Medicare Questions & Answers: Medicare Part B
Medicare Part B Q&A
Showing 84 questions
What's the financial risk of sticking with Original Medicare without a Medigap plan?
Sticking with Original Medicare (Parts A and B) without a Medigap (Medicare Supplement) plan can expose you to significant out-of-pocket costs because Medicare doesn’t have an annual limit on what you might pay for covered services. You’re responsible for 20% of all Part B expenses — including doctor visits, outpatient care, surgeries, and medical equipment — after meeting your deductible. If you face a serious illness or require frequent treatments such as chemotherapy, dialysis, or hospital stays, those 20% coinsurance payments can add up quickly and create major financial strain.In addition, Original Medicare doesn’t cover many common healthcare needs such as prescription drugs, routine dental or vision care, or extended stays in skilled nursing facilities beyond the limited covered period. Without a Medigap plan to help fill those coverage gaps, beneficiaries are essentially “self-insuring” against potentially high medical bills, making them financially vulnerable in the event of unexpected or chronic health issues.
How can I lower my Medicare Part B premium if my income drops after retirement?
Your Medicare Part B premium is based on your modified adjusted gross income (MAGI) from two years prior (per the Medicare & You 2025 handbook). So, for example, your 2025 premium is based on your 2023 tax return.If your income has dropped due to retirement or another life change, here’s how you can potentially lower your premium:
1. Request a “Life-Changing Event” Adjustment
The Social Security Administration (SSA) handles Medicare premium billing. They allow you to appeal your Income-Related Monthly Adjustment Amount (IRMAA) if you’ve had a life-changing event that reduces your income, such as:
Retirement or reduced work hours
Marriage, divorce, or annulment
Death of a spouse
Loss of pension income
Employer settlement payments
File Form SSA-44 (Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event). You’ll need documentation (such as your retirement letter, pension change notice, or tax return).
2. File Taxes to Reflect Your Lower Income
If you’re newly retired, your recent tax return may not yet reflect your reduced income. Filing the appeal with updated tax information helps SSA re-calculate your Part B premium.
3. Consider Timing for Retirement Withdrawals
Large withdrawals from 401(k)s, IRAs, or capital gains can temporarily spike your MAGI and increase your premiums.
Planning withdrawals strategically (with a financial advisor) can help you stay under IRMAA thresholds.
4. Apply for Medicare Savings Programs (if eligible)
If your income drops significantly, you may qualify for state programs that help pay your Part B premium (and sometimes Part A and D too). These include:
QI (Qualified Individual Program)
SLMB (Specified Low-Income Medicare Beneficiary Program)
QMB (Qualified Medicare Beneficiary Program)
5. Stay Proactive
Watch for your IRMAA determination letter from SSA.
If your income goes down again, you can re-appeal.
Keep records of retirement changes, pensions, or severance payments.
Bottom line: You don
I just enrolled in Medicare, and I've got my Part A and B, but I'm hearing there are gaps in coverage. What are these gaps exactly?
Yes — even with Original Medicare (Parts A & B), there are coverage gaps you should be aware of. Here’s the short breakdown:1. No prescription drug coverage
Part B covers some medications administered in a doctor’s office, but most prescriptions you fill at a pharmacy aren’t covered.
Solution: Add a Part D prescription drug plan.
2. No routine dental, vision, or hearing
Exams, glasses, hearing aids, and most dental work are not covered.
Some Medicare Advantage plans include limited benefits.
3. Long-term care
Medicare does not cover custodial care (assisted living, nursing home stays beyond short rehab).
Only short-term skilled nursing after hospitalization is covered.
4. Out-of-pocket costs
Deductibles, copays, and coinsurance can be significant.
Part A has hospital deductibles; Part B has a monthly premium and 20% coinsurance for most services.
Solution: Consider Medigap (Supplement) coverage.
5. Limited preventive coverage
Part B covers many preventive services, but some screenings or therapies may require extra approval or cost-sharing.
Bottom line: Original Medicare covers hospital and medical services but leaves gaps in prescriptions, dental/vision/hearing, long-term care, and out-of-pocket expenses.
I'm still working at 67, and I don't know if I need Part B. Why is something so basic so hard to figure out?
I get it—Medicare feels like it’s written in another language! It is totally normal to find this frustrating.Here is the deal on whether you can skip Part B for now while you are still working: The "Big Company" Rule20+ Employees: If your company has 20 or more workers, your work insurance is more than likely "creditable" and will stay primary. Therefore, if you are actively working and covered by your Employer Group Health Plan (EGHP), you can safely skip Part B and won't face any late penalties. When you finally retire, you get an 8-month window to sign up.
If your employer has under 20 Employees: If it’s a small business, Medicare becomes the main boss. Your work insurance expects Medicare to pay first. You almost certainly need Part B right now, or your work plan might refuse to pay your medical bills.
The HSA Catch: If you are still putting money into a Health Savings Account (HSA), signing up for any part of Medicare locks that down. You cannot contribute to an HSA once you are on Medicare. Many people delay Part B just to keep their HSA tax perks going.
What About Part A? Since Part A (hospital care) is usually free if you've worked enough years, most people just grab it at 65. It sits in the background as a backup, unless you are trying to save into that HSA we just talked about.
To figure out your exact next move, reach out to a local Medicare Expert and your HR. Find out if your company has a "creditable" employer group health plan. If there are more than 20 employees it is most likely creditable and you can delay Part B until you retire. AND, remember if you are actively contributing to an HSA, and over 65, you need to stop contributing to the HSA 6 months before retiring and moving to Medicare to avoid an IRS penalty on your HSA contributions.
Great question... working with a local Medicare expert will ease your mind and lessen the confusion for you!
I thought I signed up for both Part A and B when I got my Social Security, but now I'm getting bills for Part B. Did I miss something during the enrollment period?
Many people believe that when they sign up for Social Security, everything under Medicare is free. That is not exactly how it works.Medicare Part A usually does not have a monthly premium if you worked and paid Medicare taxes for at least 40 quarters, which equals 10 years. If someone worked fewer than 40 quarters, they may have a monthly premium under Part A.
Medicare Part B is different. Part B always has a monthly premium. The standard premium changes each year. For 2026, it is $202.90. Some individuals with higher incomes may pay more due to income IRMAA adjustments.
If you are receiving Social Security benefits, the Part B premium is usually deducted automatically from your monthly check. If you are not yet collecting Social Security, Medicare will send you a quarterly bill.
Receiving a bill does not necessarily mean you missed your enrollment period. It usually just means that Part B has a premium that must be paid directly.
If someone delays enrolling in Part B and does not have other creditable coverage, they face a late enrollment penalty. The penalty is 10 percent for every full 12-month period a person was eligible but not enrolled, and that penalty continues for as long as they have Part B.
If you would like, we can review your enrollment timeline together to make sure everything was processed correctly.
Educational Disclosure:
This information is provided for educational purposes only and is not a guarantee of benefits. Medicare premiums, deductibles, and penalties may change annually. Income adjustments may apply. I am not affiliated with or endorsed by the federal government or the Medicare program. For official Medicare information, please visit www.medicare.gov
or call 1-800-MEDICARE.
Janix Barbosa-Llanos, MBA, PMP, CEP, RSSA, FSN
Licensed Health Insurance Broker
Why do some seniors end up paying lifelong penalties for Medicare Part B or Part D?
Late Enrollment penalties (LEP's) are a result of not having creditable coverage through an employer or spouse and not being enrolled in Medicare Part B or Part D after age 65. Part B and Part D (drug) penalties are calculated based on how my many months you went without being enrolled in Medicare Part B and Part D past age 65. Medicare Part B penalties may go away after a certain amount of time, Part D penalties never go away. LEP's are avoidable by enrolling in Medicare Part B and Part D at age 65 if you do not have "creditable" coverage. Medicare considers most group employer plans creditable, but it a good idea to check with your HR dept ahead of your 65th birthday to verify.
My friend said she got a free annual physical with Medicare, but my doctor billed me. What's going on?
Medicare covers a Wellness Visit at 100%, but it is not the same as a traditional physical exam. If your doctor performed anything beyond the Wellness Visit checklist, they can (and usually will) bill you.Here’s the difference:
Medicare Annual Wellness Visit (free)
Covered at 100%
Includes:
Health history review
Medication review
Height, weight, blood pressure
Cognitive screening
Preventive planning
No hands‑on exam. No labs. No tests.
Annual Physical (not free under Medicare)
Medicare does not cover this.
If your doctor:
Listened to your heart/lungs
Checked reflexes
Ordered labs
Addressed new symptoms
Managed chronic conditions
…that becomes a billed service, and you may owe a copay or coinsurance.
You didn’t do anything wrong; Medicare’s terminology is confusing.
This is exactly why I walk clients through what’s covered, what isn’t, and how to avoid surprise bills. Having your own Medicare agent who really clarifies these details can make all the difference.
Why is regular Medicare better than an advantage plan?
This is one of the biggest debates in Medicare, and the answer depends on your priorities. Many people choose Medicare Advantage because the low premiums and extra benefits (like dental or vision) sound attractive. But here’s why Original Medicare (“regular Medicare”) is often considered better by doctors, hospitals, and patient advocates:Reasons why Original Medicare is often preferred include: 1. Freedom to See Any Doctor Nationwide. With Original Medicare, you can see any doctor or hospital in the U.S. that takes Medicare, no networks, no referrals. With Medicare Advantage, you’re limited to the plan’s network, and going out-of-network can mean big bills or no coverage at all; 2. Guaranteed Coverage for Medically Necessary Care; Original Medicare covers medically necessary care as defined by federal law. Medicare Advantage plans can require prior authorization, meaning the plan must approve before you get care.
This can delay or deny treatments; 3. No “Surprise” Network Changes. Doctors and hospitals can leave an Advantage network anytime during the year. With Original Medicare, as long as the provider accepts Medicare, you’re covered; 4. Easier When Traveling or Moving; Original Medicare works anywhere in the U.S.
Medicare Advantage plans are local/regional, move or travel, and your plan may not cover you. 5. Predictability with Medigap
If you add a Medigap supplement, your out-of-pocket costs with Original Medicare can be very low and predictable. Advantage plans have lower premiums up front, but if you get really sick, you could face thousands in costs (up to $8,850 per year in 2025, not including drugs).
The tradeoff is that Medicare Advantage = lower monthly costs, extra perks, managed care (but with restrictions). Original Medicare = more freedom, broader coverage, stronger protections (but you’ll likely pay more monthly if you add Medigap + Part D). Many people who value choice of doctors and fewer hassles prefer Original Medicare.
I'm on Original Medicare with no supplement, and I'm wondering how much I'd pay if I need an ambulance ride to the hospital tomorrow.
