All About Medicaid
What is Medicaid part A and part B?
Medicaid Part A
Is sometimes referred to as “hospital insurance.” As the name implies, this is the Medicare plan that covers hospital stays and inpatient treatment. For treatment to be covered by Medicare Part A, it must be deemed medically necessary. This means a doctor has agreed that the treatment is required to prevent or treat a condition or illness.
Medicare Part A covers:
● Home health services, including nursing care, physical therapy, and occupational therapy
● Hospice, is care aimed at making terminally ill individuals as comfortable as possible after they decide they no longer want to pursue treatment for their illness
● Hospital care, including long-term care facilities and inpatient rehab
● Nursing home care, but only if the beneficiary requires more than custodial care
● Skilled nursing facility care, including meals, supplies, and nurse-administered injections
How much Part A covers for these services depends on which type of facility you stay in, whether you've met the deductible (which resets for each new stay), and how long your stay lasts.
Medicare Part B
Is known as “medical insurance” because it covers doctor visits and
medical care outside the hospital. Like with Medicare Part A, treatment must be
determined as medically necessary or preventative to be covered by Medicare Part B.
Medicare part B covers:
● Ambulance services, including the ride and any medical care administered
● Doctor’s office visits
● Durable medical equipment, or DME, which is equipment such as wheelchairs,
walkers, and bathtub transfer benches
● Bloodwork and lab tests
● Mental health and substance abuse treatment.
● Outpatient surgery, which is surgery where you return home the day of the
procedure rather than staying in a hospital or facility to recover
Medicare Part B also covers a variety of preventive care services:
● Tobacco cessation therapy
● Annual wellness visits
● Nutrition therapy
● Flu shots
● Diabetes screenings
● Cancer screenings
● HIV and STD screenings and counseling
Preventive care is care intended to prevent disease, rather than treat disease after it
has occurred
Medicare Part B pays 80% of costs for covered services, leaving beneficiaries to pay
the remaining 20% of Part B expenses out of pocket.
What Part A and B don’t cover:
● Acupuncture
● Cosmetic surgery
● Dentures
● Eye exams for prescription glasses
● Hearing aids and related exams
● Long-term custodial care
● Most dental care
● Most prescription drugs
● Routine foot care
If you require any of these services, you may want to consider switching to a Medicare Advantage Plan that offers additional coverage beyond Original Medicare, which is a common term for Part A and Part B combined. Or, consider adding Part D prescription drug coverage. Learn more about Original Medicare versus Medicare Advantage.
Who is eligible for Medicare?
You’re 65 or older.
You qualify for full Medicare benefits if:
● You are a U.S. citizen or a permanent legal resident who has lived in the United States for at least five years and
● You are receiving Social Security or railroad retirement benefits or have worked long enough to be eligible for those benefits but are not yet collecting them.
● You or your spouse is a government employee or retiree who has not paid into Social Security but has paid Medicare payroll taxes while working.
Younger than 65? You still may be eligible
You qualify for full Medicare benefits under age 65 if:
● You have been entitled to Social Security disability benefits for at least 24 months (that need not be consecutive); or
● You receive a disability pension from the Railroad Retirement Board and meet certain conditions; or
● You have Lou Gehrig’s disease, also known as amyotrophic lateral sclerosis (ALS), which qualifies you immediately; or
● You have permanent kidney failure requiring regular dialysis or a kidney transplant — and you or your spouse has paid Social Security taxes for a specified period, depending on your age.
Other ways to get Medicare coverage
If you do not qualify on your own or through your spouse’s work record but are a U.S.
citizen or have been a legal resident for at least five years, you can get full Medicare
benefits at age 65 or older. You just have to buy into them by:
● Paying premiums for Part A, the hospital insurance. How much you would have to pay for Part A depends on how long you’ve worked. The longer you work, the more work credits you will earn. Work credits are earned based on your income; the amount of income it takes to earn a credit changes each year. In 2021 you earn one work credit for every $1,470 in earnings, up to a maximum of four credits per year. If you have accrued fewer than 30 work credits, you pay the maximum premium — $471 in 2021. If you have 30 to 39 credits, you pay less — $259 a month in 2021. If you continue working until you gain 40 credits, you will no longer pay these premiums.
● Paying the same monthly premiums for Part B, which covers doctor visits and other outpatient services, as other enrollees pay. In 2021 the amount is $148.50 for individuals with a yearly income of $88,000 or less or those filing a joint tax return with $176,000 in income or less. Rates are higher for people with higher incomes.
