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By John M. Bigler As I explained last month, very often for individuals receiving medical assistance through the Department of Social Services, the cost of medical insurance is a legitimate monthly deduction and therefore can actually be free for Medicaid recipients. For others, it's necessary to take a closer look at the policy to see what coverage is available and to compare the cost.
In New York, there are 10 standard plans, which are the same no matter which insurance company one deals with. The plans are labeled "A" through "J". All of the plans contain basic benefits. Basic benefits included are the coverage for hospitalization in conjunction with Medicare. The basic benefits pay the Part A co-insurance plus coverage for 365 additional days after Medicare benefits end. Part B co-insurance generally pays 20% of Medicare approved expenses. Basic benefits also cover the first three pints of blood received every three years. The A policy only covers basic benefits. The B policy covers basic benefits and also covers the Part A deductible benefits. The C Plan covers basic benefits, Part A and Part B deductible as well as skilled nursing home co-insurance payments and foreign travel emergency payments.
The D Plan covers basic benefits, skilled nursing home co-insurance, Part A deductible, foreign travel emergency and at-home recovery. It should be recognized that at-home recovery is again limited to those services requiring skilled care and is typically quite limited. The E Plan covers basic benefits, skilled nursing co-insurance, Part A deductible, foreign travel emergency and preventive care. The F Plan covers the same as the C Plan but also covers the excess cost of Part B up to 100%. The G Plan covers basic benefits, skilled nursing co-insurance, Part A deductible, but not Part B deductible, Part B excess up to 80%, foreign travel emergency and at-home recovery.
The H Plan covers basic benefits, skilled nursing co-insurance, Part A deductible, foreign travel emergency and adds basic drug coverage with a $1,250 yearly limit. The I Plan covers basic benefits, skilled nursing co-insurance, Part A deductible, Part B excess of 100%, foreign travel emergency, at-home recovery and basic drug coverage, again with the $1,250 limit.
The J Plan is the Cadillac of all plans and covers everything already described plus extended drug coverage with a $3,000 limit.
Plans F and J also have an additional option called a high-deductible Plan F and a high-deductible Plan J. The high-deductible plans offer the same benefits as Plans F and J after one has paid a calendar year deductible of $1,500. Benefits from high-deductible Plans F and J will not begin until out-of-pocket expenses are $1,500. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. These expenses include the Medicare deductibles for Parts A and B, but do not include, in Plan J, the plans' separate prescription drug deductible or, in Plans F and J, the plans' separate foreign travel emergency deductible.
Obviously, this is just a bare-bones outline of these policies. In order to choose which policy is best, it will be necessary to meet with an expert who can make suggestions based on needs. However, keep in mind that the policies are the same no matter which company you're dealing with. Again, remember that for those people who are receiving Medicaid benefits and have a monthly income spend down it may be the most expensive plan is appropriate because the certain monthly amount will have to be spent on medical expenses in any event.
Reprinted with permission of the Suffolk Times © 2002
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Skilled nursing home coverage is particularly useful. As noted in previous articles, if an individual enters a nursing home coming from at least a three day hospital stay, then the first 20 days in the nursing home are covered by Medicare in full and the next 80 days can be covered with a co-insurance payment, all assuming that the patient requires and receives skilled care on a daily basis.