Q If I Dont Qualify For Medicaid Is There Any Other Help For Me Or My Children
A. Yes. Many organizations in Delaware are dedicated to the principle that health care should never be beyond the reach of those who need it. If you need health care, but do not have insurance coverage, the people at the Delaware HelpLine have a wealth of information about organizations that provide health care at reduced rates for uninsured individuals. Call the Delaware HelpLine toll-free at 1-800-464-HELP from Monday Friday from 8:00 a.m. to 5:00 p.m. The Delaware Helpline service is also available in Spanish. Additional information about the support provided by the Delaware Helpline can also be found by visiting www.delawarehelpline.org.
For example, you may qualify to receive discounted medical services through the Community Healthcare Access Program . CHAP helps connect uninsured individuals with affordable health care from primary care doctors, medical specialists, and other health providers including prescription programs, laboratory and radiology services. To find out more about this program, visit the website for the Community Healthcare Access Program, or call 1-800-996-9969 for eligibility guidelines.
You can read about CHAP and other healthcare resources for uninsured individuals in the Delaware Healthcare Resource Guide. This guide is also available in Spanish: Guía de Recursos de Salud.
Under 18:
Over 65:
Legislation Aims To Make Medicare More Affordable For Lower
The Improving Medicare Coverage Act, introduced in the U.S. House in September by Washington Representative Pramila Jayapal, would do away with cost-sharing and premiums for Medicare beneficiaries with income up to 200% of the poverty level .
This bill, or something like it, would eliminate the current sticker shock that can go along with the transition from expanded Medicaid to Medicare. If you have an opinion on the legislation, you can reach out to your elected officials to speak with them about it.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health marketplace updates are regularly cited by media who cover health reform and by other health insurance experts.
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Q How Can I Find Out If I Can Get Medicaid
A. You can find out if you qualify for Medicaid or other medical assistance and social service programs by speaking with a representative at your local State Service Center. Call Medicaid Customer Relations at 1-800-372-2022 or 255-9500 to be directed to the appropriate office where someone can help you.
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Medicare And Medicaid Whats The Difference Are They State Or Federal Programs
Before we get into Medicare Advantage vs. Medicaid, here are some brief basics on Medicare and Medicaid.
Medicare and Medicaid have the same âparentâ agency: the Centers for Medicare & Medicaid Services.
As you might already know, Medicare is a government health insurance program. Itâs mainly for people aged 65 or older, but some people qualify by disability before age 65. âOriginal Medicareâ is made up of Medicare Part A and Part B .
Medicare has four parts:
- Part A: Helps pay for hospitalization costs
- Part B: Helps pay for physician services, lab and x-ray services, durable medical equipment, and outpatient and other services
- Part C: Medicare Advantage plan offered by private companies approved by Medicare to provide at least the same benefits as Original Medicare Part A and Part B .
- Part D: Stand-alone Medicare Part D prescription drug plans and Medicare Advantage prescription drug plans offered by private companies approved by Medicare to assist with the cost of prescription drugs.
Medicaid is also a government health insurance program, but those who qualify generally have low incomes or disabilities, and donât have to be over 65 years old. Medicaid is administered by the states, but must follow certain federal rules.
Medicaid Coverage Has Evolved Over Time
Under the original 1965 Medicaid law, Medicaid eligibility was tied to cash assistance or federal Supplemental Security Income starting in 1972) for parents, children and the poor aged, blind and people with disabilites. States could opt to provide coverage at income levels above cash assistance. Over time, Congress expanded federal minimum requirements and provided new coverage options for states especially for children, pregnant women, and people with disabilities. Congress also required Medicaid to help pay for premiums and cost-sharing for low-income Medicare beneficiaries and allowed states to offer an option to buy-in to Medicaid for working individuals with disabilities. Other coverage milestones included severing the link between Medicaid eligibility and welfare in 1996 and enacting the Childrens Health Insurance Program in 1997 to cover low-income children above the cut-off for Medicaid with an enhanced federal match rate. Following these policy changes, for the first time states conducted outreach campaigns and simplified enrollment procedures to enroll eligible children in both Medicaid and CHIP. Expansions in Medicaid coverage of children marked the beginning of later reforms that recast Medicaid as an income-based health coverage program.
Figure 3: Medicaid has evolved over time to meet changing needs.
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Does Private Insurance Also Cover A Newborn
It depends. Small group employer-sponsored plans must include the EHBs, including maternity and newborn care, but large group and self-insured employer-sponsored plans are exempt from this requirement. While the requirement for newborn care covers childbirth and immediate care following birth, women must enroll their babies in coverage soon after birth.
