Medicaid, Medicare and Affordable Health Care
The following information is in regards to United States regulations and resources. Although we value our international members of the K-T.org community, at this time we do not have enough information on the regulations and resources of other countries to place that information on our website. If some of our international members would like to assist with this project, please email [email protected]
Medicare is a federal insurance program available to two primary groups:
- Individuals age 65 and older
- Individuals receiving social security disability for at least two years
Those with permanent kidney failure and ALS are also eligible for Medicare.
Medicare includes Parts A, B, C, and D depending on which you qualify for. Part A is Medicare insurance without premiums, Part B is insurance that includes a premium, parts C and D are prescription plans to go with the insurance.
For more detailed information see the U.S. Medicare site.
From Centers for Medicaid and Medicare Services https://www.cms.gov/
Medicaid non-emergency medical transportation (NEMT) is an important benefit for beneficiaries who need to get to and from medical services but have no means of transportation. The Code of Federal Regulations requires States to ensure that eligible, qualified Medicaid beneficiaries have NEMT to take them to and from providers.
However, every State’s Medicaid program is different. In addition, each State has the option of developing and implementing Medicaid waiver programs, which can provide coverage for additional transportation needs. Waiver program rules can also vary from State to State and even within the same State’s programs. Providers are responsible for knowing and abiding by the specific rules for each State where they furnish services, and for each of the programs for which they furnish services. The booklet cites Statespecific examples to illustrate the rule discussed.
Medicaid is an insurance program supported by a combination of state and federal funds. Medicaid is managed at the state level. Each state has its own requirements for eligibility relevant to financial or family status. However, all states provide Medicaid for individuals receiving social security disability benefits as well as for pregnant women.
States have some discretion over what medical services will be covered by Medicaid, however the following services are federally mandated for Medicaid coverage in all states:
- Inpatient and outpatient hospital services
- Screening, treatment, and diagnostic services
- Nursing facility services
- Home health care
- Doctor's services
- Rural health clinic services
- X-ray and laboratory services
- Family planning services
- Midwife services
- Freestanding Birth Center services
- Pediatric and Family Nurse Practitioner services
- Tobacco cessation counseling for expectant mothers
Some individuals qualify as being both Medicare and Medicaid eligible. This is known as being "dual eligible". Those who are dual eligible may be able to receive additional coverage benefits for their insurance and prescription plans.
Affordable Health Care
Affordable health care coverage through a private insurance marketplace system is one of the key features of the Affordable Health Care Act of 2010. Individuals who do not qualify for Medicare or their state Medicaid program can select an insurance plan through the marketplace system. If you meet certain financial criteria, you may be eligible for a discounted subsidized rate on the premiums and other expenses associated with your selected plan.
Some states have their own website for registering for Affordable Healthcare coverage, however the Healthcare.gov site is a good place to start.
Page last updated June 10, 2019