Medicare and Medicaid Information

Medicare

The program covers people who are:

• Age 65 or older
• Under the age of 65 but with certain disabilities
• Any age but have End Stage Renal Disease

Coverage is the same regardless of income.

Medicare has four parts:

1. Part A Hospital Insurance - This section of Medicare is usually paid for by payroll taxes while working or through a spouse that paid the taxes. Part A covers inpatient care in hospitals and skilled nursing facilities (not custodial or long-term care. It also covers hospice care and some home healthcare.
   
   
2. Part B Medical Insurance - Most people pay a premium for Part B, which helps cover doctor's services and outpatient care. It also covers some of the medical services not paid for by Part A, such as physical and occupational therapists and some home healthcare.
   
   
3. Part C, usually called Medicare Advantage - Part C is an alternative to Parts A and B and was originally called Medicare+Choice. Under Part C, private health insurance companies can contract with the federal government to offer Medicare benefits through their own policies. This health coverage can be through private fee-for-service plans (PFFs), Health Management Organization plans (HMOs), or Preferred Provider Organization plans (PPOs).
   
   
4. Part D, the Prescription Drug Plan - Most people pay a monthly premium for this coverage. It is available to everyone who participates in Medicare. It is intended to lower prescription medicine costs. Private companies provide the coverage. People participating choose from as many as 100 companies according to the drugs they cover and the premiums they charge. If a Medicare beneficiary does not sign up for Part D when he first becomes eligible, then he must pay a penalty of 1% per month for every month he is not enrolled for the rest of his coverage once he does enroll. The Low-Income Subsidy (LIS), for very low-income individuals, considerably reduces the costs of Part D.

You can learn more about Medicare by going to www.medicare.org.

Medicaid

Medicaid is a federally-funded, state-run program that provides medical assistance for individuals and families with limited incomes and resources. It pays for healthcare costs.

Medicaid covers the following:

• Doctor and dentist services
• Clinic and hospital services
• Nursing home and home healthcare services
• Family planning services and prenatal care
• Pediatric care
• Mental health care
• Prescription drug coverage
• Optometrist services and eyeglasses

Qualifications vary from state to state. To apply or learn more about this program, contact your local Social Security office, Welfare department or Department of Human Services. To find your local Social Security office call 800-772-1213. To learn more about this program, go to www.cms.hhs.gov/MedicaidGenInfo.

Created 12/23/06