Medicare

1

• Medicare
• Medicaid

2
Public Health Care - Medicare

• Medicare goes along with SSDI
• 2 year waiting period after becoming eligible for
  SSDI
• Not means tested
• Administered by the federal government
• Standard benefits

3
Medicare

• Medicare Part A
• Hospital insurance that pays for inpatient
  hospital stays, care in a skilled nursing
  facility, hospice care and some home health care.
  
• Medicare Part B
• Medicare medical insurance that helps pay for
  doctors' services, outpatient hospital care,
  durable medical equipment, and some medical
  services that are not covered by Part A
• Medicare Part D
• Prescription Drug Program new Jan 2006

4
Public Health Care - Medicaid

• Medicaid goes along with SSI
• Means tested programs (financial criteria)
• SSI recipients are eligible for Medicaid
• Some states require a separate application
• While most provide Medicaid automatically to SSI
  eligible recipients
• Medicaid is administered by each state
• If youve seen one state Medicaid program,
  youve seen one state Medicaid program.

5
Medicaid / Medicarefor people with disabilities
who work
6
Medicare vs. Medicaid

• Medicare is administered by the Social Security
  Administration
• Age 65, or
• Received Social Security disability 2 years, or
• End-stage renal failure

• Medicaid is administered by the State.
• For low income families, senior citizens and
  persons with disabilities.
• Must meet specific program criteria.

7
Medicare

• Medicare Part A
• Hospital insurance that pays for inpatient
  hospital stays, care in a skilled nursing
  facility, hospice care and some home health care.
  
• Medicare Part B (optionalrequires premium)
• Medicare medical insurance that helps pay for
  doctors' services, outpatient hospital care,
  durable medical equipment, and some medical
  services that are not covered by Part A
• Medicare Part D
• Prescription Drug Program new Jan 2006

8
Things to remember about Medicaid

• A federal-state partnership.
• Each state develops its own State Plan.
• The Federal government matches State money.
• Match rates vary from state to state.
• Medicaid will supplement other health insurance

9
Continuation of Medicaid 1619a and 1619b
-for people on SSI who work

• 1619a
• Earning above SGA amount (800 for 2007)
• Check is reduced by Earnings Disregard (85 ½)
• Continues to receive some SSI
• 1619b
• Earnings too high for monthly SSI check (0 SSI)
• Earnings under the Medicaid threshold amount
  (27000 for Utah)
• Disability continues, and assets below limit

10
Continuation of Medicare(for people on SSDI who
work)

• If Social Security disability benefits stop
  because of earnings, but person is still disabled
• Medicare coverage will continue for at least 7½
  years after the nine-month trial work period.
• After that, individuals can buy Medicare coverage
  by paying a monthly premium.

11
Medicaid Buy-In for people with disabilities who
work

• Why? People with disabilities should not have
  to live in poverty to have health care coverage.
• Congress authorized option for states in 1997
• Allows earnings up to 450 of Federal Poverty
  Limit
• Allows higher asset limits than other Medicaid
  groups
• In Utah Medicaid Work Incentive (MWI) program

12
SSA vs. Medicaid

• Social Security Disability Determination Service
  and the Medicaid Medical Review Board use the
  same medical criteria (individuals w/significant
  disabilities more likely to meet criteria).
• If disability is denied by Social Security
  because the individual is earning too much money
  Substantial Gainful Activity (SGA)-900/month,
  the State Medicaid Medical Review Board may still
  look at disability without considering the SGA.

13
Primary Care Network (PCN)

• Services are limited. They include
• Primary care (what your doctor can do in his
  office).
• Pharmacy maximum of 4 prescriptions a month
• Emergency Room
• 50 annual enrollment fee