Medical Insurance Programs
Medicare
Medicare is the federal health insurance system for people receiving Social Security Retirement and Social Security Disability Insurance (SSDI) benefits. For those on disability insurance, an individual becomes eligible for Medicare two years after the date they became disabled as determined by Social Security. For example, Social Security might determine that a person became disabled one year before they applied. If it took eight months for the application to be approved they would become eligible for Medicare after only four months.
Once the waiting period is over, the applicant will receive a letter of notification of eligibility for Medicare. No matter what the individual does next, they will automatically be signed up for Medicare Part A, which is the hospitalization portion of the insurance. The individual will need to make decisions regarding the other portions and options of Medicare.
Obtaining Medicare means making a choice between two different Medicare Medical Insurance systems: Original Medicare, and Medicare Advantage.
Related:
Medicaid
Medicaid is a comprehensive medical insurance program that covers most general hospital and medical procedures. It includes prescription drug coverage and also covers nursing home care. There are no premiums, although there may be small co-payments. For those on Supplemental Security Income (SSI), Medicaid coverage is automatic from the date of acceptance. If you are on a form of state general assistance, you will also probably be covered by Medicaid.
Hospitals accept Medicaid. However, health and medical care providers may choose not to participate in Medicaid, and a majority of doctors do not take Medicaid patients. Those relying on Medicaid must find doctors willing to accept the coverage.
Each state administers its own Medicaid program. In many states disabled persons with other income (under a certain dollar amount), not eligible for financial assistance, may be eligible for Medicaid. In Massachusetts, Medicaid is offered under MassHealth. There is no income limit for individuals with disabilities, although they may need to pay a premium and a one-time deductible to qualify.
MassHealth Safety Net
MassHealth Safety Net is a Massachusetts program that is available for those with limited income who have no medical insurance or only partial insurance, as well as for people with higher incomes who have large medical bills. The Safety Net coverage only applies to hospital bills or to community health clinics associated with hospitals. If the hospital has a prescription drug dispensary, then the Safety Net program can cover the prescription drug cost.
The Safety Net program has an income eligibility standard, but no asset standard (savings, property, etc.)
COBRA
COBRA is a federal law that allows persons on Long-term Disability (LTD) or Unemployment Compensation to purchase medical insurance at a Group rate, thus reducing the cost one would pay for an individual policy. In most circumstances, you can stay on COBRA for 18 to 36 months.
Patient Assistance Programs for prescription drugs
Patient Assistance Programs (PAP’s) are programs established by drug companies that provide free or low-cost drugs to individuals who are unable to pay for them. Most prescribed drugs are available through these programs. All of the major drug companies offer patient assistance programs, but each company has its own eligibility requirements and application procedures.
To utilize these programs for prescriptions, first find out which company manufactures each prescription, then apply to each company for the specific medication(s) the company manufactures. Income eligibility requirements may differ from company to company. Generally, individuals must have an income below 200% of the federal poverty standard, must be a U.S. resident or citizen, and must not have other prescription drug coverage.
RxAssist is a resource center that provides comprehensive information on which medications are manufactured by each company, as well as how to obtain applications for each company’s program.
If an individual is approved, the medication may be sent directly to the patient, to the doctor’s office, or to the patient’s pharmacy—depending on the program. Most medications provided are free, but some companies require a small co-payment.
Resources
Health Care for All assists individuals without health insurance to learn about various insurance options and how to go about obtaining insurance.
What are Medicare and Medicaid? (PDF) is a quick overview of these programs and their eligibility requirements.