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What Is The Difference Between Medicare & Medicaid?

When clients first come to Kitzke & Canfield LLC to discuss their long-term planning options, they often ask us to explain the major differences between Medicare and Medicaid. Here is what you need to know about the two government-run programs.

Medicare Explained

Medicare provides health insurance for senior citizens and people under 65 who qualify due to certain disabilities. If you have been making Social Security contributions through your earnings, then you are automatically eligible for Medicare when you reach the age of 65. Unlike Medicaid, Medicare covers all who qualify, regardless of income.

Medicare coverage is broken down into four sections:

  • Medicare Part A: Covers hospital care, most notably the cost of being in a medical facility. People enrolled are responsible for paying deductibles and coinsurance.
  • Medicare Part B: Covers doctor visits, medical tests, and certain types of medical equipment and procedures. There is a monthly premium for Part B coverage.
  • Medicare Part C: This serves as an alternative to standard Medicare coverage. It usually includes Parts A, B, and D, and sometimes includes procedures that aren’t covered by Medicare, like hearing, vision, and dental. Medicare Part C is also known as the Medicare Advantage plan and is administered by private insurance companies
  • Medicare Part D: Covers prescription drugs. This Part is administered by private insurance companies. Medicare recipients are required to have it unless they have coverage from another source. Part D also requires monthly premium payments.

If you have been paying your taxes, then you have been contributing to Medicare and will likely receive Part A coverage at no cost to you. However, you might be required to pay a monthly premium for additional coverage under Part B, Part C, or Part D.

Medicaid Explained

States and the federal government provide funding for the Medicaid program. Medicaid is intended to provide health insurance and other services to low-income Americans of all ages, so eligibility requirements are based on your earned income and assets. Applicants might be required to show proof of medical screening and provide other types of documentation for past and present financial transactions.

The following groups usually qualify for Medicaid:

  • Pregnant Women: Expecting mothers who meet the income requirements, regardless of their marital status, can apply for Medicaid to obtain coverage for themselves and their child.
  • Single Parents: If you have a child under 18 and you need financial assistance, you can apply for Medicaid. Teenagers living on their own might also be eligible for Medicaid coverage.
  • Elder & Disabled Individuals: People over the age of 65 who can't afford the expensive premiums that come with Medicare can apply for Medicaid. People with disabilities can apply too, regardless of age.
  • Individuals Without Children or Disabilities: Under the Affordable Care Act, states have the option to provide Medicaid to low-income individuals under the age of 65 who aren’t disabled and don’t have minor children.

Perhaps one of the greatest benefits of Medicaid is that it covers long-term care, which includes custodial care and nursing home care. Long-term care costs are expensive, which is why clients often inquire about eligibility requirements for Medicaid if they are researching their long term care needs. In addition to medical services, long-term care under Medicaid also covers personal services at nursing homes, such as nurse visits and caregiver assistance with bathing and dressing.

Consult with Kitzke & Canfield LLC Today

Please note that this explanation of the differences between Medicare and Medicaid is intentionally broad. Eligibility for both programs varies from situation to situation, which is why you should speak to one of the seasoned lawyers at our law firm so we can discuss all of your options and address your concerns.

To discuss Medicare and Medicaid planning with a lawyer at Kitzke & Canfield LLC, give us a call today at (262) 214-6827 to request your case consultation.

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