Medicare is available for people age 65 or older, younger people with disabilities and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant). Medicare has two parts, Part A (Hospital Insurance) and Part B (Medicare Insurance). You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can get Part A at age 65 without having to pay premiums if:

• You are receiving retirement benefits from Social Security or the Railroad Retirement Board.
• You are eligible to receive Social Security or Railroad benefits but you have not yet filed for them.
• You or your spouse had Medicare-covered government employment.

If you (or your spouse) did not pay Medicare taxes while you worked, and you are age 65 or older and a citizen or permanent resident of the United States, you may be able to buy Part A. If you are under age 65, you can get Part A without having to pay premiums if:

• You have been entitled to Social Security or Railroad Retirement Board disability benefits for 24 months. (Note: If you have Lou Gehrig’s disease, your Medicare benefits begin the first month you get disability benefits.)
• You are a kidney dialysis or kidney transplant patient.

While most people do not have to pay a premium for Part A, everyone must pay for Part B if they want it. This monthly premium is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you do not get any of these payments, Medicare sends you a bill for your Part B premium every 3 months.

Prescription Drug Coverage

Since January 1, 2006, everyone with Medicare, regardless of income, health status, or prescription drug usage has had access to prescription drug coverage.

Informational Source

With the hectic life style schedule of individuals , the risk of the person suffering from a disease also has gone up. 

As the cost of living has gone up in metros and other cities, along with it Medical expenses are sky-rocketing, so the best advisable thing is to opt for health insurance and cover the medical costs thereby saving money and other resources in times of emergency.

There are various plans available to the insurer provided by government and private health insurance providers to cover every aspect of a medical emergency.

Keeping in mind the needs of the individuals, the health insurance companies have come out with various plans to suit individuals, family members, group of people, and senior citizens. Salient features of health insurance​ and the various plans offered by health insurance companies are described below.

Salient Features of Health insurance:

Pre and Post Hospitalization: This feature covers pre and post hospitalisation charges for a month or 60 days and the person is reimbursed after submitting bills and other expense related documents incurred during the period of hospitalisation.

Cashless treatment  : This feature allows ​the benefit to get admitted to any listed hospital as per the list of hospitals of the insurance provider without paying anything for treatment. This saves the relatives and friends of the person who has been admitted with stress of arranging money in case of emergency . 

Plans:

Individual Health Insurance Plans : This policy covers takes care of the expenses incurred by an individual in case of hospitalisation and is designed to cover various illnesses with cashless hospitalization and pre and post hospitalisation expenses. There are various riders or top up plans also available along with these plans to individuals which they can opt for.

Surgery & Critical Illness Policy – This plan takes care of the life threatening diseases like Cancer, heart attack, Brain tumours and kidney failures. This plan can be taken as a stand alone policy or can be added as a top up to the existing policy. The premium paid by the policy holder is high in such a plan for the expenses incurred in treatment of the diseases is on the higher side. 

Pre-Existing Disease Cover – This policy covers pre existing diseases a person suffers before buying the policy. The diseases can be life style diseases also. The various ailments which a person suffers can be diabetes, hypertension, kidney failure, cancer etc. before the policy comes into effect.

Family Floater Mediclaim: This policy caters to the family members of the policy holder. People who worry about their families can opt for these plans for it covers all family members against diseases under a single cover. The benefit of this cover is that a stipulated sum is insured for the entire family members that can be availed either by an individual member or as a sum total for treatment of one person. ​

Senior Citizen Health Plan: This plans takes care of people who have reached old age and their medical expenses can be take care of via such plans. As per the rule, every health insurance company should offer cover to individuals till 65 years of age.​​ 

Informational Source

Insurance implies a contractual arrangement between two parties, i.e. insurance company (insurer) and insured, by which the insurer, in return for a fixed sum (premium) commits to compensate the insured for the loss sustained or damage caused on the occurrence of a certain event. The document which covers all the details of the contract is called as an insurance policy. Life insurance is a contract that protects against the risk of life.

