Employee Sponsored Coverage

Some companies in the United States offer health care incentives to their employees.  Because the company has a large number of employees, they can obtain health care at a lower rate than individuals.  These “group” rates are often supplemented by the employer.   Some companies will pay 100% of the health care premiums.  This is an excellent benefit for employees, and should be something that is seriously considered when job hunting.  Other companies may pay 50%, 75% or none of the health care premiums.  If an employer pays for 50% of the premiums, the remainder is deducted from the employee paycheck.  Patients who are part of a group plan can save a lot of money over the cost of an individual plan. 

Individual Plans—Not Covered by an Employer?  It’s okay!

There are options for those people who are not covered by employee plans.  Medical insurance companies offer individual plans which can be customized to a person’s specific needs.  Individual plans usually cost more than group plans, however the cost of the premiums is far less than having to directly pay for expensive medical care.

There are many resources available for people seeking information on health care plans.  Because there are so many plans available, it is a good idea to compare several different ones to determine which is most appropriate for you.  These websites allow you to obtain instant online quotes for various plans.  Although you are given the option of enrolling online, it is a good idea to contact a representative at the company you are interested in.  This way, you can ask questions and determine if the selections you made are appropriate for your situation.

www.ehealthinsurance.com This site offers basic definitions and descriptions of health care plans as well as instant insurance quotes.

www.insweb.com Comprehensive site that discusses plan options and also offers instant quotes on medical insurance.

www.quotesmith.com A third site that offers information on various plans as well as instant medical insurance quotes.

http://www.usnews.com/usnews/nycu/health/hehcchkl.htm This link offers a list of questions you can ask when choosing a plan.  The questions will help you determine the best plan for your situation.

Health Care for Seniors—Tough Dilemma for Elderly Immigrants

Because seniors often require more health care (due to disease, age, health problems, etc.), it is extremely expensive for them to buy a private policy.  Add to the equation a fixed income, and most seniors simply cannot afford private health care.  Because of this, the Health Care Financing Administration (HCFA) set up two types of health care plans for seniors, certain people with disabilities and a select group of patients who meet income guidelines.

Medicare—Medical Care for The Golden Years

Medicare is a government sponsored health insurance program for people 65 years of age or older.  The program also covers certain patients under the age of 65, with disabilities.  Generally, to qualify for Medicare, patients or their spouses must have worked for at least 40 quarters in Medicare-covered employment.  Because of this, immigrants over the age of 65 cannot qualify (unless they have been employed at a Medicare-covered employer for the required period of time).  Additionally, Medicare patients must be citizens or permanent residents of the United States.  Therefore, elderly immigrants face special problems when trying to obtain health care coverage.

The Medicare Plans

PLAN A  Hospital Coverage—All seniors aged 65 and older who have been employed in a Medicare-covered workplace for 40 quarters are automatically enrolled in this program.  Additionally, spouses of eligible patients are covered under Plan A.  Plan A covers care in hospitals, skilled nursing facilities, hospice, and some home health care.  Typically, there is no cost to patients for Part A coverage.  This is because patients and/or their spouses paid Medicare taxes while employed.  (Medicare taxes are deducted from each paycheck. The deductions fund care for seniors.)  Plan A does not pay for all expenses.  After patients pay a deductible, they are usually required to pay a percentage of the total bill.

PLAN B Medical Insurance—Plan B is a supplement to Plan A.  Seniors are NOT automatically enrolled in this plan.  If seniors wish to enroll in Plan B, they pay a monthly premium of $45.50 (as of November 2000), which is deducted automatically from their social security check, railroad retirement or civil service retirement.  If patients do not receive any of these benefits, they are billed for the premiums every three months.  Plan B covers doctors, outpatient hospital care, and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some health services. Part B helps pay for covered doctor services that are medically necessary.  Patients typically pay a percentage of the total bill.

Some states also have programs that pay some or all of Medicare's premiums and may also pay Medicare deductibles and coinsurance for certain people who are on Medicare and a low income. To qualify, patients must have:

• Plan A (Hospital Insurance)
• Assets, such as bank accounts, stocks, and bonds that are not more than $4,000 for a single person, or $6,000 for a couple
• A monthly income that is below certain limits.

Medigap Supplemental Insurance—A Money Saving Option

Should seniors wish to obtain a supplemental policy to absorb the costs left over after Medicare coverage, they can do so through private insurance companies.  A Medigap plan is a health insurance plan that fills the gaps in original Medicare plan coverage. In all states, there are basic standardized Medigap plans. Each plan has a different set of benefits. Any standardized plan may also be sold as a Medicare Select plan. Medicare Select plans usually cost less because you must use certain doctors and hospitals, except in an emergency.

For more information on Medicare Plans and Medigap Supplemental Insurance, take a look at:

www.medicare.gov

Medicaid—Medical Care for Lower Income Patients

Medicaid is a joint federal and state program that helps pay medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state. Seniors on Medicaid may also get coverage for nursing home care and outpatient prescription drugs which are not covered by Medicare.

Who is eligible for Medicaid?—It’s Not Cut and Dry!!

Ø     Low income families with children (must meet eligibility requirements as set forth in each state’s AFDC plan)

Ø     People receiving Supplemental Security Income (or in States using more restrictive criteria--aged, blind, and disabled individuals who meet criteria which are more restrictive than those of the SSI program and which were in place in the State's approved Medicaid plan as of January 1, 1972)

Ø     Infants born to Medicaid-eligible mothers.  As long as the infant remains in the mother’s household and she is eligible, coverage will continue through the first year of life.

