What is Medicaid?
Medicaid is meant for people with limited income and resources, including children and disabled. It is a joint federal and state government funded initiative to support the medical needs of the impoverished. However, poverty is not the only eligibility criteria for receiving Medicaid benefits. The factors that determine a person’s eligibility for Medicaid include pregnancy, disability, age, blindness, income, resources, and U.S. citizenship. Applicants for Medicaid for the aged, blind, and disabled should meet the eligibility requirements set for each category; aged people must be 65 or above; blind and disabled must meet the definition of blind and disabled given by the Social Security Administration. Similarly, children must be under the age of 19. The resources that are considered for eligibility are bank accounts, land or house, and other sale-able assets or items. An evaluation of the circumstances and income is performed by the State Medical Assistance office. If there is an increase in the beneficiary’s income, it has to be reported to the authorities to effect eligibility changes; any failure in this will affect future eligibility. The rules regarding income and resource eligibility can differ from state to state and the Medicaid programs also will vary accordingly. Medicaid has more extensive coverage than Medicare, especially in the case of nursing home care. It is also considered as the best long term care insurance plan for the low income group. The only limitation is that the number of facilities that come under the Medicaid program is less. The cost of medical services under the Medicaid program is shared by the federal and state governments; while the federal government pays... read more
Choosing a Medigap Policy
Now that you’re on Medicare, all your health insurance worries are over, right? You think you’ll never have to make a decision about health insurance again, or be concerned about how to pay premiums for coverage, or pay exorbitant fees for services? Think again. There are gaps left by traditional Medicare – you could end up paying thousands out of your own pocket if you don’t have a supplemental insurance policy, also known as a “Medigap” policy. Let’s take a look at what Medicare covers, and more importantly, what it doesn’t cover. Medicare is a Federally provided health insurance program for American citizens over the age of sixty-five or citizens with certain disabilities. It’s a “fee for service” arrangement, which simply means you may go to any health care provider: doctor, lab, hospital, etc., that accepts Medicare, pay your deductible and your share of cost, and Medicare pays its share of cost. There are two parts to Medicare: Part A and Part B. Part A covers the “hospital-type” expenses: inpatient care in a hospital or skilled nursing facility, home health care and hospice. There are certain limits, such as it covers only the first 60 days in the hospital, and you pay a deductible and a co-payment. Part A is generally premium-free, and almost everyone qualifies for Part A. Part B is the “medical-expenses” portion: doctors, ambulance, X-rays, kidney dialysis, outpatient therapy, emergency care, artificial limbs, medical supplies, neck braces, etc. There is an annual deductible for Part B, and it is optional. Premiums vary each year, and are typically deducted by your Social Security check. Because not all... read more
Cancer Expense Coverage
Are you at risk of developing cancer? The American Cancer Society says that women have a 1 in 3 lifetime risk of developing some form of cancer; men have a 1 in 2 risk. A family history of cancer or a smoking habit can increase those risks. Is your basic health insurance coverage enough? Cancer expense insurance is a relatively new type of coverage offered by some insurance companies – it’s designed to give you supplemental coverage, typically in the form of cash payments direct to you, in the event you’re diagnosed with certain types of cancers. Is it worth the additional cost? Let’s take a look. Your basic medical insurance coverage may not be enough, if you’re stricken with a catastrophic illness such as cancer. Most medical insurance plans have deductibles and co-payments, for everything from prescription drugs to hospital and doctor’s fees, to lab tests and nursing care. As the costs of treatment for illnesses such as cancer continue to skyrocket, health insurance carriers are forcing insureds to pay more of the costs out of their own pocket. Your plan may have an out-of-pocket expense maximum, but if it has no upper limit, you could be under-insured. For example, say you have a PPO plan with a $1,000.00 deductible and a 20% out-of pocket co-payment. If you’re diagnosed with leukemia, and put on chemotherapy, you’re total cost of treatment may be in excess of $100,000.00 If your insurance company pays only 80%, your out-of-pocket cost could be more than $20,000.00. Do you have the resources to pay for that yourself? If not, cancer expense insurance is something... read more
Unproven Medical Treatments Effect Elderly
