Do you get mixed up between Medicaid and Medicare? During Medicare’s Open Enrollment Period, it is important to remember that Medicare is not Medicaid.  Let us highlight four differences to keep in mind.

1. Qualifications. Medicare covers adults aged 65 and older and individuals younger than 65 with a qualifying disability. Medicaid, on the other hand, is generally available to individuals of all ages based upon qualifying low-income. Another important difference in coverage is that Medicare only provides coverage for individuals, it does not offer family plans. Medicaid, however, can provide coverage for qualifying families.

2. State v. Federal. Medicare coverage plans are more uniform because it is run through the federal government. Medicaid benefits can vary state to state because it is a state run program governed by federal guidelines.

3. Cost. Medicare recipients pay premiums, deductibles, and some out of pocket costs depending on their plan. Medicaid recipients do not pay for coverage, although they may have small co-pays in some states for certain services.

4. Coverage. Medicare is meant for acute health issues and does not cover long-term inpatient care or nursing home care. Medicaid can assist qualifying individuals with long-term care while also providing coverage for routine medical care. Unfortunately, there are many times when families are forced to navigate the muddy waters between where Medicare stops and Medicaid begins when dealing with an elderly relative’s acute health issue that has turned into a long-term care problem. For example, consider the scenario of an elderly relative suffering a fall and breaking her hip. Now this relative needs surgery to repair the hip and then requires long-term care because she will not recover from the surgery successfully enough to be able to ever live independently again.  If this elderly relative is on Medicare, her Medicare plan will cover the surgery and perhaps some of her rehabilitation, but she will need Medicaid coverage to cover her long-term care. Oftentimes, obtaining this coverage can be difficult and confusing. This is just one of the many examples of why it is beneficial to have a comprehensive plan in place to address the possibility of requiring long-term care. 

For help understanding Medicaid and Medicare benefits as well as planning for long term care coverage, please feel free to reach out to our office with any questions or concerns you may have.