Medicare vs Medicaid – Understand the Difference in NY

medicare vs medicaidWith their similar-sounding names, Medicaid and Medicare frequently are confused. However, these government programs are different. While many people will never qualify for Medicaid, most people will become eligible for Medicare once they turn 65.

People who are wondering about their eligibility for one or both of these programs are encouraged to consult with a Elder Care Attorney in New York. Complex laws govern both programs, and numerous factors may affect your ability to qualify. If you are struggling to pay medical bills or are planning for your future care needs, then it’s only sensible to meet with a lawyer who focuses their practice in this area of the law.

The Basics of New York Medicaid

This program is funded and administered by the state and the federal government. The federal government sets the major guidelines, and it is the responsibility of the state to comply with these. Nonetheless, this public assistance program looks different from state to state as governments do have some latitude with regard to how they implement it.

People qualify for this program based on financial need. Americans of all ages may be eligible if they meet certain requirements. Pregnant women, parents of minor children and teenagers living on their own all may qualify if they meet the income restrictions. People who are elderly, blind or disabled may be able to obtain this assistance, especially if they cannot pay the premiums that are associated with Medicare. Under the Affordable Care Act, even people who don’t have a disability and do not have minor children may qualify.

Income requirements for the program typically are based on the current Federal Poverty Level. However, individuals with high medical expenses and income above the requirements still may qualify. This involves demonstrating that the individual is medically needy. Doing so may be complicated, which is why it is sensible to consult with a lawyer to ensure that proper paperwork and evidence are submitted.

Under the program, recipients are covered for outpatient and inpatient hospital services as well as home health care and nursing home care. X-ray and laboratory diagnostic services are covered as are tobacco-cessation counseling for pregnant women and transportation to medical facilities.

The Basics of Medicare

Medicare is a federal health insurance program that’s available to people over 65 and to younger people who have certain disabilities. Working Americans help to fund Medicare with automatic deductions from each paycheck. Medicare eligibility comes at the age of 65, and it is available to everyone, regardless of their income.

Because it is a federal program, Medicare looks much the same in every state. It is divided into four parts. Part A provides coverage for hospital services. Enrollees may pay coinsurance and deductibles. Part B covers things like doctor visits, laboratory and other medical tests and medical procedures and equipment. Participants pay a monthly premium and adjustment amounts may be required for those who have higher incomes.

Medicare Advantage, which frequently is referred to as Part C, comprises Parts A, B and D. It covers things that are not protected by traditional Medicare such as dental, vision and hearing. Part D is a prescription drug coverage plan that is required for all recipients.

Taxpayers contribute to Medicare throughout their working years. Part A is offered to them without out-of-pocket costs. Parts B and D also may be required, and these typically come with monthly premiums. Because Medicare doesn’t cover everything, there may be gaps that need to be filled with additional insurance.

Medicare savings programs are available for those who do not qualify for Medicaid and are struggling with the costs of medical care. The Qualified Medicare Beneficiary Program, Specified Low-Income Medicare Beneficiary, Qualifying Individual Program and Qualified Disabled and Working Individuals programs all may help to defray expenses for qualifying individuals.

Medicare vs Medicaid: Do You Qualify for Both Programs?

Some individuals are eligible to receive benefits from both programs. Determining such eligibility can be tricky, which is why it is wise to always consult with a lawyer to check your entitlements.

Moreover, meeting with a lawyer is essential if you want to protect your assets as you age and are likely to require more expensive and comprehensive care. Medicaid planning is a valuable resource that typically is offered by elder law lawyers. Thanks to their familiarity with the pertinent laws, these professionals are able to help people to qualify for Medicaid without having to exhaust their assets.

Whether you are faced with being unable to pay for your mounting medical bills and require assistance or want to plan in advance so that you receive the best care as you age, contact lawyer Kyle Steller to learn more. Her experience as a Medicaid planning attorney may enable you to qualify for one or both programs so that your hospital and nursing home costs are covered.