Tag: Medicaid

For those unsure or unaware, Medicare and Medicaid are both government health insurance programs. However, they are still different programs, and therefore require different eligibility requirements and different coverage. Essentially, Medicare is a government program designed to provide health insurance coverage for the elderly and disabled. On the other hand, Medicaid is a needs program, which means that it exists to cover the healthcare costs for the very low income individuals.

Medicare is a purely federal government program attached to Social Security. It is available to citizens and certain other legal residents at the age of 65, and also covers people who are disabled under the Social Security guidelines. It is a 4-part program which covers hospitalizations through Part A, outpatient and doctors visits through Part B (more about parts A and B), potentially private plans (Medicare Advantage Plans) through Part C, and prescription coverage, through Part D (more about parts C and D).

Medicaid is a joint federal and state program that covers healthcare costs for low income individuals. Additionally, it covers long-term custodial care for poor and elderly individuals. There is a Medicaid program for each state in the U.S., and the federal government funds up to 50% of the costs of each state’s Medicaid program.

Read More about The Key Differences between Medicare and Medicaid

In my last blog, I discussed how to determine eligibility for Medicare Parts A and B. This blog today will focus on Parts C and D.

Medicare Part C, known as a Medicare Advantage Plan, replaces Medicare Parts A and B through a health insurance plan offered by a private insurer. In order to be eligible for a Medicare Advantage Plan, you must already be enrolled in Medicare Parts A and B and must reside in the service area of the insurer with whom you are seeking coverage.

Additionally, if you have a Medicare Advantage Plan you will not need a Medicare Supplemental Plan, as Advantage plans usually cover more than what Medicare Parts A and B cover.

The enrollment period for a Medicare Advantage Plan is the same as the initial enrollment period for Medicare Parts A and B. Alternatively, you can sign up during the Annual Election Period from October 15 to December 7, for coverage effective January 1^st of the following year. You can also enroll during a Special Election Period, if you qualify.

Medicare Part C is optional, and there is no penalty for choosing this alternative to the traditional Medicare Parts A and B. In addition, you will continue to make your Medicare Part B premiums even if you enroll in an Advantage Plan. Monthly rates and plan coverage will vary by the insurance company and your specific plan.

Medicare Part D, known as the Medicare Prescription Drug Plan, is prescription coverage and is available through private insurers, like a Medicare Advantage Plan, and it is completely optional. To be eligible to enroll in a Medicare Prescription Drug Plan you must have Medicare Parts A and B, and live in the service area for the plan in which you wish to enroll.

If you have any questions about Medicare and retirement benefits, it is recommended that you speak with experienced legal counsel to discuss your situation.