HEARING - U.S. Senate Special Committee on Aging

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Compikments of: Mutual of Omaha Insurance Company Home Office: Omaha, Nebraska Health Care Financing U S. Department of Health and Human Services 191 Guide to Health Insurance for People with Medicare 1987 Some Basic Things You Should Know Hints on Shopping for Private Health Insurance Types of Private Health Insurance What Medicare Pays and Doesn't Pay COMPLIMENTS OF Compdnies ppoe you can coon; on... A0rnimStratron Developed jointly by the National Associatlon of Insurance Commissioners and the Health Care HCFA02110 1-87 Financing Administratirn of the U.S Department of January 1987 Health and Human Services.
SOME BASIC THINGS YOU SHOULD KNOW Medicare pays a large part of your health care expenses. It does not pay them all. There are linets on some omered services and you must pay certain amounts called deductibles and 0o-payments. Medicare does not cover some services at as. Neither does most private Insurance, for example: * What many people think of as nursing home care is rnot usually covered by Medicare or insurance policies on the market today. (See page 3.) * Medicare and most private health Insurance policies pay only a specified percent of the amount approved by Medicare. You pay the rest. To avoid extra charges, ask your doctor it he or She participates or accepts assignment of Medicare benefits. Assignment means that your doctor (or other supplier) agrees to accept the arnount approved by Medicare as the total charge for covered services and supiplies. Participating doctors or suppliers aocept assignment on all Medicare clains. (See page 5.) * Insurance to supplement Medicare is not sold or serviced by the government. Do not believe advertisig or agents who suggest that Medicare supplement insurance is a government-sponsored program. Before you consider buying insurance to supplement Medicare. you should know what Medlicare benefits are. Pages 4 through 7 explain your Medicare coverage. Please review thern carelulty. DO YOU NEED PRIVATE HEALTH INSURANCE IN ADDITION TO MEDICARE? Not everyone does... * Lowvncorne people who are eligible for Medicaid gerceraty do not need additional insurance. Medicaid pays almost at costs induding long-tesm nursing care Contact your local social service agency to find out if you quality and what the benefits are in your state. * Whether you need health insurance in addition to Medicare is a decision which you should discuss with someone you know who understands insurance and your financial situation. The best time to do Etis is before you reach age 65. 192 page I HINTS ON SHOPPING FOR Shop Carefutly Before You Buy.. policies differ widely as to coverage and cost, and companies differ as to service. Contact different companies and compare the policies carefuiy before you buy. Don't Buy More Policies Than You Need ... duplicate coverage is costly and not necessary. A single comprehensive policy is better than several policies with overlapping or duplicate ooverages. For oemprehensive coverage, consider continuing the group coverage you have at work; joining an HMO~ buying a catastrophic or major medical policy or buying a Medicare Supplemnent policy. (See page 3.) Check For Preexisting Condition Exclusions which reduce or eliminate coverage for existing health conditions. Many policies exclude coverage tor prrexisting health conditions. Don't be misld by the phrase no medical examination required. If you have had a health problem, the insurer might not cover you for expenses connected with that protlem. Beware of Replacing Existing Coverage. .. be suspicious of a suggestion that you give tip your policy and buy a replacement. Often the new policy wil impose waiting periods or will have exclusions or waiting periods for preexisting widitions your current policy covers On the other hand, don't keep inadequate policies simply because you have had them a long time. You don't get credit wth a company just because you've paid many years for a policy. Be Aware of Maximum Benefits ... most poicies have some type of limit on benefits which may be expressed in terms of dollars payable or the number of days for which payment wiU be made.
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S. HRG. 100-69 CATASTROPHIC HEALTH
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CONTENTS Opening statement by Senat
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2 Second, I think the private insur
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4 So the question before us is how
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6 the elderly, long-term health car
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8 ments for our retirement. I might
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10 Mrs. YELINECK. Well, it would be
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12 As I understand it, you have not
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14 Mrs. YELINECK. One does not expe
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16 Senator BURDICK. Well, thank you
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18 Mrs. YEL.INECK. No. I started ou
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20 Therefore-I am supposed to take
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22 Chairman MELCHER. Well, I am ple
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24 month. Let us assume it costs $1
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26 STATEMENT BY SENATOR PETE WILSON
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28 Mrs. RIEGER. We have; we have wo
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30 Four years ago this August was w
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32 she has only 50 percent vision i
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34 Senator HEINZ. So it is both a p
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36 rich. Indeed, in the academic co
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38 pointedly in the comment from Mr
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40 finding out is that it is very l
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42 industry's role in providing cat
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44 Senator HEINZ. So things are wor
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46 Chairman MELCHER. In exactly the
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48 plement policy, what should that
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50 - 2 - I am Robert Shapland, Vice
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52 - 4 - CATASTRIPC PROTECTION IiDE
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54 -6- MiCIGAP INSJRANCE: A RPL1C/P
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56 To ensure that all of these cont
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58 - 10 - The HJAA also endorses Me
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60 - 12 - Finally, given that Congr
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62 - 14 - A recent HLAA survey of o
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64 Chairman MELCHER. Senator Heinz.
