CDISNM Blog
After age 50, men have an increased risk of developing certain cancers, like prostate and colorectal cancer. Colorectal cancer is the number two leading cause of cancer-related deaths—and risk only goes up with age according to cancer.org. Men also have higher rates than women for heart disease, diabetes, and stroke, three of the top 10 causes of death. Luckily, regular screening tests are the most effective way to reduce risk. For men on Medicare, being proactive about health is easy, as the program covers many preventive services and screenings at little or no cost. Here’s some information on men’s health and Medicare, and how you can benefit from the program.
Medicare covers a variety of preventive services and tests designed to identify problems early when treatment can work the best. Some of the services men can take advantage of right now include:
Prostate and colorectal cancer screenings
Diabetes screenings
Cardiovascular screenings
Prostate and Colorectal Cancer Screenings Medicare Part B covers a variety of prostate and colorectal cancer screening tests to help identify precancerous growths when treatment is most effective. A digital rectal exam is covered (less deductible and coinsurance) once every 12 months to detect prostate cancer. Medicare also pays for a prostate-specific antigen (PSA) test at 100 percent, at no cost to you. Men who are considered high risk for colorectal cancer can receive a colonoscopy test and enema paid in full every 24 months, or every 48 months for those of average risk. The average risk for developing colorectal cancer means no personal or family history of polyps, inflammatory bowel disease, or hereditary colorectal cancer. In addition, Medicare Part B pays for a multi-target DNA stool test every 3 years and a fecal occult blood test annually. While most screenings are covered 100 percent, if a biopsy or removal is required, you may be responsible for a copay or coinsurance.
Diabetes Screenings Medicare Part B covers the full cost of screenings to check for diabetes at 100 percent. Men who are considered high-risk are eligible for 2 screenings per year. High-risk factors include the following:
High blood pressure
History of abnormal cholesterol and triglyceride levels
Obesity
History of high blood sugar
You may also receive 2 tests per year if any 2 of the following apply to you:
Over 65 years old
Overweight
Family history of diabetes
History of gestational diabetes
Cardiovascular Screenings and Stroke Prevention Medicare Part B also covers screening blood tests for cholesterol, lipid, and triglyceride levels at 100 percent every 5 years. These screenings are an important part of detecting conditions that may lead to a heart attack or stroke. Your doctor may recommend more tests than Medicare covers. Be sure to ask questions to understand why your doctor is recommending services, and if Medicare will pay for them or if you will be responsible for paying all or some of the costs.
References:
https://www.medicare.gov/coverage/colorectal-cancer-screenings.html
https://www.medicare.gov/coverage/prostate-cancer-screenings.html
https://www.medicare.gov/coverage/diabetes-screenings.html
https://www.medicare.gov/coverage/cardiovascular-disease-screenings.html
https://www.cancer.org/cancer/colon-rectal-cancer/about/key-statistics.html
MUC64-2017-BCBS
CDISNM Blog
As you approach age 65, you may be worrying about how you will handle unexpected medical costs. Luckily, Medicare can help. Understanding your options, and what is available to you can help you manage your health expenses as you age. There are only two ways to get Medicare coverage for things like doctor visits, outpatient care, and inpatient hospital care—through Original Medicare (Part A and Part B) or a Medicare Advantage Plan. The costs associated with each vary considerably, and the choices you make directly influence how much you will pay out-of-pocket for coverage.
Medicare Costs in 2024
The exact amount you pay for Medicare coverage is based on several factors, including your income. Original Medicare typically carries a monthly premium along with a few other out-of-pocket expenses, such as a deductible, coinsurance, and copay. While there are five different income tiers used to calculate costs, Part A is typically free for most people. Part B is not, and carries a standard premium of $174.70 per month. There is also a Part B deductible of $240 per year. Once this is met, you can expect to pay a copay for most doctor services, outpatient therapy, and durable medical equipment equal to 20 percent of Medicare-approved costs.
Seniors who choose a Medicare Advantage plan (also known as “Part C”) over Original Medicare receive their Part A and Part B benefits, along with a few extras, such as dental, vision, and often, prescription drug coverage. Most MA plans carry a monthly premium for the plan, in addition to the standard monthly premium for Part B benefits. Costs associated with Medicare Advantage vary by plan. Some plans pay a portion of your Part B premium. Some plans charge yearly deductibles, regular copays, and coinsurance, while others do not.
