How Medicare Part D Formularies Work: Drug Tiers, Prior Authorization & Step Therapy Explained
Quick AnswerA Medicare Part D formulary is the list of drugs your plan covers
Drugs are organized into tiers—Tier 1 costs the least, and Tier 5 costs the most. Your plan may also require prior authorization (doctor approval) or step therapy (trying a cheaper drug first) before covering certain medications. Knowing your formulary before you enroll can save you hundreds—or thousands—of dollars per year.
Most people choose their Medicare Part D plan based on the monthly premium. That’s a mistake that can cost you far more than you save.
The plan with the lowest premium may place your most important medications on a high, expensive tier — or not cover them at all. Understanding how formularies work is the single most important skill for choosing a Part D plan that actually saves you money.
What Is a Medicare Part D Formulary?
A formulary is your Part D plan’s official drug list—the specific prescription medications the plan has agreed to cover and their cost. Every Medicare Part D plan has its own formulary, and formularies differ significantly from plan to plan.
CMS requires that all Part D formularies include drugs in each “therapeutic category” (broad medical purpose), but plans have significant discretion in choosing which specific drugs to include and at which tier. This is why the same drug can have wildly different copays — or be covered by one plan and not another — depending on which plan you’re enrolled in.
📌 Key rule: Plans must cover at least two chemically distinct drugs in each therapeutic category. But they don’t have to cover every drug. If your specific brand-name drug isn’t on a plan’s formulary, you’re responsible for the full cost—or you must request a formulary exception.
Formularies are updated at least annually (plans submit changes to CMS each fall for the coming year), and plans can make changes mid-year with limitations. We’ll cover what to do if your drug is dropped mid-year later in this article.
The Five Drug Tiers Explained
Most Medicare Part D plans use a 5-tier structure, though some plans use three or four tiers. The tier your drug falls on determines your copay or coinsurance amount.
4 Non-preferred brands $80–$150+ copay Brand drugs not on preferred list
5 Specialty drugs 25–33% coinsurance Cancer drugs, biologics, MS treatments
The specific copays shown above are typical—your plan’s actual amounts depend on the plan you choose. Always check your plan’s Evidence of Coverage (EOC) document or the drug pricing tool on Medicare.gov before enrolling.
A note on Tier 5 specialty drugs
Specialty drugs — biologics, chemotherapy agents, and other high-cost medications — are almost always on Tier 5. Plans can charge up to 33% coinsurance on specialty drugs, meaning if a drug has a $10,000 monthly cost, your share could be $2,500–$3,300. This is exactly why the 2026 $2,000 out-of-pocket cap is so important for patients on specialty medications.
Coverage Rules: Prior Authorization, Step Therapy, and Quantity Limits
Being on the formulary doesn’t always mean automatic coverage. Plans apply three main coverage rules that can restrict when and how a drug is covered.
Prior Authorization (PA)
Prior authorization means your doctor must get approval from the plan before prescribing a specific drug. Plans use PA to verify that the drug is medically necessary, is being prescribed for an approved condition, and that cheaper alternatives have been considered.
PA is common for brand-name drugs, specialty medications, and drugs with high abuse potential. The process typically takes 1–3 business days (or 72 hours for expedited reviews). If your doctor submits the correct documentation, approval rates are generally high.
⚠️ Picking up a PA-required drug without approval means you pay full retail price at the pharmacy. If your prescription requires prior authorization, make sure your doctor’s office submits the PA request before your first fill. This is one of the most common and costly surprises for new Medicare enrollees.
Step Therapy
Step therapy (also called “fail first”) requires you to try one or more lower-cost drugs before your plan will cover the drug your doctor originally prescribed. The logic: if a generic or lower-tier drug treats your condition equally well, the plan prefers you use that first.
Example: Your doctor prescribes Eliquis (apixaban, a brand-name blood thinner). Your plan may require you to first try warfarin (generic, Tier 1) for 30–60 days. If warfarin causes complications or doesn’t control your INR, your doctor can then document the failure and request coverage for Eliquis.
Step therapy restrictions cannot be applied when a beneficiary is already stable on a medication at the time they join a plan. If you were taking Eliquis before enrolling in Medicare, the plan cannot force you to switch to warfarin to start.
Quantity Limits (QL)
Quantity limits restrict how much of a drug your plan will cover per fill or per month—for example, no more than 60 tablets per 30-day supply or one injection pen per 28 days. These limits are based on FDA-approved dosing guidelines. If your doctor prescribes above the quantity limit, you’ll need a quantity limit exception.
How to Check If Your Drug Is Covered
There are three reliable ways to check your drug’s formulary status:
1
Medicare.gov Plan Finder The official Medicare plan comparison tool at medicare.gov/plan-compare lets you enter your drugs and see exactly which plans cover them, at what tier, and at what estimated annual cost. This is the most reliable tool and uses real-time formulary data.
2
Your plan’s website or member portal If you’re already enrolled, log in to your plan’s member portal and use their formulary search tool. Enter your drug name and dosage. The tool will show your tier, any restrictions, and your estimated copay.
3
Call the plan directly Call the member services number on the back of your plan card. Ask specifically: “Is [drug name, dosage] on your formulary? What tier is it? Are there any prior authorization or step therapy requirements?” Ask the representative to confirm in writing by mail or secure message.
What Happens If Your Drug Is Removed Mid-Year?
Plans can remove drugs from their formulary or move them to a higher tier during the year, but only under limited circumstances and with required notice to members.
If your drug is removed mid-year, Medicare rules require your plan to
Notify you at least 60 days before the change takes effect
Continue covering your drug at the old cost-sharing for at least 30 days while you transition
Give you a Special Enrollment Period to switch plans in some circumstances
If you’re mid-treatment with a covered specialty drug, the plan generally must provide a temporary supply to allow you to finish a treatment course or transition to a different drug safely.
How to Request a Formulary Exception
If your drug isn’t on the formulary — or is on a tier that makes it unaffordable — you can request a formulary exception. This is a formal process where your doctor argues that a specific drug is medically necessary for your condition.
Request Type
What It’s For
Timeframe
Coverage determination
Standard request for coverage of a non-covered or restricted drug
72 hours (standard), 24 hours (expedited)
Formulary exception
Request to cover a non-formulary drug or waive step therapy
72 hours (standard), 24 hours (expedited)
Tier exception
Request to cover a drug at a lower tier copay
72 hours (standard), 24 hours (expedited)
Appeal (Level 1)
Appeal a denied coverage determination
7 days (standard), 72 hours (expedited)
Your doctor must provide a “statement of medical necessity” supporting the exception. Exceptions are more likely to be approved when your doctor documents why lower-tier alternatives are inappropriate for your specific medical situation.
How to Compare Formularies When Shopping for a Plan
During Medicare’s Annual Enrollment Period (Oct 15 – Dec 7), you can review and switch Part D plans. Here’s how to compare formularies effectively:
List every drug you take — name, dosage, and how many you take per month. Include drugs you take occasionally.
Use Medicare.gov’s Plan Finder — enter your drug list and your zip code. The tool calculates your estimated annual cost for each plan, including premiums plus drug cost-sharing.
Sort by estimated annual drug cost, not premium. A plan with a $0 premium but your drug on Tier 5 with 33% coinsurance can cost far more than a $40/month premium plan that puts your drug on Tier 3.
Check pharmacy network—using your plan’s preferred pharmacy (often a mail-order or specific retail chain) often reduces your copay further.
Look for quantity limits and PA requirements — the Plan Finder shows these restrictions for each drug on each plan.
Get help comparing Part D formularies
A licensed Medicare specialist can run a full drug cost analysis across all plans available in your zip code — at no cost to you.
A formulary is the list of prescription drugs your Part D plan covers. Drugs are organized into tiers—lower tiers cost less, and higher tiers cost more. Each plan’s formulary is different, which is why your costs for the same drug can vary dramatically from plan to plan.
Prior authorization is a requirement that your doctor receive plan approval before the plan will cover a specific drug. Without prior authorization for a PA-required drug, you pay full retail price at the pharmacy.
What is step therapy in Medicare drug plans?
Step therapy requires you to try a lower-cost drug first before the plan will cover a more expensive alternative. If the first-step drug doesn’t work or causes side effects, your doctor can document the failure and request coverage for the drug they originally prescribed.
