Home Blog Page 12

Does Medicare Cover Mental Health Care? Therapy, Counseling & Inpatient (2026)

By
SeniorAffair Editorial Staff
-
0
Does Medicare Cover Mental Health Care? Therapy, Counseling & Inpatient
Does Medicare Cover Mental Health Care? Therapy, Counseling & Inpatient
Yes, Medicare covers mental health care—both outpatient and inpatient—but the details matter. Recent expansions have added new covered provider types. You pay 20% coinsurance for most outpatient mental health services after your Part B deductible, the same as for other medical services.

Mental health care is just as important as physical health care — and Medicare has gradually expanded its mental health coverage over the years. If you or a family member on Medicare needs therapy, psychiatric care, or substance use treatment, here’s the complete picture of what’s covered and what you’ll pay in 2025.

Outpatient Mental Health Coverage (Medicare Part B)

Medicare Part B covers outpatient mental health services. “Outpatient” includes visits at a doctor’s office, mental health clinic, hospital outpatient department, or community mental health center.

Provider or ServiceMedicare Coverage
PsychiatristCovered — 80% after deductible
Psychologist (PhD)Covered — 80% after deductible
Licensed Clinical Social Worker (LCSW)Covered — 80% after deductible
Nurse practitioner (mental health)Covered — 80% after deductible
Marriage and Family Therapist (MFT) New 2024Covered — 80% after deductible
Licensed Professional Counselor / Mental Health Counselor New 2024Covered — 80% after deductible
Group therapyCovered — 80% after deductible
Depression screening (annual)Covered 100% — no cost-sharing
Alcohol misuse screening and counselingCovered 100% — up to 4 brief sessions
Addiction counseling (opioid treatment)Covered under Medicare Opioid Treatment Program

The 2024 expansion adding marriage and family therapists and licensed mental health counselors as covered Medicare providers is significant. Previously, many Medicare beneficiaries had to see a psychiatrist or psychologist to get covered therapy—now a wider range of licensed therapists qualify.

What You Pay for Outpatient Mental Health in 2026

The cost-sharing for mental health services is the same as for other Part B services:

  • You meet your $283 annual Part B deductible.
  • Medicare pays 80% of the approved amount.
  • You pay the remaining 20% coinsurance.

A typical therapy session with a psychologist or licensed therapist costs $100 – $200 when billed to Medicare. Your 20% share is $20 – $40 per session after your deductible is met. Seeing a psychiatrist (an MD who prescribes medication) may cost more — your 20% share could be $30 – $60 per visit.

There is no limit on the number of covered outpatient mental health visits per year, as long as they are medically necessary.

Inpatient Psychiatric Hospital Care (Medicare Part A)

Medicare Part A covers inpatient care in a psychiatric hospital or the psychiatric unit of a general hospital. The coverage rules differ slightly between the two:

Facility TypeCoverage LimitCost-Sharing
Inpatient psychiatric hospital (freestanding)190-day lifetime limitSame as Part A hospital: deductible + coinsurance by day
General hospital psychiatric unitNo 190-day lifetime limitStandard Part A hospital benefit periods apply

The 190-day lifetime limit applies only to inpatient stays in freestanding psychiatric hospitals. If you receive inpatient psychiatric care in the psychiatric unit of a general acute-care hospital, your regular Part A benefits apply with no lifetime limit.

Does Medicare Cover Substance Use Disorder Treatment?

Yes. Medicare covers evidence-based substance use disorder treatment in several ways:

  • Opioid Treatment Program (OTP): Medicare covers a comprehensive opioid use disorder treatment benefit that includes methadone or buprenorphine therapy, counseling, and toxicology testing from certified OTP providers. You pay 20% coinsurance after the Part B deductible.
  • Outpatient substance use counseling: Covered under Part B the same as other outpatient mental health services.
  • Inpatient detox and rehabilitation: Covered under Part A when medically necessary.
  • Alcohol misuse counseling: Covered 100% (up to 4 brief counseling sessions per year for those who screen positive for alcohol misuse).

Telehealth Mental Health Coverage

Medicare significantly expanded telehealth mental health coverage. You can now receive covered mental health therapy via video call from your home — you no longer need to live in a rural area or travel to a healthcare facility to use telehealth for mental health services. This is a permanent expansion that has made mental health care significantly more accessible for Medicare beneficiaries.

The provider must be Medicare-enrolled and using an approved telehealth platform. Many therapists now offer telehealth sessions specifically for Medicare patients.

Does Medicare Cover Online Therapy Apps?

Not directly. Subscription-based online therapy services like BetterHelp or Talkspace are not covered by Original Medicare. However, if a licensed therapist on those platforms is Medicare-enrolled and bills Medicare directly for the session (rather than the subscription fee), coverage may apply. Ask your therapist whether they accept Medicare assignment.

Frequently Asked Questions

Does Medicare cover anxiety treatment?

Yes. Anxiety disorders are a recognized medical condition, and Medicare Part B covers outpatient treatment—including therapy sessions and psychiatric medication management—as medically necessary care. Anti-anxiety medications prescribed as part of treatment are covered under Medicare Part D.

Does Medicare cover dementia care?

Medicare covers medical diagnosis and management of dementia, including specialist visits, cognitive assessments, and medications. The Cognitive Impairment Care Planning visit is a covered Medicare benefit. However, Medicare does not cover the long-term custodial care (personal care and supervision) that many dementia patients require—that falls under Medicaid or private pay.

Does Medicare cover crisis hotlines or emergency mental health?

Emergency mental health care in a hospital or emergency room is covered under Part A or Part B depending on whether you are admitted. For crisis support, the 988 Suicide and Crisis Lifeline is free and available 24/7 without any insurance.

Related Articles on SeniorAffair:
Does Medicare Cover Home Health Care? • Medicare and Alzheimer’s Care: What’s Covered? • Does Medicare Cover Prescription Drugs?

If you or someone you know is in crisis, call or text 988 (Suicide and Crisis Lifeline) or go to your nearest emergency room. This article is for informational purposes only and does not constitute medical advice.

 

Does Medicare Cover Physical Therapy in 2026? Limits, Costs & What to Expect

By
SeniorAffair Editorial Staff
-
0
Does Medicare Cover Physical Therapy in 2026? Limits, Costs & What to Expect
Does Medicare Cover Physical Therapy in 2026? Limits, Costs & What to Expect
Yes, Medicare covers physical therapy — but you share the cost, and high-dollar claims face additional scrutiny. Medicare Part B pays 80% of medically necessary outpatient PT after your annual deductible. You owe the remaining 20% with no per-session dollar cap unless you have Medigap or a Medicare Advantage plan with therapy benefits.

Physical therapy is one of the most important tools for recovering from surgery, managing chronic conditions, and preventing falls in older adults. Understanding exactly how Medicare covers PT — and where the potential cost risks are — helps you plan and avoid surprises.

How Medicare Covers Outpatient Physical Therapy (Part B)

Medicare Part B is the primary payer for outpatient physical therapy. Here’s how the cost-sharing works:

  1. You first meet your annual Part B deductible ($283 in 2026).
  2. After the deductible, Medicare pays 80% of the Medicare-approved amount for covered PT services.
  3. You pay the remaining 20%—called coinsurance—with no upper limit per year in Original Medicare.

Physical therapy sessions at outpatient facilities are typically billed at $75 – $150 per session. Your 20% coinsurance is approximately $15 – $30 per session after your deductible is met.

Is There a Limit on How Much Physical Therapy Medicare Will Cover?

The old “therapy cap” was permanently repealed in 2018. There is no longer a hard annual dollar limit on Medicare-covered physical, occupational, or speech therapy.

However, there is a medical review threshold. In 2025, if your combined physical therapy and speech-language pathology costs exceed $2,430 in a calendar year, Medicare conducts a medical review to confirm the services are medically necessary. For occupational therapy, the same $2,430 threshold applies separately.

This review is not a denial — it is a documentation check. As long as your doctor and therapist can demonstrate continued medical necessity, therapy continues to be covered beyond the threshold.

What Medicare Covers Under Physical Therapy

SettingCoverage Under Medicare
Hospital outpatient PT clinicPart B covers 80% after deductible
Private PT practicePart B covers 80% after deductible
Home-based PT (homebound patient)Part A/B, 100% covered via home health benefit
Skilled nursing facility PT (days 1–20)Part A covers 100%
Skilled nursing facility PT (days 21–100)Part A covers 80%; you pay $217/day copay for all SNF care
Gym or fitness center sessionsNot covered
Massage therapy (without skilled need)Not covered

What Types of Therapy Does Medicare Cover?

