Monthly Archives: October 2012
Medicare is a government run health insurance system available to most people over the age of sixty-five. It is also available in other circumstances to people who are younger if they have certain disabilities. Medicare serves about forty-four million Americans, and about seven million of those people are younger and have a disability that qualifies them for Medicare coverage. Medicare coverage can apply to those who qualify through Social Security Disability Insurance, or because they suffer from either Lou Gehrig’s disease or End State Renal Disease.
Social Security Disability
If you are receiving SSDI, then you are likely eligible for Medicare. Your SSDI benefits are determined through what you have earned via work credits. In many cases, people with disabilities aren’t eligible for SSDI benefits because they don’t have enough work credits.
If this is your situation, and you don’t have access to SSDI through other means, like a family member who qualifies, then you may want to look into Supplemental Security Income benefits instead. This may qualify you for other insurance coverage.
Disability Testing
Qualifying for SSDI involves a very strict test, and there are medical evidentiary requirements and a host of proof that the government requires. If you are between the ages of eighteen and sixty-two, then you have to show your disability has stopped you from working for at least a year meaning you have a qualifying physical or mental impairment, or that you have a fatal impairment.
Medicare Benefits With SSDI
Before you can receive Medicare, you must get SSDI. After you officially qualify, you will wait for five months before you start to receive your cash benefits from SSDI. There will be another twenty-four month wait before you receive your first Medicare benefits. If you qualify for SSDI because you have Lou Gehrig’s disease, then you will begin receiving Medicare benefits from your first month of SSDI. For End Stage Renal Disease qualifiers, you may begin to receive Medicare benefits within three months of your first dialysis treatment.
The End Of Medicare
Because your Medicare insurance is based on your disability, if your condition gets better and you stop being disabled, then you will no longer be eligible for Medicare benefits. The Social Security Administration has a review process for beneficiaries, and periodically your file will be reviewed to determine if you are still disabled. If you lose your SSDI benefits, then you will also lose your Medicare coverage.
Medicare is available to most people ages sixty-five years and older. It is also available to people younger than sixty-five with certain illnesses and disabilities. If you have high risk factors for diabetes and are eligible for Medicare benefits, then you may be eligible for Fasting Blood Glucose tests.
High Risk Factors
There are signs that you may be at risk for diabetes, and some are more severe than others.
If you have any of the following high risk factors, then you will be eligible for Medicare-covered testing:
- hypertension
- obesity
- a history of high blood sugar
- a history of high or abnormal cholesterol and triglyceride levels
Medicare also has a list of questions that may indicate that testing is covered. If you answer yes to two or more of these questions, then you are likely to qualify qualify:
1. Are you sixty-five years of age or older?
2. Are you are overweight?
3. Do you have a family history of diabetes?
4. Do you have a history of gestational diabetes
Diabetes Testing Equipment
There are many different items that you will need to buy regularly if you have diabetes. For example, you will need to have a glucose monitor, testing strips, and lancets. In certain cituations, other equipment like insulin pumps and blood sugar control solutions, and even special therapeutic shoes are necessary.
If you aren’t sure if Medicare covers some of your diabetes equipment, you should check because Medicare may not cover everything. For example, insulin is only covered if you use an external insulin pump. On the other hand, if you have Medicare Part D, you may be able to get some insulin and other medical supplies covered, as well as other oral diabetic drugs. If you aren’t sure if your medication is coverage, check with the Medicare guidelines, or on the Medicare website.
Your Cost and Other Details
Because diabetes treatment is covered under your Part B coverage, you will be able to get your diabetes coverage at twenty percent of the Medicare-approved amount. Of course, that kicks in after you’ve paid your yearly deductible under Part B.
Medicare also covers self-management training, which is available to people at risk for complications involved with diabetes. In order to get this training, you must have an order from a doctor or healthcare provider. Just like your other diabetes treatment, you will pay twenty percent after your yearly deductible.
There are many choices when it comes to your Medicare plan, and you may not understand all of them at first. That’s okay. This is complicated stuff, and understanding won’t come overnight. What you need to know are some basic details about the types of Medicare plans available to you, and what kinds of basic coverage each plan can provide for you.
Original Medicare
The Original Medicare plan is provided by Medicare, and comes in two parts — Part A and Part B. Part A covers hospital insurance, while Part B is medical insurance. There is a difference between the two! Generally speaking, you will have your choice of doctors, hospitals, and health care providers, as long as they accept Medicare. In most cases, you or your supplemental coverage, if you have it, will pay deductibles and coinsurance. Most Part B coverage requires the payment of a premium.
