Patients with Medicaid or Medicare Coverage
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:
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.
- 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
The Department of Social Services processes Medicaid applications. The numbers to call for the St. Louis area are:
|St. Louis City
|St. Louis County
||(located in Hillsboro, MO)
||(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 (2016 Rates)
Medicare Part A
If you or your spouse worked 10 years or more: no premium
The Social Security Act provides that certain aged and disabled persons who are not insured may voluntarily enroll, but are subject to the payment of a monthly Part A premium. Since 1994, voluntary enrollees may qualify for a reduced Part A premium if they have 30 - 39 quarters of covered employment. When voluntary enrollment takes place more than 12 months after a person's initial enrollment period, a 2-year 10% penalty is assessed for every year they had the opportunity to (but failed to) enroll in Part A. The 2015 Part A premiums are listed in the table below:
|Voluntary Enrollees Part A Premium Schedule
||$411 per month
|Base Premium with 10% Surcharge
||$452.10 per month
|Base Premium with 45% Reduction
||$226 per month (for those who have 30 - 39 quarters of coverage)
|Base Premium with 45% Reduction and 10% surcharge
||$248.60 per month
Medicare Part B
Monthly premium: Based on patient's income, ranging from $146.90 to $335.70 per month
Standard Premium: $121.80 per month
Annual Deductible: $166
Inpatient Hospital Deductibles and Copayments
$1,288 deductible per benefit period
No coinsurance for days 1-60
$322 daily coinsurance for days 61-90
$644 daily coinsurance for 60 lifetime reserve days
Skilled Nursing Facility
No deductible for each benefit period
No coinsurance for days 1-20
$161 daily coinsurance for days 21-100
Home Health Care
No deductible or coinsurance
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
Care outside of the United States
Eyeglasses, except after cataract surgery
For more information regarding Medicare, call (800) 633-4227 (800-Medicare), or visit http://www.medicare.gov.
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