What You Need to Know About Medicare and Medicaid

When considering affordable health insurance, you have likely heard of Medicare and Medicaid. These government-funded programs are frequently misunderstood. This is not ideal, especially when not knowing what they are or offer can prevent you from getting the care and support you need. Keep reading to learn the differences between Medicare and Medicaid.

What Is Medicare?

Medicare is a program that provides healthcare for Americans age 65 and older and people living with a disability. While Medicare assists with medical costs, it does not fully cover all care, such as long-term care. This program is the main health care insurance company for older Americans. Medicare consists of four parts, including Part A, B, C, and D. These parts cover different health expenses for those that qualify.

Medicare Eligibility Requirements 

Check out the Medicare eligibility requirements below. 

  • Be a U.S. citizen.
  • You are 65 or older.
  • You are living with a disability.
  • You have been diagnosed with end-stage renal disease.

Medicare Enrollment Options

On average, around 10,000 U.S. citizens enroll in Medicare. There are specific enrollment time periods, which are important to be aware of. 

  • Initial Enrollment Period – People have a seventh month window around their 65th birthday to sign up for Medicare. This enrollment window opens three months before their birthday and then ends three months after their birthday month. It’s recommended to enroll during this early period, so you can avoid any late enrollment penalties.
  • General Enrollment Period – The general enrollment period is from January 1st to March 31st every year. If you sign up for Medicare during this period, coverage will start on July 1st of the same year. It’s possible that you may pay a higher Part A or B premium for not enrolling during the initial period. 
  • Special Enrollment Period – If you are 65 or older and still working, you can enroll at any time you’re still covered in a group health plan or eight months after your coverage ends. This enrollment period is also for seniors that are considering retirement.

Enroll in Medicare

If you do not receive Social Security benefits, but want to enroll in Medicare, visit the Social Security Administration’s Benefits. Or, you can enroll over the phone at 1-800-MEDICARE. After you are enrolled in this program, you will be mailed a red, white, and blue card and welcome packet.

What Does Medicare Cover?

Medicare is broken up into four main sections. The federal government manages Part A and Part B, while private companies contracted through the government manage Part C and Part D. Let’s take a look at what each part covers next.

Medicare Part A

Medicare Part A covers hospital and hospice services. This includes inpatient, hospice, and home health care, as well as short-term care in skilled nursing facilities. Seniors qualify for premium free Part A if they are 65 or older and they worked (or their spouse worked) and paid Medicare taxes for at least a decade.

Typical Hospital Costs Part A Covers:

  • Drugs for inpatient treatment
  • General nursing care
  • Meals
  • Other hospital services and supplies as needed for inpatient treatment
  • Semi Private rooms

Medicare Part B

Medicare Part B covers preventative and medically necessary care. You will likely pay a premium for this coverage every month. This will be deducted from your check if you receive a Social Security check. For those not receiving Social Security, you will receive a bill in the mail for this care.

Services Covered By Part B

  • Ambulance transportation
  • Durable Medical Equipment (DME)
  • Screenings
  • Vaccinations
  • Wellness visits every year

Medicare Part C (Advantage Plans)

These plans are offered through private companies that provide coverage to people through Medicare. Several plans provide dental, drug, hearing, and vision services for seniors. The con of this part C is that most plans require you to see doctors that are in network. This limits the number of options you have in your area, unless you can pay high costs for out of network care.

Medicare Part D

Medicare Part D provides coverage for prescription drugs. Enrollment dates are April 1st to June 30th, which would start your coverage on July 1st. When signing up for other types of Medicare, ask about what services are offered. You may discover that some plans cover prescription drugs.

Medigap (Supplement Health Insurance)

Medigap helps cover copays for Medicare Part A and B, as well as any deductibles. While this supplement health insurance doesn’t cover dental, vision, or long-term care, it can help cover healthcare costs when you are out of the country. If you are currently enrolled in a Medicare Advantage plan, you cannot also enroll in Medigap.

What Is Medicaid?

Medicaid is a health care program offering coverage to low-income individuals. While there are federal guidelines to follow, Medicaid services and coverage are operated by individual states. It’s not uncommon for some seniors to qualify for Medicare and Medicaid.

Medicaid Eligibility Requirements

Your eligibility for Medicaid is based on your family’s income, size, and your age. If you have a disability, this also is considered when applying for this program. Since Medicaid requirements change every year, it’s possible that you and your family may qualify after not meeting the requirements during a previous year. 

How to Apply for Medicaid

To apply for Medicaid, there are two options. You can contact your state’s Medicaid agency or fill out an application at www.healthcare.gov. It’s recommended to fill out applications online

What Does Medicaid Cover?

While each state operates their own Medicaid program, there are still federal government guidelines that must be met. There may be additional benefits offered, but it depends on the state you live in. It’s recommended to contact your local Medicaid office to determine which benefits are offered in your specific state.

The Federal Government Requires State to Offer These Medicaid Benefits

  • Birth center services
  • Certified pediatric and family nurse practitioner services
  • EPSDT (early and periodic screening, diagnostic, and treatment services)
  • Family planning services
  • Federally qualified health centers
  • Home health services
  • Inpatient hospital care
  • Laboratory and x-ray services
  • Nurse midwife services
  • Nursing facility care
  • Outpatient hospital care
  • Physician care
  • Rural health clinic services
  • Tobacco cessation counseling for pregnant women
  • Transportation services for medical appointments

As you can see, there are major differences in Medicare and Medicaid in terms of who receives benefits, qualifications, and what services are provided. If you are considering affordable health care, we encourage you to research your options to find the best care for your needs. Contact Liberty Healthcare and Rehabilitation Services to learn more about our services, including everything from short-term care to long-term care.