Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to Medicare three sixty, where the world of Medicare
is simplified and you are empowered to make informed healthcare choices.
With over two decades of experience and insurance and financial
solutions with host licensed insurance agents Jennifer Lee, you are
guided through the ins and outs of Medicare, whether you
(00:22):
are nearing retirement, navigating your options, or just curious about
what's available. Everything you need to know is covered. Tune
in for knowledgeable insights, tips and answers to your Medicare
questions so you can take charge of your health and
your future. And Now Medicare three sixty.
Speaker 2 (00:45):
Welcome to today's Medicare three sixty show. I'm your host,
Jennifer Lee, and we are getting started with finding out
what Medicare covers in a Medicare New Handbook five. So
we are going to begin with page fifty today. Rural
(01:08):
health clinic services. Rural health clinics provide many outpatient primary
and preventive services in rural and underserved areas. Generally, you
pay twenty percent of the charges. The part be deductible applies.
You pay nothing for most preventive services. Second surgical opinions
(01:30):
Medicare covers a second surgical opinion in most cases for
medically necessary surgery that isn't an emergency. In some cases,
Medicare covers third surgical opinions. Pay twenty percent of the
Medicare proved amount. The Part B deductible applies preventive services.
(01:52):
Sexually transmitted infection STI.
Speaker 3 (01:54):
Screenings and counseling.
Speaker 2 (01:57):
Medicare covers STI screens for chlamydia, gonorrhea, syphilis, and or
hepatitis beed. Medicare covers these screenings if you're pregnant or
increase risk for an STI. When you're a primary care
doctor or other healthcare provider orders the test, Medicare covers
these tests once every twelve months or at certain times
(02:19):
during pregnancy. Medicare also covers up to individual twenty to
thirty minute face to face high intensity behavioral counseling sessions
each year. If you're a sexually active adult at increase
risk for STIs. Medicare will cover these counsing sessions with
(02:41):
a primary care doctor or healthcare provider in a primary
care sitting like a doctor's office. Medicare won't cover counseling
as a preventive service as an inpatient setting like a
skilled nursing facility. Yeah, I think sometimes seniors are very
active in those facilities. You pay nothing for these services.
(03:04):
If your primary care doctor or provider accepts assignment shots
or vaccines part be covers. Flu shots go to page
forty one. Hepatitis B shots go to page forty two.
There's just an outbreak of that if you haven't heard lately.
And monocal shots go to page four forty eight. Coronavirus
(03:25):
disease twenty nineteen, COVID nineteen vaccines.
Speaker 3 (03:29):
Go to page thirty seven.
Speaker 2 (03:31):
So important. Through March thirty first, twenty twenty five, you
could get telehealth services at any location in the US,
including your home. Starting April first, twenty twenty five, you
must be in an office or medical facility located in
a rural area in the United States first most telehealth services, However,
(03:52):
you still could get Medicare telehealth services without being in
a rural healthcare setting. Include monthly and stage renal disease
YESRD visits for home dialysis. Services for diagnosis, valuation, or
treatment of symptoms of an acute stroke whether you are
(04:14):
including a mobile stroke unit. Services for the diagnosis evaluation
or treatment of a mental and or behavioral health disorder,
including a substance use disorder in your home. You pay
twenty percent of the Medicare.
Speaker 3 (04:33):
Where is that you pay?
Speaker 2 (04:37):
Where am I at? Sorry? Let's start over again. So important.
Medicare Drug Covered Part D generally covers all other adult
immunizations recommended by the Advisory on Immunization Practices to protect
(05:04):
you from diseases like shingles to tetanus, diphtheria purchases, and
respiratory sync Deo virus RSV at no cost to you.
If the shot isn't on your plans drug list yet,
you can ask for coverage and a coverage exception or
(05:25):
get reimbursed. Contract your plan for details, and talk to
your doctor or other healthcare provider about which vaccines are
right for you. To learn more about cover vaccines, visit
medicare dot gov slash coverage. Hey, we're a page fifty one.
Medicare covers medically necessary evaluation and treatment to regain and
(05:47):
strengthen speech and language skills. This includes cognitive and swallowing
skills to improve or maintain current to maintain current function
or slow decline. When your doctor other healthcare provider certifies
you need it, You pay twenty percent of the Medicare
(06:09):
proved amount. The Part B deductible applies surgical addressing services.
Medicare covers medically necessary treatment of a surgical or surgical
treated wounds. You pay twenty percent of the Medicare proved amount.
For your doctor or other healthcare provider services. You pay
a set co payment for these services when you get
(06:32):
them in a hospital outpatient setting. The Part B deductible
applies telehealth. Medicare covers certain telehealth services you get from
a doctor or other healthcare provider who's located somewhere else
using technology to communicate with you in real time. Important
Through March thirty first, twenty twenty five, you get telehealth
(06:54):
services at any location in the US, including your home.
