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PSSC DISCUSSIONS

Facts About Medicare and Medicate

Friday, July 29, 2016

There is a lot of confusion about the Medicare and Medicaid programs. When I talk to people about Medicare they often ask about Medicaid but what they are referring to is Medicare Part B. I will give a brief explanation of both to try and resolve this confusion.

Medicaid is a federal program for medical coverage of individuals using needs based criteria. The basis for entitlement to these benefits is determined by each state, and the benefits are administered by the county Department of Jobs and Family Services. There is no age requirement for the benefits.

In many states, entitlement to Supplemental Security Income (SSI) benefits automatically entitles you to Medicaid. Medicaid is not tied directly to Medicare but states will pay the monthly Medicare Medical Insurance (Part B) premium for individuals entitled to both insurance programs. Medicare is the primary insurance carrier in these situations and it saves the states Medicaid money to pay these premiums.

Medicare is a federal program run by the Center for Medicare Services (CMS). You enroll in Medicare at the Social Security Administration (SSA). Medicare Hospital Insurance (Part A) is premium free for individuals who are age 65 and have at least 40 quarters of coverage and are therefore entitled to monthly SS benefits. You also qualify if you have received a monthly Social Security disability benefit for 24 months, or if you have End Stage Renal Disease (ESRD).

You don’t have to draw these benefits but you do have to be entitled to receive them. Medicare Medical Insurance (Part B) is available to those outlined above. The basic cost is currently $115.40 per month. Medicare prescription drug coverage is also available to those enrolled in Medicare for an additional monthly premium. The premium is based on the plan you choose and where you live.

For more information about entitlement to Medicaid you should contact your local Department of Jobs and Family Services. For more information about Medicare you should contact CMS or SSA.

Jim Blair
Social Security Consultant
1-800-518-0761
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