Ø     Children under age 6 and pregnant women whose family income is at or below 133 percent of the Federal poverty level

Ø     Recipients of adoption assistance and foster care under Title IV-E of the Social Security Act

These guidelines are flexible depending on the state.  For specific eligibility requirements, select the appropriate state from this link http://www.hcfa.gov/medicaid/obs5.htm. The link offers toll free numbers for each state’s Medicaid office.

Medicaid does not provide medical assistance for all poor persons. Even under the broadest provisions of the Federal statute (except for emergency services for certain persons), the Medicaid program does not provide health care services, even for very poor persons, unless they are in one of the groups listed above. Low income is only one test for Medicaid eligibility; assets and resources are also considered.

Medicare and Medicaid—Tandem Coverage for Seniors

Medicare patients who have low income and limited resources may be eligible to receive help paying for their out-of-pocket medical expenses from their State Medicaid program. There are various benefits available to patients who are entitled to Medicare and are also eligible for some Medicaid benefits.

If senior patients are fully eligible for Medicaid benefits (as outlined in the eligibility requirements), then they are typically not required to pay any out-of-pocket expenses.  For example, if a patient falls ill and is admitted to the hospital and the bill totals $10,000, Medicare would first pay for the portion allowed.  (Typically it is 80%, and the patients pays the remainder)  If Medicare pays 80% of the bill, the patient would be required to pay the remaining 20% or $2,000.  Medicaid will pay for this amount if the patient is eligible for coverage.  Medicaid also covers additional services (e.g., nursing facility care beyond the 100 day limit covered by Medicare, prescription drugs, eyeglasses, and hearing aids).

Medicaid will also pay Medicare Plan B premiums for select patients if they qualify.  Eligibility varies from state to state.  Specific information can be found by calling the toll free Medicaid number for your state: http://www.hcfa.gov/medicaid/obs5.htm.

Medicaid for Immigrants

States have the option to cover certain immigrants under Medicaid.  The provisions vary greatly from state to state.  For specific eligibility requirements, patients should contact their state Medicaid office http://www.hcfa.gov/medicaid/obs5.htm.

There are certain immigrants who are covered by Medicaid in every state.  To qualify, they must fall into one of the following categories:

Ø     Refugees: Eligible for the first five years after entry into the US

Ø     Asylees: Eligible for the first five years after granted asylum

Ø     Individuals whose deportation is being withheld by the INS (for first five years after grant of deportation withholding)

Ø     Lawful permanent residents.  They must have been covered by Social Security benefits for 40 quarters based on their own work and/or that of spouse or parents.

Ø     Honorably discharged U.S. military veterans, active duty military personnel and their spouses and unmarried children – at any time.

Immigrants who were admitted to the United States on or after August 22, 1996 and who do not fall into one of the categories above are not eligible for Medicaid for five years after they are admitted to the U.S.  Once the five-year ban on eligibility expires, the immigrant’s access to Medicaid is determined by the state in which they reside.  If immigrants have individual sponsors who sign new, legally binding affidavits of support (signed after February 1997), the state will take into consideration the income and resources of the sponsor when determining eligibility for Medicaid.  The state will not consider the sponsor’s income and resources if the immigrant entered the U.S. under an old affidavit of support (signed prior to February 1997).

Guidelines for determining eligibility after the five-year ban are listed below. 

Ø     Income and resources of sponsor and sponsor spouse are only considered if sponsor signed an affidavit of support after February 1997.

Ø     Both the sponsor and the sponsor spouses’ income and resources will be counted when determining the income and resources available to the immigrant they sponsor (assuming they signed a new affidavit)

Ø     Sponsor income considerations only apply to those immigrants who are sponsored by individuals

Ø     Battered immigrants and those who would be unable to obtain food and shelter without assistance are exempt from sponsor consideration

Ø     The state will continue to consider the sponsor and sponsor spouses’ income until the immigrant is naturalized or the immigrant has been credited with 40 quarters of social security coverage

Ø     Sponsors are required to reimburse Federal, State and local governments for the costs of benefits received by the sponsored immigrant during the consideration period.  This excludes emergency medical services.

Ø     Provided they meet financial and other eligibility requirements, qualified and un-qualified immigrants are eligible for emergency care under Medicaid.

It’s important to consider the ramifications of health care for immigrants.  Unless patients are able to obtain coverage through individual plans or employee sponsored plans, they will often be left with no coverage at all.  If a patient falls ill and does not have medical coverage to pay the bills, the consequences can be devastating.

Even more serious is the consideration of senior immigrants.  While it is often difficult for immigrants to receive care without obtaining it through an individual plan or an employer plan, it is nearly impossible for senior immigrants to obtain coverage.  Because Medicare exists, many insurance companies will not offer policies to seniors.  However, senior immigrants are not eligible for Medicare, and are therefore without many options for health coverage.  If a senior immigrant is sponsored by an individual, that individual will most likely be expected to pay for most health care costs.

For more information on Medicare, please visit www.medicare.gov 

For more information on Medicaid, please visit www.hcfa.gov

Both of these websites offer an abundance of information in an easy-to-read format.  They also provide phone numbers for local agencies which can answer questions about eligibility, coverage and information for immigrants new to the U.S.