Medicare only covers medically necessary surgical procedures. Medicare defines medically necessary services as “health care services or supplies that are needed to diagnose or treat an illness, injury, condition, disease, or its symptoms – and that meet accepted standards of medicine.” Medicare further defines medically necessary services as ones that: Are proper and needed for
Medicare covers skilled nursing facility (SNF) care in certain circumstances, but some situations can impact what is covered or even or if SNF care will be covered and your costs for that care. If you are in the hospital, your doctor can order observation services to decide if you should be admitted to the hospital
Whether or not to admit you as an inpatient to a hospital is a decision made by your doctor after reviewing your medical situation, and they decide whether it is necessary to admit you to the hospital. According to Medicare, an inpatient admission is generally appropriate when you’re expected to need 2 or more midnights
Medicare Advantage plans can be very cost-effective, and in fact, there are plans with $0 premiums. So how is that possible? To understand how $0 premium plans are possible, you must understand how Medicare Advantage plans are paid. There are two parts to how Medicare Advantage plans get paid. The first is the premium members
Medicare Part D plans are not standardized, so each plan may have different drug formularies, copays, coinsurance, or deductibles. Part D plans can change the formulary, which is the list of covered drugs, the deductibles, copays, coinsurance, and plan premiums every year. If you are enrolled in Part D, you’re your insurance company will mail
If you have original Medicare, Part B will cover telehealth services, and you will have to pay a 20% coinsurance of the Medicare-approved amount for your doctor or other health care provider’s services after you pay the Part B deductible. You will have to pay the same amount for most telehealth services as if you
Each Medicare Part D plan has a list of covered drugs that are called a formulary. Within every formulary, there are a set of rules applied to the prescription drugs covered by the plan. One of those rules is called step-therapy. If you get a prescription for a medication that has step-therapy rules, there is
There are several stages of Part D prescription drug plans. Below is a high-level outline of the various stages of Part D plans: Stage 1 – Deductible (not all Part D plans have deductibles) Stage 2 – Initial Coverage Stage 3 – Coverage Gap also known as the Donut Hole Stage 4 – Catastrophic Coverage
The donut hole begins after you and your Part D insurance company have together spent $4,130 (2021 amount) for covered prescription drugs. If you have a deductible, the entire amount you pay for the deductible will contribute towards reaching the $4,130 limit that will put you in the donut hole. If your Part D plan
Most Part D drug plans have a coverage gap (also called the “donut hole”). There is a limit on what the drug plan will cover for your prescription drugs when you are in the donut hole. The donut hole begins after you, and your drug plan have spent $4,130 in 2021 for covered drugs. This
