What Is the Difference Between Medicaid and Medicare?

Medicare and Medicaid, even though the names might seem similar, are actually very different types of services for different people. It’s important to make sure you know which of these services you need and qualify for so you do not waste your time with the wrong program. Here are the basics of each of these programs to give you an idea of what they do.

What Is Medicare?

Medicare is a type of insurance program generally reserved for those who are 65 years of age and older, those who have been on Social Security disability for a certain period and those who are on dialysis. The medical bills for those who are on Medicare receive payment via trust funds of the people who have paid into the program. The amount of income someone has does not matter with Medicare.

The patients are responsible for part of the costs of the services and supplies. For the non-hospital coverage, called Part B, the users will pay a monthly premium. This program comes right from the government, who runs the program. Though they run the program, they do not have federal hospitals for the services. Instead, those who are using the service can choose from a variety of doctors and clinics that are part of the Medicare system. This gives those who use the system more choice when they are choosing their providers.

What Is Medicaid?

Medicaid is quite different from Medicare. This is an assistance program for those who are unable to afford general healthcare. The payment for the bills from Medicaid comes from the government tax funds at the local, state, and federal levels. The goal of the system is to provide those people who have low incomes with the care they need. In some cases, they may require a co-payment. In the event that they do, it is typically quite small.

The Medicaid program is federal and state and it can vary a bit from state to state. Those who may need to use the system will want to check into the options and features in their state of residence to see how everything works.

Someone who is on Medicare could also use Medicaid in some cases. It depends on the situation and need. Those who have low incomes, for example, will likely qualify. Before relying on the system though, it is important to check to make sure that you actually qualify for the service.

Medicare Could Help with Sleep Apnea

Sleep apnea or CPAP, Continuous Positive Airway Pressure, is a serious issue that many today are facing. Those who are suffering from these issues will be happy to know that there is a possibility that Medicare can give them some help. Those who have Medicare and who receive a diagnosis of obstructive sleep apnea are able to receive a 3-month trial of CPAP therapy. If, after the trial period finishes, the doctor claims the CPAP therapy machine was able to help your condition, there is a possibility that Medicare could actually cover it longer.

What Would It Cost?

Eligible patients will pay 20% of the amount approved by Medicare to rent one of the machines, and for the purchase of additional necessary supplies. It is also important to know that the only way they will cover the machine is if your doctor is enrolled in Medicare. In the event that you rent the machine for more than 13 months – without any interruption – then you will own the machine. If you rent a machine for three months, for example, and then have to switch to a different machine for some reason, then the 13-month rental requirement will actually start over.

Those who had one of these machines before they got Medicare may find that Medicare will cover the rental or replacement of the machine and accessories when needed. You will need to meet certain requirements in order for this to happen though. Additionally, if you already own your machine, then you will need to use a supplier who has a Medicare contract for the supplies you need to replace if you want Medicare to pay the costs.

Those Who Need More Treatment

Something else to consider is that some people who suffer from sleep apnea may need to have additional treatments that the Medicare will not cover. If that’s the case, it means you will likely have to pay for those costs out of pocket. Of course, this depends on the type of plan and any additional coverage you might have. Your doctor will let you know exactly what type and how much therapy you truly need.

It is good to know that those who suffer from sleep apnea and who have to go through treatment have some options through Medicare. It can give them the hope and the help they need, and it could help to pay for a machine that can make life far more bearable.

Different Types of Medicare

A number of different types of Medicare plans are available for those who qualify. At the most basic level, there is Original Medicare and Medicare Advantage Plans. These are quite different and contain different parts and options.

What Is Original Medicare?

Original Medicare is a government-operated program that offers medical services for a fee. This consists of two different parts, Part A and Part B. Part A covers inpatient stays at the hospital, as well as stays in nursing homes and hospice care. In some cases, it will also pay for certain types of home health care. Part B covers medical insurance for things such as visits to the doctor’s office, medical supplies, preventive services, and typical outpatient care. Some may wish to add Part D to the plan as well. This is prescription drug coverage. These plans come from approved insurance companies.

What Are Medicare Advantage Plans?

