Medicare and Medicaid explained: What are the differences between the two?
By David L. Podos
The Utica Municipal Housing Authority recently conducted a free public workshop on Medicare and Medicaid at the Utica Public Library.
The Department of Health and Human Services oversees both programs with a budget over $1 trillion.
A government agency of this size can be quite a challenge to manage. For the public, there is often confusion over what the programs offer in the way of services, as well as who is actually eligible.
The following is a an abbreviated and generic explanation of services, so note there are variances in both programs regarding coverage, costs and eligibility requirements.
Basically, Medicare Part A covers people aged 65 and over and is for hospitalization coverage only. For the most part, it is free and there are no costs to the end user. Medicare Part B is for all other medical services; for example, visits to a local doctor. Part D is for prescriptions and can incur additional costs for the subscriber.
There is also a cost for Part B that is predicated on one’s income.
Medicaid is health care coverage for low-income adults, children, the elderly as well as those with disabilities. Services provided to Medicaid subscribers are usually free.
Dennis Tuttle, service coordinator for the housing authority, and Tim Dittfield, former Medicaid training coordinator for the Oneida County Department of Social Services, spoke at the forum.
“This is the first time the Utica Municipal Housing Authority has sponsored this kind of workshop,” said Tuttle. “We are trying to connect services to people in our community. Services are out there, but people do not know how to find them.”
”Because Medicare and Medicaid have similar names, many people get confused on what each program offers and are not aware of the differences, Dittfield said.
“We have a big problem here in Oneida County because of the growing number of baby boomers, people who will eventually need these services,” he added.
Here is what a few local residents said about their experiences with Medicare and Medicaid:
— Jim Feketa, a Whitesboro resident: “I have been receiving Medicare services for almost three years. For me, the transition from personal health care to Medicare was shocking. I just didn’t understand the system. Luckily, I had a friend who helped me through the process of understanding costs as well as coverage. On a more positive side, I have supplemental insurance along with Medicare which provides me full coverage.”
— Patty Lieber of Utica: “I have been on Medicaid for almost 23 years. It has been a huge benefit to people like me who are financially disadvantaged and unable to work. It really has been a great help. I would not be able to pay my doctor bills without it.
“A few times, I had to call our local social services department as I had questions. While it took them a few days to get back to me, I got the answers I was looking for, so I was pleased with the service.”
— Joe Aiello, Lee Center: “I have been on Medicare for nearly four years. I only signed up for Part A. Signing up for Part B or Part D is cost prohibitive for me.”
— Frank Wolack of Whitesboro: “I have been receiving Medicare services going on four years. Personally, I have had no problems. Everything I need is covered and there are no issues with billing and or services.
“I signed up on the Medicare website. When you do that, you receive annual updates on preventive diagnostic testing that you might need. They also remind me of my free annual physical I am entitled to. It is very helpful.”
Clarifying the situation
In addition to the confusion many people have in differentiating Medicaid and Medicare, there are other obstacles.
”The complexity of navigating the service system is real,” Dittfield said. “Also, another big problem is the drug formulary and trying to figure out what medicines are covered and which are not.”
A drug formulary is a list of prescription drugs, both generic as well as brand name drugs. A committee of experts chooses these lists for their safety and effectiveness.
“People need to be educated on all of this,” said Dittfield. “For the most part, generic medications are just as effective as brand names but with huge cost savings to the end user.”
While the mission of the Utica Municipal Housing Authority is to be a leader in the housing industry by providing safe, clean, and affordable housing opportunities to low-income persons, Dittfield and Tuttle made it clear at the forum that MHA is available to reach out and help anyone seeking assistance or those who have questions regarding Medicaid or Medicare, regardless of whether they are looking for affordable housing.
Another source that can answer questions on Medicare and Medicaid is the Oneida County Department of Social Services and local county offices for the aging. There are also plenty of sites online.
Finding a best option for information on Medicaid and Medicare can be based on other factors such as access to a home computer or access to transportation.
Face-to-face counseling is another method. The goal is to be educated on these services, understand eligibility status and minimize frustration.
For further information, Dittfield is available at firstname.lastname@example.org or Tuttle can be reached at 315-735-5246 ext. 21.
For people who are utilizing Medicaid and Medicare, the following additional information will also be helpful:
— In August, the Centers for Medicare & Medicaid Services mailed new Medicare cards to more than 3.5 million people with Medicare in New York state.
— CMS is mailing the new Medicare cards in geographic waves. People with Medicare in Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, Rhode Island and Vermont will also be receiving their new card.
People with Medicare in these states and New York were expected to receive their new cards by the end of August and can begin using it right away.
— Social Security numbers have been replaced with new unique identifying numbers, helping protect people with Medicare from identity theft as CMS attempts to fight fraud. The new Medicare card is free.
Tuttle and Dittfield will also be helping to conduct another free public workshop on Medicare and Medicaid.
It will be held from 6-7:30 p.m. Sept. 25 at the Utica Public Library, 303 Genesee St., Utica, second floor.
Parking is in the rear lot. Refreshments will be served.
Besides the topics of Medicaid and Medicare, information will be presented on the Home Energy Assistance Program, Supplemental Nutrition Assistance Program, BillPayer, transportation for those in need and disabled persons, and Meals on Wheels.
It will include presentations as well as a question–and-answer period. AmeriCorps members will be available to provide individual followup assistance.