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. Like most health insurance plans, Medicare doesn’t pay for long-term care costs of residency at an assisted living facility or day-to-day custodial care. Under specific circumstances, if a beneficiary requires a short-term […]
Does Medicare pay for all surgeries?
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 – and that meet accepted standards of medicine.” Medicare further defines medically necessary services as ones that: – Are proper and needed […]
What is the Medicare SNF Three-Day Rule?
Medicare covers skilled nursing facility (SNF) care in certain circumstances, but some situations can impact what is covered or even or if SNF care will be covered and your costs for that care. If you are in the hospital, your doctor can order observation services to decide if you should be admitted or discharged. When […]
What is the Two-Midnight rule in Medicare?
Whether or not to admit you as an inpatient to a hospital is a decision made by your doctor after reviewing your medical situation, and they decide whether it is necessary to admit you to the hospital. According to Medicare, an inpatient admission is generally appropriate when you’re expected to need 2 or more midnights […]
How is it possible for Medicare Advantage plans to cost the consumer zero?
There are two parts to how Medicare Advantage plans get paid. The first is the premium members pay; how the premium depends on the benefits of the plan you purchase. It can be as low as $0, or it can be higher in other cases. Secondly, since Medicare Advantage Plans completely replace Original Medicare, Medicare […]
Changes to Medicare Part D prescription drugs in 2026
In 2026, Medicare Part D continues its significant modifications aimed at enhancing affordability and accessibility for beneficiaries. The cornerstone remains the $2,000 yearly limit on out-of-pocket expenses for prescription drugs, which was implemented in 2025. This cap still offers significant financial relief to those who faced higher costs. The elimination of the 5% coinsurance requirement […]
Can I use my Medicare coverage to utilize telehealth services?
If you have original Medicare, Part B will cover telehealth services, and you will have to pay a 20% coinsurance of the Medicare-approved amount for your doctor or other health care provider’s services after you pay the Part B deductible. You will have to pay the same amount for most telehealth services as if you […]
What does “step therapy” mean in Medicare drug coverage?
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 get a prescription for a medication that has step-therapy rules, there is […]
When does “catastrophic coverage” kick in with Medicare Part D coverage?
Starting in 2025, the structure of Medicare Part D changed significantly, and in 2026, catastrophic coverage continues to begin once your out-of-pocket spending on covered prescription drugs reaches $2,000 for the year. This includes what you pay directly and certain payments made on your behalf, such as through the Extra Help program. Once you reach […]
If I enroll in a Medicare plan with an initial deductible, does the deductible determine when I go into the “Doughnut hole”?
In 2026, Medicare Part D continues to offer simplified prescription drug coverage. The coverage gap, commonly known as the “donut hole,” remains eliminated. Now, after meeting your plan’s deductible (which can be up to $605 in 2026), you enter the initial coverage phase, where you pay a portion of your prescription costs. Once your out-of-pocket […]