Understanding Medicare and Medicaid
Medicare
For seniors who are aging at home or in their community, the Medicare program is an important source of coverage and lifeline for ongoing primary care and other outpatient visits and prescription drug coverage. The program’s limited coverage of home health visits (generally after a hospitalization) also is important for our members to understand. Innovations in Medicare and private plans Medicare Advantage are leading to greater use of care coordination, telemedicine, and programs to support patient health and wellness. Any aging-at-home strategy needs to make sure that seniors are connected to a coordinated system of health care and have access to services and programs that keep them healthy. Resources below can help our members understand developments in Medicare that can support those aging-at-home goals.
What Is a SHIP and How Can It Help Me? (ncoa.org). This report from the National Council of Aging offers advice about where to go to understand your Medicare benefits.
Understanding Medicare
The following organizations are credible resources to help beneficiaries navigate the Medicare program:
- Medicare Rights Center – this highly credible national, non-profit, consumer-focused organization, offers a free hotline to answer beneficiary questions and an education center to help beneficiaries navigate the program. The organization is also engaged in advocacy and public policy development to support Medicare beneficiaries.
Visit: https://www.medicarerights.org - Center for Medicare Advocacy – This national, credible, non-profit organization helps Medicare beneficiaries understand and access their benefits. Its primary focus is on legal rights, but it also has good educational resources that provide background about the program in an understandable way.
Visit: https://medicareadvocacy.org - AARP Medicare Question and Answer Tool – This tool helps Medicare beneficiaries to better understand the benefits available to them given their needs and circumstances. This includes information on eligibility and enrollment requirements, plus plan options, coverage, and costs.
Use the Tool by clicking here
Medicare Interactive, powered by the Medicare Rights Center, provides free resources for patients to learn more about Medicare, what services Medicare covers, and coverage options. In addition to patient resources, they provide resources for providers to help answer questions about Medicare.
https://www.medicareinteractive.org
Securian Financial – This website provides information about the basics of Medicare, how to navigate Medicare, and how to save for health care costs when planning for retirement.
https://www.securian.com/insights-tools/articles/medicare-tips-in-retirement.html
Medicaid
Medicaid is an important safety net program for facility-based long-term care like nursing homes that many seniors end up needing later in life. The program limits eligibility based on people’s assets and income, so families often must spend down their assets first before becoming eligible. Many states also provide coverage for home and community-based services through this program. We provide information to our members below to help educate them about how the program operates in their states.
Understanding Medicaid
State-based Medicaid programs vary in their coverage of long-term care services. Use the resources below to learn more about what your state provides to qualified Medicaid beneficiaries:
- Medicaid.gov – Home and Community Based Services
This site describes how Medicaid provides opportunities for beneficiaries to receive services in their own home and communities. Programs serve a variety of target groups such as people with developmental or physical disabilities.
Click here to learn more - Medicaid.gov – Long-Term Services and Supports
This site describes Medicaid’s role in providing long-term services and supports for people with disabling conditions and chronic illnesses.
Click here to learn more - Medicaid.gov – Institutional Long-Term Care
This site describes Medicaid’s role in providing long-term residential based care supports such as nursing home care.
Click here to learn more - Medicaid.gov – State Overviews
Learn more about Medicaid eligibility requirements and state-based Medicaid program information through this government-maintained directory.
Click here to learn more - Medicaid.gov – State Directory
State by state links to Medicaid Web sites.
Click here to learn more - Medicaid.gov – State Scorecard Data – Long Term Services and Supports
Medicaid is beginning the process to measure state-by-state performance in delivering long term services and supports such as nursing home care. The link below will deliver this data in the future as it becomes available.
Click here to learn more