Medicare Vs Medicaid // Whats The Difference
Medicare and Medicaid are two terms that get thrown around frequently when discussing health care coverage. Many people seem to use them almost interchangeably although the two are completely separate and distinct programs. Medicare is an insurance program, while Medicaid is intended more as an assistance program. So, just what are the differences between the two? Some of the main differences include eligibility requirements and coverage basics. Keep reading to learn more about what each program is, what each one covers, how to qualify for either, and the key differences between the two. Well also discuss what happens if you qualify for both programs. Lets get started.
Consolidated Omnibus Budget Reconciliation Act
Yeah, thats a mouthful. No wonder we just call it COBRA. To put it simply, COBRA gives you the chance to extend your employer-based coverage for a limited period of time after youve stopped working for them. Big sigh of relief, right? Here are some of the upsides and downsides:
Advantages of COBRA
The good thing about COBRA is that it makes it mandatory under federal law for an employer to allow employees to pay to stay on their health care 18 months after theyve left their job. This can also stretch to 36 months if you qualify.
Disadvantages of COBRA
The not-so-great thing about COBRA is that it does mean youll pay the full cost of the health insurance premium yourself. Youll pay more than what you saw coming out of your paycheck when you were employed because your employer was subsidizing a percentage of that health care premium.
Now, if this is going to break the bank, dont worry! You can buy individual ACA health insurance instead . But its always a good idea to speak to your employer before or as soon as you leave your job to get the lowdown on what your new COBRA premium might be. That way you have all your bases covered.
What Happens if You Change Your Mind About COBRA?
Everyones allowed to change their mind. Right? A couple of months of COBRA coverage might leave you thinking that its just too expensive. Or maybe you got another job sooner than you thought you would and dont need it anymore. What now?
Can I Get Meals On Wheels
Meals on Wheels operates through different local programs throughout the nation. Each programs eligibility requirements are slightly different, but for the most part, you will need to be homebound and over the age of 60 . Some people may be able to get Medicare Advantage plans that offer Medicare meal delivery services through Meals on Wheels.
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Q How Will I Receive My Medical Care
A. In Delaware, Medicaid benefits are provided mainly through a managed care organization, or MCO, under contract with the state. Managed care is an organized way to ensure that people receive the quality medical care they need in the most cost-effective manner. Some Medicaid recipients in Delaware those who also receive Medicare and those in Long Term Care Medicaid programs such as the Nursing Facility program do not receive their medical care through a managed care organization.
DMMA provides a choice of managed care organizations so you can select the MCO plan that is best for you and your family.; Delaware contracts with two managed care plans AmeriHealth Caritas and Highmark Health Options.
The Medicaid MCO provides almost all of the care for Medicaid members who join their plan. Prescription and non-emergency medical transportation services are covered directly by Medicaid, not through the MCO. Medicaid recipients need to show their Medicaid card to pharmacies and transportation providers when receiving these services.
Q Where Do I Go To Apply For Medicaid
A. There are several ways to apply for Medicaid and other medical assistance programs:
- On the internet, you can use ASSIST to check your eligibility for several different assistance programs by completing a self-screening questionnaire. ASSIST then allows you to apply online.
- You may also print an Application for Health Insurance/Medicaid. The application form is also available in Spanish/en Español.
- By phone, you can contact Medicaid Customer Relations at 1-800-372-2022 or 255-9500 to be directed to the Division of Social Services office closest to where you live. DSS staff members will help you find out more about eligibility for Medicaid and other assistance programs. Then the appropriate information and application forms will be mailed to you. Complete, sign and date the application form in ink and mail it to the address provided.
- For Long Term Care applications, please call the Long Term Care Medicaid Unit listed for the county where you live.
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What Is The Income Range For Beneficiaries Who Are Dual Eligibles
Generally, beneficiaries earning less than 135 percent of the federal poverty level are eligible for the MSP if they also have limited savings . This equates to $17,226 annually for single beneficiaries and $23,274 for married couples. Beneficiaries qualify for full Medicaid benefits if their incomes and assets are even lower .
Many seniors who live in nursing homes are dual eligible: they qualify for Medicare based on their age, and Medicaid because of their financial circumstances. It is also common for Medicare beneficiaries who are under 65 and live on Social Security Disability Insurance to receive Medicaid benefits.
How To Qualify For Medicaid
May 15, 2020, 12:00 AM
It can be expensive to pay for health insurance when you lose your job, but many people dont realize that theyre eligible for Medicaid coverage. If you live in one of the 36 states that expanded Medicaid coverage for low-income adults, you can qualify for coverage if your monthly income is less than $1,467 for an individual or $3,013 for a family of four even if you earned a lot more than that during the first few months of the year.
