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In Last 10 years, has any person to be covered received medical or surgical consultation, advice or treatment (including medication) for any of the following:  Yes No
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  Plans Options
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* HMO(Health Maintenance Organization) - Requires you to obtain medical care from a specified list of hospitals and doctors. You must choose a PCP (Primary Care Physician) and you need a referral from your PCP to see Specialists. Out of network expenses are not covered.
* PPO(Preferred Provider Organization) - Allows you to use specified in-network hospitals and doctors but you can also use out of network hospitals and doctors who are not members of the PPO network. If you are seen by PPO providers your benefit will be at a higher return than if you were seen by an out of network provider. Unlike a POS, you do not have to choose a PCP (Primary Care Physician) in order to receive In Network benefits.
* INDEMNITY PLANS - allow you to use any doctor or hospital. This type of plan will pay covered expenses on what is known as a reasonable and customary basis. Typically all expenses are subject to a deductible ($250), and coinsurance (80%).
 
Health Insurance Knowledge Base
PPO Preferred Provider Organization

Individual & Family Insurance

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POS Point of Service Medicare
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INDEMNITY Plan Fee For Service COBRA

 

Indemnity Plan Fee For Service:

This is the traditional kind of health care policy. Insurance companies pay fees for the services provided to the insured people covered by the policy. This type of health insurance offers the most choices of doctors and hospitals. You can choose any doctor you wish and change doctors any time. You can go to any hospital in any part of the country.

With fee-for-service, the insurer only pays for part of your doctor and hospital bills. This is what you pay:

Bullet  A monthly fee, called a premium.

Bullet A certain amount of money each year, known as the deductible, before the insurance payments begin. In a typical plan, the deductible might be $250 for each person in your family, with a family deductible of $500 when at least two people in the family have reached the individual deductible. The deductible requirement applies each year of the policy. Also, not all health expenses you have count toward your deductible. Only those covered by the policy do. You need to check the insurance policy to find out which ones are covered.

Bullet After you have paid your deductible amount for the year, you share the bill with the insurance company. For example, you might pay 20 percent while the insurer pays 80 percent. Your portion is called coinsurance.

To receive payment for fee-for-service claims, you may have to fill out forms and send them to your insurer. Sometimes your doctor's office will do this for you. You also need to keep receipts for drugs and other medical costs. You are responsible for keeping track of your medical expenses.

There are limits as to how much an insurance company will pay for your claim if both you and your spouse file for it under two different group insurance plans. A coordination of benefit clause usually limits benefits under two plans to no more than 100 percent of the claim.

Most fee-for-service plans have a "cap," the most you will have to pay for medical bills in any one year. You reach the cap when your out-of-pocket expenses (for your deductible and your coinsurance) total a certain amount. It may be as low as $1,000 or as high as $5,000. Then the insurance company pays the full amount in excess of the cap for the items your policy says it will cover. The cap does not include what you pay for your monthly premium.

Some services are limited or not covered at all. You need to check on preventive health care coverage such as immunizations and well-child care.

There are two kinds of fee-for-service coverage: basic and major medical. Basic protection pays toward the costs of a hospital room and care while you are in the hospital. It covers some hospital services and supplies, such as x-rays and prescribed medicine. Basic coverage also pays toward the cost of surgery, whether it is performed in or out of the hospital, and for some doctor visits. Major medical insurance takes over where your basic coverage leaves off. It covers the cost of long, high-cost illnesses or injuries.

Some policies combine basic and major medical coverage into one plan. This is sometimes called a "comprehensive plan." Check your policy to make sure you have both kinds of protection.

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What Is a "Customary" Fee?

Most insurance plans will pay only what they call a reasonable and customary fee for a particular service. If your doctor charges $1,000 for a hernia repair while most doctors in your area charge only $600, you will be billed for the $400 difference. This is in addition to the deductible and coinsurance you would be expected to pay. To avoid this additional cost, ask your doctor to accept your insurance company's payment as full payment. Or shop around to find a doctor who will. Otherwise you will have to pay the rest yourself.

