Vancouver Home Health Care Agency

Understanding Medicaid and Medicare

Understanding Medicaid and Medicare

While Medicaid and Medicare are different, they are two branches of the same government program available to provide medical insurance to specific individuals. Both programs are managed by the Centers for Medicare and Medicaid Services, or CMS.

Medicare is defined as a social insurance program, serving millions of enrollees. Medicaid is defined as social welfare, serving another group of millions of Americans. Both programs were created during the term of President Lyndon B. Johnson, as an amendment to the Social Security Act of July 30, 1965.

Medicaid Explained

Medicaid is specifically for low-income families with few resources. While primary oversight is handled by the federal government, states have some say in what services are offered. Each state will:

  • Establish eligibility standards
  • Determine type, duration, amount, and scope of services
  • Set rates for service payments
  • Administer state Medicaid programs
  • Services provided include:
  • Outpatient and inpatient hospital services
  • Vaccines for children
  • Nursing facility services
  • Physician services
  • Family planning services
  • Home health care
  • Pediatric nursing services
  • Nurse-midwife services
  • Ambulatory services
  • Screening services
  • Eligibility for Medicaid

Individual states set the standards for eligibility, and some states will extend the guidelines beyond income to include age, disability, pregnancy status, and other assets. Every state looks at citizenship for a qualification.

Individuals who are always eligible for Medicaid include:

Those meeting the requirements for Aid to Families with Dependent Children, a program effective in 1996.

  • Children under 6 in low-income households
  • Low-income pregnant women
  • SSI recipients

Adoption or foster care assistance recipients

Medicaid will not cover a person solely because he or she is poor. The qualifications are stringent; the best way to find out if a person qualifies is to find an Economic Services Administration office and apply.

Medicare Explained

Medicare is best explained as a federal program giving health insurance to elderly and specific disabled individuals. There are two parts for hospital stays, Part A and Part B, and two parts for flexibility in care and prescription drugs, Part C and Part D.

Medicare Part A is hospital insurance. It pays for any hospital stays, including means, testing, supplies, and semi-private rooms. This will also help pay for home health care, including occupational, physical, and speech therapy. Medical equipment is covered in this section, such as walkers and wheelchairs.

Medicare Part B is referred to as Supplementary Medical Insurance. Medically necessary physician visits are covered, as well as outpatient visits, additional home health care costs, and additional elderly services, such as:

  • Medical equipment
  • Physician and nursing services
  • Vaccinations
  • X-rays and lab tests
  • Transfusions
  • Renal dialysis
  • Ambulance transportation
  • Outpatient procedures
  • Chemotherapy
  • Eyeglasses and prosthetic devices

Part B does require a monthly premium, payable by the patient. All patients must meet an annual deductible before coverage begins. Part B enrollment is always voluntary.

Medicare Part C allows users to create custom plans to align insurance with medical needs. Private insurance companies will provide some coverage, but the details will vary per patient.

Medicare Part D covers prescriptions. This part of Medicare requires a premium and deductible. This part of Medicare is covered by private insurance companies, who choose what drugs will be covered.

Are There Services Not Covered by Medicare?

Yes. There’s also and answer to that issue. Supplemental coverage is offered through Medigap plans. These plans consist of 12 separate plans covered by Centers for Medicare and Medicaid Services, who have authorized private insurance companies to sell and administer extra insurance. Medigap will not cover prescription drugs.

Eligibility

A person must be 65 or older, under 65 and disabled, or at any age with End-Stage Renal Disease. The participant must also be a United States citizen with permanent residence over 5 years and eligible for Social Security benefits with at least 10 years of payments contributed to Social Security.

The Vancouver Home Healthcare Agency can help clients find an office to further understand, and qualify, for Medicaid or Medicare.
At Vancouver Home Healthcare Agency, Caring and Compassion is our business.

1 thought on “Understanding Medicaid and Medicare”

  1. My grandmother has been experiencing a headache from the bureaucratic dance she is in with Medicaid. Even though she has all the necessary paperwork and procedures, the redetermination process still seems overwhelming. It feels like a fight between paperwork and granny, therefore I’m thinking it might be time to locate a Medicaid redetermination service to help her obtain the help she needs and reduce her stress. By the way, I appreciate your assistance in clarifying that Medicaid does not provide coverage for an individual only because they are impoverished due to strict eligibility requirements. 

Leave a Comment

Your email address will not be published. Required fields are marked *

one × three =

Scroll to Top