Health Insurance Options for Immigrants to USA

美国移民医疗保险的选择

September 27, 2011

By Howard Houghton

Fairfax County VICAP Program

2011年9月27日
霍华德·霍顿 费县VICAP计划

中文翻译 王焕燈 2011/9/23日

OVERVIEW

· There are very few options for affordable health care for new immigrants to the USA. We will discuss the options generally available to most county residents.

· The state Medicaid program generally requires citizenship status for all new enrollees effective January 1, 2006.

· The federal Medicare program requires a legally qualified alien to be living in the USA for 5 years prior to being eligible to buy into that program.

· The Fairfax County Community Health Care Program has a 9-month residency requirement.

· Private/individual insurance is very expensive.

· For prescriptions coverage try www.needymeds.org

概述

• 对于来美国的新移民，负担得起的医疗服务只有极少数选择。我们将讨论本县多数居民一般可获得的选择。
• 对于2006年1月1日起生效的所有新参保者，州医疗补助计划( Medicaid program)一般都要求有公民身份。
• 联邦医保计划要求合法的外国人在美国居住5年方有资格购买加入该计划。
• 费县社区医疗服务计划还有(在本县)住满9个月的要求。
• 私营的个人保险是非常昂贵的。
• 对于处方药承保，请尝试www.needymeds.org.

Medicaid

· Medicaid is a state health program that helps pay for medical care.

· To be eligible you must have limited income and resources.

• You must also be in one of the covered categories of people covered by Medicaid. Some of those categories include people with disabilities; people who are blind; and people age 65 or older.

医疗补助计划（Medicaid）

• 医疗补助计划是一种帮助支付医疗保健费用的州卫生计划。
• 欲符合资格，您须是有限收入和有限资产。
• 您还须是Medicaid所涵盖的承保类别人之一种，其中这些类别人包括伤残人、盲人以及65岁或65岁以上的老年人。

How Do I Apply?

· Contact one of the local Department of Family Services offices in Fairfax County. They are located in Alexandria, Fairfax, Falls Church and Reston. You can call 703-324-7500 for info and applications for various programs.

· You will need to complete an application that will ask about your income and assets; your U.S. citizenship and identity; or your alien status.

· A face-to-face interview is not required.

我该如何申请？

• 请与费县当地家庭服务部办公室联系。它们分别位于亚历山德里亚(Alexandria)，费尔法克斯(Fairfax)，瀑布教堂(Falls Church)和莱斯顿(Reston)。对各计划的资料和申请程序，您可致电703-324-7500。
• 您须完成将会向您问及有关您的收入和资产、美国国籍和身份状况、或您的外国人身份状况的申请程序。
• 无需进行面对面交谈。

When Does it Start?

· An eligibility decision will be made on your completed application within 45 days.

· Medicaid coverage starts on the first day of the month in which you apply and are found to be eligible.

· Medicaid coverage can start as early as three months before the month in which you applied if you meet all eligibility requirements and received a medical service during that time.

医疗补助什么时候开始？

• 在您完成申请的45天内作出是否合格的裁决。
• 医疗补助承保自您申请并认为合格的这个月的第一天开始。
• 如您符合所有资格并在申请月份之前的3个月期间内接受过医疗服务，则医疗补助承保可提前到您申请月份之前的3个月。

How Do I Keep Coverage?

· Once approved for Medicaid, coverage will continue for 12 months, provided that all of the eligibility requirements continue to be met.

· If you are notified to complete a form or send in proof of income or resources, it is very important that you do so immediately. If you fail to do so your coverage will be cancelled.

· One common problem is not realizing that if you leave the state you need to notify Medicaid to close your case. If they were paying your Medicare premium you will now be responsible for it. Be aware!

我如何保持医疗补助的承保？

• 医疗补助(Medicaid)一旦经批准，若合格性要求持续满足，则承保将持续12个月。
• 如果通知您填写表格或寄送收入或资产证明，非常重要的一事是立即照办。如不照办，您的承保会被取消。
• 通常没有意识到的一个问题是：如您离开本州，您须通知医疗补助部门关闭您的个案。如果它们给您支付了联邦医疗保险的保费，那您现在得为此承担责任。务请注意！

What Is Covered?

· Physician Services

· Hospital Care

· Home Health Services

· Durable Medical Equipment

· Nursing Facility Care

· Prescription Drugs, unless you are on Medicare Part D.

