Millions of Americans get health care coverage through Medicare or Medicaid, both of which are United States government health insurance programs. Here’s what each program offers so that you know which might apply for purposes of meeting your health care needs in Indiana.
If you are 65 or older, or you are under 65 and disabled, or you have end-stage renal disease, then you could receive health coverage through Medicare – a federal health insurance program. Medicare is the main medical coverage provider for disabled persons and American’s seniors. Medicare comes in Parts A-D, explained below:
Hospital Coverage. If you have Part A, then this means that you have coverage for hospitalizations. For you to get Part A, you must pay your Medicare taxes for no less than 10 years and have worked for at least 10 years. Part A normally does not contain a premium requirement – meaning that you don’t have to pay unless you need to rely on the insurance.
However, Part A contains coinsurance depending on the benefit period – which is how long you are an inpatient at a hospital. 2021’s costs: for the first 60 days, there is no coinsurance, but for days 61-90, you pay $352 per day ($371 in 2021), and after 90 days, the coinsurance jumps to $704 per day ($742 in 2021). You might be responsible for all costs if you are hospitalized beyond a certain point. The deductible is $1,408 ($1,484 in 2021) per benefit period.
Medical Insurance. If you get Part A, then you automatically qualify for Part B, which provides you with coverage for medically necessary services, preventative services and equipment. Think flu shots, lab work, doctor’s office visits, walkers, wheelchairs, x-rays and outpatient surgeries. The monthly premium for Part B is currently $144.60. In 2021, it is $148.50; however, it will cost more if you make more than $88,000 (or $176,000 if you are married). After meeting a $198 deductible ($203 in 2021) deductible annually, you pay 20% for approved doctor’s services, including in-hospital services, outpatient therapy and durable medical equipment.
Medicare Advantage Plan. Part C is formally known as Medicare Advantage, which works sort of like an HMO or PPO. This is available for those who are eligible for Part A and Part B. Private companies offer Medicare Advantage – not the government. Part C goes beyond the coverage provided by Parts A and B by providing you with hearing, vision and dental coverage. Some Part C plans cover prescription drugs. The cost of Part C depends on your plan.
Prescription Drugs. Part D covers your prescription drug costs. Depending on the prescription, Part D could subject you to out-of-pocket costs, premiums, deductibles and copayments. For this reason, those who have Part C don’t rely on Part D unless they need Part D for their particular prescription drug needs. Also note that Part D could be more expensive based on your income.
Medicaid is a health insurance program jointly provided by the state and federal government that helps low-income Americans pay for medical care and long-term custodial care. While the federal government provides guidelines for Medicaid, it is the states who generally determine the amount, scope and duration of benefits. Medicaid has various programs, some of which relate to disabled people and older Americans.
Notably, the federal government mandates coverage for hospitalizations, doctor’s services, x-rays, laboratory services, family services, clinic treatment, midwife services, pediatric and family nurse practitioner services, nursing facility services, and home healthcare for people who are eligible for nursing facility services.
A major thing to note is that Medicaid, not Medicare, can pay for your long-term care costs in a nursing home or elsewhere. Particularly, the biggest funding source for long-term care comes from Medicaid. However, for this coverage to apply, you are typically required to deplete most if not all of your assets and have no other way to pay for care.
Health Care Programs In Indiana
In Indiana, Medicaid health coverage is made available through the Family and Social Services Administration (“FSSA”) to those who are eligible based on their income, age, financial resources and medical needs. Here are nine major programs offered in Indiana:
- Healthy Indiana Plan. This is a state health insurance program for qualified adults who are age 19 to 64, covering things like medical costs and potentially dental and vision coverage.
- Traditional Medicaid. Covers a full range of services including hospital care, doctor’s visits, wellness visits, well-child visits, clinic services, prescription drugs, over-the-counter drugs, lab and x-ray services, mental health care, substance abuse services, medical supplies and equipment, home health care, nursing facility services, dental care, vision care, physical therapy, speech therapy, hospice care, emergency and non-emergency transportation, family planning services, routine foot care, surgical foot care, chiropractic services and more.
