Health Insurance Specialists - Long Term Care, Medicare Supplements, Senior Plans.

Long-Term Care Insurance

Designed to pay the high cost of Nursing Home Care or Home Health Care if you are unable to care for yourself, due to accident or illness. Long Term Care Insurance

Today, many plans will pay the benefit, even if the care is provided by your own family members, even if it is in your home or theirs.

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Original Medicare

Options to Supplement or Replace Original Medicare

Medicare (sometimes referred to as "original Medicare")

Medicare is a Federal program that provides health care coverage to persons age 65+, and to the totally disabled.

Medicare has Part A (hospital or facility benefits) and Part B (outpatient medical benefits, including Doctors' charges). As of 2006, it now has a Part D, which is for Prescription Drugs.

Part A is premium-free to eligible beneficiaries through Social Security. If you are eligible for Part A, you are also eligible to enroll in Part B and D. The premium for Part B is deducted from your Social Security Check. The premium for Part D is paid to the Insurance Company that you choose to provide your Prescription Drug benefits.

Most people also supplement or replace Medicare with a plan chosen through an Insurance Company or Health Plan. This is because Medicare has some gaps in coverage. It has large deductibles for hospitalization, and it only pays 80% of the bill for Part B expenses (which are most of your covered outpatient expenses). Supplements or replacements to Medicare are known as Medi-Gap plans, or Medicare Advantage Plans (see the columns to the right for more explanation).

Also, most people choose a Prescription Drug Plan, for their Part D coverage. See below

Medicare Advantage and Supplements

Medigap (sometimes referred
to as Medicare Supplements)

These are private Insurance plans meant to supplement, but not replace your Medicare.
You are NOT required to use an HMO system, and are NOT required to select a Primary Care Physician.
Plans A-L are the names of the Medigap plans. The government strictly regulates the benefits of plans A-L, so that every Insurance Company offers the same benefit plans. The only variations that Insurance Companies can offer are different premium rates, different levels of Customer Service, and, in some cases, particular Networks of Preferred Providers.
There is a premium charge for these plans.
In addition to your Medigap plan, you will need to choose a Prescription Drug plan (Medicare Part D plan). This is separate from your Medigap plan, and it can be provided by one of a number of Insurance Companies. See below.

Medicare Advantage or Medicare +Choice (sometimes thought of as a Medicare HMO)

These plans allow you to use a Managed Care system (including HMO's), instead of your Medicare coverage, however, you can switch back to your original Medicare plan if you choose.
HMO-type plans REQUIRE you to select a Primary Care Physician to refer you to a Specialist. You must use Providers from their network (except for emergencies)
These plans have comprehensive benefits, with lower copays.
These plans are regulated by the government to meet certain standards.
Often, there is NO premium (or a very low premium) charged by the Insurance Company, however, the premium charged by the Federal government for Medicare Part B will still be deducted from your Social Security check.
These plans often include your "Part D" Prescription Drug coverage. If so, you do not need to apply for a separate Prescription Drug plan.

Medicare Part D - Prescription Drug Coverage

Medicare provides Prescription Drug Coverage through a number of Insurance Companies, not directly through the Federal Government. You will probably need to enroll in one, unless you already receive Prescription Drug coverage through a Medicare Advantage (Medicare + Choice) HMO type plan, or through a group plan.

You can purchase a standard plan, or you can purchase an enhanced plan offered by many different insurance companies. The premium is usually very modest (often about $6 for a standard plan and $25-$30 for an enhanced plan).

To find out which plan(s) might be best for you, you should list the names of your prescription drugs, the dosage, and how often you take the drug. Then, each insurance company can calculate what your costs would be under their program(s).

Usually, the standard plan is most beneficial for those individual who have more than $5,100 of drug costs in a year. This is because they will be in the Catastrophic level of coverage, no matter which plan they choose. For those with lower annual drug costs, an enhanced plan may be better, but it is our observation that the standard plan is the most common sense approach for most Seniors.

This is not intended to be a full description of Medicare or its supplementary choices.