Medicare Guides for Patients and Caregivers
Compare coverage options, learn how to appeal denied claims, lower out-of-pocket costs, and coordinate care. Practical guides for the parts of Medicare that nobody explains.
Solace takes on the hardest parts of navigating Medicare for patients. These guides come from what our advocates experience every day.
Solace advocates support patients nationwide.
Better outcomes for patients who work with a Solace advocate
Advocates work on behalf of patients, not hospitals or insurers.
Guides to Navigating Medicare
Medicare has benefits, plans, deadlines, and rules that change every year. These guides cover how Medicare works, what it actually pays for, how to push back when a claim is denied, what's covered for specific conditions, and how families can navigate caregiving. When a guide isn't enough, a Solace advocate can take the work off your plate, and it’s covered by insurance.
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How Medicare Covers Your Care
Appealing a Medicare Denial
Medicare Coverage by Condition
What Medicare Pays For Beyond Doctor Visits
How Medicare Covers Your Care
The plans and rules, plus how to stop overpaying.
Appealing a Medicare Denial
When you get a no, here's how to improve your chances of turning it into a yes.
Medicare Coverage by Condition
What's covered for specific diagnoses, and how to actually access it.
What Medicare Pays For Beyond Doctor Visits
For the families managing a parent's care, often from a distance.
FAQs
Eligibility, Cost & Coverage
Yes, but coverage depends on how your doctor documents medical necessity. For neuropathy, Medicare covers physical therapy, nerve testing, and therapeutic shoes for diabetic patients. For COPD, it covers pulmonary rehab, oxygen equipment, and inhalers under Part D. For diabetes, it covers continuous glucose monitors, insulin pumps, and testing supplies. Incomplete documentation is the most common reason these claims are denied — and most are overturned when appealed with complete records.
To appeal a denied claim, first file a Redetermination using Form CMS-20027, submitted to the Medicare Administrative Contractor on your denial notice within 120 days. The key is including any documentation missing from the original claim, as that's usually what caused the denial. After submission, you'll receive a decision within 60 days. If you have Medicare Advantage, the timeline is slightly different. You have 65 days to appeal, and your request goes to your plan directly rather than a contractor.
According to KFF analysis of 2024 CMS data, more than 80% of Medicare Advantage prior authorization appeals fully or partially overturned the initial denial. (KFF — Medicare Advantage Prior Authorization Determinations, 2024) KFF
Medicare can cover more than most patients expect. Medicare Part B can cover durable medical equipment such as wheelchairs, walkers, and oxygen equipment. It can also cover outpatient physical therapy and mental health services, though cost-sharing may apply. Some preventive screenings are available at no cost. For patients who qualify, Medicare can cover home health care — eligibility requirements go beyond simply being homebound. For patients with a terminal diagnosis and a life expectancy of six months or less, Medicare can cover hospice care. Medicare can also cover up to 20 acupuncture sessions per year for chronic lower back pain. Many Medicare Advantage plans add dental, vision, hearing, and over-the-counter benefits on top of original Medicare coverage.
Part A is free for most people who worked at least 10 years. Part B costs $202.90 per month, automatically deducted from Social Security for most beneficiaries. Part D drug coverage averages $34.50 per month. Medicare Advantage averages $11.50 per month on top of Part B. Higher-income beneficiaries pay more through IRMAA surcharges, which start at incomes above $109,000 for individuals.
Yes — for most Medicare patients, advocacy is covered through Medicare and supplemental insurance. A Medicare patient advocate is a registered nurse, social worker, or other healthcare professional who handles the parts of the system most patients don't have the time or the expertise to navigate: appealing denied claims, fixing documentation issues, coordinating between providers, and identifying financial assistance programs you qualify for. At Solace, our advocates have an average of 16 years of experience in healthcare.