The ABC’s of Medicare

Medicare versus Medicaid

Medicare is federal health insurance for people aged 65 or older, and some people under age 65 with certain disabilities that have paid into the social security system for at least 10 years.  In sum, Medicare is “short term” coverage for health events including hospitalization, doctor visits, therapy, home health care and preventative care. Original Medicare includes Part A and Part B. Prescription Drug Coverage is Part D.  Medicare Advantage Plans are covered by Part C.  Many individuals confuse Medicare and Medicaid; however, these are two vastly different forms of government health insurance.  Medicaid is a need-based state and federal program determined by financial and medical eligibility specific to the state a person resides in. In addition to also covering what is covered by Medicare, Medicaid benefits cover “long-term” health situations such nursing home care, home care and assisted living care.

Dually Eligible

If you qualify, you can receive both Medicare and Medicaid at the same time. People who have both Medicare and Medicaid are deemed “dually eligible.” When individuals are dually eligible, Medicare pays first for Medicare-covered services and Medicaid pays last, after Medicare and any other health insurance you have, as the payor of last resort pursuant to Florida law.

The Different Parts of Medicare. Let’s break it down…

Part A (Hospital Insurance): Medicare Part A covers inpatient hospitalization, skilled care, such as rehabilitation in a skilled nursing facility, hospice care, and home health care. A Medicare recipient can use any doctor or hospital that accepts Medicare in the United States.

Part B (Medical Insurance): Medicare Part B helps cover doctors’ visits, outpatient care, ambulance services, home health care, durable medical equipment, and preventative care such as vaccinations and wellness visits.

Part C (Medicare Advantage Plans): Part C Medicare Advantage plans are a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These plans usually bundle the services traditionally available under Part A, Part B and Part D. Although these plans may have lower or no monthly premiums, they require you to use doctors and providers in their network and can limit your healthcare access.  Some Advantage Plans also provide extra benefits such as fitness programs, vision, hearing, and dental services.  Once enrolled in an Advantage Plan, you are generally only permitted to make changes during open enrollment.

Part D (Drug Coverage): Medicare Part D helps cover the cost of prescription drugs. It is mandatory to select a Part D plan when you enroll for Original Medicare.

Medicare Supplemental Insurance (also known as Medigap): A Medicare Supplement is additional insurance coverage recipients of Original Medicare can purchase from a private company to assist in covering your share of cost such as copayments at doctor visits or coinsurance at rehabilitation in a skilled nursing facility.

Making Changes to Your Medicare Coverage

Life circumstances change. Each year it is important to review your coverage and decide if you need a change. You can call 1-800-Medicare for more information.

Now what? Do you want more information about the ins and outs of Medicare and Medicaid? Contact SAMUELS WOOD PLLC at 561-864-3371 for a consultation.

*Resource: 2023 Medicare & You Handbook, www.Medicare.gov, and www.CMS.gov (the U.S. Centers for Medicare and Medicaid Services).