Medicare and Medicaid
Medicare is our country's health insurance program for people age 65 or older, certain people with disabilities who are under 65, and people of any age who have permanent kidney failure. It provides basic protection against the cost of health care, but it does not cover all medical expenses nor the cost of most long-term care. There are two ways to get benefits under Medicare - the traditional fee-for-services system or the managed care program. The Health Care Financing Administration is the agency in charge of the Medicare program, but the Social Security office helps you enroll in the program and will give you general Medicare information.
Part A & Part B
There are two parts of Medicare:
Part A: Hospital Insurance - financed by a portion of your payroll (FICA) tax that also pays for Social Security
Part B: Medical Insurance - partly financed by monthly premiums paid by people who choose to enroll
You are automatically enrolled in Part B when you become entitled to Part A. Because you must pay a monthly premium for Part B coverage, however, you have the option of paying for the coverage or turning it down. Each part of Medicare covers different kinds of medical costs, has different rules about enrolling and so on. For additional information view Your Medical Benefits (PDF), a guide to what Medicare covers and what you pay for your covered health care services and supplies.
Visit the Medicare website for more information on Part A & Part B.
Part D - Prescription Drug Coverage
Everyone needs to make a decision about prescription drug coverage. This coverage is offered through private plans. The Medicare prescription drug coverage pays for brand name and generic medications up to $2,510. Some plans have enhanced coverage.
Visit the Medicare website for information on Part D Prescription Drug Coverage.
Everyone who has Medicare is eligible to enroll in a plan. You can enroll during the initial enrollment period, which is three months before to three months after you turn 65. Plan costs and enrollment vary by year.
Visit the Medicare website for information regarding Plan Enrollment.
Medicare Advantage Plans
Medicare Advantage Plans, sometimes called Part C, are plans offed by private companies and approved by Medicare to cover Medicare Part A and Part B benefits. They may include drug coverage.
Visit the Medicare website for more information about Medicare Advantage Plans
Medicaid is a state-run program designed primarily to help those with low income and little to no resources. While the federal government helps to pay for Medicaid, each state has its own rules on eligibility and what is covered under Medicaid.
Visit the Medicaid website for more information on eligibility.
The federal Medicare program provides hospital insurance (HI), also known as Part A coverage, and supplementary medical insurance (SMI), also known as Part B coverage. Coverage for HI is automatic for persons age 65 and older (and for certain disabled persons) who have insured status under Social Security or Railroad Retirement. Coverage for HI may be purchased by individuals who do not have insured status through the payment of monthly Part A premiums. Coverage for SMI also requires payment of monthly premiums.
Medicare beneficiaries who have low income and limited resources may receive help paying for their out-of-pocket medical expenses from their state Medicaid program. There are various benefits available to dual eligible that are entitled to Medicare and are eligible for some type of Medicaid benefit.
For persons who are eligible for full Medicaid coverage, the Medicaid program supplements Medicare coverage by providing services and supplies that are available under their state's Medicaid program. Services that are covered by both programs will be paid first by Medicare and the difference by Medicaid, up to the state's payment limit. Medicaid may also cover additional services such as nursing facility care beyond the 100-day limit covered by Medicare, prescription drugs, eyeglasses and hearing aids.
It is important to know the differences between Medicare and Medicaid and what each will and will not pay for. For more information on these programs visit:
www.medicare.gov or www.medicaid.gov