It’s hard to give you an exact number because ambulance charges vary by distance and service level, but here’s the general rule with Original Medicare and no supplement: ambulance rides are covered under Part B. You’d first pay the Part B deductible ($257 in 2025 if you haven’t met it yet), then 20% of Medicare’s approved amount for the ride. For example, if the approved amount was $1,000, your share would be about $450. One tip is to make sure the ambulance company accepts Medicare assignment, because if they don’t, your cost could be higher.
I'm on Medicare Part B, and I'm wondering how my physical therapy visits are covered. Do I have to hit my deductible first?
Yes, Medicare Part B does cover physical therapy, but there are a few things to keep in mind about how the costs work.First, you’ll need to meet your Part B deductible, which for 2025 is $240. Until you hit that amount, you’ll pay the full cost of your physical therapy visits out of pocket.
After you’ve met the deductible, Medicare typically covers 80% of the approved amount for your therapy, and you’re responsible for the remaining 20%. If you have a Medigap plan or other supplemental insurance, it might help cover that 20%.
There’s no longer a strict cap on how much Medicare will pay for therapy each year, but if your total therapy costs go above a certain threshold (around $2,330 in 2025 for physical therapy and speech therapy combined), your therapist may need to show that the treatment is still medically necessary in order for Medicare to keep covering it.
So in short: yes, it’s covered—but you’ll need to pay the deductible first, then usually 20% of the cost after that. The 20% of the cost may be reduced by your Medicare Supplement or Advantage Plan.
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Legal: The information provided is for general informational purposes only and is not intended as legal, financial, or insurance advice. While I strive to ensure the accuracy and timeliness of the information, Medicare rules and policies are subject to change. You should consult directly with Medicare, a licensed insurance agent, or a qualified professional for advice specific to your situation. I am not affiliated with or endorsed by the U.S. government or the federal Medicare program.
My friend got her cataract surgery covered by Medicare, but they didn't cover the lens she wanted. How does that work?
Original Medicare does cover cataract surgery itself under Part B, including removing the cloudy lens and implanting a replacement intraocular lens (IOL), as long as it's medically necessary (e.g., the cataracts affect daily activities like driving or reading).As long as the medical necessity requirement is met Medicare covers a standard monofocal IOL. This is a basic man-made lens that usually corrects vision at just one distance (usually far vision). The surgery and the basic lens are covered after the Part B deductible (currently $283), you will also pay a 20% coinsurance of the Medicare-approved amount.
Original Medicare does NOT cover premium or advanced IOLs. This includes options like: Multifocal lenses for seeing at multiple distances without glasses,
Toric lenses that correct astigmatism, or other specialty lenses that reduce or eliminate the need for glasses/contacts.
If your friend chose one of these premium lenses then Medicare pays for the surgery and the cost of a standard lens, but she is responsible for the additional out-of-pocket cost of the upgraded lens itself. This can range from $1,000–$4,000+ per eye, depending on the type and provider—it's considered an elective upgrade, not medically necessary under Medicare rules.
PLEASE NOTE:
* Medicare also covers one pair of standard prescription eyeglasses or contact lenses after the surgery with an IOL implant.
*Coverage can vary slightly if your friend has a Medicare Advantage plan (Part C) instead of Original Medicare. Some MA plans may offer partial coverage for premium lenses but most follow similar rules to Original Medicare. It's best practice to check with the specific plan/provider for details.
I'm interested in nutrition counseling to help manage my diabetes. Will Medicare cover this as preventive care?
Yes, Medicare will cover nutrition counseling, specifically medical nutrition therapy (MNT), for individuals with diabetes as part of preventive care. Medicare Part B covers 100% of the cost of MNT for those with diabetes, as long as they meet specific criteria and use a doctor who accepts Medicare assignment.Elaboration:
Coverage for Diabetes:
Medicare provides coverage for MNT when a doctor refers a beneficiary with diabetes for these services.
Preventive Care:
MNT is considered a preventive health service, meaning Medicare covers the full cost, and you won't have to pay any copay or deductible.
Other Conditions:
Medicare also covers MNT for individuals with kidney disease or who have had a kidney transplant within the last 36 months.
Diabetes Self-Management Training:
Medicare also covers diabetes self-management training, which is an important part of managing diabetes.
Importance of MNT:
MNT is an effective way to help individuals with diabetes manage their condition and reduce the risk of complications.
Limited Coverage Hours:
While Medicare covers MNT, there are limits on the number of hours covered each year. For example, Medicare typically covers 3 hours of MNT in the first year and 2 hours in subsequent years.
Why am I paying more for Medicare Part B and D than my friends? What is IRMAA and how is it calculated?
IRMAA stands for the Income-Related Monthly Adjustment Amount. It's an additional premium some people pay for Medicare Part B and Part D if their income is above certain limits.Medicare looks at your Modified Adjusted Gross Income (MAGI) from your federal tax return filed two years earlier. For example, your 2026 Medicare premiums are generally based on your 2024 tax return.
* Your friends may pay less because their income falls into a lower IRMAA bracket.
* IRMAA is recalculated each year based on the most recent tax information available.
* If you've experienced a life-changing event—such as retirement, marriage, divorce, or the death of a spouse—you may be able to request a reduction by filing Form SSA-44 with the Social Security Administration.
If you're unsure whether your IRMAA is correct, I'd be happy to help you determine which income bracket you fall into and whether you may qualify for an adjustment.
2026 IRMAA income brackets
Higher income results in higher Medicare Part B and Part D premiums. Based on 2024 tax returns for individuals.
income level
≤ $110k 1
$110k–$138k 2
$138k–$172k 3
$172k–$206k 4
$206k–$550k 5
>$550k 6
How does Medicare Part B handle coverage for preventative screenings like mammograms?
Medicare Part B covers preventive screenings like mammograms as part of its focus on early detection and health maintenance, with specific rules on frequency, cost, and eligibility. Here’s how it works:Screening Mammograms: These are covered for women aged 40 and older to detect breast cancer early, before symptoms appear.
Frequency: Part B fully covers one screening mammogram every 12 months (anytime after 11 months from your last one). If you’re new to Medicare, you also get a baseline mammogram covered between ages 35–39.
Cost: There’s no out-of-pocket cost—no coinsurance, copayment, or Part B deductible—as long as the provider accepts Medicare assignment (agrees to Medicare’s payment rates). This applies to 2D and 3D (tomosynthesis) screenings, though 3D coverage was clarified in updates around 2018 to match evolving standards.
Diagnostic Mammograms: If a screening finds something abnormal or you have symptoms (like a lump), Part B covers diagnostic mammograms to investigate further.
Frequency: No strict limit—covered as medically necessary, which could mean multiple in a year if your doctor orders them.
Cost: After meeting the Part B deductible ($240 in 2025), you pay 20% of the Medicare-approved amount. There’s no cap on how many are covered, but each one triggers that 20% coinsurance unless you have a Medigap plan to offset it.
Key Details: The mammogram must be done at a Medicare-approved facility (like a radiology center or hospital outpatient department). If it’s bundled with other services (e.g., a biopsy), additional costs might apply under Part B’s standard rules. Preventive coverage assumes you’re symptom-free—once it’s diagnostic, it shifts to a treatment framework.
This setup reflects Part B’s broader approach to preventive care: full coverage for annual screenings to catch issues early, with cost-sharing kicking in when it’s about diagnosis or follow-up. It’s a balance between encouraging checkups and managing expenses when care escalates.
My doctor recommended a bone density test. Is this considered preventive care under Medicare?
Yes — a bone density test (DEXA scan) is considered preventive care under Medicare.Medicare Part B covers a bone mass measurement once every 24 months (2 years) if you’re eligible — or more often if medically necessary.
You qualify if you’re at risk for osteoporosis, for example if:
• You’re a woman who is estrogen-deficient and at risk for osteoporosis
• You have vertebral abnormalities or fractures
• You’re taking (or have taken) long-term steroid medications
• You have primary hyperparathyroidism
Cost: If your doctor accepts Medicare assignment, you pay $0 for this test.
It’s a great preventive benefit to help detect bone loss early and protect your bone health!
I live in Tennessee, turn 65 in August, and signed up for Medicare Part A only. I have coverage through my wife’s Blue Cross Blue Shield plan, which she’ll keep for about seven more years. Will I owe a penalty now or later if I wait until she retires to get Part B?
You will not have to pay a penalty if you are covered by your wife's employer's group health plan, provided it has 20 or more employees. You can delay Part B enrollment until your wife retires without a penalty, and will have an 8-month Special Enrollment Period to sign up once her coverage ends.What you can do now
Keep Part A only for now: Since you are eligible for premium-free Part A and have other coverage, you can keep it and delay Part B to avoid paying premiums on both.
Notify Social Security: Before your 65th birthday in August, contact the Social Security Administration to let them know you are delaying Part B because you have other creditable coverage through your wife's employer.
Verify employer size: For this to be a "no-penalty" delay, your wife's employer must have 20 or more employees. If it has fewer than 20 employees, you may face a late enrollment penalty.
What to do when your wife retires
Enroll during the Special Enrollment Period (SEP): When your wife retires, her employer coverage will end, and you will have a Special Enrollment Period (SEP) to sign up for Part B.
Understand the SEP timeframe: The SEP begins when the employer coverage ends or she stops working, whichever comes first, and lasts for 8 months.
Avoid penalties: As long as you enroll within this 8-month SEP, you will avoid the Part B late enrollment penalty. The penalty is typically 10% of the monthly premium for each full 12-month period you could have enrolled but didn't.
I signed up for part A. I'm still on my husband's insurance so I didn't sign up for part B. is there a form I need to fill out stating I'm still on my husbands insurance?
So the question is, I signed up for Part A, I'm still on my husband's insurance so I didn't sign up for Part B. Is there a form I need to fill out stating I'm still on my husband's insurance?
The first thing we need to pick apart is figuring out if your husband's or spouse's insurance is what's known as creditable coverage. Basically what that means is that it's as good as Medicare. Usually the insurance policy from your employer has to have prescription drug coverage, and it has to pay for hospital and medical services. One way to find out if it is deemed creditable is to basically find out from the benefits department of your employer or your spouse's employer.
As far as doing something to prove that you have insurance, you don't need to do that until the time comes for when you need to sign up for Part B. There's a form called a CMS L564 form, which is basically going to show Medicare, the government, that you've had health insurance and will not be hit with a late penalty for Part B.
And then there is a separate form if you have Part A already. That is known as a CMS 40B form, and that is your actual application for the Part B portion. What you do is you upload it on your Social Security portal to apply for Medicare.
But long short of it is that you do not have to prove anything at that time. It just comes down to when you are ready to retire. That's when you get those forms in place to apply.
I'm confused about all these different Medicare costs - premiums, deductibles, copays. How do they all work together?
