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Medicare Medicaid

Medicare Medicaid. Public Health Care - Medicare. Medicare goes along with SSDI 2 year waiting period after becoming eligible for SSDI Not “means tested” Administered by the federal government Standard benefits. Medicare. Medicare Part A

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Medicare Medicaid

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  1. Medicare Medicaid Cathy Chambless, Utah State University

  2. Public Health Care - Medicare • Medicare goes along with SSDI • 2 year waiting period after becoming eligible for SSDI • Not “means tested” • Administered by the federal government • Standard benefits Cathy Chambless, Utah State University

  3. Medicare • Medicare Part A • Hospital insurance that pays for inpatient hospital stays, care in a skilled nursing facility, hospice care and some home health care. • Medicare Part B • Medicare medical insurance that helps pay for doctors' services, outpatient hospital care, durable medical equipment, and some medical services that are not covered by Part A • Medicare Part D • Prescription Drug Program – new Jan 2006 Cathy Chambless, Utah State University

  4. Public Health Care - Medicaid • Medicaid goes along with SSI • “Means tested” programs (financial criteria) • SSI recipients are eligible for Medicaid • Some states require a separate application • While most provide Medicaid automatically to SSI eligible recipients • Medicaid is administered by each state • “If you’ve seen one state Medicaid program, you’ve seen one state Medicaid program.” Cathy Chambless, Utah State University

  5. Medicaid / Medicarefor people with disabilities who work Cathy Chambless, Utah State University

  6. Medicare is administered by the Social Security Administration Age 65, or Received Social Security disability 2+ years, or End-stage renal failure Medicaid is administered by the State. For low income families, senior citizens and persons with disabilities. Must meet specific program criteria. Medicare vs. Medicaid Cathy Chambless, Utah State University

  7. Medicare • Medicare Part A • Hospital insurance that pays for inpatient hospital stays, care in a skilled nursing facility, hospice care and some home health care. • Medicare Part B (optional–requires premium) • Medicare medical insurance that helps pay for doctors' services, outpatient hospital care, durable medical equipment, and some medical services that are not covered by Part A • Medicare Part D • Prescription Drug Program – new Jan 2006 Cathy Chambless, Utah State University

  8. Things to remember about Medicaid • A federal-state partnership. • Each state develops its own State Plan. • The Federal government “matches” State money. • Match rates vary from state to state. • Medicaid will supplement other health insurance Cathy Chambless, Utah State University

  9. Continuation of Medicaid “1619a” and “1619b” -for people on SSI who work • 1619a • Earning above SGA amount ($800 for 2007) • Check is reduced by Earnings Disregard ($85 + ½) • Continues to receive some SSI • 1619b • Earnings too high for monthly SSI check ($0 SSI) • Earnings under the Medicaid threshold amount (~$27000 for Utah) • Disability continues, and assets below limit Cathy Chambless, Utah State University

  10. Continuation of Medicare(for people on SSDI who work) • If Social Security disability benefits stop because of earnings, but person is still disabled • Medicare coverage will continue for at least 7½ years after the nine-month trial work period. • After that, individuals can buy Medicare coverage by paying a monthly premium. Cathy Chambless, Utah State University

  11. Medicaid Buy-In for people with disabilities who work • Why? “People with disabilities should not have to live in poverty to have health care coverage.” • Congress authorized option for states in 1997 • Allows earnings up to 450% of Federal Poverty Limit • Allows higher asset limits than other Medicaid groups • In Utah: “Medicaid Work Incentive” (MWI) program Cathy Chambless, Utah State University

  12. SSA vs. Medicaid • Social Security Disability Determination Service and the Medicaid Medical Review Board use the same medical criteria (individuals w/significant disabilities more likely to meet criteria). • If disability is denied by Social Security because the individual is earning too much money [Substantial Gainful Activity (SGA)-$900/month], the State Medicaid Medical Review Board may still look at disability without considering the SGA. Cathy Chambless, Utah State University

  13. Primary Care Network (PCN) • Services are limited. They include • Primary care (what your doctor can do in his office). • Pharmacy – maximum of 4 prescriptions a month • Emergency Room • $50 annual enrollment fee Cathy Chambless, Utah State University

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