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Medicare vs Medicaid Benefits

What is the difference between Medicare and Medicaid?

Though the names sound similar, Medicare and Medicaid are two different government programs that provide assistance to people across the United States. Medicare is a program that is focused on providing support to the elderly, while Medicaid helps people with limited income. Individuals with disabilities can qualify for both Medicare and Medicaid in some circumstances.

Another major difference between the two programs is that Medicaid frequently covers services not covered by Medicare. Medicaid will often cover costs relating to doctor visits, prescription drugs, and hospital stays under a single program. Medicare divides coverage into the four parts listed above, some of which are covered and some of which are not.

Medicare vs Medicaid Benefits in Kentucky

One of the most significant differences between Medicare and Medicaid is how long-term care is handled. Medicaid will usually cover the cost of a nursing home or assisted living facility that is medically necessary. Medicare’s long-term care benefits are often limited.

Also, depending on the circumstances, a disabled person who is approved for Social Security Disability (SSD) Insurance benefits could also receive either Medicaid or Medicare benefits.

Those who are approved for Social Security Disability (SSD) Insurance benefits can receive Medicare, and disabled individuals who receive Supplemental Security Income (SSI) can also receive Medicaid.

Do you need help determining what medical benefits might be available to you? The Paul Baker Law Office represents people with SSD claims in Barbourville and surrounding areas of Kentucky. You can have one of our experienced social security lawyers review your case and answer all of your legal questions when you call us or complete an online contact form to receive a free consultation.

Overview of Kentucky Medicare Benefits & Coverage

Medicare is the federal health insurance program for Americans 65 years of age and older who have paid payroll taxes. Medicare also covers people younger than 65 who are disabled.

Medicare is divided into four parts:

  • Part A — Hospital/hospice insurance
  • Part B — Medical insurance
  • Part C — Medicare Advantage plans
  • Part D — Prescription drug plans

Medicare is a federal program run by the Centers for Medicaid and Medicare Services (CMS). Part A and Part B costs are usually covered by the government, but participants can pay Part C and Part D costs out of pocket.

According to CMS, there were 56.8 million Medicare beneficiaries in one recent year, 47.8 million of whom qualified based on age and 9 million of whom qualified because of a disability. AARP estimated that this number is expected to reach 79 million by 2030. The Henry J. Kaiser Family Foundation (KFF) reported that there were 862,887 Medicare beneficiaries in Kentucky, or approximately 20 percent of the state population.

People qualify for Medicare when they are approved for SSD benefits. The Social Security Administration (SSA) defines disability as “the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.”

The SSA will consider you disabled under Social Security rules if you cannot do work that you did before, you cannot adjust to other work because of your medical condition, and your disability has lasted or is expected to continue for at least one year or to result in death. Most SSD recipients are automatically covered under Medicare after receiving SSD benefits for two years.

Overview of Medicaid Benefits in Kentucky

Medicaid is a joint federal and state program for Americans with limited incomes. Medicaid also provides coverage for people with disabilities.

CMS is the federal agency that works with state governments to administer Medicaid benefits. In Kentucky, the Department for Medicaid Services in the Kentucky Cabinet for Health and Family Services oversees the handling of Medicaid claims.

While Kentucky implemented a Medicaid expansion under the terms set out in the Affordable Care Act (ACA) in January 2014, Governor Matt Bevin sought a Section 1115 waiver entitled “Kentucky Helping to Engage and Achieve Long Term Health” or KY HEALTH to change the expansion and make terms of enrollment more restrictive. While CMS originally approved the waiver, United States District Judge James E. Boasberg of the United States District Court for the District of Columbia vacated that approval after concluding that the Secretary of the Department of Health and Human Services “never adequately considered whether Kentucky HEALTH would, in fact, help the state furnish medical assistance to its citizens, a central objective of Medicaid.”

CMS reported that there were 52,528,101 individuals enrolled in Medicaid and the Children’s Health Insurance Program (CHIP, known in Kentucky as KCHIP) in expansion states as of June 2018, and there were 20,827,119 people enrolled in these programs in non-expansion states. According to KFF, over 1.2 million people in Kentucky are covered by Medicaid, and 53 percent of the state’s Medicaid spending is for the elderly and disabled. Medicaid covers 1 out of every 2 individuals with disabilities in Kentucky, 2 in 3 nursing home residents, and 2 out of every 5 children in the state.

A person is eligible to apply for Medicaid as soon as they are approved for SSI benefits. SSI awards are based on an applicant’s income and assets. The applicant’s work history does not impact SSI decisions.

Contact an Experienced Medicare and Medicaid Attorney in Kentucky

If you need assistance applying for benefits or appealing a decision for Medicare, Medicaid, or SSD in Kentucky, it is in your best interest to talk to a lawyer. An experienced attorney can help you take the necessary steps to seek the benefits you need and deserve.

The Paul Baker Law Office helps people pursue the benefits they need to support themselves and their families. Call us or contact us online to schedule a free consultation with an experienced and knowledgeable Medicare and Medicaid lawyer today.

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