MEDICARE
Medicare is a national health insurance program in the United States, begun in 1966 under the Social Security Administration (SSA) and now administered by the Centers for Medicare and Medicaid Services (CMS). It primarily provides health insurance for Americans aged 65 and older, but also for some younger people with disability status as determined by the Social Security Administration, as well as people with end stage renal disease and amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease). (https://en.wikipedia.org/wiki/Medicare_(United_States)
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It is important to note that while Part A is premium free for most users (earned by working 40 quarters and paying Social Security Taxes), Part B and Part D (and in some cases Part C) all have monthly premiums. the premium is income based, so some people will pay less than others. Also, you should keep in mind, that original Medicare, as it is called, that's Part A and Part B, only cover 80% of most healthcare services, so you will be responsible for the rest. That means if you have a $100,000 surgery and it's covered by Original Medicare, you still owe $20,000. Something to keep in mind when setting up your health insurance. Medicare is divided into four parts, in order to serve you better. Click on each box to learn more about each one.
Other Health Plans
Did you know you have other options outside of Medicare? Yes! ln some situations you can keep your medical benefits included in your retirement/pension plan. Click on the buttons below to learn more.
Coverage Choices
With Medicare, you have coverage choices. That means you can combine certain coverage to best meet your specific needs. The chart below is the standard way to utilize Medicare coverage options.
Helpful Publications
Ready for a one-on-one consultation?
After reading all about Medicare, you're probably ready to find out how Medicare will work for you. Schedule a time to meet with a professional counselor to help you make the best decision for your situation.
MEDICARE SUPPLEMENT
Contrary to it's name, Medicare Supplements are NOT apart of Medicare Health Insurance. They have no government afflliation at all. Medicare Supplements, also called Medigap, are policies sold by private insurance companies. These policies can help cover some of the medical expenses Original Medicare leaves behind. Including covered services and supplies, copayments, coinsurance and deductibles. Some Medicare Supplements also cover medical services outside of the U.S. It is important to note that Medicare Supplements are NOT Long-term care plans and don't cover things like nuring homes or private nursing care.
Important!!
Beginning January 1, 2020, plans C and F are NOT available to new comers to Medicare. Medigaps are no longer allowed to the Part B deductible to those who are new Medicare enrollees. If you already had plans C or F prior to January 1, 2020, then you are able to keep your plan
MEDICAID
Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities.
Introduction
Did you know that you can have BOTH Medicare and Medicaid? Yes. If you meet the eligibility requirements, you may receive even more assistance paying for your helthcare needs.
Resource Limitations
Aid to Aged Blind and Disabled (AABD) Medical covers seniors, persons who are blind and persons with disabilities with income up to 100 percent of the federal poverty level (FPL) and no more than $2,000 of non-exempt resources (one person). Federal matching funds are available under Medicaid for these individuals.
Appeals
If you applied for Medicaid and were denied or a service was denied, you can appeal the decision. Click on the link to learn the steps.Link.
Eligibilty
Medicaid, funded by both the federal government and the state, has income requirements, click on the link below to learn more. MORE
Transfer of Assets
Sometimes you may want to 'transfer your assets' in order to qualify for Medicaid to cover long-term care. Read the summary of rules for IL before you begin. Link.
Applying
When applying for Medicaid, you have options. You can apply online, go to the nearest DHS office and apply in-person, call 800.843.6154 for an application or to apply by phone or set an appointment with a SAIL benefit consultant, an IDHS community partner.
Medicaid & LTCi
Did you know that IDHS may be able to help pay for your long-term care needs? Click the link to learn more! Link.
Important!!
Ready to enroll? SAIL can help! As an IDHS Community Partner, we are authorized to provide enrollment assistance. Best of all it's FREE of charge! Contact us today to get started!
Facts You need
to know
Important!!
Once you turn 65 and are collecting Social Security benefits, you must enroll in Medicare Part A, which covers hospital costs. If you don't want to enroll in Medicare, then you must repay your Social Security benefits. Medicare A is free for most people who have worked at least 10 years to earn the minimum 40 credits required for coverage or who are married to someone who is eligible for Medicare. If you are not yet collecting Social Security, you can delay enrolling in Medicare penalty-free under certain conditions.
Important!!
Your initial enrollment period (IEP) to sign up for Medicare Part B, which covers outpatient services and doctors' fees, begins three months before your 65th birthday, includes your birthday month and extends three months beyond that. Miss that seven-month window and you will pay a delayed enrollment penalty of 10% per year for each year you were eligible but failed to enroll. Wait until 70 to enroll, for example, and that five-year delay will cost you an extra 50% of the standard Part B premium every month you are enrolled in Medicare. There is also a 1% per month delayed enrollment penalty for Medicare prescription drug plans.
Long Term Care Insurance
What is it?
Long term care insurance (LTCi) is a policy that helps provide non-medical care for those who have a chronic illness or disability. Sometimes called, custodial care, LTCi coverage includes, personal care assistance (such as bathing), adult day care,and. home delivered meals.
Who Needs it?
Long-term care is required for persons with chronic disabilities that impair their ability to perform activities necessary for daily living. An estimated 8 million individuals in the United States require long-term care assistance in performing daily functions such as bathing, dressing, eating, and moving about. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4191481/)
Helpful Publications
5 Things you need to know about LTCi
1.
You may not need to purchase a LTCi policy. Keep in mind, LTCi policies must be purchased far in advance of the need. Traditional LTCi policies are often seen as a 'waste of money' because they can only be used for specific needs.
2.
There are 'hybrid' LTCi policies available. These polies are gaining popularity as you don't lose money if you don't need Long-term care.
3.
Even if a family member decides to care for you, they may experience loss of income and still may need a break from time to time. Keep this in mind when making your plan.
4.
Be sure to put health and financial power of attorneys in place, as well as advanced care directives to ease the stress of making last minute decisions for your loved ones.
5.
Make a plan and review it often!! Ask for help from an attorney if neccessary.
Ready for a one-on-one consultation?
After reading all about your coverage options, you're probably ready to find out how to make it all work for you. Schedule a time to meet with a professional counselor to help you make the best decision for your situation.