What is the Difference Between Medicare and Medicaid

Little boy having fun with his grandparents in park

 

Differences between Medicare and Medicaid at a glance:

Medicare: Federal health insurance, administered by SSA.

  • To be eligible,
    • You or your spouse must have paid into the Medicare system for at least ten years.
    • You must be 65 or older unless you have a disability or permanent kidney failure.
    • You must be a citizen or permanent resident of the United States.
  • No income requirements.
  • May have premiums, copays & deductible.
  • To enroll:
    • If already receiving SS or Railroad benefits before age 65, then automatically enrolled in Part A & Part B.
    • If not receiving, should contact SSA three months before your 65th

ABD (Aged, Blind and Disabled) Medicaid: Health insurance program funded by state and federal money, administered by Ohio Department of Medicaid.

  • To be eligible,
    • U.S. citizen and Ohio resident.
    • Have or get a Social Security number.
    • Must be 65 or older or disabled.
  • Meet Income and Resource Limits.
  • No cost.
  • To apply:
    • Complete application with the Dept. of Medicaid.

The biggest difference between Medicare and Medicaid Coverage is Long Term Care Coverage.

Medicare Covers Only Skilled Nursing for a Maximum of 100 days.

  • Medicare Part A (Hospital Insurance) will pay up to 100 days of skilled nursing care in a nursing home or at home, if the patient is home-bound and it is physician authorized, or inpatient care in a rehabilitation facility.
  • Coverage includes meals, skilled nursing care, physical and occupational therapy, speech-language pathology service, medications, medical supplies and equipment, and dietary counseling.
  • There is no charge for the first 20 days. However, there is a co-pay per day for the next 80 days, with Medicare covering the remaining expenses.
  • Sometimes a patient is determined by the facility to not be entitled to the full 100 days of coverage based on Medicare guidelines.
  • Medicare will not cover care in a facility after 100 days has passed.
  • If a patient needs long term care that is not medical care but instead assistance with activities of daily living like bathing, dressing, toileting, and mobility, it is not covered by Medicare.

Medicaid covers long term care costs at a nursing home, assisted living or at home. There is no time limit to Medicaid coverage and you can qualify with our without the need for skilled medical care.

Obviously, Medicaid coverage is key to paying for long term care costs. The question then is, how do I qualify. That will be covered in my next post, How to Qualify for Medicaid.

For more information on the differences between Medicare and Medicaid coverage of long term care costs, contact a Cleveland Medicaid Planning lawyer.