Medicare / Medicaid is So Confusing
New benefits and plans are emerging every year.
Medicare / Medicaid is So Confusing
New benefits and plans are emerging every year.
USA Health Insurance is complicated
Health insurance options, for people under the age of 65, range from employer sponsored benefits to individual policies through the Affordable Care Act at healthcare.gov.
Government programs for people who qualify for low-income earners and families called Medicaid.
Medicare covers people 65 years and older and special groups of people with disabilities.
Lastly, the active military and veterans receive care through the Veterans Administration.
$899.9B
Medicare income last year
76M+
receive Medicaid sponsored health services
18.4%
people with Medicare benefits nationwide
Overview
Medicare
Medicare is a Federal Government health insurance program that pays some medical costs for people age 65 and older, and for all people with late-stage kidney failure. It also pays some medical costs for those who have gotten Social Security Disability Income (discussed later) for 24 months. It does not cover ongoing personal care at home, assisted living, or long-term care.
Part A
Medicare
- Hospital costs after you pay a certain amount called the “deductible”
- Hospice Care in the last 6 months of life
- Short stay in a nursing home to get care for a hospital-related medical condition
Part B
Medicare
- Some preventive services, such as flu shots and diabetes screening
- Part of the costs for doctor’s services, outpatient care, and other medical services that Part A does not cover
Part D
Medicare
- Some medication costs
Overview
Medicaid
Some people may qualify for Medicaid, a combined Federal and State program for low-income people and families. This program covers the costs of medical care and some types of long-term care for people who have limited income and meet other eligibility requirements. Who is eligible and what services are covered vary from State to State.
Notes from the Author
Program of All-Inclusive Care for the Elderly (PACE)
Some States have PACE, Program of All-Inclusive Care for the Elderly, a Medicare program that provides care and services to people who otherwise would need care in a nursing home. PACE covers medical, social service, and long-term care costs for frail people. It may pay for some or all of the long-term care needs of a person with Alzheimer’s disease. PACE permits most people who qualify to continue living at home instead of moving to a long-term care facility. You will need to find out if the person who needs care qualifies for PACE. There may be a monthly charge. PACE is available only in certain States and locations within those States.
State Health Insurance Assistance Program (SHIP)
SHIP, the State Health Insurance Assistance Program is a national program offered in each State that provides counseling and assistance to people and their families on Medicare, Medicaid, and Medicare supplemental insurance (Medigap) matters.
Department of Veterans Affairs
The U.S. Department of Veterans Affairs (VA) may provide long-term care or at-home care for some veterans. If your family member or relative is eligible for veterans’ benefits, check with the VA or get in touch with the VA medical center nearest you. There could be a waiting list for VA nursing homes.
Social Security Disability Income (SSDI)
This type of Social Security is for people younger than age 65 who are disabled according to the Social Security Administration’s definition.
For a person to qualify for Social Security Disability Income, he or she must be able to show that:
- The person is unable to work
- The condition will last at least a year
- The condition is expected to result in death
Monica Stynchula – CEO / REUNIONCare, Inc.