· Plus More Services listed in the Medicaid handbook or online at www.dmas.virginia.gov

医疗补助(Medicaid)覆盖哪些范围？

• 医生服务
• 医院护理
• 居家(在家)健康服务
• 耐用医疗设备
• 护理所的护理
• 处方药，除非您已有联邦医保 Part D
• 另还有医疗补助手册或www.dmas.virginia.gov 网上所列的服务。

Limited Coverage Groups

· Individuals who are eligible for Medicare & meet one of the following covered groups may receive limited Medicaid coverage. Medicaid pays the Medicare costs on behalf of these beneficiaries as indicated. These are called Medicare Savings Programs (MSP).

· Qualified Medicare Beneficiary (QMB): must be entitled to Medicare Part A. Income must be at or below 100% of the Federal Poverty Guidelines ($928 single/$1246 couple) and resources must be at or below $6,680 for a single person and $10,020 for a couple. If eligible, Virginia will pay for the Medicare Part A and B premiums and the coinsurance and deductibles that Medicare does not pay.

有限的保险人群

• 符合联邦医保(Medicare)资格并满足如下所列的保险人群之一种者，可能获得有限的医疗补助承保。医疗补助计划将为这些受益人支付联邦医保的费用。这类人被称为联邦医疗保险储蓄计划 (MSP)。
• 合格的联邦医保受益人 (QMB)：他们必须享有联邦医保 Part A资格。收入必须处在联邦医保贫困线或在100%联邦贫困线以下(该贫困线标准是： 单人$928/夫妇$1246)，而资产必须是单人$6680或以下，夫妇$10,020或以下。如合格，维州将支付联邦医疗保险 Part A 、Part B的保险费和共保费以及联邦医保所不支付的抵扣额 (即垫底费)。

Limited Coverage Groups

· Special Low-Income Medicare Beneficiary (SLMB): Must be entitled to Medicare Part A. Income must be between 100% and 120% of the Federal Poverty Income Guidelines ($1,109 single/$1,491 couple) and resources must be at or below $6,680 for a single person and $10,020 for a couple. If eligible, Medicaid pays the Medicare Part B premium.

有限的保险人群

• 特殊低收入联邦医保受益人(SLMB)：必须享有联邦医保 Part A资格，收入必在联邦贫困线的100%～120%之间（单人$1109/夫妇$1491）而资产必须处在或低于$6,680(单人)和$10,020(夫妇)。如符合条件，医疗补助计划将支付联邦医保 Part B的保险费。

Limited Coverage Groups

• Qualified Individual-1 (QI-1): Must be entitled to Medicare Part A. Income must be equal or exceed 120% but be less than 135% of the Federal Poverty Income Guidelines ($1,246 single/$1,675 couple) and resources must be at or below $6,680 for a single person and $10,020 for a couple. If eligible, Medicaid pays the Medicare Part B premium.

有限的保险人群

• 合格的QI-1类个人：必须享有联邦医保 Part A资格，收入必须处在120%～135%的联邦贫困线区间（即单人$1246/夫妇$1675）而资产必须等于或低於单人$6,680/夫妇$10,020。如符合条件，医疗补助计划将支付联邦医保 Part B 保险费。

Medicare

· The law requires a legally qualified alien, with a green card, to live for five uninterrupted years in the USA prior to becoming eligible for Medicare. The person may apply for Medicare during the General Enrollment Period between January 1 and March 31 of any year, with an effective date of the next July 1^st. They can also apply during their Initial Enrollment Period, any time during the three months prior to reaching age 65 through the third month after reaching age 65.

· Generally, a person must reach age 65 to be eligible though persons who have been receiving Social Security disability for two years can apply for Medicare at that time.

联邦医疗保险(Medicare)

· 联邦医疗保险法要求，合法外国人、持有绿卡，在美国不间断地住满5年方有资格享受联邦医保。这种人可在任何年份的1/1日～3/31日的一般加入期里申请联邦医保，其生效日为接下来的7月1日。他们也可在其初次登记期间，亦即达到65岁前的3个月至65岁后的3个月内的任何时间申请。

· 一般说，必须达到65岁的人才有资格，但已领取社安伤残两年的人即可随时申请联邦医疗保险。

Medicare

· You apply for Medicare Parts A and/or B at the Social Security office; online or over the phone. It’s best to have an appointment to apply in person.

· You should call the Social Security toll-free number at 1-800-772-1213 to schedule an appointment.

· Part A has premiums unless you have earned 40 qualified work quarters. Without work quarters it costs $450 monthly for Part A in 2011.

· Part B has a base premium of $115.40 for new enrollees.

