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Does Medicare pay for assisted living?

Medicare does not cover custodial long-term care such as assisted living facilities but under specific circumstances may cover stays at a nursing home. Medicare covers a range of health services to beneficiaries in any living situation. However,…

Does Medicare pay for all surgeries?

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Medicare only covers medically necessary surgical procedures. Medicare defines medically necessary services as “health care services or supplies that are needed to diagnose or treat an illness, injury, condition, disease, or its symptoms –…

Medicare Advantage plans can be very cost-effective, and in fact, there are plans with $0 premiums.

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So how is that possible? To understand how $0 premium plans are possible, you must understand how Medicare Advantage plans are paid. There are two parts to how Medicare Advantage plans get paid. The first is the premium members pay; how the…

What does "step therapy" mean in Medicare drug coverage?

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Each Medicare Part D plan has a list of covered drugs that are called a formulary. Within every formulary, there are a set of rules applied to the prescription drugs covered by the plan. One of those rules is called step-therapy. If you…

What is the "Doughnut hole" in Part D Medicare coverage and how does it work?

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Most Part D drug plans have a coverage gap (also called the "donut hole"). There is a limit on what the drug plan will cover for your prescription drugs when you are in the donut hole. The donut hole begins after you, and your drug plan has…

What does a Medicare drug formulary with tiers mean?

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Every Part D plan has something called a formulary, which is a list of drugs covered under the plan. Each formulary has a set of tiers, and in most cases, Part D plans have between three and six tiers. A lower-tier drug usually has lower copays…

If I sign up for Part D during Medicare enrollment, how soon does the coverage start to take effect?

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The date the coverage becomes effective depends on which enrollment period you used to sign up for your Part D plan. If you sign up for a Part D plan during the Annual Enrollment Period, which runs from October 15th through December 7th, your…

I am covered by Medicare, but I don't take any medications

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Is it necessary to sign up for a drug plan? There is nothing that requires you to enroll in a Part D prescription drug plan when you become eligible for Medicare. However, suppose you do not enroll when you first become eligible. In that case,…

What's the late enrollment penalty for Medicare Part D and when does it take effect?

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Suppose you don't enroll in a Part D prescription drug plan or a Medicare Advantage plan that includes Part D coverage when you are first eligible for Medicare. In that case, you may be assessed something called the Part D late enrollment penalty.…

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We do not offer every plan available in your area. Currently, we represent 8 organizations which offer 75 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Assistance Program (SHIP) to get information on all of your options. This is a proprietary website and is not associated, endorsed, or authorized by the Social Security Administration, the Department of Health and Human Services or the Center for Medicare and Medicaid Services. This site contains decision-support content and information about Medicare, services related to Medicare and services for people with Medicare. If you would like to find more information about the Medicare program, please visit the Official U.S. Government Site for People with Medicare located at http://www.medicare.gov.