Starting for April twenty twenty five, USB in Office are
medically facility located in rural areas in the US for
most telehealth services. However, you can still get Medicare telehealth
services without being in a rural area setting, including monthly
(07:16):
and stage junal disease visits for home dialysis services for diagnostics, valuation,
or treatment symptoms of an acute stroke. Wherever you are,
including a mobile stroke unit, services for diagnosis, evaluation, or
treatment of a mental or behavioral health disorder, including a
substance use disorder in your home. You know, I totally
(07:37):
apologize I read this again.
Speaker 3 (07:42):
But hey, sometimes you want to just listen to it twice.
Speaker 2 (07:45):
Okay, So you pay twenty percent of the Medicare approved
amount for your doctor, other healthcare provider, or practitioner services.
The part B deductible applies for most of these services.
You pay the same amount you would uh if you
got the services in person. Compare Medicare advantage plants and
some providers in original Medicare may offer more telehealth benefits
(08:09):
and the basic coverage and original Medicare, for.
Speaker 3 (08:11):
Example, you may be able to get.
Speaker 2 (08:13):
Some services from home no matter where you live. If
your provider an Original Medicare, participates in an accountable care organization,
check with them to find out what telehealth benefits may
be available. Go to pages one ten to one eleven
for more information about acos. So keep in mind maybe
(08:37):
you were doing telehealth visits with your doctors in the past.
Make sure that it is covered, because I am hearing
some of my clients complain that now it's no longer covered,
or the doctor won't do it because it's not covered
by Medicare, so just make sure it is covered if
that happens. Test non laboratorycare covers X rays, MRIs, cat scans, EKGs, ECGs,
(09:06):
and some other diagnostic tests. You pay twenty percent of
the Medicare proved amount. The Part B deductible applies. Okay,
if you get the test at a hospital as an outpatient,
you also pay the hospital a co payment that may
be more than twenty percent of the Medicare proved amount.
Most cases, this amount can't be more than the Part
(09:28):
A hospital stay deductible. Go to the laboratory tests on
page forty four for other Part B cover tests. Transitional
care management services. Medicare may cover this service if you're
returning to your community after an impatient stay at certain
facilities like a hospital or a skilled nursing facility. The
(09:49):
healthcare provider who's managing your transition back into the community
will work with you and your caregiver to coordinate and
manage your care for the first thirty days after you
retur turn home. The Part D deductible and co insurance apply.
Visit Medicare dot gov. Sauce coverage, so's transitional dash care,
dash management, dash services to learn more transplants and immunosuppressive drugs.
(10:15):
Medicare covers doctor services for how hearts, long kidney, pancreous
and testine, testine and liver transplants under certain conditions, but
only in Medicare certified facilities. Medicare also covers bone, marrow
and cornea transplants under certain conditions. Medicare covers m no
(10:38):
suppressive drugs. If Medicare paid for the organ transplant, you
must have Part A the time of the covered organ transplant,
and you must have Part B at the time you
get IMMA nos re separate uh oh my gosh, imma
no suppressive drugs, immuna expressive drugs, or call five for
(11:00):
the immunosuppressive drug benefit described on this page. You pay
twenty percent of the Medicare proved them out for the drugs.
The Part B deductible applies. Keep in mind Medicare coverage
Part D covers immunospress suppressive drugs if Part B doesn't
cover them. If you're thinking about joining a Medicare advantage
plan and are on a transplant waiting list or think
(11:23):
you need a transplant. Check with the plan before you're
joined to make sure your doctors and other healthcare providers
and hospitals are in the plans network. Ask for information
about covered drugs and their costs. Also check the plans
coverag rules for prior authorization and coverage for your living donors.
Medicare may cover transplant surgery as a hospital and patient
(11:47):
surgery under Part A. Go to page twenty seven to
twenty eight. Medicare pays a full cost of care for
your kidney donor, and you and your donor won't have
to pay to reductible co insurance need other costs for
the hospital stay. Immunosuppressive drug Benefit. If you only have
(12:09):
Medicare because of ND stage unal disease, your Medicare coverage,
including immunosuppressive drug coverage, ends thirty six months after successful
kidney transplant. Medicare offers a benefit to help you pay
for your immunosuppressive drugs beyond thirty six months. If you
don't have certain types of other health coverage like a
(12:29):
group health plan, trycare or Medicaid that covers immunosuppressive drugs,
this benefit only covers your immunosuppressive drugs and no other
items or services. Okay, it isn't a substitute for health coverage.
