Monthly Archive: April 2019

Common questions about Medicaid eligibility

How can I find out if I am eligible for Medicaid?

How can I find out if I am eligible for Medicaid?

The federal government provides online display tools to determine if you qualify for Medicaid and other government programs. Visit GovBenefits and Benefits CheckUp and complete the online questionnaires. Following questions about where you live, your income and other circumstances, the site will provide you with additional resources, or you qualify for medical assistance. In addition, each state has social services representatives we can meet with you in person or over the phone to help determine if you are eligible for Medicaid.

How do I apply for Medicaid?

How do I apply for Medicaid?

Each state has its own application process. Visit your state’s insurance website to find out how to apply for Medicaid. The website benefits.gov also has a search-for-state feature with links and phone numbers to apply for each state’s Medicaid programs. Most countries allow you to apply directly online. But for those who prefer to apply in person or by phone, resources are available to help navigate the process. Moreover, for those who need help with translation, reading or writing, the state offers representatives to assist with the Medicaid application.

Can My Kids Qualify for Medicaid?

Can My Kids Qualify for Medicaid?

Children qualify for Medicaid based on their needs, not the needs of their parents. Therefore, it is possible for a child to be eligible for Medicaid when their parents are. Foster children, for example, are eligible for Medicaid, as a child with someone other than their biological parent. For example, the child can stay with family members eligible for Medicaid because of the relative income and resources that have no influence on the child’s Medicaid eligibility. Many countries have sponsored state health insurance plans even when the child does not qualify for Medicaid.

Are illegal immigrants eligible for Medicaid?

Are illegal immigrants eligible for Medicaid?

Many countries only allow US citizens and illegal immigrants with permanent legal status to qualify for full Medicaid benefits. An alien who is illegal or legal in the country but has been in the United States for less than five years may not be eligible for Medicaid, depending on the state, although they may be eligible for medical emergency services. Aliens who are not US citizens but who are legal permanent US residents may qualify for full Medicaid benefits if they have lived in the US for five years. This requirement is often waived for refugees and asylum seekers.

What is a Health Insurance Exchange?

 

Health insurance exchange

health insurance exchange

A health insurance exchange is a platform that is used to help consumers identify healthcare plans that can be purchased and who are also allowed to provide services in the jurisdictions where they reside. Platforms of this type can be provided by state or national health regulatory agencies or government departments which are responsible for ensuring all citizens have up-to-date and complete information on health insurance options available to them. This type of program is especially useful if applicable laws and regulations require all citizens to have access to health care coverage that is considered affordable for various income groups represented in the general population.

Two main functions of health insurance exchange

Two main functions of health insurance exchange

There are two main functions, such as a health insurance exchange. One function is to ensure that citizens have easy access to a list of insurance companies that meet the basic ethics standards and the scope of services is considered acceptable by jurisdiction. Individuals and families looking for sustainable health care plans can often use an exchange to be sure that a given healthcare provider plan is approved for delivery to people living within a particular geographical area and that the chances of the insurance company failing to honor claims that within the terms and conditions of these plans are kept to a minimum.

Along with providing citizens with current health care provider information that meets the minimum requirements that state or national government health insurance exchanges also work to provide authorized providers continue to meet these standards after incorporation into the listings. This involves periodic review of each provider to ensure that no changes in form or other factors that have occurred that indicate a plan no longer meet minimum standards and should be removed from the list. In addition, new plans can be added from time to time, giving consumers more opportunities for health insurance.

The actual rules governing a health insurance exchange may vary from one jurisdiction to the next. This means that a provider can meet the requirements of one state health insurance exchange but not be eligible for listing in another state. Similarly, some providers may be part of a national health insurance exchange associated with a country but do not meet the minimum standards for admission to another nation. For consumers who are required by law to maintain health insurance of a type that takes the time to consider all options listed on the stock exchange, including the extent of coverage, the cost of insurance premiums and the supply of doctors and health facilities, to accept a given insurance plan , will make it much easier to achieve coverage, and lock in the highest quality of healthcare possible.

What is Health Insurance Fraud?

Health insurance fraud

Health insurance fraud

Fraudulent behavior can be resolved within a health insurance context such as any behavior designed to request money that a person or group is not entitled to. There are so many types of health insurance fraud it would be difficult to name them all. This is especially the case because health insurance fraud perpetrates by a variety of sources, including health insurance companies, insurance brokers, unscrupulous doctors, chiropractors, ally health professionals, medical institutions, and patients.

Some examples of institutional or health education led health insurance fraud include forgery of information in forms. This is not always intended for the personal benefit of the healthcare professional or the institution. Sometimes, a doctor may omit information on forms that would lead a patient not to receive treatment due to an existing condition, or a hospital, will change the time of admission slightly so a patient is not charged for a full day. Although these actions are good sense, they are nevertheless false because they do not accurately report to the patient’s insurance company.

Intentional health insurance fraud

Intentional health insurance fraud

Intentional health insurance fraud does not even have this excuse to try to help a patient. Instead, doctors can ally healthcare professionals or hospitals file false claims, claim treatments for patients who never took place, fill out prescriptions under patient names, and then sell them on the black market, diagnose non-existent diseases, and order unnecessary trials. Occasionally, a medical worker is working in pursuit with a personal injury lawyer to forge medical reports, in which case more than one type of insurance fraud can be perpetuated.

Health insurance companies or brokers can also commit various forms of health insurance fraud. The largest of these is not paying for legitimate claims. Some companies must deliberately refuse payment in the hope that applicants will not protest the treatment. They may also refuse based on reasons that are unfounded or illegal, but may change their decisions if people want to investigate denial. Routine misleading information of the cover may fall under the health insurance fraud umbrella as well. When insurance representatives do not truthfully disclose information about what is covered, which can happen, they can deceive their clients by avoiding payment, or by preventing customers from getting treatments they need, which are really covered by their insurance.

