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Medicare-vs-Medicaid.jpeg

July 20, 2021

Medicaid and Medicare are frequently misunderstood or used interchangeably. These 2 programs appear to be very similar, yet they are rather distinct.

Each is governed by its own set of laws and policies, and the programs are typically tailored to certain groups of individuals. It is possible, though, to be eligible for both programs.

It’s critical to grasp the have a clear idea of Medicare vs Medicaid in order to choose the right program for your requirements.

What is Medicare?

Medicare is a healthcare insurance program for those 65 and older in the United States who are having trouble paying for medical care and treatments. This program assists seniors and their families who require financial assistance for medical expenses.

Medicare benefits may be available to those under the age of 65 who have certain disabilities. Each case is assessed based on the program’s qualifying standards and specifics.

Those who are in the terminal stages of kidney disorders can also apply for Medicare coverage.

Original Medicare and Medicare Advantage are the 2 primary branches of Medicare to choose from.

Original Medicare

Original Medicare is a government-funded medical insurance program that many seniors use as their primary coverage. Inpatient hospital services are covered (Medicare Part A).

Hospital visits, hospice care, limited skilled nursing facility care, and at-home healthcare are all covered under these benefits.

Medical treatments are provided on an outpatient basis (Medicare Part B). These advantages include coverage for health-related preventive, diagnostic, and treatment services.

Medicare Advantage

Medicare Advantage (Part C) is a health insurance option for people who desire original Medicare coverage but with more options.

Medicare Advantage plans are provided by private insurance providers. Many of these plans include services that aren’t covered by basic Medicare, such as prescription medication coverage, dental, vision, and hearing care.

What is Medicaid?

Medicaid is a program that combines the efforts of the federal and state governments in the United States to help low-income families with healthcare costs. Major hospitalizations and treatments, as well as ordinary medical care, may be included in these costs.

Every year, the program serves millions of adults, children, and persons with disabilities. In November 2020, 72,204,587 people had signed up for Medicaid, while 6,695,834 children had signed up for the Children’s Health Insurance Program (CHIP).

What is the cost of Medicare vs. Medicaid?

Medicare Costs

For things like hospital stays, people who receive Medicare coverage pay a portion of the cost through deductibles.

Medicare mandates minor monthly charges for coverage outside of the hospital, such as a doctor’s appointment or preventative treatment. Prescription medicines, for example, may have some out-of-pocket expenditures.

The following is a breakdown of expenditures for both Original Medicare and Medicare Advantage:

Original Medicare Medicare Advantage
Monthly premium Part A: typically $0

Part B: typically $148.50

It varies (can start at $0)
Deductible Part A: $1,484 for each benefit period.

Part B: $203

It varies (can start at $0).

If your plan covers both health and medication coverage, you may have a health and drug deductible.

Coinsurance/copays Part A: $0, $371, or $742+ per day (depending on the length of your stay).

Part B: After the deductible is met, 20% of all approved medical treatments are covered.

It varies (generally, $0–$50+ per visit).
Out-of-pocket expenses (max) None $3.400–
$10,000+

 

Medicaid Costs

Medicaid recipients normally don’t have to pay anything for eligible services, although in rare situations, a small copayment is required.

As a form of cost sharing, states might impose limited premiums and enrollment fees. This is true for certain types of Medicaid recipients, such as:

  • Pregnant women and infants with a household income at or above 150% of the federal poverty level (FPL).
  • Medically needy individuals
  • Working individuals and qualified disabled with an income above 150% of the FPL.
  • Disabled working individuals who are eligible under the Ticket to Work and Work Incentives Improvement Act of 1999.
  • Disabled children who are eligible under the Family Opportunity Act.

The Takeaway

When it comes to Medicare vs Medicaid, these are basically 2 government programs in the United States that are designed to assist diverse populations in gaining access to healthcare.

Medicare normally covers people aged 65 and up, as well as those with certain chronic illnesses or disabilities, whereas Medicaid eligibility is determined primarily by income and need.

chris dsouaz

medicare-benefits-for-seniors.jpeg

July 19, 2021

Medicare is a health insurance program for persons over the age of 65 in the United States. People under the age of 65, such as those with disabilities or those who have permanent kidney failure, may be eligible for Medicare. In this blog, we shall learn about Medicare benefits for seniors.

