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Overlooked Benefits of Medicare and Medicaid

Posted by Lucy Lazarony May 27 2015

Paying a stroke survivor’s medical bills can feel like a daunting task.

Here’s a look at some of the benefits of Medicare and Medicaid that may be able to help. 

Understanding Medicare and Medicaid

Medicare is a federal program and you can become eligible by age, 65 and older, or by disability. 

In contrast, Medicaid is a needs-based, states-run program with qualifications that vary from state to state.

“Qualifications are very different depending on where you live,” says Tricia Blazier, a personal health and financial planner director at Allsup.

Qualifying for Cash Benefits

To receive assistance with medical bills during a stroke survivor’s recovery, apply early for federal disability benefits through the Social Security Disability Insurance program and explore Medicaid assistance in your state.

Qualifying for Medicaid

Aaron Tidball, manager of Medicare operations at Allsup, encourages stroke survivors to explore Medicaid assistance in his or her state, even if their income exceeds their state program’s income requirement.

“Medicaid may subtract medical expenses from monthly income when determining eligibility,” Tidball explains.

“(So) even if their income is above what’s listed on the state website, they may still want to apply because of that spend down opportunity.”  

Apply Early for Benefits

To receive Medicare benefits based on disability, you must first qualify for Social Security Disability Insurance (SSDI).  And because there is a five-month waiting period for these benefits, it is good idea to apply early.

“You can receive Medicare 24 months after you begin receiving SSDI cash benefits,” Blazier says.

Coordinating Medicare and Medicaid Coverage

In some instances, stroke survivors may be able to use their Medicaid coverage to pay for their out-of-pocket costs associated with Medicare.

“If someone is eligible for both Medicare and Medicaid, they will have very few if any out-of-pocket expenses,” Tidball says.

Medicaid could help a stroke survivor pay for Medicare premiums, the deductibles associated with Medicare Parts A and B, and the 20 percent co-insurance associated with Medicare Part B, Tidball explains.

And many stroke survivors may become eligible for Medicaid as they wait for Medicare coverage to begin.

“One thing we see a lot at Allsup, we see people becoming eligible for Medicaid as they are waiting for Medicare eligibility,” Tidball says.

And once a stroke survivor qualifies for Medicaid, their state program can help them coordinate their federal coverage with Medicare.

“If you already have Medicaid, your state program will work with Medicare to coordinate coverage,” Blazier says.

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