Program Spotlight – Medicare & Medicaid

One of the most significant costs Americans face is the cost of healthcare. US healthcare spending was estimated to reach $14.5 trillion in 2022, roughly $13,500 per person. Healthcare spending can put a burden on already tight budgets. While having insurance can help ease this burden, for some living on lower incomes, coverage isn’t affordable. 

If this is the position you find yourself in, there are programs that can help. Medicare and Medicaid target different segments of the population and work to help make healthcare coverage more affordable. Let’s look at both programs to understand what they cover, who is eligible, and how you can apply.

Medicare

What does the program offer?

Medicare is a program that offers health insurance benefits to those over age 65. There are four different parts of Medicare, and each offers distinct benefits. Original Medicare is made up of two parts, Part A and Part B. 

Part A provides coverage to help an individual pay for hospital care, home healthcare, care in a skilled nursing facility, and hospice care. 

Part B helps cover services from doctors and other healthcare providers, such as in-home care, outpatient care, and many preventative services like routine screenings or vaccines. It can also help cover durable medical equipment like wheelchairs, walkers, or hospital beds. If you sign up for Medicare, you’ll automatically get Parts A and B.

Medicare Part D is prescription drug coverage you can sign up for in addition to original Medicare. This will help you cover the costs of necessary medications. 

Medicare Part C is known as Medicare Advantage. This coverage is offered by private insurance companies that follow Medicare rules. With Medicare Advantage, you’ll typically get Parts A, B, and D. 

You can also opt for a Medicare Supplemental Insurance policy. This is health insurance that you’ll pay for out of pocket to cover the portion of healthcare charges you’re responsible for while on Medicare.

Who is eligible for the program?

Typically, to be eligible for Medicare, you need to be 65 or older. There are a few exceptions that can allow you to access Medicare earlier. They include being in End-Stage Renal Failure, having a disability, or having ALS (Lou Gehrig’s disease).

How do you apply? 

Depending on your situation, there are a few ways that you might apply for Medicare. 

If you start receiving Social Security Benefits between the ages of 62 and 4 months before turning 65, you’ll be automatically enrolled in Medicare at the age of 65. 

If you wait to take Social Security benefits until you’re 65, you can sign up for Medicare when you apply for your Social Security Benefits. You’ll receive a postcard from the government before you turn 65 with instructions on applying. If you decide to work past age 65, you can apply for Medicare online at age 65 or wait and apply once you retire during a special enrollment period.

How do I maintain my eligibility? 

Typically, Medicare automatically renews each year. To maintain coverage, you need to continue to pay the premiums associated with Medicare Part A and remain enrolled in Part B.

Medicaid

What does the program offer?

Medicaid is a health insurance program for low-income adults, children, pregnant women, the elderly, and individuals with disabilities. The program is funded and administered jointly by the federal government and state governments.

Who is eligible for the program?

As Medicaid is both a federal and state program, your state will set your eligibility requirements. The program is designed to help low-income adults, children, pregnant women, those with disabilities, and some elderly adults gain healthcare coverage. A few requirements are constant across states. 

• You need to meet financial eligibility requirements based on modified adjusted gross income (MAGI). 
• You must meet non-financial requirements including being a resident of the state where you apply for coverage and being either a US resident or a qualified non-citizen, like a lawful permanent resident.

To see full eligibility requirements and apply, you can find state program information here.

How do you apply? 

There are two ways you can apply for Medicaid. 

1. You can apply for Medicaid directly with your state. A list of state Medicaid programs can be found here. 
2. You can apply online through the insurance marketplace. To do this, you’ll want to visit healthcare.gov. When asked if you want to see if you qualify for help paying for insurance, select yes.

How do I maintain my eligibility? 

To continue to receive coverage under Medicaid, you’ll need to continue to meet the eligibility requirements in your state. Be sure your contact information is accurate and up to date so they can reach you if they have questions or need documentation. You’ll also want to inform your state office if any changes to your status might affect your eligibility.