Who Can Get Medicaid
- No matter your state, you may qualify for Medicaid based on your income, household size, disability, family status, and other factors. But if your state has expanded Medicaid coverage, you can qualify based on your income alone.
- Enter your household size and state. We’ll tell you who is eligible for Medicaid, if your state expanded and if you qualify for Medicaid based only on your income.
- If you think you have Medicaid eligibility, you can create an account and fill out a Marketplace application. If it looks like anyone in your household qualifies for Medicaid or CHIP, we’ll send your information to your state agency. They’ll contact you about enrollment. You can apply any time of year.
- If you don’t qualify for Medicaid, we’ll tell you if you qualify for financial help to buy a Marketplace health plan instead.
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Medicaid Disability Benefits Rules
Your ability to qualify for Medicaid is going to vary depending upon which program you are receiving disability benefits through. Many people obtain disability benefits from the Social Security Administration , while some people receive disability income through workers compensation or through a private disability insurer.
If you are receiving disability benefits through workers compensation for a work injury, your workers comp benefits should cover your medical care for all health issues arising from your work injury. With coverage through workers comp for medical care, you may not need Medicaid. If you still want or need Medicaid coverage to supplement the care that workers comp is paying for, your ability to qualify will depend upon your income and resources.
If you are receiving disability benefits through private insurance, your income will also be determinative regarding whether you are eligible for Medicaid. The amount of countable assets you own is going to matter as well. Medicaid is a needs-based program and people with too many resources or with high incomes cannot get benefits coverage.
Other Mo Healthnet Programs
When you apply for MO HealthNet, we will also check to see if you can get help through:
- Spend Down: If you make too much money, you may still be able to get MO HealthNet coverage if you agree to pay, or spend down, a certain amount. Once you spend this amount, you will have MO HealthNet coverage for the month. For more information visit our frequently asked questions.
- Ticket to Work: If you are disabled and make too much money to qualify for MO HealthNet, you can still get help with your healthcare costs if you agree to take part in this program. Learn more about Ticket to Work.
- Home & Community Based Services: These services may be able to help you or a loved one stay at home and out of a nursing home by providing the in-home services you need.
- MO HealthNet Nursing Home Coverage: If you live in a nursing home, we may be able to help pay for any nursing home costs you arent responsible for. You will be responsible for using all of your income towards costs except for a $50 monthly allowance, any health insurance premiums, and any income set aside for a spouse or other dependents.
NOTE: There is no separate application process for these programs. You will automatically get more information if your MO HealthNet application shows you are eligible.
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Ssi And Ssdi Eligibility
Some disability recipients will be approved for concurrent benefits that is, they will draw disability money from both SSDI and SSI. In such instances, the issue of whether a claimant will get Medicare or Medicaid is not so cut and dry. Claimants who are approved for concurrent disability benefits should consult their local Social Security office regarding their Medicare/Medicaid eligibility.
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How Much Does Medicaid Cost
For most health care services, you won’t pay anything, or you’ll have just a small copayment at the time of your visit. Most often, you show your Medicaid coverage card, and the state pays the full cost of your care to your doctor directly.
Some states, under a federal waiver, charge a monthly premium for certain eligibility categories.
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What Does This Mean
Imagine that you have an employer insurance plan, but it has a high deductible, and you have to pay out of pocket for your first $3,000 before the insurance will pay anything. If you are Medicaid eligible, Medicaid will be the second insurance , and Medicaid will pick up what the employer insurance doesn’t cover.
Medicaid as a secondary insurance can significantly reduce your bills!
Will Medicaid Pay For Primary Insurance Copays
Most Medicaid recipients in Arizona dont owe a monthly premium for the services. Instead, youll only need to make payments while receiving care.
If youre 19 or older, you might have to make small copayments for Medicaid-covered services. You wont have to cover copayments, however, if youre 18 or younger, pregnant, in hospice care, or exempt under certain other conditions.
Arizona Medicaids copayments will be much more affordable than copayments from private insurance companies. Keep in mind that if your primary insurance provider charges a copay to receive services, Medicaid may not cover that. You will need to contact your Medicaid service provider to find out.
