6 Important Things to Know About Medicare and Medicaid

Finding the right health insurance is one of the most crucial decisions you can make about your medical care. The numerous private options can feel overwhelming, but federally-provided plans could provide the coverage you need too. This guide has a few important things to know about Medicare and Medicaid that will help you make the best choice for your health needs.

1. Medicaid Is for Low-Income Individuals

Medicaid is the federal program that provides health insurance for low-income Americans. As of July 2022, it covered 82.8 million people of all ages. Children can access coverage through the Children’s Health Insurance Program (CHIP) and adults can find health insurance if they qualify for Medicaid plans.

Although Medicaid receives federal funding, states set the qualifications regarding each applicant’s income, age, disabilities, family size and other factors. Your State Medicaid Agency will put you in touch with representatives who can see if you might qualify. If that’s the case, you can apply online.

2. Medicare Is for Retirees

Medicare is the other type of federally-funded health insurance. It’s available for people who are 65 or older because it generally helps people who retire and no longer receive employer-provided insurance. However, people under 65 may qualify based on their disabilities.

There are no income restrictions for Medicare applicants. It may also provide coverage in addition to an active, private insurance plan. This is usually only the case when the private insurance reaches its maximum coverage and the secondary payer on the plan can’t receive additional coverage for further medical care.

3. You Could Qualify for Both

Some individuals may qualify for both Medicare and Medicaid. In that case, they can receive dual eligibility if they have full coverage with Medicare or a Medicare Savings Program (MSP). After Medicare reaches its full coverage limits, Medicaid would step in to provide additional financial assistance.

This is often helpful for retired people who need long-term personal care assistance and don’t receive coverage through Medicare. Medicaid allows enrollees to receive more than 100 days of assisted living care and other services like transportation, meal delivery, therapies and respite care.

4. You Should Watch for Fraud

Scammers are always looking to take advantage of people who desperately need help or don’t know how to navigate a financial system. Medicare and Medicaid applicants often find themselves dealing with potential fraud.

When that happens, enrollees can report the fraud under the False Claims Act and potentially receive financial compensation. Since representatives amended the act in 1986, the federal government has reclaimed over $35 billion to help victims of fraud and provide job protection.

While applying and receiving care under a federally-provided health insurance program, you should watch for common forms of fraud such as:

  • Claims of additional payments after supposed kickbacks from physicians or pharmacies
  • Inflated medication prices
  • Sales of defective or broken medical devices

If you have any questions or need to report fraud, Medicare and Medicaid fraud attorneys can consult you about your options. You can also call your state Medicare or Medicaid offices, as well as the federal toll-free phone numbers for each program.

5. Both Have Open Enrollment Periods

Enrollment periods streamline the application process for applicants and federal workers. Although you can call your state office or the federal program offices to address any questions you may have about enrollment, you’ll have to wait until those periods to apply.

The deadlines you should note on your calendar if you’d like to apply are:

  • December 15, 2022: the last day to enroll or adjust your coverage that begins January 1, 2023
  • January 15, 2023: the last day to enroll in a 2023 Medicare or Medicaid plan

The only other opportunity to apply for 2023 coverage will be if you qualify for a special enrollment period. People who meet those qualifications may have moved, lost their health insurance unexpectedly, had a baby, adopted a kid, married or experienced a significant loss of income.

There’s no set calendar date for special enrollment periods, so watch for updated posts on the Medicare and Medicaid websites.

6. You May Need Supplemental Insurance

Although many people rely on these programs for health insurance coverage, Medicare doesn’t include every possible medical service you could need. People are often surprised to find that Parts A and B don’t cover services like:

  • Dental care
  • Eye exams
  • Hearing aid exams
  • Routine physical exams
  • Long-term custodial care

You can apply for private insurance plans to supplement these lapses in coverage. The companies will walk you through the application process to find the best solution for your health and financial needs.

Learn About Your Health Insurance Options

Medicare and Medicaid are essential health care options that many people can consider to access the medical services they need at affordable prices. Think about these important factors while evaluating your potential future. You’ll quickly find the best coverage without any confusion.

Team PainAssist
Team PainAssist
Written, Edited or Reviewed By: Team PainAssist, Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:November 22, 2023

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