Understanding Eligibility Criteria for Medicaid and Medicare

Understanding Eligibility Criteria for Medicaid and Medicare

Ana Rangel, Eligibility Manager at LBU

 

Medicaid and Medicare are two government-run health insurance programs that provide healthcare coverage to millions of Americans. While both programs are designed to provide affordable healthcare to those who need it, they have different eligibility criteria and benefits. In this blog, we will discuss the eligibility criteria for Medicaid and Medicare.

Medicaid

Medicaid is a joint federal and state program that provides healthcare coverage to low-income individuals and families. To be eligible for Medicaid, you must meet certain income and asset requirements. The income requirements vary by state and are based on the federal poverty level. In most states, individuals who earn up to 138% of the federal poverty level are eligible for Medicaid. However, some states may have different eligibility criteria, so it is important to check with your state's Medicaid office.

In addition to income requirements, Medicaid also has asset limits. This means that individuals and families must have limited assets to be eligible for Medicaid. The asset limits vary by state, but they typically exclude certain assets such as a primary residence and a vehicle.

Medicare

Medicare, on the other hand, is a federal health insurance program that provides coverage to individuals who are 65 years of age or older, or those with certain disabilities. Medicare also covers individuals with End-Stage Renal Disease (ESRD) and Amyotrophic Lateral Sclerosis (ALS).

To be eligible for Medicare, you must be a U.S. citizen or a permanent legal resident who has lived in the United States for at least five years. You also need to have paid into the Medicare program through payroll taxes for a certain amount of time. The amount of time you need to have paid into the program varies depending on your age and work history.

 

In addition to the eligibility criteria, Medicaid and Medicare also have different benefits. Medicaid provides comprehensive healthcare coverage, including doctor visits, hospital stays, prescription drugs, and long-term care. Medicare, on the other hand, has four parts, each covering different aspects of healthcare. Part A covers hospital stays, Part B covers doctor visits and outpatient services, Part C is a Medicare Advantage plan, and Part D covers prescription drugs.

Understanding the eligibility criteria for Medicaid and Medicare is important to determine if you are eligible for healthcare coverage. Medicaid provides coverage to low-income individuals and families, while Medicare provides coverage to those who are 65 years of age or older, or those with certain disabilities. Both programs have different benefits, and it is important to understand which program may be right for you. If you have any questions about eligibility or benefits, it is recommended to speak with a healthcare professional or contact your state's Medicaid or Medicare office.

For help navigating all Medicare and Medicaid programs or for any other insurance related questions, please call our eligibility department at (214) 752-8204.

 

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