Medicaid Vs Medicare: You Can Have Both
Posted: January 17, 2020
Medicaid and Medicare. Its hard to think of two words that cause as much confusion.
- Whats the difference between these two government health insurance programs?
- What exactly are Medicaid and Medicare?
- Whos eligible to get Medicaid or to get Medicare?
- And how can some people get both?
Read on to find out the answers to these questions and more.
What Are The Differences Between Medicare And Medicaid
Medicare is a federal health insurance program open to Americans age 65 and older and those under the age of 65 with specific disabilities. Medicaid, a combined state and federal program, is a state-specific health insurance program for low-income individuals with limited financial means, regardless of their age.
Medicare, generally speaking, offers the same benefits to all eligible participants. However, coverage is divided into Medicare Part A, Part B, and Part D. Medicare Part A is for hospice care, skilled nursing facility care, and in-patient hospital care. Medicare Part B is for out-patient care, durable medical equipment, and home health care. Part D is for prescription coverage. Not all persons will elect to have coverage in all three areas.
In addition, some persons choose to get their Medicare benefits via Medicare Advantage plans, also called Medicare Part C. These plans are available via private insurance companies and include the same benefits as Medicare Part A and Part B, as well as some additional ones, such as dental, vision, and hearing. Many Medicare Advantage plans also include Medicare Part D.
Medicaid is more comprehensive in its coverage, but the benefits are specific to the age group. Children have different eligibility requirements and receive different benefits from low-income adults and from elderly or disabled persons.
Helpful Resources
What Is The Difference Between Medicare And Medicaid
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How Much Do You Have To Pay
For beneficiaries with dual eligibility for Medicare and Medicaid, most health care costs are covered , including the monthly premiums for Original Medicare and Medicare Advantage Plans. Original Medicare provides basic inpatient and outpatient medical care, but doesnt cover prescriptions.
As an alternative to Original Medicare, Medicare Advantage Plans often cover extra services, such as dental cleanings and eye exams for glasses. Most Medicare Advantage Plans also include prescription coverage. Dual-eligible beneficiaries will automatically qualify for Extra Help paying for Medicare drug coverage . Medicare Part D is a prescription drug plan often purchased with Original Medicare to ensure coverage of medication costs.
If you need a medication that Medicare doesnt cover, Medicaid may cover some of the costs. Total out-of-pocket costs for a dual-eligible individual depend on several factors, including the type of plan you select and whether you need a Part D plan.
Qualified Disabled And Working Individuals
The Qualified Disabled and Working Individuals Program helps pay Medicare Part A premiums for eligible individuals. To qualify for the QDWI program, you must be under 65, have a disability, and meet the income and resource requirements. You cant be on state medical assistance and must have lost your premium-free Part A coverage and SSDI benefits because you decided to return to work.
At up to 200% of the FPL, the income limit for the QDWI program is much higher than the QMB, SLMB, and QI programs. You may also have up to two times the SSI limit in financial resources. In addition, enrollees who qualify for QDWI arent eligible for other Medicaid benefits.
2021 Dual Eligible Standards for QDWI in all states and D.C. except Alaska and Hawaii:
| Individual |
In Alaska: $5,449/$7,342, in Hawaii: $5,025/$6,765
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Does Medicaid Cover Nursing Homes
Medicaid covers nursing home costs if you qualify. Medicaid is the largest fund-source for nursing home care. For eligible seniors, Medicaid covers long-term nursing home care in Medicaid-certified facilities4 when medically necessary. You’ll have to be under a certain income level and meet other state-specific requirements to qualify.5
All 50 states offer Medicaid, but nursing home services, cost coverage, and eligibility requirements vary widely by state. For example, each state sets its own income limit to determine if you are eligible for Medicaid. Not all nursing homes accept Medicaid, so check with each facility.
Unlike Medicare, Medicaid does not impose an official time limit on nursing home stays as long as they’re in a licensed and certified Medicaid nursing facility.
What Is Covered by Medicaid
- Long-term care covers nursing home stays for qualifying patients needing ongoing care for a chronic mental or physical condition.
- Skilled nursing and related medical care.
- Rehabilitation from illness, injury, or disability.
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$2800 Flex Card For Seniors On Medicare And Medicaid
The seniors are the people who have worked hard and want to live a better life. Indeed the government also provides different assistance to make sure they can live longer and healthier. Part of this, Medicare is one of the programs for them to let them live well and be healthy. Medicare is a long program and has different parts that seniors should know one by one. When they choose the Medicare advantage plan, they can easily personalize coverage with a new Visa Flex card.
