Medicare & Medicaid Help
Understanding Medicare and Medicaid, Made Simple
Plain-English answers about what each program covers, when you can enroll, and how to compare your options with a licensed agent, free and with no obligation.
Licensed agents are available Monday to Friday, 7:30 AM to 6:00 PM Central. Plan help is provided by EOS Insurance Services, LLC.
ⓘ
The Annual Election Period runs October 15 to December 7. If you have Medicare, this is when you can review your coverage and change plans for next year.
The Basics
Medicare and Medicaid: What’s the Difference?
They sound alike, but they are different programs. Some people qualify for both.
Medicare
Federal health insurance
✓
For people age 65 and older, and some younger people with disabilities or certain conditions
✓
Available regardless of income
✓
Made up of Parts A, B, C and D, plus optional Medigap
✓
Has premiums, deductibles and copayments
Medicaid
State and federal program
✓
For people with limited income and resources
✓
Eligibility rules are set by each state
✓
Can help pay some Medicare costs, such as premiums, deductibles and copayments
✓
In some cases, covers long-term care services
✦
Have Both? You Are “Dual Eligible.”
Dual-eligible people can enroll in special Medicare Advantage plans designed to coordinate Medicare and Medicaid benefits. Learn more below.
Medicare 101
Who Is Eligible for Medicare?
Medicare started in 1965 so that older Americans would not be left without health coverage. Today it also serves some younger people.
65+
Age
If you are 65 or older, you can get Medicare. It does not matter whether you are still working, retired, or planning to retire soon.
24
Disability
If you have received Social Security Disability Insurance for at least 24 months, you qualify for Medicare, regardless of age.
+
Certain Conditions
Some medical conditions, including End-Stage Renal Disease (ESRD) and ALS (Lou Gehrig’s disease), can qualify you before age 65.
Parts of Medicare
A, B, C, D: What Each Part Covers
Medicare does most of the heavy lifting, but it does not eliminate all of your costs. Each part has its own rules and costs.
A
Hospital Insurance
Part A
Covers: inpatient hospital stays, skilled nursing facility care after a qualifying hospital stay, and some home health care.
Costs: most people pay no premium for Part A. A deductible applies for each benefit period, and coinsurance applies for longer hospital stays.
B
Medical Insurance
Part B
Covers: doctor and specialist visits, preventive care, outpatient services, some home health, and durable medical equipment such as walkers and wheelchairs.
Costs: a monthly premium, a yearly deductible, and usually 20% of the approved amount for most services.
C
Medicare Advantage
Part C
Covers: everything in Parts A and B through a private insurance company, often with drug coverage and extra benefits.
Costs: vary by plan. You still pay your Part B premium, and plans have a yearly out-of-pocket maximum.
D
Prescription Drug Coverage
Part D
Covers: prescription drugs through private plans. Many Medicare Advantage plans include it. With Original Medicare, you can add a separate drug plan.
Costs: a monthly premium, a possible deductible, and copayments or coinsurance. Check that your medications are on the plan’s list.
Medicaid & Medicare Together
How Medicaid Affects Your Medicare Choices
Many people rely on both programs. If you are eligible for Medicaid, or already enrolled, it can change which Medicare plans make sense for you.
✓
Dual-eligible special needs plans (D-SNPs). These Medicare Advantage plans work with your state Medicaid program to coordinate benefits, and some also provide Medicaid services.
✓
Help with costs. Medicaid can help cover Medicare premiums, deductibles and copayments. In some cases, Medicaid pays after Medicare pays its share.
✓
Prescription drugs. If you have Medicare and full Medicaid, all D-SNPs include Part D. Medicaid may cover some drugs Part D does not. With limited income and resources, you may qualify for Extra Help with drug costs.
✓
Check your eligibility. Contact your State Medical Assistance (Medicaid) office to verify whether you qualify. In Texas, that is Texas Health and Human Services.
Medicaid rules are complex and change. For long-term care planning, consider speaking with an elder law attorney, and confirm details with your state Medicaid office.
