What is the Difference between Medicare and Medicaid Eligibility?

Medicare Eligibility

Medicare is a health insurance benefit provided by the federal government to those over age 65, or under age 65 and disabled. Medicare covers doctor visits, tests, hospital care, and some rehabilitation benefits in a nursing home (more below).

Medicaid Eligibility

Medicaid is health insurance for the poor provided by the State of Alabama (and other states). Those who qualify must have income and asset limits below stated amounts. If your income or assets exceed the qualifying limits, you will not be eligible. Generally, there is no age restriction to qualify.

What is the Difference between Medicare and Medicaid Qualification?

Medicare Qualification

You must be over 65 and eligible for Social Security benefits to qualify for Medicare benefits. The payment is deducted from your Social Security payment unless you are eligible for the State Medicaid to pay your premium. You may also qualify if you are under age 65 and have been disabled for two years. It is easy to qualify for Medicare. You apply at a local Social Security office or on-line.

Medicaid Qualification

Medicaid qualification requires a 15-page application, plus proof of income and asset amounts. Nursing home benefits involve an investigation into the past 5 years of your finances, called the look-back period. The asset limit is $2,000 (single person) which includes your bank account, stock, IRA, 401k, and all other assets. All money spent in the past 5 years must be explained or proven to not have been gifts. Any gifts or unproven expenses or any assets sold at less than fair-market value causes a penalty.

What is the Difference between Medicare and Medicaid Nursing Home Benefits?

Medicare Nursing Home Benefits

If someone has a three-day hospital stay and is prescribed physical therapy (rehab) after release, Medicare will pay for 100% of the first 20 days. If some rehab continues, Medicare will pay 20% of the next 80 days in a nursing home. The benefit ceases if there is no progress in physical abilities.

Medicaid Nursing Home Benefits

Medicaid will pay the expense of long-term care at a nursing home if you qualify. This requires that you pay all income to the nursing home, less $30 for personal needs, and Medicaid covers the rest. This includes medications, co-pays, deductibles, etc., again if you qualify. See the Medicaid Qualification section for more on that.

Medicaid Benefits for Assisted Living

Alabama Medicaid does not provide any benefit for assisted living programs. You must be in a nursing home to receive long-term care benefits. There are some, limited at-home Medicaid benefits but those fall far short of around-the-clock supervision.

Medicare and Medicaid are different programs that provide different benefits. It is important to get assistance from someone familiar with the differences.