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 Information provide here is for basic informational purposes and is not intended to be personalized advice.
  1. Major Medical Plans - The basics of health insurance plans. (Medical Expense plans)
  2. What is a PPO plan (Preferred Provider Organization)?
  3. What is an HMO (Health Maintenance Organization)?
  4. What is a POS plan (Point of Service)?
  5. Explain an Indemnity or Traditional health plan.
  6. A few words about health insurance and benefits for mental health issues and substance abuse treatment.
  7. Common exclusions of major medical health plans.
  8. What are normal "out of pocket" expenses?
  9. What does "Co-insurance limit" mean? (also referred to Max. out of pocket or co-insurance cap)
  10. Are Co-payment and Co-insurance the same thing?
  11. How do preexisting conditions limitations and clauses effect me?
  12. A discussion of Prescription Drug Coverage
  13. Life Insurance basics.
  14. Permanent whole life vs. Term Life insurance.
  15. How Much Life Insurance Do I need?
  16. I'd like to check the ratings of a life insurance company.
  17. When should I use Short Term Major Medical insurance?
  18. What do most Short Term Major Medical plans cover?
  19. Tell me about the usual limitations of Short Term Major Medical plans.
  20. I only need health insurance for a short time. What should I do?
  21. What is Short Term Medical Expense Insurance?
  22. What is more important Life Insurance or Disability Income Insurance?
  23. How much Disability Insurance should I purchase?
  24. What are the differences in STD or LTD? (Short Term Disability or Long Term Disability)
  25. What is an elimination period
  26. What qualifies me as eligible for disability insurance?
  27. What are the differences between "non-cancelable" and "guaranteed renewable?"
  28. How much does Disability insurance typically cost?
  29. Should I apply for a private LTD plan from my agent or should I apply at work for the group LTD?
  30. Will I have to pay income taxes on Disability benefits?
  31. Where to find ratings of health plans.
  32. What is Medicare
  33. What is Medicaid
  34. What is a Health Savings Account (Treasury Dept. Presentation) "All About HSAs)
Medicare
Medicare is a federally administered program that provides hospital and medical insurance protection to people aged 65 and older, disabled people under age 65 who receive cash benefits under Social Security or Railroad Retirement programs, and people of all ages with chronic kidney disease. Since 1973, aliens and some federal civil service employees and annuitants have been eligible to enroll by paying a monthly premium.

Benefits
Medicare consists of two parts: Part A and Part B. Part A is compulsory hospital insurance (HI), financed by contributions from employees, employers, and participants. HI pays for hospital, nursing home, home health and hospice service. Part B is voluntary supplemental medical insurance Part B is financed by payments from those who enroll in it. Part B covers physicians' services and a variety of other goods and services. More details about Medicare  This will open a new window. Simply close it to return to this site.

Health Insurance Information for Seniors
Each state has a special program for the purpose of counseling senior citizens about health insurance issues. You may contact your state's Insurance Counseling and Assistance (ICA) program.

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What are My Medicare Choices

This is a brief introduction to the types of Medicare health plans that may be available to you. You must have Medicare Parts A and B, and not have End-Stage Renal Disease (permanent kidney failure) to be eligible for some of options. The Original Medicare Plan is available nationally. Other Medicare + Choice health plan options may be available to you, depending upon where you live. 

It is important that you carefully consider your options your health care. carefully and /or seek assistance from people and sources you trust.  One option will continue to be the Original Medicare Plan. Another choice could be one of the new health plan options. There are differences among Medicare health plans that you need to know about. For example, there will be differences in

  • how much it will cost;
  • whether extra benefits, like prescription drugs, are offered;
  • and how much choice you have in using certain doctors, hospitals and other providers.

No matter which health plan option you choose to join or stay in, you are still in the Medicare program. You will receive all services Medicare covers. However, the Original Medicare Plan does not pay for everything and it does not cover all services. Some health plan options provide coverage for services not otherwise covered by the Original Medicare Plan. Some can reduce your out-of-pocket costs like deductibles and coinsurance.

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What are My Medicare Choices

This is a brief introduction to the types of Medicare health plans that may be available to you. You must have Medicare Parts A and B, and not have End-Stage Renal Disease (permanent kidney failure) to be eligible for some of options. The Original Medicare Plan is available nationally. Other Medicare + Choice health plan options may be available to you, depending upon where you live. 

It is important that you carefully consider your options your health care. carefully and /or seek assistance from people and sources you trust.  One option will continue to be the Original Medicare Plan. Another choice could be one of the new health plan options. There are differences among Medicare health plans that you need to know about. For example, there will be differences in

  • how much it will cost;
  • whether extra benefits, like prescription drugs, are offered;
  • and how much choice you have in using certain doctors, hospitals and other providers.

No matter which health plan option you choose to join or stay in, you are still in the Medicare program. You will receive all services Medicare covers. However, the Original Medicare Plan does not pay for everything and it does not cover all services. Some health plan options provide coverage for services not otherwise covered by the Original Medicare Plan. Some can reduce your out-of-pocket costs like deductibles and coinsurance.
What is Medicaid
Medicaid eligibility is much more complex than Medicare. Medicaid is a welfare program, and each applicant must show that their income is less than  levels set by states according to federal guidelines. Eligibility also varies significantly from state to state. 

How Does Medicaid Work?
Medicaid is administered by each state according to federal requirements and guidelines, and is financed from both state and federal funds. It provides medical assistance to people eligible for cash assistance programs such as Aid to Families with Dependent Children (AFDC) and Supplemental Security Income (SSI). States have broad discretion in covering different groups under their Medicaid program. To be eligible for federal funds, the program must provide for individuals receiving federal aid.

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Information for Those on Medicaid
Some state Medicaid agencies give consumers information on how Medicaid managed care plans perform. New federal legislation requires all states to give consumers managed care performance information in the future. You can ask your state Medicaid agency if they will provide:

  • Statistics on grievances, showing the number of Medicaid recipients that complained about their plans, and what kinds of problems they encountered and how well the plans resolved their problems;
  • Statistics on disenrollments, showing how many Medicaid recipients decided to leave their managed care plan;
  • results from external quality reviews, showing what problems auditors identified within the managed care plans, such as the quality of care  and if those plans corrected the problems.
HMOs

A Health Maintenance Organization (HMO) is like a club for both patients and health care providers. Subscribers to an HMO receive medical services from participating physicians, clinics and hospitals. An insurance company sets up an HMO and recruits a group of doctors to participate. The HMO and providers agree on certain costs and charges, this lets the insurance company control expenses and prices. If you join an HMO and your doctor isn't a member, you must choose a doctor in the HMO panel. This is how an HMO works:
  • You choose a primary care physician (PCP) from a list of participating doctors. This doctor is the one you see see for routine medical care such as annual exams and health concerns. If you need to see a specialist, be hospitalized, or have lab or X-ray work, your PCP will refer you to a provider or facility. Your PCP authorize these services to be covered by your HMO.
  • You may have to pay a small portion of the cost (called a co-payment) for each office or hospital visit, such as $15 or $20 per doctor visit, regardless of what the services cost.
  • Some services will cost extra such as (emergency room, mental health and chemical dependency services, for example).
  • As an HMO member you do not have to fill out claim forms. 

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What is Medicaid
Medicaid eligibility is much more complex than Medicare. Medicaid is a welfare program, and each applicant must show that their income is less than  levels set by states according to federal guidelines. Eligibility also varies significantly from state to state. 

How Does Medicaid Work?
Medicaid is administered by each state according to federal requirements and guidelines, and is financed from both state and federal funds. It provides medical assistance to people eligible for cash assistance programs such as Aid to Families with Dependent Children (AFDC) and Supplemental Security Income (SSI). States have broad discretion in covering different groups under their Medicaid program. To be eligible for federal funds, the program must provide for individuals receiving federal aid.

