ALTERNATIVE COVERAGE Flashcards
Are you covered at work?
Employers offer their eligible employees the option to enroll in group health care plans that cover expenses related to medical services, prescription drugs, dental and vision benefits. Group health insurance plans help employers save on administrative costs associated with individual policies and provide employees who don’t have insurance from another source or employer access to quality health care coverage.
If your group health plan is “creditable,” you don’t have to sign up for Medicare. Creditable is a term that only applies to Medicare, but in general, it applies to employers with more than 20 employees. Ask your employer if your plan is “creditable.”
But suppose you decide to enroll in Medicare while working, depending on the employer plan. In that case, it may be able to supplement an employee’s Medicare coverage by filling some of the gaps not typically provided by traditional Medicare.
Retiree benefits:
A great tool that many employers offer is a group Medicare supplement policy or a Medicare Advantage plan. These supplemental plans can help offset rising healthcare costs and make care more affordable for retirees enrolled in original Medicare. If a retiree does have additional coverage through their spouse’s employer health plan, they may not need to purchase additional medicare supplement insurance. However, those considering retirement coverage options must consult with their employer’s benefits coordinator and learn what kind of gap coverage the plan offers before making any decisions about medicare supplement insurance.
COBRA:
COBRA coverage from an employer plan is a beneficial option for those individuals who leave their job. This allows for the temporary continuation of health coverage offered initially in the job.
It is essential to be aware that there is an 8-month period after a job termination to enroll in Medicare, and if not done so that a LIFETIME penalty may be imposed when enrolling at a later stage.
Further, if you are still within your initial enrollment period, it is crucial to enroll within this window to circumvent the penalty. Additionally, Medicare supplement policies can be attained up to 63 days after the loss of COBRA coverage.
When considering whether or not to utilize COBRA coverage from an employer plan, weighing the costs and benefits of doing so is essential. Seeking advice from qualified and certified Medicare Insurance Agents can assist an individual in making this critical decision about their healthcare needs and coverage options available for them post-employment. When making the best decision regarding COBRA plans, get pertinent information, including cost and coverage details, before moving forward.
If utilizing COBRA after you turn 65, proceed with caution. COBRA is not considered creditable coverage.
Medicaid:
Medicaid is a health coverage program the state and federal governments provide for low-income people. It covers many services that Medicare does, including hospital care, doctor visits, and prescription drugs. However, it goes beyond these primary benefits and offers additional services such as dental, mental health, preventative care, and more. The amount that Medicaid pays for your medical expenses will depend on eligibility requirements determined by your state.
In addition to covering your medical costs, Medicaid helps with out-of-pocket expenses such as deductibles and coinsurance. Moreover, if you qualify for Medicaid, you can use it instead of Medicare supplement insurance, which may be beneficial because it can provide better coverage or even save money compared to other private health insurance options. While Medicaid is not perfect since individual states determine eligibility requirements and benefits vary heavily between them, it can provide comprehensive health coverage for those with limited resources at a much lower cost than private plans.
Medicare Savings Programs (MSP) under Medicaid:
MSPs are an invaluable resource for those who qualify. These Medicaid-sponsored programs pay for Medicare premiums, deductibles, and coinsurance. This is helpful for seniors or people with disabilities who cannot afford the cost of Medicare coverage on their own. Additionally, these programs help individuals save even more money by allowing them to use the savings from the program to cover other expenses or to buy more coverage.
The three savings programs include the Qualified Medicare Beneficiary (QMB) program, the Specified Low-Income Medicare Beneficiary (SLMB) program, and the Qualified Individuals (QI) program. Each program has different eligibility requirements, which vary based on income and medical expenses. Therefore, it’s vital that you read through all of the available information so that you can determine if you’re eligible for any of them. Once qualified, these programs can make a big difference in helping qualifying individuals save money while accessing the essential healthcare services they need.
Enrollment dates:
Enrolling in Medicare is a critical decision requiring you to know specific eligibility dates.
If you’re turning 65, you can enroll up to 3 months before your birthday, the month of, and another three months after. In most cases, your coverage for original Medicare will start on the 1st of your birthday month. However, if your birthday falls on the 1st of the month, your coverage will start a month earlier.
You should also know that coverage for any other plan, such as Medicare Supplement (Medigap) or Medicare Advantage, will also start on the 1st of the month after you enroll. You cannot back-date coverage, and coverage will not begin mid-month.
Take advantage of the pre-65 enrollment time, so you don’t miss any coverage gaps. In addition to turning 65, there is an Annual Election Period (AEP) during which anyone eligible can switch plans or modify their existing coverage from October 15th through December 7th. But if specific circumstances arise, such as moving out of your plan’s service area, Special Election Periods (SEP) allow for enrollment outside these standard windows.
Your Costs:
Original Medicare contains two parts: Part A and Part B. Patients must pay monthly premiums and other costs such as deductibles, copays, and coinsurance. The amount you have to pay may vary each year in January. For Part A, most people don’t have to pay any premiums since they paid a tax during their working years. However, everyone must pay the premium for Part B to keep their coverage.
You need to pay a deductible before Medical begins chipping in for your medical expenses. This amount can differ depending on the type of care you receive, for example, inpatient hospitalization or a doctor’s office visit outside a hospital setting. In addition, there might be services not covered by Medicare at all, meaning you will have to bear the total cost yourself. Therefore, checking with your doctor before receiving a service is important to ensure your plan covers it!
In addition to their premiums and co-payments, individuals with Original Medicare are also responsible for the total cost of any services that Medicare does not cover.