Gradually, the scope of life insurance has widened and now plans like health insurance, disability insurance and pension plans are in vogue. It is no wonder that life insurance and health insurance are misconstrued but they are different as in health insurance is the insurance policy that compensates the cost of medical bills, in case of illness or accident.

Definition of Life Insurance

Life insurance, as the name suggests is the insurance agreement, whereby the insurance company agrees to pay a definite sum either on the demise of the insured or the expiry of the stipulated term to the nominee, in return for a specific sum (premium) paid by the insured, either in the lump sum or at regular intervals, i.e. instalments.

The sum assured may be paid to the nominee or the insured in a lump sum or instalments, i.e. annuity, on the maturity of the policy.

As the occurrence of the risk insured is certain and so the insurance company is bound to pay the amount assured, sooner or later, so the life insurance contract, is also known as life assurance.

Life insurance is classified into three types:

• Whole Life Assurance: When the sum assured is to be paid on the happening of the certain event, i.e. death of the insured, then it is called a whole life assurance.
• Term Life Assurance: On the maturity of the life insurance policy, the amount is paid in one shot to the policyholder.

Definition of Health Insurance

Health insurance is a contract between the insurance provider and the insured, who can be an individual or a group such as family, employees of an organization, etc., wherein a specified insurance cover is offered by the insurer, on the payment of premium, provided terms and conditions of the agreement are satisfied.

It is a type of personal insurance, offered by non-life insurance or general insurance companies, in which hospitalization expenses are compensated. In health insurance, either the amount spent is reimbursed, or cashless service is provided through tie-up arrangements, with a network of hospitals, throughout the country, but only up to the amount covered in the policy.

It covers room expenses, nursing expenses, fees of surgeon, physician, specialist, consultant, etc., medical bills, operation theatre charges, x-ray, dialysis, and so forth.

Key Differences Between Life and Health Insurance

The following points explain the difference between life insurance and health insurance:

1. Life insurance, as the name suggests, is insurance plan that covers the risk of contingencies that can affect human life and pays out the sum assured to the nominee on the death of the insured, or to the insured on the expiry of the definite term. Conversely, an insurance product, taken out by an individual, to compensate the cost of medical and surgical expenses, but only up to the amount covered, is called as health insurance.
2. In life insurance, both survival and death benefits are provided to the policyholder. On the contrary, health insurance provides treatment and medical benefits, in case of illness or accident.
3. The premium for life insurance can either be paid in lump sum or periodic intervals, usually quarterly. In contrast, the health insurance premium is paid in lump sum for the whole term.
4. An assured amount is paid to the nominee on the demise of the insured or the insured on the maturity of the policy, in life insurance. However, in case of health insurance, no money is recovered, if the term of the policy is expired instead it is reimbursed in case of any health issue.
5. Life insurance is usually taken for a long-term say 10 or 20 years. As against, health insurance is taken for the short term, say 1 or 3 years.

Conclusion

By and large, in a life insurance policy, the nominee or the insured, get the sum assured on the demise of the insured or the expiry of the term for which policy is taken. In health insurance, no return is paid to the insured at the end of the term, instead, in case of any medical emergency, the medical expenses are either reimbursed or cashless treatment is provided, subject to the amount covered.

Informational Source

Medicare is the nation’s health care program for citizens age 65 years and up, and it covers many major medical expenses for participants. But choosing the right Medicare plan can be confusing in many cases, and it may be difficult to decipher all of the language that is written into these plans and options.

Here are some potential mistakes to avoid when you choose your plan, so that you end up with the coverage that you need.

• Not enrolling during your enrollment window: This can be one of the biggest mistakes that you can make with Medicare. If you are receiving Social Security when you turn 65, then you will be automatically enrolled and have the premiums deducted from your monthly benefits. But if you have delayed taking Social Security until a later age, then you will have to manually enroll when you turn 65. The enrollment period begins three months before the month in which you turn 65 and lasts for three months after that. You do not have to sign up if you are still covered under a health insurance policy from your job. (COBRA coverage and coverage from a former employer where you still pay the premiums don’t count for this.) Once you quit working, you have eight months in which to sign up. And if you work for a company with fewer than 20 employees, then you may be required to sign up even if you have current coverage with the company. You can also delay signing up if you have current coverage through a younger spouse’s plan. But failure to sign up within the prescribed window can result in surcharges on your future premiums and potential gaps in your coverage.