All parts of Medicare have some cost associated, whether it be a premium, deductibles, copays for services, or even a max out-of-pocket.Premiums are the payments you make for the coverage. Deductibles are the amount you must pay out-of-pocket before your coverage will pay anything. Copays are the amount you pay for specific services after meeting your deductible.
Medicare Part A is free once you retire if you or your spouse worked for the last 40 quarters (10 years) before you signed up, because you paid taxes while working. Medicare Part A:
* Has a deductible for each benefit period (every 60 days) for inpatient hospital stays.
* Has copays for hospital stays longer than 60 days.
* Has daily coinsurance for days 61-90 and 91-150.
Medicare Part B has a premium that comes out of your Social Security check before it is dispersed to you. If you are not receiving Social Security, you must pay the premium for Part B out-of-pocket until you start drawing your Social Security. Medicare Part B:
* Has an annual deductible.
* Does not have copays for most services.
* Has a 20% coinsurance for most services after the deductible is met.
Medicare Supplements (Medigap) provide benefits to help cover out-of-pocket costs like deductibles, coinsurance, & copays. Each Med Sup has a premium, & each one has different benefits. Medigaps:
* Help pay the 20% coinsurance for services covered by Original Medicare Part B (medical insurance).
* Many cover the Medicare Part A (hospital insurance) deductible.
* May cover additional days in the hospital after Medicare benefits are used up.
* Some may cover costs for skilled nursing facilities, hospice care, excess charges from non-participating providers, & foreign travel health care emergencies.
Medicare Advantage usually does not have premiums, but may have a deductible(s), has copays for services, & an annual max out-of-pocket.
I need a new wheelchair, and I'm not sure if Medicare will cover it. What's the process for getting durable medical equipment?
Yes — Medicare Part B covers wheelchairs as durable medical equipment (DME) if your doctor certifies it's medically necessary for use in your home.How to Get a Wheelchair Through Medicare
1. Visit Your Doctor
You’ll need a face-to-face appointment with your doctor or treating provider.
They must document your medical need for a wheelchair (ex: you have difficulty walking or getting around at home).
The doctor must write a prescription/order for the wheelchair.
2. Get the Order Sent to a Medicare-Approved DME Supplier
The supplier must accept Medicare assignment, or you may end up paying more out-of-pocket.
Not all suppliers do, so ask if they "accept assignment" before proceeding.
(For power wheelchairs, Medicare often requires prior authorization before approval. Once approved, Medicare will cover 80% of the Medicare-approved amount. You (or your supplemental insurance) cover the remaining 20% after meeting your Part B deductible.)
I'm confused about which vaccines Medicare covers. Can you explain which ones are free?
Medicare covers most recommended adult vaccines for free with no out-of-pocket costs (no copayments or deductibles), though which part of Medicare covers them depends on the specific vaccine.Vaccines Covered by Medicare Part B (Medical Insurance)
You pay nothing for these vaccines as long as your healthcare provider accepts Medicare assignment:
Flu shot: One annual shot.
Pneumococcal shots: For pneumonia prevention. This typically involves two different shots given a certain time apart.
COVID-19 vaccines: Includes primary series and all recommended boosters.
Hepatitis B shots: For people at medium or high risk of contracting the virus.
Vaccines related to injury or exposure: Such as a tetanus shot if you step on a rusty nail or rabies shots after an animal bite.
Vaccines Covered by Medicare Part D (Prescription Drug Plans)
If you have a Medicare Part D plan (either a stand-alone plan or through a Medicare Advantage plan that includes drug coverage), you also pay nothing out-of-pocket for all other adult vaccines recommended by the CDC's Advisory Committee on Immunization Practices (ACIP).
These include, but are not limited to:
Shingles vaccine (Shingrix): A two-dose series recommended for adults 50 and older.
RSV vaccine (Respiratory Syncytial Virus): Recommended for adults 60 and older (based on shared decision-making with a doctor).
Tdap vaccine: Protects against tetanus, diphtheria, and whooping cough (pertussis).
Hepatitis A vaccine.
MMR vaccine: Measles, mumps, and rubella.
Important Tip: Ensure you go to a pharmacy or provider within your plan's network to avoid potential issues where you might have to pay upfront and seek reimbursement later. It's always a good idea to confirm coverage details with your specific plan or provider beforehand
My doctor wants me to try acupuncture for my back pain. Will Medicare cover any of this?
Yes — but only in a very specific situation, and this is where people get tripped up.Original Medicare (Part B) only covers acupuncture for chronic low back pain, and it has to meet all of these criteria:
• The pain has lasted 12 weeks or longer
• It’s not associated with surgery, pregnancy, infection, or cancer
• The acupuncture is provided by a qualified practitioner (MD, DO, NP, PA, or an auxiliary provider under their supervision)
If you qualify, Medicare will cover:
• Up to 12 sessions in 90 days
• An additional 8 sessions if you’re improving - 20 visits max per year
What Medicare does not cover:
• Acupuncture for neck pain, migraines, arthritis, sciatica, or general pain
• “Wellness” or maintenance acupuncture
• Most stand-alone acupuncture clinics unless they meet Medicare’s provider rules
Also important: Medicare Advantage plans may offer broader acupuncture benefits, sometimes covering more conditions or visits than Original Medicare.
Bottom line:
If this is chronic low back pain, there’s a good chance some of it is covered. If it’s for anything else, you should assume Medicare won’t pay unless you’re on a Medicare Advantage plan with extra benefits.
I'm considering a smartwatch that monitors my heart rhythm for atrial fibrillation. Will Medicare help cover this type of wearable technology?
Original Medicare generally will not pay for a smartwatch that monitors heart rhythm (like an Apple Watch or similar consumer wearable).Medicare classifies smartwatches as consumer/wellness devices, not medically necessary equipment, so they aren’t covered under Part A or Part B.
There are a few exceptions or alternatives:
✅ Medicare Advantage (Part C) plans
Some Medicare Advantage plans offer wellness or technology benefits that may include a fitness tracker or smartwatch allowance as an extra benefit — but it varies widely by plan and location.
✅ Medically necessary cardiac monitors
If your doctor determines you medically need a diagnostic heart monitor (like a Holter monitor or monitored ECG patch) and orders it as part of your treatment, Medicare Part B can cover those devices. These are medical devices, not consumer smartwatches.
Bottom line
💡 Smartwatches for AFib monitoring are not covered by Original Medicare.
📱 Some Medicare Advantage plans may offer some wearable benefits, but you need to check your specific plan.
🩺 If your doctor prescribes a medical‑grade cardiac monitor for your condition, Medicare may cover the medically necessary device under Part B.
Are preventative screenings covered by Medicare?
Medicare covers a wide range of preventive screenings and services to detect illnesses early, generally with no out-of-pocket cost (no deductible or coinsurance) if the provider accepts assignment.Most of these services are covered under Medicare Part B (Medical Insurance).
Key Details on Covered Services & Parts:
Part B Coverage: Covers yearly "Wellness" visits, "Welcome to Medicare" visits, cardiovascular screenings, diabetes screenings, cancer screenings (mammograms, colonoscopies, Pap tests), flu shots, and HIV screenings.
Preventive vs. Diagnostic: While preventive screenings (to prevent illness) are free, if a screening turns into a diagnostic test (to diagnose a known symptom or condition), you may owe copayments.
Requirements: Services must be deemed "medically necessary" and, in some cases, are only covered for those with specific risk factors.
Vaccines: Part B covers influenza, pneumococcal, and Hepatitis B vaccines.
Part D: Covers certain vaccines, such as the shingles shot, which are not covered by Part B.
Always ensure your doctor accepts assignment to ensure the $0 cost share.
I'm a smoker trying to quit. What smoking cessation benefits does Medicare offer for someone in my situation?
Medicare covers up to eight face-to-face counseling sessions for smoking cessation per year, provided by a Medicare-recognized practitioner, and can also cover prescription medications for quitting. You may be eligible for counseling and other services through Medicare Part B, and prescription medications are often covered by Part D or a Medicare Advantage plan. Counseling sessions are typically provided at no out-of-pocket cost if your provider accepts Medicare assignment.What Medicare Covers
Counseling Services:
Medicare Part B covers up to eight individual or group counseling sessions over a 12-month period, for up to two separate quit attempts. These sessions are considered preventive care and are available for regular tobacco users.
Prescription Medications:
You may be covered for certain prescription drugs that aid in quitting smoking, such as bupropion (Wellbutrin) or varenicline (Chantix), under your Medicare Part D plan or a Medicare Advantage plan with drug coverage.
Over-the-Counter (OTC) Products:
Medicare generally does not cover over-the-counter smoking cessation products like nicotine patches or gum, but this may vary with your specific Part D or Medicare Advantage plan.
How to Access These Benefits
Contact your Doctor: Start by talking to your primary care physician or other Medicare-recognized healthcare provider.
Check Your Plan Details: Review your specific Medicare Part D or Medicare Advantage plan's drug formulary to see which prescription medications are covered and what your out-of-pocket costs will be.
Use the Medicare Plan Finder: You can also use the Medicare Plan Finder tool on the Medicare.gov website to find out how Part D and Medicare Advantage plans in your area cover specific medications.
Important Considerations
Accepts Assignment:
To receive counseling sessions at no cost, your healthcare provider must accept Medicare assignment, meaning they agree to be paid directly by Medicare and not bill you for more than the approved amo
Does Medicare Part A cover outpatient surgery, or is that strictly under Part B?
Medicare Part A: does not pay for outpatient surgery. Part A covers inpatient services to include inpatient hospital care up to 150 days and inpatient skilled nursing care for up to but no more than 100 days per stay. Part A has a modest deductible of $1676 for 2025, and is subject to per day coinsurance begining after day 60 of inpatient hospital care and day 20 of in-patient skilled nursing care. Medicare Part A does not pay for Long Term Care services.Medicare Part B: pays for outpatient surgery and all other Medicare appoved outpatient services like like Doctor Visits, Lab Work, Outpatient Surgery, Physical Therapy, etc. Part B has a monthly cost to obtain coverage. The cost in 2025 for most Americans is $185 per month. If your Adjustable Gross Income (AGI) is higher than most, the premium for Part B is higher.
My doctor prescribed physical therapy, but I'm not sure how many visits Medicare will cover. How do I find out?
I have gotten this question for years and years, and the good news is that the rules are much better than they used to be.The short answer is: There is no longer a hard limit on physical therapy visits.
As long as your doctor and physical therapist can show that the care is medically necessary and you are making progress, Medicare will cover it.
But how it actually works, also depends on the type of plan you have:
Medicare Supplement (Medigap):
You can use any physical therapist who accepts Original Medicare. Medicare Part B pays 80% of the cost, and your Supplement automatically pays the remaining 20% (once your Part B deductible is met). There are no pre-approvals required. If you need a lot of therapy over the year, your therapist simply adds a special billing code to tell Medicare that your continued treatment is still necessary.
