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How Does Hospital Indemnity Insurance Work?

No one wants to end up in the hospital. Despite hospitals being a healthcare hub full of solutions for most ailments that people experience, most of us avoid going to them at all costs. This is often due to the fact that it can be prohibitively expensive to access hospital services, particularly if people have little to no insurance. However, hospital indemnity insurance is one solution to this problem.

What is Indemnity Insurance?

One of the most common forms of insurance, including hospitalization insurance, is called indemnity insurance. Indemnity insurance is also called fee-for-service. Policyholders can use any doctor or hospital, they are not confined to a network. Either the beneficiary or the service provider sends the bill to the insurance company, who then reimburses the holder or the provider. Typically, there is a deductible that the beneficiary must meet before the insurance starts to kick in. Then, the insurer usually pays a certain percentage of the “usual and customary” costs from the services. This percentage is usually around 80%, and usual and customary fees are healthcare field standards for what something usually costs. These indemnity plans may not pay for preventative care.

Hospital Indemnity Insurance

Now, hospital indemnity insurance functions as most indemnity insurance policies do. It is a supplemental insurance plan that is supposed to pay for the hospital admissions costs that are not covered by other standard policies. Because the majority of Americans do not have the savings to cover unplanned medical bills, this can be a very useful financial safety net if someone is admitted to the hospital or the ICU due to injury or illness. The payments from the insurance company can be used to cover any of the costs associated with the hospital admission, including copays, deductibles, and even food, rent, or other bills.

There are also guaranteed issue policies that require no disclosure of medical history in order to enroll. One of the major differences between standard insurance policies and indemnity policies is to whom the payments are made. Indemnity insurance policies for hospitalization make payments directly to the hospitalized person, the policy holder, rather than the hospital. This allows for much more flexibility as to where the money goes and how it is used.

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Medicare Scams

There are several reasons why Medicare is rife with people trying to scam beneficiaries and businesses alike. For one, the rise of automated and exclusively-online enrollment means that it can be easier to use technology to scam the unsuspecting. Additionally, the population who uses Medicare is mostly elderly, and the elderly are often targets of scams. Medicare also covers an enormous population of people – 65 million at last count in 2023.   Additionally,  more people become eligible and enroll each year. The federal Medicare program continues to warn beneficiaries to watch out for scammers.  Warning particularly people who try to take Medicare ID numbers in order to file false claims. The purpose of Medicare scams is to obtain Medicare payments, which is usually done by filing false claims for services, items, procedures, or equipment. It is estimated that Medicare fraud costs taxpayers billions of dollars each year.

Here are the top three Medicare scams to watch out for right now.

1. Offers of free genetic testing

With how popular DNA testing has become, it’s no wonder scammers have been using that buzz to commit fraud. The “free genetic testing” is offered under the guise of helping test for diseases or susceptibility to certain illnesses, and find the right medications. The offers most often come over the phone but there are some reported door-to-door attempts as well.

2. Calls or emails about free medical equipment

Scammers are also disguising themselves for other scams. Some people attempting to commit fraud are pretending to be Medicare representatives and making unsolicited calls to people under the guise of offering them free medical devices such as back braces, canes, walkers, or even wheelchairs. These callers have been reported to be extremely persistent, even asking the beneficiaries to accept the equipment simply because it is free if they do not need it. When the beneficiaries agree, the scammers then ask for their Medicare ID number, which gives them access to their private medical information and records.

3. Solicitations for other services

These attempts at fraud are sometimes called Medicare Call Scams. Often they are robocalls, but there are live people making these calls as well. Their goal is to get the Medicare ID number, social security number, or other personal information about their targets. The scammers often do this by doing their research, knowing some things about their target, and pretending to be Medicare representatives.

In order to protect themselves against these three common scams, Medicare beneficiaries should always remember that Medicare will not reach out to beneficiaries via call or email unless they are answering their inquiry. Medicare will also never offer free gifts, medical equipment, or any other service for free. Calls requesting health care information should, as a rule, not be trusted.

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Medicare Supplement Plan N

There are a large variety of Medicare Supplement plans to choose from. Medicare Supplement Plans, also known as Medigap, are plans that private insurance carriers sell to Medicare beneficiaries to remedy some of the gaps in coverage that occur in Original Medicare. Medicare supplemental plans can help pay the beneficiary’s share of out-of-pocket costs such as copays, coinsurance, or other fees. Medigap policies are named after letters of the alphabet in all but three of the continental United States.