Questions to Ask About Fee-for-Service (Indemnity) Insurance

Bullet  How much is the monthly premium? What will your total cost be each year? There are individual rates and family rates.

Bullet  What does the policy cover? Does it cover prescription drugs, out-of-hospital care, or home care? Are there limits on the amount or the number of days the company will pay for these services? The best plans cover a broad range of services.

Bullet  Are you currently being treated for a medical condition that may not be covered under your new plan? Are there limitations or a waiting period involved in the coverage?

Bullet  What is the deductible? Often, you can lower your monthly health insurance premium by buying a policy with a higher yearly deductible amount.

Bullet  What is the coinsurance rate? What percent of your bills for allowable services will you have to pay?

Bullet  What is the maximum you would pay out of pocket per year? How much would it cost you directly before the insurance company would pay everything else?

Bullet  Is there a lifetime maximum cap the insurer will pay? The cap is an amount after which the insurance company won't pay anymore. This is important to know if you or someone in your family has an illness that requires expensive treatments.

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Health Maintenance Organizations (HMOs)

Health maintenance organizations are prepaid health plans. As an HMO member, you pay a monthly premium. In exchange, the HMO provides comprehensive care for you and your family, including doctors' visits, hospital stays, emergency care, surgery, lab tests, x-rays, and therapy.

The HMO arranges for this care either directly in its own group practice and/or through doctors and other health care professionals under contract. Usually, your choices of doctors and hospitals are limited to those that have agreements with the HMO to provide care. However, exceptions are made in emergencies or when medically necessary.

There may be a small co-payment for each office visit, such as $5 for a doctor's visit or $25 for hospital emergency room treatment. Your total medical costs will likely be lower and more predictable in an HMO than with fee-for-service insurance.

Because HMOs receive a fixed fee for your covered medical care, it is in their interest to make sure you get basic health care for problems before they become serious. HMOs typically provide preventive care, such as office visits, immunizations, well-baby checkups, mammograms, and physicals. The range of services covered vary in HMOs, so it is important to compare available plans. Some services, such as outpatient mental health care, often are provided only on a limited basis.

Many people like HMOs because they do not require claim forms for office visits or hospital stays. Instead, members present a card, like a credit card, at the doctor's office or hospital. However, in an HMO you may have to wait longer for an appointment than you would with a fee-for-service plan.

In some HMOs, doctors are salaried and they all have offices in an HMO building at one or more locations in your community as part of a prepaid group practice. In others, independent groups of doctors contract with the HMO to take care of patients. These are called individual practice associations (IPAs) and they are made up of private physicians in private offices who agree to care for HMO members. You select a doctor from a list of participating plan.

In almost all HMOs, you either are assigned or you choose one doctor to serve as your primary care doctor. This doctor monitors your health and provides most of your medical care, referring you to specialists and other health care professionals as needed. You usually cannot see a specialist without a referral from your primary care doctor who is expected to manage the care you receive. This is one way that HMOs can limit your choice.

Before choosing an HMO, it is a good idea to talk to people you know who are enrolled in it. Ask them how they like the services and care given.

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Questions to Ask About an HMO

Bullet  Are there many doctors to choose from? Do you select from a list of contract physicians or from the available staff of a group practice? Which doctors are accepting new patients? How hard is it to change doctors if you decide you want someone else? How are referrals to specialists handled?

Bullet  Is it easy to get appointments? How far in advance must routine visits be scheduled? What arrangements does the HMO have for handling emergency care?

Bullet  Does the HMO offer the services I want? What preventive services are provided? Are there limits on medical tests, surgery, mental health care, home care, or other support offered? What if you need a special service not provided by the HMO?

Bullet  What is the service area of the HMO? Where are the facilities located in your community that serve HMO members? How convenient to your home and workplace are the doctors, hospitals, and emergency care centers that make up the HMO network? What happens if you or a family member are out of town and need medical treatment?

Bullet  What will the HMO plan cost? What is the yearly total for monthly fees? In addition, are there co-payments for office visits, emergency care, prescribed drugs, or other services? How much?

