Who Qualifies For Medicaid
Medicaid beneficiaries generally must be residents of the state in which they are receiving Medicaid. They must be either citizens of the United States or certain qualified non-citizens, such as lawful permanent residents. In addition, some eligibility groups are limited by age, or by pregnancy or parenting status.
Expansion Of Coverage Under The Affordable Care Act
As of December 2019, 37 states and the District of Columbia had agreed to expand Medicaid under the Affordable Care Act.
In the first quarter of 2016, states that expanded Medicaid had a 7.3 percent uninsured rate among persons aged 18 to 64, while non-expansion states had a 14.1 percent uninsured rate.
Several states declined the option after a 2012 Supreme Court ruling that stated that states would not forfeit Medicaid money if they did not expand Medicaid under the Affordable Care Act. These states are home to more than half of the countrys uninsured.
According to the Centers for Medicare and Medicaid Services , the cost of expansion in 2015 was $6,366 per person, up 49 percent over previous estimates.
Medicaid coverage had been extended to an estimated 9 to 10 million people, the majority of whom were low-income adults. In October 2015, the Kaiser Family Foundation predicted that 3.1 million more people were uninsured in states that refused to expand Medicaid.
In several states, the poverty line was much lower than 133 percent of the median income. Medicaid was not offered in many states to non-pregnant people without impairments or dependent children, regardless of their income. Because such people were not eligible for subsidies on commercial insurance plans, they had few options for medical coverage.
Medicaid Eligibility And Costs
The federal and state partnership results in different Medicaid programs for each state. Through the Affordable Care Act , signed into law in 2010, President Barack Obama attempted to expand healthcare coverage to more Americans. As a result, all legal residents and citizens of the United States with incomes 138% below the poverty line qualify for coverage in Medicaid participating states.
While the ACA has worked to expand both federal funding and eligibility for Medicaid, the U.S. Supreme Court ruled that states are not required to participate in the expansion to continue receiving already established levels of Medicaid funding. As a result, many states have chosen not to expand funding levels and eligibility requirements.
Those covered by Medicaid pay nothing for covered services. Unlike Medicare, which is available to nearly every American of 65 years and over, Medicaid has strict eligibility requirements that vary by state.
However, because the program is designed to help the poor, many states have stringent requirements, including income restrictions. For a state-by-state breakdown of eligibility requirements, visit Medicaid.gov and BenefitsCheckUp.org.
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Can Families Rely On Medicare To Cover Home Care Costs
Medicare doesnt pay for long-term home care costs or 24-hour assistance. Similar to Medicares nursing home coverage, Medicare contributes to short-term home health care services. Medicare Part A and Part B entitle seniors to fewer than eight hours of care per day for a 21-day period. A doctor must prescribe this care and recommend a Medicare-certified agency to arrange and facilitate it.
Medicare primarily pays for treatments that help seniors recuperate from an injury or stroke, such as:
- Physical therapy
- Occupational therapy
- Speech-language pathology services
Many families hire a home caregiver to give their loved one companionship or to reduce their at-home responsibilities, like chores and meal preparation. In these cases, Medicare cant serve as a payment method.
Medicare doesnt pay for these aspects of home care:
- 24-hour supervision
- Daily tasks like personal shopping, cleaning, and laundry
- Personal care services like bathing and toileting
Implications For The Future
The three decades of experience with Medicare as a primary insurer and Medicaid as a supplement for the low-income elderly demonstrate the importance of both basic coverage for all elderly people and additional financial assistance for low-income elderly people. For those in the elderly low-income population jointly covered by Medicare and Medicaid, access to care, financial protection, and satisfaction with the cost of medical care are all notably higher than for low-income elderly who depend solely on Medicare. With the universal base of Medicare as a building block for health care coverage, the elderly poor and near-poor with Medicaid supplementation are able to access mainstream medical care without severe financial burden.
To assure Medicare’s adequacy for coverage in the future, it is important to maintain assistance with financial obligations and additional benefits that Medicaid provides today. It is critical to either maintain the Medicare-Medicaid partnership for the low-income elderly or to provide direct federal assistance to supplement Medicare for the elderly poor. Without such guarantees, Medicare’s notable progress in reducing gaps in service use between poor and non-poor elderly could be undone and millions of low-income elderly Americans could have their access to medical care compromised.
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Taxes Set To Fund Medicare
Medicare is funded in part by payroll taxes established by the Federal Insurance Contributions Act and the Self-employment Contributions Act of 1954. In the case of employees, the tax is equal to 2.9% of wages, salaries and other compensation.
Until 31 December 1993, the law provided for a maximum amount of wages, in which the Medicare tax could be imposed each year. As from 1 January 1994, the compensation limit was removed. A self-employed worker must pay the entire 2.9% tax on net earnings, but can deduct half of the income tax in the income tax calculation.
