The Medicare program became law in 1966. Under Title XVIII of the Social Security Act, Medicare provides health insurance for persons over the age of 65, persons who are under 65 and disabled, persons with ALS-Lou Gehrig's Disease and persons with End State Renal Disease (ESRD).
Even though the full retirement age is no longer 65, most people sign up for Medicare three months before their 65th birthday.
Part A provides hospital insurance. Part A is premium free to most beneficiaries who contributed 40 quarters into the Medicare system. For those with less than 30 quarters, Part A has a premium. Part A covers in-patient hospital stays, care at a skilled nursing facility, hospice care and some home health care.
Part B covers doctor visits, outpatient care, medical supplies and preventive care. Part B requires the payment of a premium which is typically deducted from the Social Security check. There is a Part B deductible which must be met each year. Once the deductible is met, Medicare will pay for 80% of the covered charges and the individual pays 20% coinsurance or co-pay.
Part C gives individuals the option of choosing a Medicare Advantage Plan to provide their Part A and Part B benefits. The Medicare Advantage Plan is a type of Medicare health plan which is offered by a private company that contracts with Medicare. Medicare Advantage Plan services may be offered through a Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private-Fee- For- Service (PFFS), Special Needs Plan (SNP), Medical Savings Account (MSA), Provider Sponsored Organization (PSO) or a Cost Plan.
Part D provides prescription drug coverage for Medicare participants enrolled in Part A and Part B through Medicare Prescription Drug Plans (PDPs). The PDPs are sold by private insurance companies. The federal government, through the Social Security Administration, provides a subsidy to assist qualified Medicare beneficiaries with the cost of the Prescription Drug Plan.
Medicaid pays for health services and is funded and administered by both the federal and state governments.
The Center for Medicare and Medicaid Services (CMS) is the federal agency that administers the program, the Division of Medical Assistance is the state agency that administers the program and the local Department of Social Services is the contact point for administration and application in each county.
Medicaid applicants must meet the income and resource test (Below) and also meet other qualifying criteria (blind, disabled, aged or other special categories of adults and children). Qualified applicants must be US Citizens or a legal permanent resident for five years. There will be a residency requirement to apply in their state and the applicant must have a social security number. The applicant can't be receiving Medicaid from another program, county or state and can't be an inmate or in a public institution. An application for Medicaid is an application for SSI.
Medicaid can provide
- Monthly Income-SSI.
- Payment of Medicare premiums for those enrolled in Part A and Part B.
- Payment of Medicare Part B premiums for individuals enrolled in Part A.
- Payment of Medicare Part A premiums.
- Community Alternative Program.
- Payment for Long Term Care. Refer to the Nursing Home Medicaid Eligibility section of this manual for further discussion.
Countable Assets and Resources
- Real Property -not the primary home
- Other Vehicle(cars, boats)
- Cash and bank accounts over limit
- Life Insurance with cash value >$10,000
- Revocable trust funds
- Certain irrevocable trusts and Annuities
- Proceeds from reverse mortgage payments
Not Countable Assets and Resources
- Primary residence
- Personal effects and household items.
- One car
- $1500 towards burial
- Tenancy-In-Common interests in real property
- Life Estate In Real Property