Captain Health USA

Making Health Insurance Great Again!


Leave a comment

Here’s to a Happy New Year and a Healthy You!

Now that you have gone through the open enrollment process for health insurance coverage, it is time to take advantage of what is available to you!

Living Your Healthiest Year!

Did you know that once you are covered under Obamacare, there are at least 15 FREE preventative services available with Obamacare and each year you have access to one wellness visit? 

Curious what is included?  Read on!

Annual Physical

Included in Obamacare, you have access to one well visit each and every year.  This annual trip to the doctor is an important one!  It provides a baseline measurement to your overall health status.  This baseline provides your doctor and healthcare professionals a picture of what your homeostatic state is.  Even more important, a baseline measurement of your health makes early detection of health issues a lot easier to recognize. 

Do Your Homework

Make yourself aware of what is covered under a well checkup/preventative care visit.  Anything outside the scope of the services listed below may result in copay fees.

When going for your annual physical, make sure your insurance company in being billed correctly by your doctor’s office.  For example, if you are visiting your doctor for a well check, make sure you ask the office how they are coding your visit and if they are coding for anything outside of why you visited.  If they code it differently than a well check, it may cause you to pay extra in copay and diagnostic fees.

FREE Preventative Care Services

Below is a comprehensive list of what is included in preventative well check visits to your doctor.

Adults

Adults have access to the following 15 preventative services while children have access to 26:

  • Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
  • Alcohol Misuse screening and counseling
  • Aspirin use to prevent cardiovascular disease for men and women of certain ages
  • Blood Pressure screening for all adults
  • Cholesterol screening for adults of certain ages or at higher risk
  • Colorectal Cancer screening for adults over 50
  • Depression screening for adults
  • Diabetes (Type 2) screening for adults with high blood pressure
  • Diet counseling for adults at higher risk for chronic disease
  • HIV screening for everyone ages 15 to 65, and other ages at increased risk
  • Immunization vaccines for adults–doses, recommended ages, and recommended populations vary:
  • Hepatitis A
  • Hepatitis B
  • Herpes Zoster
  • Human Papillomavirus
  • Influenza (Flu Shot)
  • Measles, Mumps, Rubella
  • Meningococcal
  • Pneumococcal
  • Tetanus, Diphtheria, Pertussis
  • Varicella
  • Obesity screening and counseling for all adults
  • Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
  • Syphilis screening for all adults at higher risk
  • Tobacco Use screening for all adults and cessation interventions for tobacco users

Women receive some specialized preventative care services like:

  • Anemia screening on a routine basis for pregnant women
  • Breast Cancer Genetic Test Counseling (BRCA) for women at higher risk for breast cancer
  • Breast Cancer Mammography screenings every 1 to 2 years for women over 40
  • Breast Cancer Chemoprevention counseling for women at higher risk
  • Breastfeeding comprehensive support and counseling from trained providers, and access to breast feeding supplies, for pregnant and nursing women
  • Cervical Cancer screening for sexually active women
  • Chlamydia Infection screening for younger women and other women at higher risk
  • Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, as prescribed by a health care provider for women with reproductive capacity (not including abortifacient drugs). This does not apply to health plans sponsored by certain exempt “religious employers.”
  • Domestic and interpersonal violence screening and counseling for all women
  • Folic Acid supplements for women who may become pregnant
  • Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes
  • Gonorrhea screening for all women at higher risk
  • Hepatitis B screening for pregnant women at their first prenatal visit
  • HIV screening and counseling for sexually active women
  • Human Papillomavirus (HPV) DNA Test every 3 years for women with normal cytology results who are 30 or older
  • Osteoporosis screening for women over age 60 depending on risk factors
  • Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
  • Sexually Transmitted Infections counseling for sexually active women
  • Syphilis screening for all pregnant women or other women at increased risk
  • Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users
  • Urinary tract or other infection screening for pregnant women
  • Well-woman visits to get recommended services for women under 65