Medicare Advantage Plan:
You will usually pay a flat copay for each visit, and you will use a therapist in the plan's network. Instead of unlimited visits upfront, Advantage plans manage care by approving therapy in "batches." For example, they might authorize 8 to 10 visits to start. If you reach the end of that batch and still need more help, your therapist just submits an update to your plan to get the next batch approved.
The bottom line: Don't stress about hitting a magic number of visits. Just focus on your recovery and let your therapist handle the updates with your plan!
I have a family history of colon cancer. Will Medicare cover more frequent colonoscopies for someone in my situation?
Medicare does cover more frequent colonoscopies if you have a family history of colorectal cancer, because that places you in the high‑risk category.For high‑risk beneficiaries, Medicare allows a screening colonoscopy every 24 months instead of the standard 10‑year interval for average‑risk individuals
If you have a first‑degree relative (parent, sibling, or child) with colon cancer or advanced polyps, Medicare classifies you as high risk.
-Under this classification: Screening colonoscopy is covered every 24 months.
-Diagnostic colonoscopy is covered whenever medically necessary (e.g., symptoms, positive stool test, follow‑up on polyps).
The cost for screening: $0 out‑of‑pocket. If polyps are removed (procedure becomes diagnostic), you may owe 20% coinsurance under Part B.
I'm considering concierge medicine but already have Medicare. How would these work together?
Concierge medicine is separate from Medicare. You pay a membership fee for better access—longer visits, same-day appointments, direct communication—and Medicare does not cover that fee.Here’s how concierge works with Medicare:
Original Medicare (especially with a supplement):
This is where concierge usually works best. If the doctor accepts Medicare, they bill Medicare for covered services, and your supplement applies as normal.
Most of my clients who use concierge care are on Original Medicare with a High Deductible Plan G—it keeps premiums lower while still giving strong protection for bigger expenses.
Medicare Advantage plans:
This can be more difficult. These plans use networks, and many concierge doctors are out-of-network or don’t participate. That means you could be paying the membership fee and out-of-pocket for care.
If the doctor opts out of Medicare:
Medicare won’t pay at all—you’re fully private pay.
Bottom line:
Concierge care can complement Medicare, but it usually works much better with Original Medicare (often paired with a High Deductible Plan G) than with Medicare Advantage.
Call our office if you still have questions or concerns about Medicare.
I'm caring for my spouse with dementia and experiencing caregiver burnout. Will Medicare cover any mental health support for me?
Yes. Medicare Part B covers mental health services for you, including counseling and therapy to manage caregiver burnout. You can see psychiatrists, clinical psychologists, clinical social workers, and other licensed mental health professionals, typically for a copayment or coinsurance.Understanding your Medicare coverage and accessing the right resources can make a significant difference:
OUTPATIENT THERAPY: Original Medicare covers individual and group psychotherapy to help you process stress, grief, and burnout. You can search for local participating providers using the Medicare Provider Finder.
SPECIALIZED SUPPORT: Many Medicare Advantage (Part C) plans offer additional supplemental benefits, such as care coordination, adult day care referrals, or specific wellness programs for caregivers.
RESPITE CARE RELIEF: While Medicare does not generally pay family caregivers or cover everyday respite care, it does cover up to 5 consecutive days of inpatient respite care for your spouse if they are receiving Medicare-approved hospice services.
EDUCATIONAL RESOURCES: Learn more about navigating caregiver stress and burnout through the Alzheimer's Association.
MENTAL HEALTH SUPPORT OPTIONS: Explore dedicated resources and counseling options tailored for seniors and spousal caregivers on platforms like Sailor Health.
If you are experiencing a crisis, free, confidential 24/7 support and referrals are available through the SAMHSA National Helpline.
My income fluctuates significantly year to year from investment distributions. How can I avoid IRMAA surcharges when I have an unusually high-income year?
Avoiding IRMAA (Income-Related Monthly Adjustment Amount) surcharges can be challenging, especially with fluctuating income. Here are some strategies you might consider:1. **Income Management:** Plan your investment distributions carefully. If possible, spread out distributions over multiple years to avoid spiking your income in any single year.
2. **Tax-Advantaged Accounts:** Maximize contributions to tax-advantaged accounts like IRAs or 401(k)s, which can reduce your taxable income.
3. **Roth Conversions:** Consider converting traditional IRA funds to a Roth IRA in years when your income is lower, which can help manage taxable income in future years.
4. **Charitable Contributions:** Make charitable contributions, which can be deducted from your taxable income if you itemize deductions.
5. **Harvesting Losses:** Use tax-loss harvesting to offset gains with losses, potentially reducing your taxable income.
6. **Filing an Appeal:** If your income has decreased due to a life-changing event (like retirement, divorce, or loss of income-producing property), you can file an appeal with the Social Security Administration using form SSA-44 to request a reduction in your IRMAA.
7. **Consult a Professional:** Consider working with a financial advisor or tax professional who can help you strategize and manage your income effectively.
Let me know if you have any more questions!
Are mental health services like therapy fully covered under Original Medicare?
Short answer: no, not fully.Under Original Medicare, most outpatient therapy is covered by Part B—you pay the Part B deductible (if not yet met) and typically 20% coinsurance of the Medicare-approved amount; a Medigap plan can cover some/all of that.
Preventive screenings (e.g., annual depression screening) are generally $0 when you see a Medicare-enrolled provider.
Inpatient psychiatric care falls under Part A with its own deductible and day limits (including a 190-day lifetime cap in psychiatric hospitals).
Make sure your therapist is Medicare-enrolled and accepts assignment to avoid extra charges.
I've heard Medicare covers an annual wellness visit. What exactly is included in this visit?
You're absolutely right—Medicare does cover an Annual Wellness Visit, and it's an important benefit designed to help you stay on top of your health. However, it’s important to know that this visit is not a full physical exam, but rather a preventive service focused on long-term wellness and disease prevention.Here's what's typically included in the Annual Wellness Visit:
Health Risk Assessment: You'll fill out a questionnaire about your health history, current health status, and lifestyle.
Review of Medical and Family History: Your provider will go over your personal and family health background.
Medication and Provider Review: A review of all your current medications and the doctors or specialists you see.
Height, Weight, Blood Pressure, and BMI Measurement: Basic checks to monitor your physical health.
Cognitive Function Assessment: A brief screening to check memory and mental sharpness.
Screening Schedule: A personalized checklist of recommended preventive screenings, vaccines, and other services based on your age, gender, and health status.
Advance Care Planning (if you choose): You can discuss your preferences for future care, including setting up advance directives.
What’s not included:
It may or may not be a hands-on physical exam. Consult with your physician.
Lab test may or may not be included, consult with your physician and contact your insurance provider.
Cost:
If your doctor accepts Medicare assignment, the Annual Wellness Visit is free—no deductible or copay. However, if additional tests or services are performed during the visit that aren't covered under preventive care, you may have to pay part of the cost.
All services are subject to the terms and limitations of your insurance policy/policies.
Steven Graves
Does Medicare cover chiropractic appointments?
Kind of, but not in the way you might hope.Medicare only covers one thing at the chiropractor: manual manipulation of the spine to correct a spinal subluxation. That’s it. No X-rays, no massage therapy, no acupuncture, and definitely no general maintenance visits. Just that one service, and only if it’s medically necessary and properly documented.
So if you’re going in just for back pain, stiffness, or to “stay aligned,” Medicare’s not covering that. And unfortunately, plenty of people find that out the hard way when the bill shows up.
If it’s covered and you have Original Medicare, you’ll typically pay 20% of the Medicare-approved amount, and it counts toward your Part B deductible. If you have a Medicare Supplement (Medigap) policy, it may cover some or all of that 20%, depending on which plan you have. So in many cases, you’d end up paying little to nothing out of pocket for the visit, as long as it meets Medicare’s criteria.
Some Medicare Advantage plans may offer additional chiropractic benefits, but just to be clear, that’s the insurance company adding it and not Medicare itself. If it’s not covered by Original Medicare, the Advantage plan is the one footing the bill, not the federal program. This is where you’ll often hear mixed answers, since people tend to confuse the two.
Bottom line: If chiropractic care is a big part of your routine, plan ahead. Medicare coverage for it is very limited in most cases.
I want to be proactive about my health. What preventive services should I be taking advantage of with Medicare?
Covered Preventive Services with Medicare Part B:1. "Welcome to Medicare" Visit (First 12 Months)
One-time check-up to review your health, risk factors, and future screenings.
2. Annual Wellness Visit (Yearly)
A personalized prevention plan to update screenings and manage health goals.
3. Screenings (Usually Once a Year or as Recommended):
Mammogram (Breast cancer)
Colorectal cancer screening (includes colonoscopy and stool tests)
Lung cancer screening (for high-risk individuals)
Prostate cancer screening
Cardiovascular disease screening
Diabetes screening
Depression screening
Bone density test (osteoporosis)
4. Vaccinations:
Flu shot (yearly)
Pneumonia shot
Hepatitis B (for those at higher risk)
COVID-19 vaccines and boosters (as recommended)
5. Additional Services:
Smoking cessation counseling
Obesity counseling
Nutrition therapy (for diabetes or kidney disease)
Glaucoma tests (for high-risk individuals)
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Most of these are free if your provider accepts Medicare. Staying up to date on these can make a big difference in staying independent and active.
I've been diagnosed with bipolar disorder at age 66. How should I structure my Medicare coverage to ensure I get the mental health care I need?
Here is how to structure your 2026 coverage for maximum support:1. The Outpatient Strategy: Therapy & Psychiatry
Bipolar disorder typically requires regular visits with a psychiatrist (for medication management) and a therapist.
The Original Medicare + Medigap Route (Highly Recommended): If you choose Original Medicare with a Medigap Plan G, you pay your Part B deductible ($283 in 2026), and after that, your therapy and psychiatry visits are generally $0 out-of-pocket. This is ideal because there is no limit on the number of sessions as long as they are medically necessary.
The Medicare Advantage Route: These plans often have lower monthly premiums but require copays for every mental health visit (often $25–$50). If you see a therapist weekly, these costs can add up to more than a Medigap premium. Also, check that your preferred mental health providers are "in-network," as many therapists do not join Advantage networks.
2. The Medication Strategy: Part D
Medicare Part D (Drug Plans) must follow "protected class" rules. This means every plan is legally required to cover substantially all antipsychotic and antidepressant medications.
2026 Drug Cap: Starting this year, there is a $2,100 annual out-of-pocket cap on all Part D drugs. If you are prescribed expensive brand-name mood stabilizers, you will never pay more than $2,100 in a year for your prescriptions.
The "Medicare Prescription Payment Plan": In 2026, you can opt into a program that allows you to spread that $2,100 out over the year in monthly installments rather than paying a large amount at the pharmacy counter all at once.
