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Medicare Insurance Plans

Medicare and Medicaid are two programs provided by the U.S. government that offer health-related and medical services to a certain group of people. While the programs are extremely different, they are each managed by the Centers for Medicaid and Medicare Services, which is a part of the U.S. Department of Health and Human Services.

Medicare insurance plans are the social insurance program, which provides services for over 44 million people. Medicaid is a type of social welfare, also referred to as social protection, which provides services for over 40 million people. Both of the programs were created by former President Lyndon B. Johnson when the amendments were signed on July 30, 1965 on the Social Security Act.

 Understanding Medicare

Medicare Insurance PlansMedicare is the health insurance program that is provided by the federal government that pays for the medical care and hospital expenses for the disabled and elderly Americans. The Medicare program has two parts for medical and hospital insurance, which include Part A and Part B. Additionally, there are parts that provide flexibility and prescription coverage, Part C and Part D.

Medicare Part A

This is referred to as hospital insurance and covers expenses related to hospital stays including supplies, meals, semi-private rooms and testing. Part A also covers home health care, which includes occupations, speech and physical therapy on a part-time basis. Equipment for those that are disabled or older is also covered, which includes wheelchairs and walkers.

Medicare Supplemental

This is referred to as Supplementary Medical Insurance and covers outpatient hospital visits, physician visits, the costs for home health care. Some of the health and medical services that are covered under Part B include what is considered durable medical equipment such as scooters, walkers, canes and wheelchairs, nursing and physician services, laboratory and diagnostic testing, x-rays, some vaccinations, any blood transfusions, dialysis, outpatient procedures, some instances of ambulance transportation, chemotherapy, some hormonal treatments and eyeglasses and prosthetic devices.

Part B participants are required to pay a premium each month and meet an annual deductible prior to the coverage actually starting. Enrollment in Part B of Medicare is voluntary.

Medicare Advantage

Medicare Part C is often referred to as Medicare Advantage Plans or Medicare + Choice and allow each user to design a plan that meets their medical needs. These types of Medicare insurance plans are offered by private insurance companies, which means that participants are able to shop around for suitable rates and benefits. While the plans use private insurance carriers to offer some of the different coverage options, the details of the coverage will be dependent on the actual program and the actual patient’s eligibility.

There are some Advantage Plans that team up with health maintenance organizations, better known as HMOs, or the preferred provider organizations, or PPOs that provide specialist or preventative health services. There are other plans offered in Part C that cater to special needs patients, such as ones with diseases such as diabetes.

Medicare Part D Prescription Drug

This is the prescription drug plan offered by Medicare and provides affordable medications for elderly and disabled citizens. Part D is provided by some private insurance companies that offers different drugs and costs dependent on the provider. If a person wishes to participate in Medicare Part D they must pay a deductible and premium. The pricing has been designed so that up to 75 percent of the drug costs are covered by the Medicare insurance, up to $2,250. After this plateau, the next $2,850 is not covered by the plan, and once $3,600 is reached, Medicare covers 95 percent of the prescriptions for the patient.

Understanding Medicaid

Medicaid is a program that offers medical and health services for individuals, as well as families, who have few resources and low incomes. While the program is primarily regulated on the federal level, each state does the following:

  • Determines the duration, amount, scope and type of the services that are provided;
  • Sets eligibility standards;
  • Sets the payment and rate for the services that are provided.

While each state has the final decision of what services Medicaid provides, there are certain mandatory requirements that are set on a federal level that must be met by each state if they wish to receive funding for the program. The federally required services are:

  •  Inpatient/outpatient hospital services;
  • Prenatal care;
  • Physician services;
  • Children’s vaccines;
  • Family planning;
  • Rural health clinic types of services;
  • Nursing facility provisions;
  • Home health care;
  • Periodic screening;
  • Midwife/nurse services.

While each state determines who is eligible, the program was created for those who have low incomes. Other eligibility factors include age, disability or pregnancy status, any other owned assets and citizenship.

Our knowledgeable and helpful staff at McClerkin Insurance can help you wade through the confusing waters of Medicare insurance plans and Medicaid to determine if you qualify, what is covered and what type of coverage you need.

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