This card may be useful to let you go freedom and can extend your dental, vision, and hearing coverage. It is your choice for you and you should know every part of this plan to make sure you will benefit. So we will discuss Flex Card for Seniors and what it pays you.
Eligibility To Get A Flex Card
Flex Card is typically offered as part of health insurance plans or private Medicare plans. There may be eligibility criteria but the most common is to qualify for a health insurance plan with a flexible spending account. Additionally, the eligibility may also come on different aspects such as income, health needs, and participation in other assistance programs.
It is also important to note that the flex card is healthcare-related and there are so many optional plans that include various Medicare and other services into health care services. These highly are designed for the seniors to make sure they can choose the need that can adapt to their health needs.
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Alternative State Payments For Assisted Living Expenses
States offer a broad range of alternative coverage for seniors that are not part of the typical Medicaid program. These payments are provided through alternative programs that allow for the waiver of some federal rules such as income eligibility. Most seniors who apply for these waivers must exhibit care needs equivalent to a senior who lives in a nursing home in order to qualify.
Alternative payment programs also have a limited number of spots available, often significantly fewer than Medicaid. Because the waiting list is quite common and lengthy, many seniors will apply well in advance of their actual needs. Support programs differ from region to region and not all programs may be available to seniors statewide. Make sure to ask your enrollment officer about alternative programs available for their location when researching assisted living communities to join.
There are also other non-traditional assistance programs that are available for specific groups of seniors. For example, veterans or the surviving spouse of a veteran have special programs available to help defray the cost of assisted living. Many religious groups and organizations also offer funding for long-term care or have assisted living facilities for seniors that operate on a not for profit model.
Qualifying And Applying For Medicare And Medicaid
Medicaid eligibility requirements can be confusing, especially for applicants under 65 who get Medicare coverage for a qualifying disability. Area Agencies on Aging have trained counselors on hand to answer questions about Medicare and help current Medicare beneficiaries determine if they might be dually eligible. AAA counselors can also help you determine if youre eligible for the QMB, SLMB, QI, or QDWI programs.
Some communities have geriatric care managers available to assist. A geriatric care manager is a registered nurse or social worker who has been trained to help older adults access health and social services. In addition, elder care attorneys, State Health Insurance Assistance Program counselors, and commission-based Medicaid planners are also good resources for information on Medicaid eligibility and benefits.
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The Bottom Line For Using Medicaid And Medicare For Senior Living Costs
It is common knowledge that the cost of living in an assisted living community can stretch a family’s budget, even to the breaking point. Unfortunately, the alternative is to allow seniors to live in an environment that is lacking the much-needed assistance required for them to thrive. Over time, the cost of spot treatments for accidents, declining health and in-home assistance will often surpass the cost of living in a monitored facility.
Though Medicaid and Medicare wont cover all of the costs associated with moving to an assisted living home, it can cover many of the supplementary services associated with it. These programs not only will pay for medical cost but in some cases, they can pay for part of the stay at a residential long term care facility such as an assisted living home. Every state has different rules that regulate eligibility, so it is critical that you speak with your State Medical Assistance Office for more information.
Other resources that seniors can use to help pay for assisted living expenses can be found in your local Area on Aging department or other programs. Many assisted living communities will offer guidance from case managers and intake workers to help you navigate the Medicaid/Medicare process.
Medicare Vs Medicaid: Compare Benefits
In the context of long-term care for the elderly, Medicares benefits are very limited. Medicare does not pay for personal care . Medicare will pay for a limited number of skilled nursing days following hospitalization no more than 100 days for a minimum of 3 days. Medicare will also pay for some home health care, provided it is medical in nature. In recent years, some Medicare Advantage plans started offering long-term care benefits. These services and supports are plan-specific. But they may include:
Read Also: What Do I Need To Apply For Medicaid
Medicaid Could Also Cover The Cost Of Programs Of All
PACE programs have a monthly premium. If you have Medicaid, then that premium could be covered by your benefits. This is great news, because it means qualifying members can receive a wide variety of needed health services at little to no cost.
Mobility Aids
Many Medicaid plans cover mobility aids. Depending on the Medicaid plan, qualifying members could receive their mobility aids at a reduced price or at no cost at all.
