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Senior Health Insurance

Senior Health Insurance:

Seniors have some reasons to cheer, for there is Medicare a health insurance program meant for people who are (i) 65 years or older (ii) below 65 with certain disabilities and (iii) having End-Stage Renal Disease with permanent kidney failure needing dialysis or a kidney transplant. From January 1, 2006, the new Medicare Part D has been implemented which is a prescription drug program.

Under the new program, the patient has a choice of prescription insurance plans which offer considerable benefit for paying for prescription drugs. Under the Part D program, Medicare beneficiaries are presented a choice for procuring a private, independent Medicare Prescription Plan (PDP) or a Medicare Advantage Plan. Under this plan Medicare will cover around 75% of the expenses incurred in prescriptions. There is also provision for considerable assistance for low income beneficiaries.

Employer Group Health Plans (EGHP) and Medicare:

Employer group health insurance is a type of private insurance which one has purchased from an employer or union membership. It might be continued or changed over to a plan which operates like a Medicare supplement on retirement or attaining the age of 65. There are some employers who offer extension or conversion as a retirement benefit that permits retirees to continue group coverage or change over to a plan which serves as a Medicare supplement. Under this type of plan, there are no conditions of minimum standards for Medicare supplements and might provide for higher or fewer benefits compared to Medicare supplemental insurance. However, it is secondary to Medicare benefits.

How does it work

In certain cases, an employee might choose to continue working even after attaining 65 years of age. In such situations, if there are 20 or more employees and the employer offers an employer group health plan, the age of the worker more than 65 should be covered under the same EGHP with identical benefits under the age 65. Hence EGHP is crucial to Medicare, offering complete benefits prior to applying of Medicare benefits. The following things must be looked into :

(i) The price and the benefits, inclusive of the benefits for the spouse require attention.

(ii) EGHP coverage is sometimes less costly compared to individual health insurance

(iii) The coverage that pays for health care services that are not covered under Medicare like prescriptions, hearing aids, routine dental care, and physical checkups has to be looked into

(iv) The things also to be checked are the effect the continued coverage will put on the insurance coverage of the spouse besides checking on the term of coverage.

(v) Besides, the term of the coverage has also to be checked to make sure whether EGHP will always be present or not.

As regards getting the availability of Medicare Part A the following points are worthwhile:

(i) In case of most people aged 65 years, there is no premium for Part A.

(ii) Part A might supplement the EGHP

(iii) In case after attaining the age of 65, an individual has already been receiving Social Security or Railroad (RR) cash benefits, one becomes automatically enrolled in Part A and will get to avail Medicare card in the mail.

Similarly, as regards getting the availability of Medicare Part B the following points are worthwhile:

(i) The monthly premium

(ii) An individual may like to delay enrollment in Part B till the person and his/her spouse are employed and are covered by an EGHP. The person will be eligible for a Medicare supplement open enrollment from the date he/she leaves the EGHP

(iii) It has to be carefully checked as regards how completely the EGHP covers doctor and other health services are covered by Part B as well.

(iv) It has to be found out whether the secondary benefits Part B are going to pay become worth the cost of the premium.

Volunteer counselors of SHIP give counseling free of cost, on a wide range of topics on health insurance including:

(i) Insurance Policy Comparison relating to supplemental and long-term care

(ii) Assistance with Claims

(iii) Medicare-contracted Health Maintenance Organizations

(iv) Medicare supplement (Medigap) Insurance

(v) Medicare Appeals Process

Counselors of SHIP give advisory information only and do not arrive at decisions for clients. Every information which is shared with a counselor remains secret and the counselor will not try to sell the client anything. The information is passed on to the clients to help them in arriving at informed decisions. Besides, SHIP counselors do not take any fee for providing this service.

One can delay applying for Medicare Part B, but it is not advisable to do such unless the person or his/her spouse are working and the person is covered by an EGHP. Delayed enrolment without penalty or waiting period can be got in case one has been covered by an EGHP since one became eligible for a Medicare. In order to avoid penalty for late enrollment in Medicare Part B, the Social Security has to be notified that the person is covered by the EGHP and want to make some delay in enrolling in Part B. However, making delay in enrolment in Part B, the following recourse can be taken at the time when the EGHP coverage terminates:

In case the person is more than 65 years, he/she can enroll in Part B during the eight-month period starting with whichever arrives first i.e (i) the month the person or his/her spouse are nor more working (ii) The month from which the person is no more covered under the EGHP. Special enrollment period rules are no more applicable in case one stops working or loses his/her EGHP coverage at the time of the initial enrolment period.

Various provisions of Employer Long-Term-Care Insurance (ELTC):

(i) The employer might offer long-term insurance care as an added benefit

(ii) Long-term insurance provided by the employer is similar to what could be bought from an agent

(iii) ELTC normally gives employees an option of benefit periods, maximum payments, and waiting periods

(iv) ELTC might offer non-forfeiture benefits and permit employees to keep their coverage following their leaving the group.

(v) A lot of employers also permit to buy coverage for ones parents.

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