News & Articles Category: Medicare
A state and federally-funded health insurance program, Medicaid is designed to help low-income adults, children, pregnant women, and seniors get the medical care they need. To be eligible for benefits, recipients must meet the required income level and family size.
Eligibility
Income-based eligibility is determined using the federal poverty level, which is updated annually. Since 2014, when the Affordable Care Act passed, Medicaid eligibility has expanded. In addition to placing income requirements on recipients, states may charge enrollees a premium, along with copayments, deductibles, and coinsurance for benefits. Children and pregnant women are excluded from many of these fees, but all applicants must meet state and federal requirements concerning residency, immigration status, and documentation of U.S. citizenship.
Coverage
While Medicaid varies from state to state, each must meet certain mandatory federal minimum requirements. The program pays for basic inpatient and outpatient hospital services, nursing and home health care, laboratory and x-ray services, pediatric care, and necessary medical equipment. Many states have expanded the mandatory federal minimums to include benefits for physical, occupational, and speech therapy, optometry, podiatry, dental and vision care, chiropractic services, hospice care, and more. Benefits are provided through Medicaid that are not covered by Medicare, such as personal care and homemaker services. Medicaid covers out-of-pocket expenses associated with Medicare, like premiums, deductibles, and coinsurance.
Dual Enrollment
Dual eligibility in both Medicaid and Medicare is common, and millions of seniors receive benefits from both programs. As a Medicare recipient with low income, Medicaid may be able to help pay for out-of-pocket expenses associated with Medicare. Medicaid often covers treatment and services not typically covered by Medicare, such as prescription drugs, eyeglasses, and hearing aids. If you qualify for Medicaid benefits, you may be eligible to receive retroactive coverage that can help pay for medical debts you incurred up to three months before applying.
References:
https://www.medicaid.gov/medicaid-chip-program-information/by-topics/eligibility/seniors-and-medicare-and-medicaid-enrollees.html
https://www.medicaid.gov/medicaid-chip-program-information/by-topics/cost-sharing/cost-sharing.html
https://www.medicaid.gov/medicaid-chip-program-information/by-topics/eligibility/eligibility.html
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News & Articles Category: Medicare
While the Affordable Care Act (ACA) was signed into law in 2010, there is still confusion, particularly in the senior community about how the healthcare law impacts Medicare coverage.
Not Replacing Medicare
The new law established a Health Insurance Marketplace (online exchange) where consumers can go to purchase healthcare coverage. Many seniors are concerned that they are now obligated to purchase coverage through the Marketplace. Medicare isnāt part of the Marketplace. If you are enrolled in Medicare or have a Medicare Part C plan, your coverage will stay the same and you will never need to obtain your benefits through exchanges. It is against the law for anyone to knowingly sell you a health insurance plan through the Marketplace if you are currently enrolled in Medicare.
Essential Coverage
The individual mandate as described by the ACA can be confusing. While it is true that some people who are uninsured or underinsuredĀ will be required to pay a penalty, seniors on Medicare do not have to worry. Medicare is considered āessential coverageā and recipients will not be required to add healthcare coverage to an existing plan. Since most seniors are eligible for Medicare coverage at 65, as long as you are enrolled, you will not be responsible for paying a fee under the Affordable Care Act.
Preventive Care
The passage of the Affordable Care Act also means more services for seniors in Illinois, on Medicare, particularly preventive care. Medicare is now required to cover a host of services at no additional cost to you, including immunizations, mammograms, colonoscopies, annual wellness visits, and more ā all without a co-pay.
Prescription Drugs
The coverage gap, also called the ādonut holeā that many seniors experience with prescription drug coverage can make it challenging to afford medication. Provisions of the Affordable Care Act require Medicare to pay more, which reduces costs for seniors entering the gap. The ACA plans to eliminate the donut hole completely by 2020, but until then, seniors enjoy a 55 percent discount on covered brand name prescriptions and a 35 percent discount on generic drugs until out-of-pocket limits have been reached. While prescription drug costs have decreased for most recipients, costs have increased slightly for individuals who earn more than $85,000 and couples earning $170,000 or more.
References:
https://www.medicare.gov/Pubs/pdf/11493.pdf
MUC18-2016-BCBS
News & Articles Category: Medicare
As a senior about to retire and eligible for Medicare and COBRA, understanding your options will help you decide which coverage is best for you.
COBRA
Consolidated Omnibus Budget Reconciliation Act, was passed by Congress in 1985 to protect qualified beneficiaries and their dependents from losing health coverage abruptly should group health insurance stop. Benefits are typically available when a qualifying event occurs, such as a divorce or legal separation, death of a covered employee, retirement, or, in some cases, eligibility for Medicare.Ā
Current Coverage
Seniors often delay signing up for Medicare Part B if they have comparable health insurance, COBRA is not considered comparable coverage. If you wait to enroll in Part B until your coverage ends, you will pay a late enrollment penalty. If you have coverage at the time you become eligible for Medicare, sign up for Part B to avoid the late penalty. Enrollment in Part B triggers open enrollment rights for Medicare Supplement. You will have six months from the date you enroll in Part B to choose a plan without regard to your current health condition.Ā If you have COBRA before enrolling in Medicare, your benefits may end on the date you sign up for Medicare. However, your spouse and dependents may be able to keep coverage for up to 36 months. You may be able to keep benefits for services not provided by Medicare. For example, if dental or vision coverage is provided, you may be able to continue paying for benefits for as long as you are entitled.