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66 Mr. SHAPLAND. I think we are in
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68 Those problems are real problems
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70 Mr. SHAPLAND. Oh, no. There are
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72 comprehension, and it is growing
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74 that educational process, and we
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76 So we have supported and activel
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78 Mr. SHIAPLAND. How much would nu
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80 rently being offered by the indu
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82 Recently, Karri Lynn has started
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84 Mr. Chairman and Members of the
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86 standards for voluntary certific
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88 non-group subscribers of reporti
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90 We believe a new federal program
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92 However, public awareness is nee
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94 Item 3 Testi~ony of GAIL SHEARER
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96 to Secretary Bowen's proposals c
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98 -4- most-states do not monitor t
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100 Catastrophic Protection within
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102 - a - participants and in part
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104 - 2-- Consumers Union suV orts
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106 29), but fails to acknowledge t
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108 explore all alternatives to lon
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110 adds to the complexity of Medic
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112 - 10- Consider first the propos
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114 - 12- insurance premiums and me
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Consunmer Unon Pubtishcr of Consume
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FOR RELEASE AT 9:00 P.M. H2ST) TUES
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120 Itema I CENTER FOR MEDICARE ALw
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Page 3 122 aide services, however,
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Page 5 state treasuries." 124 Judge
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126 462 6485 New Developments 10,05
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128 462 6-85 New Developments 10,05
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130 462 6-85 New Developments 10,05
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132 10,930 New Developments tI.PZ ;
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10,932 134 New Davelopments 492 346
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136 10,934 New Developments It! ;6
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10,936 138 New Developmenlt I. Thc
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Page 145 and 146: 10,940 142 New Developments i92 586
Page 147 and 148: ATroR EYS -HARLES C. -ULiIN JUDITH
Page 149 and 150: 146 reformed its decision-making pr
Page 151 and 152: 148 : 14 2i57 New Developments 13,1
Page 153 and 154: ~ 150 a>, rsn Cdw ~w (e d rum 0A7,.
Page 155 and 156: 152 All Of these figures are based
Page 157 and 158: 154 The requirements of this Act sh
Page 159 and 160: 156 Drefting Note: Where the word "
Page 161 and 162: 158 (b) The issuance of the group p
Page 163 and 164: 160 (2) Contain a provision establi
Page 165 and 166: 162 and competitive reasons. It is
Page 167 and 168: 164 -13- E. Affordability of Long T
Page 169 and 170: NAIC LTC ADVISORY COMMITEE EXPOSURE
Page 171 and 172: Setinzn IS. Poicyx D~efinitieno aid
Page 173 and 174: 170 3. The term "noncancellable' ma
Page 175 and 176: 172 extension of benefits beyond th
Page 177 and 178: artinM B Requirmnts for Rplnmacwt 1
Page 179 and 180: 176 The above "Notice to Applicant"
Page 181 and 182: (pinnal Rasting &mdsninn 178 Benefi
Page 183 and 184: APPEMI!X B 180 OCWARISCN OF lVLCY i
Page 185 and 186: COMPAIeSON OF LOtG TEIM CoAt PfLtCI
Page 187 and 188: COMPABI:SZN OF LC#C TE" CAiE -OLICI
Page 189 and 190: COWaPAISON Of LOSt TERM CARE POLICI
Page 191 and 192: cowRiiSOi or touTE reM CasE nOuczcS
Page 193: COGPARISON OF LONG TERM CARE POLICI
Page 197 and 198: Private health insurance is availab
Page 199 and 200: WHAT MEDICARE PART B PAYS 196 MEDIC
Page 201 and 202: EXPENSES NOT COVERED BY MEDICARE Me
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HEARING - U.S. Senate Special Committee on Aging

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