Tag: us medicare
There are times in life when things don’t quite go accordingly to plan, and sometimes these instances can influence our health for better or worse. Chronic disease is a concept that has been around for ages, but it is taking on more meaning as we learn more about what it is and how it impacts people. In this article, we will explore chronic disease in general and the ways that it might influence your overall wellness.
What is Chronic Disease?
Chronic disease is any kind of disease that is around for the long haul. These diseases can last a few months—or a lifetime. Presented in many different forms, chronic disease can impact our health immediately, and have long-lasting impacts as well. Since chronic disease is an active part of an individual’s life for a long amount of time, the impacts on overall health and wellness can be significant.
How Chronic Disease Influences Wellness
Anyone that has ever been diagnosed with a chronic disease will tell you that it changes the way that you live. Some of these diseases are present at birth, but chronic diseases can also show up later in life. Regardless of their duration, they can influence your wellness in some substantial ways.
Mental and Emotional Fatigue
Chronic disease is known to come with its fair share of mental and emotional fatigue. It can place limitations on the way that you live, forcing you to miss out on big events or even just causing you to wear down with time. Having a chronic disease can be a heavy weight on your life, particularly if it is left unmanaged. Many people struggle to balance chronic disease with maintaining their own mental health.
Physical Fatigue
With any chronic disease, there is generally a degree of physical fatigue. It might be the sapping exhaustion of living with chronic pain, or the drain on your body’s power and resources as your body responds to the disease. For some people, this fatigue can get worse at certain stages of the disease cycle, or it can just get worse with time.
Medication Stresses
Medication can have a big impact on your wellness, and most people with chronic diseases take one or several kinds of medication. It is common for medication to have side effects, and this can put added stress on your body and mind. These stressors can be frustrating, and sometimes they bring worse pain or discomfort.
The Takeaway
Everyone responds to chronic disease differently, and the disease that you have will come with its own hardships. It is clear why disease would impact us, but sometimes it is important to consider how they can impact us as well. To find comfort while living with chronic disease, we must address just how much it really affects us and find the support that we need to keep pushing through.
The Size of Medicare (Nationally) in the U.S.
For the whole US, Medicare enrolls 64 million people. Of those, 9.1 million are on Medicare due to a disability, 16% of the Medicare population. Another 500,000 are on Medicare due to End-Stage Renal Disease (ESRD). Medicare accounts for 4% of the US Gross Domestic Product (GDP), or around $780 billion dollars, making it the second most expensive Federal program. (Social Security, at about one trillion ($1,000,000,000,000) per year.
The average total cost per Medicare beneficiary is $12,187 per year. Of that, beneficiaries pay an average of $170.10 per month, or $2041,20, for Part B in 2022 and pay an additional average of ca. $6,000 out of pocket, for a total of around $8100. A very good private insurance plan, in contrast, would cost around $26,000 per year.
Medicare accounted for 20 percent of total national health spending, 30 percent of spending on retail sales of prescription drugs, 25 percent of spending on hospital care, and 23 percent of spending on physician services in 2017.
Saving on Prescription Drugs While on Medicare
If you are on Medicare, you probably spend an average of $581 per year, out-of-pocket on your prescription drugs, over and above your Part B premiums and any Medicare Advantage, Medigap, or prescription drug plan premiums that you pay. For some, it can be much more.
87% of adults aged 65-79 use prescription drugs, and the average number prescribed per person is 20.
How can you save? Medicare Advantage and Medicare Part D plans are required to provide a mail-order pharmacy option. When you use mail order, you are avoiding a retail pharmacy, prices are generally somewhat lower than in-person pharmacy service, but not always: it depends on the plan and the drug in question.
If you compare the full retail pharmacy price, using a discount card like GoodRx versus the mail-order cost, you may occasionally find that using the discount card is cheaper.