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Preferred Provider Organizations (PPO's)

The preferred provider organization is a combination of traditional fee-for-service and an HMO. Like an HMO, there are a limited number of doctors and hospitals to choose from. When you use those providers (sometimes called "preferred" providers, other times called "network" providers), most of your medical bills are covered.

When you go to doctors in the PPO, you present a card and do not have to fill out forms. Usually there is a small copayment for each visit. For some services, you may have to pay a deductible and coinsurance.

As with an HMO, a PPO requires that you choose a primary care doctor to monitor your health care. Most PPOs cover preventive care. This usually includes visits to the doctor, well-baby care, immunizations, and mammograms.

In a PPO, you can use doctors who are not part of the plan and still receive some coverage. At these times, you will pay a larger portion of the bill yourself (and also fill out the claims forms). Some people like this option because even if their doctor is not a part of the network, it means they don't have to change doctors to join a PPO.

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Questions to Ask About a PPO

Bullet  Are there many doctors to choose from? Who are the doctors in the PPO network? Where are they located? Which ones are accepting new patients? How are referrals to specialists handled?

Bullet What hospitals are available through the PPO? Where is the nearest hospital in the PPO network? What arrangements does the PPO have for handling emergency care?

Bullet What services are covered? What preventive services are offered? Are there limits on medical tests, out-of-hospital care, mental health care, prescription drugs, or other services that are important to you?

Bullet What will the PPO plan cost? How much is the premium? Is there a per-visit cost for seeing PPO doctors or other types of co-payments for services? What is the difference in cost between using doctors in the PPO network and those outside it? What is the deductible and coinsurance rate for care outside of the PPO? Is there a limit to the maximum you would pay out of pocket?

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Point-of-Service (POS) Plan Health Insurance Quotes Rates & Plans

Many HMOs offer plan members the option to self direct care, as one would under an indemnity or PPO plan, rather than get referrals from primary care physicians. An HMO with this opt-out provision is known as a point-of-service (POS) plan. How the plan functions (i.e., like an HMO or like an indemnity plan) depends on whether individual plan members use their primary care physician or self direct their care at the "point of service."

To illustrate this point, this is how these plans typically work. When medical care is needed, the individual plan member essentially has up to two or three choices, depending on the particular health plan. The plan member can choose to go through his or her primary care physician, in which case services will be covered under HMO guidelines (i.e., usually a co-payment will be required). Alternatively, the plan member can access care through a PPO provider and the services will be covered under in-network PPO rules (i.e., usually a co-payment and coinsurance will be required). Lastly, if the plan member chooses to obtain services from a provider outside of the HMO and PPO networks, the services will be reimbursed according to out-of-network rules (i.e., usually a co-payment and higher coinsurance charge will be required). Because people who belong to POS plans are responsible for deciding how to access care within the various options, it is important that they understand the financial implications of these choices.

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Small Group Medical Health Insurance Quotes Rates & Plans

Most Americans get health insurance through their jobs or are covered because a family member has insurance at work. This is called group insurance. Group insurance is generally the least expensive kind. In many cases, the employer pays part or all of the cost.

Some employers offer only one health insurance plan. Some offer a choice of plans: a fee-for-service plan, a health maintenance organization (HMO), or a preferred provider organization (PPO), for example. Employers with 25 or more workers are required by Federal law to offer employees the chance to enroll in an HMO.

What happens if you or your family member leaves the job? You will lose your employer- supported group coverage. It may be possible to keep the same policy, but you will have to pay for it yourself. This will certainly cost you more than group coverage for the same, or less, protection.

A Federal law makes it possible for most people to continue their group health coverage for a period of time. Called COBRA (for the Consolidated Omnibus Budget Reconciliation Act of 1985), the law requires that if you work for a business of 20 or more employees and leave your job or are laid off, you can continue to get health coverage for at least 18 months. You will be charged a higher premium than when you were working.

You also will be able to get insurance under COBRA if your spouse was covered but now you are widowed or divorced. If you were covered under your parents' group plan while you were in school, you also can continue in the plan for up to 18 months under COBRA until you find a job that offers you your own health insurance.

Not all employers offer health insurance. You might find this to be the case with your job, especially if you work for a small business or work part-time. If your employer does not offer health insurance, you might be able to get group insurance through membership in a labor union, professional association, club, or other organization. Many organizations offer health insurance plans to members.

