Medicare/Medicaid Primer

ErinTalksMoney

At age 65

Plan A & Plan B

Plan A — Hospitalization 80% of approved costs

Plan B — Doctor visits

Medicare Advantage & Medicaid, MediGap

  • Fills the coverage

  • Moves shift to public insurance companies

  • Both must be enrolled in Plan B, and both over 65, ONLY a 6-mo window to switch to Medicaid.

  • MediGap may reject you for pre-existing conditions. Harder switching from Advantage to MediGap—desired for higher medical needs. If you often exceed annual out of pocket, you likely desire MedicGap but less appealing to MedicGap. But MedicAid has higher premiums.

  • Must apply between 3 months prior to leaving Advantage, and before 3 months after.

Employer Coverage Advantage Plans

(10-15% population)

  • Equivalent to Advantage Plan, but may offer more benefits or payment to physician

  • Drug coverage

  • Dental or optical options may be add on

  • More attractive when you are younger

  • But limits use of Medicaid, where decision has an impact

Michael Wei