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Information for Those on Medicaid
Some state Medicaid agencies give consumers information on how Medicaid managed care plans perform. New federal legislation requires all states to give consumers managed care performance information in the future. You can ask your state Medicaid agency if they will provide:

  • Statistics on grievances, showing the number of Medicaid recipients that complained about their plans, and what kinds of problems they encountered and how well the plans resolved their problems;
  • Statistics on disenrollments, showing how many Medicaid recipients decided to leave their managed care plan;
  • results from external quality reviews, showing what problems auditors identified within the managed care plans, such as the quality of care  and if those plans corrected the problems.
HMOs

A Health Maintenance Organization (HMO) is like a club for both patients and health care providers. Subscribers to an HMO receive medical services from participating physicians, clinics and hospitals. An insurance company sets up an HMO and recruits a group of doctors to participate. The HMO and providers agree on certain costs and charges, this lets the insurance company control expenses and prices. If you join an HMO and your doctor isn't a member, you must choose a doctor in the HMO panel. This is how an HMO works:
  • You choose a primary care physician (PCP) from a list of participating doctors. This doctor is the one you see see for routine medical care such as annual exams and health concerns. If you need to see a specialist, be hospitalized, or have lab or X-ray work, your PCP will refer you to a provider or facility. Your PCP authorize these services to be covered by your HMO.
  • You may have to pay a small portion of the cost (called a co-payment) for each office or hospital visit, such as $15 or $20 per doctor visit, regardless of what the services cost.
  • Some services will cost extra such as (emergency room, mental health and chemical dependency services, for example).
  • As an HMO member you do not have to fill out claim forms. 

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PPOs

PPOs offer choices and access, but there is typically a cost associated with that freedom that is higher than HMO costs. Like an HMO, it is a network, but you do not have to choose a primary care physician, you can see any health care professional in the network any time you choose to make an appointment. Nor do you need referrals for specialists or other services. You can even see providers outside the PPO network, but if you do, your portion of the costs will be higher. This is how a PPO works:

  • You will have choices to make about your insurance options within the PPO system at the time of initial enrollment. Your choices will apply to you and any dependents you enroll in the plan. These initial choices can usually only be changed once a year during "open enrollment" periods.
  • You'll receive a list of participating medical professionals (provider directory), which you can use help you find a provider or to see if your current provider is in the network. You may continue to see your current provider, but if he/she is not in the PPO Network your share of costs will be greater. Check the directory or ask your provider if you need to know if current providers are in your network.
  • You most likely will have pay a portion of the cost for each office or hospital visit,(co-payment)  regardless of how much the visit costs.
  • As in an HMO You may have to pay extra for some services (emergency room, mental health and chemical dependency services, for example).

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What are My Medicare Choices

This is a brief introduction to the types of Medicare health plans that may be available to you. You must have Medicare Parts A and B, and not have End-Stage Renal Disease (permanent kidney failure) to be eligible for some of options. The Original Medicare Plan is available nationally. Other Medicare + Choice health plan options may be available to you, depending upon where you live. 

It is important that you carefully consider your options your health care. carefully and /or seek assistance from people and sources you trust.  One option will continue to be the Original Medicare Plan. Another choice could be one of the new health plan options. There are differences among Medicare health plans that you need to know about. For example, there will be differences in

  • how much it will cost;
  • whether extra benefits, like prescription drugs, are offered;
  • and how much choice you have in using certain doctors, hospitals and other providers.

No matter which health plan option you choose to join or stay in, you are still in the Medicare program. You will receive all services Medicare covers. However, the Original Medicare Plan does not pay for everything and it does not cover all services. Some health plan options provide coverage for services not otherwise covered by the Original Medicare Plan. Some can reduce your out-of-pocket costs like deductibles and coinsurance.
What is Medicaid
Medicaid eligibility is much more complex than Medicare. Medicaid is a welfare program, and each applicant must show that their income is less than  levels set by states according to federal guidelines. Eligibility also varies significantly from state to state. 

How Does Medicaid Work?
Medicaid is administered by each state according to federal requirements and guidelines, and is financed from both state and federal funds. It provides medical assistance to people eligible for cash assistance programs such as Aid to Families with Dependent Children (AFDC) and Supplemental Security Income (SSI). States have broad discretion in covering different groups under their Medicaid program. To be eligible for federal funds, the program must provide for individuals receiving federal aid.

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Information for Those on Medicaid
Some state Medicaid agencies give consumers information on how Medicaid managed care plans perform. New federal legislation requires all states to give consumers managed care performance information in the future. You can ask your state Medicaid agency if they will provide:

  • Statistics on grievances, showing the number of Medicaid recipients that complained about their plans, and what kinds of problems they encountered and how well the plans resolved their problems;
  • Statistics on disenrollments, showing how many Medicaid recipients decided to leave their managed care plan;
  • results from external quality reviews, showing what problems auditors identified within the managed care plans, such as the quality of care  and if those plans corrected the problems.
HMOs

A Health Maintenance Organization (HMO) is like a club for both patients and health care providers. Subscribers to an HMO receive medical services from participating physicians, clinics and hospitals. An insurance company sets up an HMO and recruits a group of doctors to participate. The HMO and providers agree on certain costs and charges, this lets the insurance company control expenses and prices. If you join an HMO and your doctor isn't a member, you must choose a doctor in the HMO panel. This is how an HMO works:
  • You choose a primary care physician (PCP) from a list of participating doctors. This doctor is the one you see see for routine medical care such as annual exams and health concerns. If you need to see a specialist, be hospitalized, or have lab or X-ray work, your PCP will refer you to a provider or facility. Your PCP authorize these services to be covered by your HMO.
  • You may have to pay a small portion of the cost (called a co-payment) for each office or hospital visit, such as $15 or $20 per doctor visit, regardless of what the services cost.
  • Some services will cost extra such as (emergency room, mental health and chemical dependency services, for example).
  • As an HMO member you do not have to fill out claim forms. 

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Point-Of-Service Plans

Point of Service Plans combine characteristics of HMOs and PPOs. You choose a primary care physician who controls all aspects of care, including referrals to specialists. All care received under that physician's guidance (including referrals) is fully covered. Care received by Non-Network providers is reimbursed, but you have to pay a greater share of the costs by means of higher co-payments or deductibles. To get the most financial benefit from your plan you need to decide each time you need medical care whether you want to use your plan as an HMO or a PPO.ack to Top

Traditional Indemnity Major Medical Expense Plans

Of HMOs, PPOs and Indemnity Plans, Indemnity Plans are the least restrictive type of plan. Traditional Indemnity plans let you see any licensed health care professional for anything covered by the insurance. You choose deductible and other options when you enroll, and those apply to you and any dependents you enroll in the plan. It works like this:

  • The deductibles you choose apply to each person covered by the plan (so if you and a spouse enroll and select a $5000 deductible, you each must pay $5000 in medical expenses before your plan starts paying further costs each year). Most insurance companies set a maximum of two or three deductibles per family per year.
  • Costs that exceed your deductible are covered by a coinsurance plan, so you and the insurance company share the cost for services covered by the policy. For example, with an 80/20 provision, the insurance company pays 80% and you pay 20%.
  • After you meet your deductible, coinsurance maximums limit your total out of pocket expense and protect you from catastrophic losses.
  • For some services such as emergency room and mental health benefits you may have to pay extra. These services may also have annual benefit limit amounts. 

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What are My Medicare Choices

This is a brief introduction to the types of Medicare health plans that may be available to you. You must have Medicare Parts A and B, and not have End-Stage Renal Disease (permanent kidney failure) to be eligible for some of options. The Original Medicare Plan is available nationally. Other Medicare + Choice health plan options may be available to you, depending upon where you live. 

It is important that you carefully consider your options your health care. carefully and /or seek assistance from people and sources you trust.  One option will continue to be the Original Medicare Plan. Another choice could be one of the new health plan options. There are differences among Medicare health plans that you need to know about. For example, there will be differences in

  • how much it will cost;
  • whether extra benefits, like prescription drugs, are offered;
  • and how much choice you have in using certain doctors, hospitals and other providers.

No matter which health plan option you choose to join or stay in, you are still in the Medicare program. You will receive all services Medicare covers. However, the Original Medicare Plan does not pay for everything and it does not cover all services. Some health plan options provide coverage for services not otherwise covered by the Original Medicare Plan. Some can reduce your out-of-pocket costs like deductibles and coinsurance.
What is Medicaid
Medicaid eligibility is much more complex than Medicare. Medicaid is a welfare program, and each applicant must show that their income is less than  levels set by states according to federal guidelines. Eligibility also varies significantly from state to state. 

How Does Medicaid Work?
Medicaid is administered by each state according to federal requirements and guidelines, and is financed from both state and federal funds. It provides medical assistance to people eligible for cash assistance programs such as Aid to Families with Dependent Children (AFDC) and Supplemental Security Income (SSI). States have broad discretion in covering different groups under their Medicaid program. To be eligible for federal funds, the program must provide for individuals receiving federal aid.

