Medicare
• Medicare is a National Health Insurance Program for people 65 years of age and older
• Certain persons with disabilities under the age of 65
• People with end stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant)
Medicare is not an entitlement program and should not be confused with Medicaid. The income and assets of a Medicare applicant are not a consideration in determining eligibility or benefit payment.
Medicare has four components, Part A, Part B Part C and Part D:
Part A covers inpatient hospital care, hospice care, inpatient care in a skilled nursing facility, and home health care services. Individuals have either paid into Medicare over the course of their employment and automatically become enrolled at age 65, or, if they have been a legal resident for five years or more, they can buy into Medicare.
Part B covers medical care and services provided by doctors and other medical practitioners, durable medical equipment, some outpatient care and home health care services. Individuals choose to become enrolled in Part B when they become eligible for Medicare and pay a monthly premium for that enrollment. If you don’t sign up for part b when you are first eligible, you may have to pay a late penalty.
Part C or Medicare Advantage (MA) plans are health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered health care through that plan which can include prescription drug coverage. Medicare Advantage plans include: Health Maintenance Organization (HMOs), Preferred Provider Organizations (PPO), Private fee-for-service plans and special needs plans.
Part D covers some prescription drug expenses. Part D is available to any Medicare beneficiary who has Medicare Part A or Part B or both. Part D drug plans are sold by private companies. There is a monthly premium, an annual deductible & co-payments for each prescription and costs vary from plan to plan. Enrollment in Part D is optional. But if you do not sign up when you are first eligible & change your mind later on, you may have to pay a penalty of a higher premium. However, there are some exceptions to the penalty.
“Extra Help” for Medicare beneficiaries may be available for those with limited income & assets to help pay part or all of the costs.
Medigap (Medicare Supplemental Plans)
A Medigap policy is health insurance sold by private insurance companies to fill the “gaps” in Original Medicare Plan coverage. Medigap policies help pay some of the health care costs that the Original Medicare Plan doesn’t cover. If you are in the Original Medicare Plan and have a Medigap policy, then Medicare and your Medigap policy will pay both their shares of covered health care costs.
Medicaid (Title 19)
Medicaid is a needs-based program which was created by Congress to help pay for medical care for those aged and disabled persons as well as indigent children and their caregiver relatives who meet strict eligibility criteria. It is jointly financed by the federal and state government and administered through the CT Department of Social Services. Unlike Medicare, Medicaid applicants must satisfy both the financial and non-financial eligibility requirements and the rules for establishing eligibility for Medicaid vary for a person living at home vs. a person residing in a nursing home.