August 27, 2010

What is the difference between Medicaid and Medicare?
This is a very common question. Medicaid is a type of government program that offers health insurance to people with limited incomes. It is available to people of all ages, including children, and it can vary from state to state. Medicare, on the other hand, is a government health insurance program only available to people 65 and over, people under 65 with certain disabilities, and people of all ages with end-stage renal disease.

What is the difference between Medicare Part A, Part B, Part C, and Part D?

  • Part A is hospital insurance.
  • Part B helps pay for general medical services that Part A doesn’t cover.
  • Part C is called Medicare Advantage. If you have Parts A and B, you can choose this option to receive all of your health care through a provider organization, like an HMO.
  • Part D is prescription drug coverage. It helps pay for some medicines.

Medicare Part A, Hospital Insurance helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care, but it does not usually cover dental, vision, and prescription drugs. Certain conditions must be met to get these benefits. Many people do not have to pay a monthly premium for Part A because they or a spouse paid Medicare takes while working. Most people are enrolled in Part A when they turn 65. To see if you are enrolled, look at your Medicare card and if you are covered, it will list Hospital Part A.

Medicare Part B, Medical Insurance helps cover doctors’ services and outpatient care. It also covers some other medical services that Part A doesn’t cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.

Medicare Part B is optional. You can sign up for Part B anytime during a seven-month period, which begins three months before you turn 65. Unlike Medicare Part A, Medicare Part B does have a premium, which is paid each month, and there is also a deductible. Part B is typically paid for out of your Social Security check or a civil retirement plan payment. There may be state funds available to help cover the costs of the monthly premium and the deductible, so if you are concerned about these costs, you should contact your local Medicare office. Use our Resource Locator to find the office nearest you.

Medicare Advantage, Part C is a health insurance plan offered by a private company that is approved by Medicare. These plans offer you all the protection of Medicare Part A and Medicare Part B, plus extra coverage on things like vision, hearing, dental, and/or health and wellness programs. Most plans will also offer prescription drug coverage.

Medicare Part D is Medicare prescription drug coverage run by private companies approved by Medicare. There are two types of plans:

  • Medicare Prescription Drug Plans. These plans (sometimes called “PDPs”) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans. You must have Medicare Part A and/or Medicare Part B to be eligible for the PDPs.
  • Medicare Advantage Plans (like an HMO or PPO) are other Medicare health plans that offer Medicare prescription drug coverage. You get all of your Part A and Part B coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.” In order to be eligible for this plan, you must have Medicare Part A and Medicare Part B.

Does Medicare cover care for people with Alzheimer’s?
Thanks to a recent, important policy change, Medicare beneficiaries can no longer be denied coverage for mental health services, hospice care and home healthcare solely because they have Alzheimer’s disease or any other preexisting condition. Prior to this policy change, people with Alzheimer’s could be denied coverage for such services.

The services Medicare now covers include “reasonable and necessary” doctors’ visits; physical, occupational or speech therapy; psychotherapy or behavioral management therapy by a mental health professional; and skilled home-care services (such as skilled nursing, speech or physical therapy).

Another policy change, which was officially in place as of late 2001 but only became public in March 2002, reflects recent scientific evidence indicating that people with Alzheimer’s can often benefit from mental health services and specialized types of therapy. Alzheimer’s experts say the new rules will enable people with the disease to stay at home longer by providing access to services that help improve activities of daily living and help people with the disease maintain a better quality of life.

Medicare still does not pay for prescription drugs for Alzheimer’s (unless you enroll in Medicare Part C or D), adult day care, room and board at assisted-living facilities, or custodial care in a nursing home, though it will pay for medically necessary skilled-care services at assisted-living facilities or nursing homes.

I have questions about Medicare. Who do I contact?
Medicare can seem complicated, but do not worry, there is help available. Find your local Medicare office through our Resource Locator or call the Medicare Help Line to get your questions answered 1-800-MEDICARE. You can also read more online at Medicare.gov (will open in a new window).

US Department of Health and Human Services, Centers for Medicare and Medicaid Services: http://www.cms.gov/
Medicare.gov: The Official US Government Site for Medicare: http://www.medicare.gov/
MedlinePlus, National Institutes of Health: http://www.nlm.nih.gov/medlineplus/medicare.html


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