What are the Medicare and Medicaid Programs and do I qualify for benefits?

Health care can be very expensive in the United States. For some groups of people, this means that health care is unavailable. In order to provide care for more people, the federal government created the Medicare and Medicaid programs. These programs provide health benefits at low cost or no cost to certain groups. This article will overview the Medicare and Medicaid programs, and will describe who can qualify for benefits.

Medicare Defined. Medicare is a federal health insurance program. The program pays medical bills for the elderly (generally age 65 or older) and people with certain disabilities. The benefits are divided into four parts: A, B, C, and D.

  • Part A. The first part of Medicare is “Hospital Insurance.” These benefits pay for brief hospital visits and sometimes for care in a skilled nursing facility.

  • Part B. The second part of Medicare is “Medical Insurance.” This part pays for tests, treatments, procedures, and equipment that are not covered by Part A. Examples include x-rays, chemotherapy, eyeglasses, and artificial limbs.
  • Part C. The third part allows Medicare beneficiaries to apply their benefits to private health insurance plans. These “Medicare Advantage” plans provide more flexibility by allowing a person to choose an insurance package that meets their individual needs.
  • Part D. The fourth part helps to cover the cost of prescription drugs.

Medicare Costs. While Medicare makes treatment less expensive, it does not make healthcare free. Beneficiaries may be required to pay premiums (monthly fees), deductibles (one-time fees), or other associated costs.

Medicaid Defined. Medicaid is a joint federal/state social welfare program. The program pays medical bills for some people who are poor and members of certain groups. However, many people living in poverty do not qualify for Medicaid.

Eligibility. The eligibility requirements for Medicaid are set by each state. However, certain groups are automatically qualified. This includes a person who has a low income (per federal law) and is: (1) a child; (2) pregnant; (3) a Supplemental Security Income recipient; or (4) a member of other specified groups. Also, recent laws require that a beneficiary is a legal resident of the United States.

For more information about the Medicare or Medicaid programs, see the Centers for Medicare & Medicaid Services (CMS) at http://cms.gov.

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