Medicare vs Medicaid - What's the difference!!

People always get confused regarding Medicare and Medicaid. They may sound alike but they are very different programs. Both programs provide health coverage, but Medicare is a program offered to those who reach age 65 and are entitled to receive Social Security benefits. They will also be eligible for Medicare. (Medicare also covers people of any age who are permanently disabled or who have end-stage renal disease.)

Medicaid, on the other hand, is a public assistance program.  It helps pay medical costs for individuals with limited income and assets. To be eligible for Medicaid, you must meet the program’s income and assets guidelines. These guidelines can be very strict. While Medicaid is a joint state-federal program, Medicare is a completely Federally funded program. Each state operates its own Medicaid system, and must follow federal guidelines in order for the state to receive federal money, which pays for about half the state’s Medicaid costs. (The state covers the rest.)

Medicare and Medicaid Coverage for Nursing Home/Skilled Living and Long-Term Care

The most significant difference between Medicare and Medicaid in the realm of long-term care planning, however, is that Medicaid covers nursing home care, while Medicare only pays under certain circumstances for a short period of time.  Medicare Part A covers only up to 100 days of care in a “skilled nursing” facility per spell of illness. (The first 20 days is paid at 100%) The care in the skilled nursing facility must follow a stay of at least three days in a hospital. And for days 21 through 100, you must pay a copayment of $200 a day in 2023.  If you have a Medicare supplement or Medigap policy, it may cover the co-pay for you. 

With no other programs covering long-term care (also referred to as skilled nursing), Medicaid has become the most utilized nursing home payment source.  You may end up paying privately until you become eligible for Medicaid. Some long-term insurance policies will help offset cost of nursing home but may not cover the full amount. Medicaid will only retro back for a short period. Also, once you apply for Medicaid in a long-term care facility, you must be there at least 30 days for Medicaid to pay. You should keep in mind that Medicaid eligibility rules are different from state to state, and they keep changing. There is also a program in Georgia through Medicaid called a QIT (Qualified Income Trust) that can qualify some people who are just over the financial allowance for Medicaid.  For a QIT you will need to consult an Eldercare Attorney to help you. (I will be glad to recommend one.) The income allowance for Medicaid is $2742 and that is different for couples.  

Home Health is typically covered by Medicare, but Medicaid does not normally cover home care.

It’s possible to qualify for both Medicare and Medicaid.  Those people are typically referred to as being “dual eligible.”  Medicare beneficiaries who have limited income and resources can get help paying their out-of-pocket medical expenses through the Medicaid program. 

If you have any questions, please feel free to reach out to me at: honestanswers306@gmail.com. or on our website: https://www.honestanswersonaging.com