Having good health insurance is critical to maintaining your health and financial wellbeing. For many seniors, Medicare is an excellent insurance option, but understanding Medicare’s ins and outs – like Medicare requirements and the benefits covered by Medicare – can feel overwhelming. In this guide, we’ll help answer the question, “How does Medicare work?” and address the core differences of Medicaid vs Medicare.
GoGoGrandparent believes everyone deserves access to quality healthcare services. We understand that every person has a different budget and medical situation, so GoGo offers a variety of plans and financing options that fit your situation. Keep reading to learn how our members leverage GoGo’s services – like transportation and pharmacy pickup – to make use of their benefits covered by Medicare.
Medicaid vs Medicare
Despite their similar names, Medicaid vs Medicare are different government programs. Both are health insurance, but they serve different demographics.
What is Medicare?
Medicare is a federal health insurance program designed for individuals ages 65 and older. Medicare may also cover some people under that age range with disabilities or certain medical conditions. There are four “parts” to Medicare: hospital care, doctor visits, Medicare Advantage plans, and prescription drug coverage.
Understanding Medicare’s funding is vital to ensure eligibility and options. Benefits covered by Medicare are not entirely government-funded. Medicare is funded through three avenues:
- You’re taxed a specific amount during your working years that help fund Original Medicare
- You pay a monthly or annual premium while receiving benefits covered by Medicare, especially for parts B, C, and D
- Federal government supports the remainder
What is Medicaid?
Medicaid is a joint federal and state program that provides health coverage to low-income individuals and families based on financial need rather than age. However, seniors with limited financial resources may also utilize Medicaid vs Medicare in some instances.
Funding for Medicaid comes from both the federal and state governments. States allocate a certain amount to their Medicaid fund, and the federal government matches a percentage of the state’s allocation. Thus, Medicaid coverage varies from state to state. Medicaid also tends to have less flexibility compared to those benefits covered by Medicare.
Medicare requirements and eligibility
To be eligible, you must meet at least one of the following Medicare requirements:
- You are 65 and older, and you or your spouse paid Medicare employment taxes for at least ten years.
- You are under 65 with a disability and have received Social Security Disability Insurance (SSDI) for at least two years.
- You are any age with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS).
What is Medicare Part A, B, C, and D?
You might look at the Medicare website and wonder, “How does Medicare work?” Understanding Medicare can feel confusing because of all the different Parts, eligibility, and Medicare requirements.
Let’s simplify understanding Medicare. The benefits covered by Medicare are divided into four main parts.
Medicare Part A is hospital insurance. This covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health services. There are usually no Medicare requirements for monthly premiums for Part A, because it is paid for through payroll taxes from you or your spouse’s employment.
Medicare Part B is medical insurance, covering doctor visits, outpatient care, preventative services, and medical supplies. This is most similar to traditional healthcare you may have had in the past. See a complete list of benefits covered by Medicare coverage here. This coverage is income-based, and beneficiaries usually must pay a monthly premium to receive the benefits covered by Medicare Part B.
Medicare Part C is Medicare Advantage, which allows seniors to receive benefits covered by Medicare through private insurance companies approved by Medicare. This means you’d have a traditional HMO or PPO plan, but Medicare pays the private insurer a fixed monthly amount to help cover your expenses. Medicare Advantage plans often include Part A, B, D, and additional benefits like dental and vision care that aren’t included in Original Medicare (Part A and B). When understanding Medicare Part C, it’s important to note that each insurance company charges different out-of-pocket costs and has different Medicare requirements, so a Medicare Advantage Plan may have higher expenses and may not be as easy to navigate as traditional Medicare.
Medicare Part D is prescription drug coverage, which helps cover the cost of prescription medications. Part D benefits covered by Medicare are typically included in Medicare Advantage Plans and are offered as a supplemental plan to Original Medicare (Part A and B). The Low-Income Subsidy (LIS) helps qualifying beneficiaries with limited incomes cover their Medicare Part D prescription drug costs.
How does Medicare work in terms of out-of-pocket costs? Medicare Part A is often premium-free, but Part B requires a monthly premium. Parts C and D may also incur additional expenses. You may also be responsible for deductibles, co-insurance, and copayments for certain services.
What are Medigap plans?
Medigap plans (Parts F and G) are private insurance policies that help “fill in the gaps” of the benefits covered by Medicare Parts A, B, and D. Unlike Medicare Advantage Plans (Medicare Part C) that are entirely private, Medigap is Original Medicare – and follows all Medicare requirements – but it helps you get more medical and financial benefits covered by Medicare. Learn more about Medigap supplemental insurance here.
Understanding Medicare enrollment
If you’re already receiving Social Security benefits, enrollment in Medicare will be automatic when you turn 65. If not, you can apply for Medicare through the Social Security Administration’s website during the Initial Enrollment Period (IEP) – which extends from three months before your 65th birthday to three months after your birthday. If you miss the IEP for enrollment in any Medicare coverage, you may have higher premiums or face a late fee.
Once you enroll, you’re not stuck with that plan forever. Medicare beneficiaries can change their coverage and benefits covered by Medicare during specific periods:
- You can switch from Original Medicare to Medicare Advantage plan (or vice versa) during the Medicare Annual Enrollment Period (AEP). This occurs from October 15 to December 7 every year. You can also change or enroll in a Part D prescription drug plan.
- Medicare Advantage Open Enrollment Period runs from January 1 to March 31, in which time you can switch to another Medicare Advantage plan or return to Original Medicare (with or without Part D coverage).
