Medicaid
Medicaid is a program that provides medical assistance to needy persons. It is not a program directed primarily to the elderly, but rather to the poor. It depends on financial need, low income and low assets. Medicaid is a state administered program and each state sets its own guidelines regarding eligibility and services.
Medicaid is not available to seniors under 65 unless they are blind or disabled.
If someone over 65 lives with an adult child, the child's income and assets do not count in determining eligibility. Only the seniors income assets are counted.
Remember, Medicaid helps needy people pay for medical care. In determining your eligibility for Medicaid they do not look at how much your rent, car payments or food costs. They only look at medical expenses.
Medical expenses include:
- Care from hospitals, doctors, clinics, nurses, dentists, podiatrists and chiropractors.
- Drugs, medical supplies and equipment.
- Health insurance premiums.
- Transportation to get medical care.
At the present time, there are TWO ways to receive Medicaid:
- Supplemental Security Income eligibility may provide Medicaid.
- Medicaid Spend-down.
Spend-down is similar to a deductible or co-pay amount you must pay before you can receive Medicaid. You must meet the spend-down every month. Once you meet your spend-down you are eligible for Medicaid for the remainder of the month.
To qualify for Medicaid a person must pass FOUR eligibility tests:
- Categorical Eligibility - Aged 65, blind or disabled
- Non Financial Eligibility - State Resident, Citizen/Alien Status, Social Security Number
- Financial Eligibility Requirements - Income, Assets
- Procedural Requirements - Complete and sign an application form; Provide proof of eligibility; Report changes in circumstances
Medicare
Medicare is health insurance for the following:
People age 65 or older, people under age 65 with certain disabilities; people of any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant).
The Different Parts of Medicare: The different parts of Mediare help cover specific services. Medicare has the following parts:
Medicare Part A (Hospital Insurance)
- Helps cover inpatient care in hospitals
- Helps cover skilled nursing facility, hospice and home health care
Medicare Part B (Medical Insurance)
- Helps cover doctors' services, outpatient care, and home health care
- Helps cover some preventive services to help maintain your helalth and to keep certain illnesses from getting worse
Medicare Part C (Medicare Advantage Plans) (like and HMO or PPO)
- A health coverage option run by private insurance companies approved by and under contract with Medicare
- Includes Part A, Part B, and usually other coverage like prescription drugs
Medicare Part D (Medicare Prescription Drug Coverage)
- A prescription drug option run by private insurance companies approved by and under contract with Medicare
- Helps cover the cost of prescription drugs
- May help lower your prescription drug costs and help protect against higher costs in the future
Medicare is the federally administered health insurance program for people sixty-five years of age and older, certain disabled people under sixty-five years of age, and people with end-stage renal disease. Medicare is divided into four parts, known simply as Part A, Part B, Part C and Part D. The benefits associated with Part A are free and automatic once an individual turns sixty-five. Part B is an add-on that requires a monthly premium. Below are the benefits associated with each plan.
Part A - Hospital Insurance
- Inpatient hospital care
- Skilled nursing care
- Hospice care
- Home health care (with certain restrictions)
Part B - Medical Insurance
- Doctors
- Services
- Outpatient hospital care
- Durable medical equipment such as wheelchairs and hospital beds
- Additional medical services not covered by Part A
Part C - Medicare Advantage
- Medical savings accounts
- Coordinated care plans—private health care plans provided by preferred HMOs, POSs, PPOs and PSOs
Part D - Prescription Drug Coverage
- Individual plans are available through Medicare-contracted insurance companies
Eligibility and Qualifications
Medicare is provided when Social Security benefits begin, unless the individual is under sixty-five years of age and disabled or has end-stage renal disease, in which case it is provided at that time. Individuals who are entitled to Part A and enrolled in Part B are eligible to switch to Part C.