• Assume your spouse is covered: Medicare coverage applies only on an individual basis. Just because you have coverage does not mean that your spouse is also covered. He or she also has to have paid his or her dues in the workforce for at least 10 years in order to qualify for Part A. If your spouse is not yet 65, then he or she will have to find coverage elsewhere, such as with their employer or through COBRA or a policy that is sold on the exchange. It does not matter whether your spouse is receiving spousal Social Security benefits.
• Not purchasing enough coverage: While Medicare Part A is free, Parts B, C and Dall require a monthly premium. Most people should probably get at least Part B, so that they have coverage for doctor’s visits and outpatient care. The standard premium of $121.80 can be deducted from your monthly Social Security benefit. But Parts C and D can also provide important coverage for things like dental, vision and prescription drugs. You can also opt for a Medicare Advantage policy that helps to defray these costs. The average premium for this type of coverage will run you about $32.60 in 2016. And a Medigap insurance policy can help you to pay for things that are not covered elsewhere, like coinsurance, copays and deductibles.
• Not seeking assistance if you can’t afford the premiums: If your income is low enough that you will have trouble affording the premiums, your state or local department of social services may have programs available for those who financially qualify.

The Bottom Line

Medicare is a complex program that has many parts and options to choose from. Don’t hesitate to seek professional guidance from a qualified financial advisor who has been trained in this area to help you if you need it. 

Informational Source

A thief may use your name or health insurance numbers to see a doctor, get prescription drugs, file claims with your insurance provider, or get other care. If the thief’s health information is mixed with yours, your treatment, insurance and payment records, and credit report may be affected.

If you see signs of medical identity theft, visit IdentityTheft.gov to report and recover from identity theft.

• Detecting Medical Identity Theft
• Correcting Mistakes in Your Medical Records
• Protecting Your Medical Information
• Checking For Other Identity Theft Problems

Detecting Medical Identity Theft

Read your medical and insurance statements regularly and completely. They can show warning signs of identity theft. Read the Explanation of Benefits (EOB) statement or Medicare Summary Notice that your health plan sends after treatment. Check the name of the provider, the date of service, and the service provided. Do the claims paid match the care you received? If you see a mistake, contact your health plan and report the problem.

Other signs of medical identity theft include:

• a bill for medical services you didn’t receive
• a call from a debt collector about a medical debt you don’t owe
• medical collection notices on your credit report that you don’t recognize
• a notice from your health plan saying you reached your benefit limit
• a denial of insurance because your medical records show a condition you don’t have.

Correcting Mistakes in Your Medical Records

Get Copies of Your Medical Records

If you know a thief used your medical information, get copies of your records. Federal law gives you the right to know what’s in your medical files. Check them for errors. Contact each doctor, clinic, hospital, pharmacy, laboratory, health plan, and location where a thief may have used your information. For example, if a thief got a prescription in your name, ask for records from the health care provider who wrote the prescription and the pharmacy that filled it.

You may need to pay for copies of your records. If you know when the thief used your information, ask for records from just that time. Keep copies of your postal and email correspondence, and a record of your phone calls, conversations and activities with your health plan and medical providers.

A provider might refuse to give you copies of your medical or billing records because it thinks that would violate the identity thief’s privacy rights. The fact is, you have the right to know what’s in your file. If a provider denies your request for your records, you have a right to appeal. Contact the person the provider lists in its Notice of Privacy Practices, the patient representative, or the ombudsman. Explain the situation and ask for your file. If the provider refuses to provide your records within 30 days of your written request, you may complain to the U.S. Department of Health and Human Services’ Office for Civil Rights.

Get an Accounting of Disclosures

Ask each of your health plans and medical providers for a copy of the “accounting of disclosures” for your medical records. The accounting is a record of who got copies of your records from the provider. The law allows you to order one free copy of the accounting from each of your medical providers every 12 months.

