Archive for May, 2008
Most people who are Medicaid recipients know that their income must stay below a certain level in order for them to maintain their Medicaid eligibility and benefits. Therefore, they must carefully check their finances so that they do not exceed that amount and lose their benefits. This is critical, since Medicaid is a lifeline for many who can’t otherwise get health care and need to continue treatment, medicine or both.
There has been a lot of confusion regarding the tax rebate checks that are being distributed right now. Individuals receiving Medicaid are worried about whether this extra money will count as income and cause them to lose their benefits.
The answer to this is, “No.” The economic stimulus rebate will not count as income; therefore will not cause individuals to lose their Medicaid, according to South Dakota State University.
Some Medicaid programs count resources as assets, so it is best to check the information at www.ssa.gov, which is the federal Social Security Administration website. Some nursing-home waiver and other SSI-related programs count resources as assets, so it is important to check the site to see if any of these situations apply to you. They could include Disabled Adult Children, Widow/Widower, Grandfathered Children or a few others. You can get specific information regarding these situations on the site.
If you or someone in your family is part of any of these programs, Medicaid will not count the tax rebate as income during the month the rebate is received or for two months afterward. That means that this money will not be counted when Medicaid is deciding whether a person is eligible for that month and the two months after the rebate is received. It is important, however, to note that if the money has not been spent or otherwise disbursed by the fourth month, it will be counted as a resource for the programs listed in the previous paragraph.
If you are a Medicaid recipient, hopefully this clears up the confusion so you can breathe a bit easier now. If you have further questions, go to www.medicaid.gov or www.ssa.gov for more information.
There is a lot of information around about what a Medigap or Supplemental Medicare Insurance policy is and what it covers. What it does not cover is just as important to you if you are contemplating whether or not you should purchase a supplement.
The 12 Medigap plans cover basic benefits, but each differs depending upon what state you are in. The twelve plans are labeled A through L, with plan A being the basic policy. Plan B through L offer the same basic coverage found in plan A, and also offer other additional benefits. Plans K and L offer similar coverage as plan A, but the cost sharing is different.
None of the standard or basic Medigap plans cover certain benefits, such as long term care for help with bathing, dressing or using the bathroom. They also do not cover vision, dental care or hearing aids, private duty nursing or prescription drugs. As mentioned, there are other variations based on the state you are living in and receiving benefits from.
To explore the differences and to look for coverage you can contact your state insurance department, or find The Guide to Health Insurance for People with Medicare: Choosing a Medigap Policy.
Another offering is Medicare Select, which is a type of Medigap policy that often costs less than standard Medigap plans. That’s the plus part. The negative is that you can only go to certain participating physicians and hospitals if you need any sort of medical treatment or assistance. To find out if Medicare Select is available in your state, simply call your state insurance department.
Since Medicare Part A is the most basic plan let’s start there. Plan A covers your hospital stay up to 60 days. Starting with day 61, you are responsible for costs through day 150. Since Medicare doesn’t pay at that point, All Medigap plans cover days 61 to 150, though you will have to pay the shortfall, as the Medigap plans don’t cover the entire cost during that time. You will also be responsible for any deductible before Medigap kicks in.
With Part B, you will pay your annual deductible which is $135 in 2008. Medicare then pays 80% of the doctor and other medical services, 50% of some health services and 100% of some preventative services.
Since Medicare does not pay for all services, as described in the paragraphs above, this is where a Medigap policy takes over. Plans B through J cover expenses such as the deductible above, skilled nursing home costs, some deductibles for other services, including at home recovery, preventive care, prescription drugs and foreign travel emergency or urgent care.
As you can see, the expenses that the right Medigap policy covers can offset a lot of out of pocket expenditures. It is an excellent idea to research this type of coverage so that you can see how cost-effective the coverage could be and whether it is right for you. To research the plans more thoroughly you can call Medicare at 1-800-MEDICARE or you can check on the internet at www.aarp.org and www.cms.gov. These sites have links to other information, as well.
Whatever you decide to do, research thoroughly, ask questions, calculate the cost of purchasing a Medigap plan vs. the cost in out of pocket expenses if you don’t purchase one. Get information from your employer, your insurance agent and any other sources on the web. Another great way to get information is to ask friends what type of insurance they have and how happy they are with the coverage.
They say that people spend more time looking for furniture or buying groceries than they do researching their insurance, yet it is your insurance – especially Medigap – that can literally make them or break them. Don’t get caught without protection. Determine what your needs are and then do your homework. You’ll be glad that you did.
Many individuals with disabilities want to go to work and are able to work at a job. This is a very positive thing in many ways. It helps the individual to build their self-esteem and pride, helps them become a more integrated part of the community, it helps the individual become more self-sufficient and it helps the economy.
There is a drawback for many people with disabilities who want to work. The drawback is simply that individuals are worried that they will lose their benefits – especially their medical benefits – if they go to work. It can feel devastating to be willing and ready to work but have to choose between work and medical care.
The truth is, however, that an individual with a disability can begin – and continue – working and still maintain their benefits. States can extend Medicaid to people who are working but who are earning too much money to qualify for Medicaid under the current rules.
