The question I’m most often asked is “What’s the difference between Medicare & Medicaid?” Medicare is federal health insurance for anyone age 65 and older, and some people under 65 with certain disabilities or conditions.
Medicaid is a 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 care services, and assistance paying for Medicare premiums and other costs. If you qualify, you can have both Medicare and Medicaid. To apply for Medicaid, you can visit www.hhs.texas.gov/services/ health/medicaid-chip, or you can call the Texas HealthandHumanServices Commission at (800) 2528263. Their hours are Monday –Friday, 7 a.m.to7 p.m.
Critical Information: In response to the Covid-19 pandemic, the federal government declared a public health emergency and passed a law that allowed you to automatically keep your Medicaid coverage. Based on new federal law, continuous Medicaid coverage ended on March 31, 2023. If you had Medicaid, you should have received a letter to renew. If you have not applied to renew your Medicaid benefits, please contact the office listed above to confirm you are still eligible. Many have not re-applied and are shocked when they are asked to pay for services when seeing their doctor.
If you have both Medicare and Medicaid, there are Dual Special Needs Plans (DSNP) available, so let’s talk and find the best one for you.
When you have Medicare and other health insurance (like from your job), one will pay first (called a “primary payer”) and the other second (called a “secondary payer”).
If you have other insurance, who pays first depends on a number of items, like if you’re still working, the type of insurance you have, and if you have a special situation, like End-Stage Renal Disease (ESRD).
If you are working past age 65.
If you (or your spouse) are still working and have health insurance from that job, you can wait until you (or your spouse) stop working (or lose your health insurance, if that happens first) to sign up for Part B (Medical Insurance), and you won’t pay a late enrollment penalty. If you don’t have to pay a premium for Part A (Hospital Insurance), you can choose to sign up when you turn 65 (or anytime later). Your jobbased insurance pays first, and Medicare pays second. Ask the employer that provides your health insurance if you have creditable coverage when you turn 65. Medicare defines “creditable coverage” as coverage that is at least as good as what Medicare provides. If you do not have creditable coverage after age 65, you could incur a late enrollment penalty when you sign up for a Part D prescription drug plan.
If you do get Medicare and keep your job-based insurance, Medicare pays for services first, and your job-based insurance pays second.
If you (or your spouse) are still working and have health insurance, but it’s not from a job (like Medicaid or Marketplace), contact your health insurance to get more information about what to do when you turn 65.
If you have retiree coverage from a previous job, it may not pay for your health services if you don't have both Part A and Part B. Ask your benefits administrator how your retiree coverage works with Medicare.
If you have COBRA before signing up for Medicare, your COBRA will probably end once you sign up. Don’t wait until your COBRA coverage ends to sign up for Part B — Getting COBRA doesn’t extend your limited time to sign up for Medicare. If you got COBRA coverage after you signed up for Medicare, COBRA pays after Medicare (unless you have End-Stage Renal Disease).
When you’re leaving your employer health plan, you only have 2 months to join a Medicare supplement plan, including a Part D prescription drug plan. Ideally, you want your Medicare plan’s coverage to start when your job-based insurance ends, so sign up for Medicare and join a plan before your job-based insurance ends. Call Social Security at least 2 months before leaving your employer health plan because it usually takes 4-6 weeks to receive your Medicare identification card, which is needed to complete the application process for Medicare supplements.
Remember: If you can’t afford insurance, there are ways to get help paying costs.
Medicare insurance doesn’t have to be confusing! Please contact a trusted licensed and certified advisor to review your options and answer questions. Your friend’s cousin’s neighbor may be in a great Medicare plan, but it may not be the best fit for your needs. Give me a call at (806) 607-6307 and I’ll help! You can also visit medicare.gov to find additional information.
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