Health Insurance Plans for Mature Adult/Elderly
The population of elderly people is rapidly increasing and this means providing a better and more efficient medical insurance plan for them.
Americans have put pressure on the government to implement improved health care insurance packages that should provide complete services to people including senior citizens.
However, the cost of the health care package for older people has skyrocketed, with Medicare benefit payments totaling $374 billion in 2006. The total cost accounts for 12 percent of federal government expenditure and 20 percent of the total health care spending in the country.
The elderly now amounts to 13 percent of the population but they use up more than one-third of the country’s health care services, including out-of-pocket expenditures and supplemental insurance policies. Over the next decade, an 8-percent increase in spending will be seen annually.
Elderly patients are no always aware of cost in terms of their medical care consumption, including their use of prescription drugs. Studies show that elderly people would lessen their medical insurance consumption if cost sharing was to increase. When prices of drug co-payment go up, elderly people’s drug consumption is reduced as well. The research also suggests that the demand for any kind of drugs is price sensitive.
Therefore lower consumption of essential drugs, as a result of a high price tag, may lead to a person becoming more ill. This event may maximize his or her need for hospitalization, leading up to more costs.
It is, therefore, important to remember that the most adequate health insurance plan would have health status linked to cost sharing.
Being covered under medical insurance is important, especially for the elderly. Some senior citizens even want to purchase additional health plans just to cover other medical expenses that are not covered by their existing health plan.
Medicare is the most common medical insurance for the elderly. Medicare is a federal health plan specially designed for seniors under the Social Security Act of 1965. Any applicant who wishes to have a Medicare health plan should have worked for at least 10 years to become eligible. If the applicant doesn't meet this requirement, he needs to pay for a health insurance premium.
The coverage of Medicare is expansive, although there are some services such as in-patient hospital deductibles that have separate fees. Seniors usually avail of secondary health insurance plans, apart from their existing Medicare health plan, to ensure that their health-related expenses get covered. One of the most popular options when purchasing supplemental health plans is Medigap, an individual health insurance policy for seniors.
Another important reason why seniors need a health plan is medication. Seniors need a lot of medicines, and since Medicare only covers limited prescription drugs, most of them opt to avail of the Elderly Pharmaceutical Insurance Coverage. The EPIC Program subsidizes the cost of prescription drugs, and the good news is that it covers most prescription drugs. Their deductible plan can also be availed by seniors who earn $20,000 annually.
Some people nearing retirement age dream of spending the remaining years of their lives in a community full of camaraderie and friendship, which is also a place that provides various social, cultural, and fitness activities. Others grab the chance to stay in a smaller house that is easier to maintain and provides the luxury of seclusion, while at the same time feeling the comfort of being surrounded by fellow senior residents. Both scenarios provide the elderly with a sense of independence.
Senior citizens are provided with six housing options for their retirement, namely, Independent Living, Assisted Living, Board and Care, Nursing Homes (Skilled Nursing Facilities), Congregate Housing, and Continuing-Care Retirement Communities (CCRCs). Among these housing options, Independent Living is the best choice for those who want freedom and versatility. It provides a residence in a compact, easy-to-maintain, private apartment or house within a community composed of fellow senior citizens.
True to its name, Independent Living allows the elderly to maintain their own residence and enjoy their daily routine without custodial or medical assistance. However, the senior citizens are allowed to bring in their preferred custodial or medical assistance from outside the community once it becomes necessary.
Independent Living for senior citizens includes community services, such as laundry and cleaning. There are also some community activities offered, namely, outings, golf, and other social events. The residents are free to decide what will be in their daily schedules, and since the residents are generally in good physical and emotional health, it will be up to them to arrange for their own medical insurance, such as Medicare, which provides health insurance coverage to people who are 65 years old and above. Medicare operates a single-payer health care system.
