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The Differences Between Medicare and Medicaid

Health care insurance these days can be confusing with all the actual changes and proposed changes being discussed. Where does one start to get a good picture of the differences between Medicaid and Medicare?

The “most” important thing to know about Medicare and Medicaid is that that two programs, despite being close in name, are decidedly different and offer their various services to different types of individuals at different ages.

Medicare is

  • A federal health care program developed in the mid-1960s, part of the Social Security program
  • Social security took money from paychecks during working years, returned it as income after 65
  • Helps offer affordable health care for seniors and reduce health care costs
  • Part A covering nursing home care, hospice, and other inpatient and hospital stays
  • Part B covering out patient medical costs (medical supplies, doctor visits, etc.)
  • Part B means paying an out-of-pocket monthly fee
  • No plan B? Sign up later, but pay a 10 percent increase for every 12 months you do not have it
  • Part C offering a health plan from a private company (PPO, HMO) called Medicare Advantage. It covers Part A, B and sometimes prescriptions. This plan can be less expensive than paying premiums for other plans.
  • Part D covering drug costs and added to whatever other plans you choose
  • Medicare is funded by a tax added to a worker’s paycheck plus premiums paid by Medicare beneficiaries plus government funding

Medicaid is

  • Funded by the federal government, but the money passes down to each state to allocate as they see fit
  • Medicaid was “born” about the same time as Medicare and was intended to help lower income citizens afford health care
  • Set up so that the federal government matches state funding
  • Overseen by the Centers for Medicare & Medicaid Services in each state to pass out funding and endure the state meets the federal government’s minimum standards
  • Who it funds as opposed to Medicare. Medicaid serves those with limited resources and income and that includes seniors, low-income individuals, those at the poverty level by offering personal care services/nursing home care. Recipients do not have to be 65 years or older. Those served by Medicaid are a wide ranging swath of Americans needing and qualifying for such services
  • The ability of older Americans who subsist on just Social Security to also receive Medicare benefits and classified as low income while over the age of 65

Of course, Medicaid and Medicare are much more than just a summary of highlights on a page. It is best to research what you want and need, what suits your lifestyle and budget and to ask as many questions as you can to understand what you are likely going to purchase. There are highly trained health insurance brokers and health insurance agents that have answers right at their fingertips and can help you make informed choices. Just do not wait until the last minute to make a decision, as often the last minute purchases are those that are regretted.

Posted on Thursday, October 31st, 2019. Filed under Medicare.

Health Care Fraud Affects Everyone in the United States

Health care fraud is prevalent. Many scams try to sell bogus insurance policies to unsuspecting victims. There is another form of health care fraud — perpetrated inside the system. When scams and fraud are uncovered, the health insurance system usually responds with stricter regulations and policies.

The biggest impact health insurance fraud has on patients is that it raises insurance prices. For every insurance claim paid that turns out to be fraudulent, the insurer has to raise prices to cover their losses. Health care fraud within the government has an even bigger impact because your tax dollars pay for it. Ultimately, it means health care is then not available for those who desperately need it.

This means those who need medicine or treatment may not get it because someone else got it under false pretenses. There are also instances of health care fraud via medical identity theft — this is far more common than we would like to think, where a thief uses another persons insurance to get health care services.

Being aware that there are many health insurance scams out there is important. If you think that you have been a victim of a scam, make sure to contact the relevant authorities.

Posted on Monday, October 28th, 2019. Filed under Health Insurance.

New scam to watch out for

A new insurance scam has emerged recently. The scam consists of a telemarketer urging a prospect or target to pay cash up front for the health insurance policy they are selling. This is one of the biggest red flags and one of the most common forms of health insurance fraud.

It is important to remember that agents for Medicare and/or Medicaid, do not call people to sell insurance. If you are about to buy a health insurance policy over the phone and you are asked for money hang up immediately — it is clearly a scam. Often scammers will try and get the target to send them money or to divulge personal details such as their Medicare number, bank account information, credit card information or other personal identifiers.

