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Alzheimer's Disease and Financial Planning

(continued)

Medicare and Medicaid continued...

What Is Medicaid?

Medicaid is a joint federal-state health insurance program providing medical assistance primarily to low-income Americans. It also is available to people underage 65 if they are blind or disabled.

The purpose of Medicaid is to provide preventive, therapeutic, and rehabilitative health services and supplies that are essential to attain an optimum level of well-being.

How Do People Receive Medicaid Benefits?

There are two ways to receive Medicaid:

  • Supplemental Security Income (SSI) -- People who receive a cash grant under SSI and Aid to Dependent Children are automatically eligible for Medicaid benefits.
  • Medicaid spend down -- This is similar to a deductible or a co-payment that you must pay every month. Once you meet your "spend down" amount, you are eligible for Medicaid for the remainder of the month.

Who Is Eligible for Medicaid?

Medicaid eligibility requirements depend on financial need, low income, and low assets. In determining Medicaid eligibility, officials do not review rent, car payments, or food costs. They only review medical expenses. Medical expenses include:

  • Care from hospitals, doctors, clinics, nurses, dentists, podiatrists and chiropractors
  • Medications
  • Medical supplies and equipment
  • Health insurance premiums
  • Transportation to get medical care

Medicaid Coverage

Medicaid coverage varies from state to state. For specific coverage guidelines, contact your state's Department of Human Services. Generally, Medicaid benefits include:

Transportation

  • Ambulance services when other means of transportation are detrimental to your health
  • Transportation to and from the hospital at time of admission or discharge when required by your condition
  • Transportation to and from a hospital, outpatient clinic, doctor's office, or other facility when the doctor certifies the need for this service

Ambulatory Centers

  • Ambulatory health care centers are often private corporations or public agencies that are not part of a hospital. They provide preventive, diagnostic, therapeutic, and rehabilitative services under the direction of a doctor. Ambulatory services covered by Medicaid include dental, pharmaceutical, diagnostic, and vision care.

Hospital Services

  • Inpatient hospital care
  • Private hospital rooms only when the illness requires you to be isolated for your own health or the health of others
  • Outpatient preventive, therapeutic, and rehabilitative services
  • Professional and technical laboratory and radiological services

Medical Supplies and Medications

  • General medical supplies (when prescribed by a doctor)
  • Durable medical equipment (such as hospital beds, wheelchairs, side rails, oxygen administration apparatus, special safety aids, etc.)
  • Medications prescribed by a doctor, dentist, or podiatrist

Home Health Care

  • Visiting nurse
  • Home health aide
  • Physical therapist

Skilled Nursing Facilities

Skilled nursing facilities and intermediate care facilities (providing short-term care for a patient whose condition is stable or reversible) are covered through Medicaid with a doctor's authorization.

For More Information:

U.S. Department of Health and Human Services
The U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
1-877-696-6775

 

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WebMD Medical Reference

Reviewed by Neil Lava, MD on June 12, 2014
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