Medicare and Medicaid

Medicare is a health insurance program for people aged 65 and older.  People who have disabilities, permanent kidney failure, and Lou Gehrig’s disease can also qualify for Medicare.  Medicare does not cover all medical expense or the cost of long-term care.

What is Medicaid? 

Medicaid is a state-run program that provides hospital and medical coverage for people with low income and little or no resources.  Each state has its own rules about who is eligible and what is covered under Medicaid.  Some people qualify for both Medicare and Medicaid. 

There are some groups of people that must be covered by Medicaid to get federal funding.  They are:

• Limited income families with children, as described in Section 1931 of the Social Security Act, who meet certain of the eligibility requirements in the state's Aid to Families with Dependent Children (AFDC) plan in effect on July 16, 1996;
• Supplemental Security Income (SSI) recipients (or in States using more restrictive criteria--aged, blind, and disabled individuals who meet criteria which are more restrictive than those of the SSI program and which were in place in the State's approved Medicaid plan as of January 1, 1972);
• Infants born to Medicaid-eligible pregnant women. Medicaid eligibility must continue throughout the first year of life so long as the infant remains in the mother's household and she remains eligible, or would be eligible if she were still pregnant;
• Children under age 6 and pregnant women whose family income is at or below 133% of the Federal poverty level
• Recipients of adoption assistance and foster care under Title IV-E of the Social Security Act;
• Certain people with Medicare; and
• Special protected groups who may keep Medicaid for a period of time

Contact your local medical assistance agency, social services or welfare office for more information.

Basic Medicare Facts

You can apply for Medicare through Social Security but the program is run by the Centers for Medicare and Medicaid Services.  The following is some basic information about Medicare:

• Medicare is funded in part through workers payroll taxes and premiums deducted from Social Security checks.
• There are four parts to Medicare
• Part A – hospital insurance that helps pay for  inpatient care in a hospital or skilled nursing facility (following a hospital stay), some home health care and hospice care.
• Part B that helps pay for  doctors’ services and many other medical services and supplies that are not covered by hospital insurance.
• Part C -- Medicare Advantage plans are available in many areas. People with Medicare Parts A and B can choose to receive all of their health care services through one of these provider organizations under Part C.
• Part D -- Prescription drug coverage that helps pay for medications doctors prescribe for treatment.

What does Medicare Cover?

Medicare is an insurance program just like private insurance.  Coverage and limitations are listed in the Medicare handbook you receive when you become eligible.  There is an appeal process for denial of certain benefits under Medicare or if you feel, you have not received enough care.

Summary

Medicare is a health insurance program for people aged 65 and older. It also provides health insurance for people with disabilities and certain conditions.  Medicaid is a state-run program that provides hospital and medical coverage for people with low income and little or no resources. Eligibility for Medicaid coverage is determined by state law although there are mandatory coverage requirements for federal funding. Medicare includes hospital care, outpatient care, some HMO plans and prescription drug coverage, but does not cover all medical expenses or the cost of long-term care.