What You Need To Know About Medicare, Medicaid Coverage and Private Insurance

Choosing an insurance plan is a hard and sometimes overwhelming task. It is important that you know your options and what each plan has to offer. Here are the three main insurance plans and what you need to know about each one:

Medicare 

Medicare is the federal government program that provides health care coverage. The Center for Medicare and Medicaid Services (CMS) is the federal agency that runs Medicare. Unlike Medicaid, Medicare does not depend on income. The program is funded in part by Social Security and Medicare taxes you pay on your income, in part through premiums that people with Medicare pay, and in part by the federal budget. People who are eligible for Medicare: 

• People over the age of 65 
• People under the age of 65 with disabilities
• People with End Stage Renal Disease 

Medicare also has 2 parts, Part A which is Hospital Insurance and Part B Medical Insurance. If you are 65 years or older you are eligible for premium free Hospital Insurance and if you or a spouse paid medicare taxes for at least 10 years. 

Medicare Part A Coverage:

• Impatient hospital care 
• Skilled nursing facility care (SNF) 
• Home health care 
• Hospice care 

Medicare Part B Coverage 

• Provider services 
• Durable medical equipment 
• Home health services 
• Ambulance services preventive services 
• Therapy services 
• Mental health services 
• X-rays and lab results 
• Chiropractic care
• Select prescription drugs – including immunosuppressant drugs, some anticancer drugs, some anti-emetic drugs, some dialysis drugs, and drugs that are typically administered by a physician.

This list includes commonly covered services and items, but it is not a complete list. Keep in mind that Medicare does not usually pay the full cost of your care, and you will likely be responsible for some portion of the cost-sharing (deductibles, coinsurances, copayments) for Medicare-covered services.

Learn More.

Medicaid

Medicaid is a federal and state program that provides health coverage for certain people with limited income and assets.  You may qualify for free or low-cost care through Medicaid based on your family size and your income. People who are eligible for Medicaid:

• Older Adults 
• Children 
• People with disabilities 
• People who are pregnant 
• Parents or caretakers of children  

Each state also has Medicaid programs for people with limited assets and are in need of nursing home care, long term care, and home health care. Some states also have additional programs for people who don’t fit into those categories. 

All states use financial eligibility guidelines to determine whether you are eligible for Medicaid coverage. Usually, your assets and income must be below a certain amount to qualify but this varies by state and program. As long as you fall into one of the eligible groups and financial requirements you will be able to receive Medicaid. 

Medicaid Coverage:

• Doctor visits
• Hospital expenses
• Nursing home care  
• Home health care
• Long-term care costs (both at home and nursing home)

Institutional Medicaid 

This provides general health coverage and coverage for nursing home services such as room and board, nursing care, personal care, and therapy services. You are eligible for Institutional Medicaid if you need nursing home level care or meet that criteria and if you have the right financial requirements. 

Learn More.

Private Health Insurance 

Private health insurance refers to any health insurance coverage that is offered by a private entity instead of a state or federal government. Both Medicare and Medicaid are public insurance plans. According to the U.S. Census Bureau most Americans are enrolled in a private insurance plan. Employer-based coverage continues to be the most common, followed by 19% of Americans with Medicaid and 17% with Medicare. Why you might need private health insurance: 

• If you are 26 years and older and no longer under your parents insurance (under the provisions of the Affordable Care Act) 
• If you are unemployed 
• If you work part-time 
• If you’re self-employed 
• If you are retired 
• If you are not eligible for either Medicare, or Medicaid and your employer does not offer an employer-sponsored plan 

There are several different health insurance plans which have different features and different coverages. For example: 

• Preferred Provider Organization (PPO) which is an insurance plan in which medical professionals and facilities provide services to subscribed clients at reduced rates
• Short-Term Insurance Policy which is covers any gap in coverage you might experience if you change jobs and new coverage doesn’t come in quick enough
• Catastrophic Coverage This type of health insurance is intended for people who cannot afford much money every month and typically are only available for adults 30 years or younger. 

Learn more about what private health insurance plan is best for you and which each covers.

Spring Hills 

In an effort to make this a pleasant and stress free experience, we have aligned ourselves with resources to provide you with complimentary services to help make this transition more affordable. We recognize that when it comes to payment, families appreciate options. Our goal is to help you find the best financing solution available to your family. Our Signature Financial Solutions program through Elderlife Financial Services offers an array of financing options. They will guide you, so you can access the funds you need to enter our community today. Contact our Elderlife Financial Services Advisor at 1.888.228.4500.