Many clients have questions about Medicaid and Medicare, often confusing the two benefits programs. Although they are both established by the federal government and both provide healthcare-related services, there are some major differences between Medicaid and Medicare. The primary difference is that Medicaid is state-run, whereas Medicare is entirely federal. Missouri Medicaid provides coverage for eligible individuals who meet the needs-based requirements.
What is Medicaid?
Medicaid is an assistance program that provides health care benefits to those with few assets. Federal, state and local taxes are used to fund this program and those funds are used to help eligible individuals pay their medical expenses. In most cases, Medicaid recipients are not required to pay anything for covered medical expenses, with the exception of a small co-payment.
Medicaid is state-run
One major way that Medicaid differs from Medicare is that Medicaid is run by state and local governments within the federally established guidelines. In other words, the eligibility requirements and types of benefits provided by Medicaid programs will vary from one state to the next. Nevertheless, most states offer coverage for families with children who live below a set income level, pregnant women, seniors, and individuals with disabilities.
What is Medicare?
Medicare is a federal health insurance program that provides benefits to individuals age 65 and older, disabled individuals and dialysis patients. Unlike Medicaid, eligibility for Medicare is not based on income. Also, because Medicare is run solely by the federal government, eligibility and benefits are the same in every state. If you need more information about eligibility and benefits, you can visit www.Medicare.gov.
Medicare benefits are provided by private companies
Another way that Medicare is different from Medicaid is that benefits are provided by private companies who have contracted with Medicare to provide coverage. Like many insurance policies, Medicare patients pay only a portion of their covered medical expenses through deductibles, along with small monthly premiums for non-hospital coverage.
Types of Medicare coverage
Medicare is divided into two primary types of coverage—Medicare Part A and Part B. Medicare Part A provides coverage for health care received in hospitals, skilled nursing facilities, home health care and hospice care. Most individuals do not pay for Medicare Part A. Medicare Part B covers doctor visits, outpatient hospital care, and other medical services.
When should I consider Medicaid planning?
Despite what you might think, it is never too late to plan for Medicaid. While it is better to start early and plan ahead in order to ensure that you will qualify for Medicaid, there may still be options later on. Even if you unexpectedly find yourself in need of Medicaid, or a loved one does, it’s not too late to talk to your Missouri Medicaid attorney to discuss options.
Why Medicaid planning is important
If there is any possibility that you will need long-term care, you need to consider Medicaid planning. First, of all, Medicaid is a need-based benefits program. That means, in order to be eligible for Medicaid, you cannot have financial resources totaling more than a few thousand dollars. Although your residence or homestead is generally not included in that calculation, it is still pretty easy to spend all of your savings before Medicaid will start paying for the cost of long-term care. The purpose of Medicaid planning is to keep that from happening.
Giving away your property is not the answer
Many people have the mistaken belief that they can simply transfer their assets to someone else, in preparation for applying for Medicaid benefits. However, if you do that at any point within five years of applying for Medicaid, a period of ineligibility will be imposed. That means you won’t receive any benefits until that period has ended. For that reason, the timing of your transfers is important and early planning is critical.
How can I protect my assets before going into a nursing home?
Many clients believe there is nothing that can be done to protect their assets from Medicaid when they need long-term nursing home care. That is not the case. With properly advance planning it is possible to retain control of your assets while still qualifying for Medicaid. The earlier you start planning the better of you will be. Whether you are facing long-term care issues yourself or you have a family member who is, call us with your questions.
Other services covered by Medicaid
Although Medicaid pays for a variety of medical services, it does not cover everything. Of those services it does cover, there may also be limits, especially for adults. In order to qualify for certain services, you may need prior approval or authorization from your primary care physician. Medicaid will typically pay for some in-home services, but only if a doctor says the home care services are actually needed for specific medical reasons.
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