancer who sign up for Part C plans have lower out-of-pocket costs than those who have Original Medicare without Medigap, saving a median of $668 and as much as $9,884 at the 95th percentile. However, people enrolled in Original Medicare who had high expenses for their cancer treatment still saved as much as $9,634 in some cases. Frequently asked questions Can Medicare refuse cancer treatment? Generally, Medicare should cover most treatments that are medically necessary. But if your treatment is denied, you can file an appeal. Is cancer insurance worth it with Medicare? Cancer insurance is a private health insurance plan specifically for cancer treatment. It's an additional, non-Medicare policy you can purchase to help you pay for cancer treatment costs. But whether it's worth buying depends on the added cost and the specific coverage of your plan. If you're at a higher risk of developing certain cancers that are associated with high treatment costs, you may want to consider it.
Yahoo
3 days ago
- Business
- Yahoo
Paytient Secures $40 Million from Trinity Capital to Fuel Market Expansion
Funding supports Paytient's rapid growth as cost-smoothing becomes a standard component of modern benefit design COLUMBIA, Mo., June 3, 2025 /PRNewswire/ -- Paytient, the healthcare payments company helping people better access and afford care, has secured $40 million from Trinity Capital, a trusted partner for innovative companies seeking tailored growth capital solutions. The facility will support Paytient's expansion into large group employer-sponsored plans, alternative health plans, the ACA marketplace, and Medicare, as plan-embedded out-of-pocket affordability or cost-smoothing solutions are becoming standard in health plan benefits. Paytient enables employers and insurers to transform how cost share responsibility feels for patients. As part of the health plan, Paytient enables people to easily access care from providers and manage out-of-pocket healthcare costs over time, without interest or fees. Paytient empowers members to confidently choose lower-premium plans by creating certainty that any healthcare expense that they need to self-pay will be more affordable. Paytient improves patient decision making, lowers premium costs and creates financial savings for employers. "This partnership allows us to scale faster and meet the growing demand from insurers and employers looking to offer smarter, more human-centered ways to help people navigate the cost of care," said Brian Whorley, founder and CEO of Paytient. "The last twenty years have been characterized by shifting responsibility to patients without a matching ability to pay for care. When ability to pay is part of the plan, you see better decision-making and a healthier health system in several important ways." Today, Paytient serves over 23 million members and partners with nearly 7,000 employers, insurers and providers, including major payers who now embed cost-smoothing into their plan designs as a standard affordability benefit. The company is riding several tides: The Medicare Prescription Payment Plan (M3P solution) gives every Part D beneficiary the ability to pay for care over time. Paytient is America's largest provider of M3P payment solutions, powering 40% of the Part D marketplace. A strategic partnership with HealthEquity that gives employees greater confidence to access and afford healthcare. Expansion of ACA marketplace partnerships, now active in 13 states, up from 8 in 2024—with a nationwide expansion in 2026 through a previously unannounced partnership with a major national insurer. "As healthcare costs continue to rise, Paytient is solving a critical pain point for both patients and the organizations that serve them," said Jack McNamara, Director of Tech Lending for Trinity Capital. "Their proven model, strong leadership, and rapid market traction position them well for long-term success." "Cost-smoothing isn't just a feature—it's a foundational shift in how we pay for care that creates a virtuous cycle of value creation within the system," said Whorley. "We're committed to making it a standard part of every health plan, no matter what kind of insurance someone has." About PaytientPaytient is transforming how Americans access and afford healthcare. The company provides employer- or health plan-embedded payment solutions that members can use to pay for out-of-pocket medical, dental, vision, pharmacy, and veterinary expenses. About Trinity CapitalTrinity Capital Inc. (Nasdaq: TRIN) is an international alternative asset manager that seeks to deliver consistent returns for investors through access to private credit markets. Trinity Capital sources, structures, and invests in well-capitalized growth-oriented companies. With distinct business verticals: Sponsor Finance, Equipment Finance, Tech Lending, Asset-Based Lending, and Life Sciences, Trinity Capital stands as a long-term trusted partner for innovative companies seeking tailored debt structures. Headquartered in Phoenix, Arizona, Trinity Capital's dedicated team is strategically located across the United States and in London (UK). For more information on Trinity Capital, please visit and stay connected to the latest activity via LinkedIn and X (@trincapital). View original content to download multimedia: SOURCE Paytient Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
Health Line
3 days ago
- Business
- Health Line
How Your Marital Status Affects Your Medicare Coverage