3. Inpatient "Lifetime Limit" Warning
It is important to be aware of a specific Medicare quirk regarding inpatient psychiatric care:
The 190-Day Limit: Medicare Part A covers inpatient mental health care, but if you are treated in a specialized psychiatric hospital (rather than a psychiatric unit within a general hospital), there is a 190-day lifetime limit.
I've been diagnosed with prediabetes. What preventive services does Medicare cover to help prevent progression to type 2 diabetes?
So the question is, I've been diagnosed with pre-diabetes. What preventative services does Medicare cover to help prevent progression to type 2 diabetes? Here’s the information I found, and I hope you find it useful.
Diabetes screening is covered under Medicare Part B. Eligibility includes having risk factors such as high blood pressure, obesity, or a history of high blood sugar. The frequency is up to two screenings per year, depending on your risk level, and the cost is free. That covers diabetes screening.
Then there’s the Medicare Diabetes Prevention Program. This is a structured program for a proven lifestyle change to help prevent type 2 diabetes. It includes 12 months of group sessions focusing on weight loss, healthy eating, and physical activity, along with ongoing maintenance sessions for eligible participants.
Eligibility includes being diagnosed with pre-diabetes, having a BMI of 25 or higher (23 or higher for Asian individuals), never having had type 1 or type 2 diabetes before, and never having participated in the Medicare Diabetes Prevention Program before. The cost is free for eligible beneficiaries.
There’s also something called Medical Nutrition Therapy (MNT), which is covered under Medicare Part B. Eligibility includes being diagnosed with diabetes or kidney disease, or having had a kidney transplant in the last 36 months. If you progress from diabetes to diabetes, services include nutrition assessment, diet counseling, and follow-up visits with a registered dietitian. The cost is free if the provider accepts Medicare assignments.
Obesity screening and behavioral counseling are also covered under Medicare Part B. Eligibility requires a BMI of 30 or higher. Services include one face-to-face visit every week for the first month, every other week for months two through six, and monthly sessions for months seven through twelve if you meet weight loss goals. The cost is free.
I hope you found this information useful. If you have any other questions about pre-diabetes or any other Medicare coverage options, feel free to reach out. I look forward to hearing from you.
If we choose a Medicare Advantage plan and later regret it, can we go back to Original Medicare without penalties?
Yes, there are no "penalties" if you choose to go back. You always have "original Medicare" that pays 80% of your costs. When you first turn 65, you have a choice to stay on original Medicare with a supplement or choose Advantage. If you choose the advantage, you can drop the plan and go back to original Medicare each year between Oct 15th and Dec. 7th. It's the SUPPLEMENT that is hard to get back on, just depending. 1.) When you turn 65, you have "guaranteed issue" rights to be on a supplement plan without going through underwriting. 2.) If your advantage plan drops you, you have another opportunity for "guaranteed issue" and can get a supplement without question. 3.) If you choose the supplement first, and want to try an advantage plan in the fall, you have a year to try it; if you do not like it, you can go back to the Supplement on "guarantee rights" again. "Your Trial Right". So you have several opportunities to go to a supplement plan, you just have to understand how it works, so you can make smart choices for yourself. Also, later in life, you can drop your Advantage plan, go back to original Medicare, and ASK for a Supplement Plan, but you will have to go through underwriting, and if you have any medical issues or preexisting conditions, they will not take you. However, Advantage Plans do not have "underwriting," they take everyone, it doesn't matter what their medical conditions. Hope this helps..... Kim Humphries
Does Medicare cover weight-loss programs or bariatric surgery if I’m classified as obese?
Generally Medicare does not cover commercial weight-loss programs or services such as gym memberships, meal delivery plans, or counseling solely for weight management. These programs are considered lifestyle choices and are not typically covered under Original Medicare (Part A and Part B). However, Medicare may cover certain preventive services for obesity, such as obesity screenings and behavioral counseling, if they are provided by a primary care provider in a clinical setting. These services are designed to help beneficiaries make healthy lifestyle changes to reduce obesity-related health risks.Medicare Coverage for Bariatric Surgery
Medicare may cover bariatric surgery (such as gastric bypass, laparoscopic banding, or sleeve gastrectomy) if you are classified as obese and meet specific medical criteria. Coverage is typically available when:
• You have a body mass index (BMI) of 35 or higher.
• You have at least one obesity-related health condition, such as type 2 diabetes, high blood pressure, or heart disease.
• You have tried other medically supervised weight-loss methods without success.
• The surgery is deemed medically necessary by your healthcare provider.
• The procedure is performed at a Medicare-approved facility.
Before approving bariatric surgery, Medicare typically requires documentation of your medical history, failed attempts at non-surgical weight loss, and a referral from a qualified physician. Not all bariatric procedures are covered, so it's important to consult with your doctor and confirm coverage with Medicare before proceeding.
I keep hearing about free preventive services with Medicare. What exactly is free and what will I still pay for?
Medicare Part B covers many preventive services at 100% with no deductible or copayment if you meet the eligibility criteria and the provider accepts Medicare assignment. However, some services may still have cost-sharing (20% coinsurance) depending on specific conditions or if a screening turns diagnostic.What is Free (No Cost)
The following preventive services are generally covered with no out-of-pocket costs when performed by a Medicare-approved provider:
• "Welcome to Medicare" preventive visit: A one-time visit within the first 12 months of enrolling in Part B.
• Annual Wellness Visit (AWV): A yearly visit to develop or update a personalized prevention plan (not a physical exam).
• Vaccinations: Flu shots, pneumococcal shots, COVID-19 vaccines, and Hepatitis B shots for intermediate/high-risk individuals.
• Screenings:
o Abdominal aortic aneurysm screening (one-time for qualifying individuals).
o Alcohol misuse screening and counseling.
o Bone mass measurements (for qualifying individuals).
o Cardiovascular disease screenings (cholesterol, lipid, and triglyceride levels) once every 5 years.
o Cervical and vaginal cancer screenings (Pap tests and pelvic exams).
o Colorectal cancer screenings (fecal occult blood tests, flexible sigmoidoscopies, colonoscopies, etc., at set intervals).
o Depression screenings.
o Diabetes screenings (for those at risk).
o Hepatitis C screening (for qualifying individuals).
o HIV screening (for qualifying individuals).
o Lung cancer screening (for qualifying individuals at high risk).
o Mammograms (screening) once every 12 months.
o Obesity screening and behavioral therapy.
o Prostate cancer screening (digital rectal exam is free, but the associated blood test has a 20% coinsurance).
o Sexually transmitted infections (STI) screenings and counseling.
• Counseling & Therapy:
o Cardiovascular disease behavioral therapy.
o Counseling to prevent tobacco use.
o Medical nutrition therapy services (for those with diabetes or kidney dise
Am I responsible for an IRMAA surcharge?
2025 Medicare beneficiaries with higher incomes will pay surcharges, known as IRMAA (Income-Related Monthly Adjustment Amount), on top of their standard Part B and Part D premiums. These surcharges are based on modified adjusted gross income (MAGI) from 2023. For 2025, individuals with incomes above $106,000 and couples filing jointly with incomes above $212,000 will be subject to IRMAA. Basically, these surcharge amounts vary based on income brackets, with higher incomes incurring larger surcharges. So if your income falls in these categories, you may get to pay a surcharge.Does Medicare cover mammograms, and how often can I get them?
🩺 Under Original Medicare (Part B)Medicare covers:
✅ Screening Mammograms
Once every 12 months
Covered at 100% (no deductible, no coinsurance)
You must use a provider that accepts Medicare
If you’re between ages 35–39, Medicare covers one baseline mammogram.
✅ Diagnostic Mammograms
If you’re having symptoms (like a lump, pain, or abnormal screening result):
Covered as medically necessary
You may pay 20% coinsurance after your Part B deductible
Additional imaging (like ultrasound) may also apply cost-sharing
🌟 If You Have Medicare Advantage
Medicare Advantage plans must cover at least what Original Medicare covers.
Most plans cover annual screening mammograms at no cost in-network.
Diagnostic mammograms may have copays depending on the plan.
💡 Important Tip
Make sure the facility bills it as a screening mammogram if it’s routine.
If it’s coded as diagnostic, cost-sharing can apply.
What is the best MAPD plan in South Carolina?
There is no single “best” MAPD plan in South Carolina — it depends on your county, doctors, prescriptions, and budget. Carriers like Aetna, Devoted Health, Wellcare, and BlueCross BlueShield of South Carolina often offer competitive 4-star or higher plans in many areas. The strongest plans typically balance low premiums, reasonable MOOP limits, solid Part D formularies, and broad provider networks. Star ratings, PPO vs. HMO structure, and local hospital participation should heavily influence the decision. The best plan is the one that aligns with your specific providers and medication profile.I'm at high risk for heart disease based on my family history. What additional preventive services might Medicare cover for someone with my risk factors?
1. Cardiovascular Disease Screenings: Medicare Part B covers these screenings once every 5 years. This includes blood tests to check your cholesterol, lipid, and triglyceride levels, which can indicate conditions that may lead to a heart attack or stroke. If your provider accepts assignment, you won't have to pay anything for these screenings.2. Cardiovascular Behavioral Therapy: Medicare Part B covers one session each year with your primary care physician or practitioner. This therapy helps you lower your risk for cardiovascular disease and may include a blood pressure check and healthy diet advice. You pay nothing if your provider accepts assignment.
3. Abdominal Aorta Aneurysm Screening: If you have a family history of abdominal aorta aneurysm, Medicare covers a one-time screening. This screening involves a one-time ultrasound to check for a ballooning of the main blood vessel transporting blood to the legs.
4. Intensive Behavioral Therapy (IBT) for Obesity: Medicare covers IBT for obesity, especially relevant if being overweight contributes to your heart disease risk. This counseling is typically done by a doctor or other healthcare professional in a primary care setting. If the provider accepts Medicare assignment, there are no out-of-pocket costs for the counseling and assessments.
5. Other Related Preventive Services: Tobacco Cessation Counseling: If you use tobacco, Medicare Part B covers counseling to help you quit.
Medical Nutrition Therapy: Medicare covers medical nutrition therapy if your doctor determines it is medically necessary.
Intensive Behavioral Therapy for Cardiovascular Disease: This therapy is specifically designed to reduce CVD risk through counseling on diet, exercise, and aspirin use.
Annual Wellness Visit: This annual visit provides an opportunity to discuss preventive care and establish a personalized screening schedule.
I'm confused about preventive services under Medicare. Which screenings are actually free?
Great question — Medicare covers a long list of preventive services at no cost to you, as long as the provider accepts Medicare.That means $0 copay and no deductible, as long as the service is preventive and not diagnostic.
