You are eligible for Medicare benefits if you are 65 or older or are disabled. There are various “parts” of Medicare coverage.

Part A: This is your hospital coverage. This is currently available for free to all Medicare beneficiaries. There is a $1676 deductible per year (as of 2025).

Part B: This is your outpatient coverage, meaning doctors, physical therapists, anyone you see outside of the hospital. There is a $257 deductible (as of 2025), and then Part B will cover 80% of all approved visits. There is a monthly premium for Part B benefits, which is generally $185 (as of 2025) but could be more if you have a higher income. Many people opt to pay for this premium through their social security benefits (so it’s taken out of your social security payment prior to going into your bank account).

Part C: This is called Medicare Advantage, where they group the Part A, B, and D benefits into one package (similar to what you see with commercial insurance policies). Very often you will see a low or zero premium payment, but the network of physicians is also very small compared to the traditional Medicare network. Also, please note that you still often pay the Part B premium so technically it’s not free the way it might be advertised.

Part D: This is your prescription plan.

SUPPLEMENTAL: For Part B, you can purchase a supplemental plan that will cover the 20% remaining of the visits (and sometimes even part or all of the deductible). If Medicare covers the visit, then your supplemental will cover the remaining amount. If Medicare denies a visit, then your supplemental will not cover the visit. AARP members often choose a plan offered by AARP (underwritten by United Healthcare), but please know that there are many options available. Probably more than you want to see.

If you go through traditional Medicare, you have to purchase Part B and Part D separately. If you don’t purchase a supplemental plan when you first sign up for Part B, it may be difficult to get a supplemental plan in the future. If you don’t sign up for Part D right away, you will be penalized when you do ultimately purchase a policy. Meaning you will pay a higher premium each month.

Medicare is confusing, and they are often the forefront of changing the rules (which is actually quite interesting, but waaaay too long of a topic to start here). If you’re confused, speak to the Medicare representatives. Just expect a long wait on the phone, so be prepared with something to do while you’re waiting.

More terminology:

EOB: This stands for Explanation of Benefits. Once you see a doctor, a claim is submitted to your insurance company for payment. You will get back documentation, called an EOB, that explains how the claim for the visit was processed, and who received payment for what. They will tell you each line item charge, what was billed, how much they “allowed” or covered, and how much went towards your deductible, coinsurance or copayment. If they deny any line items, they will tell you why. You can always appeal denied items.

Appeal: If you want to appeal or fight a denied claim, then you or your doctor’s office can send a letter to ask the insurance company to reconsider their denial. Usually you need a letter explaining why the claim should be covered, and very often is accompanied by medical records. Usually you can fight an insurance company twice (internal appeal) and then it would have to move to an external appeal, which means a third party is hired to review the appeal and renders a final decision. Sometimes an external appeal costs money, but is supposed to be an impartial party since it doesn’t involve the insurance company. They have a copy of your benefits along with the documentation you send.

Coordination of Benefits: Some people have multiple insurance company policies. Let’s say you’re eligible for Medicare and you signed up for Part A & B (Hospital and Doctors), but you also still work and have benefits from your employer. Then your employer’s company decides who is the primary insurance coverage and who is secondary. You don’t get to choose. So if your doctor doesn’t accept your primary insurance but accepts your secondary insurance, you would still consider your doctor as out of network. Let’s say you and your spouse both work and have benefits, and both of your benefits cover your child. Which is the primary insurance for the child? You then use the birthday rule. Take the month of the birthday for both parents (you and your spouse) and whoever has the first birthday (doesn’t matter the year, ONLY the month), that is the primary insurance for the child. The determination of primary, secondary, and even tertiary insurance coverage is called the coordination of benefits.

Hidden Health Benefits: Very often, many insurance companies offer special promotions or discounts for patients of which they may not be aware. For example, some insurance companies may offer to pay for part of a gym membership. Some may offer free products that encourage healthy habits.