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What To Do If Your Life Insurance Keeps You From Getting Medicaid
If your life insuranceâs cash value amount disqualifies you from Medicaid, you can get rid of your policy by canceling it â you may get some cash surrender value â or selling it, which isnât recommended. You can maintain some amount of coverage by:
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Converting to extended term life insurance: A common option in most permanent policies, this allows you to use your cash value to purchase a new policy with the same death benefit for a shorter coverage period.
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Taking a reduced paid-up option: This option uses your accumulated cash value to purchase a new permanent insurance policy with no premiums owed and no cash value. The amount will be lower than your original death benefit, but you get lifetime coverage.
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Transferring your policy: Transferring ownership of your life insurance policy to a family member or an irrevocable trust means the cash value is no longer your asset. An estate planning attorney can walk you through the process.
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Use your cash value to pay your premiums: If youâve built up enough cash value you may be able to spend it down by using it to pay your premiums, then resume payments once the amount is below the maximum allowed by Medicaid.
If someone still depends on you for financial support, consider the alternatives to canceling your policy. A reduced paid-up or extended term option ensures your loved ones have financial support but doesnât come with continued premium payments.
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Q Where Do I Go To Apply For Medicaid
A. There are several ways to apply for Medicaid and other medical assistance programs:
- On the internet, you can use ASSIST to check your eligibility for several different assistance programs by completing a self-screening questionnaire. ASSIST then allows you to apply online.
- You may also print an Application for Health Insurance/Medicaid. The application form is also available in Spanish/en Español.
- By phone, you can contact Medicaid Customer Relations at 1-800-372-2022 or 255-9500 to be directed to the Division of Social Services office closest to where you live. DSS staff members will help you find out more about eligibility for Medicaid and other assistance programs. Then the appropriate information and application forms will be mailed to you. Complete, sign and date the application form in ink and mail it to the address provided.
- For Long Term Care applications, please call the Long Term Care Medicaid Unit listed for the county where you live.
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Can I Apply For Medicaid If We Already Have Private Health Insurance
Medicaid is one of the most famous entitlement programs in America, but there is some confusion on who can apply and how they can do it. Medicaid is available to people who fit into several categories, including those with very low incomes, some who are disabled and the children of people who fit into various categories. If youre thinking about trying to qualify for Medicaid, you need to know whether you qualify. One of the most common questions has to do with private health insurance. Are you barred from seeking Medicaid if you already have insurance? The short answer is no, but there are other questions to answer about your financial situation.
Medicaid eligibility varies from state to stateThe first thing to know about Medicaid eligibility is that there is no singular national standard. The original version of the Affordable Care Act sought to force states to expand Medicaid to include people up to a higher level of income. The Supreme Court struck this down as unconstitutional, though, leaving states to make a choice on expansion. While some states chose to expand the program, others chose to keep it the same. This has let to a hodgepodge of state requirements.
Medicare For Disabled Persons On Ssi
If youve been approved for SSI, can you receive Medicare coverage? In most states, SSI claimants normally only receive Medicaid insurance. Keep in mind that Medicaid is based on asset and income limitations. Its a county- and state-administered program for low-income individuals that helps them pay for prescriptions and doctor visits every month. It may even pay for nursing home care in some circumstances.
If you receive SSI, will you ever qualify for Medicare? SSI recipients only qualify for Medicare coverage once you reach the age of 65 and if you only received SSI and no other disability payments. Once you reach 65 years of age, you can complete an uninsured Medicare claim and save your state from paying for Medicaid coverage. Instead, they reduce costs by paying your medical premium for Medicare.
Medicare also provides Extra Help for individuals with limited assets and income to cover prescription drug costs. Extra Help pays for the premiums and co-pays of a Medicare prescription drug plan. See the Social Security Administration website to apply.
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If You Qualify For Both Medicare And Medicaid Youre Whats Known As Dual Eligible
Medicare provides medical coverage and benefits to people age 65 or older, or who have a qualifying disability. Medicaid is a federal and state program that helps with medical costs for some people with limited income and resources, and also offers benefits not normally covered by Medicare.
In most cases, even if you have Medicaid, you must enroll in Medicare when youre eligible. This is because Medicare is the primary insurance and will provide benefits and coverage for health care services you need. If you do not enroll when youre eligible, you may face a late enrollment penalty.
That said, you are able to be enrolled in both Medicare and Medicaid at the same time, and just because you become eligible for Medicare does not mean youll lose Medicaid. This is called dual eligibility, and more than 12 million people are dual eligible each year.
Understanding when youre eligible, how to be eligible, and how Medicare and Medicaid work together can help bring clarity to your health care coverage needs.
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