Here are the main screenings and checkups that are completely free:
Yearly Preventive Visits
“Welcome to Medicare” visit (first 12 months on Part B)
Annual Wellness Visit (once every 12 months)
Cancer Screenings
Mammograms (yearly)
Colorectal cancer screening
Colonoscopy
FIT tests
Stool DNA tests (like Cologuard)
Prostate cancer PSA test (once a year for men 50+)
Pap test and pelvic exam (every 24 months; every 12 months if high-risk)
Heart & Vascular Screenings
Cardiovascular screenings (cholesterol, lipid, triglyceride testing)
Abdominal aortic aneurysm ultrasound (once for certain people)
Bone & Joint Screening
Bone density test (osteoporosis screening)
Mental & Cognitive Health
Depression screening
Alcohol misuse screening
Cognitive assessment (part of your wellness visit)
Vaccines (covered at 100% under Part D or Medicare Advantage)
Flu shot
Pneumonia vaccine
COVID-19 vaccine
Shingles vaccine
Tdap (tetanus, diphtheria, pertussis)
Other Preventive Screenings
Diabetes screening (up to twice a year)
Hepatitis B and C screenings
HIV screening
STI screenings
Obesity counseling
Important note:
These services are free only when they are preventive. If doctors find something and need to do additional testing or follow-up, that part may come with a cost.
I'm homebound and need remote monitoring for my heart condition. What Medicare benefits might apply to someone in my situation?
If you are homebound and have a heart condition, Medicare may help cover remote monitoring and care. Medicare Part B can pay for remote patient monitoring, which lets your doctor track things like your heart rate or blood pressure from devices you use at home, as long as your doctor says it is medically necessary. If a doctor certifies that you are homebound, Medicare may also cover home health services, such as skilled nursing visits to help manage your heart condition, often at little or no cost to you. Medicare can also cover some telehealth doctor visits from home, and Medicare Advantage plans may offer extra benefits like more telehealth or monitoring programs, depending on the plan.
When should my plan be reviewed?
The best time to do this is during Medicare’s Annual Enrollment Period (AEP):📅 October 15 – December 7 each year.
During this period, you can:
• Review your current coverage (whether you have Original Medicare + Part D or a Medicare Advantage plan).
• Compare new plan options for the coming year.
• Switch plans, add or drop drug coverage, or move back to Original Medicare.
Any changes you make take effect January 1 of the next year.
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🧭 You should also review your plan anytime your needs or costs change, such as:
• Your medications change or you start a new prescription.
• Your doctors or preferred hospitals are no longer in your plan’s network.
• You move to a new ZIP code or state (this can trigger a Special Enrollment Period).
• Your income changes and you may qualify for Extra Help or a Medicare Savings Program.
• Your plan announces premium or copay increases for the next year.
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Tip:
Even if you’re happy with your plan, check each fall that it still covers your medications, doctors, and pharmacies — plans update their benefits and drug lists every year.
How can I use Medicare to cover occupational therapy for arthritis or mobility issues, and what are the limits?
How to Use Medicare for Occupational Therapy (OT) for Arthritis or Mobility IssuesIf you’re dealing with arthritis or other mobility problems, occupational therapy (OT) can make a big difference in your daily life. The good news is that Medicare Part B can help cover the cost, as long as a few conditions are met.
What’s Covered
Medicare Part B helps pay for outpatient occupational therapy when it’s considered medically necessary. This includes therapy to help with things like:
Joint stiffness or limited movement from arthritis
Difficulty dressing, bathing, or performing daily tasks
Recovering function after surgery or injury
To qualify, you’ll need:
A doctor’s referral
A treatment plan outlining the services you need
Services from a Medicare-approved therapist or facility
What It Costs
Once you meet your Part B deductible (which is $240 in 2025), Medicare typically pays 80% of the approved cost. You're responsible for the other 20%, unless you have a Medigap plan that picks up the difference.
Legal Note: This information is intended for general guidance only and does not guarantee that Medicare or any Medicare Supplement or Advantage Plan will cover specific services or claims. All coverage decisions, authorizations, and payments are made solely by Medicare and/or your plan provider based on your individual eligibility, medical necessity, and current policy rules. Always consult with your healthcare provider and plan administrator to confirm your benefits and coverage before starting any treatment
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How does Medicare cover outpatient mental health intensive programs for seniors with severe conditions?
Coverage:Medicare Part B covers IOPs for mental health, substance use disorders, or co-occurring disorders. This includes services like individual and group therapy, occupational therapy, and medication management.
Cost-Sharing:
After meeting the Part B deductible, beneficiaries pay a percentage (coinsurance) of the Medicare-approved amount for each day of intensive outpatient services.
Location:
IOPs can be received at hospitals, community mental health centers, Federally Qualified Health Centers, Rural Health Clinics, or Opioid Treatment Programs.
Requirements:
While partial hospitalization requires a doctor's certification that inpatient treatment would otherwise be needed, IOP services don't require this certification if the individual needs a minimum of nine hours per week of intensive outpatient care.
Services:
These programs can include individual and group therapy, medication management, activity therapies, and family counseling.
Telehealth:
Medicare also covers telehealth services for mental health and substance use disorders, allowing for treatment at any location in the US, including at home.
I need both a psychiatrist for medication and a therapist for talk therapy. How does Medicare coordinate coverage for these different providers?
Medicare Part B covers both psychiatrists (medication management) and therapists (talk therapy) as outpatient services, typically paying 80% of the Medicare-approved amount after the deductible is met. No referrals are needed for Original Medicare; they coordinate by allowing concurrent, medically necessary treatment from both types of providers.KEY COVERAGE and COORDINATION DETAILS:
* Providers: Coverage applies to services from psychiatrists, clinical psychologists, clinical social workers, and as of 2024, licensed mental health counselors and marriage/family therapists.
* Cost-Sharing: After the yearly Part B deductible, you usually pay a 20% coinsurance for visits.
* Medication Management: Psychiatrists and other doctors covered under Part B manage medications, with prescriptions typically covered by Part D.
* Talk Therapy: Unlimited sessions are allowed if deemed medically necessary by the provider.
Medicare Advantage: If you have a Medicare Advantage plan (Part C), you may need referrals and must use network providers.
CORRDINATION TIPS:
* Ensure both providers accept Medicare assignment to minimize costs.
* If using Medicare Advantage, check with your plan, as Medicare.gov rules can vary, and pre-authorization might be required.
What is Medicare Part B?
Medicare Part B is an optional program that generally covers 80% of approved medical services after an annual deductible. If you are actively working and have creditable employer coverage, you may be able to delay Part B enrollment without penalty.For most people, Part B requires a monthly premium, which is higher for individuals with higher incomes.
You can enroll in Part B during your Initial Enrollment Period, which runs from three months before your birth month through three months after your birth month.
If you miss this window and do not have other creditable coverage, you must wait until the General Enrollment Period (January 1–March 31). Coverage will begin the first day of the month after you enroll, and you may be subject to a late enrollment penalty.
What are Medicare’s coverage options for mental health apps or virtual therapy platforms for seniors with depression or anxiety?
Medicare Part B covers outpatient mental health services, including virtual therapy visits with licensed, Medicare-enrolled providers, when treatment is medically necessary. After you meet the Part B deductible, you typically pay 20% coinsurance. Standalone mental health or meditation apps are generally not covered unless they qualify as FDA-authorized digital therapeutics and are prescribed by a provider. Medicare Advantage plans may offer expanded telehealth or app-based mental health benefits, but coverage varies by plan. Always verify provider participation and platform eligibility before starting services to avoid unexpected costs.I've heard about new AI-powered diagnostic tools for early disease detection. Does Medicare cover any of these cutting-edge technologies?
Yes, Medicare has begun covering certain AI-powered diagnostic tools, particularly those that have received FDA clearance and demonstrate significant clinical benefits. For instance, AI-enabled coronary plaque analysis tools, such as those using CT-based quantitative coronary topography (AI-QCT), are covered when deemed medically necessary for diagnosing conditions like coronary artery disease. Additionally, AI algorithms for diabetic retinopathy screening have seen increasing Medicare claims, indicating growing adoption in clinical settings.However, coverage is not universal for all AI diagnostic tools. Medicare Advantage plans may also utilize AI technologies, but they must adhere to regulations ensuring that coverage decisions are based on individual patient circumstances and medical necessity, not solely on algorithmic recommendations.
It's important to note that while Medicare is expanding its coverage of AI diagnostics, the inclusion of specific tools depends on factors like FDA approval, demonstrated clinical efficacy, and adherence to Medicare's coverage criteria.
If you're considering an AI-powered diagnostic tool, it's advisable to consult with your healthcare provider and Medicare plan administrator to determine if the specific technology is covered under your plan.
Does Medicare part A and B cover urgent care office visits?
Yes, urgent care visits are covered, but they are covered specifically by Medicare Part B (Medical Insurance), not Part A.Here is the breakdown of how coverage and costs work for 2025:
Part B Covers the Visit: Medicare Part B covers urgent care visits for non-life-threatening illnesses or injuries (like a flu, small wound, or earache) that require immediate attention.
Part A Does Not Apply: Part A generally only covers inpatient hospital stays. Unless you are transferred from urgent care and admitted directly into a hospital as an inpatient, Part A will not pay for the visit.
Your Costs for Urgent Care (in 2025)
If you have Original Medicare (Part A and Part B), you will pay the following for an urgent care visit:
Part B Deductible: You must pay the first $257 of medical costs for the year (if you haven't met this deductible yet).
Coinsurance (20%): Once the deductible is met, you pay 20% of the Medicare-approved amount for the visit and any services received (like X-rays or stitches).
Copayment: You may also be charged a fixed copayment depending on the specific facility's rules and if the visit takes place in a hospital outpatient setting.
Important Note: To avoid higher costs, you should verify that the urgent care center accepts Medicare assignment. If they do not, they may charge you up to 15% more than the Medicare-approved amount (known as an "excess charge").
How long after I apply for Medicare A&B will I receive my Medicare card?
There’s no definitive answer, but in general the typical time is between 3-6 weeks. Allow 2-4 weeks for application processing (it’s faster if you apply in person or online) and about 2 weeks for the physical card to be delivered. Your number should be available online immediately after approval, and you don’t need your physical card to apply for your supplemental coverage. You just need the number (your agent will still verify eligibility in the system).The fastest way to check status is through a my Social Security account:
(https://www.ssa.gov/myaccount) or by calling the SSA.
Is there a penalty for Medicare Part A or B for a 65-year-old green card holder who hasn’t met the five-year U.S. residency requirement and has no other insurance?