Back to Top

Information for Those on Medicaid
Some state Medicaid agencies give consumers information on how Medicaid managed care plans perform. New federal legislation requires all states to give consumers managed care performance information in the future. You can ask your state Medicaid agency if they will provide:

  • Statistics on grievances, showing the number of Medicaid recipients that complained about their plans, and what kinds of problems they encountered and how well the plans resolved their problems;
  • Statistics on disenrollments, showing how many Medicaid recipients decided to leave their managed care plan;
  • results from external quality reviews, showing what problems auditors identified within the managed care plans, such as the quality of care  and if those plans corrected the problems.
HMOs

A Health Maintenance Organization (HMO) is like a club for both patients and health care providers. Subscribers to an HMO receive medical services from participating physicians, clinics and hospitals. An insurance company sets up an HMO and recruits a group of doctors to participate. The HMO and providers agree on certain costs and charges, this lets the insurance company control expenses and prices. If you join an HMO and your doctor isn't a member, you must choose a doctor in the HMO panel. This is how an HMO works:
  • You choose a primary care physician (PCP) from a list of participating doctors. This doctor is the one you see see for routine medical care such as annual exams and health concerns. If you need to see a specialist, be hospitalized, or have lab or X-ray work, your PCP will refer you to a provider or facility. Your PCP authorize these services to be covered by your HMO.
  • You may have to pay a small portion of the cost (called a co-payment) for each office or hospital visit, such as $15 or $20 per doctor visit, regardless of what the services cost.
  • Some services will cost extra such as (emergency room, mental health and chemical dependency services, for example).
  • As an HMO member you do not have to fill out claim forms. 

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Life Insurance - The Basics
Proceeds from Life insurance are tax-free, and is therefore often used as a tool in estate planning, cash accumulation, retirement funding, and the transfer of wealth to beneficiaries.  But generally most people purchase life insurance to protect their families financially by replacing income that would be lost if the wage earner died. 

There are many types of life insurance available today and many factors that influence the cost. It is recommended that you know the basic differences in each type to determine which best suits your needs and your budget.

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Permanent Whole Life Insurance

Permanent life insurance, also called Whole Life or Cash Value Life insurance, provides lifetime protection and allows you to accumulate cash value over time. These policies allow you to borrow against the cash value in the event of emergencies, to fund college for your children or to make a needed major purchase possible. 

Benefits:

  • Accumulate cash value, tax deferred.  
  • Premiums remain constant.
  • Death benefits are paid upon the death of the insured. 
  • Some offer Accelerated Death Benefits -policies will advance death benefits to pay for nursing care or terminal illness expenses. (Some Term polices also offer this benefit).
  • You can borrow against accumulated cash value.

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What are My Medicare Choices

This is a brief introduction to the types of Medicare health plans that may be available to you. You must have Medicare Parts A and B, and not have End-Stage Renal Disease (permanent kidney failure) to be eligible for some of options. The Original Medicare Plan is available nationally. Other Medicare + Choice health plan options may be available to you, depending upon where you live. 

It is important that you carefully consider your options your health care. carefully and /or seek assistance from people and sources you trust.  One option will continue to be the Original Medicare Plan. Another choice could be one of the new health plan options. There are differences among Medicare health plans that you need to know about. For example, there will be differences in

  • how much it will cost;
  • whether extra benefits, like prescription drugs, are offered;
  • and how much choice you have in using certain doctors, hospitals and other providers.

No matter which health plan option you choose to join or stay in, you are still in the Medicare program. You will receive all services Medicare covers. However, the Original Medicare Plan does not pay for everything and it does not cover all services. Some health plan options provide coverage for services not otherwise covered by the Original Medicare Plan. Some can reduce your out-of-pocket costs like deductibles and coinsurance.
What is Medicaid
Medicaid eligibility is much more complex than Medicare. Medicaid is a welfare program, and each applicant must show that their income is less than  levels set by states according to federal guidelines. Eligibility also varies significantly from state to state. 

How Does Medicaid Work?
Medicaid is administered by each state according to federal requirements and guidelines, and is financed from both state and federal funds. It provides medical assistance to people eligible for cash assistance programs such as Aid to Families with Dependent Children (AFDC) and Supplemental Security Income (SSI). States have broad discretion in covering different groups under their Medicaid program. To be eligible for federal funds, the program must provide for individuals receiving federal aid.

Back to Top

Information for Those on Medicaid
Some state Medicaid agencies give consumers information on how Medicaid managed care plans perform. New federal legislation requires all states to give consumers managed care performance information in the future. You can ask your state Medicaid agency if they will provide:

  • Statistics on grievances, showing the number of Medicaid recipients that complained about their plans, and what kinds of problems they encountered and how well the plans resolved their problems;
  • Statistics on disenrollments, showing how many Medicaid recipients decided to leave their managed care plan;
  • results from external quality reviews, showing what problems auditors identified within the managed care plans, such as the quality of care  and if those plans corrected the problems.
HMOs

A Health Maintenance Organization (HMO) is like a club for both patients and health care providers. Subscribers to an HMO receive medical services from participating physicians, clinics and hospitals. An insurance company sets up an HMO and recruits a group of doctors to participate. The HMO and providers agree on certain costs and charges, this lets the insurance company control expenses and prices. If you join an HMO and your doctor isn't a member, you must choose a doctor in the HMO panel. This is how an HMO works:
  • You choose a primary care physician (PCP) from a list of participating doctors. This doctor is the one you see see for routine medical care such as annual exams and health concerns. If you need to see a specialist, be hospitalized, or have lab or X-ray work, your PCP will refer you to a provider or facility. Your PCP authorize these services to be covered by your HMO.
  • You may have to pay a small portion of the cost (called a co-payment) for each office or hospital visit, such as $15 or $20 per doctor visit, regardless of what the services cost.
  • Some services will cost extra such as (emergency room, mental health and chemical dependency services, for example).
  • As an HMO member you do not have to fill out claim forms. 

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Term Life Insurance
Term life insurance covers you for a selected period of time. (such as, 10 or 20 years). Often Term policies are used to ensure payment of debts, should the insured die before a debt is repaid. Term Life only pays benefits if you die during the selected time period. You may have heard Term Life referred to as temporary insurance. These policies do not accumulate cash value. There is no coverage or value after the time period selected. If the insured person does not die within the coverage period no benefits are paid out. Most insurance companies allow you to convert all or a portion of your Term policy to a permanent policy. This means that an insured person can turn their Term life policy into a "permanent" policy under some circumstances. The permanent policy will, of course be more expensive but will begin accumulating cash value with the same benefits of other Whole or Permanent Life policies . (terms and allowable circumstances will vary from contract to contract).

Benefits:

  • Proceeds are not taxable to your beneficiaries.
  • Excellent source of supplemental life insurance if employer-sponsored life plans, or currently owned permanent policies are inadequate due to inflation.
  • Provides "Insurability Protection"  - policies with conversion privileges typically do not require "evidence of insurability" if the conversion is done while the policy is in effect. (meaning that further medical questions are not asked in order to approve the conversion).
  • Initially, much larger amounts of coverage can be purchased at far less cost.

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How much life insurance should I purchase?
There are many questions that one should ask themselves in determining how much life insurance to purchase:
  • How much will your dependents need to live comfortably if you die? 
  • What are your budget constraints?
  • What are your debt obligations?
  • Do you hope to accumulate cash value to fund education or retirement costs? 
  • Do you have estate planning issues to consider?

Seek advice from an trusted advisor for an assessment of your insurance needs.
How do I know which insurance company to buy from?
  • Choose a trusted insurance agent that uses only highly rated companies.
  • Check the ratings and claims payment history of an insurance company.
Check out your state's Department of Insurance website

AM Best Rating service     www.ambest.com 

National Committee on Quality Assurance (NCQA).     www.ncqa.org

The Joint Committee on Accreditation     www.naic.org.

The National Insurance Commission. 

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What are My Medicare Choices

This is a brief introduction to the types of Medicare health plans that may be available to you. You must have Medicare Parts A and B, and not have End-Stage Renal Disease (permanent kidney failure) to be eligible for some of options. The Original Medicare Plan is available nationally. Other Medicare + Choice health plan options may be available to you, depending upon where you live. 

