Understanding Your Medicare and Medicaid Entitlements

By: Regency Nursing & Rehabilitation Centers

Joe Sanders never expected to wind up in the hospital for an extended stay. At age 68, he was in good health, leading an active life. So when a sudden attack on the golf course landed him in the local emergency room, he was surprised to learn that his government health benefits weren't going to see him through the long haul.

Unfortunately, like most of us, Joe never bothered to take a close look at his entitlements before an emergency struck. Had he understood his options, he might have been better financially prepared for the long-term care he now requires.

Understanding Your Entitlements

MEDICARE Part A & B - Benefits For Your Retirement Years

Medicare is a two part program underwritten by the U.S. Department of Health and Human Services that provides basic hospitalization and medical coverage for people age 65 and over and also serves people under the age of 65 with certain disabilities. For example, if you have permanent kidney failure that is being treated with dialysis or a transplant, or have been receiving Social Security or Railroad Retirement disability checks for at least 24 months, you are eligible for Medicare even if you're under age 65. Medicare part A provides automatic hospital coverage, as long as you have worked at least 10 years in a Medicare-covered employment. Part B membership helps cover medical and doctors' bills, and helps pay for rental or purchase of necessary equipment such as prostheses, wheelchairs and post-surgical supplies. Consult you local durable medical equipment carrier for details about this benefit. While Part A is yours free of charge, Part B is considered elective coverage and requires monthly contributions from you.

There are also several health care options available to Medicare beneficiaries which come under the label of Medicare + Choice.

Most people receive a Medicare Enrollment Package just prior to reaching their 65th birthday. At that point they may choose whether or not to opt for Medicare Part B benefits and pay the required premiums for that coverage. If you have reached the age of 65 and have NOT received a Medicare Enrollment Package, you must call your local Social Security Officer in order to determine your eligibility.

MEDICAID: Benefits For Low Income Households

Medicaid is a federal-sate program usually operated by the state welfare or health departments and designed to furnish several basic services to low-income individuals. These include inpatient and outpatient hospital care, physicians' services, nursing home care, and laboratory and x-ray services. Under financial hardship, Medicaid may also be used to pay for your Medicare premiums, deductibles and co-insurance.

MEDIGAP: Benefits That Take Over Where Medicare Leaves Off.

MediGap refers to one of several supplemental health insurance policies that can be purchased to cover the costs Medicare often doesn't cover, like prescription drugs, dental care, orthopedics, hearing aids or eyeglasses. For a complete list of recognized MediGap providers, consult your State Office for the Aging.

There is also an option called Medicare Managed Care, which requires you to use the doctors, hospitals and health care providers in the plan's network in rturn for more comprehensive coverage. This usually entails paying a small monthly premium, but enables you to dispense with MediGap coverage.

(Rates examples in the chart above are from 2007)

Additional Entitlements

• Pharmaceutical Assistance for the Aging and Disabled (PAAD)
• Hearing Aid Assistance to the Aged or Disabled (HAAAD)
• Lifeline - a utility assistance program for recipients of PAAD

These state funded programs were designed to provide needed benefits in those areas not covered by Medicare and for those individuals whose income levels would make it difficult for them to obtain these services on their own.

Don't Assume Your Benefits Are Automatic.

Most government entitlements are NOT automatic. You have to apply for them and meet all government requirements for coverage.

Be Aware of the Limitations of Your Coverage.

Be an educated health care consumer. Never assume that you'll be covered for anything that comes along, or you could be in for an expensive shock. Always familiarize ourself with the details of every aspect of your medical coverage, and make sure to fill in any gaps with a recognized supplementary plan. Consult a trusted attorney or government counselor to help you make sense out of  complex requirements or limitations in your coverage.

Good luck!