Benefit Gaps And Supplemental Coverage
Medicare provides protection against the costs of many health care services, but traditional Medicare has relatively high deductibles and cost-sharing requirements and places no limit on beneficiariesâ out-of-pocket spending for services covered under Parts A and B. Moreover, traditional Medicare does not pay for some services that are important for older people and people with disabilities, including long-term services and supports, dental services, eyeglasses, and hearing aids. In light of Medicareâs benefit gaps, cost-sharing requirements, and lack of an annual out-of-pocket spending limit, most beneficiaries covered under traditional Medicare have some type of supplemental coverage that helps to cover beneficiariesâ costs and fill the benefit gaps .
Figure 4: Distribution of Types of Supplemental Coverage Among Beneficiaries in Traditional Medicare in 2016
In 2018, one-third of all beneficiaries were enrolled in Medicare Advantage plans rather than traditional Medicare, some of whom also have coverage from a former employer/union or Medicaid. Medicare Advantage plans are required to limit beneficiariesâ out-of-pocket spending for in-network services covered under Medicare Parts A and B to no more than $6,700, and may also cover supplemental benefits not covered by Medicare, such as eyeglasses, dental services, and hearing aids.
New For 2022 Healthy Food And Otc Products Will Be Combined Into 1
Starting in 2022, our dual plan benefits will get even better. To make things easier and more convenient, UnitedHealthcare will introduce one combined benefit called OTC + Healthy Food. All your OTC and healthy food credits will be loaded on a single prepaid debit card. You can use your prepaid debit card to shop at thousands of participating retailers and buy approved OTC health care products or covered groceries you choose. Also new in 2022, youll have the added option to get your healthy food delivered to you from Walmart.com and some other retailersl.
*NOTE: Benefits, features and/or devices vary by plan/area. Limitations and exclusions apply. OTC and Healthy Food benefits have expiration timeframes. Call the plan or refer to your Evidence of Coverage for more information.
See UnitedHealthcare plans in your area.
Please note: What dual-eligible plans you can get depends on where you live. To find a UnitedHealthcare Dual Complete® plan for you, please search plans in your state.
Were here to help.
Contact us at:
Were here to help.
Contact us at:8 a.m. to 8 p.m. local time, 7 days a week.
Looking for the federal governments Medicaid website? Look here at Medicaid.gov.
Medicare Eligibility Due To A Disability
If you have been receiving SSDI benefits for more than 24 months, often known as the two-year waiting period, you may be eligible for Medicare as a result of your disability. The two-year waiting period begins the month you receive your first SSDI payment. At the start of the 25th month, following the receipt of an SSDI check, you will be automatically enrolled in Medicare.
If you receive SSDI as a result of Amyotrophic Lateral Sclerosis or ALS, Medicare coverage begins the month automatically after your SSDI benefits begin. You do not have to wait two years.
Not Medicare, but Social Security determines whether you qualify for SSDI benefits and runs the program that distributes them. It is recommended that you contact your local Social Security Administration office for additional information about the Social Security Disability Insurance program.
Railroad employees should contact the Railroad Retirement Board for information on disability annuities and eligibility for Medicare.
Read Also: Is Medicare A Federal Program
To Qualify For Medicare You Need To Get Disability Benefits From:
- Social Security
- Railroad Retirement Board
If you or your spouse worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772.
If you live in Puerto Rico or outside the U.S.
Exploring Medicare Benefits In 2022
As a federal health insurance program, Medicare stands out among the examples of successful social programs if for no other reason than the fact that it has survived for the past five decades with few significant modifications. To understand how Medicare affects your life as an American citizen, you need to appreciate that that the program was an unprecedented measure in its day. Today, it continues to fulfill a vital need for senior citizens and those with certain disabilities or illnesses. In the following sections, well discuss the history of Medicare, its impact as a social program on the country and what it means to you as an individual.
Also Check: How Do I Qualify For Medicare Low Income Subsidy
American Disabilities Act Notice
In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 , UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.
Looking To The Future
Medicare faces a number of critical issues and challenges, perhaps none greater than providing affordable, quality care to an aging population while keeping the program financially secure for future generations. While Medicare spending is on a slower upward trajectory now than in past decades, total and per capita annual growth rates appear to be edging away from their historically low levels of the past few years. Medicare prescription drug spending is also a growing concern, with the Medicare Trustees projecting a comparatively higher per capita growth rate for Part D in the coming years than in the programâs earlier years due to higher costs associated with expensive specialty drugs.
