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Health insurance options

October 21, 2009

Free clinic patients uninsured for variety of reasons

Uninsured struggle to get specialized care

If you don't have health care insurance or can't get it, or if you recently have lost coverage, there are options available.

The federal and state governments provide a range of insurance programs. Following is a list of some of those options and information on what they provide, and what they don't. All of the information was obtained at the Web sites listed.

COBRA



www.cobrahealth.com

What is it? COBRA is an acronym for Consolidated Omnibus Budget Reconciliation Act of 1985, which among other things established health care continuation requirements.

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Whom does it cover? COBRA requires that if an employee or other qualified beneficiary loses employer-provided health coverage due to termination of employment or another specified event, the group health plan must offer continued health care coverage to the qualified beneficiary.

What does it cost? To retain coverage, the former employee or beneficiary might be required to pay the entire group rate premium for health care coverage. In the past, the employer might have paid a percentage of that cost.

The recently passed economic stimulus plan contains a subsidy that discounts health insurance premiums by 65 percent to laid-off employees and their families who currently are enrolled in COBRA. It also allows those who recently lost their jobs to re-enroll in COBRA even if they were denied coverage in the past.

How long does coverage last: COBRA coverage has limited duration. In most cases, the maximum COBRA period is 18 or 36 months from the date of the qualifying event. You might be able to purchase extended health care coverage under COBRA under certain circumstances.

Medicare



http://questions.medicare.gov

1-800-MEDICARE, 1-800-633-4227

TTY Users, 1-877-486-2048

What is it? The Centers for Medicare & Medicaid Services (CMS) administers Medicare, the nation's largest health insurance program, which covers nearly 40 million Americans.

Whom does it cover? Medicare covers people ages 65 and older, some disabled people younger than 65, and people of all ages with end-stage renal disease (permanent kidney failure treated with dialysis or a transplant). If you are younger than 65 and disabled, and have been entitled to disability benefits under Social Security or the Railroad Retirement Board for 24 months, you automatically are entitled to Medicare Part A and Part B beginning the 25th month of disability benefit entitlement.

What does it cover?

Medicare Part A -- Pays for inpatient hospital, skilled nursing facility and some home health care. For each benefit period, Medicare pays all covered costs except the Medicare Part A deductible, which for 2009 is $1,068, during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.

Medicare Part B -- Covers Medicare-eligible physician services, outpatient hospital services, certain home health services and durable medical equipment. Pays for preventive services such as smoking cessation counseling, screenings for certain cancers and shots such as flu, penumococcal and hepatitis, glaucoma tests and more.

What does it cost?

Medicare Part A -- Most people do not pay a monthly Part A premium because they or a spouse have 40 or more quarters of Medicare-covered employment. The Part A premium is $244 per month for people having 30 to 39 quarters of Medicare-covered employment. The Part A premium is $443 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.

For each benefit period you pay a total of $1,068 for a hospital stay of 1 to 60 days; $267 per day for days 61 to 90 of a hospital stay; $534 per day for days 91 to 150 of a hospital stay; all costs for each day beyond 150 days.

Medicare Part B -- Most people will pay the standard monthly Part B premium of $96.40 in 2009. Some will pay a higher premium based on their modified adjusted gross income.

Medicaid



www.dhmh.state.md.us/mma/mmahome.html

410-767-5800 or 1-800-492-5231 

What is it? Medicaid is a joint federal and state program. In Maryland, the program is run by the state Department of Health and Mental Hygiene (DHMH), which provides medical assistance, or Medicaid, coverage to people who have low income and cannot afford medical care. It provides health insurance for low-income families, children, the elderly and people with disabilities; long-term care for older Americans and individuals; supplemental coverage for low-income Medicare beneficiaries, such as payment of Medicare premiums, deductibles and cost sharing.

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