Find the Right Insurance Without the Confusion

Medicare is a federal health insurance program primarily for people age 65 and older, as well as certain younger individuals with disabilities or specific medical conditions. Medicaid is a state and federally funded program that provides healthcare coverage for individuals and families with limited income and resources.

Some people may qualify for both Medicare and Medicaid at the same time, which is known as being “dual eligible.”

You may qualify for Medicare if you:

• Are age 65 or older
• Have received Social Security Disability benefits for 24 months
• Have End-Stage Renal Disease (ESRD)
• Have ALS (Lou Gehrig’s Disease)

Most people become eligible for Medicare beginning three months before their 65th birthday.

Medicare has four main parts:

• Part A – Hospital insurance
• Part B – Medical insurance
• Part C (Medicare Advantage) – Private insurance plans that combine Parts A & B and often include additional benefits
• Part D – Prescription drug coverage

Each part covers different healthcare services and may involve separate costs.

Not always. While many people receive premium-free Medicare Part A, most individuals pay a monthly premium for Part B. Additional costs may include:

• Deductibles
• Copayments
• Coinsurance
• Prescription drug costs

Costs vary depending on the plan selected and income level.

A Medicare Advantage plan (Part C) is an alternative to Original Medicare offered by private insurance companies approved by Medicare.

These plans often include:

• Hospital coverage
• Medical coverage
• Prescription drugs
• Dental, vision, and hearing benefits
• Fitness programs

Plans may have provider networks and annual out-of-pocket limits.

Medicare Supplement insurance helps pay certain out-of-pocket costs not covered by Original Medicare, such as:

• Copayments
• Coinsurance
• Deductibles

These plans work alongside Original Medicare and generally allow you to see any provider that accepts Medicare. Prescription drug coverage is not included in Medigap plans.

Yes. Some individuals qualify for both programs at the same time.

People who qualify for both may receive help with:

• Medicare premiums
• Deductibles
• Coinsurance
• Prescription drug costs
• Additional healthcare services

Eligibility depends on income and other factors determined by your state Medicaid office.

Your Initial Enrollment Period begins:

• 3 months before your 65th birthday month
• Includes your birthday month
• Ends 3 months after your birthday month

There are also other enrollment periods, including:

• Annual Enrollment Period (AEP)
• Open Enrollment Period
• Special Enrollment Periods (SEP)

Missing enrollment deadlines may result in penalties.

Medicaid may help cover long-term care services, including nursing home care, for eligible individuals who meet financial and medical requirements.

Coverage rules vary by state and may include:

• Nursing home care
• Home health services
• Assisted living support
• Personal care assistance

Asset and income limits apply.

The best plan depends on your:

• Doctors and hospitals
• Prescription medications
• Budget
• Healthcare needs
• Preferred coverage type
• Travel habits

It’s important to compare:

• Monthly premiums
• Deductibles
• Copays
• Provider networks
• Drug formularies
• Additional benefits

A licensed insurance agent can help review your options and explain plans available in your area.