What is the difference between Medicare and Medicaid?
Medicare and Medicaid are both government funded programs created to help
those who need financial assistance in covering their health care costs. Although they are often confused due to their similar names they are in fact very different programs.
Medicaid is a joint Federal-State health care program designed to help people with low incomes.
If you are on Supplemental Security Income in Texas, you are eligible for Medicaid. Medicaid is often confused with Medicare, but it is a separate program and differs in some important ways.
Medicare is a federal program designed for Americans who are 65 or older or who are disabled. Medicaid is controlled by both the federal and state governments and is for anyone who meets the criteria for low-income and limited resources.
Both programs cover different services. Medicare, as previously discussed, comes in parts, with Part A covering in-patient services, Part B covering other medical costs, and Part D covering medications.
Medicaid varies from state to state in what it covers.
All Medicaid programs must provide the following:
- Preventative medical and dental check-ups
- Nursing Facility services
- Federally Qualified Health Centers
- Home health care
- Hospital services
- Physician services
- Rural health clinic services
- Family planning services
- Laboratory and radiology services
- Midwife services
- Certified Pediatric and Family Nurse Practitioner Services
- Freestanding Birth Center Services
- Transportation to medical care
- Tobacco cessation counseling for pregnant women
As you can see, Medicaid benefits provide a great boon to the disabled. Some states provide additional benefits on top of these.
Texas provides the following additional benefits:
- Prescription drug coverage
- Expanded coverage of medical care to include care from:
- Nurse practitioners
- Certified registered nurse anesthetists
- Physician’s assistants
- Licensed professional counselors
- Licensed marriage and family therapists
- Licensed clinical social workers
- Limited chiropractic services
- Optometry and audiology
- Renal dialysis
- Rehabilitation; including mental health and substance abuse services
- Maternity service clinics and special case management for pregnant applicants
There are also some optional services which other states provide and Texas does not.
If you have a condition that could benefit from these services you should be aware some states provide:
- Speech and language services
- Specialized respiratory care services
- Prosthetic limbs
- Specialized programs for tuberculous
In order to receive Medicaid in Texas you must have a low income and be:
“either pregnant, a parent or relative caretaker of a dependent child(ren) under age 19, blind, have a disability or a family member in your household with a disability, or be 65 years of age or older.”
Medicaid is available to those collecting Supplemental Security Income. The Texas Health and Human Services handbook on Medicaid states that:
“Persons found eligible for SSI cash payment are automatically determined eligible for Medicaid. “
Medicare has federally mandated eligibility requirements. Those collecting Social Security Disability Insurance benefits will be automatically enrolled in Medicare after two years. Otherwise, most people must wait until they are 65 years old to become eligible for Medicare.
If you are eligible for Medicaid, you may also be able to apply for Retroactive Coverage.
Retroactive Coverage helps reimburse you for medical expenses prior to when you became eligible for SSI benefits. Generally, retroactive benefits cover the three months prior to the date of the SSI application.
Once you have obtained benefits, Health and Human services will review your file annually to determine your continued eligibility. If you make any changes to your address, income, or insurance you are obligated to inform Health and Human Services within 10 days.
It’s likely if you become ineligible for Supplemental Security Income you will lose your Medicaid benefits. If you lose SSI benefits, the Social Security Administration will contact Health and Human Services to determine if you may apply to continue Medicaid coverage.
Medicaid eligibility is an important aspect of collecting SSI benefits. If you have applied for Supplemental Security Income benefits and been denied, contact the attorneys at Bemis, Roach and Reed for a free consultation.
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