2. Wills & Estate Planning Probate & Administration
Tax Planning Business Succession Elder Law
Medicaid versus Medicare
MEDICAID vs. MEDICARE
Medicare
• Entitlement
• Regardless of
Income, Resources
• Premiums and co-payments
• Age 65, receiving disability
benefits 2+ years
• No Long Term Care benefit
Medicaid
• Needs Based
• Based on Income; Resources
• No premiums, subsidized or
no co-payments
• Age 65+, blind or disabled
• Has Long Term Care benefit
3. Wills & Estate Planning Probate & Administration
Tax Planning Business Succession Elder Law
Medicare: Eligibility
MEDICAID vs. MEDICARE
• Must pay in Social Security system for 10 years
• Available to individuals who meet these criteria:
• Over 65;
• Received SSDI benefits for 2 years;
• Received Disabled Adult Child benefits for 2 years; or
• Have end-stage renal disease or ALS (Lou Gehrig’s
Disease)
4. Wills & Estate Planning Probate & Administration
Tax Planning Business Succession Elder Law
Medicare: Classes of Coverage
Broadly Defined
MEDICAID vs. MEDICARE
• Part A – Hospitalization
• Part B – Doctor Visits and Outpatient Care
• Part C – Medicare Advantage Plans
• Part D – Prescription Drug Coverage
5. Wills & Estate Planning Probate & Administration
Tax Planning Business Succession Elder Law
Medicare: Function
MEDICAID vs. MEDICARE
• Designed to pay for “spell” of injury or illness
• Pays 80% of allowable medical charge while patient
pays 20%
• Limited preventative care
6. Wills & Estate Planning Probate & Administration
Tax Planning Business Succession Elder Law
Medicaid: Eligibility
MEDICAID vs. MEDICARE
• Must be Aged, Blind or Disabled to qualify
• SSI recipients automatically qualify in Georgia and most states
• Must meet Income and Resource limits
• Most income will count toward limits
• Many resources are exempt from limits, including a house, a
car, and personal items
• Limits vary depending on type of Medicaid sought
7. Wills & Estate Planning Probate & Administration
Tax Planning Business Succession Elder Law
Medicaid: Common Classes of Assistance
MEDICAID vs. MEDICARE
• Georgia’s Medicaid Manual defines 36 Medicaid Classes of
Assistance
• Common Medicaid sought for seniors:
• Nursing Home Medicaid
• Qualified Medicare Beneficiary Medicaid
• Low Income Subsidy Medicaid
• Medically Needy Medicaid
8. Wills & Estate Planning Probate & Administration
Tax Planning Business Succession Elder Law
Medicaid: Function
MEDICAID vs. MEDICARE
• To provide a medical and long term care safety net to our
elderly and disabled.
• Medicaid waiver programs increasingly provide support services
allow elderly and disabled to remain in the community instead
of moving to a nursing home for long-term care.
9. Wills & Estate Planning Probate & Administration
Tax Planning Business Succession Elder Law
Help Is Available
MEDICAID vs. MEDICARE
Finding the right mix of Medicare, private coverage, and Medicaid can
be confusing and complicated. To qualify for Medicaid benefits, legal
representation is increasingly necessary.
Our Elder Law specialists have significant experience helping elderly
and disabled individuals and their families ensure the best outcome
for all concerned. Please call us if we can be of assistance.
Notas do Editor
Medicaid is a means test – income and resources (do you have money in savings?)4 different types of medicaid:Nursing home – senior pays almost all of their income to nursing home and medicaid pays the rest.Qualified Individual Medicaid (Q-track) pay for medicare premiums. People with traditional medicare actually do pay monthly premiums just like you pay for ins except these amounts are deducte from your SS check. in this situation, your premium is covered and perhaps even your co payment. if you qualty for Q-track, you probably also qualify for low income sub. This pays for your prescription drug premium and you also get reduced or possibly no copay on presription drug.If your expenses after medicare are so small that you only net a few hundred dollars a month, you may qualify for medically needy medicaid – because you can’t pay meidcal and food – so medicaid picks up remainder of expenses.We’re also seeing a lot of seniors who qualify for payment thorugh the VA. Generally if you have service-related injuries, you can qualify for services through the VA. Services vary from state to state. there are reasons to go to VA, you can get prescription drugs and medical applicances (which medicaid won’t pay for). If you were in vietnam and in a combat zone and experienced some hearing loss as a result of loss incurred during your service. there are also a variety of medical condisiotns, like if you can demonstrate that you were exposed to a situation that led to the development of diabaetes, you can get coverage for that.
Medicaid is a means test – income and resources (do you have money in savings?)4 differnet types of medicaid:Nursing home – senior pays almost all of their income to nursing home and medicaid pays the rest.Qualified Individual Medicaid (Q-track) pay for medicare premiums. People with traditional medicare actually do pay monthly premiums just like you pay for ins except these amounts are deducte from your SS check. in this situation, your premium is covered and perhaps even your co payment. if you qualty for Q-track, you probably also qualify for low income sub. This pays for your prescription drug premium and you also get reduced or possibly no copay on presription drug.If your expenses after medicare are so small that you only net a few hundred dollars a month, you may qualify for medically needy medicaid – because you can’t pay meidcal and food – so medicaid picks up remainder of expenses.We’re also seeing a lot of seniors who qualify for payment thorugh the VA. Generally if you have service-related injuries, you can qualify for services through the VA. Services vary from state to state. there are reasons to go to VA, you can get prescription drugs and medical applicances (which medicaid won’t pay for). If you were in vietnam and in a combat zone and experienced some hearing loss as a result of loss incurred during your service. there are also a variety of medical condisiotns, like if you can demonstrate that you were exposed to a situation that led to the development of diabaetes, you can get coverage for that.
