Education

THE DIFFERENCE BETWEEN MEDICARE AND MEDICAID

This is a question that is surprisingly confusing to many people we meet, but especially prevalent among Business Associates focused on data processing.

The two words might sound similar; however they are very different programs. Medicaid is a program governed by the state, and Medicare is a federal-governed program.

Medicaid assists individuals with low income levels such as:

  • Pregnant women
  • Children under the age of 19
  • People 65 and over
  • People who are blind
  • People who are disabled
  • People who need nursing home care
  • Individuals make an application for Medicaid at the State’s Medicaid agency

 Medicare is for:

  • People 65 and over
  • People of any age who have kidney failure or long term kidney disease
  • People who are permanently disabled and cannot work
  • Medicare is applied for at the local Social Security office
  • Some people qualify for both Medicaid and Medicare, Medicaid is sometimes used to help pay for Medicare premiums. People who qualify for both programs are called “dual eligible”.

The Different Parts of Medicare

The different parts of Medicare help cover specific services:

Medicare Part A (Hospital Insurance)

• Helps cover inpatient care in hospitals, skilled nursing facilities (SNF), hospice, and home health care.

• Most people don’t have to pay a premium for Medicare Part A because they or a spouse paid Medicare taxes while working in the United States. If you don’t automatically get premium-free Part A, you may still be able to enroll, and pay a premium.

Medicare Part B (Medical Insurance)

• Helps cover doctors’ and other health care providers’ services, outpatient care, durable medical equipment, and home health care.

• Helps cover some preventive services.

• Most people pay up to the standard monthly Medicare Part B premium.

Note: You may want to get coverage that fills gaps in Original Medicare coverage. You can choose to buy a Medicare Supplement Insurance (Medigap) policy from a private company.

Medicare Part C (also known as Medicare Advantage)

• Offers health plan options run by Medicare-approved private insurance companies

Medicare Advantage Plans are a way to get the benefits and services covered under Part A and Part B

Most Medicare Advantage Plans cover Medicare prescription drug coverage (Part D)

• Some Medicare Advantage Plans may include extra benefits for an extra cost

Medicare Part D (Medicare Prescription Drug Coverage)

• Helps cover the cost of prescription drugs

• May help lower your prescription drug costs and help protect against higher costs

• Run by Medicare-approved private insurance companies

• Costs and benefits vary by plan

For more information, visit http://www.medicare.gov , or call 1-800-MEDICARE

Sponsored by: RISC Management, www.RISCsecurity.com

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