Medicare is a federal health insurance program available to people who are 65 or older, certain younger people with disabilities, and people with end-stage renal disease. Medicare can cover inpatient hospital stays, care in a skilled nursing center, hospice care, and some home health care.
Depending on your eligibility, Medicare can cover certain expenses, such as short-term care in a skilled nursing facility. Medicare is divided into four parts, each of which covers specific services. These links will take you to more details on the Medicare.gov website.
- What Medicare Part A covers
- What Medicare Part B covers
- What Medicare Part C covers (Medicare Advantage Plans)
- What Medicare Part D covers (prescription drug coverage)
Medicare and pharmacy
When you are on a Medicare stay, the facility is responsible for all medications.
Medicaid is a joint federal and state program that provides eligible low-income adults, children, pregnant women, seniors, and people with disabilities with health coverage. Eligibility is based on income, assets and resources.
This overview on the Texas Health and Human Services website summarizes how Medicaid functions in the state of Texas.
Information about how to apply for benefits, how to qualify, and what’s covered are available on the New Mexico Human Services Department website.
Medicaid and pharmacy
Once coverage is approved, Medicaid covers most prescription costs. If you have applied for Medicaid and are awaiting a coverage determination (also known as “Medicaid Pending” status), you will be billed privately for all medications and are responsible for paying those charges if coverage is denied.
If Medicaid approval is backdated to your application date, you will continue to receive bills for all medications until Medicaid covers those claims. (*The Medicaid application process can take many weeks (and sometimes months) before a coverage determination is made; likewise, it can take many weeks after coverage approval for Medicaid to make payments for medications received during the “Medicaid Pending” timeframe.)”