Medicaid and Medicare programs contain different eligibility requirements.
The federal government provides states with federal funds to administer subsidized health insurance plans to its low-income and senior citizen residents. Known as Medicaid and Medicare, eligibility requirements for each program differ. The Social Security Administration office of each state is charged with eligibility determination and processing of claims. In addition to meeting each program's eligibility requirements, recipients must be lawful U.S. residents or citizens.
Medicare's Basic Coverage
The Medicare program provides health insurance to senior citizens who are at least 65 years old, those younger than 65 with certain health conditions and serious disabilities or individuals suffering from permanent kidney disease who need a transplant or dialysis treatments. The different coverage rules for various Medicare plans or parts determine whether individuals must pay for coverage.
Parts A, B and D of Medicare
Medicare has several basic components. Coverage under Part A is typically free and depends upon previous payroll contributions and taxes to subsidize Medicare benefits. Medicare Part A covers hospital care, a limited amount of nursing home care and hospice care. Part B is Medicare's medical insurance plan, and recipients typically pay a premium for this portion. Part B covers outpatient treatment, doctors, limited amounts of physical therapy and home health care. Part B's monthly premium amount for 2010 is $110.50. Part D, prescription drug insurance provides drug coverage and reduced prescription drug fees. Recipients pay monthly fees for this insurance, and private drug and insurance companies maintain the insurance for the recipient.
Medicaid's Basic Coverage
Medicaid coverage is available to individuals with very limited incomes. Eligible applicants are age 65 or older, under 65 with covered disabilities and blind individuals. All applicants must have limited household incomes and assets. Individuals receiving Supplemental Security Income through their state's Social Security office generally automatically qualify for Medicaid coverage.
Medicaid's Asset Limitations and Reimbursement
Medicaid coverage provides reimbursement to physicians who provide Medicaid patients with healthcare. Since Medicaid's requirements and rules slightly differ from Medicare's rules, states are generally responsible for administering Medicaid and determining eligibility. In order for states to receive federal funding assistance, states must implement their own asset-recovery programs to ensure most recipients possess very limited assets and will help pay their Medicaid benefits if they have assets that exceed the limited resource amount but disallowed due to the Medicaid restrictions.
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