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Prescription drugs are the most expensive items in a senior citizen’s medical needs. Even though Medicare Part D offers coverage for prescription medicines, it is not a hundred percent payment for costly medicines. Several out-of-pocket expenses are part of the Medicare Part D plan. Since Part D does not cover all the prescription drugs, these expenses have to borne by the policy holders. Other Medicare expenses relating to Part D include annual deductibles and drug cost co-payments. Most of the Part D plans have an annual deductible of $250 and a 25% co-payment. This 25% co-payment is applicable until the enrollees have reached $2250 limit in drug expenditure. Up to this limit, the out-of-pocket expenses are $750. But, once the beneficiaries cross the $2250 limit, the enrollees will be paying hundred percent of the drug cost which can be very expensive for people with limited income or resources. This coverage gap that defines the range of drug expenditure is often called the Doughnut hole. Because of this factor, it is observed that a number of senior citizens have not enrolled in the Part D plan. This will eventually lead to a rise in the premiums of the existing policy holders. However, not all purchases are considered as out-of-pocket expenses. The following instances do not come under the out-of-pocket expenses criteria: purchase of drugs that are not covered by the chosen plan, purchase of prescription drugs during travels from a pharmacy outside the plan area or network, using other medical insurance plans that the individual holds to buy prescription drugs, and purchase of medicines from other countries. In all these... read more
Medicare is touted as the best option for medical care in old age. Unfortunately, it does nothing in terms of long term care. Medicare long term coverage is not realized as this is a very costly affair for the federal government. The maximum number of days that Medicare can take care of medical care is 100 days’ stay in hospitals or nursing homes as inpatients under the Medicare Part A plan. Even in this case, only the first twenty days are fully covered by Medicare; the remaining eighty days’ payments are made on a co-payment basis. All expenses beyond this limit are borne by the individual. Long term care insurance becomes a necessity for majority of people aged 65 or over. It is estimated that the average visit in a long term care facility is about 2 ½ years or 900 days. And, Medicare cannot pay for such a long term with the limited premiums. Individuals are encouraged to find alternative insurance plans that cover long term care in medical facilities or at home. The eligibility criteria for long term care insurance state that the person must be unable to complete any two of the six “activities of daily living”: eating, bathing, continence, dressing, toileting, and transferring (such as from a bed). Other categories of people eligible for long term care insurance include those with Alzheimer’s disease or cognitive impairment. People with a doctor’s approval that they need additional care for at least ninety days are also eligible for this insurance. Long term care insurance provides you the flexibility to choose the type of medical care you prefer to... read more
Poverty alone cannot ensure you that you are eligible for receiving Medicaid benefits. About 60% of poor Americans are not covered by Medicaid just because they do not qualify the criteria for eligibility to get Medicaid services. Therefore, it is essential to know what the different aspects of Medicaid eligibility are and who can apply for Medicaid benefits. Medicaid is a federal and state government joint venture to provide medical insurance coverage to the people belonging to the low income and resources group. Even though Medicaid is a federal and state government funded initiative, the rule regarding eligibility and the range of coverage differ considerably for each state. However, some common criteria are applicable in all cases. The most important factor in deciding the eligibility for Medicaid is income and resources. The income threshold may be different for the various states of the country. The calculation of one’s resources also has slight variations from state to state. Usually, the factors that are considered while assessing the resources are bank accounts, real estate property like land and house, and other assets and items which will make cash if sold. The State Medical Assistance office may help you to assess your eligibility for Medicaid plan. If you receive Supplemental Security Income from the Social Security Administration, you could be eligible for Medicaid depending on your state’s rule. Other factors that affect the eligibility for Medicaid are age, residency, citizenship or legal status, pregnancy, and family size. Low-income families with children, children under 19 (in some states 21), pregnant women and the child born when the mother is on Medicaid, single parents,... read more
Preferred Provider Organizations (PPO’s) are Managed Care Organization (MCO) that contract with a network of doctors, hospitals, and other health care providers. This agreement allows treatment at a reduced cost. In other words, Preferred Provider Organizations offer discounts to visit health care providers, within their provider’s network. Two most important characteristics of PPOs are: The first important characteristic of PPO is that it allows its plan members to visit any doctor or hospital without referrals from the members’ Primary Care Physicians (PCP). In other words, it is just opposite to another popular type of managed care plan, HMO (Health Maintenance Organization), which needs referrals from a PCP. Another appealing characteristic is the flexibility to visit or choose doctors and hospitals outside the network. But it also has some limitations—visits outside the network are not fully covered as visits within the network; thus require higher payments from patients. Despite of above mentioned facts, both these characteristics (no need to referrals and flexibility to choose outside the network) are very appealing to many employees. So, if you wish to avail any of these appealing characteristics, then it’s worth your time to consider PPO as a part of your health benefit package. In sum, PPO’s are virtually having all the advantages of managed care health insurance and fee-for-service health insurance. The only disadvantage is that you must have to pay full rate for physicians and hospitals outside the network. So if you agree to pay for your choice, then PPO’s are the best option for you. Points To Be Considered: Checking and evaluating the network of doctors. When evaluating a Preferred Provider... read more
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
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
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 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
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
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
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MedicareHelp.org is a privately-owned Non-governmental agency. The government website can be found at HealthCare.gov.
Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. Enrollment depends on the plan’s contract renewal.
Every year, Medicare evaluates plans based on a 5-star rating system.
