Medicare, Medicaid, and Health Insurance

What you need to know about Medicaid, Medicare, and paying for health care in Georgia

Feeling stuck with healthcare costs and don’t know what insurance options are right for you?

Man takes notes while accessing an online resource on a laptop

We all have healthcare costs at some point in our lives, and these costs are likely to rise as we age or have a disability. Many things bring health insurance top of mind—maybe you are on the verge of retirement, or have recently received a new diagnosis, or are experiencing a change in employment, or are seeing your medical bills start to pile up. Whatever the reason, you might be looking at some alternative options to private insurance and trying to find opportunities to access public funds to help pay for your healthcare.

If you don’t have much income, you might be wondering how to access Medicaid. If you turned 65 recently, you are probably thinking about Medicare. If you already have Medicare and you are wondering how you can get additional help, you may qualify for Medicare Supplement Insurance, sometimes called Medigap Insurance. If you were or are a uniformed U.S. service member, you may be interested in TRICARE, or perhaps you qualify for veterans’ benefits.

Together, we can understand your payment options, identify the best approach to managing your care, and access resources to confidently navigate the healthcare system – informed and educated.

What is Medicare?

Medicare is the basic healthcare program for people 65 or older and people with disabilities. You can enroll through the Social Security Administration. Medicare is split into different “parts” that cover different areas of care, such as certain services and supplies in hospitals, doctors’ offices, and other healthcare settings. The four basic parts are labeled with the letters A, B, C, and D. Medicare Parts A and B are commonly referred to as “Original Medicare.” Anything that is not covered by parts A and B may be covered by Medigap or Medicare Advantage Plans.

If you already know what you need and are looking to explore Medicare options, contact our partners at Georgia State Health Insurance Assistance Program.

What does Medicare Part A cover?—How to pay for hospital stays and skilled nursing

Medicare Part A, or inpatient hospital insurance, is generally for short-term care including inpatient care in hospitals, short-term stays in a skilled nursing facility (or nursing home), hospice services, and time-limited home health services. Sometimes these short-term services after a hospital stay are considered “post-acute.”

What does Medicare Part B cover?—How to pay for doctors, medical equipment, and screenings

Medicare Part B, or outpatient insurance, covers doctors’ services, many outpatient services, ambulance trips, durable medical equipment (sometimes called DMEs, which may include blood sugar monitors, oxygen equipment, walkers, and other tools you may need to live your daily life), and preventative services (such as screenings and counseling by a doctor, including the new Annual Wellness Visit).

What does Medicare Part C cover?—How to pay for care beyond Medicare

Medicare Part C includes Medicare Advantage Plans, which are managed health plan options approved by Medicare and offered by private companies that provide both Part A and B coverage and may provide drug coverage. Some plans may offer extra coverage, such as vision, hearing, dental and/or health and wellness programs. Patients must select doctors from an approved network. Since each Medicare Advantage Plan can charge different premiums and other out-of-pocket costs and provides a different package of covered benefits, it is important to compare plans before enrolling. For more information, contact our partners at GeorgiaCares.

What does Medicare Part D cover?—How to pay for your prescriptions

Medicare Part D offers prescription drug coverage. Part D policies are available from private health insurance companies. You can sign up for Medicare prescription drug coverage through:

  1. Medicare Prescription Drug Plans. These plans (sometimes called “PDPs”) add drug coverage to original Medicare (Parts A and B) and some Medicare Advantage Plans (Part C).
  2. Medicare Advantage Plans that offer prescription drug coverage ( sometimes called “MA-PDs”). You get all of your Part A and Part B coverage, including prescription drug coverage (Part D), through these plans.

Even if you do not take a lot of prescription drugs, you should still consider joining a Medicare drug plan. If you do not sign up for Medicare Part D when you first become eligible or during a special enrollment period, you may pay a late enrollment penalty. If you have limited income and resources, you may qualify for extra help from Medicare and Medicaid to pay for your prescription drug coverage. For more information, check out the official Medicare website or contact our partners at GeorgiaCares.

Explore more of our resources if you need additional help managing your medications.

What is Medigap?

Medigap (or Medicare Supplemental Insurance) is an insurance policy that covers costs that original Medicare doesn’t cover, including copays and deductibles for Parts A and B. You can buy a Medigap policy from a private insurance company for a monthly premium. Visit the official Medicare website for more information about Medigap or contact our partners at GeorgiaCares.