Illinois Medicaid Vs. Medicare

The elderly and disabled experience higher rates of poverty than most other populations, according to the website Disabled World. This means it's often difficult for them to get the complete health care they need. Medicare is a federal program that offers free health insurance to both the elderly and disabled, but it often has other costs associated with it. Elderly and disabled persons in especially dire financial situations may qualify for Medicaid, a state program, to get help. Other low-income individuals may also qualify for Medicaid. Illinois has a Medicaid program, and understanding how these programs differ and work together can help consumers who may qualify.

Medicaid Eligibility

• Illinois Medicaid bases eligibility on whether an individual falls into a qualified population and income range. Income includes such things as payments from a job, Social Security payments, alimony and child support. Mothers with infants who are less than a year old, pregnant women and those with breast and cervical cancers qualify with incomes less than 200 percent of the federal poverty limit. The qualifying income was $1,805 a month for singles and $2,428 for couples in 2010. Children over a year old and parents qualify with incomes less than 133 percent of the federal poverty level, or $1,200 a month for singles and $1,615 for couples in 2010. Persons 65 and older, or who are blind or disabled qualify if their income is less than 83 percent of the federal poverty level, or $739 for singles and $1,009 for couples in 2010. An elderly, blind or disabled person also must not have more than $2,000 in assets if she is single or $3,000 in assets for a couple. Assets include such things as bank accounts, cars and property, but it excludes the home the applicant lives in.

Medicare Eligibility

• Medicare eligibility is based solely on age or disability and is administered by the federal government. To qualify by age, a person must be 65 or older. If disabled, the person must have been receiving Social Security Disability Insurance benefits for at least 24 months, or have been diagnosed with end-stage renal disease or Lou Gehrig's Disease. Those with end-stage renal disease are eligible after four months of dialysis, after beginning a self-dialysis program or after beginning treatment for a kidney transplant. Someone with Lou Gehrig's Disease is eligible when he receives his first SSDI check. There are no income or asset qualifications for Medicare.

Services

• Illinois Medicaid is a comprehensive health care program. It offers complete health insurance, including hospital coverage, medical coverage for such things as doctors' visits, emergency care, mental health care, medical equipment, supplies, family planning, nursing home care and long-term care. There is also a prescription drug package available that can either work on its own, or for those with both Medicare and Medicaid, it can wrap around Medicare Part D.

  Medicare is also a comprehensive health insurance program, but does not offer as many benefits as Medicaid. For example, Medicare does not offer comprehensive nursing home or long-term care coverage.

Billing

• If an individual has both Medicare and Medicaid, then he is considered "dual eligible.” The health care provider should send any bills or claims to Medicare first. After Medicare pays what it would normally cover for the bill, the provider should then send the remainder of the bill to Medicaid. If it's a Medicaid-covered service, the dual-eligible beneficiary should not have any out-of-pocket costs.

Extra Help

• Those with both Medicare and Medicaid are automatically enrolled in a program called Extra Help. Extra Help is a federally administered program run by the Social Security Administration. Extra Help pays for many of the Medicare Part D prescription drug benefit costs. Between Extra Help and Medicaid, Medicare enrollees with both Medicare and Medicaid should pay very little out-of-pocket for prescription drugs.