MEDICARE & MEDICAID

MEDICARE 2013

Do you know what 2009 costs were for long term care costs for nursing homes, assisted living, adult day services and adult day care services?

Do you want to know more about key changes to Medicare under the 2010 Healthcare Reform Law?

The Social Security Administration provides a video that explains the Medicare Changes under the 2010 Healthcare Reform Law.

MEDICAID

Medicaid is health insurance that helps many people who can't afford medical care pay for some or all of their medical bills.


Medicaid Is Available Only To People Of Limited Income  

  1. You must meet certain requirements in order to be eligible for Medicaid.

  2. Medicaid does not pay money to you; instead, it sends payments directly to your health care providers.

  3. 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.


Many Groups Of People Are Covered By Medicaid

  1. It’s important to understand that, even within these groups, 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.

  2. The rules for counting your income and resources vary from state to state and from group to group.

  3. There are special rules for those who live in nursing homes and for disabled children living at home.

  4. In general, you should apply for Medicaid if your income is limited and you match one of the descriptions of the Eligibility Groups.  (Even if you are 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.)


When Medicaid Eligibility Starts

  1. Coverage for Medicaid may start retroactive to any or all of the three months prior to application, if the individual would have been eligible during the retroactive period.

  2. Coverage generally stops at the end of the month in which a person's circumstances change.

  3. Most states have additional "state-only" programs to provide medical assistance for specified people with limited incomes and resources who do not qualify for the Medicaid program.


What Medicaid Does Not Cover

  1. Medicaid does not provide medical assistance for all people with limited incomes and resources.

  2. Even under the broadest provisions of the Federal statute (except for emergency services for certain persons), the Medicaid program does not provide health care services for everyone.  

  3. You must qualify for Medicaid.  

  4. Low-income is only one test for Medicaid eligibility; assets and resources are also tested against established thresholds. Categorically needy persons who are eligible for Medicaid may or may not also receive cash assistance from the Temporary Assistance for Needy Families (TANF) program or from the Supplemental Security Income (SSI) program.

  5. Medically needy persons who would be categorically eligible except for income or assets may become eligible for Medicaid solely because of excessive medical expenses.
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MEDICARE


Medicare Is A Health Insurance Program For

•People age 65 or older,

•People under age 65 with certain disabilities, and

•People of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).


Medicare Has Several Parts

Medicare Part A Hospital Insurance

  1. Most people don't pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working.

  2. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care).

  3. It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.


Medicare Part B Medical Insurance

  1. Most people pay a monthly premium for Part B. Medicare Part B (Medical Insurance) helps cover doctors' services and outpatient care.

  2. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.


Medicare Prescription Drug Coverage

  1. Most people pay a monthly premium for this coverage.

  2. Starting January 1, 2006, new Medicare prescription drug coverage became available to everyone with Medicare. Everyone with Medicare can get this coverage that may help lower prescription drug costs and help protect against higher costs in the future.

  3. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium.

  4. Like other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later. 
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MEDICAID

Find information about enrolling in Medicaid. For specific information about Medicaid eligibility, enrolling in Medicaid, areas of coverage and services in your State, contact your local Medicaid office.

FIND MORE RESOURCES FOR INFORMATION, BENEFITS AND PROGRAMS FROM THE U.S. GOVERNMENT 


Brochures

Caregiver Resources

Federal Web sites

National Resources

National Clearinghouse for
Long Term Care Information

Benefits Check Up

FIND EXTRA HELP PROGRAMS FOR MEDICARE, MEDICAID AND PRESCRIPTION DRUGS


  1. The Medicare Extra Help Program provides information about the

Social Security assistance program and application process for the

Medicare Part D Subsidy.

www.ssa.gov/prescriptionhelp


• The State Pharmaceutical Assistance Program (SPAP) provides

information about any available state-funded assistance programs

for prescription drug costs.

www.medicare.gov/spap.asp


• The Pharmaceutical Assistance Program (PAP) provides information

about pharmaceutical companies that offer assistance programs for

the drugs they manufacture.

www.medicare.gov/pap


  1. Learn about Prescription Drug Options for Seniors in this brochure designed to help older adults manage their medicines, get the best value for the money they spend on medicines and prescription drugs, and find help when making prescription drug choices.

http://www.eldercare.gov/Eldercare.NET/Public/Resources/fact_sheets/pdfs/EldercareMedicareBrochure.pdf

MEDICARE

Types Of Information Required

When You Apply For Medicaid


•Proof of age, like a birth certificate

•Proof of citizenship or alien status*

•Recent paycheck stubs (if you are working)

•Proof of your income from sources like Social Security, Supplemental Security Income (SSI), Veteran's Benefits (VA), retirement

•If you or anyone who lives with you is 65 years old or older, certified blind, or certified disabled, you need to give information on bank accounts, insurance policies and other resources

•Proof of where you live, like a rent receipt, landlord statement, mortgage statement, or envelope from mail you received recently

•Insurance benefit card or the policy (if you have any other health insurance)

•Medicare Benefit Card (the red, white and blue card)

The MetLife 2009 Guide  To Long Term Care Costs

If you are a Senior who is struggling to pay for your medical needs and, medical bills and prescription drugs your state’s Medicaid program may be able to help you.

Medicaid Programs are designed for Seniors and others with limited income, Seniors included.

Applying for Medicaid programs and assistance can be time consuming, confusing and very often overwhelming. 


State Legislatures and county governments are constantly seeking ways to curb Medicaid spending. This can mean changing the rules to meet budget shortfalls. 


If you are not aware of the most current rules and regulations you will not know what your eligibility and rights are.

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The content on AsYouAge.com is provided as a courtesy for our site visitors. The information, resources, links, advertisements and other material on AsYouAge does not constitute a professional opinion or advice; nor does it constitute an endorsement of any organization or the information, products and/or services they may offer. As You Age reviews and updates its content regularly when new and relevant information is made available. This information is neither intended nor implied to be a substitute for professional advice in any area: health, medical, legal, insurance, financial or any other area. Always seek the advice of your physician or qualified health provider, or caregiver, attorney, financial, insurance expert or other specialist prior to starting, dropping or changing your current program or have questions or concerns  regarding current or anticipated issues.


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