Medicare is a federal health insurance program primarily for individuals aged 65 and older, but it also covers certain younger individuals with disabilities or specific diseases. Medicare consists of several parts.
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Part A (Hospital Insurance). Covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
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Part B (Medical Insurance). Covers outpatient care, doctor’s visits, preventive services, and some home health care.
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Part D (Prescription Drug Coverage). Covers the cost of prescription drugs.
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Part C (Medicare Advantage). Offered by private companies, these plans provide all Part A and Part B services and may include additional benefits like vision, hearing, and dental coverage.
Medicaid is a joint federal and state program that provides health coverage to individuals with low income and limited resources. Medicaid covers a wide range of health services, including long-term care services such as nursing home care and home-based care. Medicaid eligibility and benefits can vary from state to state, as the program is administered at the state level.
There are key differences between Medicare and Medicaid beginning with eligibility criteria that can include.
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Medicare eligibility is primarily based on age (65 and older) or disability status. There are no income or asset limits for Medicare.
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Medicaid eligibility is based on income and asset limits, which vary by state. Applicants must meet certain financial criteria to qualify.
When it comes to the difference in the coverage.
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Medicare covers hospital care, medical services, and prescription drugs but does not cover long-term custodial care.
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Medicaid covers a broader range of services, including long-term care services such as nursing home care and in-home personal care services.
You may wonder if Medicare will pay for Florida Medicaid? The short answer is no, Medicare and Medicaid are separate programs with different eligibility criteria and coverage. Medicare does not pay for long-term care services provided by Medicaid. Individuals, however, who are eligible for both Medicare and Medicaid (known as dual-eligible) can receive benefits from both programs. Here’s a little bit more information on how it works.
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Dual-Eligible Individuals. These individuals qualify for both Medicare and Medicaid. Medicare acts as the primary payer for medical services, while Medicaid covers long-term care services and other benefits that Medicare does not cover.
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Long-Term Care Coverage. While Medicare may help with short-term rehabilitation in a skilled nursing facility after a hospital stay (typically up to 100 days), it does not cover long-term custodial care. Medicaid, on the other hand, provides comprehensive coverage for long-term care services, including nursing home care and in-home care for those who meet the financial and functional eligibility criteria.
Understanding that Medicare does not cover long-term custodial care highlights the importance of planning for long-term care needs. Let us share a few key steps to consider.
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Medicaid Planning. Work with an experienced elder law attorney to navigate the complexities of Medicaid eligibility and to develop a strategy for protecting your assets while qualifying for Medicaid benefits.
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Long-Term Care Insurance. Consider purchasing long-term care insurance to cover the costs of long-term care services that are not covered by Medicare. An elder law attorney can help you evaluate whether this option is suitable for your situation.
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Estate Planning. Ensure that your estate plan includes provisions for long-term care. This may involve setting up trusts, designating healthcare proxies, and making other legal arrangements to protect your assets and ensure your healthcare needs are met.
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Dual-Eligible Benefits. If you or your loved one is eligible for both Medicare and Medicaid, an elder law attorney can help you understand how to maximize the benefits from both programs to cover medical and long-term care expenses.
We know this blog may raise more questions than it answers. Medicare and Medicaid are distinct programs with different eligibility criteria and coverage. While Medicare does not pay for long-term care services provided by Medicaid, dual-eligible individuals can benefit from both programs. Understanding the limitations of Medicare and the comprehensive coverage provided by Medicaid is crucial for effective long-term care planning. Working with an experienced estate planning and elder law attorney can help you navigate these complexities, ensuring that you have the resources and legal protections in place to meet your long-term care needs. We welcome you to schedule a free 30-minute initial meeting with our legal team to discuss your options and start to develop a plan tailored to your needs.
