Understanding Medicare and Medicaid Benefits: Health Insurance

Learn About Your Medical Insurance

Doctors with old couple

Many senior adults receive Medicare or Medicaid benefits, or both. Understanding what is covered by your benefits can be tricky. In any case, it's best to begin with a definition of each medical insurance program.

Medicare is a health insurance program specifically for those individuals who are over age 65 or who are blind or disabled. The United States government funds the Medicare program.

Medicaid is a health insurance program funded by both the United States Government and the states. Medicaid is designed for individuals and families with low income or those who are disabled. Medicaid is managed by the state in which an individual lives.

Although the government funds both programs, a significant difference is that Medicare is available to citizens regardless of their income level while Medicaid is only available to low-income individuals and families.

Medicare benefits can be divided into four categories:

  1. Part A--Hospital Insurance. Medicare Part A (along with Medicare Part B) is part of what is called the original Medicare plan. Part A helps cover inpatient care in hospitals, critical access hospitals, and short-term stays at skilled nursing facilities. It can also help with hospice and home health care expenses. It is important to note that Part A pays some, not all, of these expenses. Most recipients of Part A do not pay a premium for the benefit due to the Medicare taxes they paid while they were working. Individuals who did not pay Medicare taxes prior to receiving Medicare may be required to pay a premium.
  2. Part B--Medical Insurance. Medicare Part B (along with Medicare Part A) is part of what is called the original Medicare plan. Part B helps cover doctor bills, outpatient services, and other medical services. It may also help cover certain preventative services. It is important to note that Part B may not pay for all of these expenses. Most recipients of Part B pay a standard monthly premium.
  3. Part C--Medicare Advantage plans. These insurance plans are run by private companies and therefore offer more coverage choices. If a Medicare recipient opts for a Medicare Advantage plan, then their hospital and medical expenses will be paid through that plan and not through Part A or Part B. Recipients of Medicare Part C typically pay a premium.
  4. Part D--Prescription Drug plans. Individuals on Medicare can get prescription drug coverage through a Medicare Prescription Drug Plan or as part of a Medicare Advantage plan. This coverage helps with the cost of prescription medication. It is important to note that all prescription drug costs may not be covered. Recipients of Medicare Part D typically pay a premium.

Medicaid benefits vary from state to state, but they nearly always include inpatient hospital care, some outpatient hospital care, some lab and x-ray costs, nursing facility care and services (custodial care for adult recipients), physician's services, dental services, pregnancy-related services, and more. Check with your state's Medicaid office to determine coverage for specific treatments. Because these services are being offered to members of the lowest income bracket, no premium is charged.

Many adults over age 65 qualify for both Medicare and Medicaid benefits. In this instance, the Medicaid program may pay for the part of services that is not covered by Medicare. In addition, Medicaid recipients may not have to pay Medicare premiums, deductibles, and coinsurance. For complete details, contact your Medicaid office.

Medicare and Medicaid benefits can seem complex and confusing at first. These tips can help you understand your medical insurance coverage though. With patience and study - whether through your local office or through online health care policy classes - you can determine what benefits you are entitled to receive. If you have questions concerning your eligibility for either program, or to determine whether a treatment is covered, contact your Medicare or Medicaid office.


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