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What you need to know about your loved one's health insurance

Lupus Foundation of America

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Health insurance covers an insured person’s medical and surgical expenses. Whether they have private health insurance or public health insurance, like Medicare or Medicaid, it’s important for you and your loved one to feel knowledgeable about your loved one’s coverage. Review their health insurance policy together. You should have easy access to policy numbers, claim forms, and contact information. Keep a file with benefit summaries, any out-of-pocket costs that may occur, and insurance premium costs for tax purposes and financial planning.  If the technical language used in written policies is difficult to understand, discuss the policy with an insurance agent.

If your loved one does not have health insurance, this is a good time to research the different options available, and to consider signing up.

Insurance information that you should know: 
  • Services that are covered, and not covered, in the policy.
  • Prescriptions that are covered and not covered in the policy, including any medications that fall into special tiers.
  • If the coverage applies to a specific network of doctors and hospitals.
  • If outpatient services (services provided in a medical center without an overnight stay) are covered
  • Specific coverage limitations
  • Deductibles and out-of-pocket expenses (percentage of healthcare costs not covered under the policy), and annual insurance premiums, to help you with financial planning.
  • Policies associated with long-term disability, long-term care or life insurance, if your loved one requires it.
  • Filing a claim (most policies include information about filing a claim).

Medicare

Medicare is a federal health insurance program, for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease. Caregivers should be familiar with:

  • What Medicare covers and the different types of coverage
  • The claims process
  • Out-of-pocket costs that my occur
  • Supplemental insurance plans

Social security disability

If the person that you are caring for is already receiving social security disability benefits or supplemental security income benefits (Medicaid), payment information should be carefully maintained to help with planning a financial budget and tax purposes. If not, then information about social security disability benefits can be requested and added to your loved one’s file. Applying for benefits will be less difficult when prepared.

  • According to Federal law, “Social Security pays disability benefits to you and certain members of your family if you have worked long enough and have a medical condition that has prevented you from working or is expected to prevent you from working for at least 12 months or end in death. “
  • The vast majority of applications for Social Security disability will be denied. Persons applying for disability should be familiar with the appeals process.
  • A disability starter kit may be helpful. 
  • A legal representative can help guide the process.