Choosing Your Coverage
Medicare Advantage or Medicare Supplement (Medigap)?
These are the two most common choices. Neither is right for everyone, and you generally cannot have both.
Medicare Advantage (Part C)
Medicare Supplement (Medigap)
What It Is
An all-in-one alternative to Original Medicare from private insurers approved by Medicare. It bundles Parts A and B and often drug coverage.
Extra insurance that works with Original Medicare. It helps pay costs Medicare does not, such as deductibles, copayments and some foreign travel emergencies.
Monthly Cost
Premiums are typically lower. Out-of-pocket costs vary by plan.
Premiums can be higher, but plans can reduce your out-of-pocket costs.
Yearly Spending Cap
Yes. Plans have an annual out-of-pocket maximum.
Plans are standardized, so each plan letter offers the same benefits regardless of the company.
Choice of Doctors
Often a plan network, and referrals to specialists may be needed.
Any doctor or hospital that accepts Medicare, with no referrals needed.
Prescription Drugs
Often included. Check the plan’s drug list.
Not included. You can add a separate Part D drug plan.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply. If you have a Medicare Advantage plan, it is illegal for anyone to sell you a Medigap policy unless you are switching back to Original Medicare.
Medicare & Senior Care
What Medicare Does and Does Not Pay for in Senior Care
Families are often surprised by what Original Medicare covers after a hospital stay, and what it does not.
Often Covered
Hospital Stays
Part A covers inpatient hospital care for up to 90 days per benefit period, with 60 additional lifetime reserve days. Deductibles and coinsurance apply.
Limited Coverage
Skilled Nursing & Rehab
After a qualifying hospital stay of at least three days, Part A can cover up to 100 days of skilled nursing care per benefit period, if the care is medically necessary.
Limited Coverage
Home Health Care
Medicare covers part-time or intermittent skilled nursing and therapy at home when a doctor certifies the need and sets up a care plan.
Long-term care is different. Medicare generally does not pay for long-term custodial care, such as help with bathing and dressing in assisted living. Families often use savings, long-term care insurance, veterans benefits or Medicaid programs. See how families pay for care or talk to us about placement.
Veterans and Medicare
If you have VA benefits or Tricare, Medicare can add another layer of coverage and more choice.
You can have VA benefits and Medicare at the same time.
VA benefits generally cover care at VA facilities; Medicare covers care outside them. You choose which to use each time.
With Tricare for Life, Medicare pays first and Tricare typically pays the remaining costs. You must have Medicare Parts A and B to keep Tricare past 65.
Both the VA and Medicare Part D offer drug coverage, so compare your medications and costs.
Higher Income and IRMAA
People with higher incomes pay an extra monthly amount on top of their Part B and Part D premiums. It is called the Income-Related Monthly Adjustment Amount, or IRMAA.
The Social Security Administration looks at your tax return from two years earlier.
The more you earn above set thresholds, the larger the surcharge.
Amounts and thresholds change every year, so check Medicare.gov for the current figures.
If your income dropped because of a life-changing event, such as retirement, marriage or the death of a spouse, you can ask Social Security to reconsider.
Your Medicare Checklist
Six Steps to Navigate Medicare with Confidence
1
Understand the Basics
Learn what Medicare is, who is eligible, and how the parts work. This page is a good start.
2
Get Personalized Recommendations
Answer a few questions about your needs and see plan options matched to you.
3
Compare Plans, Including Your Current One
Look at costs, doctors, drugs and benefits side by side before you decide.
4
Enroll in a Plan
Enroll online yourself, or call a licensed agent to find a plan and enroll.
5
Get Support After Enrolling
Ask questions and learn how to use your plan benefits once you are enrolled.
6
Review Your Plan Every Year
Come back each year to make sure you are not missing coverage or savings.
Compare Plans with a Licensed Agent
Get Free, No-Obligation Medicare Plan Help
Senior Living USA works with EOS Insurance Services, LLC, so families can compare Medicare Advantage and Medicare Supplement plans with licensed insurance agents. There is no cost for a plan review, and no obligation to enroll.
