Navigating Medicare and Medicaid
Medicare vs Medicaid
Medicare is a federal health insurance program generally for people age 65 or older who are receiving Social Security retirement benefits or who are younger than 65 and received Social Security disability benefits for at least 24 months.
Medicare covers inpatient hospital care and some of the doctors’ fees and other medical items for people with Alzheimer’s or dementia who are age 65 or older. Medicare Part D also covers many prescription drugs.
Medicare will pay for up to 100 days of skilled nursing home care under limited circumstances. However, custodial long-term nursing home care is not covered.
Medicare will pay for hospice care delivered in the home, a nursing facility or an inpatient hospice facility for people with dementia who are determined by a doctor to be near the end of life.
For more information on benefits and eligibility go to Medicare’s website: medicare.gov
Medicare covers an Annual Wellness Visit and Health Risk Assessment. Medicare pays for an Annual Wellness Visit once every 12 months. Prior to or during an annual wellness visit appointment, a Medicare beneficiary (or caregiver) will be asked by his or her doctor or health professional to complete a Health Risk Assessment (HRA). The HRA includes some questions about the beneficiary’s health which may provide important information to discuss with the health professional during the annual wellness visit.
The A-B-C-Ds of Medicare
Part A: Hospital/Inpatient Insurance
Part A helps pay for your care while you are in the hospital. It also pays some of the costs if you stay in a skilled nursing facility after a hospitalization and if you have a medical need for limited, skilled healthcare at home. You can’t be turned down because of your medical history or pre-existing illness.
Part B: Outpatient Health Insurance
Part B helps pay for doctors’ services, outpatient hospital care, and home health care that Part A does not pay for. It also provides coverage for laboratory tests, ambulance services, and many screenings and preventive services that can help you to stay healthy, including a Welcome to Medicare Exam and Annual Wellness Visits. A monthly premium is charged for Part B services.
Part C: Medicare Advantage (MA)
Medicare Advantage plans (sometimes called Part C) are private insurance plans that deliver Medicare Part A and Part B coverage. Some of these plans also provide Medicare drug coverage. Medicare Advantage plans also may cover additional services that Original Medicare does not pay for—for example, coverage for vision and hearing care. Most Medicare Advantage plans have a network of doctors and hospitals.
Part D: Prescription Drug Coverage
Medicare Part D helps you pay for your prescription drugs. If you have or are eligible for Medicare Part A or Part B or have both, you are eligible to join a Part D plan. You must join a private insurance plan to get Medicare’s drug coverage. There is no screening for pre-existing conditions. Plans must accept everyone who is eligible and enrolls, but you can only join at certain times of the year.
Medicaid is a federal/state program. It pays for medical care for people who have few assets and very low income.
Eligibility and benefits vary from state to state which means each state determines who is eligible. Typically provisions are made for Alzheimer’s and Dementia patients if they are receiving SSI.
How Does Medicaid and long-term care work?
Once qualified, Medicaid covers a large portion of the cost of a skilled nursing facility or nursing home. Each nursing home decides if they will accept Medicaid – so check in with the one that interests you to see if they accept Medicaid. Most states also have home and community care options for people who qualify, which allows individuals to live in their home instead of a skilled nursing facility. These services provide for an individual to receive long term care services while living at home.
How to apply for Medicaid:
Department of Welfare or Department of Health can provide an application or go to Medicaid.gov. Since Medicaid is based on financial need. you should be ready to provide information about where you live, how much income you get each month, what type of assets you have, etc.
Most nursing homes that accept Medicaid will have staff who can assist you in applying.Go to Medicaid’s website for more information: http://www.medicaid.gov/index.html