Guide for Organizational Representative Payees

Medicare and Medicaid

As a payee, you should know some things about Medicare and Medicaid coverage because you may be asked to use funds to pay some of the beneficiary's medical bills.

Medicare

Medicare is a federal health insurance program, administered by the Centers for Medicare & Medicaid Services (CMS). Social Security beneficiaries are entitled to Medicare automatically at age 65. If the beneficiary is under age 65 and receiving Social Security disability benefits, Medicare usually starts after receiving 24 months of Social Security payments. Medicare beneficiaries must pay certain deductibles and coinsurance payments. Medicare Part B, Supplementary Medical Insurance, also requires beneficiaries to pay a monthly premium that is usually deducted from the Social Security benefit payment. The Medicaid program, described below, may be able to help beneficiaries with limited income and resources pay Medicare premiums and/or Medicare deductibles and coinsurance. For more information about Medicare coverage or to get more information about help paying for Medicare expenses and prescription drugs, call the toll free Medicare Hotline at 800-MEDICARE (800- 633-4227) to speak to a Medicare Customer Representative and ask for a copy of the publication Medicare and You (CMS Publication No. 10050). You can also reach CMS on the Internet at http://www.medicare.gov to access Medicare information.

In 2005, Medicare began offering a discount card for prescription drugs. Beginning in 2006, Medicare beneficiaries may obtain Medicare part D prescription drug coverage through a Prescription Drug Provider (PDP) or through a Medicare Advantage plan that offers prescription drug coverage (MAPD).

Beneficiaries who elect Medicare prescription drug coverage will be responsible for a monthly premium (which will vary from provider to provider based on the scope of coverage offered and the geographical area) as well as certain other costs, like deductibles and co-payments. Information on the new prescription drug coverage is available at http://www.medicare.gov or 800-MEDICARE (800-633-4227).

Medicaid

Medicaid is a joint federal-state health insurance program, administered by the state. States have some discretion in determining which groups of people Medicaid will cover and the financial criteria for Medicaid eligibility. States usually provide Medicaid for individuals who receive federally funded cash assistance payments such as SSI. In many states, an SSI application also serves as a Medicaid application. Even in states where this is not the case, SSI beneficiaries usually qualify for Medicaid. Contact your local SSA office for more information regarding SSI and medical assistance.

Some Medicaid programs do not require receipt of cash assistance for eligibility. A person may qualify even if his or her income and resources are too high for SSI. These programs include help with Medicare expenses; and vary from state to state. For more information about Medicaid, contact the beneficiary's medical assistance (Medicaid) agency, social service or welfare office.

Key Differences Between Medicare and Medicaid