TRUE OR FALSE:
MEDICAID AND MEDICARE are the same.
MEDICARE pays for long term care.
MEDICAID pays for all nursing home costs.
All FALSE!
Navigating the US healthcare system can be incredibly overwhelming. There are so many programs with different levels of qualifications, all with different benefits. While it’s best to discuss these options with a professional, it’s always a good idea to have a general knowledge of the primary public benefits programs. Read on to learn about the differences between Medicare and Medicaid, and how those differences apply and potentially help you and your loved ones.
MediCARE is health insurance you can qualify for once you are 65. There are no income or asset limits for Medicare, billionaires can qualify for Medicare. You may become eligible for medicare based on your work history or that of your spouse. Medicare offers coverage options and you can decide among them to determine the coverage you want. Some of the costs Medicare may cover include doctor’s visits, some tests and hospital stays BUT one thing Medicare does not pay is long-term care ( nursing home or assisted living facility costs).
MediCAID is an entitlement program, you must meet financial and health eligibility standards. Medicaid is a joint program of the state and federal government. The very fundamental requirements to be eligible to receive Florida Medicaid are that you are a resident of Florida, a U.S citizen or permanent resident or legal alien. Then you must be both sick enough and broke enough. To be eligible for Florida Medicaid, you must be a resident of the state of Florida, a U.S. national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income. You must also be one of the following:
- Pregnant, or
- Be responsible for a child 18 years of age or younger, or
- Blind, or
- Have a disability or a family member in your household with a disability, or
- Be 65 years of age or older.
Sometimes it helps to think of Medicaid as being like ice cream: it comes in many flavors. Not all programs are needed or appropriate for all people.Here, we are focused on the Medicaid programs that can help you pay for long term “custodial care”. This would be placement in a skilled nursing home or assisted living facility.
Our discussion here will be limited to the Medicaid programs that provide long term custodial care: Home and Community Based Services and Institutional Care Program. To meet the initial eligibility to receive Medicaid in Florida you must be a Florida resident, and a US citizen, permanent resident, or legal alien. Then the next steps are to determine if you are“Sick enough and broke enough”.
Sick enough: This is determined by your ability to perform certain activities of daily living:
- Bathing: personal hygiene and grooming.
- Dressing: dressing and undressing.
- Transferring: movement and mobility.
- Toileting: continence-related tasks including control and hygiene.
- Eating: preparing food and feeding.
If you are unable to perform 2 or more of these or if you have advanced dementia you are likely “sick enough” to be considered for Medicaid assistance with the costs of long-term care.
Broke enough: There are limits to the amount of income and assets for you and or your spouse can control and still qualify for Medicaid long term care benefits. As of March 2022, the current financial eligibility limits are the following:
| Income | Asset | |
| Individual | $ 2,382.00 | $ 2,000.00 |
| Couple | $ 4,764.00 | $ 3,000.00 |
Do not be discouraged if your personal financial situation does not meet these limits. There are steps you can take, that are permitted by law, to qualify financially for Medicaid, however these should be discussed with an elder law attorney knowledgeable in this particular area.
We are all always tempted to try to do things on our own but in this area you could do more harm and ultimately create greater costs and delays if you do this at home on your own!You are better served and doing a better service to the person you are trying to help if you seek the guidance of professionals who know how to navigate what can be a true minefield of laws and regulations.
If you would like to discuss Medicaid eligibility, immediate or planning for possible future needs for yourself or someone else, please visit our website at www.mcbelolaw.com/medicaid-planning/ or call us at (352) 448-4500 to schedule a consultation. .