Medicare and Medicaid Basics
Many workdays I have the task of explaining how Medicare and Medicaid work. I’m sure many of you may not even know the difference between the 2, I know I didn’t before I entered this field!
Medicaid is medical coverage offered to people with low incomes. I remember the difference by -Aid as in financial aid. Medicaid will cover you very well but the network of Doctors willing to accept about $.10 on the $1 is limited, not bad, but limited. As Medicaid is strictly a goverment program and you have no choices if you accept financial assistance, the government does not feel the need to publish a summary of benefits. As one government employee expressed it to me – “you get what you get”. Presently an individual earning less than $16,683 per year should be eligible for Medicaid. NY has expanded the Medicaid program to offer low cost coverage to individuals earning up to $23,540. This expanded Medicaid is called The Esseential Plan.
Medicare is what people over 65 or under 65 having a disability for over 2 years are entitled to from the government. Medicare Part A is free to most people if they have worked and contributed to the system for 40 Quarters. Medicare Part B is an option (that may incur a penalty if you do not opt for it) that will likely cost you $134 per month.
Part A covers your Hospital related medical expenses at 80% after you have met the deductible of $1340 per admission.
Part B covers your outpatient related medical expenses at 80% after you have met the annual deductible of $183.
MediGap or Medicare Supplements (2 names for the same thing) fill in some or all of the gaps in Part A and Part B.
Part C is basically the combination of A+B with several important extras. Also referred to as an Advantage Plan/MA or MAPD if it includes Prescription Drug coverage.
Part D is Prescription Drug coverage/ PDP (that may also incur a penalty if you do not opt for it)
Simple? Yes, but oh so complicated. Within all of these choices are, of course, many more details but also the difficult choice of picking the plan that is right for you without knowing what the future will bring.
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(amounts quoted are as of 9/2018)