Can I appeal if my Part D plan won’t cover my drug?
Yes. You can request a coverage determination, formulary exception, or tier exception. If those are denied, you can appeal. Your doctor must provide documentation supporting why the specific drug is medically necessary. Expedited reviews are available within 24–72 hours for urgent cases.
Can I switch Part D plans if my drug is dropped from the formulary?
Yes, under certain circumstances. If your plan drops your drug or moves it to a higher tier, you may qualify for a Special Enrollment Period to switch plans mid-year. Contact Medicare at 1-800-MEDICARE or visit medicare.gov to determine your eligibility.
Medicare's New $2,000 Drug Cap in 2026: What It Means for You
Quick AnswerStarting in 2025, Medicare Part D has a $2,000 annual out-of-pocket capOn covered prescription drugs. Once your spending hits $2,000 in a calendar year, you pay $0 for all covered drugsFor the rest of the year. This is one of the biggest Medicare drug benefit improvements in decades — and it affects anyone taking expensive medications for cancer, diabetes, arthritis, or other chronic conditions.
For decades, Medicare Part D had a design flaw: once your drug spending crossed a certain threshold — the infamous “donut hole” — your costs actually increased. The 2010 Affordable Care Act started closing the donut hole, but it wasn’t until the Inflation Reduction Act of 2022 that Congress created a true out-of-pocket cap.
That cap is now in effect. Here’s exactly how it works and what it means for your Medicare drug coverage.
What Changed With Part D in 2025 and 2026
The Inflation Reduction Act (IRA) of 2022 restructured Medicare Part D in several stages:
Year
IRA Change
Impact
2023
Insulin capped at $35/month
Lower costs for diabetics
2024
Manufacturer discounts in catastrophic phase required
Reduced plan costs in high-spend years
2025
$2,000 out-of-pocket cap introduced; M3P available
Hard cap on annual drug spending for first time ever
2026
Cap continues; Medicare drug price negotiations take effect for more drugs
Lower formulary costs on negotiated drugs
The cap went into effect January 1, 2025. In 2026, the standard Part D out-of-pocket cap remains $2,000. Some plans set even lower caps, but no Medicare drug plan can set the threshold higher than $2,000.
How the $2,000 Cap Works
The cap is simple in principle: track your total out-of-pocket spending on covered Part D drugs throughout the year. The moment that total hits $2,000, you move into the catastrophic phase and pay nothing for covered drugs for the rest of the calendar year.
The clock resets every January 1.
💡 Example: You take a specialty drug for rheumatoid arthritis that costs $400 per month in copays. By May, you’ve spent $2,000 out-of-pocket. From June through December — seven months — you pay $0 at the pharmacy for that drug and any other covered Part D medication. Your plan absorbs the cost.
What Counts Toward the $2,000 Cap
Not every dollar you spend on prescription drugs counts toward the $2,000 threshold. Here’s the breakdown:
Spending Type
Counts Toward Cap?
Annual Part D deductible (paid at the pharmacy)
✅ Yes
Copays and coinsurance for covered drugs
✅ Yes
Monthly Part D premiums
❌ No
Drugs NOT on your plan’s formulary
❌ No
Over-the-counter medications
❌ No
Extra Help / Low Income Subsidy amounts
❌ No
Manufacturer discount program amounts (on covered drugs)
✅ Yes (new rule for 2025+)
The inclusion of manufacturer discounts as counting toward the cap is a notable change from prior years. Previously, manufacturer rebates and discounts in the donut hole didn’t count toward beneficiary spending totals, which slowed many people’s path to catastrophic coverage. That changed in 2025.
The Three Phases of Part D Coverage in 2026
1
Deductible phase
You pay 100% of drug costs until you meet your plan’s deductible. The standard 2026 deductible is up to $590, but many plans set it lower or waive it for certain tiers.
2
Initial coverage phase
After meeting your deductible, you pay your plan’s copays or coinsurance. Your plan pays the rest. This phase continues until you’ve spent $2,000 out-of-pocket.
3
Catastrophic phase (the cap) ✓
Once you’ve spent $2,000 out-of-pocket on covered drugs, you pay $0 for the rest of the calendar year. No copays, no coinsurance — zero. This is new as of 2025.
📌 The donut hole is gone. The coverage gap (donut hole) that existed from 2006–2024 — where beneficiaries temporarily faced much higher costs — has been eliminated. The 2026 Part D structure goes straight from the initial coverage phase into the catastrophic (zero-cost) phase when you hit $2,000.
Who Benefits Most From the $2,000 Cap
The cap helps anyone who takes expensive medications, but some groups benefit dramatically more than others:
People on specialty drugs
Specialty medications for cancer, multiple sclerosis, rheumatoid arthritis, Crohn’s disease, and similar conditions can carry retail prices of $5,000–$30,000 per month. Under the old rules, these beneficiaries could spend $10,000+ out-of-pocket annually. Under the new cap, they spend a maximum of $2,000 — a transformative difference.
Diabetics on GLP-1 medications
Ozempic and Mounjaro, covered by Part D for diabetes, can cost $40–$150 per month in copays. High-tier specialty placement can mean beneficiaries hit $2,000 by mid-year, after which their costs drop to zero. Insulin remains separately capped at $35/month regardless of where you are in the benefit phases.
Anyone with multiple chronic conditions
Seniors taking five or more medications — common in people managing heart disease, diabetes, COPD, and arthritis simultaneously — accumulate Part D spending quickly. The cap provides a predictable annual ceiling for household budget planning.
People who previously skipped medications due to cost
Studies consistently show that Medicare beneficiaries who hit the old donut hole often skipped doses or stopped taking medications to manage costs. The $2,000 cap is expected to reduce this dangerous behavior significantly.
The Medicare Prescription Payment Plan (M3P)
Even a $2,000 annual cap can feel like a large bill if you hit it in January or February — paying $2,000 in two months is painful even if you pay $0 for the rest of the year.
To address this, the Inflation Reduction Act also created the Medicare Prescription Payment Plan (M3P), which launched in 2025. M3P allows you to spread your out-of-pocket drug costs across equal monthly payments throughout the year, rather than paying large amounts at the pharmacy counter.
How M3P works
You opt in through your Part D plan (it’s not automatic)
Instead of large copays at the pharmacy, you pay a calculated monthly amount spread over the year
Your plan bills you monthly, similar to a phone bill
Your total annual spending doesn’t change — just how it’s distributed
M3P is most valuable to people who expect to hit the $2,000 cap (specialty drug users)
To enroll in M3P, contact your Part D plan directly. You can switch in or out of M3P at certain times during the year.
Does the $2,000 Cap Apply to Medicare Advantage Plans?
Yes. If you have a Medicare Advantage plan with drug coverage (an MA-PD plan), the $2,000 out-of-pocket cap applies to the drug benefit portion of your plan. The federal law applies uniformly to all Medicare drug coverage — standalone Part D plans and MA-PD plans alike.
Note that Medicare Advantage plans have a separate out-of-pocket maximum for medical services (doctor visits, hospital stays, etc.). That limit is different from the drug cap and is set by CMS each year. In 2026, the Medicare Advantage maximum out-of-pocket for in-network medical services is $9,350.
Coverage Type
Drug Cap (2026)
Medical OOP Max (2026)
Standalone Part D (with Original Medicare)
$2,000
No cap on medical (Medigap recommended)
Medicare Advantage + Drug (MA-PD)
$2,000 for drugs
Up to $9,350 for medical (in-network)
Find a Part D plan that minimizes your drug costs
Different plans charge different copays for the same drugs. A licensed specialist can compare plans in your area based on your specific medications.
What is the Medicare Part D out-of-pocket cap in 2026?
The 2026 Medicare Part D out-of-pocket cap is $2,000. Once your annual out-of-pocket spending on covered prescription drugs reaches $2,000, you pay $0 for the rest of the calendar year.
Does the $2,000 cap apply to Medicare Advantage drug plans?
Yes. The cap applies to both standalone Part D plans and Medicare Advantage plans that include drug coverage (MA-PD plans).
Do premiums count toward the $2,000 cap?
No. Monthly Part D premiums do not count toward the out-of-pocket cap. Only your cost-sharing payments at the pharmacy (deductibles, copays, coinsurance) count.