Medicare is a social program provided and administered by the U.S. government. It grants health insurance benefits to senior citizens, and other people who meet certain criteria. If a citizen is granted Medicare health insurance, he or she is also granted other rights pertaining to it. Some of these are the right to partake in the decisions that affect health care; the right to understand, identify and freely choose all treatment options; the right to appeal the decision to deny a member certain services; the right to get medical services in cases of emergency; the right to file grievances and complaints; the right to a timely and fast appeal resolution; the right to privacy regarding personal medical information; the right to be treated fairly and without discrimination.
In general, the rights most often executed by patients are the right for a speedy appeal of a decision and the right to appeal a health care resolution that is not acceptable to a policyholder’s satisfaction. No matter what type of Medicare plan a person has, he or she has the right to make an appeal regarding the decisions of his or her insurance company or of Medicare.
Whenever a policyholder feels that services and benefits available to him or her are ending before they should, he or she can make a Fast-Track appeal. This is available if the policyholder is released from a skilled nursing care facility, a hospital, a rehabilitation facility, an agency for home health care, or a hospice.
Health insurance has always been a necessity, especially for seniors. Many older people even consider purchasing supplemental health plans to cover medical expenses that their insurance plan may not cover.
Medicare, a federal health insurance developed for seniors through the Social Security Act of 1965, is the most popular option among the elderly. To qualify for Medicare health insurance, the applicant must have worked for 10 years. If the person does not meet this requirement, he or she is required to pay a monthly premium.
Medicare covers diverse health care services, although some services are subject to extra costs. Services that are often not covered by this type of insurance include in-patient hospital deductibles and other fees.
Usually, to ensure that most of their medical expenses will be covered, many seniors enroll in secondary health insurance plans to supplement their Medicare health plan. A Medigap policy, an individually purchased health insurance policy, is a widely used option as a supplemental health plan for seniors. Since only a few prescription drugs are covered by Medicare, many seniors also choose to enroll in Elderly Pharmaceutical Insurance Coverage or the EPIC Program, which subsidizes prescription drugs costs. This insurance covers almost all prescription drugs. The insurance’s deductible plan is also applicable to seniors who earn over $20,000 per year.
Medicare coverage used to be limited to hospital care, physician and outpatient care. But in 2003, through the Medicare Prescription Drug Improvement and Modernization Act, Medicare started providing coverage for the cost of prescription drugs.
Seniors may also enroll in other Medicare Advantage Plans, such as Medicare Medical Savings Account Plans, Preferred Provider Organizations, Private Fee-For-Service Plans, Health Maintenance Organizations, and Medicare Special Needs Plans.
Among the direct results of the complexity of a highly civilized society are diverse lawsuits. Dockets are heaped with various cases, and there are lawsuits that involve Health Maintenance Organizations or HMO’s.
The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that provides the guidelines or the minimum standards concerning health, retirement and other welfare benefit plans, as well as life insurance, disability insurance, and apprenticeship plans. This law also prescribes the limitation of the amount of damages patients employed by private entities may recover when they file a case against an HMO.
Texas was the first state to enact a law that makes it legally possible for a patient to file a lawsuit against an HMO when the latter fails to apply ordinary care in making decisions in health care treatment. This Texan law was put into effect in 1997. In 1999, Georgia and California followed suit. The law in Georgia, however, is slightly different. An HMO in Georgia may only be sued when there is failure on the part of the organization to adjust claims in an appropriate and timely manner. The Californian law, on the other hand, has a wider scope. While it also covers the failure to use the amount of precaution expected in providing medical care, such a failure must be proven to have caused serious damage or harm and resulted in a health care service being denied, delayed, or changed.
There are also other states that give patients the right to sue their HMO’s. These states are North Carolina, Oregon, Washington, West Virginia, New Jersey, Maine, and Arizona.
Many U.S. residents see Alzheimer’s as a very alarming disease. But what is even more alarming is the thought of paying for health care for an Alzheimer’s sufferer with the current American health care system. However, there are actually health plans for those who cannot afford the costs associated with Alzheimer’s. These options include long-term care insurance, Medicare, disability insurance, and Medigap.
