How Do You Know If Your Eligible for Insurance?

Medicare is a medical insurance designed for:

  • People 65 years of age or older;
  • People under the age of 65 with certain types of disabilities;
  • People of any age with end-stage kidney disease (ESRD) (chronic renal failure requiring dialysis or kidney transplant).

What are the different parts of the Medicare program?

Part A (Hospital Insurance) helps cover the following:

  • Inpatient treatment in hospitals;
  • Qualified Nursing Care Facility (SNF) Care;
  • Hospice;
  • Home Health Care.

As a rule, you do not pay a monthly installment for Part A if you or your spouse paid Medicare taxes during your work. This is sometimes called Part A without paying premiums. If you are not entitled to Part A without paying premiums, then you can buy Part A and pay premiums.

Part B (Health Insurance) helps cover the following:

  • Services of doctors and other health care providers;
  • Ambulatory treatment;
  • Home Health Care;
  • Durable Medical Equipment (DME);
  • Some preventative services.

Most people pay a standard monthly installment for Part B.

Note. You may wish to receive insurance coverage for expenses that are not covered by the original Medicare program. You can buy additional insurance for Medicare (Medigap) from a private insurance company.

Part C (Medicare Benefit Plan):

  • Includes all benefits and services covered by Parts A and B;
  • Typically, such a plan includes Medicare prescription drug coverage (Part D);
  • Implemented by private insurance companies approved by the Madicare Program;
  • May include additional benefits and services for an additional fee.

Part D (Medicare Prescription Drug Coverage):

  • Helps cover the cost of prescription drugs;
  • Implemented by private insurance companies approved by the Medicare Program;
  • May help reduce prescription drug costs and protect against future high costs.

Note. If you have low income and resources, you may have the right to help pay for your health care and prescription drugs. For more information, visit socialsecurity.gov or call Social Security at 1-800-772-1213, or contact your local state health office (Medicaid).

What is the Medicaid program?

Medicaid is a joint federal and state program that helps pay for the medical expenses of certain people with limited income and resources. Medicaid may also cover services that are not usually covered by Medicare (such as long-term care and services and personalized care). Each state has different provisions on eligibility for the Medicaid program and how to apply for it. If you are eligible for Medicaid in your state, you will automatically be eligible for additional assistance to pay for Medicare prescription drugs (Part D).

You may be eligible to participate in the Medicaid program if you have a limited income, or:

  • Age 65 or more;
  • Child under the age of 19;
  • Pregnant;
  • Disabled;
  • Parent or adult caring for a child;
  • Adult without dependent children (in some states);
  • Eligible immigrant.

In many states, more parents and other adults are currently eligible for coverage. If you have been denied in the past, you may try again and possibly have the right now.

When registering in the program, you can get the necessary medical services:

  • Doctor visits;
  • Hospital stays;
  • Long-term services and assistance;
  • Preventive services, including immunization, mam-mography, colonoscopy and other necessary services;
  • Prenatal services and maternity care;
  • Psychiatric care;
  • Essential medicines;
  • Eye and dental care (for children).

You must apply for Medicaid if you or someone in your family needs medical attention. If you are not sure if you are eligible for this program, a qualified social worker in your state can evaluate your situation. Contact your local or state Medicaid office to find out if you are eligible to apply for the program. For information about your state’s Medicaid program, visit the HealthCare website: https://www.healthcare.gov/medicaid-chip/getting-medicaid-chip.

The right to participate in both programs

Some individuals eligible to participate in both Medicare and Medicaid programs are called dual eligibles. If you have Medicare coverage and full Medicaid coverage, then most of your medical expenses are likely to be covered.

You can get Medicare coverage through the original Medicare program or through a Medicare preferential plan like (HMO (plan to use contracted medical facilities and doctors) or PPO (plan to use your preferred healthcare provider organization). If you participate in Medicare and Full Medicaid, then Medicare covers prescription drugs for Part D. Medicaid may cover certain medicines and other services that are not covered by Medicare.

If you have questions about the Medicare program, you can also call 1-800-MEDICARE (1-800-633-4227).