Medicare assists with healthcare costs, although it does not cover all medical bills or most long-term care costs. You can receive Medicare coverage in a variety of ways. You can purchase a Medicare Supplement Insurance (Medigap) policy from a private insurance provider if you opt to have Original Medicare (Part A and Part B) coverage.

Coverage

Part A of Medicare covers hospitalization. It pays a portion of the costs of inpatient hospital stays, hospice care, some home health care, and skilled nursing facility care.

Medical insurance is covered through Medicare Part B. Part B covers doctor visits, medical supplies, mental health services, preventive care, and a limited amount of prescription medicines.

Part D of Medicare covers a greater range of prescription drugs.

What is Medicare Advantage

Medicare Part C is another name for Medicare Advantage. Private medical insurance companies that have a contract with Medicare to offer coverage administer these plans. Parts A and B are merged into a single policy.

All Medicare-approved services must be covered by Medicare Advantage, and some carriers may offer additional benefits such as vision, hearing, and dental care.

Prescription drug coverage

Prescription drug coverage is provided under Medicare Part D.

Part D plans are sold separately by private medical insurance firms.

Prescription drug coverage is available through Medicare Advantage plans. However, a person cannot get a separate policy on top of that.

Part D of Medicare is an optional benefit. A late enrollment penalty may apply if a person does not enroll when they are first eligible.

Individuals can use Medicare’s online Find a Medicare Plan page to locate a prescription drug plan in their area.

Supplementary insurance plans (Medigap)

Supplementary insurance or Medigap plans are Medicare policies that help pay for some out-of-pocket expenses.

Out-of-pocket expenses that may be covered include:

  • Deductibles
  • coinsurance
  • copayments

Furthermore, some Medigap plans cover medical treatment needed while traveling outside of the US.

Some Medigap policies have exclusions. The following are typically excluded from coverage:

  • dental treatment
  • long-term care
  • hearing aids
  • eyeglasses
  • private nursing
  • vision care

Finding the Right Medicare

A Medicare plan that covers all of your medical and financial needs is the best option to go for. Each Medicare plan has advantages and cons, ranging from cost-effectiveness to provider limitations and more.

If you’re thinking of enrolling in a Medicare plan this year, you might be wondering which one is the best since different plans have different Medicare benefits for seniors.

While there are many Medicare plan alternatives available, the optimal plan for you will be determined by your medical and financial circumstances. Fortunately, you may compare the benefits and drawbacks of each Medicare plan to pick one that is right for you.

Whether you go for original Medicare with add-ons or Medicare Advantage, make sure that you around and compare different plans. National Senior Services can help you find the best Medicare for you.

chris dsouaz

types-of-medicare.jpeg

July 19, 2021

One of your largest retirement expenses is your health care. When you reach the age of 65, you will be eligible for Medicare and will be able to choose a health plan depending on your medical needs.

Read : Medicare Benefits Policy Manual

The 4 types of Medicare coverage are as follows:

1. Medicare Part A: Hospital insurance

Medicare Part A is hospital insurance and is one-half of Original Medicare, the federally regulated health insurance program. The following are covered in Part A:

  • Inpatient hospital treatment for injuries or diseases
  • Following a qualified hospital stay, short-term qualifying nursing facility care is available.
  • Nursing home care (if professional nursing care is considered medically required for you)
  • Short-term respite care and hospice care
  • Home health services that are eligible, such as physical therapy or occupational therapy

You don’t have to pay a Medicare Part A premium if you or your spouse paid Medicare taxes while working for a particular period of time. Most people are qualified for premium-free Part A coverage, but if you aren’t, you can purchase it. You could pay up to $471 per month, depending on how much you paid in Medicare taxes over your lifetime.

2. Medicare Part B: Medical insurance

Medicare Part B a is medical insurance, and it is the other half of Original Medicare. It covers medically necessary services that satisfy accepted standards of care and are required to diagnose or treat your illness. Preventative care, such as most vaccines and early-detection screenings, is also covered.

