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 Medicaid vs
Medicare
AARP.ORG
MedicareRX
is a popular Medicare Prescription Drug
Coverage Plan.
By Carolyn Magura
Just like there's confusion over the difference between SSDI and SSI,
there's confusion over the difference between Medicare and Medicaid.
So, here in a nutshell, is the
definition of each.
Medicare - the very same health plan
that retired people over 65 enjoy - can be obtained after
receiving SSDI for 24 months.
(NOTE: ONCE YOU
QUALIFY FOR SSDI, YOU HAVE TO WAIT FOR 29 MONTHS
BEFORE RECEIVING YOUR FIRST CHECK.) Medicare
has two parts: Part A, which you pay for through
your payroll taxes, and which covers overnight
hospital bills, hospices, home health care and
very limited, partial nursing home care. And
Part B, three-fourths of which is paid for by
federal income tax, and one-fourth ($84.00 a
month in 2006, deducted from your SSDI check) by
you. It pays for doctor, ambulance, emergency
room, clinic and most other outpatient care
(except drugs and nutritional products).
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As of May 15th,
2006, Medicare now has a Part D
which covers partial payment of prescriptions.
Most people who qualify for Medicare select a
"Supplement" package that covers additional
things such as Doctor visits (minus the co-pay)
and other things usually covered by a Health
Insurance Plan. You have to pay extra for this.
If you become eligible for Medicare after May
15th, 2006, you have to select a carrier for
Part D. This can be included in your
"supplemental" package, as mine is, or it can be
a separate coverage.
Tip! The
Medicaid program, available to American citizens
who fall into a specified low income bracket,
provides health care to adults and children, as
well as the elderly and those in nursing homes.
While much hand wringing and spin continues in
the U.
Medicaid
is run by the state and local governments. It
completely covers hospitalization, clinic
visits, emergency room visits, doctors' visits,
hospices, home health care, nursing home stays,
ambulance and outpatient prescription drugs.
Medicaid has very small co-payments for
prescriptions, doctor visits and some other
care. While all hospitals and almost all drug
stores accept Medicaid, most doctors don't, and
many home health agencies, nursing homes, and
hospices are also reluctant to accept Medicaid.
People on SSI are eligible for Medicaid, and in
most but not all of the states in the nation,
SSI sends lists of recipients to the local
government, which then automatically sends
Medicaid cards out to them. But in some states,
you must always apply separately for Medicaid at
the welfare office, even if you're on SSI.
It's possible -
indeed, sometimes it's absolutely necessary - to
be on both Medicare and Medicaid. In that
case, Medicare first pays medical bills up to
whatever its rules allow, then Medicaid pays the
rest. Always get Medicaid, if you can, to
supplement Medicare, because with it, you'll
have a way to pay deductibles and co-payments
that you would otherwise face without it.
Moreover,
Medicaid pays for some things Medicare
doesn't cover at all. Conversely, always get and
keep Medicare (including Part B) even if you are
already on Medicaid. Medicare pays doctors and
hospitals more than Medicaid does, and therefore
will make them more likely to accept you as a
patient and devote adequate time to your case.
Don't be afraid of the Part B monthly premium,
either. Once you're on Medicaid, it will start
paying the Medicare premium for you, and your
SSDI check will go up by $84.00.
According to the
Social Security Administration some assets are
considered exempt (not countable) toward SSI
eligibility such as:
• The house an
individual lives in and the land it is on;
• Personal and
household goods (depending on their value);
• Life insurance
with a face value of $1,500 or less;
• Burial plots or
spaces for the individual and immediate family;
burial funds for the individual;
• A car with a
current fair market value up to $4,500. The car
may be of any value, however, if it has been
modified to accommodate a person¹s disability or
if it is needed for necessary activities.
Some of an
individual's income is also not counted toward
SSI eligibility such as: The first $20 of most
income received in a month (from any source);
the first $65 a month earned from working and
half the amount over $65; food stamps; most food
clothing and shelter from non-profit
organizations; most home energy assistance. If
the individual with a disability works, any
wages used to pay for items needed for work
related to the disability are not counted as
income. (Source: Social Security
Administration.) Since eligibility for
government benefits is dependent on these
financial restrictions, a person with a
disability would be in jeopardy of loosing those
benefits if he or she amasses any resources
above the limit.
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