Medicare at a Glance

Medicare is a federal program, and as such the law in New York should be same the as in any other state. Medicaid is a federal state cooperative program, where each state can choose different benefits for its residents; as such, each state may have different benefit levels and requirements.

Medicare is modeled after private insurance. When it became law in 1965, it was the first medical insurance many retirees had ever had.  It consists of four different parts:  A, B, C and D. Part A – Hospital Insurance covers limited stays in nursing homes and some rehabilitative services such as physical, vocational, and speech therapy. Part B – Outpatient Insurance covers 80 percent cost of physician office visits, medical devices and some rehabilitative services as above.

Part C – Medicare Advantage Program is not original or traditional Medicare. It is private insurance in which the federal government pays a capped amount for each enrollee to provide “equal” services to Medicare Part A and B. Many plans add drug coverage, so there is no need for an additional Part D plan. Some plans have no additional premiums, but do have co-payments. The most popular Medicare Advantage plans are HMOs.

Part D – Prescription Drug Coverage was created in 2006. This is the first drug coverage under Medicare. It is offered by private companies, but must comply with the federal requirements. Originally, this plan was created to protect beneficiaries from catastrophic drug costs.  It provided reduced costs until a threshold is met, at which beneficiaries would pay a fraction of the cost. Recent changes will gradually alter Plan D so that by 2020 the plan will resemble other traditional drug insurances.

An individual will initially become eligible for Social Security or railroad retirement benefits when they turn 65 years old. At that point in time they should consider applying for Medicare benefits. When the spouse of a person entitled to Social Security or railroad retirement benefits turns 65 years old, they should also apply for Medicare benefits as well. Those who receive Social Security Disability (SSD) benefits automatically receive Medicare Part A and B benefits 24 months after eligibility is determined. SSD recipients diagnosed with end-stage renal failure and amyotrophic lateral sclerosis (ALS) are eligible with the first benefit check.

The enrollment application should be made within the seven month “initial enrollment period” (the 3 months immediately the month of the consumer’s 65th birthday, the month itself, and the 3 months after). Although you have a seven month window to apply, it is best to apply during the months prior to the consumer’s 65th birthday to avoid delays in coverage.

The special enrollment period provides circumstances for enrolling after the “initial enrollment period” without a penalty. If you or your spouse are working and covered by a group health plan, or during the 8 month period after your work or coverage ends, you can get and keep a letter from you group health plan during initial enrollment period to prove coverage.  If you have lived out of the country, you will receive a special enrollment period within the two months that you return although you will still be subject to a late enrollment period.

Medicare can help you pay for medical expenses, as well as long-term nursing care. Both Medicare and Medicaid are federally funded programs designed to help eligible beneficiaries cover healthcare costs. Medicaid provides medical insurance and long-term care to middle-to low-income persons, including the elderly and disabled. If you are interested in securing Medicaid benefits for you or a loved one contact the Long Island office of P&P Medicaid who specialize in Medicaid eligibility and applications. We are available 24/7 for a consultation. Contact us today at (516) 541-4770 or by filling out our contact form.

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