Medicare Part B coverage includes the following:

  • Flu shots
  • Mammograms
  • Yearly wellness doctor visits
  • Diabetes screenings
  • Ground ambulance transportation
  • Cardiovascular disease screenings
  • Durable medical equipment, including wheelchairs and blood sugar monitors

Unlike Medicare Part A, which usually does not require payment of a monthly premium, Medicare Part B requires payment of a monthly premium. The Part B premium in 2021 will be $148.50 per month, according to the US Centers for Medicare & Medicaid Services.

3. Medicare Part C: Medicare Advantage plans

Rather than Original Medicare, many people choose Medicare Part C, generally known as a Medicare Advantage plan.

Medicare Advantage plans, unlike Original Medicare, are issued by private health insurance providers and are not funded by the federal government. Part C plans combine the advantages of Parts A and B, and they frequently include things that Original Medicare doesn’t, such as hearing, dental, and vision care. Many plans also include coverage for prescription drugs.

In some circumstances, the out-of-pocket payments of a Medicare Advantage plan are less than those of Original Medicare, making them a more affordable option. In fact, in 2021, the average monthly payment, in addition to your Medicare Part B premium, is just $21.

4. Medicare Part D: Prescription drug plans

Many people are astonished to learn that Parts A and B of Original Medicare do not cover prescription drugs. You can enroll in a Medicare Part D plan if you want coverage for your prescriptions. This is a supplemental benefit that covers prescription drugs. You can acquire a prescription drug plan (PDP) that meets your needs through Medicare Part D.

According to the Kaiser Family Foundation, the national average prescription drug plan premium in 2021 is $30.50. The cost of your particular plan is determined by its coverage, deductible, and coinsurance or coayment amount.

When selecting a Medicare Part D plan, look over the plan’s formulary, which is a list of drugs that the plan covers. Formularies differ per plan, and they may or may not cover all of your required prescriptions. As a result, while comparing Medicare Part D plans, it’s critical to look at the different coverage options.

Choosing the right health plan

It’s crucial to remember the different aspects of each type of Medicare while enrolling in Medicare and choosing the right health plan for you. The National Senior Services can help you locate available plans in your area, compare rates, and check that your drugs are covered.

chris dsouaz

medicare-benefits-policy-manual.jpeg

June 15, 2021

Medicare is a federal health insurance program that subsidizes healthcare services in the United States. The plan covers those aged 65 and over, as well as younger persons who meet certain conditions and people with particular conditions. Medicare is broken down into numerous plans that cover a wide range of healthcare needs, some of which are paid for by the covered person. While this allows the program to provide consumers with more cost and coverage options, it also adds to the program’s complexity for those looking to enroll. In this blog, you will get to know about Medicare benefits policy manual.

How Medicare Works

Medicare is a federally sponsored national healthcare program in the United States. In 1965, Congress established the program as part of the Social Security Act to provide health insurance to persons aged 65 and up who did not have it.

The Centers for Medicare and Medicaid Services (CMS) currently administers the program, which now covers persons with certain disabilities, as well as individuals with end-stage renal illness and amyotrophic lateral sclerosis (ALS), sometimes known as Lou Gehrig’s illness. Medicare is divided into 4 components, each of which provides distinct types of services to the insured:

  • Medicare Part A
  • Medicare Part B
  • Medicare Part C
  • Medicare Part D

Types of Medicare Coverage

Individuals can choose from 4 distinct types of Medicare programs, as indicated above. Basic Medicare coverage is primarily provided by Parts A and B (commonly known as Original Medicare) or the Medicare Part C plan. Individuals can also sign up for a Medicare Part D plan.

Medicare Part A

Hospitals and similar inpatient or inpatient-like settings, such as skilled nursing facilities, hospice, and some home-based healthcare, are covered under Medicare Part A. However, this plan excludes long-term or custodial care. Anyone who receives Social Security income is automatically covered. Enrollment is available on the Social Security website for those who do not currently receive benefits.