Around 42 million Americans are covered under the Medicare insurance plan. People who are 65 years old and above and people who have qualifying disabilities receive insurance coverage funded by the government through Medicare. However, many people still need to supplement their Medicare coverage. Many private insurance companies offer this supplementary coverage called Medigap.
As supplementary coverage, Medigap can be combined with an individual’s Medicare coverage. Health insurance companies throughout the U.S. offer this kind of insurance coverage. State and federal laws define the coverage of the policies of Medigap. These policies include details regarding hospital and coinsurance costs that are not included in the person’s Medicare coverage, as well as deductibles that are associated with a stay in the hospital.
For those worried about contracting Alzheimer’s, one of the better options might be disability insurance. Insurance companies only offer this kind of insurance before the diagnosis of the disease.
In case a person does not have disability insurance but is stricken with Alzheimer’s disease, he or she can qualify for Social Security Disability Income, which is offered by the U.S. government.
A large number of men in the United States and across the world are affected by prostate cancer. Erectile dysfunction and difficulty urinating are some of the symptoms of the disease. Prostate cancer is the most common form of cancer experienced by American men. It is estimated that in 2007, 218,890 American men will have been diagnosed with this type of cancer.
Age is one of the important causative factors for prostate cancer. Around 70 percent of American men who have been diagnosed with prostate cancer are 65 years old and above. According to the American Cancer Society, African-American males have a greater risk of being diagnosed with the disease than White, Asian and Hispanic men. Another factor that influences the disease is genetics. The risk of having prostate cancer is directly correlated to the number of relatives a man has who also developed prostate cancer.
With the abundant research done on the disease one conclusion is clear, men with individual health insurance are less likely to die because of prostate cancer.
This does not mean, however, that men with health insurance will not develop prostate cancer. It only means that these men can get the health care they need to ameliorate the adverse effects of the cancer. This is one of the strongest arguments in favor of men having health insurance. When you are searching for a good health plan, ensure that the policy will cover prostate treatment as well as preventive care.
Yearly prostate examinations are recommended for men who are 50 years old and above, men who have a high risk of cancer and men who have a family history of prostate cancer. Prostate examinations will help detect the cancer at an early stage, thus making treatment more effective.
The average lifespan for an American is about 80 years. Although there is an increasing focus on making better lifestyle choices like diet, exercise, and preventative care, no one is immune to the effects of aging. Some kind of physical or mental incapacity will eventually drive many of us to spend at least part of our later years in long term care situations.
In 1994 about seven million Americans needed some form of long term care, at an average cost of $44,000 per person, per year. By 2000, that number had risen to more than nine million people and nearly $56,000 per year. Currently, the cost for long term care hovers around $75,000 per person annually; and, it has been projected that by 2030 more than 23 million Americans will need some kind of long term care, at an average cost of up to $300,000 per person yearly.
So what is long term care and why is it so expensive? Long term care provides essential medical services either in the home or in 24-hour nursing facilities for elderly people with conditions like Alzheimer’s, Parkinson’s, stroke, and those related to the effects of advanced age like dementia and physical incapacitation. Care is usually tailored to meet a patient’s particular needs and involves constant monitoring by nurses, doctors, therapists and aides. There are several different levels of long term care: in home care by family and friends, in home care by a professional caregiver, residence at an assisted living facility, and comprehensive care at a skilled nursing facility -- also called a nursing home.
While studies have shown it is more beneficial for patients to remain in their own homes for as long as possible, the costs for this type of care can add up quickly. Families are then forced to make important decisions about the long term care of their loved ones based solely on financial factors rather than on the course of treatment that would provide the most benefit for the patient.
Most health insurance plans do not cover long term care, and Medicare will only pay for care for a limited time period and under very specific circumstances. Medicaid and plans offered through the Veteran’s Administration do pay for long term care; but because funds to these programs are limited, the quality of care is sometimes lacking.
