Page 18 - Diabetes

company outside of the government gram authorized in 1965 that covers only Medicare options that offer both
marketplace. These plans, which go the cost of hospitalization, medical health and prescription drug coverage
by many different names, may or may care and some related health services in one plan.
not meet all of the same minimum for most people over age 65 and certain Part D: These plans (sometimes
requirements as plans sold through other eligible individuals. There are called Prescription Drug Plans (PDPs))
the marketplace. In addition, you will multiple parts of Medicare. add drug coverage to Original Medi-
not be able to get federal subsidies to Part A: Hospital insurance care. The plans cover insulin not used
help pay the premiums for these pri- Part B: Medical and outpatient in a pump, certain medical supplies to
vate health plans. These are the main insurance (A and B constitute Original administer insulin (syringes, needles,
types of plans. Medicare). People with diabetes are alcohol swabs and gauze), inhaled
Health maintenance organization concerned with Part B, which covers insulin devices, glaucoma tests, foot
(HMO): Covers only care provided by the following: most medically neces- exams and treatment. They are offered
doctors and hospitals inside the HMO’s sary doctors’ services, preventive care, by private insurance companies con-
network. Patients are usually required durable medical equipment, hospital tracted with the government. Medicare
to get a referral from their primary care outpatient services, laboratory tests, beneficiaries may already have drug
physician to see a specialist. X-rays, medical nutrition therapy, dia- coverage from an employer or union
Preferred provider organization betes self-management training, con- of TRICARE (military health plan, the
(PPO): Covers care provided by both tinuous glucose monitoring, mental Department of Veterans Affairs (VA),
in-network and out-of-network provid- health care, insulin used in insulin the Indian Health Service or a Medi-
ers, but patients usually pay a higher pumps, external insulin pumps, blood care Supplement Insurance (Medigap)
percentage of the cost for out-of-net- glucose meters, test strips, lancets, lan- policy). If this is the case, it’s best to
work care. cet devices, glucose control solutions, compare your current coverage to the
Exclusive provider organization therapeutic shoes and inserts, and Medicare drug coverage. The drug
(EPO): Similar to HMOs. Health care some home health and ambulance ser- coverage you already have may change
received by out-of-network providers is vices. You do pay a monthly premium because of Medicare drug coverage, so
not covered, but patients may not need for this coverage. consider all your coverage options for
a referral to see a specialist. Part C: Medicare Advantage Plans. the specific prescription medications
Point of Service (POS) plan: Hybrid These plans are offered by private you take for your diabetes. Also note
of an HMO and a PPO. A referral to insurance companies that contract with that your Medicare Advantage Plan
see a specialist may be required, but the government. They provide hospi- (Part C) will disenroll you and you’ll
coverage for out-of-network care may tal and medical benefits included in go back to Original Medicare if both of
also be available with higher out-of- Original Medicare coverage (with the these apply: 1) your Medicare Advan-
pocket costs. exception of hospice care) and cover tage Plan includes prescription drug
Medicare: National, federally additional health benefits beyond Orig- coverage and 2) you join a Medicare
administered health insurance pro- inal Medicare. Currently, they are the Prescription Drug Plan (Part D).

TABLE 2: KEY DIFFERENCES BETWEEN HSAs AND FSAs

FOR 2018 HEALTH SAVINGS ACCOUNT (HSA) FLEXIBLE SPENDING ACCOUNT (FSA)
Ownership Employee Employer
Eligibility Must have high-deductible health plan (HDHP) None
Contributions: • Individual: $3,450; family: $6,900 Employee contribution limit is $2,650. Employer could either provide
employer + • HDHP minimum deductibles: individual: matching contribution or limit its annual account contribution to $500.
employee $1,350; family: $2,700
• HDHP maximum out-of-pocket amounts (deductibles,
copays, other amounts, but not premiums): individual:
$6,650; family: $13,300
Contribution Can change your contribution any time during Can be changed only at open enrollment or with change in employment
amount change the year or family status
Rollover of Can roll over into the next year Can roll over up to $500 of unused FSA dollars to next year, but anything
unused balance over $500 at year end is forfeited. May have additional 2½ months
(through March 15) to incur new expenses using prior-year funds.
New employer Can go with you when you change employers Lost with job change, unless you are eligible for FSA continuation
through COBRA
Contribution Contributions are tax-deductible; can also be Contributions are pretax; payments made out of FSA are untaxed.
and taxes taken out of your pay pretax.

16 March/April 2018