Do you know the difference between Medicaid and Medicare? If not, don’t worry – you’re not alone. These two programs, established in 1965, are programs sponsored by the federal government and designed to help American citizens cover health care costs. There are lots of rules, regulations and intricacies that make it easy to confuse the two – and make both of them incredibly confusing.
Addie Ricci, Executive Director at Bridges® by EPOCH at Norwalk, located in Norwalk, CT, has seen many residents come to their community who don’t understand how either of these systems work or how they apply to them in particular. And that’s okay, she says.
“While it’s good to know the basics about these two programs, especially if you’re eligible for the benefits, there’s no reason you should have to become an expert,” she says. “With the ever-changing rules, regulations, requirements and everything else, researching them would be your full-time job. We do our best to help our residents understand the benefits they qualify for, how they can use them to assist with covering health care costs and any changes that may affect them personally.”
Medicare: The Basics
What is Medicare?
Medicare is a national health insurance program for citizens as well as some permanent legal residents. Usually, people are eligible to receive Medicare once they turn 65. This depends upon your employment history or your spouse’s employment history. Individuals under the age of 65 who have qualifying disabilities are also eligible for Medicare.
What does Medicare cover?
That’s a complicated question to answer. There are four parts when it comes to Medicare coverage. Some of these are mandatory for everyone who’s enrolled. Others are optional for an additional cost. Here’s the breakdown.
Part A: Hospitalization Coverage
Medicare Part A will cover hospitalization costs – free – for qualified individuals. In order to qualify, the senior has to be 65 years or older, and either they or their spouse worked and paid Medicare taxes for at least 10 years. Part A does not cover copays, monthly premiums or deductibles.
Part B: Medical Insurance
If you’re eligible for Medicare Part A, you also qualify for Medicare Part B. This part covers medically necessary equipment and services, which includes outpatient surgeries, doctor’s office visits, x-rays, lab work, walkers, wheelchairs, preventative services (like wellness screenings) and others.
Medicaid Part B, like private health insurance plans, requires you to pay a monthly premium payment. If you’re an individual who earns more than $85,000 a year or a couple that earns more than $170,000, your costs will be higher.
Seniors are not required to sign up for Part B as soon as they’re eligible. However, if you join later in life, it may cost you more due to a penalty for late enrollment.
Part C: Supplemental Insurance
Medicare Part C, also known as Medicare Advantage, has the same eligibility requirements as Part A and Part B. Part C is a more comprehensive form of coverage that includes dental and vision coverage in addition to medical insurance and hospitalization coverage. In this option, seniors enroll for health insurance through a private insurance company. Confusing, we know! Depending on your situation and medical needs, though, Part C can offer significant benefits and may be a good option to help protect you from high healthcare costs.
Part C is one of two ways that seniors can protect themselves against high medical costs. Another option is Medicare Supplement Insurance, also known as Medigap coverage. This is offered to seniors who are enrolled in Medicare proper (so, not available to those who are enrolled in Part C). This is a form of insurance that can be purchased to cover expenses that aren’t covered otherwise, such as deductibles, copayments and coinsurance.
Part D: Prescription Drug Coverage
Medicare Part D provides coverage for prescription drugs. Participants must pay a monthly premium in order to receive this coverage.
Can I switch plans in Medicare?
Yes. There is a window of time – for 2019, the dates are October 15 to December 7 – where participants can switch their plans without paying a penalty.
Medicaid: The Basics
What is Medicaid?
Medicaid is a program owned jointly by federal and state governments. It was designed to help low-income Americans of any age pay for healthcare costs.
Who is eligible for Medicaid?
That depends on the state you’re living in. Individuals must be below a certain income level in order to qualify (see what your state’s income level is here). Seniors also may have a cap on the dollar amount of liquid assets they own. If you are eligible, you will pay nothing for services that are covered by Medicaid.
If I’m eligible for Medicaid, am I also eligible for Medicare?
Yes. Medicaid participants who reach the age of 65 are eligible to receive Medicaid in addition to their Medicare benefits. Based on your situation, though, your Medicaid coverage may change.
What services does Medicaid Cover?
Although coverage varies by state, generally Medicaid participants are covered for:
- Hospitalization
- X-rays
- Lab work
- Doctor visits and services
- Nursing and nursing facility services
- Clinic treatment
- Home healthcare services
Can Medicaid be used to fund long-term care?
Yes. Medicaid is very often used to fund long-term care if an individual has no other means to pay for nursing care. This is a benefit that’s not covered by most private health insurance policies or by Medicare.
“Medicaid and Medicare can be confusing to navigate, which is why we at Bridges® by EPOCH at Norwalk stay up-to-date on policy changes and regulations in order to best help our residents and families,” says Addie. “Our goal is to help you and your loved ones manage the dementia journey with the highest quality of life possible. During this time, you shouldn’t have to be worrying and wondering what’s covered and what’s not with your insurances. We are happy to help at any time, whether you’re a member of our community or not. We are here to provide support, advice and assistance however it’s needed.”
For more information about the basics of Medicare and Medicaid, or to learn more about our memory care assisted living community, please contact us on our website.
Compassionate Care for All Stages of Memory Loss
Bridges® by EPOCH at Norwalk provides assisted living memory care that is comfortable, positive, safe and engaging. Exclusively dedicated to caring for those with Alzheimer’s disease and other forms of dementia or memory impairment, we’ve created a wellness-focused lifestyle that promotes dignity and individual preferences. Our memory care professionals receive specialized and ongoing training designed to help residents maximize their independence in a secure, calm environment – making a truly positive impact on the lives of our residents each and every day.
Personalized Services
Bridges® by EPOCH at Norwalk’s services are designed to recognize and adapt to the unique challenges and individuality of each resident, while ensuring comfort and safety. We believe in a full-service approach to care and provide a high level of personalized attention for every stage of memory loss. At Bridges® by EPOCH at Norwalk, our residents have it all for one simple monthly fee.
Community Amenities
Within a beautiful residential design, Bridges® by EPOCH at Norwalk provides everything residents with Alzheimer’s disease and other dementias need to enjoy comfort, familiarity and security. Soft colors, directional cues, aromatherapy and interactive life stations create a peaceful and secure environment where residents feel at home.
Contact us today to learn more.