FOMAA Capital Region organized an online event Overview of Medicaid and Medicare program on May 17, 2023. As more and more parents, grandparents come to USA as citizens, it is important to know the complete details of Medicare and Medicaid coverage to protect the4 family and live happily. Medicare is federal health insurance for anyone age 65 and older, and some people under 65 with certain disabilities or conditions. Medicaid is joint federal and state program that provides health coverage for some people with limited income and resources. Medicaid offers benefits, like nursing home care, personal health care services, and assistance paying for Medicare premiums and other costs.
The program was started with prayer song by Sadhika Anilkumar. That was followed by a song from the FOMA Juniors Affairs Committee member Ajrin Niwaz, to wish Happy Mother’s Day and a tribute to the sacrifice of all mothers. FOMAA Capital Region RVP Dr. Madhusoodana Nambiar welcomed all the guests including FOMAA President Dr. Jacob Thomas and all the FOMAA National Executives, FOMAA office bearers and all the FOMAA members. Dr. Nambiar also welcomed FOMAA Capital Region national committee members Rajeev Sukumaran and Mathew Varghese, and member Malayalee Associations presidents, executive committee and all the members, and participants who joined all across the nation. Dr. Nambiar also extended warm welcome to the main speaker of the day George Joseph Charted Financial Consultant, Enrolled Agent, United Taxes and Insurance Services LLC.
Mr. George Joseph first spoke on Medicaid and indicated that Medicaid is a joint federal and state program that, together with the Children’s Health Insurance Program (CHIP), provides health coverage to over 72.5 million Americans, including children, pregnant women, parents, seniors, and individuals with disabilities. Medicaid is the single largest source of health coverage in the United States. Low-income families, qualified pregnant women and children, and individuals receiving Supplemental Security Income (SSI) are examples of mandatory eligibility groups.
The Affordable Care Act of 2010 created the opportunity for states to expand Medicaid to cover nearly all low-income Americans under age 65. Eligibility for children was extended to at least 133% of the federal poverty level (FPL) in every state, and states were given the option to extend eligibility to adults with income at or below 133% of the FPL. Most states have chosen to expand coverage to adults, and those that have not yet expanded may choose to do so at any time.
Modified Adjusted Gross Income (MAGI) is used to determine financial eligibility for Medicaid, Childrens Health Insurance Plan (CHIP), and premium tax credits and cost sharing reductions available through the health insurance marketplace.
MAGI is the basis for determining Medicaid income eligibility for most children, pregnant women, parents, and adults. The MAGI-based methodology considers taxable income and tax filing relationships to determine financial eligibility for Medicaid.
To be eligible for Medicaid, individuals must also meet certain non-financial eligibility criteria. Medicaid beneficiaries generally must be residents of the state in which they are receiving Medicaid. They must be either citizens of the United States or certain qualified non-citizens, such as lawful permanent residents. In addition, some eligibility groups are limited by age, or by pregnancy or parenting status.
Next, Mr. Joseph spoke on Medicare. Medicare is health insurance for people aged 65 or older. You may be eligible to get Medicare earlier if you have disability, End-Stage Renal Disease (ESRD) or other similar situations. Medicare offers different options for you to get health care coverage. Medicare has four parts, A, B, C, and D.
Part A: Hospital Insurance: Covers inpatient care at hospital, skilled nursing facility care, hospice and home health care. Usually no monthly premium. If you don’t qualify for premium-free Part A, you might be able to buy it.
Part B: Medical Insurance: Covers certain doctor visits, outpatient care, medical equipment (wheelchairs), many preventive services (like screening, shots, or vaccines, yearly wellness visits). Usually pay premium every month, $164.90 each month or higher depending on your income. If you don’t sign up when first eligible, then you pay late enrollment penalty, which is added to the monthly premium.
There are deductible and copayment. If you have limited income and resources, you may be able to get help from your state to pay your premiums and other costs.
Part A and Part B are original Medicare.
Part D: Part D provides Prescription Drug Coverage. You join a Medicare Drug Plan in addition to Original Medicare, or you get it by joining a Medicare Advantage Plan with drug coverage. There is monthly premium that depends on the type of plan.
Remember to consider Part D options when first eligible to avoid late penalty.
Part C: Medicare Advantage Plan: Medicare Advantage is a Medicare-approved plans offered by private companies that bundled Part A and Part B coverages, usually with Part D also. Plans May also offer extra benefits that Original Medicare doesn’t cover - like vision, hearing, dental, and more.
You will automatically receive Medicare Part A and B if already getting retirement/disability benefits from Social Security or Railroad Retirement by the time you turn 65. You will need to sign up for Medicare if you are close to 65 and are not receiving benefits due to still working. You can an qualify for Medicare when you are 65+ or if under 65 and receiving disability benefits for at least 24 months.
Initial enrollment period is 7-month period around 65th birthday. 3 months before; 1 month during; 3 months after. However, if your birthday is 1st of the month, then initial enrollment period will be 4 months before; 1 month during; 2 months after
If you sign up during first 3 months, your coverage starts the month you turn 65.
If you sign up during birthday month or last 3 months, your coverage starts the month after you sign up.
You will receive premium free Part A coverage if you or spouse paid Medicare taxes for at least 10+ years; otherwise, may purchase Part A and B coverage.
If you miss the enrollment period, you may have to wait to sign up and pay a late enrollment penalty for Part A (if you do not have free coverage) and Part B that is added to the monthly premium for the duration of coverage. The longer you wait, the higher the penalty.
Original Medicare vs Medicare Advantage: Original Medicare- Part A and Part B Covers certain medical services and supplies in hospitals, doctor offices, and other health care facilities. You can choose any doctor or hospital that takes Medicare in the US. You pay deductible and coinsurance / copay.
Medigap: Medicare Supplemental Insurance: Medigap is Supplemental Insurance policy to lower your share of costs. There is monthly premium and sold by private companies that cover some of the costs of deductible, coinsurance and other services and supplies.
Part D: Prescription Drugs Plan: Medicare Part D is separate plan that provides coverage for prescription drugs and each plan varies in cost and drugs covered. There is monthly premium and premium varies by plan. You have to pay more, depending on your income. Deductibles, copayments, and coinsurance varies by plan and pharmacy. If you have limited income and resources, you may be able to get Extra Help to pay our plan premiums and other drug costs.
If you select to stay with Original Medicare then you may have to enroll in both Medigap and Part D Prescription Plan, if you need these benefits.
Medicare Advantage: Part C Plans: You must have Part A and Part B and keep paying your Part B premium to enroll and stay in your Medicare Advantage Plan. Generally, Medicare Advantage (Part C) plans have a low or $0 monthly premium and offer more coverage than Original Medicare alone. There are a broad range of plans including both HMO and PPO plans. Premiums, deductibles, coinsurance and copayments varies by plan and companies. You will need to join a private plan from private companies that bundles Part A, Part B and Part D.
There is yearly limit on out-of-pocket costs for Part A and B and other costs. Once the limit is reached, then you pay nothing for the rest of the year. Most Medicare Advantage Plans offer extra benefits like Vision, Hearing, Dental, Physical Fitness Program- membership at participating SilverSneakers facilities, Over the counter (OTC) Health and Wellness Products and more.
Mr. Joseph advised that all should understand your coverage options and choose the plan that best fits your needs. Dr. Nambiar provided the vote of thanks.
The contact address of the speaker is,
George Joseph ChFC, EA
United Taxes and Insurance Services LLC
435 Murphy Road, Suite K
Stafford, TX 77477