No, there is no penalty for not having Medicare at age 65 if you do not yet meet the residency requirement.Medicare penalties only begin to accrue once you are eligible to enroll and choose not to. Since a green card holder is generally not eligible for Medicare until they have lived in the U.S. continuously for at least five years, the "penalty clock" does not start until that five-year mark is reached.The Rules for Your SituationEligibility Gap: As a green card holder, you must be 65 or older and have 5 years of continuous U.S. residency to qualify for Medicare.No "Pre-Eligibility" Penalty: You cannot be penalized for not having a service you aren't legally allowed to buy yet.When the Penalty Starts: Once you hit your 5th anniversary of residency, your Initial Enrollment Period begins. If you do not sign up at that time (and don't have other "creditable" coverage like a job-based plan), you will then face lifetime late-enrollment penalties for Part B and Part D.Important ExceptionsThere is one major way you might be eligible before the five-year mark:Spousal Credits: If you have been married for at least one year to a U.S. citizen or green card holder who is at least 62 and has worked in the U.S. for 10 years (40 quarters), you may be able to qualify for Medicare based on their work record. In this specific case, the five-year residency rule is waived.What should you do in the meantime?Since you are currently ineligible for Medicare, you may want to look into:The Health Insurance Marketplace: Lawfully present immigrants can purchase plans through the ACA Marketplace (Healthcare.gov) even if they haven't been here for five years. You may even qualify for subsidies depending on your income.Short-Term "New Immigrant" Insurance: Some private companies offer temporary medical insurance specifically for new green card holders waiting for Medicare eligibility.
What is the Medicare Give Back Benefit and how does it lower my Part B premium?
What is the Medicare Give Back Benefit and how does it lower my Part B premium?The Medicare Give Back Benefit, also called a Part B premium reduction, is offered by some Medicare Advantage plans. It means the insurance carrier pays a portion of your Medicare Part B premium for you.
For 2026, the standard Medicare Part B premium is $202.90 per month. Some Medicare Advantage plans may reduce that amount by giving back part of the premium. For example, if a plan offers a $50 giveback, your Social Security deduction for Part B may be reduced by $50.
The important thing to understand is that a giveback does not mean Medicare Part B is free, and it does not eliminate your need to keep Part B. You still must have Medicare Part A and Part B, and you must continue paying any remaining Part B premium to stay enrolled in the Medicare Advantage plan. Medicare Advantage plan premiums, copays, deductibles, coinsurance, and out-of-pocket costs vary by plan.
Here’s the tradeoff: some plans that offer a giveback may have higher out-of-pocket costs, higher copays, smaller provider networks, or different drug coverage. So while the plan may lower your monthly Part B premium, it may not always lower your total healthcare costs.
That’s why I would not pick a plan based on the giveback alone. The better question is: after we review your doctors, prescriptions, hospitals, copays, and maximum out-of-pocket exposure, does the giveback plan still make sense?
If I have Medigap or secondary insurance, does it cover my Medicare Part A and Part B deductibles?
It depends on what type of coverage you have.If you have a Medicare Supplement (Medigap) plan, most of them will cover your Part A hospital deductible. When it comes to the Part B deductible, only certain older plans like Plan F or Plan C cover it. If you became eligible for Medicare after 2020, your plan will not cover the Part B deductible. For example, Plan G covers everything except that Part B deductible.
If you just have secondary insurance, like from an employer or retirement plan, it may cover some or all of your deductibles, but every plan is different so you would need to check the details of that specific coverage.
The simple way to think about it is this: most Medicare Supplement plans cover the big costs, but you may still have a small out-of-pocket amount depending on your plan.
What are Medicare Part B excess charges, and how can I avoid them?
Part B excess charges are when doctors accept Medicare patients but does not accept Medicare assignment. They can bill you above the Medicare-approved amount legally up to 115% of the Medicare approved rate. You are responsible for the 20% standard coinsurance plus the excess charge up to 15%. Always ask your doctor or supplier: (medical equipment etc.) "Do you accept Medicare assignment?" To avoid these extra costs make sure you are in the right Medigap Plan (Medicare Supplement Plan). Plan G covers these excess charges. Plan F also covers these excess charges (if eligible before 2020). Plans like Plan N do not cover excess charges.How many physical therapy visits does Medicare cover per year?
Medicare does not limit the number of physical therapy visits per year. Coverage depends on medical necessity, not a fixed number of sessions.As of 2026 here is no hard cap on outpatient physical therapy under Medicare Part B.
Once your total Medicare-approved charges reach $2,480 (for PT and speech therapy combined), your therapist must add a KX modifier to claims. This simply confirms the services are still medically necessary.
A higher targeted medical review threshold of $3,000 applies. Claims above this amount may receive extra review.
You pay 20% coinsurance after your Part B deductible.
Your therapist must document why continued therapy is needed. Medicare can deny visits if they’re not considered medically necessary.
Summary: You can receive as much physical therapy as medically necessary, but good documentation becomes especially important once you pass the $2,480 threshold.
Is my Medicare Part B premium automatically deducted from my Social Security check?
Yes, your Medicare Part B premium is automatically deducted from your monthly Social Security check if you are enrolled in both programs. You do not need to take any action to set this up, as it happens automatically.The standard Medicare Part B premium is $202.90 per month. However, this amount can vary depending on your modified adjusted gross income and is protected by the federal "hold harmless" rule, which prevents your premium increase from being larger than your annual Social Security cost-of-living adjustment (COLA)
There are only a few instances where your premium will not be automatically deducted:
YOU ARE NOT COLLECTING SOCIAL SECURITY: If you delay claiming Social Security benefits but enroll in Medicare Part B, you will receive a bill from Medicare (typically quarterly) to pay directly.
YOUR BENEFIT IS SMALLER THAN THE PREMIUM: If your monthly Social Security check is less than your premium amount, Social Security cannot deduct it, and Medicare will bill you directly for the difference.
YOU QUALIFY FOR A MEDICARE SAVINGS PROGRAM: If your state's Medicaid program covers your Part B premiums, nothing will be deducted from your check.
Does everyone pay the same for Medicare?
No. While most people pay the standard Medicare Part B premium, higher-income beneficiaries may pay more due to the Income-Related Monthly Adjustment Amount (IRMAA). IRMAA is based on your income from two years prior and can increase the cost of Part B and Part D coverage.In addition, Medicare Advantage, Part D, and Medicare Supplement plan premiums vary by plan, carrier, age, location, and other factors. As a result, two people with Medicare may pay very different amounts for their overall coverage.
How do you avoid IRMAA surcharges on Medicare premiums?
You can’t always avoid IRMAA, but you can often reduce or minimize it through income planning. IRMAA is based on your Modified Adjusted Gross Income (MAGI) from two years ago, so large IRA withdrawals, Roth conversions, capital gains, and other taxable income can push you into a higher premium bracket.Strategies may include spreading withdrawals over multiple years, using Roth assets strategically, and working with a tax professional to manage taxable income. If your income drops because of a life-changing event such as retirement, you can request an IRMAA reconsideration through the Social Security Administration using Form SSA-44.
Planning ahead is often the best way to keep Medicare premiums lower.
Does Medicare cover shoulder replacement surgery?
Yes. Medicare may cover shoulder replacement surgery when it is medically necessary, but how it’s covered depends on the type of Medicare coverage you have.Medicare Part A helps cover inpatient hospital care if you are formally admitted to the hospital for the surgery. This can include your hospital stay, meals, nursing care, and some rehabilitation services after surgery.
Medicare Part B helps cover outpatient medical services, including doctor visits, imaging, the surgeon’s fees, outpatient surgery centers, durable medical equipment like slings or walkers, and physical therapy. Part B typically covers 80% of approved costs after your deductible, leaving you responsible for the remaining 20% unless you have supplemental coverage.
Medicare Part C (Medicare Advantage) combines Part A and Part B coverage through a private insurance company. These plans must cover everything Original Medicare covers, but costs, prior authorization requirements, hospital networks, copays, and rehabilitation coverage can vary by plan, so it’s important to review your specific benefits carefully.
Does Medicare have a deductible?
Yes Medicare has deductibles for both Part A and B. Part A i(Hospital) is not a standard yearly deductible, but a deductible for a benefit period of $1,736 if you have an inpatient hospital stay. A benefit period begins when you are admitted to a hospital and ends when you haven't received inpatient care for 60 days in a row. You can have multiple benefit periods in a single year. If you have multiple benefit periods, your Part A deductible will reset.Part B (Medical) has a standard yearly deductible of $283. Once the deductible has been met, Medicare pays 80% and you pay 20%. If you add an Advantage Plan, deductibles wil vary by plan. If you add a Prescription Drug Plan, deductibles will vary but are capped at $615 per year by the government.
Part A has no premium, Part B has a premium of $202.90. If you decide to add other sevices, like a Supplement Plan and a Prescription Drug Plan (Part D) you will still need to pay your Part B premium and whatever premium you have for a supplement or drug plan.
Does Medicare cover MRI scans?
Yes, Medicare does cover MRIs, but the amount of coverage depends on the plan you have. If you have Original Medicare (and the doctor or facility accepts Medicare), Medicare would pay 80% of the cost and you (or your Medicare Supplement plan) would be responsible for the 20%. Medicare Advantage plans cover MRIs, but prior authorization for MRIs must be obtained. There may also be a copayment or cost-sharing amount to be paid, depending on your plan.
Is just Medicare Part A and Part B enough coverage, or do I need supplemental insurance?
I don't recommend that anyone just have part A and B alone. There are some significant gaps in coverage, and no maximum out of pocket cost.Adding a supplemental plan can be the best approach to cover those gaps, for most seniors, as the premiums are predictable and your retirement savings is protected against significant out of pocket costs. Seniors with Medicare plus a Medicare Supplement can see any Medicare doctor in the country, or go to any hospital, without worrying about networks or approvals.
Medicare Advantage can also help limit out of pocket costs and will cost less in the short term. However, advantage plans are known as "managed care" meaning that you have to stay within a network, they can require referrals and pre-approvals, plus you'll pay cost sharing (co-pays, co-insurance) up to a maximum out of pocket limit that must be reached before you're covered in full. Out of pocket limits will typically average $5000 to $7000 in network and much higher if any of your providers was an out of network provider.
For most seniors, the predictable costs, freedom of choice, and limited out of pocket exposure makes a Medicare Supplement plan the best long term choice.
How long does the IRMAA surcharge last, and is it permanent?
It is not permanent. It is adjusted each year with a two year look back. If your income drops significantly, you can request to have the SSA reassess your income level. Also if you have a life altering event such as marriage, death, divorce, etc you can also have the SSA reassess.
Which inhalers are covered by Medicare Part B vs Part D?
The simple answer is…if the inhalers are hand held and prescribed then they are typically covered under part D. If they are in liquid form and require a nebulizer then Part B is utilized. Under Part B, the patient will pay the deductible, if there is one and then 20% of the cost unless they have a Medicare supplement or advantage plan. With an advantage plan with drug coverage or a stand alone drug plan, the max out of pocket is $2100. After that, the patient will receive the handheld inhalers for $0.I’m 67, working full time, and previously had a 4-month job gap. I enrolled in Medicare A and B to avoid penalties, but SSA won’t let me disenroll from A. I haven’t claimed Social Security and don’t need Part A, which blocks my HSA. What can I do?
