Medicare and Medicaid Coverage

Mayor's Office of Employee Assistance
Medicare and Medicaid Coverage

Medicare and Medicaid are federal programs that were started to ensure the availability of health and hospitalization insurance for the elderly. Not everyone is eligible for all forms of Medicare and Medicaid, so it is important that you research the eligibility requirements for so that you can plan for the insurance and health care needs of your elderly relatives.

Medicare Part A

Part A covers hospitalization, skilled nursing facility stays, home health care and hospice care. For those who meet the qualifications, Part A does not have a premium; it is covered by the Medicare taxes that the recipient paid while working. People who don’t meet the qualifications have the option to purchase it. A person is eligible for premium-free Part A Medicare if he or she meets one of the following requirements:

  • 65 and older, receiving or eligible to receive Social Security retirement benefits or benefits from the Railroad Retirement Board, or

  • Under 65 and has been receiving Social Security disability benefits for 24 months

  • Under 65 and receiving Railroad Retirement disability benefits, and meeting the Social Security Act disability requirements, or

  • Retired from Medicare-covered government employment

  • Under 65 and is a kidney dialysis or kidney transplant

  • Medicare Part B

    Part B is medical insurance that pays for the services of doctors, outpatient care and some medical services not covered by Part A. Any U.S. citizen or permanent resident is eligible upon turning 65. People who are eligible for premium-free Part A are also eligible for Part B. Part B is voluntary, and the beneficiary must pay premiums (which are deducted from your Social Security, Railroad Retirement or Civil Service Retirement payments). People who don’t receive payments from any of these sources can also be billed quarterly.

    Original Medicare Plan

    The Original Medicare Plan is based on a pay-per-visit arrangement. With this plan, a person is free to go to any doctor, hospital, or other health care provider—as long as they accept Medicare. There is a deductible, and after the deductible Medicare will cover a percentage of the costs. There are two parts to the Original Medicare Plan: Part A (Hospital Insurance) and Part B (Medical Insurance).

    Medicaid

    Medicaid is a joint federal-state program to assist lower income people—U.S. citizens or “qualified aliens”—who need help paying for medical care. Medicaid picks up the expenses that Medicare Parts A and B do not pay: the deductibles, coinsurance and premiums. Because it is administered by the individual states, eligibility requirements and benefits vary greatly. Check with your individual state to find out about its program, who is covered and what benefits it offers.

    Feedback