Many people confuse Medicare and Medicaid. And, why not? They are spelled almost the same, and they both are government programs that have to do with health care. However, they are very, very different, and a proper understanding of the basics is necessary to make sure that you or your loved one can does not misstep when making important decisions concerning health care or long-term care. Even if you are not in that situation right now, it is never too early to gain a basic awareness and understanding of these programs that are so important to older Americans and their loved ones. In this piece, I will attempt to help you navigate through some of the basics.
Medicaid is a health care assistance program. Its guidelines (and substantial funding) come from the federal government, but it is administered by the state. Each state’s program is different, but must work within the guidelines that the federal government provides.
Medicaid eligibility is based on a person’s income and assets and, generally speaking, is available to people with disabilities, people over age 65, children (and the parents of eligible children), and pregnant women. Moreover, Louisiana Medicaid can also pay for long-term nursing home care. With proper planning by a Louisiana elder law attorney, seniors can become qualified such that they have a co-pay based on their income for the nursing home care, and Medicaid will cover the rest. Medicare does NOT pay for long-term care. There are extensive regulations and laws that govern who can qualify for Medicaid, so it is important to talk with a lawyer skilled in this field regarding you or a loved one becoming eligible.
Medicare is a health insurance program funded by and administered by the federal government. This means that it is uniform from state to state. As with any government program, a person must meet certain requirements before receiving Medicare. To qualify for Medicare benefits at least 65 years old or have a severe disability. To qualifiy at age 65, a person must be a United States citizen or a permanent legal resident that has lived here for at least five consecutive years. Additionally, he or she must have worked long enough to be eligible for Social Security retirement benefits (regardless of whether he or she has started receiving those benefits). However, in order for a disabled person under the age of 65 to receive Medicare, he or she must have received Social Security Disability Insurance (SSDI) for two years. (SSDI is not the same as SSI, which is Supplemental Security Income, a means-based program.) If a person meets Medicare’s eligibility requirements, her or she can receive Medicare without regard to his or her income or assets. Costs for Medicare are based on the recipient’s work history. This means that costs are determined by the amount of time a person paid Medicare taxes. These costs like all insurance include premiums, copays, and prescriptions.
Another thing that can be confusing about Medicare is its so-called alphabet soup of “plans.” We all hear advertisements referring to Parts A, B, C, D. Although I will explain these in detail in a later piece, I will provide you with a quick summary. Part A works like insurance for hospitalization. Part B works like insurance for medical. Part D is an option plan that provides prescription drug coverage. Parts A and B are covered in Original Medicare offered by the government. Part C is often called the Medicare Advantage Plan. This is a private health plan. The Medicare Advantage Plan or Medicare Part C plan are required to include the same coverage as Original Medicare but usually also include Part D as well. Additionally, there are other plans, such as Part F. Part F, sometimes referred to as Medigap, is supplemental insurance that covers those things that Medicare does not. It is important to do your homework on these plans to find what works best and is most cost effective for you.
Can You Qualify for Both Medicare and Medicaid?
In some circumstances, one can be eligible for both Medicaid and Medicare. In this situation, the two programs can work together. For example, Full Medicaid benefits can cover the costs of Medicare deductibles and cover the 20% of costs not covered by Medicare. (Medicare costs include premiums, copays, and deductibles.) Medicaid may also cover the costs of premiums for Medicare Part A and/or Part B.)
If you are interested in learning more about how you or a loved one may be able to qualify for having Medicaid defer some or all of your or your loved one’s long-term care nursing home costs, please contact Ruston, Louisiana elder law attorney Add Goff.