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Top 3 Facts About Medicare in Idaho

1. Medicare Costs Differ Based on Plan

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Original Medicare has premiums, deductibles, copayments and coinsurance to pay for. Most people receive Part A premium-free. This benefit is awarded to people who have worked and earned money for at least 10 years (40 calendar quarters) while paying taxes to Social Security. People whose spouses are eligible also receive this benefit, along with people who have received Social Security Disability Insurance for at least two years.

Medicare Advantage plans come with premiums, deductibles, and copayments.

Medicare Part D comes with monthly premiums, a deductible, and copayments for each prescription. If you make over a set amount in income, you will be charged an Income Related Monthly Adjustment Amount (IRMAA) which you pay directly to Medicare.

Medigap/Medicare Supplement plans come with monthly premiums and a deductible.

2. Medicare and Medicaid Are Different

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Doctors and patients consulting and diagnostic examining sit and talk. At the table near the window in the hospital medicine conceptEligibility. Medicare eligibility is based on advanced age or disability. Most Americans become eligible for Medicare when they turn 65. About 15% of Medicare beneficiaries qualify for the program because they have a disability or end stage kidney failure. With a disability, you can qualify if you are under the age of 65. Medicaid eligibility is based on income and resources requirements. There are many different programs that your state can offer, and each has its own eligibility requirements. Idaho offers three Medicare savings programs in conjunction with Medicaid to help low income seniors afford their health insurance.

Coverage. Medicare offers Part A hospital insurance and Part B medical insurance. This combination will cover inpatient care in a hospital, mental health facility, and skilled nursing facility and outpatient care for doctors visits and emergency visits, along with preventive care services and medically necessary care. Medicaid covers inpatient and outpatient hospital services, physician services, laboratory and x-ray services, and home health services, and can cover prescription drugs, case management, physical therapy, and occupational therapy. Importantly, Medicare does not cover long term care but Medicaid does.

Funding. Medicare is federally funded and administered by the Centers for Medicare and Medicaid Services (CMS) and Social Security. Medicaid is jointly funded by the same outfit federally along with each state. That is why the states can choose which of the programs they can provide to their residents.

3. Medigap and Medicare Advantage Are Different

medicare coverage for end stage renal diseaseCoverage differences. Medicare Advantage plans are an alternative provider for Medicare Part A and Part B coverage. You receive the same coverage for hospital and medical insurance as you do with Original Medicare, but may have the opportunity to purchase additional packages for dental, vision, hearing, prescription drug coverage, and more. Medigap plans do not cover your health care. They provide reimbursement for the out-of-pocket expenses from Medicare Part A and Part B. Coverage offerings between the 10 available plans range from basic to comprehensive, covering things like Part A coinsurance and hospital costs, Part B copayments and coinsurance, hospice care, skilled nursing facility care, your first three pints of blood, the Part A deductible, and more.

Location differences. To enroll in a Medicare Advantage plan, you have to live within the plan’s service area. Counties all have Medicare Advantage plan coverage, with networks of health care providers in the area. With a Medicare Supplement plan, your coverage is still through Original Medicare, meaning you can see any provider that accepts Medicare.

To learn more about the finer differences between Medicare plans, contact Teton Medicare.

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