Medicare? Medicaid? MediWhat? A Simple Guide to Senior Healthcare Coverage

It’s no wonder Medicare and Medicaid are often confused for each other, as well as misunderstood overall. Not only do the two programs sound the same, they each have similar purposes: to help cover healthcare expenses.

Helpful? Yes. Confusing? Also yes. Check out how we’ve made it a bit more simple, even if you’re a beginner.

There are many options to help you tackle healthcare costs early — before you or your loved one even needs them. Research and planning can go a long way. Consider talking to your medical expert or even friends and family members who have experience with Medicare or Medicaid.

It may seem like an overwhelming amount of information, and while both programs are a huge help to senior citizens, that doesn’t make it easy. We’re here to help.  Let us know how we can assist you in understanding your healthcare coverage options, so you can utilize the benefits you deserve.

  TERMS TO KNOW   Premium: The monthly $ you pay an insurer for coverage   Deductible: The $ you must pay during an annual period before insurance starts covering your costs   Copay: The $ that is your share of a doctor visit, health care service or product   Coinsurance: The % of your medical bill for which you are responsible   Sources: AARP.org __________________________________________________________________   MEDICARE: A health insurance program for people who have disabilities or are over the age of 65, regardless of income, and paid with funds collected through taxes   Quick Facts: -   There are 4 parts: A, B, C and D. Knowing what’s covered is key. -   Currently there are 60 million people covered. -   There is an open enrollment period, so planning is important.   Why are there so many parts? -   Part A: Hospital Insurance After enrolling, coverage is automatic and includes hospitalizations costs. For most people, there is no monthly cost, but there is a deductible ($1,408 per benefit period in 2020). In addition, there is coinsurance for some extended inpatient hospital and skilled nursing facility stays.   -   Part B: Doctors and Tests When you are enrolled in Medicare, Part B coverage is automatic, but may be declined or in some cases deferred. Medicare Part B coverage is for a long list of medical services, like doctors visits and outpatient procedures. You will pay a premium and deductible for this coverage, as well as coinsurance once your deductible is met.   -   Part C: Medicare Advantage This is an alternative to traditional Medicare coverage and is administered by private insurance companies. It normally includes Parts A, B and D, as well as some other benefits, depending on your choice of plan. The monthly premium varies by plan.   -   Part D: Prescription Drugs Also administered by private insurance companies, this prescription drug coverage is optional (but you will pay a late fee if you do not enroll when you are first eligible, unless you have prescription drug coverage from another source). Enrollees pay monthly premiums and cost sharing for prescriptions, with costs varying by plan.   Sources: KFF.org, Medicare.gov, Aarp.org   __________________________________________________________________   MEDICAID: A health insurance program based on financial need and paid with funds collected through taxes   Quick Facts: -   As of December 2019, there were 63.9 million people covered — about 1 in 5 Americans. -   Application rules vary by state and may take weeks to months. -   Income requirements are a factor.   Each state has different eligibility requirements, but you will likely be covered if you meet financial need requirements and: -   Are pregnant -   Live alone with a child/dependent -   Are over 65 or disabled   Medicaid also offers two types of care that Medicare does not: -   Custodial Care: The daily personal care activities like eating, bathing and dressing that are often required after someone suffers an injury or a stroke. -   Nursing Facility Care: Long-term care under skilled nurse supervision (Medicare only covers short term care or rehabilitation).   Sources: Healthcare.gov, Medicaid.gov, KFF.org.
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