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Medicare
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Medicare Supplement policies cover costs not paid
by Medicare, such as co-pays and deductibles for
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Medicare
Advantage
Medicare Advantage plans are new health care options
that are part of the Medicare program. Coverage
may include Medicare Part D prescription drug
coverage as well as hospital, doctor, skilled
nursing, and other medical services. Premiums
are often low and $0 premium plans are available
in many areas.
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Part D is the federal government's
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More About MediCare , Medicaid , Medigap
Insurance : |
About Medicare
Medicare
is a federal program that
provides health insurance to retired individuals,
regardless of their medical condition. Below
are some basic facts about Medicare you
should know.
What does Medicare
cover?
Medicare coverage consists of two parts--Medicare
Part A (hospital insurance) and Medicare
Part B (medical insurance). A third part,
Medicare Part C (Medicare+Choice) is a
program that allows you to choose from
several types of health-care plans.
Medicare
Part A (hospital insurance)
Generally known as hospital insurance,
Part A covers services associated with
inpatient hospital care (i.e., the costs
associated with an overnight stay in a
hospital, skilled nursing facility, or
psychiatric hospital, such as charges
for the hospital room, meals, and nursing
services). Part A also covers hospice
care and home health care.
Medicare
Part B (medical insurance)
Generally known as medical insurance,
Part B covers other medical care. Physician
care--whether it was received while you
were an inpatient at a hospital, at a
doctor's office, or as an outpatient at
a hospital or other health-care facility--is
covered under Part B. Also covered are
laboratory tests, physical therapy or
rehabilitation services, and ambulance
service.
Medicare
Part C (Medicare+Choice)
The 1997 Balanced Budget Act expanded
the kinds of private health-care plans
that may offer Medicare benefits to include
managed care plans, medical savings accounts,
and private fee-for-service plans. The
new Medicare Part C programs are in addition
to the fee-for-service options available
under Medicare Parts A and B.
Are you eligible for Medicare
?
Most people become eligible for Medicare
upon reaching age 65 and becoming eligible
for Social Security retirement benefits.
In addition, you may be eligible if you
are disabled or have end-stage renal disease.
Back to Top
Who administers the Medicare
program?
The Health Care Financing Administration
(HCFA), a division of the U.S. Department
of Health and Human Services, has overall
responsibility for administering the Medicare
program. Although the Social Security
Administration processes Medicare applications
and claims, the HCFA sets standards and
policies.
However, as a beneficiary, you deal mostly
with the private insurance companies that
actually handle the claims on the local
level for individuals receiving Medicare
coverage. Insurance companies handling
Medicare Part A claims are called Medicare
intermediaries, and insurance companies
handling Part B claims are called Medicare
carriers. Managed care plans handle Part
C claims. Although the same private insurance
company may handle both Part A and Part
B claims, Part A and Part B are very different
in regard to administration (e.g., different
deductibles and co-payment requirements).
There is virtually no overlap; it is as
if you have two separate health insurance
policies.
How do you sign up for Medicare
?
Any individual who is receiving Social
Security benefits will automatically be
enrolled in Medicare at age 65 when he
or she becomes eligible. If you are not
receiving Social Security benefits prior
to age 65, you will be automatically enrolled
when you apply for benefits at age 65.
However, if you decide to delay retirement
until after age 65, remember to enroll
in Medicare at age 65 anyway, because
your enrollment won't be automatic. Individuals
who will be automatically enrolled in
Medicare will receive notification by
mail from the Social Security Administration,
usually three months before their 65th
birthday.
Back to Top
About
Medicaid
What is Medicaid?
Medicaid is a health insurance program
for people with low income. It was
created in 1965 as a joint federal-state
program to provide medical assistance
to aged, disabled, or blind individuals
(or to needy, dependent children)
who could not otherwise afford the
necessary medical care.
Who administers Medicaid?
Each state administers its own Medicaid
programs based on broad federal
guidelines and regulations. Within
these guidelines, each state (1)
determines its own eligibility requirements,
(2) prescribes the amount, duration,
and types of services, (3) chooses
the rate of reimbursement for services,
and (4) oversees its own program.
How do you qualify for
Medicaid?
Approximately 39 million people
receive Medicaid benefits. To qualify
for Medicaid, you must meet two
basic eligibility requirements.
First, you must be considered categorically
needy because you are blind, disabled,
or elderly. Second, you must be
financially needy. This means that
your income and your assets must
fall under a certain limit set by
the state in which you live.
Back to Top
How do you apply for Medicaid?
You can apply for Medicaid at your
state welfare office, public health
department or state social service
agency.
What types of benefits
are available?
Medicaid pays for a number of medical
costs, including hospital bills,
physician services, home health
care, and long-term nursing home
care. States may elect to provide
other services for which federal
matching funds are available. Some
of the most frequently covered optional
services are clinic services, medical
transportation, services for the
mentally retarded in intermediate
care facilities, prescribed drugs,
optometrist services and eyeglasses,
occupational therapy, prosthetic
devices, and speech therapy. Check
with your state's Medicaid representative
to see what coverage your state
offers.
Medicaid and long-term
nursing home care
Over 60 percent of all nursing home
residents receive Medicaid benefits
that help pay for their care. An
aging population and the increased
cost of long-term care have made
Medicaid planning an important topic.
If you're interested in Medicaid
planning, here are some things you
should know.