· You can call Medicare at 1-800-633-4227 to ask any questions about that program. They have interpreters available in many languages.

联邦医疗保险(Medicare)

• 您可在社会保障办公室、在线或在电话上申请联邦医疗保险 Part A 和/或 B。但最好是亲自做预约申请。
• 您应打电社保免费电话1-800-772-1213 安排预约时间。
• Part A需交纳保费，除非您已有40个合格季点，否则2011年的Part A月保费是$450。
• 对于新参保者，Part B 的基础保费是每月 $115.40。
• 您可致电联邦医保1-800-633-4227，询问有关联邦医保计划的任何问题。他们有多种语言的口译员。

Medicare Parts C & D

· Beginning in 2006 Medicare introduced a medication benefit, commonly called Part D. It provides needed medications through private companies. There are about 30 plans in our area from which to choose. The average cost of premiums is about $40 monthly.

· Part C plans are commonly called Medicare Advantage. They are supposed to provide the same services as Medicare. Some offer limited dental benefits and other benefits, but are full of problems so be VERY careful enrolling in them. You can learn more about both types of plans at www.medicare.gov

联邦医疗保险Part C 和Part D

• 2006年开始，联邦医保推出用药福利，它通常称为Part D。该福利通过私营公司提供所需的药物。在我们(费县)地区约有30计划个可供选择。平均保费为每月约$40。
• Part C 通常称为“联邦医保优势计划(Medicare Advantage)”。据推测，它提供与联邦医保Medicare相同的医疗服务。其中有些计划还提供有限的牙科福利和其它福利，但问题多多，所以加入时要非常小心。您可在www.medicare.gov网上了解有关Part C 和 D这两类计划的更多内容。

Part C & D Financial Assistance

· Some persons qualifying for Part C or D may qualify for some assistance with the cost of their plan’s copayments, deductibles and premiums.

· Persons receiving Medicaid or in an MSP will automatically receive this help.

· Other persons may qualify for low-income assistance (LIS) by applying through the Social Security Administration. This can be done by application or online at www.ssa.gov.

· See Low-Income Subsidy handout.

Part C 和 Part D的经济援助

• 一些符合Part C 或 D资格的人可能也符合他们计划中的共付费、抵扣额(垫底费)和保费的某些援助。
• 获得医疗补助(Medicaid)或处在联邦医保储蓄计划(MSP)中的人将自动获得这种援助。
• 其他人可通过向社保局申请获取低收入补助(LIS)资格。这可通过www.ssa.gov网上申请或在线申请而进行。
• 请参看低收入生活补助(Low-income Subsidy (LIS))小册子。

Medicare Supplement Insurance

· Medicare supplemental insurance is meant to work in coordination with Medicare to pay for beneficiary cost sharing of medical expenses.

· You can obtain such coverage from a former employer as retiree health coverage or by buying an individual Medigap health plan.

· Federal law requires insurers to sell Medigap policies that are one of 10 standard plans. These plans are labeled with the letters A through N. Each plan offers various benefits.

联邦医保的补充保险

• 联邦医保的补充保险是指：与联邦医保协同为受益人支付医疗开支的费用。
• 您可从作为退休人员医疗承保的前雇主那里或通过购买个人的联邦医保填补空白计划(Medigap)而获得这种保险。
• 联邦医保法要求各保险公司推销10个标准计划中某一标准计划的Medigap保单。这些标准计划分别以A～N字母标识，每计划福利不同。

Medicare Supplemental Insurance

· Medigap policies pay most, if not all, of traditional Medicare’s coinsurance amounts and in some cases deductibles.

· These plans cost more as you get older. The cost for a good plan at age 65 would be about $115 monthly.

· For more data about Medigap go online to: www.scc.virginia.gov/boi .

联邦医保的补充保险

• Medigap保单支付联邦医保的传统的共保额和某些情况下的垫底费，其支付额即便不是全部也是大部。
• 这些Medigap计划，随着您的年龄增大而变得更贵。对于一个好的计划，65岁时的保费将是每月$115左右。
• 有关Medigap计划的更多资料，请上网：www.scc.virginia.gov/boi

Long-Term Care Costs

· Long-term care is a term used when a person needs care on a long-term basis, whether while in a nursing facility or in their home.

· The type of care normally needed during this time is usually custodial care such as bathing, feeding or dressing rather than skilled nursing care. Medicare does not pay for unskilled care unless it is being received in conjunction with skilled care.