You also have the option of Part D coverage with Original Medicare, which covers prescription drugs. These plans are run through Medicare-approved private companies, and you will pay a monthly premium.
Medicare Advantage
If you go with a Medicare Advantage plan, you’ll have Part C insurance, which is a combination of Part A and Part B. Medicare-approved private companies offer these plans, however you will have to abide by plan coverage rules. That means that you are restricted to the health care providers listed in your individual plan. A monthly premium is typical, and so are co-pays and coinsurance for covered services. Read your plan carefully for additional details.
Medicare Supplemental
There are gaps in the Original Medicare coverage that you may choose to fill in with the use of Medicare Supplemental, sometimes referred to as Medigap. These policies are purchased through private companies, and costs and details vary by plan. Medigap policies are not available to those who elect Medicare Advantage.
There are important differences between these two government healthcare programs, and it is important for anyone who may take advantage of these programs to understand the differences. On the most basic level, Medicare is a social security program that is run nationally, while Medicaid is a governmental program that operates on the state level. Medicare benefits are given to most people at the age of sixty-five, although certain disabled individuals can qualify for Medicare benefits earlier. Your ability to receive Medicaid is also influenced by your income and assets.
Medicaid: The Basics
The Medicaid program is for low-income families, children, and adults who need health coverage. It is offered at no charge to beneficiaries, and is run by your state. Because this program is income-based, qualifying for it is very strict. You must give the Medicaid program proof of all your income and assets, and that includes anything you own. If you don’t report something, you may be denied coverage. Children may be covered under Medicaid even if their parents are not. In fact, children are the biggest recipients of Medicaid benefits, because they are able to receive coverage for vision, dental, hearing, and other health coverage that is not available to adults.
Medicare: The Basics
Unlike Medicaid, Medicare is a more open program, at least if you are receiving it because of age. Most people are automatically enrolled in Medicare at the age of sixty-five, although some people receive Medicare benefits because of disability or certain illnesses. If you are disabled, you may receive up to twenty-four months of disability coverage under Medicare. Medicare is not a free program. Part A is offered at no cost, and covers your hospital care. Part B is also an automatic enrollment, but it includes a deductible and monthly fees.
Can The Two Combine?
Many Medicare beneficiaries are curious about receiving a combination of Medicare and Medicaid benefits. It can be done, and many elderly individuals receive benefits under both plans. If you receive Medicare, you may still apply and qualify for Medicaid. Medicare doesn’t cover 100% of all costs, because you will still have copayments and a deductible in many cases. If you need the assistance, you can use Medicaid to help you make ends meet. This is an option that many elderly patients pursue, especially because Medicaid is free for qualified enrollees, unlike Medicare Supplemental Insurance plans, which may fill in gaps and pay for fees that Medicare doesn’t cover.
When you enroll in Original Medicare, you may notice that there are still some expenses to you. While Medicare Part A is free and automatic, there are monthly expenses and a yearly deductible involved in Medicare Part B. You must also be aware that there are healthcare procedures that Medicare doesn’t cover. What then? The answer is simple. When you buy a Medigap policy, you are buying an insurance plan that aims to cover the gaps left in your healthcare coverage provided by Medicare Parts A and B.
What Exactly Is Medigap?
Medigap, which is also known as Medicare Supplemental Insurance or Med Sup, is a policy that you can buy through private insurance companies to help cover the things that your Original Medicare plan just doesn’t cover. The goal is to give you the most complete coverage possible. While this plan doesn’t come directly through the Medicare system, it is offered only by Medicare-approved insurance companies, and there are federal and state laws that must be complied with in every Medigap policy, including the basic coverage that must be offered.
Who Can Buy Medigap Policies?
This may sound obvious, but the only people who are eligible for Medigap policies are those who are first eligible for Medicare. Medicare covers most people over the age of sixty-five, and some people under the age of sixty-five who are disabled or suffer from certain illnesses. If you are covered under Medicare, and you receive Original Medicare, then you can purchase a Medigap policy. Medigap is not available to those people who elect to receive Medicare Advantage coverage.
When Can I Enroll?
