Based in Punta Gorda, FL, Senior Health OTG, Inc. offers expert Medicare insurance services tailored to your needs. Our experienced agents specialize in Medicare supplemental insurance and are here to simplify the entire process. From helping you compare Medicare Advantage Plans to answering searches for “health insurance near me,” we deliver trusted, local guidance. As a veteran-owned agency, we provide personalized options that include VA benefits, travel health coverage, and no-cost consultations Monday to Friday, 9 AM to 5 PM. Trust Senior Health OTG for clarity, care, and Medicare expertise that puts you first.
Medicaid is a joint federal and state program that provides health coverage to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. Under federal law, Medicaid programs are required to cover certain mandatory benefits. These include inpatient and outpatient hospital services, physician services, laboratory and x-ray services, and home health services, among others. Additionally, states must provide early and periodic screening, diagnostic, and treatment (EPSDT) services for children under 21.
Beyond the federally mandated essentials, states have the discretion to offer optional benefits under their Medicaid plans. These can vary widely from state to state but often include prescription drugs coverage, physical therapy, occupational therapy, speech-language pathology services, chiropractic services, dental care for adults (dental care for children is a mandatory benefit), vision services including eyeglasses as well as podiatry.
Medicaid is a critical source of funding for long-term care in the United States. It covers institutional care for individuals who require nursing home facilities or intermediate care facilities for individuals with intellectual disabilities. Furthermore, many states have opted to provide home and community-based services (HCBS) through waivers or other mechanisms that allow beneficiaries to receive long-term care in their homes or communities rather than institutional settings.
A significant portion of Medicaid beneficiaries receives their benefits through managed care plans. These plans contract with state Medicaid programs to deliver comprehensive coverage that includes most of the mandatory and optional benefits in an integrated fashion—typically through networks of providers that members must use except in emergencies or with prior authorization.
Mental health and substance abuse disorders are also covered by Medicaid programs. This includes behavioral health treatment such as counseling or psychotherapy sessions. Since the expansion of Medicaid under the Affordable Care Act (ACA), more Americans have access to these important services which are crucial components of comprehensive healthcare but were historically underfunded before Medicaid's expansion.
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Medicare is a federal health insurance program for people aged 65 or older, certain younger individuals with disabilities, and those with End-Stage Renal Disease. The program has different parts that cover specific services: Part A (hospital insurance), Part B (medical insurance), and Part D (prescription drug coverage). Knowing what each part covers is crucial when determining if you need additional prescription drug coverage.
Part D of Medicare provides outpatient prescription drug coverage. This coverage is offered through private insurance companies that have contracts with the government. It's important to note that Part D is optional, but it can help lower your prescription drug costs and protect against higher costs in the future.
If you're enrolled in Medicare Parts A and/or B, you're eligible to join a separate Medicare Prescription Drug Plan (PDP) under Part D. Enrollment isn't automatic; you must sign up for it during your initial enrollment period or during the annual open enrollment period to avoid paying a late-enrollment penalty unless you have creditable prescription drug coverage from another source.
Creditable prescription drug coverage is coverage that's expected to pay, on average, at least as much as Medicare's standard prescription drug coverage. If you already have this type of coverage—perhaps from an employer or union—you may not need to enroll in a separate Medicare drug plan. However, if your existing coverage isn't considered creditable or if you lose this coverage, enrolling in a Medicare Prescription Drug Plan could be beneficial.
Some individuals opt for a Medicare Advantage Plan (Part C) instead of original Medicare. These plans are offered by private companies approved by Medicare and include both Part A and Part B benefits—and oftentimes, prescription drug benefits are also included within these plans. In this case, enrolling in a separate standalone Prescription Drug Plan might not be necessary since it's already integrated into the comprehensive plan package.
Deciding whether you need a separate prescription drug plan requires evaluating your current health needs, financial situation, and any existing prescription drug coverages you might have. It's essential to compare costs among available plans—including premiums, deductibles, copayments/coinsurance rates—and consider how well each plan covers the medications you take regularly before making any changes to your current healthcare strategy. Consulting with experts or using online resources provided by the Centers for Medicaid & Medicare Services can aid in making an informed choice.
They offer unbiased guidance and access to plans from multiple carriers to help you find the best fit.
Also called Medigap, it covers costs like deductibles and coinsurance. You must have Medicare Part A & B to qualify.
Typically ID, Social Security number, proof of income, and immigration status if applicable.