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Individual, Family Insurance & Self Employed

If your employer does not offer group insurance, or if the insurance offered is very limited, you can buy an individual policy. You can get fee-for-service, HMO, or PPO protection. But you should compare your options and shop carefully because coverage and costs vary from company to company. Individual plans may not offer benefits as broad as those in group plans.

If you get a non-cancelable policy (also called a guaranteed renewable policy), then you will receive individual insurance under that policy as long as you keep paying the monthly premium. The insurance company can raise the cost, but cannot cancel your coverage. Many companies now offer a conditionally renewable policy. This means that the insurance company can cancel all policies like yours, not just yours. This protects you from being singled out. But it doesn't protect you from losing coverage.

Before you buy any health insurance policy, make sure you know what it will pay for...and what it won't.

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Tips when shopping for individual insurance:

Bullet  Shop carefully. Policies differ widely in coverage and cost. Compare different plans and companies.

Bullet  Make sure the policy protects you from large medical costs.

Bullet  Read and understand the policy. Make sure it provides the kind of coverage that's right for you.

Bullet  Check to see that the policy states: the date that the policy will begin paying (some have a waiting period before coverage begins), and what is covered or excluded from coverage.

Bullet  Make sure there is a "free look" clause. Most companies give you at least 10 days to look over your policy after you receive it. If you decide it is not for you, you can return it and have your premium refunded.

Beware of single disease insurance policies. There are some polices that offer protection for only one disease, such as cancer. If you already have health insurance, your regular plan probably already provides all the coverage you need. Check to see what protection you have before buying any more insurance.

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Medicare

The Medicare Program

Medicare is a health insurance program for:

Bullet  People age 65 or older.

Bullet  People under age 65 with certain disabilities.

Bullet  People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).

Medicare Has Two Parts

Part A - Hospital Insurance.

Most people pay for Part A through their payroll taxes when they are working.

Part B - Medical Insurance.

Most people pay monthly for Part B.

Medicare Health Plans

Today's Medicare is about choice. Your health plan choices include:

Bullet  The Original Medicare Plan

Bullet  Medicare + Choice Plans, including:

Bullet  Medicare Managed Care Plans

Bullet  Medicare Private Fee-for-Service Plans

Bullet  Medicare Preferred Provider Organization Plans

Medicare + Choice Plans are available in many areas.

The Medicare health plan that you choose affects many things like cost, benefits (some have extra benefits like prescription drugs), doctor choice, convenience, and quality.

What is Medicare Part A?

Medicare Part A (Hospital Insurance) helps cover your inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. You must meet certain conditions.

Cost
Most people don't have to make a monthly payment, called a premium, for Part A. This is because they or a spouse paid Medicare taxes while they were working.

If you (or your spouse) didn't pay Medicare taxes while you worked and you are age 65 or older, you may be able to buy Part A*. If you aren't sure if you have Part A, look on your red, white, and blue Medicare card (see sample card below). If you have Part A, "Hospital (Part A)" is printed on the lower left corner of your card. You can also call the Social Security Administration at 1-800-772-1213 or visit your local Social Security office for more information about buying Part A. Medicare Part A Helps Cover Your medically Necessary:

Hospital Stays
Semiprivate room, meals, general nursing, and other hospital services and supplies. This includes inpatient care you get in critical access hospitals and mental health care. This doesn't include private duty nursing, or a television or telephone in your room. It also doesn't include a private room, unless medically necessary. Inpatient mental health care in a psychiatric facility is limited to 190 days in a lifetime.

Skilled Nursing Facility Care
Semiprivate room, meals, skilled nursing and rehabilitative services, and other services and supplies (after a related 3-day inpatient hospital stay).

Home Health Care
Part-time or intermittent skilled nursing care and home health aide services, physical therapy, occupational therapy, speech-language therapy, medical social services, durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers), medical supplies, and other services.

