There are 2 primary government payers: Medicare and Medicaid. Medicare is for individuals who are 65 and older and disabled. Medicaid covers low-income individuals and families.
Medicaid and Medicare can offer a wealth of reduced health care cost or even no cost at all. However, every situation and individual circumstance can be different, that leads to different costs. There are several things you might need to remember and take note of when you have coverage through Medicare or Medicaid, they have been provided below:
Government Health Options with Medicare
Medicare is not entirely free. Part A (Hospitalization Services) is usually free, if a beneficiary has worked long enough to qualify them as having earned enough credits to receive Part A for free, they won’t have to pay a premium. A beneficiary will have to pay a premium for Part B (medical insurance). This amount varies depending on wages earned. Higher income wage earners will pay higher premiums to have Part B coverage. If a beneficiary has both Part A and Part B, this is referred to as original Medicare.
What Medicare Covers
Medicare covers more than the elderly. Medicare can cover individuals who are disabled or who have an end-stage renal disease. Medicare now offers preventative care visit, where you get a 1-time physical. You have to have Part B coverage and you need to have the visit within the first month of having Part B coverage. Medicare wellness visits are slightly different, the focus is more towards prevention planning, and offered on an annual basis.
Who Medicare Covers
To be eligible you for Medicare at age 65, your or a spouse had to have worked and paid Medicare taxes for at least 10 years. You also have to be a US citizen or legal resident of the United States. Medicare has gaps in coverage. If you have original Medicare then purchasing Medigap plans can help cover the cost of coinsurance and copays. If you decide on Original Medicare, then you may need to purchase Medicare Part D, which is the prescription drug option. Medicare Part C or Medicare Advantage is the alternative to Original Medicare. This plan, like Original Medicare, has deductibles, coinsurance, and copays but at a lower cost. Individuals with both Medicare and Medicaid are referred to as “Dual-Eligibles”.If you don’t enroll in Medicare during the initial enrollment period, then you could be penalized for late enrollment. The Part B penalty could go up 10% for every 12 month period that you were eligible but didn’t enroll.
Government Health Options with Medicaid
Medicaid covers low-income families and individuals that include, pregnant qualified women and children, individuals with disabilities and seniors with households below certain poverty levels. When spouse #1 is institutionalized, it can create a great hardship on the spouse #2 who still resides in the home. The cost of nursing homes can wipe out financial resources relatively quickly. This can leave the spouse #2 without enough financial resources to meet household obligations. As a result, the “spousal impoverishment” provision protects a certain amount of the couple’s resources.
What To Consider With Medicaid
Medicaid will seek reimbursement from your estate for a person 55 years and older. Individuals can receive services such as skilled nursing home care or home and community-based services, inpatient hospital services as well as prescription drug services. Medicaid may seek to recover payment for the services under certain conditions. There are exceptions to the law, as an example, if the enrollee has a living spouse, disabled adult child or child under the age of 21, Medicaid will forgo recovery efforts. If a Medicaid enrollee is permanently institutionalized, Medicaid can plan a lien on your property unless your spouse, disabled adult child or child under 21 live in that home. Medicaid will release the lien if the enrollee returns home.
What If The Insurer Has Other Insurance
Although enrollees may have other insurance in addition to Medicaid, the other insurance is always responsible for paying first on any eligible medical expenses. The law protects Medicaid and makes them a payer of last resort. If a Medicaid enrollee has transferred assets for less than the fair market value within the last 5 years and now requires long-term care services (LTCS), Medicaid may deny coverage. As an example, if a parent gifts a child $10,000 within the last 5 years and ends up needing to go to a nursing home, the coverage will be denied by Medicaid.
The Costs Of Medicaid
Medicaid is not free in every state. Some states have the option to impose cost sharing. This means that enrollees may be responsible for some out-of-pocket expenses for premiums, deductibles, coinsurance, and copays. Under certain conditions, some groups of individuals, such as children under 18 or individuals receiving hospice care, are exempted from out-of-pocket expenses. There are also certain medical services that are exempt such as Emergency, Family Planning, and Pregnancy. Cost sharing can’t exceed 5% of the family’s income.
Qualifying for Cheap Insurance to Cover Your Healthcare Needs
Qualifying for cheap insurance is an important step toward getting an affordable health insurance plan. Qualifying for cheap insurance to cover your healthcare needs is easy if you are eligible for government healthcare plans under Medicare or Medicaid.
How to Qualify for Cheap Insurance
You may prefer qualifying for cheap insurance to cover your healthcare needs by applying for a short-term health insurance plan, rather than a comprehensive healthcare plan. The problem with a short-term healthcare plan is that the tax penalties that can be avoided under the Affordable Care Act when you take a comprehensive health insurance plan, are not applicable to short-term health insurance plans. You can qualify for subsidized healthcare insurance plans only if you have a low income.
Other Means To Qualify
You can also qualify for a low-cost health insurance plan if your employer subsidizes your health insurance. You need to be a full-time employee to get the benefit and it is not applicable to part-time employees. You may be eligible for low-cost health insurance if the employer of your spouse subsidizes the health insurance of the spouse of the employee. You may qualify for coverage under the healthcare plan of your parent if you are less than 26 years of age or if your parent has a job-based health insurance coverage plan.
Applying for Insurance Companies
Before applying for insurance companies to ensure your health, you must shop among the many available health insurance plans. There are many online portals that have tools that help you apply for insurance companies that have the best plans for your specific needs. You will need to fill a form on the portal and the tool will give you a list of plans offered by insurance companies in your location that suit your requirements. Once you find the best medical insurance plan that gives you coverage for all your health needs and charges an affordable premium, you can start applying for insurance companies that give you a good insurance plan.
How to apply
You can apply online on the website of the insurance company or phone the insurance company or download the application from the website of the insurance company, print the application out fill it and mail it to the insurance company. You can also visit the representative of the insurance company or have the representative visit you and apply for your chosen plan in person after discussing the plan or other plans with the insurance company’s representative.
The Difference Between HMO and PPO Insurance
One consideration to be kept in view while applying for health insurance is whether the plan is an HMO or a PPO plan. Both types of plans have their advantages and drawbacks. You should the plan that works well for your unique healthcare needs. The difference between HMO and PPO is that HMO or Health Maintenance Organization allows you to go to one primary physician who will refer you to a specialist if required. While a PPO or Preferred Provider Organization allows you the flexibility of going to a specialist without the need for a referral from a primary care physician. The difference between HMO and PPO insurance is that HMO is cheaper than PPO insurance plans but does not give patients freedom of choice. PPO plans usually cost two to four times more than HMO plans. The difference between HMO and PPO Insurance is that HMO plans are comprehensively coordinated and you don’t have to submit claim forms while with a PPO plan you need to submit claims for services that are out of network.
Calling in Claims to your Insurance Provider
There are two ways for calling in claims to your insurance provider when you have a health issue that is covered under your health insurance plan. The first method of filing a claim is by requesting your medical services provider, physician, specialist or hospital to send the claim directly to the health insurance company. The other method of calling in claims to your insurance provider is to send the claim yourself. You may have to file a claim yourself if the medical services provider is not one of the providers in the network of the insurance company.
How to Submit the Claim
You can submit the claim online or visit a representative of the insurance company to help you file your claim. If you submit your claim online, the payment may be faster than a direct claim. Insurance companies give a time frame to make payments and you should contact them if the payment is not received within the time frame.
Created by health and insurance professionals, Gov Health Option provides a one-stop source for healthcare from insurance, Medicaid, Medicare, and options for children. Let Gov Health Option help you understand your health care options.