Preventative Services for Children

  • Autism screening for children at 18 and 24 months
  • Behavioral assessments for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
  • Blood Pressure screening for children at the following ages: 0 to 11 months, 1 to 4 years , 5 to 10 years, 11 to 14 years, 15 to 17 years.
  • Cervical Dysplasia screening for sexually active females
  • Depression screening for adolescents
  • Developmental screening for children under age 3
  • Dyslipidemia screening for children at higher risk of lipid disorders at the following ages: 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
  • Fluoride Chemoprevention supplements for children without fluoride in their water source
  • Gonorrhea preventive medication for the eyes of all newborns
  • Hearing screening for all newborns
  • Height, Weight and Body Mass Index measurements for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
  • Hematocrit or Hemoglobin screening for children
  • Hemoglobinopathies or sickle cell screening for newborns
  • HIV screening for adolescents at higher risk
  • **Hypothyroidism screening for newborns
  • Immunization vaccines for children from birth to age 18 —doses, recommended ages, and recommended populations vary:
  • Diphtheria, Tetanus, Pertussis
  • Haemophilus influenza type b
  • Hepatitis A
  • Hepatitis B
  • Human Papillomavirus
  • Inactivated Poliovirus
  • Influenza (Flu Shot)
  • Measles, Mumps, Rubella
  • Meningococcal
  • Pneumococcal
  • Rotavirus
  • Varicella
  • Iron supplements for children ages 6 to 12 months at risk for anemia
  • Lead screening for children at risk of exposure
  • Medical History for all children throughout development at the following ages: 0 to 11 months, 1 to 4 years , 5 to 10 years ,11 to 14 years , 15 to 17 years.
  • Obesity screening and counseling
  • Oral Health risk assessment for young children Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years.
  • Phenylketonuria (PKU) screening for this genetic disorder in newborns
  • Sexually Transmitted Infection (STI) prevention counseling and screening for adolescents at higher risk
  • Tuberculin testing for children at higher risk of tuberculosis at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years,11 to 14 years, 15 to 17 years.
  • Vision screening for all children.

Preventative Services for Seniors

Medicare Part B (Medical Insurance) covers:

  • Abdominal aortic aneurysm screening
  • Alcohol misuse screenings & counseling
  • Bone mass measurements (bone density)
  • Cardiovascular disease screenings
  • Cardiovascular disease (behavioral therapy)
  • Cervical & vaginal cancer screening
  • Colorectal cancer screenings
  • Depression screenings
  • Diabetes screenings
  • Diabetes self-management training
  • Glaucoma tests
  • Hepatitis C screening test
  • HIV screening
  • Mammograms (screening)
  • Nutrition therapy services
  • Obesity screenings & counseling
  • One-time “Welcome to Medicare” preventive visit
  • Prostate cancer screenings
  • Sexually transmitted infections screening & counseling
  • Shots:
  • Flu shots
  • Hepatitis B shots
  • Pneumococcal shots
  • Tobacco use cessation counseling
  • Yearly “Wellness” visit

Did you know?

Know the facts about health insurance coverage!  Included in your Obamacare Health Plan are 10 Essential Health Benefits.  They are:

  1. Outpatient care—the kind you get without being admitted to a hospital
  2. Trips to the emergency room
  3. Treatment in the hospital for inpatient care
  4. Care before and after your baby is born
  5. Mental health and substance use disorder services: This includes behavioral health treatment, counseling, and psychotherapy
  6. Your prescription drugs
  7. Services and devices to help you recover if you are injured, or have a disability or chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more.
  8. Your lab tests
  9. Preventive services including counseling, screenings, and vaccines to keep you healthy and care for managing a chronic disease.
  10. Pediatric services: This includes dental care and vision care for kids

“Specific health care benefits may vary by state. Even within the same state, there can be small differences between health insurance plans. When you fill out your application and compare plans, you’ll see the specific health care benefits each plan offers.”

Source:  Healthcare.gov

Still have questions or concerns?  Contact me today!  I can be reached at (813) 391-3448 or Email me at Dave@YourObamacareGuy.com

Advertisements


Leave a comment

2017 Open Enrollment…Are you READY?

It’s that time of year again!  Get ready to start thinking about open enrollment and what you need to do to make sure you and your family have health insurance coverage.

Here is what you need to know!

2016:

Open enrollment for 2016 is CLOSED.  BUT, If you still need coverage for the rest of 2016, you can get it but, only if you qualify. 

To qualify you need to meet one of these two criteria:

  • Special Enrollment Period due to a life event — like losing health coverage, getting married, or having a baby.
  • You qualify for Medicaid or the Children’s Health Insurance Program (CHIP).

You can apply for these programs any time throughout the year.

