Because of the similarities between the two benefits programs, Medicaid and Medicare, many people are confused and have questions about eligibility and benefits. Your Medicaid attorney can answer your questions and alleviate your concerns. 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. Kansas Medicaid provides coverage for eligible individuals who meet the needs-based requirements.
What is Medicaid and how does it work?
Medicaid is an assistance program that provides healthcare benefits to individuals 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.
Explaining the Medicare program
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.
Be familiar with the different 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 it may be time to 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 Kansas Medicaid attorney to discuss options.
The importance of Medicaid planning
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, generally you cannot have financial resources totaling more than $2,000. Although your residence or homestead is typically 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.
You cannot simply give away your property
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.
Protecting your 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 advanced planning it is possible to retain control of your assets while still qualifying for Medicaid. The earlier you start planning the better off 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.
Additional 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.
Join us for a FREE workshop! If you have questions regarding Medicaid, or any other elder law planning matters, contact Gaughan & Connealy for a consultation either online or by calling us at (913) 262-2000.