What is the Medicare Prescription Payment Plan (M3P)?
M3P is an optional program that lets you spread your Part D drug costs across equal monthly payments throughout the year, instead of paying large amounts at the pharmacy. You must opt in through your plan — it is not automatic.
Is the donut hole still a thing in 2026?
No. The Medicare Part D coverage gap (donut hole) has been eliminated as of 2025. Part D now goes directly from the initial coverage phase to the catastrophic phase (zero-cost) once you’ve spent $2,000.
Does the $2,000 cap reset every year?
Yes. Your out-of-pocket spending resets to $0 on January 1 every year. You must reach $2,000 again in the new year to re-enter the catastrophic (zero-cost) phase.
The Complete Guide to PACE (Program of All-Inclusive Care for the Elderly)
PACE (Program of All-Inclusive Care for the Elderly) is a Medicare and Medicaid program that provides comprehensive medical and social care — including primary care, dental, transportation, meals, and home health — to adults age 55 and older who need nursing-home-level care but want to remain in their community. For most people enrolled in both Medicare and Medicaid, PACE is completely free: no premiums, no deductibles, no copays. As of 2026, PACE operates through more than 376 centers across 33 states.
376+
PACE centers nationwide as of 2026
87,000
Seniors currently enrolled in PACE
95%
Of PACE participants who remain living in their community
$0
Monthly cost for most dual-eligible Medicare/Medicaid recipients
What Is PACE?
The Program of All-Inclusive Care for the Elderly—almost always called PACE—is a federal healthcare program run jointly by Medicare and Medicaid. It was designed to solve a specific, painful problem: What do you do when an aging parent or spouse needs the kind of intensive, 24-hour care a nursing facility provides but desperately wants to stay home?
PACE’s answer is to bring the nursing home to the person — not physically, but in terms of the scope and quality of care. Rather than placing a senior in a facility, PACE surrounds them with a dedicated team of up to 11 healthcare professionals who coordinate every aspect of their medical, social, and personal care. Primary care, specialist visits, physical therapy, dental cleanings, medication management, transportation to appointments, hot meals, mental health counseling — it all flows through a single, unified plan.
The program was founded in San Francisco in 1971 as an experiment to see whether comprehensive community-based care could actually keep frail seniors out of nursing homes. It worked. By 1994, PACE was established as a permanent Medicare benefit. Today it operates through 194 organizations running more than 376 centers across 33 states, serving approximately 87,000 participants.
The average PACE participant is 76 years old, has multiple chronic conditions, and would otherwise qualify for a nursing home bed. About 94% of them live in the community — in their own homes or with family — rather than in a facility. That number, by itself, tells you most of what you need to know about how PACE works.
Note on naming: In Pennsylvania and several other mid-Atlantic states, PACE is called LIFE — Living Independence for the Elderly. The program is identical; only the name differs. If you live in Pennsylvania, search for “LIFE program” rather than “PACE program.”
Who Qualifies for PACE?
PACE eligibility comes down to four requirements. All four must be met:
Age 55 or older. There is no upper age limit.
Live in a PACE service area. PACE organizations define geographic coverage zones. You must reside within the designated area served by a local PACE organization.
Certified as needing nursing-home-level care. Your state must certify that your health condition meets the clinical threshold for nursing facility placement. This doesn’t mean you have to be bedridden—it means your chronic conditions, functional limitations, or cognitive impairments are serious enough that a nursing home would be the standard recommendation.
Able to live safely in the community with PACE support. At the time of enrollment, you must be able to live at home or in a community setting—with the help PACE provides—without posing a risk to your own health or safety.
Do You Need Medicare or Medicaid to Enroll?
No — you do not need to be enrolled in Medicare or Medicaid to apply for PACE. However, approximately 90% of PACE participants are dual-eligible, meaning they qualify for both programs. Being dual-eligible is significant because it means PACE is free.
If you have Medicare but not Medicaid, you can still enroll in PACE. You’ll pay a monthly premium for the long-term care portion of PACE benefits and a separate premium for prescription drug coverage (Part D). If you don’t qualify for either program, you can enroll as a private-pay participant — though this is considerably more expensive.
What Doesn’t Disqualify You
There are no financial criteria that determine whether you can apply for PACE. Income and asset levels are not evaluated as part of the eligibility assessment — they only affect how much you pay, not whether you qualify.
What Disqualifies You
There are a few conditions that make someone ineligible, even if they meet all four requirements above:
Current enrollment in a Medicare Advantage (Part C) plan, a Medicare prepayment plan, or a Medicare Prescription Drug Plan (Part D)—you must disenroll from these before joining PACE
Current enrollment in hospice services
Current enrollment in certain other long-term care programs that conflict with PACE’s all-inclusive structure
Important: When you enroll in PACE, it becomes your sole source of Medicare and Medicaid-covered services. You must use PACE’s provider network for your care. If you have a long-standing relationship with a doctor who is not part of the PACE team, you may need to transition your care—this is one of the program’s most significant trade-offs and worth discussing with the PACE enrollment team before signing.
What Services Does PACE Cover?
PACE’s coverage is exceptionally broad. It covers everything Medicare and Medicaid normally cover, plus additional services the interdisciplinary care team determines you need. In practice, this means PACE will cover services that most insurance plans routinely deny.
Medical and Clinical Services
Primary care physician visits
Specialist visits (cardiology, neurology, etc.)
Emergency room care
Hospital inpatient care
Outpatient surgery
Lab work and X-rays
Radiology and imaging
Prescription drugs (all approved by PACE team)
Over-the-counter medications (as directed)
Durable medical equipment (wheelchairs, walkers)
Preventive care and screenings
Skilled inpatient rehabilitation
Therapeutic Services
Physical therapy
Occupational therapy
Speech therapy
Recreational therapy
Dental, Vision, and Hearing
This is one of PACE’s most significant advantages over standard Medicare. Traditional Medicare Part A and Part B provide no coverage for routine dental, vision, or hearing care. PACE covers all three—cleanings, exams, dentures, glasses, and hearing aids—when the interdisciplinary team determines these services are necessary for the participant’s overall health.
Home and Personal Care
Home health aide services
Personal care assistance (bathing, dressing)
Homemaker services
Respite care for family caregivers
Nutritional counseling
Meals (at the day center and some home delivery)
Social and Mental Health Services
Behavioral health counseling
Social work services
Caregiver support and training
Adult day health programs
Recreational and social activities
End-of-life and palliative care planning
Transportation
PACE covers transportation to and from the PACE day center, to specialist appointments, and to other approved activities. For many seniors — especially those who no longer drive — this service alone is transformative. Transportation is not a secondary benefit; it is considered a core component of the PACE model.
Nursing Home Care
If at any point it becomes necessary for a PACE participant to receive care in a nursing home—due to a health crisis or significant decline—PACE covers this too. The interdisciplinary team continues to supervise the participant’s care even during a nursing home stay. Importantly, participants do not lose their PACE benefits simply because they need temporary nursing home placement.
Key rule: All services must be approved by the PACE interdisciplinary care team (IDT). Unlike traditional insurance, PACE participants cannot simply see any specialist they choose — all care is coordinated through the IDT. This creates extraordinary continuity of care but requires participants to work within the PACE network.
How Much Does PACE Cost?
Cost is where PACE often surprises people. For the majority of participants, PACE costs nothing out of pocket. For others, the cost structure depends on their insurance status.
Insurance Status
Monthly Premium
Deductibles
Copays
Dual-eligible (Medicare + Medicaid)
$0
$0
$0
Medicaid only (no Medicare)
$0
$0
$0
Medicare only (no Medicaid)
Varies by program; typically $500–$900/month for LTC portion + Part D premium
$0
$0
Private pay (no Medicare or Medicaid)
Typically $4,000–$7,000/month (varies by program and location)
$0
$0
Even for private-pay participants, the cost is often comparable to or lower than a nursing home bed, which averages over $8,000 per month nationally for a semi-private room—and does not include extras like dental or transportation that PACE provides as standard.
How Does PACE Get Funded?
PACE organizations receive monthly capitation payments from Medicare and Medicaid for each enrolled participant. In exchange, the PACE organization assumes full financial responsibility for all of that participant’s healthcare needs. This structure is what enables PACE to cover services that traditional fee-for-service Medicare does not—because the organization is managing a fixed budget across its participant population and has a financial incentive to keep people healthy and out of expensive hospital beds.