Increasing Popularity

Medicare Supplement Plan N has become increasingly popular due to its wide range of coverage. Plan N covers 100% of the Medicare Part B coinsurance costs. Beneficiaries are left to cover a $20 copay for office visits and a $50 copay for emergency room visits. These low costs are appealing to many purchasers. Medicare Plan N also provides the following benefits:

• For hospitalization, Plan N pays for Part A (of Original Medicare) coinsurance plus coverage for an additional 365 days after Medicare benefits end. That is an entire year of additional hospitalization coverage.

• Plan N also pays for Part B’s coinsurance, excluding a $20 copay for office visits and a $50 copay for emergency rooms. Copayments for hospital outpatient services are also covered.

• The first three pints of blood each year are paid for by Plan N coverage.

• Perhaps most vitally for many seniors, Plan N covers the hospice care Part A coinsurance.

• Skilled nursing facility care is covered under Plan N.

• The Medicare Part A deductible for hospitalization is covered under these benefits.

• And, Plan N provides travel abroad medical emergency help.

There was a previously very widely used Medicare Supplement Plan called Medigap Plan F. Plan F was discontinued in 2020, and carriers were no longer allowed to enroll additional beneficiaries in Plan F. Because of this new gap where the popular plan no longer exists, Plan N is one of the Medigap plans that is growing increasingly popular because of its wide range of coverage.

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What Are Medicare Savings Programs?

At last count, in 2023, there were over 65 million Americans enrolled in the federal healthcare program Medicare. There are additional people qualifying for and enrolling in Medicare every day. It is an extremely valuable program that helps to ensure that some of the most vulnerable populations have the access to healthcare that they need. However, it is not a perfect program, and, despite its subsidization by the government, there are out of pocket costs (OOP costs) associated with Medicare. Most people will not have to pay a premium for Part A (hospital insurance), but the majority of enrollees will pay a premium for Part B, which is medical insurance. There are also copayments, deductibles, and coinsurance. All of these costs can add up quickly, particularly if a beneficiary has chronic health issues.  What Are Medicare Savings Programs?

That’s why there are Medicare Savings Programs. Medicare Savings Programs are special benefit programs.    State Medicaid agencies sponsor these programs. They are designed to help adults who have limited assets and income by relieving some of the out of pocket expenses associated with Medicare.

MSP Levels

There are four different Medicare Savings Programs (MSPs) that help to cover premiums, deductibles, coinsurance, and copayments.

1. Qualified Medicare Beneficiary (QMB): This program helps to pay for Part A premium and Part B premium. It also covers deductibles, coinsurance, and payments.

2. Specified Low-Income Medicare Beneficiary (SLMB): This program helps pay for Part B premium.

3. Qualifying Individual (QI): This also helps pay for Part B premium.

4. Qualified Disabled Working Individual (QDWI): This helps pay for Part A premium.

Beneficiaries cannot choose the program that they want to enroll in. Rather, they will be assigned to the program that most closely matches their assets and income, as well as other details that the enrollee provides on their application. The guidelines for who qualifies for which program differ by state.

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Medicare Advantage vs. Medicare Supplements/Medigap

While Medicare does cover the majority of elderly Americans and provide access to some essential health services, there are many aspects of healthcare that are not covered at all by the federal program. To fill in these gaps, many eligible people end up enrolling in a Medicare Advantage policy or a Medicare Supplement policy, also known as Medigap. But which is the right choice for your unique situation? Here’s a comparison Medicare Advantage vs. Medicare Supplements/Medigap.

Medicare Advantage

• Many plans have $0 deductibles, no copay for a primary care doctor’s visit, and lower copays for specialists.

• Beneficiaries are restricted to a list of certain doctors, hospitals, and suppliers.

• The beneficiary must also be enrolled in Original Medicare (Parts A and B).

• Most policies do include at least some Part D coverage (prescriptions), as well as limited hearing, vision, and dental.

• There are limited policies available that allow for out-of-network provider coverage.

Medicare Advantage is provided by private insurance carriers, and essentially replaces Original Medicare as your primary insurance provider. Some plans require more authorizations to access care under these plans. Most people will have over 30 Medicare Advantage policies to choose from, but not all plans are available in all areas.