You can assign up for this benefit any time after
(12:52):
your Medicare Part A coverage ends, as long as you
had Medicare because of ESRD at the time of your
kidney transplant. To sign up, call Social Security eight seven
seven four six five oh three fIF five to five,
or you could call eight hundred through two five oh
seven eighty eight. You'll pay a monthly premium of one
(13:14):
hundred and ten dollars and forty cents a higher base
of your income, and two hundred and fifty seven dollars
deductible for immunosuppressive drug benefit in twenty twenty five. Once
you met the deductible, you pay twenty percent of the
Medicare proved amount for immunosuppressive drugs. If you have limited
income and resources, you may able to get help from
(13:35):
your state to pay for this benefit. Go to page
ninety four or visit Medicare dot gov, slash basics, slash
and stay Eage Renal Disease to learn more. Travel. Medicare
generally doesn't cover healthcare while you're traveling. Outside the US.
The US includes the fifty Staints, the District of Columbia,
Puerto Rico, the US Virgin Islands, Guam, the Northern Mariana Island,
(14:00):
and American Samoa. There are some limited exceptions. Visit medicare
dot gov slash coverage travel offside in the United US
to learn more. Medicare may cover medically necessary ambulance transporation
to a foreign hospital only with emission. For a medically
necessary covered and patient hospital service, you pay twenty percent
(14:22):
of the Medicare pood amount the part B deductible applies.
Speaker 3 (14:28):
Okay, yeah, keep this in mind.
Speaker 2 (14:30):
If you are on original Medicare, it generally doesn't cover
the healthcare outside the US. Of course, if you do
get a supplemental plan. These plans typically have a fifty
thousand dollars lifetime maximum. You do have debate, a deductible
and the co insurance for that. On Medicare advantage plans,
(14:51):
typically you don't. You might have a deductible or a copay,
but it is covered. Some plans have unlimited coverage. Some
plan have a certain coverage limit. Okay. Urgently needed care.
Medicare covers urgently needed care to treat a sedd in
(15:14):
illness or injury that isn't a Medicare emergency. You pay
twenty percent of the Medicare proved amount for your doctor
other healthcare provider services, a co payment and an outpatient setting.
The part B deductible applies. Virtual check ins. Medicare covers
virtual check ins in with your doctor certain other providers
(15:36):
virtually check and allows you to briefly communicate with your
healthcare providers using audio or video communication technology like your
phone or a computer without getting to the doctor's office.
Your doctor can also conduct remote assessments using photo or
video images you send for a review to determine whether
you need to go to the doctor's office. Your doctor
(15:56):
other provider can respond to you by phone, virtual deliver
very secure test message, email, or patient portal. Virtual checks
are different from telehealth visit because they're usually ten minutes
or less and aren't done in real time, and also
have a virtual check in. If you meet these conditions,
you talk to your healthcare provider about starting these type
(16:18):
of visits. You virtually consent to the virtual check in,
and your doctor documents your consent and your medical record.
Your doctor may get one consent for a year's work.
For these services. The virtual check in doesn't relate to
a medical visit you had within the past seven days,
and it doesn't lead to the medical visits within the
next twenty four hours or the soonest appointments available. Okay,
(16:44):
we're at page fifty four. Compare you pay twenty percent
of the Medicare proved amount for your doctor or other
healthcare provider services. The Part B deductible applies. Medicare advantage
plans may offer some virtual check in services, then original Medicare.
Check with your plan to find out what they offer.
(17:05):
Preventive services Welcome to Medicare Preventive Visit. During the first
twelve months that you have Part B you can get
a Welcome to Medicare Preventive visit. The visit includes a
review of your medical and social history related to your health.
It also includes education and counseling about preventive services, including
certain screening shots or vaccines like CLUE, pneumoniacle and other
(17:30):
recommended shots or vaccines, and referrals for other care if needed.
When you make your appointment, let your doctor's office know
you'd like to schedule your Welcome to Medicare Preventive visit.
You pay nothing for the welcome to Medicare preventive visit
if the doctor other qualified healthcare provider accepts assignment. If
(17:52):
you have a current prescription for opioids, your provider will
review your potential risk factors for the opioid use disorder,
evaluate your severity of pain, en current treatment plan, provide
information on non opioid treatment options, and refer you to
a specialist of appropriate. Your provider will also review your
(18:12):
potential risk passers for substance use disorder and alcohol and
tobacco use and refer you for treatment if needed. Apartit,
if your doctor of the healthcare provider performs additional test
or services during the same visit that Medicare doesn't cover
under the preventive benefit, you might also have to pay
co insurance and the part be deductible may apply. Medicare
(18:35):
doesn't cover the additional test or services like a routine
physical exam, you may have to pay the full amount
preventive services. Yearly wellness visit. If you had Part B
for longer than twelve months, you could get a yearly
wellness visit. The yearly wellness visit isn't a physical exam,
it's a visit develop or update your personalised plan to
(18:56):
prevent disease or to disability based on your current health,
health and risk factors. Medicare covers this visit once every
twelve months. Your doctor healthcare provider will ask you to
fill out questionnaire called a health risk assessment. As part
of this visit, you may also visit including routine measurements,
health advice, a review of your medical and family history,
(19:17):
a review of your current prescriptions, advanced care planning, and more.
