There are various ways in which the Medicare beneficiaries cover up the “gaps” in the Medicare health plans. They options taken are:
- QMB/Medicaid/SLMB which are government programs
- Non- standardized group retirement policies
- Individual Medigap policies which are non-standardized and issued before July 31, 1992
- Individual Medigap policies which are standardized and issued post July 31, 1992.
Medigap insurance is not required for people by beneficiaries of Medicare who qualify for Medicaid because the latter will cover all their expenses related to health care. The Qualified Medicare Beneficiary program is for people who are within the 100% federal poverty level and are not eligible for Medicaid. The advantages of this program are:
- Premium payments for Medicare
- Payment of annual deductibles for Medicare
- Payment of co-insurance for Medicare
People who are eligible for QMB programs neither need nor should pay for the Medicare Supplement Insurance. Every year, in the month of April, the income figures to qualify for the program change. To know more about eligibility and enrollment for QMB and also for information on Title 19, get in touch with the local office of Department of Social Services.
For people with higher incomes who cannot enroll for QMB programs may be eligible for SLMB (Specified Low-insurance Medicare Beneficiary Program) or QI (Qualified Insurance Program). The eligibility for either QI or SLMB is for people who fall within the range of 120%-135% of federal poverty level. Only Part B program payments are made by these two programs. Hence, people who have either of these policies might also consider opting for the Medicare Supplement Insurance if it is affordable. The income figures to gain eligibility for these two programs also change annually in April and you can contact the local office of the Department of Social Services for more information.
Coverage for health insurance is offered by some employers for their retirees. There is no need for such retirees to opt for individual health insurance plans. Though some retirees may want to opt for individual plans, it is not considered to be a wise choice because they need not pay anything for the group plans which are in fact better than the individual policies. Before such retirees consider buying individual policies, they should compare quotes for Medigap policies from various companies and also think about the stability of their employer. If the retiree feels that the company is unstable or the Medigap policy offers better coverage, then, he can opt for individual policy. When the new policy has been obtained, the old policy will cease to exist.
Many Medicare beneficiaries have to opt for the Medigap Insurance since they are neither eligible for QMBs nor SLMBs and QIs. Nearly 66% of the Medicare beneficiaries purchase the Medigap policy. All Medigap policies within the United States were standardized from July 31, 1992. The 1990 Omnibus Budget Reconciliation Act passed the Congress made the process of standardization compulsory. Ten plans which are approved by the federal law can be offered as Medigap policies. In the year 2006, two more plans were added to this list. The marketing of these plans varies from one state to the other. The “core benefit” plan which is the fundamental benefit package is permissible in all states and companies that sell Medigap insurance should offer it.
There are some elderly people who are covered by non-standardized plans that were issued prior to July 31, 1992. Though such non-standardized policies cannot be purchased any longer, people can opt to retain it, which is the option chosen by most of them. However, people holding such policies should opt for standardized policies. Any person buying the new policy which has been standardized should drop the non-standardized one to avoid duplication.
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