There are great doctors, nurses, aides, and others in the healthcare system—but the systems themselves are not necessarily consumer friendly and can add to the frustration and exhaustion on the part of the caregiver. Not everyone listens and understands the position of the family caregiver—and every healthcare system seems to have a different way of communicating with families and patients. No one stops to explain unless you make them slow down and spell things out.
Here are some guidelines to help determine whether or not you qualify for Medicare or Medicaid.
At present, all states, the District of Columbia, and some territories participate in Medicaid. As long as a state participates in Medicaid, the following are examples of eligibility groups that must be covered:
Certain low-income families, including parents who meet the financial requirement of the former Aid to Families with Dependent Children cash assistance program
Pregnant women with annual income at or below 133 percent of the federal poverty level, or FPL (for a family of four, this 133 percent income threshold was $34,846 in 2020).
Children with family income at or below 133 percent of FPL
Aged, blind, or disabled individuals who receive cash assistance under the Supplemental Security Income (SSI) program
Children receiving foster care, adoption assistance, or kinship guardianship assistance under Title IV-E of the Social Security Act
Certain former foster care youth
Individuals eligible for the Qualified Medicare Beneficiary program
Certain groups of legal permanent resident immigrant
The following are examples of eligibility groups to which states may provide Medicaid:
Pregnant women with annual income between 133 per- cent and 185 percent of FPL
Infants with family income between 133 percent and 195 percent of FPL
Certain medically needy individuals who are otherwise eligible for Medicaid but who have incomes too high to qualify and spend down their incomes on medical care
Non-elderly adults with income at or below 133 percent of FPL (the Affordable Care Act Medicaid expansion)
Some people are eligible for both Medicaid and Medicare. The two main categories of dual eligibles are full dual eligible beneficiaries and partial dual eligible beneficiaries.
Full dual eligible beneficiaries receive full benefits from Medicare, and Medicaid provides them with full benefits in addition to financial assistance with their Medicare premiums and cost sharing.
Partial dual eligible beneficiaries receive full benefits from Medicare and financial assistance with their Medicare premiums and cost sharing.