Recently, we have all been overwhelmed with talk about the proposed healthcare reform that many Democrats want to pass. President Barack Obama and volunteers that comprise of e-mail lists of the volunteers used during the elections and supporters of Barack Obama during the campaign have been on a major mission to pursuade patients, doctors, and politicians to join them.
The idea is to “cover all Americans”, mostly through government mandates to purchase insurance.
We currently have little information but still, there are already many supporters of the plan, but some others are not comfortable with parts of the proposed plans. Many who support the plan bring up the fact that there are many in this country who are uninsured.
This is where Medicare and Medicaid come up.
Medicare is a system of insurance that assists the elderly who are eligible for social security payments. While no system is infallible, many who are on Medicare are satisfied with it. For the elderly who wish to get what they consider better care, they are able to get supplemental insurance from many private insurers, often at a discount. Many senior citizens choose this option, and many who live in a single-payer system would also prefer to supplement their insurance with this option. Medicare is also available to the disabled.
Medicaid is a health insurance program for low-income people. States are required to cover many that wish to have insurance whose income is at or below the poverty level. They may cover those that make more as well, and often cover people with higher income levels if they are minors, are pregnant, infants, and others, and are required to cover children under 6 and pregnant women who make 133% of the poverty level or below. Children in foster care and some children who are adopted also receive Medicaid. Most states go beyond these federal mandates and choose to cover a much wider group of people.
The idea that all people who do not have insurance are too poor to afford it is not entirely true. Those that are too poor to afford insurance are covered by a state program, in the same way that people that are too poor to afford food are covered by programs to assist in that matter.
There may be some who have fallen on hard times and have bills to pay, but the idea of “repossessing” medical care will remain in science fiction movies and has not been a way of life for the American people, and people have bills of all sorts, not just those that are medical. The idea that someone is too poor to afford medical care, either in insurance form or with actual doctors, is more of a matter of personal opinion, as most who are actually poor are already covered with a government program.
This is where the issue comes in. I had a friend with two children and a mother who was ill. She took care of all of them - alone. They all went without health insurance for several years, even though the mother was very ill and had been in a serious accident leaving her with brain damage. With all that, high blood pressure and some other serious problems, the mother was denied medicare. The friend, who was taking care of her family made just enough so that they couldn't get medical help but she didn't qualify at work. When her son had to have emergency knee surgery, they finally gave her CHIP for her kids and gave her mother PCN which is a very, very, very scaled down version of Medicare - totally bare bones. Basically, it helped with her prescriptions.
At any rate, people think that the poor and the elderly are all insured and taken care of. That is not true. It is a fact that over 50% are, but it is also a fact that those who make even $10 too much are often denied care even if their doctor pleads for it.
Hopefully everyone from the president down on the left or the right will leave politics out of the heathcare issue and make sure everyone who needs it is taken care of with the new legislation.
Medicaid was designed to cover low income individuals and their families for hospital services ( in and out patient), laboratory services, x rays, home nursing care, doctors services, physical therapy, hospice and rehabilitation care. Medicaid recipients must go to a Medicaid-approved doctor who is on the Medicaid list. Sometimes, in some areas, there are a limited number of doctors that accept Medicaid, so some individuals have to search carefully and, once they find the right physician that they are comfortable with that are Medicaid approved and accept Medicaid for payment. As a result, there is often a waiting list for an appointment, even if it’s an urgent situation. In a serious emergency, the doctor’s office may take you right away and “squeeze you in” to their schedule. More often, they send you to the emergency room, which ends up costing you, taxpayers, the community, the hospital and Medicaid more money than if Medicaid reimbursed good doctors enough money to be able to enroll and appoint more, thus eliminating some of the long waiting line.
Federal laws state that if you become eligible for Medicaid, which is based on income and need, the states may not reduce other welfare benefits you are receiving. In addition, we have been hearing a lot about trying to exclude legal immigrants from Medicaid system. The problem with this is that Medicaid only requires – by law – for an individual to establish and prove residency (and meet low income requirements) to apply for and, if approved, receive Medicaid benefits. States cannot impose citizenship requirements on anyone who needs Medicaid benefits. Regardless of age or whether or not the individual works is not a reason that Medicaid can use to eliminate you from the program.
Unfortunately, these situations are taking place in a number of states. If you or someone you know feels that they are not being treated fairly regarding Medicaid benefits, you can contact some places that can help. Information is available to you through www.seniorlaw.com.
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.
When you become eligible for Medicare at age 65 or because of a disability, you will automatically receive original Medicare benefits.
Something you may not realize is that depending upon the state you live in, you may be entitled to two other choices. These choices provide more coverage for issues that original, basic Medicare does not cover.
One choice is Original Medicare with supplemental insurance, such as a Medigap or retiree plan. The other choice is a Medicare Private Health Plan, also known as a Medicare Advantage Plan, such as a Health maintenance Organization (HMO), a Preferred Provider Organization (PPO), a Point of Service Plan (POS), a Provider Sponsored Organization (PSO), a Private Fee For Service Plan (PFFS), a Special Needs Plan (SNP) or a Medicare Medical Savings Account (MSA).
All of these plans provide various forms of coverage that is different than original Medicare. In addition to these plans, Medicare Part D is available to cover prescription drugs. If you are covered by original Medicare, it is important that you find additional coverage that will work well with your coverage. Often, a stand-alone prescription plan that only covers drugs (PDP) is the best choice.
A Medicare private health plan can be obtained to fulfill the health plan’s benefit package that covers drugs. If you join a PFFS without drug coverage or an MSA, you can get stand-alone drug coverage.
Regardless of which type of plan you decide on and depending upon what is available to you where you live, it is essential that you research available plans and coverage and decide what will be the best for your situation.
