Happy senior mature couple in love outside in nature

Understanding Medicare and Medicaid

Caregivers often find themselves in a position where they must help a loved one sort out their options for medical care and insurance coverage. With the rapidly growing population of Americans over the age of 65, there is a greater need than ever for additional sources of coverage.

Currently, Medicare and Medicaid are the most common sources for health coverage for the elderly. For caregivers and those exploring these options for themselves, it is crucial to understand the differences between the programs, Medicare and Medicaid eligibility, the offerings within each program and how to enroll in either program.

How Does Medicaid Work?

Medicaid is a program operated at the state level that provides medical coverage for qualifying individuals and families. It is a federally aided program, as well, meaning that some federal tax dollars help states fund their programs. Because the programs are operated at the state level, offerings and elements of the program may vary between states. So, how does Medicaid work? Medicaid is not based on Social Security benefits or even the person’s age; qualification is solely based on income and resources. The Centers for Medicare and Medicaid Services (CMS) report that an estimated 73 million people were enrolled in Medicaid as of September 2018.

The Medicaid program has several parts:

  • There is a separate part of Medicaid that covers long-term nursing home care.
  • In some states, a Medicaid-related program can help with the costs of an assisted living facility.
  • Medical coverage through the Medicaid program includes most common forms of health care, including premiums, deductibles and co-pays.
  • There are specific, Medicaid-funded programs that cover long-term, in-home care.

What is Medicare?

What is Medicare? Medicare is available to all people age 65 and older or younger individuals who meet disability requirements. The program is federally funded by tax dollars and provides health insurance coverage and medical benefits. All seniors qualify for Medicare coverage, but your payment requirements will vary based on how long you paid into the Medicare/Social Security system through payroll taxes.

There are three parts of Medicare that help cover specific services:

  • Medicare Part A

Part A is hospital insurance. Part A covers inpatient hospital stays, care in a skilled nursing facility (SNF), some types of home health care and hospice care.

  • Medicare Part B

Part B is medical insurance. This part covers certain doctors’ services, medical supplies, outpatient care, and preventive services.

  • Medicare Part D

Part D helps cover the cost of prescription drugs and may cover the costs of many recommended vaccines.

Commonly Asked Questions

How do you qualify for both Medicare and Medicaid?
Many people qualify for dual eligibility in both Medicare and Medicaid. These people are referred to as “full dual eligible” and they receive Medicare, as well as full Medicaid benefits. For individuals who are full dual eligible, Medicaid covers the cost of care for services that Medicare does not cover or only partially covers. Some of these services include:

  • Nursing home care
  • Long-term care at a facility
  • Care at an intermediate-level care facility
  • Home health services
  • Transportation services
  • Additional home and community-based services

Will I lose my Medicaid if I get Medicare?
The short answer is no. According to CMS reports, there are currently 12 million people who are enrolled in both Medicaid and Medicare. As long as the individual meets federal qualification guidelines for Medicare eligibility, as well as the state requirements for Medicaid, you are dual-eligible for both programs.

Who pays first: Medicare or Medicaid?
In all cases, Medicaid is referred to as a “payer of last resort.” This means that any health care services that a dual eligible individual receives are paid first by Medicare and then by Medicaid.

Planning for the Future

When exploring options for care or choices for living arrangements for an elderly loved one, it is important to understand coverage and how Medicaid and Medicare work together. At Mission Chateau, we provide a range of options, including memory care, assisted living and independent living. We serve the needs of couples and individuals and will work with the entire family to help make sure you understand your coverage and your choices. Contact us today to schedule a consultation.