Frequently Asked Questions (FAQ) | Medicare & Medicaid

Medicare is a federal health insurance program primarily for people aged 65 and older, but it also covers certain  younger people with disabilities and individuals with End-Stage Renal  Disease. 

Medicare has four parts:

• Part A (Hospital Insurance): Covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
• Part B (Medical Insurance): Covers certain doctors' services, outpatient care, medical supplies, and preventive services.
• Part C (Medicare Advantage): An alternative to Original Medicare (Parts A and B) that offers additional benefits through private insurers.
• Part D (Prescription Drug Coverage): Helps cover the cost of prescription drugs.

Medicare Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and limited home health care services. 

Medicare Part D is prescription drug coverage  available to anyone with Medicare. It is offered by private insurance  companies and covers a portion of the cost of prescription drugs. You must enroll in a Part D plan separately unless you have a Medicare Advantage plan that includes drug coverage.

Medicare Advantage plans are offered by private insurance companies approved by Medicare. These plans include all benefits and services covered under Parts A and B, often with additional benefits like vision, dental, and hearing coverage. 

To choose the right Medicare Advantage plan,  consider factors such as the plan's coverage, network of doctors and hospitals, costs (premiums, copayments, and deductibles), additional benefits, and customer service. You can compare plans using the Medicare Plan Finder on the Medicare website. 

Yes, you can change your Medicare Advantage plan during the Annual Enrollment Period (October 15 - December 7) or during the Medicare Advantage Open Enrollment Period (January 1 - March 31). 

SNPs are a type of Medicare Advantage plan designed for individuals with specific diseases or characteristics. These plans tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.

Medigap, or Medicare Supplement Insurance, is a private insurance policy that helps cover some of the costs not covered by Original Medicare, such as copayments, coinsurance, and deductibles. 

The "donut hole" is a gap in prescription drug coverage under Medicare Part D. After you and your drug plan have spent a  certain amount on covered drugs, you enter the coverage gap, where you pay a higher percentage of prescription costs until you reach  catastrophic coverage. 

Medicare Part D is prescription drug coverage  available to anyone with Medicare. It is offered by private insurance  companies and covers a portion of the cost of prescription drugs. You must enroll in a Part D plan separately unless you have a Medicare Advantage plan that includes drug coverage.

Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources. It also offers benefits not typically covered by Medicare, like Long-Term Care and personal care services. 

Eligibility for Medicaid is determined by state-specific guidelines but generally includes low income individuals and families, pregnant women, the elderly, and people with disabilities.  Each state has different income and resource limits. 

You can apply for Medicaid through your state’s Medicaid office or online through your state’s health insurance marketplace. Eligibility and application processes vary by state. The Medicaid HHS Directory for every state is conveniently accessible in the "Resources & Support" section of this website, offering contact details for the respective state agencies.

Yes, individuals who qualify for both Medicare and Medicaid are known as "dual-eligible." Medicaid can help pay for costs and services that Medicare does not cover, including Long-Term  Care. 

Medicaid is jointly funded by the federal government and state governments. The federal

government provides a matching rate to states based on the state's per capita income, with poorer states receiving a higher matching rate.

Income and asset limits for Medicaid eligibility vary by state and program. Generally, income limits are based on the Federal Poverty Level (FPL), and asset limits are low to ensure the program supports those with limited financial resources. Contact your state’s Medicaid office for specific limits.

Medicaid plans can include fee-for-service (traditional Medicaid), managed care organizations (MCOs), primary care case management (PCCM), and special programs like waivers for home and community-based services. States may offer different types of plans based on eligibility groups.

Medicaid provides a range of services for individuals with disabilities, including medical care, personal care assistance, physical and occupational therapy, durable medical equipment, and home and community-based services. Eligibility and specific services vary by state.

The Medicaid Buy-In program allows individuals with disabilities who are working to "buy into" Medicaid by paying a premium based on their income. This program supports individuals with disabilities in maintaining their Medicaid coverage while they are  employed.

Medicaid estate recovery rules require states to seek reimbursement from the estates of deceased Medicaid beneficiaries for Long-Term Care and related services paid by Medicaid.