Medicare

People who are enrolled in both Medicare and Medicaid, also known as dually eligible individuals, fall into several eligibility categories. These individuals may either be enrolled first in Medicare and then qualify for Medicaid, or vice versa.

Part A 

Covers hospitals, hospice, and skilled nursing care; no charge to Medicare beneficiaries for premiums, but deductibles and co-insurance apply.

Part B 

Covers doctors’ services, outpatient care, and preventive services; income-based premiums apply, along with an annual deductible and 20% coinsurance.

Part C 

Also known as Medicare Advantage. Coverage is the same as Part B, and may also include dental, vision, fitness, and meals. It is provided by private insurance carriers and requires payment of the Medicare Part B premium; some plans have additional premium costs. These plans are subject to restricted networks, pre-authorization requirements, and referrals for specialist care. Usually covers medications.

Part D 

This is for medications only; it is administered by a private company. Beginning in 2025, the annual out-of-pocket cost for Part D is capped at $2,000. Once enrollees have spent $2,000 in out-of-pocket costs for covered medications, there are no copayments or coinsurance costs for the rest of the year.

Health insurance sold by private insurance companies to fill the “gaps” in Traditional Medicare Plan coverage. Medigap policies help pay some of the health care costs that the Traditional Medicare Plan does not cover, such as deductibles and coinsurance. Eligibility requirements are the same as for Medicare A. Medigap providers are any providers that accept Medicare.

Information coming soon.