More About Insurances

Federal Insurances:

Medicare:

• For people who are 65 years and above
• Policy ID format: 9 digit numeric by alpha/ Alpha numeric suffix. 
• Examples: 123-45-6789A where A = Self, B = Spouse, C1 = First Child, C2 = Second Child etc.
• When call to Medicare alway we need 3 pieces information: a. NPI, b. TAX ID and c. PTAN.
• Medicare the only payer who after processing the claim forward to additional payer if any exists.
• Medicare do not pay claim status over phone, they assist only with the denial.

Medicaid:

• It is also Called as "Poor Man's Policy".
• Depends on the NAV (Net Asset Value) of the House Hold Income.
• Should have proof of getting Govt. sponsored temporary funds like TANF, TCA and SSI.

                                           1. TANF: Temporary Assistance for Needy Families.

                                           2. TCA: Temporary Cash Assistance.

                                           3. SSI: Supplemental Security Income.

Rail Road Medicare:

• It is also called as RR Medicare.
• Exclusive for the retirees of the Railways.
• Policies & Guidelines - similar to Medicare.
• Retirees need to enroll themselves in a Centralized database system called RAIL-ROAD RETIREMENT BOARD (RRB).
• Policy ID format: Alha prefix followed by 9 digit numeric. Example: A123-45-6789.

ChampUS:

• Civilian Health And Medical Program of Uniformed Services.
• A medical program for those who join te Uniformed Services & their family members.
• Now it is called as Tricare.
• 
  
• DEERS (Defence Enrollment Eligibility Reporting System) is the centralized database system for the the Uniformed Services.

ChampVA:

• Civilian Health And Medical Program of Veteran Affairs.
• Disabled during Service period.
• Spouse of a deceased uniformed Service Personnel.
• Administered by DVA (Department of Veteran Affairs).

Commercial Insurances

BCBS (Blue Cross Blue Shield) is the foremost Commercial Insurance which pioneered the concept of Health Insurance in US started their business in the period of 1930s.

Plans Under BCBS:

• Federal Employee Program (FEP): Exclusively for the Employees of he Federal Government. Policy ID format = "R" followed by 8 digit Number. Eg: R12345678.

• National Accounts: For Extensive Travellers.
• Local Plan:  For Non-travellers.

Policy ID format for the above two plans = 3 Alpha followed by 9 digit numeric. Eg: JRI12345789.

Co-Ordination of Benefits (COB)

It is an arrangement held by he Patient between Insurance COmpanies on their Payment responsibilities.

Standard COB:

It is a traditional coordination of benefits allows the beneficiary to receive upto 100% of expenses from a combination of the primary and secondary plans.

Non-Duplicate COB:

In the case of Non-DUplicate COB, if the primary carrier paid the same or more carrier is not responsible for any payment at all.

Difference Between Medicaid nad Medicare

                                                  Medicaid                                  Medicare

Who Runs IT:      Medicaid is a federal program,                     Medicare is a federal program with 

                             administered by the states.                           uniform, national rules.  

                             Information is available at 

                             your state's health services office.

Eligibility:           Low-income people can qualify,                  Medicare benefits can begin as early as

                            regardless of age.                                          65, or even earlier in the case of serious                                                                                                    disability covered by Social Security.

Coverage:            Medicaid covers basic health care                Part A: Hospital and post hospital                                      costs such as visits to the doctor                   facility charges,  as well as home health 

                            and hospital stays, but can also cover           Care.

                            things like the cos of eyeglasses.                  Part B: Doctor fees and lab costs,                                                                                                              outpatient care (can include physical                                                                                                        therapy and medical equipment).

                                                                                                  Part C: Prescription Drug Coverage.

Costs:                 Generally Medicaid do not charge                There is a yearly deductible for all 3 

                           to patient. But in very rare cases they           Medicare plans.

                           charge small fees for certain services.

                           Medicaid will often pay for Medicare          Part A: Copayments for lengthy 

                          deductibles and premiums and it can            hospitalizations.

                          cover the 20 % of medical costs that             Part B: 20 to 35 % od medical bills with                            Medicare will not pay for.                             monthly premium.

                                 

                                                                                                 Beneficiaries must also pay a monthly                                                                                                       premium and 25 % of drug costs once                                                                                                       the deductible is met.