This type of Medicaid has different eligibility requirements than the version that provides nursing home coverage for people over age 65 there is no asset test for this type of Medicaid. Instead, eligibility is based on your family size and your modified adjusted gross income .
Many people dont know that theyre eligible for Medicaid, says Robin Rudowitz, co-director of the Program on Medicaid and the Uninsured at the Kaiser Family Foundation. Medicaid is based on monthly income, so people who have significant drops in income could become eligible. There is no open enrollment period for Medicaid, so when people experience a change in their circumstances, they dont have to wait for a special open enrollment period to enroll.
Heres more information about how to qualify for Medicaid, how the coverage works and what you can do if your state hasnt expanded coverage.
Who Is Eligible for Medicaid?
See the Kaiser Family Foundations Medicaid Income Eligibility Limits table for each states requirements.
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The Problem: Medicare Alone Will Cost You Money
Medicare is a great health insurance program, but it does have costs. You must pay your monthly Part B premium to stay enrolled in Medicare, plus premiums, out-of-pocket costs, etc.; Copayments for medical services and prescriptions can add up beyond what many people can afford.
You could even wind up paying more than other folks for the same basic Medicare coverage, simply because extra coverage add-ons are out of reach.
Qualified Disabled And Working Individual
You may be eligible to purchase Medicare Part A benefits, but unable to afford it because of your low income. In this case, Medicaid will pay your Medicare Part A premium. This is more common with people under the age of 65.
In 2021, the maximum monthly income to qualify is $4,379 for an individual and $5,892 for a couple. The 2021 maximum asset level, however, is set at just $4,000 for an individual and $6,000 for a couple.
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Preclusions For Unemployment Benefits
There are additional conditions when you may be excluded from unemployment benefits. These incorporate inadequate profit, being let go for cause, or in the case when you are being terminated for some genuine reasons. Different preclusions incorporate if you already have your own business or are self-employed or leaving to attend the school.
You can always go through our past articles on our website to describe what can disqualify you for getting the unemployment benefits. While you are in the corporate world, you should have an idea about those factors.
If you petition for unemployment and your claim is turned down, you can file or claim an unemployment appeal on the off chance you trust you should get unemployment. The procedure, as said above, is different, relying upon the state. However, the general rules and regulations are the same.
When you file or claim an unemployment offer, you will go to a hearing a casual trial held before an unemployment bid board or judge and affirm why you trust you are qualified for unemployment protection benefits.
Your previous employer or boss will likewise affirm. You can go through our previous articles on our website, where we have described the whole process of how you can smoothly file for the unemployment benefits appeal.
Q If I Have Private Health Insurance Can I Be Eligible For Medicaid
A. It depends. If your income is low, and you have minor children, you and your children can have private health insurance and still be eligible for Medicaid. Certain Medicaid qualifying programs require that you not have any other health insurance in order for you to get Medicaid. If you have both private health insurance and Medicaid, you should show both your Medicaid card and your private health insurance card to your medical provider each time you receive services.
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Can I Get Medicaid
States have different rules to decide who’s eligible for Medicaid. You may be eligible if:
You’re disabled. Your state may let you use Medicaid no matter how much money you make in a year. In other states, a disabled person may only qualify for Medicaid when their income falls below a cutoff level.
You already get Supplemental Security Income . In the majority of states, SSI eligibility automatically qualifies you for Medicaid unless your state uses more strict criteria. Those states are commonly called 209 states.
You don’t make much money during a year. The rules are different in each state.
Check with your state’s Medicaid office to get the exact income requirements. You can also find out if you qualify by going online at www.healthcare.gov.
Some states have expanded their Medicaid program to allow more people to qualify. In those states, the income rules have loosened for adults without children. Other states have chosen not to expand Medicaid.
If your state has expanded Medicaid under the Affordable Care Act:
You’re eligible if:
- You’re single, don’t have children, and make less than $17,609 a year.
- You have a family of three and make less than $29,974 a year.
If your state has NOT expanded Medicaid:
In Alaska and Hawaii, youâre able to make a slightly higher income than in other states and still qualify. Your state Medicaid office can help you with the specific income limits based on how many people are in your family.
How Does Unemployment Insurance Work
Employers pay into an unemployment fund that covers unemployment compensation for residents of their state. Normally, you would have to prove youre looking for work while receiving benefits, but in many states, these requirements have been relaxed or waived if youre sick or taking care of someone who is.
The best time to apply for unemployment insurance is immediately after you lose your job. Due to an unprecedented volume of unemployment claims across the country, it may take longer than usual to process your request.
