If you are retiring after a successful career and wondering what you will do for health insurance now that it is no longer provided by your employer, or if you have an aging parent and the family is encountering the financial burden of chronic illness or disease, you may be eligible for Medicare benefits.

There are many misconceptions about Medicare, and knowing exactly what decisions to make for the coverage you need can be difficult. We break down some of the most commonly asked questions about Medicare below. 

What is Medicare, exactly? 

Medicare is health insurance provided by the federal government for people who are:

  • 65 years old or older
  • under 65 with certain disabilities
  • people of any age with end-stage renal disease, which is permanent kidney failure that requires dialysis or a kidney transplant 

Am I eligible for Medicare benefits?

If you are in one of the three groups mentioned above, Medicare has two great resources that can help determine eligibility: 

If you prefer to speak over the phone, you can call 1.800.Medicare to have your questions answered. 

Medicare Blog 2 

What does Medicare cover? 

There are four different parts of Medicare—Part A, Part B, Part C and Part D. 

  • Medicare Part A is hospital insurance that covers inpatient care in hospitals or skilled nursing facilities, home health care or hospice care. You typically do not pay a premium for Part A coverage. 
  • Medicare Part B is medical insurance that covers services from doctors or other healthcare providers, outpatient care, home health care, durable medical equipment and some preventive services. You will likely pay a standard monthly premium. 
  • Medicare Part C is also called Medicare Advantage, and it includes Part A and Part B, as well as prescription drug coverage and other benefits and services for an extra cost. Part C is run by Medicare-approved private insurance companies. 
  • Medicare Part D helps cover the cost of prescription drugs and is run by Medicare-approved private insurance companies. 

Medicare.gov has a great search resource where you can type the service, test or item you’re in need of, and find out if it is covered by Medicare. The Medicare Plan Finder offers a general or personalized search for estimates on coverage information. 

What is excluded from Medicare? 

Medicare does not cover all of your healthcare expenses. Some of the items not covered are: long-term custodial care; most dental or eye care; cosmetic surgery; hearing aids and exams for fitting them; and routine foot care. If you are not sure if the service you need is covered by Medicare, use the search resource linked above to learn more. 

How can I get help with my Medicare costs? 

Even if you don’t qualify for Medicaid, there are other programs that may help you pay for your Medicare premiums and other costs.

  • Qualified Medicare Beneficiary (QMB) Program
  • Specified Low-Income Medicare Beneficiary (SLMB) Program
  • Qualifying Individual (QI) Program
  • Qualified Disabled and Working Individuals (QDWI) Program

 Medicare Blog 1

What is the difference in Medicare and Medicaid?  

Like Medicare, Medicaid acts as a government-supported health insurance and is administered together by the federal government and individual states. The difference is that Medicare provides health coverage for those over 65 or with end-stage renal disease, while Medicaid provides health coverage for people with low incomes and few resources. However, some people are eligible for both, or dual-eligible.

Some groups eligible for Medicaid are: 

  • 65 or older
  • a child under 19
  • pregnant
  • living with a disability
  • a parent or adult caring for a child
  • an adult without dependent children (in certain states)
  • an eligible immigrant

Unlike Medicare, Medicaid can be used to pay for long-term nursing home care in all states. Many states also allow their residents to use Medicaid to pay for assisted living communities or other alternatives to nursing homes such as in-home care.

If you would like to learn more about Medicaid eligibility, you can contact your local or state Medicaid office to speak with a qualified caseworker about your situation. For more information about your state’s Medicaid program, visit HealthCare.gov.

While Medicare is a federally funded health insurance program, each state has its own guidelines, so you will need to contact a State Medical Assistance office for more details:

You may also want to speak with an elder law attorney who can help guide you through the nuances of a successful Medicaid application.

If you have questions about Medicare eligibility or coverage, let Kindred help. Call 1.866.KINDRED to speak with a Registered Nurse 24 hours a day, seven days a week to learn more about the resources available to help you get coverage for your healthcare needs. 

By Blair Klayko