Who Runs Medicare And Medicaid
The federal government runs the Medicare program. Each state runs its own Medicaid program. Thats why Medicare is basically the same all over the country, but Medicaid programs differ from state to state.
The Centers for Medicare and Medicaid Services, part of the federal government, runs the Medicare program. It also oversees each states Medicaid program to make sure it meets minimum federal standards.
Although each state designs and runs its own Medicaid program, all Medicaid programs must meet standards set by the federal government in order to get federal funds .
In order to make significant adjustments to their Medicaid programs, states must seek permission from the federal government via a waiver process.
How Much Does Medicaid Cost How Much Does Medicare Cost
Both Medicare and Medicaid may include premiums, deductibles, copays and coinsurance. For Medicare, how much you pay will vary based on when you enroll, what coverage options you select and what health services and items you use throughout the year. For Medicaid, the amount you pay depends on your income and the rules in your specific state. Additionally, some specific groups under Medicaid are exempt from many out-of-pocket costs.
There are also four different Medicare Savings Programs, which are designed to help with the cost of Medicare. If you meet the conditions to qualify for one of these programs, you could get help paying for your Medicare premiums, and in some cases, also get help paying Medicare Part A and Part B deductibles, coinsurance and copayments.
Who Is Eligible For Medicaid
You may qualify for free or low-cost care through Medicaid based on income and family size.
In all states, Medicaid provides health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities. In some states the program covers all low-income adults below a certain income level.
- First, find out if your state is expanding Medicaid and learn what that means for you.
- If your state is expanding Medicaid, use this chart to see what you may qualify for based on your income and family size.
Even if you were told you didn’t qualify for Medicaid in the past, you may qualify under the new rules. You can see if you qualify for Medicaid 2 ways:
- Visit your state’s Medicaid website. Use the drop-down menu at the top of this page to pick your state. You can apply right now and find out if you qualify. If you qualify, coverage can begin immediately.
- Fill out an application in the Health Insurance Marketplace. When you finish the application, we’ll tell you which programs you and your family qualify for. If it looks like anyone is eligible for Medicaid and/or CHIP, we’ll let the state agency know so you can enroll.
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National Health Care Expenditures
Historical Overview
Health spending in the United States has grown rapidly over the past few decades. From $27 billion in 1960, it grew to $898 billion in 1993, increasing at an average rate of more than 11 percent annually. This strong growth boosted health care’s role in the overall economy, with health expenditures rising from 5.1 percent to 13.7 percent of the gross domestic product between 1960 and 1993.
During the last 6 years, however, strong growth trends in health care spending have subsided. Health spending rose at a 5-percent average annual rate between 1993 and 1998 to reach $1.1 trillion. Similarly, the share of GDP going to health care stabilized, with the 1998 share measured at 13.5 percent. This trend reflects the nexus of several factors: the movement of most workers insured for health care through employer-sponsored plans to lower-cost managed care low general and medical-specific inflation and excess capacity among some health service providers, which boosted competition among providers to be included in managed care plans and drove down prices. For the 281 million people residing in the United States, the average expenditure for health care in 1998 was $4,094 per person, up from $141 in 1960.
Projected Expenditures
Get The Health Care You Deserve
Health First Colorado, Colorados Medicaid program, is the Medicaid plan for children , adults age 19 to 65 and pregnant women who live in Colorado and meet income and other requirements. Members are assigned to a Regional Accountable Entity . Rocky Mountain Health Plans serves members in RAE Region 1.
This plan is available in the following counties: Archuleta, Delta, Dolores, Eagle, Garfield, Grand, Gunnison, Hindsdale, Jackson, La Plata, Larimer, Mesa, Moffat, Montezuma, Montrose, Pitkin, Ouray, Rio Blanco, Routt, San Juan, San Miguel, and Summit.
Visit Colorado PEAK to apply online. It is the fastest way to apply. Most people find out right away if they qualify. Check your application status online.
To see if you qualify, you can visit or
Apply by phone: Call / State Relay: 711. Phone applications are available Monday through Friday from 8 a.m. to 4 p.m.
Apply in person: Apply in person at your county of residences local county officeor at a local application assistance site.
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The Parts Of Medicare
Social Security enrolls you in Original Medicare .
- Medicare Part A helps pay for inpatient care in a hospital or limited time at a skilled nursing facility . Part A also pays for some home health care and hospice care.
- Medicare Part B helps pay for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services.
Other parts of Medicare are run by private insurance companies that follow rules set by Medicare.
- Supplemental policies help pay Medicare out-of-pocket copayments, coinsurance, and deductible expenses.
- Medicare Advantage Plan includes all benefits and services covered under Part A and Part B prescription drugs and additional benefits such as vision, hearing, and dental bundled together in one plan.
