What is Medicaid and Medicare?

Health insurance can very confusing.   If you are retired, you may have insurance from your previous employer.   If you are lower-income and/or a senior on social security, you may qualify for state and federal health coverage programs.

Millions of Americans on insured by government programs in order to get the healthcare they need.   There are two options when it comes to government-run programs, Medicaid and Medicare.

What is the difference between Medicaid and Medicare?

Although very similar, Medicaid and Medicare serve two different populations.   Medicaid is a program run by a state and the federal government.   It provides coverage if you are considered low income regardless of age.   Each state runs its own Medicaid program.  

Medicare is solely a federal program that provides health coverage to people who are 65 or older and have a qualifying work history or if they are under 65, they must have a disability regardless of income.

Some people can be eligible for both Medicare and Medicaid.   They are considered dual-eligible. Both programs are in place to help people in need including seniors.

How do I get on Medicare or Medicaid?

To get on Medicaid you must apply either in person or online.   The local Medicaid office in your state will determine if you are eligible.   You may need to provide them with documentation.

You can apply for Medicare if you are 65 or older and have worked under the social security system or if you are on disability.   You can apply online or at the local Medicare office.

The biggest difference between the two is Medicaid usually covers what Medicare doesn’t.

How does Medicaid and Medicare Work?

Each state may work a little differently for both types of insurance.   You can either get your care straight through Medicaid or Medicare or you can enroll in a health plan.   For Medicare, this is known as a Medicare Advantage Plan.    If you enroll in a health plan, they are responsible for your healthcare needs.   The health plan must cover everything Medicaid and Medicare cover, however, they may also have other benefits they cover on top of what is already covered by government healthcare.   You can compare health plans in your state and choose the one that fits your needs best.

If you are eligible for both types of insurance, it is possible to have a different insurance carrier for each line of business.   

Medicare also offers supplemental programs to help with costs if you are low income.   These include:

Medicare Savings Programs (MSPs)

Extra Help

State Pharmaceutical Assistance Programs

Coverage

Medicaid

  Pays for basic healthcare needs such as doctor visits and hospital stays.  

Pays for the cost of assisted living, nursing homes, and other long-term care as long as it is medically necessary.

Some services may have minimum co-pays

Medicare

Part A covers hospital stays and nursing homes for recovery purposes as well as homecare.

Part B covers doctor visits, labs, outpatient care and some carved out services such as dietitians or medical equipment.

Part C is the Medicare Advantage that is provided by private insurance.

Part D is the pharmacy component and it pays up to $3,750 in prescription costs.   Insured must pay out of pocket until the cost reaches $5,000 and then Medicare payment kicks back in.

Medicaid and Medicare Coverage for Personal Emergency Alert Systems (PERS)

An important benefit of the Medicaid program is that it pays for the cost of a medical alert system.   The cost of a PERS may be a barrier for low income seniors and their families who want the peace of mind of having an alert system.

There are four programs through Medicaid that provide funding to pay for a PERS system.

• Home Community Based Services Waivers- This is the most common funding source for medical alert systems.   Through this program the waiver will cover the monthly cost of a medical alert system that costs between $25-$75 a month.   There is also a waiver for up to $200 to pay for the initial costs of setting up the system.
• Consumer Direct Services- This funding is for daily assistive care.   The type of care is not specified so the insured can determine that a medical alert system is assistive care.
• Money Follows the Person (MFP)- This is a grant for people who are in nursing homes or assisted living facilities.   If they wish to go back to their home or the home of a family member, a medical alert system will be covered as part of the aging-in-place initiative.
• State Plan Care Attendant – These are entitlement programs and work like the Home Community Based Services waiver.

Medicare does not cover the cost of medical alert systems, however if you have a Medicare Advantage Plan, it may be covered under Medicare Part C.   This will vary for each carrier, so check with your insurance company to see if medical alerts are a covered benefit.

 How to get  Medihill® Medical Alert System by Medicaid, Medicare or other Insurance

If you would like to get you Medical Alert paid by your insurance program, you need to contact either your Case Manager or Insurance Agent to verify your eligibility. Make sure that you let them know that Medihill should be your Provider. They will add Medihill as the service provider and will send the Authorization form to us. After that we will contact you and arrange the delivery and activation.

We are at Medihill are not able to contact any insurance company on behalf of the participant. If you would like to start the service immediately than you can pay by credit card and we will issue the refund once your insurance pays for it.