Most people have heard of both Medicare and Medicaid. In fact, people often use the names of the two healthcare programs interchangeably when, in fact, there are important differences between them. Because there is a good chance that you will need to rely on both programs as a senior, understanding those differences is important. To get you started, the Woburn Medicaid planning attorneys at DeBruyckere Law Offices compare the Medicare and Medicaid programs.
Medicaid Benefits and Eligibility Guidelines
Medicaid is a healthcare program that is primarily funded by the federal government; however, the individual states have the option to supplement funding for Medicaid if they choose to do so. Although the federal government provides oversight for Medicaid, it is administered by the individual states which explains why you will notice differences in the eligibility criteria and benefits offered from state to state. In all states, however, Medicaid covers basic healthcare, such as:
- Certain inpatient and outpatient hospital services
- Early and Periodic Screening, and Diagnostic, and Treatment (EPSDT) services for children
- Nursing facility services
- Home health services
- Doctor’s services
- Rural health clinic services
- X-ray and laboratory services
- Family planning services
- Midwife services
- Freestanding Birth Center services
- Certified pediatric and family nurse practitioner services
- Tobacco cessation counseling for expectant mothers
Every state is required to provide these basic services. States may, if they choose to, provide additional benefits; however, they must include the basic benefits. If you qualify for Medicaid benefits, there are no monthly premiums nor co-payments.
Medicaid is a “needs based” program, meaning that an applicant must prove the need for benefits in order to qualify. To be eligible for Medicaid, an applicant must have both income and assets that are below the program limits. Income limits are directly tied to the Federal Poverty Level for the area where the applicant lives. Asset limits are typically extremely low — $2,000 for an individual and $3,000 for a couple in most states, including Massachusetts. If your non-exempt assets exceed the limit, Medicaid will turn down your application and you will be expected to “spend-down” your assets until their value falls below the program limit. As a senior applying for Medicaid to help pay for long-term care expenses, special guidelines apply that protect your “community spouse” if he/she remains in your home. To find out if you are eligible for Medicaid in Massachusetts, navigate to the Massachusetts MassHealth website.
Medicare Benefits and Eligibility Guidelines
Medicare is also a federally funded healthcare program; however, Medicare is exclusively for people over age 65 and for certain individuals under age 65 who are also disabled. Unlike Medicaid, Medicare is an “entitlement” program, meaning if you (or your spouse) paid into the program for the required length of time – 10 years — through your payroll taxes during your working years you are automatically entitled to Medicare benefits. Medicare comes in four parts. Part A, or basic Medicare is free. If you wish to sign up for the additional parts of Medicare, however, it may require payment of a monthly premium similar to private health insurance. The four parts of Medicare and the benefits included in each part are as follows:
- Part A – Hospital care – Covers the cost of being in a medical facility.
- Part B – Covers doctors, medical tests and procedures – basically, anything done to you. There is a monthly premium for Part B coverage.
- Part C – Medicare Advantage – Part C is an alternative to traditional Medicare coverage. Coverage often includes Parts A, B and D. Medicare Advantage plans are administered by private insurance companies.
- Part D – Prescription drug coverage – D is administered by private insurance companies, and you are required to have it unless you have coverage from another source. Part D requires you to pay a monthly premium in most cases.
To find out more about Medicare, or to apply online, navigate to the Social Security Administration “Medicare Benefits” page.
Contact Woburn Medicaid Planning Attorneys
For more information, please join us for an upcoming FREE seminar. If you have additional questions about the difference between Medicare and Medicaid, or about Medicaid planning in general, contact the Woburn Medicaid planning attorneys at DeBruyckere Law Offices by calling (603) 894-4141 or (978) 969-0331 to schedule an appointment.
Daniel DeBruyckere
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