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We can not emphasize it enough: Medicare is Confusing! 

In a nutshell, Medicare is medical care, hence medicare, for the elderly and the disabled. Just like most social programs, part of your wage has been withheld and used towards a medicare tax, and if you are elderly and/or disabled, it is time to collect on these benefits you have been paying for! 

Medicare consists of four different parts:

  • Part A – Hospital insurance (inpatient hospital care, inpatient care in a Skilled Nursing Facility, hospice care, and some home health services)
  • Understanding Part A:
  • Part B – Medical insurance (physician services, outpatient care, durable medical equipment, home health services, and many preventive services)
  • Part C – Medicare Advantage (MA) (Medicare-approved private insurance companies provide all Part A and Part B services and may provide prescription drug coverage and other supplemental benefits)
  • Part D  (Extra Help Program) – The Prescription Drug Benefit (Medicare-approved private companies provide outpatient prescription drug coverage)

The Extra Help Program, or low income subsidies, helps beneficiaries with limited income afford their medicines. This program currently supports over 11.8 million beneficiaries by waiving or lowering premiums and deductibles, copayments as well as lowering cost for prescription medicines. 

Medicaid is a joint venture funded by Federal and State governments that pays for medical costs for certain individuals and families with low incomes and limited resources. The Federal government sets statutes, regulations, and policies that each State operates within while establishing their own eligibility standards, determining the type, amount, duration, and scope of services, setting the rate of payment for services, and administering its own programs. Because of this, your medicaid benefits and eligibility will vary depending on the state you currently reside in.


Dual Eligible Beneficiaries

‘Dual Eligible Beneficiaries’ describes beneficiaries eligible for both medicare and medicaid.  

It is important to note that services covered by medicare and medicaid are always paid first through medicare and medicaid covers certain additional costs not covered by medicare. It is estimated that over 9.2 million people are eligible for dual eligibility status. 

Medicare Savings Programs are state programs that help pay for your Medicare premiums, as well as Medicare Part A and Medicare part B deductibles, coinsurance, and copayments, if a potential beneficiary qualifies based on an individual’s income, resources, and other criteria.

Full Medicaid Coverage through optional coverage groups, such as social security, based on medically needy status, special income levels for institutional individuals or home and community based waivers.  Medicaid may pay Part A (if any) and Part B premiums and cost-sharing for Medicare services furnished by Medicare providers to the extent consistent with the Medicaid State Plan

  • Qualified Medicare Beneficiary Program (QMB) medicaid pays Part A (if any) and Part B Premiums allows for medicaid to pay deductibles, coinsurance, and copayments for Medicare services and furnished by Medicare providers consistent with the Medicaid State Plan even if the Medicaid State Plan payment Isi unavailable for these charges, the QMB is not liable for them) 
  • QMB Plus – Full medicaid coverage; Medicaid pays Part A (if any) and Part B premiums, and may pay deductibles, coinsurance, and copayments consistent with the Medicaid State Plan (even if the Medicaid State Plan payment is unavailable for these charges, the QMB is not liable for them)
  • Specified Low-Income Medicare Beneficiary Program (SLMB)  helps pay Part B premiums
  • SLMB Plus – Full Medicaid Coverage; Medicaid pays part B premiums
  • Qualifying Individual Program (QI) Helps pay Part B premiums
  • Qualified Disabled Working Individual Program (QDWI) Pays the Part A premium for certain disabled and working beneficiaries 

So as confusing as it may be, luckily there are companies that can make it easier. They help you find the right plan for you by focusing on the things you need and eliminating the things you don’t. Therefore not paying for benefits you cant or wont use. These companies work with various of the most reputable insurance carriers in the industry and match you with the best in your area. The service is usually free and a licensed insurance agent Is always on hand to recommend the best and most affordable Medicare plan for your specific needs.

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