Part C is the Medicare Advantage Plan. These are plans offered from third party insurance companies. The company works with Medicare to provide the buyer with the same types of benefits in Part A and B. Since it is a private company though, they tend to have more options and they can cover a variety of other health issues, such as health, vision, and dental. Plans that fall into this category could include HMOs, PPOs, Medicare Savings Account Plans, and more. These programs will often have prescription medical coverage as well, so the buyer will not need to purchase the supplemental D plan. Verify this though, so if they do not offer prescription coverage, you will be able to add Part D to your plan.

These are the main types of Medicare available, and it can sometimes be confusing as to which one offers the best coverage and options for you. It will really depend on just how much you are able to spend on the coverage, as well as what type of coverage you need. For example, if you find that you need dental coverage and you are in need of a hearing aid, then the Advantage plans will generally be the best possible choice.

Take the time to sort through the options though so you can be sure you are making the right choice. When you are choosing an Advantage coverage option, it should take time and research. Do not simply go with the first plan you find.

Do You Qualify for Medicare?

Are you able to qualify for Medicare? This is a common question that does not always have a cut and dried answer. Let’s look at whether you are able to qualify or not.

First, you have to be at least 65 years old or older. In addition, you need to be a United States citizen or permanent resident. You or your spouse needs to have worked long enough to be eligible to receive Social Security benefits as well. This generally amounts to at least ten years of work, or 40 credits. This sounds simple enough, but it can become a bit more complicated. Now that you know the basics, we can get into some of the other ways that people may qualify.

It is possible to qualify for Medicare on a spouse’s work record in some cases. In this case, you will still need to be at least 65 years old. He or she will need to be at least 62 years old. It’s also possible to qualify in some instances on the work record of a spouse you divorced, as well as a deceased spouse.

Can You Qualify When You Are Not 65?

In some cases, it may actually be possible to qualify for Medicare even if you are not yet 65 years old. You will need to have been able to receive Social Security disability benefits for at least 24 months. It is important to know that these do not have to be consecutive months. Other qualifications can include receiving a disability pension for the Railroad Retirement Board, having Lou Gehrig’s disease, or permanent kidney failure and you or your spouse also having paid Social Security taxes for a certain period.

Most people will receive annual statements that come from the Social Security office. These statements often have information on them that let you know whether you are eligible for Medicare or not.

It can be confusing to know whether you are able to receive Medicare benefits or not. However, this short and simple guide should give you a good idea of where you stand when it comes to qualifications. If in doubt, you can contact an expert in the field, or you can simply apply to see if you may qualify for the service or not. Whenever in doubt, you can call the Social Security office at 1-800-772-1213. They will be able to help you if you still have questions regarding your eligibility.

Does Medicare Cover Hearing Aids?

Are you in need of a hearing aid? As we get older, our hearing might not be quite as acute as it was in our youth. A good quality hearing aid can make all the difference in the world. Whether the hearing loss is due to age, because of an illness or injury, or any condition, getting a hearing aid can be a huge benefit. While Medicare does not always pay for hearing aids, you may be eligible for coverage in certain situations.

What Do They Cover?

Most of the time Medicare and Medicare Supplement will not cover hearing aids. They will not cover fittings for hearing aids, or even hearing exams. Thus, if you do not have other insurance, there is a chance that you could have to pay for 100% of the cost of the hearing aid out of pocket.

However, Medicare Part B can cover diagnostic hearing tests ordered by a doctor for a specific medical need. This could include a hearing loss because of a recent injury or illness. If the doctor orders the test, you would pay 20% of the amount Medicare approves and the Part B deductible. Still, they will not cover the cost of the actual hearing aid — only the cost of the test.

It is very important to realize that Medicare Part A and Part B will not pay for your hearing aid under any circumstances. That does not mean you are out of luck if you are looking for a Medicare plan though.

Medicare Advantage, or Part C, will actually cover hearing exams and hearing aids. The Advantage plans are able to provide you with far more options, features, and benefits than Part A and B, the traditional Medicare options. Those who have the option and the ability should certainly look in to Medicare Advantage just to see if it is the right program for them. The plans are all different, so go over each of them carefully to determine which option is the best for your needs.

Choosing a Hearing Aid

When you are choosing a hearing aid, it is important to make sure that you buy right. Using insurance, such as Medicare Advantage, may mean you have a limited number of suppliers from which you can choose when buying your hearing aid. Make sure you follow the rules and instructions of any insurance plan you have, just to make sure that you can choose a quality hearing aid that works well and fits your needs.