Purchasing a separate long term care insurance plan, therefore, makes sense. Long term care coverage supports your independence as you age, gives you more choice in your care, and protects your loved ones from financial hardship. Premiums for this type of insurance generally increase as you age; however, once a policy has been purchased, the price is locked in for the life of the policy regardless of a patient’s aging or health. Experts recommend people as young as 40 start thinking about long term care insurance. For those who can afford the monthly premiums, this option ensures a lifetime of protection at a reasonable cost. A price comparison of long term care insurance plans can be conducted online.
Many Americans over the age of 50 have a difficult time qualifying for health coverage. Some of these people are self-employed, have taken early retirement, or have exhausted COBRA coverage following a lay-off. Because Medicare benefits do not take effect until age 65, the only option for many of these “in-betweeners” is to purchase individual health insurance coverage.
While buying an individual health insurance policy is a viable option for many people, several problems can arise for those over the age of 50. Some insurance companies require new applicants aged 50 and older to undergo a physical or series of medical tests to rule out potential health issues. Also clients with a pre-existing condition such as cancer or diabetes may be rejected for coverage based on their medical history.
There are options available for those over the age of 50 who are looking for health insurance. Fee-for-service plans offer the most freedom, but premiums are higher than with any other individual coverage, making them cost-prohibitive for many people. Managed care is perhaps the most popular choice for individual health insurance. In managed care, HMOs, PPOs, etc., insurance companies establish contracts with doctors and hospitals to provide care for plan members at an agreed-upon rate. These types of plans typically involve a network of approved providers and plan members are free to choose facilities and services from the network. Choice can be limited, however, and patients may have to pay more out of pocket to see a non-network provider. Managed care plans often require small co-pays for office visits and prescriptions. Open enrollment managed care is another attractive option. Customers have a one-month window of opportunity during which the insurance company must let people join regardless of medical history or pre-existing health conditions. This is an excellent choice for those who have been excluded from other plans or have been denied coverage based on their health. Open enrollment managed care usually does not require a medical exam.
For those who are members of a trade organization or labor union, association-based health insurance may be available and offered at discounted group rates.
Some states have programs called high-risk pools, which are good options for those in poor health who have been denied coverage elsewhere. This is a last resort kind of plan and in order to qualify an applicant must have been refused medical coverage by at least two independent insurers and be unable to find coverage anywhere for less than the monthly premium offered by the risk pool. Another option for those who are struggling to get coverage is a specific disease policy. These limited plans pay only for care associated with a particular medical condition such as cardiovascular disease, cancer, diabetes or hypertension. Coverage can be spotty, though, and it is generally advisable to find a more comprehensive plan if possible.
The process of comparing and purchasing health insurance can be daunting. Consult with a trusted broker for help in deciding which plan best suits your needs.
Since being enacted in July of 1965, Medicare has become an important part of American life. According to the Center for Medicare Advocacy, approximately 44.8 million people are expected to be enrolled in Medicare in 2008, up from 43.1 million in 2006. Medicare not only provides healthcare coverage for people aged 65 and older, but also people under the age of 65 with certain disabilities, and people with End-Stage Renal Disease.
While Medicare with its many benefits and parts may seem confusing at first glance, there is a vast amount of information readily available to help you make an informed decision about which plan best meets your healthcare needs. The four major parts that make up Medicare are Part A, B, C, and D.
Medicare Part A covers inpatient hospital services and skilled nursing facility stays. Its benefits also cover some short-term home health care and hospice care, providing certain conditions are met. Part A and Part B Medicare are often referred to as the "Original Medicare". There is no fee for Part A Medicare.
Medicare Part B covers outpatient services such as doctor's visits, lab tests, hospital treatments that are not inpatient, and other basic medical care including preventative services. Part B usually will pay 80% of a service covered by the program and you will be responsible to pay the other 20% along with a yearly deductible amount and a monthly fee.
