Medicare vs. Medicaid

Medicare and Medicaid are frequently confused with one another, so it is important to know what they are and how they differ.

Medicare

There are four components to Medicare, which is a health insurance program with monthly premiums. Clients are typically 65 and older, but certain disabilities or end stage renal failure can result in coverage as well.

Part A

The first part covers skilled nursing and home health, (both for a limited time,) in addition to medically necessary hospital stays and hospice care.

Part B

The second part helps pay for flu vaccines, doctor appointments, outpatient care, and other health care services.

Part C

Part three consists of Medicare Advantage Programs, which are offered by private companies with Medicare approval. Additional services and plans are available for purchase, in addition to the original Medicare services.

Part D

The final portion covers prescription drug costs.

There is extended insurance available via MEDIGAP, which helps pay for copayments and deductibles for an added fee.

This coverage does not include in-home care or care facilities, such as Adult Care Homes or Assisted Living Communities. Medicare has specific enrollment periods with potential penalties for failure to enroll.

Medicaid

This is a low income program administered by the state to help cover health and care services for qualified applicants. This coverage includes Assisted Living, Adult Care Homes, and long-term Nursing Care at Medicaid-contracted communities.

There are three criteria to qualify:

  1. The individual’s income must be equal to or less than 300% of Supplemental Security Income. ($2,199 in 2015)
  2. They can have no more than $2,000 in total assets available for care coverage, excluding a home (up to $500,000 in equity if you or your spouse live there), medical equipment, one vehicle, a $1,500 pre-paid burial plan, and household items.
  3. They must need assistance with a minimum number of Activities of Daily Living (ADLs). ADLs measure a person’s ability to function daily, including bathing, feeding, grooming, dressing, toileting, medication management, mobility, and the ability to stand from a sitting position.