Medicare payment rules prohibit coverage for a service if a beneficiary is not financially responsible for the care or if another government entity is obligated to provide or pay for the item or service. For years, the Medicare rules interpreting and implementing this...

A new report from the U.S. Department of Health and Human Services’ (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE) examines trends in health care access and outcomes in rural America. While insurance rates in these areas are improving,...

The Inflation Reduction Act (IRA) made significant improvements to Medicare prescription drug access and affordability, including by restructuring the Part D benefit to limit enrollee expenses. Those changes began in January 2024, when the IRA eliminated cost sharing...

Now is the time for people who need health insurance in 2025 to shop for coverage. For those without employer, Medicare, or Medicaid coverage, Healthcare.gov or their state exchange is the place to shop for Affordable Care Act (ACA) plans. Most shoppers will be able...

When the Centers for Medicare & Medicaid Services (CMS) pays Medicare Advantage (MA) organizations, they increase the payments when plans enroll sicker people. This is called risk adjustment, and it is an important guardrail to ensure that all people with Medicare...

Medicare coverage is personal — and changes to those plans and benefits may feel unnerving as it affects one’s overall health and well-being. Originally passed in 2022, the Inflation Reduction Act brought about many changes to Medicare that are now being implemented...

Finding a doctor you like and trust can be a long process, so I understand that it can be frustrating when your doctor no longer accepts Medicare. If your doctor has “opted out” of Medicare, this means that he or she no longer accepts Medicare assignment...

It’s important to plan for your health care needs, but sometimes life throws unexpected curve balls. And when that happens, you’ll need to know what’s covered. Fortunately, there are ways you and your loved ones can get the necessary care at home. Here’s what you need...

The Wall Street Journal recently published a story regarding diagnoses and plan payments in Medicare Advantage. The story was fundamentally flawed and overlooked the value of Medicare Advantage for millions of American seniors. Here are the facts: More than 33 million...

Today, more Americans than ever are choosing Medicare Advantage for affordable, quality health care — with over 33 million seniors and people with disabilities enrolled in the program. BMA wanted to learn more about seniors’ views on Medicare Advantage and how...

How Medicare Advantage In-Home Health Assessments Keep Seniors Healthier Today, Medicare Advantage delivers affordable, high-quality care to more than 33 million seniors and people with disabilities, with better health outcomes than Fee-for-Service Medicare (FFS). One...

Whether you’re switching from one type of Medicare coverage to another, or you’re new to Medicare, you might be concerned about being able to continue seeing your health-care specialist. Will your specialist’s services be covered by Medicare? That may depend upon:...

Expensive medications? You’ll save thousands. Dementia or mental health care? More options Key takeaways Changes from Inflation Reduction Act will take effect next year. Lower out-of-pocket limit in Part D drug plans erases old “donut hole.” You may find weight loss...

Today, Medicare Advantage delivers affordable, high-quality care to more than 33 million seniors and people with disabilities, with better health outcomes than Fee-for-Service Medicare (FFS). One of the most effective ways to ensure seniors receive comprehensive care...

There’s no age limit on exercise – physical activity is for everyone! In fact, as you get older, physical activity becomes an even more important part of your overall health. According to the Centers for Disease Control and Prevention, regular exercise can help...

  Annual physical check-ups are essential in maintaining your health. These check-ups can identify health issues in their early stages, so you can take care of them as early as possible. If you have Medicare and have had Medicare Part B for more than 12 months,...

Monitoring your oral health isn’t just about good teeth: it can give insight into your overall health. There are many reasons why it’s important that you visit your dentist regularly. Dental health should be a major concern for seniors. Monitoring your oral health...

Mental health is a critical part of overall health. Conversations on the topic of mental health were rare when the baby boomer generation was young. Today, the topic is far more accepted. Mental health is a critical part of overall health. Conversations on the topic...

5 steps to taking care of what matters most: You The Annual Enrollment Period (AEP) is the time of year when you can decide to stick with your current health plan or make changes for the upcoming year. As you consider coverage for next year, it’s important to review...

Whether you need medical care while traveling, in the comfort of home, or you want the flexibility to see any medical doctor or specialist that accepts Medicare, a Medicare Supplement plan may be just what you need. As you prepare for the next chapter of your journey,...

