HSA

Health Savings accounts are bank accounts that can be invested using untaxed dollars. There is an annual contribution amount set by congress yearly, often more for people 55 and older. You can keep this money saved year after year. You can spend this money at anytime for health related costs, like dental care or doctor visits. Your plan MUST be “HSA compatible” for you to partake in an HSA. If you need help reach out to Miss Katie.

If you need to spend this money on non-healthcare related items then you will need to pay taxes on this money, please contact your CPA or Accountant for help.

HRA

Health reimbursement accounts, typically provided by employers to cover healthcare costs incurred during a given year. These usually don’t roll over every year, and you will need to use the money within the plan year or lose it.

HMO

Health Maintenance Organization (HMO)
A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.

PPO

Preferred Provider Organization (PPO)

A type of health plan where you pay less if you use providers in the plan’s network. You can use doctors, hospitals, and providers outside of the network without a referral for an additional cost.

POS

Point of Service (POS)

A type of plan where you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans require you to get a referral from your primary care doctor in order to see a specialist.

EPO

Exclusive Provider Organization (EPO)

A managed care plan where services are covered only if you use doctors, specialists, or hospitals in the plan’s network (except in an emergency).

Private Fee-for-Service (PFFS) Plans

A PFFS is a type of Medicare Advantage Plan. PFFS plans aren’t the same as Original Medicare or Medigap. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.  Doctors and hospitals can opt out of these plans at anytime, meaning they don’t have to accept the plan if they do not want to, in which case you could have to pay full price for services.

Medicaid

Medicaid is a joint federal and state program that helps cover medical costs for some people with limited income and resources. Medicaid offers benefits not normally covered by Medicare, like nursing home care and personal care services. The rules around who’s eligible for Medicaid are different in each state.
Generally, you must meet your state’s rules for your income and resources, and other rules (like being a resident of the state).

You might be able to get Medicaid if you meet your state’s resource limit, but your income is too high to qualify. Some states let you “spend down” the amount of your income that’s above the state’s Medicaid limit. You do this by paying non-covered medical expenses and cost sharing (like Medicare premiums and deductibles) until your income is lowered to a level that qualifies you for Medicaid. To get more details, call your State Medical Assistance (Medicaid) office and ask about help for people with limited resources.

Medicare

Medicare is the federal health insurance program for:

• People who are 65 or older
• Certain younger people with disabilities
• People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)

What are the parts of Medicare?

The different parts of Medicare help cover specific services:

• Medicare Part A (Hospital Insurance)
  Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
• Medicare Part B (Medical Insurance)
  Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
• Medicare Part D (prescription drug coverage)
  Helps cover the cost of prescription drugs (including many recommended shots or vaccines).

Part A & Part B Premiums

Most people don’t pay a monthly premium for Part A.If you don’t qualify for premium-free Part A, you can buy Part A.Everyone pays a monthly premium for Part B.

How does Medicare work?

With Medicare, you have options in how you get your coverage. Once you enroll, you’ll need to decide how you’ll get your Medicare coverage. There are 2 main ways:
Original Medicare
Medicare Advantage

Medicare prescription drug coverage (Part D)

Medicare drug coverage helps pay for prescription drugs you need. To get Medicare drug coverage, you must join a Medicare-approved plan that offers drug coverage (this includes Medicare drug plans and Medicare Advantage Plans with drug coverage).

Learn more about how to get Medicare drug coverage.

Each plan can vary in cost and specific drugs covered, but must give at least a standard level of coverage set by Medicare. Medicare drug coverage includes generic and brand-name drugs. Plans can vary the list of prescription drugs they cover (called a formulary) and how they place drugs into different “tiers” on their formularies.

Learn more about Medicare drug coverage.

Plans have different monthly premiums. You’ll also have other costs throughout the year in a Medicare drug plan. How much you pay for each drug depends on which plan you choose.

Learn about your costs for Medicare drug coverage.

If you have questions about your health insurance plan or options call Miss Katie Your insurance lady

Here to answer your health & life insurance questions!

_{Calling the number above will direct you to a licensed insurance agent. We do not offer every Medicare Insurance plan available in your area. Currently we represent 5 Organizations and 38 plans in the Yellowstone County area. Please contact Medicare.gov, 1-800-MEDICARE or your local State Health Insurance Program (SHIP) to get information on all your options.}