The more information a scammer can get, the greater the chance of identity theft or money theft. Be wary of anyone selling health insurance over the phone.

Posted on Friday, October 25th, 2019. Filed under Health Insurance.

Is the Price of the Insurance Policy to Good to be True?

Sometimes, thanks to the very competitive insurance marketplace, insurance policies are sold for really reasonable prices. Competition in the insurance marketplace is what can force prices to be reasonable for consumers. Affordable insurance plans are not always too good to be true. Policies that cover what they say they cover for a reasonable price are possible to find.

Due to the prevalence of scams people are often skeptical. Many people believe that affordable insurance seems too good to be true. In some instances that is actually the case. However, in other cases, it is the insurance agent or agency pricing their products so that more people have access to them. Competitive policy pricing is key for agencies to stay relevant.

Shopping around for health insurance shows how policy prices vary from location to location. Shopping for insurance is a smart move that, in the final analysis, is going to save money.

Do not forget to ask about what the policy does and does not cover. The content of your policy is the most important factor in coverage. To find the best combination of coverage and price, speak to an experienced insurance agent.

Posted on Thursday, October 24th, 2019. Filed under Health Insurance.

Reading the Fine Print of Your insurance Policy

If you have heard this once, you have heard it more times than you can count — “Read the fine print.” This is actually really good advice because there is things in an insurance policy you need to know and you will not find out about them until you need to use your health insurance and then find out that what you needed to use it for is not covered.

Your health insurance policy tells you a variety of things not the least of which is what it covers, but also, what it does not cover. If you do not read the entire policy, you could be in for a surprise later. However, insurance policies tend to be dense and complex. If you find that you have questions or concerns about your insurance policy, talk to your insurance agent.

Insurance agents are there to answer all of your questions. No one wants to be in a situation where they were sure their health insurance policy covered all they needed and wanted, but because they did not read the entire policy, it turned out to not be the case. To avoid a situation where you are faced with mounting medical bills, discuss your policy with informed insurance agents.

Posted on Tuesday, October 22nd, 2019. Filed under Health Insurance.

Potential Clients Question Insurance Providers

Many potential clients are often not entirely certain about an insurance provider, particularly when they receive information that they do not understand or information that does not make sense. It is important for potential clients to check with the State Insurance Commission to verify the provider. Also, it is necessary to make sure that the company or agency that sent the information is formally licensed to sell insurance locally or state-wide.

Often when brochures or mailers arrive in people’s mailboxes, it is hard for them to determine if the information and the people promoting it are genuine and honest. With various scams trending, potential clients want to make certain that they are not tricked into buying a product that is fraudulent. Assuming an insurance policy offer is valid based on vague advertising can be dangerous.

Potential clients should be warned about fraudulent policies. Insurance agents should work hard and fast to remedy scams and frauds. Agents should bring awareness to the public about dishonest policies. Being proactive and answering questions it the best way for agents to protect potential clients.

Posted on Monday, October 21st, 2019. Filed under Uncategorized.

Health Insurance Fraud is an On-going Concern

It seems that not a day goes by without someone trying to scam people with phony health insurance. Insurance scams are common. There are so many types of insurance fraud scams that it is virtually impossible to list them.

Frequently, these scams are not caught until it is too late and the victim is left holding a very high doctor’s bill when they thought they had the insurance to cover it. Victims find out at the last second, when their claim is denied, that they were the victim of insurance fraud.

While insurance scams are common, it is possible for seniors to stay vigilant and protect themselves from possible threat. There are some things to watch out for to protect you and your family.

First, if the price is too good to be true, steer clear of the offer. Low prices are a good sign of a scam. Be wary of mail that offers low cost insurance. Second, be weary of insurance providers whose names you do not recognize. Scammers will often use a name that is similar sounding to a national brand in order to trick people. Next, pay attention to spelling and grammar errors. Scams are often filled with spelling mistakes and grammatical errors. Lastly, before signing up check the company information and confirm that it exists.