Another option has recently become available…
Billionaire Mark Cuban has started a mail-order pharmacy called CostPlusDrugs.com. Around 100 generic medications are available from this site, all at cost plus a 15% markup. You may find that the price from this site, assuming your drug is available, is far less than the mail-order price with your Medicare Advantage or prescription drug plan. New drugs will be added each month. At present, the plan is to offer only generics, but this may change. You can check if a generic is available for your prescription drug by asking your doctor’s office or googling “generic for name-of-prescription drug.” Currently, CostPlusDrugs.com does not accept insurance to keep administrative costs down. This may change in the future.
If you are considering ordering from other mail-order pharmacies, Blink Health has been rated best, it accepts most insurances and is available 24/7. Blink has most drugs available in addition to generics.
More than ever now, it pays to shop around for your prescriptions, as it true with so much else.
Dental Coverage Under Medicare
Medicare covers almost no dental services. Not exams. Not cleaning. Not dentures. Not drilling. Not filling. Zip. Zero. Nada. The exceedingly rare situations in which Medicare covers dental services are those in which dental services are an integral part of care for a non-dental problem, such as a jaw injury or bone cancer.
That being said, the only way that you will obtain dental services under Medicare is to enroll in a Medicare Advance Plan that offers dental services as an extra benefit or enroll in a dental plan for seniors on Medicare. With Medicare Advantage Plans, precisely because they are an extra benefit, they tend to be limited, but some coverage is certainly better than none. Coverage in separate dental plans may be more generous.
Because both Medicare Advantage Plans and dental plans for seniors on Medicare are both private businesses not affiliated with the federal government, you must deal with a Medicare agent in order to get them. The Social Security office or Medicare can only refer you to an agent if you have questions about these plans.
When Can I Enroll?
For Medicare Advantage Plans that offer dental services as an extra benefit, your Original Enrollment period starts the third month before your 65th birthday and runs for seven months. There is also an open enrollment period from January 1 to March 31 of each year. You also have a special enrollment period if you lose coverage because your plan shut down, or stopped offering services in your area, you lost employer-provided insurance that you were using as evidence of creditable coverage, you were given wrong information about enrollment by a Federal employee, and a few other situations.
Open enrollment for stand-alone dental plans for seniors is usually year-round, but this may vary in some states and localities. Again, your Medicare insurance agent is your best source here; Medicare cannot help you.
How Much Does It Cost?
As with American health care in general, prices vary widely and wildly. Premiums for Medicare Advantage Plans with dental services range from $0 per month to around $100 per month; premiums for stand-alone dental plans range from $0 to $100 per month. That being said, why, you may ask, does not everyone pick the zero-premium plans? The answer is coverage. You get what you pay for, and higher-cost plans generally, but not always, offer lower deductibles and copayments and a wider range of services.
About half of adults on Medicare do not have dental coverage. It is not advisable to be one of them.
Does Medicare Cover Ambulance Services?
The short answer is yes. If ground or air ambulance transport is medically necessary, Medicare will pay to transport you to the nearest facility that can provide the needed services. Services are provided under Part B. If you do not have Part B, Medicare will not pay.
The Part B deductible, which is $233 in 2022, applies. After that, you pay 20% of the Medicare-approved charges.
Most of the time when ambulance transport is necessary, it is obvious. In cases where it is not, your doctor can provide a certification that it is needed. For example, a dialysis patient may need ambulance transport to a dialysis center.
What If There’s a Question?
If the ambulance service doubts that you meet the definition of medical necessity, they are required to give you a notice that Medicare may not pay. This is called an Advanced Beneficiary Notice of Non-coverage. It is given if you requested an ambulance in a clearly non-emergency situation or the company believes Medicare will not pay. (The fact that you received such a notice, alone, does not mean that Medicare will not pay; this is determined later.)
Are There Special Situations?
Yes. If you live in the states of Delaware, the District of Columbia, Maryland, New Jersey, North Carolina, South Carolina, Virginia, or West Virginia, and you use non-emergency ambulance services more than three times in a ten-day period or once a week for three weeks or more, the company may request a pre-authorization before providing services. If the pre-authorization request is not approved, Medicare will not pay for the services.