To address the health care financing challenges posed by the aging of the population, a number of changes to Medicare have been proposed, including restructuring Medicare benefits and cost sharing raising the Medicare eligibility age shifting Medicare from a defined benefit structure to a âpremium supportâ system and allowing people under age 65 to buy in to Medicare. As policymakers consider possible changes to Medicare, it will be important to evaluate the potential effect of these changes on total health care spending and Medicare spending, as well as on beneficiariesâ access to quality care and affordable coverage and their out-of-pocket health care costs.
Read Also: How Do I Change Medicare Supplement Plans
Als And Esrd Exceptions
If youre younger than 65 and have amyotrophic lateral sclerosis , youll automatically get Medicare Part A and Part B the month your disability benefits begin.
There used to be a five-month waiting period between diagnosis with ALS and the start of disability benefits. But legislation that was enacted in late 2020 eliminated that waiting period. This means that disability benefitsand Medicare coveragecan begin as soon as a person is diagnosed with ALS.
If youre undergoing dialysis for ESRD, your Medicare coverage usually starts the first day of the fourth month of dialysis treatments.
However, if you go through training for a home dialysis program and your doctor thinks youll be able to do your own dialysis at home, coverage can start as early as the first month of dialysis.
Depending on where you live, you may be able to join a Medicare Special Needs Plan for people with ESRD, if theres one in your area.
B Enrollment May Be Impacted If You Lose Coverage Through Your Spouse
In most cases, individuals who do not enroll in Part B when they first become eligible may have to pay late enrollment penalties. However, if you were covered by a spouses employer or retiree coverage, you may be eligible for a Special Enrollment Period during which to get Part B.
The online blog doesnt take into account every situation, so its important that you ask questions and get answers for your specific situation. You may want to contact the Social Security Administration for more information by calling 1-800-772-1213 , Monday through Friday from 7 a.m. to 7 p.m.
Recommended Reading: Is Medicare Medicaid The Same
Understand Medicare Home Health Benefits
After Connie Henderson’s husband, Eugene, was diagnosed with a rare genetic condition that causes lung problems, a doctor gave the rural Minnesota couple a bit of good news: Medicare’s home health benefit would pay for a nurse to come to their home and administer the weekly plasma infusions that Eugene would need to treat the condition.
Unfortunately, the doctor was wrong. Because Eugene was not homebound, the home health agency said, he didn’t qualify for the Medicare benefit, and the Hendersons would have to pay about $200 a week for the service. That left Connie, 66, in a bind: She could let her husband go to an infusion center at a clinic, where she feared exposure to other ill patients could damage his health, or learn to give the intravenous infusions herself. She chose the latter. At first, it was “scary,” she says. “I didn’t think we could do it.”
As the Hendersons discovered, even health providers have a hard time understanding Medicare’s home health care benefit. To qualify, you must need skilled services such as nursing, physical therapy or speech therapy. And you must be “homebound,” meaning you have difficulty leaving home without help or leaving home isn’t recommended because of your condition.
5 of 7
Medicare Plans Can Compliment Va Benefits
Veterans should know that a Medicare Advantage plan may complement their existing VA benefits and may help reduce gaps in their health care coverage. Enrolling in a Medicare Advantage plan may provide access to additional services and benefits, like urgent care and dental coverage which may not be covered by VA health care.
When looking into your options, you may want to consider a Medicare Advantage plan designed with veterans in mind. For example, Humana Honor plans, which are available to anyone eligible for Medicare, may provide additional benefits like dental care with a $0 monthly plan premium. Although Humana Honor plans are designed with veterans in mind, Medicare-eligible veterans can select from any Medicare Advantage plan in their area.
Another important factor to understand is how Medicare Advantage works with TRICARE and CHAMPVA. As veterans may know, TRICARE for Life coverage is generally richer than other types of coverage, so Medicare Advantage or Prescription Drug plans are not recommended for veterans with TRICARE or CHAMPVA. Veterans with this type of coverage should carefully consider how their coverage would be impacted by enrollment in Medicare Advantage.
Read Also: Can You Sign Up For Medicare Part B Anytime
Who Is Eligible For Ssdi
The rules are different when youre applying for SSDI. Youll need 40 work credits if youre applying at age 62 or older.
To qualify for SSDI, you must:
- be unable to work because of a medical condition that will last at least 12 months, or is terminal
- not currently have a partial or short-term disability
- meet SSAs definition of a disability
- be younger than full retirement age
You must be able to prove you meet these criteria, and this process can be difficult. Once you qualify for SSDI, the amount of disability youll receive may be based on your age and the amount of time youve worked and paid into Social Security.
This table explains what benefits are offered based on your age and number of years worked:
Risk Of Going Uninsured
VA health care benefits are fragile. Because the VA health care program relies on funding by Congress, no one knows if theyâll cut the funding in the future. Essentially, thereâs no guarantee that you wonât be kicked off at any time.
