Medicare and Medicaid: Who, What, When, How

What is Medicare? Who is eligible? How does one sign up and receive benefits? How is Medicaid different from Medicare? Can I receive benefits from both? There continues to be a lot of confusion and questions regarding these two government programs. Follow along below for some basic information related to Medicare and Medicaid.

What is Medicare?

According to the Department of Health and Human Services, Medicare is a federal insurance program that pays medical bills from trust funds which those covered have previously paid into. Patients also pay a portion of the costs through deductibles for hospital and other costs, as well as small monthly premiums that are required for non-hospital coverage.

Medicare is basically the same everywhere in the U.S. and is run by the Centers for Medicare and Medicaid Services (CMS), an agency of the federal government. It serves people over 65 primarily, whatever their income; and also serves younger, disabled people and those on dialysis.

When can I sign up?

You are eligible to sign up three months prior to turning 65 or earlier if you have a disability.

What are the different parts of Medicare?

Medicare is broken down into the following parts:

• Part A – Hospital insurance that helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.
• Part B – Medical insurance that helps cover services from doctors, outpatient care, home health care, many preventive services, and durable medical equipment.
• Part D – Drug coverage that helps cover prescription drug costs. A Medicare drug plan must be joined in addition to the original Medicare or by joining a Medicare Advantage plan. Plans that offer Medicare drug coverage are run by private insurance companies that follow rules set by Medicare.
• Part C – Otherwise known as Medicare Advantage. Medicare Advantage is a Medicare-approved plan from a private company that offers an alternative to original Medicare for health and drug coverage.

What is Medicaid?

Medicaid is an assistance program serving low-income people of every age, including eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. Typically, patients pay nothing for covered medical expenses.

Medicaid is funded jointly by states and the federal government. It varies state to state within federal guidelines.

Who is eligible for Medicaid?

As of May, 2021, Nebraska expanded Medicaid coverage to low-income adults. Most Medicaid eligibility and all CHIP (Children’s Health Insurance Program) eligibility is based on modified adjusted gross income (MAGI). Income eligibility levels are tied to the federal poverty level (FPL).

Can I be enrolled in both Medicare and Medicaid at the same time?

The short answer is yes. Some individuals qualify for both and are known as dual-eligibles. To determine if you are eligible, reach out to your state Medicaid office. The CMS also maintains a list of state agencies that oversee Medicaid.

I have Medicare or Medicaid, now what?

It is important for individuals who are eligible for Medicare or Medicaid to secure their benefits and then locate a trustworthy, primary care provider to ensure the prioritization of their (and their family’s) health and wellness.

Bluestem Health Piedmont Clinic offers integrated and comprehensive healthcare services that are client-driven, culturally sensitive, and family-focused. Our medical team would be honored to provide primary care services to you and your family and happily accept Medicare and Medicaid patients, as well as commercial insurance. Furthermore, Bluestem Health’s Patient Support Services excel at assisting patients to navigate the Medicare and Medicaid eligibility and enrollment requirements.

Bluestem Health Piedmont Clinic is here to serve you with quality medical care in a caring, welcoming environment. Schedule an appointment today!