Health care payers

Government-funded health insurance

Mnemonic

• MedicarE is for Elderly.
• MedicaiD is for Disadvantaged.

Medicare

Medicare is funded by the federal government.

• Eligibility
  • Individuals ≥ 65 years old who:
    • Are US citizens or lawful permanent residents
    • And have worked and paid Medicare taxes for a minimum of 10 years
  • Irrespective of age, individuals with any of the following may be eligible:
    • End-stage renal failure on dialysis or with a kidney transplant
    • Amyotrophic lateral sclerosis
    • Permanent disabilities

Mnemonic

• Part A: hospital Admissions, including hospice, skilled nursing
• Part B: Basic medical bills (eg, physician fees, diagnostic testing)
• Part C: (parts A + B = Combo) delivered by approved private companies
• Part D: prescription Drugs

Medicaid

Medicaid is jointly funded by federal and state governments.

• Eligibility: Individuals must meet both nonfinancial and financial criteria.
  • Nonfinancial
    • US citizen or lawful permanent resident
    • Residence in the state in which coverage is received
  • Financial: Factors that impact financial eligibility include household income, presence of children in the home, pregnancy, disability, age, and state of residence.
    • Children and pregnant individuals living in households with income ≤ 133% of the federal poverty level (FPL) are eligible in every state.
    • Eligibility for adults < 65 years of age with a household income ≤ 133% of the FPL is decided by each state.