Medicaid

If a Medicare beneficiary needs long-term care, he or she is not covered by traditional Medicare. The Medicare program was designed to provide medical benefits, and may only cover medically necessary short-term care services if their are necessary for a person’s recovery from a critical health condition such as sever illness or an accident.

In other words, Medicare beneficiaries needing long term care, must find other resources that may help them pay for long term care costs if they are not able to pay out of their own pocket. One of the programs that may help qualifying individuals with long term care costs, is PACE. The Programs of All-inclusive Care for the Elderly is a Medicaid related program designed to assist persons to meet their health care needs in their community instead of having to live in a nursing or other care facility.

Under specific requirements, PACE helps cover costs for prescription drugs, doctors’ visits, transportation, home health care, medical check-ups, hospital stays, and even stays at a nursing home when necessary.

To qualify for PACE, you must meet all of the following conditions:

• Be 55 or older,
• Live in the service area of a PACE organization,
• Need a nursing home-level of care (as certified by your state), and
• Be able to live safely in the community with help from PACE.

… Read more

There is a common misunderstanding about what Medicare and Medicaid really are, as they sound so similar.

Unlike Medicare, which is solely a federal social insurance program, each state operates its own Medicaid system, which however must follow federal guidelines. Medicaid is sometimes also referred to as ‘Medical Assistance’.

Medicare provides health insurance for seniors 65 years or older, people under 65 with certain disabilities, and persons of any age with End-Stage Renal Disease (ESRD). There are 3 different parts of traditional Medicare, each helping cover specific health services: Part A (Hospital Insurance), Part B (Medical Insurance), Part C (also known as Medicare Advantage) offering health plan options run by Medicare-approved private insurance companies, and Part D (Medicare Prescription Drug Coverage).

Medicaid on the other hand is a needs-based social welfare program, available to certain persons and families with limited income and resources. Eligibility may also depend on age and and other factors such as pregnancy, or whether you are blind or have other disabilities, and whether you are a U.S. citizen. Eligibility is largely determined by income and the rules for counting an applicant’s income and eligibility differ significantly from state to state, although all states must be in line with the federal regulations.… Read more

Medicaid
Ohio Medicaid pays for covered medical bills, dental bills, eyeglasses and homemaker services. Medicaid might pay all of your eligible bills or just
some portion of them – it depends on your income. Certain persons in Ohio covered by Medicare will qualify for full Medicaid. Others can qualify for partial Medicaid, called spend-down.

Ohio Medicaid Eligibility
Single Monthly income: $ 609
Married Monthly income: $ 1,031
Total resources: $ 1,500 (single) $ 2,250 (married)

Medicaid Spend-Down
Ohio Medicaid deducts from your income amounts you pay for covered medical expenses or health insurance.

Qualified Medicare Beneficiary (QMB)
The QMB program acts like a free Medicare supplement policy. QMB pays:
All deductibles and coinsurance that Medicare does not pay
Medicare Part B premium ($115.40/month for those new to Medicare in 2011)

Specified Low Income Medicare Beneficiary (SLMB)
The SLMB program has higher limits than QMB. Once you qualify, SLMB
pays:
Medicare Part B premium ($115.40/month for those new to Medicare in 2011)
Retroactive Part B premium amounts for each of the past three months

Qualified Individual (QI)
Unlike the other programs described in this brochure, QI benefits are
limited to those who apply first. QI pays the Medicare Part B premium
($115.40/month for those new to Medicare in 2011).… Read more