- Medicare Part D helps cover the cost of prescription drugs.
Most people age 65 or older are eligible for free Medicare hospital insurance if they have worked and paid Medicare taxes long enough. You can sign up for Medicare medical insurance by paying a monthly premium. Some beneficiaries with higher incomes will pay a higher monthly Part B premium. To learn more, read .
Medicaid Eligibility And Costs
The federal and state partnership results in different Medicaid programs for each state. Through the Affordable Care Act , signed into law in 2010, President Barack Obama attempted to expand healthcare coverage to more Americans. As a result, all legal residents and citizens of the United States with incomes 138% below the poverty line qualify for coverage in Medicaid participating states.
While the ACA has worked to expand both federal funding and eligibility for Medicaid, the U.S. Supreme Court ruled that states are not required to participate in the expansion to continue receiving already established levels of Medicaid funding. As a result, many states have chosen not to expand funding levels and eligibility requirements.
Those covered by Medicaid pay nothing for covered services. Unlike Medicare, which is available to nearly every American of 65 years and over, Medicaid has strict eligibility requirements that vary by state.
However, because the program is designed to help the poor, many states have stringent requirements, including income restrictions. For a state-by-state breakdown of eligibility requirements, visit Medicaid.gov.
When Medicaid recipients reach age 65, they remain eligible for Medicaid and also become eligible for Medicare. At that time, Medicaid coverage may change based on the recipient’s income. Higher-income individuals may find that Medicaid pays their Medicare Part B premiums. Lower-income individuals may continue to receive full benefits.
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How To Choose The Right Health Care Coverage For You
Although you may be eligible for both programs, in some cases, you might be in a position to choose between Medicare and Medicaid.
If youre eligible for Medicare, you have to choose between Original Medicare or Medicare Advantage, based on your preferences. But how do you decide? Take a look at some of the key differences.
Medicaid Is Structured As A Federal
Subject to federal standards, states administer Medicaid programs and have flexibility to determine covered populations, covered services, health care delivery models, and methods for paying physicians and hospitals. States can also obtain Section 1115 waivers to test and implement approaches that differ from what is required by federal statute but that the Secretary of HHS determines advance program objectives. Because of this flexibility, there is significant variation across state Medicaid programs.
The Medicaid entitlement is based on two guarantees: first, all Americans who meet Medicaid eligibility requirements are guaranteed coverage, and second, states are guaranteed federal matching dollars without a cap for qualified services provided to eligible enrollees. The match rate for most Medicaid enrollees is determined by a formula in the law that provides a match of at least 50% and provides a higher federal match rate for poorer states .
Figure 2: The basic foundations of Medicaid are related to the entitlement and the federal-state partnership.
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Medicare And Medicaid Funding
Medicare is funded:
- In part by the Medicare payroll tax
- In part by Medicare recipients premiums
- In part by general federal taxes
The Medicare payroll taxes and premiums go into the Medicare Trust Fund. Bills for healthcare services to Medicare recipients are paid from that fund.
Medicaid is:
- Partially funded by the federal government
- Partially funded by each state
The federal government pays an average of about 60% of total Medicaid costs, but the percentage per state ranges from 50% to about 78%, depending on the average income of the state’s residents .
Under the ACA’s expansion of Medicaid, however, the federal government pays a much larger share.
For people who are newly eligible for Medicaid due to the ACA , the federal government pays 90% of the cost, while the states pay just 10% of the cost.
Can I Change Plans If Im Dual Eligible
Yes. If you have Medicare and full Medicaid coverage, you can change plans once per calendar quarter for the first three quarters. The new plan will take effect the first day of the following month.
Fourth-quarter changes must be made during Medicares Open Enrollment Period. Also known as the Annual Enrollment Period, it runs from October 15 and December 7, and changes will go into effect January 1.
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The Majority Of The Public Holds Favorable Views Of Medicaid
Public opinion polling suggests that Medicaid has broad support. Seven in ten Americans say they have ever had a connection with Medicaid including three in ten who were ever covered themselves. Even across political parties, majorities have a favorable opinion of Medicaid and say that the program is working well . In addition, polling shows that few Americans want decreases in federal Medicaid funding. In addition to broad-based support, Medicaid has very strong support among those who are disproportionately served by Medicaid including children with special health care needs, seniors, and people with disabilities.
Figure 10: Large Shares Across Parties Say They Have a Favorable Opinion of Medicaid
Filing A Grievance Or Appeal
You have many rights as an RMHP Colorado RAE member. You have the right to complain about RMHP. You have the right to complain about your care. You, your provider or a Designated Client Representative may complain about anything you are unhappy about or have a problem with. To get more information about appeals and grievances call Member Services.
