Medicare and Medicaid  Basics for Elderly Parents

What's the Difference between Medicare and Medicaid?

Many elderly parents and caregivers are confused about the benefits provided by Medicare and Medicaid, or the basic requirements of eligibility for each one.

It's important for elderly parents and caregivers to understand the differences between the two programs and what each service offers and covers. At its most basic definition, Medicare was designed to pay for health care services provided to Social Security beneficiaries starting at age 65. In addition, these services are available to individuals with permanent disabilities, various groups of individuals, and those suffering from end-stage renal disease processes. Medicaid is controlled by state governments and is designed to provide health care coverage for low-income families and individuals such as elderly parents.

Medicare Basics

Medicare was first designed and implemented in the mid-1960s. By the early 1970s, Medicare benefits expanded to include individuals suffering from permanent disabilities or end-stage renal disease. Medicare provides hospitalization insurance (Medicare Part A) to individuals who receive Social Security benefits.

Medicare also offers supplemental medical insurance (Medicare Part B) to help pay for non-hospital services such as medical surgical supplies, physician’s or surgeon’s services as well as medical services obtained at your local doctor's office and so forth.

Individuals or elderly parents who receive Medicare Part B pay extra for those benefits. However, to help fill in gaps in Medicare coverage, Medicare recipients may also supplement benefits with private insurance policies that are referred to as Medigap insurance policies.

Medicare coverage from Part A is provided free of charge to individuals over the age of 65 or those who are eligible for Social Security benefits or Railroad Retirement benefits. This portion of the Medicare program covers inpatient hospital care, long-term care, and skilled nursing facility care as well as some home health care and hospice care. Benefits begin the day the beneficiary is admitted to the hospital and ends if they haven't been hospitalized for 60 consecutive days. Beneficiaries to this portion of Medicare are usually limited to about 90 days per “benefit”, although there is no limit to the number of benefits in a beneficiary’s lifetime.

Skilled nursing facility (SNF) care is covered only if it occurs within 30 days of a three-day or longer stay in an acute hospital facility and is certified as being medically necessary. Individuals utilizing the benefits of skilled nursing facilities under Medicare are limited to a 100-day stay at that facility. Co-payments are required for the 21st through the hundredth day. Consumers are also advised to be aware that Medicare Part A doesn’t cover skilled nursing facility care if the patient doesn't require skilled nursing care or rehab services.

Home health care under Medicare Part A has no limitations on length of stay, no co-payments, and no deductibles. However, in order to qualify for reimbursement for Medicare for hospice care, patients and/or elderly parents are required to relinquish their standard Medicare benefits for treatment of terminal illnesses in order to receive the hospice care benefits.

Medicare for Elderly

Medicare Part B covers such services as physician and surgeon services, and may cover services by podiatrists, chiropractors, dentists and so forth. (Always check first). Medicare part B also offers coverage for Medicare approved practitioners who aren't physicians, such as clinical social workers, physician’s assistants, and others working with a physician. These services also cover outpatient clinic or emergency department services, including same-day ambulance services and surgeries. Medicare Part B may help to cover home health care that is not covered under Medicare Part A.

Always check to make sure that you are aware of what is covered and what is not covered under Medicare Part A or B! More information can be found on the government website.

Medicaid Basics

Medicaid was designed to provide medical assistance to individuals as well as families with limited financial resources and low incomes. Medicaid is rendered by state governments, which also may differ slightly in their categories of eligibility. Always check with your state of residence to determine eligibility.

Medicaid services generally offer medical assistance for, but are not limited to:

  • Inpatient hospital services
  • Outpatient hospital services
  • Prenatal care
  • Emergency services
  • Physicians services
  • Skilled nursing facility care for individuals 21 years of age or older
  • Laboratory and x-ray services
  • Family planning services
  • Rural health clinic services
  • Home health care for elderly parents or individuals eligible for skilled nursing services

Medicaid is considered a payer of last resort. If an individual or elderly parents are covered by Medicare as well as Medicaid, services must be covered by Medicare before they may be paid for by Medicaid.

Medicaid is able to offer assistance to individuals of any age, and is financed by state, federal and county tax dollars. Eligibility is based on financial need.

Compare the benefits of Medicaid and Medicare programs and become familiar with what are included or not included in such services. Understanding the basic difference between Medicare and Medicaid will help you make better medical and financial decisions regarding your health care.

When considering retirement and estate planning please see Estate Planning Hub

For more detailed information regarding Medicare and Medicaid services, visit the center for Medicare services: the Medicare Website or Medicaid Website

Medicare Medicaid

Medicare General Discussion

Medicare Part A, Part B, Part D

Medicare Topics

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