It is normal to worry whether Medicare will affect your Medicaid eligibility, or whether getting Medicaid would affect your current Medicare. But the truth is, there is nothing to worry about.
Medicaid does not affect Medicare; neither does Medicare affect your Medicaid eligibility. So long your income and asset fall below the limit, you are eligible. Thousands of people in New York are currently enjoying both Medicare and Medicaid.
Let us now understand the differences and relationships between Medicare and Medicaid.
Medicaid and Medicare
These two social programs sound alike and easily get citizens confused about the distinct coverage each provides. Medicaid and Medicare are two social programs specifically designed to cover health care costs for American citizens who can’t readily afford it. They were both created by the US government in 1965 and anyone who pays tax is indirectly funding these programs.
However, these two programs have different requirements for eligibility.
Medicare
Medicare typically caters to seniors above the age of 65 and other disabled individuals. The social program is made up of four parts as follows:
Part A: Hospitalization coverage
Part A of Medicare covers the cost of staying in the hospital for an individual of 65 years or older. There is no income limit for this benefit. However, eligibility demands that the individual or their spouse must have worked and paid Medicare taxes for up to 10 years. Most people usually don’t pay premiums for part A.
Part B: Medical insurance
Part B covers medical equipment and services for hospitalized individuals. The coverage includes cost of lab work, x-rays, outpatient care and treatment, doctor’s visits, and disease screenings.
Most people who qualify for Part A also qualify for Part B. However, they would need to pay a higher premium for Part B if they earn over $88,000 annually ($176,000 for couples). Deductibles and coinsurance apply.
Part C: Medicare advantage plans
Those eligible for A and B are automatically eligible for part C. However, the benefits here are provided by private companies associated with Medicare. This part offers coverage for vision, hearing, dental and prescription costs.
It is a wise idea to consider whether you will need these services because you may have to pay for such special services from your bank account.
Part D: Prescription drug coverage
Individuals must pay monthly premiums, a yearly deductible, and co-payments to get continued access to prescription drug. Note that Part C also covers prescription drug coverage. So if you have already enrolled in that part, you shouldn’t bother about this part.
Medicaid
Medicaid, on the other hand, is a program that covers the healthcare cost of long term care for low income Americans who cannot afford the high cost of assisted living.
Notably, Medicaid caters to people of all age unlike Medicare. It caters to children and older adults, each with their own requirements, nonetheless.
The following persons can apply for Medicaid
- Adults earning below $884 monthly and having an estate worth less than $15,900
- Pregnant women
- Single individuals
- Children below 18
- Someone having blindness or other disability
- Parents and caretakers
- New York residents
- Legal aliens.
- An individual wills huge medical bills
Eligibility for Medicaid is typical determined by your income. If you earn over the limit of $884 monthly with estate worth over $15,900, you may not qualify for Medicaid.
What does Medicaid cover?
Medicaid covers a host of things that border on long term care, whether in a nursing home facility or at home. It covers:
- Doctor visits
- Hospital expenses
- Home health care
- Nursing home costs for long term care.
- Pediatric and family nurse practitioner services, and the likes.
Medicaid does not cover prescription drugs.
Medicare and Medicaid working together
You may have noticed that Medicaid covers some things already covered by Medicare. However, you may also have realized that Medicare does not cover long term care. Medicare and Medicaid can actually work in coordination rather than antagonistically.
Medicaid is the payer of last resort, that is, it makes the last payment. When you get treatment from a health care provider that accepts both Medicaid and Medicare, Medicare will pay first while Medicate will pay for the things not covered, such as Medicare cost-sharing, co-pays and coinsurance.
Get help from an elder law attorney near you
If you have any questions about Medicaid and Medicare eligibility or you need help with the application in New York City, our NYC elder law attorneys can assist you. Call us.