长期护理的费用

• 长期护理是当一个人需要长期照护时所使用的一种术语—不管是在护理所或居家的护理。
• 在此期间需护理的类型通常是监管性护理，如洗澡、喂食或梳妆而不是专业护理。联邦医疗保险不支付非专业性护理的费用，除非它是和专业护理一起而获取的。

Long-Term Care Costs

· The majority of LTC costs are paid by the state Medicaid program but you need to have a very low income and very low assets to qualify. You should contact your local Dept of Family Services to apply for LTC Medicaid.

· Fairfax County residents would call 703-324-7504. You can also learn more online at www.dmas.virginia.gov .

· You can buy LTC insurance to cover such costs. This insurance is very costly. You can find such plans at www.scc.virginia.gov/boi .

长期护理的费用

• 长期护理(LTC)的多数费用由州医疗补助计划支付，但您须符合非常低收入和非常低资产资格。申请长期护理的州医疗补助，您应与当地家庭服务部联系。
• 费县居民可致电703-324-7504。您也可在www.dmas.virginia.gov上了解更多在线信息。
• 您还可购买长期护理保险来承保这种费用。但这种保险非常昂贵。您可在www.scc.virginia.gov/boi 上找到这种保险的计划。

Community Health Care Network

· The Fairfax County Health Department offers 3 clinics that provide health care services to lower income residents. You must not have other health coverage; meet income guidelines; and be a resident of the county for 9 months prior to applying except in rare circumstances.

· Clinics are located in Alexandria, Falls Church and Reston. Call 703-246-2411 for more details.

· All household income in counted for eligibility.

· There are some other health clinics not administered by the county that also provide some medical services. Please refer to the list of clinics found at www.needymeds.org .

社区医疗服务网

• 费县卫生署有3个诊所为较低收入居民提供医疗服务。您必须没有其它医疗保险；符合收入标准线；且在申请前已在本县住了9个月的居民，少数情况例外。
• 这些诊所设在亚历山德里亚(Alexandria)、瀑布教堂(Falls Church)和莱斯顿(Reston)。更多详情请致电703-246-2411。
• 所有家庭收入均视为是否合格的条件。
• 还有一些不受本县管辖的其他诊所，他们也提供一些医疗服务。请参看www.needymeds.org 网上所列的诊所表。

Private/Individual Insurance

· If you are not eligible for Medicare, Medicaid or the Community Health Care Network then you need to consider purchasing a private health plan. Such plans will cost several hundred dollars or more monthly.

· You can locate the names of insurance companies in the phone book or by going online to the Virginia Bureau of Insurance at the following web address: www.scc.virginia.gov/division/boi/webpages/boiindividhealthinscoverage.htm

私营的个人保险

· 如您不符合联邦医保(Medicare)、州医疗补助(Medicaid)或社区医疗服务网(Community Health Care Network)的资格，那您便需考虑购买一种私营的医疗计划。这种计划每月费用在几百美元以上。

· 您可通过电话簿或联网到维州保险局的网址：www.scc.virginia.gov/division/boi/webpages/boiindividhealthinscoverage.htm 找到保险公司名单的地址。

Needy Meds

· If your most pressing health care problem is finding low cost prescriptions you can try to find low cost generic medications at Wal-Mart, Giant, Target or some other store.

· You should also look at www.needymeds.org.

· Needy Meds is a clearinghouse for the drug manufacturer patient assistance programs. You can find free or low-cost medications on their site. If eligible, you usually receive a 90-day supply of medications at no cost.

穷困药

• 如果您最迫切的医疗服务问题是寻求低廉处方药，那您可在沃尔玛(Wal-Mart)、巨人(Giant)、塔基(Target)或某些其他店尝试寻找低廉仿制药。
• 您还应查看www.needymeds.org。
• 穷困药是药品生产企业患者援助项目的交易中心。您可在他们网站上找到免费或低廉的药物。如符合资格，您通常可收到90天服用的免费药。

QUESTIONS ???

· It takes proper planning to arrange these services. Phone numbers for various offices are located in this presentation.

· Please ask questions before enrolling in any health plan so you know what you are joining.

· You can always contact the VICAP program at 703-324-5851 with questions.

· Thank you for your time and patience.

有问题吗？？？

• 安排这些服务需有适当的规划。各办事处的电话号码列在本演示文稿内。
• 请在加入任何医疗计划前多提问，以便知晓您正在加入的是什么计划。
• 有问题您可随时致电703-324-5851与维州保险资讯和援助计划(VICAP)联系。
• 谢谢大家光临（医保报告会）和耐心。 （完）