The Nebraska Medical Assistance Program, also known as the Medicaid Program, is a program that is jointly funded by the State and the Federal governments to provide medical services to those who cannot afford to pay for medically necessary services. Medicaid pays the Medicare co-payments and deductibles, and Part B monthly premium amounts for persons eligible for both Medicare and Medicaid. It also covers the cost of nursing facilities, inpatient/outpatient hospital services, personal assistance service, home nursing, rural health clinic services, laboratory and x-ray services, physicians' assistants, and other medical services. Most of the income guidelines and some of the resource guidelines for Medicaid are adjusted every year. To find out if you are eligible, visit http://www.accessnebraska.ne.gov.
Medicare is a health insurance program for people age 65 or older, those under age 65 with certain disabilities and for all ages with End-Stage Renal Disease. Original Medicare has two parts: Part A and Part B.
Medicare Part A helps cover your inpatient care in hospitals, critical access hospitals, and skilled nursing facilities. It also helps cover hospice care and some home health care. You must meet certain conditions.
Medicare Part B helps cover your doctors' services and outpatient hospital care. It also covers some other medical services that Part A does not cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.
Medicare prescription drug coverage is insurance that covers both brand-name and generic prescription drugs at participating pharmacies in your area. Medicare prescription drug coverage provides protection for people who have very high drug costs. For more information on Medicare, visit www.medicare.gov.
Medicare Advantage Plans
In addition to the Original Medicare Plan, there are optional plans, called Medicare Advantage Plans. Private companies, not a government agency, offer Medicare Advantage Plans. They sign an annual agreement with Medicare to provide services for at least a year. They must provide basic Medicare benefits, and can change the extra benefits they offer from time to time. If the plan is discontinued, a person would be notified and given a chance to join a different Medicare Advantage plan or choose Original Medicare. For more information, visit www.medicare.gov.
Medicare Supplemental Insurance
A Medicare Supplemental Insurance policy is a health insurance policy sold by private insurance companies to fill the "gaps" in the Original Medicare Plan. If a person is in the Original Medicare Plan and has a Supplemental policy, then Medicare will pay its share and the Supplemental policy will pay its share of the health care costs. It is important to compare Supplemental Insurance policies because costs can vary. For more information, visit www.doi.ne.gov/shiip
Medicare Prescription Drug Coverage (Part D)
Medicare offers prescription drug coverage for all people with Medicare. Medicare beneficiaries must join a plan run by an insurance company or other private company approved by Medicare. Plans vary in cost an drugs covered. If a person decides not to join a Medicare drug plan when they are first eligible, and don’t have other creditable prescription drug coverage, or don’t get Extra Help or Low Income Subsidy, they will likely pay a late enrollment penalty of 1% per month for every month they are eligible to be enrolled in Part D. For more information, visit http://www.medicare.gov/navigation/medicare-basics/medicare-benefits/part-d.aspx
Nebraska Senior Health Insurance Information Program (SHIIP)
The Nebraska Senior Health Insurance Information Program provides information and counseling to older Nebraskans regarding Medicare, Medicaid, and health insurance. Trained Volunteers make presentations or provide one-on-one counseling when requested. SHIIP volunteers provide accurate, objective information and help people to better understand the options available so that a well-informed decision can be made. Volunteers have been trained in Medicare and Medicaid benefits, claims and eligibility, as well as Medicare Supplement, Long-Term Care, and group health insurance. The Nebraska Department of Insurance sponsors this program with additional funding from the Centers for Medicare & Medicaid Services. For more information contact your local SHIIP representative at 800-234-7119 or visit the Website at www.doi.ne.gov/shiip
Qualified Medicare & Specified Low-Income Medicare Beneficiaries
States are required to pay the Medicare premiums, copayments, and deductibles for a special class of Medicare beneficiaries called Qualified Medicare Beneficiaries (QMBs). In Nebraska, beneficiaries are eligible for additional medical services at minimal cost. In order to be a QMB one must meet certain resource and income guidelines. Medicare is generally available to those who are age 65 and older but Nebraska has made the QMB program available to those who are under 65 and those who are blind or disabled. Those under 65 do not receive the Medicare benefits of the program. The Specified Low-Income Medicare beneficiaries (SLMB) program is only available to those who are Medicare eligible. For more information contact your local Department of Health & Human Services Office or visit www.medicare.gov.