Let’s Brush Up On The Marketplace

About The Marketplace:

Who is it for?  The Marketplace is for individuals who do not have health coverage for the coming year.  That means, you do not have coverage through:

  • Your employment
  • Medicare
  • Medicaid
  • The Children’s Insurance Program (CHIP)
  • Another source providing qualifying coverage

How Much It Costs:

Health insurance through the Marketplace depends on your estimated income for the coverage year.  Did you know?  In 2017, roughly 8 out of 10 of uninsured people who are eligible for Marketplace coverage will qualify for financial assistance.*  The financial assistance  provided goes towards lowering the cost of the monthly premiums and in some cases is can also help with things like deductibles and copays.  Get an idea of what that could mean for you HERE.

Discover What The Marketplace Insurance Covers:

Essential health benefits – Every plan must include the following:

  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  • Emergency services
  • Hospitalization (like surgery and overnight stays)
  • Pregnancy, maternity, and newborn care (both before and after birth)
  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)
  • Pre-existing conditions, including pregnancy
  • Preventive care
  • Birth control coverage
  • Breastfeeding coverage

Pre-existing conditions, including pregnancy

Preventive care

Get a list of what that includes for:

What If You Do Not Get Health Insurance?

If you can afford health insurance and fail to obtain qualifying health coverage for the 2017 year, you may be fined.  This fine is referred to the “individual shared responsibility payment”. 

Fees are calculated in two different ways.  They are:

  • A percentage of your house hold income
  • Per person

You will be required to the highest rate calculated.

Fines for 2017 have not been released as of yet.

Do you have questions about your health insurance coverage for 2017?  I can help!  Contact me, Your Obamacare Guy!  I can be reached at:  (813) 391-3448 or email address:  dave@YourObamacareGuy.com

* source:  http://www.HealthCare.gove/quickguide


1 Comment

Physician Referrals, YOU Have A Choice!

Physician Referrals, YOU Have A Choice!

Health care and visiting the doctor has become increasingly complicated to navigate. Rules are always changing.  Life is busy which makes it hard to keep up with the changes.  Good news!  I am here to help!  So, let’s dive in!!!

Wednesday 7 6 16When do I need a referral?

Referrals are generally required when you need to see a specialist for a condition that your regular primary care physician cannot treat.  Not all specialists need a referral.  The services that DO NOT require referrals are:

  • In network:
    • Obstetrician/gynecologist
    • Urgent care centers or walk in clinics
    • Eye examinations
    • Mental health disorder and substance abuse services
    • Pathologist
    • Radiologist
    • Anesthesiologist
    • Emergency room visits/admissions
    • Non-physician services such as:
      • Outpatient labs
      • Diagnostics
      • Physical Therapy
      • Durable medical equipment

How do I obtain a referral for a specialist?

Once your primary care physician determines a specialist is needed, to help you with your condition, a referral is given.

A Referral is an authorization for you to see a specialist.

In some cases, your physician may give you a recommendation of who to see along with his referral.  A recommendation is exactly what it sounds like.  It is a suggestion of who you might want to consider seeing for treatment, not a mandate.  This is great news!  Why?  For many reasons!  Check them out:

  • Many times, your primary physician may recommend a specialist who is not in your network.  This can be a very expensive option for you.
  • You have the opportunity to research and find the perfect specialist for you within your health insurance network
  • In some cases, referrals are generated due to a quid pro quo arrangement between doctors.

Now that you have your referral in hand, it is time to select your specialist.  One of the first things you should do is fire up your computer and search for the doctor in your insurance plan’s database.  Not sure who is in your carrier’s database or where to even find the database?  No worries, use this handy tool:  Dave’s Doctor Search.  Here you will find all of the doctor’s listed in the each of the major health insurance carriers.

Select at least three specialists you are interested in possibly using for treatment and learn more about them.  Some of the things you will want to look for are:

  • Is the doctor licensed?  You can verify this by visiting your state’s physician licensing board
  • Is the physician board certified?  A board certified physician is one who demonstrates exceptional expertise in a specialty or subspecialty.  They are certified and recognized by the ABMS Member Board.  Qualifications to be recognized by this board includes rigorous testing and peer evaluations.  These evaluations and tests are engineered and administrated by other specialists in the same field of specialty.
  • Consider the age of the doctor.  Are they older and considering retirement, are they younger and have a passion for cutting edge technology and techniques or have they been practicing a long time giving them ample experience to treat your condition well?
  • Discover how long the doctor has been practicing by visiting online doctor listing sites.
  • Have there been interruptions in their practice and why?
  • What hospitals is the doctor affiliated with and how are those hospitals ranked?
  • Has the doctor experienced any reprimands or malpractice suits?
  • Consider researching doctor ratings sites and review sites.
  • Has the doctor authored any papers, studies or conducted research in the field you are looking to get treatment in?

