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Medicare vs. Medicaid – What is the Difference?

So what is the difference between Medicare and Medicaid?


Medicare is a federal rights-based program. In general, Medicare provides health insurance coverage for (1) people over the age of 65, (2) certain younger people with disabilities, and (3) people with end-stage renal disease (permanent kidney failure requiring dialysis or a transplant) .


Medicare has four main parts:

– Part A – Hospice and hospice coverage;

– Part B – General medical coverage (monthly premium);

– Part C: Medicare Advantage (monthly premium), which covers more services including prescriptions (subject to copays and deductibles); Y

– Part D – Prescription drugs (monthly premium).


Medicare has no income or asset limitations associated with qualification, but it does consider other eligibility requirements (depending on the Parts of Medicare being sought), such as citizenship and state of residence, if the applicant has paid into the system for at least minus 10 years, if Social Security Disability Insurance (SSDI) benefits are being collected, and more.


In particular, Medicare does not DO NOT pay for long-term care, such as permanent relocation to an assisted living facility or nursing home. Medicare will only provide coverage for the rehabilitation phase of your recovery, and it does so for a very limited number of days. Also, the longer the rehabilitation takes, the more daily copay you will have to pay. Once you are deemed no longer in the rehabilitation / recovery phase, Medicare will no longer cover your nursing home care.


On the other hand, Medicaid WILL BE pay for long-term care in nursing homes and assisted living facilities beyond the rehabilitation phase for as long as you are in the facility. Unlike Medicare, Medicaid is a needs-based program, not an entitlement program. Eligibility for Medicaid is based on medical qualification and meeting strict income and asset tests.


In essence, Medicaid exists to protect the elderly against the exorbitant costs associated with long-term care. Medicaid benefits include covering almost Total cost from a nursing home bill and / or a large percentage of an assisted living facility bill (subject to a “patient liability” amount), as well as benefits to cover a portion of home care costs . A proper Medicaid plan prepared by a Medicaid planning and elder law attorney can qualify you for Medicaid long-term care benefits, even if you initially fail the asset and income tests.


Our law firm focuses on Medicaid planning for “crisis” (when you need long-term care coverage now) and Medicaid “proactive” planning (when planning Medicaid eligibility prior to need the benefits). Whether you need long-term care assistance now or want to be prepared for the future, you must consider your options without delay. Time is of the essence and not planning is planning for failure.


By contacting our attorneys, we can provide a comprehensive analysis of your situation to determine what steps are necessary to qualify for Medicaid benefits. There is no one-size-fits-all solution when it comes to long-term care, so the sooner you get your affairs in order, the more effective counseling will be to qualify you for Medicaid benefits.


Our attorneys are here to help you and your loved ones. We serve clients throughout Florida. For more information or for a FREE INITIAL CONSULTATION please contact us today by calling 305.722.5533 or by emailing us at [email protected]!