Medicare Part B covers three types of rehabilitation therapy when medically necessary:

  • Physical therapy (PT): Restoring movement, strength, and function after injury, surgery, or illness.
  • Occupational therapy (OT): Helping you perform daily activities (dressing, bathing, cooking) after illness or injury. The 2025 OT threshold is also $2,430.
  • Speech-language pathology (SLP): Treating speech, language, cognitive communication, and swallowing disorders. Combined with PT under the $2,430 threshold.

Does Medicare Cover Physical Therapy After a Hip or Knee Replacement?

Yes—and this is one of the most common reasons Medicare beneficiaries need PT. After a hip or knee replacement, Medicare covers physical therapy during:

  • Your inpatient hospital stay (Part A)
  • A skilled nursing facility stay if you need continued rehab (Part A)
  • Home-based PT if you qualify as homebound after discharge (Part A/B home health benefit)
  • Outpatient PT once you can leave home (Part B, 80% after deductible)

The key decision after joint replacement is whether to go to a skilled nursing facility for rehab or go home with outpatient PT. Medicare covers both, but your recovery trajectory and home support situation should guide that choice.

Does Medicare Cover Physical Therapy After a Fall?

Yes. Falls are a leading cause of injury in older adults, and Medicare covers PT to help you recover from fall-related injuries and — importantly — to prevent future falls. Balance training, strength conditioning, and gait therapy are all covered when ordered by a doctor and deemed medically necessary.

How to Reduce Your Out-of-Pocket PT Costs

  • Medigap Plans: Most Medigap policies cover the 20% Part B coinsurance, effectively making medically necessary PT free at the point of service beyond your deductible.
  • Medicare Advantage Plans: Many MA plans have lower copays for PT visits ($20–$50 per visit) and out-of-pocket maximums that cap your total annual exposure.
  • Hospital outpatient departments: Rates may differ from private PT offices; compare your out-of-pocket costs before starting a course of treatment.

Frequently Asked Questions

Does Medicare cover massage therapy?

Medicare does not cover massage therapy as a standalone service. If massage is performed by a licensed physical therapist as part of a medically necessary PT plan, it may be included in the covered services — but it cannot be billed separately.

Does Medicare cover chiropractic care?

Medicare Part B covers chiropractic manipulation of the spine when medically necessary to treat subluxation. However, Medicare does not cover other services provided by a chiropractor (X-rays, massage, or other therapies).

Does Medicare cover aquatic physical therapy?

Medicare covers aquatic therapy (hydrotherapy) when it is part of a medically necessary PT plan and the therapist is present throughout the treatment. It is covered at the same 80/20 split as other outpatient PT.

Related Reading:
Does Medicare Cover Home Health Care? • Does Medicare Cover Skilled Nursing Facility Care? • Medigap vs. Medicare Advantage: Which Covers More?

This article is for informational purposes only. Therapy coverage thresholds and costs change annually. Verify current amounts at Medicare.gov.

 

Does Medicare Cover Hearing Aids in 2026? (The Honest Answer)

By
Greg Wilson, Founder
-
0
Does Medicare Cover Hearing Aids in 2026?
Does Medicare Cover Hearing Aids in 2026?
The Short Answer: No — Original Medicare (Parts A and B) does not cover hearing aids or routine hearing exams. However, many Medicare Advantage (Part C) plans do include hearing aid benefits, and a new category of FDA-regulated over-the-counter hearing aids has made affordable options available without a prescription since 2022.

Roughly 1 in 3 adults between ages 65 and 74 has some degree of hearing loss, and that number rises to nearly 50% for those over 75. Despite this, hearing aids are among the most significant coverage gaps in Original Medicare — and one of the most financially painful for seniors.

Here’s exactly what Medicare does and doesn’t cover and what your real options are in 2025.

What Original Medicare (Parts A and B) Covers for Hearing

Original Medicare provides very limited hearing-related coverage:

  • Diagnostic hearing exams: Covered under Part B at 80% after your deductible — but only when ordered by a doctor to diagnose a medical condition (not a routine hearing test).
  • Balance exams: Covered if your doctor orders them to diagnose a medical problem.
  • Cochlear implants: Covered under Part B as a durable medical device when medically necessary.

What Original Medicare does not cover:

  • Routine hearing exams
  • Hearing aids (any type, any price point)
  • Hearing aid fittings or adjustments

Does Medicare Advantage Cover Hearing Aids?

This is where coverage gets more interesting. Medicare Advantage (Part C) plans are required to cover everything Original Medicare covers, but they are allowed to add extra benefits. Hearing coverage is one of the most common supplemental benefits offered by Advantage plans.

What hearing coverage through Medicare Advantage typically looks like:

BenefitWhat Plans Commonly Offer
Annual hearing examCovered (often $0 copay)
Hearing aid allowance$500–$2,500 per year on many plans; some offer per-pair
Hearing aid fittingOften included
Follow-up adjustmentsVaries by plan
OTC hearing aidsSome plans now include OTC allowances through supplemental benefit cards

Coverage varies significantly from plan to plan and zip code to zip code. The only way to know your specific plan’s hearing benefit is to check the plan’s Summary of Benefits or call the plan directly before enrollment.

Over-the-Counter Hearing Aids: A New Option Since 2022

In October 2022, the FDA created a new category of over-the-counter (OTC) hearing aids for adults with mild-to-moderate hearing loss. These devices do not require a prescription, a hearing exam, or fitting by an audiologist. You simply purchase them at a pharmacy, big-box store, or online retailer.

OTC hearing aid brands available at major retailers include options from Sony, Jabra Enhance, Lexie (backed by Bose), and others. Prices range from approximately $200 to $1,500 per pair—a fraction of the $3,000–$8,000 cost of traditional prescription pairs.

OTC hearing aids are appropriate for:

  • Adults 18 and older
  • Mild-to-moderate hearing loss
  • People who want to self-fit and self-manage their devices

OTC hearing aids are not appropriate for children, people with severe hearing loss, or those with medical causes of hearing loss that require professional evaluation.

What You Can Expect to Pay for Hearing Aids in 2026

TypeAverage Cost Per PairMedicare Coverage
OTC hearing aids (mild-moderate loss)$200–$1,500No (some MA plans offer OTC allowances)
Basic prescription hearing aids$2,000–$4,000Original Medicare: No; Many MA plans: partial
Mid-range prescription hearing aids$4,000–$6,000Original Medicare: No; Some MA plans: partial
Premium prescription hearing aids$6,000–$8,000+Original Medicare: No; Rare MA plan coverage
Cochlear implants$30,000–$50,000+Yes — Part B (medically necessary)

Other Ways to Get Help Paying for Hearing Aids

If your Medicare plan doesn’t cover hearing aids, these programs may help:

  • State Health Insurance Assistance Programs (SHIP): Free counseling to compare Medicare Advantage plans that include hearing benefits.
  • Veterans Affairs (VA): If you’re a veteran, the VA provides hearing aids at no cost to eligible veterans.
  • Lions Clubs Hearing Aid Recycling Program: Reconditioned hearing aids at low or no cost.
  • Hear Now (Starkey Hearing Foundation): Provides hearing aids to people with limited income.
  • Flexible Spending Account (FSA) or Health Savings Account (HSA): Hearing aids are an eligible expense, so pre-tax dollars can offset the cost.

The Bottom Line: What You Should Do

If hearing loss is a concern and you’re currently on Original Medicare, the most impactful step you can take during the next Medicare Open Enrollment Period (October 15 – December 7) is to compare Medicare Advantage plans in your area that include strong hearing benefits. Even a $1,500 annual hearing aid allowance can save thousands over a few years.

If you need hearing aids now and can’t wait for open enrollment, look at OTC options — they’ve improved significantly and are a legitimate solution for mild-to-moderate loss.

Related Reading on SeniorAffair:
Does Medicare Cover Dental Care? • Does Medicare Cover Vision and Eye Exams? • Medicare Advantage vs. Original Medicare: Which Is Right for You?

Frequently Asked Questions

Can I get Medicare to pay for hearing aids if my doctor recommends them?

Unfortunately, no. A doctor’s recommendation does not change Original Medicare’s coverage policy. Hearing aids are excluded regardless of medical necessity under Parts A and B. Only Medicare Advantage plans can fill this gap.

Does Medigap cover hearing aids?

No. Medigap (Medicare Supplement) policies fill the cost-sharing gaps in Original Medicare, but they do not add new benefits. Since Original Medicare doesn’t cover hearing aids, Medigap does not either.

Will Medicare ever cover hearing aids?

There have been legislative proposals to add hearing coverage to Original Medicare, but as of 2026, no such law has passed. The closest thing is the expansion of Medicare Advantage plans offering hearing benefits and the OTC hearing aid market created in 2022.