- Special Enrollment Period (SEP) lets you make changes outside of these regular enrollment periods for certain life events like moving, loss of a spouse, loss of primary health coverage, or new Medicaid requirements and eligibility.
Who’s eligible for Medicaid vs Medicare?
Unlike Medicare, Medicaid eligibility is determined by income. Since Medicaid follows both state and federal guidelines, criteria can vary based on the state. Generally, you would be eligible for Medicaid if you fall into any of the following categories:
- Low-income individuals or families, including children, teens, and pregnant women
- Seniors with limited financial resources who meet the state’s income and asset requirements and/or live in a nursing home
- Individuals receiving Supplemental Security Income (SSI) benefits
- Individuals who are blind or disabled and with limited income
- Low-income adults who gained eligibility through the Medicaid expansion provision under the Affordable Care Act (ACA)
How do you enroll in Medicaid?
Medicaid enrollment varies by state. You should apply through your state’s Medicaid agency or Health Insurance Marketplace.
If you are 55 or older, eligible for nursing home care, and live near a PACE organization, you might want to look into the Program of All-Inclusive Care for the Elderly. PACE provides medical and social services to seniors eligible for both Medicare and Medicaid.
How do you find doctors that accept benefits covered by Medicare?
Not all healthcare providers accept Medicare and Medicaid. Find doctors on the official Medicare website’s “Find and Compare” tool. You can input your location and keywords to find doctors, hospitals, nursing homes, home health services, hospice services, rehab facilities, long-term care hospitals, and dialysis facilities that meet Medicare requirements.
For Medicaid, you should contact your state’s Medicaid agency. You can also check directly with your healthcare provider to see if they accept Medicaid patients.
How does Medicare work with other types of insurance, like Medicaid?
Medicare can coordinate with other insurance plans to ensure you receive comprehensive coverage. For example, if you are still working and have health coverage through your employer or your spouse’s employer, Medicare will work as a secondary payer. This means Medicare might cover some or all costs not paid by the primary plan.
If you are eligible for both Medicare and Medicaid, you are considered “dual eligible.” These two programs work together to provide comprehensive coverage for low-income seniors. For example, Medicare will often be the first payer, and Medicaid will help lower associated costs from premiums, deductibles, and copayments.
Are there any other health insurance programs for seniors?
Along with Medicare and Medicaid, you might consider other local or state health insurance programs.
- Federally Qualified Health Centers (FQHCs) are community-based clinics that offer healthcare services based on income. These provide comprehensive services – like health, mental health, dental, and hospital and specialty care – for those who qualify for enhanced reimbursement from Medicaid vs Medicare.
- Some nonprofit organizations run clinics that provide free or low-cost healthcare services. Learn more about local agencies that offer services for seniors here.
Want help understanding Medicare? If you meet Medicare requirements, the State Health Insurance Assistance Program (SHIP) offers free counseling and assistance to help you understand your options, rights, and finances.
How GoGo is bridging the gap with affordable healthcare options
Some seniors find it challenging to fully utilize all the benefits covered by Medicare because they don’t have access to quality transportation. Getting to and from doctor’s appointments can be a chore, especially for seniors who no longer drive.
GoGo’s transportation services are vital in facilitating access to medical facilities, doctors’ offices, pharmacies, and more. With just a phone call to one of our friendly operators, GoGo members can request or schedule a ride to medical appointments, doctors’ visits, social calls, and more. Our GoGoGuardians screen drivers, vet cars for accessibility, and monitor your ride every step of the way. This eases the stress of transportation, allowing members to focus on their health and wellbeing.
Our other services also help promote health and wellness:
- Grocery and meal delivery help you have healthy, nutrient-dense food in the house to support your health and diet plan.
- Prescription delivery ensures you never miss a day of your medication, including prescription pickup covered under Medicare Part D. Click here to learn how to get your prescriptions delivered as soon as they’re filled.
- Home services connect you to trusted service providers, so you know your home and pets are cared for while you’re taking care of your health. For example, many of our members hire pet sitters during their doctor’s visits.
These services aim to keep healthcare expenses manageable and improve the lifestyle of seniors who are living independently. With our plans, financing options, and partnerships, we strive to provide cost-effective services for our members.
GoGo Plans
GoGoGrandparent offers a range of plans, so you can find a solution that best works for you. Our four plans including Basic (starting at $14.99 per month), Value, Premium, and Total Care. The membership model helps us appropriately staff our hours to support all requests. Learn more about our plans and pricing here.
GoGo Financing
GoGoGrandparent offers flexible payment options, like low-income plans, home equity conversion lines of credit, and family payment plans. Learn more about our flexible financing options here.
GoGo Partnerships
Along with GoGo’s financing options, our strategic partnerships with various organizations, businesses, and nonprofits help subsidize rides and other amenities for our members. These partners help lower expenses, offer discounts, and provide the most cost-effective services.
Learn more about affordable ways to age at home here.
Understanding Medicare for health and wellness
Medicare provides essential health insurance options for eligible seniors, while Medicaid is another option for those with limited financial resources. Researching Medicare requirements and the benefits covered by Medicare is critical to selecting the best plan for your situation so you can lead a happy, healthy life.
At GoGoGrandparent, we are committed to supporting our members’ health. Our resources, plans, flexible financing options, and strategic partnerships empower seniors to lead healthy, fulfilling lives. Register for GoGoGrandparent here to get started.
