Medicare and Medicaid are commonly confused with one another. The fact is that they’re both government programs involved with healthcare also further confuses people. Both Medicare and Medicaid differ in regards to the people they cover, their funding, and how they’re governed by the state and/or federal government. Although these healthcare-related programs serve different purposes for Americans, they’re considered a necessity for low to middle-income workers in need of healthcare.

Behind Medicare

Medicare is primarily an insurance program. The program involves patients deferring payments to trust funds while they are working full-time, which covers their medical bills once they retire.

This program mainly covers people over age 65 at any income level; younger disabled holders and other patients, like dialysis patients, are also covered by the program.

Patients are required to pay a portion of their costs through deductibles for hospital and other related costs. Smaller monthly premiums are also required for other types of coverage. The program is run by the Centers for Medicare & Medicaid Services, a federal government agency. As a federally run program, its standards remain constant across the United States.

Medicare may require payment or co-payments for deductibles against certain services provided to beneficiaries. The program reserves the right to refuse to pay for treatments otherwise considered unnecessary.

Behind Medicaid

Medicaid is primarily an assistance program for low-income individuals and/or families. The program helps pay medical bills via state, federal, and local tax funds. Patients under the program usually aren’t required to pay any part of the costs for their covered medical expenses.

As a federal state assistance program, it can vary across states. State and local governments run this program according to their federally imposed guidelines.

Low-income individuals and families of any age are eligible for receiving Medicaid. The eligibility criteria, however, are considered strict, varying on a state-by-state basis. Beneficiaries of this program must hold less than USD 1,000 in liquid assets. The income restriction, too, varies by state. As an example, New York residents who earn less than $700 per month are eligible.

Some states require beneficiaries to pay their healthcare or another provider a ‘co-payment,’ usually up to $30 per month or a one-time payment upon receiving medical-related services. People who qualify for both Medicare and Medicaid are known as ‘dual eligible’ beneficiaries. If they qualify and subsequently enroll in both programs, they might be able to have both programs work together to cover most of their healthcare costs.

Did you know that there are many ways how to save money on Medigap? Here are our five ways to save:

1. Consider a high deductible: in a High Deductible Plan F, both you and Medicare pay shares until you hit the plan’s premium.
2. Utilize household discounts: some Medigap carriers offer discounts if both spouses use the same company.
3. Give thought to an off-brand company: there are a number of highly-rated insurance companies that offer Medigap plans, even if you’ve never heard of them.
4. Take advantage of free physical treatment: preventative care is of the utmost importance in early detection. Not to mention, it could lower your spending in the long run by maintaining your health at the get-go. 
5. Shop around when rates increase: with every new company you apply to, there are a series of health questions you need to answer. Sometimes, you can get the exact same coverage 

With a few tips outlined above, the next step is to contact Health Plans of America to connect you to a licensed insurance agent. Reach out today to start your savings!

Medicare is a federal health program for people 65 years of age and older. When choosing a Medicare plan, there are a lot of terms to understand and know. The most basic of terms are outlined here for your convenience:

• Premium: the monthly amount you pay to have the plan
• Deductible: the amount you must pay up to before your medicare plan incurs the costs
• Co-pay: the specific amount your insurance asks the insurer to pay for specific services
• Co-insurance: the percentage amount the insurer is responsible for after your deductible is met
• Max-out-of-pocket limit: in the worst-case scenario, this is the most the insurer would be responsible to pay for

Outside of these core terms, there are other things about medicare to know. Health Plans of America makes it easy by connecting you to a licensed insurance agent. Connect today to get started!

In the complex landscape of health insurance, individuals often find themselves confused by the array of options available. It’s crucial to understand the nuances of each plan to make an informed decision about your healthcare coverage. In this guide, we’ll delve into three prominent health insurance plans, shedding light on their distinctive features and helping you determine which one aligns best with your needs.

1. Health Maintenance Organization (HMO) Plans:

Health Maintenance Organization plans, or HMOs, are among the most popular choices for individuals seeking comprehensive coverage within a designated network. With an HMO, subscribers are required to select a Primary Care Provider (PCP) who oversees their healthcare journey. The PCP acts as a gateway, coordinating all medical services, including referrals to specialists.

Pros:

• Cost-effective: HMOs generally have lower out-of-pocket expenses.
• Comprehensive care: Centralized coordination ensures a holistic approach to healthcare.
• Ideal for regular PCP visits: Suited for individuals who prefer consistent visits to their primary care physician.

