Medicaid vs. Medicare -- What You Need to Know | St. Lucie County, FL Estate Planning Attorneys (2024)

You have probably heard of the Medicaid program; however, if you have never before needed to rely on Medicaid to pay for your heath care expenses, you probably don’t know exactly what the program covers nor how to qualify for participation in the program. Likewise, if you have yet to reach retirement age, you probably lack an intimate knowledge of the Medicare program benefits or eligibility guidelines. Like many people, you may even get Medicaid and Medicare confused with each other and/or think they are the same program. Given the likelihood that you will need to rely on both Medicare and Medicaid as a retiree, however, now is the time to learn more about both programs. To get you started, the Medicaid planning attorneys at Kulas & Crawford explain what you need to know about Medicaid and Medicare.

Medicaid Benefits and Eligibility Guidelines

Medicaid is a healthcare program that is primarily funded by the federal government; however, the individual states have the option to supplement funding for Medicaid if they choose to do so. Although the federal government provides oversight for Medicaid, it is administered by the individual states which explains why you will notice differences in the eligibility criteria and benefits offered from state to state. In all states, however, Medicaid covers basic healthcare, such as:

• Certain inpatient and outpatient hospital services
• Early and Periodic Screening, and Diagnostic, and Treatment (EPSDT) services for children
• Nursing facility services
• Home health services
• Doctor’s services
• Rural health clinic services
• X-ray and laboratory services
• Family planning services
• Midwife services
• Freestanding Birth Center services
• Certified pediatric and family nurse practitioner services
• Tobacco cessation counseling for expectant mothers

Every state is required to provide these basic services. States may, if they choose to, provide additional benefits; however, they must include the basic benefits. If you qualify for Medicaid benefits, there are no monthly premiums nor co-payments.

Medicaid is a “needs based” program, meaning that an applicant must prove the need for benefits in order to qualify. To be eligible for Medicaid, an applicant must have both income and assets that are below the program limits. Income limits are directly tied to the Federal Poverty Level for the area where the applicant lives. Asset limits are typically extremely low — $2,000 for an individual and $3,000 for a couple in most states. If your non-exempt assets exceed the limit, Medicaid will turn down your application and you will be expected to “spend-down” your assets until their value falls below the program limit. To find out if you are eligible for Medicaid in Florida, navigate to the Florida Department of Family and Children Access Florida website.

Medicare Benefits and Eligibility Guidelines

Medicare is also a federally funded healthcare program; however, Medicare is exclusively for people over age 65 and for certain individuals under age 65 who are also disabled. Unlike Medicaid, Medicare is an “entitlement” program, meaning if you (or your spouse) paid into the program for the required length of time – 10 years — through your payroll taxes during your working years you are automatically entitled to Medicare benefits. Medicare comes in four parts. Part A, or basic Medicare is free. If you wish to sign up for the additional parts of Medicare, however, it may require payment of a monthly premium similar to private health insurance. The four parts of Medicare and the benefits included in each part are as follows:

• Part A – Hospital care – Covers the cost of being in a medical facility.
• Part B – Covers doctors, medical tests and procedures – basically, anything that is done to you. There is a monthly premium for Part B coverage.
• Part C – Medicare Advantage – Part C is an alternative to traditional Medicare coverage. Coverage often includes Parts A, B and D. Medicare Advantage plans are administered by private insurance companies.
• Part D – Prescription drug coverage – D is administered by private insurance companies, and you are required to have it unless you have coverage from another source. Part D requires you to pay a monthly premium in most cases.

To find out more about Medicare, or to apply online, navigate to the Social Security Administration “Medicare Benefits” page.

Long-Term Care Expenses

For many seniors, the most important difference between Medicaid and Medicare can be found in how the programs treat long-term care (LTC) expenses. Medicare will not pay for long-term care while Medicaid does cover LTC expenses. You must first qualify for benefits. In order to ensure that you are eligible for Medicaid, without putting your assets at risk, down the road, be sure to include Medicaid planning in your comprehensive estate plan now.

Contact Port St. Lucie & Vero Beach Medicaid Planning Attorneys

To learn more, please join us for an upcoming FREE seminar. If you have additional questions or concerns about Medicare or Medicaid planning, please contact the experienced Port St. Lucie and Vero Beach Medicaid planning attorneys at Kulas & Crawford by calling (772) 398-0720 to schedule an appointment.