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.
Did you know Baby Boomers are a designated group of people who were born between 1946 and 1964? In fact, 76.4 million people were born during that 22-year period. This group comprises about one-quarter of the U.S. population.
A Baby Boomer born before 1954 is at least 65 years of age and is accordingly entitled to Medicare medical assistance if he or she has received Social Security credits for 40 quarters of coverage. This means he or she has paid into Social Security for at least 10 years.
A person aged 65 and older who has not received credit from Social Security for 29 quarters of coverage has to pay a $437 per month premium in 2019 for Medicare coverage. An individual who has 30-39 quarters of Social Security credits must pay a $240 per month premium in 2019 for Medicare coverage. Persons of any age who have end-stage renal disease or amyotrophic lateral sclerosis can also receive this coverage at no cost. Likewise, a person who has received Social Security disability benefits or Railroad Retirement Disability Income for 24 months or longer is eligible for Medicare.
A person under 65 years of age is only categorically entitled to Medicaid medical assistance if his or her income is less $12,060 per year and his or her countable assets are less than $2,000. Fortunately, persons under age 65 with expensive health care needs may still be entitled to the Medicaid share of cost program. This is for people who make too much money to qualify for regular Medicaid but not enough money to pay for their healthcare needs.
This program essentially allows people to subtract their medical expenses from their income and qualify for Medicaid if and when their medical expenses reach a certain amount determined by the Department of Children and Families. The day a person’s health care expenses for the month exceed his or her share of cost, Medicaid coverage begins. From that day until the end of the month, the person has full Medicaid coverage. On the first day of the next month, a person is again without coverage until health care expenses exceed his or her share of cost.
These are critical considerations for both our Florida Baby Boomer clients and their loved ones.
Knowing just what health care coverage you are entitled to and what is paid for needs to be a priority, especially during the annual Medicare Open Enrollment period. Remember, in almost all instances, there is a provider who will cover custodial long-term care needs. We can plan forward with you and your loved ones for these expenses. Do not wait to contact us to schedule a meeting.
Original Medicare coverage, also known as Medicare Parts A and B, is reserved for what’s considered “medically necessary” health care. In other words, care that’s required to diagnose or treat an illness or condition. What this means is that, unfortunately, dental and vision care does not fall into Medicare’s medically necessary framework.
So are seniors just out of luck? Not at all!
There are two main ways to obtain important dental and vision coverage. One is through Medicare Advantage, or Part C. Another is through supplemental coverage.
Medicare Advantage is an alternative to Original Medicare, with approved coverage plans being administered through private insurance companies. While these plans must offer the same basic hospital and medical services coverage as Parts A and B, they can also offer more options on top, such as prescription drug coverage, and dental and vision benefits.
Keep in mind that Advantage plans’ costs and coverage features may depend on where you live and what plan you choose. They may also require a monthly premium.
Medicare supplemental insurance, sometimes called Medigap, is another avenue to secure dental and vision coverage. It helps pay for items Original Medicare does not cover. This can include deductibles, copays and coinsurance for doctors’ visits, hospital stays, and other medical services. It is also issued by private insurance companies.
While Medigap itself may not provide dental and vision coverage, certain insurers can offer their Medicare supplemental insurance customers additional options for dental and vision care, or discount programs to help save money on dental and vision costs. Supplemental insurance plans can also depend on where you live, although unlike Medicare Advantage, coverage is standardized by the federal government.
One of the best ways to explore supplemental insurance offerings in your area is to log on to Medicare “Medigap Policy Search” webpage and type in your zip code. The site provides plan details from insurance companies.
The online Medicare “Plan Finder” tool is also a great way to search for the right Medicare supplemental insurance plan. It also offers search assistance for Medicare Advantage plans.
For most people, and especially for senior citizens, dental and vision coverage is just too important not to have. Exploring Medicare Advantage and Medicare supplement insurance options can help you get the services you want and need. Do you not wait to find the answers you need during this Medicare Open Enrollment Period, which will end on December 7th of this year.
We know that this article may raise more questions than it answers for you. Do not wait to contact our office and schedule meeting with Attorney Scott Selis.