If youâre in a lower priority group, you could lose your VA health coverage, and if you arenât signed up for Medicare, you could be completely uncovered. With the average cost of a heart attack costing upwards of $1 million, you donât want to go without insurance!
If you donât sign up for Medicare when youâre first eligible , you canât sign up again until January of the following year. Unfortunately, thereâs also a penalty involved. So, be sure to sign up your Medicare coverage.
You May Like: Can I Get Medicare At Age 62
Do You Automatically Get Medicare With Social Security
Both federal initiatives are linked, meaning that many individuals receiving Social Security payments may automatically receive Medicare benefits once they qualify for Medicare based on age or disability.
In this article we review how people can receive Medicare health insurance coverage alongside their Social Security benefits.
Disabilities Under Social Security Disability Insurance
One of the requirements to qualify for Social Security disability benefits is that you must have a medical condition thats expected to last at least one year. It must also significantly limit your ability to perform basic work activities, such as sitting, standing and remembering. You also have to meet earnings requirements based on your work history.
If your medical condition meets the criteria of a listing in the U.S. Social Security Administrations list of impairments, you have a qualifying disability. Medical experts outlined the objective medical or physical findings needed to satisfy the criteria for each listing. The impairments are organized into categories such as neurological disorders, respiratory disorders and immune system disorders.
Examples of disabilities that qualify individuals for SSDI include:
- Multiple sclerosis
- Depression, bipolar and related mental illnesses
- Cystic Fibrosis
- Autism spectrum disorder
After submitting your application with your personal, medical and work history information and receiving approval, theres a five-month waiting period before you can start receiving disability benefits.
However, youre exempt from the waiting period if you have ALS and you were approved for benefits on or after July 23, 2020.
Recommended Reading: Does Medicare Pay For Private Duty Nursing
What Are Other Medicare Advantage Benefits
In some cases, you may be able to enroll in a Medicare Advantage plan that covers alternative therapies such as chiropractic care and even acupuncture. In addition, your plan may include other comprehensive benefits such as:
- Counseling to manage life changes, conflict resolution, and grief in both individual and group sessions that would not otherwise be covered under Original Medicare.
- Enhanced disease management services for people with serious or chronic medical conditions such as heart disease, diabetes, and Alzheimers and related dementias.
- Bathroom safety devices and safety counseling for individuals at risk for falls. Your plan may also cover a comprehensive in-home safety assessment to help minimize the risk of injury and falls at home.
- Temporary home meal delivery for up to four weeks following surgery or inpatient hospital stay
- Personal emergency response system to notify emergency personnel in the event of fall or other medical event.
- Telemedicine or other remote health services, including a nursing hotline in some cases, you may also qualify for remote monitoring devices.
- Transportation assistance to get you to and from covered health care appointments.
- Wigs for hair loss following chemotherapy for cancer.
Who Is Eligible For Social Security Retirement Benefits
As mentioned, youll need to meet a few requirements to be eligible for Social Security retirement benefits. Just like with Medicare, youll need to be a United States citizen or permanent resident. You might also need to have worked and earned credits. The amount of credits you need depends on your circumstances and the type of benefit youre applying for.
Youll need at least 40 credits in order to apply for retirement benefits. Since you can earn up to four credits a year, youll earn 40 credits after 10 years of work. This rule applies to anyone born after 1929.
The amount youll receive per month will depend on your income throughout your working life. You can use the calculator on the Social Security website to estimate your retirement benefits.
Also Check: Do I Have Medicare Or Medicaid
How Much Does Medicare Cost
Original Medicare is divided into Part A and Part B .
- Part A helps pay for inpatient hospital care, some skilled nursing care, home health care and hospice care.
- Part B helps pay for doctor services, outpatient hospital care, durable medical equipment, home health care not covered by Part A, and other services.Medicare was never intended to pay 100% of medical bills. Its purpose is to help pay a portion of medical expenses. Medicare beneficiaries also pay a portion of their medical expenses, which includes deductibles, copayments, and services not covered by Medicare.The amounts of deductibles and copayments change at the beginning of each year.
Part A – Monthly Premium
If you are eligible, Part A is free because you or your spouse paid Medicare taxes while you were working. You earn Social Security “credits” as you work and pay taxes. For each year that you work, you earn 4 credits.
You are 65 or older, and you receive or are eligible to receive full benefits fr om Social Security or the Railroad Retirement Board
You are under 65, and you have received Social Security disability benefits for 24 months You are under 65, and you have received Railroad Retirement disability benefits and you meet Social Security disability requirements You or your spouse had Medicare-covered government employment You are under 65 and have End-Stage Renal Disease
Unitedhealthcare Dual Complete Plans
Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. This information is not a complete description of benefits. Call TTY 711 for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.
Read Also: Does Medicare Cover Any Dental Surgery