What is a Medicare Supplement Guaranteed Issue plan?
The Guaranteed Issue Rights (also known as Medigap Protections) are your rights when insurance companies are required to offer you certain Medigap policies. In these situations, an insurance company: – Must sell you a Medigap policy – Must cover all your pre-existing health conditions – Can’t charge you more for a Medigap policy because of […]
Medicare Treatment for Alcoholism and Substance Use Disorders
Mental illness and substance abuse disorders are covered by Medicare, but special rules limit coverage and reimbursement. Mental health, behavioral health, and substance abuse disorders are not as well covered by Medicare as other services. Treatment for Alcoholism and Substance Use Disorders Alcoholism and substance use disorders can be treated both inpatient and outpatient under […]
Does Medicare Have a Flex Card for Seniors?
A flex card is a debit card beneficiaries can use to purchase medical items and equipment. The cards are typically associated with flexible spending accounts and are available to health plans throughout the country. Insurance companies issue these cards on specific plans only. Moreover, each card has a different spending limit. The flex card benefit […]
“Skinny Labeling” and Medicare
“Skinny labeling” is a practice by which follow-on drug manufacturers seek approval for some but not all indications for which branded drugs are approved. Medicare saved $1.5 billion between 2015 and 2020 as a result of competition between five biologic drugs and their skinny-label biosimilars. Recent judicial rulings are threatening these savings for Medicare and […]
Medicaid and Medicare Integration
The Federal Coordinated Health Care Office (Medicare-Medicaid Coordination Office) serves people who are dually enrolled in both Medicare and Medicaid, also known as dually eligible individuals or Medicare-Medicaid enrollees, to make sure dually eligible individuals have full access to seamless, high-quality health care and to make the system as cost-effective as possible. The goals of […]
Getting Reimbursed by Medicare
Medicare beneficiaries are generally not required to submit claims to get reimbursed. You may, however, need to pay for medical services at the time of service and file for reimbursement later. Typically, Medicare reimbursements are filed by Medicare providers and suppliers who send Medicare claims. If you do need to file for reimbursement from Medicare: […]
What is the Medicaid 5 year look back penalty?
Using the Medicaid 5-year lookback, the government ensures that you have not given away your resources or money. The law attempts to prevent schemes in which the government pays for a senior’s care instead of them using their own funds or assets. Medicaid helps pay for long-term care, but it requires you to exhaust your […]
Seven life-changing events that can exempt you from Medicare premium surcharges
Seven qualifying life-changing events can help you avoid Medicare premium surcharges if your income has decreased. These events include death of a spouse, marriage, divorce or annulment, work reduction such as switching to part-time employment, work stoppage from retirement or layoffs, loss of income from property due to disasters or theft, and loss of pension […]
What is Medicare Payment Advisory Commission (MedPAC) ?
The Medicare Payment Advisory Commission (MedPAC) is a nonpartisan, independent legislative branch agency that provides the U.S. Congress with analysis and policy advice on the Medicare program. In 1997, Congress created the Medicare Payment Advisory Commission (MedPAC) as an independent congressional agency to advise it on Medicare issues. Additionally, MedPAC advises Congress on Medicare’s traditional […]
Medicare Coverage Gap changes for 2026
Big changes continue for Medicare drug coverage in 2026. The coverage gap, also known as the donut hole, was officially eliminated on December 31, 2024. For 2026, Medicare Part D plans include a $2,050 annual cap on out-of-pocket costs for covered prescription drugs. Once you spend $2,050 out of pocket, including certain payments made on […]