You your doctor healthcare provider may also use question er
to better stand your social needs and refer you for
appropriate services and support. This is called a Social Determinants
of Health Risk Assessment and it's free when you get
(19:39):
it as part of your yearly wellness visit. For information,
visit medicare dot gov slash coverage. Your doctor healthcare provider
will also perform a cognitive assessmant to look for signs
of dementia, including Alzheimer's disease. Signs of cognitive impairment include
trouble remembering, learning, you think, concentrating, managing finances, and making
(20:01):
decisions about your everyday life. If you're a doctor, a
healthcare provider thinks you may have cognitive impairment. Medicare covers
a separate visit to do a more thorough of your
cognitive function and check for conditions like dementia, depression, anxiety,
or delirium, and design a health a care plan page
thirty five. Your doctor healthcare provider will also evaluate your
(20:24):
potential risk factors for substance uses, order and for you
for treatment if needed. If you use opioid medication, your
pride or over your plan treatment, share information about non
opioid treatment options and refer you to specialists as appropriate.
Your first yearly visits, your first yearly wellness visit can
(20:45):
take place within twelve months of your part BE enrollment
or you're welcome to Medicare Preventive visit. However, you don't
have to have a visit to Medicare Preventive to qualify
for yearly wellness visit. You pay nothing for the yearly
wellness visit if the doctor healthcare provides accepts assignment important.
If your doctor healthcare provider performs additional tests or services
(21:08):
during your wellness visit that Medicare doesn't cover under the
preventive benefit, you may have to pay co insurance and
Part B deductible may apply. Medicare doesn't cover the additional
test or services like routine physical exam, you have to
pay the full amount. When isn't covered, what is it
covered by Part A and B? Medicare doesn't cover everything.
(21:31):
If you need certain services Part aar B doesn't cover,
you'll have to pay for them yourself unless you have
other coverage, including Medicaid to cover the cost. You're in
a Medicare advantage plan or a Medicare cost plan that
covers these services. Medicare advantage plans and Medicare cost plans
may cover some extra benefits, like fitness programs and vision,
(21:53):
hearing and dental services.
Speaker 3 (21:56):
Some of the.
Speaker 2 (21:57):
Items and services that original Medicare doesn't cover include eye
exams for prescription eyeglasses, long term care, cosmetic surgery, massage therapy,
routine physical exams, hearing, aids, and exams for fitting them.
(22:18):
Concierge care also called concierge medicine, retainer based medicine, boutique medicine,
platinum practice, or direct care covered items or services you
get from a doctor other provider that has opted out
of participating in Medicare, except in the case of an
emergency or urgent care or urgent need or go to
(22:39):
page sixty. Most dental care. In most cases, Original Medicare
doesn't cover dental services like routine cleanings, fillings, tooth extractions,
or items like dentures. However, in some cases, Original Medicare
may pay for some dental services closely related to certain
covered services like a heart job repair or replacement, an
(23:02):
organ transplant, cancer related treatments. Paying for long term care,
Medicare and most health insurance, including Medicare Supplements insurance MEDICAP
don't pay for these type of services.
Speaker 3 (23:19):
Okay.
Speaker 2 (23:20):
This includes personal care assistance like help with everyday activities
including dressing, bathing, using bathroom. Non medical long term care
services may also include home delivered meals, adult day healthcare,
home and community based services.
Speaker 3 (23:37):
On others.
Speaker 2 (23:38):
You may be eligible for some of these care through Medicaid,
or you could choose to buy private long term care insurance.
Speaker 3 (23:45):
You could get.
Speaker 2 (23:46):
Non medical long term care services at home, in the community,
in assisted living facility, or in a nursing home. And
it's important sense to start planning for non medical long
term care now to maintain your independence and to make
sure you get the care you may need in the
setting you want and now in the future. Yeah, this
(24:08):
is definitely something that is not covered. I've been seeing
out a lot more with my older clients or their
parents that basically Medicare does not cover long term care
and they either have to go out of their pocket
or a relative or the son or daughter or even
the grandkids help out in the situation. Can take turns,
(24:30):
but sometimes it is a big ordeal, and I do
recommend looking at your long term care options out there
just in case you know this is needed in the future.
But we're going to end that for today, look forward
to next week. As always, please feel free to reach
(24:51):
out to us if you have any questions, Take care,
and have a wonderful day.
Speaker 1 (24:57):
Thank you for joining the program Medicare at three sixty.
Hope you found today's episode insightful and empowering. Remember understanding
your Medicare options is key to making the right choices
for your health and financial well being. If you have
questions or topics you would like covered in future episodes
of Medicare three sixty, don't hesitate to reach out and
(25:20):
speak with our licensed insurance agent. Until next time, Stay
informed and take charge of your healthcare journey. This has
been Medicare three sixty, your trusted source for all things Medicare.
