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Marci’s Medicare Answers: May 2014

If you have Original Medicare and you see an opt-out doctor, keep in mind that the doctor should have you sign a private contract that states that you understand you are responsible for the full cost of services you receive. If the opt-out doctor does not give you this contract before providing you with care, you are not responsible for paying for that care. Also, keep in mind that psychiatrists have been more likely to opt out of Medicare in recent years, compared to other doctors. Be sure to ask your doctor if he/she accepts Medicare, before you begin to receive health care services.

If you have a Medicare Advantage plan, also known as a Medicare private health plan, you will most likely need to get health care services from in-network doctors. Contact your plan directly to learn more about which types of doctors you can see for covered care.

Before you see any type of doctor, ask your doctor what types of insurances he/she accepts so you can get a sense of whether the health care services you receive will be covered.

—Marci

Dear Marci,

My mother has both Medicare and Medicaid. What is the difference between Medicare and Medicaid?

—Pamela

Dear Pamela,

This is a great question. Medicare is the federal health insurance program for older adults and individuals with disabilities. People with Medicare can get their Medicare benefits through Original Medicare, the traditional Medicare program administered directly through the federal government, or through a Medicare Advantage plan, also known as a Medicare private health plan. Medicaid, on the other hand, is a federal and state health insurance program for individuals with limited incomes. Those interested in learning more about Medicaid benefits should contact their local Medicaid office for more information.

While Medicare is different from Medicaid, keep in mind that someone can have both Medicare and Medicaid if he/she qualifies for both programs. Individuals with both Medicare and Medicaid are oftentimes referred to as dual-eligibles.

—Marci

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Marci’s Medicare Answers is a service of the Medicare Rights Center (www.medicarerights.org), the nation’s largest independent source of information and assistance for people with Medicare. To subscribe to “Dear Marci,” MRC’s free educational e-newsletter, click here.

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