Health Insurance - What's Special About It?

TYPES OF HEALTH INSURANCE PLANSrequired to provide speech-language pathology and
AVAILABLEaudiology services.
In order to understand your health insurance coverage,To ascertain the coverage in your health insurance
you must first be able to identify what type of healthstate, you should contact the state Medicaid agency.
plan you may have. There are 3 different health plansFor children under the age of 21, the Medicaid law
available to consumers:requires the states to provide hearing screenings and
PRIVATE HEALTH INSURANCE PLANSassessment of communication skills and language
AVAILABLEdevelopment as part of the Early and Periodic
Typically, a health insurance benefit plan is a contractScreening, Diagnostic and Treatment (EPSDT) service.
between your employer and a third party (anBased on the findings of this screening, the state must
insurance company). These contracts vary widelyprovide services and related devices such as hearing
depending on the benefits and coverage levelsaids and AAC devices to treat or ameliorate the
negotiated by your employer. Oftentimes, the benefitscondition. Medicaid recognizes the importance of
information provided by your health insurance plan isschool-based speech-language pathology and
confusing-leaving you unsure of what speech and/oraudiology services although it is a medical assistance
hearing services will or won't be covered.program. The federal Medicaid program actually
Remember, the benefits booklet you receive is merelyencourages states to use their Medicaid programs to
a summary of benefits-not actual contract language.help pay for certain health care and health insurance
You may need to examine the policy or contract toservices delivered in the schools if federal regulations
truly understand your health insurance plan's coverageare followed. Contact your local school district to
and limitations. The policy or contract can be obtainedinquire if they participate in the Medicaid program.
from your benefits manager. It is vital that you reviewMEDICARE
the speech and hearing benefits information providedIn 1965, the Social Security Act established both
by your health plan and employer before you receiveMedicare and Medicaid. Medicare is the federal health
services.insurance program that is designated for those people
MEDICAIDwho are 65+ years of age. Although directed towards
Medicaid provides medical assistance to certaina specific age bracket, Medicare plans are also
individuals and families with low incomes andapplicable to certain disabled people.
resources. It is jointly funded by the Federal and StateMedicare covers most health insurance services for
governments. Although the federal governmentassessing and treating speech, language, swallowing,
establishes national guidelines, each state has thehearing and balance disorders. It covers most hearing
authority to establish its own eligibility standards forexaminations but it does not cover hearing aids or
health insurance, determine the type and duration andtests for hearing aids.
scope of services for health insurance, set the ratesMedicare has two major parts: Part A is hospital
of payments and administer the program. As part ofinsurance and is financed through federal taxes while
the plan, the state must offer medical assistance forPart B is supplementary medical insurance and has a
certain basic services to those living under the povertymonthlypremium.
level. For adults over the age of 21, the states are not