Questions about Medicaid/ Medicare and Health Insurance:

Individuals who receive Medicaid and Medicare may have a number of questions about these types of healthcare coverage. Below is a list of frequently asked questions pertaining to Medicaid, Medicare and other types of healthcare coverage.

Q: What is the difference between Medicaid and Medicare?

A: Many people confuse Medicaid and Medicare. Medicaid and Medicare are both forms of health insurance; yet eligibility for each program is different. Medicaid is the state-federal funded program for low income children and families, elderly and people with severe disabilities. Medicare is a federally funded health insurance program for Social Security beneficiaries.

Congress created Medicaid as part of the Social Security Act in 1965. Sometimes Medicaid is referred to as “Title 19”. Medicaid is funded by both the federal government and the state. The Center for Medicare and Medicaid Services (CMS) is the federal agency that administers the Medicaid program, and requires all states to provide certain mandatory services. However, because states must also provide funding for their Medicaid program, each state chooses several optional services they wish to provide in addition to the mandatory Medicaid services.

Although the definition of disability eligibility requirements for Medicaid are similar to the definition of disability eligibility requirements for SSI, in Indiana, individuals must make a separate application for Medicaid.

Medicare is a federally funded health insurance program for Social Security beneficiaries. In general, Individuals with disabilities who are eligible for Social Security Disability Insurance or Social Security for Childhood Disability Benefits will have a 24-month waiting period (also called a Medicare Qualifying Period) after their disability cash benefits begin before they will receive Medicare coverage. Some people qualify for both Medicaid and Medicare. There are several  parts to Medicare:

• Medicare Part A covers hospital insurance. If you are eligible for Social Security Benefits and have received these benefits for 24 months, you will probably be eligible for Medicare Part A.

•  Medicare Part B helps pay for doctors services and a variety of other medical supplies. Medicare Part B is voluntary and is financed in part by monthly premiums.

• Medicare Part C is Medicare’s managed care program, also known as Medicare Advantage.  Some people find this program is useful to them.  To learn if you may benefit from the Medicare advantage program, you may contact Indiana’s State Health Insurance Assistance Program---SHIP at 1-800-772-1313 or go to the following link: http://www.in.gov/idoi/2495.htm

• Medicare Part D is a program that helps Medicare beneficiaries cover the costs of prescription drugs. To find more information on this program, you may call 1-800 MEDICARE or visit the following websites: http://www.in.gov/idoi/2495.htm http://www.medicare.gov/

Q: What will happen to my Medicaid if I go back to work?

A: Depending on whether you receive SSI or SSDI, you have some options to continue Medicaid coverage when you return to work.

If you receive SSI:

• If you have earnings higher than $1433 per month, yet your earnings are low enough that you are still eligible for an SSI benefit, (even if it’s just a small amount of SSI) you will continue your Medicaid under Section 1619a of the Social Security Act.

• If your earnings are high enough that you no longer receive an SSI check but less than $32,615 gross earnings annually (the amount in Indiana in 2009), and you need Medicaid in order to continue working, and you continue to have a disability, you are eligible for continued Medicaid coverage under Section 1619b of the Social Security Act.

• If your gross earnings are over $32,615 annually, and you continue to have a disability and need Medicaid in order to keep working, you may be eligible for MED Works, Medicaid for employees with disabilities. This is Indiana’s Medicaid work incentive.

• Remember, in order to keep your Medicaid under Section 1619b, your resources must be under $1500 for a single individual and $2250 for an eligible couple in Indiana. Resources are defined as assets or things you own, such as cash (savings accounts) or things that can easily be converted to cash, such as cars, property, livestock, and life insurance that might have a cash value. Resources that are typically disregarded are a home (if it is your primary residence) or one automobile if it is used to drive to work or medical appointments.

• To receive Medicaid, you must report all income, resources, in addition to their address, and any household changes to the caseworker at the Division of Family Resources. Accurate and complete record keeping is important to avoid any problems with reporting for Medicaid.

• If you are working, always provide your paycheck stubs to the Division of Family Resources caseworker.

If you receive SSDI:

• If your resources are under $2000 for an individual and $3,000 for an eligible couple, you may qualify for MED Works, Medicaid for Employees with disabilities. This is Indiana’s Medicaid work incentive.

• MED Works allows working individuals with incomes too high for regular Medicaid to be eligible for health coverage. If your income is more than 150% of the federal poverty level, you will be charged a premium on a sliding-fee scale based on your income. If you are eligible for MED Works, you will receive the full-range of traditional Medicaid-covered services and will pay the same co-payments for services.

• If you are working, always provide your paycheck stubs to the Division of Family and Children caseworker.

Q: What happens to my Medicare if I go back to work?

A: As long as you continue to have a disability, you should be able to keep your Medicare when you go to work for at least the first 12 months. After that, if you are still disabled, you will be able to keep your Medicare if you continue working. There is a special provision that is called Extended Medicare Coverage that allows Social Security beneficiaries who have worked their way off of benefits to continue Medicare coverage. This extended coverage is for at least 93 months following the completion of the Trial Work Period. Because work efforts vary from individual to individual, please talk to a benefits counselor of the Social Security Administration to see the exact dates that Extended Medicare Coverage will last.

For some individuals who are “dual eligibles” (eligible for Medicaid and Medicare) Medicare Part D will help to pay for prescription drugs.

Q: I receive Medicaid or Medicare and have a job. Should I accept my employer’s health insurance?

A: It is usually a good idea to get additional coverage under your employer’s health insurance. Look for plans that will cover your doctor and hospital bills with little deductible or co-payment, your prescriptions, and those that do not have a waiting period for pre-existing conditions. Private insurance will usually cover your medical expenses first, and Medicaid and Medicare will cover the remainder of your medical costs. If you receive Medicaid, you may also want to understand the rules for Medicaid and Care Select. This is Indiana’s Medicaid managed care program. You may want to check to see if your primary provider under Medicaid also accepts your employer health insurance coverage.

Q: What if an employer’s health insurance plan does not cover pre-existing conditions?

A: In 1996, the Health Insurance Portability and Accountability Act (HIPPA) was passed in congress. This law says that employers cannot exclude a pre-existing condition for longer than 12 months. In addition, if you had coverage under a group health insurance plan for at least 12 months, when you start a new job, your new health insurance must cover pre-existing conditions right away. If you’ve been receiving Medicaid or Medicare you also have some protections under HIPAA. The Indiana Department of Insurance.

Q: How do I apply for Medicaid?

A: You may apply for Medicaid at your local Division of Family Resources office.

Q: What is a Medicaid spend-down?

A: Medicaid spend-down is a provision which enables you to qualify for some Medicaid assistance even if your income or assets exceed the Medicaid eligibility standards. A spend-down amount is the amount of medical expenses you are responsible for paying and which Medicaid cannot pay. Each month when your medical expenses equal or exceed your spend-down amount, Medicaid can help pay your remaining medical expenses.

Q: What is MED Works?

A: MED Works (Medicaid for Employees with Disabilities) is Indiana’s Medicaid Work Incentive.