Women spend a substantial amount of money on healthcare compared to men. It is estimated that a 65-year-old woman will pay 20% more for healthcare throughout retirement compared to a 65-year-old man, according to a HealthView Service study. The main reason senior women pay more for healthcare is that they tend to live longer than men. It is expected for a woman to live 2.3 years longer than a man, according to Social Security’s website.

Since women live longer than men, women should plan differently for Medicare. Medicare is America’s healthcare system for seniors aged 65 or older or for people with specific disabilities. Women’s bodies consistently evolve, and preventative checkups are essential as the percentage of breast cancer and osteoporosis increase as you age. Here is why women should plan differently for Medicare.

Medicare and breast cancer

Breast cancer is the second most common form of cancer in women, according to the Centers for Disease and Prevention (CDC). Medicare is a big advocate for screenings and preventative services.  A preventive service that helps detect breast cancer is a mammogram exam, a low energy x-ray of the breast.

Medicare Part B (outpatient coverage) covers a mammogram exam at 100% once per year. If the doctor were to find something during your exam, it would be considered a diagnostic test. After you have met the deductible, you would pay a 20% coinsurance for a diagnostic mammogram exam. However, if you have a Medigap plan, your plan will likely pick up the coinsurance cost.

If you have a mastectomy, Medicare Part A (inpatient coverage) covers surgically implanted breast prostheses if the procedure takes place in an inpatient facility. However, Part B will cover the surgery if it takes place in an outpatient setting. With that said, Part B covers some external breast prostheses and a post-surgical bra after a mastectomy.

Menopause and Medicare

Women typically begin to experience menopause around age 50. Menopause is a natural decline in the production of reproductive hormones. What this means is your body is producing a drastically smaller number of hormones. Symptoms of menopause consist of hot flashes, night sweats, insomnia, and vaginal dryness.

Medicare covers hormone replacement therapy for menopause, which is used to treat menopausal symptoms. The treatment replaces the hormones that stop producing during menopause, which will ease the symptoms as well.

Hormone replacement drugs come in the form of a pill, cream, and patch, as well as a vaginal ring. Your doctor may recommend one over the other. With that said, Medicare Part B may cover the vaginal ring for hormone replacement therapy if the doctor deems the treatment medically necessary. If you receive the treatment in the form of a pill or cream, Medicare will not cover it, considering Medicare does not cover prescriptions.

Hormone replacement therapy via pill or cream will be covered by Medicare Part D (prescription drug coverage). However, each Part D plan has a different list of prescriptions they cover. If your doctor prescribes you a particular hormone replacement therapy drug, you will want to ensure that your Part D plan has that needed drug listed on the plan’s formulary.

Now, hormone replacement therapy can also reduce the possibility of developing osteoporosis.

Women with osteoporosis

Osteoporosis is a condition that makes your bones weak and fragile. Many senior women have no signs of osteoporosis until they have a bone fracture. Bone density tests can detect a decrease in your bone density and determine if you are at risk of fractures. Medicare Part B covers a bone density test once every 24 months if you meet a set of qualifying conditions.

There are injectable drugs for osteoporosis that Medicare Part A and Part B will cover. You can also have a home health nurse come to your home and inject you with the medication if you meet these conditions:

  • You have Part B and meet the home health services criteria
  • You have a bone fracture that is related to postmenopausal osteoporosis
  • You’re a woman
  • Your doctor declares that you and a family member are unable to give you the injectable drug.

You will not have any out-of-pocket costs for a home health nurse to visit your home. However, you must meet the Part B deductible and pay coinsurance for the injection’s Medicare-approved amount.

Summary

Women must look at Medicare differently as their bodies consistently evolve throughout their lives, and health conditions can arise. As you age, know that Medicare covers any service that is deemed medically necessary from a physician. For more information on Medicare coverage, contact a trusted Medicare broker, or visit medicare.gov.

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