Posted: May 2, 2023

Demystifying Medicare and Medicaid: Your Guide to Applying for Healthcare Coverage

The U.S. government introduced certain special programs to cover healthcare costs for American citizens who have some sort of disability or come from a limited income background. The programs were launched in 1965 and are funded by taxpayers.

Although the names of these programs sound a bit similar yet both of these have different sorts of privileges with different eligibility criterias.

Medicare is for senior citizens ( 65 or older) and for people with disabilities. It does not concern with peoples’ income level.

On the other hand, Medicaid is a program that is intended for persons with low incomes and is frequently a last alternative for those who have no other options.

Medicare vs Medicaid: The Main Difference

Medicare: What You Need To Know

What Is Medicare?

Medicare is a program run by the federal government that gives funding for health care in “parts.” Part A covers insurance for hospital stays, and Part B covers outpatient treatments. Most of the time, when people say “Medicare,” they mean “Original Medicare,” which is made up of Part A and Part B.

Medicare Advantage, which is also called Medicare Part C, includes everything Original Medicare does and combines Parts A and B into a single plan. Most of the time, these plans give extra benefits that Original Medicare doesn’t. These extra benefits are usually offered by private insurers who follow the rules set by the federal government.

What Does Medicare Cover?

Part A of the original Medicare plan pays for stays in hospitals, skilled nursing care, home health care, and hospice care. It also pays for doctor visits, preventive care, mental health services, physical therapy, occupational therapy, lab services, and other outpatient services (Part B).

Original Medicare doesn’t pay for prescribed medications, spectacles, hearing aids, or dental care (unless it’s done in the hospital under Part A). Part D is a separate plan that people who choose Original Medicare can buy to cover their prescription drugs.

Original Medicare covers everything, and so does Medicare Advantage. The majority of  Medicare Advantage programs cover prescription drugs and often also cover dental and eye care, hearing aids, and fitness. Plans vary in what they cover.

What Is The Eligibility Criteria For Medicare?

Medicare is available to U.S. citizens and permanent residents over 65. Most people who qualify for Social Security are also qualified for Medicare. People under 65 with certain illnesses or CKD patients (who have had a kidney transplanted or require dialysis) are also eligible.

How To Apply For Medicare?

The application for medicare can begin three months prior to any individual turning to 65. Besides, people below 65 with certain disabilities can also apply for medicare. Usually, the coverage is on motion after a month of signing up. 

The open enrollment period of Medicare begins from 15th October- 7th December. During this period, you can make changes to the coverage. After the enrollment is done, you will receive a card along with a welcome package in the mail to confirm your coverage and benefits.

Medicaid: What You Need To Know

What Is Medicaid?

Medicaid is a health insurance program for low-income Americans that is run by the federal government and the states. For Medicaid benefits, your income must be beneath the state’s limits, which in states that have expanded Medicaid is 138% of the federal poverty line.

Different states and situations, like having some sort of impairment or being pregnant, have different rules about who can get the waiver. You can use to put in your projected income and find out if you are considered eligible based on how many people live in your home.

As you will notice, when the number of people who count on you in your household goes up, so does the income limit for Medicaid.

What Does Medicaid Cover?

Medicaid provides coverage for a range of services mandated by the Federal government, including hospital services, diagnostic and treatment services for children, nursing facility services, and more. Additionally, each state has the option of offering additional benefits like prescription drugs, dental services, and medical transportation.

One area where Medicaid stands out is in funding long-term care, which is typically not covered by private health insurance or Medicare. In fact, Medicaid is the primary payer of long-term care in the US, covering the cost of nursing facilities for those who have exhausted their savings and have no other means to pay for nursing care.

How Priority Groups Can Help With Medicaid

Priority Group Services can help you with Medicaid in several ways:

Determine Eligibility For Both Medicaid and Medicare

We can help you to determine your qualification for both medicaid and medicare. According to your state’s laws, we can go through the complex process and make do all the checking on your behalf and ensure that you are

Assist With Medicaid and Medicare Application

Priority Group Services helps clients go through the complex procedure of medicare and medicaid application. We gather all the required documents and submit them on your behalf.

Coordinate Medicaid Benefits

We can help you to coordinate your medicaid or medicare benefits with your home care services. It might require us to work with your healthcare providers closely to ensure that they are being covered and authorized by Medicare or Medicaid, whatever you are qualified for.

 Provide home care services

When you are qualified for the program you are eligible for, our expert team will provide you with a recommendation on a range of services to meet your healthcare needs. Starting from daily living, medication management, to wound care, the caregivers will assist you or your loved one with all of their healthcare needs.

Moreover, we have expertise on projects like CDPAP, NHTD, OPWDD. Therefore, you can rely on us in this regard.

Moreover, we have expertise on projects like CDPAP, NHTD, OPWDD. Therefore, you can rely on us in this regard.

Submit Medicaid claims

A home care agency can help clients submit Medicaid claims for services rendered, ensuring that the claims are accurate and complete and that the agency is reimbursed for services provided.

By working with a home care agency, clients can receive the support and guidance they need to navigate the Medicaid system and access the services they require to maintain their health and independence at home.

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