Medicare benefits are available to individuals regardless of income at age 65. Younger individuals with severe handicaps may also receive Medicare benefits.
Medicaid is a program designed to help people with low incomes regardless of age.
Medicare services are the same for all participants, depending on which options they choose. Assistance from Medicaid is based on total family income and patient needs.
Both programs were created in 1965 to deal with the issue of elderly and low-income people being unable to secure traditional insurance benefits. Both programs were part of the “Great Society” plan of President Lyndon B. Johnson, according to the Medicare Interactive website.
While both programs seek to provide assistance to the elderly and the needy, there are situations that will not be covered as noted in the following sections. .
Medicare: A Health Plan for People 65 and Older
Medicare provides access to healthcare for a person age 65 and older. The only qualification is that the person receives or is eligible to receive Social Security benefits or railroad retirement benefits.
There are situations where younger people with disabilities such as blindness or other serious handicaps that prevent or limit employment may also be eligible for Medicare.
Most hospitals will accept Medicare as well as a majority of the doctors. It is accepted by most hospitals and a majority of doctors in the United States.
Medicare Part A will cover hospital visits. Doctor visits are covered under Part B and prescription coverage is under Part G. There is no additional cost for Part A, hospital coverage. However, there are annual premiums for Part B and G.
Usually Medicare normally pays 80 percent of most hospital and doctor bills. A supplemental or Medigap policy can be secured that will pay most of the remaining 20 percent. There will be situations were certain procedures are not covered by Medicare, and accordingly the Medigap policy will not pick up the bill.
Some Items Not Covered
Medicare covers eye examinations, but not eyeglasses. Medicare will cover optical surgery, such as cataracts. Many durable goods, such as walkers, braces, etc. are available through Medicare.
Medicare does not cover routine dental needs. Some procedures may be covered under special circumstances. If a dental issue requires a hospital stay, Medicare will pay for the hospital stay but not the dental procedures.
Medicare does not normally cover the cost of staying in a nursing home. However, Medicare will cover hospital-type procedures, laboratory tests, physical therapy, and other health services.
Complete information about Medicare services and requirements may be found in a brochure published by the social security administration, entitled Medicare.
Medicaid: A Health Plan for the Needy at Any Age
Since Medicaid is available to people regardless of age, and who fall within the income limitations, different services are provided. By being a combined state and federal programs, much of the management of Medicaid is at the state level, while Medicare management is at the federal level.
The covered services must fall within the broad federal guidelines.
Federal law requires states to provide certain “mandatory” and allows the state to offer certain “optional benefits. Mandatory benefits include inpatient and outpatient hospital services, doctor visits as well as laboratory and x-ray services.
Among the optional benefits include services like prescription drugs, physical and occupational therapy.
Medicaid also provides nursing home assistance and other services that will in part be dependent upon the patient’s financial situation.
Understanding Medicaid Eligibility
Medicaid, along with the Children’s Health Insurance Program (CHIP) provides health care coverage to approximately 72.5 million Americans. Those covered include children, pregnant women, parents, seniors, and individuals with disabilities.
While Medicare may be more identifiable, Medicaid is the single largest source of health coverage in the United States, according to the website, Medicaid.
There are three categories of individuals who have to be provided Medicaid coverage by the states. They include:
Qualified pregnant women and children
Individuals already receiving Supplemental Security Income from the federal government
The various states can provide additional coverage such as:
Individuals receiving home and community-based services
Children in foster care
Nursing home assistance
Inpatient hospital services, such as room and board, drugs, lab tests and other services when staying in a hospital
As a result of Affordable Care Act or Obamacare, a new methodology is being used to determine income eligibility, which is based on Modified Adjusted Gross Income or MAGI.
By using MAGI as a test to determine eligibility the ACA made it easier for people to apply and enroll in the appropriate program.
Through the availability of Medicaid expansion offered at the state level by the federal government and the Affordable Care Act, the states have the opportunity to provide health services to more people.
At the present time, 32 of the states and the Washington, D.C. are in the Expanded Medicaid programs. The other 19 states are not in the program, according to healthinsurance.org.
Under the Medicaid Expansion program, the federal government will cover 100 percent of the cost for Medicare Expansion.
After 2016, the federal contribution will start to drop. By the year 2020, the federal government’s contribution will be at 90 percent with the participating states paying the additional 10 percent.
The Effectiveness of Medicaid and Medicare
Both programs provide medical services. However, because of the lower reimbursements, all doctors do not accept one or both of the plans. Medicare is more widely accepted.
However, many physicians do not accept one or sometimes both of the policies. The Medicaid acceptance rate varies by state. The average acceptance rate was found to be 45.7 percent in 2014 according to a study by health care company Merrit Hawkins and published on medicaleconomics.com.
The acceptance rate for Medicare by doctors is approximately 80 percent, according to a study by Kaiser Family Foundation.
Medicaid and Medicare are two separate programs that play a major role in the level of health care enjoyed today in this country.
Those members of the population, who have insurance through their employer or some type of association, may not immediately, realize the importance of Medicare.
Medicare has changed and expanded over the years. Filing claims is easier than it was 20 years ago. Through in enactment of the Affordable Care Act, Medicaid benefits have been expanded to many people.
As people approach retirement age and learn that the company-provided insurance will no longer be available at some future date, the concern over health care increases.
It is then that the importance and accessibility of Medicare services are needed. It is at that point, where Medicare becomes an important health care program that is available to virtually everyone.
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