Medicaid: Medicaid was created in 1965 as a joint federal public assistance program for those in certain Federal poverty limits, who could not afford health care. Since the program is administered by the individual states under federal guidelines, the benefits offered and eligibility requirements vary widely. About 60 million+ people around the US., including children, pregnant women, the elderly, the blind and disabled, are currently covered by Medicaid. States set individual eligibility criteria within federal minimum standards. States have the option to charge premiums and to establish out of pocket spending (cost sharing) requirements for Medicaid enrollees. Out of pocket costs may include copayments, coinsurance, deductibles, and other similar charges.
Medicare: Medicare is a federal insurance program which primarily serves those over 65 years old and younger, disabled people and dialysis patients. It currently covers about 37 million Americans. Medicare is divided into Part A, which covers inpatient hospital services, nursing home care, home health care and hospice care; and Part B, which helps pay the cost of doctors’ services, outpatient hospital services, medical equipment and supplies, and other health services and supplies. Recipients pay some part of the costs through deductibles. Since Medicare doesn’t cover all expenses, recipients often supplement their coverage through separate Medigap policies (also called Medicare Supplement Insurance Plans).
Medicare Prescription Drug Coverage, Part D: To get prescription drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and specific drugs covered.
There are two ways to get Medicare prescription drug coverage:
Look in the next column for the enrollment dates you must adhere to if changing plans.
Medicare Advantage: Medicare Advantage, also known as Medicare Part C, is a type of Medicare Plan run by private insurance companies. A Medicare Advantage plan offers all of the benefits covered under Original Medicare and more. Medicare pays a fixed fee to the plan you choose in accordance with the 2003 Medicare Prescription Drug, Improvement, and Modernization Act. When enrolled in a Medicare Advantage Plan, benefits are provided according to the Evidence of Coverage for that particular plan. Providers (doctors, specialists, hospitals, etc.) bill the Medicare Advantage plan, and not Original Medicare. Many Medicare Advantage plans also include a Part D prescription drug plan.
To join a Medicare Advantage Plan, a person must have an enrollment period and meet the following criteria:
Medicare Supplement Insurance Plan (Medigap): A Medicare Supplement Plan will help pay part A and part B deductibles, as well as Part B coinsurance, depending on the plan you purchase. “If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share. ”All Medigap plans are standardized by the federal government and labled “A” thru “N.” This means the only difference in benefits for a standardized Medigap plan, with the same letter, is the premium an insurance company charges. (Massachusetts, Minnesota, and Wisconsin Medigap policies are standardized in a different way). A Medigap policy is different from a Medicare Advantage Plan. Medicare Advantage Plans are ways to get Medicare benefits, administered from a private insurance company, while a Medigap policy only supplements your Original Medicare benefits. One cannot be enrolled in a Medicare Advantage Plan and a Medigap policy at the same time.
Applicants qualify for Open Enrollment during the first six months they are enrolled in Medicare Part B and are age 65 or older; this may vary by state. Generally, one needs to be enrolled in Part A and Part B at the time of the plan effective date. Changing (replacing) to a new carrier's plan can be done throughout the year; there is no annual enrollment date. When replacing one Medicare Supplement Insurance Plan carrier for another, some plans have guaranteed issue (do not require underwriting); this varies by carrier and state although replacing the supplement doesn’t follow the annual enrollment periods/dates, one must adhere to proper the enrollment dates if you’re considering changing Medicare Prescription Part D plans, and that can only be done certain times of each year”.
For newly MA- eligible individuals, the OEP occurs the first 3 months in which they have both Part A and Part B.
Individuals enrolled in a MAPD plan can use the OEP to get a different MAPD plan, a MA-only plan, or Original Medicare (with or without a PDP):one time.
Individuals enrolled in a MA-only plan can use the OEP to switch to a different MA-only plan , a MAPD plan, or Original Medicare ( with or without a PDP): one time.Individuals enrolled in Original Medicare cannot use the OEP to join a MA or MAPD plan, add a PDP, or change their PDP.