This article is for informational purposes only. Medicare benefits and costs change annually. Verify your specific plan’s hearing benefits at Medicare.gov or by calling your plan directly.

 

Does Medicare Cover Walk-In Tubs or Walk-In Showers in 2026?

By
SeniorAffair Editorial Staff
-
0
Does Medicare Cover Walk-In Tubs or Walk-In Showers in 2026?
Does Medicare Cover Walk-In Tubs or Walk-In Showers in 2026?
No, Original Medicare does not cover walk-in tubs, walk-in showers, grab bars, or any home bathroom modification. These are classified as home improvements, not medical equipment. However, there are several programs that can help seniors offset these costs — and Medicare does cover certain bathroom safety equipment that doesn’t require installation.

Falls in the bathroom are the leading cause of fall-related injury hospitalizations among adults 65 and older. A walk-in tub or roll-in shower can meaningfully reduce that risk. But despite the clear health benefit, Original Medicare draws a firm line at home modifications—they are considered improvements to real property, not durable medical equipment. Here’s what’s available, what Medicare does cover in the bathroom safety category, and where else to look for help.

What Medicare Does NOT Cover in the Bathroom

Item or ModificationOriginal Medicare Coverage
Walk-in tubNot covered
Walk-in shower or roll-in shower conversionNot covered
Grab bar installationNot covered
Handheld showerhead installationNot covered
Non-slip flooringNot covered
Widened doorways for wheelchair accessNot covered
Ramp installationNot covered
Bathroom remodel of any kindNot covered

The reason: Medicare’s durable medical equipment (DME) benefit covers equipment that can be used in the home and serves a medical purpose—wheelchairs, CPAP machines, and hospital beds. Home modifications are permanent improvements to real property. Congress has never extended Medicare coverage to home modification, despite frequent advocacy from aging-in-place specialists and disability groups.

What Medicare DOES Cover for Bathroom Safety

Medicare Part B covers bathroom safety equipment classified as durable medical equipment—items you use in the bathroom that can be moved or removed, not permanently installed modifications.
EquipmentMedicare CoverageRequirement
Shower chair or shower bench80% after Part B deductibleDoctor’s prescription for medical necessity
Commode chair (portable toilet)80% after Part B deductibleDoctor’s prescription
Raised toilet seat80% after Part B deductibleDoctor’s prescription
Transfer bench (for getting in/out of tub)80% after Part B deductibleDoctor’s prescription
Handheld shower attachment (as DME—not installation)80% in some casesDoctor’s prescription; must meet DME criteria
Grab bars (freestanding, not wall-mounted)Not covered—
Wall-mounted grab barsNot covered—

The distinction is between portable, personal use equipment (covered) and permanent structural modifications (not covered). A shower chair you set inside a tub is covered DME. The walk-in tub that replaces the tub itself is a structural modification and is not covered.

Does Medicare Advantage Cover Walk-In Tubs?

Possibly — and this is worth checking carefully. The Special Supplemental Benefits for the Chronically Ill (SSBCI) provision allows Medicare Advantage plans to offer non-traditional benefits — including home modifications — to qualifying enrollees who have at least one chronic condition and are expected to benefit from the modification.

Some Medicare Advantage plans now offer:

  • Home safety assessments followed by covered modifications
  • A home modification allowance (typically $250–$1,500 per year) that can be applied toward grab bars, ramps, bath modifications, or other safety upgrades
  • Access to a preferred vendor network for home modification installations

This benefit is not universal — only a subset of Medicare Advantage plans include it, and eligibility often requires meeting specific chronic condition criteria. During Medicare Open Enrollment (October 15 – December 7), compare plans in your area specifically for home modification or home safety benefits using the Medicare Plan Finder supplemental benefits filter.

Other Programs That Help Pay for Walk-In Tubs and Bathroom Modifications

Medicaid Home and Community-Based Services (HCBS) Waivers

Many states’ Medicaid HCBS waivers cover environmental accessibility modifications — including bathroom safety upgrades — for eligible low-income seniors who might otherwise require nursing home care. Eligibility is based on income, assets, and functional need. Contact your state Medicaid office or Area Agency on Aging to inquire about HCBS waiver programs in your state.

VA Home Adaptation Grants (Veterans)

Veterans with service-connected disabilities may qualify for the Specially Adapted Housing (SAH) grant (up to $111,837 in 2026) or the Special Home Adaptation (SHA) grant (up to $22,406 in 2026). These grants fund significant home modifications, including roll-in shower installations, widened doorways, and ramp construction. Contact your VA regional office or Veterans Service Organization for eligibility guidance.

Area Agency on Aging (AAA) Programs

Local Area Agencies on Aging administer programs that help older adults age in place, including some home modification assistance. Programs vary by county and funding availability. Find your local AAA at eldercare.acl.gov or call the Eldercare Locator at 1-800-677-1116.

HUD Title I Home Improvement Loans

The U.S. Department of Housing and Urban Development’s Title I program offers loans specifically for home improvements, including accessibility modifications. These are low-interest loans (not grants), available through HUD-approved lenders. Loan amounts up to $25,000 for single-family home improvements.

USDA Rural Development Section 504 Program

For seniors in rural areas, the USDA offers grants of up to $10,000 (for those 62 and older who cannot repay a loan) and loans of up to $40,000 for home repairs to remove health and safety hazards — including accessibility modifications. Income limits apply.

State and Local Programs

Many states have dedicated senior home modification grant or loan programs. Examples include California’s HCBD, New York’s EISEP, and Illinois’ Community Care Program. Your State Health Insurance Assistance Program (SHIP) counselor or your local senior center can point you to state-specific resources.

Tax Deductions for Medical Modifications

Home modifications that are medically necessary and prescribed by a physician may be deductible as medical expenses on your federal income taxes (Schedule A, itemized deductions) to the extent they exceed 7.5% of your Adjusted Gross Income. A walk-in tub prescribed by a doctor for a qualifying medical condition (severe arthritis, balance disorder, etc.) with a letter of medical necessity may qualify. Consult a tax advisor.

Walk-In Tub Costs: What to Expect

For seniors budgeting for this purchase without coverage:

  • Basic walk-in tub: $1,500–$3,000 (tub only)
  • Mid-range walk-in tub with jets: $3,000–$6,000
  • Premium walk-in tub (air jets, heated seat, chromotherapy): $6,000–$10,000+
  • Installation (plumbing, fitting, finish work): $1,000–$3,500
  • Total installed cost range: $2,500–$13,000+
  • Walk-in shower conversion: $3,000–$8,000 installed (typically less expensive than a full walk-in tub)

Frequently Asked Questions

Does Medicare cover a hospital bed at home?

Yes—a hospital bed is covered under Medicare Part B as durable medical equipment at 80% after your deductible when prescribed by a doctor as medically necessary for home use. This is a portable, removable piece of equipment—distinct from a structural home modification.

Does Medicare cover stair lifts?

No. Stair lifts are classified as home modifications and are not covered by Original Medicare. Some Medicare Advantage plans with home modification benefits may cover stair lifts. The same alternative programs listed above (Medicaid waivers, VA grants, AAA programs) may help with stairlift costs.

Does Medicare cover a wheelchair ramp?

No. Ramps are permanent home modifications and are not covered by Original Medicare. However, modular ramps—portable, non-permanent ramp systems—may qualify as durable medical equipment in some cases. Check with a Medicare-enrolled DME supplier and get a doctor’s prescription before attempting to bill Medicare for a ramp.

Related Medicare Coverage Guides:
Does Medicare Cover Home Health Care?
Does Medicare Cover Physical Therapy?
Does Medicare Cover It? Complete Guide
Medicare Advantage Supplemental Benefits Explained

 

This article is for informational purposes only. Program availability, grant amounts, and Medicaid waiver services vary by state and are subject to funding availability. Information on veterans’ grants reflects 2025 benefit amounts and is subject to change. Verify current program details with the relevant agency before making financial decisions.

 

Does Medicare Cover an Annual Physical in 2026? The “Welcome Visit” vs. “Physical” Difference

By
Greg Wilson, Founder
-
0
Does Medicare Cover an Annual Physical in 2026?
Does Medicare Cover an Annual Physical in 2026?

Partially — and the distinction matters. Medicare does not cover a traditional annual physical examination. What it does cover — free, once per year — is the Annual Wellness Visit (AWV), a preventive care visit focused on health risk assessment and prevention planning, not hands-on examination. Understanding the difference protects you from unexpected bills at your “free yearly checkup.”