Unproven and untested medical treatments are a 20 billion dollar a year business. “Miracle cures” are announced weekly, if not daily. Internet marketers trumpet the benefits of their latest creation, while infomercials on late night television persuade, cajole and outright misrepresent the assertions of whatever product they’re promoting. Who is all this marketing aimed at? Why does it work so well? And most importantly, is it dangerous to your health? According to a House Subcommittee report on Health and Long-Term care, more than 60% of people who try unproven treatment are above the age 65, and they spend billions on useless treatments. It’s been estimated that just about 80 percent of retired people have at least one chronic health problem; their distress and infirmities can lead to depression and despondency, making them targets for scam artists and those selling the latest craze in health care. But the elderly aren’t the only ones purchasing these products: from weight loss to hair replacement gimmicks to vitamin supplements, younger people as well are opening their checkbooks and spending big bucks on these remedies. It’s enough to drive the FDA (Food and Drug Administration) crazy, since they’re the agency that regulates such activity. Trying unproven or untested treatments can not only be a waste of time and money, it can also be dangerous. The danger lies in two areas: direct health hazard or indirect health hazard. Direct health hazards are just that – the product can actually cause some action or reaction that endangers the health of the person using that product. For example, back in the early 1990′s, the herb Chaparral was... read more
Early Retirement – Health Insurance
Well, you’ve finally reached the big day. You’re employer is throwing you a big retirement party, and then you’re going to go fishing every day. Or play bingo. Or travel. Retirement is supposed to be a joyful occasion – the start of the rest of your life. All too often, it brings its own set of problems and concerns, not the least of which is health insurance. Early retirement in particular, before age 65, when you become eligible for Medicare, can present some interesting challenges in the area of health insurance coverage. It’s a fact of life: as we age, things start to go wrong with our health. Just at the time in life when you’ll probably need more insurance benefits, you’ll find the options are limited. Some things you need to consider before making the decision for early retirement: If your employer offers retirement benefits for health insurance, are you sure the company will be around for a long period of time? What if they go out of business and don’t pay your health insurance premiums? What if your employer doesn’t offer retiree health insurance? What if you can’t afford to pay the premiums for an individual plan? Early retirees have four choices when it comes to health insurance: Use your employer-paid health insurance Purchase an individual health insurance policy Continue coverage under COBRA Go without health insurance coverage Use your employer-paid health insurance – The first thing you need to find out is if your employer offers this benefit. Is it part of your benefits package? And if it is, check out the coverage very carefully; many... read more
What is Maternity Health Insurance Coverage?
Most people assume that an expensive health insurance issue, such as maternity coverage, is automatically included on health insurance policies. You may be surprised to find that pregnancy/maternity expenses are not covered on all insurance policies, and in fact, can be a costly additional premium, or not available at all via many insurance companies. How do you protect yourself, or your partner, if she is pregnant or thinking about becoming pregnant? First, find out if your current health insurance includes maternity coverage. Most group plans through employers and organizations (churches, trade associations, chambers of commerce) do include this item, as a service to the participants. If it does include maternity expenses, you’re in the clear. If you currently do not have insurance, or your insurance does not carry the maternity option, and you plan to start a family in the near future – you need get organized. As stated above, not all insurance companies offer the pregnancy option, and if they do it may be pricey and may include a waiting period of 3 months to one year before conception. So if possible, plan ahead before you become pregnant and are without insurance. If you are already pregnant and do not have insurance, you are at an extreme disadvantage. You will probably have a very hard time finding an insurance company who will insure you, or may insure you, but will exclude any maternity costs. But, you do have a few options. Because employers’ healthcare plans usually include maternity coverage, you may want to find a job with a decent insurance plan, just so you have some type of... read more
Health Insurance Alternatives for the Elderly
