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What is Medicaid? I bring this subject up because a lot of folks out there are confused, mostly Medicare recipients who often think Medicare is Medicaid.

Medicare and Medicaid are two different government-run programs that were both created in 1965 so people who reach “senior” status and low-income citizens are able to purchase private health insurance. Medicare and Medicaid are social insurance programs that allow the financial burdens of illness to be shared among healthy and sick individuals, and affluent and low-income families.

However, Medicaid is not Medicare.

Medicaid is a jointly funded Federal and State health insurance program for low-income and needy people. It covers children, the aged, blind, and or disabled and other people who are eligible to receive federally assisted income maintenance payments. In other words, Medicaid is a state and federal program that provides health coverage if you have a very low income.

Medicare is a federal program that provides health coverage if you are 65 or older or have a severe disability, no matter your income. This basically means you should receive no assistance paying for your secondary insurance. All cases are not the same because there are Medicare funded programs for some Medicare recipients, for example Pace and Pace-net.

Here is some recent news on Medicaid and the requirement to work:

Here at BGA Insurance Group we run into a lot of folks who are eligible for both Medicare and Medicaid. The term we use for this is (dual eligible). This means you can have both Medicare and Medicaid and it will work together to provide you with very substantial health coverage. Unlike Medicare Advantage, Original Medicare and medigap plans will not fall under the dual eligible umbrella.

The current national statistics say that 1 in 5 Americans who are low income with many costly needs for healthcare fall under the Medicaid system. The Affordable Care Act expanded Medicaid to reach low-income adults previously excluded from the program. Over the last 10 years there has been considerable federal funding for this program in addition to state funding.

There are a lot if debates right now in DC about how much federal funding should be thrown at Medicaid. Over the last 9 years we had an administration who used Medicaid funding to certain states as a deal breaker to get the Affordable health care act pushed through.

Now we have an administration who have called for major changes to Medicaid to hold back on federal funding and believe it should be governed by the states as originally planned. There is a lot of data, research and information that has critics at odds about the Medicaid program.

States have received strong financial incentives to manage Medicaid closely and ensure the program’s integrity because they must pay a large share of Medicaid costs and must also balance their budgets.

I bring this up because with all the changes Washington makes regarding Medicare and Medicaid it is important to keep in touch with your BGA agent for the most updated information and facts.

What does Medicaid cover? Although prescription coverage is an optional benefit under federal Medicaid law, all States currently provide coverage for outpatient prescription drugs to all categorically eligible individuals and most other enrollees within their state Medicaid programs.

Some mandatory benefits include inpatient hospital services, outpatient services, physician services and home health services and other benefits included. Optional benefits include prescription drugs, physical therapy and occupational therapy. It is important if you fall under the Medicaid program that you ask your BGA agent what is covered and what is not as every state is different.

Some people ask how often can I change my Medicaid coverage? If you have Medicare and full Medicaid coverage, you can change plans at any time throughout the plan year for example month to month. The plan change will be effective at the beginning of the next month. With traditional Medicare and a medigap plan you can also change any time but you be subject to qualified underwriting.

Where do you apply for Medicaid? In Pennsylvania you can apply in person, through the mail and online. If you want to apply in person you can do so at your local County Assistance Office. There are several locations throughout the state of Pennsylvania to ensure all residents in need of assistance receive it.

If you prefer to apply on-line you can apply through the Department of Human Services’ website. “COMPASS”, Pennsylvania’s health portal, can be accessed at any time of day or night, and can be used to apply for Medicaid, as well as other state-sponsored services. You can also apply by telephone by calling the toll-free number 866-550-4350 and speak to a local representative.

Remember that although you may be applying in the state of Pennsylvania there are different strokes for different folks regarding coverage. BGA Insurance Group is appointed with many A rated insurance carriers like Independence Blue Cross, Aetna, Coventry and United Health Care just to name a few.

BGA is now licensed in Pennsylvania (PA), New Jersey (NJ), Delaware (DE), North Carolina (NC), South Carolina (SC), Maryland (MD) and Florida (FL).

Please contact us if you are looking for income limits or other information as well as dual-eligibility.

Joseph-Bachmeier

Joe Bachmeier is a co-founder of BGA Insurance Group

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