MEDICARE

Medicare is one of the federal government’s largest programs and it provides health care benefits primarily to elderly people and the disabled.

The usual age of eligibility for those benefits is 65, although certain people qualify for the program earlier. (Medicare is available to people under age 65 who have been eligible for Social Security disability benefits for at least 24 months or who have end-stage renal disease.)

Outlays for Medicare are projected to increase rapidly in coming decades because of the retirement of the baby-boomer generation and because growth in per capita spending for health care is expected to continue to exceed growth in per capita gross domestic product over the long term.

Moreover, increases in life expectancy mean that the average length of time that people are covered by Medicare has risen significantly since the program began in 1965. That trend, which increases the program’s costs, will almost certainly continue.

Medicare Supplement

(MediGap)

• Medigap plans are supplemental insurance plans sold by private insurance companies to fill the "gaps" of Original Medicare. You must have both Medicare Parts A and B to enroll in a Medigap plan and you cannot have coverage through a Medicare Advantage plan.

• There are 11 standardized Medigap plans you can choose from with varying levels of coverage (A, B, C, D, F, high deductible F, G, K, L, M, and N).

• Medigap plans allow you to go to any doctor that accepts Medicare and is accepting new patients. The plan will only pay for services after original Medicare pays its share.

  • E.g. For a doctor visit, original Medicare would pay first, the Medigap policy would pay their portion, and then the beneficiary would be responsible for any remaining balance.

Medicaid

• Medicaid provides health coverage to more than 4.6 million low-income seniors, Medicaid also provides coverage to 3.7 million people with disabilities. In total, 8.3 million people are "dually eligible" and enrolled in both Medicaid and Medicare. 

• Medicaid also covers additional services beyond those provided under Medicare, including nursing facility care beyond the 100-day limit or skilled nursing facility care that Medicare covers, prescription drugs, eyeglasses, and hearing aids. Services covered by both programs are first paid by Medicare with Medicaid filling in the difference up to the state's payment limit.

Extra Help with Medicare

If you meet certain income and resource limits, you may qualify for Extra Help from Medicare to pay the costs of Medicare prescription drug coverage. 

In 2016, costs are no more than $2.95 for each generic/$7.40 for each brand-name covered drug.

Other people pay only a portion of their Medicare drug plan premiums and deductibles based on their income level. 

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For the year 2017 If your income is below $18,090 per year for a single person (or $24,360 for a married couple living together), AND if your assets are below $13,820 for a single person (or $27,600 if you are married).