For participants, there are never any deductibles or copayments for any drug, service, or care that the PACE team approves—regardless of which payment category you fall into.
PACE vs. Nursing Home: Key Differences
Most families facing the question of senior care end up comparing PACE to a nursing home or skilled nursing facility. The comparison is stark.
Factor
PACE
Nursing Home
Where you live
At home or in community
In the facility
Monthly cost (dual-eligible)
$0
$0 (Medicaid pays, but assets/income rules apply)
Monthly cost (private pay)
$4,000–$7,000
$7,500–$12,000+
Dental, vision, hearing
Covered
Typically not covered
Transportation
Covered
N/A (you live there)
Caregiver respite
Included
N/A
Independence
High — you set your schedule
Low — facility determines daily structure
Family involvement
Active and encouraged
Visits limited by facility rules
Personalized care plan
Yes—updated regularly
Varies by facility
Can you leave the program?
Yes, any time, no penalty
Yes, with discharge planning
For most people who qualify, PACE is the superior option in terms of quality of life, range of services, and cost. The primary reasons families choose a nursing home over PACE are geographic (no PACE program nearby), safety concerns that make community living impractical even with maximum support, or the participant’s preference for a more structured, supervised environment.
Is PACE Available Where You Live?
InnovAge operates PACE centers in Florida, California, Colorado, New Mexico, Pennsylvania, and Virginia. Find out if there’s a center near you.
The heart of PACE is the interdisciplinary team, universally called the IDT. This is the group of professionals who assess your needs, build your care plan, and coordinate every service you receive. Federal regulations require a specific composition for the IDT:
Primary care physician
Registered nurse
Social worker
Physical therapist
Occupational therapist
Recreational therapist or activity coordinator
Dietitian
PACE center supervisor
Home care coordinator
Personal care attendant representative
Transportation coordinator
All 11 members conduct a comprehensive assessment of each new participant. The team then meets regularly—in person, as a group—to review each participant’s status, update care plans, and make decisions about services. This is categorically different from fragmented fee-for-service care, where a participant’s cardiologist may not know what their neurologist prescribed or where a fall at home goes unreported to any physician for weeks.
The IDT structure also enables PACE to catch problems early. Because participants are seen regularly at the day center and are known personally to a team of 11 professionals, a subtle change in gait, mood, or appetite can trigger an immediate clinical response — often preventing hospitalizations that would otherwise be costly and traumatic.
The PACE Day Health Center
Each PACE organization operates at least one PACE center — a facility that functions as the hub of the program. It is not a nursing home and not a traditional adult day program. A PACE center typically includes:
A primary care clinic
An adult day health program with structured activities
Physical, occupational, and speech therapy areas
Social spaces for meals and recreation
Mental health and social work offices
Personal care areas
Participants typically attend the day center two to three times per week on average, though frequency ranges from once a month to daily depending on individual care needs. Attendance is based on the IDT’s determination of what is clinically appropriate, not on a fixed schedule. Transportation to and from the center is provided.
For many participants, the day center becomes a meaningful source of social connection—one of the most underappreciated aspects of PACE. Isolation and loneliness are significant contributors to health decline in older adults, and the regular, structured social environment of the PACE center addresses this directly.
PACE for Dementia and Alzheimer’s
PACE is particularly well-suited for seniors living with dementia, Alzheimer’s disease, or other cognitive impairments—and for the family caregivers who support them.
Several features of the PACE model benefit dementia patients specifically:
Behavioral health integration
The IDT includes social work and mental health professionals who regularly assess cognitive and behavioral changes. Early intervention with dementia-related symptoms—agitation, sleep disruption, wandering risk—is part of the standard care model.
Caregiver respite
Family caregivers of dementia patients face extraordinary burnout. PACE’s day center program provides structured, supervised time for the participant away from home—giving caregivers essential breaks during the week. PACE also provides caregiver training and formal respite programs for longer periods of caregiver absence.
Home safety assessments
The PACE home care coordinator conducts home safety assessments and can recommend and arrange modifications—grab bars, removal of fall hazards, door alarms—to allow dementia patients to remain home safely longer than they otherwise could.
Continuity through decline
PACE does not discharge participants as their condition worsens. The care plan evolves with the participant’s needs. If nursing home placement eventually becomes necessary, PACE covers that too, and the IDT remains involved in the participant’s care.
For families: PACE does not require the person with dementia to make their own enrollment decision. A family member, caregiver, or legal representative can complete the enrollment process on behalf of a participant who lacks the capacity to do so independently.
How to Apply for PACE: Step-by-Step
Enrolling in PACE is a structured process that typically takes two to six weeks from first contact to coverage start date. Here’s exactly what to expect.
1
Confirm you meet the basic eligibility requirements.
You must be 55 or older, live in a PACE service area, and have a health condition that your state would classify as requiring nursing-home-level care. If you’re unsure about the nursing-home-level requirement, the PACE enrollment team can help assess this during an initial conversation — you do not need to figure this out on your own.
2
Find a PACE organization near you.
Use the PACE program finder at npaonline.org or call 1-800-MEDICARE (1-800-633-4227) and ask for PACE programs in your zip code. If InnovAge operates in your state (FL, CA, CO, NM, PA, or VA), visit our InnovAge state-by-state guide for direct contact information.
3
Contact the PACE organization and request an enrollment assessment.
Call or visit the PACE organization and express interest in enrolling. They will schedule a comprehensive health assessment—typically conducted by the IDT physician and a nurse, either in your home or at the PACE center. This assessment evaluates your medical conditions, functional needs, and living situation.
4
Complete state certification for nursing-home-level care.
Your state must formally certify that you meet the nursing facility level of care (NFLOC) standard. The PACE organization typically assists you in completing this step and coordinates with the appropriate state agency. In most states, the PACE team does the heavy lifting here — you do not have to navigate this paperwork alone.
5
Apply for Medicaid if you haven’t already.
If you believe you may qualify for Medicaid but are not enrolled, the PACE enrollment team can help you apply. Medicaid eligibility determines whether PACE is free for you. In states like Colorado, you can apply via an online portal (Colorado uses the PEAK system). PACE staff will guide you through this process.
6
Review and sign the enrollment agreement.
Once eligibility is confirmed and all assessments are complete, you’ll sign a PACE enrollment agreement. This agreement outlines your rights, the services you’ll receive, and the terms of the program. You will also disenroll from any existing Medicare Advantage plan or Medicare prescription drug plan, as PACE becomes your sole Medicare provider.
7
Coverage begins.
Your PACE benefits begin on the first day of the month following your enrollment agreement. Your IDT will conduct a comprehensive initial assessment and build your personalized care plan within the first few weeks of enrollment.
Can you change your mind?
Yes — at any time. PACE enrollment is always voluntary, and you can disenroll for any reason without penalty. If you leave PACE, your Medicare and Medicaid benefits revert to their previous structure, typically within 30 days.
States Where PACE Is Available
As of 2026, PACE operates in 33 states and the District of Columbia. The program is not available in: Alaska, Arizona, Connecticut, Georgia (in implementation), Hawaii, Idaho, Maine, Minnesota, Mississippi, Montana, Nevada, New Hampshire, South Dakota, Utah, Vermont, West Virginia, and Wyoming.
If you live in a state without PACE, or in a part of a PACE state that falls outside a service area, contact your State Health Insurance Assistance Program (SHIP) for information about alternative long-term care options, including Medicaid HCBS waiver programs.
Important California Update
California PACE Application Pause: Effective November 20, 2025, the California Department of Health Care Services (DHCS) has imposed a pause on new PACE applications for a minimum of two years. If you or a loved one was planning to enroll in PACE in California—including through InnovAge California—this pause affects new applications. Existing participants are not affected. Contact InnovAge California directly for information on waitlist options.
For the states where InnovAge operates—Florida, California, Colorado, New Mexico, Pennsylvania, and Virginia—see our detailed guide: InnovAge PACE Centers: State-by-State Guide.
Pros and Cons of PACE
The Case For PACE
Free for most participants. If you’re enrolled in both Medicare and Medicaid, there are no premiums, deductibles, or copays—for any service, any drug, any transportation. This is exceptional value.