Cons:

• Limited flexibility: Going out-of-network may result in additional fees.
• Referral requirements: Specialists need approval from the PCP, potentially causing delays.

2. Preferred Provider Organization (PPO) Plans:

Preferred Provider Organization plans, or PPOs, offer a more flexible approach to healthcare. Subscribers have the freedom to visit any healthcare provider within the network without requiring a referral, making it an attractive option for those who frequently consult specialists.

Pros:

• Greater flexibility: No need for referrals to see specialists.
• Nationwide coverage: Access to a broad network of healthcare providers.
• Out-of-network options: PPOs provide partial coverage for services obtained outside the network.

Cons:

• Higher premiums: PPOs generally come with higher monthly premiums.
• Increased out-of-pocket costs: Choosing out-of-network providers may lead to higher expenses.

3. Exclusive Provider Organization (EPO) Plans:

Exclusive Provider Organization plans, or EPOs, strike a balance between HMOs and PPOs. Subscribers have access to all healthcare providers within the EPO network, including specialists. This plan is ideal for individuals who infrequently visit their primary care physician and are comfortable with a more restricted provider network.

Pros:

• Comprehensive coverage within the network: Access to specialists without referrals.
• Lower premiums compared to PPOs: EPOs often have more affordable monthly costs.
• Suitable for those not requiring frequent PCP visits.

Cons:

• Limited out-of-network coverage: EPOs typically do not cover services obtained outside the network.
• Less flexibility compared to PPOs: Subscribers must adhere to the EPO network.

Choosing the right health insurance plan is a critical decision that hinges on personal preferences, healthcare needs, and budget considerations. Health Plans of America is committed to simplifying this process by providing the tools and resources necessary for a hassle-free insurance buying experience. Whether you are a first-time buyer or considering a policy change, arming yourself with knowledge about HMOs, PPOs, and EPOs will empower you to make an informed choice tailored to your unique circumstances.

It is in the best interest of your health insurance to ensure that you are healthy. That’s why companies offer certain perks and benefits to help keep your health on track. Depending on your insurance carrier, taking advantage of these perks can even get you discounts on some of your favorite things. Here are some of the things health insurance companies are giving to their members:

• • Money for meeting your walking steps goal – some insurance companies have apps that allow you to set goals and track progress. For reaching or surpassing your goals, you can get gift cards as a reward for taking care of your health.

• • Gym fee reimbursement – even though gyms can be expensive, health insurance companies want you to go to take care of your health. Some will offer a reimbursement for you and sometimes even your spouse.

• • • Call your doctor or nurse for free – depending on your healthcare provider, you can call your doctor or nurse, talk about your symptoms, and then they’ll tell you your next steps. Whether it be an in-person visit or staying at home and resting, you’ll know what to do.

   

  • Free preventive care – according to the Affordable Care Act, those who had insurance plans by March 23, 2010, will have their preventative care visits covered. Things like blood pressure tests, breast or colon cancer screenings, routine vaccines, HIV screenings, and well-baby visits are all considered preventative care and are covered.

Get full access to all these amazing benefits by talking to your insurance provider today!

Need to get started? Health Plans of America can match you with a healthcare plan that meets your needs at a price you can afford. Call today to get connected to a health insurance provider.

On Tuesday, September 27, 2022, the Centers for Medicare & Medicaid Services (CMS) announced that the monthly premiums, deductibles, and coinsurance for Medicare Part A and Part B are expected to decrease by about $5 (or 3%) in the coming year. This is the first time a cost like this has been lowered in more than a decade.

According to Health and Human Services Secretary Xavier Becerra, federal spending on the new Alzheimer’s drug, Aduhelm, will not be as high as initially projected, which has contributed to this pay decrease in premium.

Medicare Part B covers things like doctor visits, certain home health services, durable medical equipment, and other medical and health services that are not covered by Medicare Part A. 

Each year the Medicare Part B premium, deductibles, and coinsurance rates change (typically as an increase), depending on the Social Security Act. In 2023 the standard monthly premium for enrollees of Medicare part B will decrease to $164.90 from $170.10. 

2023 Open Enrollment for Medicare will begin on October 15 and will end on December 7, 2022. People eligible for Medicare can compare coverage options between Original Medicare, Medicare Advantage, and Part D prescription drug plans for 2023. 

Need help choosing a plan? Connect with one of our licensed insurance agents today and compare plan options.