There is so much to consider when selecting a doctor and a specialist!  The most important thing to remember is that YOU get to make the choice on who treats you.  Take control of your health and your healthcare by selecting the physician that makes the most sense for you and your health goals.

Remember, the referral you receive from your primary care physician (PCP) is the authorization you need to go to the specialist.  The name of a doctor they give is a recommendation only.  Do your homework and find the right fit for you.

Do you need help navigating your way through today’s healthcare arena?  I can help!  Contact Dave, Your ObamaCare Guy for more information at: (813) 391-3448 or email me at dave@YourObamacareGuy.com.


Leave a comment

SureMed…It’s What You Have Been Waiting For!

SureMed…It’s What You Have Been Waiting For!

YOCG Wednesday 5 4 16 CanvaWhat if I told you there was a healthcare solution allowing you the opportunity where your entire family can talk to a physician anytime, for only $20 a month!?!  It’s true!  Without any other additional or hidden charges either!  20 dollars…that’s it!

Great news!  This plan IS a reality!!!  PLUS…your own health insurance plan may cover prescriptions if one is called in!

Interested?  Read on!

SureMed offers a unique service that gives you access to a physician by phone 24/7 without being charged an additional consultation fee.

This service completely revolutionizes visiting the doctor!  Imagine…

  • Speaking to a U.S. licensed, board certified physician and getting your questions answered from the comfort of your own home!
  • Receiving advice and consultation from knowledgeable, board certified physicians with an average of 15 years practice experience!
  • Being diagnosed via the phone or video consultation!
  • The pleasure of avoiding crowded waiting rooms, busy walk-in clinics and additional germs found in those places!
  • Quick response time!  Call backs from qualified physicians take place within an average just 16 minutes!

What can be diagnosed over the phone or by video consultation?

YOCG Thursday 5 5 16 CanvaSureMed has made it easy for you to receive consultation, diagnoses, and prescriptions over the phone for common illnesses like:

  • Colds
  • Flu
  • Poison Ivy
  • Respiratory Infections
  • Bronchitis
  • Allergies
  • Pink eye
  • Sinus Problems
  • Urinary Tract Infections
  • Ear Infections
  • Non-emergency illnesses

Treatment Recommendations

The doctor can advise patients on the treatment actions to be taken and may even prescribe medications such as antibiotics and other substances not controlled by the DEA or other medications which are susceptible to abuse.  If a prescription is required to treat the illness diagnosed, the doctor can have it called in to the local pharmacy of your choice.

Check out what else is included…

The $20/month program includes ALL of these amazing benefits:

  • Doctors by phone
  • Counselors by phone
  • Dental discounts
  • Vision discounts
  • Prescription discounts
  • Retail health clinic discounts
  • Medical bill saver – medical billing advice and negotiation help
  • Vitamin discounts and price comparison
  • Lab discounts
  • Diabetic supplies discounts
  • MRI & CT Scan discounts
  • Hearing aid discounts
  • Durable medical equipment discounts

It almost sounds too good to be true but it is!

If you have questions about this plan and want more details, call me!  I would love to talk you about this incredible opportunity for you and your family!

Call me, Your Obamacare Guy at (813) 391-3448 or email me at dave@YourObamacareGuy.com.


Leave a comment

Easy To Understand Life Insurance Guide: Navigating What It Is and Why It Is so Important!

Easy To Understand Life Insurance Guide:  Navigating What It Is and Why It Is so Important!

YOCG Tuesday 4 5 16 CanvaWho needs life insurance?  Ask yourself this…..If you don’t come home tonight will anyone be financially harmed?  If the answer is yes…..then you need Life Insurance.

Life Insurance is one of those things we know we should have but maybe we just haven’t gotten around to getting it due to our hectic lives, possibly it is hard to understand or may be we think it only applies to people who are a certain age and older.  Whatever is stopping you from having life insurance, you need to change it and this article will tell you why.

