Reaching age 65 opens the door to many benefits, one of which is access to government-sponsored insurance coverage. We've all heard the terms Medicare and Medicaid, but you may not have a clear understanding of what they are, who qualifies, what is covered, and what it costs.
At Visiting Health Services, we've developed this simple tool to help you make sense out of the system.
Medicare Part A is health insurance for people who are 65 and older and people who are disabled. It covers hospitalization, inpatient skilled nursing care, home health care and supplies, and hospice care. There is no premium cost.
What: Health insurance (entitlement program)
Who: People 65 and older; people who are disabled
Covers: Hospitalization, skilled nursing (inpatient), home health care / supplies, hospice
Cost: Premium free
Medicare Part B is a fee-for-service plan. That means that anyone who receives Part A can purchase Part B, which covers physician fees, outpatient services and hospitalization, home health care, equipment, ambulance, some drugs, and prosthetic and orthotic devices.
What: Fee-for-service plan
Who: Anyone receiving Part A can purchase Part B
Covers: Physician fees, outpatient services / hospitalization, home health, equipment, ambulance, some drugs, prosthetic / orthotic devices
Cost: Monthly premium
Medicare Part C is similar to an HMO or fee-for-service plan. People who choose Parts A and B, and who reside in the plan's service area are eligible to pay a monthly premium to receive Part C, which may offer prescription drug or additional hospital benefits.
What: Similar to an HMO or fee-for-service plan
Who: People with Part A and B and who reside in the plan's service area
Covers: Offers services similar to Part A and B; some plans offer prescription drug or additional hospital benefits
Cost: Monthly premium
Medicare Part D provides insurance for outpatient prescription drugs to Medicare beneficiaries.
What: Insurance for outpatient prescription drugs
Who: Medicare beneficiaries
Covers: Outpatient prescription drugs
Medicaid is a government insurance program that is administered by states. It is for those individuals or families who meet low income qualifications. It provides inpatient and outpatient services, such as home health care. It may also pay for some services not covered by Medicare such as eyeglasses, hearing aids, and prescription drugs. The cost for Medicaid is minimal and payment for services goes directly to the health care provider.
What: State administered program
Who: Individuals or families who meet low income qualifications
Covers: Inpatient and outpatient services; pays for some services not covered by Medicare (i.e. eyeglasses, hearing aids, drugs)
Cost: Minimal; Payment for services made directly to health care provider
For more information about these plans, go to www.medicare.gov. Of course, if you have private insurance, remember that what's covered and how much it costs varies. If you have questions about your plan call the customer number on your insurance card to speak with a customer service representative.
If you have questions about home health care and want to know if your insurance covers the services, call our Visiting Health Services Advisors 24 hours a day, 7 days a week at (973) 256-4636. Our Advisors take the guesswork out of finding the services that are right for you or a family member.