Understanding coverage can sometimes feel complex, but Medicare makes important health services accessible for those who qualify. With proper benefits in place, you can receive skilled care in the setting that feels most natural. Medicare helps ensure you continue to receive needed assistance.
Medicare
Medicare is the federal health insurance program for people age 65 and older. Certain individuals under 65 also qualify, including those with permanent disabilities, kidney failure, or amyotrophic lateral sclerosis.
What does Medicare cover?Medicare helps with health care costs but does not cover all expenses or most long-term care. The program includes four parts:
- Part A: Hospital insurance
- Part B: Medical services not covered by Part A
- Part C: Medicare Advantage, combining Parts A and B through private organizations such as HMOs
- Part D: Prescription drug coverage
Managed Care
Managed care plans are a form of health insurance that contract with health care providers and facilities to deliver services at reduced cost. Coverage depends on the plan’s network rules.
Types of managed care plans:
- Health Maintenance Organization (HMO): Coverage is limited to in-network providers. Requires choosing a primary care doctor who coordinates most of your care.
- Preferred Provider Organization (PPO): Higher flexibility, but costs are lower within the network. Some coverage applies outside the network.
- Point of Service (POS): Combines HMO and PPO options, allowing you to choose each timeyou need care.
Choosing a Doctor or Health Care Service
Selecting a provider can be difficult, but important factors include:
- Insurance coverage
- Accreditation of the provider or service
- Service location
- Hours of availability
- Whether the provider’s approach suits your preferences
Tip: Reviewing these elements helps you make informed decisions about where and from whom you receive care.
Health Insurance
Health insurance helps protect you from high medical costs. It is a contract with an insurance company where you pay a premium, and the company helps cover your health care expenses.
How do people get health insurance?- Many Americans receive insurance through employers, often with the employer covering part of the cost.
- Employer-based insurance is often a managed care plan, which contracts with providers and facilities to reduce costs.
- Individuals may also purchase their own health insurance policies.
- Government programs such as Medicare and Medicaid provide coverage for eligible groups.
Note: The Affordable Care Act expanded access to health insurance for many people in the U.S.
Medicaid
Medicaid is a government health insurance program for low-income individuals and families in the U.S. It helps pay for medical care and services. While the federal government sets guidelines, each state manages its own program with specific rules.
Who may qualify for Medicaid?Eligibility often depends on:
- Age
- Pregnancy status, disability, or blindness
- Income and resources
- Citizenship or immigration status
Tip: States may require a small payment for certain services. For complete details, check your state’s Medicaid program rules.
Centers for Medicare and Medicaid Services (CMS)