- Hoosier Care Connect. This is a program for those who are age 65 or older and for those who are blind, disabled or can’t meet Medicare eligibility requirements. Those who receive supplemental security income are eligible for this program. Services consist of those listed under Traditional Medicaid.
- Hoosier Healthwise. This is a health care program for pregnant woman and for children up to age 19, covering the same services as Traditional Medicaid. Children’s Health Insurance Program (CHIP) ,which is for children up to age 19 and whose families have higher income, fall under this Hoosier Healthwise umbrella. CHIP requires a small monthly premium and copays for some services. Notably, under CHIP, services that are not included include nursing facility services, hospice care, non-emergency transportation and routine foot care.
- Medicare Savings Program. Medicaid is required under federal law to pay certain elderly and disabled persons’ Medicare deductibles, coinsurance and premiums. This happens through a Medicaid Savings Program such as Qualified Medicare Beneficiaries (QMB) and Specified Low-Income Medicare Beneficiaries (SLMBs). However, to be eligible, you have to be entitled to Medicare, have a low income and personal resources, and be at least the age of 65 unless you are entitled to Medicare prior to that age.
- HoosierRx. If you need help with your monthly medications, then you might be eligible for HoosierRx. In fact, this program could provide you with as much as $70 on a monthly basis that can help cover your Medicare Part D premiums.
- MED Works. If you are disabled and under Medicaid benefits, then you might be reluctant to return to work for fear of losing those benefits. Fortunately, in Indiana, you could be eligible for MED Works which is a program for employees with disabilities that can provide coverage equal to Medicaid albeit a small premium is applied on a monthly basis which is impacted by your monthly income. Also, MED works might be ideal for someone who wants to work and who has SSDI but no cash benefits.
- Indiana’s Program of All-Inclusive Care For The Elderly (PACE) serves the needs of seniors who have chronic care needs. It provides care in the community when possible. You have to be at least 55 years of age, certified by Indiana as needing nursing home care yet be able to live in the community safely and in an area in which PACE services. Notably, a small fraction of those living in nursing homes have PACE but the program still covers and coordinates care in a nursing home if the care is needed. PACE helps cover adult day care, medical care via a PACE physician, home health care, personal care, audiologists, dentists, optometrists, podiatrists, speech language therapists, social services, prescription drugs, respite care, nursing home care (if necessary) and transportation.
- Medicaid HCBS Programs. In Indiana, eight programs fall under Home and Community Based Services. Among them is the Aged and Disabled Waiver which is overseen by the Division of Aging. This program enables you to remain at home and receive services which supplement your support that you would otherwise require in a nursing home. This waiver could also come into play if you aim to leave the nursing home and need support to transition yourself from the nursing home to another location such as home, an assisted living facility or adult family care.
Hiring An Attorney
Experience and legal scholarship are essential attributes for elder law and estate planning attorneys. For almost three decades, Hawkins Elder Law has helped clients make personalized estate plans for managing their personal business and health decisions during health crises and distributing assets after their deaths. The firm’s lawyers also work year-round with their estate, trust, and elder law colleagues to study and propose improvements to the Indiana laws that affect their clients.
About the Authors
Jeff R. Hawkins and Jennifer J. Hawkins co-author this blog with Thomas E. Hynes, a lawyer admitted to practice in Pennsylvania, New Jersey and Florida who has a background in estate planning and elder law. Jeff and Jennifer are Trust & Estate Specialty Board Certified Indiana Trust & Estate Lawyers. They are also active members of the Indiana State Bar Association and the Indiana Chapter of the National Academy of Elder Law Attorneys (NAELA). Jeff is also a member of the Illinois NAELA Chapter.
Jeff is a Fellow of the American College of Trust and Estate Counsel and the Indiana Bar Foundation. He is also a member of the Illinois State Bar Association and he served as the 2014-15 President of the Indiana State Bar Association.
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