This confusion generates more surprise medical bills for Medicare beneficiaries than almost any other coverage misunderstanding. A patient schedules their “free annual physical.” The doctor takes blood pressure, reviews medications, discusses health goals. A few weeks later, a bill arrives for $150–$350. What happened? The visit was coded as an office visit, not an Annual Wellness Visit — or extra services were added that triggered diagnostic billing. Here’s how to navigate this correctly.

The Three Preventive Visit Types Medicare Covers

Visit TypeWhen AvailableYour CostKey Features
Welcome to Medicare Visit (IPPE)One time only, within first 12 months of Part B enrollment$0One-time baseline assessment; vision test; EKG referral; referrals for preventive screenings
Annual Wellness Visit (AWV)Once per year (at least 12 months after your first AWV or Welcome Visit)$0Health risk assessment; cognitive screening; depression screening; prevention plan; medication review
Traditional physical examAny time medically needed20% coinsurance after Part B deductibleHead-to-toe physical examination; diagnostic workup; billed as a standard office visit

What the Annual Wellness Visit Includes (and Doesn’t)

Included in your free Annual Wellness Visit:

  • Review and update of your medical and family history
  • A list of your current providers and prescriptions
  • Height, weight, BMI, blood pressure, and other routine measurements
  • Cognitive impairment detection (brief screening)
  • Depression screening
  • Review of functional ability and safety (fall risk, hearing, vision)
  • Written schedule of preventive services you should receive based on your age and risk factors
  • Advance care planning discussion (if you choose to have it)
  • Referrals for other covered preventive services

Not included in the AWV — and not covered at $0:

  • Physical examination of the heart, lungs, abdomen, joints, or reflexes
  • Routine blood work ordered to check your cholesterol, blood sugar, kidney function, etc.
  • Urinalysis or other diagnostic tests
  • Any evaluation or treatment of a new or existing health problem
  • Discussion of or treatment for symptoms or conditions you bring up during the visit
The trigger for a bill during your “free” visit: If your doctor addresses a medical issue during the Annual Wellness Visit — even something you casually mention like “by the way, my knee has been hurting”—that portion of the visit is billed separately as a diagnostic office visit. You will owe your deductible and 20% coinsurance for that additional billing. This is legal, appropriate, and very common — but it surprises patients who expected $0 for the entire visit.

How to Have a $0 Annual Wellness Visit

To keep your AWV at $0, follow these steps:

  1. Schedule the visit specifically as an “Annual Wellness Visit.” Use those exact words when scheduling. Some offices call it an AWV, some call it a Medicare Wellness Exam. Confirm before you arrive that the visit is coded as an AWV, not a general physical or office visit.
  2. Save new medical concerns for a separate appointment. If you have symptoms, new pain, or medical questions beyond the AWV’s preventive scope, schedule a separate follow-up appointment. Don’t bring up medical problems during your AWV if you want to avoid additional billing.
  3. Decline optional add-ons unless you understand the billing. If your doctor wants to draw blood during the AWV, ask how it will be billed. Preventive screening labs (once-every-5-year lipid panel, diabetes screening, etc.) are still $0. Diagnostic lab work ordered because of findings is not.
  4. Ask at checkout what codes were used. Request a copy of the visit’s billing codes. The AWV should be billed under HCPCS code G0438 (first AWV) or G0439 (subsequent AWV). If you see a standard evaluation and management (E&M) code instead, your visit was not billed as an AWV.

The Welcome to Medicare Visit—Your One-Time First-Year Benefit

When you first enroll in Medicare Part B, you are entitled to a one-time “Welcome to Medicare” preventive visit (also called the Initial Preventive Physical Examination, or IPPE). This must be used within your first 12 months of Part B enrollment and is covered at $0.

The Welcome to Medicare visit includes:

  • A comprehensive review of your medical and social history
  • Height, weight, BMI, blood pressure measurement
  • A vision test
  • An EKG (electrocardiogram)—though only the electrocardiogram tracing itself, not interpretation and report, which may cost more
  • Referrals for other covered preventive services you are due for
  • Education and counseling about preventive services and health risks

Many newly enrolled Medicare beneficiaries miss this one-time visit — it’s valuable for establishing a baseline and getting all your preventive service referrals organized at the start of Medicare coverage. Schedule it within your first 12 months.

Medicare Preventive Services Covered at 100%

Beyond the AWV itself, Medicare covers a wide range of preventive services at $0 — no deductible, no coinsurance. Your Annual Wellness Visit is a good time to receive referrals for these services if you haven’t completed them on schedule:

Preventive ServiceFrequencyYour Cost
Mammogram (breast cancer screening)Once per year$0
Colonoscopy (average risk)Every 10 years$0 (screening rate)
Cardiovascular disease risk screening (cholesterol)Every 5 years$0
Diabetes screeningUp to twice per year if at risk$0
Flu vaccineAnnually$0
Pneumococcal vaccines (PCV15, PPSV23)Per schedule$0
Shingles vaccine (Shingrix)2-dose series$0 under Part D on most plans
Depression screeningAnnually$0
Lung cancer screening (CT)Annually (qualifying smokers)$0
Bone density measurement (osteoporosis)Every 24 months for high-risk women$0
Abdominal aortic aneurysm ultrasoundOne time (qualifying male smokers)$0

Frequently Asked Questions

If Medicare doesn’t cover a traditional physical, how do I get one?

You can ask your doctor for a standard physical examination at any time. It will be billed as a diagnostic office visit under Part B — you pay 20% coinsurance after your $283 annual deductible. A comprehensive physical exam typically costs $150–$400 before Medicare’s share; your 20% would be $30–$80. Alternatively, a Medigap plan covers this coinsurance.

Can my doctor do both an Annual Wellness Visit and a problem visit on the same day?

Yes — but they must be billed separately, and you will receive two separate charges. The AWV portion is $0; the problem visit (for a symptom or condition) is billed as a standard office visit with 20% coinsurance. This is legitimate and allows you to handle both preventive and medical needs in one trip. Just know in advance that you’ll receive a bill for the problem portion.

Does my Annual Wellness Visit reset every calendar year or every 12 months?

Every 12 months from your previous AWV — not necessarily on a calendar year basis. If you had your last AWV in September 2026, you are eligible for your next one in September 2027, not January 2027. Medicare requires at least 12 months between AWV visits.

Does Medicare Advantage cover a physical exam differently?

Many Medicare Advantage plans include benefits beyond the standard AWV. Some plans cover an annual physical examination (with hands-on exam) at $0 or a low copay as an added supplemental benefit. Check your plan’s Summary of Benefits—if a physical exam is listed as a covered benefit, the cost-sharing your plan specifies applies.

Related Medicare Preventive Care Guides:
Does Medicare Cover Lab Tests and Blood Work?
Does Medicare Cover Colonoscopy?
Does Medicare Cover It? Complete Guide
What Does Medicare Cover 100%? Full Preventive Services List

 

This article is for informational purposes only. Medicare billing codes and covered services are updated periodically by CMS. The best way to avoid billing surprises is to confirm how your visit will be coded before you arrive — ask your provider’s office directly. For questions about specific claims, contact Medicare at 1-800-MEDICARE or visit Medicare.gov.

 

Veteran Guide: Landing a VA Loan When Home buying, 7 Tips to Consider

By
Mia Wilson
-
0
7 VA loan tips

One standout benefit of serving in the military, National Guard, or Reserves is your qualification to apply for a VA mortgage. Administered through a broad range of lending institutions, VA loans are guaranteed by the federal government. That’s why they usually feature lower interest rates and more flexible qualification standards. Many service members buy their homes through the VA with no money down. Overall, lenders consider VA loans less risky than conventional private mortgages.

To be eligible for a VA loan, you need to be an active or former member of the military. In general, you must have been honorably discharged, although there are rare exceptions to that rule. Additionally, surviving spouses of veterans can also apply for a VA loan unless they have been remarried. Depending on when you served and why you were discharged, there are service benchmarks you must meet in terms of time served. But to be clear just because you qualify to apply for a VA mortgage, doesn’t necessarily mean you’ll be able to secure one. Here are several tips for increasing your chances of being approved to take advantage of this useful benefit.

Veteran Guide: Landing a VA Loan When Homebuying

Don’t Let the Paperwork Overwhelm You

Applying for any mortgage can be confusing and time-consuming. But VA loans come with an additional layer of complexity. Anything involving the government comes with red-tape, right? First, you’ll need to secure a Certificate of Eligibility to be approved for a VA loan, which involves gathering a little more documentation than you would need to apply for a conventional loan. But you don’t need to have a certificate to begin the VA loan application process. In fact, most lenders will be glad to assist you in getting one. Remember that lenders want your business. And a good one will bend over backward to get it.

