Government Health Programs (Medicare, Medicaid, and Related)
Medicare
Medicare is federal health insurance for people 65 and older, certain younger people with disabilities, and people with end-stage renal disease. Know the parts: Part A (hospital insurance, generally premium-free with sufficient work history), Part B (medical insurance, premium-based, covers physician and outpatient services), Part C (Medicare Advantage, private plans delivering A and B benefits, often with extra benefits), and Part D (prescription drug coverage). Know Medigap supplemental policies, enrollment periods (initial, general, special), and late enrollment penalties for Parts B and D.
Medicaid and Related Programs
Medicaid is a joint federal-state program for low-income individuals, with eligibility and benefits set by state rules. Know CHIP (Children's Health Insurance Program) and TRICARE for military families, and workers' compensation as a separate statutory benefit system for work-related injury.
Traps in Questions
- Part A vs. Part B. Part A is hospital; Part B is medical/outpatient. Questions often ask which part covers a specific service.
- Medicare Advantage vs. Medigap. Part C replaces Original Medicare delivery; Medigap supplements Original Medicare and generally does not work with Medicare Advantage.
- Late enrollment penalties. Penalties apply to Parts B and D, generally for as long as the person has that coverage.
- Medicaid vs. Medicare. Medicaid is income-based and state-administered; Medicare is age/disability-based and federally administered.
Rule of Thumb
Ask what kind of service and what kind of eligibility? Hospital → Part A; outpatient/physician → Part B; drugs → Part D; low income → Medicaid.