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What you need to know about Medicaid, Medicare, and paying for health care in Georgia

We all have healthcare costs at some point in our lives, and these costs are likely to rise as we age or have a disability. Many things bring health insurance top of mind—maybe you are on the verge of retirement, or have recently received a new diagnosis, or are experiencing a change in employment, or are seeing your medical bills start to pile up. Whatever the reason, you might be looking at some alternative options to private insurance. If you don’t have much income, you might be wondering how to access Medicaid. If you turned 65 recently, you are probably thinking about Medicare. If you already have Medicare and you are wondering how you can get additional help, you may qualify for Medicare Supplement Insurance, sometimes called Medigap Insurance. If you were or are a uniformed U.S. service member, you may be interested in TRICARE or perhaps you qualify for veterans’ benefits.

Overall, if you’re feeling stuck with healthcare costs and don’t know what insurance options are right for you, you’ve come to the right place. Together, we can understand your payment options, identify the best approach to managing your care, and access resources to confidently navigate the healthcare system, informed and educated.

Understanding the differences between Medicaid, Medicare, Medigap, and TRICARE

If private health insurance is not an option for you, there are many opportunities to access public funds to help pay for your health care. This article can help you understand the basics. If you already know what you need and are looking to explore Medicare options, contact our partners at GeorgiaCares.

What is Medicare?

Medicare is the basic healthcare program for people 65 or older and people with disabilities. You can enroll through the Social Security Administration. Medicare is split into different “parts” that cover different areas of care, such as certain services and supplies in hospitals, doctors’ offices, and other healthcare settings. The four basic parts are labeled with the letters A, B, C, and D. Medicare Parts A and B are commonly referred to as “Original Medicare.” Anything that is not covered by parts A and B may be covered by Medigap or Medicare Advantage Plans.

What does Medicare Part A cover?—How to pay for hospital stays and skilled nursing

Medicare Part A, or inpatient hospital insurance, is generally for short-term care including inpatient care in hospitals, short-term stays in a skilled nursing facility (or nursing home), hospice services, and time-limited home health services. Sometimes these short-term services after a hospital stay are considered “post-acute.”

What does Medicare Part B cover?—How to pay for doctors, medical equipment, and screenings

Medicare Part B, or outpatient insurance, covers doctors’ services, many outpatient services, ambulance trips, durable medical equipment (sometimes called DMEs, which may include blood sugar monitors, oxygen equipment, walkers, and other tools you may need to live your daily life), and preventative services (such as screenings and counseling by a doctor, including the new Annual Wellness Visit).

What does Medicare Part C cover?—How to pay for care beyond Medicare

Medicare Part C includes Medicare Advantage Plans, which are managed health plan options approved by Medicare and offered by private companies that provide both Part A and B coverage and may provide drug coverage. Some plans may offer extra coverage, such as vision, hearing, dental and/or health and wellness programs. Patients must select doctors from an approved network. Since each Medicare Advantage Plan can charge different premiums and other out-of-pocket costs and provides a different package of covered benefits, it is important to compare plans before enrolling. For more information, contact our partners at GeorgiaCares.

What is Medigap?

Medigap (or Medicare Supplemental Insurance) is an insurance policy that covers costs that original Medicare doesn’t cover, including copays and deductibles for Parts A and B. You can buy a Medigap policy from a private insurance company for a monthly premium. Visit the official Medicare website for more information about Medigap or contact our partners at GeorgiaCares.

What does Medicare Part D cover?—How to pay for your prescriptions

Medicare Part D offers prescription drug coverage. Part D policies are available from private health insurance companies. You can sign up for Medicare prescription drug coverage through:

  1. Medicare Prescription Drug Plans. These plans (sometimes called “PDPs”) add drug coverage to original Medicare (Parts A and B) and some Medicare Advantage Plans (Part C).
  2. Medicare Advantage Plans that offer prescription drug coverage ( sometimes called “MA-PDs”). You get all of your Part A and Part B coverage, including prescription drug coverage (Part D), through these plans.

