Retirement Planning Articles |
Medicare, Medigap, and Medicaid
| Medicare | Medigap | Medicaid | |
| What is it? | Federal health
insurance program for Social Security recipients. Parts A
and B comprise the original Medicare program.
Medicare Advantage (also referred to as Part C) plans are also available in some areas. They provide managed care and fee-for-service options through private insurers. |
Medicare
supplement insurance issued by private companies.
Typically, individuals who have Medicare Advantage would not need a Medigap plan. |
Joint
federal-state need-based health insurance program.
Eligibility requirements and covered services vary from state to state. |
| What does it cover? | All or some
portion of:
Part A: Hospital and skilled nursing facilities, home health agency care, hospice care, inpatient psychiatric care, and blood transfusions. Part B: Doctors, outpatient mental health services, therapy, part-time skilled home health care, certain preventative services, and other medical services. |
All or some
portion of:
Medical care not covered by Medicare, deductibles, co-payments, and coinsurance; plans may also cover other services such as eye and dental exams. |
All or some
portion of:
A broad range of medical services including inpatient and outpatient hospital care, prescription drugs, nursing home care, and skilled care. |
| Part C: All the
benefits offered by the original Medicare plan. Some
offer added benefits such as prescription drugs, eye
exams, and hearing aids. Part D: Prescription drug coverage (optional). |
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| Who is eligible? | Generally,
persons age 65 or older, and those with certain
disabilities or diseases are eligible for Medicare Parts
A and B.
Anyone eligible for Parts A and B is eligible for Part C and Part D. |
Individuals who are enrolled in Medicare Parts A and B. | Individuals who have limited income and resources and who meet other eligibility requirements. |
| What is the cost? | Part A: Most
participants don't pay for this coverage because of prior
Social Security covered employment.
Part B: $93.50 monthly premium, $131 annual deductible; $124 daily co-pay for skilled nursing care for days 21-100 (in 2007). Part C: Varies by insurer, state, and plan. Part D: Varies by insurer, state, and plan. |
Premiums vary by company, region, and plan. There are generally 12 available plans (A-L), each offering different levels of coverage. Not all plans are available in every state. | No premium.
Deductibles vary from state to state. |
| What does it take to enroll? | If you are
receiving Social Security or Railroad Retirement benefits
(or are applying for benefits) at or prior to age 65, you
will be automatically enrolled in Part A and Part B.
Contact the Social Security Administration to enroll if:
|
Purchase a
policy from an insurance company.
You can find information on Medigap policies offered in your area by visiting the Medicare website or calling (800) 633-4227. |
Application
procedures vary from state to state.
For information, contact the agency responsible for administering Medicaid in your state. |
