Health Insurance Information
Medicare and Medicaid
What is Medicare?
Medicare is our Country's health
insurance program for people age 65 or older, certain people
with disabilities who are under 65, and people of any age
who have permanent kidney failure. It provides basic
protection against the cost of health care, but it does not
cover all your medical expenses nor the cost of most
long-term care. You can choose one of two ways to get
benefits under Medicare: the traditional fee-for-services
system or the managed care program.
The Health Care Financing Administration
is the agency in charge of the Medicare program. But the
Social Security office helps you enroll in the program and
will give you general Medicare information.
For additional information view
Medicare on the web...
Medicare - Part A &
Part B:
There are two parts of Medicare, they
are:
Hospital Insurance (also called "Part A" Medicare), which is financed by a portion of your payroll (FICA) tax that also pays for Social Security; and Medical Insurance (also called "Part B"
Medicare), which is partly financed by monthly premiums
paid by people who choose to enroll.
You are automatically enrolled in Part B
when you become entitled to Part A. However, because you
must pay a monthly premium for Part B coverage, you have the
option of paying for the coverage or turning it down.
Each part of Medicare covers different
kids of medical costs, has different rules about enrolling,
and so on.
For additional information view
Your Medicare Benefits, a guide to what Medicare
covers and what you pay for your covered health care
services and supplies. This guide is available from
Medicare's website in Adobe Acrobat format.
Medicare Part D - Prescription Drug Coverage
Everyone needs to make a decision about prescription drug coverage. The Medicare Prescription Drug Program
began in January 2006, offering prescription drug coverage to people with medicare the first time.
The coverage is offered through private plans. The Medicare prescription drug coverage pays for brand name
and generic medications up to $2,510. Some plans have enhanced coverage.
- If you have limited income (below $15,600 for an individual or $21,000 for a married couple)
and limited resources (below $11,990 for individual or $23,970 for a married couple), you may be eligible for
"extra help" in paying the estimated $29 per month premium, the $275 deductible, and the 25% co-pay per
prescription.
- The Senior Prescription Drug Assistance Program (SPDAP) offers premium assistance up to
$25.00 per month for those with incomes below $30,360 for an individual or $41,070 for a married couple.
Call 1.800.551.5995 for an application.
- Everyone who has Medicare is eligible to enroll in a plan. You can enroll during the
initial enrollment period, which is three months before and three months after you turn 65. Annual open
enrollment is every November 15th - December 31st of each year. If you do not enroll when you are first
eligible and you choose to enroll at a later date, you may have to pay a premium penalty, which will be
1% (one percent) for every month you delay enrollment.
For more information or to select a plan, call 1.800.MEDICARE or visit them online at
www.medicare.gov or contact the Harford County
Office on Aging Senior Health Insurance Program at 410.638.3025.
Medicare Advantage Plans
Medicare Advantage Plans or sometimes called "Part C" these are plans offered by
private companies and approved by Medicare to cover Medicare Part A and Part B benefits. They may include
drug coverage. Medicare pays an amount of money to the plan each month to take care of you. You must have
both parts of Medicare to join one of the plans. They may also offer additional benefits such as
vision and dental riders. You must choose a Part D Medicare drug plan from the Medicare Advantage plan
if they offer one. Medicare Advantage plans are HMOs, PPOs, or PFFs plans. If you are enrolled in a
Medicare Advantage Plans, Medicare services are covered through the plans, and are not pain for under
original Medicare. If you use a provider outside of your plans network, you may pay 100% of the cost.
In addition to the monthly premium, you will pay copays for doctor services, diagnostic services, and
hospital services.
For more information or to select a plan, call 1.800.MEDICARE or visit them online at
www.medicare.gov or contact the Harford County
Office on Aging Senior Health Insurance Program at 410.638.3025.
What is Medicaid
(or Medical Assistance)?
Many people think that Medicaid and
Medicare are two different names for the same program.
Actually, they are two different programs. Medicaid became
law in 1965 as a cooperative venture between the Federal and
State governments. Medicaid (or Medical Assistance as it is
often referred to in Maryland) is a State-run program
designed primarily to help those with low income and little
or no resources. While the Federal Government helps pay for
Medicaid, each state has its own rules about who is eligible
and what is covered under Medicaid. Some people qualify for
both Medicare and Medicaid. Medicaid is the largest program
providing medical and health-related services to American's
poorest people. Thus, the Medicaid program varies
considerably from State to State, as well as within each
State over time.
For additional information see
Maryland Medical Programs - Medicaid/Medical Assistance
Overview.
Medicaid
Eligibility
To be eligible for Federal funds, states
are required to provide Medicaid (Medical Assistance)
coverage for most individuals who receive Federally assisted
income maintenance payments, as well as for related groups
not receiving cash payments. Just a few examples of the
mandatory Medicaid eligibility groups are:
-
Low income families with children, as
described in Section 1931 of the Social Security Act, who
meet certain eligibility requirements of the State's AFDC
plan in effect on July 16, 1996;
-
Supplemental Security Income (SSI)
recipients (or in States using more restrictive criteria -
aged, blind, and disabled individuals who meet criteria
which are more restrictive than those of the SSI program
and which were in place in the State's approved Medicaid
plan as of January 1, 1972);
-
Certain Medicare beneficiaries
(described later); and
-
Special protected groups who may keep
Medicaid for a period of time, such as persons who lose
SSI payments due to earnings from work or increased Social
Security benefits.
-
Certain aged, blind, or disabled adults
who have incomes above those requiring mandatory coverage,
but below the Federal poverty level;
-
Institutionalized individuals with
income and resources below specific limits;
-
Persons who would be eligible if
institutionalized but are receiving care under home and
community-based services waivers;
-
Recipients of State supplementary
payments.
For additional information see
Maryland Medical Programs - Medical Care Programs
Eligibility.
Medicaid -
Medicare Relationship
The Federal Medicare program provides
hospital insurance (HI), also known as Part A coverage, and
supplementary medical insurance (SMI), also known as Part B
coverage. Coverage for HI is automatic for persons aged 65
and older (and for certain disabled persons) who have
insured status under Social Security or Railroad Retirement.
Coverage for HI may be purchased by individuals who do not
have insured status through the payment of monthly Part A
premiums. Coverage for SMI also requires payment of monthly
premiums.
Medicare beneficiaries who have low
income and limited resources may receive help paying for
their out-of-pocket medical expenses from their State
Medicaid program. There are various benefits available to
"dual eligibles" that are entitled to Medicare and are
eligible for some type of Medicaid benefit.
For persons who are eligible for full
Medicaid coverage, the Medicaid program supplements Medicare
coverage by providing services and supplies that are
available under their State's Medicaid program. Services
that are covered by both programs will be paid first by
Medicare and the difference by Medicaid, up to the State's
payment limit. Medicaid may also cover additional services
(e.g., nursing facility care beyond the 100-day limit
covered by Medicare, prescription drugs, eyeglasses, and
hearing aids).
It is important to know the differences
between Medicare and Medicaid (Medical Assistance) and what
each WILL and WILL NOT pay for. Should you need help in
understanding these, or other health insurance matters,
contact the Senior Health Insurance Program at the
Harford County Office on Aging at 410.638.3025.
Additional Resources:
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