What is the difference between
Medicare and Medicaid? Part 2
Medicare and Medicaid are both government funded programs created to help
those who need financial assistance with their health care costs. Although they are often confused due to their similar names they are in fact very different programs.
In our previous segment we discussed Medicaid eligibility. Recently, President Obama has tried to expand eligibility for Medicaid. The Medicaid Expansion provision proposed by the president requires states to expand Medicaid coverage to nearly all adults earning less than $17,236 per year(2020). This would have provided coverage for over a million Texans. The federal government would have funded the expansion for the first three years. Governor Rick Perry opposed the proposition, claiming that the Medicaid system is broken. Governor Gregg Abbot continues to oppose Medicaid Expansion, calling it a “Hotel California” arrangement where the state can opt into the program but will be unable to opt out when it proves financially unfeasible. While in general, it is nearly impossible for a childless adult to receive Medicaid in Texas, the state does provide Medicaid for those collecting Supplemental Security Income.
Medicaid and Medicare are also different in how much they cost.
For Medicare, each part has different cost requirements. Part A requires an annual deductible and co-pays; Part B requires 20% copay and possibly a monthly premium; Part D also requires copay, premium and deductible. Medicaid can be used to cover some these Medicare costs. Medicaid costs vary from state to state.
Texas has a Medicaid Buy-In Program which helps people who are either disabled or over age 65.
In order to be eligible you must be disabled, working, earning less than $2,453(2020) per month, and have less than $2,000 in countable assets (countable assets include cash and bank accounts). Once you are found eligible, your Medicare costs will be determined based on your income. The Buy-In Program considers your work income above $1,471 per month and other income above $733 per month.
Texas also has a special Medicare savings program for Qualified Disabled and Working Individuals (QWDI).
Unfortunately, you cannot be covered by Medicaid and QWDI at the same time. If you are eligible for both programs, Medicare will generally offer the most benefits. The eligibility requirements for QWDI are as follows:
- be under 65 years of age;
- be entitled to benefits under Medicare Part A;
- not otherwise certified under any other Medicaid-funded program;
- have a monthly income equal to or less than 200% of the federal poverty level; and
- have no more than twice the countable resources allowed under the SSI program. ($4,000 for individual, $6,000 for a couple)
If you do meet the stringent requirements of this program, it will pay for Medicare Part A premiums.
Medicare Part A is the in-patient care segment of Medicare. There is also a monthly income limit of $4,249 for individuals and $5,722 for couples (as of 2020). If you exceed the income limit, then you will be required to pay your Part A Premium.
Medicare and Medicaid are both very helpful towards paying medical expenses. If you are disabled, you likely have high healthcare costs. If you are collecting disability, you may be eligible for Medicare, Medicaid, and additional help with medical expenses. If you have applied for disability benefits and been denied, contact the law offices of Bemis, Roach and Reed for a free consultation. We can help you understand the benefits available to you and help you apply successfully.
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