Other Options for Individuals with Medicare

Explore tailored healthcare solutions with our guide on ‘Other Options for Individuals with Medicare.’ Discover supplementary plans, alternative coverage, and personalized options to complement your Medicare benefits. Stay informed about unique choices that cater to individual needs, ensuring comprehensive health coverage. Whether you seek specialized care, additional benefits, or cost-effective alternatives, our resource provides insights to empower your healthcare decisions. Unlock a world of possibilities beyond traditional Medicare plans and optimize your coverage for a healthier and more secure future. Explore diverse options and make informed choices for your individualized healthcare journey now!

Employer Group Health Plans

Disabled Employees

The Omnibus Budget Reconciliation Act of 1990 (OBRA) requires that large group health plans (100 employees or more) must provide primary coverage for disabled individuals under age 65 who are not retired.

Employees with Kidney Failure

The Omnibus Budget Reconciliation Act of 1990 as amended by the Balanced Budget Act of 1997 requires the employer health plan to provide primary coverage for 30 months for individuals with end-stage renal (kidney) disease before Medicare becomes primary.

Individuals Age 65 and Older

If an employee is still employed upon reaching age 65, federal laws require allowing the employee to remain on the group health insurance rolls and to defer Medicare coverage until retirement. The employee has the right to reject the company’s plan and elect Medicare, but the company can offer no incentives for switching to Medicare.

If an employee remains on the group plan and signs up for Medicare, in groups of fewer than 20 employees, Medicare will be the primary coverage. In groups of 20 or more, the group coverage will be primary over Medicare.

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Anyone over the age of 65 may choose to either keep the employer's group health coverage or elect coverage through Medicare.
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Connector Models

The Ohio Public Employees Retirement System (OPERS) is a public pension fund which offers health care coverage for retirees and eligible dependents. Coverage through the OPERS includes medical plans, prescription drug plans, dental plans, and vision plans. OPERS replaces Social Security.

The OPERS Connector is a service offered to Medicare Part A and B enrollees. The purpose of the Connector is to provide education, plan selection, enrollment, and advocacy pertaining to Medicare. OPERS offers assistance with selection of the most suitable Medicare plan based on an individual’s lifestyle and financial needs.

Individuals who enroll through a Connector receive a monthly allowance through a Health Reimbursement Account (HRA), which can be used to pay for qualified medical expenses.

Medicaid

Medicaid is a federal and state funded program for those whose income and resources are insufficient to meet the cost of necessary medical care. Individual states design and administer the Medicaid programs (typically through the state’s Department of Public Welfare) under broad guidelines established by the federal government.

Eligibility

To qualify for Medicaid, individuals must meet income and other eligibility requirements. Once a person is determined to qualify with low income and low assets, the person must meet other qualifiers, some of which are blindness, disability, pregnancy, age (over 65), or caring for children receiving welfare benefits. For many eligibility groups, income is calculated in relation to a percentage of the Federal Poverty Level (FPL). 

After the implementation of the Affordable Care Act, new, modernized rules regarding verification of Medicaid eligibility will mean that state Medicaid agencies will rely primarily on information available through data sources (such as the Social Security Administration, the Departments of Homeland Security and Labor) rather than paper documentation from families. Each state has prepared a verification plan for Medicaid in order to comply with the new rules.

In addition to certain levels of income and assets, there are other nonfinancial eligibility criteria that are used in determining Medicaid eligibility. In order to be eligible for Medicaid, individuals need to satisfy federal and state requirements regarding residency, immigration status, and documentation of U.S. citizenship.

Benefits

Medicaid mandates that the states provide at least the following services:

  • Physician’s services;
  • Inpatient hospital care;
  • Outpatient hospital care;
  • Skilled nursing home services;
  • Laboratory and x-ray services;
  • Home health care services;
  • Rural health clinic services;
  • Periodic screening, diagnosis, and treatment;
  • Family planning services; and
  • Medicaid also pays for prescription drugs, dental services, private duty nursing services, eyeglasses, check-ups, and medical supplies and equipment.

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An Overview of Annuity Principles and Concepts

Unlock the key principles and concepts of annuities with our comprehensive guide. Explore the intricacies of this financial tool, gaining insights into annuity types, payout options, and investment strategies. Whether you're planning for retirement or...

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Other Options for Individuals with Medicare​

Explore tailored healthcare solutions with our guide on ‘Other Options for Individuals with Medicare.’ Discover supplementary plans, alternative coverage, and personalized options to complement your Medicare benefits. Stay informed about unique choices that cater to individual needs, ensuring comprehensive health coverage. Whether you seek specialized care, additional benefits, or cost-effective alternatives, our resource provides insights to empower your healthcare decisions. Unlock a world of possibilities beyond traditional Medicare plans and optimize your coverage for a healthier and more secure future. Explore diverse options and make informed choices for your individualized healthcare journey now!

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