Getting On and Beyond: Are you qualified for Medicare or Medicaid?

By Tai Blair

Enrollment Specialist

Caring for an aging family member is a difficult and often confusing job. There are so many things to think about and manage that it can feel as though they are drowning. The number of choices in care, insurances, providers, etc. can overwhelm anyone! Now add the complications of Medicare and Medicaid; the average person cannot tell you the difference between them, if they qualify for them, or what to do when they have them! As there is so much to these two programs alone I thought that it may be helpful to explore what each basically is, and where to get more information on them.

Medicare is a federally-funded health insurance that is provided for seniors aged 65 and older as well as disabled adult children who qualify. It is delivered in four parts: Part A is hospitalization; Part B applies to medical coverage; Part C are the Medicare Advantage Plans (MAP’s) that add to Medicare’s original coverage; and Part D is the prescription drug plan.  For Parts C and D, a beneficiary has to shop around, selecting from plans that suit their needs and budget. Medicare will not only cover healthcare like any other insurance plan, but will also pay for limited stays in a skilled nursing facility for a short amount of time for specific reasons. For more details, please consult the current edition of the official U. S. Government Medicare handbook “Medicare and You” or call 1-800-Medicare.

On the other hand, Medicaid is a health and long-term care program that is funded by

individual states, with some additional backing by the Federal Government. There are several types of Medicaid that are important to note: Adult Medical Assistance or general Medicaid pays for healthcare; Medicaid Long-Term-Care (LTC) which pays for the long-term care needs and incorporates Adult Medical Assistance.  The Department of Health and Human Services (DHHS) provides and processes the applications and eligibility determinations, and are entrusted to monitor Medicaid dollars.  There are financial qualifications for Medicaid, as well as functional for long-term care, that are determined by DHHS.

Some people, called “dual eligible,” have both Medicare and Medicaid. If you think that you qualify for both, contact your local Department of Health and Human Services, or seek out either a Senior Health Insurance Assistance Program (SHIP) advisor, or your local  Connect For Health Colorado navigator for more information.  There are many resources out there to help you understand these programs and how to integrate them together. Here is a list of other resources you might utilize:

  • Social Security Administration –
  • Department of Health and Human Services – Colorado State –
  • Medicare – 1-800-MEDICARE (633-4227) or
  • Medicaid – Department of Health Care Policy and Financing – (303) 866-2993
  • Centers for Medicare and Medicaid –
  • The Department of Regulatory Agencies (DORA) – The Division of Insurance (DOI) –  1-800-866-7675 or
  • SHIP/SMP (Medicare) Counselors – R.S.V.P-Colorado West – (970)-249-9639
  • Connect For Health Colorado – 1-855-PLANS-4-YOU (752-6749) or

Good luck! Also, watch the Region 10 event calendar for future classes related to this topic.


Category: Insurance

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