Hospice Care
For people with a terminal illness, includes drugs for symptom control and pain relief, medical and support services from a Medicare-approved hospice, and other services not otherwise covered by Medicare. Hospice care is usually given in your home. However, Medicare covers some short-term hospital and inpatient respite care (care given to a hospice patient so that the usual caregiver can rest).

Blood
Pints of blood you get at a hospital or skilled nursing facility during a covered stay.

What is Medicare Part B?

Medicare Part B (Medical Insurance) helps cover your doctors' services and outpatient hospital care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.

Cost
You pay the Medicare Part B premium each month* ($66.60 in 2004). In some cases, this amount may be higher if you didn't sign up for Part B when you first became eligible. The cost of Part B may go up 10% for each 12-month period that you could have had Part B but didn't sign up for it, except in special cases. You will have to pay this extra amount as long as you have Part B.

Medicare Part B Helps Cover Your Medically Necessary:

Medical and Other Services
Doctors' services (not routine physical exams), outpatient medical and surgical services and supplies, diagnostic tests, ambulatory surgery center facility y fees for approved procedures, and durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers). Also covers second surgical opinions, outpatient mental health care, and outpatient occupational and physical therapy including speech-language therapy. (These services are also covered for long-term nursing home residents.).

Clinical Laboratory Services
Blood tests, urinalysis, some screening tests, and more.

Home Health Care
Part-time or intermittent skilled nursing care and home health aide services, physical therapy, occupational therapy, speech-language therapy, medical social services, durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers), medical supplies, and other services.

Outpatient Hospital Services
Hospital services and supplies received as an outpatient as part of a doctor's care.

Blood
Pints of blood you get as an outpatient or as part of a Part B covered service.

What is the Original Medicare Plan?

The Original Medicare Plan is a "fee-for-service" plan. This means you are usually charged a fee for each health care ser vice or supply you get. This plan, managed by the Federal Government, is available nationwide. If you are in the Original Medicare Plan, you use your red, white, and blue Medicare card when you get health care. If you are happy getting your health care this way, you don't have to change. You will stay in the Original Medicare Plan unless you choose to join a Medicare + Choice Plan.

Your costs in the Original Medicare Plan

What you pay out-of-pocket depends on:

Bullet  Whether you have Part A and Part B

Bullet  Whether your doctor or supplier agrees to accept "assignment"

Bullet  How often you need health care

Bullet  What type of health care you need

Bullet  Whether you choose to get services or supplies not covered by Medicare. In this case, you would pay for these services yourself.

Whether you have other insurance

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Medigap Policies

A Medigap policy is a health insurance policy sold by private insurance companies to fill "gaps" in Original Medicare Plan coverage. Medigap policies must follow federal and state laws. These laws protect you. The front of the Medigap policy must clearly identify it as "Medicare Supplement Insurance.

A Medigap policy must be one of ten standardized policies so you can compare them easily. Each policy has a different set of benefits. Two of the standardized policies may have a high deductible option. In addition, any standardized policy may be sold as a "Medicare SELECT" policy.

Medicare Part A (2005)

Part A is Hospital Insurance and covers cost associated with confinement in a hospital or skilled nursing facility.

When you are
hospitalized for:

Medicare Covers

You Pay

1-60 Days

Most confinement costs after the required Medicare Deductible

$912 Part A Deductible

61-90 Days

All eligible expenses, after the patient pays a per-day copayment.

$228/Day
Co-payment
as much as:
$6,840

91-150 Days

All eligible expenses, after patient pays per-day copayment.
(These Are Liftetime Reserve Days Which may never be used again.)

$456/Day
COPAYMENT
as much as:
$27,360

151 days or more

Nothing

You Pay All Cost

Skilled Nursing Confinement:
When you are hospitalized for at least 3 days and enter a Medicare Approved skilled nursing facility within 30 days after a hospital discharge and are receiving skilled nursing care.

All eligible expenses for the first 20 days; then all eligible expenses, (if you qualify), for days 21-100, after patient pays a per day copayment.

After 20 days
$114/Day
COPAYMENT
as much as:
$9,120

Medicare Part B (2005)

Part B is Medical Insurance and covers physicians services, outpatient care, test, and supplies.