Will Medicaid Pay For Assisted Living
Medicaid typically pays for some but not all assisted living services. Families and seniors can expect help with costs related to medical treatments and personal care services, reducing their overall bill. However, Medicaid often wont cover the total price of room and board in an assisted living community. In most states, Medicaid can be used to pay for the following:
- Help with ADLs like toileting, mobility, and dressing
- Home health services, which may be provided in an assisted living community
- Physical, occupational, or speech therapy
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Navigating Medicare Medicaid And Long
Determining eligibility for Medicare or Medicaid as well as considering how these programs affect long-term care access and costs poses a challenge for most seniors. Shifting requirements in different states mean one-size-fits-all advice rarely applies to each familys unique situation. If seniors are eligible for other cost assistance, such as VA benefits, the process can be complicated further.
Doing your own research and then talking to an expert is so critical, urges McDowell. In the same way a financial advisor would talk to someone about how to reduce their taxes, thats how an elder care attorney would help someone decide the best option for their long-term care.
Seniors can find a qualified elder care attorney in their area, including one who specializes in Medicare and Medicaid policies, by using NAELAs up-to-date database.
Section : National Priorities And The Future Of Medicare And Medicaid
Spending Priorities
Reflecting the high regard the public holds for these programs, Americans are generally opposed to cutting back federal spending on Medicare or Medicaid, as previous surveys have found. Nearly half say theyd like to see the President and Congress keep Medicare and Medicaid spending about the same, while roughly four in ten say they would support an increase in spending. Support for spending increases for Medicare and Medicaid fall just below support for such increases in education and Social Security. Relatively few support cuts to either program.
Figure 12
Democrats say they favor increased government spending on Medicare and Medicaid , while Republicans favor keeping spending about the same . In terms of peoples connection to the programs, those covered by Medicare are no more likely than those with employer coverage to support increases in Medicare spending. However, for Medicaid, roughly half of those covered by Medicaid say they support increased spending for the program, while a similar share of those with coverage through an employer say they would like spending to remain as it is. Those who say they have no personal experience with Medicaid and no close friends or family who have are somewhat more likely to support cuts to Medicaid . .
Financial Future Of Medicare
Figure 13
Figure 14
Proposed Changes To Medicare
Figure 15
Figure 16
Proposed Changes To Medicaid
Figure 17
Partisan Divisions On Who Americans Trust To Handle Programs
Figure 18
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Medicare Or Medicaid: Senior Care & Nursing Home Costs
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What does Medicare cover?
Medicare is divided into four different parts. Part A covers in-patient and hospice care. Part B covers outpatient services. Part C grants plans that lower the government costs while still allowing patients to choose the benefits that meet their needs.
Part D covers prescription drugs. Medicare can also cover rehab stays in nursing homes for short periods after injuries or surgeries. Rehab and therapy at home may also be covered for a restricted period of time if ordered by a doctor.
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What doesn’t Medicare cover?
Medicare doesnt cover assisted living, long-term care at a nursing facility, residential care homes, or any long-term care.
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What is Medicaid?
While Medicare is a Federal program, Medicaid programs can vary depending on the state. Medicaid pays benefits directly to the provider and is the primary source of health insurance for low-income people.
Medicaid can cover long-term care in nursing homes and is the primary way nursing home residents pay for their stays. Only those who are low-income or how have already exhausted their own savings and retirement money can qualify for Medicaid programs.
Medicare is a single payer health insurance program that is nationally based. Americans 65 years of age must sign up for Medicare. It will be their first source of health insurance. Cost not covered by Medicare, approximately 50%, need to be covered by private insurance, supplemental insurance or out of pocket.
Using An Annuity For Medicaid Planning
An annuity is a regular stream of payments back to you, in exchange for a lump sum of money. It can be either a private arrangement or commercial . Medicaid only allows commercial annuities.
For example, if you are a male, age 70, you could transfer $50,000 to an insurance company in exchange for a monthly annuity payment of $400, guaranteed for your life, no matter how long you lived. But what if you died unexpectedly after two years? The annuity payments would stop. Most people do not like that, and therefore will typically purchase the annuity with a “guarantee period” of at least a certain number of years.
According to the Medicaid rules, a male age 70 has a life expectancy of 12.8 years. So you cannot purchase an annuity with a guarantee period that exceeds 12.8 years without causing a period of disqualification from Medicaid. So let’s stick with 12.8 years to be safe. Because you are guaranteed payments for the longer of your life expectancy or 12.8 years, the monthly payments will be lower. In this example, they drop from $400 to $354 per month.
So if the Medicaid “bill” is for two years of Medicaid coverage, it could easily be in the amount of $96,000 . Since that exceeds the value of the annuity, the state will receive all of the remaining payments and your family will get nothing.
- How much money is there to invest in the annuity?
- What is the age of the nursing home resident?
- What is the expected life expectancy of the resident?
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Does Medicare Pay For Nursing Homes
The number one misconception about Medicare is that it will pay for your long-term care, says McDowell. It will only pay for a rehabilitative stay.
Seniors who need care in a skilled nursing facility due to an injury can receive Medicare coverage for up to 100 days. It comes with the following costs:
- Older adults pay nothing for days one through 20 of a nursing home stay, with Medicare covering the entire bill. This covered nursing home stay is available to seniors after a three-night inpatient stay in a hospital.
