Medicare and Medicaid Under the Law
Due to the similarity of their names, the Medicare and Medicaid programs are often confused. However, they have different goals and different eligibility requirements. The purpose of Medicare is to offset the healthcare costs that aging people accumulate as their earning power wanes. Virtually anyone who is eligible for Social Security benefits by paying into that program is automatically eligible for Medicare when they turn 65. By contrast, Medicaid is meant to assist people who have very low income and few assets. Its administration varies from state to state, while Medicare is the same throughout the U.S. Being eligible for one program thus does not necessarily mean that you are eligible for the other.
Medicare Eligibility and Coverage
As noted above, you are almost certainly eligible to receive Medicare benefits if you are 65 or older. You also may be eligible if you receive Social Security Disability Insurance, often known as SSDI, or if you suffer from permanent kidney failure. Medicare is divided into three main parts. Part A essentially provides hospital insurance, while Part B provides medical insurance. Part A can cover hospital stays, treatment in nursing facilities after hospital procedures, and some forms of home health care. Part B also can cover home health care, in addition to the costs of doctor appointments, lab tests, medical equipment used in the home, and physical therapy. Part D covers certain costs related to prescription medications.
Medicare Part A requires paying a yearly deductible and copayments that can be substantial if you spend a long time in the hospital. Medicare Part B requires paying 20 to 35 percent of doctors’ bills, as well as a monthly premium. Medicare Part D also requires paying a monthly premium, in addition to a deductible and copayments. You still must cover prescription drug costs that go beyond a certain amount if you are not eligible for a subsidy based on your income. However, there is also a ceiling on the costs that you are required to cover in Part D.
Medicaid Eligibility and Coverage
If you are 65 or older and receiving Medicare benefits, you may or may not be eligible for Medicaid. You would need to show that you meet this program’s income-based eligibility requirements. The scope of Medicaid coverage can be broader than Medicare, although the amount depends on the state. It can apply to both inpatient and outpatient healthcare costs. Medicaid often covers prescription drugs more thoroughly than Medicare Part D, and it can pay for prescription eyeglasses, as well as diagnostic and preventive care.
Someone who qualifies for both programs can use Medicaid to pay for Medicare deductibles. Medicaid also can cover the 20 percent of doctors’ bills that Medicare does not cover. It can cover the Medicare monthly premiums. In many cases, Medicaid comes at no cost to a consumer, but sometimes a consumer will need to pay a small fee for a certain type of service. You can learn more about Medicaid by consulting the social services or welfare office in your county, or the equivalent agency.
Medicaid is not limited to elderly people. It can be available to someone who is suffering from a disability or a certain medical condition, or to a woman who is going through a pregnancy, assuming that the disabled person or the pregnant woman meets the financial eligibility requirements.