Assure That Your New Home Is Eligible

Here’s why working with a VA loan-savvy realtor can be a tremendous boon. The last thing you want to do is spend lots of time trying to purchase a property that won’t qualify for a mortgage in the end. The government doesn’t want to invest in properties that have major defects and neither do you. They’ve established a set of Minimum Property Requirements for homes purchased under the VA loan program. Your realtor or lender can explain these to you and help you steer clear of properties that don’t stack up to VA standards.

Get Familiar with Acceptable Use and Occupancy Guidelines

VA loans aren’t made for every type of property. Loans are only written for primary residences. Your new home can be a Colonial, a condo, a manufactured home, or anywhere in between but you have to live there. You can even take out a loan to build a home from scratch. But vacation homes and investment properties aren’t eligible for VA financing. In addition, the VA sets time limits around occupancy. Generally, you must move into your home within 60 days of closing. If you’re currently deployed, that rule can be challenging. A spouse can substitute for a deployed service member to meet the occupancy date, but single people may have a harder time fulfilling the requirement. It can be done, though.

Your Credit Still Counts

One important advantage VA loans have over traditional mortgages is that VA borrowers are subject to more lenient financial qualifications. Officially, there is no credit score bar you have to clear before you can be approved for a VA mortgage. But having good-to-excellent credit can help you secure a larger loan and/or a better interest rate.

Even a quarter-point difference in the interest rate you’re offered can amount to thousands of dollars over the life of your mortgage. That’s why getting your credit in the best possible shape before you apply for a loan is essential. Download a free copy of your credit report from each of the three credit reporting bureaus to see where you stand. Then do whatever credit repair that needs to be done. Make sure all of your credit accounts are current—and stay that way—while you’re applying for a mortgage. Close any accounts that you’re no longer using. If you find any negative remarks on your report that aren’t legitimate, dispute them. Fixing mistakes on your credit report can take some time. So be sure you attend to your credit well in advance of submitting a loan application.

Remember to Get Pre-Qualified Before You Start House Hunting

Today’s real estate market is very competitive. Nowadays, home sellers are inundated with offers and 43% accept one within a week of listing their homes. Sellers aren’t interested in wasting time and want to talk to serious buyers only. Prequalifying for a loan through one or more lenders—that is, securing a letter that states how much money a lender would be likely to loan you and at what interest rate—is one way to show home sellers that it’s worth their time to work with you. Many home sellers won’t even entertain offers from buyers who aren’t prequalified.

Getting prequalified also can help you set home price parameters for yourself and hone in on properties you can reasonably afford. It’s easy to do. And it won’t affect your credit score, even if you prequalify with more than one lender.

As someone who has served our country, you’re entitled to the rewards a VA mortgage can provide. And you’re entitled to great service from the professionals you work with during the home buying process.

Does Medicare Cover Travel Outside the US in 2026? International Medical Coverage Explained

By
SeniorAffair Editorial Staff
-
0
Does Medicare Cover Travel Outside the US
Does Medicare Cover Travel Outside the US
Almost never. Original Medicare provides virtually no coverage for medical care received outside the United States. If you travel internationally and have a medical emergency, you will likely pay entirely out of pocket—hospital bills in many countries can run tens of thousands of dollars. There are three narrow exceptions and several planning strategies that can protect you.

International travel in retirement is one of life’s great pleasures—and one of its more significant financial risks for Medicare beneficiaries. The average American traveler doesn’t realize until they’re abroad that the Medicare card in their wallet is essentially useless outside US borders. Here’s exactly where coverage stops, what the exceptions are, and how to protect yourself.

Where Medicare Does and Doesn’t Work

LocationOriginal Medicare Coverage
All 50 US statesFull coverage
Washington D.C.Full coverage
Puerto RicoFull coverage
US Virgin IslandsFull coverage
GuamFull coverage
American SamoaFull coverage
Northern Mariana IslandsFull coverage
CanadaNot covered (with one narrow exception)
MexicoNot covered (with one narrow exception)
All other international destinationsNot covered
International cruise shipsNot covered (except when within 6 hours of a US port)

The Three Narrow Exceptions

Original Medicare makes three specific exceptions where international care may be covered. All three are emergency scenarios—not routine or planned medical care abroad.

Exception 1: Emergency Care in Canada or Mexico When the US Hospital Is Farther

If you have a medical emergency in the US but the nearest hospital is in Canada or Mexico — closer than any US hospital — Medicare may cover the emergency care received at that foreign hospital. This primarily applies to people living near the Canadian or Mexican border. The key qualifier is that the foreign hospital must be closer than any US hospital that can treat you.

Exception 2: Emergency Care in Canada While Traveling Between Alaska and the Contiguous US

If you are traveling between Alaska and another US state, and the most direct land route passes through Canada, Medicare covers medically necessary emergency care in Canada along that route. This recognizes that Alaska is geographically separated from the rest of the US and travel through Canada is sometimes the only practical option.

Exception 3: Cruise Ship Emergency Within 6 Hours of a US Port

If you are on a cruise ship and the ship is within 6 hours (by sailing) of a US port, Medicare Part B may cover emergency services provided on the ship by a doctor enrolled in Medicare. Once the ship is more than 6 hours from port, coverage stops — which means for most of a typical cruise itinerary, you have no Medicare coverage.

These three exceptions are narrow and situational. For the vast majority of international travel—a cruise through the Mediterranean, a trip to Europe, a visit to family in another country, a tour of Asia—Original Medicare provides zero coverage.

Medigap Foreign Travel Emergency Coverage

The best Medicare-adjacent international protection: Most Medigap (Medicare Supplement) plans include a foreign travel emergency benefit. Medigap plans C, D, F, G, M, and N all include this benefit as a standard feature. Plan A and B do not.

How the Medigap foreign travel emergency benefit works:

  • Benefit trigger: A medical emergency that begins during the first 60 days of a trip outside the US
  • Deductible: $250 per trip (you pay the first $250 of emergency costs)
  • Coverage level: 80% of medically necessary emergency care after the deductible
  • Lifetime maximum: $50,000 (this is a lifetime cap, not per-trip)
  • What qualifies: Emergency hospital care, emergency physician services, emergency surgery — care that cannot wait until you return to the US
  • What does not qualify: Routine care, elective procedures, non-emergency care, care after the first 60 days of a trip

The $50,000 lifetime cap is an important limitation. A serious illness requiring extended hospitalization in a high-cost country (Switzerland, Japan, UK, Australia) can easily exceed $50,000. The Medigap foreign travel benefit is a helpful safety net for typical emergencies—a broken hip, appendicitis, or cardiac event—but it is not comprehensive international health insurance.

What Happens When the Medigap Cap Isn’t Enough

For travelers who want more robust international coverage, supplemental travel medical insurance is the answer. Travel medical insurance specifically designed for seniors is widely available and affordable:

Coverage TypeWhat It CoversApproximate Cost
Travel medical insurance (primary)Emergency and non-emergency medical care abroad, no US primary insurance required$50–$200 per trip depending on age, duration, destination
Travel medical insurance (secondary/excess)Medical costs beyond what any other coverage paysLess expensive; supplements Medigap foreign travel benefit
Medical evacuation coverageAir transport back to the US for medical treatmentOften included in comprehensive travel plans; or $200–$400 standalone annual plan
Annual multi-trip travel medical planCovers multiple international trips per year$200–$600/year for seniors 65+
Medical evacuation is often overlooked — and can be the most expensive piece. Being airlifted back to the United States from a foreign country for medical care can cost $50,000–$250,000 depending on distance and level of care required during transport. A medical evacuation policy (or a comprehensive travel plan that includes evacuation) covers this cost. Organizations like MedJet Assist and GeoBlue offer annual evacuation memberships starting around $200/year.

What to Do Before Every International Trip

  1. Check your Medigap plan. Confirm whether your plan includes the foreign travel emergency benefit and review the $250 deductible and $50,000 lifetime cap. Know your remaining cap if you’ve used the benefit before.
  2. Purchase travel medical insurance for the trip. For trips beyond the Medigap emergency safety net, purchase a travel medical policy with primary coverage, medical evacuation, and ideally trip cancellation for trip investments over $3,000.
  3. Carry your information in writing. Bring a card listing your Medicare number, Medigap plan information, travel insurance policy number and 24-hour claim line, and emergency contact information. Foreign hospitals will often require payment upfront — having your travel insurer’s phone number allows them to provide a guarantee of payment.
  4. Know that Medicare Advantage has different rules. If you have a Medicare Advantage plan, check your Evidence of Coverage for international emergency provisions—some plans do offer limited overseas emergency coverage. Call your plan before your trip.
  5. Consider destination-specific risks. Some destinations have very high medical costs (Western Europe, Japan, Australia, Scandinavia). Others have limited quality of care that may require evacuation. Tailor your coverage level to your specific itinerary.

