What does Medicaid Cover? How to Apply and Qualify for it in USA

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Medicaid is a health insurance program for low-income individuals, families and people with disabilities who cannot afford health care costs. Medicaid is set up by the federal government and administered differently in each U.S state. This program is called ‘Medi-Cal’ in California. The Health Insurance Association of America describes Medicaid as a “government insurance program for persons of all ages whose income and resources are insufficient to pay for health care.” It is the largest source of funding for medical and health-related services which is jointly funded by the state and federal governments and managed by the states. This form of social insurance or social protection program serves more than 44 million enrollees (as of 2008) at a cost about $432 billion, or 3.2% of GDP, in 2007.

What does Medicaid Cover?

Medicaid provides a broad level of health insurance coverage, including hospital expenses, doctor visits, nursing home care, home health care, and many other likes. It also covers costs for long-term care, both in a nursing home and at-home. Medicare does not provide this coverage. The examples of Medicaid covers are:

(a)    Inpatient hospital services,

(b)    Outpatient hospital services

(c)    Skilled nursing-home services

(d)    Physician services

(e)    Laboratory and x-ray services

(f)    optional services like diagnostic, clinical services, etc.


What is Medicare?

Medicare is the U.S federal health insurance program for people who are 65 or older and certain people on Social Security disability. It is also available to certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD) or permanent kidney failure who require regular dialysis or a kidney transplant. The program of Medicare consists two main parts for hospital and medical insurance (Part A and Part B) and two additional parts that provide flexibility and prescription drugs (Part C and Part D).

The Part A is also known as Hospital Insurance (HI). It helps to pay for medical expenses during one’s hospital stay which may include the cost of testing, meal, supplies, wheel chair or similar equipments and the cost of hospital bed in a semi-private room. It also includes necessary regular or occasional home health care expenses incurred on the treatment of diseases related to the condition of occupation, physical, and speech therapies. The benefits of Part A are generally available without having to pay a monthly premium because payroll taxes usually cover these costs.

The Part B is also known as Supplementary Medical Insurance (SMI). It helps to pay for home health care costs, outpatient hospital visits, necessary physician visits, physical therapy and other services for the aged and disabled.

Medicare Part C is sometime known as Medicare Advantage Plans or Medicare (+) Choice allows eligible person to build a custom plan more closely aligned with own medical needs. Private insurance companies or Health Maintenance Organizations (HMOs) are sometime invited to participate in this program but the details of the programs vary depending upon the program and eligibility of the eligible individual.

Medicare Part D is a Prescription Drug Plan (lists of drugs that are covered) administered by one of several private insurance companies offering different plans at different costs. Participation in Part D requires payment of a premium and a deductible. The benefit under the plan is dependent upon the premium you pay.

What is the Difference between Medicare & Medicaid

Medicaid and Medicare are two different government-run social insuranceprograms that were created in 1965 as a part of President Lyndon Johnson’s vision on “Great Society”—a social commitment to meet individual health care needs. They are different on the following grounds.

(1)    Medicare is a federal program whereas Medicaid is a state and federal program.

(2)    Medicare provides health coverage for individual people who are 65 or older irrespective of their levels of income. Medicaid provides health coverage to individuals with very low income.

(3)    An individual may fulfill eligibility to avail benefits under both the plan Medicare and Medicaid (dual eligibility)

How to Qualify for Medicaid

The eligibility for Medicaid other than low income status is further extended upon fulfillment of some other requirements based on age, disability status, pregnancy status, other assets and citizenship. Its eligibility is not tied to individual need rather, it is an “entitlement program” intended for a specified eligibility that covers the age, condition of disablement, blindness and single parent families. Families with unemployed parents may qualify, children and pregnant women may qualify under higher income limits and without asset limits. Families who lose regular Family Medicaid because a parent returns to work may continue to be covered for up to one year. Being eligible for Medicare does not necessarily deprive one from the entitlement of Medicaid.

How to Apply for Medicaid

Although the rules are different from state to state, the basic process to apply for Medicaid is similar. The steps involved in the process of applying for Medicaid are mentioned here.

(1)    Check the rules:Go online to Medicaid.gov. Click on the state you live in. Or, call your state’s medical assistance office. You can either download the form from your state’s Medicaid web site or get it in the mail by calling 800-633-4227. A recipient of Supplemental Security Income (SSI) from the Social Security Administration usually qualifies for Medicaid. Know about the recent limits on benefits.

(2)    Gather up documents: Your state authority may need some personal and financial information to check whether you are eligible. They may ask you to submit some of the following documents like tax bill for your home, your income statement and declaration, your birth certificate, social security number, other personal information. They may request you to show the copies of your medical or life insurance policies, list of all assets and all other benefits you receive.

(3)    Turn in the application: Many states prefer you visit their office to fill in and submit the application.

(4)    Wait for a decision: Normal waiting period for the decision is 45 days but a pregnant woman may hear within 30 days.

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