Your insurance policy can be divided into medical (doctors, hospitals, etc.) and pharmacy plan/benefits. So you might have a deductible for medical and a separate deductible for pharmacy. Sometimes it’s the same (especially if it’s a high deductible plan). You will have separate deductibles and out of pocket maximums for in and out of network plans.

FSA and HSA: FSA and HSA are saving accounts that are specifically used for medical costs. Generally pre-tax dollars are put into the account if your employer is putting the money into the account when running payroll. Meaning, you don’t pay taxes on the money put into the account. If you use post-tax dollars but depositing directly into an HSA, you can usually request a credit for taxes in your tax return. FSA monies generally expire once a year (usually March 15) so you should only put in what you think you’re going to spend in a year. HSA is generally only available to those with high deductible plans, but the monies don’t expire in the same way as FSA.

GAP Exception or Network Deficiency: If you’re seeing an out-of-network doctor who does something special and you can’t get it in-network, you can request authorization from your insurance company for something called a GAP Exception or Network Deficiency. Basically you’re asking your insurance company to help cover something that isn’t provided in the network of doctors with whom they have contracted (hence the name, GAP or deficiency). Not all policies will allow this (especially self-funded policies), but always worth a shot! Every plan has a different process. Sometimes the doctor you want to see has to start the process, sometimes you have to start the process, sometimes an in-network doctor has to start the process (and state that they are referring you to this special doctor).

Prior Authorization: This is a request made by a doctor’s office for authorization, or permission, to perform a certain procedure or request a certain medication for you. These authorizations can take time to be done, and even longer for an insurance company to get back to you with an answer. When I perform prior authorizations for medications, I can get an answer back right away, or I might have to wait 72 hours for an answer. I have also waited up to two weeks for an answer about an authorization for an MRI!!  Now, that’s a bit unusual, but it can happen!

Let’s start with some basics:

Basic Plan Terminology

Plan Year versus Calendar Year: Your plan will reset every year. The date of the reset can vary. Plans that reset on a calendar year will always reset on January 1. Plans that work off a plan year will reset on the date that the insurance policy initially started.

Deductible: You have a certain amount of money that you will be required to pay upfront. This is your deductible. Very often, insurance companies have offset the premium (the monthly amount you pay for the policy) by offering a high deductible. This means people who don’t use their insurance often may save money by paying a lower premium and not paying much into their deductible. Almost all out-of-network policies will include a deductible.

In-Network versus Out-of-Network: Your insurance company has contracted with various hospitals, doctors, pharmacies, and medical supply companies to provide you with healthcare needs. These contracted providers are considered “in-network”. Anyone who has not contracted with your insurance company is “out-of-network”. Therefore, your insurance plan coverage will vary based on your in-network or out-of-network provider.

Copayment: A copayment is a set dollar amount being paid to a facility or doctor for a specific type of visit. For example, you may have a $0 copayment to see a primary care doctor, but you have a $30 copayment to see a specialist. That means each time you see the specialist, you will need to pay $30/visit.

Coinsurance: A coinsurance is a percentage of the cost of the visit being paid by the patient. So let’s say you’re seeing a doctor for a quick visit. Perhaps the insurance company has contracted to pay $100 for that type of visit, and your coinsurance is 15%. That means you’re responsible for 15% of $100 (or $15) for the visit.

Out of pocket maximum: Once you’ve hit your maximum out of pocket, your insurance company will pay for 100% of the visit. However, what’s included in the maximum out of pocket can vary from plan to plan. This might mean your deductible and your coinsurance together will go towards your out of pocket maximum.

Many patients suffer from dehydration or imbalance of electrolytes, causing symptoms of dizziness and fatigue. This can be related to dysautonomia, EDS, POTS, or another diagnosis.

Patients will require varying doses of electrolytes, so please contact your healthcare provider to make sure you’re taking the right amount!

