Retirement is fast approaching, and that means making important changes and decisions. One of the most important considerations after retirement is your health. As an employee, you often get health benefits from your employer, so you rarely worry about your basic health care costs. After retirement, health becomes a vital factor, considering our health deteriorates as we age.
With that in mind, it’s vital to note that you have several options for meeting your health care costs, including Medicare and Medicaid. Most people usually automatically qualify for Medicare when they hit 65 years old, but can you receive Medicaid too?
Medicare Basics
Medicare is a national health insurance program for people who are 65 or older. It also covers some disabilities and patients with end-stage renal disease (ESRD). It has four parts: A, B, C, and D.
Parts A and B are provided by the federal government and are the same in every state. Medicare-approved private insurance companies provide parts C and D, and they vary by state. They essentially supplement or offer alternatives to parts A and B. Here is what they cover:
- Part A– Hospital insurance that covers inpatient hospital care, nursing home care, hospice, lab tests, and surgery.
- Part B– Medical insurance for home health care, outpatient care, durable medical equipment, doctor services, and some preventive services.
- Part C– Medicare Advantage plan combines both parts A and B into a single plan and may offer extra benefits.
- Part D– Coverage for the cost of prescription drugs.
Medicaid Basics
Medicaid is a federal and state health insurance program for people with limited income and resources. It also covers people with certain disabilities, pregnant women, children under 19, and elderly adults. States administer the program as per federal regulations.
Eligibility for Medicaid varies by state—you’ll need to understand your state’s specific requirements before applying. Generally, the Affordable Care Act uses your household’s Modified Adjusted Gross Income (MAGI) to determine eligibility. However, people with disabilities, blindness, and those aged 65 and older are exempt from MAGI-based income rules.
Medicaid covers some of the same benefits as Medicare. These include laboratory and x-ray services, inpatient and outpatient hospital services, home health services, physician services, among other services. There are also optional services, such as case management, prescription drugs, occupational therapy, and physical therapy.
Dual Eligibility
Some people are eligible for both Medicare and Medicare. However, Medicare is usually used first to pay for services that Medicaid also covers. If you’re a dual-eligible beneficiary, you’re enrolled in Medicare Part A and/or B and Medicaid. You can be a “partial-dual” or “full-dual” beneficiary. This depends on the level of Medicaid benefits you’re eligible for.
The dual plan covers different services, including home health services, nursing home care, long-term institutional care, transportation services, personal care services (in some states), dental services, and eye exterminations. If you have Original Medicare, you can get more benefits if you qualify for dual coverage. This is possible without paying any monthly premiums.
How to Choose a Plan
When choosing the right plan, you should look at both state and federal requirements. This is particularly important for Medicaid, which is usually dictated by your state. Bear in mind your state may also limit plans and programs.
Most people who qualify for dual coverage are those receiving Supplemental Security Income (SSI). This is a program that provides cash assistance to those who are disabled, aged, or blind. You can receive dual coverage through Original Medicare, Medicare Advantage, Medicare Managed Care, Dual Eligible Special Needs Plans (D-SNP), and Programs of All-Inclusive Care for the Elderly (PACE).
You should have adequate knowledge of the different requirements and what you’re eligible for. If you need assistance, be sure to talk to a licensed insurance agent to understand your options. They can help you compare the different options while breaking down the pros and cons of each plan. Click here to learn more about Medicare vs. Medicaid for easy comparison and decision-making.
Choose the Right Plan
Medicare and Medicaid both provide cost-effective options for meeting your health costs, particularly as a retiree. However, the ideal plan depends on your health needs and the plans available in your state. Whichever plan you opt for, be sure to take into account your current and future health care needs.
