CDIS Blog

For men on Medicare, being proactive about health is easy, as the program covers many preventive services and screenings at little or no cost. Medicare covers a variety of preventive services and screening 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

 

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CDIS 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. Did you know that Medicare has a variety of programs available to help you pay for health care and drug coverage? If you’re interested in learning how you will pay for Medicare, here’s some information on what to expect, along with some options to explore that could end up saving you some money.

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 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.

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. Seniors who have full Medicaid or get Supplemental Security Income (SSI) benefits, automatically qualify. Of course, using generic drugs over brand names, using mail-order services, and choosing the right drug plan can help keep drug costs low.

 

 

 

 

 

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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CDIS 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.

Covered Diabetic Supplies and Services – Part B

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.

Covered Diabetic Supplies and Services – Part D

Medicare Prescription Drug coverage (Part D) provides coverage for injectable insulin as well as supplies to administer insulin, like syringes, needles, alcohol swabs, gauze, and inhaled insulin devices. Certain anti-diabetic drugs for controlling blood sugar with medicine, not insulin are covered as well.

Factors That Influence How Much You Pay

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 treatment. 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

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CDIS Blog

If you’re new to Medicare, or about to turn 65 soon, you may have questions about your benefits and how much you can expect to pay. There are many parts to Medicare and it makes sense to familiarize yourself with coverage and costs so you’re prepared to make an informed decision when the time is right. 

Coverage

Original Medicare includes both Part A and Part B. Part A is hospital insurance, which includes benefits for inpatient care while in the hospital, skilled nursing facility, and some home health care. Part B is medical insurance, which includes benefits for outpatient care such as doctor’s services, medical supplies, and preventive services.

Part A covers lab tests, surgeries, and other inpatient services and supplies you may receive while in a hospital, skilled nursing facility, inpatient rehabilitation facility, or long-term care hospital. Inpatient care typically includes semi-private rooms, meals, general nursing, and medication necessary to treat your condition while in the hospital. As long as you have a qualifying hospital stay (formally admitted for 3 inpatient days), you are eligible to receive Part A benefits.

Part B provides benefits for two types of services: medically necessary services and preventive services. Medically necessary services include services or supplies that are needed to diagnose or treat a medical condition. Preventive services are those designed to prevent or detect illnesses, such as flu or heart disease. For example, cancer or diabetes screenings, yearly wellness visits, and immunizations are covered under Part B.

Costs

Most people do not pay a premium for Medicare Part A. As long as you or your spouse paid Medicare taxes while working, you’re eligible for premium-free coverage. Part B however, carries an average monthly premium ($174.70 in 2024). Premiums are based on income, but most people pay the standard premium amount. The Part B premium is deducted automatically from your Social Security check each month. In addition to the monthly premium, Part B recipients pay a deductible ($40 per year) as well as coinsurance (up to 20% of the Medicare-approved amount for doctor services, outpatient care, and some medical equipment). 

Medicare Supplement Insurance Is Not Original Medicare

There are only two ways to get Medicare coverage: Original Medicare or Medicare Advantage (Part C). Enrollment in Original Medicare is automatic for most people when they turn 65, but if you wish to have Medicare Advantage, you need to choose a plan that fits your needs. Many seniors who stay with Original Medicare supplement their coverage with Medicare Supplement Insurance (Medigap) or a Prescription Drug Plan (Part D). Medigap does not provide Part A and Part B benefits, but instead, adds to them. The right plan can help shoulder some of the out-of-pocket expenses associated with Original Medicare coverage, like deductibles, coinsurance, or copays. While most Medicare Advantage plans include coverage for prescription drugs, Original Medicare does not. However, prescription drug benefits can be added to Original Medicare as a stand-alone Part D plan.

 

 

 

 

 

 

 

References:

Medicare: https://www.medicare.gov/what-medicare-covers/

Part B coverage: https://www.medicare.gov/what-medicare-covers/part-b/what-medicare-part-b-covers.html

Part A coverage: https://www.medicare.gov/what-medicare-covers/part-a/what-part-a-covers.html 

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CDIS 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 under Part D, 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. 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. 

In the event you realize your drugs are not covered under a current 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 the generic, or low-cost alternative. 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 plan.

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 Part D 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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