Medicare Benefits

Medicare benefits are provided by the federal government. The good news is that they pay for the majority (but not all) of most senior’s medical bills.

Unfortunately, the not so good news is that Medicare benefits typically do not cover about 20% of senior’s medical bills; and with medical expenses frequently running into thousands and hundreds of thousands of dollars, uncovered expenses can be a very big number. In addition, Medicare does not cover most home care and long-term care expenses.

Fortunately, in addition to Medicare, there are several low-cost and possibly no-cost government funded healthcare insurance options. ACCESSMed’s mission is to help low income seniors understand and enroll in them.

Original Medicare

Original Medicare is made up of two parts: Medicare Part A covers hospital insurance, and Medicare Part B covers medical expenses such as doctor visits, lab work and some medical equipment.

Original Medicare typically covers about 80% of Part A and Part B expenses. Patients are responsible for the remainder of their medical expenses, including prescriptions.

Individuals who select Original Medicare should consider selecting an additional private insurance plan to to cover their prescription drug expenses, or a more comprehensive Medicare Supplement Insurance plan (known as Medigap) to fill in the “gaps” in hospital and medical expenses that Original Medicare does not cover.

Medicare Advantage

Many seniors prefer Medicare Advantage plans to Medigap plans as a way to extend their Medicare coverage. Medicare Advantage provides Medicare Part A and Part B benefits through a private, Medicare-approved insurance company. Many plans provide extensive additional benefits possibly including prescription drug coverage, routine vision and dental care, over the counter health products and equipment, meals and transportation to health care appointments. The most common plan types are HMO and PPO.

• An HMO, or Health Maintenance Organization is a group of doctors, hospitals, and other health care providers who agree to give health care to beneficiaries for a fee that the government pays them. In an HMO, you usually must get all your care from the providers that are part of the plan and you need a referral from a primary care physician to go to specialists.

• A PPO, or Preferred Provider Organization is a managed care plan that provides you with services from doctors, hospitals and other providers that belong to a network. You have the option of receiving services from providers outside the network at additional cost. You do not need a referral from a primary care physician to go to a specialist.

Both HMO and PPO plans generally include prescription drug coverage through a Medicare Advantage Prescription Drug Plan (MAPD). In addition, it may be possible to have both Medicare Advantage and Medicaid insurance coverage at the same time.

Read more about Medicare Advantage.

Medicare Advantage + Medicaid

Medicaid is a joint federal and state health insurance program that that provides low-cost and possibly no-cost healthcare coverage for seniors and some other individual with limited income and resources.

In Arizona, qualified individuals can sign up for a Medicare Advantage plan when they enroll in Medicaid. This dual coverage is referred to as a Special Needs Plan called Special Needs Plans. There are several types of Special Needs Plans available to individuals who are entitled to both Medicare and medical assistance from a state plan under Medicaid. In Arizona, the state side of the plan is managed by the Arizona Health Care Cost Containment System (AHCCCS).

Read more about Medicaid.