Medicare vs. Medicaid

Similar in sound,but different in definition.   

Both of these health care insurance programs were developed by the U.S. government in 1965 as a way to assist the older generation and the impoverished in getting good health insurance, but there is all too often confusion between the two. While they were created for the same reason,the end goal and execution are vastly different. 

At NKP - Elder Law and Medicaid Planning Attorneys, we are skilled in Medicaid planning and are here to help make the distinction between these two types of elder health care insurance programs so you can make the proper decision when planning for the future. Let’s start with the basic meaning of each: Medicare is available for anyone, no matter what their income or disability status, who has been a legal U.S. resident for at least five years, is 65 years or older or has received SSDI for 24 months, and has paid into the system for 40 quarters. 

On the flip side, Medicaid does require some level of poverty disability in order to be received. It’s federal and state-based, so when working with an elder law attorney, it’s important to make sure they are aware of your particular state’s laws regarding Medicaid. NKP’s elder law attorneys are extremely well-versed in Florida’s ESS Medicaid manual,making us your top choice for Medicaid planning in South Florida. 

Ready to dive deeper?

The Differences Between Medicare and Medicaid

Some of the differences between medicare and medicaid are as follows:

Medicare, while great for doctor’s visits and prescription cost coverage, is not the best when it comes to long-term care. The benefits are limited, meaning that Medicare does not pay for long-term care in full. It will pay for 90 days of hospitalization, with a specific cost for the first 60 days, followed by a significantly higher copay responsibility for the next 30 days. For a shorter hospitalization stay lasting three days, Medicare will only pay for a maximum of 100 days of rehab or nursing home care, only after the patient has been admitted to a hospital for two nights. (Side note: being admitted is not the same as being held for observance; so be careful to distinguish this with the hospital if Medicare is in your post-hospital stay plan.) After that 100 days, the patient is on their own and responsible for costs via deductibles depending on which Medicare program they’ve chosen. In short, Part A includes coverage for inpatient hospital services, inpatient stays at professional nursing centers, and hospice and home health care services; Part B provides specific physician services, out-patient care, medical supplies, and preventive services; Part C, called Medicare Advantage, combines Parts A and B; and Part D is for prescription drug coverage, and can be combined with any plan. 

Important areas to note when looking into Medicare programs include the following: 

●     Medicare Advantage programs are often HMOs with limited coverage areas, which means the insured may not be able to see their preferred specialist; however, it is often the least expensive.

●     Medicare plans can only be changed during specific times of the year. Open enrollment to switch to Part C is from October 15-September 7, and switching from Part C back to Parts A orB can only be done during the Medicare Advantage Disenrollment Period from January 1-February 14.

●     Medicare does not cover more than 100 days of long-term care, so you need to have a plan in action once that 100-day period comes to fruition. 

This is when Medicaid, and the right Medicaid planning attorney, can step in and save the day with its extremely comprehensive long-term care benefit. Once approved for the Medicaid ICP Benefit, Medicaid will pay your entire nursing home bill, and a significant portion of your ALF or home-health care expenses — forever. In Florida, all residents who are 65+, blind, or disabled and in need of skilled nursing facility services, and qualifies financially, must be provided with ICP Medicaid. Medicaid covers all of the following areas: specific health care inpatient services and outpatient hospital treatments, nursing home costs, at-home health care services, regular physical services such as checkups, blood tests and extended treatment, rural healthcare clinic costs, family planning and maternal services, and specific pediatric and nursing practitioner costs. As you can see, Medicaid basically pays for all of the Medicare Part B premiums and copays. 

Our job at NKP - Elder Law & Medicaid Planning Attorneys, a top Medicaid planning and elder law firm serving Miami-Dade and Broward counties, is to assist our clients in the various steps toward becoming qualified for Medicaid, while protecting and preserving the applicant’s assets so they are able to provide for their loved ones.  

We will start by helping you with the application process. Then, once you’ve qualified, we will come up with the most effective and efficient strategy to help pay for your long-term care, including everything from hiring a home-health aide to paying for assisted living facilities or skilled nursing home care. The costs and amount of planning can be overwhelming, but with the right elder law attorney by your side, you’ll never have to worry.  

Contact us today to discuss getting started on your Medicaid planning.