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For many Americans today, the Medicare and Medicaid systems are a source of great confusion and worry.  Most know that at some point in their lives they will need to rely on one of these systems for medical care, but how they work, remains a mystery to many Americans. The following will provide basic information regarding both of these government programs.

Medicare is a health insurance system for those aged 65 or older. Those under 65 can become eligible to receive Medicare only after they are entitled to Social Security Disability benefits for 29 months. Persons of any age with End-Stage Renal disease are also eligible.

The Medicare system is comprised of four parts: Part A, Part B, Part C and Part D.  Medicare Part A provides hospital, hospice and nursing insurance.  Part B includes medical insurance for doctors’ visits, outpatient care, some preventive care and medical equipment.  Part C is the “Medicare Advantage” health plan run by Medicare approved private insurance companies.  Part D helps cover the costs of prescription drugs.

Medicare is not means tested.  Medicare does require monthly premiums and co-pays.  Medicare generally allows access to a wide range of physicians. The program is so successful, that protestors have demanded that government keep its hands off Medicare.

Medicaid is a means tested program available only to low income adults and their minor children.  Low income persons with disabilities who are eligible to receive Supplemental Security Income (SSI) become entitled to receive Medicaid benefits after receiving SSI benefits for one month.  Effective 2014, the Patient Protection and Affordable Care Act will increase Medicaid eligibility to people whose income is up to 133% of the poverty income threshold. There are no co-pays or premiums paid by Medicaid recipients.

Because Medicaid is jointly funded by the State and Federal governments, states are required to offer certain mandatory benefits including inpatient and outpatient hospital services, physicians’ services and home health services, among other benefits.  Some states also provide optional benefits, including prescription drug coverage and physical therapy.  Because the reimbursement rates for doctors under Medicaid is much lower than under Medicare, far fewer physicians participate in Medicaid.

As experienced disability attorneys, we will be happy to answer any and all of your questions regarding Medicare and/or Medicaid.

We have significant experience representing clients seeking disability benefits. For more information and how you may be impacted, contact one of our Disability Benefits attorneys, Elliott Andalman and  Peter Casciano.