Back to Top
In years past, attorneys and financial
planners devised strategies for
the middle class and people of means
to qualify for Medicaid by transferring
funds to family members and by establishing
trusts. Consequently, Congress tightened
the Medicaid rules regarding the
transfer of assets.
The Omnibus Reconciliation Act
of 1993 makes qualifying for Medicaid
more difficult for those people
who transfer their assets away without
receiving fair value in return.
If you transfer assets away for
less than fair consideration within
36 months of your application for
Medicaid, the law creates a waiting
period before you can collect Medicaid
benefits. Transfers into certain
trusts within 60 months of your
Medicaid application also will also
cause a period of ineligibility.
However, it's still possible to
plan for long-term care and comply
with the various Medicaid rules.
Trusts, transfers of the family
home, purchase of exempt assets,
outright transfers under the "half-a-loaf
strategy," and the purchase
of long-term care insurance, among
others, can be effective planning
tools and strategies for this purpose.
For details, see your financial
adviser or an attorney experienced
with Medicaid planning.
About
Medigap Insurance
Because Medicare won't cover all
your health-care costs during retirement,
you may want to consider purchasing
a supplemental medical insurance
policy called Medigap. Medigap is
specifically designed to fill some
of the gaps in your Medicare coverage.
When's the best time to
buy a Medigap
policy?
The best time to buy a Medigap
policy is during
your open enrollment period, since
you can't be turned down or charged
more because you are in poor health.
If you are age 65 or older, your
open enrollment period starts when
you first enroll in Medicare Part
B. Or, if you are not yet 65, your
open enrollment period starts when
you turn 65, and then lasts for
six months. A few states also require
that a limited open enrollment period
be offered to Medicare beneficiaries
under age 65.
If you don't buy a Medigap
policy during your
open enrollment period, you may
not be able to buy the policy you
want later.
Note: If you are currently age
62 or younger, you should be aware
that your eligibility for Medicare
may be affected by the increase
in the normal retirement age for
Social Security. Starting in 2000,
the age for collecting full Social
Security benefits will gradually
increase from age 65 to age 67 over
a 22-year period. This means that
the age at which you can begin receiving
Medicare benefits may be greater
than 65 (if current law still applies)
because the date you become eligible
for Medicare is the date you reach
normal retirement age. However,
neither the Social Security Administration
nor the Health Care Financing Administration
has yet published information on
how the change in normal retirement
age will affect Medicare eligibility.
Back to Top
What does a Medigap
policy cover?
Under federal law, only ten standardized
plans can be offered as Medigap
plans. All ten must cover certain
services, no matter in which state
you live. Medigap policies pay most,
if not all, Medicare coinsurance
amounts. Some also provide coverage
for deductibles and services that
are not covered by Medicare such
as prescription drugs and preventive
care.
Each Medigap
policy is labeled
with the letter "A" through
"J". You can buy the Medigap
plan that best suits your needs.
Plan "A" is the basic
benefit plan, while Plan "J"
offers the most coverage. However,
it is important to note that not
all ten plans are available in every
state.
What is Medicare SELECT?
Medicare SELECT is another Medicare
supplemental health insurance product.
It's almost identical to standard
Medigap insurance. When you buy
a Medicare SELECT policy, you are
buying a standard Medigap plan.
The only difference between a Medicare
SELECT plan and a Medigap plan is
that Medicare SELECT is a managed
care plan. In order to be eligible
for full benefits, you must use
specific hospitals, and sometimes
specific doctors. That's why Medicare
SELECT premiums are usually lower
than premiums for Medigap policies
that do not require the use of managed
care.
bus Reconciliation Act of 1993
makes qualifying for Medicaid more
difficult for those people who transfer
their assets away without receiving
fair value in return. If you transfer
assets away for less than fair consideration
within 36 months of your application
for Medicaid, the law creates a
waiting period before you can collect
Medicaid benefits. Transfers into
certain trusts within 60 months
of your Medicaid application also
will also cause a period of ineligibility.
However, it's still possible to
plan for long-term care and comply
with the various Medicaid rules.
Trusts, transfers of the family
home, purchase of exempt assets,
outright transfers under the "half-a-loaf
strategy," and the purchase
of long-term care insurance, among
others, can be effective planning
tools and strategies for this purpose.
For details, see your financial
adviser or an attorney experienced
with Medicaid planning.
Back to Top
Medicare Rx
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Please Note: The information
contained in this Web site is provided
solely as a source of general information
and resource. It is a not a statement
of contract and coverage may not apply
in all areas or circumstances. For a complete
description of coverages, always read
the insurance policy, including all endorsements
Medicare Rx
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Affiliate Program at Alabama, Alaska, Arizona,
Arkansas, Connecticut, Delaware, District of Columbia
(Washington DC), Florida, Georgia, Hawaii, Idaho,
Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana,
Maine, Maryland, Massachusetts, Michigan, Minnesota,
Mississippi, Missouri, Montana, Nebraska, Nevada,
New Hampshire, New Jersey, New Mexico, New York,
North Carolina, North Dakota, Ohio, Oklahoma,
Oregon, Pennsylvania, Rhode Island, South Carolina,
South Dakota, Tennessee, Texas, Utah, Vermont,
Virginia, Washington, West Virginia, Wisconsin,
and Wyoming. Medicare Rx |
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