How You Pay for Medicare
Whether you have Original Medicare or a Medicare Advantage Plan, if you receive Social Security benefits, Railroad Retirement benefits, or Office of Personnel Management benefits, your Part B premium will be deducted automatically each month from your benefits check. If you do not receive these benefits, you will receive a bill for Medicare coverage. If you have a Medicare Advantage plan with a monthly premium, you can expect to be billed separately by the insurance company that provides your Part C coverage. If the plan requires you to pay a Part B monthly premium, it is usually deducted automatically from your benefits check. Again, in 2024, most Original Medicare recipients pay the standard Part B premium amount, and you can expect $174.70 to be taken from your benefits check. Retirees with higher incomes pay a higher premium, calculated using the modified adjusted gross income on the most recent tax return.
Financial Help Is Available
The good news is, that there are several programs available to help people with limited income and resources get the coverage they need and deserve.
Medicaid is a joint federal/state program that helps pay for medical costs for people with limited income and resources. In many cases, Medicaid offers additional benefits not provided by Medicare, such as nursing home care and prescription drug coverage. Eligibility rules differ by state. Be sure to call your state Medicaid program to see if you qualify.
State Medicare Savings Programs were created to help seniors pay for premiums and out-of-pocket costs like deductibles, coinsurance, copays, and even prescription drug coverage costs. Eligibility is based on income.
The PACE program was created to help elderly seniors in need of nursing home-level care receive services at home or in a PACE center rather than at a nursing home or elder care facility. To qualify, you must be at least 55 years old, live in the service area of a PACE organization, and need nursing home-level care. PACE often covers dental care, prescription drugs, meals, preventive care, emergency services, and more.
If you qualify for Medicaid, you pay nothing for PACE coverage. If you do not qualify for Medicaid, you pay a monthly premium for prescription drugs along with a monthly premium to cover the costs of long-term care. However, there is no deductible or copayment.
Extra Help paying for prescription drug coverage is available for those who meet certain income and resource limits. If you qualify, you may pay a reduced amount for your Medicare drug plan premium and deductible.
References:
Medicaid:
https://www.medicare.gov/your-medicare-costs/help-paying-costs/medicaid/medicaid.html
Medicare Savings Program
https://www.medicare.gov/your-medicare-costs/help-paying-costs/medicare-savings-program/medicare-savings-programs.html
PACE
https://www.medicare.gov/your-medicare-costs/help-paying-costs/pace/pace.html
Extra Help with Part D
https://www.medicare.gov/your-medicare-costs/help-paying-costs/save-on-drug-costs/save-on-drug-costs.html
https://www.medicare.gov/your-medicare-costs/
https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.html
https://www.medicare.gov/your-medicare-costs/part-a-costs/part-a-costs.html
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CDISNM Blog
Diabetes is one of the most common health conditions among seniors, impacting 25.2 percent of adults over age 65. Millions more are underdiagnosed or living with pre-diabetes. Original Medicare covers free diabetes screenings for those who are at risk and pays for many services and supplies for those who currently have the disease. If you have recently been diagnosed, and you’re wondering what to expect from your Medicare coverage.
Diabetic Supplies and Services
Medicare Part B covers blood sugar self-testing equipment and supplies including glucose testing monitors and test strips, lancet devices, lancets, and glucose control solutions for testing the accuracy of testing equipment. There may be limits to how much or how often you can get these supplies, and you may be required to use specific suppliers. If you use insulin, you may be able to get more test strips and lancets than someone who does not use insulin. Part B also covers foot exams and treatment (including therapeutic shoes or inserts), yearly eye exams and glaucoma tests, insulin pumps and the insulin used by the device, nutritional therapy services, and diabetes self-management training to help you learn how to better manage your disease.
Factors That Influence Cost
The amount that you need to pay for many of these services and supplies varies. However, some factors can influence your cost. For instance, where you receive treatment, and whether or not your doctor accepts Medicare assignment can impact your cost. Note: Medicare does not cover all recommended diabetes treatments. If your doctor suggests you receive additional supplies or services beyond what Medicare covers, you may have to pay some or all of those costs.