There is an open enrollment period during the first six months following your sixty-fifth birthday and your enrollment in Medicare Part B that an insurance company must sell you a Medigap policy without using medical underwriting. This means an insurance company must sell you a policy and can’t charge you more than someone in perfect health. In most cases you can purchase a Medigap policy outside of the open enrollment period, but you will be subject to medical underwriting and there is no guarantee that you will be offered a policy.
Medigap or Medicare Advantage?
There are two distinct options that Medicare enrollees have to choose from, and you will have to evaluate your options and choose the best coverage and cost for you. You may elect to choose Original Medicare, which is comprised of Medicare Parts A and B, and then fill in the blank spots of coverage with a Medigap policy. Your second choice is Medicare Advantage, which combines the types of coverage for a hybrid policy that is designed for more complete coverage overall.
There is a lot to learn about Medicare, including the various kinds of coverage that are available to participants. It may sounds intimidating but Total Medicare is here to help you navigate the system. You may be happy with your Original Medicare, which includes Medicare Parts A and B, and sometimes Part D. But, if you are concerned with gaps in your Medicare coverage, however, then you may want to investigate Medicare Supplemental Insurance, also called Medigap Insurance.
What Is Medigap?
While Medigap is associated with Medicare, it is not a government run program. Instead, Medicare-approved private companies provide private health plans that give applicants a way to cover the gaps that occur in health care coverage through Medicare Part A and B. That means that you can get coverage that isn’t available through Original Medicare, while allowing Medicare to continue to do its job. You don’t have to sacrifice your classic Medicare coverage in order to get things like dental and certain vision coverage.
The Rules
Of course, because Medigap is approved by the Centers for Medicare and Medicaid Services (CMS), and works in concert with the Medicare program, there are rules that must be followed. These are mostly in place to protect you as a consumer. For example, every program must be compliant with Federal and State laws, and they must all comply with certain coverage requirements. That means that your Medigap plan must be standardized, and must also be identified with the letters A through N. These policies must offer similar benefits, no matter who is selling the policies.
In fact, according to CMS:
“Cost is usually the only difference between Medigap policies with the same letter sold by different insurance companies.”
All of this works to protect you, the consumer.
Buying Medigap Policies
A Medigap policy doesn’t have any overlap with your Original Medicare policies. It is also not available to those people who elect to use Medicare Advantage. Medigap is also not connected with Medicaid coverage. You can buy these policies from many different private companies, and with the guarantee that these companies have been approved to work with Medicare, you will know that no matter what your choice, you will get the coverage you seek.
That doesn’t mean you shouldn’t be careful, of course. Because the policies are standardized, the main difference is cost. Monthly premiums can vary dramatically, so make sure you compare providers and pick one that is both highly rated and low cost.
There are many different types of health care, and one that is particularly important is not always covered by health insurance — dental care. Like many other medical health insurance plans, Medicare’s coverage of dental is scarce. In fact, the general rule is that you will pay one hundred percent of your dental services while under Medicare.
Covered Services
There are a few exceptions to the general rule. While dental care that isn’t covered includes fillings, cleanings, tooth extractions, and dentures, you will be able to get coverage for a couple of procedures with your Medicare plan. These procedures usually have more to do with an underlying health condition that will require medical treatment. For example, if you break your jaw and require your teeth to be wired, Medicare will pay in connection with the reduction of that jaw fracture. These exceptions are minute and very particular.
Dental Exclusion
The exclusion of dental coverage isn’t new. In fact, it was a part of the original Medicare program. The Social Security Act, which governs Medicare, provides for the exclusion of dental coverage in connection with the care of teeth or structures supporting the teeth. That’s why treatment of the teeth or other dental areas related to another health problem may not be covered.
This exclusion is very broad, which leads to the general presumption that dental coverage is zero. Whether you are seeking a cavity filling, routine preventative care, or denture work, you can anticipate paying for everything unless you have supplemental coverage under a different plan.
Discount Dental Plans
Because Medicare does not pay for the vast majority of dental procedures, discount dental plans have been developed as an alternative. These plans are offered at a low cost to individuals who need them, and they often fill in this particular gap in Medicare coverage for those who are enrolled. You will need to be cautious, of course, just like you would be when signing onto any insurance plan. Read all your paperwork carefully and ask a lot of questions. Your covered services under your discount dental plan will vary from plan to plan. You’ll need to follow plan guidelines for choosing a dental provider and for the procedures covered under the plan. Choose your discount dental plan based on your budget and your annual dental needs.