Truly comprehensive coverage. Dental, vision, hearing, transportation, meals, home care, mental health — covered. Standard Medicare covers none of these.
You stay home. For most seniors, remaining in their own home or with family is vastly preferable to institutional care. PACE is specifically designed to make this possible for people who would otherwise need a nursing home.
Coordinated care. The IDT structure eliminates the fragmented, siloed care most seniors experience. One team knows your complete picture.
Social connection. The day center provides structured social engagement — a documented factor in longevity and cognitive health.
Voluntary. You can leave anytime. There is no lock-in, no penalty, and no long-term commitment required.
Caregiver support. Respite care, training, and support groups reduce the burden on family caregivers significantly.
The Trade-offs
You must use PACE’s provider network. This is the most significant downside for many families. If your parent has a trusted cardiologist or oncologist outside the PACE network, continuing to see them is generally not permitted under PACE. All care must flow through the PACE IDT.
Geographic availability is limited. PACE does not operate in all states, and even within PACE states, service areas are defined geographically. If you live outside a service area, you cannot enroll.
The day center is a requirement, not optional. Attendance at the PACE day center is part of the program model. Frequency is set by the IDT based on your clinical needs, not your personal preference.
Application can take time. The enrollment process—assessment, state certification, and Medicaid application—typically takes two to six weeks. In some cases, especially if Medicaid applications are complex, it can take longer.
All or nothing. When you enroll in PACE, it becomes your complete healthcare plan. You cannot supplement it with a separate Medicare Advantage plan or keep a standalone Part D drug plan.
Frequently Asked Questions About PACE
Does PACE cover prescription drugs?
Yes — completely. PACE covers all prescription drugs, and in many cases over-the-counter medications, that the interdisciplinary care team determines are medically necessary. There are no formulary restrictions, no coverage gaps, and no copays for medications approved by the PACE team. PACE replaces Medicare Part D drug coverage entirely.
Can a person with dementia enroll in PACE?
Yes. Cognitive impairment — including Alzheimer’s disease and other forms of dementia — does not disqualify someone from PACE. In fact, PACE is often an excellent option for dementia patients because of the program’s behavioral health integration, structured day center activities, caregiver respite, and ability to scale care intensity as the disease progresses. A family member or legal representative can complete the enrollment process on behalf of a person who cannot do so independently.
What happens if I need to go to the hospital or a nursing home while enrolled in PACE?
PACE covers all necessary hospital and nursing home care. If you are hospitalized, your PACE team coordinates with the hospital and maintains oversight of your care. If you require temporary nursing home placement, PACE pays for it, and your IDT continues to manage your care plan. You do not lose your PACE benefits during a nursing home stay.
Can I keep my current doctor if I enroll in PACE?
Not in most cases. PACE is an all-inclusive model — you receive all your care through the PACE network, led by the PACE primary care physician who is part of your IDT. If your current doctor is not affiliated with PACE, you would need to transition your primary care to the PACE physician. Specialist referrals outside the PACE network require IDT authorization and are handled case-by-case.
How often do I have to go to the PACE day center?
Attendance frequency is determined by your IDT based on your clinical and social needs. On average, PACE participants attend the day center about two to three times per week, but the range is wide — from once a month to every day. The day center is not optional; it is a clinical component of the program. However, attendance schedules are built around your needs and are adjusted as those needs change.
Can I enroll in PACE if I live in an assisted living facility?
Yes. PACE participants can live in a variety of community settings, including their own home, a family member’s home, or an assisted living facility. The key eligibility requirement is that you must be able to live safely in the community — wherever that is — with the support PACE provides.
Is PACE available for veterans?
Veterans who meet PACE eligibility criteria can enroll. If you are a veteran with VA healthcare benefits, enrolling in PACE will change how you receive certain services — you should speak with both a PACE enrollment counselor and a VA benefits coordinator before making a decision to ensure you understand the impact on your VA coverage.
What states call PACE by a different name?
In Pennsylvania, Maryland, and parts of the mid-Atlantic region, PACE is called LIFE — Living Independence for the Elderly. The program structure, eligibility requirements, and benefits are identical; only the name differs. If you’re searching for PACE in Pennsylvania, search for “LIFE program” as well.
Ready to Learn More or Find a PACE Program?
InnovAge is one of the largest PACE providers in the country, with centers in Florida, California, Colorado, New Mexico, Pennsylvania, and Virginia.
If your knees have started vetoing your workouts, rowing deserves a second look. It’s one of the few cardio exercises that works your legs, back, core, and arms at once—without pounding your joints the way running or the elliptical can. Aviron has become one of the most talked-about names in home rowers, thanks to a big touchscreen, video-game-style workouts, and a design that’s noticeably easier to get on and off than older rowing machines. We took a close look at whether it holds up for a 55+ audience specifically—not just fitness influencers in their 30s.
Bottom line up front: the Aviron is a genuinely well-built, low-impact rower with real accessibility advantages (higher seat, lower step-over, and guided coaching), but it’s a bigger investment than a basic rower and works best if you’ll actually use the touchscreen features. Here’s the full breakdown.
Why Rowing Makes Sense After 55
Before getting into the machine itself, it’s worth understanding why rowers keep coming up in conversations about senior-friendly fitness equipment.
Rowing is a seated, low-impact movement—your body weight never lands on your knees or hips the way it does with walking or jogging. The smooth, sliding motion increases blood flow to the joints, which can support mobility and help with everyday stiffness, and because it’s a weight-bearing exercise, it also helps maintain bone density. It’s a full-body workout, engaging roughly 80% of your muscle groups in a single session, which makes it efficient if you don’t want to be doing separate strength and cardio routines. Most guidance suggests 3-4 sessions a week, 15 to 30 minutes each, to see real benefit—a pace that’s realistic for most schedules.
That combination — cardio, strength, and joint-friendliness in one seated machine — is exactly why rowers have become popular with the 55+ crowd over the last few years.
Talk to your doctor before starting any new exercise routine, especially if you have an existing joint, heart, or back condition.
Getting On and Off: The Detail Most Reviews Skip
For a lot of people over 55, the real dealbreaker with home gym equipment isn’t the workout — it’s the awkward business of getting into position. Aviron seems to have designed around this specifically.
The seat sits about 20 inches off the ground, noticeably higher than a traditional rower, so you’re not lowering yourself into a low crouch to sit down. At the same time, the frame itself is a low 10 inches, so you don’t have to lift your leg high to step over it. The seat is also wide, cushioned, and stable rather than the narrow sliding seats you’ll find on budget rowers. In practice, that means less strain on your knees, hips, and lower back just getting in and out — which matters if you’re rowing daily rather than once a week.
Aviron Model Lineup: Which One Fits You
Aviron currently sells three main lines. Here’s how they compare:
Aviron Strong Go Rower — around $1,499 The most affordable entry point. It uses your own tablet or phone rather than a built-in touchscreen, which keeps the price down but means one more thing to set up before each row.
Aviron Impact Series Rower — around $1,900 A lighter, more compact rower with the same 22″ HD rotating touchscreen as the flagship model, built for smaller spaces or households sharing the machine. This is a strong middle-ground pick if space or budget is a bigger concern than resistance range.
Aviron Strong Series Rower — around $2,499 The flagship model, with dual air-and-magnetic resistance for a smoother, more adjustable feel and steel-and-aluminum construction rated to support users up to 507 lbs. This is the one most reviewers point to as the best all-around experience.
All three share the same core design advantages: the 20″ seat height, low step-over frame, and access to Aviron’s guided programs.
Every Aviron model (aside from the Strong Go, which uses your own device) comes with a 22-inch touchscreen that rotates, so you can follow along with off-rower stretching or strength segments, too. It’s the centerpiece of what makes Aviron different from a plain rowing machine.
On the screen, you get access to guided workouts, scenic rows, and light, game-like challenges — plus the ability to log into your own Netflix, Hulu, Prime Video, Disney+, or YouTube account and watch while you row. For anyone who finds a plain rowing motion boring after five minutes, this is a meaningful difference. It’s also genuinely helpful for beginners: step-by-step instructional videos walk you through form before you start, which lowers the risk of straining your back with poor rowing technique.
