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Medicare and Medicaid: What do they do?

What Does Medicare Do?

Medicare is the U.S. federal government health program that provides health insurance coverage for people 65 years of age and older, people of all ages who have disabilities, those with End-Stage Renal Disease and those with Lou Gehrig’s disease.

The Parts of Medicare

Medicare comes in four different parts, with Medicare Part A, Medicare Part B and Medicare Part D as the parts of Original Medicare.

Medicare Part A

Medicare Part A is the hospital portion of the health plan. This portion covers hospital stays, hospice care, skilled nursing facility care and some home health care services. Most people receive their Medicare Part A benefits without having to pay a monthly premium. This is the case if you or your spouse paid Medicare taxes while you were working.

Medicare Part B

Medicare Part B is the health insurance portion, and it covers preventive services, medical supplies, outpatient visits and visits to a primary care physician. Medicare Part B has a premium that is equal to $164.90 this year.

Medicare Part D

Medicare Part D is the plan’s prescription drug coverage. It covers prescription medications along with vaccines and other shots. You will receive your Part D benefits if you join a plan that Medicare approves for drug coverage. If you are going to choose a Medicare Advantage plan, you only need to select one that has the prescription drug coverage that is appropriate for you.

Each drug plan covers different medications, so it is very important that you make sure that a drug plan covers your medications before you purchase the plan. You must also know what other costs you will be required to pay for this coverage before you select a particular plan.

How Medicare Works…

Original Medicare includes Medicare Part A and Medicare Part B. If you want to add prescription drug coverage, you may choose a plan that is offered under Medicare Part D. Each year begins with a deductible, and you are charged coinsurance when you have medical services that Medicare approves. In most cases, Medicare pays about 80% of the charges, and you are responsible for the remaining 20%.

The copayments, coinsurance payments and deductibles can add up to a lot of money even though Medicare pays a significant portion of the costs. You can lower the amount of money that you need to pay out-of-pocket by purchasing a Medicare Supplemental Plan, which is known as a “Medigap” plan. Some of these plans will pay health coverage for foreign travel along with copays, coinsurance and deductibles.

What Is Medicare Part C?

Medicare Part C is also known as “Medicare Advantage,” and it is a Medicare plan that you purchase from a private health insurance company that has been approved by Medicare. This is the alternative that you can choose in lieu of Original Medicare. You might choose a Medicare Advantage plan because you will receive dental, hearing and vision benefits. Original Medicare does not offer these benefits. Medicare Advantage is still a part of Medicare, so you don’t have to worry that you will not receive the protections that you get with Original Medicare.

What Does Medicaid Do?

Medicaid is a state health insurance plan that low-income individuals or families must qualify to receive. The plan pays the provider rather than the patient, but you may be required to pay a copayment for your services. This copayment will be a small amount of the charges. The following are people who may qualify for Medicaid:

Older People, the Blind and the Disabled

If you are 65 years old or older, are blind or are disabled, you may apply for Medicaid if you have limited resources and income. If you are terminally ill, you can apply for Medicaid to receive hospice care. If you are living in a nursing home, you are eligible to apply for Medicaid. You can also apply if you need nursing care services and are blind, disabled or 65 years of age or older, but you must be able to remain at home. You will receive special community care services in this case. If you are eligible for Medicare, you can apply for Medicaid as well if your income is low and you have limited resources.

People Under the Age of 18

If you have a child under the age of 18 and you have limited resources, you may apply for Medicaid if your child is sick but can remain at home with the appropriate level of care. If you are a teenager, you may be able to apply for Medicaid on your own. You may also have an adult apply for you, and your state may cover you until you turn 21 years old.

Pregnant Women

If you believe that you are pregnant, you may apply for Medicaid now. You can be single, or you can be married. After the child is born, your Medicaid coverage will extend to your baby.

Additional Situations

If you are losing your welfare benefits and need health insurance coverage, apply for Medicaid. If your family’s resources are limited and you have children, you may apply for Medicaid. If you are disabled, pregnant, blind, over the age of 65 or under the age of 18, apply for Medicaid if you have exorbitant medical bills that you cannot afford to pay. 

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