Even if you do not take a lot of prescription drugs, you should still consider joining a Medicare drug plan. If you do not sign up for Medicare Part D when you first become eligible or during a special enrollment period, you may pay a late enrollment penalty. If you have limited income and resources, you may qualify for extra help from Medicare and Medicaid to pay for your prescription drug coverage. For more information, check out the official Medicare website or contact our partners at GeorgiaCares.

If you need additional help managing your medications, explore more of our resources.

What is Medicaid?

Medicaid offers a wide range of medical and long-term services to certain individuals who do not have much income or many assets. Medicaid is managed at the state level, so there are many differences from state to state in what is covered and who is eligible. To find out if you are eligible for Medicaid in Georgia, check the Georgia Department of Community Health webpage or contact empowerline.

Medicaid covers health and long-term care expenses for certain categories of people including:

  • SSI recipients—Older adults and individuals with qualifying disabilities who have very low income and few assets may be eligible for a program called Supplemental Security Income (SSI), which provides cash assistance. SSI recipients are automatically eligible for Medicaid coverage.
  • Individuals eligible for a nursing home or Medicaid home and community-based waiver—individuals who meet both financial criteria and nursing home level of care criteria can receive Medicaid for their long-term care.

What is TRICARE?

If you are an active or retired uniformed service member you and your family may be covered by the TRICARE health plan. This includes active duty and retired members of the:

  • U.S. Army
  • Air Force
  • Navy
  • Marine Corps
  • Coast Guard
  • Commissioned Corps of the U.S. Public Health Service
  • Commissioned Corps of the National Oceanic and Atmospheric Association
  • National Guard/Reserve members and others registered in the Defense Enrollment Eligibility Reporting System (DEERS)

What is Long-Term Care Insurance?

Just because you have health or disability insurance, including Medicare, doesn’t mean you have coverage for long-term supports and services, whether the services are delivered in your own home, an assisted living community or nursing home. Many Americans are unable to afford long-term supports and services through their income and personal savings. So, for most people the only options are long-term care insurance or paying privately until they become financially eligible for Medicaid.

Long-term care insurance helps pay for a variety of services that assist people with health or personal issues that might result from a chronic disease, serious accident, sudden illness, or cognitive impairment such as Alzheimer’s disease. For more information on long-term care insurance in Georgia, visit the Department of Aging Services’ page on long-term care insurance or contact our partners at GeorgiaCares for individual assistance.

Additional health insurance resources

You can also download several resources to learn more about the coverage that is right for you. If you feel ready to enroll for Medicare but have questions or concerns, contact our partners at GeorgiaCares.

An overview of Medicare

This GeorgiaCares resources, The Road to Medicare: Planning Your Drive Toward 65, provides more details about Medicare and enrollment information.

Medicare Made Clear

This resource from MedicareMadeClear.com can help you understand whether you should enroll in Medicaid or Medicare.

Official Medicare Website

On Medicare’s main site, you can learn more about Medicare and enroll in benefits. If you are already enrolled, you can check the status of your claims. You can also download their guide, Medicare and You.

Compare Medicare Health Plans and Medigap Policies

With this tool, you can find and compare Medicare Advantage/Health Plans and find and compare Medigap policies.

Medicare Guidance

Medicare Interactive is a free resource of the Medicare Rights Center and provides Medicare-related guidance on topics such as eligibility and enrollment, coverage, rights and protections, health plan options, prescription drugs, and programs for people with lower income.

Extra help for Medicare Part D – Prescription Drug Plans.

On the Social Security Administration’s website you can learn about your social security benefits and apply for additional benefits, including the “extra help” benefit for Medicare Part D.

Know what you are eligible for

Georgia Gateway is the common point of access to social services in Georgia. This website is a quick and easy way for people who live in Georgia to find out if they might be able to get assistance with paying Medicare Part B premium and co-insurance, Medicaid benefits, help with buying food, low or no-cost health care, home energy assistance, cash assistance, and more.

The Benefits CheckUp is a website that was developed by The National Council on Aging (NCOA). It’s a web-based service to screen for benefits programs for seniors with limited income and resources. Benefits CheckUp includes information on benefits programs such as prescription drugs, food assistance, energy assistance, and other services.

Have more questions about health insurance or paying for your care?

You can always contact empowerline with specific questions about your situation. Our counselors will help identify the best solutions for you.

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