Medicare Supplement (Medigap)

Policies There are twenty-nine states that require carriers to offer at least one Medicare Supplement policy to those adults on Medicare due to disability and not age.  Other states only require insurers to offer these policies to those adults on Medicare due to end-stage renal disease (ESRD).  Although it is required by law for carriers to provide Medigap policies for people with disabilities in California, it is not required to provide Medigap policies to those under sixty-five with ESRD. Across the country, any insurer that wants to offer Medigap must offer Plan A and if they want to offer any plan in addition to Plan A then they must offer Plan C or Plan F.

 

If you buy a Medigap policy, you cannot be dropped from your policy unless it is shown that you lied on the application, the insurance company goes insolvent, or you stop paying your premium.

 

High-Risk Pool 
Many states offer a public plan for those citizens who have been denied coverage in the private market (or who’ve been charged very high premiums) because carriers believe they’d be too expensive to insure. In California individuals are only eligible for this high-risk pool if they are medically eligible.

 

Mini-COBRA Policies (Small Group) 
Federal Law requires large businesses to provide health insurance for their former employees up to eighteen months after a split.  In most cases, smaller businesses (2-19 employees) are required to cover their employees, too.  However each state has different eligibility for “mini-Cobra” companies. In California, the law requires smaller businesses to cover past employees for thirty-six months after termination of employment.

 

State Disability Insurance Program 
California’s Temporary Disability Insurance Plan provides temporary wage replacement for those who become disabled in the course of working for a California-based employer. If you live in California and have a disability you may be eligible for benefits.

 

Medicare Savings Program (Premium Support) 
Most states have a form of premium support for low-income Medicare beneficiaries; the amount of support is directly correlated to the beneficiary’s income as a percentage of the Federal poverty level.

 

In California:

 

• Qualified Medicare Beneficiaries—individuals are covered who have a monthly income under $903 and couples with a monthly income under $1,215, The state pays all premiums for Part B, co-pays and deductibles for Medicare Part A and Medicare Part B;

• Specified Low-Income Medicare Beneficiaries—individuals are covered who have a monthly income under $1,083 and couples with a monthly income under $1,457, the state pays premium for Part B;

• Qualified Individuals—individuals are covered with a monthly income under $1,219 and for couples with a monthly income under $1,640 and the state pays premium for part B.

 

Please note that for all types of beneficiaries there is an asset limit of $6,600 for individuals and $9,900 for couples.

 

State Health Insurance Assistance Program (SHIP) 
The California Department of Aging’s Health Insurance Counseling and Advocacy Program (HICAP) is part of the State Health Insurance Assistance Program (SHIP) which is a public assistance program funded in part by the Federal Government that works to inform community groups about current Medicare issues and concerns in each of the 50 states.  California’s HICAP works in unison with SHIP in order to provide the state’s communities with helpful information on Medicare benefits, including:

 

• Prescription Drug Plan Coverage

• Medicare Advantage Plans

• Medicare Supplemental Policies

• Medicare Savings Programs and,

• Long Term Care Insurance

 

Low-Income Subsidy (“extra-help”) for Prescription Drugs
This program is a subsidy for Part D recipients with resources under $13,070 (or $26,120 for a couple) to receive money towards a Medicare prescription drug plan. The benchmark of support is different depending on which region of the country you live in.  In California in 2012, the low-income subsidy was $30.62.

 

If you live in California, and you are interested in getting a Medicare Plan, please contact the Medicare experts at eAmeriFamily Insurance.  They are industry veterans and will guide you through the process of getting the right Medicare, Medicare Advantage, MediGap, or Medicare Supplement Plan for you.