Medicare Versus Medicaid – A Big Difference for the Elderly

Despite the similarity in the words, Medicare and Medicaid are two very different health care programs.  Medicare and Medicaid affect the elderly in different ways.

Medicare vs. Medicaid

Medicare is a federal health care program for people over the age of 65 and those people with disabilities who qualify for Medicare insurance. There is no other qualification. Income level does not matter with Medicare. Medicaid, however, is run by each state (with assistance from the federal government) and is a health care program for lower income people. Each state creates its own Medicaid program based on federal guidelines. Unlike Medicare, where benefits are automatic at a certain age, you have to qualify for Medicaid benefits.

This difference becomes very obvious when you are moving a loved one into assisted living. Medicare, the federal health insurance program, does not cover assisted living. Medicaid does. However, Medicaid requires a person to have a certain income and asset level in order to qualify for Medicaid payments to assisted living centers. Each state is different. For example, in Michigan, the asset level is $2,000.00. Again, Medicaid is for people with little financial means.

Assisted Living and Medicaid

If assisted living is required with your loved one and they do not qualify for Medicaid, then payments to the assisted living center come from personal income and assets. Medicaid requires you to “spend down” these assets until they reach a certain level before Medicaid begins paying. There are certain exempt assets, such as a home, a car, etc., but if your loved one has an IRA, savings account, stocks or any other assets, payments to the assisted living center come from your loved one’s income and assets first. This can financially devastate a family. So, the more time you have to plan for a loved one’s move to assisted living, the better. There are ways that you can decrease the amount of assets, but Medicaid typically has a 60 month look-back period, meaning they will look at all of the asset movement for the past 60 months to determine whether it was a legitimate transfer or whether the asset should be included as part of your loved one’s assets. The Medicaid rules get very tricky, so if you think that the government is going to help pay for your loved one’s stay at a facility, you need to become familiar with Medicaid rules in your state and perhaps seek an attorney for some estate planning for your loved one.

Some individuals are eligible for both Medicare and Medicaid and they are called “dual eligible.” For those that receive both coverages, most of their health care costs are covered. Medicare pays first, then Medicaid will pick up most, if not all, of the balance.

Advertisements

Medicaid for Parents Going Into Assisted Living

What is Medicaid?

Medicaid (not Medicare) is a federal/state health program for the needy and low-income. The rules are state-by-state and many of us are now looking at Medicaid for our parents that have little to no assets and who need to be in either assisted living or full time nursing care.

Each State has Different Medicaid Rules

The Medicaid rules in all states are very detailed and hard to follow. But, safe to say that there are two eligibility requirements – income and assets. There are assets that are counted by Medicaid and assets that are exempt. For instance, in Michigan, a person can own only $2,000.00 in assets to be eligible for Medicaid, and a person’s primary residence is exempt – not counted – in the total assets. If the assets exceed the minimum, a person must personally pay for the assisted living or nursing care until the assets reach that level.

Income levels are another eligibility requirement. Most, if not all of a person’s income, is paid directly to the assisted or nursing care facility. Again, the requirements go by state.
The cost of assisted living and nursing care facilities also vary by type and by state. The costs can be $4,000.00 per month and up, depending on where you live, the type of facility and the level of nursing care needed by the ailing person. The best thing to do is, when it is getting harder for a family to take care of an ailing person on their own, begin to check out some of the facilities for cleanliness, level of care, cost and waiting time. Some of the better facilities have a waiting list and, if you will need Medicaid, only a certain number of beds may be allocated to Medicaid patients. Don’t wait until the last minute, especially if you can do your research now.

Medicaid Recovery after Death

If you are able to qualify for Medicaid, there is another caveat that you must watch out for after death, and that is Medicaid recovery. States are required to seek recovery from a person’s estate for payments made by Medicaid. Some states seek repayment in an aggressive manner, but some states don’t make a big effort in the recovery process. In any case, remember that it is the person’s estate from which Medicaid can seek recovery. So, if there is nothing in the estate – nothing that needs to go to probate court – there is no recovery to seek. One of the main items of recovery is a person’s primary residence. If the spouse is no longer living, or if there is no spouse, and the house isn’t deeded to another person at the time of death of the Medicaid recipient, the house will most likely go to probate court and the state could file a claim to recoup its money. In these instances, it is best to put someone else’s name on the deed. Many states call the deed different names – transfer on death deed, beneficiary deed, ladybird deed, etc. With these types of transfers, upon death, then the house automatically goes to the other person listed on the deed. This avoids the house going into probate, and consequently, avoids a recovery claim by Medicaid.