The benefits of Medicare are initially activated when you turn 65. That is when you first enroll in this federal healthcare program for seniors. But what if you are still working at the age of 65 and don’t want to officially retire? Medicare enrollment and retirement...

Whether you are already part of the nearly 60 million enrollees of the program, or are looking to join its ranks soon, we are here to help you answer the most commonly asked question – how to choose the right Medicare plan for you. Before you apply for Medicare, it is...

To help bring clarity, we have compiled a "New to Medicare" checklist to help you out with all the basic Medicare information that you’ll need. Before 1965, Americans over the age of 65 had difficulty gaining access to private health insurance coverage. This is why...

Stress is a significant contributor to declining health and wellbeing; it has even been identified as a primary cause of cardiovascular diseases, mental health disorders and the weakening of the immune system. Stress is a significant contributor to declining health...

This article explores the scope of Medicare coverage for dementia patients. Since dementia is progressive in its different forms, it can develop over a number of years and is classified into multiple stages. Why is dementia a rising concern? Dementia is recognized as...

The difficult truth about Alzheimer’s disease and other forms of dementia is that currently there is no full-fledged cure available. However, with early detection and appropriate treatment, its symptoms can be managed and even slowed down. Cognitive diseases such as...

Are you worried about rising health care costs? There are many ways to save money, available to you. One of these is our new Price Check My Rx tool. You can also learn how to save money by using generic drugs. Know your prescription cost and options As a soon-to-be or...

‘So often caregivers are often unseen and unsung heroes,’ head of Centers for Medicare & Medicaid Services says Family members, often thrust into caregiving with little notice, also must navigate a complex medical system without any training or guidance. “I feel...

Diabetes affects many Americans – especially seniors. In fact, around 20% of Medicare beneficiaries 65 and older have diabetes. If this is you, or someone you love, it’s important to know what Medicare will cover in terms of care, supplies and more. Learn all about...

As you grow older, life and tough circumstances can lead to issues such as depression, anxiety and more. The human body is a complex and highly sophisticated system that has many delicate parts working in harmony. The command center for this entire system is, of...

A third face month-long delays for appointments, but most are happy with their overall care A survey of beneficiaries enrolled in both original Medicare and Medicare Advantage (MA) plans revealed a common problem: More than a third of those polled had to wait a month...

The rate increases for Medigap (Medicare Supplement) plans, including Plan N, can vary based on several factors and may differ from one plan to another. However, it’s not accurate to categorically state that Medigap Plan N increases its rates slower than other plans...

You’ll sign up for Part A and Part B through Social Security. Once enrolled, you’ll manage your benefit plans through Medicare. Your Medicare Information Get your Medicare number To find your Medicare number, sign in to your Social Security account and view your...

Durable medical equipment, often abbreviated as DME, refers to a variety of medical devices, supplies and equipment that can help people with chronic health conditions or disabilities. Examples include wheelchairs, walkers, hospital beds, diabetic supplies, home...

The recent robust growth of Medicare Advantage plans brings challenges, opportunities, and new regulations for home health agencies. As we head into 2024, here’s a summary of the latest news, updates, and anticipated trends for Medicare Advantage. The Rising...

The Inflation Reduction Act’s Medicare Prescription Payment Plan will allow people to pay Medicare Part D out-of-pocket costs over the course of the year starting in 2025 Today, the Centers for Medicare & Medicaid Services (CMS) released the second part of draft...

Federal law set caps on some spending for seniors who are enrolled in Part D prescription drug plans. Those paying for high-cost medicines will benefit. It’s the best news that few people seem to know about: Prescription drug costs are falling this year for more than...

February is American Heart Month - a way to bring awareness to heart disease and help spread tips on heart disease prevention. That means now is the perfect time to review some of the facts about cardiovascular disease (CVD), along with tips to combat it. Then we’ll...

The Medicare Part D ‘donut hole’ coverage gap goes away in 2025. Until then, here’s how it works. Nerdy takeaways You enter the donut hole when you and your plan spend a total of $5,030 in 2024. In the donut hole, you pay up to 25% out of pocket for all covered...

Changes in income, marital status, work hours and other life events can exempt enrollees from surcharges Most people who enroll in Medicare Part B, which covers doctor visits, diagnostic tests and other outpatient services, pay a standard monthly premium, $174.70 in...

