The information provided below is intended to help explain the complexities of Medicare and Medicaid, as well as provide resources for individualized insurance counseling.
A free program offering individualized counseling to help with a wide range of insurance related issues such as:
- Understanding Medicare and Medicaid Benefits
- Assist you in filing for benefits
- Healthcare Appeals / Denials
Please note that the following information on Medicare is meant for informational purposes only and does not guarantee coverage. For specific information, please visit the Medicare website or call 1.800.MEDICARE (1.800.633.4227).
Medicare Basics – Medicare is a health insurance for people 65 years or older, under age 65 with certain disabilities, and any age with end stage renal disease or Lou Gehrig’s disease. Medicare has four parts:
- Medicare Part A is Hospital Insurance. It pays for care and procedures in various facilities based on Medicare requirements and your eligibility for Medicare part A.
- Medicare Part B is Medical Insurance and helps cover doctors' services, outpatient hospital care, and 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.
- Medicare Part C, also known as Medicare Advantage Plans, is another way for you to get your Medicare coverage. They are not supplemental insurance plans. Private insurance companies approved by Medicare provide this coverage.
- Medicare Part D is Prescription Drug Coverage. The prescription plan must be chosen from a Medicare approved list of providers. The cost of Medicare D depends on the prescription plan chosen by the recipient. Beneficiaries can sign up for Medicare D during the annual enrollment period from November 15 – December 31, or when the beneficiary begins receiving Medicare.
Please note that the following information on Medicaid is meant for informational purposes only and does not guarantee coverage. For specific information, please call the Department of Human Services at 703.746.5700. For more information about eligibility, visit the DMAS website .
Medicaid Basics: Medicaid is an entitlement health insurance program financed by the federal and state governments and administered by the states. The Virginia Medicaid program is administered by the Department of Medical Assistance (DMAS). The local Department of Community and Human Services, which includes Social Services, screens potential applicants for eligibility.
Medicaid was created primarily to assist persons with low income, but coverage is dependent on other criteria also. Eligibility is primarily for those persons falling into particular categories such as low income children, pregnant women, the elderly, persons with disabilities and parents meeting specific income thresholds. Each state sets their own income and asset eligibility criteria, while following federal guidelines. In Virginia, income and resource requirements vary by category.
Medicaid may pay for some long-term care services such as nursing home and assisted living care for elderly or disabled individuals who meet specific criteria for the program.