The accounting includes details about:

• what medical information the provider sent
• when it sent the information
• who got the information
• why the information was sent

The accounting shows who has copies of your mistaken records and whom you need to contact. It may not have details about some routine disclosure of your information, like those from your doctor’s office to another doctor’s office, or disclosure of payment information to an insurer.

Ask for Corrections

Write to your health plan and medical providers and explain which information is not accurate. Send copies of the documents that support your position. You can include a copy of your medical record and circle the disputed items. Ask the provider to correct or delete each error. Keep the original documents.

Send your letter by certified mail, and ask for a return receipt, so you have a record of what the plan or provider received. Keep copies of the letters and documents you sent.

The health plan or medical provider that made the mistakes in your files must change the information. It should also inform labs, other health care providers, and anyone else that might have gotten wrong information. If a health plan or medical provider won’t make the changes you request, ask it to include a statement of your dispute in your record.

How to Correct Errors in Your Medical Records

1. Contact each health care provider and ask for copies of your medical records.
   1. Complete the request form and pay any fees required to get copies of your records.
      If your provider refuses to give you copies of your records because it thinks that would violate the identity thief’s privacy rights, you can appeal. Contact the person the provider lists in its Notice of Privacy Practices, the patient representative, or the ombudsman. Explain the situation and ask for your file. If the provider refuses to provide your records within 30 days of your written request, you may complain to the U.S. Department of Health and Human Services Office for Civil Rights.
2. Review your medical records and report any errors to your health care provider.
   1. Write to your health care provider to report mistakes in your medical records.
   2. Include a copy of the medical record showing the mistake.
   3. Explain why this is a mistake and how to correct it.
   4. Include a copy of your police report or Identity Theft Report.
   5. Send the letter by certified mail and ask for a return receipt. Your health care provider should respond to your letter within 30 days. It must fix the mistake and notify other health care providers who may have the same mistake in their records.
3. Notify your health insurer and all three credit bureaus.
   1. Send copies of your police report or Identity Theft Report to your health insurer’s fraud department and the three nationwide credit bureaus.
4. Order copies of your credit reports if you haven’t already.
5. Consider placing a fraud alert or a security freeze on your credit reports.
6. Update your files.
   1. Record the dates you made calls or sent letters.
   2. Keep copies of letters in your files.

Protecting Your Medical Information

Your medical and insurance information are valuable to identity thieves.

Be wary if someone offers you “free” health services or products, but requires you to provide your health plan ID number. Medical identity thieves may pretend to work for an insurance company, doctor’s offices, clinic, or pharmacy to try to trick you into revealing sensitive information.

Don’t share medical or insurance information by phone or email unless you initiated the contact and know who you’re dealing with.

Keep paper and electronic copies of your medical and health insurance records in a safe place. Shred outdated health insurance forms, prescription and physician statements, and the labels from prescription bottles before you throw them out.

Before you provide sensitive personal information to a website that asks for your Social Security number, insurance account numbers, or details about your health, find out why it’s needed, how it will be kept safe, whether it will be shared, and with whom. Read the Privacy Policy on the website.

Informational Source

What’s covered in the Health Insurance Marketplace

These essential health benefits include at least the following items and services:

1. Outpatient care— The kind you get without being admitted to a hospital
2. Trips to the emergency room
3. Treatment in the hospital for inpatient care
4. Care before and after your baby is born
5. Mental health and substance use disorder services: This includes behavioral health treatment, counseling, and psychotherapy
6. Your prescription drugs
7. Services and devices to help you recover if you are injured, or have a disability or chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more.
8. Your lab tests
9. Preventive services including counseling, screenings, and vaccines to keep you healthy and care for managing a chronic disease.
10. Pediatric services: This includes dental care and vision care for kids

Specific health care benefits may vary by state. Even within the same state, there can be small differences between health insurance plans. When you fill out your application and compare plans, you’ll see the specific health care benefits each plan offers:-

• Ambulatory patient services (outpatient care you get without being admitted to a hospital)
• Emergency services
• Hospitalization (like surgery and overnight stays)
• Pregnancy, maternity, and newborn care (both before and after birth)
• Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
• Prescription drugs
• Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)

Additional benefits

Plans must also include the following benefits:

• Birth control coverage
• Breastfeeding coverage

Essential health benefits are minimum requirements for all Marketplace plans. Specific services covered in each broad benefit category can vary based on your state’s requirements. Plans may offer additional benefits, including:

• Dental coverage
• Vision coverage
• Medical management programs (for specific needs like weight management, back pain, and diabetes)

Informational Source

The tips below will help you save money wisely, but don’t rely on price alone.

