If you are a person with low incomes and it seems like it will be impossible for you to pay for all the health care costs that you need, or that paying for Medicare is too expensive for you, you may have the option of joining Medicaid. Medicaid was created to help those who cannot afford health care costs so they can cover what they need. In this article we will explain the basics of Medicaid.
What is Medicaid?
Medicaid is a joint federal and state program for people with limited income and resources that helps them paying medical costs. Medicare and Medicaid are very different programs, but they are both managed by a division of the U.S Department of Health and Human Services called the Centers of Medicare and Medicaid.
You can be eligible for both of them. In this case, the two of them will share and cover your health care costs. In fact, it is estimated that more than one in five Medicare beneficiaries also receives Medicaid benefits. As for 2017, Medicare is providing free health insurance to 74 million low-income and disabled people.
How do I know if I am eligible for Medicaid?
Rules about eligibility and applying vary from state to state. To discover if you are eligible, contact your Medicaid state program to see if you are eligible.
However, take into consideration that only having a low income does not necessarily mean that you are automatically eligible. Medicaid’s eligibility is categorical, so you must be a member of a category defined by statute. For example, some categories are parents of Medicaid-eligible children who meet certain income requirements, pregnant women and low-income seniors.
Another important thing is that even if your income is over Medicaid income levels in your state, you may still be eligible under “spend down” rules.
According to “spend down” rules, there are states in which you are allowed to join Medicaid as “medically needy”. During the process of “spend down” rules, your medical expenses are subtracted from your income so you can become eligible for Medicare. Also, your measurable resources also have to be under the resource amount of your state to be “medically needy”.
Medicaid coverage depends on the state where you are. However, there are 15 benefits that are mandatory:
- Inpatient hospital services
- Outpatient hospital services
- Early and Periodic Screening, Diagnostic, and Treatment Services
- Nursing Facility Services
- Home health services
- Physician services
- Rural health clinic services
- Federally qualified health center services
- Laboratory and X-ray services
- Family planning services
- Nurse Midwife services
- Certified Pediatric and Family Nurse Practitioner services
- Freestanding Birth Center services (when licensed or otherwise recognized by the state)
- Transportation to medical care
- Tobacco cessation counseling for pregnant women
Benefits outside the list above are optional and will depend on what your state chooses.
If you qualify and get full Medicare benefits, most of your costs will be covered and will pay very little money, because pays your out-of-pocket expenses in Medicare and most of the services they offer. Medicaid also cover thing Medicare doesn’t, like eyeglasses, extended stays in skilled nursing facilities or long-term care in a nursing home.
How Medicare and Medicaid work if I have both?
More information on Medicare Advantage plans for 2018 can found by visiting https://www.medicareadvantage2018.org/
When paying for your health care services, Medicaid is the last one to pay for Medicare covered services. Medicaid will pay what is left after Medicare, your employer group health plans, and/or Medicare Supplement Plan has paid.
In case you have full Medicaid and Medicare Part D, you will get your prescription drugs through Medicare and you will automatically qualify for Extra Help, which pays for Medicare Part D.