BY ARIEL HERNANDEZ
Medicare and Medicaid, both of which are government programs that pay for healthcare, are often mistaken due to their familiar-sounding names. However, they each provide medical services for different groups of people.
Medicare, which is federally governed, is only for people who are age 65 or above, or under age 65 but with disabilities. Medicare is intended for senior citizens since its costs were deducted from their wages in the years during which they worked. Therefore, they have already paid for it.
But while Medicare covers hospital care, medical tests and procedures, there is a monthly premium for Medicare Advantage, which is an alternative to traditional Medicare coverage and, in most cases, covers prescription drugs.
Other people who may be eligible for Medicare include persons under 65 years of age who have received at least 24 months of Social Security disability benefits or a disability pension from the Railroad Retirement Board (RRB), have permanent kidney failure and need routine dialysis or a kidney transplant, or have Lou Gehrig’s disease.
Medicaid, on the other hand, is a public assistance program largely based on financial need. It is funded and administered by federal, state and local governments. Medicaid covers inpatient and outpatient hospital services, nursing-home and home-care healthcare, laboratory and X-ray diagnostic services, transportation to a medical facility and tobacco-cessation counseling for pregnant women.
In many cases, Medicaid also provides prescription-drug coverage, physical and occupational therapy, optometry, chiropractic services, dental care and more. Among those who qualify for Medicaid are pregnant women and children, the single parent of a minor or teenager, those over 65 years of age, the disabled and low-income individuals under age 65 who do not have children.
Those who have Medicare, but struggle with premiums, deductibles and copayments, are encouraged to also apply for Medicaid, which will cover most of those payments. Seniors in nursing homes also frequently qualify for Medicaid since Medicare offers limited coverage for nursing homes.
It is important to keep in mind that when enrolled in Medicaid, a member may have to pay premiums, deductibles, copays and coinsurance depending on both the member’s income and the rules in his or her state.
If you qualify for both Medicare and Medicaid, you are then considered “dual eligible” and may qualify for benefits through state-run Medicare Savings Programs (MSPs), which provide coverage for certain Medicare premiums, deductibles and copayments, depending on the individual’s income level. In addition, if you qualify for MSPs, you automatically qualify for Medicare Extra Help, which is a program that helps low-income individuals with prescription-drug costs.
Although once people reach 65 years of age they are automatically enrolled in Medicare, they can also contact a local Social Security office to see if they are eligible beforehand. To enroll in Medicaid, call your state medical-assistance office to see if you qualify.
For more information, visit New York City’s Human Resources Administration website at www1.nyc.gov/site/hra.