DO YOU NEED MORE INSURANCE?

DO YOU NEED MORE INSURANCE?


Before buying insurance to supplement Medicare, ask
yourself whether you need private health insurance in addition
to Medicare. Not everyone does.


Medicaid Recipients


Low-income people who are eligible for Medicaid usually do
not need additional insurance. They also qualify for certain
health care benefits beyond those covered by Medicare, such as
long-term nursing home care. If you become eligible for
Medicaid, and you have Medigap insurance purchased on or after
November 5, 1991, you can request that the Medigap benefits and
premiums be suspended for up to two years while you are covered
by Medicaid. Should you become ineligible for Medicaid benefits
during the two years, your Medigap policy will be reinstated if
you give proper notice and begin paying premiums again. You do
not, however, have to suspend your Medigap policy, and
suspension is not always to a Medicaid recipient's advantage.
You may want to discuss your options with your state Medicaid
representatives.


Qualified Medicare Beneficiary Program: Assistance for


Low-Income Elderly


Limited financial assistance is available through Medicaid
for paying Medicare premiums, deductibles, and coinsurance
amounts for certain low-income elderly and disabled
beneficiaries. If your annual income is at or below the
national poverty level and your cash and savings are very
limited, you may qualify for state assistance in paying
Medicare's monthly premiums, deductibles and coinsurance. This
is called the "Qualified Medicare Beneficiary" (QMB) program.

To have qualified in 1993, your income could not have been
more than $601 per month for one person or $806 per month for a
couple, except in Alaska and Hawaii. In Alaska the income
limits were $745 per month for one person and $1,002 per month
for a couple. In Hawaii they were $690 per month for one person
and $925 per month for a couple. The limits for 1994 will be
announced in February 1994. Financial resources such as bank
accounts, stocks, and bonds cannot exceed $4,000 for one person
or $6,000 for a couple.

Financial assistance also is available for Medicare
beneficiaries under the "Specified Low-Income Medicare
Beneficiary" (SLMB) program. This program is for beneficiaries
whose incomes exceed the poverty level by not more than 10
percent and who meet certain resource limitations. To have
qualified for this program in 1993, your income could not have
been more than $659 a month for one person or $884 a month for
a couple, except in Alaska and Hawaii. In Alaska the income
limits were $818 per month for one person and $1,100 per month
for a couple. In Hawaii they were $758 per month for one person
and $1,016 per month for a couple. Individuals in this category
are eligible only for Medicaid payment of their Medicare Pan B
premium, which is $41.10 per month in 1994. If you think you
qualify for state assistance in paying your Medicare expenses
under either of these two programs, contact your state or local
social service agency. If you cannot find a telephone number
for the state agency, call 1-800638-6833 for assistance.


Federally Qualified Health Center


Medicare pays for some health services, including
preventive care, when provided by a federally qualified health
center (FQHC). These facilities are typically community health
centers, migrant health centers and health centers for the
homeless. They are generally located in inner-city and rural
areas. The services covered by Medicare at FQHCs include
routine physical examinations, screenings, and diagnostic tests
for the detection of vision and hearing problems and other
medical conditions, and the administration of certain vaccines
for immunization against influenza and other diseases.

When those services are furnished at a FQHC, the $100
annual Part B deductible does not apply (see page 5). However,
if other services are provided, such as X-rays or screening
mammograms, the FQHC may bill the Medicare carrier. In that
case, you would be responsible for any unmet portion of the Pan
B annual deductible of $.100. As for the 20 percent Part B
coinsurance, it is applicable for all FQHC services but Public
Health Service guidelines allow the FQHC to waive it in some
instances. Any Medicare beneficiary may seek services at an
FQHC.

To find out whether one of these centers serves your area,
call 1-800-638-6833.