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How is Medicare different from Medicaid

People often confuse Medicare and Medicaid. They are two distinct programs. Medicare is exclusively a federal program. Medicaid is both a federal and a state financed program. As a result, there are many differences between the two programs.

Medicare Program

Medicare is guaranteed to every individual who paid into Social Security system through their employment taxes. That contribution is automatically deducted from your pay. Upon reaching retirement age, you will qualify for Medicare as the primary provider for payment of doctors, hospital and prescription costs.

Medicare does not cover long term care for a nursing home, but will assist with the cost of short term rehabilitation services, where the goal is for the individual to return to the community they were previously living in.

Medicaid Programs

Unlike Medicare, Medicaid is a federally funded medical program for the elderly, blind and disabled persons. It is offered to persons who meet eligibility requirements of the program. The goal of Medicaid is to assist the individual in need by paying for medical services. The Medicaid program provides assistance in the community, in assisted living and nursing home. Each county has programs available to meet these needs.

Medicaid is administered by each state. As a result, there are differences between states on what is available. Medicaid pays all medical related bills for the qualified applicant, including all hospital bills, all doctors' bills, all pharmacy bills, the entire residential care facility bill, medical transportation costs, medical equipment rental bills, and any other medically necessary bills incurred by the Medicaid recipient.

Applying for Medicare

Recipients of Medicare apply for the benefits upon retirement typically. Once a person reaches retirement age, they should sign up for Medicare as well. Failure to do so, may result in increased premium costs, so it is recommended that one applies for Medicare, even if they are not collecting social security.

An individual may also receive Medicare is they are declared social security disabled and receive what is known as SSD benefits. An SSD recipient applying for this Medicare, must wait 30 months before it is effective. As a result, many SSD beneficiaries apply for Medicaid if they do not otherwise have medical insurance coverage for themselves.

Applying for Medicaid

The Medicaid program is based solely on the health of the applicant and the financial situation of the applicant. In other words, in order to qualify for Medicaid assistance, you must establish that you are in need of institutionalized care, such as assisted living or a nursing home and that you do not have the resources to pay for the care you require.

Once an applicant has been “medically” certified for Medicaid for health reasons, you must pass both an income and an assets test. This is a means tested program, that means that Medicaid is only available if you meet the specific criteria set forth in the regulations associated with the program.

In order to qualify for Medicaid, the applicant must apply through the local county Board of Social Services. That agency reviews the financial and medical situation to determine if the applicant is qualified to receive benefits and what type of benefits are available in the community or in a facility to meet the needs of the applicant. If the applicant is deemed qualified, the county will pay the costs of medical care to the providers. If the applicant is not deemed qualified, there is an appeal process to attempt to secure those medical benefits.

Disclaimer: The materials on this website are intended for general informational purposes only. These materials do not, and are not intended to, constitute legal advice. Visitors to this website should consult with competent legal counsel. This webpage is not intended to, and does not create, an attorney client relationship with Weiss, Tom & Trapanese, LLC or any of the firm's lawyers. This website is not intended as an offer to represent you.

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