National Mail Order Program
As long as you use a Medicare national mail-order contract supplier, you can have important diabetes testing supplies delivered right to your home. Medicare pays for test strips and lancets to be sent to you by mail. Or, you can pick them up locally at a drug store near you. In either case, you pay the same, whether you receive your testing strips in the mail or purchase them elsewhere. Local stores that accept Medicare assignments cannot charge more than your 20 percent coinsurance, and any unmet deductible.
References:
https://www.medicare.gov/coverage/diabetes-supplies-and-services.html
https://www.medicare.gov/Pubs/pdf/11022-Medicare-Diabetes-Coverage.pdf pg. 6, 7, 8, 10, 11
https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf pg. 2
MUC64-2017-BCBS
CDISNM Blog
There’s no question, that navigating the world of Medicare can be complicated, time-consuming, and frustrating. With many different options, varied plans, enrollment rules, and more, it’s easy to make mistakes. Errors can be costly, which is why it’s so important to understand common pitfalls. Here are the top ten Medicare mistakes, and how to avoid them.
1. Failing to Sign Up When You Are First Eligible
With more people working beyond the age of 65, it’s not uncommon to delay signing up for Medicare—and that’s okay. As long as you have health coverage after age 65 through an employer or a spouse, you can delay enrolling in Medicare without paying a penalty. However, if you do not have group coverage, the right time to sign up is during your Initial Enrollment Period. This is the seven-month period of time that begins three months before your 65th birthday and ends three months after. There are also Special Enrollment Periods for those with unique circumstances, such as losing their job. The important thing to remember is that if you fail to sign up for Medicare when you are first eligible and delay Part B enrollment without proof of other health coverage, you could end up having a lifetime late enrollment penalty added to your premium.
2. Not Taking Advantage of Annual Enrollment
Medicare Annual Enrollment takes place each year between October 15 and December 7. This is the time for everyone to evaluate their current Medicare plan to see if changing plans makes sense. Cost and coverage can vary from year to year, and taking the time during Annual Enrollment to review your plan is smart.
During Annual Enrollment, you can switch from your Original Medicare to a Medicare Advantage Plan, switch from one Medicare Advantage Plan to another, or return to your Original Medicare. You can also join a prescription drug plan, change plans, or drop one that no longer meets your needs. Not taking advantage of this opportunity means you could end up paying more for your plan or keeping a plan that doesn’t fit your changing needs.
3. Thinking You Don’t Need Prescription Drug Coverage Because You Don’t Take Medicine
One of the biggest mistakes people make concerning Medicare is failing to think ahead. If you are healthy and do not take prescription medication, great! However, if you wait to sign up for Part D benefits until you urgently need them, you risk paying a late penalty if you cannot provide proof of creditable coverage for the time you went without.
4. Choosing a Prescription Drug Plan Based on Cost Alone
Cost is a primary consideration when choosing the right Medicare plan. However, with drug coverage, it is often as important to ensure the drugs you use are on the formulary. If you choose a plan based on cost alone and your medication is not listed, you may end up paying much more for what you need.
5. Thinking You Have More Time to Enroll in Part B With COBRA Benefits
After you turn 65, Medicare becomes your primary coverage, unless you have coverage through an employer. However, the coverage must be current, and COBRA benefits or retiree benefits are not coming from a job you still work, and are not considered primary coverage.
COBRA benefits extend an employer’s health care benefits for eighteen months. However, you only have eight months, not eighteen months after your group coverage ends to sign up. If you do not sign up for Medicare during this time, you will have gaps in your coverage and may be responsible for paying a late enrollment penalty.
6. Choosing the Same Plan as Your Spouse
It’s important to realize that you and your spouse likely have very different healthcare needs. When choosing a Medicare plan, whether it’s for prescription drug benefits or Original Medicare, be sure to think about your unique needs and how the plan you’re considering can help you with your medical needs.
7. Waiting Too Long to Enroll in Medicare Supplement Insurance
The good news is, that you have a full six months after enrolling in Part B to join a Medigap plan with full protections in place. All recipients who join Medigap during this period are entitled to “guaranteed issue rights”. This means that no company can refuse to sell you a plan or charge you more for a plan because you have a pre-existing condition. Once these six months end, these protections are no longer in place and you may not be able to get a Medigap plan.