Medicare Part B

Outpatient treatment, such as doctor visits, is often covered by Medicare Part B. Preventive services, ambulance services, some medical equipment, and mental health care are all included under Part B. This plan also covers some prescription medicines. This plan’s typical monthly premium for 2021 is $148.50, with a deductible of $203. Anyone with an annual salary of more than $88,000 ($176,000 for married couples) pays a higher premium.

Medicare Part C

These Medicare Advantage plans, often known as Medicare Supplements, must provide coverage that is as least as good as Original Medicare (Plans A and B). Instead of purchasing Medicare Advantage plans directly from the government, consumers purchase them from private insurers. Many insurance plans have yearly out-of-pocket spending caps.

Many also include copays, coinsurance, deductibles, and even payments linked to insurance while traveling outside of the United States, which original Medicare patients would otherwise have to obtain through supplemental insurance such as a Medigap plan. Dental, eye, and hearing care may be included in some policies.

Medicare Part D

Through Medicare Part D, you can get extra prescription medication coverage. Part D is available to Medicare Part A and Part B beneficiaries who want to get help paying for prescription drugs that their original Medicare plans don’t cover.

chris dsouaz

Dental-Medicare-Plans.jpeg

June 15, 2021

Medicare is a national health insurance program for individuals turning 65. This best medicare coverage is also offered to individuals who have been disabled for 24 months due to a severe illness. There are widespread medicare plans significant to understand ahead of choosing a particular part of affordable medicare solutions.

If you want to sign-up for the best dental medicare plans, you primarily need to find medicare doctors and understand what kind of medicare giveback money to senior health. Around 75% of Americans have dental benefits to avail in case of emergency or general conditions.

Which One Is The Most Preferable For Your Condition – Heath Insurance vs. Dental Benefits?

While shopping for insurance, you can find the term dental benefits, which isn’t similar to issuance.

A health insurance is intended to cover a wide range of risks, such as a root canal or other ailments, and will charge you accordingly. However, the best dental medicare plan will cover everything related to dental trouble that’s fully helpful for senior health.

In case you’ve need to use medicare, you must ensure to understand what the plan covers at such an expensive or affordable cost.

How Dental Health Plans Can Be Categorized?

The features of dental benefits might vary company-to-company, although most medicare plans are grouped into the following categorizes –

  • Direct Reimbursement Programs
  • Schedule of Allowance Programs
  • UCR (Usual, Customary & Reasonable) Programs
  • Capitation Programs

Medicare benefits policy manual also enables private insurance companies to provide one of the following dental benefits –

  • Dental Health Maintenance Organizations (DHMO)
  • Preferred Provider Organizations (PPOs)
  • Special Needs Plan (SNP)
  • Private Fee-for-Service (PFFS) Plans

These enable you to get affordable medicare solutions by choosing an exact plan as per your condition over any original medicare. However, you can’t choose several plans at times as you need to pay monthly premiums on-scheduled.

What Things Are Covered Under Dental Medicare Plans?

The best medicare coverage will include outpatient services and physician’s charges, which are even considered optional coverage in some insurance packages. And also, you need to pay monthly premiums as per your previous two years of annual income. Some dental benefits will even cover most physician services, including clinics out-patient services, x-rays, preventive care, ambulance charges, sturdy medical equipment, and others. During several conditions, patients also need to pay some additional expenses of dental health benefits.

The best dental medicare policies will cover some extra points as the cost of –

  1. Preventive Care
  2. Crowns
  3. Fillings
  4. Root Canals
  5. Oral Surgery (like tooth extraction)
  6. Periodontics
  7. Orthodontics
  8. Prosthodontics (like bridges & dentures)

In case you want to get an individual policy, make sure to check what portions aren’t covered under the dental health benefits of your choice.

Sometimes, dental benefits and medical health insurance may overlap if the conditions aren’t understood accurately. In order to get a clear understanding of affordable medicare solutions, feel free to book an appointment with our experts and enroll yourself in the best dental medicare policy.

Now that if you are interested in getting medicare gym membership, you can visit us at www.nationalseniorservices.com to shop for the best medicare coverage today!

chris dsouaz

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National Senior Services is not connected with or endorsed by the US government or the federal Medicare program; Medicare has neither reviewed nor endorsed this information. We are a licensed and approved Medicare Service Provider.

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