What Is the Difference Between Medicare and Medicaid?

Understanding the intricacies of healthcare insurance can be overwhelming, especially when it comes to distinguishing between Medicare and Medicaid. Both are federally funded programs aimed at helping individuals access healthcare services, but there are important distinctions between the two. For instance, Medicare is open to people once they reach a certain age, while eligibility for Medicaid is much more limited. Yet the services the two programs offer differ significantly so it can be vital to your care and comfort to make sure you qualify for both programs as needed. Read on to learn about the major differences between Medicare and Medicaid. For help with Medicaid planning and other essential estate planning services in Florida, contact Shalloway & Shalloway to discuss your needs with a team of knowledgeable and dedicated West Palm Beach long-term care and Medicaid Planning attorneys.

Eligibility Criteria

Medicare

Medicare primarily caters to people who are 65 and older, regardless of income level. Younger individuals with certain disabilities or serious medical conditions like End-Stage Renal Disease (ESRD) can also qualify for Medicare.

Medicaid

Medicaid, on the other hand, is primarily income-based and serves low-income individuals and families. States have different Medicaid programs and eligibility criteria, including asset tests. In Florida, for instance, an applicant’s income and assets are taken into account to determine eligibility for different Medicaid programs. Asset and income limits are strict, which makes it essential to work with an experienced Medicaid planning lawyer to qualify for Medicaid while protecting your assets at the same time.

Services Covered

Medicare

Medicare is divided into four parts:

• Part A: Covers inpatient hospital stays
• Part B: Covers outpatient care and doctor visits
• Part C: Also known as Medicare Advantage, Part C is provided by private insurers, combining the services of Parts A and B along with additional benefits
• Part D: Covers prescription medications

Medicaid

Medicaid generally covers a broader range of healthcare services than Medicare. These may include inpatient and outpatient hospital care, physician services, mental health services, and even long-term care. In Florida, Medicaid also covers additional services like dental and vision care for certain populations. When it comes to services like care in assisted living or skilled nursing facilities, Medicare only covers a short-term stay. Medicaid’s expanded coverage for long-term care makes it highly desirable for people planning their futures who want to make sure they receive the care they need without going broke trying to pay for long-term care.

Funding Source

Medicare

Medicare is solely a federal program. The funding comes from payroll taxes, premiums paid by enrollees, and general federal revenue.

Medicaid

Medicaid is a joint federal-state program. While the federal government sets certain guidelines, states have significant flexibility in managing Medicaid, including how services are delivered and how much providers are paid. In Florida, Medicaid is administered by the Agency for Health Care Administration (AHCA).

Application Process

Medicare

Enrollment in Medicare is generally automatic when a person turns 65, especially if they are already receiving Social Security benefits.

Medicaid

For Medicaid, the application process is more complex and varies by state. In Florida, applications can be made online through the ACCESS Florida website, by mail, or in person at a local Department of Children and Families (DCF) office.

Why Choose Shalloway & Shalloway for Medicaid Planning?

Navigating Medicaid can be complicated, especially when you’re trying to secure quality healthcare without jeopardizing your financial security. Shalloway & Shalloway offers expertise in Medicaid planning services in West Palm Beach, Florida. Our team guides you through the Medicaid process, ensuring that you meet all state-specific requirements to maximize your benefits, while also exploring strategies to help you keep your home and other valuable assets.

If you have other questions regarding Medicare or Medicaid, or to find out how Shalloway & Shalloway can assist you in your Medicaid planning, contact us today at 561-686-6200 for a consultation.