Medicare Supplement Insurance


The stringent Medicare rules leave large gaps in the medical needs of retirees. The
gaps in the insurance needs of citizens are filled in by insurance companies with
supplemental policies known as Medigap. These policies are letter-designated and
range from A type policies with basic coverages to J type policies which offer
comprehensive insurance coverages.
Medigap Coverage
Choosing the optional benefits included in the various supplemental plans depends on
the specific requirements of the customer.

Plan A :

 Basic benefits supplement Medicare benefits by providing coverage for
hospitalization, and require co-insurance payments to be paid starting from the days
that are not covered under Medicare. Furthermore, once the insured pays the annual
deductible under Medicare Part B, the 20% and 50% co-insurance payments are
also covered.

Plan B :

This plan adds on coverage to the basic benefits by paying all deductibles
and coinsurance payments.

Plan C :

 This plan includes both A and B coverages and throws in an amount of $95
for skilled nursing care after day 20. It also includes 80% of emergency care in a
foreign country.

Plan D :

This plan includes all coverages in the other plans with the exception of
Medicare Part B deductibles but includes coverage for custodial care for up to $1600
a year for short-term assistance.

Plan E :

 This plan covers Preventative Care but excludes Medicare Part B
deductibles or custodial services. Preventative Care includes routine physical
exams, blood pressure and cholesterol screening procedures.

Plan F :

 This plan includes Excess Charges for Medicare Part B expenses, i.e. it
covers billings by a doctor who charges in excess of Medicare approved charges.

Plan G :

 This plan excludes the Medicare Part B deductible and Preventive Care
but pays the excess charges at a level of 80%, rather than the entire amount as in
Plan F.

Plan H :

 This plan pertains to prescription medication, and covers the same at 50%
(annual limit of $1,250 after payment of a $250 deductible)

Plan I :

This plan excludes Medicare Part B deductible and Preventive Care, but
includes Prescription Drugs at the basic level of $1,250 annually.

Plan J:

 This plan offers an Extended Benefit which increases the annual amount of
Prescription Drugs to $3,000. This is the most comprehensive and includes
coverage for all benefits previously listed at the maximum levels.


MEDICAID
o WHAT IS MEDICAID?
o MEDICAID COVERAGES
• WORKERS’ COMPENSATION (WC)
o AN OVERVIEW
o WHAT IS WORKERS’ COMPENSATION?
o WHO IS ELIGIBLE?


What is Medicaid?

Medicaid is targeted towards low-income families and individuals of all ages. So far, the
program has proved to be very beneficial for senior citizens, who have depleted their
resources.

Medicaid Coverages

Medicaid is the largest long-term care insurer and provides coverage for a major portion
of middle-income families. It offers a minimum set of services including hospital,
physician and nursing home services. Additional services including prescription drugs,
hospice care and personal care are at the discretion of state agencies.

Workers’ Compensation – An Overview

In addition to personal health care coverage, there also exists a type of insurance
designed to guard against any injuries or disabilities arising from occupational injuries
and disabilities. Worker’s Compensation is administered at the state level and requires
that employers provide compensation benefits for their employees.
Workers’ Compensation came into existence after the industrial revolution; after a time
when employers were almost impossible to sue and no benefits of any kind were due to
the employees, despite increasing occupational hazards, a booming and cheap labor
force and inadequate safety controls.

What is Workers’ Compensation (WC)?

As mentioned earlier, WC covers injuries and diseases arising out of, and in the course
of, employment. Of course, there must be an established, direct correlation with the
disease/injury and the kind of work that an individual does. Furthermore, the injury must
be accidental. It is important to mention here that the purpose of workers’ compensation
is to provide benefits if employees have a job-related sickness or injury and not replace
health insurance for workers.
The law also stipulates that if there is a serious or willful misconduct on the part of the
employer, the benefits will increase; if a minor is employed illegally and suffers injury,
benefits double.
Important Points
• In the case of penalty payments, workers’ compensation policies do not cover
these and all costs incurred are to be borne by the employer.
• In case an employee suffers an injury, but is able to continue work in some
other capacity but sustains another injury which leaves him/her incapacitated,
the benefits would be much higher than if the first injury had not occurred. It
follows, therefore, that if an employee has been incapacitated, the chances of
another injury leading to permanent disability are much higher. This would
mean substantially increased benefits payable to the employee for the second
injury.

Who is Eligible?

Workers’ Compensation applies to all classes of employees. Unlike health insurance
which may be offered to a certain segment of the workforce in the company, Workers’
Compensation applies to all employees, whether full time or part time. In certain cases,
even illegal workers are covered under the workers’ compensation plan.
The most important eligibility criteria is that the individual must be employed in an
industry that is covered under the Workers’ Compensation plan and must sustain an
injury that is directly related to his/her occupation. The law states that only employees
such as farm labor, domestic servants and casual workers can be excluded from this
coverage, although it is available to employers at their discretion.
Important Points
• In certain states, the law exempts employers who have less than a specified
number of workers from the Workers’ Compensation requirement. Again, the
employer may choose to offer the benefit even if he has three, or fewer,
workers.
• Most employers subject to the Workers’ Compensation rule get insured in case of a
problem of this nature. Most states do allow companies to set up a self-insurance
program.