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What Are the Differences? (Part 1)
Medicare and Medicaid What Are the Differences? (Part 1)
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Medicaid and Medicare are two important healthcare programs available to citizens of the United States
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They were created when the
Social Security Act was amended in 1965 and are managed by the Centers for Medicare and Medicaid Services
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These programs effectively extended healthcare coverage to almost all Americans age 65 or older
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and healthcare services to low-income children without parental support and the relatives who take care of them, the elderly, the blind and individuals with disabilities
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Though these programs have similar purposes, they are very different
in terms of how the programs are run, who can be eligible for benefits and the limits on those benefits
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Medicare
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Medicare is essentially an insurance program available to
people over the age of 65 regardless of income level younger people who are disabled patients with End-Stage Renal Disease requiring dialysis
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Through this program, patients pay a portion of the costs for medical treatment through deductibles and monthly premiums are required for non-hospital coverage
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Medicare benefits are usually provided by private companies that contract with Medicare to provide those benefits
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Because Medicare is a federal program, it is basically the same everywhere in the United States
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Medicare has several different parts that cover specific kinds of services:
Medicare Part A - Hospital Insurance Medicare Part B - Medical Insurance Medicare Part C - Medicare Advantage Plans Medicare Part D – Prescription Drug Coverage
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Medicare Part A
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Medicare Part A (Hospital Insurance) helps pay for care in a hospital and skilled nursing facility, home health care and hospice care
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Most people don't have to pay for Medicare Part A because Medicare provides the coverage
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You have a choice of any doctor, hospital or other healthcare provider that accepts Medicare
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You or your supplement insurance coverage would be responsible for deductibles and coinsurance (or copays)
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Medicare Part B
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Medicare Part B (Medical Insurance), which helps pay for doctors, outpatient hospital care and other preventive medical services
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Most people do pay for Medicare Part B
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With Part B, you can also choose
any doctor, hospital or other healthcare provider that accepts Medicare
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You or your supplement insurance coverage would be responsible for deductibles and coinsurance (or copays)
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Medicare Part C
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(Medicare Advantage Plans)
Medicare Part C (Medicare Advantage Plans) are offered by a private company that contracts with Medicare to provide Part A and Part B benefits
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Medicare Advantage Plans include the following:
Health Maintenance Organizations Preferred Provider Organizations Private Fee-for-Service Plans Special Needs Plans, and Medicare Medical Savings Account Plans
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Coverage is provided by the private insurance companies that are
APPROVED BY MEDICARE
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You are required with most plans to use doctors, hospitals and other
providers who are within the plan
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You are required to pay monthly premiums in addition to any Part B premium that you pay, along with deductibles and copays
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Medicare Part D
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(prescription drug coverage) adds prescription drug coverage to
Medicare Part D (prescription drug coverage) adds prescription drug coverage to Medicare Parts A and B, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans
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If you want this coverage, you should join a
Medicare Prescription Drug Plan and pay the monthly premium
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Medicare-approved companies
These plans are run by Medicare-approved companies
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Some Medicare Advantage Plans offer prescription drug coverage
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If they do not, you can join a Medicare Prescription Drug Plan
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What do you do about gaps in your healthcare coverage?
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If there are any gaps in your
healthcare coverage, you can obtain what is known as a Medicare Supplement Insurance or “Medigap” policy through a private company
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Medicare Advantage Plan, you cannot use a Medigap policy
However, if you have a Medicare Advantage Plan, you cannot use a Medigap policy to pay for any out-of-pocket costs
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In fact, if you already have a Medicare Advantage Plan,
you cannot be sold a Medigap policy
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Who is eligible for Medicare?
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You are generally eligible for Medicare if
you are 65 years or older a U.S. citizen or permanent resident of the U.S. you or your spouse have worked for at least 10 years at Medicare-covered job
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If you are not 65, but you have a disability or End-Stage Renal disease requiring dialysis or a kidney transplant, you may also qualify
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Learn More About Medicare in Arkansas
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Deborah Sexton Law Office
(479)
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