Frequently Asked Questions

Does Medicare cover medical care in Canada?

Only in the two narrow exceptions described above—emergency care near the US border when the US hospital is farther and emergency care while traveling through Canada between Alaska and the contiguous US. Routine medical care, planned procedures, or emergencies in Canada that don’t meet these exceptions are not covered.

Does Medicare cover medical care in Mexico?

Only if you live in the US near the Mexican border and the nearest hospital to an emergency is in Mexico. Planned dental or medical tourism in Mexico — which is popular for cost reasons — is not covered by Medicare regardless of the circumstances.

I live near the Canadian border and see a Canadian doctor regularly. Does Medicare cover those visits?

No. Routine care with a Canadian physician — even for a border resident — is not covered by Medicare. The border exception applies only to emergency care where no US hospital is closer.

What if I retire abroad? Does Medicare cover me?

No. If you retire to another country, Original Medicare does not cover your medical care there. You would retain your Medicare eligibility and could use it if you return to the US — but for ongoing care in your country of retirement, you would need that country’s local coverage, private expatriate health insurance, or a combination. Medicare Parts A and B premiums must still be paid to maintain coverage for when you do return to the US.

Does Medicare Part D cover prescriptions I fill in another country?

No. Medicare Part D prescription drug coverage applies only to drugs dispensed at US pharmacies. Prescriptions filled at pharmacies in Canada, Mexico, or any other country are not covered by Part D. Take an adequate supply of medications for your entire trip, or be prepared to pay out of pocket abroad.

Related Medicare Coverage Guides:
Does Medicare Cover Ambulance Transport? •
Medigap Plans Explained: Which One Is Right for You? •
Does Medicare Cover It? Complete Guide •
Medicare Advantage vs. Original Medicare

This article is for informational purposes only. Medicare’s international coverage rules are established by federal statute and are subject to change. Travel insurance products vary significantly in their terms and exclusions. Always read your policy documents carefully and call your insurer’s emergency line before seeking care abroad if possible. Verify Medicare rules at Medicare.gov or call 1-800-MEDICARE.

 

8 Costly Medicare Mistakes to Avoid

By
Mia Wilson
-
0
8 Costly Medicare Mistakes to Avoid

Sheila signed up for Medicare, picking a plan with the lowest premium. 

Her low premium plan, though, had the worst out-of-pocket expenses. Before Sheila knew it, she was paying hundreds of dollars in co-pays.

Her mistake? Assuming a low monthly premium was the right way to go. Most Americans don’t have an extra $250 to spare. So being hit with a hefty copay can be a significant problem.

When choosing a Medicare program, you have to pick a plan with reasonable expenses. What other costly Medicare mistakes do you need to know about? Read on to find out.

1. Now Knowing What Medicare Insurance Does

The first mistake to avoid is not understanding Medicare as a program. What is Medicare anyways?

Medicare was established by the United States federal government as a national healthcare program. Working as a part of the social security act, Medicare is all about providing Health services for individuals 65 years of age and older. Specifically, Medicare is there to help seniors who don’t have any current health insurance.

Now that you know more about what Medicare does, let’s talk about Medicare eligibility and registration. Many people mistakenly think that age is the only criterion for Medicare.

However, different things can help you qualify to become a beneficiary of Medicare. Controlled by the Medicare and Medicaid Services centers, Medicare also allows people with specific disabilities. For instance, if someone’s dealing with Lou Gehrig’s disease or the end stage of renal disease, they probably qualify for Medicare.

2. Thinking Medicare Covers Everything

A common mistake individuals make is falling under the pretense that Medicare will cover all of their medical needs. However, there are specific services that seniors often need that Medicare will not cover.

Here’s a short list of medical services that Medicare usually doesn’t cover:

  • Long-term Care
  • Cosmetic surgery
  • Medical Care outside of the United States
  • Foot Care
  • Eye exams
  • Hearing aids
  • Dental Care
  • Acupuncture

Routine dental care includes things like fillings and cleanings. Staying on top of your cleanings is the best way to improve your oral hygiene. Dentists say most people need biannual cleanings, while others only need annual cleanings.

However, Medicare isn’t going to pay for routine dental care. Medicare isn’t going to cover other types of dental care, such as dentures or implants.

If you go to the hospital, Medicare part A can help pay for specific dental services. But Medicare part A will only cover those dental services if medically required to get them.

As far as your eyes go, Medicare won’t cover regular eye exams or pay for glasses and contact lenses. In some cases, Medicare will be willing to cover eye exams if you have a specific health condition. For instance, if you’re at risk for glaucoma or you need to take a yearly retinopathy exam for diabetes, Medicare may be able to help.

Even though Medicare isn’t going to cover the cost of your glasses or contact lenses, it could help pay for cataract surgery. You could get coverage if you have to get cataract surgery and your doctor uses intraocular lens implantation. It’s all on a case-by-case decision for coverage approval.

3. Ignoring Medicare Advantage Plans

Understanding Medicare is just the start. Don’t make the mistake of overlooking Medicare advantage plans too.

Medicare Advantage is a type of insurance. It will not be the right fit for everyone because it’s expensive. But if you can afford the coverage, it can give you some of the best health insurance benefits.

What exactly are Medicare advantage plans? They’re private health plans. Similar to traditional Medicare, the advantage plans will not replace supplemental insurance.

You’ll enjoy the best coverage while also receiving more services. For instance, you can get part Medicare coverage and Part B Medicare and add it to a Medicare Advantage plan.

Rest assured, you get the same health insurance equal to traditional Medicare standards. However, you’ll get additional benefits and coverage too!

In other words, you won’t be eliminating yourself from traditional Medicare. Instead, you’ll be extending your benefits. You’ll maintain the same rights and protections the government guarantees traditional Medicare patients.

To qualify for a Medicare Advantage plan, you’ll need to be eligible for Medicare Part A and Part B. You also have to live somewhere where Medicare Advantage plans are available. Specific locations are outside the service range, so individuals in those areas won’t qualify.

When can you sign up for an advantage plan? You’ll have to sign up during the yearly election to be eligible for a Medicare Advantage plan. You can also sign up during your initial enrollment.

4. Using Medicare Plans With Medicaid

Are Medicare and Medicaid the same thing? Not at all!

Medicare has two parts, Part A and B. There are also advanced Medicare programs that you can look into.

Medicaid is an entirely different program altogether. It’s up to you whether you want to use original Medicare or see what Medicare advantage has to offer.

Original Medicare provides inpatient hospital services and outpatient medical services. Original Medicare is designed for older Americans. It helps with inpatient and outpatient medical services.

Medicare Advantage will help with comprehensive dental, vision, hearing, and more services. But what about Medicaid? Where does it fit into the program?

Medicaid is a broad program that focuses on helping children, adults, and people with disabilities. You can think of Medicaid for everyone and Medicare mainly for seniors. To qualify for Medicaid, you have to make a specific income.

The broad Medicaid program is funded by the federal government and our states. The entire goal of Medicaid is to help low-income families have their needs met.

When comparing costs, you’ll find that Medicare is more expensive. With Medicare, you have to pay the deductibles for different services. You also have to pay out-of-pocket costs for prescriptions when you have Medicare.

5. Missing Annual Coverage Changes

Medicare isn’t a static program. The coverages available and the types of services you can receive can change. It’s your responsibility to stay up to date with the latest Medicare benefits so you can get the most out of your plan.

For instance, did you hear about the recent changes to Medicare Part D? Specifically, the changes affect prescription drug coverage.

Medicare Part D is a prescription drug plan that’s completely optional. The coverage comes with a monthly premium, and you can get Medicare part D coverage as a standalone. However, you can add Medicare part D coverage to your advantage plan that uses medical benefits.

Starting in 2022, the way you pay your deductibles for Medicare part D coverage will be a little bit different. You’ll find yourself spending more before you can start enjoying the benefits the plan offers.

To avoid falling into a coverage gap, we suggest looking into getting your medication through the mail. Anything you can reduce your out-of-pocket drug cost will be a big help.

Once you’ve reached a certain amount of out-of-pocket drug costs, you’ll be able to get out of the coverage gap. That’s when you’ll be able to pay a more reasonable coinsurance for all the other prescriptions you might need.

We suggest reviewing your drug plan’s annual notice of the change. You’ll be able to see any changes that took place starting on January 1st of the following year. Then you’ll be able to compare the cost versus coverages to decide if the plan is serving you.

6. Getting a Physical Instead of a Wellness Visit

Will your annual physical be covered under Medicare? It all depends on the words you use.

