Health Insurance Terms - Must Know Ones: Loan Insurance US

Health Insurance: Learn Before You Go for It

 

 

The US health insurance marketplace is pretty tricky, in terms of the terms that exist there. My blog is for busy people looking for an easy access to influential information.  There are many sites and blogs nicely presenting them for people to understand them easily. However, oftentimes the oversimplification attempts just make them still harder.  So the terms with the definitions—

Deductible

Your insurance company pays for you only when your expenses have crossed a limit. The (limit of) amount you pay is (your) deductible. It is an annual thing. Your insurance company starts to pay off your bills only when you cross the deductible. So if your deductible is $1500 a year, your insurance company will not pay you anything till your costs have gone beyond $1500 within the year.

Copay

Co-pay – pay together. With co-pay, you pay an agreed upon (amount of) money every time you visit your primary care physician or have a prescription bill.  Your insurance company pays the rest. So if your physician fee is $100 and your copay is $30, you pay $30 from your pocket and the company pays the rest-- $70. The same rule applies to your prescription bills. This is an ‘each n every’ thing.

Coinsurance

Coinsurance is much like copay. But the underlying difference is that with coinsurance, you copay an agreed upon percentage of your bills you have. So if your bill comes to $1500 and you are coinsured for 10%, you pay %150 and your insurer pays the rest—$1350.

Medicare

Medicare is a US federal government health insurance policy for people at 65 and beyond. People below the age-group can also avail the policy under certain conditions like disability.

Medicaid

Medicaid is also a health insurance for people of low-income and resources background with no age group restrictions. Recipients get their healthcare benefits from private insurers who get monthly premiums from the government.

Medigap

Medigap is one kind of health insurance policy. You probably know that Medicare has four parts –A, B, C and D. Of these, the first two A and B are known as Original Medicare.  Medigap is a supplemental policy to this Original Medicare. You receive supplemental support instead of benefits. Medigap shares your costs upon your paying deductibles, copays or coinsurance.

Medicare Advantage Plan

It is better to say plurally — plans. Medicare Advantage Plans are health insurance policies that are suited to your personal healthcare needs.

Medicare HMO

HMO stands for health maintenance organization. It is one of the four (types of) Medicare Advantage Plans. You receive healthcare service only from within your insurance company’s network. (An emergency may be an exception, though). You require to choose your primary physician who refers you within the network service providers.

Medicare PPO

PPO—preferred provider organization works within a network of service providers. However, you can go outside the network without a referral if you are willing to spend more out of your pocket.

Medicare PFFS

Stands for private fee for service. It allows you to go to any service provider of your choice so long they are ready to accept the terms of the plan you are on.

Medicare MSA

MSA stands for Medical Savings Account. Here is how it works:

1. You receive Medicare Part A and B once you have paid your deductible. The deductible is pretty high.

2. You receive deposit into your bank account from Medicare. You can spend it only for medical purposes that must qualify. Else you pay penalty. Deductible is applicable here as well. MSA does not cover prescription drug coverage.

Medicare SNP

SNP stands for special needs plan. It is one of the four types of Medicare Advantage Plans for people with specific ailments and characteristics. ‘Specific’ here means conditions that requireinstitutional or home care for their chronic conditions.

Donut Hole

This is perhaps one of the most confusing health insurance terms for many. To understand this you need to associate it with your Medicare Part Dor Prescription Drug Coverage Plan. Like any health insurance plan, Part D also has a yearly limit of expenses for you. When you cross this limit, your insurance company ceases to pay for you, leaving you in the ‘gap’. This does not, however, mean they leave you completely alone until the next year. They start to pay you backwhen you have crossed another limit paying from your pocket. So the time you are in between the two limits  is the donout hole state for you.








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USA Federal Government Healthcare—Medicare Part A: Loan Insurance US

1. Does the USA government provide healthcare to its citizens?

Answer — Yes, the federal government provides healthcare to the citizens through two programs --Medicare and Medicaid. However, these programs are not for all. Medicare is for senior citizens who are 65 or above only. In certain cases, disabled people also avail of it. On the other hand, Medicaid is a program designed for the low-income people. Their children under 6 also benefit from this program.

However, the much-discussed Obamacare promises healthcare for Medicaided people's children under 27.

2. Are Medicare and Medicaid free?

Answer — No, they are insurance plans. As such, they are not free. You buy them two ways—direct or indirect.

3. What is my eligibility for Medicare?

Answer — You are eligible if ---

 

a. You are 65 or above and paid up your social security taxes from your job of at least ten years (continuous or continual).

b. Your spouse (living, dead or separated) has paid up his/her social security taxes from his/her job of at least ten years (continuous or continual).

c. You or your spouse paid  your premiums for Medicare.

d. You or your spouse has been a government employee with Medicare benefits.

4. In what cases are people below 65 eligible for Medicare?

Answer -  In the following cases, you qualify for Medicare even if you are below 65---

a. If you have social security disability benefits.

b. If you have disability pension from the railroad authority.

c. If you have Lou Gehrig's disease or kidney failure, require dialysis or transplant.

d. If you are dependent of an eligible parent who is 50 or above.

3. What is basic Medicare?

Answer — Federal Government provides four types of healthcare insurance. They are--

 

a) for in-patients, known as Part A

b) for out-patients, known as Part B

c) for personal health requirements, known as Part C

d) for drug purchase, known as Part D

Of these, Part A and B are non-optional and federal-run. They are basic Medicare programs. The other two (C and D) are optional private insurance programs. You cannot get them unless you already are on Part A and B.

4. What does Part A cover? Are they ‘all free’?

Answer — Part A covers expenses for and certain support services to hospitalized patients. Following is a list of what Part A usually covers—

a) physician fees b) in-care nursing c) semi-private room  service d) meals e) certain therapies f) certain equipments g) diagnosis bills

Answer to your stem question—they are not ‘all free’. Guidelines are set for the program.

5. How do I get Medicare Part A?

Answer — You have it two ways—premium free and premium paid. You actually buy both. You buy or earn premium-free by already paying your or your spouse’s social security or payroll taxes for ten years or more. You pay premiums when you have worked less than ten years. Premiums vary depending on how long you/or your spouse have already worked.

6. Do I need to apply for Medicare before or when I turn 65?

Answer — You need to apply to your social security office if you are not already collecting any social security benefits. If you are enjoying any of them, it should have come to you automatically when you have turned 65. You usually receive your enrollment card three months before your turning 65. Your social security office sends this to you.

7. What should I do if I do not retire and enjoy social security benefits beyond 65?

Answer — Medicare is part of your social security benefits. So it comes with SS benefits. You should sign up for Medicare if you are deferring retirement.

8. Do I qualify for Medicare if I am divorced or widowed?

Answer — You do. If you are a widowed or divorced partner of someone who (has) earned his/her Medicare, you benefit from that.

9. Does a son or daughter of a deceased person benefit from his/her parent’s Medicare eligibility?

Answer - Yes, they do.

10. Do same-sex marriage partners qualify for Medicare?

Answer — Yes. The same rule of earning 10 year social security etc. applies to them. They have to be legally married in a state where same-sex marriage is recognized.

11. What if we married outside (same-sex)of our state or outside of the USA?

Answer — In that case, your case comes under the rule of the District of Columbia.

12. Can new immigrants get Medicare?

Answer — Once they have lived in the US for five years at a stretch, they can buy Medicare insurance. However, they will not get Part A.

























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