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Medicare provides certain adults with disabilities with publicly funded health insurance. Medicare helps pay for a broad array of routine, acute, and preventive care, rehabilitation, mental health, home health services and durable medical equipment essential to health and independence. Accessing these services and supports is crucial to enabling millions to avoid far more costly hospitalization and long-term institutionalization. Without Medicare, millions of Americans, especially those with disabilities and chronic conditions, would be unable to obtain or afford any health insurance at all.
Because Medicare is a federally funded health insurance program, eligibility is the same in each state and covers:
Medicare.gov is the official site for Medicare information and resources
Medicare and You is a comprehensive publication that has information on all areas of the Medicare program, including a review of what has changed.
Medicare Eligibility Tool provides information on enrollment and eligibility
Medicare: A Primer, Kaiser Family Foundation
Talking About Medicare: Your Guide to Understanding the Program, Kaiser Family Foundation
Medicaid assistance may be available for people with disabilities if they have a waiver or meet Medicaid's low income guidelines. An individual may want to have Medicare in addition to Medicaid because the combination can provide better access to care. Medicaid patients are usually seen only at public health clinics. Private practices would rather treat Medicare patients because of the higher reimbursement rate. This situation becomes even more extreme in adult health care and finding a private physician can be extremely difficult.
There are other benefits available to "dual eligibles" who are entitled to both Medicare and Medicaid benefits. Medicaid can help pay for out-of-pocket medical expenses and play a critical role filling in Medicare’s gaps in coverage. It can provide additional services and supplies that are available under the individual's state Medicaid program. Services that are covered by both programs will be paid first by Medicare and the difference by Medicaid, up to the state's payment limit. Medicaid can pay for nursing facility care beyond the 100 day limit covered by Medicare, prescription drugs and monthly premiums, eyeglasses and hearing aids. An individual may want to have Medicare in addition to Medicaid because the combination can provide better access to care. Because Medicare reimbursement is higher than Medicaid, more physicians will accept Medicare patients over Medicaid patients. Most physicians who treat adults accept Medicare but very few accept Medicaid. Medicaid would cover premiums and co-pays for Medicare.
Centers for Medicare and Medicaid Services information and brochure on dual eligibility.
Medicare's prescription drug coverage, sometimes called Medicare Part D, began January 1, 2006. You have a choice of prescription drug insurance plans which are available through private insurance companies. Participation is income driven, therefore you will pay a monthly insurance premium plus a portion of the prescription cost through a co-payment. Medicare prescription insurance plans are open to everyone who is eligible for Medicare.
CVS Pharmacy has information about the prescription drug coverage under Medicare, as well as a savings calculator to compare plans that would best meet your needs in the area you live.
Medicare provides an overview of the prescription drug plan.
Medicare Prescription Drug Plan Finder will help you identify plans through a personalized search or through a search by state.
We want to hear from you. Email us with your feedback or suggestions for additional resources.
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