Medicaid is a federal- and state-sponsored health insurance program that helps individuals who can’t afford medical care pay some or all of their medical bills. Medicaid is available only to certain low-income individuals and families who fit into an eligibility group that is recognized by federal and state law. Medicaid does not pay money to individuals; instead, it sends payments directly to participating health care providers. Depending on the state’s rules, individuals may also be asked to pay a small part of the cost (copayment) for some medical services.
Medicare Supplement/Medigap Insurance
Medicare supplement or Medigap policies typically cover the coinsurance and deductible amounts after Medicare pays its portion. In New York State, individuals enrolled in Medicare (even those with Medicare due to a disability and under age 65) can purchase a Medigap policy at any time; people cannot be turned down or charged higher premiums due to poor health. There are several standard Medigap policies that are offered by several different insurance companies.
Medicare is the national health insurance program for people age 65 or older, some individuals under age 65 with disabilities, and people with End-Stage Renal Disease (ESRD), which is permanent kidney failure requiring dialysis or a kidney transplant.
Generally, Medicare pays for only a very limited part of long-term care services. Medicare will pay only for a medically necessary skilled nursing facility or home health care, and only on a part-time or “intermittent” basis.
Long-Term Care Insurance
This type of private insurance policy can help pay for many types of long-term care, including both skilled and non-skilled care. Long-term care insurance coverage can vary greatly. Some policies may cover only nursing home care. Others may include coverage for a whole range of services, such as care in an adult medical day center, assisted living, medical equipment or formal and informal home care.
Long-term care insurance premiums vary, depending on age and health status at the time the policy is purchased and on how much coverage is requested. Individuals must be in general good health when purchasing a policy. For this reason, it would be better to secure long-term insurance at a younger age when premiums are lower. If this is done, a periodic review is advised to make sure the policy covers current and future long-term needs. Those looking at long-term care insurance should talk with a family member, insurance agent or financial advisor to determine the best approach.