Medicare is managed by the Centers for Medicare and Medicaid Services (CMS) and Social Security works with CMS by enrolling people in Medicare. It is a government sponsored program. You are eligible for Medicare if you are 65 years or older, or if you are younger than 65 but have a disability such as dementia. There are two Medicare plans to choose from. Medicare part A covers hospital insurance, inpatient hospital stays, care in skilled nursing facility, home health care, and hospice care. Medicare part B has medical insurance that covers certain doctors’ services, outpatient care, medical supplies, and preventive services. You can choose if you want part A and B or if you want to wait before getting part B (you can drop part B any time). Medicare is available to people of all income and any hospital takes it.
Medi-Cal is a government sponsored health insurance for low income families. You are eligible for Medi-Cal at any age. Medi-Cal pays for “medically necessary” health such as physician visits, x-ray and laboratory tests, hospital and nursing home care, home health care, certain prescription drugs, prosthetic and orthopedic devices, hearing aids, medical equipment, ambulance services, and hospice care. It will only cover these costs if the service provider accepts Medi-Cal (most county hospitals take Medi-Cal). If you have both Medi-Cal and Medicare, Medicare is the primary payer, which means that Medicare will pay first for everything that is covered under Medicare. Medi-Cal will is the secondary payer so it will pay for everything that Medicare doesn’t cover. If you qualify for full Medi-Cal, then you will not need to share the cost with Medicare because full Medi-Cal covers both part A and part B of Medicare.
Social Security Administration (SSA):
SSA is for people who make more money and have pension. The disability benefits are for people who are unable to work because of a medical condition that is expected to last for one year or until death ( such as dementia), or for people who have not been denied disability benefits in the last 60 days. If you have spent all of your income on SSA you can be transferred to SSI.
Social Security Disability Insurance (SSDI):
SSDI is for people who have a disability such as dementia and have worked long enough, as well as paid tax benefits.
Supplemental Security Income (SSI):
SSI is for people who are aged, blind, or disabled and are considered low income. It is a federal income supplement program funded by the general tax revenues. To qualify for SSI you need to be 65 or older, or have a medical condition that keeps you from working and is expected to last a year or up until death (such as dementia). The SSI provides money to meet basic requirements of survival such as food, clothes, and shelter.
Health Insurance Counseling and Advocacy Program (HICAP):
HICAP is a free and objective Medicare counseling non-profit agency. They provide information and education about Medicare policy. They deal with insurance and insurance management as well as fix insurance problems.