On Expenses
incurred for:

Medicare Covers

You Pay $110 Annual Part B Deductible PLUS

Medical Expenses:
Physicians services, impatient, outpatient medical/surgical services, physical/speech therapy, diagnostic test.

80% of approved amount

20% of approved amount

Clinical Laboratory Services
Blood Test, Urinalysis

Generally 100% of approved amount

Nothing for Services

Home Health Care
Part-time or intermittent skilled care, home health aide services, durable medical supplies and other services.

100% of approved amount; 80% of approved amount for durable medical equipment

Nothing for Services; 20% of approved amount for durable medical equipment

Outpatient Hospital Treatment
Services for the diagnosis or treatment of an illness or injury

Medicare payment to hospital based on hospital cost

20% of Billed Amount

Blood

After first 3 pints of blood, 80% of approved amount

First 3 pints plus 20% of approved amount for additional pints

On all Medicare-covered expenses, a doctor or other health care provider may agree to accept Medicare "assignment." This means the patient will not be required to pay any expense in excess of Medicare's "approved" charge. The patient pays only 20% of the "approved" charge not paid by Medicare.

Physicians who do not accept assignment of a Medicare claim are limited as to the amount they can charge for covered services. In 2004, the most amount a physician can charge for services covered by Medicare is 115% of the fee schedule amount for nonparticipating physicians.

 

Medigap Policies

A Medigap policy is a health insurance policy sold by private insurance companies to fill "gaps" in Original Medicare Plan coverage. Medigap policies must follow federal and state laws. These laws protect you. The front of the Medigap policy must clearly identify it as "Medicare Supplement Insurance."

In all states, except Massachusetts , Minnesota , and Wisconsin , a Medigap policy must be one of ten standardized policies so you can compare them easily. Each policy has a different set of benefits. Two of the standardized policies may have a high deductible option. In addition, any standardized policy may be sold as a "Medicare SELECT" policy. Medicare SELECT policies usually cost less because you must use specific hospitals and, in some cases, specific doctors to get full insurance benefits from the policy. In an emergency, you may use any doctor or hospital.

Outline of Medicare Supplement Coverage
(Benefit Plans A-J)
Medicare Supplement Insurance can be sold in only ten standard plans. This chart shows the benefits included in each plan. Every company must make available Plan "A". Some plans may not be available in your state as indicated below.
Basic Benefits Included in all Plans
Hospitalization:

Part A coinsurance plus coverage for 365 additional days after Medicare benefits end.

Medical Expenses: Part B coinsurance (20% of Medicare-approved expenses).
Blood: First three pints of blood each year.

 

A

B

C

D

E

Basic Benefits

Basic Benefits

Basic Benefits

Basic Benefits

Basic Benefits

 

 

Skilled Nursing Coinsurance

Skilled Nursing Coinsurance

Skilled Nursing Coinsurance

 

Part A Deductible

Part A Deductible

Part A Deductible

Part A Deductible

 

 

Part B Deductible

 

 

 

 

 

 

 

 

 

Foreign Travel Emergency

Foreign Travel Emergency

Foreign Travel Emergency

 

 

 

At Home Recovery

 

 

 

 

 

 

 

 

 

 

Preventive Care

F

G

H

I

J

Basic Benefits

Basic Benefits

Basic Benefits

Basic Benefits

Basic Benefits

Skilled Nursing Coinsurance

Skilled Nursing Coinsurance

Skilled Nursing Coinsurance

Skilled Nursing Coinsurance

Skilled Nursing Coinsurance

Part A Deductible

Part A Deductible

Part A Deductible

Part A Deductible

Part A Deductible

Part B Deductible

 

 

 

Part B Deductible

Part B Excess (100%)

Part B Excess (100%)

 

Part B Excess (100%)

Part B Excess (100%)

Foreign Travel Emergency

Foreign Travel Emergency

Foreign Travel Emergency

Foreign Travel Emergency

Foreign Travel Emergency

 

At Home Recovery

 

At Home Recovery

At Home Recovery

 

 

Basic Drugs ($1,250)

Basic Drugs ($1,250)

Extended Drugs ($3,000)

 

 

 

 

Preventive Care

 

