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Beginning to Understand Medicare & Medicaid

When my grandparents began to age and succumb to health issues (my grandmother was permanently and totally blind from diabetes complications and my grandfather had high blood pressure and eventually suffered a debilitating stroke). When they could no longer care for themselves or each other it seemed 2nd nature to mom to become their fulltime caregiver. They needed someone to prepare their meals properly, dress them, give them medication, etc. So it made sense to move them in.

I recall vividly that once they moved in it was impossible to find a salt shaker and the occasional fried delicacy no longer existed. As their caregiver my mom took her parents to their doctor appointments, explained in layman’s terms what it all meant, she talked to insurance companies regarding coverage issues until they were resolved.

My grandfather died in March of 1988 and my grandmother died in June 1989. I was able to glean so much from them being there…mostly I learned that it’s important to care for our seniors in such a manner that leaves them with their dignity, preserves their well being and somehow enhance their quality of life.

Fortunately, for me (and my mom) my mom is pretty spry. She is college-educated, tints her hair, and can still wear 3+ inch heels…but when she received her Medicare packet just before her 65th birthday she had a host of questions: Do I have to do anything or is coverage automatic? I don’t need prescription drug coverage now, but what if I do later? What is the difference between Medicare Part A,B,C and D?

The task of mulling through the Medicare packet can be a daunting one at best. November 15-December 31, 2008 is open enrollment for Part-D – Prescription Drug Coverage.

As the insurance editor I am committed to providing a weekly article on “Insurance for Seniors” including Medicare and Medicaid through the end of November. My goal is to alleviate some of the frustrations associated with signing up for the coverage, determining one’s eligibility, what exactly is covered, can there be overlapping coverage, etc.

Brief History of Medicare and Medicaid
In 1965 the Social Security Act established both Medicare and Medicaid. Medicare is federally funded and administered at the federal level. Medicaid is administered at the state level with federally funding assistance. Both programs are serviced through the Centers for Medicare and Medicaid Services (CMS).

Eligibility for Medicare

Most individuals who are 65 or older are entitled to Medicare. If payroll tax contributions were made for at least 10 years by either themselves or a spouse. There are some individuals who are under the age of 65, but who qualify for Medicare. Individuals, any age, who are permanently disabled, and have been receiving Social Security Disability Insurance for 2 years (a permanently disabled person is eligible for Medicare after a 2 year waiting period). Individuals with End-Stage Renal Disease (permanent kidney failure with dialysis or a transplant) are also eligible.

Eligibility for Medicaid

Individuals with low incomes and limited resources who can not afford medical care. Depending on individual state guidelines, beneficiaries (healthcare recipient) may be asked to pay a small portion of the medical costs (co-pays).

Eligibility for both Medicare and Medicaid

Individuals who qualify for both Medicare (age) and Medicaid (financial need) are known as Dual eligible.

Visit this site often as a tool to decipher Medicare and Medicaid. Upcoming articles will address each Medicare part in detail, medigap policies, late enrollment penalties, and Medicaid. I welcome your specific topic questions and suggestions.

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