Medicare Supplements/Medigap

• These programs can be expensive, but the monthly payments are predictable.

• Plans K and L have annual out-of-pocket cost limits.

• Limited plans available do cover some vision, dental, and hearing services.

• International travel coverage is available.

• Beneficiaries will have to enroll in Part D separately, as Medigap does not provide prescription coverage.

• These policies only cover one person – spouses need separate plans.

There are 10 Medigap plans to choose from that provide standardized care and help pay for things like deductibles, coinsurance, and copays. In 2018, about 34% of the people enrolled in Original Medicare had coverage provided by Medicare Supplements to help cover costs – which is over 11 million people. These plans can help make the out-of-pocket costs more predictable and easier to budget. One thing that people do report positively from Medigap plans is the lack of restriction on in or out of network healthcare. The estimated average monthly premium can range from $150 to $200 a month, depending on the state that you live in and the insurer.

Depending on your situation, both Medicare Advantage and Medicare Supplement (Medigap) policies can be helpful for coverage gaps in healthcare for beneficiaries of Original Medicare.

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UHC OTC Benefits

Over the Counter Benefits from UnitedHealthcare are also called UHC OTC benefits.

For beneficiaries who are eligible for both Medicaid and Medicare, there are many benefits available that are often less utilized than the standard medical and healthcare services. By design, these benefits  help those on fixed incomes or low incomes meet their needs and keep their health.

UHC OTC benefits offer more.

UCard

Clients who are dually eligible and enrolled in a UnitedHealthcare plan can utilize these benefits as a monthly credit loaded on to their UnitedHealthcare UCard every month.  Use to purchase healthy food, over the counter products such as cold medicines, and even utility bills. UnitedHealthcare is currently advertising that their Mom’s Meals benefits works for dually eligible enrollees with their over the counter (OTC) benefit and Renew Active. This means that a member can order healthy meals using the loaded credit on their UCard for home delivery. Those members being discharged from hospitals or from nursing facility stays can also order these for delivery.

In addition to UHC OTC benefits, Mom’s Meals are fully cooked, refrigerated meals that can be easily reheated. Meals are re-heatable.  In addition,  consist of 28 meals over a 14 day period. There are many dietary specifications available as well, from meals that take renal health into account to gluten-free meals or purees for those with trouble handling solid foods. UnitedHealthcare advertises these meals as helpful for seniors who would like to avoid the hassle of shopping and cooking while still living independently and maintaining good nutrition.

Members who are interested in utilizing this over the counter benefit from UnitedHealthcare need to access their Renew Active portal. Under the “home delivery” tab, there is an option to order Mom’s Meals. Pricing is typically $7.59 per meal with some additional charges for dietary specifications as needed. All of the UnitedHealthcare plans that include Renew Active have access to home delivery of Mom’s Meals.

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Medicare AEP versus OEP: What’s the Difference?

Even for savvy clients, the enrollment process for Medicare can be confusing. One of the reasons for this is the multiple enrollment periods. The two most important time periods for both beneficiaries and agents to know the details of are the Open Enrollment Period (OEP) and the Annual Enrollment Period (AEP). Let’s compare the two:

AEP vs OEP – Open Enrollment Period

This is the time during the year when anyone who is eligible for Medicare can enroll in, change coverage from, or unenroll from a Medicare Advantage Plan or a Medicare Part D (or prescription drug) plan. This is the time when beneficiaries can make choices about their Medicare coverage without restrictions.  It usually runs from January 1st to March 31st each year. To be eligible to enroll in a Medicare Advantage plan during OEP.

AEP vs OEP – Annual Enrollment Period

This is the time period that is specifically designed for beneficiaries who are enrolled in Medicare Advantage plans to change their coverage. It occurs from October 15th to December 7th each year. There are some restrictions as to what beneficiaries can do during this time period, but those actions that they can take include enrolling in a different Medicare Advantage plan, switching to or back to Original Medicare (parts A and B), or enrolling in a Medicare Part D plan (prescription drug coverage). In order to be qualified to do any of those things, the beneficiary must already be enrolled in a Medicare Advantage plan.

It is of vital importance that beneficiaries are aware of these timelines.  If they are not aware of the time periods, missing OEP or AEP and failure to act can cause them to have lapses in their healthcare coverage or miss their opportunity to enroll in a different plan for the coming year.

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