It is important that you carefully consider your options your health care. carefully and /or seek assistance from people and sources you trust.  One option will continue to be the Original Medicare Plan. Another choice could be one of the new health plan options. There are differences among Medicare health plans that you need to know about. For example, there will be differences in

  • how much it will cost;
  • whether extra benefits, like prescription drugs, are offered;
  • and how much choice you have in using certain doctors, hospitals and other providers.

No matter which health plan option you choose to join or stay in, you are still in the Medicare program. You will receive all services Medicare covers. However, the Original Medicare Plan does not pay for everything and it does not cover all services. Some health plan options provide coverage for services not otherwise covered by the Original Medicare Plan. Some can reduce your out-of-pocket costs like deductibles and coinsurance.
What is Medicaid
Medicaid eligibility is much more complex than Medicare. Medicaid is a welfare program, and each applicant must show that their income is less than  levels set by states according to federal guidelines. Eligibility also varies significantly from state to state. 

How Does Medicaid Work?
Medicaid is administered by each state according to federal requirements and guidelines, and is financed from both state and federal funds. It provides medical assistance to people eligible for cash assistance programs such as Aid to Families with Dependent Children (AFDC) and Supplemental Security Income (SSI). States have broad discretion in covering different groups under their Medicaid program. To be eligible for federal funds, the program must provide for individuals receiving federal aid.

Back to Top

Information for Those on Medicaid
Some state Medicaid agencies give consumers information on how Medicaid managed care plans perform. New federal legislation requires all states to give consumers managed care performance information in the future. You can ask your state Medicaid agency if they will provide:

  • Statistics on grievances, showing the number of Medicaid recipients that complained about their plans, and what kinds of problems they encountered and how well the plans resolved their problems;
  • Statistics on disenrollments, showing how many Medicaid recipients decided to leave their managed care plan;
  • results from external quality reviews, showing what problems auditors identified within the managed care plans, such as the quality of care  and if those plans corrected the problems.
HMOs

A Health Maintenance Organization (HMO) is like a club for both patients and health care providers. Subscribers to an HMO receive medical services from participating physicians, clinics and hospitals. An insurance company sets up an HMO and recruits a group of doctors to participate. The HMO and providers agree on certain costs and charges, this lets the insurance company control expenses and prices. If you join an HMO and your doctor isn't a member, you must choose a doctor in the HMO panel. This is how an HMO works:
  • You choose a primary care physician (PCP) from a list of participating doctors. This doctor is the one you see see for routine medical care such as annual exams and health concerns. If you need to see a specialist, be hospitalized, or have lab or X-ray work, your PCP will refer you to a provider or facility. Your PCP authorize these services to be covered by your HMO.
  • You may have to pay a small portion of the cost (called a co-payment) for each office or hospital visit, such as $15 or $20 per doctor visit, regardless of what the services cost.
  • Some services will cost extra such as (emergency room, mental health and chemical dependency services, for example).
  • As an HMO member you do not have to fill out claim forms. 

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   www.naic.org. www.naic.org 

What is short term medical insurance? 
 Short term major medical is the perfect solution for those times you find yourself in need of temporary coverage. Short term major medical plans typically offer coverage for 30 - 180 days, offer options in deductible and co-insurance levels and have high maximum limits for the period of time covered, such as 2  to 5 million dollars.

Short term plans do not cover pre-existing conditions, but are usually issued very quickly upon answering a few gatekeeper questions satisfactorily per underwriting guidelines. 

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What types of situations give rise to a need for short-term medical insurance?
Individuals that are between jobs, can't afford COBRA, satisfying waiting period to qualify for employer's plan, newly graduated, etc. can be served well with Short term major medical health insurance. It is a perfect solution for those times when a person finds themselves in need of temporary coverage. 
What will short-term medical insurance pay for?

Typically, short-term medical insurance covers a wide range of medical services. Though it may differ from one carrier to another they commonly cover  hospital room and board and routine nursing services during hospital stays, outpatient services, physician and surgeon services, X-ray and laboratory services, prescription drugs, home health care, treatment in a skilled nursing facility following a hospital stay, and many other types of expenses normally covered under a major medical expense insurance policy. Just as traditional plans do, short-term medical insurance does exclude some services from coverage. Carefully read the exclusions, extensions of coverage and other terms of a short-term medical insurance policy before you make a purchase. 

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What are My Medicare Choices

This is a brief introduction to the types of Medicare health plans that may be available to you. You must have Medicare Parts A and B, and not have End-Stage Renal Disease (permanent kidney failure) to be eligible for some of options. The Original Medicare Plan is available nationally. Other Medicare + Choice health plan options may be available to you, depending upon where you live. 

It is important that you carefully consider your options your health care. carefully and /or seek assistance from people and sources you trust.  One option will continue to be the Original Medicare Plan. Another choice could be one of the new health plan options. There are differences among Medicare health plans that you need to know about. For example, there will be differences in

  • how much it will cost;
  • whether extra benefits, like prescription drugs, are offered;
  • and how much choice you have in using certain doctors, hospitals and other providers.

No matter which health plan option you choose to join or stay in, you are still in the Medicare program. You will receive all services Medicare covers. However, the Original Medicare Plan does not pay for everything and it does not cover all services. Some health plan options provide coverage for services not otherwise covered by the Original Medicare Plan. Some can reduce your out-of-pocket costs like deductibles and coinsurance.
What is Medicaid
Medicaid eligibility is much more complex than Medicare. Medicaid is a welfare program, and each applicant must show that their income is less than  levels set by states according to federal guidelines. Eligibility also varies significantly from state to state. 

How Does Medicaid Work?
Medicaid is administered by each state according to federal requirements and guidelines, and is financed from both state and federal funds. It provides medical assistance to people eligible for cash assistance programs such as Aid to Families with Dependent Children (AFDC) and Supplemental Security Income (SSI). States have broad discretion in covering different groups under their Medicaid program. To be eligible for federal funds, the program must provide for individuals receiving federal aid.

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Information for Those on Medicaid
Some state Medicaid agencies give consumers information on how Medicaid managed care plans perform. New federal legislation requires all states to give consumers managed care performance information in the future. You can ask your state Medicaid agency if they will provide:

  • Statistics on grievances, showing the number of Medicaid recipients that complained about their plans, and what kinds of problems they encountered and how well the plans resolved their problems;
  • Statistics on disenrollments, showing how many Medicaid recipients decided to leave their managed care plan;
  • results from external quality reviews, showing what problems auditors identified within the managed care plans, such as the quality of care  and if those plans corrected the problems.
HMOs

A Health Maintenance Organization (HMO) is like a club for both patients and health care providers. Subscribers to an HMO receive medical services from participating physicians, clinics and hospitals. An insurance company sets up an HMO and recruits a group of doctors to participate. The HMO and providers agree on certain costs and charges, this lets the insurance company control expenses and prices. If you join an HMO and your doctor isn't a member, you must choose a doctor in the HMO panel. This is how an HMO works:
  • You choose a primary care physician (PCP) from a list of participating doctors. This doctor is the one you see see for routine medical care such as annual exams and health concerns. If you need to see a specialist, be hospitalized, or have lab or X-ray work, your PCP will refer you to a provider or facility. Your PCP authorize these services to be covered by your HMO.
  • You may have to pay a small portion of the cost (called a co-payment) for each office or hospital visit, such as $15 or $20 per doctor visit, regardless of what the services cost.
  • Some services will cost extra such as (emergency room, mental health and chemical dependency services, for example).
  • As an HMO member you do not have to fill out claim forms. 

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Are there typical limitations with short term medical insurance?
With short-term medical insurance, you do not have an automatic right to renew when the original contract expires. If your health status has changed since you purchased the plan, you may not qualify for a new policy or an extended benefit period under the original policy. Should this occur,  you could be left without health insurance protection. To secure additional coverage after the original term has expired, you will be required to submit a new application  and get approval by the insurer before the renewed coverage begins.  There could be a break in coverage if the new coverage period does not start when the the new coverage period begins. Medical conditions that may have developed during the original policy period will be treated as preexisting - and will not be covered or the carrier may decline to issue new coverage.  Generally, refunds of premium are only available if the policy is canceled within the first 10 days of the contract. After that, refunds are not usually available even if your need for coverage ends sooner than originally predicted. 
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Medical Expense (Health) Insurance

What are the principal types of medical expense insurance coverage?

