Is It Medicare or Medicaid?
As people approach retirement age, they start to think about how they will pay things, including the expenses that arise due to illness or other emergencies. This includes medical bills and living options, such as home care, assisted living, memory care, or a nursing home. Some of these concerns can be alleviated with a solid understanding of Medicare and Medicaid. If you are like many others, you may be confused about how these two programs work, the differences between the two, and how to know what you are eligible for.
Oasis Senior Advisors is here to help you navigate the senior care landscape. We can answer your questions about the many options available to you and clarify any confusion about what these two programs entail. To learn more, simply call us at 475.619.4123 or 914.356.1901 or reach out using our online form.
Medicaid vs. Medicare 101
The most fundamental difference between Medicaid and Medicare is that one, Medicare, is health insurance, the other, Medicaid is an entitlement program—a safety net for those without the financial resources to pay for care.
All American taxpayers have paid into Medicare and Medicaid throughout their lives, though eligibility and what each program provides for differs. Most people begin Medicare benefits when they are 65, though younger people are also eligible if they meet certain criteria such as medical necessity or disability. Once you sign up, you can use Medicare to pay your medical bills, though there may be some copays or deductibles. This federal program is the same no matter where you live in the United States.
Because it provides assistance to low-income people, Medicaid has certain eligibility requirements related to finances but has nothing to do with age. Medicaid must align with federal guidelines, but it is administered by each state, and thus can vary depending on where you live.
If you are wondering, “Is assisted living covered by Medicare?” The answer is no, Medicare does not cover those expenses. In some states, however Medicaid may cover the cost of assisted living or memory care and, in all states, Medicaid will cover nursing home care costs, but only in Medicaid certified facilities.
Once you have a handle on the ins and outs of Medicare, it will make sense to you. It can seem confusing, but the one thing to remember is that Medicare is your right as an American citizen. It is a system you supported with your taxes, and once you’ve hit 65 you are eligible to benefit from it.
The following pertains to Medicare, depending on when and for what you sign up:
- There are four parts: A, B, C, and D
- The federal government provides and oversees parts A and B
- Parts C and D are overseen by the federal government but provided by private insurance carriers
- Each part covers something different:
- Part A – hospitalization
- Part B – medical costs
- Part C – also known as Medicare Advantage, incorporates A, B, and D under one umbrella and may cover things like vision or dental.
- Part D – prescription costs
Medicare is a health insurance and may require the payment of premiums, deductibles, coinsurance, and copays. Your out-of-pocket costs are affected by when you enroll, your chosen coverage options, and the services you receive. The enrollment period comes around once a year and offers you the opportunity to choose the type of coverage you want. You should reevaluate your coverage each year during ‘open enrollment’.
Because Medicaid is administered at the state level, there are fewer constants across the board, but below are some basic facts that pertain to Medicaid benefits. Remember, Medicaid eligibility is limited by regulations around assets and income.
- The federal government mandates that all Medicaid plans cover the following:
- Physician care
- Lab work and x-rays
- Hospital services (inpatient and outpatient)
- Other services that may be covered include:
- Occupational therapy
- Physical therapy
- Case management
- Long term room, board and care in a certified community or facility
Let Oasis Senior Advisors Help You Find Your Safety Net
We can help you understand what is available to you based on your specific criteria for your medical coverage. If you have any questions about Medicare or Medicaid, reach out today to speak with one of our advisors. The security, reassurance, and practical advice you seek are at your fingertips. Our expertise and advice are offered at no cost to you. We can be reached through our online form or by calling 475.619.4123 or 914.356.1901.