What Is Medicaid Vs Medicare?
For people with low income and assets, both Medicaid and Medicare are available. Medicaid is a federal program that helps pay for medical costs.
Medicare is the government insurance program for people 65 and older and some younger people with disabilities.
Medicaid is managed by each state with their own rules. Medicaid is an entitlement program, which means that qualified people are entitled to the coverage. Even though Medicare is a federal program, each state has different rules about Medicaid.
You can get Medicaid even if you have Medicare. There are several ways to be eligible for Medicaid.
First, you must have a low income, with the amount depending on the state (perhaps up to $2,250 for a single person). Then you have to have limited assets, with the amount depending on the state (perhaps $2,000 for a single person).
If you have a medical problem and need help finding the right provider, you might consult the family doctor or a primary care physician (PCP). The PCP will probably refer you to a specialist. If you get health care from a provider who accepts Medicaid patients, the clinic will pay for the care.
Medicare's resources to help you find the right health care provider include the health care provider directory. The directory is a free service that Medicare patients can use to find doctors and other health care providers. Some states provide a similar service. If you do not have an Internet connection, you can call the toll-free number listed in the directory to locate a health care provider.
What is primary care?
Primary care refers to the first place that a person with a health problem seeks medical care. The primary care provider coordinates all your health care. For people with Medicare, one of the following people might be a primary care provider:
A doctor who is part of a health care team that includes doctors, nurses, therapists, and others.
A certified nurse practitioner.
A clinical nurse specialist.
A physician assistant.
What are copayments?
Copayments are a set amount that you pay for each service you get. If you are covered by Medicare, you will usually have to pay a copayment for each doctor visit or other medical service you get. Your Medicare Advantage Plan may pay some or all of your copayments.
What if I have to go to the hospital?
Medicare has two parts: Part A and Part B. Part A helps pay for hospital services. Part B helps pay for other medical needs, such as ambulance services, nursing home care, and medical equipment.
After you are admitted to the hospital, Part A pays your deductible and up to 90 days of inpatient hospital services. If you have not paid the Part A hospital deductible, you may have to pay a coinsurance rate.
Part B pays for hospital outpatient services, such as lab tests.
Part B does not cover the same services as the Part A deductible. For example, if you are admitted to the hospital for a heart attack and have a pacemaker, Part A will cover the heart attack, but Part B will not cover the pacemaker. If you have a second hospital stay for a bad cough, you will need to pay the Part B deductible and coinsurance for the new hospitalization.
If you are in the hospital, you may have to pay a deductible for up to 60 days in a year under Part A. If you are in a nursing home or other long-term care facility, you will need to pay a deductible of $1,184 per month and up to $335 per day for days 21 through 100 in a year under Part A.
If you have to go to the hospital or other health care facility, make sure that you have the right insurance card with you. It is a good idea to take a list of all the medications you take with you to the hospital. This list of medications is called a medication list, medication profile, or medication record. If you have a health care provider, you should keep this list at home. You can ask your health care provider for a copy.
What if I need nursing home care?
Medicare does not pay for the first 20 days in a nursing home. However, if you or your spouse paid Medicare taxes for at least 10 years, Medicare will pay for 21 days in a nursing home in any month. If you or your spouse paid Medicare taxes for at least 30 years, Medicare will pay for 100 days in a nursing home in any month. For this benefit, you must sign up for Part A at age 65 or later.
Medicare may also pay the following nursing home costs:
Medicare will pay $335 per day for days 21 through 100 in a year.
For a person who is in a nursing home before starting Medicare, the Medicare Part A deductible is waived for nursing home care.
For people with Medicaid eligibility, Medicaid will pay for nursing home care.
What if I need help paying for a home health aide?
If you are eligible for Medicare, you can apply for Medicaid and get help paying for a home health aide and other health care costs.
If you have Medicaid, you have to pay $0 for a home health aide or other help you get.
If you have Medicare, you must pay a part of the cost if it is not covered by Part B.
What if I have a Medicare Advantage Plan?
Medicare Advantage Plans are health care plans, such as HMOs, PPOs, and special needs plans, that are authorized by Medicare. Medicare Advantage Plans can be offered by private insurance companies, local and regional health care providers (such as hospitals and nursing homes), and other organizations.
Medicare Advantage Plans include Part A and Part B medical services. Medicare Advantage Plans may offer additional services, such as vision and dental care, and prescription drug coverage.
Medicare Advantage Plans may use medical practitioners, other than doctors. For example, they may use nurse