Medicaid: The Basics

Medicare and Medicaid are both types of health insurance, but they are not the same. Medicare is for people age 65 or older or who are blind or disabled. Medicaid is for people with low incomes who fit into certain categories.

• The Medicaid program is a partnership between the federal and state governments.

Who Can Get Medicaid?

Medicaid helps low-income persons of all ages pay for medical and long-term care. It may also help people who have extremely high medical bills or need to pay for nursing home care. To qualify for Medicaid, you must meet the income and resource guidelines in your state. Income is money you get from Social Security, a job, pension, or other sources. Resources are things you own, such as a savings account. But Medicaid doesn't count everything. Some things, such as your home and one car, are not counted.

In some states, people whose incomes are too high to initially qualify for Medicaid can still qualify if their medical bills are very high. Then Medicaid asks you to pay some of the bills and it will pay the rest. This is called "spending down" to Medicaid eligibility.

What Are the Benefits?

Federal law requires states to provide nursing home coverage; also, states may elect to provide community long-term care services for individuals who are eligible for Medicaid and qualify for institutional care.

Medicaid must pay for some services, such as inpatient and outpatient hospital services, physician and certified nurse practitioner visits, laboratory tests and x-rays, nursing home and home health care, and certain screenings. It may also pay for services, such as prescription drugs, clinic visits, prosthetic devices, hearing aids, dental care, eye exams, glasses, transportation for medical care, and medical services not covered by Medicare. It can also help pay Medicare costs.

Applying for Medicaid

You apply for Medicaid in the state where you live. Obtain and submit an application at your local Medicaid office. Also, most states have a toll-free number to help answer your questions.

Those without access to the Internet can call their local Social Security office or call Medicare at 1-800-633-4227. This is a voice-automated system. You will need to request information about Medicaid and, when prompted, say the state in which you live. After doing so, you will get the number of the Medicaid office closest to where you live.

Some states also let you apply on the Internet, by telephone, or at locations in your community. To find out your state's options, call your local Medicaid office.

In many states, if you are eligible for Supplemental Security Income (SSI), you are automatically eligible for Medicaid. To get Medicaid benefits by applying for SSI, call the Social Security Administration at 1-800-772-1213.

You will usually need to bring the following documents with you when you apply:

• Proof of who you are (such as a birth certificate)
• Proof of where you live (such as a lease, utility bills)
• Proof of your income (such as pay stubs, letter from Social Security)
• Proof of what you own (such as bank account statements, car registration)
• Your medical bills