Millions of Americans have their medical costs paid with the help of Medicare or Medicaid. Medicare assists persons age 65 or older or who are disabled and some spouses and former spouses. People who meet other requirements qualify regardless of income level. Medicaid pays for medical services for some low income persons who meet income, asset and other requirements.
Medicare, run by the Health Care Financing Administration (HCFA), offers two types of coverage. Part A, hospital insurance, helps cover the costs of inpatient hospital care, post hospital or skilled nursing facility care, some home health care, and hospice care. Part B includes doctor's services and such out-patient medical services as X-rays, lab tests, ambulances, rehabilitation, therapy, prosthetic devices and durable medical equipment, and some home health services. The hospital insurance (Part A) is usually free, whereas the Part B has a monthly premium of $45.50. Medicare recipients must also pay deductibles and co-payments out of pocket.
Persons usually qualify for Medicare if they are age 65 or older and receive Social Security retirement or Railroad Retirement benefits. Persons under age 65 who have received Social Security disability benefits for 24 months are also eligible. Spouses or former spouses who qualify for Social Security Title II benefits as dependents are also eligible at age 65. Persons who are not otherwise eligible can enroll voluntarily at age 65.
Medicare does not pay for such medical costs as dentures, eyeglasses, routine dental and eye exams, prescription drugs, and physicals. However, a person eligible for Medicaid may be able to use those benefits to pay those expenses and the monthly Medicare premiums. If a person meets income and resource requirements, Medicaid will pay for Medicare premiums, deductibles and co-payments.
Medicaid follows broad federal guidelines. The state administers the program and determines eligibility, covered services, and payment levels. Persons who are eligible for Supplemental Security Income (SSI) are automatically eligible for Medicaid. SSI recipients are generally persons below certain income levels who are either age 65 or older or children or adults who are blind or disabled. If a person loses his SSI benefits, he may still be eligible for Medicaid. Contact the state Division of Medicaid at 1-800-421-2408 for more information.
Others eligible for Medicaid include individuals receiving Temporary Assistance for Needy Families (TANF) and children under the state's assistance for adoption or foster care. Nursing home or long-term care patients with limited income and resources also qualify. Low income pregnant women and children qualify for Medicaid under four programs managed by the Mississippi Department of Human Services. An individual may qualify for Medicaid in the nursing home with a much higher income level than is allowed for other Medicaid programs (300 percent of the SSI monthly amount). Furthermore, in 1989 Congress passed laws to address the financial problems of the spouses of individuals in nursing homes. In 1999 the community spouse is entitled to a monthly maintenance needs allowance of up to $2,049/month. The community spouse is entitled to a resource allowance, above and beyond exempt property, in the amount of $81,960 (1999). To apply, contact the local DHS office or call toll free at 1-800-843-0868.
Medicaid covers inpatient hospital care, emergency room visits, nursing home care, physician services, prescription drugs, laboratory services, home health services, ambulance services, and child health services. Because Medicaid pays the health care provider directly, the patient should only use those who accept Medicaid payments.
If authorities deny an application for Medicare or Medicaid or discontinues coverage, the person has the right to appeal that decision.