This is great news, as mobile aids can range in cost from hundreds to thousands of dollars. With Medicaid covering part or all of the cost, seniors can get the equipment they need to enjoy life and remain independent.
People Who Have Both Medicare & Medicaid
People who have both Medicare and full Medicaid coverage are dually eligible. Medicare pays first when youre a dual eligible and you get Medicare-covered services. Medicaid pays last, after Medicare and any other health insurance you have.
You can still pick how you want to get your Medicare coverage: Original Medicare or Medicare Advantage . Check your Medicare coverage options.
If you choose to join a Medicare Advantage Plan, there are special plans for dual eligibles that make it easier for you to get the services you need, include Medicare coverage , and may also cost less, like:
- Special Needs Plans
- Medicare-Medicaid Plans
- Program of All-Inclusive Care for the Elderly plans can help certain people get care outside of a nursing home
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What Services Does Medicaid Cover
Medicaid covers more than 60 percent of all nursing home residents and roughly 50 percent of costs for long-term care services and supports.
Federal rules require state Medicaid programs to cover certain mandatory services, such as hospital and physician care, laboratory and X-ray services, home health services, and nursing facility services for adults. States are also required to provide a more comprehensive set of services, known as the Early and Periodic Screening, Diagnostic, and Treatment benefit, for children under age 21.
States can and all do cover certain additional services as well. All states cover prescription drugs, and most cover other common optional benefits include dental care, vision services, hearing aids, and personal care services for frail seniors and people with disabilities. These services, though considered optional because states are not required to provide them, are critical to meeting the health needs of Medicaid beneficiaries.
About three-quarters of all Medicaid spending on services pays for acute-care services such as hospital care, physician services, and prescription drugs the rest pays for nursing home and other long-term care services and supports. Medicaid covers more than 60 percent of all nursing home residents and roughly 50 percent of costs for long-term care services and supports.
How Much Does Medicaid Cost? How Is It Financed?
Poverty And Illness In The Elderly Population
Despite general improvements in the economic situation of the elderly population over the last 3 decades, many elderly Americans continue to struggle to pay living expenses on low or modest incomes. Forty-one percent of the Nation’s 31 million elderly people living in the community have incomes below twice the Federal poverty level and 1 in 5 are poor or near-poor .
In 1994, the FPL was $7,100 per year in income for a single elderly adult and $9,000 for an elderly couple. Twelve percent of the elderly population3.7 million people had incomes below the poverty level and another 7 percent2.2 million people were near-poor with incomes between 100 and 125 percent of FPL .1 Together, these 5.9 million poor and near-poor people comprise Medicare’s non-institutionalized low-income elderly population. Another 1.4 million elderly reside in nursing homes and receive assistance from Medicaid .
Distribution of Elderly, by Poverty Level: 1994Percent of the Elderly Who Are Low-Income, by Age, Sex, and Race: 1994Characteristics of Elderly Medicare Beneficiaries: 1992Percent of Elderly Medicare Beneficiaries Reporting Fair or Poor Health: 1992Percent of Elderly Medicare Beneficiaries With Selected Conditions: 1992Percent of Elderly Medicare Beneficiaries Needing Help With ADL Limitations: 1992
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About Medicaid For Elderly Or Adults With Disabilities
Medicaid covers adults with intellectual and development disabilities as well as adults with physical disabilities. Medicaid also covers elderly individuals who may need additional services to help them live as independently as possible. The goal of the Medicaid program is to get the right care at the right place at the right cost with the right outcomes. After Medicaid eligibility is determined, and individual will have an assessment regarding the level of care required to help meet individuals needs and care.
Individuals who are elderly or live with a disability can be eligible for Medicaid coverage if they meet the following criteria:
- Be a U.S. citizen or eligible non-citizen
- Have a disability diagnosis under the Social Security Act
- Be over the age of 65 years
Those with Developmental Disabilities can receive services specific to their disability when they meet certain criteria.
Medicaid/Medicare Participants
A dual eligible beneficiary is someone over the age of 21, has Medicare A, B, and D and is eligible for enhanced Medicaid. There are two programs available for dual eligible beneficiaries, Medicare Medicaid Coordinated Plan and the Idaho Medicaid Plus Program. For more information, visit the Medicaid/Medicare Participants page.
To be eligible for Medicaid for the Aged, Blind and Disabled program, you cannot own resources in excess of the resource guidelines.
Resources that count toward eligibility:
- Other resources
Resources that do not count include:
