Medicare and Medicaid are two government programs that are often confused. The better we understand what each program offers, the better we will be able to utilize the benefits these programs might offer to us or our loved ones. In short, Medicare is the federal health insurance program for citizens of the United States who are over 65. Medicaid is managed by each state to provide health coverage for low-income individuals and people with disabilities.
If you’ve worked and contributed to Medicare from your paychecks, you will be eligible for this federal government sponsored health insurance at age 65 without having to pay premiums. For women who’ve been homemakers, they are eligible if their spouse paid into Medicare while working. Some people with disabilities or specific Illnesses may be eligible earlier than age 65. Medicare also works with private insurance companies to offer coverage.
After you turn 64, you will start receiving information about enrolling in Medicare, which is done online. If needed, you can get help with enrollment from your local senior center or Area Agency on Aging, such as Salt Lake County Aging Services. There is no fee for that help. If you have a trusted family member or friend familiar with working on the Internet, they may also be able to help. You will need to have certain information available to apply, such as: Social Security Number, birthdate, address, and the list of the prescription medications you take. Be careful when sharing personal identification information with others. The government agencies mentioned above are generally very safe options and will protect your personal identification information.
The first time you apply for Medicare it will generally be just prior to your 65th birthdate, but after that, Medicare has an Open Enrollment time each fall so that the health insurance coverage is in place by January 1st. If you are deemed eligible for Medicare earlier than age 65 due to illness or disability, you will receive information about when you can apply. If an individual is still working and has insurance coverage through an employer or a spouse’s insurance coverage, they can present a letter to Medicare showing they already have health care coverage. If an individual simply fails to apply for Medicare, a fee will be charged to them by the federal government. This fee can increase each year…don’t wait. After applying, you will receive information about coverage which you should put in a safe place for future reference. When you receive your Medicare card in the mail, protect it! You will need to show it when you attend medical appointments, procedures, and when purchasing medications.
Medicare has different coverages and options as explained below:
PART A covers inpatient hospital stays, hospice, skilled nursing facility stays and home health. Part A is offered to all individuals at NO PREMIUM COST. You might remember “A” covers when “At the hospital”.
PART B does have a premium which depends on the individual’s income and by each person’s contributions into Medicare over the years. If you qualify for Medicaid, there is no monthly premium for Medicare. During 2018 the Part B premium started at about $134.00. Part B covers outpatient doctor visits, as well as medical equipment like wheelchairs and walkers and some preventive care. You might remember “B” for “back home” after a simple doctor’s appointment.
PART D covers DRUGS. The premium will again depend upon the individual’s income but also on the type of medications taken. There is some cost paid by the individual for needed medications. Of course, generic medications are generally less expensive. Also, if you are willing to purchase a 90-day supply of your medications through a mail-order type system, this can save you money.
MEDIGAP PLANS have a premium charged and cover some of the “gaps” not usually covered by the basic Medicare plans. These plans are offered by private insurance companies such as United Health Care, AARP and Blue Cross Blue Shield.
MEDICARE ADVANTAGE PLANS are similar to health insurance offered by employers in that they often include “extra” coverage for things such as vision and dental care, which are NOT included in parts A, B or D. An Advantage Plan takes the place of A, B and D and covers all those separate parts in one.
Medicare changes yearly. Plans are added or dropped. Premiums will change. Speaking with your Area Authority on Aging or an insurance will help you navigate the process of applying for Medicare and deciding which option is best for you.
Medicaid is a program that covers medical expenses for certain groups of people who have limited income and resources. On the state’s website, www.medicaid.utah.gov, Medicaid is described as “a source of health care coverage for Utah’s vulnerable populations”. This group includes low-income people who are: older adults, people with disabilities, pregnant women and children, and individuals with certain health conditions. There are specific eligibility guidelines that must be met to qualify for Utah Medicaid. The program receives state and federal funds, but each state manages its Medicaid programs differently. Which means that a Medicaid program or service available in one state, may not be available in another.
To find out more about Medicaid or to apply for Medicaid benefits, go to www.medicaid.utah.gov. The application can all be done on line. Information is also available at your nearest Department of Workforce Services office. Many Senior Centers and Area Agencies on Aging may also be able to help. There is no fee to apply for Medicaid. If you live in a facility, there is usually a social worker available to help you apply or direct you to someone who can help.
Having the appropriate health insurance coverage is important, and there are many resources available for help throughout our state. Don’t be afraid to ask for assistance if you don’t understand these programs or need help signing up. We want your “Golden Years” to be as bright and healthy as possible for you!