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Anyone Wants Health Insurance?
This article may just help you discover and find out how you as a consumer can understand
your health insurance plan as well as provide further contacts to assist you in understanding
and obtaining the health insurance coverage you need to receive speech and hearing services.
TYPES OF HEALTH INSURANCE PLANS AVAILABLE
In order to understand your health insurance coverage, you must first be able to identify what
type of health plan you may have. There are 3 different health plans available to consumers:
PRIVATE HEALTH INSURANCE PLANS AVAILABLE
Typically, a health insurance benefit plan is a contract between your employer and a third party
(an insurance company). These contracts vary widely depending on the benefits and coverage
levels negotiated by your employer. Oftentimes, the benefits information provided by your health
insurance plan is confusing-leaving you unsure of what speech and/or hearing services will or
won't be covered.
Remember, the benefits booklet you receive is merely a summary of benefits-not actual contract
language. You may need to examine the policy or contract to truly understand your health
insurance plan's coverage and limitations. The policy or contract can be obtained from your
benefits manager. It is vital that you review the speech and hearing benefits information
provided by your health plan and employer before you receive services.
MEDICAID
Medicaid provides medical assistance to certain individuals and families with low incomes and
resources. It is jointly funded by the Federal and State governments. Although the federal
government establishes national guidelines, each state has the authority to establish its own
eligibility standards for health insurance, determine the type and duration and scope of services
for health insurance, set the rates of payments and administer the program. As part of the plan,
the state must offer medical assistance for certain basic services to those living under the
poverty level. For adults over the age of 21, the states are not required to provide speechlanguage
pathology and audiology services.
To ascertain the coverage in your health insurance state, you should contact the state Medicaid
agency.
For children under the age of 21, the Medicaid law requires the states to provide hearing
screenings and assessment of communication skills and language development as part of the
Early and Periodic Screening, Diagnostic and Treatment (EPSDT) service. Based on the
findings of this screening, the state must provide services and related devices such as hearing
aids and AAC devices to treat or ameliorate the condition. Medicaid recognizes the importance
of school-based speech-language pathology and audiology services although it is a medical
assistance program. The federal Medicaid program actually encourages states to use their
Medicaid programs to help pay for certain health care and health insurance services delivered
in the schools if federal regulations are followed. Contact your local school district to inquire if
they participate in the Medicaid program.
MEDICARE
In 1965, the Social Security Act established both Medicare and Medicaid. Medicare is the
federal health insurance program that is designated for those people who are 65+ years of age.
Although directed towards a specific age bracket, Medicare plans are also applicable to certain
disabled people.
Medicare covers most health insurance services for assessing and treating speech, language,
swallowing, hearing and balance disorders. It covers most hearing examinations but it does not
cover hearing aids or tests for hearing aids.
Medicare has two major parts: Part A is hospital insurance and is financed through federal taxes
while Part B is supplementary medical insurance and has a monthly
premium.
Medicare Part A helps cover hospital stays, limited skilled nursing facility care when daily skilled
services are needed, home health care and hospice care. Most services for speech, language,
hearing and related disorders such as those effecting swallowing and balance are covered in
these settings. Medicare regulations allow rehabilitation services when significant functional
progress is expected and/or maintenance care is needed.
Medicare Part B helps cover physician services, audiology testing services, outpatient hospital
services, rehabilitation agency services and comprehensive outpatient rehabilitation facility
services. Service for speech and related disorders are covered in these settings. Thanks for
reading.
And more from this great ebook....
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