New analysis finds limiting out-of-pocket drug spending will help older Americans afford medications Had the upcoming cap on out-of-pocket spending on Medicare Part D-covered prescription drugs been in effect in 2021, 1.5 million enrollees would have saved money on...

6 skills that will help you care for the ones you love As family caregivers, we play many roles: scheduler, money manager, house cleaner, health aide, nurse, navigator, nurturer and more. Perhaps the most important role is advocate, as we ensure the best possible care...

Your guide to buying Medicare ​supplemental health insurance If you decide to enroll in original Medicare, one way you can help pay the extra costs the program doesn’t cover is to buy a supplemental — or Medigap — insurance policy. Here’s what you need to know if...

Average premiums could go down, but some could see large increases The average monthly premium for Medicare Part D prescription drug coverage is expected to fall slightly in 2024, to $55.50, a 99-cent drop from the 2023 average of $56.49, the Centers for Medicare...

Medicare drug coverage helps pay for prescription drugs you need. It's optional and offered to everyone with Medicare. Even if you don’t take prescription drugs now, consider getting Medicare drug coverage. If you decide not to get it when you’re first eligible, and...

KEY POINTS The government has made several changes to Medicare that could reduce your prescription drug costs in 2024. It has also expanded coverage for things like mental health and chronic pain treatment. Those signing up during a special enrollment period will be...

The new year rings in more Rx drug savings, higher Part B premiums and new Advantage rules What’s new for Medicare beneficiaries in 2024? A lot — including changes that expand care and make coverage more affordable. For starters, Medicare’s more than 65 million...

ach calendar year brings a new set of changes to Medicare, from premiums and deductibles to rules and regulations. To get the most from Medicare in 2024, it’s helpful to understand what will be different. Here’s a primer on 2024 Medicare changes: Part A costs will...

2024 will bring some positive changes and expanded Medicare benefits. Below is a summary of some of these changes with references for more information. You can also view your 2024 Medicare & You handbook for more information. Prescription Drug Savings Starting...

Changes are coming to Medicare costs and coverage in 2024. Announced in time for the annual open enrollment period, which continues through December 7, the adjustments affect both Original Medicare and Medicare Advantage beneficiaries. It’s crucial that enrollees stay...

About half of all Medicare beneficiaries will be enrolled in MA plans next year The average monthly premium for Medicare Advantage (MA) plans is projected to increase by 64 cents in 2024, but officials at the Centers for Medicare & Medicaid Services (CMS) say that...

New proposal would standardize broker commissions, add mental health services and more The federal government is continuing its efforts to protect older Americans signing up for Medicare coverage for the first time or switching to a new health plan during open...

Quality, affordable health care is crucial to aging well, and Medicare makes it possible for millions of older adults in the U.S. However, the system can be confusing and it’s easy to make mistakes. “Our messy health insurance system causes anxiety for everyone,” says...

New proposal would standardize broker commissions, add mental health services and more The federal government is continuing its efforts to protect older Americans signing up for Medicare coverage for the first time or switching to a new health plan during open...

How the nation’s health insurance coverage for older adults and people with disabilities works Ever since President Lyndon Baines Johnson made Medicare the law of the land in 1965, hundreds of millions of Americans have relied on this program to help them get...

Answers to questions about how the new law affects insulin, vaccines, other Rx prices and more The Inflation Reduction Act of 2022 will help millions of Americans better afford their life-sustaining medications and also help them pay for other out-of-pocket health...

While most services come with a cost, some preventive screenings, vaccines and counseling are covered without charge We worry a lot about what Medicare beneficiaries must for pay out of pocket, such as monthly premiums, annual deductibles, and copays for doctor visits...

Those who are 65 or older typically rely on Medicare to get the healthcare they need. Medicare has two primary types of coverage. For hospital costs and other inpatient care, Medicare Part A is the go-to standard. When you need to see a doctor or get other outpatient...

How the federal insurance program helps older Americans afford the health care vital to their well-being What is Medicare? For more than 58 years, it’s been the program that older Americans and people with disabilities turn to for their health care coverage. In 2023,...

Nursing home care is costly, but there are ways to manage without going broke. Many people grow up with grandparents who lived for years in their homes and, despite various illnesses and conditions, never saw the inside of a nursing home. That still may be true for...