Medicare Part C or Medicare Advantage plans include both hospital and outpatient services, similar to Part A and Part B, but are provided by private insurance companies that have been approved by Medicare. Most plans will provide you with a list of doctors that are approved by the plan. Usually Medicare Advantage plans require you to see a doctor on their list, or your medical service may not be covered. Additional costs such as copayments, coinsurance, or deductibles are often part of the Medicare Advantage plans. Costs can vary greatly depending on the plan. Prescription drug coverage and dental or vision care may be included in Medicare Advantage Plans at an additional cost.
Medicare Part D is also known as the Medicare Prescription Drug Plan. These plans are optional and are also provided by private insurance companies. Each prescription drug plan will have different costs and will cover different prescription drugs. It is very important to be careful when choosing a Prescription Drug Plan to be sure the prescriptions you are currently using are on the plan you choose and a pharmacy you want to use is also included in the plan. Medicare Part D may not only lower your current prescription drug costs, but it may help protect you against higher costs in the future.
Medicare Supplemental coverage or Medigap plans are provided by private insurance companies. They pay for health expenses that Medicare doesn't cover, such as co-payments. There is an additional cost for these supplemental plans and costs vary depending on the plan you choose.
The first step in choosing any healthcare plan is determining what healthcare benefits you want and need. The coverage you choose will not only affect your current, but also your future health care. Medicare has been a life saver for many older Americans over the years, providing access to affordable healthcare to more older Americans than ever before.
We learn on the playground that empty threats are pointless, even dangerous. That's how some analysts view the possibility of the federal government negotiating Medicare Part D drug prices: virtually a waste of time, but potentially damaging to the program. Advocates of negotiation say that if the Veterans Health Administration can negotiate lower drug prices for its members successfully, why can't the Department of Health and Human Services?
Net Medicare Part D costs for fiscal year 2008 are estimated to be 30 percent less - $189 billion lower - than projected when the benefit was created back in 2003, according to independent actuaries. In addition, based on competitive bids by health care plans in 2007, the average monthly premium will be approximately $22, down from $23 in 2006, if enrollees remain with their current plans. The updated Medicare Part D baseline of payments to Part D plans for the fiscal year 2008 budget cycle was decreased from last summer's mid-session review numbers by $113 billion over the next 10 years (from 2007 to 2016).
Jerry Kelly, 59, a Redwood City, Calif., accountant and his wife, Brenda, 57, were stunned after being rejected recently for private health insurance: "We were turned down for ridiculous reasons, including the fact that I take 10 milligrams of Lipitor every day," he says. Lipitor, for lowering cholesterol, is one of the most common prescription drugs sold in the United States, and Kelly says it is the only medication he takes regularly. "Last October my wife and I had complete physicals and were told we were in excellent health," he says. "Nothing [the insurer] listed in their rejection added up to any real health problems.
Total outlays for the Old Age, Survivors and Disability Insurance (OASDI) for 2008 is estimated at $612 billion, an increase of $26 billion, or 4.4 percent, over FY 2007 . This includes estimated outlays of $499 billion in retired-worker benefits (OASI), $103 billion in disabled-worker benefits, and $9.7 billion in other expenses such as administration, beneficiary services, payments to the Railroad Retirement Board, and demonstration projects. Additionally, the number of individuals receiving benefits under the Social Security programs is expected to increase by 900,000.
Back in 1999, there were over six million enrolled in Medicare+Choice, but the insurance companies wanted more federal funding for these programs and began shutting them down when they did not get it. More than a million seniors had lost their coverage by 2003. The Medicare reform in 2003 gave new financial life to the program and gave it a much needed new name - Medicare Advantage. But, many in Congress have been concerned about the federal dollars flowing into the program.
Medicare | Studies Examine Medication Prices, Language Services Under Medicare Prescription Drug Benefit [Mar 01, 2007] Two studies released this week examine cost increases for Medicare beneficiaries enrolled in the prescription drug benefit and language services provided by Medicare drug plans. Summaries of news coverage appear below.Drug costs: More than 25% of Medicare drug plans increased beneficiaries' copayments and prices for prescription drugs in 2006, often after beneficiaries were committed to plans for the year, according to a study released Wednesday by Consumers Union, USA Today reports.
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