Frequently Asked Questions

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If you are age 65 or over.

If you are under 65 and have a qualifying circumstance:

• You have been on SS Disability for at least 24 months
• You are on disability pension from the Railroad Retirement Board
• You suffer from ALS
• You suffer from end stage renal failure

 Hospital insurance that covers care including inpatient hospital stays,  hospice care, nursing facility services, and in some cases, home health  care. 

 Medical insurance that covers services and supplies required to diagnose  or treat a condition. These services may include lab tests, surgeries,  doctor’s visits, and medical supplies. It also covers preventive  services 

 Prescription drug coverage available with Medicare. 

 A supplemental insurance plans that helps to supplement coverage not  provided by Original Medicare. This includes co-payments, coinsurance,  and deductibles. Medigap plans can be purchased in addition to your  Medicare plan through private insurance companies 

 Plans offered through private insurance companies as an alternative to  Original Medicare. These plans include Medicare Parts A and B, and  sometimes Part D. The benefits and costs associated with the plans vary but are mandated to be at least as robust as Original Medicare.

When you first become eligible you are allowed to sign up for  Medicare during the 3 months prior to the month your eligibility begins  through 3 months after the month you become eligible for a total of a  7-month enrollment period. This is known as your Initial Enrollment  Period.  If you do not sign up for Medicare during your initial enrollment  period, you will likely have to wait until the annual enrollment period  which begins in October unless you qualify for a special enrollment period

 Health insurance is a contract with an insurance company, which agrees  to pay some or all of your medical bills based on your “coverage,” or  the terms of your policy. In exchange, the insurer is paid a set amount  of money — a “premium” — on a regular basis. Most Americans have private  health insurance, either through their employer’s group plan or through  buying their own individual policy 

 It’s no secret that health care is expensive today. . Without insurance,  many Americans would be one health setback away from financial despair.  Regularly paying a set premium for health coverage assures that money  will be available to minimize the cost of everything from routine  checkups to catastrophic medical bills 

 All three are medical charges you pay out of your own pocket. Plans may  have separate individual and family deductibles and/or deductibles for  separate services such as hospitalization. A co-payment is a fixed amount  you pay toward each medical service, such as $25 for a checkup.  Coinsurance is a fixed percentage, rather than a flat amount, that you  pay toward medical care. 

A person enrolled in an HMO plan selects a primary care  physician. All health care services go through that doctor, including referrals to see any other health care  providers, and visits to health care providers outside the  network are not covered by the plan.

However, there are certain exceptions, including emergencies. Another  typical exception is routine service visits to see an  obstetrician/gynecologist within the network for routine services,  such as Pap tests and obstetrical care. 

PPO plans allow people to go to whatever health care professional  they wish without a referral. This includes professionals both inside  and outside the network. However, remaining inside the network ensures  full coverage and means less out-of-pocket costs.

Coordinating care through a single doctor means there is less  paperwork and lower health care costs associated with HMOs. But for  people who want to see particular specialists, PPOs are the better  option.

Dental insurance can benefit most people who  plan to take care of their teeth by regularly seeing a dentist. Dental  plans allow you to see a dentist routinely for check ups, and also help  pay for major treatments like root canals or crowns which can be  expensive. Dental plans also have the advantage of offering provider  networks, procedure discounts, and other helpful features. 

Dental  insurance plans typically consist of PPO dental plans, DHMO plans, and  Indemnity dental plans. PPO plans have provider networks, but generally  allow members to see any dentist. DHMO plans are usually In-Network  only, while Indemnity plans do not have a network and pays the same at  any dental office. There are also discount dental plans that are not  insurance but they give members discounts on services at In-Network  dentists. 

 Some DHMO plans or discount dental plans require members to use an  In-Network dentist in order to receive plan benefits. But PPO dental  plans and Indemnity plans allow members to also see Out of Network  dentists 

 It is common for some individual dental plans to have waiting periods  for major services. However, there are certain plans and carriers that  offer plan options with no waiting periods. Some plans offer no waiting  periods for major services like crowns and root canals. 

 Some dental plans will have coverage for dental implants, but many  individual plans do not offer benefits for implants. So it’s important  to check plan details to make sure coverage is offered if you need  implants. Until prices for implants come down, usually a smaller portion of the costs is covered by a dental plan than more traditional procedures.

 Your need for life insurance varies with your age and responsibilities. It is a very important part of financial planning.   You may need to replace income that would be lost with the death of a  wage earner. You may want to make sure your dependents do not incur  significant debt when you die. Life insurance may allow them to keep  assets versus selling them to pay outstanding bills or taxes. 

•  Medical expenses prior to death, burial costs and estate taxes;
• Support while remaining family members try to secure employment;
• Continued monthly bills and expenses, day-care costs, college tuition and retirement.

 All policies are not the same. Some give coverage for your lifetime and  other cover you for a specific number of years. Some build up cash  values and others do not. Some policies combine different kinds of  insurance, and others let you change from one kind of insurance to  another. Some policies may offer other benefits while you are still  living. There are two basic types of life insurance: term insurance and  permanent insurance. 

 Ask yourself the following questions:

• How much of the family income do I provide?
• If I were to die, what would my family need to get by?
• Does anyone else depend upon my income that I should consider?
• Are there educational expenses need to be provided?
• Does my family have the means to pay for my funeral and final expenses?
• Do I have estate or business considerations?
• How will inflation affect my families needs?