We do not promote any single product; rather we like to offer various solutions due to various needs (and tastes!). Therefore, we present some options as follows:

• Vitassium / Salt Sticks
• Normalyte
• LMNT
• Nuun
• Buoy
• Liquid IV

Each company has varying products so check for what you need and run it by your doctor! Also, some of the companies offer discounts for chronic illnesses, so check that out as well.

Please see an interview with Dr. Norman Marcus and Jay Gill, discussing the use of low dose naltrexone for treating chronic pain related to Ehlers-Danlos Syndrome (EDS).

Ehlers Danlos Syndrome (EDS) is a connective tissue disorder that affects skin and joints between bones. The most common type of EDS is hEDS or hypermobility EDS. People with hEDS are usually more flexible or bendy than the average person. Being able to do a split, being able to bend your thumb back so it touches your wrist, and stretchy skin are three common signs of joint hypermobility. On the surface, these symptoms don’t seem too problematic, but hEDS can cause widespread pain in the body and many other problems.

There is growing research on the link between hEDS and another condition called called Mast Cell Activation Syndrome (MCAS). One recent study done by Song et al. in 2020 identified that 24% of a group of EDS patients also had MCAS.  This is a very exciting finding for EDS researchers because as of now, the genetic causes of EDS are unknown. Therefore, studying MCAS may provide an avenue for exploring the origins of EDS in the body.

Both of these conditions share many different symptoms including skin hives, skin flushing, itchy skin, nasal or sinus congestion, asthma, gastrointestinal disorders like irritable bowel disorder or celiac disease, and many more. Research connecting these two conditions is a new and exciting field for researchers trying to get to the bottom of the physiology of Ehler’s Danlos Syndrome.

If you know you have EDS or hypermobility, and also experience pain and allergy symptoms like hives, coughing, wheezing, or redness in the skin, it’s possible you also have Mast Cell Activation Syndrome.

Ehler’s Danlos Syndrome (EDS) is a condition that affects the connective tissues of the body. There are 13 types of EDS, and the most common one is hEDS or hypermobility EDS, which affects approximately 1 of 3,100-5,000 people. EDS can be inherited genetically.

The three most common symptoms in people with hEDS are joint hypermobility, skin hyperextensibility, and tissue fragility.

Can you do a split? Or does your thumb bend backwards so far that it can touch your wrist? Those are two examples of joint hypermobility. Joints are the pieces of connective tissue that are between our bones. Joint hypermobility can be a problem because it makes people more likely to be injured through dislocations, sprains, or other joint problems.

Skin hyperextensibility means excessively stretchy skin. A common test for this is putting your hand flat on a table, and gently pinching and pulling the skin on the back of your hand.

Tissue fragility can also be a problem for people with EDS. Medically speaking, tissues are like the armor of our bodily organs. For example, our skin is a type of tissue (epithelial), but there is also nervous tissue, connective tissue and muscle tissue. Tissue fragility can be a problematic part of EDS because it leaves our organs more vulnerable to damage and injury. Because tissue is in all parts of our bodies, tissue fragility can pose a wide range of other symptoms, from bruising to gum disease.

Because EDS symptoms can vary so widely, there is no one mainstay of treatment for EDS patients. Rather, treatment plans are based on the individual. EDS patients should seek a care team of specialists from multiple disciplines to ensure that all of their symptoms are being treated differently and professionally.

Do you have widespread pain? Do you also have allergy symptoms like itching, hives, or wheezing? You may have gone a long time thinking pain and allergy symptoms were unrelated, but you could have Mast Cell Activation Syndrome (MCAS), a condition that causes both.

If you have never heard of MCAS, that’s because MCAS is a condition that is only gaining recognition in the past decade or so. There are many doctors who are not familiar with MCAS. It was once thought to be a rare condition, but current estimates are that it could affect up to 17% of the general population. It’s important that such a common condition be understood.

