What is Medicare/Medicaid?

What is Medicare/Medicaid?

Medicare is a federal health insurance program supported through premiums and payroll taxes.
Part A is Hospital Insurance. It is available at age 65 to anyone who is eligible to collect Social Security or Railroad Retirement. It is also available to people who have been on Social Security disability for more than 24 consecutive months and those who are on dialysis. Part A helps cover hospitals, nursing homes, home health care, and hospice care.

Part A is Hospital Insurance. It is available at age 65 to anyone who is eligible to collect Social Security or Railroad Retirement. It is also available to people who have been on Social Security disability for more than 24 consecutive months and those who are on dialysis. Part A helps cover hospitals, nursing homes, home health care, and hospice care.

Part B is Medical Insurance. It is available the same as Part A. Premiums for Part B are deducted from Social Security and Railroad Retirement benefits. Medical Insurance helps to pay for physicians, durable medical equipment, outpatient services, and home health care.

Part C is the Medicare Advantage Program. Under this program private insurance companies have contracted with Medicare to provide both Part A and Part B coverage under a single plan. They may add additional coverage for services not covered by Part A and Part B. If you are under a Medicare Advantage plan you need to use the card provided by the insurance company, since that company is providing your Medicare coverage. If you use your Medicare card when you have a Medicare Advantage plan, it will delay payment to your medical providers. With some Medicare Advantage plans you must use in-network providers or you may incur financial penalties.

Part D is Medicare’s plan for Prescription Coverage. Some Medicare Advantage Plans include Part D. Otherwise, you will need to choose a participating insurance company for Part D benefits.

Medicare’s website, www.medicare.gov, contains more detailed information on each of these plans. They also have tools to help you locate insurance providers and to compare their plans.

Medicaid is a combined federal and state program which provides health coverage for people who meet strict income and asset guidelines.
In Pennsylvania the Medicaid program is called Medical Assistance, and it is abbreviated as MA. Medicaid covers costs of hospitals, nursing homes, physicians, equipment, home health and, in some cases, medications. In Pennsylvania the Department of Public Welfare (DPW) handles the Medicaid program. Their website is www.dpw.state.pa.us.

If you are not in a nursing home and are eligible for Medicaid for more than a month, you will be directed to select one of the contracted companies that provide Health Maintenance Organization (HMO) coverage for the program.

If you have both Medicare and Medicaid, you will be directed to choose one of the DPW contracted companies for a Medicare Advantage program.

If you are in a nursing home, Medicaid supplements your monthly income to pay for your care. With the high cost of nursing homes, presently averaging over $7,500 each month, (many local facilities average $8-9,000 per month) most people needing long-term care will eventually utilize Medicaid, even if they are not eligible when they enter the nursing home. There are a number of rules about what can and what cannot be done with your assets for up to five years prior to entering a nursing home. The attorneys at Keystone Elder Law understand these rules and can help you get the benefits you legally deserve, without requiring your spouse to move from your home or depriving your children of an inheritance.