Key factors in choosing a policy

Company financial stability – Because you may not collect for decades to come, be sure to buy from a company that has been around for some time and is financially stable. You may want to look up, from an independent rating agency, the financial strength ratings of a company you’re considering.

Percentage of income – Keep the premium for your long-term care insurance policy to 7 percent of your income, or less. For example, if your monthly income is $4,000, the long-term care insurance premium should not be more than $280 per month. (This is what the National Association of Insurance Commissioners recommends in its Model Regulation for Long-Term Care Insurance.) Another expert advises that the income to use in this calculation isn’t your current income, but your expected income in retirement, since that’s the income from which you’ll be paying premiums for most of the policy’s existence.

Other ways of saving

1. Find out if long-term care benefits are available through a group policy from your employer. Employers might subsidize the cost, lowering what you must pay.
2. Check whether you can add long-term care benefits as a rider on an existing life insurance or annuity policy. These “combination” arrangements can save because the insurance company gains operational savings that it can pass along to you.
3. Buy a policy with the longest waiting period you can afford. For example, choosing a 90-day period instead of a 30-day period can cut the premium by 30%. However, if you do need long-term care services, you should save some money to pay these costs until the waiting period ends.
4. If both spouses of a married couple are considering buying long-term care policies, look into buying one joint policy for both of you. Such a policy pays when either one needs care and can pay for both, if necessary, up to its benefit limits.
5. If you’re still looking to trim the premium further, consider buying a policy that will pay most, but not all, of the average nursing home costs in your area. For example, if a nursing home room now costs $120 per day, buy a policy that pays $100 per day. However, be sure to buy an inflation-protection provision.
6. Check with several companies and agents, comparing both benefits and costs. As with other types of insurance (and many other purchases), comparison shopping can save you money. Just be sure you’re comparing policies with similar provisions and companies with comparable financial strength and service records.

Informational Source

There are two types of disability policies: Short-Term Disability (STD) and Long-Term Disability (LTD):

1. Short-Term Disability policies – have a waiting period of 0 to 14 days with a maximum benefit period of no longer than two years.
2. Long-Term Disability policies – have a waiting period of several weeks to several months with a maximum benefit period ranging from a few years to the rest of your life.

Disability policies have two different protection features that are important to understand:

1. Noncancelable means the policy cannot be canceled by the insurance company, except for nonpayment of premiums. This gives you the right to renew the policy every year without an increase in the premium or a reduction in benefits.
2. Guaranteed renewable gives you the right to renew the policy with the same benefits and not have the policy canceled by the company. However, your insurer has the right to increase your premiums as long as it does so for all other policyholders in the same rating class as you.

In addition to the traditional disability policies, there are several options you should consider when purchasing a policy:

• Additional purchase options 
  Your insurance company gives you the right to buy additional insurance at a later time.
• Coordination of benefits 
  The amount of benefits you receive from your insurance company is dependent on other benefits you receive because of your disability. Your policy specifies a target amount you will receive from all the policies combined, so this policy will make up the difference not paid by other policies.
• Cost of living adjustment (COLA)  The COLA increases your disability benefits over time based on the increased cost of living measured by the Consumer Price Index. You will pay a higher premium if you select the COLA.
• Residual or partial disability rider  This provision allows you to return to work part-time, collect part of your salary and receive a partial disability payment if you are still partially disabled.
• Return of premium 
  This provision requires the insurance company to refund part of your premium if no claims are made for a specific period of time declared in the policy.
• Waiver of premium provision This clause means that you do not have to pay premiums on the policy after you’re disabled for 90 days.

Informational Source