News & Articles Category: Medicare
Medicare is available for certain people with a disability who are under 65. To qualify, you must have received Social Security Benefits for 24 months, or have End-Stage Renal Disease or Lou Gehrig’s Disease.
End-Stage Renal Disease
If you have ESRD, you can sign up for Medicare before 65 if you need regular dialysis, or have had a kidney transplant, and meet one of the following:
Worked the required amount of time under Social Security or Railroad Retirement Board.
Eligible to receive or already receiving Social Security or Railroad Retirement Benefits.
Spouse or dependent child of a person who meets the requirements listed above.
Eligible for Medicare because of ESRD, enrollment is not automatic and you will need to enroll in Medicare by contacting your local Social Security office. Benefits typically start on the first day of the fourth month of your dialysis treatments. If you are covered by an employer health plan, your coverage will still start the fourth month of dialysis treatments. Your group may pay for the first 3 months of dialysis. If you participate in a Medicare-certified training program to learn how to administer dialysis treatments from home and are expected to do so, treatments continue through the waiting period. Medicare will end 12 months after you stop dialysis or 36 months after you have a kidney transplant. Coverage can be extended if you start dialysis or get a transplant within 12 months of stopping treatment, or 36 months after the transplant.
Enrollment
Even if you are under 65, enrollment with a disability is automatic. After receiving Social Security benefits or Railroad benefits for 24 months, you will receive your Medicare card in the mail. Look for the card to arrive three months before your 25th month of disability. If you have Lou Gehrig’s Disease, enrollment is automatic, but benefits are available after your first month of disability. You can opt out of Part B coverage if you choose. Instructions on the back of the card explain the process. If you choose not to accept Part B before age 65, you will automatically be enrolled again when you turn 65.
References:
Medicare with a disability: https://www.medicare.gov/people-like-me/disability/signing-up-for-part-b-disability.html
Medicare with ESRD: https://www.medicare.gov/people-like-me/esrd/getting-medicare-with-esrd.html#collapse-3178
MUC56-2017-BCBS
News & Articles Category: Medicare
Medicare covers dual residence. With Part A and Part B, you can travel anywhere within the United States and still be covered, as long as you choose providers who accept Medicare. This is good news for anyone planning to spend part of the year in one state and part of the year in another. Whether you are in Florida or Michigan, any doctor or hospital that accepts Medicare will honor your benefits. Medicare does not cover the care you receive outside of the country.
Coverage Area
All 50 states
The District of Columbia
Puerto Rico
The Virgin Islands
Guam, American Samoa
The Northern Mariana Islands
Medicare Supplement
Like Medicare, Medicare Supplement does not rely on service networks, and as long as the doctor or hospital you choose accepts Medicare, you’re covered. As a senior with homes in two states, you can travel freely with the peace of mind and confidence that when you need medical care, you can get it and your plan will be applied. If you are a dual resident considering coverage, be sure to compare policies offered by each state to learn about any differences that may impact your benefits.
Part C and Part D
For Medicare Part C and D, the rules for out-of-state coverage are different and your plan may not cover your care while you travel within the United States. With many plans, you need to be a permanent resident of the state where you originally enrolled and you must live in the service area of your plan. In some cases, you can receive out-of-network care, but it will likely cost you more money. In addition, your plan may have specific rules you need to follow, such as needing prior authorization before receiving care that can impact your coverage. With all Medicare plans, Medicare, Medicare Part C, and Medicare Supplement, you are covered in any state if you need emergency medical care or urgent care out of network.
References:
https://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/switching-plans/switch-medigap-.html#collapse-2514
https://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/original-medicare/how-original-medicare-works.html#collapse-3111
MUC58-2017-BCBS
News & Articles Category: Medicare
Seniors over the age of 55 and in need of care may be eligible for the Medicare Pace Program ( Programs of All-inclusive Care for the Elderly) Designed to provide personalized, coordinated care for the disabled in a community setting. The goal is to help Illinois seniors preserve their independence and delay nursing home care as long as possible.
Eligibility
Enrollment in the program is involuntary, but to be eligible to receive benefits, seniors must meet a few conditions. Applicants must be at least 55 years old and certified by the state as requiring a nursing home level of care. Must reside in the service area of the PACE organization and be capable of living safely in the community. Seniors who are eligible for Medicare, Medicaid, or both can enroll. While PACE uses Medicare and Medicaid funds to pay for care and services, the cost of the program depends on each applicant’s financial situation. Medicaid recipients may pay nothing at all or a small fee for services. Medicare-only recipients who join pay a monthly premium for long-term care and prescription drugs. In either case, there are no deductibles or coinsurance.Â
Coverage
Benefits in Illinois include all Medicare and Medicaid-covered services in addition to some services not covered by Medicare. This includes doctor and nursing services through a primary care physician, care while in the hospital (including laboratory and x-ray services), emergency services, physical and occupational therapy, nursing home and home care, prescription drugs, dental, meals, and nutritional counseling, social services, and transportation. Seniors who enroll will receive all of their Medicare benefits through the program. Each applicant is assessed daily on an individual basis by a team of skilled healthcare professionals.
Primary care physician
Activity Coordinator
Nurse
Dietitian
Social Worker
Center supervisor
Physical therapist
Home care liaison
Occupational therapist
Driver
For older adults suffering from a disability or chronic condition, having medical and supportive services available in a community setting offers peace of mind, promoting independence and delaying nursing home care. The mission of PACE is to help well-deserving seniors and their families accomplish this goal by offering comprehensive medical and social services provided by a team of health professionals.
References:
https://www.medicare.gov/your-medicare-costs/help-paying-costs/pace/pace.html
MUC13-2016-SSI/CDIS
News & Articles Category: Medicare
Illinois seniors suffering from a debilitating chronic health condition may qualify to enroll in a Medicare-approved Special Needs Plan. These different plans provide additional benefits above and beyond Medicare, offering seniors special healthcare and services.
Special Needs
Treatment of certain chronic health conditions such as cancer or dementia may require additional services above and beyond that which Medicare provides. For many seniors, the extra cost associated with treatment is a burden and Special Needs Plans address these concerns. Most benefits provided are paid in full for recipients who are enrolled in both Medicare and Medicaid. However, for seniors who do not qualify for Medicaid, participating in the plan costs about the same as enrollment in a typical Part C plan.
Eligibility
You must be enrolled in Medicare Part A and B, reside in the plan’s service area, and meet specific health requirements. Seniors with a disabling chronic condition or who live in a nursing home, require in-home care or currently receive both Medicare and Medicaid benefits may qualify. Plans may not be available in all states as insurance companies providing benefits decide which counties will offer plans.
Qualifying Conditions
You must have one or more of the following conditions:
Alcohol or drug dependence
Hematologic disorder
Autoimmune disorder
HIV/Aids
Cancer
Chronic lung disorder
Cardiovascular disorder
Disabling mental health conditions
Chronic heart failure
Neurologic disorder
Dementia
Stroke
Diabetes
End-stage liver disease
A Special Needs Plan may be the right choice, with an increased network of providers who specialize in treating your condition and providing additional benefits.
References:
https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/special-needs-plans.html
https://www.medicare.gov/Pubs/pdf/11302.pdf
MUC14-2016-BCBS
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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