Question
How does MediCal / Medicare work? How is it determined who and what is covered?
I was recently talking with my art teacher who is in remission for breast cancer about the costs of chemotherapy and all that, and she said she wouldn't know because MediCal (California version of Medicare, I think) paid for it all, and that it was actually a blessing she hadn't had insurance at the time because her out of pocket expenses would have still been enormous. She said she'd been very fortunate to be treated by one of the few doctors who accept MediCal at Cedars Sinaii (Beverly Hills, CA) rather than having to go to a Medicare doctor. She's a college-educated, successful woman who works independantly, so I guess that's why she didn't have health insurance. My friend's older sister who was 26 and didn't have insurance broke her jaw while roller blading and ended up having her credit tarnished because she couldn't pay the $15,000 hospital bill. How come Medicare / MediCal didn't pay for her? I'm 17 and not in a situation where this directly affects me, so excuse my ignorance. I just really want to understand how this works.
2 months ago - 3 answers
Best Answer
Chosen by Asker
I think you mean MediCal being the California version of Medicaid. (Medicare is primarily for people ages 65 and over, though there are limited circumstances where the permanently disabled can receive Medicare.) Medicaid/MediCal are programs designed for low income individuals. The specific income criteria can vary from state to state - I don't know what the cutoff is for California. But any person who would be interested in receiving Medicaid/MediCal has to apply for it. If your friend's older sister didn't receive MediCal, I'm guessing that either she didn't apply for it and/or her income and assets were too high to qualify. P.S. Some states have special eligibility criteria for people with conditions like breast cancer. The person might not normally be low-income enough for regular Medicaid, but qualify due to the cancer. (My own state has some special enrollment rules for uninsured women with breast cancer to enroll in Medicaid.) Either your art teacher had low enough income/assets to qualify for MediCal, or she may have had special eligibility due to her cancer.
Source(s)
15 years working for medical providers and health insurance companies
by sarah314
2 months ago
Asker's Rating: 
Other Answers
First things first Medical and Medicare are different. Medical is more like medicaid (California gives it a different name is all). Medicare covers the elderly over 65 while Medicaid covers low income subsidy needs. As for your friend was the broken jaw... MediCal has to be applied for and if accepted they can at points make retroactive payments to cover her costs... I believe thy only go back 3 months but I'm not positive. I only really know the rules that apply to medicaid according to pregnancy. I really know more about Medicare because I work in the field of Health insurance for Seniors. I hope that helps! Healthcare can be quite confusing.
by Colleen- 2 months ago
I followed your link and was relieved to find this wasn't about matriarchal societies. The previous two answers pretty well cover the issue. As they said Medicare is for the elderly unless a person is completely disabled. Then you usually start off on Medicaid and after a time period Medicare takes over. You receive the disability rate until you hit retirement age. The disability payments really are not enough to get by on. That is one reason I drag myself to work every day. With my preexisting condition I could never get private insurance so I need to work until I'm either completely disabled or reach 65. My grandson's case is also interesting. My state provides a Medicaid sort of program for kids. However, one of the eligibility requirements is the child must have been without any medical insurance for at least 6 months. So the question is do you feel like playing Russian roulette? What if he got seriously injured or ill during those 6 months? It would bankrupt my daughter. The harsh realities of life are so much fun. So does CA actually have any money left to pay for MediCal?
by Crusty Curmudgeon- 2 months ago