Written by Chad Eichorn
From his column Elder Law
Medicare and Medicaid have long been a mystery to many consumers. In fact, they can baffle and confuse some of the smartest citizens. You may have thought, “I’ve got plenty of time, so I don’t need to worry about these right now.” However, it is never too early to gain an understanding that might help an aging loved one or you down the road. As the saying goes, “Time flies,” and all of us will be there sooner than we think. Today, let’s remove some of the mystery by considering some of the differences between Medicare and Medicaid.
Medicare
Medicare is a health insurance program provided through the federal government. To receive Medicare, a person must be 65 years of age or older and retired, or have a severe disability. For a disabled person under the age of 65 to be eligible, one must have received Social Security Disability Insurance (SSDI) for a minimum of two years. Because Medicare is administered by the federal government, the program is uniform from state to state. If a person meets Medicare eligibility requirements, they can receive Medicare regardless of their income or assets. Costs for Medicare are based on a recipient’s work history and is determined by the length of time they paid Medicare taxes. These costs, like all insurance, include premiums, copays, and prescriptions.
Medicare can be confusing because there are four parts. TV commercials talk about Parts A, B, C, and D. But what does this mean? Parts A, B, and D can be somewhat simplified. Part A is hospital insurance, Part B is medical insurance, and Part D is prescription drug coverage. Parts A and B are covered in Original Medicare offered by the government. Part C is often called Medicare Advantage and is a private health plan. Medicare Advantage or Medicare Part C is required to include the same coverage as Original Medicare but usually includes Part D as well. It is important to do your homework on these plans to find what works best and is most cost effective for you.
Medicaid
Medicaid is a health care assistance program. Its guidelines come from the federal government, but it is administered by each state. Medicaid is for those who cannot afford to pay for care on their own. It is based on the amount of one’s income and assets, and is available to persons who belong to one of the eligible groups. Those groups are: children, persons with disabilities, persons over the age 65, pregnant, or the parents of eligible children. Seniors who require nursing home care may qualify for Medicaid and only pay a share of their income to the nursing home. Medicaid then pays the remainder.
A person can be eligible for both Medicare and Medicaid and receive both. The two programs work together to help the recipient best afford the expenses of health care. For example, Medicare costs include premiums, copays, and deductibles. Full Medicaid benefits can cover the costs of Medicare deductibles as well as cover the 20% of costs not covered by Medicare. Medicaid can also help with Medicare assistance and may cover costs of premiums for Part A and/or Part B.
Editor’s Note: Medicare eligible persons who are covered by any of the benefit programs provided by Pensions and Benefits USA have free access to Via Benefits Insurance Services (formerly OneExchange) to help with selection of Medicare supplement coverage. Via Benefits offers a variety of plans by the nation’s leading insurers and there is no charge for their services. For assistance, phone 888-902-4910 or visit online at my.viabenefits.com/pbusa.
Medicare Open Enrollment for 2019 ends December 7, 2018.
Chad Eichorn is an attorney licensed in Iowa only. This article is provided as legal information only and is not intended as legal advice. If you have questions regarding your specific situation, please contact an estate planning and elder law attorney licensed in your state of residence.