Going in for an annual physical could cause problems with receiving coverage. Going in for a yearly wellness check guarantees you’ll get the Medicare coverages you need.

Every year, Medicare gives you the option to schedule a wellness check. The wellness check is included in your Medicare part B coverage.

As long as the provider you’re going to accepts Medicare, you won’t have any charge. During the wellness check, your doctor will evaluate your state of mind and check your vital signs. After reviewing your cognitive skills, you’ll be able to get advice for staying healthy in the future.

If you have a Medicare Advantage plan, you can also schedule a wellness check under it. When calling your doctor’s office, let them know to specifically schedule the appointment as a wellness visit. By categorizing the appointment as a wellness visit instead of a physical, you’ll be able to get the coverage you need.

Remind Yourself

Don’t miss your appointment either! Set up your smartphone so that it’s easier to navigate your appointments.

Doing things like setting enrollment reminders would be a great start. For instance, Medicare’s annual enrollment will always be from October 15th through December 7th. Your initial enrollment is 7 months.

The 7-month period begins 3 months before you turn 65 and ends 3 months after turning 65. Keep an eye open for reminders from the social security office.

7. Assuming Medicare Coverage Doesn’t Cover Chemo

Hopefully, you and your loved ones will never have cancer. However, it can be nice to have peace of mind knowing whether or not your Medicare coverage will help with chemotherapy.

Another mistake individuals make assuming that Medicare doesn’t cover chemotherapy. We’re happy to report that Medicare does cover chemo. You’ll be able to enjoy coverage for chemo whether you have a traditional Medicare plan such as original Medicare or a private Medicare Advantage plan.

Both original Medicare and private Medicare Advantage plans cover outpatient and inpatient chemo treatments. However, before you can start receiving a payout for Medicare, you will have to meet your deductible.

For outpatient chemotherapy, part B will cover around 80% of the chemo cost. For instance, if you get a round of chemo at a doctor’s office or a free-standing clinic, Medicare part B will cover 80% of the cost.

There are special stipulations regarding receiving chemo treatments at a skilled nursing facility. Typically, Medicare will cover a specific number of treatments for a certain period. If additional treatments are necessary, they’ll be out of pocket.

8. Mistaking Podiatry for Routine Foot Care

Don’t fall into the trap of mistaking routine foot care for specialized services. Regular foot care means managing an ongoing underlying foot condition.

Routine foot care includes filing down calluses, clipping nails, and caring for flat feet. Medicare will not cover most types of regular foot care.

However, there are ways to receive Medicare coverage for visiting a podiatrist. A podiatrist specializes in helping people with their feet and ankles. If you’re having foot problems, a quick trip to the podiatrist could help improve your life.

Thanks to Medicare part A and part B, you may qualify for inpatient and outpatient podiatric care. If you decide to receive in-home care or go to a specialist office, you’ll be relying on Medicare part B.

Medicare part B can help with coverages related to foot injuries, foot diseases, and diabetes nerve damage. For Medicare coverage to kick in, your doctor must deem the services medically necessary.

Completely Understanding Medicare Insurance

From grasping coverages to knowing how to make your plan work, a lot goes into understanding Medicare. Here at Senior Affair, we’re dedicated to helping individuals like you find the answers they need.

Whether you have questions about retirement, aging, diet, or something else, you’re in the right place. Our curated blog is highly researched and full of helpful resources.

Resources like our detailed blog posts are full of helpful tips. For instance, does medicare cover the silver sneakers program? Read our post to find out!

Is Social Security Income Taxable? What Retirees Need to Know

By
Mia Wilson
-
0
is-social-security-income-taxable

In 2022, millions of retirees are going to get a boost in their Social Security benefits. At 5.9%, this is the largest cost-of-living adjustment that has been made in nearly 40 years. The coronavirus pandemic led to an economic meltdown throughout the world, which has resulted in staggering inflation in the U.S.

If you receive Social Security income or are going to be receiving it soon, you might be wondering what implication this has for your taxes.

For example, is Social Security income taxable? If so, how is Social Security taxed? What percentage of SS is taxable?

Let’s take a look at the answers to these questions and more.

Is Social Security Income Taxable?

For most Americans, Social Security is taxable. What this means is that most individuals in the U.S. that receive Social Security benefits do pay income tax on a portion of the money they receive. This is because the amount of money they receive in income from Social Security and other sources makes it so their income is above the limit which requires that taxes are paid.

For individuals that have a total gross income of $25,000 or more (including the amount received from Social Security), up to half of their Social Security income is considered taxable. For married couples that are filing their taxes jointly, their combined gross income must be $34,000 or more for this income to be taxable.

For individuals who have a combined gross income of $34,000 or more, up to 85% of benefits from Social Security are taxable. For married couples that are filing jointly, this threshold is $44,000.

However, if an individual doesn’t have much in the way of income other than Social Security, they likely won’t have to pay any taxes on the benefits that they receive. In some cases, the person might not even have to file a tax return at all.

Determining How Much of Your Social Security Income Is Taxable

Since 1983, Social Security benefits have been subject to taxation for people above certain income limits. The limits have not been changed due to inflation adjustments since then. What this means is that most of the people who get Social Security benefits will have additional income sources and therefore have to pay taxes on the SS they receive.

For no individual is 100% of Social Security income taxed, however. The most that anyone pays is 85% of the benefits.

The IRS has a process for how they determine what percentage of your Social Security benefits are taxable. It is as follows:

  • They take your adjusted gross income from all sources including Social Security
  • They then add tax-exempt interest which is a part of the calculation but isn’t taxed
  • If an individual has a total that is above the minimum taxable levels, that means that at least half of your SS benefits will be considered as taxable income
  • An individual can itemize deductions or take the standard deduction
  • Federal income tax tables exist to determine the precise amount that you owe based on your income

It’s worth understanding that your combined income is the sum of your nontaxable interest, half of your Social Security benefits, and your adjusted gross income.

Individual Tax Rates

If you file a federal tax return as an individual, your benefits might be subject to tax if your combined gross income is more than $25,000.

If your combined gross income is between $25,000 and $34,000, up to half of your SS benefits might be subject to income tax. If your income is more than $34,000, it means that up to 85% of your Social Security income might be taxed.

Married Tax Rates

If you are married and file taxes jointly with your spouse, you will have to pay taxes on a portion of your Social Security income if your combined income is over certain limits.

For those that make between $32,000 and $44,000, up to half of the SS income might be taxable. For those that make more than $44,000, their benefits might be taxable up to 85%.

Social Security and Taxes: The Interactive Tax Assistant

The IRS offers an interactive tool to help people understand how much they will owe in Social Security taxes. This is known as the Interactive Tax Assistant (ITA). Basically, it will go through a number of potential complications to help you determine what percentage of your SS income is taxable.

How Do I Pay Taxes on Social Security?

When you receive Social Security benefits, you should receive a statement each January that outlines your received benefits for the prior tax year. This form is known as Form SSA-1099.

You can use this document to help you learn how much federal income tax you will have to pay on the income you received. If you enroll on the Social Security website, you can also access this information online.

You can have federal taxes withheld from your Social Security benefits before you receive them if you choose to. Otherwise, you can also make quarterly estimated tax payments to the IRS.

How Can I Legally Avoid Paying Taxes on Social Security Benefits?

There are a number of ways that you can reduce how much you pay in taxes on your Social Security benefits. The most obvious choice is to keep your income below a certain limit. However, this is likely not realistic for many Americans who hope to have a more flush retirement than simply living on SS benefits.

Let’s take a look at some of the other options you have for avoiding paying taxes on your benefits.

Withdraw Your Taxable Income Before You Retire

You might consider maximizing your taxable income in the years before you are going to start receiving benefits. An example of this would be to tax distributions from your retirement accounts as you near retirement. If you wait until after you’re 59.5 but before you retire, you can avoid being negatively impacted by these withdrawals and pay taxes while you still have a heftier income source.

You have to plan your withdrawals carefully because they are taxable. If you can plan it out correctly, you can pay less in tax by increasing withdrawals before you receive SS than after you start receiving benefits.

You will also need to plan for the fact that you’re required to take RMDs from this type of retirement account at the age of 72.

Lastly, this strategy can also help to boost your income when you’re getting close to retirement or recently retired. This means that you might be able to hold off on when you apply for your benefits. This can boost how big your payments are when you do receive them.

Put Some of Your Retirement Income in Roth Accounts

When you contribute money to a Roth 401(k) or a Roth IRA, the money you put in is already taxed. That means that when you withdraw the money, you don’t have to pay taxes again.

