Medicaid = What is it?
Good health is important to everyone. If you can’t afford to pay for medical care right now, Medicaid can make it possible for you to get the care that you need so that you can get healthy – and stay healthy.
Medicaid is available only to certain low-income individuals and families who fit into an eligibility group that is recognized by federal and state law. Medicaid does not pay money to you; instead, it sends payments directly to your health care providers. Depending on your state’s rules, you may also be asked to pay a small part of the cost (co-payment) for some medical services.
Medicaid is a state administered program and each state sets its own guidelines regarding eligibility and services.
Many groups of people are covered by Medicaid. Even within these groups, though, certain requirements must be met. These may include your age, whether you are pregnant, disabled, blind, or aged; your income and resources (like bank accounts, real property, or other items that can be sold for cash); and whether you are a U.S. citizen or a lawfully admitted immigrant. The rules for counting your income and resources vary from state to state and from group to group. There are special rules for those who live in nursing homes and for disabled children living at home.
In general, you should apply for Medicaid if your income is low and you match one of the descriptions of the Eligibility Groups. (Even if you not sure whether you qualify, if you or someone in your family needs health care, you should apply for Medicaid and have a qualified caseworker in your state evaluate your situation.)
What is not covered?
Medicaid does not provide medical assistance for all poor persons. Even under the broadest provisions of the Federal statute (except for emergency services for certain persons), the Medicaid programs does not provide health care services, even for very poor persons, unless they are in one of the designated eligibility groups. Low income is only one test for Medicaid eligibility; assets and resources are also tested against established thresholds. As noted earlier, categorically needy persons who receive cash assistance from the TANF program or from the SSI program. Medically needy who would be categorically eligible except for income or assets may become eligible for Medicaid solely because of excessive medical expenses.
Medicaid is health insurance that helps many people who can’t afford medical care pay for some or all of their medical bills.
Medicare – What is it?
Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities, and any age with permanent kidney failure (called “End-State Renal Disease”). You must have entered the United States lawfully and have lived here for 5 years to be eligible for Medicare.
Medicare has two parts:
Medicare Part A (Hospital Insurance)
helps pay for inpatient care you get in a hospital, skilled nursing facility, or hospice, and for home health care if you need certain conditions. Most people don’t have to pay a monthly premium for Medicare Part A because they, or a spouse, paid Medicare taxes while working in the United States. If you don’t automatically get premium-free Part A, you may still be able to enroll, and pay a premium.
Medicare Part B (Medical Insurance)
helps pay for medically-necessary doctors’ services and other outpatient care. It also pays for some preventive services (like flu shots) to help keep you healthy and some services that keep certain illnesses from getting worse. Most people pay the standard monthly Medicare Part B premium.
You have choices about how to get your Medicare coverage. Here are the two main options:
Original Medicare
Managed by the Federal government, it provides your Medicare Part A and Part B coverage. (You can choose to have either one, or both parts). You have to pay a deductible, and you are usually charged co-insurance each time you get services.
Medicare Advantage Plans (called Part C)
You must have both Part A and Part B to join one of these plans. The plans provide all of your Part A and Part B services and generally provide additional services. You usually pay a monthly premium, and copayments that will likely be less than the coinsurance and deductibles under Original Medicare. In most cases, these plans also offer Part D prescription drug coverage. These plans are offered by private insurance companies approved by Medicare. Costs and benefits vary by plan.
Note: Help is available. If you have limited income and resources, you may qualify for help paying your Medicare health care, and/or prescription drug coverage costs.
For more information, call Social Security at 1-800-772-1213, visit the social security website, or apply at your State Medical Assistance (Medicaid) office.
If you have a question about Medicare or the Medicare health and prescription drug plans in your area, please visit the medicare website, or call 1-800-MEDICARE (1800-633-4227). TTY users should call 1-877-486-2-048, Medicare/Medicaid Assitance Program or State Health Insurance Program at (800) 803-7174, ext. 247.