● Paying the same monthly premium for Part D prescription drug coverage as others enrolled in the drug plan you choose.
You can enroll in Part B without buying Part A. But if you buy Part A, you also must
enroll in Part B.
You can get Part D if you’re enrolled in either A or B.
You cannot enroll in a Medicare Advantage plan, which is a private insurance alternative
to Original Medicare, or buy a Medigap supplemental insurance policy unless you’re
enrolled in both A and B.
How to apply for Medicare?
Apply via internet by going to SSA.gov
Apply via phone by calling 1-800-772-1213 or 1-800-325-0778, if you’re deaf or hard of hearing.
It could be done in person but offices are currently closed until further notice.
For more information on other services and coverage either call the above numbers or go to
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Medicaid
What is Medicaid?
Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by states, according to federal requirements. The program is funded jointly by states and the federal government.
Who is eligible?
To participate in Medicaid, federal law requires states to cover certain groups of individuals. Low-income families, qualified pregnant women and children, and individuals receiving Supplemental Security Income (SSI) are examples of mandatory eligibility groups (PDF, 177.87 KB). States have additional options for coverage and may choose to cover other groups, such as individuals receiving home and community-based services and children in foster care who are not otherwise eligible.
The Affordable Care Act of 2010 created the opportunity for states to expand Medicaid to cover nearly all low-income Americans under age 65. Eligibility for children was extended to at least 133% of the federal poverty level (FPL) in every state (most states cover children to higher income levels), and states were given the option to extend eligibility to adults with income at or below 133% of the FPL.
Most states have chosen to expand coverage to adults, and those that have not yet expanded may choose to do so at any time. See if your state has expanded
Medicaid coverage to low-income adults.
MAGI is the basis for determining Medicaid income eligibility for most children, pregnant women, parents, and adults. The MAGI-based methodology considers taxable income and tax filing relationships to determine financial eligibility for Medicaid. MAGI replaced the former process for calculating Medicaid eligibility, which was based on the methodologies of the Aid to Families with Dependent
Children program that ended in 1996. The MAGI-based methodology does not allow for income disregards that vary by state or by eligibility group and does not allow for an asset or resource test.
To be eligible for Medicaid, individuals must also meet certain non-financial eligibility criteria. Medicaid beneficiaries generally must be residents of the state in which they are receiving Medicaid. They must be either citizens of the United States or certain qualified non-citizens, such as lawful permanent residents. In addition, some eligibility groups are limited by age, or by pregnancy or parenting status.
Once an individual is determined eligible for Medicaid, coverage is effective either on the date of application or the first day of the month of application. Benefits also may be covered retroactively for up to three months prior to the month of application, if the individual would have been eligible during that period had he or she applied. Coverage generally stops at the end of the month in which a person no longer meets the requirements for eligibility.
DCF determines Medicaid eligibility for:
● Parents and caretakers relatives of children
● Children
● Pregnant women
● Former Foster Care Individuals
● Non-citizens with medical emergencies
● Aged or disabled individuals not currently receiving Supplemental Security
Income (SSI)
What to do if Medicaid is denied?
States must provide individuals the opportunity to request a fair hearing
regarding a denial, an action taken by the state agency that he or she believes
was erroneous, or if the state has not acted with reasonable promptness. States
have options for how to structure their appeals processes. Appeals may be
conducted by the Medicaid agency or delegated to the Exchange or Exchange
Appeals Entity (for appeals of denials of eligibility for individuals whose income
is determined based on MAGI). Appeals also may be delegated to another state
agency, if a state obtains approval from CMS under the Intergovernmental
Cooperation Act of 1968. For more information go to
https://www.medicaid.gov/medicaid/eligibility/index.html. Also, please refer to
https://www.myflfamilies.com/service-programs/access/medicaid.shtml
What does it cover?
● Alternative Benefit Plans
● Autism Services
● Behavioral Health Services
● Dental Care
● Early and Periodic Screening, Diagnostic, and Treatment
● Hospice Benefits
● Mandatory & Optional Medicaid Benefits
● Prevention
● Telemedicine
How to apply?
Go to https://www.myflorida.com/accessflorida
FAX: 1-866-886-4342
Mailing Address
ACCESS Central Mail Center
P.O. Box 1770
Ocala, FL 34478-1770
Or call 850-300-4323