MCAS is hard for doctors to diagnose for a few reasons. The main reason is that it is an under researched condition, despite being likely very prevalent. Furthermore, MCAS has a lot of symptoms that aren’t frequently associated with each other. Mainly, pain symptoms and allergy symptoms. In fact, a MCAS diagnosis requires that symptoms occur in two organ systems, for example, the skin (hives), and the gastrointestinal system (stomach pain). The two other most common organ systems affected by MCAS are the cardiovascular system, and the respiratory system. Cardiovascular symptoms include low blood pressure and fainting. Respiratory symptoms include shortness of breath, congestion, sneezing, or wheezing.

MCAS can be a confusing condition due to the vast range of symptoms that a person with MCAS can experience. A person with MCAS could go to a pain doctor and an allergist separately to seek answers for their two different symptoms. They might not bring up their stuffy nose and skin hives with the pain doctor, and they might skip the pain conversation with the allergist. As a result, the pain doctor and allergist might diagnose this patient with something completely different. Without a full picture of a person’s overall symptoms, it is tough to diagnose MCAS, which is why it is important for doctors to learn more about this condition.

If you have allergies and pain symptoms, you may have never thought about how these two seemingly unrelated symptoms might be a sign of a single condition. To learn more about a potential MCAS diagnosis, visit the link below and find out about a clinical trial on a medication for MCAS that may ease allergy and pain symptoms.

Mast cells are important cells in our immune systems that help us fight off sickness, infections, and allergies. Although these cells are vital to protecting our bodies, some peoples’ mast cells can be too active for no good reason. In these cases, the mast cells might cause more harm than good. When Mast Cells are overly active, Mast Cell Activation Syndrome (MCAS) may sometimes be diagnosed. In MCAS, Mast Cells release excessive chemicals into the bloodstream. This reaction can cause swelling, hives, coughing, and pain.

There are three main types of MCAS that are recognized:

1. Primary
2. Secondary
3. Idiopathic.

Primary MCAS is when the bodies’ mast cells clone themselves excessively. In these cases, mast cells gather in organ tissues in excessive numbers. Symptoms of primary MCAS can occur in pretty much any organ in the body. Common symptoms are allergy-like. For example, skin rashes, hives, and abdominal pain. Especially serious cases of primary MCAS can be called mastocytosis, a life-threatening condition that can cause serious allergic reactions called anaphylaxis.

Even though you may have not heard of it, you are probably familiar with secondary MCAS. Do you have any allergies? If so, you may have secondary MCAS. Secondary MCAS may be diagnosed when a person experiences allergic reactions, for example, to nuts or shellfish. Unlike in primary MCAS, mast cells do not clone themselves abnormally in second MCAS. In fact, people with secondary MCAS have a perfectly normal amount of mast cells. However, these mast cells are overactive and release excessive chemicals into the bloodstream (such as histamine), which cause allergic like reactions. Some examples of environmental triggers can include pollen, food, and alcohol.

Idiopathic MCAS is an interesting condition that can be frustrating for patients who have it. This is because these patients experience allergy-like symptoms, but they are not allergic to anything. In other words, idiopathic MCAS can cause seemingly allergic reactions for no reason at all. For MCAS to fall into the idiopathic category, there must be no evidence of an excessive amount of mast cells (primary MCAS), and the allergy-like symptoms must not be triggered by an actual allergy. For someone to be diagnosed with idiopathic MCAS, the doctor must make sure that they rule out all potential causes of the allergy symptoms.  Although not typically, patients with idiopathic MCAS may still have serious reactions (anaphylaxis).MCAS in all its forms is treatable through different strategies. Helpful interventions for primary, secondary and idiopathic MCAS may include antihistamines to calm allergy symptoms. For cases of secondary MCAS where the allergic trigger is known, lifestyle changes can go a long way in calming down mast cells.

Are your “allergic symptoms” and pain related to idiopathic Mast Cell Activation Syndrome (MCAS)?