Because health insurance scams are so common, it is best for seniors to be cautious. If you are unsure about which health plan to chose, reach out to the qualified agents at for help.

Posted on Friday, October 18th, 2019. Filed under Health Insurance.

Helpful Medicare Fraud Tips

You should be wary and suspicious if your provider informs you that:

  • Medicare wants you to have this service
  • Medicare want you to have this item
  • The higher the volume of tests they perform, the less expensive they are
  • The service is free and won’t cost you anything
  • The equipment is free and won’t cost anything
  • The test or tests are free and they only need your Medicare number
  • They know how to get Medicare to pay for it

Avoid fraud by:

  • Not allowing anyone but accredited medical professionals to recommend services/review your medical records
  • Never giving out your Medicare Health Insurance Claim Number unless it is to your doctor/other Medicare provider
  • Being wary of accepting Medicare services that are supposedly free
  • Exercising caution when you are told you get free testing if you provide your Medicare number
  • Being cautious if you are told the service/item is not usually covered, but they can bill Medicare anyhow
  • Being alert and wary if a provider says they are endorsed by Medicare or by the federal government
Posted on Tuesday, October 8th, 2019. Filed under Medicare.

Medicare Fraud is Alive and Well, Beware

Medicare fraud is far more common that we might expect. The definition is purposely invoicing Medicare for services that were never received or never provided. Some examples of this kind of fraud include:

  • Invoicing Medicare or other insurer for services/items never received
  • Invoicing Medicare for equipment/services that are not the same as what you received
  • Invoicing Medicare for home medical equipment once its been returned
  • Using another beneficiaries Medicare card to obtain equipment, medical care, supplies

While you may not be aware of such fraud going on, it may, overtime become clear that something is wrong. When in doubt, speak out. Defrauding Medicare means those who need it receive less benefits than they should be entitled to because someone defrauded the program.

If you do know someone intentionally defrauding Medicare, take the time to report it. Everyone benefits when you do.

Posted on Monday, October 7th, 2019. Filed under Medicare.

Larger Medicare Supplement Payment? Options for Seniors

Although many, if not all, Medicare supplements do increase on renewal, there are instances where some seniors are facing a 15 percent renewal. What does a Medicare beneficiary do in the face of such an increase?

When faced with such a dramatic increase, it is usually best to start shopping around as soon as possible. Although, some industry watchers suggest anyone facing this kind of situation has to wait until Medicare Open Enrollment, which is typically in October. Contrary to popular opinion on when beneficiaries can change a Medicare supplement plan, the Medicare supplement underwriting rules start when beneficiaries have had their Medicare Part B longer than 6-months.

Put another way, any beneficiary who wants to make changes to their Medicare supplement plan can do so at any time during the year. Medicare Open Enrollment is the time to make changes to a Medicare Advantage or Medicare Part D prescription drug plan.

In other news for Medicare recipients, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) made, among other changes, a tweak to Medicare supplement’s plans F and C that kick in for 2020. Medicare plans F and C are available until January 1, 2020. You may also want to consider Plans G or N.

The Plans in brief:

  • Plan F: Has more benefits and higher premiums. If you enroll now or already have Plan F, you are not going to be forced to move because this change only affects newly eligible Medicare recipients with effective dates of January 1, 2020. Plan F is not going to be available to those new to Medicare.
  • Plan G: Has lower rates and same benefits as Plan F, but the Part B deductible is not covered – the beneficiary pays for it.
  • Plan N: Generally has lower premiums than Plan G, but more out-of-pocket expenses. For instance, there is a $20 co-pay for seeing a physician and $50 co-pay for using the ER. Part B deductible is not covered.

New to Medicare? Want to apply for a new Medicare supplement? Medicare Plan F and C are available until January 1, 2020.

Do not be in a rush to choose. Always ask questions to ensure your medical needs are met. Most importantly, do not cancel an existing Medicare supplement policy until a new insurance company has approved you. Remember, you can replace your Medicare supplement policy at any time.

Posted on Friday, September 20th, 2019. Filed under Medicare.