Medicare and Medicaid
Medicare and Medicaid are very import elder resources. Health insurance is a way to pay for visits to the doctor, hospital, emergency room or clinic. Insurance is paid for with a premium which is a fixed monthly payment to the insurance company in anticipation of needing services in the future. When the need arises through an accident or illness, you may have to pay a ‘deductible’ which is a fixed amount you pay before your health insurance pays for the remaining cost of your health services. After the deductible is paid, you may have to pay an additional cost or ‘co-payment’ for the services provided. The insurance you buy is called a ‘policy’ and is designed to keep the cost of medical care predictable and affordable. Part of planning for your future is buying insurance for your car, home, life, and in this case, your health needs.
Medicare is a federal government insurance program that pays for your health care if you are 65 or older, have a disability, or suffer from certain chronic illnesses. Medicare legislation was passed by the US Congress in 1965 and prior to that time only 51% of people 65 and older had health care coverage and 30% were living in poverty. While you were working you and your employer paid the premium for this insurance coverage to the government and it was deducted from your pay separately from your federal, state and local (if applicable), and social security taxes.
Medicare services are administered by the federal government under four (4) classifications or Parts A, B, C, and D. Each classification is summarized as follows:
Part A is medical insurance that covers the care and treatment you receive while in the hospital. It also covers care given at a skilled nursing facility, home health care services, and hospice care. The cost of this care is paid for by the government from the taxes you paid during your working years.
Part B is medical insurance that covers most necessary doctor’s visits, medical equipment required for your treatment and recovery (Durable Medical Equipment), preventive care necessary for your ongoing health, outpatient services, laboratory tests, and scanning procedures like x-rays. Part B services also cover some mental health care, home health and transportation to and from the hospital. There is a monthly fee charged for Part B medical coverage.
Part C is called Medicare Advantage Plans and are offered by private insurance companies that are approved by Medicare. Under this plan a private company does the paperwork for your Part A and B medical care plus they may provide additional coverage for vision, dental, and health and wellness programs not covered under other parts of Medicare. An additional premium is charged by the private or third party company for this coverage.
Part D is an outpatient prescription drug insurance plan administered by private insurance companies who have been approved and contracted by the government. Part D is optional coverage which you should consider depending on your medication needs. This is separate insurance for which an additional monthly premium is charged.
Medicare sounds very complicated and it is. Web sites like controlmyfuturetoday.com can provide information you need to plan for your health care needs well in advance of your 65th birthday. As in any complicated government program, read as much as you can and contact professionals in the legal and insurance field to develop a plan and answer your questions before you commit to the program.
As in any medical insurance program there are procedures not covered under the plan. For instance: Alternative medicine including experimental treatment, most care received outside the United States, cosmetic surgery, most dental care, hearing aids, most personal care if not under doctor’s orders for treatment, and transportation services are not generally provided under Medicare. However, there are many exceptions so it is always good advice to talk to an insurance professional, your family and friends to learn as much as you can how Medicare will impact you.
Medicaid is a health care program supported by the federal government but administered and partially paid for by each state. Each state sets their guidelines but in general Medicaid programs are available to low income individuals over 65 who are in need of care and services. Medicaid is supported locally by numerous Not-For-Profit organizations across the country that provide additional services and support for those in need. As with any government program, learn as much as you can from resources like controlmyfuturetoday.com and search for local support groups who can help you find the services you need. One group that can assist you to live independently and safely in your home is the local branch of the Area Agency on Aging. You can look them up on the Internet and there are hundreds of locations across the United States. For further information about Medicaid in your state, click on the link below.