MEDICARE & MEDICAID
MEDICARE
Medicare is a federal government program that provides health insurance coverage for individuals who are 65 years or older, those under 65 and receiving Social Security Disability Insurance (SSDI) for a certain amount of time, or those under 65 and diagnosed with End-Stage Renal Disease (ESRD).
MEDICAID
Medicaid is a federal and state program that helps people with limited income and resources cover healthcare costs. In addition to benefits normally covered by Medicare, Medicaid also covers nursing home care and personal care services.
What does Essential Plan mean?
ESSENTIAL PLAN RESIDENCY REQUIREMENTS
The Essential Plan is a health insurance program in New York designed for state residents who do not qualify for Medicaid or the Child Health Plus Program.
Low and moderate-income families that are residents of New York State and legal immigrants are eligible for the Essential Plan program. All four Essential Plans don't have a monthly premium, yet plan benefits are generous and provide you with the ten essential health benefits mandated by the Affordable Care Act. Following are the different variations of the NYS Essential Plans:
Essential Plan 1
For individuals with income greater than 150% and less than or equal to 200% of the FPL.
Essential Plan 3
For individuals with income equal to or greater than 100% and less than or equal to 138% of the FPL who are not eligible for Medicaid due to immigration status.
Essential Plan 2
For individuals with income greater than 138% and less than or equal to 150% of the FPL.
Essential Plan 4
For individuals with income below 100% of the FPL who are not eligible for Medicaid due to immigration status.
PARTS OF MEDICARE:
PART A
(Hospital Insurance):
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Inpatient care in hospitals
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Skilled nursing facility care
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Hospice care
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Home health care
PART B
(Medical Insurance):
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Services from doctors and other healthcare providers
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Outpatient care
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Home health care
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Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)
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Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits)
Medicare Advantage (also known as Part C):
A Medicare Advantage is another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called "Part C" or "MA Plans" are offered by Medicare-approved private companies that must follow rules set by Medicare. If you join a Medicare Advantage Plan, you'll still have Medicare, but you'll get most of your Part A and Part B coverage from your Medicare Advantage Plan, not Original Medicare. These "bundled" plans include Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), and usually Medicare drug coverage (Part D).
With a Medicare Advantage Plan, you may have coverage for things Original Medicare doesn't cover, like fitness programs (gym memberships or discounts) and some vision, hearing, and dental services (like routine checkups or cleanings). Plans can also choose to cover even more benefits. For example, some plans may offer coverage for services like transportation to doctor visits, over-the-counter drugs, and services that promote your health and wellness. Plans can also tailor their benefit packages to offer these benefits to certain chronically-ill enrollees. These packages will provide benefits customized to treat specific conditions.
PART D
(Drug coverage):
Helps cover the cost of prescription drugs (including many recommended shots or vaccines). You join a Medicare drug plan in addition to Original Medicare, or you get it by joining a Medicare Advantage Plan with drug coverage. Plans that offer Medicare drug coverage are run by private insurance companies that follow the rules set by Medicare.
Medicare Supplemental Insurance
(Medigap):
Extra insurance you can buy from a private company that helps pay your share of costs in Original Medicare. Policies are standardized and, in most states named by letters, like Plan G or Plan K. The benefits in each lettered plan are the same, no matter which insurance company sells it.
Medigap is Medicare Supplement Insurance that helps fill "gaps" in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining healthcare costs, like Copayments, Coinsurance, and Deductibles.