Medicare/Medicaid

What are Medicare and Medicaid?

Medicare is a health insurance program for people 65 years old and older, or those who are under age 65, but have certain disabilities. Medicare also insures anyone with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant). There are four parts of Medicare: Part A (hospital insurance), Part B (medical insurance), Medicare Advantage/Part C (private insurance plans that administer Medicare benefits) and Part D (Prescription Drug Coverage).

Medicaid is a health care program available only to certain low-income individuals and families who unable to afford medical care. As Medicaid is a state-administered program, each state sets its own requirements concerning eligibility and available services.

Am I eligible for Medicare or Medicaid?

To be eligible for Medicare you must be at least 65 years old, under age 65 but have certain disabilities, or be diagnosed with End Stage Renal Disease. For more information on what disabilities qualify for Medicare or to apply for disability benefits, please contact the Social Security Administration at 1-800-772-1213 (TTY: 1-800-325-0778).

Only low-income individuals and families are eligible for Medicaid, and each state has the authority to set its own eligibility requirements. For more information on the state of New York's Medicaid program and eligibility, and how to apply, click here.

How do I apply for Medicare?

If you are already receiving Social Security retirement or disability benefits, the Social Security Administration should contact you several months before you become eligible for Medicare. At that time, Social Security will give you the information you need to register. If you are not already receiving a Social Security check, you should call the Social Security Administration 3 to 4 months before your 65th birthday in order to sign up for Medicare. The telephone number is 1-800-772-1213 (TTY: 1-800-325-0778).

What medications does Medicare's prescription drug benefit cover, and how do I apply for it?

There are a variety of Medicare drug plans, which vary in terms of what drugs are covered, how much you will have to pay yourself, and what pharmacies you can use. Medicare covers some brand name drugs as well as generic prescription drugs. However, all plans have an appeal process in case you need drugs that are not covered by your plan. Enrollment in the Medicare prescription drug program is voluntary, which means you must take the initiative and sign yourself up for a plan.

For more information on the specific plans and coverage, click here.

Useful contact information

Medicare:
Medicare Main Line: 1-800-MEDICARE (1-800-633-4227)
Medicare website: http://www.medicare.gov/default.aspx

Medicaid (New York):
Medicaid Helpline: 1-800-541-2831
Medicaid Fraud Hotline: 1-877-87 FRAUD

New York Department of Health Medicaid Program website: http://www.health.state.ny.us/health_care/medicaid/index.htm

As always, if you have any additional questions, please do not hesitate to contact my office.