New enrollees increasingly opting for the private insurance alternative to the federally-run program For decades, as Americans approached their 65th birthday, all they had to do to get Medicare, the nation’s government-sponsored health insurance for older adults, was...

Trustees project solvency until 2031, but Congress still must act for the long term For the second year in a row, the trustees who oversee Medicare’s finances say the trust fund that helps pay for inpatient hospital care for 65 million beneficiaries has gotten...

Popular but pricey blood thinners, diabetes medications, cancer treatments make historic list he names of the first 10 Medicare drugs whose prices the federal government will negotiate directly with manufacturers were released Aug. 29. It marks the first time in...

Answers to common questions, including the July 1 implementation for pumps One of the first provisions to take effect of a new law designed to cut prescription drug costs for tens of millions of Medicare enrollees is a $35-a-month cap on out-of-pocket costs for...

Starting in 2024, more people will qualify for the full Medicare Part D assistance program With up to 3 million more Medicare enrollees with low incomes and limited resources eligible in January 2024 for additional financial assistance to pay for their Part D...

Starting in 2024, more people will qualify for the full Medicare Part D assistance program With up to 3 million more Medicare enrollees with low incomes and limited resources eligible in January 2024 for additional financial assistance to pay for their Part D...

July inflation report suggests next year’s boost likely to be around 3%, analysts say After two years that saw Social Security cost-of-living adjustments (COLAs) soar to their highest level in four decades, beneficiaries will likely see a more modest increase in their...

Which path you take will determine how you get your medical care — and how much it costs As you think about how Medicare will cover your health care needs, your first major decision should be whether you want to enroll in federally run original Medicare or select...

Errors can prove costly to new enrollees Missing deadlines, delaying enrollment or choosing the wrong plan can cost you a bundle when it comes to Medicare. Here’s a list of 10 common mistakes new Medicare enrollees make and how to avoid them, according to the Medicare...

CMS projects average monthly prescription drug charge to fall nearly $1 The average monthly premium for Medicare Part D prescription drug coverage is expected to fall slightly in 2024, to $55.50, a 99-cent drop from the 2023 average of $56.49, the Centers for Medicare...

If your total income is more than $25,000 for an individual or $32,000 for a married couple filing jointly, you must pay federal income taxes on your Social Security benefits. Below those thresholds, your benefits are not taxed. That applies to spousal...

No. Medicare covers only ear-related medical conditions, not routine hearing care, hearing aids or exams for fitting hearing aids. But with the FDA’s approval of over-the-counter hearing aids for mild to moderate hearing loss, you can now find lower-cost options....

You’ll need to plan to pay for some common medical expenses Medicare covers the majority of older Americans’ health care needs, from hospital care and doctor visits to lab tests and prescription drugs. Here are some needs that aren’t part of the program — and how you...

The Inflation Reduction Act of 2022 includes several provisions to lower prescription drug costs for people with Medicare and reduce drug spending by the federal government, including a number of changes to the Medicare Part D drug benefit. These changes include a cap...

If you have Original Medicare, your doctor, other health care provider, or supplier may give you a written notice if they think Medicare won’t pay for the items or services you’ll get. This notice is called an “Advance Beneficiary Notice of Non-coverage,” or ABN. The...

Updated Medicare Advantage and Part D policies ensure the overall Medicare program remains strong and stable for the 65 million beneficiaries today and future generations to come, payments to private insurance companies are accurate, and taxpayer dollars are well...

A new prescription drug law that went into effect January 1, 2023, will help save money for people with Medicare. This law improves access to affordable treatments and strengthens the Medicare program. Here’s what the law means for you: More vaccines covered People...

Many Americans are asking themselves “How can I get free healthcare in the U.S.?”, an answer may be in the hands of legislators. One national health insurance plan for all Americans called “Medicare for All” is an idea being promoted, among others, by Vermont Senator...

If you have Original Medicare, your doctor, other health care provider, or supplier may give you a written notice if they think Medicare won’t pay for the items or services you’ll get. This notice is called an “Advance Beneficiary Notice of Non-coverage,” or ABN. The...

When it comes to Medicare, there’s no such thing as one-size-fits-all. That’s because every person has individual health needs. Coverage varies based on where you live, which doctors and hospitals you prefer, and whether you want to pay more money upfront or pay as...