1
Sign Up in Minutes
Answer a few questions to get plan recommendations.
2
View Your Results
Compare personalized options for plans that fit your needs.
3
Get Help and Enroll
Enroll online or over the phone with a licensed agent.
Quincy Jackson
Your EOS Advisor Profile
Quincy is the founder of Senior Living USA and has an advisor profile with EOS, where you can start a plan search or ask for help.
Hours
Mon–Fri, 7:30 AM to 6:00 PM Central
Common Questions
Medicare and Medicaid FAQs
Does a Plan Review Cost Anything?
No. A plan review with a licensed EOS agent is free and there is no obligation to enroll. Your current or future Medicare enrollment status will not be affected, and there is no automatic enrollment.
Is This a Government Website?
No. We are not connected with or endorsed by the U.S. Government or the federal Medicare program. For official information, visit Medicare.gov or call 1-800-MEDICARE.
When Can I Change My Medicare Plan?
Most people can review and change plans during the Annual Election Period, October 15 to December 7. If you are in a Medicare Advantage plan, you also have a one-time change window from January 1 to March 31. Life events can open a Special Enrollment Period.
Medicare Advantage or Medigap: Which Should I Choose?
It depends on your health needs, budget, and how much freedom you want in choosing doctors. Medicare Advantage often has lower premiums and a yearly spending cap but may use a network. Medigap can cost more but works with any provider who accepts Medicare. A licensed agent can compare both for you.
I Have Medicaid. Can I Also Have a Medicare Plan?
Yes. People with both are called dual eligible and may qualify for special plans, called D-SNPs, that coordinate Medicare and Medicaid benefits. Confirm your Medicaid eligibility with your state Medicaid office.
Does Medicare Pay for Assisted Living?
Generally, no. Medicare does not pay for long-term custodial care. It can cover short-term skilled nursing or rehab after a qualifying hospital stay. Families often pay for assisted living with savings, long-term care insurance, veterans benefits or Medicaid programs.
I Am a Veteran. Do I Still Need Medicare?
Many veterans keep both. Medicare adds coverage and choice, especially outside VA facilities, and you need Parts A and B to keep Tricare for Life. Compare your options before deciding.
Paying for Care
Start Planning With a Care Funding Review
Many families are paying for care out of pocket. Care Funding Review looks at the gap between the cost of care and available income, and at whether part of savings could be turned into monthly income to help cover it. It is a good way to start the conversation and begin planning.
Senior Living USA uses this service with families. It is a review, with no obligation to go further.
Care Funding Review is a separate service. We provide guidance and coordination, not medical, legal or financial advice, and we can’t promise any result.
1
Calculate the Care Gap
Compare what care costs with the income available to pay for it.
2
Review Health, Assets and Options
Look at the whole picture, so the plan fits your family.
3
See Whether a Care Plan Makes Sense
Decide together whether an Immediate Care Plan is right, or whether it is not.
Ready When You Are
Take the Next Step with Your Medicare Coverage
Compare plans online, call a licensed agent, or talk to us about your family’s care needs.
Licensed agents: 833-614-4065 (TTY 711) · Mon–Fri, 7:30 AM–6:00 PM Central
Important Disclosures
EOS Insurance Services, LLC is a licensed and certified representative of Medicare Advantage organizations and stand-alone PDP prescription drug plans with a Medicare contract. This is an advertisement for insurance and will be sold by a licensed agent. We are not connected with or endorsed by the U.S. Government or the Federal Medicare Program. We do not offer every plan available in your area. Currently we represent organizations which offer products nationally. Please contact Medicare.gov, 1–800–MEDICARE, or your local State Health Insurance Program to get information on all of your options.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply. Enrollment in a plan may be limited to certain times of the year unless you qualify for a Special Enrollment Period or you are in your Medicare Initial Enrollment Period.
Senior Living USA is a separate company from EOS Insurance Services, LLC. We may receive compensation from our partners when a service is selected. The information on this page is for general education only and is not insurance, legal, tax or financial advice.