Health insurance is broadly categorized into two principal types of coverage: basic plans and major medical plans. 
Basic plans are usually hospital expense plans or surgical expense plans or both.  Basic hospital and surgical expense plans typically provide coverage on a first-dollar basis, meaning no deductible to satisfy and provide 100 percent reimbursement of covered expenses, up to a relatively low maximum of $10,000, $25,000, $50,000 or $100,000. 
Major medical plans, differ in that a deductible will apply to initial expenses,  ranging from $100 to $2500 per calendar year. After the deductible is satisfied, major medical plans reimburse 90,80, or 70 percent of eligible expenses up to a relatively high maximum, such as $500,000 or $3,000,000 lifetime maximums . In addition to deductibles, insured's will also share in expenses incurred through the co-insurance, (10,20,30 percent) up to an annual co-insurance maximum. Major medical plans cover a broader array of medical expenditures than Basic plans, including hospital expense, surgical expense, physician (non-surgical) expense, private duty nursing, diagnostic X-ray and laboratory services, prescription drug expense, artificial limbs and organs, ambulance services, and many other types of medical expenses under specified conditions.  Always review the plan outline carefully before applying for any type of health plan.

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What are My Medicare Choices

This is a brief introduction to the types of Medicare health plans that may be available to you. You must have Medicare Parts A and B, and not have End-Stage Renal Disease (permanent kidney failure) to be eligible for some of options. The Original Medicare Plan is available nationally. Other Medicare + Choice health plan options may be available to you, depending upon where you live. 

It is important that you carefully consider your options your health care. carefully and /or seek assistance from people and sources you trust.  One option will continue to be the Original Medicare Plan. Another choice could be one of the new health plan options. There are differences among Medicare health plans that you need to know about. For example, there will be differences in

  • how much it will cost;
  • whether extra benefits, like prescription drugs, are offered;
  • and how much choice you have in using certain doctors, hospitals and other providers.

No matter which health plan option you choose to join or stay in, you are still in the Medicare program. You will receive all services Medicare covers. However, the Original Medicare Plan does not pay for everything and it does not cover all services. Some health plan options provide coverage for services not otherwise covered by the Original Medicare Plan. Some can reduce your out-of-pocket costs like deductibles and coinsurance.
What is Medicaid
Medicaid eligibility is much more complex than Medicare. Medicaid is a welfare program, and each applicant must show that their income is less than  levels set by states according to federal guidelines. Eligibility also varies significantly from state to state. 

How Does Medicaid Work?
Medicaid is administered by each state according to federal requirements and guidelines, and is financed from both state and federal funds. It provides medical assistance to people eligible for cash assistance programs such as Aid to Families with Dependent Children (AFDC) and Supplemental Security Income (SSI). States have broad discretion in covering different groups under their Medicaid program. To be eligible for federal funds, the program must provide for individuals receiving federal aid.

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Information for Those on Medicaid
Some state Medicaid agencies give consumers information on how Medicaid managed care plans perform. New federal legislation requires all states to give consumers managed care performance information in the future. You can ask your state Medicaid agency if they will provide:

  • Statistics on grievances, showing the number of Medicaid recipients that complained about their plans, and what kinds of problems they encountered and how well the plans resolved their problems;
  • Statistics on disenrollments, showing how many Medicaid recipients decided to leave their managed care plan;
  • results from external quality reviews, showing what problems auditors identified within the managed care plans, such as the quality of care  and if those plans corrected the problems.
HMOs

A Health Maintenance Organization (HMO) is like a club for both patients and health care providers. Subscribers to an HMO receive medical services from participating physicians, clinics and hospitals. An insurance company sets up an HMO and recruits a group of doctors to participate. The HMO and providers agree on certain costs and charges, this lets the insurance company control expenses and prices. If you join an HMO and your doctor isn't a member, you must choose a doctor in the HMO panel. This is how an HMO works:
  • You choose a primary care physician (PCP) from a list of participating doctors. This doctor is the one you see see for routine medical care such as annual exams and health concerns. If you need to see a specialist, be hospitalized, or have lab or X-ray work, your PCP will refer you to a provider or facility. Your PCP authorize these services to be covered by your HMO.
  • You may have to pay a small portion of the cost (called a co-payment) for each office or hospital visit, such as $15 or $20 per doctor visit, regardless of what the services cost.
  • Some services will cost extra such as (emergency room, mental health and chemical dependency services, for example).
  • As an HMO member you do not have to fill out claim forms. 

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Are mental health expenses covered?
Major medical plans typically provide coverage for treatment of substance abuse (e.g., alcoholism and drug usage) and mental illness. Higher co-insurance percentages and lower maximum benefits may apply.  There may also be different benefits for in-patient care as opposed to out-patient care. 
Generally what are the excluded expenses of major medical plans.  Common exclusions of Major Medical plans  include medical expenditures arising from: (1) convalescent or custodial care; (2) physical examinations, unless required for the treatment of an injury or illness (unless your plan offers preventive benefits); (3) cosmetic surgery unless required to correct a condition resulting from an injury or a birth defect; (4) occupational injuries and illnesses that are otherwise covered under a Workers' Compensation law; and (5) routine dental and vision care (care required for treatment of an injury and dental and eye surgery are frequently covered, however).  Always consult your insurance contract (certificate) for a complete list of excluded expenses.

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What are Out-of-Pocket Expenses?
Your "out-of-pocket" costs under a major medical  plans will include the deductible, co-insurance, and medical charges that are considered by the plan to be in excess of "reasonable and customary" charges for your geographic area. "Reasonable and customary" may vary somewhat from one medical expense plan to another and one location to another.
What is Co-insurance and how does it work?
Coinsurance is sometimes called "percentage participation."  The co-insurance clause requires the insured to share in the cost of medical care. Under an 80/20 coinsurance provision, the medical expense plan pays 80 percent of eligible medical charges after the deductible is satisfied. The insured is required to pay the remaining 20 percent. Often insurance carriers offer other coinsurance options, such as, 90/10 or 70/30 arrangements.  In the event of catastrophic medical expenses, the insured's co-insurance portion could be a significant amount of money and could cause severe financial hardships.  In anticipation of this possibility most major medical plans contain a co-insurance limit, also referred to as the coinsurance cap, or stop-loss limit. This provision places a limit on the insured's out-of-pocket costs in a given year. Once the co-insurance maximum (out-of -pocket limit) has been reached, all eligible expenses above this amount are paid in full (100%), up to the plan's overall limit. The out-of-pocket limit resets at the beginning of each policy year and can range from $1000 to $10,000/year.

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What are My Medicare Choices

This is a brief introduction to the types of Medicare health plans that may be available to you. You must have Medicare Parts A and B, and not have End-Stage Renal Disease (permanent kidney failure) to be eligible for some of options. The Original Medicare Plan is available nationally. Other Medicare + Choice health plan options may be available to you, depending upon where you live. 

It is important that you carefully consider your options your health care. carefully and /or seek assistance from people and sources you trust.  One option will continue to be the Original Medicare Plan. Another choice could be one of the new health plan options. There are differences among Medicare health plans that you need to know about. For example, there will be differences in

  • how much it will cost;
  • whether extra benefits, like prescription drugs, are offered;
  • and how much choice you have in using certain doctors, hospitals and other providers.

No matter which health plan option you choose to join or stay in, you are still in the Medicare program. You will receive all services Medicare covers. However, the Original Medicare Plan does not pay for everything and it does not cover all services. Some health plan options provide coverage for services not otherwise covered by the Original Medicare Plan. Some can reduce your out-of-pocket costs like deductibles and coinsurance.
What is Medicaid
Medicaid eligibility is much more complex than Medicare. Medicaid is a welfare program, and each applicant must show that their income is less than  levels set by states according to federal guidelines. Eligibility also varies significantly from state to state. 

How Does Medicaid Work?
Medicaid is administered by each state according to federal requirements and guidelines, and is financed from both state and federal funds. It provides medical assistance to people eligible for cash assistance programs such as Aid to Families with Dependent Children (AFDC) and Supplemental Security Income (SSI). States have broad discretion in covering different groups under their Medicaid program. To be eligible for federal funds, the program must provide for individuals receiving federal aid.

