PART 2—Breaking Down the 3 M’s of Health Insurance Options

This article is part of our new Summer Series lineup that will take you through the ins and outs of some common government benefits programs that many people utilize post-brain injury, including SSDI, SSI, Medicaid, Medicare, and more!

Note: The information presented in this article is not intended to be comprehensive and is not official legal advice. Its purpose is to provide you with insights and direction to help you access the resources most appropriate to your individual situation. You should consult a professional regarding documentation, additional questions, etc.

At the onset of a brain injury, survivors can experience loss of work, income, and even family support. If your health insurance was tied to your employment, it can also be a scary time if you now need new health insurance coverage.

In this installment of our summer series, we continue to get you up to speed on the big three government health care options: Medicaid, Medicare, and the Marketplace (a.k.a. “Obamacare” and The Affordable Care Act).

Applying for each of these programs can be a challenging process. Fortunately, you don’t have to do it alone. There are services that can help you complete the applications, answer your questions, and provide further information and resources as needed. It is recommended that you utilize these resources as able.

MEDICARE

This federal health insurance program is designated for:

• Those age 65 or older
• Certain younger people with disabilities (must be approved for SSDI)
• People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)

If you have a disability and are approved for Social Security Disability Income (SSDI), after two years, you will automatically begin receiving Medicare benefits.

Medicare is broken down into several parts:

• Medicare Part A (hospital insurance)
  Covers in-patient hospital stays, care in a skilled nursing facility (SNF), hospice care, and some home health care.

• Medicare Part B (medical insurance)
  Covers certain doctors’ services, out-patient care, medical supplies, and preventive services.

• Medicare Part D (prescription drug coverage)
  Also known as Medicare Rx. Differs from Parts A & B in that it’s privatized, meaning Medicare contracts with private companies allowed to sell coverage for Part D. Subsidizes the costs of out-patient prescription drugs and prescription drug premiums.

Note: Medicare Advantage (also known as Part C) is an “all-in-one” alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D.

Federally funded Medicare Savings Programs (MSPs), which are administered by each state, are for people with limited income and resources. These programs help pay some or all the Medicare premiums, deductibles, copayments, and coinsurances for those who qualify. There are four types of MSPs:

• Qualified Medicare Beneficiary (QMB)
• Specified Low-Income Medicare Beneficiary (SLMB)
• Qualifying Individual (QI or QI-1)
• Qualified Disabled & Working Individuals (QDWI)

Those who are eligible for a Social Security Medicare Savings Program are:

• Age 65 or older
• Receive SSDI benefits
• Have certain disabilities or permanent kidney failure (even if under age 65)
• Meet standard income and resource requirements

For a full list of requirements, visit the Medicare Savings Program page on the Medicare.gov website.

To find out if you’re eligible for any of Social Security’s benefit programs, use the U.S. Social Security Administration’s (SSA) Benefit Eligibility Screening Tool. Once you have completed the eligibility screening questionnaire, you will be provided with a list of benefits. (Print this page for your records before going to the application site).

Most people pay a Part B premium of $144.60 (the amount for the year 2020) each month. This amount can vary depending on longevity and Social Security income.

To get started with the application process for Medicare, you can visit the aforementioned Medicare.gov website. If you need help through the winding maze of different plans, premiums, and costs, remember, you don’t have to struggle through this process alone. BIAAZ is available for guidance, as well as free resources for all survivors of brain injury, their families, caregivers, and professionals.

If you have any questions or would like additional information or resources regarding Medicare, email your inquiries directly to resources@biaaz.org or outreach@biaaz.org, or call the BIAAZ office at 1-888-500-9165.

ABOUT BRAIN INJURY ALLIANCE OF ARIZONA

The Brain Injury Alliance of Arizona (BIAAZ) is the only statewide nonprofit organization dedicated to improving the lives of adults and children with all types of brain injuries through prevention, advocacy, awareness, and education. BIAAZ also houses the Arizona Brain Health Resource Center, a collection of educational information and neuro-specific resources for brain injury survivors, caregivers, family members, and professionals.

What began in 1983 as a grassroots effort has grown into a strong statewide presence, providing valuable life-long resources and community support for individuals with all types of brain trauma at no charge.

The Brain Injury Alliance of Arizona:

• Works with the Congressional Brain Injury Task Force
• Houses Arizona Brain Health Resource Center
• Hosts the Statewide Opioid Use Disorder & Cognitive Impairment Workgroup
• Deploys a  Statewide Opioid Use Disorder & Cognitive Impairment Response Team with peer support, training and family wraparound services
• Facilitates the Brain Health Advisory Council
• Manages a Statewide Neuro Info-Line 888-500-9165