This blog post will go over what Medicare and Medicaid are and what they cover, how to apply for them, and how they can help you as a patient or caregiver.
Table of Contents
Medicare
Medicare is a health insurance program available to Americans over the age of 65. It is federally funded and can help pay for some of your healthcare costs. Medicare consists of four parts: Part A, Part B, Part C, and D.
Part A
Part A is hospital insurance that helps pay for inpatient services and skilled nursing care at hospitals, long-term care facilities, and in your home. This insurance does not pay for hospice, routine self-care at home, or preventative services such as flu shots or immunizations.
Part B
Part B is medical insurance that helps pay for services received from doctors, labs, outpatient surgeries, other medical procedures, and preventative services such as annual checkups and vaccines. It also may cover preventive care needs like mammograms and prostate cancer screenings, provided Medicare has approved them on an exception basis. It is required if you have Part A.
Part C
Part C is Medicare Advantage, which is a program available in all states. It covers everything that Parts A and B cover and includes prescription drug coverage and vision and dental benefits. This plan can be privately purchased but is not required to receive Medicare coverage. If eligible for Part C, you can also join a Medicare Advantage Plan (MAP). These plans are private insurers that provide the same types of coverage as the traditional Medicare program does. However, the two have some differences, such as how premiums are paid, or specialized services are covered under each plan according to ClearmatchMedicare.
Part D
Part D is a prescription drug program for people with Medicare that helps pay for the medicine they need. It is a Medicare requirement to have Part D drug coverage if you have Part A and B. There are multiple private insurance companies that offer plans under part D with different costs and coverage. These plans are not the same as Medicare Advantage, although there is some overlap in some of the covered drugs or services.
How To Apply/Enroll
To apply for Medicare, you must first have a Social Security number, be a United States citizen or an eligible non-citizen and meet the eligibility requirements based on how old you are or if you have approved disabilities. If you are 65 years or older, your application should be automatically processed within four months of your birthday. If you enrolled on Part B within eight weeks of your 65th birthday but delayed signing up for Part A until later than this date, the date that Medicare began covering medical care will be retroactive to when Part B was signed up for. If you were born in 1910 or earlier, you qualify for Part A without having to apply.
There are other ways to apply for Medicare, such as using your health insurance company or a government service such as the Social Security Administration’s (SSA) website or phone lines. Many states have their own Medicare offices that help provide information on how to enroll this information can be found on your state’s website.
Medicaid
Medicaid is a health insurance program that provides subsidized healthcare to certain low-income individuals and families. In the past, one could only qualify for Medicaid coverage if they were expectant or disabled. Still, under the Affordable Care Act (ACA), Medicaid is now available for all low-income adults.
If you qualify for Medicaid, you can choose from certain health plans from your state’s Medicaid office or any private insurance company. Each state has different benefits and plans available to Medicaid patients, so be sure to research what your state offers. The ACA has made it a requirement for Medicaid to cover many of the same benefits on par with Medicare, including most preventative care, mental health services, substance abuse treatment, and outpatient prescription drugs.
How To Apply/Enroll
Eligibility for Medicaid is determined through the SSA. If you do not qualify for this program, you can apply through your state’s Medicaid office. You will be interviewed about your income and assets by a social worker or case worker, who will then determine if you are eligible based on their guidelines. Once approved, Medicaid will pay your portion of the bills and will cover services such as medicines, doctor visits, and hospitalizations. If you are eligible for Medicaid, you can use a government service such as the SSA’s website or phone line to apply. The SSA will review your information regarding income and assets before approving you for Medicaid.
Medicaid Advantages
Medicaid has many advantages, including the fact that it is available to everyone regardless of age. Medicaid provides free healthcare services such as doctor visits and drug prescriptions up to a certain annual income. You are not expected to pay anything out of pocket; your doctor can bill Medicaid directly.
Medicaid also offers health insurance at a lower cost than private insurance companies due to the federal funding and government subsidies that help cover the cost for low-income individuals. This low-cost policy makes it more affordable for everyone in need by allowing them access to quality care without paying high premiums or co-pays. If a person is eligible for Medicaid, they are often able to obtain medications at a lower price than if they went through a private insurance company or pharmacy.
Some states also have “Kids in Health” programs that help parents who do not have health insurance obtain low-cost prescription drugs for their children and provide Medicaid coverage to childless adults without children.
In conclusion, Medicare and Medicaid are healthcare programs that provide accessible, affordable health insurance. Medicare is a federally funded program with many different plans and services available for beneficiaries, and Medicaid is state-funded and provides low-income individuals with access to healthcare.
