I’m an elder care attorney, so many people come to see me about a family member’s long-term care needs. Many of them will say to me, “We want to qualify our mother for Medicare.” To which, invariably, I will say, “You mean Medicaid.”
Those who confuse Medicare and Medicaid typically are the children of the person who requires long-term care, and typically, the children are not old enough to be enrolled in Medicare themselves. Given this fact, there confusion is somewhat natural.
Even those who are old enough to be enrolled in Medicare wonder if their potential receipt of Medicaid benefits will disqualify them from their Medicare benefits. In other words, they wonder if they will be disenrolled from Medicare benefits if they qualify for Medicaid benefits.
But what is the difference between Medicare and Medicaid? And does qualification for Medicaid affect a person’s Medicare benefits? If so, how does it affect those benefits?
Medicare is a government health insurance program. Taxpaying workers in the United States pay into the Medicare program through deductions from their pay during their working years. A person must work a certain number of quarters (three-month periods) in order to qualify for Medicare, typically, forty quarters or ten years.
Once a worker satisfies the forty quarters of work, he must either be aged, which is defined as aged sixty-five, or disabled in order to qualify for Medicare benefits. Most people qualify based upon age, not disability, though there are a lot of people who qualify based upon disability. Beneficiaries who qualify based upon age begin receiving benefits immediately. People who qualify based upon disability must (in most cases) wait twenty-four months before they begin receiving Medicare benefits.
Like most policies of insurance, Medicare has deductibles and co-payments. To cover these gaps in the insurance, there are private policies of insurance called Medigap policies (shore for Medicare gap policies). There are ten different, standard Medigap policies with different levels of coverage. The better the policy the more of the deductibles and co-payments that the Medigap policy will cover. Of course, the more the policy covers the more the premiums will be for the policy.
Medicare does not cover long-term care services. Medicare will cover some rehabilitative services, and for this reason, Medicare is often confused with insurance that covers long-term care costs. For instance, if Mr. Smith falls and breaks his hip, he will go to the hospital first, then he will go to a rehabilitation facility. The rehabilitation facility is, in most instances, a nursing home. Medicare will help pay for Mr. Smith’s care in the hospital and it will pay for up to 100 days of rehabilitative services in the nursing home. I think, for this reason, many people believe that Medicare pays for long-term care services, but it doesn’t. It only pays for rehabilitative services.
A person who worked the requisite quarters will qualify for Medicare benefits even if the worker is rich. Bill Gates, for instance, will qualify for Medicare benefits when he attains the age of sixty-five.
Unlike Medicare, Medicaid is means-tested. That means that in order to qualify for Medicaid, a person must have a limited amount of assets (typically less than $2,000), and he must have insufficient income to pay for his care. Medicaid is a health payment plan, not health insurance. Medicaid will pay for certain services if a person qualifies.
Medicare and Medicare are mutually exclusive. A person can qualify for both Medicare and Medicaid. Qualification for one program does not disqualify a person from eligibility for the other program. Also, unlike Medicare, Medicaid will pay for long-term care services.