Take care,
Welcome to Medicare three sixty, where the world of Medicare
is simplified and you are empowered to make informed healthcare choices.
With over two decades of experience and insurance and financial
solutions with host licensed insurance agents Jennifer Lee, you are
guided through the ins and outs of Medicare, whether you
(00:22):
are nearing retirement, navigating your options, or just curious about
what's available. Everything you need to know is covered. Tune
in for knowledgeable insights, tips and answers to your Medicare
questions so you can take charge of your health and
your future. And Now Medicare three sixty.
Speaker 2 (00:45):
Welcome to today's Medicare three sixty show. I'm your host,
Jennifer Lee, and we are getting started with finding out
what Medicare covers in a Medicare New Handbook five. So
we are going to begin with page fifty today. Rural
(01:08):
health clinic services. Rural health clinics provide many outpatient primary
and preventive services in rural and underserved areas. Generally, you
pay twenty percent of the charges. The part be deductible applies.
You pay nothing for most preventive services. Second surgical opinions
(01:30):
Medicare covers a second surgical opinion in most cases for
medically necessary surgery that isn't an emergency. In some cases,
Medicare covers third surgical opinions. Pay twenty percent of the
Medicare proved amount. The Part B deductible applies preventive services.
(01:52):
Sexually transmitted infection STI.
Speaker 3 (01:54):
Screenings and counseling.
Speaker 2 (01:57):
Medicare covers STI screens for chlamydia, gonorrhea, syphilis, and or
hepatitis beed. Medicare covers these screenings if you're pregnant or
increase risk for an STI. When you're a primary care
doctor or other healthcare provider orders the test, Medicare covers
these tests once every twelve months or at certain times
(02:19):
during pregnancy. Medicare also covers up to individual twenty to
thirty minute face to face high intensity behavioral counseling sessions
each year. If you're a sexually active adult at increase
risk for STIs. Medicare will cover these counsing sessions with
(02:41):
a primary care doctor or healthcare provider in a primary
care sitting like a doctor's office. Medicare won't cover counseling
as a preventive service as an inpatient setting like a
skilled nursing facility. Yeah, I think sometimes seniors are very
active in those facilities. You pay nothing for these services.
(03:04):
If your primary care doctor or provider accepts assignment shots
or vaccines part be covers. Flu shots go to page
forty one. Hepatitis B shots go to page forty two.
There's just an outbreak of that if you haven't heard lately.
And monocal shots go to page four forty eight. Coronavirus
(03:25):
disease twenty nineteen, COVID nineteen vaccines.
Speaker 3 (03:29):
Go to page thirty seven.
Speaker 2 (03:31):
So important. Through March thirty first, twenty twenty five, you
could get telehealth services at any location in the US,
including your home. Starting April first, twenty twenty five, you
must be in an office or medical facility located in
a rural area in the United States first most telehealth services, However,
(03:52):
you still could get Medicare telehealth services without being in
a rural healthcare setting. Include monthly and stage renal disease
YESRD visits for home dialysis. Services for diagnosis, valuation, or
treatment of symptoms of an acute stroke whether you are
(04:14):
including a mobile stroke unit. Services for the diagnosis evaluation
or treatment of a mental and or behavioral health disorder,
including a substance use disorder in your home. You pay
twenty percent of the Medicare.
Speaker 3 (04:33):
Where is that you pay?
Speaker 2 (04:37):
Where am I at? Sorry? Let's start over again. So important.
Medicare Drug Covered Part D generally covers all other adult
immunizations recommended by the Advisory on Immunization Practices to protect
(05:04):
you from diseases like shingles to tetanus, diphtheria purchases, and
respiratory sync Deo virus RSV at no cost to you.
If the shot isn't on your plans drug list yet,
you can ask for coverage and a coverage exception or
(05:25):
get reimbursed. Contract your plan for details, and talk to
your doctor or other healthcare provider about which vaccines are
right for you. To learn more about cover vaccines, visit
medicare dot gov slash coverage. Hey, we're a page fifty one.
Medicare covers medically necessary evaluation and treatment to regain and
(05:47):
strengthen speech and language skills. This includes cognitive and swallowing
skills to improve or maintain current to maintain current function
or slow decline. When your doctor other healthcare provider certifies
you need it, You pay twenty percent of the Medicare
(06:09):
proved amount. The Part B deductible applies surgical addressing services.
Medicare covers medically necessary treatment of a surgical or surgical
treated wounds. You pay twenty percent of the Medicare proved amount.
For your doctor or other healthcare provider services. You pay
a set co payment for these services when you get
(06:32):
them in a hospital outpatient setting. The Part B deductible
applies telehealth. Medicare covers certain telehealth services you get from
a doctor or other healthcare provider who's located somewhere else
using technology to communicate with you in real time. Important
Through March thirty first, twenty twenty five, you get telehealth
(06:54):
services at any location in the US, including your home.