Approximately 61 million Americans live in rural Tribal, and geographically isolated communities across the United States. These communities often experience significant health inequities. Compared to urban Americans, rural Americans are more likely to have heart...

Plan includes increased taxes for high-income earners and more prescription drug negotiations President Joe Biden’s federal budget proposal will include increasing Medicare taxes for people earning more than $400,000 a year and expanding and accelerating prescription...

KEY POINTS Roughly 29.1 million people are enrolled in Medicare Advantage Plans. Each year from Jan. 1 through March 31, those beneficiaries can switch to another Advantage Plan or drop their current one altogether. Here’s what to be aware of if you consider making a...

You have the right to be treated fairly, understand the information you get, and keep your personal information safe. If you have Medicare You have the right to be: Treated with courtesy, dignity and respect at all times. Protected from discrimination. Every company...

he 2023 Physician Fee Schedule updates include new billing codes and more ways to access care Each year, the Centers for Medicare & Medicaid Services (CMS) releases several policy proposals and updates with many taking effect on January 1 of the new calendar year....

Medicare is a great way to get health coverage as you get older, but the timing for enrolling or changing plans can be tricky. Opportunities to sign up for Medicare or switch to a Medicare Advantage (MA) plan are usually limited to very specific and standard...

When you enroll in Medicare Part B, the federal government picks up the tab for most of your health care costs. Most, but not all. Medicare Part B premiums can be a surprising and costly retirement expense for many people. The minimum monthly Medicare Part B premium...

Scams to steal your personal information are at an all-time high. It’s important to continue to safeguard personal documents such as your Social Security card. A Social Security card is not an identification document. In many situations, you only need to know your...

For starters, they’re both options for people with Medicare, but Medigap coverage supplements original Medicare, while Medicare Advantage is a private insurance alternative to federally run Medicare. They’re very different, and their unique types of coverage can’t be...

Medicare fraud is widespread and is among the long list of health care fraud schemes that cost the government billions of dollars annually. Medicare scammers continue to evolve their methods, making their ploys increasingly more believable. Recently, a RetireMed...

Three important documents grant caregivers permission to consult with a parent’s doctor, access medical records, ask questions about claims and make health care decisions on a parent’s behalf: Health care proxy Health Insurance Portability and Accountability Act...

Making sense of the alphabet soup of health care choices Medicare is complicated and can be confusing to sort through. To make it easier, the program has been broken down into four basic parts that include coverage for everything from hospital care to doctor visits to...

Reforms embedded in the Inflation Reduction Act will bring savings to seniors this year. Already some lawmakers are aiming to repeal the changes. Steve Lubin spent a lot last year on insulin to control his Type 2 diabetes. A retired nurse in Philadelphia, Mr. Lubin...

How did the donut hole change for 2023? As has been the case in previous years, the thresholds where a person enters and exits the “donut hole” increased in 2023. We’ll explain this in more detail below, but the short story is that the initial coverage limit increased...

With 2023 fully underway, there are new costing guidelines associated with Medicare that went into effect Jan. 1. CNBC noted that copays and deductibles for Medicare Part A (which includes hospital stays) are going up, while Part B premiums and deductibles (outpatient...

With almost one in two seniors now enrolled in the privatized health plan alternative to traditional Medicare known as “Medicare Advantage,” look for growth to escalate in 2023 and beyond. Though there have been probes into aggressive marketing practices and other...

KEY POINTS Roughly 29.1 million people are enrolled in Medicare Advantage Plans. Each year from Jan. 1 through March 31, those beneficiaries can switch to another Advantage Plan or drop their current one altogether. Here’s what to be aware of if you consider making a...

Planning well in advance of your Medicare eligibility can help you get every dollar in Medicare benefits you have coming to you. Here, in a nutshell, is what you should do and when you should do it. 12-6 months before your 65th birthday Set up your post-retirement...

The new year brings a cap on insulin copays, free vaccines, lower premiums and more Some of the biggest changes to Medicare in years take effect in 2023, with more than 65 million Americans paying lower premiums and deductibles and about to feel the effects of...

With 2023 fully underway, there are new costing guidelines associated with Medicare that went into effect Jan. 1. CNBC noted that copays and deductibles for Medicare Part A (which includes hospital stays) are going up, while Part B premiums and deductibles (outpatient...