The subscription is $29/month and unlocks the full library of guided programs and games. You can also use the rower without a subscription — you’ll still see your resistance, time, distance, and stroke metrics — but you’ll lose the guided coaching and entertainment features, which are arguably the best reasons to choose Aviron over a cheaper rower in the first place.
Warranty and Peace of Mind
This is worth calling out for anyone making a bigger equipment purchase later in life: Aviron backs its rowers with a 10-year frame warranty and 2-year parts warranty standard, and if you order directly from Aviron’s website, that extends to a 20-year limited warranty on the Impact, Strong, and Tough series. That’s an unusually long warranty for home fitness equipment, and it’s a meaningful reassurance if you’re investing in a machine you plan to use for years, not months.
Who Should and Shouldn’t Buy an Aviron
A good fit if:
You want a low-impact cardio option that’s easier on the knees, hips, and back than walking or running
You’d actually use guided workouts and entertainment to stay motivated
Getting on and off the machine easily is a real priority, not an afterthought
You want a long warranty on a piece of equipment you’re planning to keep long-term
Maybe not, if:
You just want the cheapest possible rower and won’t use the touchscreen or subscription
You have very limited space (the Strong Series is the largest of the three)
You’re not comfortable with a recurring monthly fee for the full feature set
The Verdict
For adults 55 and up looking for a joint-friendly way to build cardio fitness and strength without giving up on their knees, the Aviron lineup stands out for reasons that go beyond the flashy screen: the higher seat, lower step-over frame, and beginner-guided coaching are the kind of details that actually matter day to day. The Impact Series is the sensible middle choice for most households—full features in a smaller footprint—while the Strong Series is worth the upgrade if you want the smoothest resistance feel and don’t mind the larger frame.
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What to Do If Your Flight Is Delayed or Cancelled: A Senior Traveler's Action Plan
Flight disruptions happen to even the best-planned trips. A weather delay, mechanical issue, or airline overbooking can throw off a carefully planned itinerary — and for seniors with connecting flights, hotel check-ins, or pre-booked transfers, a delay can cascade quickly. Here’s exactly what to do, step by step.
Step 1: Get to the Gate Agent Immediately
The moment your flight is delayed or cancelled, go directly to your gate agent—don’t wait for an announcement that never comes. Gate agents have the authority to rebook you while seats are still available. The longer you wait, the fewer options remain.
While waiting in line at the gate simultaneously:
Call the airline’s customer service line (often faster than the gate line)
Check the airline app for rebooking options
Step 2: Know What You’re Owed
Your rights depend on where and with which airline you’re flying:
Up to 4x ticket price, capped at $1,550 on U.S. flights
Step 3: Register with AirHelp (Before You Even Travel)
AirHelp is the world’s largest flight compensation service. You register your flight, and they monitor it automatically. If a delay or cancellation makes you eligible for compensation, they file the claim with the airline on your behalf — on a no-win-no-fee basis. You pay nothing if the claim fails; they take a percentage of what they recover if it succeeds.
Set up AirHelp before every trip. It takes 5 minutes and could recover hundreds of dollars per passenger if a disruption occurs.
Step 4: Protect Your Downstream Bookings
If your delay will cause you to miss connecting flights, hotel check-in, or pre-booked transfers:
Contact your hotel immediately—most will hold your room if you call ahead
Contact your transfer service — Welcome Pickups and GetTransfer monitor flight times and adjust automatically when you provide your flight number at booking
Contact your travel insurance—if the delay is long enough, meal and accommodation costs may be reimbursable. Check your policy from VisitorsCoverage or Insubuy
Step 5: Save All Receipts
During a delay, keep receipts for every expense—meals, taxi to hotel, hotel room, and pharmacy items needed because your bag was delayed. These are potentially reimbursable through your travel insurance or airline compensation claim. Take photos of receipts immediately in case the paper fades.
Step 6: Document Everything
Screenshot the delay/cancellation notification
Get a written statement from the gate agent confirming the reason for the delay (required for EU compensation claims)
Keep your original boarding pass—do not discard
Note the time of every communication with the airline
How to File a Compensation Claim
You can file directly with the airline (time-consuming, frequently rejected on first attempt) or use AirHelp to handle it for you. AirHelp has legal teams in every major country and a higher success rate than individual claims because airlines know they’ll escalate if rejected. For busy seniors, AirHelp’s automated monitoring and filing is the easiest solution.
FAQ: Flight Delays for Senior Travelers
Am I entitled to compensation if my flight is delayed?
On EU flights delayed over 3 hours due to airline fault, passengers are entitled to €250–€600 per person. U.S. regulations are less structured. AirHelp checks your eligibility automatically and files on your behalf.
What does AirHelp do?
AirHelp monitors your flights and files compensation claims automatically when you’re eligible. They work on a no-win-no-fee basis — you pay nothing if the claim fails.
Arthritis isn’t only a pain in the backside. It’s a painful inflammation that surrounds the joints in your body. Many people suffer from osteoarthritis, the most common arthritis type, but there are more than 100 other types of arthritis.
The first certainty about arthritis is that it’s misunderstood. The term ‘arthritis’ actually refers to a collection of diseased, degenerated, or painfully inflamed joints. The second certainty is that it reduces your quality of life.
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Before you can learn how to manage arthritis naturally, you’ll need to learn about the seven arthritis variants that affect people globally.
Seven Main Arthritis Variants
The Centers for Disease Control and Prevention (CDC) shared the current statistics for Americans, and 54 million people suffer from some form of arthritis, while 24 million of these people have a lower quality of life.
Losing the ability to be active and fully functional is emotionally debilitating. Start understanding your variant of arthritis to manage it on your terms.
Ankylosing Spondylitis (AS)
This type of arthritis doubles as a tongue twister. Ankylosing spondylitis is a debilitating type of arthritis that affects the spine. It most commonly affects the lower spinal vertebrae that connect to the pelvic area.
Spondylitis means inflammation, and ankylosing means fused joints. The tissues between your joints wear down, and the bones fuse into an immovable joint. The bones involved are the vertebrae, and the tissues between them are known as discs.
Over time, the inflammation surrounding the discs will wear them to a non-functioning state, which causes a condition referred to as bamboo spine. Men are more likely to suffer from AS, and it’s also genetically inherited with the human leukocyte antigen B27 protein.
Having the B27 protein doesn’t guarantee that you’ll develop AS, and some patients can develop AS even though they don’t have the B27 genetic marker. AS can also be caused by autoimmune dysfunction.
Gout
Gout is more common than AS, and it normally affects one joint at a time, often starting in the big toe. It’s caused by inflammation, crystallization of high levels of uric acid, or both. Unfortunately, it’s also extremely painful.
Repeated flares are a sign that the condition isn’t simply temporary but, instead, has evolved into inflammatory gouty arthritis.
It’s quite intriguing to think how common gout is in patients when you consider that it’s one of the easiest to manage and can often be prevented. It’s best to make use of nutritional and lifestyle changes and leave medication as a last resort.
Juvenile Arthritis
Juvenile arthritis is a broad-spectrum term used to cover arthritis in children. Yes, even children can suffer from arthritis. It’s either genetic, the result of an injury, or inflammation from a continuing autoimmune phenomenon.
Osteoarthritis (OA)
Osteoarthritis is called the degenerative type because it often comes with age and the wear and tear you experience in life. Its main targets are the hips, knees, and hands. Risk factors for developing this type are overusing joints, sedentary behavior, old injuries, and obesity.
Age and gender also play a role, and genetics and ethnicity are also determining risk factors. Asian cultures have a lower risk of developing it. Fortunately, OA can be easily managed with a proactive lifestyle.
Psoriatic Arthritis
This type of arthritis typically affects people with skin conditions like psoriasis. People often don’t realize how an infection in the body or on the skin can impact their bone and tissue health.
Reactive Arthritis
This is another type of arthritis that develops after having an infection, most commonly food poisoning or sexually transmitted infections. It affects the feet, hips, toes, ankles, and knees.
Rheumatoid Arthritis (RA)
Rheumatoid arthritis is another common type. It normally develops when the body’s self-defense system becomes self-destructive, attacking the body instead of defending it.
RA is an autoimmune disorder that commonly affects the hands and feet, but it can also harm your organs. RA can be managed effectively with the same lifestyle changes as most arthritis variants.
