This is not in place of or a full representation of the benefits of Medicare.
For complete information please call SSA at 800-772-1213 www.ssa.gov or 800-Medicare (800-633-4227) www.medicare.gov
¨ Medicare is a medical insurance for those who are 65 or older.
¨ It is also a medical insurance for those who are disabled and qualify for disability.
¨ It is for those who have end stage Renal disease (permanent kidney failure requiring dialysis or a kidney transplant)
¨ The first part is called Part A. This part is automatic enrollment if you are already receiving social security at age 65. Part A helps to cover the costs of inpatient care at a hospital, and skilled care at a nursing home. Part A also helps with the costs of hospice and some home health care that meet certain criteria.
¨ Part B is also a medical insurance that helps with the costs of outpatient hospital care and doctor appointments. Part B is optional and if
you sign up the fees are automatically deducted from your social security check. The initial enrollment period is 3 months prior to age 65 and ends 3 months after age 65. To apply call Social Security at 800-772-1213.
¨ www.cms.gov This site can provide information on Medicare and Medicaid
¨ Medicare prescription drug card Program. This will assist with the costs of some drugs at some pharmacy’s
¨ Medicare Advantage =This is Medicare plus a Choice plan
¨ Medigap (Medicare Supplement Insurance) = Open enrollment lasts for 6 months, starting on the 1st day of the month that you turn age 65.
¨ PACE programs = (Programs for All-Inclusive Care for the Elderly) Pace combines medical, social and long term care services for frail people. PACE is available only in states that have chosen to offer it under Medicaid. To find out if your state provides such services please visit www.medicare.gov/nursing/alternatives/pace.asp
¨ Department of Health and Human Services, Office of the Inspector General 800-447-8477 = Call regarding any suspected Fraud and Abuse
¨ Railroad Retirement Board (RRB) 800-808-0772 Railroad Retirement benefits
¨ Department of Veterans Affairs 800-827-1000 Veteran’s Benefits
¨ Department of Defense 888-363-5433 TriCare for life and eligibility for military retiree health benefits
¨ Office for Civil Rights 800-368-1019 Call if needing to file a privacy complaint
Medicaid Basics
This is not in place of or a full representation of the benefits of Medicaid.
For complete information please call your local Medicaid office.
¨ This is a joint program from the Federal government and the State government. This insurance program is designed to help pay for health costs of those who have low income. This program varies from state to state.
¨ California calls this program Medi-Cal, Massachusetts refers to this program as MassHealth and the rest of the states call it Medicaid.
¨ Medicaid is a medical insurance that a person must financially qualify for. If your income and financial resources are limited you may qualify for Medicaid.
¨ Medicaid is the only medical insurance that will pay for most of the costs at a nursing home.
¨ Medicaid is the only medical insurance that will help pay for “custodial care” (non skilled care) in a nursing home.
¨ Medicaid will help pay for many prescriptions Consult with an eldercare attorney who specializes in Medicaid
¨ www.cms.gov This site can walk you through the eligibility list and provide information on Medicaid and Medicare.
¨ These websites provide Screening Tools to help you see if you may be eligible for a variety of governmental programs: www.govbenefits.gov and http://www.benefitscheckup.org
¨ Apply for Medicaid at your local Medicaid office
Medicare Qualifications 1-800-772-1212
¨ Must be at least 65 or disabled to qualify
¨ Must be a legal resident or citizen
¨ Either you or your spouse must have worked in Medicare-covered employment for at least 10 years.
Medicare Parts A and B
¨ Part A is usually is premium free, helps cover hospitalization, skilled nursing, home health and hospice care.
¨ Part B is usually with a very low premium, helps cover doctor visits, outpatient care and medical services.
Medicaid
¨ Low income medical insurance
¨ Qualification process can take several months (Hospitals usually have a Medicaid worker to process emergency applications when a patient is in the hospital, otherwise one must apply at the Medicaid office, social services department or welfare office.) (If a person is in a nursing home usually the nursing home social worker can assist the resident in applying for Medicaid as well.
Will pay for custodial (non skilled nursing care) long term care in a nursing home. This is the only insurance that will pay for this type of care! Limitations include: nursing home Medicaid/MediCal beds usually have several beds in same room, many facilities, doctors do not accept Medicaid/Medical for payment.
Medicare and Medicaid Basics
