Medicaid, Medicare, and The Marketplace - Explained

This column originally appeared in the Jan. 2022 edition of The AARP Wyoming News


By Nancy Drummond
Northeast Region Navigator for Enroll Wyoming

These are three programs of insurance that are available to many people and lots of people get stressed about them! So, I will try to make them easy to understand.

Medicare is a federal program for people over 65 or those with disabilities. You have three months before you turn 65, three months after you turn 65 and the month you turn 65 to sign up. There are four parts to Medicare A, B, C or Medicare Advantage and D for Drugs. As a person has worked, they have paid into Medicare A - if they have worked 40 quarters or 10 years, Medicare A is offered to them when they turn 65 at no premium. Medicare A covers hospitalization. Medicare B costs $144.60 a month with a yearly deductible of $203. Medicare B covers Doctor appointments, Labs and outpatient surgeries. There is Medicare C or Medicare Advantage, when a person chooses Medicare Advantage, the premium that they pay $144.60 a month for Medicare B goes to an insurance company which in our area happens to be United Healthcare – they become your primary insurance and you do not have traditional Medicare A and B any longer – many people think we can get all the services that they show on TV in Wyoming – the simple answer is no.

Along with Medicare A and B, there is also Medicare D for drug coverage. These programs run from $7.30 on up to over $100 a month. There is a $445 yearly deductible for Brand name drugs with most companies. Open enrollment for Med D is Oct 15th thru Dec 7.

There is also a program called extra help to pay for Medicare D if you qualify. There are penalties assessed if a person does not sign up for Medicare B and Medicare D when they are eligible.

Medicaid is a 50/50 state and federal matching program that can help those with limited income pay for their Medicare B premium of $144.60 if they qualify. With this program the top limit is $1191 for a couple and no more than $3000 in assets which does not count your car or home that you live in.

Marketplace Insurance is available to those under 65 with income limits of $12,880 a year for 1 person to $31,040 a year for a family of five. The income limits have just changed so if a person needs insurance and has not qualified for assistance before, a person just needs to call 211 and ask for a navigator or go to www.healthcare.gov to see if they qualify.

I hope this makes the programs listed above easier to understand – if you have questions, you can make an appointment at the HUB on Smith by calling 307-672-2240 for Medicare and Medicaid help or call 211 for more information about the Marketplace.