Final Thoughts
Knowing more about the type of arthritis you’re experiencing is the starting point, but you must also learn about what causes it. With this knowledge, you can manage your condition much better.
High blood pressure is often considered a silent or invisible condition because its symptoms are very mild. But don’t let this fool you.
Even though it may feel like you don’t have a problem due to this ‘lack’ of symptoms, this doesn’t mean it can’t cause serious damage to your health.
On the contrary, the damage can be quite extensive, especially if you don’t recognize that you have high blood pressure in a timely fashion.
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Learning the most common symptoms of high blood pressure can help you identify them more easily when they do make themselves known, which means you can start treatment as early as possible.
What Is High Blood Pressure?
High blood pressure is also called hypertension. It’s a condition that typically results in damaged or blocked arteries, which reduces how efficiently blood is able to circulate through your body. With elevated blood pressure, more wear and tear is placed on your arteries and heart.
High blood pressure can be dangerous because it restricts blood and oxygen supply to different parts of your body. This taxes your body and may lead to organ failure if it’s not appropriately managed, though most cases of hypertension don’t progress this far.
Understanding Blood Pressure
Your blood pressure is a measure of the force with which your blood cells press against the walls of your veins and arteries. It’s measured as one number over another.
You’ve probably heard your doctor say your blood pressure this way, but you might not have known exactly what it meant.
The first number represents your systolic blood pressure, which is the pressure on your artery walls at the time the heart is contracting and squeezing blood out through the arteries. The second is your diastolic blood pressure, which measures the pressure when the heart relaxes between beats.
Either number being too high can indicate a problem, but it’s best to find out what the average blood pressure is over a period of time before considering further treatment.
Healthy Blood Pressure Measurements
If your blood pressure doesn’t fall into the healthy range, it needs to be investigated further. A normal systolic blood pressure reading is 120 mm Hg, while diastolic blood pressure is normally about 80 mm Hg.
Blood pressure is generally considered elevated if it’s above 140 systolic and 90 diastolic. If your blood pressure reading spikes up to levels of 180 systolic or 120 diastolic, you should seek medical attention right away.
Oftentimes, the best way to know if you have high blood pressure is to test it. You can purchase a monitor that you can use to measure your blood pressure at home or schedule an annual physical with your regular doctor.
Symptoms of High Blood Pressure
Symptoms aren’t always present when your blood pressure is elevated, but it’s important to pay attention to them when they are. Keep a lookout for any of the following abnormalities:
Fatigue
Confusion
More frequent or severe headaches
Dizziness
Nausea
Rapid heartbeat
Nosebleeds
Chest pain
Vision problems
Blood in your urine
You’ll notice that many of these symptoms are nonspecific and could apply to a number of different conditions. This is why it’s so important to have your blood pressure tested so you can know for sure why these issues may be occurring.
High Blood Pressure Treatment for Invisible Symptoms
Many people don’t realize that they have high blood pressure because their symptoms can be overlooked. They often don’t interfere with normal activity, but the problem is that the high blood pressure is still doing damage to your body.
Even though the symptoms can be somewhat invisible, high blood pressure can have very serious effects. By the time you begin to notice these effects, often, much damage has already been caused by the ongoing high blood pressure. Thus, it’s important to do all you can to normalize your blood pressure at an early stage of the diagnosis.
Most routine physicals involve checking your blood pressure. If your doctor is concerned, don’t ignore it. Simple lifestyle changes like eating better and getting more exercise can go a long way toward reducing hypertension.
Final Thoughts
Regular check-ups will help to reduce your risk of damage to your body from uncontrolled high blood pressure. The sooner you make a change to more healthy habits, the sooner you’ll see improvements in your blood pressure.
Over time, you’ll start to feel better too. The only way to get proper treatment for your high blood pressure is by seeing your doctor or healthcare provider. Be sure to do your part in identifying whether or not the condition exists.
Medicare covers a wide range of free preventive benefits designed to help seniors stay healthy and catch health issues early. In 2026, Medicare beneficiaries have access to more preventive services than ever before — at no cost when you see a participating provider.
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What Are Medicare Preventive Benefits?
Medicare preventive benefits are covered services aimed at preventing illness or detecting health problems at an early stage. Under the Affordable Care Act, most preventive services are covered at 100% — meaning $0 out-of-pocket for you when you use a Medicare-participating provider.
Free Preventive Services Covered by Medicare in 2026
1. Annual Wellness Visit (AWV)
Once you’ve had Medicare Part B for more than 12 months, you’re entitled to a free Annual Wellness Visit. This is not a physical exam — it’s a personalized prevention plan where your doctor reviews your health history, updates your medical record, and helps you prevent disease.
Cost: $0 with Medicare Part B
Frequency: Once per year
What it includes: Blood pressure check, height/weight, depression screening, cognitive assessment, medication review
2. Cancer Screenings
Medicare covers several cancer screenings at no cost:
Mammogram (breast cancer): Once per year for women 40+
Colonoscopy (colorectal cancer): Every 10 years (or every 2 years if high risk)
Pap smear & pelvic exam (cervical cancer): Once every 24 months
Prostate cancer screening (PSA test): Once per year for men 50+
Lung cancer screening: Annually for adults 50–77 who smoke or recently quit
3. Cardiovascular Screenings
Medicare covers cardiovascular screening blood tests every 5 years — including cholesterol, lipid, and triglyceride testing. These help assess your risk for heart disease and stroke.
4. Diabetes Screening & Self-Management
If you’re at risk for diabetes, Medicare covers up to 2 fasting blood glucose tests per year. If you’re already diagnosed with diabetes, Medicare also covers diabetes self-management training and supplies.
5. Vaccines & Immunizations
Medicare covers several important vaccines at no cost:
Flu vaccine: Once per flu season
COVID-19 vaccine: Covered vaccines and boosters
Pneumococcal vaccine: Up to 2 shots (different types)
Hepatitis B vaccine: If you’re at medium or high risk
RSV vaccine: One-time dose for adults 60+
6. Bone Mass Measurement (Osteoporosis)
Medicare covers bone density tests every 24 months for people at risk for osteoporosis. Women over 65 and men over 70 are considered at elevated risk.
7. Depression Screening
Medicare covers one depression screening per year in a primary care setting. Depression is common among seniors but highly treatable — early detection matters.
8. Alcohol Misuse Screening & Counseling
Medicare covers annual screenings for alcohol misuse and up to 4 brief counseling sessions per year if you’re found to be misusing alcohol.
9. Obesity Counseling
If your BMI is 30 or higher, Medicare covers up to 22 intensive behavioral therapy sessions per year for obesity, including diet counseling.
10. “Welcome to Medicare” Preventive Visit
Within the first 12 months of having Medicare Part B, you’re entitled to a one-time “Welcome to Medicare” visit. This is your chance to review your health and establish a prevention plan with your doctor — at no cost to you.
How to Use Your Medicare Preventive Benefits
To take advantage of these free services:
Choose a Medicare-participating provider — this ensures the $0 cost benefit applies
Tell your doctor you want to use your Medicare preventive benefits
Keep track of which screenings you’ve had and when you’re due for the next one
Check your Medicare Summary Notice (MSN) to confirm claims were processed correctly
Frequently Asked Questions
Are all preventive services free under Medicare?
Most preventive services covered by Medicare Part B are free when you use a participating provider. However, if your preventive visit turns into a diagnostic visit (e.g., your doctor finds something and treats it), you may pay a copay for that portion.
Does Medicare Advantage cover preventive benefits?
Yes — Medicare Advantage plans must cover all Medicare-approved preventive services at no cost. Many Advantage plans offer additional preventive benefits like dental, vision, and hearing that Original Medicare doesn’t cover.
Can I get COVID tests through Medicare?
Medicare covers COVID-19 lab-based diagnostic tests (PCR/antigen) ordered by a doctor at no cost. Coverage for at-home OTC COVID tests through Medicare has varied by program year — check medicare.gov for current coverage details.
Make the Most of Your Medicare Benefits
Many seniors don’t take advantage of all the free preventive benefits available to them. Don’t leave these benefits on the table. Schedule your Annual Wellness Visit, stay current on screenings, and use Medicare’s preventive care program to protect your health — at no cost.
