MEDICARE, MEDICAID & THE MARKETPLACE Alaska Primary Care Association September 2014

Medicare Health Insurance for people 65 and over on disability (SSDI) End Stage Renal Disease, Lou Gehrig Disease

Medicare ++++ Many people have Medicare only Some have Medicare and a Medicare Supplement Medicare works with Medicaid Medicare works with IHS/tribal healthcare Veterans can also have Medicare It’s not “one or the other”

Medicare Part A Part A – helps pay for inpatient hospital stays, skilled nursing facility care, home health care, hospice care and blood Premium free – no monthly premium if you or your spouse paid Medicare taxes while working – 40 or more credits (FICA) work credits - $234/month Less than 30 work credits - $426/month

Medicare Part B Medicare Part B covers a variety of medically-necessary outpatient services and supplies: Doctors’ Services Outpatient Medical and Surgical Services Laboratory, Diagnostic services Durable Medical Equipment Home Health Services Part B premium is $ paid by state if on Medicaid or Medicare Savings (SLMB)

Medicaid Basics Medicaid is the primary public program for financing basic health and long-term care services for low-income Alaskans. Focuses on coverage for low-income children, pregnant women, families, the elderly, blind and permanently disabled.

Medicare & Medicaid key points: Help people re-certify for Medicaid Medicare is primary; Medicaid pays last Bring proof of both coverages to providers Get/keep Part A and B – the state buys premiums Medicaid stops covering prescriptions, so dual beneficiaries need to have Part D

The Marketplace Must meet the ACA’s requirement to maintain Minimum Essential Coverage For people who do not have insurance If a person is 65+ they can have Medicare Most have premium-free Part A

Frequently Asked Questions Prohibition against the sale of duplicate coverage to an individual with Medicare What if a person is eligible but not enrolled? What if they have Part B only? What if they don’t have free Part A?

Questions? Judith Bendersky, MPH Gerontologist Priya Helweg, Office of External Affairs CMS