Starting for April twenty twenty five, USB in Office are
medically facility located in rural areas in the US for
most telehealth services. However, you can still get Medicare telehealth
services without being in a rural area setting, including monthly
(07:16):
and stage junal disease visits for home dialysis services for diagnostics, valuation,
or treatment symptoms of an acute stroke. Wherever you are,
including a mobile stroke unit, services for diagnosis, evaluation, or
treatment of a mental or behavioral health disorder, including a
substance use disorder in your home. You know, I totally
(07:37):
apologize I read this again.
Speaker 3 (07:42):
But hey, sometimes you want to just listen to it twice.
Speaker 2 (07:45):
Okay, So you pay twenty percent of the Medicare approved
amount for your doctor, other healthcare provider, or practitioner services.
The part B deductible applies for most of these services.
You pay the same amount you would uh if you
got the services in person. Compare Medicare advantage plants and
some providers in original Medicare may offer more telehealth benefits
(08:09):
and the basic coverage and original Medicare, for.
Speaker 3 (08:11):
Example, you may be able to get.
Speaker 2 (08:13):
Some services from home no matter where you live. If
your provider an Original Medicare, participates in an accountable care organization,
check with them to find out what telehealth benefits may
be available. Go to pages one ten to one eleven
for more information about acos. So keep in mind maybe
(08:37):
you were doing telehealth visits with your doctors in the past.
Make sure that it is covered, because I am hearing
some of my clients complain that now it's no longer covered,
or the doctor won't do it because it's not covered
by Medicare, so just make sure it is covered if
that happens. Test non laboratorycare covers X rays, MRIs, cat scans, EKGs, ECGs,
(09:06):
and some other diagnostic tests. You pay twenty percent of
the Medicare proved amount. The Part B deductible applies. Okay,
if you get the test at a hospital as an outpatient,
you also pay the hospital a co payment that may
be more than twenty percent of the Medicare proved amount.
Most cases, this amount can't be more than the Part
(09:28):
A hospital stay deductible. Go to the laboratory tests on
page forty four for other Part B cover tests. Transitional
care management services. Medicare may cover this service if you're
returning to your community after an impatient stay at certain
facilities like a hospital or a skilled nursing facility. The
(09:49):
healthcare provider who's managing your transition back into the community
will work with you and your caregiver to coordinate and
manage your care for the first thirty days after you
retur turn home. The Part D deductible and co insurance apply.
Visit Medicare dot gov. Sauce coverage, so's transitional dash care,
dash management, dash services to learn more transplants and immunosuppressive drugs.
(10:15):
Medicare covers doctor services for how hearts, long kidney, pancreous
and testine, testine and liver transplants under certain conditions, but
only in Medicare certified facilities. Medicare also covers bone, marrow
and cornea transplants under certain conditions. Medicare covers m no
(10:38):
suppressive drugs. If Medicare paid for the organ transplant, you
must have Part A the time of the covered organ transplant,
and you must have Part B at the time you
get IMMA nos re separate uh oh my gosh, imma
no suppressive drugs, immuna expressive drugs, or call five for
(11:00):
the immunosuppressive drug benefit described on this page. You pay
twenty percent of the Medicare proved them out for the drugs.
The Part B deductible applies. Keep in mind Medicare coverage
Part D covers immunospress suppressive drugs if Part B doesn't
cover them. If you're thinking about joining a Medicare advantage
plan and are on a transplant waiting list or think
(11:23):
you need a transplant. Check with the plan before you're
joined to make sure your doctors and other healthcare providers
and hospitals are in the plans network. Ask for information
about covered drugs and their costs. Also check the plans
coverag rules for prior authorization and coverage for your living donors.
Medicare may cover transplant surgery as a hospital and patient
(11:47):
surgery under Part A. Go to page twenty seven to
twenty eight. Medicare pays a full cost of care for
your kidney donor, and you and your donor won't have
to pay to reductible co insurance need other costs for
the hospital stay. Immunosuppressive drug Benefit. If you only have
(12:09):
Medicare because of ND stage unal disease, your Medicare coverage,
including immunosuppressive drug coverage, ends thirty six months after successful
kidney transplant. Medicare offers a benefit to help you pay
for your immunosuppressive drugs beyond thirty six months. If you
don't have certain types of other health coverage like a
(12:29):
group health plan, trycare or Medicaid that covers immunosuppressive drugs,
this benefit only covers your immunosuppressive drugs and no other
items or services. Okay, it isn't a substitute for health coverage.