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Information for Those on Medicaid
Some state Medicaid agencies give consumers information on how Medicaid managed care plans perform. New federal legislation requires all states to give consumers managed care performance information in the future. You can ask your state Medicaid agency if they will provide:

  • Statistics on grievances, showing the number of Medicaid recipients that complained about their plans, and what kinds of problems they encountered and how well the plans resolved their problems;
  • Statistics on disenrollments, showing how many Medicaid recipients decided to leave their managed care plan;
  • results from external quality reviews, showing what problems auditors identified within the managed care plans, such as the quality of care  and if those plans corrected the problems.
HMOs

A Health Maintenance Organization (HMO) is like a club for both patients and health care providers. Subscribers to an HMO receive medical services from participating physicians, clinics and hospitals. An insurance company sets up an HMO and recruits a group of doctors to participate. The HMO and providers agree on certain costs and charges, this lets the insurance company control expenses and prices. If you join an HMO and your doctor isn't a member, you must choose a doctor in the HMO panel. This is how an HMO works:
  • You choose a primary care physician (PCP) from a list of participating doctors. This doctor is the one you see see for routine medical care such as annual exams and health concerns. If you need to see a specialist, be hospitalized, or have lab or X-ray work, your PCP will refer you to a provider or facility. Your PCP authorize these services to be covered by your HMO.
  • You may have to pay a small portion of the cost (called a co-payment) for each office or hospital visit, such as $15 or $20 per doctor visit, regardless of what the services cost.
  • Some services will cost extra such as (emergency room, mental health and chemical dependency services, for example).
  • As an HMO member you do not have to fill out claim forms. 

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What is the difference between co-insurance and co-payment?
These terms are often confused and used interchangeably. However, they are two different means of cost sharing of medical expenses.
A co-payment or co-pay  is a set dollar amount ($10, $20, $30) the insured is required to pay at each encounter for certain medical services such as a doctor's visit or Emergency Room visit. Co-payments are also often called Encounter Fees.  Co-payments are a common feature of HMO and PPO arrangements.  Co-payments are now also common in prescription drug plans.

Co-insurance is the portion of medical expenses that the insured is responsible for after the deductible is met and the insurance plan has paid their portion such as 70,80,or 90%. 

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What are pre-existing limitations and how do they affect me?
A preexisting condition is often defined as a medical condition, illness or injury that the insured sought treatment for (or knew about) during a prescribed period of time prior to the insured's effective date of coverage under the major medical plan (3,6,or 12 months).  A preexisting conditions clause may exclude coverage for preexisting conditions for up to 12 months after the policy is in force.  Preexisting limitations and will differ depending on the insurance carrier. Therefore it is very important that applicants learn the provisions of each plan that they are considering.
How does coverage of traditional plans and HMO (Health Maintenance Organizations) differ?
Traditional major medical expense plans are classified as indemnity contracts. These plans indemnify, or reimburse, the insured for medical expenses incurred and may require the completion and filing of claim forms. These plans usually contain deductible and coinsurance cost sharing provisions and may restrict coverage for certain types of medical care. Indemnity plans, however, allow the insured the freedom to choose any primary care physician or specialist.  

Conversely, HMO plans emphasize comprehensive care and usually have fewer exclusions. HMO plans may have smaller deductibles and co-pays than other plans.  However, HMOs do not offer the freedom of choice that other plans do.  Under and HMO plan, you will be required to choose a primary care provider that will act as a "gatekeeper" for other services under the plan.   Today some HMOs  offer a POS point-of-service option, which allows a patient to elect to go "out of network".  In this case, benefits will be paid as Fee for Service like in an Indemnity plan and the patients share of costs will be greater. 

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Prescription Drug Coverage
This type of "ancillary" medical insurance helps cover the cost of prescription drugs.   Most plans contain co-payment features and some may have annual drug deductibles.  Established Prescription drug plans  usually use sophisticated computer claims filing  and processing systems and interact directly with the pharmacies involved.  Most plans utilize Preferred Pharmacy Networks. 

Do I need prescription drug insurance if I already have major medical coverage?
 Prescription drug coverage is offered in the marketplace as a supplemental policy, separate and apart from any major medical insurance covering the individual. Although most major medical plans cover prescription drug expense, the benefits may be subject to a per-person deductible ($100, $250, $500 or higher) with annual benefit maximums and coinsurance cost sharing. Insureds might wish to consider the purchase of a prescription drug plan to supplement the coverage of  their primary medical expense plan.

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What are My Medicare Choices

This is a brief introduction to the types of Medicare health plans that may be available to you. You must have Medicare Parts A and B, and not have End-Stage Renal Disease (permanent kidney failure) to be eligible for some of options. The Original Medicare Plan is available nationally. Other Medicare + Choice health plan options may be available to you, depending upon where you live. 

It is important that you carefully consider your options your health care. carefully and /or seek assistance from people and sources you trust.  One option will continue to be the Original Medicare Plan. Another choice could be one of the new health plan options. There are differences among Medicare health plans that you need to know about. For example, there will be differences in

  • how much it will cost;
  • whether extra benefits, like prescription drugs, are offered;
  • and how much choice you have in using certain doctors, hospitals and other providers.

No matter which health plan option you choose to join or stay in, you are still in the Medicare program. You will receive all services Medicare covers. However, the Original Medicare Plan does not pay for everything and it does not cover all services. Some health plan options provide coverage for services not otherwise covered by the Original Medicare Plan. Some can reduce your out-of-pocket costs like deductibles and coinsurance.
What is Medicaid
Medicaid eligibility is much more complex than Medicare. Medicaid is a welfare program, and each applicant must show that their income is less than  levels set by states according to federal guidelines. Eligibility also varies significantly from state to state. 

How Does Medicaid Work?
Medicaid is administered by each state according to federal requirements and guidelines, and is financed from both state and federal funds. It provides medical assistance to people eligible for cash assistance programs such as Aid to Families with Dependent Children (AFDC) and Supplemental Security Income (SSI). States have broad discretion in covering different groups under their Medicaid program. To be eligible for federal funds, the program must provide for individuals receiving federal aid.

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Information for Those on Medicaid
Some state Medicaid agencies give consumers information on how Medicaid managed care plans perform. New federal legislation requires all states to give consumers managed care performance information in the future. You can ask your state Medicaid agency if they will provide:

  • Statistics on grievances, showing the number of Medicaid recipients that complained about their plans, and what kinds of problems they encountered and how well the plans resolved their problems;
  • Statistics on disenrollments, showing how many Medicaid recipients decided to leave their managed care plan;
  • results from external quality reviews, showing what problems auditors identified within the managed care plans, such as the quality of care  and if those plans corrected the problems.
HMOs

A Health Maintenance Organization (HMO) is like a club for both patients and health care providers. Subscribers to an HMO receive medical services from participating physicians, clinics and hospitals. An insurance company sets up an HMO and recruits a group of doctors to participate. The HMO and providers agree on certain costs and charges, this lets the insurance company control expenses and prices. If you join an HMO and your doctor isn't a member, you must choose a doctor in the HMO panel. This is how an HMO works:
  • You choose a primary care physician (PCP) from a list of participating doctors. This doctor is the one you see see for routine medical care such as annual exams and health concerns. If you need to see a specialist, be hospitalized, or have lab or X-ray work, your PCP will refer you to a provider or facility. Your PCP authorize these services to be covered by your HMO.
  • You may have to pay a small portion of the cost (called a co-payment) for each office or hospital visit, such as $15 or $20 per doctor visit, regardless of what the services cost.
  • Some services will cost extra such as (emergency room, mental health and chemical dependency services, for example).
  • As an HMO member you do not have to fill out claim forms. 

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I can only afford life or disability insurance, not both. Which one should I buy?
There is no universal answer to this question. Both life insurance and disability (income replacement) insurance are vital to any financial strategy.  But in the real world, we all are faced with financial limitations at one time or another. There are many factors that would need to be considered to arrive at an appropriate answer to this questions, (i.e., age, occupation, assets, debts, dependents, etc.)  You will need to consult an experienced  financial/insurance services person that will do a comprehensive assessment of your situation before advising you on this issue. 
How much disability insurance coverage should I have?

Generally it is recommended that a person carry disability insurance that covers  60-70 percent of pretax income.  Many factors need to be considered in making this determination such as income level, tax-bracket and other sources of coverage such as Workers' Compensation, Social Security, and employer-provided disability benefits under pension or group insurance plans and whether the benefits themselves are taxable.  A professional insurance adviser can assist you in making a decision in this matter. 