Hives, rashes, itching, problems breathing, and pain in your stomach or other parts of your body may all be related to allergies. Your doctor may have tested you, but did not find what you might be specifically allergic to, for example types of foods or substances surrounding us like pollen, dust, and mold. If you didn’t have evidence of an allergy to any or only a few of these substances, then what is causing your symptoms?

Your symptoms may be caused by excessive activity in a special cell in your body called the Mast Cell (MC) which is stimulated whenever you experience any irritation. The MC helps to fight off infections and help repair damaged tissue by producing many different powerful substances. However, when it is overactive, these substances may be produced by the MC after exposure to ordinary stimuli including a hot shower, sunlight, perfumes, cleaning solutions, and a variety of foods. Overactive MCs may cause diffuse pain in various parts of your body.

Doctors have been aware that increased numbers of MCs can cause serious symptoms in different organs. When there are too many MCs the diagnosis is often Mastocytosis, which requires specialized treatment. When the number of MCs is normal and the MCs are just overactive, the diagnosis, which is a relatively new discovery, is often idiopathic Mast Cell Activation Syndrome (MCAS) and can be diagnosed with several blood and urine tests. However, if you have symptoms in 2 or more organ systems, for example skin rashes, heart burn, asthma like symptoms, and your symptoms improve with an anti-histamine, you may be diagnosed with idiopathic MCAS without complicated testing.

Our body makes a substance that can down-regulate the activity of the MC. It is called palmitoylethanolamide (PEA). It is in the family of substances, called cannabinoids, and is related to the molecules that are present in marijuana. Other substances can down regulate the MC such as Cromolyn Sodium. Since one of the main substances produced by the MC is histamine, medications that block histamine. such as antihistamines used for allergies and histamine antagonists used for heart burn, may be helpful in reducing the symptoms of overactive MCs.

If you have diffuse pain and other symptoms, like the ones above, that have been difficult to diagnose and treat, you may have MC problems that can be treated.

How do we test new medicines before they are released to the public?

Let’s say for the sake of this example that there’s a new drug that is potentially effective at treating people with muscle pain. The process to test that treatment is called clinical trials. To test the medicine, clinical trials occur in different stages, called phases. Phase I testing is done on healthy volunteers without muscle pain. If the drug is found have unsafe side effects, it would fail phase 1 and be withdrawn from further testing. If the drug passes Phase 1, it goes on to Phase 2 which studies a small group of patients with muscle pain to see if the new drug is effective in treating the condition without producing serious side effects. If the drug passes Phase 2 it goes on to Phase 3 which tests a larger group of patients with muscle pain to confirm the effectiveness and safety found in Phase 2.

There are strict guidelines that researchers must follow when conducting clinical trials to ensure the safety of their human subjects. Regulatory bodies such as the FDA monitor clinical trials to ensure that all guidelines are being followed. If the physicians in charge of a new drug trial are found to not follow the guidelines, they are removed from their trial and may lose their ability to participate in any future trials.

Participation in a new drug study can be an exciting experience–especially when it results in a decrease or elimination of your symptoms. Before a patient begins a clinical trial, all the possible risks that may occur during the study are spelled out in a document called the consent form. The consent form is signed by the participant before they start treatment. The consent form makes it clear that declining to participate in a study will not affect the participant’s future care, and that they may withdraw from the study at any time for any reason.

A drug study is an experiment. To ensure that enthusiasm about the new drug doesn’t influence the outcome–for example hoping that the treatment is going to work will make you believe that it works–some participants will receive an inactive drug called a placebo. Whenever possible, the physician administering the drug will not know if they are giving you the real drug or the placebo. This type of study, where the physician and the study participant do not know which medication they receive, is called a double-blind study. Participants are informed at the end of the study if they received the active drug or the placebo.

Some drug trials provide financial compensation for time and participation. Some trials will only compensate you for any expenses that you incur in the process of participating in the study. Participation in a study may or may not benefit you directly but will potentially benefit many patients in need of new effective treatments.