living) and, the costs of nursing home care.
It rarely covers the costs of medical care
doctors or hospitals. This coverage works in conjunction with Medicare
and/or private health insurance. A long-term care insurance policy is a
contract between an individual and an insurance company. In exchange for the
payment of premiums, the insurance company provides for the payment of a
daily benefit to cover the costs of long-term care.
Lump-Sum Death Benefit
When a Social Security recipient dies, a lump-sum
death benefit is payable either to the surviving spouse or to a qualifying
child [42 USC §402(I)]. A qualifying child is one who was entitled to
receive benefits as a result of the wage-earners Social Security benefits.
Medicaid
Medicaid is a medical assistance program intended for those who have no
other means to pay for necessary health care services. Entitlement is based
on need alone and no premium payments are required. Medicaid is primarily
administered by the states with a federal contribution that ranges between
50 and 80% of the funds paid out by the state for Medicaid services.
Although specific regulations governing Medicaid vary from state to state,
each state must comply with strict requirements in the Medicaid statute
regarding eligible services, eligibility of participants, estate recovery,
and other matters.
Medicaid for Long-Term Care
Medicaid may be used to supplement Medicare for
what is sometimes referred to as "community Medicaid benefits." Community
benefits are traditional medical services delivered by physicians,
hospitals, and other health care providers outside of nursing homes.
Medicare
Medicare is a federal health
insurance program for people aged 65 and older, those with certain
disabilities, some under 65, and people of any age who suffer from permanent
kidney failure. It is intended to provide basic insurance protection against
health care costs, not to cover all medical expenses nor long-term care. An
eligible individual may choose to get benefits under Medicare through the
traditional fee-for-service system (sometimes called Medicare) or through a
managed care program, Medicare+Choice. The traditional Medicare program has
two parts. Part A is Hospital Insurance, and Part B is Supplementary Medical
Insurance. Part A pays some of the costs of hospitalization, very limited
nursing home care, and some home health services. Part B primarily covers
doctors' fees, most outpatient and certain related services. Part A is free
to qualifying participants. A small monthly premium ($66.60 per month in
2004) is charged for Medicare Part B coverage. Medicare Advantage
As a result of legislation passed in 1997, beneficiaries could (starting in
1999) opt out of the "traditional" Medicare program in favor of a private
managed care plan or private fee-for-service plans. Medicare had been
experimenting with managed care, specifically HMOs, for some time prior to
the adoption of this legislation and a large number of Medicare
beneficiaries have had coverage through HMOs for a number of years. To be
eligible for
Medicare managed care plans an individual must
Have both Part A (Hospital Insurance) and
Part B (Medical Insurance) coverage,
Not have end-stage renal (kidney) disease
(unless they were already in a managed care
plan prior to the enactment of the legislation), and
Live in the service area of a Medicare
managed care plan.
Medicare Benefit Period
Deductible and co-payment amounts for Medicare Part A are determined per
benefit period. A benefit period begins when a participant enters the
hospital and continues until after the patient has been out of the hospital
or skilled nursing care for 60 days. After that time, a new benefit period
begins. Consequently,
(cont)
