Medicaid and Medigap Questions and Advice
Medicare, Medicaid, and medigap are all government programs?
Medicare and Medicaid are government programs; medigap is not.
Medicare Part A and Part B are funded and run by the federal government; Medicare Part C and Part D are regulated by the federal government but operated by private healthcare and insurance companies.
Medicaid is funded by the federal government, but state governments run their own programs, each with slightly different rules. (For those who live in California, Medi-Cal is the name California gives its Medicaid program.)
Medigap is insurance that supplements Medicare coverage (filling in Medicare’s “gaps” — hence the name). Medigap rules are made by the federal government, but the policies themselves are issued by private insurance companies.
Each program has different eligibility rules, and not all seniors are eligible.
Almost everyone 65 or over is eligible for Medicare.
There’s a guaranteed right to buy a Medigap policy (through our website), but only within six months after first enrolling in Medicare Part B. If you don’t buy within that time, insurance companies might
decide not to sell you a policy because of your health history.
Medicaid is only available to people with very low incomes and few assets (other than their home).
Which program covers almost all medical costs?
Medicaid pays almost all medical care costs (except very small copayments for some services), though it limits what healthcare providers you can use.
Medicare by itself covers only a little more than half of all medical costs for seniors.
Medigap can pay some of the costs Medicare doesn’t, but how much a medigap policy pays depends on which one you buy.
Which programs cover at least some long-term care?
Medicaid can pay for home healthcare and for the full cost of nursing home care (in facilities that accept Medicaid payment), without time limits.
Medicare covers a limited amount of home healthcare, plus a short stay in a skilled nursing facility directly following a three-day or more hospital stay.
If Medicare covers a portion of the costs of nursing home care, some medigap policies help pay those costs that Medicare doesn’t.
Everyone must enroll in all four parts of Medicare — parts A, B, C, and D?
Each part of Medicare requires separate enrollment, and people may choose which parts to enroll in.
Medicare Part A covers inpatient hospital and nursing-facility stays (though not the bills from doctors who treat you there), as well as hospice.
Medicare Part B covers doctors’ bills (whether you’re an inpatient or outpatient), clinics, laboratories, home healthcare, physical therapy, and medical equipment and supplies.
Medicare Part C is an alternative to Parts A and B, delivered through a private managed care plan, such as an HMO. Also called Medicare Advantage, Part C combines Part A and Part B in one plan. If you enroll in a Medicare Part C plan, you don’t separately use or pay for Medicare Parts A or B. People enroll in Medicare Part C because it may cost slightly less than care with traditional Medicare Parts A and B, and because it sometimes offers a few minor extra services. Some Part C plans also have drug coverage (with one of these, there’s no need for a
Medicare Part D plans. Part C plans limit the choice of healthcare providers from whom you get your care.
It’s run through individual plans offered state-by-state by private insurance companies. Each plan has different drug coverage. You must sign up directly with a Part D plan in order to get drug coverage.
You must pay at least a portion out of pocket even if you have Medicare, Medicaid, or medigap?
Each program has its own set of premiums, deductibles, and copayments that you’re personally responsible for paying.
Medicare Part A has a large deductible for each hospital or nursing home stay, as well as large copayments for long stays. Some people also have to pay a sizable Medicare Part A premium.
Everyone with Medicare Part B is charged a monthly premium, plus a substantial copayment for almost every medical bill.
With medigap, you pay a monthly premium, but a medigap policy in turn pays some Medicare Parts A and B deductibles and copayments.
Medicare Part D drug plans charge a monthly premium plus copayments for individual prescriptions. Part D plans leave some drugs uncovered and pay little or nothing once you reach a yearly coverage limit.
Medicaid pays almost the entire cost of all covered care, charging only very small copayments for certain medical services.