Justin Doherty, Medicare Insurance Broker

Answer: The 3-midnight rule is a common requirement that a plan member be admitted as an in-patient in a hospital for 3 full days (3 overnights) before being transferred to a Skilled Nursing Facility. In most cases, the plan will not cover the SNF stay if the plan member did not satisfy this (and other) requirements.

Answer: Medicare coverage is generally based on medical necessity (as determined by CMS). Unfortunately, only the Monofocal lenses are deemed medically necessary and the other lenses, such as multifocal, toric, EDOF, and LAL are considered NOT medically necessary and are therefore, not covered by Medicare. As such, most insurance companies follow this same rule of thumb and also cover only the monofocal lenses.

Answer: In short, Medicare Advantage plans cover the same services as regular Medicare. However, the amount you pay for services may be higher or lower than regular Medicare. In addition, the MA plans may offer additional benefits not covered by Medicare, such as routine Dental, Vision, Hearing, and more. The way the plans operate are also different. With MA plans, you generally have a network of providers to use, while regular Medicare allows you to use any doctor that accepts Medicare. Your personal preferences on out of pocket costs vs monthly premiums will play a large roll in helping you decide which type of coverage will best meet your needs.

Answer: In some ways, yes, and in other ways, no. For many people, Medigap (Medicare Supplement) policies are not affordable. Staying with regular Medicare without a supplement is not appealing because of the potential out of pocket costs associated with your health needs. MA plans do offer a maximum amount you can pay each year, as well as smaller co-pays for more common, less expensive services, as well as additional benefits not offered by Medicare. That being said, regular Medicare is very user friendly and when combined with a Medigap policy is a very comprehensive medical coverage. With more people choosing MA plans, that is likely to increase the costs of Medigap policies making them less affordable for even more seniors.

Answer: If the following criteria is met, Medicare will likely cover the services: The care is medically necessary; The cruise ship is in U.S. waters (within six hours of a U.S. port) when you receive the care; The doctor providing care is legally allowed to provide medical services on a cruise ship.

Outside of that, Medicare generally does not cover health services while onboard a cruise ship.

Medicare Supplement (Medigap) policies and Medicare Advantage plans may help cover those expenses. Separate travel insurance policies may also be purchased to cover health services while onboard a cruise ship or in a foreign country.

Answer: This depends entirely on your age and current insurance situation. If you are already eligible (or will be eligible upon your retirement date), you will need to verify your enrollment in Medicare. This will be automatic if you're also receiving Social Security income. However, if you are not yet receiving SS retirement income, you will need to actively apply for Medicare by contacting Social Security. You will also want to make sure you have your new Medicare Advantage plan, or Medigap plan applied for prior to your work insurance being terminated.

Answer: Your health should not change your Medicare plan. However, you should review your plan options to make sure your plan will adequately cover the health needs of your new condition.

Answer: No, you cannot be dropped because of a health condition. In fact, your premium cannot be changed because of your specific health reasons either.

Answer: The premium is the amount you pay every month for your insurance. Medicare Part B premiums are withheld from your Social Security benefit. If you have a Medicare Supplement policy or a Medicare Advantage plan, you may have an additional premium. When you need services, you must first pay your deductible amount to the provider(s) (unless your plan has a $0 deductible). Once you have paid that amount, you generally have a copay amount payable for each service. Some services will require a coinsurance percentage instead of a flat copay amount. Generally, the coinsurance is 20% and those are applied to services like Durable Medical Equipment, Medicare Part B covered medications (IV, Infusions, etc.), Diabetic supplies, etc.

Answer: Original Medicare does not cover hearing aids. You will either pay out-of-pocket or use a separate hearing insurance policy. However, some Medicare Advantage plans do offer coverage of hearing aids. The benefit amounts and types of aids vary by plan.

Answer: For seniors that use expensive medications, this will likely reduce their costs as they will only pay $2,000 for covered medications. Depending on plan availability, some seniors will pay more in monthly premiums than in previous years. That's because the insurance companies have to offset the cost of the lower maximum. For others that generally only use few, inexpensive, generic medications, they'll not likely see much difference.

Answer: For now, there are only 7 apps that are eligible under Medicare. However, coverage generally requires a prescription and an unusual billing process that involves the providers instead of pharmacies. Sadly, these hurdles will likely cause more roadblocks to getting help paying for digital therapeutics.

That being said, the 7 apps currently eligible are:

1) SleepioRx for insomnia 2)Daylight for anxiety 3) Rejoyn for depression 4) reSET for substance use disorder 5) reSET-O for opioid use disorder 6) Somryst for chronic insomnia 7) MamaLift Plus for maternal mental health