You can assign up for this benefit any time after
(12:52):
your Medicare Part A coverage ends, as long as you
had Medicare because of ESRD at the time of your
kidney transplant. To sign up, call Social Security eight seven
seven four six five oh three fIF five to five,
or you could call eight hundred through two five oh
seven eighty eight. You'll pay a monthly premium of one
(13:14):
hundred and ten dollars and forty cents a higher base
of your income, and two hundred and fifty seven dollars
deductible for immunosuppressive drug benefit in twenty twenty five. Once
you met the deductible, you pay twenty percent of the
Medicare proved amount for immunosuppressive drugs. If you have limited
income and resources, you may able to get help from
(13:35):
your state to pay for this benefit. Go to page
ninety four or visit Medicare dot gov, slash basics, slash
and stay Eage Renal Disease to learn more. Travel. Medicare
generally doesn't cover healthcare while you're traveling. Outside the US.
The US includes the fifty Staints, the District of Columbia,
Puerto Rico, the US Virgin Islands, Guam, the Northern Mariana Island,
(14:00):
and American Samoa. There are some limited exceptions. Visit medicare
dot gov slash coverage travel offside in the United US
to learn more. Medicare may cover medically necessary ambulance transporation
to a foreign hospital only with emission. For a medically
necessary covered and patient hospital service, you pay twenty percent
(14:22):
of the Medicare pood amount the part B deductible applies.
Speaker 3 (14:28):
Okay, yeah, keep this in mind.
Speaker 2 (14:30):
If you are on original Medicare, it generally doesn't cover
the healthcare outside the US. Of course, if you do
get a supplemental plan. These plans typically have a fifty
thousand dollars lifetime maximum. You do have debate, a deductible
and the co insurance for that. On Medicare advantage plans,
(14:51):
typically you don't. You might have a deductible or a copay,
but it is covered. Some plans have unlimited coverage. Some
plan have a certain coverage limit. Okay. Urgently needed care.
Medicare covers urgently needed care to treat a sedd in
(15:14):
illness or injury that isn't a Medicare emergency. You pay
twenty percent of the Medicare proved amount for your doctor
other healthcare provider services, a co payment and an outpatient setting.
The part B deductible applies. Virtual check ins. Medicare covers
virtual check ins in with your doctor certain other providers
(15:36):
virtually check and allows you to briefly communicate with your
healthcare providers using audio or video communication technology like your
phone or a computer without getting to the doctor's office.
Your doctor can also conduct remote assessments using photo or
video images you send for a review to determine whether
you need to go to the doctor's office. Your doctor
(15:56):
other provider can respond to you by phone, virtual deliver
very secure test message, email, or patient portal. Virtual checks
are different from telehealth visit because they're usually ten minutes
or less and aren't done in real time, and also
have a virtual check in. If you meet these conditions,
you talk to your healthcare provider about starting these type
(16:18):
of visits. You virtually consent to the virtual check in,
and your doctor documents your consent and your medical record.
Your doctor may get one consent for a year's work.
For these services. The virtual check in doesn't relate to
a medical visit you had within the past seven days,
and it doesn't lead to the medical visits within the
next twenty four hours or the soonest appointments available. Okay,
(16:44):
we're at page fifty four. Compare you pay twenty percent
of the Medicare proved amount for your doctor or other
healthcare provider services. The Part B deductible applies. Medicare advantage
plans may offer some virtual check in services, then original Medicare.
Check with your plan to find out what they offer.
(17:05):
Preventive services Welcome to Medicare Preventive Visit. During the first
twelve months that you have Part B you can get
a Welcome to Medicare Preventive visit. The visit includes a
review of your medical and social history related to your health.
It also includes education and counseling about preventive services, including
certain screening shots or vaccines like CLUE, pneumoniacle and other
(17:30):
recommended shots or vaccines, and referrals for other care if needed.
When you make your appointment, let your doctor's office know
you'd like to schedule your Welcome to Medicare Preventive visit.
You pay nothing for the welcome to Medicare preventive visit
if the doctor other qualified healthcare provider accepts assignment. If
(17:52):
you have a current prescription for opioids, your provider will
review your potential risk factors for the opioid use disorder,
evaluate your severity of pain, en current treatment plan, provide
information on non opioid treatment options, and refer you to
a specialist of appropriate. Your provider will also review your
(18:12):
potential risk passers for substance use disorder and alcohol and
tobacco use and refer you for treatment if needed. Apartit,
if your doctor of the healthcare provider performs additional test
or services during the same visit that Medicare doesn't cover
under the preventive benefit, you might also have to pay
co insurance and the part be deductible may apply. Medicare
(18:35):
doesn't cover the additional test or services like a routine
physical exam, you may have to pay the full amount
preventive services. Yearly wellness visit. If you had Part B
for longer than twelve months, you could get a yearly
wellness visit. The yearly wellness visit isn't a physical exam,
it's a visit develop or update your personalised plan to
(18:56):
prevent disease or to disability based on your current health,
health and risk factors. Medicare covers this visit once every
twelve months. Your doctor healthcare provider will ask you to
fill out questionnaire called a health risk assessment. As part
of this visit, you may also visit including routine measurements,
health advice, a review of your medical and family history,
(19:17):
a review of your current prescriptions, advanced care planning, and more.
