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If you are currently uninsured, you may qualify for Medicaid or Medicare
coverage.
Facts about Medicaid
Medicaid is an insurance program jointly funded by your state and federal government. Patients have 90 days from date of treatment to apply for Medicaid; this applies to inpatient and outpatient treatment.
Eligibility is determined by:
- Disability due to medical reasons
- Number of minor children (under the age of 18) in the home
- Inability to return to work for four months or more
- Pregnancy
- Income
- Assets
If a patient is receiving disability (SSI), he/she must apply for Medicaid eligibility. Missouri is one of 11 states that requires the patient to apply for Medicaid; for the other 39 states, persons receiving SSI are automatically enrolled in Medicaid.
The Department of Social Services processes Medicaid applications. The numbers to call for the St. Louis area are:
| St. Louis City |
(314) 340-5000
(314) 340-5246 |
(Main number)
(Medicaid number) |
| St. Louis County |
(314) 426-9600
(314) 877-3030
(314) 416-2700 |
(Central)
(North)
(South) |
| Jefferson County |
(636) 797-9601 |
(located in Hillsboro, MO) |
| Franklin County |
(636) 583-2571 |
(located in Union, MO) |
If you live in a different county, or are uncertain which number to call, call (800) 392-1261 to be directed to the office in the county where you live.
For more info visit Missouri Medicaid.
Facts about Medicare
Medicare is a federally funded health insurance program for people age 65 or older, some people with disabilities under age 65, and people with End-Stage Renal Disease. Medicare has 2 parts, Part A and Part B. Part A is hospital insurance - most people do not pay for Part A coverage. Part B is medical insurance - most people pay monthly for Part B coverage.
If you qualify for Medicare, you also have the option of choosing a Medicare + Choice plan, which is a managed care plan administered by a private company that replaces your Medicare coverage.
There are limitations on a number of services and items covered by Medicare and Medicaid, depending on the plan you have. You are responsible for copayments, deductibles, and other services not covered. If your Medicare or Medicaid coverage is through an HMO, it is important that you bring this to our attention.
Medicare Premiums and Deductibles/Copayments (2007 Rates)
Medicare Part A
Monthly premiums:
If you or your spouse worked 10 years or more: no premium
If you or your spouse worked between 7.5 & 10 years: $226
If you or your spouse worked less than 7.5 years: $248.30
Medicare Part B
Monthly premium: Based on patient's income, ranging from $93.50 to $161.40 per month
Annual Deductible: $131
Coinsurance: 20%
Inpatient Hospital Deductibles and Copayments
$992 deductible per benefit period
No coinsurance for days 1-60
$248 daily coinsurance for days 61-90
$496 daily coinsurance for 60 lifetime reserve days
Skilled Nursing Facility
No deductible for each benefit period
No coinsurance for days 1-20
$124 daily coinsurance for days 21-100
Home Health Care
No deductible or coinsurance
Hospice Care
No deductible
Small copayment for outpatient drugs and inpatient respite care
Physician and other medical services: 20% (providers who accept assignment)
Outpatient hospital care: coinsurance or copayment (as determined by Medicare)
Home health care and clinical diagnostic lab services: nothing
Medicare does not cover the following services (you must pay the full cost yourself):
Private duty nursing
Most prescription drugs
Custodial care, unless skilled nursing is provided at the same time
Most chiropractic services
Cosmetic surgery
Care outside of the United States
Acupuncture
Eyeglasses, except after cataract surgery
Dental Care
For more information regarding Medicare, call (800) 633-4227 (800-Medicare), or visit http://www.medicare.gov.
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