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What is the difference between short-term disability (STD) and long-term disability (LTD) insurance?
These two types of insurance policies differ most  in terms of the length of the elimination (waiting) period, the length of the maximum benefit period, coordination of the benefits payable under the policy with benefits payable under social insurance programs such as Social Security and Workers' Compensation, and the legal definition of disability in the contract language.
Should I purchase short-term disability (STD) and long-term disability (LTD)? 

If you can only purchase one type of disability coverage, it would be wise to purchase LTD to cover what could be the greater risk to your financial security.   LTD insurance protects the insured against disabilities that may last many years, or even a lifetime, and therefore  protects you against  potentially catastrophic losses. Statistically, long-term disabilities happen less frequently than short term disabilities.  Therefore the loss of income for a short time period (weeks or even a few months) are easier to absorb than the loss of income for a disability of a year, years, or a lifetime. 

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What are My Medicare Choices

This is a brief introduction to the types of Medicare health plans that may be available to you. You must have Medicare Parts A and B, and not have End-Stage Renal Disease (permanent kidney failure) to be eligible for some of options. The Original Medicare Plan is available nationally. Other Medicare + Choice health plan options may be available to you, depending upon where you live. 

It is important that you carefully consider your options your health care. carefully and /or seek assistance from people and sources you trust.  One option will continue to be the Original Medicare Plan. Another choice could be one of the new health plan options. There are differences among Medicare health plans that you need to know about. For example, there will be differences in

  • how much it will cost;
  • whether extra benefits, like prescription drugs, are offered;
  • and how much choice you have in using certain doctors, hospitals and other providers.

No matter which health plan option you choose to join or stay in, you are still in the Medicare program. You will receive all services Medicare covers. However, the Original Medicare Plan does not pay for everything and it does not cover all services. Some health plan options provide coverage for services not otherwise covered by the Original Medicare Plan. Some can reduce your out-of-pocket costs like deductibles and coinsurance.
What is Medicaid
Medicaid eligibility is much more complex than Medicare. Medicaid is a welfare program, and each applicant must show that their income is less than  levels set by states according to federal guidelines. Eligibility also varies significantly from state to state. 

How Does Medicaid Work?
Medicaid is administered by each state according to federal requirements and guidelines, and is financed from both state and federal funds. It provides medical assistance to people eligible for cash assistance programs such as Aid to Families with Dependent Children (AFDC) and Supplemental Security Income (SSI). States have broad discretion in covering different groups under their Medicaid program. To be eligible for federal funds, the program must provide for individuals receiving federal aid.

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Information for Those on Medicaid
Some state Medicaid agencies give consumers information on how Medicaid managed care plans perform. New federal legislation requires all states to give consumers managed care performance information in the future. You can ask your state Medicaid agency if they will provide:

  • Statistics on grievances, showing the number of Medicaid recipients that complained about their plans, and what kinds of problems they encountered and how well the plans resolved their problems;
  • Statistics on disenrollments, showing how many Medicaid recipients decided to leave their managed care plan;
  • results from external quality reviews, showing what problems auditors identified within the managed care plans, such as the quality of care  and if those plans corrected the problems.
HMOs

A Health Maintenance Organization (HMO) is like a club for both patients and health care providers. Subscribers to an HMO receive medical services from participating physicians, clinics and hospitals. An insurance company sets up an HMO and recruits a group of doctors to participate. The HMO and providers agree on certain costs and charges, this lets the insurance company control expenses and prices. If you join an HMO and your doctor isn't a member, you must choose a doctor in the HMO panel. This is how an HMO works:
  • You choose a primary care physician (PCP) from a list of participating doctors. This doctor is the one you see see for routine medical care such as annual exams and health concerns. If you need to see a specialist, be hospitalized, or have lab or X-ray work, your PCP will refer you to a provider or facility. Your PCP authorize these services to be covered by your HMO.
  • You may have to pay a small portion of the cost (called a co-payment) for each office or hospital visit, such as $15 or $20 per doctor visit, regardless of what the services cost.
  • Some services will cost extra such as (emergency room, mental health and chemical dependency services, for example).
  • As an HMO member you do not have to fill out claim forms. 

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Are elimination, or waiting, periods different in an STD policy than in a LTD policy?
The elimination, or waiting, period in disability insurance is the length of time between the onset of a qualifying disability and the point in time when benefits  first become payable. In STD plans, waiting periods may range from 0 days to 3, 7, 10 or 14 days, depending on the insurance policy and the reason for the disability. Disabilities resulting from accidents usually require shorter elimination periods (3 or 7 days) than disabilities caused by sickness.  LTD plans usually have elimination periods that range from 3 to 6 months, or longer, for for both accidents and illnesses related disabilities.

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What is a maximum benefit period and do they differ in STD and LTD policies? 
The maximum benefit period in disability income insurance refers to the maximum length of time during which benefits will be payable to an insured for an ongoing, qualifying disability. STD (Short Term Disability) insurance provides coverage for benefit periods lasting a maximum of 13 or 26 weeks. 

LTD (long term disability) insurance policies usually provide benefits (providing contract requirements are met) for periods ranging from 5 years to age 65, some may even be for the insured's lifetime.
Is disability defined the same  in STD and LTD insurance policies?
Some disability income insurance contracts provide coverage only for "total and permanent" disabilities. Others provide coverage for "total and permanent" disabilities, "partial disabilities," and "temporary" disabilities. Some policies providing "partial" disability coverage require that the "partial" disability be proceeded by a period of "total" disability. These terms can be confusing and will differ from one carrier to another. Therefore it is recommended that you seek the advise of a qualified insurance professional. 

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What are My Medicare Choices

This is a brief introduction to the types of Medicare health plans that may be available to you. You must have Medicare Parts A and B, and not have End-Stage Renal Disease (permanent kidney failure) to be eligible for some of options. The Original Medicare Plan is available nationally. Other Medicare + Choice health plan options may be available to you, depending upon where you live. 

It is important that you carefully consider your options your health care. carefully and /or seek assistance from people and sources you trust.  One option will continue to be the Original Medicare Plan. Another choice could be one of the new health plan options. There are differences among Medicare health plans that you need to know about. For example, there will be differences in

  • how much it will cost;
  • whether extra benefits, like prescription drugs, are offered;
  • and how much choice you have in using certain doctors, hospitals and other providers.

No matter which health plan option you choose to join or stay in, you are still in the Medicare program. You will receive all services Medicare covers. However, the Original Medicare Plan does not pay for everything and it does not cover all services. Some health plan options provide coverage for services not otherwise covered by the Original Medicare Plan. Some can reduce your out-of-pocket costs like deductibles and coinsurance.
What is Medicaid
Medicaid eligibility is much more complex than Medicare. Medicaid is a welfare program, and each applicant must show that their income is less than  levels set by states according to federal guidelines. Eligibility also varies significantly from state to state. 

How Does Medicaid Work?
Medicaid is administered by each state according to federal requirements and guidelines, and is financed from both state and federal funds. It provides medical assistance to people eligible for cash assistance programs such as Aid to Families with Dependent Children (AFDC) and Supplemental Security Income (SSI). States have broad discretion in covering different groups under their Medicaid program. To be eligible for federal funds, the program must provide for individuals receiving federal aid.

Back to Top

Information for Those on Medicaid
Some state Medicaid agencies give consumers information on how Medicaid managed care plans perform. New federal legislation requires all states to give consumers managed care performance information in the future. You can ask your state Medicaid agency if they will provide:

  • Statistics on grievances, showing the number of Medicaid recipients that complained about their plans, and what kinds of problems they encountered and how well the plans resolved their problems;
  • Statistics on disenrollments, showing how many Medicaid recipients decided to leave their managed care plan;
  • results from external quality reviews, showing what problems auditors identified within the managed care plans, such as the quality of care  and if those plans corrected the problems.
HMOs

A Health Maintenance Organization (HMO) is like a club for both patients and health care providers. Subscribers to an HMO receive medical services from participating physicians, clinics and hospitals. An insurance company sets up an HMO and recruits a group of doctors to participate. The HMO and providers agree on certain costs and charges, this lets the insurance company control expenses and prices. If you join an HMO and your doctor isn't a member, you must choose a doctor in the HMO panel. This is how an HMO works:
  • You choose a primary care physician (PCP) from a list of participating doctors. This doctor is the one you see see for routine medical care such as annual exams and health concerns. If you need to see a specialist, be hospitalized, or have lab or X-ray work, your PCP will refer you to a provider or facility. Your PCP authorize these services to be covered by your HMO.
  • You may have to pay a small portion of the cost (called a co-payment) for each office or hospital visit, such as $15 or $20 per doctor visit, regardless of what the services cost.
  • Some services will cost extra such as (emergency room, mental health and chemical dependency services, for example).
  • As an HMO member you do not have to fill out claim forms. 