Your marital status can affect your Medicare coverage, eligibility, and costs. Understanding the role of marriage in Medicare can help you plan your healthcare for yourself and your spouse. In general, you qualify for Medicare if you are over 65 or younger but living with certain disabilities. You must also have worked in the United States and paid taxes for at least 10 years. If you meet these criteria, your legal spouse may also qualify for Medicare even if they do not meet the criteria. This article discusses the rules of eligibility for Medicare based on having a spouse who qualifies for the program, as well as considerations regarding coverage, costs, and changes in marital status. How does marital status affect Medicare eligibility and benefits? To be eligible for Medicare Part A benefits based on your spouse, you must have been married to a spouse eligible for Social Security benefits for at least 1 year before applying for those benefits. Once you qualify for Medicare Part A, you are also eligible to enroll in Part B and Part D. In addition, you can choose to enroll in Medicare Advantage (Part C) instead of Original Medicare (Parts A and B). Once you enroll, both you and your spouse are eligible for all the benefits of Medicare. How does marital status affect Medicare costs? For Medicare Part D, you'll each need to meet a deductible of $1,676 before coverage will apply. If you or your spouse worked and paid taxes for the required period, there's no premium for Part A. If you worked 30 to 39 quarters, you can buy Part A for $285 each, monthly, in 2025. Working less than 30 quarters results in a $518 premium for each spouse. For Part B, each spouse pays an individual premium starting at $185 each, depending on income. The same structure applies to Part D, Part C, and Medigap plans, with private insurers setting their premiums and deductibles. Each spouse must choose their separate plan and meet their individual deductible. How does marriage affect Medicare income limits? Your Part B and D premiums may be higher depending on your income and whether or not you are filing taxes jointly. The following chart summarizes the income tiers and their equivalent Medicare Part B and Part D premiums. Income (married and filing jointly) Income (married and filing separately) Part B premium Part D premium $212,000 or under $106,000 or under $185 your plan's base premium $212,000 to $266,000 not applicable $259 +$13.70 $266,000 to $334,000 not applicable $370 +$35.30 $334,000 to $400,000 not applicable $480.90 +$57 $400,000 to $750,000 $106,000 to $394,000 $591.90 +$78.60 $750,000 or above $394,000 or above $628.90 +$85.80 Medicare Savings Programs and Extra Help Medicare savings programs (MSPs) can help you cover the costs of Part A and B premiums, deductibles, copays, and coinsurance. To be eligible, your monthly income and household resources must not exceed certain limits as follows: Note that Medicare typically defines resources as funds in checking, savings, or retirement accounts, stock investments, or bond holdings. Some states may exclude certain things from counting as assets. These include: your residence a single vehicle a burial plot up to $1,500 earmarked for burial expenses from Social Security furniture other personal and household belongings Like MSPs, the Extra Help program, also called the Part D Low Income Subsidy, offers financial assistance for prescription medications. Eligibility for this subsidy depends on income and economic necessity. The married income and asset thresholds to qualify for Extra Help are: How does divorce or death affect Medicare coverage? If you are divorced, you can still qualify for Medicare based on your former spouse's eligibility for Social Security benefits if you were married for at least 10 years. Similarly, if you're widowed, you must have been married for at least 9 months before your spouse's death, and they must have been eligible for Social Security benefits. You must also be single now. Whether or not you have to pay a premium for Part A with your former spouse will depend on the exact length of time they worked and paid taxes. Can one spouse be on Medicare and the other not? Eligibility for Original Medicare is automatic for both of you as long as your spouse is eligible. That said, Medicare enrollment is not necessarily automatic. If you don't qualify for Medicare yourself but your spouse receives benefits from the Social Security Administration (SSA) or Railroad Retirement Board (RRB), you may be eligible for premium-free Part A. However, you'll have to enroll manually. You'll be enrolled automatically only if you are receiving these benefits yourself. After enrollment, you'll both receive your Medicare cards 3 to 4 months before the birthday of the qualifying spouse. Note that while Medicare Part A is mandatory, Part B is not. You have the option to cancel Part B if you do not need it. If your spouse qualifies solely by age, manual enrollment is required, and you can choose not to enroll in Part B or Part D. That said, delaying enrollment can result in a late fee if you don't qualify for a special enrollment period. In addition, if your spouse qualifies by age and you have employer group insurance, you can usually keep your group plan, with Medicare as a secondary payer for costs not covered by your employer's insurance. Special enrollment periods for married couples Generally speaking, there are only specific periods during which you can enroll in Medicare or switch Medicare plans without a penalty. These are known as Medicare enrollment periods. However, you can enroll outside of these periods in certain situations, including when you undergo a qualifying life change, such as a divorce or the death of a spouse. Takeaway Because the rules around Medicare in relation to marriage can be complex, it's essential to educate yourself thoroughly about your eligibility and that of your spouse. Generally, Medicare is for those over 65 or with specific disabilities who have worked in the U.S. for at least 10 years, along with eligible spouses. That said, special rules may apply for eligibility and enrollment following a divorce or a spouse's death. Your enrollment options include Original Medicare, Part D, Medicare Advantage (Part C), and Medigap. Spouses pay separate premiums for each Medicare part. These premiums can be affected by a couple's total income and their joint or separate tax filings. Financial assistance programs like Medicare Savings and Extra Help can help you pay for Medicare costs, but eligibility for these can also depend on your total married income and resources.
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.