- Medicare pays for nearly all nursing home costs for days 21-100 of a nursing home stay, but seniors are responsible for a daily coinsurance. This coinsurance payment is approximately $170.50 per day.
- After 100 days, Medicare will not pay any nursing home costs.
Medicare also pays for the entirety of hospice and palliative care in a skilled nursing community.
Medicaid Works For Seniors
Medicaid provides essential care for 7 million seniors. Medicaid covers nursing home care and other long-term services and supports, as well as other medical care and supportive services that Medicare doesnt cover, which help many low-income seniors and people with disabilities stay independent and healthy. It also covers premiums, deductibles, and cost-sharing for Medicare beneficiaries.
Cutting Medicaid or radically changing its financing structure for example to a per capita cap as in recent congressional Republican proposals to repeal the Affordable Care Act would threaten the essential services and other assistance that seniors rely on to maintain their health and independence. Instead of placing a cap on Medicaid, federal policymakers should support positive state innovations that improve coverage for seniors.
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Does Medicaid Pay For Memory Care
Though not all communities accept Medicaid, the program does pay for 24-hour dementia care in many memory care facilities as well as memory-related care in skilled nursing communities. This usually includes all costs associated with room and board. Under Medicaid policies, seniors must forfeit most of their available income including Social Security checks toward their care and can retain only a small monthly personal allowance. Allowance amounts differ by state but typically are less than $75.
How To Apply For Medicaid Nursing Home Care
If you need assistance with nursing home care, Id recommend applying for Medicaid. First, check to see if youre eligible for Medicaid. In general, Medicaid is open to all ages and is based on income and family size. You may also need to show proof of citizenship.
Then, Id recommend visiting your respective states government website and apply through the Health Insurance Marketplace or with your state Medicaid agency. When applying for a specific Medicaid policy, its important to ensure that coverage is for Medicaid-certified nursing homes. While navigating the application process for Medicaid can be tedious or confusing at times, know that there are many resources out there to help you.
For resources on how to apply for Medicaid or receive coverage for services related to nursing homes, Id recommend visiting Medicaid.gov. For additional resources about Medicaid and Medicare, read the following articles:
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Can One Have Dual Eligibility For Both Medicare And Medicaid
Yes, Medicare and Medicaid are not mutually exclusive programs. Persons who are eligible for both are referred to as having Dual Eligibility, Dual Eligibles, or often simply Duals. Medicare is the first payer of covered benefits, while Medicaid is the secondary payer. Typically, Medicaid will pay for Medicare premiums and co-payments for dual eligibles. In fact, many states have special programs intended to make it easier for seniors to manage their dual eligibility status as it can be confusing to know where to turn for what services. This is generally in the form of managed care.
There are also programs called Medicare Saving Programs for low-income seniors that dont quite qualify for Medicaid.
Medicare And Medicaid Facts For Seniors
Medicare and Medicaid are not the same despite what some people think. And even though they have been around for an extremely long time, many people still confuse these two healthcare programs.
Medicare and Medicaid are U.S. government-sponsored programs designed to help cover healthcare costs for US citizens. Funded by taxpayers, these two programs have similar-sounding names, which makes it even more confusing to remember how they work and the coverage they provide.
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How Is Medicaid Funded
The funding for Medicaid comes from both federal and state governments. When your state spends funds on Medicaid, that amount is matched or exceeded at the federal level. The average is somewhere between $1.57-$1.60 per dollar the state spends on its Medicaid program.
States are also incentivized to spend more on Medicaid. This is, in part, because of overwhelming evidence showing a strong correlation between states with more comprehensive Medicaid assistance and their residents reporting much higher health, wellness, and quality of life.
What You Don’t Know About Medicare That Could Hurt You
Medicare is a complicated program however, once you’re equipped with the right information, you can enroll knowing you’re getting the most out of your Medicare plan! Before you enroll, watch the video below with our Editor-in-Chief, Jeff Hoyt, as he covers topics you might not know about Medicare that could hurt you.
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Implementation By The States
States may combine the administration of Medicaid with other programmes, such as the Childrens Health Insurance Program , so that the same entity that manages Medicaid can also manage the other programmes. Separate programmes that are supported by the states or their political subdivisions to offer health coverage for indigents and minors may exist in some locations.
State participation in Medicaid is voluntary but, since 1982, when Arizona established the Arizona Health Care Cost Containment System programme, all states have participated. Medicaid is subcontracted to private health insurance firms in certain states, while it is paid directly to providers in others.
There are a variety of services that might be covered by Medicaid, and some states provide more programmes than others.
Does Medicare Pay For Assisted Living
Generally, Medicare pays for short-term, intensive care for seniors who have experienced an injury or for seniors who are in the end-of-life stage. In contrast, assisted living provides care to seniors who are largely independent but could benefit from assistance with activities of daily living and who need increased supervision, as well as older adults who desire more opportunities for socialization. Given this more limited range of care, Medicare doesnt cover assisted living.
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