Under IRS rules, you cannot contribute to a Health Savings Account (HSA) while enrolled in any part of Medicare. Because premium-free Medicare Part A comes automatically when you are over 65, the only legal way to unenroll from Part A to restore your HSA eligibility is to formally withdraw your Social Security application and pay back any retirement benefits already received. So whoever is saying that you cannot disenroll is incorrect. It is however not a good idea. When you are on Medicare, and HSA can be achieved in other ways. Namely through what is called an MSA account i.e. Medicare Medical Savings account. This is a Medicare Advantage plan.If I already have part A and am already terminal on hospice care, do I need to get on part B and go through the MAPD/MedSup enrollment process?
Medicare Part A covers 100% hospice related services. Some of these services include nursing care, medical equipment (such as oxygen, hospital beds and wheelchairs), hospice aide services, counseling, and respite care.The only exceptions that are not covered by Medicare are co-pays for prescription medication dealing with pain management. These co-pays are limited to a $5 charge. If respite care is used, there is a 5% co-insurance.
Respite care is where relief is provided for primary caregivers. This allows a break for caregivers while making sure their person is still safe. Respite care is covered up to 5 days at a time.
Whether or not you should get on Part B depends on your prognosis from your doctor. Hospice care is designed to support individuals with a life expectancy of six months or less if their illness follows its natural course. Hospice can be extended as long as the patien continues to meet eligibility standards. Recently, former President Carter was in hospice for 22 months before he passed away in December 2024.
Overall statics show the median length of hospice care in the US is 18 days. 50% of patients pass away in the first three weeks. Up to 15% of patients survive longer than 6 months. With those statistics in mind, I would suggest to someone that they go through the Part B process only if they have a complete understanding of their remaining life expectancy from their doctor.
Some people will stay enrolled in Part B and Advantage or Supplement Plans if they need medical care or prescriptions unrelated to the hospice diagnosis. Obviously you want to have coverage if you have needs for non-medical care or prescriptions. Conversely, I suspect someone on hospice is not going to have a need to see an orthopedic surgeon. My best advice is use common sense based on your current condition.
How to sign up for A & B?
You can sign up for Medicare Part A and Part B online through the Social Security Administration (SSA) website during your 7-month Initial Enrollment Period (3 months before to 3 months after your 65th birthday). The process takes about 10 minutes, and you will need to create a login.gov account.Several ways to Enroll:
- Online, visit SSA.gov and click "Sign up for Medicare".
- Phone: Call Social Security at 1-800-772-1213
- In-Person: Visit your local Social Security office.
Does Medicare cover CT scans, and how much do they cost?
Yes. Medicare generally covers medically necessary CT scans when they're ordered by your doctor.Original Medicare: CT scans are usually covered under Part B. After you've met your Part B deductible, you typically pay 20% of the Medicare-approved amount, unless you have supplemental coverage that helps with those costs.
Medicare Advantage: CT scans are covered as well, but your copay or coinsurance depends on your specific plan.
The exact cost varies based on where the scan is performed and your Medicare coverage, so it's always a good idea to check your plan's benefits before scheduling the test.
Do husband and wife each pay their own Medicare premiums, or is there a family plan option?
There is no family or joint plan option for Medicare. Medicare is strictly individual coverage, meaning a husband and wife must enroll in their own separate plans and each pay their own individual premiums.While you cannot share a plan, being married can impact your individual costs. If one spouse did not work enough quarters to qualify for premium-free hospital insurance, they can qualify based on their spouse’s work history once they turn 65. If you file taxes as Married Filing Jointly, your combined income determines whether you must pay a high-income surcharge (IRMAA) on your Part B and Part D premiums.
Aside from those factors, your premiums, deductibles, and benefits are entirely separate.
Do I need Medicare Part B if I have VA benefits?
VA benefits and TRICARE are treated very differently when it comes to Medicare Part B.VA benefits are a separate health care system. Medicare gives the veteran more flexibility outside the VA system, but Part B is not technically required just because someone has VA benefits.
TRICARE is different. For most Medicare-eligible TRICARE beneficiaries, Medicare Part B is required in order to keep TRICARE active.
Even with VA benefits, I would still strongly consider enrolling in Medicare Part B in most cases.
The reason is simple. VA benefits and Medicare do not work together the same way employer insurance and Medicare do. If you receive care through the VA, the VA generally covers care provided within the VA system. But if you go outside the VA system, Medicare may be what gives you access to non-VA doctors, hospitals, outpatient services, specialists, and medical equipment.
If you have both Medicare and VA benefits, you can use either program, but they generally do not pay for the same service at the same time. That is why Part B is often an important planning decision, even though it is not technically required for VA benefits.
Unless you are enrolled in TRICARE For Life, you may also want to consider how you would cover the costs that Medicare Part B does not fully pay if you receive care outside the VA system. For some people, that may mean reviewing a Medicare Supplement plan to help cover Original Medicare cost-sharing. For others, it may mean reviewing a Medicare Advantage plan as an alternative way to receive Medicare benefits.
If there is a chance you may need or want care outside the VA system, Medicare Part B should be strongly considered. You may also want to review whether a Medicare Advantage plan or Medicare Supplement plan makes sense to help cover the Medicare Part B cost-sharing that VA benefits may not cover outside the VA system.
Is IRMAA recalculated every year?
The Social Security Administration reviews your income annually They usually base it on your tax return from two years prior Example: your 2026 IRMAA is typically based on your 2024 income.Your IRMAA can go up, down, or disappear each year depending on your income. If your income drops, your IRMAA may be reduced the following year automatically.
If your income drops significantly due to certain events, you don’t have to wait a full year. You can request a reassessment using SSA-44 for situations like:
Retirement or reduced work hours
Divorce or death of a spouse
Loss of income-producing property
Pension loss
Can I cancel or drop Medicare Part B if I move abroad?
Yes, you can drop Medicare Part B if you move abroad, since Medicare generally doesn’t cover care outside the U.S. To do this, you must contact the Social Security Administration and submit a request to disenroll.Keep in mind, if you later return to the U.S. and want Part B again, you may face a late enrollment penalty and have to wait for an appropriate Enrollment Period.
Before dropping Part B, make sure you’ll have adequate health coverage in the country you’re moving to.
Do husband and wife each pay their own Medicare premiums, or is there a family plan option?
Medicare is individual health insurance so husbands and wives each pay their own premiums.Although there is not a family plan option and you can't share a policy, your marital status can still impact your overall costs.
1. Qualifying for Premium-Free Part A - Most people don't pay a premium for Part A (hospital insurance). If you do not have enough work history (40 credits or 10 years) to qualify for premium-free Part A on your own, you can qualify based on your spouse's history.
2. Potential Spousal Discounts - While Original Medicare (Parts A & B) does not offer discounts, some private insurance companies offer a household discount for Medicare Supplement (Medigap) policies.
3. High-Income Surcharges - If you file your taxes jointly, the government looks at your combined marital income from 2 years prior to determine your monthly Part B (medical insurance) and Part D (prescription drugs) premiums. If your combined modified adjusted gross income exceeds the established threshold, both you and your spouse pay an extra surcharge called the Income Related Monthly Adjustment Amount (IRMAA).
Does Medicare cover ambulance rides?
Yes, Medicare does cover ambulance rides, when they're medically necessary. You typically pay 20% of the Medicare-approved amount after you've met your Part B deductible. The ambulance provider must accept Medicare assignment for these costs to apply.Medicare Advantage (Part C)
Medicare Advantage plans are required to cover at least everything Original Medicare covers. Many plans also cover medically necessary ambulance transportation, but:
Your copay or coinsurance may be different.
Some plans may have network rules for non-emergency transportation, though emergency ambulance services are generally covered regardless of network.
How much is the Medicare deductible in 2026?
For 2026, the Medicare deductibles are:Part A (Hospital Insurance): $1,736 per benefit period for inpatient hospital stays.
Part B (Medical Insurance): $283 annual deductible. After you meet it, Original Medicare generally pays 80% of covered services, and you pay the remaining 20% unless you have additional coverage.
Keep in mind that Part A has a deductible for each benefit period, while Part B has one deductible per calendar year.
Can I drop Medicare Part B if I go back to work and get employer health coverage, then re-enroll later without a penalty?
Yes, you may be able to drop Medicare Part B if you return to work and have creditable employer coverage from an employer with 20 or more employees. When that employer coverage ends, you'll generally qualify for a Special Enrollment Period (SEP) to re-enroll in Part B without a late enrollment penalty.Before dropping Part B, confirm that your employer coverage meets Medicare's requirements, because COBRA, retiree coverage, and Marketplace plans do not qualify for this protection. Also remember that dropping Part B is voluntary and requires contacting the Social Security Administration. It’s a good idea to speak with Social Security before making the change to avoid any unintended gaps in coverage.
Does Medicare cover dermatology visits?
Medicare covers dermatology visits when they are medically necessary to diagnose or treat a skin condition, such as suspicious moles, skin cancer, rashes, eczema, psoriasis, infections, or wounds.Under Original Medicare, these services are generally covered by Part B, and you will typically pay 20% of the Medicare-approved amount after meeting your Part B deductible. However, Medicare does not usually cover routine skin checks or cosmetic procedures, such as skin tag removal or treatments performed solely to improve appearance.
If you have a Medicare Advantage plan, medically necessary dermatology services are still covered, though copays, referrals, and network requirements may vary depending on the plan.
Does Medicare cover heart monitors?
Typically Medicare does cover heart monitors when it is a medical necessity. A physicians order and documented symptoms are required. Heart monitors are considered Durable Medical Equipment, so once the Part B deductible is met Medicare pays 80% and the beneficiary pays 20%.Medicare does not cover devices like Apple Watch or a Fitbit. These are considered consumer electronics.
How long can I stay abroad without losing my Medicare benefits?
There is no time limit as to how long you can be outside the U.S The bigger issue is Medicare generally does not pay for care outside the U.S, except in very limited situations:A medical emergency in the U.S. but the nearest hospital is across the border (e.g., Canada or Mexico)
You’re traveling between Alaska and another state and need emergency care in Canada
You live in the U.S. and a foreign hospital is closer than the nearest U.S. hospital.
Also If you have Part B, you must keep paying premiums to stay enrolled
If you stop paying, your coverage can be dropped—and restarting later may come with penalties.
Did you know you can receive money back each month from your part B premium?
That benefit is called the Part B Giveback or Part B reimbursement. It will return some of the premium to you monthly for whatever you may need it for. It works somewhat like a discount. As an example, if you enroll in a plan with a $150 giveback benefit, it means each month you will receive $150 of your $202 monthly Part B premium returned to you through your SS checkBrowse Other Questions & Answers
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