The Dos and Don'ts of Medicare and Medicaid - The Caring Chronicles | Senior Caring Blog

The Dos and Don’ts of Medicare and Medicaid

Medicare and Medicaid can be a tricky and daunting part of aging. With a variety of forms, regulations, and healthcare plans, it can be tough to decipher exactly what is best for your health. Administered by the U.S. government in 1966, the social insurance program provides health insurance for citizens over 65 years old or those with disabilities. Just this year it has provided insurance for over 50 million Americans. Medicaid is a resource for those that do not have sufficient income for insurance. It is the largest source of funding for medical and health-related services for people with low income in the United States.

Dos and Don’ts of Medicare and Medicaid

DO research as much as possible

Medicare is broken down into four different parts, so it’s important to be able to differentiate between each part so you can find the best possible plan for you or your loved one. Part A covers hospital bills and medical expenses. This includes food, room and board, and medical tests. Part B covers other medical expenses like physicians, nursing, and other physical therapy visits. Part C covers other unforeseen expenses as well as offers a payment plan that was not implemented until 1996. Part D is the biggest portion of the program and it covers prescription drugs. The plan offers reduced prices for many prescription drugs that will be offered.

Medicaid should also be examined so you know whether or not you qualify as well as learn the benefits offered if you do qualify for the program.

DO consider Medigap insurance

Many aren’t aware of Medigap insurance that can help pay for Medicare and Medicaid. Medigap’s name is derived from the notion that it exists to cover the difference or gap between the expenses reimbursed to providers by Medicare Parts A and B for the preceding named services and the total amount allowed to be charged for those services by the United States Centers for Medicare and Medicaid Services (CMS). This will essentially bridge the gap between your insurance plan and the required payment, covering anything your Medicare plan doesn’t.

DO remember that Medicare and Medicaid are not free

Although these are great benefits to have if you qualify for them, they do not cover all medical expenses. You will still have to pay premiums and co-payments for certain services, so make sure you are financially able to cover those costs. Medigap insurance can help foot the bill, but it’s also a good idea to have some money saved or budget your current income so you can cover all of the medical expenses of your loved one. Medicare also does not cover dependents, so make sure that children or grandchildren have their own established healthcare plan.

DO try to get home care covered by Medicare or Medicaid

There are some scenarios that will allow you or your loved one to receive financial help if home care is an option. In many cases, the caregiver can be reimbursed and can receive tax breaks depending on the state and the health care plan. Make sure to check with your state to see if these benefits are available.

DON’T fret about past health issues

Many assume that health issues could play a factor in qualifying for Medicare and fortunately, that’s just not the case. If you qualify for Medicare, you will receive full benefits no matter what your health condition is. It is against the law for the government to refuse coverage or raise prices based on your health condition.

DON’T accept cash payment for caring for a loved one

Cash payments for care will be seen as a gift and must be recorded when filing your taxes. Medicaid conducts a five-year look-back and will impose a penalty on any gifts granted during this time. The corresponding amount will be deducted from Medicaid coverage. To offset these costs, have a written contract detailing care so you do not get penalized later on.

Author: Troy Diffenderfer

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