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Medicare Information

What is Medicare?

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD).

The different parts of Medicare help cover specific services: 

  • Medicare Part A (hospital insurance) covers inpatient hospital stays, care in a skilled nursing facility, hospice care and some home health care.

  • Medicare Part B (medical insurance) covers certain doctors' services, outpatient care, medical supplies and preventive services.

  • Medicare Part C (Medicare Advantage Plans) is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans.

  • Medicare Part D (prescription drug coverage) adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.

    Medicare Prescription Drug Plans
    Your Guide to Medicare Prescription Drug Coverage
     

Need assistance paying for Medicare? These programs may help:

 

What is Medicaid?

Medicaid, or MO HealthNet as the Missouri program is known, is a federal state program that provides medical assistance for individuals with limited income and assets. Services may include:

  • Inpatient hospital care.

  • Outpatient hospital services, including diagnostic services rendered through a hospital outpatient department or clinic.

  • Laboratory and x-ray services when prescribed by a physician, and provided by either physicians, clinics, x-ray facilities, independent diagnostic testing facilities or laboratories. 

  • Nursing home services for person who are in a home which has professional license from the Missouri Department of Health and Senior Services, or who are in the extended care facility of a licensed hospital. Each such facility must also meet federal nursing home standards. 

  • Physician’s services whether furnished in the office, home, hospital, nursing home, or elsewhere. The only physicians who can receive payment are those licensed as M.D.’s or D.O.’s.

  • Dental services. ** 

  • Drugs and medicines that have been prescribed by a physician, dentist, or podiatrist, and that are obtained from a licensed pharmacy (or certain dispensing physicians where pharmacies are not available). 

  • Emergency ambulance services. 

  • Audiology services and hearing aids. **

  • Podiatry services. 

  • Ambulatory surgical services. 

  • Personal care and adult day health care services provided in the home as an alternative to nursing home care. 

  • Durable medical equipment and certain prosthetic and orthotic devices. ** 

  • Home health care services.

  • Optometric services and eyeglasses.

  • Family planning services.

  • Rehabilitative services as therapies for adaptive training in the use of prosthetic and orthotic devices, braces, and artificial larynxes.

  • Nurse midwife services in the office, hospital.

  • Hospice services.

  • Case management services for pregnant women. 

  • Services provided at a Federally Qualified Health Center (FQHC) or at a Rural Health Clinic (RHC). 

  • Community psychiatric rehabilitation services.

  • Comprehensive day rehabilitation services for head injured.** 

  • Comprehensive substance treatment and rehabilitation (C-STAR).

  • Transplant services. 

  • Certified nurse practitioner services. 

  • Other home and community based services through MO HealthNet waivers to person 65 and older, persons with AIDS, or mentally retarded/developmentally disabled individuals. 

  • Early and periodic screening, diagnosis and treatment (EPSDT) of eligible person under 21 years of age. In Missouri, this program is called "Healthy Children and Youth" (HCY). 

** Services are limited for adults who are not in a category of assistance for pregnant women or the blind

 

More information about Medicaid services

Preventing health care fraud and abuse

Each year, fraud and abuse costs the Medicare and Medicaid programs billions of dollars. Some fear that this could put the future of these programs in danger. Consumers are critical in the fight to prevent fraud and abuse in the Medicare and Medicaid programs.

How to report Medicare fraud

Tips to prevent fraud

  • Don't ever give out your Medicare number (on your Medicare card) except to your doctor or other Medicare providers.

  • Don't allow anyone, except appropriate medical professionals, to review your medical records or recommended services.

  • Be careful in accepting Medicare services that are represented as being free.

  • Be cautious when you are offered free testing or screening in exchange for your Medicare card number.

  • Be cautious of any provider who maintains they have been endorsed by the Federal government or by Medicare.

How you can make a difference

  • Be informed about Medicare benefits.

  • Know the type, frequency and quality of care being provided to you.

  • Know the services your doctor has ordered.

  • Ask questions about the services you receive.

  • Report concerns.

More information

Call the Department of Aging Services at 816/421-4980.