But first…some basics.

There are certain types of life insurance you need to understand first before you make any decisions regarding it.

What is Life Insurance?

Life Insurance is a type of insurance which pays an amount of money to beneficiaries upon the death of the person who was insured.  It is designed to help your family and dependents financially after you have passed away. For example, it can help your family with:

  • Ongoing income to help replace yours
  • Providing emergency funds for medical assistance, legal fees and funeral costs

Life insurance is usually broken down into certain types.  We are going to focus on the most common you will run into and give you a good understanding of them.

Term Life Insurance (also known as Temporary Life):

YOCG Wednesday 4 6 16 CANVASimply put, term life insurance is a policy that pays off a monetary benefit in the event of death during a certain/fixed time period, for example a 10 or 20 year time period.

Benefits of Term Life Policies:

  • Low cost – perfect for temorary coverage on a parent while kids are growing up.
  • Allows for high levels of protection at a lower cost
  • Tax-free proceeds paid to beneficiaries

Curious about how low cost this life insurance option is?  Check out my sample rate chart:

Life Rate Chart

Universal Life Insurance (also referred to as UL):

This permanent type of life insurance offers flexibility in premiums.  Individuals holding UL policies have the choice of paying the minimum premium of the insurance or including extra monies to be allocated to an accumulation account.  This account or fund may be used in the future to pay premiums or for future income in retirement.

Benefits of UL Policies Include:

  • Protects the insured for a lifetime
  • The ability to earn interest and/or grow based on outcomes of accounts tied to other investments
  • Access to tax free loans or income in the future.
  • Tax-free proceeds paid to beneficiaries

Whole Life Insurance:

YOCG Thursday 4 7 16 CANVAThis permanent type of life insurance has a fixed premium.   Tends to often come with higher premiums than a Term Life or a Universal Life Insurance policy that stays the same your whole life.

Benefits of Whole Life Policies Include:

  • Protects the insured for a lifetime
  • Offers fixed premiums
  • May or may not have excess value in the future.
  • Tax-free proceeds paid to beneficiaries

Discovering Why Life Insurance is Important

The benefits of the various policies listed above should make it easy to understand why it is so important to get coverage.  Take it one step further…

You unexpectedly die due to an accident.  The shock of your death to your family and loved ones is unimaginable.  Compound the grief and loss your family will experience in regards to your death with:

  • Medical bills sustained due to your death
  • Paying daily living expenses without your income
  • Funeral costs
  • Legal fees
  • The uncertainty of your family’s financial future

Unless you have been able to amass a large, profitable financial portfolio, how will your family manage without your regular income?  Who will pay the bills? The mortgage? Who will put food on the table and how long can they sustain it?  An affordable life insurance policy is the answer to these daunting questions.  A life insurance policy will help you to continue to provide for your family and dependents.

Do you have questions about life insurance and what policy may be right for your family and their needs?  Contact me!  I am here to help!  Your Obamacare Guy at (813) 391-3448 or dave@YourObamacareGuy.com.

 


Leave a comment

Emergency Room VS Walk -In Clinic and Your Insurance

Emergency Room VS Walk -In Clinic and Your Insurance

YOCG Tuesday 1 5 2016We all like options right?  Today we have lots of options when it comes to healthcare.  We can choose our doctor from a list of network physicians, select generic prescriptions versus brand name, and we can even choose whether or not we want to go to the Emergency Room or a Walk-In Clinic in urgent but non life-threatening circumstances.  The last option may mean a big difference in dollars you need to pay!  Read on to learn more!

 

Lower Copays
If you had the opportunity to pay lower copays, would you jump at the chance?  I know I would!  Did you know that your may have the opportunity for lower copays if you choose to get care at an in-network walk-in clinic instead of an emergency room?  That’s right!  Your insurance may reward you with a lower copay when you elect to get treatment in a walk-in clinic rather than an ER for non life threatening illnesses or injuries.  In some instances, you may only need to pay $25 to $50 in copay fees when visiting an in network walk-in clinic as opposed to thousands of dollars in Emergency Room bills.

What Type of Services Can You Expect From A Walk-In Clinic?

You may be surprised at the vast amount of services a Walk-In Clinic or Urgent Care facility can provide.  Check out our table below for details of what may be treated in an urgent care facility.