This means that when you receive distributions from these types of accounts, they are tax free. Of course, you have to wait until after you are 59.5 in addition to having had the account for at least five years in order to withdraw without penalty.

When you receive distributions from a Roth account, it doesn’t impact your taxable income calculation. This means that you won’t have to pay an increased tax on the Social Security benefits you receive.

If you receive distributions from a traditional 401(k) or a traditional IRA, though, you are receiving taxable income.

Buy an Annuity Contract

Another option is buying an annuity contract. A qualified longevity annuity contract (QLAC) is a particular kind of deferred annuity. It is funded using an IRA or using another kind of qualified retirement plan.

These are contracts that provide monthly payments for the rest of your life. Protected from the experience of dips in the stock market, there are some appealing benefits of this strategy. It is also exempt from the RMD rules until the specified annuity starting day and the beginning of payments so long as it complies with IRS requirements.

Basically, this strategy can help you limit distributions and therefore taxable income while you are in retirement.

(Are you a Veteran interested in VA loans? You can learn everything you need to know in our guide.)

What About Survivor, Spousal, SSI, and Disability Benefits?

Survivor, Spousal, and Disability benefits all fall under the same basic rules as described above. However, Social Security Income has different parameters.

Social Security Income, or SSI, isn’t considered Social Security. This is a program that is based on need for people who are disabled, blind, or over the age of 65. The benefits received through this program aren’t considered taxable income.

What Percent of My Social Security Is Considered Taxable Income?

If you make less than $25,000 during the tax year as a single person, then you won’t have to pay any taxes on your Social Security benefits. However, half of this income is taxable if you made between $25,000 and $34,000. Any more than this in terms of income means that you can be taxed on up to 85% of your social security benefits.

If you file taxes jointly with your spouse, you won’t pay taxes on your SS income if you make less than $32,000 combined. However, more than this amount and less than $44,000 means up to half of your SS income is taxes. If you make more than $44,000 as a couple, up to 85% of your benefits are considered taxable income.

What About State Taxes?

There are thirteen states in the United States that tax Social Security benefits in specific cases. These are:

  • Connecticut
  • Colorado
  • Kansas
  • Connecticut
  • Vermont
  • West Virginia
  • Rhode Island
  • Utah
  • New Mexico
  • Montana
  • Nebraska
  • North Dakota
  • Minnesota

This means that you might have to pay state tax in addition to federal tax on your Social Security benefits. There are a number of different criteria that can determine whether or not your Social Security income is subject to state tax, including income.

(If you’re starting to think about Social Security income, you likely also have questions about Medicare. You can learn more about the eligibility age here.)

Is Social Security Income Considered Income?

Social Security income is considered income in the eyes of the IRS. That being said, you can work to be financially saavy in order to minimize how much money you owe to the IRS.

You might consider using a Roth IRA account or another retirement savings account to help shield your income from tax. You can then deal with the taxes before you retire but after the after of 59.5 in order to deal with the taxes before you no longer have income.

(Are you trying to figure out how to receive healthcare in retirement? Learn about the differences between Medicare and Medicaid here.)

Social Security and Taxes: Knowledge Is Power

No one likes dealing with taxes, but understanding what your tax burden is and how to reduce it is essential to financial wellness. For this reason, it’s a good idea to understand the answer to the question “is Social Security Income Taxable?”

If you have any other sources of income other than Social Security benefits, there’s a good chance your SS benefits will be taxed. This is because the limits for taxable income haven’t been raised since the 80s when the cost of living was significantly different.

Understanding the tax implications of your Social Security benefits can mean that you can plan ahead. When you have the chance to pay ahead, you can figure out legal ways to reduce your taxable income in retirement. This can mean less stress and more money during the best years of your life!

If you’re nearing the age of retirement, you likely are starting to think about how to save money during your golden years. We’re here to help! You can take a look at our list of the best senior discounts here.

15 Things You Should Know About Home Warranties 

By
Mia Wilson
-
0
American Home Shield home warranty

If you’re in the market to buy a home or recently purchased a home, maybe you’re considering if you should get a home warranty. Home warranties protect your major appliances and systems like AC, electrical, plumbing, dishwashers, and refrigerators. On average, home warranties cost $300 to $600 every year for a comprehensive plan; according to Consumer Affairs, this is about $25 to $50 a month.

The warranty company is an insurance company, so you’ll have to prove your claim and back it up with maintenance records if applicable. 

The seller could cover a home warranty and is a negotiable item in a real estate contract.

How Do Home Warranties Work? 

If one of your covered appliances or systems breaks down, you’ll pay a service fee for a technician to evaluate the situation usually; this fee is $65 to $125 or more. Home warranties have multiple tiers, the premium tiers cover add-ons like pool and spa, but these plans cost $720 to $1800. 

Home Warranties May Be Redundant

Sometimes, they are covered under warranty for a year if you’re purchasing a new home. If the appliances in your home are new, they may have a warranty as well, which is why you’ll want to find one that compliments your homeowner’s insurance policy and does not overlap on the coverage.

Keep in mind that some home warranty coverage can be complex, and may not cover appliances and systems that aren’t properly maintained. Instead, you have to read all the terms carefully and completely understand what it covers. Some warranties only cover certain brands. 

Your out-of-pocket costs can still be high.

Some home warranties only cover repairs, not replacements, so if the item is beyond repair, you’ll need to replace it yourself. Other policies have high deductibles, so check out the maximum amount a plan covers per item. 

Are Home Warranties Worth it? 

When you consider all the costs of maintaining your home systems and purchasing nice appliances, we present some pros and cons to consider, and you can decide if a home warranty is for you. 

A home warranty gives you peace of mind knowing your appliances are covered. Sure, you hope that you won’t have to make a claim, but if something happens, you’ll have access to someone who can repair them if needed. With this, you don’t have to worry about repair costs.

When it comes to owning a home, unexpected things will happen, and things will eventually break — it’s inevitable. If something happened, you could reach into your pocket and purchase new appliances and buy the latest HVAC system, but that’s a hefty price tag, especially for retired or seniors. 

American Home Shield home warranty appliances coverage

Here are the average cost ranges to repair or replace typical household items:

  • A/C Unit: $150 – $3,800
  • Heating and Ductwork: $105 – $3,625
  • Refrigerator: $200 – $1,500
  • Water Heater: $240 – $1,200

Now, that’s just the average range for repair or replacement; those numbers don’t consider the hidden costs of a broken household system or appliance. For instance, when kitchen appliances go out, you’ll get wasted groceries and find yourself eating out. Washer and dryer out? Gas to your friend’s or family’s house or the coats of a laundromat. It’s a trickle effect that adds up.

You can make sure you’re covered when a breakdown happens by finding a company that you can trust and a home warranty plan that’s right for you.

With over 50 years in the industry and over 1.8 million members, American Home Shield is just what you need. Not like homeowner’s insurance, American Home Shield provides plans for people who have systems and appliances they’d like to keep in working order; plus, no system or appliance is too old when it comes to their plans. Also, no maintenance records or inspection is required, just protection regardless of the age or appearance of your covered items.

  • Heating & Cooling (HVAC, A/C units & heat pumps) 
  • Electrical Systems (Wiring, fuse boxes & outlets)
  • Plumbing Systems (Water heater, pipes, well & septic pump)
  • Kitchen Appliances (Refrigerator, oven, range & microwave) 
  • Laundry Appliances (Washing machine & clothes dryer)

Rest easy that you’ll be taken care of when something goes wrong. And, with American Home Shield, if they can’t repair your covered item, they’ll replace it. 

The fact is that household breakdowns are complicated and tend to come when you least expect it or need it. So when you have American Home Shield, getting the help you need is easy. So head over to their site today to check out their flexible plans and see how you can keep your house running and your wallet happy.

Conclusion: 

A home warranty is worth it if you need coverage for your appliances and home systems, and you find a plan that includes the items you want to be covered, so you end up saving money instead of wasting it. 

If you buy a home that’s been lived in, you don’t know what you’re getting, so buying a home warranty is a wise choice. Of course, you could always try it for a year or two and see if it works for you, allowing you to learn more about your new homes’ systems and appliances; you could always cancel later. 

1...111213...97Page 12 of 97
- Advertisement -spot_img

About Us

“How we keep the lights on: At Senior Affair our mission is to provide valuable, free resources for our community. To support this work, we partner with affiliate advertising programs. This means that when you click a link on our site and make a purchase, we may earn a small advertising fee or commission at absolutely no extra cost to you. We only recommend products and services we truly believe add value to your life.”

Popular Posts

Popular Categories

Stay connected

16,985FansLike
564,865FollowersFollow
2,458FollowersFollow
61,453SubscribersSubscribe

© 2026 Senior Affair Magazine