Money Matters: Exploring the differences between Medicare and Medicaid - WMUR Manchester

Advice offered by Marc Hebert, president of The Harbor Group Inc., a certified financial planner. If you have any questions about finance or if you’d like to suggest a future topic, email webstaff@wmur.com.There are two government programs that are often confused with each other: Medicare and Medicaid. Their names are similar and they generally pay for what appears to be similar health services. So just what are the differences?A very short explanation is that Medicare is for older individuals and Medicaid is for people with limited means. Medicare is a federal health insurance program. It tries to maintain reasonable prices for health insurance and is basically targeted toward retirees. The program doesn’t take into account the medical situations of those it covers. Disabled people may also be eligible to participate in Medicare regardless of their age. On the other hand, Medicaid is a health insurance assistance program. It is managed jointly by state and federal governments. Medicaid is designed to help needy people whether they are older, disabled, blind, or generally in need. Sometimes, parents of minors may also qualify. It is important to distinguish who is eligible for each program. Since Medicaid is a joint program with the states, each state has different rules for eligibility in regards to the application process. An applicant has to be a resident of the state and a U.S. citizen to qualify. As eligibility does vary, federal law steps in to make sure certain groups qualify. These include low-income families, certain pregnant women, and children. If an individual receives Supplemental Security Income (SSI), they may also qualify. Certain income and asset ownership tests must also be met. States determine the amount, duration, and types of Medicaid benefits that are offered. Some coverage examples are inpatient care, outpatient hospital services, lab work, and X-rays or other imaging. Family planning and preventative care can be included. Many states have optional benefits available, as well. Unlike Medicaid, Medicare has four distinct parts within the program: Original Medicare Part A, Original Medicare Part B, Medicare Part C, and Medicare Part D. Part A can help cover inpatient care in hospitals, skilled nursing facilities for a limited time, hospice care, and some home health care. Part B helps with health care providers, outpatient care, ambulance services, lab work, and physical therapy. Certain medical equipment and preventative services may also be covered. Part C, which is often referred to as Medicare Advantage, replaces Parts A and B. Part C participants receive managed care through health plans that are generally similar to the health plans that retirees may have received while employed. Part C usually provides more inclusive coverage and may include services such as vision. Part D is for prescription drug coverage. Eligibility for premium-free Medicare Part A begins once you reach age 65 so long as you or a spouse worked and paid Medicare taxes for at least 10 years. Under some circumstances, you may be able to buy into Part A. However, most people do not pay for Part A. Everyone pays for Part B and it is elective. The premium is often deducted from Social Security payments. So, is it possible for an individual to be covered by both Medicare and Medicaid? The answer is yes. As long as you meet the requirements of both programs, you will have coverage from both. An assumption often made is that these programs will cover long-term care. Most long-term care isn’t in the form of medical care. Long-term care helps with basic personal tasks associated with living. Medicare will pay for limited skilled nursing care provided in Medicare-certified skilled nursing facilities. This care is limited to 100 days. While each state is different, Medicaid may cover nursing home services and other home/community-based services. Be sure to check your state’s requirements if you feel you might need this care at some point in the future. It may also be worth the time and cost to discuss your unique situation with an attorney specializing in elder care planning or a certified financial planner.

There are two government programs that are often confused with each other: Medicare and Medicaid. Their names are similar and they generally pay for what appears to be similar health services. So just what are the differences?

A very short explanation is that Medicare is for older individuals and Medicaid is for people with limited means.

Medicare is a federal health insurance program. It tries to maintain reasonable prices for health insurance and is basically targeted toward retirees. The program doesn’t take into account the medical situations of those it covers. Disabled people may also be eligible to participate in Medicare regardless of their age.

On the other hand, Medicaid is a health insurance assistance program. It is managed jointly by state and federal governments. Medicaid is designed to help needy people whether they are older, disabled, blind, or generally in need. Sometimes, parents of minors may also qualify.

It is important to distinguish who is eligible for each program. Since Medicaid is a joint program with the states, each state has different rules for eligibility in regards to the application process. An applicant has to be a resident of the state and a U.S. citizen to qualify. As eligibility does vary, federal law steps in to make sure certain groups qualify. These include low-income families, certain pregnant women, and children. If an individual receives Supplemental Security Income (SSI), they may also qualify. Certain income and asset ownership tests must also be met.

States determine the amount, duration, and types of Medicaid benefits that are offered. Some coverage examples are inpatient care, outpatient hospital services, lab work, and X-rays or other imaging. Family planning and preventative care can be included. Many states have optional benefits available, as well.

Unlike Medicaid, Medicare has four distinct parts within the program: Original Medicare Part A, Original Medicare Part B, Medicare Part C, and Medicare Part D. Part A can help cover inpatient care in hospitals, skilled nursing facilities for a limited time, hospice care, and some home health care. Part B helps with health care providers, outpatient care, ambulance services, lab work, and physical therapy. Certain medical equipment and preventative services may also be covered. Part C, which is often referred to as Medicare Advantage, replaces Parts A and B. Part C participants receive managed care through health plans that are generally similar to the health plans that retirees may have received while employed. Part C usually provides more inclusive coverage and may include services such as vision. Part D is for prescription drug coverage.

Eligibility for premium-free Medicare Part A begins once you reach age 65 so long as you or a spouse worked and paid Medicare taxes for at least 10 years. Under some circumstances, you may be able to buy into Part A. However, most people do not pay for Part A. Everyone pays for Part B and it is elective. The premium is often deducted from Social Security payments.

So, is it possible for an individual to be covered by both Medicare and Medicaid? The answer is yes. As long as you meet the requirements of both programs, you will have coverage from both.

An assumption often made is that these programs will cover long-term care. Most long-term care isn’t in the form of medical care. Long-term care helps with basic personal tasks associated with living. Medicare will pay for limited skilled nursing care provided in Medicare-certified skilled nursing facilities. This care is limited to 100 days. While each state is different, Medicaid may cover nursing home services and other home/community-based services. Be sure to check your state’s requirements if you feel you might need this care at some point in the future. It may also be worth the time and cost to discuss your unique situation with an attorney specializing in elder care planning or a certified financial planner.