Urgent Care Services

Emergency Room Fees Add Up…Quickly!

YOCG Tuesday 2 2 16 CANVAEmergency room fees tend to add up fast, even before you get there, especially if an ambulance was called.  Depending on your insurance, you could be charged anywhere from as low as $25 but as high as $1,200.

Once you arrive to the Emergency Room, there is a chance that you will need x-rays, special diagnostic testing, medicine and more. Below is my list of tips for monitoring your emergency room bill:

  • Make sure you have a trusted friend or family member with you to help you do some legwork
  • Ask for an itemized list of your bill and scrutinize it for procedures not done or medication not given
  • Talk to the billing department.  Find out if there are different sets of costs for procedures done and select one that fits your budget if you can
  • Discuss a payment plan.  Typically hospitals do not want a bill to go to collection agencies.  See if they will work out a reasonable payment plan with you
  • Discover if there are financial aid programs available to you or if there are any not-for-profit organizations that can help with paying the bill

When Should You Go To An Emergency Room?

Some conditions that should be seen by an Emergency Room staff include:

  • Severe chest pain or difficulty breathing
  • Compound fracture (bone protrudes through skin)
  • Convulsions, seizures or loss of consciousness
  • Fever in newborn (less than 3 months old)
  • Heavy, uncontrollable bleeding
  • Deep knife wounds or gunshot wounds
  • Moderate to severe burns
  • Poisoning
  • Serious head, neck or back injury
  • Pregnancy-related problems
  • Severe abdominal pain
  • (Signs of) Heart attack (i.e.. chest pain lasting longer than two minutes)
  • (Signs of)Stroke (e.g. loss of vision, sudden numbness, weakness, slurred speech, or confusion)
  • Suicidal or homicidal feelings

When in doubt, get to the nearest emergency room and get the treatment you need.

Before an emergency happens, take the time to understand your policy and what is included and required during an emergency

If you have questions about your coverage and need assistance understanding your policy, contact me, Your Obamacare Guy at (813) 391-3448 or dave@YourObamacareGuy.com.  It is my pleasure to help people get the coverage they need to live the healthiest life possible!


Leave a comment

Health Insurance, Medicare, Medicaid…What’s The Difference?

YOCG Wednesday 12 23 15 CANVAMany people use “Health Insurance” as a blanket term, referring to any doctor’s visit, medication, urgent care visit, physical, diagnostic testing, etc. that is paid for or partially paid for by an insurance company.  This is true, however, when we talk about Medicare and Medicaid, there is a little more detail that we need to understand.

When you look a little closer to these three terms:  Health Insurance, Medicare and Medicaid, you see they are very different.  Each has a different type of benefit that is available to different types of people.

Let’s take a look at each, individually, to help give us a better, deeper understanding of exactly what the differences are and when it makes sense to choose “Health Insurance”, “Medicare”, or “Medicaid”.

Health Insurance:

In the simplest of terms, health insurance is a type of insurance coverage that pays for healthcare services, expenses, medication and treatment incurred by the person who is insured.

Heathcare.gov defines it as:  A contract that requires your health insurer to pay some or all of your health care costs in exchange for a premium.

Who is eligible for “Health Insurance”?  
YOCG 12 17 15Everyone!  As a result of the Affordable Care Act, (a.k.a. Obamacare) everyone is eligible for health insurance and has the opportunity to get covered during certain periods of the year or as a result of specific life circumstances.

In the traditional sense, Health Insurance is usually regarded as the insurance coverage you can purchase through The Marketplace, through private providers or it is coverage that is provided by an employer.

But wait…there is more!

Health Insurance is broken down even further, specifically into two categories or branches.  They are:  Medicare and Medicaid.  Medicare and Medicaid service two very specific demographics of American citizens.  Let’s look at each a little more closely.

What is Medicare?

Medicare is a Federal health insurance program for specific demographics of the American population.  There are 4 parts to Medicare.  Medicare Part A, Medicare Part B, Medicare Part C /Supplement and Medicare Part D.

Medicare Part A:

Medicare Part A is hospital insurance coverage which covers the following:

  • Inpatient hospital care
  • Home health care services
  • Care from a skilled nursing facility
  • Hospice care

Who is Eligible?

