Medicare, Medicaid, and Medigap

Facts about Medicare

  • Medicare covers people aged 65 and older, some people with disabilities, and people with end-stage renal disease
  • Medicare is a federal health insurance program administered by CMS (Centers for Medicare and Medicaid Services)
  • Medicare has several different parts, covering different types of services

Medicare Managed Care

Part C, or Medicare managed care, allows beneficiaries to enroll in comprehensive health insurance through private companies. These programs replace the standard Part A, Part B, and Part D coverage, usually by expanding the types of services that are covered. Most Part C plans charge a monthly premium in addition to the Medicare Part B premium. Most plans require patients to use a limited network of providers.


Medicaid

Medicaid is a government program that provides full coverage for health care costs for Medicare beneficiaries with low incomes, and substantial coverage for Medicare beneficiaries with moderate incomes and few assets.

Full Medicaid benefits cover the cost of most medical services, including visits to the doctor, hospital treatment, medical tests, physical therapy, home health care, and glasses.  Prescription drugs for Medicaid beneficiaries are now covered by Medicare prescription drug plans.

People with Medicare may be able to get help from Medicaid with very high medical bills that Medicare will not pay.  The Medicaid “spend-down” program helps people to pay catastrophic medical bills they could otherwise not afford.  Medicaid also covers many nursing home and community-based care services.

Medigap (Supplemental Medicare Insurance)

Medigap insurance fills some of the gaps in Medicare coverage, paying for some health care costs that Medicare does not pay. The more gaps that a Medigap plan covers; the more expensive the policy is to buy. 

Eligibility for Medigap policies can vary.  Plans must offer “guaranteed enrollment” for new Medicare beneficiaries who are turning 65 years old: the plan cannot refuse to enroll a beneficiary, even if he or she is injured or sick.

 


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