Monday, November 21, 2011

Deciphering Medicare Eligibility

Questions arise all the time about Medicare. Eligibility, cost and coverage are the three topics of conversation that are talked about the most.  Eligibility is a topic all in its own.  Most people are under the assumption that the only requirements to qualify for Medicare benefit is that they have turned sixty-five.  That however is not the case. This article will help layout guidelines on eligibility so that it is easy to determine if you fall under the guidelines to qualify for the Medicare benefits and Medigap supplement insurance.
The first group of people we will look into is the group of adults that are sixty-five and older.  Sixty-five is a qualifying age however there are other requirements that must be met to receive Medicare aid from our government.  It is a must that you are a United States citizen or legal resident.  You must also have proof that you have lived within the United States for at least five years.  It is also important to note that you receive Medicare from working at least ten years in Medicare covered employment. 
If you find you meet all three of these guidelines it is most likely that just prior to your sixty-fifth birthday you will receive a Medicare card and packet in the mail.  This will detail what Medicare is, what it offers to you and how you start using it for your health care needs.  You are automatically given both Medicare part A and Medicare part B.  Part B can be declined as it is optional and does require a monthly premium.
If you are under sixty-five you can also qualify for Medicare benefits under certain circumstances.  One is if you have End Stage Renal Disease.  Kidney disease does allow you to qualify for Medicare benefits if you are under sixty-five.  Another reason qualifications for Medicare are considered under sixty-five is if Social Security Disability Income has been received for twenty-four months. 
Medicare is not the perfect coverage.  It will not cover all of your medical expenses.  This is why it is so important when you finally do qualify for coverage that you look into different Medigap supplemental insurance plans.  Medicare does not cover prescriptions and does require you pay premiums and co-pays.    Additional coverage through the supplemental insurance will help to fill in gaps left by Medicare coverage. 
There are multiple items that Medicare part A and part B do not cover.  Below is a sample list of items that are not covered and that additional coverage should be sought out if they are important for your well being both financial and health.
·         Acupuncture is a type of alternative medicine is not covered.  Acupuncture is a treatment that works through the insertion of thin needles strategically placed throughout the body to help cure ailments.
·         Dental care is an incredibly important part of the aging process and is not part of Medicare.  It is advisable if your dental history has been anything less than stellar that you seek out additional insurance to fill the gap left by Medicare.
·         Chiropractic care is also something that many older people rely on that is not covered.  Often time’s doctors of chiropractics will offer discounted rates to seniors.  This is something to think about however when seeking out gap insurance if your doctor is not one that does.
Obviously the list of covered versus not covered is detailed in great lengths through handbooks, websites and pamphlets.  Supplemental insurance providers are a great source of knowledge as they can review your past history with you and based on the pattern that has developed guide you into the right combination of plans.  This way you are not purchasing additional coverage that is not ever going to be utilized.  

Understanding Medicare and Medigap

So much confusion surrounds Medicare and the different supplemental Medigap supplemental plans.  It is hard to look at the information coming in and decipher what it means to your health care coverage.  In terms understood by many it breaks down to this; Medicare part A and Medicare part B.  From here it is up to the individual to decide if a Medigap supplemental insurance policy is needed.  These plans are paid for by the individual and are for easing the out of pocket amount paid each year in deductibles, copayments and coinsurance plans.
The gap between what is covered and not covered by Medicare is Medigap.  Here is one of the many tricky parts.  Medigap only can be purchased along with an original Medicare plan, part A or part B.  That is correct, reread the last statement.  Medigap supplementalinsurance plans are not available with Medicare part C, part D, private health insurance, Medicaid, TRICARE or Veterans’ Admin benefits. 
Purchasing Medigap supplement insurance is just as tricky as figuring out if you can buy it.  The one thing that stays true no matter where you purchase the insurance from is that because it is regulated by the laws of the state and Federal government the benefits available are the same to everyone.  Although the coverage remains the same no matter the provider there are differences amongst the insurance companies themselves.  The differences will be in price, administrators of the plan and the available Medigap options.
Medigap insurance supplements are each unique and will want to be picked based upon the need of the individual.  For instance, clients who need help with copayment and deductibles for basic benefits will want to choose Medigap plan A for those are the items that it helps cover.  This plan is attractive for it is the least expensive plan available and is accepted by all doctors who accept Medicare.  Drawbacks come with each and every plan available.  The major drawback to plan A is that it covers basic necessities and not items such as long term care, skilled nursing, vision care amongst several other major areas of expense. 
Another option to all of this confusion is Medicare Advantage Plan. This plan is in place of Medicare plan A and Medicare plan B, as well as any Medigap insurance.  Medicare Advantage deals with HMO’s, PPO’s and other options.  The thing to remember is that Medicare Advantage is an option that also allows doctors and hospitals to choose.  They don’t have to take this coverage.  It is a private option not through the government but rather run through private insurance companies. 
In the year before you turn 65 it is wise to sit down and go through all of the different options.  You will want to review your needs in the past five years to see medically where money was spent.  This will help you narrow down what options you will need to further discuss with an insurance agent.  They will can help determine what supplement will maximize your benefits while minimizing the out of pocket expense you concur.