Medicare is Usually an Age-Based Healthcare Program
Medicare was designed to help people over the age of 65, as well as people under the age of 65 who have certain medical disabilities or diseases. It is an individual healthcare program, not one which covers the entire family of a qualified person. It is a federal program and your basic Medicare coverage is the same regardless of where you live in the United States.
You must apply for Medicare during specific enrollment periods, usually during a window just before or after your 65th birthday, unless you are still being covered by an employer plan at the time you turn 65. Then, you must enroll as soon as possible after your employer plan ends. If you apply outside your official enrollment period, you may have to pay a higher premium for the remainder of your life. Each year in the late fall there is also a specific period of time during which you may be eligible to make changes to your Medicare Advantage plan, if that is the form of Medicare you are using.
Original Medicare does not include most types of dental care, such as cleanings, fillings, tooth extractions, dental plates, dentures or similar devices. Medicare does include a basic vision test as part of your yearly wellness visit, but not the cost of glasses or contact lens.
If you choose a Medicare Advantage plan to administer your Medicare health insurance, your plan may include some dental, vision and hearing benefits. Some dental care may also be covered under original Medicare if you are in a hospital and it is considered medically necessary because of your special circumstances. If you are not in a Medicare Advantage plan, you may want to purchase a Medicare Supplement or Medigap plan in addition to original Medicare, because it will cover many of the medical expenses which are not covered by original Medicare.
The Parts of Medicare
Medicare is Divided into Parts. Each part covers different types of medical expenses.
Part A is hospital services. It is usually free, although there may be a premium if you did not work long enough for you to be covered.
Part B covers Medical Services. Everyone pays a premium for Part B and the premium usually increases every year. If you are on Social Security, the Part B premium is deducted from those benefits. If you are not on Social Security, for example if you are a retired government employee or waiting to apply for your Social Security benefits later than age 65, you may pay for your Medicare premiums separately.
Part C is also called Medicare Advantage and covers both Medicare Parts A and B, and may include additional services such as vision, dental and hearing care, depending on the plan your choose
Part D is prescription coverage and usually requires a separate premium. However, if you have a Part C Medicare Advantage plan, then Part D may be included, depending on your plan.
You can learn more about these programs in the helpful book: "Social Security, Medicare and Government Pensions: Get the Most out of Your Retirement and Medical Benefits." (Ad) Getting all the right information before you apply for these benefits can save you money in the future, so it is important to educate yourself before you apply.
Medicaid is for Low Income Families and Individuals
Medicaid was set up to help people who have limited financial resources get healthcare for themselves and their family. It is run jointly by state and federal governments and your eligibility is based on your income. Because of the state and federal collaboration on the program, there may be slight differences in how the plan is implemented, depending on the state where you live. For example, when the Affordable Care Act was passed, some states chose to expand the number of people who were eligible to receive benefits under Medicaid, and other states did not. As a result, not only are your benefits determined by your income, but also by the state where you live.
Unlike Medicare, you can apply for Medicaid whenever your financial situation has changed, for example if you lose your job and your insurance. You do not have to wait for a special open enrollment period if you have just experienced a financial catastrophe.
Dental care under Medicaid varies from state to state. It may cover preventative dental care for adults, and even various dental treatments in some states. Medicaid will cover dental care for your children, regardless of the state where you live. Medicaid also covers eye exams and glasses in most states for both adults and children. You need to check with your state administrator of the program.
How to Qualify for Medicare
Nearly all Americans are eligible for Medicare. The rule is that you are eligible for Medicare if you are a citizen of the United States or have been a legal resident for at least 5 years and you are age 65 or older and you or your spouse has worked for at least 10 years (or 40 quarters) in Medicare-covered employment. You may also be eligible if you are under the age of 65 but have certain disabilities or diseases. Even if you have not met the work requirement, you may still be able to buy into the program. You may also be eligible because of the work history of a former spouse.
How to Qualify for Medicaid
In order to qualify for Medicaid, the government will consider your income, household size, whether or not you or a family member is disabled, and your family status. Among those who may be eligible are pregnant women, teenagers living alone, parents who are caregivers of sick children, people with unusually high medical expenses, blind or disabled people, or most low-income families and individuals. The exact income level to be considered low-income varies from state-to-state, depending on whether or not your state has expanded their Medicaid coverage.
Included Medicaid Benefits
Among the services which must be provided by Medicaid are:
Lab tests and x-rays
Hospitalization and clinic treatment
Doctor visits, nursing services
Medical and Surgical dental services
Midwife and family planning services
Pediatric and Family Nurse Practitioner services
Screening, diagnosis and treatment for persons under age 21
Home healthcare for people eligible for nursing home facilities
Nursing home facility services for people age 21 and older
Medicare vs. Medicaid for Nursing Home Care
The last two items in the above list of Medicaid benefits are especially important, because Medicare will NOT cover long-term stays in a nursing home, but Medicaid will. This is a significant difference between the two programs. While you may be expected to contribute to the cost of your stay in a nursing home, and could have to spend down family assets, your healthy spouse is not expected to give up their home or private business. Medicaid is one of the largest payers for nursing home services in the United States, and many people do not realize they are eligible to receive this financial benefit when they or a loved one needs to be placed in a skilled nursing facility. If you or a family member needs to be admitted to a skilled nursing facility, it is important to apply for Medicaid as soon as possible.
If you or a loved one is facing an extended stay in a nursing home, you may want to read "How to Protect Your Family's Assets from Devastating Nursing Home Costs: Medicaid Secrets." (Ad) It is a very helpful book and could save you and your family a significant amount of money.
Combining Medicare and Medicaid
If you are "dual eligible" for both Medicare and Medicaid (because you meet the age or disability requirements for Medicare, and the income requirements for Medicaid), you can use Medicaid to help cover the cost of your Medicare premiums and other out-of-pocket expenses such as deductibles, which can be a significant savings for low-income senior citizens. You need to contact your local Social Security office, Social Services department, or other local agencies to find out whether or not you are eligible for both of these programs. Everyone is entitled to have the most comprehensive and affordable medical insurance they can find. Take the time to make sure you are getting all benefits for which you are eligible.
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