For the most current list of Medicare-covered preventive services, visit medicare.gov or call 1-800-MEDICARE (1-800-633-4227).
Today, you can get almost everything online — even groceries are now ordered online or delivered through an app. So it’s a modern convenience that has made things easier for the hustle and bustle of everyday life. Of course, not everything is like a space-aged blockbuster, and some things still require an in-person visit, like seeing your eye doctor. That is still something that would work best as a hands-on experience for the best results concerning your eye health. But that doesn’t mean you need to stop by the optical on your way out anymore!
You can get $45 Off Your Next Order of $150+ Plus Free Shipping.
Today, you can get almost everything online — even groceries are now ordered online or delivered through an app. So it’s a modern convenience that has made things easier for the hustle and bustle of everyday life. But, of course, not everything is like a space-aged blockbuster, and some things still require an in-person visit, like seeing your eye doctor. That is still something that would work best as a hands-on experience for the best results concerning your eye health. But that doesn’t mean you need to stop by the optical on your way out anymore!
FREE Standard Lenses at BeFitting.com with Code LENS2021
As an online retailer of premium eyewear in the US and Canada, Befitting has all the brands you know with the quality and style you love. Single and progressive lenses, prescription sunglasses, and ultra-lightweight lenses make finding what you need simple. Plus, Befitting leads the pack by being the most trusted optical retailer with the largest insurance providers in the country, such as EyeMed, Davis Vision, Superior Vision, United Healthcare, Spectera, and more, accepting more insurance plans than any other optical retailer.
With that said, many still worry about shopping for something so personal online. So how do you know if the glasses will work for your face shape? Will they be too big? Can I get lenses powerful enough for my prescription? All are valid concerns, and Befitting has the answers to help you decide if shopping online for your new glasses is the right choice.
To start, here are some of the most common questions regarding ordering glasses online:
How do I order my glasses? Once you find the frames you love, click the “Choose lenses” button to add them to your cart. Then, you’ll be prompted to select the type of glasses you want, prescription or no prescription. If you choose a prescription, you’ll then decide what type (Standard vs. Progressive). You’ll select your lenses (Standard, Polycarbonate, Ultra Lightweight, and BluTech), and finally, your lens treatment (None, Standard Anti-Reflective Coating, and Premium Anti-Reflective Coating). Now it’s time to checkout!
When do I submit my prescription? You will be prompted right after you place your order, but if you don’t have your prescription handy at the time of purchase, you can email it as soon as you have it.
What is PD and what if my prescription doesn’t have it? PD is an abbreviation for pupillary distance, which means the distance from the center of one pupil to the center of the other pupil. So why do you need this? Because this measurement helps craft lenses that provide you crystal clear vision. And, if you don’t have it, call your vision care provider to ask for your PD, and write it on the prescription like this: “PD-63” if you are given a single number, or “PD R-32 L-31” if you are given two measurements.
What are the maximum power ranges for eyeglasses? Maximum sphere powers +5.00 and -10.00 / Maximum cylinder power of -4.00 / Prism corrections: maximum of 2.0 (per eye) / Progressive add power: +0.75 to +3.00
How is sizing determined? Befitting has developed an exceptional tool to help you find the right frames for your style and fit. The soon-to-be-unveiled Befitting Virtual Stylist tool is an actual AI experience that intelligently identifies the shopper’s style preferences and maps their face through over 2000 points to determine the perfect fit. The Befitting opticians have created a general sizing chart to help you narrow your search.
Will my glasses need to be adjusted to fit me? As with any day-to-day wear item, small adjustments will need to be made to ensure your Befitting frames’ proper fit and comfort. Befitting’s optical experts prepare these recommendations for adjustments you can make at home.
And, if something doesn’t work out, you can return your glasses without worry within 30 days from receiving them. Befitting will be happy to assist you with the return and, as needed, email you a prepaid return shipping label.
So, step into the 21st century of frame shopping and head to Befitting to buy your next pair online. Not only will you have an array of colorful, on-trend collections to browse, but Befitting tackles even more tough questions to help you find the right frames to fit your personality and compliment your unique style.
Various factors cause different types of arthritis. For example, learning about the risks and causes of these debilitating conditions can help you navigate away from them or manage them more effectively.
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Some can be avoided, and the onset of others can be delayed well into the golden years. Moreover, some types of arthritis can be slowed to a halt. But the question is, where does it start? Why do you have this terrible condition?
A Stew of Arthritis Risks
What will cause your joints to weaken and be prone to functional decline? There are many reasons you can develop arthritis, ranging from inflammation to genetics.
Moreover, autoimmune complications can worsen the existing conditions, making your life even harder. The main risk factors have surfaced from a collection of research and experimentation.
Genetic Predisposition
Human leukocyte antigens (HLA) are abnormal genes present in your sixth chromosome if you have a family history of arthritis, especially rheumatoid arthritis, ankylosing spondylitis (AS), and juvenile arthritis.
HLA genes play a crucial role in the immune system as they produce proteins that stimulate cells’ receptiveness in the body. For example, cells need to be able to receive nutrients and vitamins and repair themselves.
These genes can have a functional abnormality or be harmed by an over-responsive immune system that stays alert for too long. The proteins released by these genes act to assist the immune system in distinguishing between normal bodily proteins and invaders, such as viruses and bacteria.
The bottom line is that your risk for developing arthritis increases if you have a family history of this specific genome deformity.
Cartilage Weaknesses
Most often found in osteoarthritis is the inherent weakness of cartilage, which is the soft tissue between the bones. Geneticfactors can cause this, but wear and tear are most often caused when you overuse the joints.
Repetitive movements have been the main instigator of joint weakness. Activities such as typing, stair climbing, and jogging can cause this problem.
Perhaps your job requires repetitive, hard labor for years, which places you at risk for osteoarthritis.
Nutritional Factors
The American Collegeof Rheumatology confirms that poor nutrition is a significant cause of rheumatoid arthritis and gout. Many foods promote inflammation, whereas others increase your levels of uric acid, resulting in painful crystallization.
Certain foods like red meat, refined sugars, processed foods, and high-fat dairy are some of the bad actors, increasing the risk of gouty arthritis. Unfortunately, your stomach and the immune system are far more fragile than you may believe.
What you eat will ultimately increase your risk for many unwanted health disorders. For example, the stomach has trillions of bacteria that make up the microbiome. These bacteria help the immune system function correctly.
Any imbalance in stomach bacteria leads to a dysfunctional microbiome, and diseases are a typical result.
Injuries and Overworking the Joints
Some injuries put you at a higher risk of developing osteoarthritis later in life, even if they appear to be healed, particularly for knee injuries, because the past always haunts people in their golden years.
Sometimes, injuries aren’t as straightforward as the twisted ankle or torn ligament you had as a child. Overworking or misusing joints can often cause unrecognized injuries, which predispose you to the development of arthritic disease, and you don’t even know that you have a problem.
Sedentary Behavior
Did you know that being sedentarycould predispose you to arthritis? It can also worsen arthritis because regular joint exercises keep your joints healthy and mobile, like an oiled engine.
Sedentary behavior promotes inflammation, increasing your risk for chronic autoimmune disorders like rheumatoid arthritis. Being inactive can lead to visceral fat accumulation, leading to chronic inflammation.
This lifestyle can also increase chronic fatigue and lay waste to muscles and soft tissues.
Autoimmune Disorders
However, the most significant concern for arthritis is autoimmune malfunctions, where the immune system attacks and depletes healthy cells. Therefore, your immune system is supposed to protect and preserve you, but it can also become an enemy.
Early-Onset Symptoms
What early symptoms can you look out for to avoid further progression?
Unexplained fatigue (activities, sex drive, and productivity)
A persistently mild fever that accompanies fatigue
Unintentional weight loss
Unusual stiffness in any joint
Joint pain
Swelling around the joints
Redness that accompanies the inflammation
Joints that feel warm to the touch
Numbness or tingling sensations
Any of the above symptoms on both sides of your body
Tally your risks, and make notes of the symptoms you experience before visiting your physician for an evaluation.
Final Thoughts
You might not be able to avoid all the risks, especially genetic factors. Still, you can avoid the lifestyle risks, which allows you to target your management on cellular or natural level, possibly allowing you to decrease or even stop some medications for your arthritis.
