Medicare, Medicaid, and Alphabet Soup

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Many people confuse Medicare and Medicaid. And why not? The words are similar, and both are government programs that have to do with health care. However, the programs are very different. A proper understanding of these two programs is necessary to make sure that you or your loved one does not misstep when making health care or long-term care decisions.

Medicare

Medicare does not pay for long-term nursing home care. Medicare is a health insurance program funded by and administered by the federal government. It is thus uniform from state to state.  As with any government program, a person must meet specific requirements before receiving Medicare. To qualify for Medicare benefits, one has to be at least 65 years old or have a severe disability.

To qualify 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. (He or she does not need to have started receiving those benefits.)  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, he 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, co-pays, and prescriptions.

Another thing that can be confusing about Medicare is its so-called alphabet soup of “plans” we all hear advertised. Part A works like hospitalization insurance. Part B works like the insurance one may have for medical bills. Parts A and B are covered in Original Medicare offered by the government. Part D is an optional plan that provides prescription drug coverage. Part C is often called the Medicare Advantage Plan. This is a private health plan. Medicare Part C plans are required to include the same coverage as Original Medicare, but they usually also include Part D. Part F, sometimes referred to as Medigap, is optional supplemental insurance that covers those costs that Medicare does not.  It is essential to do your homework on these plans to find what works best and is the most cost-effective.

Louisiana Medicaid

Medicaid is a health care assistance program administered at the state level. Although each state’s program is different, all must work within the guidelines that the federal government provides.  Medicaid eligibility is based on a person’s income and assets. Generally speaking, it is available to people with disabilities, people over age 65, children (and the parents of eligible children), and pregnant women.  In addition to covering health care costs, Medicaid can also pay for long-term nursing home care.  With proper planning by an elder law attorney, seniors can become qualified such that they have only a nursing home co-pay. Medicaid covers the rest. There are extensive regulations and laws that govern who can legally qualify for Medicaid, so it is essential to talk with a lawyer skilled in this field regarding your or a loved one’s eligibility.

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 nursing home costs, please contact Ruston, Louisiana elder law attorney Add Goff at (318) 255-1760 or go to www.GoffandGoffAttorneys.com.