When you turn age 65 you may have more than one health insurance option available to you. For most seniors, Medicare is the primary insurer, while for other individuals, Medicare is the only health insurance they have. If you do have other medical coverage through an employer group plan, private insurance company or a union or retiree program, having additional health benefits can affect how you use Medicare.
Individuals age 65 and older are eligible to receive Medicare – a health insurance program funded by the federal government. Medicare Part A is hospital insurance that pays for services you receive as a patient in a hospital or skilled nursing facility. It also covers home health care and hospice care if you meet certain requirements. Medicare Part B is medical insurance that pays for doctors’ fees and other outpatient care you receive. Although seniors do not pay a premium for Part A, they do pay a monthly premium for Medicare Part B. Medicare Part C offers benefits in addition to the services covered under Parts A and B. Because these are managed health-care plans, members of Medicare Part C plans are limited to doctors and hospitals within the plan’s network. Medicare Part D offers prescription drug coverage. Private insurance companies administer Part D plans; therefore, drug benefits can vary. Members pay an extra premium each month to enroll in Medicare Part D.
Medicaid is a health insurance program funded by both the federal and state governments. Programs can differ as they are managed by the individual states. In order to receive matching payments from the federal government, each state is required to provide mandatory services to specific groups of individuals. The elderly, pregnant women, children and families with low incomes are some of the eligible groups. Seniors who have limited income and resources may qualify for Medicaid in addition to their Medicare coverage. Medicaid funds a significant portion of long-term care for the elderly, paying for 40 percent of all nursing home costs, reports the Kaiser Commission on Medicaid and the Uninsured. States determine what services their Medicaid programs will cover as long as a service is medically necessary.
Medigap policies offer supplemental health insurance to cover Medicare deductibles and co-insurance payments, in addition to any medical services for which Medicare does not pay. Supplemental insurance you purchase from a private insurance company may cover all or only part of Medicare deductibles and other out-of-pocket medical expenses. The federal government has defined 12 standardized Medigap plans outlining the benefits. Not all plans are available in every state, and not all insurance companies offer all 12 plans. Seniors who are covered under a Medicare managed care plan or Medicaid do not need to buy a Medigap policy.
Veterans Health Care
Veterans can enroll in both the VA medical benefits program and Medicare even if they select Medicare as their secondary source of coverage. Enrollment in both medical benefits program will also give them access to non-VA physicians. Factors the VA uses to determine eligibility for veterans' health care include income and service connection. Elderly veterans may be eligible to receive additional health-care benefits including long-term care, adult day care, community residential care, home hospice care and nursing home care. You must meet income and asset limits to be eligible for long-term care benefits.
- Centers for Medicare and Medicaid Services; What Is Medicare; April 2008
- U.S. Department of Veterans Affairs; Information for Veterans Eligible to Enroll in Medicare; September 2009
- U.S. Department of Veterans Affairs; Geriatrics and Extended Care; January 2011
- AARP; A Boomer’s Guide to Medicare; December 2010
- Aging Parents and Elder Care: Medicare
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