Distinguishing Medicaid From Medicare

Oftentimes, people have a hard time remembering the difference between Medicaid and Medicare, the services provided, who oversees these programs, and how to qualify for benefits. While each program is run by the Center for Medicare & Medicaid Services (CMMS), they are entirely different.

To begin, Medicare is a Federal program enacted in 1965. This means that the law in each state pertaining to Medicare is the same. It is an earned-benefit program for those that are aged 65 or older or disabled that American workers pay into. It consists of four different parts: A, B, C and D. Part A – Hospital Insurance covers limited stays in nursing homes and some rehabilitative services such as physical, vocational, and speech therapy. Part B – Outpatient Insurance covers 80% cost of physician office visits, medical devices, and some rehabilitative services. A person interested in applying for Medicare Part A and Medicare Part B benefits must do so through the Department of Social Security.

Unlike Medicare, Medicaid is a cooperative program between the Federal and State government. This means that each state may have different eligibility requirements as well as offer different benefits. Medicaid provides assistance to lower income individuals that are in need, including elderly people and those with disabilities. To qualify for the Medicaid program, there are certain income and asset requirements. In addition, the Medicaid program in New York State offers two distinct programs: Community Medicaid and Chronic Care Medicaid. Community Medicaid is at home care, whereas Chronic Care Medicaid is care that is provided by a skilled nursing facility.

To qualify for Community Medicaid a single applicant may have no more than $15,150 in assets and $845 in monthly income. Furthermore, there are certain assets and income that are considered exempt such as qualifying retirement accounts where the individual is taking monthly-required distributions. Also, a primary residence is an exempt asset, as well as an irrevocable pre-paid funeral. There is no look back period for Community Medicaid, which means that an individual is eligible for benefits within one month from the date of eligibility.

To qualify for Chronic Care Medicaid there is a five-year look-back period, which means that any transfers made out of the recipient’s name five years prior to the date of entering the skilled nursing facility would impose a penalty on the recipient. However, most transfers to spouses are considered exempt. It is worth noting that a primary residence may not be exempt when applying for Chronic Care Medicaid, which is why it is important to pre-plan.

While Medicare and Medicaid are different programs, they provide some important benefits to seniors and others who qualify. However, Medicaid pays for the largest share of long-term care services, but only if the individual meets the eligibility requirements. The Medicaid application and eligibility professionals at P&P Medicaid Consulting, Inc. assists Nassau County, Suffolk County, and Queens residents in preparing applications for Medicaid eligibility while taking advantage of programs and planning options that will protect their income and assets. For more information or to schedule a consultation, call our Long Island, New York Medicaid consulting office at (516) 541-4770.

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