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  Is there anything else I should know about the definition of "disability" as it relates to disability insurance?
How the word "disability" is defined, as it relates to the inability of the insured to perform a particular occupation, is very important. Many insurers offer policies that define total disability in terms of the inability of the insured to perform the usual and customary duties of his or her "own occupation" (the occupation the insured was engaged in at the onset of the disability. Other policies may define total disability in terms of the inability to perform the regular duties of "any occupation." "Any occupation" is often defined as a job for which the insured has the necessary skills and training and, possibly, at a salary commensurate with the one in which the insured was employed at the onset of the disability. The "own occupation" definition is works more in the favor of insured and is often recommended over the "any occupation" definition. Some insurance policies will employ both definitions, using an "own occupation" definition for the first few years of the benefit period after which time, the "any occupation" definition would apply.

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Are there disability insurance policies that consider income lost instead of occupation?
Some insurance companies offer disability insurance policies that define disability  in terms of income actually lost as a result of the disability rather than in terms of a particular occupation.  Under these terms, if an insured becomes disabled benefits are paid to the extent that the insured suffers a loss of income over a predetermined threshold such as 20%.  In this example, if an insured suffered a disability benefits would begin after income lost exceeded 20% based on his/her earnings prior to the qualified disability. 
Is it standard for disability policies to cover disabilities caused by both accident and illness?
When considering the purchase of disability coverage it is important that you read the contract to determine if both illness and accident related disabilities are covered.  Not all policies cover both.  It is prudent to look for a policy that does pay benefits under either circumstance.
Do disability insurance policies exclude some causes of disability?
Yes, all disability policies will contain exclusions for acts of war and self-inflicted injuries. Many will exclude some pre-existing conditions, and some apply the exclusion for a pre-existing condition only for a limited period of time, such as two years.  

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The terms "non-cancelable" and "guaranteed renewable" are often used when referring to disability income insurance policies. What do these terms imply, and how do they differ?

The "non-cancelable" policy provision means that the insured has the right to renew their policies each year, usually until age 65, just by paying the premiums on time.  A guaranteed premium is stated in the contract and may not be changed by the insurance company. During the non-cancelable period, the insurance company can not cancel the contract or otherwise make any unilateral change in the policy benefits. 

"Guaranteed renewable" contracts also provide insureds with the right to renew their policies to age 65 if they continue to pay the premiums on time.  Guaranteed renewable policies do allow  the insurer  the right to change premium amount charged if it does so for all insureds in the same rating class. The insurance company is not permitted to cancel the policy or unilaterally amend the policy benefits during the period that the policy is guaranteed renewable. 

Additionally, under both types of contracts, the insurance company is not permitted to increase the premiums, on a selective basis, (only for those policy holders whose health status has deteriorated). Because of the premium guarantee feature, "non-cancelable" policies may be somewhat more expensive than "guaranteed renewable" policies. Generally, disability policies containing a "guaranteed renewable" or a "non-cancelable" provision offer better protection but possibly at a higher cost, than  "conditionally renewable" types of disability insurance policies. "Conditionally renewable" policies give the insurance company the right to refuse to renew coverage for reasons stated in the policy and also may allow them to alter the terms and price of the policy at renewal.

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How is the cost of disability insurance determined?
 Many factors determine the cost of disability coverage, including;
  • Age
  • Health Status
  • Occupational class
  • Weekly benefit
  • Whether the policy is non-cancelable or guaranteed renewable.
  • Elimination period chosen
  • Maximum Benefit period
  • Are benefits coordinated with other insurance or social insurance benefits?
Why is group long term disability (LTD) coverage( purchased at work) usually less expensive than individually purchased LTD insurance?
There can be several reason that this is the case:
  • Employer often pays a portion of the premium
  • Benefits for group coverage is normally coordinated with Worker's Comp or Social Security benefits. 
  • Individual plans may pay "in addition" to other sources of income.
  • Individual policies are more likely to include a non-cancelable clause.
  • Individual policies may have more options in terms of riders to enhance coverage, such as cost of living riders, extended benefit periods, and waiver of premium options. 
  • It is less costly for an insurance company to market, underwrite, enroll and administer group coverage.

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What are My Medicare Choices

This is a brief introduction to the types of Medicare health plans that may be available to you. You must have Medicare Parts A and B, and not have End-Stage Renal Disease (permanent kidney failure) to be eligible for some of options. The Original Medicare Plan is available nationally. Other Medicare + Choice health plan options may be available to you, depending upon where you live. 

It is important that you carefully consider your options your health care. carefully and /or seek assistance from people and sources you trust.  One option will continue to be the Original Medicare Plan. Another choice could be one of the new health plan options. There are differences among Medicare health plans that you need to know about. For example, there will be differences in

  • how much it will cost;
  • whether extra benefits, like prescription drugs, are offered;
  • and how much choice you have in using certain doctors, hospitals and other providers.

No matter which health plan option you choose to join or stay in, you are still in the Medicare program. You will receive all services Medicare covers. However, the Original Medicare Plan does not pay for everything and it does not cover all services. Some health plan options provide coverage for services not otherwise covered by the Original Medicare Plan. Some can reduce your out-of-pocket costs like deductibles and coinsurance.
What is Medicaid
Medicaid eligibility is much more complex than Medicare. Medicaid is a welfare program, and each applicant must show that their income is less than  levels set by states according to federal guidelines. Eligibility also varies significantly from state to state. 

How Does Medicaid Work?
Medicaid is administered by each state according to federal requirements and guidelines, and is financed from both state and federal funds. It provides medical assistance to people eligible for cash assistance programs such as Aid to Families with Dependent Children (AFDC) and Supplemental Security Income (SSI). States have broad discretion in covering different groups under their Medicaid program. To be eligible for federal funds, the program must provide for individuals receiving federal aid.

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Information for Those on Medicaid
Some state Medicaid agencies give consumers information on how Medicaid managed care plans perform. New federal legislation requires all states to give consumers managed care performance information in the future. You can ask your state Medicaid agency if they will provide:

  • Statistics on grievances, showing the number of Medicaid recipients that complained about their plans, and what kinds of problems they encountered and how well the plans resolved their problems;
  • Statistics on disenrollments, showing how many Medicaid recipients decided to leave their managed care plan;
  • results from external quality reviews, showing what problems auditors identified within the managed care plans, such as the quality of care  and if those plans corrected the problems.
HMOs

A Health Maintenance Organization (HMO) is like a club for both patients and health care providers. Subscribers to an HMO receive medical services from participating physicians, clinics and hospitals. An insurance company sets up an HMO and recruits a group of doctors to participate. The HMO and providers agree on certain costs and charges, this lets the insurance company control expenses and prices. If you join an HMO and your doctor isn't a member, you must choose a doctor in the HMO panel. This is how an HMO works:
  • You choose a primary care physician (PCP) from a list of participating doctors. This doctor is the one you see see for routine medical care such as annual exams and health concerns. If you need to see a specialist, be hospitalized, or have lab or X-ray work, your PCP will refer you to a provider or facility. Your PCP authorize these services to be covered by your HMO.
  • You may have to pay a small portion of the cost (called a co-payment) for each office or hospital visit, such as $15 or $20 per doctor visit, regardless of what the services cost.
  • Some services will cost extra such as (emergency room, mental health and chemical dependency services, for example).
  • As an HMO member you do not have to fill out claim forms. 

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Are benefits paid under a disability policy taxable as income?
This depends on who paid the insurance premiums. If the insured paid the premiums with after-tax dollars, then the disability benefits will be received income tax-free. If an employer paid for part or all of the premiums then an equivalent portion of the benefits paid to the employee are usually taxable. Consult your accountant or tax adviser to make sure you fully understand this aspect of disability coverage. 

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A few sources for "checking out" a health insurance company.

Check out your state's Department of Insurance website

AM Best Rating service     www.ambest.com 

National Committee on Quality Assurance (NCQA).     www.ncqa.org

The Joint Committee on Accreditation     www.jcaho.org

The National Insurance Commission.     www.naic.org.

What is a Health Savings Account?
 
 
 
 
 
 
 
 

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