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What Is The General Difference Between Medicaid And Medicare
Medicaid is a government assistance program that typically covers medical costs for low-income individuals, including pregnant individuals and children. Individuals must qualify for Medicaid based on their states requirements. Medicare is a government health insurance program for which most people at least 65 years old qualify.
Already Enrolled In Medicare
If you have Medicare, you can get information and services online. Find out how to .
If you are enrolled in Medicare Part A and you want to sign up for Part B, please complete form CMS-40B, Application for Enrollment in Medicare Part B . If you are applying for Medicare Part B due to a loss of employment or group health coverage, you will also need to complete form CMS-L564, Request for Employment Information.
You can use one of the following options to submit your enrollment request under the Special Enrollment Period:
Note: When completing the forms CMS-40B and CMS-L564:
- State I want Part B coverage to begin in the remarks section of the CMS-40B form or online application.
- If possible, your employer should complete Section B.
- If your employer is unable to complete Section B, please complete that portion as best as you can on their behalf and submit one of the following forms of secondary evidence:
- Income tax form that shows health insurance premiums paid.
- W-2s reflecting pre-tax medical contributions.
- Pay stubs that reflect health insurance premium deductions.
- Health insurance cards with a policy effective date.
- Explanations of benefits paid by the GHP or LGHP.
- Statements or receipts that reflect payment of health insurance premiums.
Some people with limited resources and income may also be able to get .
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Who Is Eligible For Medicare
Generally, Medicare is available for people age 65 or older, younger people with disabilities and people with End Stage Renal Disease . Medicare has two parts, Part A and Part B . You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can get Part A at age 65 without having to pay premiums if:
- You are receiving retirement benefits from Social Security or the Railroad Retirement Board.
- You are eligible to receive Social Security or Railroad benefits but you have not yet filed for them.
- You or your spouse had Medicare-covered government employment.
To find out if you are eligible and your expected premium, go the Medicare.gov eligibility tool.
If you did not pay Medicare taxes while you worked, and you are age 65 or older and a citizen or permanent resident of the United States, you may be able to buy Part A. If you are under age 65, you can get Part A without having to pay premiums if:
- You have been entitled to Social Security or Railroad Retirement Board disability benefits for 24 months.
- You are a kidney dialysis or kidney transplant patient.
While most people do not have to pay a premium for Part A, everyone must pay for Part B if they want it. This monthly premium is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you do not get any of these payments, Medicare sends you a bill for your Part B premium every 3 months.
Maternity & Newborn Care
Please visit Health First Colorado Benefits and Services webpage for information on Maternity and Newborn care: or
RMHP offers program for pregnancy care as well. WellHop & SimpliFed are programs to provide support for expectant moms during their pregnancy and beyond.
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Individuals With Special Needs
Home-and Community-Based Services
Home-and Community-Based Services help you and your family in your home. You may qualify for home health care and non-skilled home help. You can ask your doctor or an RMHP Care Coordinator for help setting up this service.
If you are new to RMHP and you have special health care needs and are seeing a doctor that is not on our list, you can:
- Keep seeing your previous primary care doctor for 60 calendar days. You can keep getting the same ongoing care you received before you joined RMHP.
- Keep seeing your other doctors for 75 calendar days. You can keep getting the same care you received before you joined RMHP.
- Keep seeing your previous primary care doctor if you are in your fourth through ninth month of pregnancy. You can keep seeing your previous primary care doctor until you finish the care you need following the birth of your child.
If you have a question, need help with your health care, or have a special need, please contact us.
Were here to help. Call Member Services at . Representatives are available MondayFriday, 8:00 a.m.5:00 p.m. If you are deaf, hard of hearing, or have a speech disability, dial 711 for Relay Colorado or use our Live Chat on uhccp.com/CO or myuhc.com/communityplan.
Unitedhealthcare Connected General Benefit Disclaimer
This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.
You can get this document for free in other formats, such as large print, braille, or audio. Call Member Services, 8 a.m. – 8 p.m., local time, Monday – Friday . The call is free.
You can call Member Services and ask us to make a note in our system that you would like materials in Spanish, large print, braille, or audio now and in the future.
Language Line is available for all in-network providers.
Puede obtener este documento de forma gratuita en otros formatos, como letra de imprenta grande, braille o audio. Llame al Servicios para los miembros, de 08:00 a. m. a 08:00 p. m., hora local, de lunes a viernes correo de voz disponible las 24 horas del dÃa,/los 7 dÃas de la semana). La llamada es gratuita.
Puede llamar a Servicios para Miembros y pedirnos que registremos en nuestro sistema que le gustarÃa recibir documentos en español, en letra de imprenta grande, braille o audio, ahora y en el futuro.
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