Important Contacts

Call:

With your questions about:

1-800-MEDICARE
(1-800-633-4227)

www.medicare.gov
24 hours a day
TTY users should call
1-877-486-2048

Bullet Medicare (in general)

Bullet Medicare health plans

Bullet Ordering Medicare booklets

Bullet Medigap policies

Bullet Assistance Programs (including help paying health care costs, such as prescription drugs)

Bullet Telephone numbers for local organizations who work with medicare, including TTY numbers

Social Security Administration
1-800-772-1213
TTY users should call
1-800-325-0778

Bullet Address/name changes

Bullet Death notification

Bullet Enrolling in Medicare

Bullet Medicare card (replacement)

Bullet Social Security benefits

Medicare is the Federal health insurance program for Americans age 65 and older and for certain disabled Americans. If you are eligible for Social Security or Railroad Retirement benefits and are age 65, you and your spouse automatically qualify for Medicare.

Medicare has two parts: hospital insurance, known as Part A, and supplementary medical insurance, known as Part B, which provides payments for doctors and related services and supplies ordered by the doctor. If you are eligible for Medicare, Part A is free, but you must pay a premium for Part B.

Medicare will pay for many of your health care expenses, but not all of them. In particular, Medicare does not cover most nursing home care, long-term care services in the home, or prescription drugs. There are also special rules on when Medicare pays your bills that apply if you have employer group health insurance coverage through your own job or the employment of a spouse.

The best source of information on the Medicare program is the Medicare Handbook . This booklet explains how the Medicare program works and what your benefits are. To order a free copy, write to: Health Care Financing Administration, Publications, N1-26-27, 7500 Security Blvd. , Baltimore , MD 21244-1850 . You also can contact your local Social Security office for information.

Some people who are covered by Medicare buy private insurance, called "Medigap" policies, to pay the medical bills that Medicare doesn't cover. Some Medigap policies cover Medicare's deductibles; most pay the coinsurance amount. Some also pay for health services not covered by Medicare. There are 10 standard plans from which you can choose. (Some States may have fewer than 10.) If you buy a Medigap policy, make sure you do not purchase more than one.

You need to shop carefully before deciding on the best policy to fit your needs. You may get another booklet, Guide to Health Insurance for People with Medicare , to help you in making the right choice. To order a free copy, write to: Health Care Financing Administration, Publications, N1-26-27, 7500 Security Blvd. , Baltimore , MD 21244-1850 .Another good source of information on the same topic is The Consumer's Guide to Medicare Supplement Insurance . To order a free copy, write to: Health Insurance Association of America, 555 13th St., N.W., Suite 600 East, Washington , D.C. 20004 .

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Medicaid

Medicaid provides health care coverage for some low-income people who cannot afford it. This includes people who are eligible because they are aged, blind, or disabled or certain people in families with dependent children. Medicaid is a Federal program that is operated by the States, and each State decides who is eligible and the scope of health services offered.

General information on the Medicaid program is given in the Medicaid Fact Sheet . For a free copy, write to: Health Care Financing Administration, Publications, N1-26-27, 7500 Security Blvd. , Baltimore , MD 21244-1850 . For specifics on Medicaid eligibility and the health services offered, contact your State Medicaid Program Office.

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HSA Health Savings Account

This can be a very advantageous component of your health care, if properly understood and implemented. We have found the link below to be one of the most reliable sources for information regarding HSA's. Please complete the health quote request above and we will contact you with information regarding HSA's in your state.

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COBRA

If you elect COBRA coverage when you leave your employer, you will pay the full amount of the health insurance coverage plus a 2% administrative fee. This can get very expensive.

The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. Qualified individuals may be required to pay the entire premium for coverage up to 102 percent of the cost to the plan.

Usually the For further information from the U.S. Department of Labor, Pension and Welfare Benefits Administration . For Cobra appeals information or notification rights, you may contact: U.S. Department of Labor Pension and Welfare Benefits Administration Division of Technical Assistance and Inquiries 200 Constitution Ave., NW (Room N-5658) Washington , D.C. 20210 (202) 219-8784 or (202) 219-8776

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