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How To Check Medicare Eligibility Online
You can qualify for Medicare by:
To check your Medicare eligibility online, go to Medicare.gov at this link and complete the series of questions. It is important that you answer them accurately to find out if you are eligible.;
When youre done, you can click on the button that says Eligibility & Premium Calculator Home at the bottom, and then click on Calculate my premium to find out what your Part B premium will most likely be.
How Are My Health Care Costs Reimbursed If I Have Medicare And Medicaid
When dual eligible beneficiaries have healthcare expenses, Medicare pays first and Medicaid pays last. But this is not the case for things Medicare doesnt cover, like long-term care. If Medicaid is covering a beneficiarys long-term care, Medicare will still be the primary payer for any Medicare-covered services like skilled nursing care or physical therapy.
Although it is less common, if a dual eligible individual has additional coverage then Medicare pays first, Medigap will pay second, and Medicaid is the last payer for their claims .
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What Does Medicaid Cover
In each state, Medicaid must cover:
- Birth control medicine and devices
- Care at rural and federally qualified health clinics
- Care at many childbirth centers
- Care from a pediatrician or family nurse practitioner
- Early Periodic Screening, Diagnostic, and Treatment Services , which includes an array of services for children and adolescents
- Doctor’s fees
- Nurse midwife care during pregnancy and childbirth
- Preventive care and immunizations for children under age 21
- Quit-smoking programs
- Transportation to medical care
Many states offer more care, such as checkups and cancer screening tests for adults, physical therapy, and occupational therapy.
Can You Have Both Medicare And Medicaid
Yes, you can qualify for coverage under both programs at the same time. When this occurs, it is called dual eligible. This generally applies when a person is over 65 or disabled and has very limited income. You still have the choice to enroll in Original Medicare or a Medicare Advantage Plan. When a person is dual eligible, most of their medical expenses are completely covered by one or both of the programs. Medications are generally covered through a Medicare Part D prescription drug plan, although Medicaid may cover additional medications or other medical services that are not covered through Medicare.
If you are eligible for both government programs, then it is usually a good idea to enroll in each. Go ahead and sign up for Medicare and Medicaid benefits. When enrolled in both programs, a person typically has very little out of pocket expense.
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What Counts As Income In General:
Examples of most sources of income that are counted, and not counted, toward MA eligibility and financial assistance for the Marketplace are listed below:
What Types of Income Count Toward MA Eligibility?
What Types of IncomeCount Toward EligibilityforMarketplace Financial Savings?
If you need more assistance, contact our helpline at 877-570-3642.
University Of Chicago Researchers Hired Assistants Who Collectively Made 2000 Calls To Four Government Offices For Each State
In New Jersey, you have less than a 20% chance of getting connected with a live human to help you with an unemployment claim, Medicaid, SNAP benefits or income taxes, according to a recent experiment.
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At the start of the pandemic, when some 23 million people were unemployed in April 2020, most state workforce agencies couldnt handle the sheer volume of calls they were receiving from individuals attempting to file for unemployment benefits.
One single mother, Alia Renée Capodici, who was furloughed from a match-making service in March 2020 told MarketWatch that she called New Jerseys Division of Unemployment Insurance 10 times a day for weeks.
I get the same message that theyre too busy and to call back the next business day every single time, she said at the time. Her experience unsuccessfully trying to reach the state government agency is hardly unique.
The assistants spent no more than 45 minutes on hold trying to get through. If they got through, they recorded how long it took.
People in New Jersey have the worst shot at connecting over the phone with a live representative for help with unemployment benefits, Supplemental Nutrition Assistance Program benefits, income tax returns and Medicaid.
Thats according to a University of Chicago experiment from Sept 2020 through March 2021. The researchers hired assistants who collectively made 2,000 calls to four government offices for each state.
The best and the worst
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Your Options Depend On Your Household Income
When you apply for Marketplace coverage youll estimate your income for the current calendar year.
- How to estimate your income if youre unemployed
Its hard to predict your annual income if youre unemployed. Still, its important to make your best estimate based on all current or expected sources of income for the year.
Types of income to include on your application:
- Unemployment compensation that you receive from your state. Visit CareerOneStop’s Unemployment Benefits Finder for more information about unemployment in your state.
- All household members income
- Additional types of income, including interest income, capital gains, and alimony
- Most withdrawals from traditional IRAs and 401ks. for information on non-deductible contributions, and IRS Publication 590-B for information on Roth accounts.)
Note: Its very important to immediatelyupdate your income information with the Marketplace if your income changes during the year. This will ensure you get the right amount of savings based on your new annual income estimate.