Health Care Coverage

Ever wonder about the difference between Medicare Parts A, B, C, and D, how Medicare interplays with Medicaid, and what the Medicare supplement plans are that they’re always talking about on television? Whether you’re simply looking to stay healthy, struggling with diabetes, or concerned about the rising costs of assisted living and nursing home care, the elder law attorneys at Goldfarb Abrandt & Salzman LLP can help guide you through the process of applying for benefits and choosing the health care coverage that is right for you.

Medicare Enrollment

Medicare enrollment, like enrollment in most health plans, is limited to a certain eligibility period. Your initial enrollment period lasts for about seven months, and it:

  • Begins three months before you turn 65
  • Includes the month in which you turn 65
  • Ends three months after the month in which you turned 65

For example, if you turn 65 in May 2018, your enrollment period begins on February 1, 2018, and ends on August 31, 2018. In certain circumstances, however, enrollment in both Medicare Part A and Part B are automatic, including if you receive Social Security benefits, are younger than 65 and legally disabled, or have certain serious illnesses. Contact the elder law attorneys at Goldfarb Abrandt & Salzman LLP if you have any questions regarding your enrollment status. Most individuals choose to enroll in at least Medicare Part A, which covers some:

  • Inpatient hospital stays
  • Nursing homes
  • Hospice care
  • Limited home health services

Medicare Part B covers your wellness visits, physicians’ services, and medical supplies, while Medicare Part D provides prescription drug coverage. Medicare Part C, however, is more complex. Remember that if you’re eligible for Medicare coverage, you typically do not have to pay for Medicare Part A.

Medicare Part C (Medicare Advantage Plans)

Despite the limited Medicare enrollment period, not all seniors are ready to retire at 65, and some worry about the limited coverage Medicare provides, including the 20 percent co-insurance with which beneficiaries are often left. Medicare Part C, commonly referred to as a Medicare Advantage Plan, provides a different option for beneficiaries more akin to the private managed care insurance coverage you’re used to. Medicare Advantage Plans provide Medicare Part A and B coverage through a private insurer, but may also provide the vision, hearing, dental, and mental health coverage generally not available through traditional Medicare. Medicare Advantage Plans are paid a set amount from Medicare per month, and you are then responsible for covering any difference in the premium. These plans can often prove the best option for some seniors who need more than basic Medicare coverage, do not suffer from chronic illness, and wish to take full advantage of wellness care.

Medicare Supplement Insurance

Although Medicare does provide a strong level of basic coverage, a deductible is still associated with your care, and Medicare generally only covers about 80 percent of medical expenses, leaving you to potentially pay the remaining 20 percent out-of-pocket. For this reason, you may have seen commercials explaining how a Medicare Supplement or “Medigap” plan can help. These plans are billed for the balance of your care secondary to Medicare, and they may help to fill certain coverage gaps. Furthermore, insurance companies can’t deny renewal of your gap coverage due to a preexisting condition. If you’re turning 65 and still employed or retired and covered under a retiree plan, your employer’s insurance may provide Medigap or secondary coverage, and you should speak with your elder law attorney about structuring your medical benefits in a way that best suits you.

New York State Medicaid Coverage

Many seniors are on fixed incomes and cannot afford both Medicare Part B and Medigap coverage. A primary concern of these seniors is that their Medicare coverage gaps in conjunction with their health concerns will drain their remaining finances and leave nothing for their families.

If you are on a low fixed income and have limited assets, you can make plans to preserve what’s left of them by speaking with an elder law attorney. New York Medicaid can supplement Medicare if you qualify for public assistance or SSI. Furthermore, if you are older than 65 or disabled, you may still be eligible for Medicaid even if your income is above the Medicaid threshold. A New York elder law attorney can help you apply for Medicaid if it is the best option for you and your family.

Advanced Care, Denials, and Discontinuation of Benefits

If you already have Medicare in conjunction with the best supplement coverage for you, this is seldom the end of your healthcare woes. Medicare denials or limitations of coverage may surprise many seniors, especially if they find themselves in need of long-term care and have limited options.

Did you know, however, that because Medicare is a federal program you likely spent years paying into, that you almost always have the right to appeal denials and limitations in coverage? Whether you’re threatened with a discontinuation of your supplementary benefits based on a preexisting condition, your income has drastically changed since selecting your coverage, or you were denied medically essential coverage, speak with a New York elder care attorney about protecting your rights and benefits. You’ve worked hard during your life to provide for yourself and your family. Don’t let your healthcare needs take that away from you.

Contact the Elder Law Firm of Goldfarb Abrandt & Salzman LLP Today

Healthcare law is constantly changing in the United States, and seniors may be concerned about the nature and reliability of their healthcare coverage. Whether you’re preparing to turn 65 and have questions about electing your Medicare coverage, are concerned about a Medicare denial, or simply seek advice about choosing the right coverage for you, the senior care attorneys at Goldfarb Abrandt & Salzman LLP are here to help. Making the right choice regarding your healthcare benefits now may save you and your family from having to make some difficult care decisions in the future. Contact them today for a consultation at (212) 387-8400.


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