Alternatively, some “health insurance companies” or “brokers” are not really legitimate and instead fraudsters are looking to make a quick buck on people who are desperate for health insurance. They have no intention of paying claims and just wanting to collect their money. An additional form of health insurance fraud is false allegations of what is being sold. For example, health discount schemes are not insurance. When represented as insurance, this can be a fraudulent act. Sale of insurance in a state where a company is not licensed to operate is fraud.

Finally, patients can commit health insurance fraud in a variety of contexts. They could make false claims about occupational diseases for a number of reasons. If an insurance company requires any kind of physical, and the patient does not provide accurate information, this may be considered fraud and may invalidate coverage. Also, patients who are willing participants in fraudulent acts of doctors or facilities that misreport information can be a feast of fraud and be prosecuted.

Medicaid guidelines income in Pennsylvania

Families with children or pregnant women

Families with children or pregnant women

income guidelines are determined by a comparison a family income with federal poverty income guidelines for the current year. Families with pregnant women and / or children under the age of 1 should not be eligible for income equal to or less than 185 percent of federal poverty income. Families with children between the ages of 1 and 5 must have an income that does not have more than 133 percent of federal poverty income guidelines. Finally, families with children between the ages of 6 and 19 should be eligible for Medicaid income equal to or less than Federal Poverty Income guidelines.

Elderly people, who are blind or disabled

Elderly people, who are blind or disabled

Medicaid benefits people who are “elderly” (age 65 or older) or who are blind or disabled related to Social Security income benefits. In order to qualify for Medicaid under this category, a person must be a recipient of social security and either age or legally blind or disabled. the applicant’s income must be equal to or less than the Federal Poverty Income Guidelines.

People with limited income or special circumstances

People with limited income or special circumstances

Families eligible to receive benefits under Temporary Assistance for Temporary Families (TANF) program qualify to receive Medicaid benefits if the family’s income is equal to or less than 25 percent of Federal Poverty Income Guidelines. Under this arrangement, children of the needy family receive full Medicaid benefits, while adults will have access to a more limited benefit plan.

Medicaid benefits are also available to adults with disabilities. Adults who are permanently disabled, according to Social Security Administration standards, can receive full Medicaid benefits as long as they do not have an income that exceeds the Federal Income Guidelines Poverty.

Workers between the ages of 16 and 64 will temporarily qualify for Medicaid benefits as long as the disability is documented and meet Social Security Administration standards, and the worker’s income is equal to or less than 250 percent of Federal Poverty Income guidelines.

Calculation of Income

Calculation of Income

Types of income that will be included in eligibility are wages, interest, dividends, Social Security and veteran benefits, pensions, and spouse’s income. For purposes of determining eligibility, benefits from Temporary Assistance for needy families program, as well as benefits from the Low Income Home Energy Assistance Program, food stamps, foster care payments, certain other housing or utility grants, and weatherization payments will not be included in calculating an applicant’s income.

Medicare Australia

 

Medicare is the name of the health insurance system in Australia. However, this is not only accessible to the residents of Australia itself, but also to travelers from selected countries including the Netherlands! Applying for this pass is completely free and can save you a lot of costs if you have to go to the doctor or the hospital. Please note, it does not replace your travel insurance that you take out in the Netherlands! Costs such as ambulance transport are not reimbursed in the Medicare program. See it as a handy side-issue for smaller matters. 

Compile your own trip to Australia?

Compile your own trip to Australia?

Do you want to travel individually, go your own way on site, and with the certainty that accommodations and activities are arranged? Travel organization Jacksaw Australia offers an extensive travel program with building blocks that you can combine yourself. Experienced travel specialists who have traveled extensively in Australia are happy to help you build your own journey.

REQUEST MEDICARE

REQUEST MEDICARE

You can apply for a Medicare card at one of their offices. On their website you can find exactly where the offices are located. All you have to do is fill in a form and bring the following documents: 

  • Two different ID proofs passport + ID card / bank card
  • Your Dutch insurance card and policy papers
  • Copy of your Working & Holiday Visa ./ Tourist visa
  • Address where the pass can be sent

When all papers have been completed, you will receive a temporary pass (type of receipt) that you can use if you want to use Medicare in the meantime. Depending on the crowds, they will indicate when you can approximately expect the pass. 

You can also take your Dutch EHIC (European health insurance card) with you. With this pass you can also apply for an Australian medicare pass, which entitles you to medically necessary care in Australia. 

PAYING / RECLAIMING COSTS INCURRED

PAYING / RECLAIMING COSTS INCURRED

When you go to the doctor or hospital you always have to take the Medicare pass. To be sure, always take your passport with you. You may not have to pay anything and everything will be paid directly by Medicare. But it can also happen that you have to advance the total amount yourself and can then reclaim this via one of the designated Medicare offices. Keep in mind that you will not always get the full 100% back. For example, if you need vaccinations because you are going to make an unexpected trip to Asia, you will also receive a large part of this back through Medicare. After all, every euro that you get as a backpacker is a bonus.

NEED HELP WITH ORGANIZING YOUR AUSTRALIA TRIP?

NEED HELP WITH ORGANIZING YOUR AUSTRALIA TRIP?

Sometimes it can be useful to have a good organization behind you for such a long journey. Rickshaw Australia can help you put together your own journey, in which you determine your own route entirely: via the well-known roads or on trackless paths. If you have any questions, before or during your trip, you can fall back on a Dutch organization. Together with the travel specialists you will find out what suits you best. You discover the real Australia in its own way.