8. Forgetting to Review Your Annual Notice of Change
The Annual Notice of Change that comes by mail each year is filled with critical information on any changes you will see in your Medicare coverage for the upcoming year. Changes in cost, network providers, and even formularies (list of covered drugs) must be noted in this documentation. Read it fully to avoid being surprised by higher out-of-pocket expenses or limited access to health care providers.
9. Not Taking Advantage of Extra Help
Medicare has safeguards in place to help those with limited income afford prescription drug coverage. Unfortunately, many Medicare recipients are not aware that they qualify, and could save money on the same plans they pay for each month. Be sure to read about extra help and make notes on whether or not you are entitled.
10. Going Out-of-Network with a Medicare Advantage Plan
Medicare Advantage makes it easy for seniors to receive all of their Part A and Part B benefits as well as a few extras like prescription drug benefits and in some cases, vision and dental care. However, most plans have very strict requirements regarding network providers. Going to a doctor or hospital outside the plan’s network of providers could end up costing you a lot more out-of-pocket.
References:
Delaying Part B
https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/should-you-get-part-b/should-i-get-part-b.html#collapse-3156
Special enrollment periods
https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/when-sign-up-parts-a-and-b/when-sign-up-parts-a-and-b.html
Open Enrollment
https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/when-can-i-join-a-health-or-drug-plan.html#collapse-3190
Part D Late Enrollment
https://www.medicare.gov/part-d/costs/penalty/part-d-late-enrollment-penalty.html
Medicare and other insurance
https://www.medicare.gov/supplement-other-insurance/how-medicare-works-with-other-insurance/how-medicare-works-with-other-insurance.html
When to buy Medigap
https://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/when-can-i-buy-medigap.html
MUC68-2017-SSI:CDIS
CDISNM Blog
If you rely on various medications to maintain your health, it’s good to know that you can secure benefits through a Medicare Prescription Drug Plan, or Part D. But different plans cover different drugs, and it’s sometimes challenging to find a plan that covers the specific medications you use. Here’s some guidance on how to find out if your drugs are covered and what to do if they aren’t covered.
Check the Formulary
Each Medicare drug plan has its list of covered drugs, called a formulary. In most cases, covered drugs are classified into tiers, with drugs in the lowest tier costing less than those in higher tiers. If you are interested in joining a Part D plan, be sure to review the formulary to ensure your drugs are on the list. Remember, each plan is different, with different formularies. If you don’t see your drugs listed, check another plan. Formularies often change yearly, meaning your drugs may no longer be available next year, even if they are covered this year. Sometimes, covered drugs change tiers, or move between classifications. Even if you are happy with your Part D coverage, you must review your plan’s Annual Notice of Change, along with the formulary for the upcoming year to avoid being surprised at the pharmacy.
Some Drugs are Covered By Original Medicare
In some cases, Original Medicare covers drugs that Part D does not. For instance, vaccines, cancer drugs, and certain injectable prescription drugs are covered under Medicare Part B if you receive them in an outpatient setting, like your doctor’s office.
Some Drugs are Not Covered By Medicare
It’s important to know which medicines may be covered under your Medicare health plan, and which are not. Neither Original Medicare nor Medicare Part D provides benefits for over-the-counter drugs. For instance, cough and cold medicine, vitamins, medication for hair growth, and medication designed to treat sexual dysfunction are not covered.
What to Do If Your Drugs Are Not Covered Under Medicare
In the event you realize your drugs are not covered under a current Part D plan or Original Medicare, there are a few things you can do.
Ask your doctor if there are substitutes available. In many cases, formularies do not cover brand-name drugs but do offer coverage for generic, or low-cost alternatives. You can also ask your doctor if there is another drug that may work the same as one that is not available through your Part D.
Request a formulary exception. Medicare is open to listening to your doctor if he or she believes that a specific drug is the only medication that will help your condition. A formulary exception may be granted if your doctor and Medicare agree that the drug is medically necessary for your health. You also have the right to file an appeal should Medicare deny your request for a formulary exception.
Switch to a new Part D plan. Each plan is different, and your drugs may be covered under a different plan’s formulary. If your current plan no longer covers your medication, and you find a new plan that does, you can switch during the Annual Enrollment Period (October 15- December 7) each year.
References:
https://www.medicare.gov/part-d/coverage/part-d-coverage.html
https://www.medicare.gov/part-d/coverage/rules/drug-plan-coverage-rules.html
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