Posts tagged 'benefits'
There is a lot of confusion regarding the difference between “original” Medicare and Medicare Advantage. This article will discuss the basic differences to help you understand what coverage is available and which plans are appropriate for you.
Medicare is made up of two basic categories Medicare (Original Plan) and Medicare Advantage Plan. Both plans have supplemental categories including Part A, B, C, and D.
The original plan includes Part A. You an add part B and D if you choose to. You will automatically be enrolled in original Medicare when you turn 65, unless you decide to choose Medicare Advantage (Part C). The Original Medicare Plan is managed by the federal government as a fee-for service plan with various options and co-pays.
The Medicare Advantage plan combines Part A and Part B and is provided by and managed by private insurance companies. If Part D coverage, which covers prescription drugs, is not included with the plan you purchase, you can purchase it as a separate supplement.
If you choose to Medicare Advantage plans, there are several types of coverage, including HMO, PPO, plans that include private fee-for-service, and Medicare special needs plans.
Part A covers hospital expenses and does not charge a premium. It also covers inpatient care in skilled nursing facilities, critical care hospitals, regular hospitals, hospice services and hoe health care services.
Part B pays for medically necessary services and supplies covered by Medicare. There is a premium for this coverage for most people. Part B covers outpatient, doctors, physical and occupational therapists and additional home health care.
Part C I the Medicare Advantage Plan which covers Part A and B. Though it is provided by private insurance companies, it is still overseen and approved by Medicare. With this program you may have lower costs and usually receive extra services.
Part D is prescription coverage which is a stand-alone plan. Most people pay a premium for this coverage and all medically necessary drugs are covered. There are different plans that cover different drugs. It is important to compare plans to be sure what coverage is best for you.
To be certain that you have the correct coverage, it is best to contact Medicare at 1-800-MEDICARE r visit them on the web at www.medicare.gov.
Sometimes the age of computers is a wonder to behold. You can get work done and emailed 24/7. It’s convenient to shop on line, apply for jobs on line, send cards and gifts by using online services, and so much more. One drawback is that there is nobody “live” to talk to in many cases, so if there are questions or problems, you’re often stuck with them.
In addition, there are still other issues to be solved. Identity theft and fraud have become much more prevalent and inputting mistakes by you or the company you are dealing with can cost a tremendous amount of time and/or money.
The state of Indiana has some unique problems when it comes to dealing with welfare programs – including Medicaid – on line. One of the biggest issues is that automated eligibility and renewal services are not always accurate, but do not offer alternatives, such as live operators. Indiana has 92 counties and has stated that they will have at least one staffed office in each county.
In the meantime, waiting for the “de-bugging” of he system is creating some serious issues for Indiana Medicaid recipients and recipients of food stamps and other services. ACLU has filed a lawsuit to deal with some of these issues. For example, one woman with hearing problems and other disabilities lost her Medicaid. Why? She was told she could not meet in person with a state caseworker. Another mother lost her food stamps and subsidized health care for her children when the tax return she provided was missing one attachment. It’s hard to believe that she wasn’t simply asked to provide the paperwork. With so much riding on it, it seems logical that she would have provided it, if asked.
Gavin Rose, an ACLU Attorney has stated that there are thousands of these cases, and, of course, they affect the most vulnerable individuals and families. Mitch Roob, of the Indiana Family and Social Services Administration, has said that it is not improper to cut off benefits if the correct paperwork is not turned in. He has also, though, stated that the benefits of these and other people who lost benefits due to the new computerized system, need to have their benefits re-instated if they turn in the correct paperwork.
Rose, of the ACLU says that complete automation creates unfair obstacles for individual with mental illness and other mental health issues, as well as other disabilities, including those with limited education. In each of the cases involved in the lawsuit one of the biggest issues has been that all of the paperwork requested had previously been requested – and the agencies had originals and copies of this paperwork – and still, their benefits were terminated.
This is a situation which will take time to clear up. ACLU, Indiana Family and Social Services and even congress, are all looking into the situation to try to fix the system and overcome the obstacles as soon as possible. If you are having issues such as these – no matter what state you are living in – contact www.medicaid.gov or your local chapter of American Civil Liberties Union (ACLU), or your local Family and Social Services Administration.
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.
This is an important question, because there are a lot of recipients that want to work. There are provisions called “work incentives” for those individuals.
One provision is the Ticket to Work- Work Incentives. These include being able to work during a “Trial Work Period” which allows you to work and see how things turn out. You will NOT lose your benefits automatically during the Trial Work Period; you will receive full benefits no matter how much you earn. You only need to report your work activity.
The Trial Work Period lasts until you accumulate 9 months of work (not necessarily consecutive months) within a 60 month period of time. Once you have accumulated 9 months of work, you can earn up to $900 per month without losing your benefits. For additional 36 months after the Trial Work Period any time your income falls below $900 per month, your benefits will be automatically reinstated.
If you are disabled and working, your Medicare benefits continue for 4.5 years after you begin work, and there is no premium charge for Medicare Part A. Because of the work incentives, the coverage for individuals with disabilities trying to work, is FREE during that period of time.
If you are trying to work and receiving Medicaid, there are provisions available for most states to be able to provide any Medicaid recipients with disabilities. It is important that you check with your state Medicaid office to determine if you can maintain your Medicaid while working.
