Federal and state governments provide health insurance benefits to those who meet certain eligibility criteria. These programs, known as Medicare and Medicaid, can help ease the burden of expenses associated with RA and are worth investigating, both as primary and supplemental means of financial assistance.

Medicare

Medicare is a federally sponsored program that provides coverage to qualifying elderly and disabled persons, regardless of income. Approximately 44 million Americans are eligible for the Medicare program. The following individuals may qualify for coverage:

• People at least 65 years old
• People who are permanently disabled
• People with ESRD (end-stage renal disease)

Medicare consists of four parts:

Part A: Hospital Insurance
Helps pay for hospital inpatient bills

Part B: Supplemental Medical Insurance
Helps pay for doctor and hospital outpatient bills

Part C: Medicare Advantage
Formerly known as Medicare+Choice, provides alternatives to Part A and Part B coverage through health maintenance organizations, preferred provider organizations, or private fee-for-service plans

Part D: Prescription Drug Coverage
Helps pay for certain prescription drugs not administered by a healthcare professional

These four forms of coverage are available individually or in different combinations, and may or may not require that the beneficiary pay a monthly premium. Most people receive Part A coverage for free (i.e., no monthly premium) because they, or their spouses, have previously paid Medicare taxes through employment. Enrollment in Part B coverage is voluntary and requires payment of a monthly premium (monthly premium amounts in 2008 range from $96.40 to $238.40, depending on the beneficiary’s income). Part C, or Medicare Advantage, provides alternatives to Part A and Part B coverage through health maintenance organizations, preferred provider organizations, or private fee-for-service plans (known as "MA plans"). Part D is the outpatient prescription drug benefit that provides coverage for some prescription drugs and is administered through a private plan. A Medicare Advantage plan may also provide Part D coverage. The type of Medicare Advantage plan that also offers Part D coverage is known as an "MA-PD plan." Coverage for physician visits and certain RA therapies is available for beneficiaries enrolled in Medicare Part A and Part B. Those enrolled in Medicare Advantage or Medicare Part D may have access to additional RA therapies not covered under Medicare Part A or Part B.

Medicaid

Medicaid is a joint federal and state program that provides medical coverage for families with low incomes and limited resources, and for certain low-income individuals who meet other eligibility requirements. Additionally, the elderly and disabled, particularly those who need assistance covering certain gaps in their Medicare coverage, may be eligible for Medicaid. Since Medicaid is a state-administered program, the criteria for eligibility vary by state. Additional factors in qualifying for coverage can include any of the following:

• Your age
• If you are pregnant
• If you have a disability or are blind
• Your financial assets
• If you live in a nursing home

Your Medicaid coverage may require a co-payment for certain medical services, depending on your income and your state’s regulations. Many people are surprised to find out that they qualify for Medicaid; with several states attempting to extend coverage to those earning up to 300% of the poverty level income, it is well worth your time to see if you are eligible.

Coverage for physician visits and certain RA therapies, at a low cost or for free, may be available to those enrolled in Medicaid.

To check your eligibility and find out more about your state’s requirements, see our Medicare and Medicaid listings.