You your doctor healthcare provider may also use question er
to better stand your social needs and refer you for
appropriate services and support. This is called a Social Determinants
of Health Risk Assessment and it's free when you get
(19:39):
it as part of your yearly wellness visit. For information,
visit medicare dot gov slash coverage. Your doctor healthcare provider
will also perform a cognitive assessmant to look for signs
of dementia, including Alzheimer's disease. Signs of cognitive impairment include
trouble remembering, learning, you think, concentrating, managing finances, and making
(20:01):
decisions about your everyday life. If you're a doctor, a
healthcare provider thinks you may have cognitive impairment. Medicare covers
a separate visit to do a more thorough of your
cognitive function and check for conditions like dementia, depression, anxiety,
or delirium, and design a health a care plan page
thirty five. Your doctor healthcare provider will also evaluate your
(20:24):
potential risk factors for substance uses, order and for you
for treatment if needed. If you use opioid medication, your
pride or over your plan treatment, share information about non
opioid treatment options and refer you to specialists as appropriate.
Your first yearly visits, your first yearly wellness visit can
(20:45):
take place within twelve months of your part BE enrollment
or you're welcome to Medicare Preventive visit. However, you don't
have to have a visit to Medicare Preventive to qualify
for yearly wellness visit. You pay nothing for the yearly
wellness visit if the doctor healthcare provides accepts assignment important.
If your doctor healthcare provider performs additional tests or services
(21:08):
during your wellness visit that Medicare doesn't cover under the
preventive benefit, you may have to pay co insurance and
Part B deductible may apply. Medicare doesn't cover the additional
test or services like routine physical exam, you have to
pay the full amount. When isn't covered, what is it
covered by Part A and B? Medicare doesn't cover everything.
(21:31):
If you need certain services Part aar B doesn't cover,
you'll have to pay for them yourself unless you have
other coverage, including Medicaid to cover the cost. You're in
a Medicare advantage plan or a Medicare cost plan that
covers these services. Medicare advantage plans and Medicare cost plans
may cover some extra benefits, like fitness programs and vision,
(21:53):
hearing and dental services.
Speaker 3 (21:56):
Some of the.
Speaker 2 (21:57):
Items and services that original Medicare doesn't cover include eye
exams for prescription eyeglasses, long term care, cosmetic surgery, massage therapy,
routine physical exams, hearing, aids, and exams for fitting them.
(22:18):
Concierge care also called concierge medicine, retainer based medicine, boutique medicine,
platinum practice, or direct care covered items or services you
get from a doctor other provider that has opted out
of participating in Medicare, except in the case of an
emergency or urgent care or urgent need or go to
(22:39):
page sixty. Most dental care. In most cases, Original Medicare
doesn't cover dental services like routine cleanings, fillings, tooth extractions,
or items like dentures. However, in some cases, Original Medicare
may pay for some dental services closely related to certain
covered services like a heart job repair or replacement, an
(23:02):
organ transplant, cancer related treatments. Paying for long term care,
Medicare and most health insurance, including Medicare Supplements insurance MEDICAP
don't pay for these type of services.
Speaker 3 (23:19):
Okay.
Speaker 2 (23:20):
This includes personal care assistance like help with everyday activities
including dressing, bathing, using bathroom. Non medical long term care
services may also include home delivered meals, adult day healthcare,
home and community based services.
Speaker 3 (23:37):
On others.
Speaker 2 (23:38):
You may be eligible for some of these care through Medicaid,
or you could choose to buy private long term care insurance.
Speaker 3 (23:45):
You could get.
Speaker 2 (23:46):
Non medical long term care services at home, in the community,
in assisted living facility, or in a nursing home. And
it's important sense to start planning for non medical long
term care now to maintain your independence and to make
sure you get the care you may need in the
setting you want and now in the future. Yeah, this
(24:08):
is definitely something that is not covered. I've been seeing
out a lot more with my older clients or their
parents that basically Medicare does not cover long term care
and they either have to go out of their pocket
or a relative or the son or daughter or even
the grandkids help out in the situation. Can take turns,
(24:30):
but sometimes it is a big ordeal, and I do
recommend looking at your long term care options out there
just in case you know this is needed in the future.
But we're going to end that for today, look forward
to next week. As always, please feel free to reach
(24:51):
out to us if you have any questions, Take care,
and have a wonderful day.
Speaker 1 (24:57):
Thank you for joining the program Medicare at three sixty.
Hope you found today's episode insightful and empowering. Remember understanding
your Medicare options is key to making the right choices
for your health and financial well being. If you have
questions or topics you would like covered in future episodes
of Medicare three sixty, don't hesitate to reach out and
(25:20):
speak with our licensed insurance agent. Until next time, Stay
informed and take charge of your healthcare journey. This has
been Medicare three sixty, your trusted source for all things Medicare.
Take care,
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