Enrolled in Medicare
You may have already signed up for Medicare when benefits are made available to you. You can sign up for coverage even if you are already enrolled in Medicare. Medicare becomes your primary payer, while COBRA acts as your secondary payer. However, you will be responsible for both the Part B premium and your COBRA premium. Maybe your benefits include prescription drug coverage or vision care. With Medicare, these services are not included but are extra. You do have the option to turn down coverage benefits. But, if you have dependents who rely on you for health coverage, be sure to consider your options carefully. Only applies to companies with 20 or more employees. If you are planning on retiring or leaving employment where it is offered, you should receive a letter notifying you of your rights and offering you the option to elect continuation coverage. Typically, benefits extend for 18, and in some cases, 36 months.
References:
https://www.medicare.gov/supplement-other-insurance/how-medicare-works-with-other-insurance/who-pays-first/cobra-7-facts.html
MUC55-2017-BCBS
News & Articles Category: Medicare
If you have recently been diagnosed with diabetes, Medicare provides tests and supplies for those who currently have the disease. Medicare also covers many other preventive tests and screeningsĀ for seniors
Test and Supplies
Part B covers blood sugar self-testing equipment and supplies including glucose testing monitors and test strips, lancet devices, lancets, and glucose control solutions for testing the accuracy of the equipment. There may be limits to how much, or how often you can get these supplies. You may be required to use specific suppliers. If you use insulin, you may be able to get more strips and lancets than someone who does not. Part B also covers foot exams and treatment (including therapeutic shoes or inserts). Yearly eye exams and glaucoma tests, insulin pumps and the insulin used by the device, nutritional therapy services, and diabetes self-management training to help you learn how to better manage your disease.
Cost
The amount that you need to pay for many of these services and supplies varies. However, some factors can influence your cost. For instance, where you receive treatment, and whether or not your doctor accepts Medicare can impact your cost. Medicare does not cover all recommended diabetes treatments. If your doctor suggests you receive additional supplies or services beyond what it covers, you may pay some or all of those costs.
National Mail Order
As long as you use a Medicare national mail-order contract supplier, you can have diabetes testing supplies delivered right to your home. Medicare pays for test strips and lancets to be sent to you by mail. Or, you can pick them up locally at a pharmacy near you. In either case, you pay the same, whether you receive your testing strips in the mail or purchase them elsewhere. Local stores that accept Medicare cannot charge more than your 20 percent coinsurance, and any unmet deductible.
References:
https://www.medicare.gov/coverage/diabetes-supplies-and-services.html
https://www.medicare.gov/Pubs/pdf/11022-Medicare-Diabetes-Coverage.pdf pg. 6, 7, 8, 10, 11
https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdfĀ pg. 2
MUC64-2017-BCBS
News & Articles Category: Medicare
Most Illinois seniors know that theyāre eligible for Medicare Part A and B, but will enroll in some form of supplemental coverage to help with the out-of-pocket cost. Medicare covers a substantial amount, but it does not cover all of the services like vision, dental, or prescription benefits. Even after paying for Part B, you are responsible for deductibles, copays, and coinsurance.
Medicare Costs
Medicare Part A is free, as long as you pay taxes throughout your working life. Part B is not free. The monthly premium for most is $174.70 in 2024 and deducted from your Social Security benefits
Medicare Supplement
Medicare Supplements were created to help pay the costs of out-of-pocket expenses like copays, deductibles, and coinsurance. When you visit your doctor, you will be expected to pay upfront to meet your deductible or satisfy a copay. Expenses can be steep, and the more care you need, the more you pay. Plans are sold through private insurers and to make it easy, the government created ten standardized plans, named after the letters of the alphabet (A). That means that every plan of the same letter, a Plan N or Plan G, must include the same benefits, regardless of which company sells it.
Part C
With aĀ Part C plan, you still receive Medicare with extra benefits like vision and dental care and prescription benefits. Plans vary significantly between companies, cost, coverage, and networks. Unlike a Medicare Supplement, plans do not cover deductibles, copays, or coinsurance. Many choose to enroll in Medicare Part C, closing the coverage gaps in Medicare.
Part D
Part D prescription plan can be purchased as a stand-alone plan to add to Medicare. If you enroll, you will continue to pay your premium for Part B each month.
Your healthcare needs may change as you age. Multiple hospital visits, ongoing doctors’ appointments, and more can potentially cost thousands of dollars in deductibles and copays.
References:
https://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/whats-medicare/what-is-medicare.html
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