A person can qualify if their income is less that 250 times the national poverty level or if they meet the definition of “disabled” under the Social Security Act and would be eligible for Social Security Disability Insurance (SSDI) if they were not working and bringing in an income. An individual can qualify for the buy-in without receiving SSI, and the state would then have to determine whether or not the individual has a disability. The fact that an individual is working will not have a bearing as to whether they are disabled or not.
Another important piece of this equation is the Ticket to Work and Self-Sufficiency Program. In fact, this program is the foundation through which many of these benefits are protected when a person goes to work. The Ticket to Work program allows for and encourages states to cover individuals between age 16 and 65 years old who decide to go back to work and the states can provide Medicaid to individuals who are working who have improved enough to lose their coverage, but still qualify as being disabled.
So, if you are considering trying to work, find out about the Ticket to Work and find out about whether your state will continue your Medicaid benefits. Take the first step toward working by finding out how you can continue receiving your benefits. You can do this by contacting your State Medicaid Office or go online for information at www.cms.hhs.gov and look up Ticket to Work.
The information you discover may make the difference between you being able to work or not.
There are many people that are enrolled in Medicaid and receive benefits, but are not aware of the fact that there are dental benefits available. Dental benefits are available as an option to individuals over the age of 21 who are enrolled in Medicaid. These benefits are a required benefit for individuals under 21. They are a component of the Early Periodic Screening and Diagnostic Treatment (EPSDT) portion of Medicaid.
EPSDT is a mandatory program through Medicaid and it focuses on prevention, early diagnoses and treatment, beginning with children and continuing through the age of 21. Dental services must be provided through this program in an effort to watch for any problems or illnesses and address them before they become worse, or before they become chronic conditions. At the very least, services must include relieving the child of pain and eliminating infection, restoring teeth and helping children and young adults maintain dental health. While some plans (usually private) only deal with emergency dental issues, this is not the case with EPSDT. EPSDT must provide regular services and not only help people when there is an emergency. The idea is that regular treatment will diminish or eliminate dental emergencies, thus keeping the system efficient and not creating additional problems for the client either.
The state sets up dental referrals at various intervals and the dentist is required to do a thorough exam, not just an oral screening only. ESPDT requires that all services covered by the Medicaid program must be provided to recipients as long as they are Medically Necessary procedures or services. In other words, if you have a cavity or need a root canal and it is necessary to be fixed, those services are covered. If, however, you are thinking of getting implants or special veneers, these services might not be covered, since they are often considered “cosmetic” procedures – not only by Medicaid, but by private dental insurance plans, as well. If a condition is discovered during an exam or screening, the state is obligated to provide treatment for that condition, even if it is not covered through the state’s dental coverage.
For further information and answers to your questions, contact Centers for Medicare and Medicaid Services (CMS). You can find them on the web at www.Medicare.gov and www.Medicaid.gov. or you can call them at 1-800-633-4227 (1-800-Medicare).
Let’s face it. When given the choice between a chiropractor and an M.D., many people have been choosing chiropractors during the past few years. They have given many reasons – more cost effective, no drugs, helpful for specific conditions involving the back, legs, neck, muscles and more.
All of the reasons make sense – especially to people who consider chiropractic care to bring the best results for them. Unfortunately, chiropractic care has not been a real priority as far as Medicare goes. That is, however, a situation that is changing.
This week, representatives from state and local chiropractic associations and colleges, health professionals and consumer organizations came together in Washington, D.C., and met with individual doctors at the first National Conference on the use of Chiropractic Care in Medicare.
The conference addressed the demands being put on Medicare, including the fact that it will not be long before over 80 million people will be served by the system. They discussed the fact that now is the time to make adjustments and changes so that Medicare can grow with its beneficiaries.
The conference was important enough for three members of the House of Representatives including Senator Ben Cardin, spoke about differing ways to adjust the program to meet current and future demands. The congressional speakers discussed the difficulty of dealing with limited funding and trying to make sure that they are distributed fairly, especially as the population receiving Medicare benefits continues to grow.
ICA President John C. Maltby, D.C. stated that it would take a great deal of cooperation between beneficiaries, doctors, chiropractors, congress and Medicare to ensure that chiropractic care takes its rightful place in the Medicare system.
Though the conference is a first step, it is a huge step and may very well lead to more choices and improved services for Medicare recipients.
Medicare recipients can look forward to improved delivery of Medicare and Managed Care benefits including medical products and prescription related products through Nations Health. These include diabetes supplies and insulin pumps, and other medical products throughout the U.S. In addition, Nations Health provides education, information and other assistance to Medicare recipients – including details about Medicare Part D.
There are other statements through Nations Health that talk about better, more efficient services and products, however, it is important to keep an eye on things to see if they deliver and how well they deliver what they say they well.
There is hope when a company like Nations Health offers assurance of improvement; however it is not always a guarantee. Various world and national events, including decrease in revenue to Nations Health could cause results not to turn out exactly as predicted.
With the advent of organizations such as Nations Health – as long as their performance is efficient, effective and organized in such a way to truly help Medicare recipients, the results can be positive for all – a win/win situation. Though it may very well turn out to be a plus if the delivery of products and other benefits is improved, it is essential to watch and see what happens.
In addition, when researching any information regarding Medicare, Medicaid or other benefits, it is essential to check the facts, compare various services available and check with the Medicare and Medicaid offices and/or websites. Get a well-rounded, realistic view of what services you can receive and who can deliver them in the best way for your needs.
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