Medicare Part A insurance is available to those American Citizens who:

  • Are 65 years old
  • Have worked at least 10 years or 40 fiscal quarters
  • Paid Medicare taxes during their 10 years or 40 fiscal quarters
  • Eligible for social security
  • Are disabled and are receiving disability benefits
  • Have end-stage renal disease
  • Have ALS/Lou Gehrig’s Disease

Once an American reaches the age of 65, they may be automatically enrolled into Medicare Part A.  Medicare is primarily available to people over the age of 65 regardless of their annual income.

Medicare Part A begins the first day of the month you turn 65.  If your birthday is on the first day of the month, your benefits will begin the month before you turn 65.

Medicare Part B:

There are two types of services that Medicare Part B covers:

  1. Medically Necessary Services
  2. Preventative Services

Medically Necessary Services:

These are services and/or supplies that are required to diagnose and treat a medical condition.  These services and supplies must meet “accepted standards of medical practice”; medicare.gov

Preventative Services Include:

  • Clinical research
  • Ambulance services
  • Durable medical equipment
  • Mental health
  • Second opinion before surgery
  • Limited outpatient drugs

What Is NOT Covered by Medicare Part A and Medicare Part B:

Medicare does not cover absolutely everything.  Some of the things that Medicare does not cover are:

  • Long term care
  • Dental care
  • Vision exams
  • Dentures
  • Cosmetic surgery
  • Acupuncture
  • Hearing aid and fittings
  • Routine foot care

Medicare Part C or a Supplement

Obamacare Guy 8 27 15 CANVA-2– Medicare Part C is also know as Medicare Advantage.  It is a private plan that is overseen by Medicare.  Part C plans vary from provider to provider, but, the common thread is that they must offer something that is equivalent to Medicare Part A and Part B.  Medicare Part C plans offer more benefits including vision, dental and hearing.  Some also include a prescription drug coverage plan as well.  Some say the dis-advantage to the Advantage plans is that you must use the plan’s doctors and service providers in order to be covered.

– Supplements work with Medicare to fill in the gap of whats not paid by Medicare for a covered expense.  Original Medicare (parts A and B) are designed to pay for 80% of your medical costs.  The supplement pays the remaining 20%.  Many people like this type of coverage because you can go to any provider who accepts Medicare and your costs are 100% covered.

Why choose one over the other?…..Cost.  Medicare Advantage plans range from $0 to about $100 per month while a supplement can cost from $80 to $230 per month.

Note:  When enrolling in a Medicare Part C plan, you are still required to pay your Medicare Part B premium.  Each private Medicare Part C plan has different pricing (some even refund your part B premium).  Make sure you understand all of the pricing and shop around to get the best plan for your needs.

Medicare Part D

Medicare Part D is the prescription drug portion of your Medicare plan.  There are two options here…..

Option 1:  Adding the Medicare Part D option as a supplement from an insurance company.

Option 2:  Selecting a Medicare Advantage plan that offers prescription drug coverage

What is Medicaid?

Medicaid is a Federally run program for low income American citizens.  It is a free or low cost option for those who are eligible.

This coverage is available to eligible Americans including:

  • Families
  • Children
  • Pregnant Women
  • Elderly
  • Those with disabilities

Each state designs their own Medicaid programs.  Overall, there are some mandatory benefits that must be recognized under Medicaid.  Those include:

  • Inpatient Hospital Services
  • Outpatient Hospital Services
  • Early and Periodic Screening, Diagnostic and Treatment Services
  • Nursing Facility Services
  • Home Health Services
  • Physician Services
  • Rural Health Clinic Services
  • Federally Qualified Health Center Services
  • Laboratory and X-Ray Services
  • Family Planning
  • Nurse Midwife Services
  • Certified Pediatric and Family Nurse Practitioner Services
  • Freestanding Birth Center Services
  • Transportation to Medical Care
  • Tabacco Cessation
  • Counseling for Pregnant Women

The eligibility for this program varies by state.

There is a lot of information packed into this one blog post.  Without a doubt, it has generated questions, specific to your individual situation and the option that is best for you.  If you need help in determining your eligibility for Medicare or Medicaid, contact me, Your Obamacare Guy at (813) 391-3448 or dave@YourObamacareGuy.com.  It is my pleasure to help people get the coverage they need to live the healthiest life possible!

Sources:

healthcare.gov, medicare.gov