Medicare & Medicaid

 
Medicare and Medicaid are national medical insurance programs regulated by the United States government. The two programs are quite different and are designed to lighten the financial burden of medical expenses. In 1965, both programs were created through the Social Security Amendments of 1965 signed by President Lyndon B. Johnson.
 

Basics of Medicare

Medicare is a national social insurance program that provides health insurance to Americans who are at least 65 years old or have a disabling condition. Medicare is a federally run program, which means the eligibility requirements are the same throughout all 50 states. The program is divided into four separate parts.

Part A – Hospital/Hospice Insurance: Covers inpatient hospital visits and hospice care. There is a yearly deductible and additional co-payments will be incurred for extended hospital stays.

Part B – Medical Insurance: Covers some outpatient care, basic doctors’ services and medical supplies. There is a yearly deductible as well as a monthly premium and recipients will have to pay for at least 20% up to 35% of the doctor bills.

Part C – Medicare Advantage Plans: Covers expenses included in Part A as well as Part B. This plan is run by private insurance companies that work with Medicare.

Part D – Prescription Drug Plans: Covers some prescription drug costs. Individuals with Medicare Part A or B are eligible for Part D. There is a yearly deductible and a monthly premium.

Who is Eligible for Medicare?

Medicare will provide benefits to any individual who meets one of the following:

  • Americans 65 years of age or older who have been a U.S. citizen or permanent for at least five years.
  • Disabled Americans who have been receiving Social Security Disability Insurance (SSDI) for at least two years
  • Americans who need a kidney transplant or are undergoing dialysis for kidney failure
  • Americans who have Amyotrophic Lateral Sclerosis (Lou Gehrig’s disease)

 

Basics of Medicaid

Medicaid is a social healthcare insurance program that provides medical insurance to Americans with low income and limited assets. Medicaid is a joint federal and state program that is largely funded by the federal government. However, Medicaid is run and administered on the state level. This means each individual state oversees their own Medicaid program and has different rules and requirements.

Services Provided by Medicare

Inpatient and outpatient hospital services
Doctor/physician services
Nurse/midwife services
Rural health clinic services
Laboratory and x-ray services
Pediatric/family nurse-practitioner services
Federally qualified health center services
Vaccines for children
Prenatal care
Family planning services supplies
Nursing facility services for people at least 21 years of age
Home health care for individuals eligible for nursing services
Early and periodic screening, diagnosis and treatment services for individuals under the age of 21

There are other approved optional services, currently 34, which may be provided with Federal support. The most common of these optional services are diagnostic services, clinic services, nursing facility services, optometrist services, physical therapy services, rehabilitation, prescription drugs, prosthetic devices, and transportation services. There are other services that can become approved. Contact a Medicaid professional for more information about other approved services.

Who is Eligible for Medicaid?

  • AFDC recipients
  • TANF (Temporary Assistance for Needy Families) recipients
  • Pregnant women whose household income is less than 133% of the federal poverty level
  • Supplemental Security Income (SSI) recipients
  • Recipients of foster care and adoption assistance under Title IV-E of the Social Security Act
  • Special protected groups
  • All children under 19 years old born after 9/30/1983 in families with incomes equal to or less than the federal poverty level
  • Children who are 6 years old or younger who meet the State’s AFDC financial requirements or whose household income is equal to or less than 133% the federal poverty level