Medicare Medicaid Comparison Snapshot

With all the definitions, requirements, and restrictions of Medicare, Medicaid and VA Benefits, an reasonable person would request and NEED a road map to navigate the system. The advantage I have as an Elder Law attorney is that I travel these roads day in and day out. And every day that I am assisting a client and helping him or her make the best decisions for their future, I find myself defining the essentials and answering these questions. I hope this Medicare Medicaid comparison and glimpse into how they work with VA benefits is useful.

Medicare

Federal program available to all U.S. citizens 65 and older and people with certain disabilities. Available regardless of income and has 4 parts:

Part A– Hospitalization coverage

Part B– Medical insurance

Part C– Privately purchased coverage that supplies services offered by A & B and some additional services

Part D– Prescription drug coverage

Part A and B are paid by payroll taxes and deductions from Social Security income. Parts C and D are paid out of pocket.

Medicaid

Joint Federal and State program but has strict eligibility requirements. Rules vary by state but are designed to help the poor. There are income and asset limits. Medicaid is the nation’s single largest source of long term care funding.

What is Dual Eligible?

Someone who receives Medicare and then becomes Medicaid eligible, is considered “dual eligible” meaning they are covered by both Medicare and Medicaid. Medicare will continue to cover physician visits and hospital care and Medicaid will cover the cost of care not covered by Medicare such as long term care costs. Medicaid will also cover the cost of your Medicare insurance, co-pays, and deductibles and prescription drug costs.

How do Medicare and Medicaid work together to pay for long term care?

Medicare

• 100 days of coverage per spell of illness
• After a 3 day hospitalization
• First 20 days in full
• Days 21-100 80% coverage
• Medications covered under Part D or private plan
• Patient responsible for co-pays and supplies not covered

Medicaid

• Unlimited coverage once qualified
• All medication costs are covered
• All supply costs are covered

How do VA and Medicaid work together?

The VA (for those who are eligible) will pay for Aid and Attendance to help cover the cost of care in the home or in assisted living. VA will also cover long term care cost in a VA home or VA approved facility if the veteran is eligible.

The rules for VA eligibility and Medicaid eligibility are different and if you spend-down to qualify under VA rules you may, in some instances, become ineligible for Medicaid.

Medicaid

• Level of care
• Look- back period (currently 5 years)
• NO Gifting without penalty except to spouse
• Income limit- $2,199 per month reduced by
• $2000 countable assets for applicant
• Spousal asset limit of $119,920

VA

• Level of care
• No look-back period
• Gifting allowed- no penalty
• Income limits – reduced by un-Qualified Income Trust reimbursed medical expenses
• $80,000 countable assets combined

This is provided for educational purposes only and is in no way to be considered legal advice. Please consult an elder law attorney to advice specific to your situation.