It’s estimated that one in eight Americans is age 65 or older, comprising about 12% of the population. According to the CDC (Centers for Disease Control) by the year 2050, that figure is expected to increase to 20% of the overall population. As baby boomers age, health insurance alternatives become an increasing concern. As it stands now, your health insurance alternatives when you reach age 65 are largely determined by your income, assets and budget. The less you have of all three, the fewer your options. Let’s look at what’s available. Medicare – This is the government-administered health insurance program for people 65 and older, some younger people with disabilities and people with end-stage Renal Disease (ESRD). Approximately 40 million people are currently enrolled in Medicare. Basic Medicare is a traditional fee-for-services program, which simply means you can go to any health care provider that accepts Medicare. You pay deductible and your share of cost, and Medicare pays the rest. There are two parts to Medicare: Part A and Part B. Part A is the “hospital insurance” portion that pays for things like inpatient hospital care, skilled nursing facility and home health care and hospice, within certain limits. Part B is the “medical insurance” portion that pays for X-Rays, prescription drugs, doctors, ambulance and the like. Medicaid – is the jointly funded federal and state program that fills in some of the gaps under Medicare. Each state administers its own Medicaid program, setting its own guidelines for who is eligible as well as individual co-payments and deductibles. Because each state is responsible for its own eligibility criteria, there are... read more
Long-Term Care – Are You Covered?
The National Council on Aging conducted a survey that concluded “more Americans worry about paying for long-term care than paying for retirement”, but the study also found that 70 percent of those surveyed flunked a quiz about the basic facts of long-term care. Almost half of those surveyed said they had done little or no long-term care planning. As America ages, long-term care becomes a critical issue. The assumption that a close relative (daughter, son, etc.) will provide care may not be a valid one. Pressures of jobs, work-related issues such as travel, lifestyle changes and impact on the caregiver; all can make caring for a family member impractical or undesirable. As a consumer, you can’t rely on Medicare, Medicare supplements or basic health insurance plans to pick up the cost of long-term care. Long term care provides to the needs of people with disabilities or chronic illnesses. If you develop Alzheimer’s, have a stroke or advanced diabetes, for example, you may need assistance with every-day tasks such as bathing, dressing, eating and toileting (moving on or off the toilet). Long-term care insurance helps compensate for some of these services, depending on the coverage you choose, in a variety of settings: from your own home to a skilled nursing facility or an assisted living facility. In most cases, health insurance plans through your employer won’t cover long-term care costs. Neither does Medicare in any significant way, although it will pay for some short term professional care. Medicaid, the federal/state program for people on limited incomes and having minimal assets, will pay for long-term care, but you must use up... read more
What is a PPO?
A PPO (Preferred Provider Organization) is a managed healthcare system popular throughout the United States. Similar to its cousin the HMO, Health Maintenance Organization, PPO’s provide a high level of healthcare, as well as a variety of medical facilities available to all participants. Unlike the HMO however, a PPO is actually a group of doctors and hospitals that work under one umbrella (called the PPO), to provide medical services at a discount to the PPO participants. By granting discounts to the participants via an insurance company, the insurance companies are able to entice people to join the PPO by offering financial incentives. These incentives may include: greater discounts for medical services performed by in-system doctors; lower deductibles and lower co-payments. Also different from traditional HMO’s is that PPO users pay for services at the time of the visit and are reimbursed some of the cost by the health care provider at a later time (though many PPO doctors prefer to invoice the healthcare provider directly). The percentage of reimbursement depends on the healthcare policy, a previously established rate agreement, and whether the doctor/hospital is within the PPO network. Unlike the HMO systems, PPO participants may utilize any doctor they wish, and are not required to select a primary care physician (PCP), and do not require authorization from that PCP before the enrollee seeks medical assistance for any ailment or malady. However, PPO enrollees are urged to select doctors within the PPO system, by way of higher reimbursement and lower co-payments. The disadvantage of a PPO healthcare system is the out-of-pocket expense to the enrollee. Because a percentage of each... read more