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medicaid and medicare dual eligibility

Medicaid versus Medicare – FAQs

I always get Medicaid and Medicare confused – Can you tell us the difference?

Distinguishing between Medicare and Medicaid can be confusing, but there are several key differences between the two.

Medicare: Generally, Medicare is available for people age 65 or older, younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or transplant). Medicare provides health insurance for most senior citizens. It is not a means-tested program.

The Medicare program is administered federally and, therefore, should be uniform throughout the United States. Generally, Medicare is designed to address short term medical needs. There are four (4) different parts of Medicare:

  1. Medicare Part A – Hospital Insurance;
  2. Medicare Part B – Medical Insurance;
  3. Medicare Part C – The component for Medicare Advantage Plans; and
  4. Medicare Part D – Prescription Drug Coverage.

Medicaid: On the other hand, Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. Medicaid is administered by states, according to federal requirements. The program is funded jointly by states and the federal government.

Unlike Medicare, Medicaid is a means-tested program that has income and resource limitations on eligibility. The Medicaid program is administered by the state (or county) and, therefore, can differ from one state to another. Medicaid is designed to address both short-term and long-term care needs, including long term care for seniors and people with disabilities, at home or in a nursing home.

What is the process to get your loved ones Medicare?

Medicare Part A coverage is automatically available to every person over the age of 65 who is entitled to receive monthly Social Security or Railroad Retirement benefits starting on the first day of the month that he or she turns 65. This automatic eligibility is extended to the insured’s spouse, dependents, and survivors provided that they are over the age of 65 as well. If you automatically qualify for Medicare Part A, you will get your Medicare card in the mail approximately three (3) months before your 65th birthday.

Medicare Part B is an optional program that is available to all persons that are eligible for Medicare Part A or who are 65 years of age or older and are citizens of the United States or lawful resident aliens that have resided in the United States for at least five (5) continuous years. It should be noted that all persons eligible for Medicare Part A Benefits will automatically be enrolled for Medicare Part B unless the individual specifically declines the coverage. There is a monthly premium for Medicare Part B that is adjusted every year.

Medicare Part B benefits are also available to individuals under age 65 that have a disability. However, such an individual must receive disability benefits from Social Security for 24 months or certain disability benefits from the Railroad Retirement Board, or suffer from end stage renal disease (ESRD) that requires dialysis or amyotrophic lateral sclerosis (ALS).

What documents should you have in place if you have an elderly parent?

The elder law attorney will encounter many seniors that desire the ability to qualify for Medicaid in order to pay for their long-term care expenses while protecting their assets as much as possible.  However, every client is unique. One size does not fit all in estate planning. The attorney must focus on the specific needs of each particular client. Key factors such as the Client’s health condition, marital status, family composition, wealth, and, of course, the Client’s goals, should all be considered.

That being said, comprehensive advanced directives are a crucial part of an estate and advance plan. The elderly client should have:

  1. Durable Power of Attorney
    • The expansive Comprehensive Durable Power of Attorney can be used to facilitate an estate plan. It permits the principal to appoint an agent or agents to handle their financial affairs in the event that they are unable to handle those affairs themselves. The agents named in the Durable Power of Attorney have a fiduciary responsibility to the principal and, therefore, must act in accordance with the principal’s instructions or, if the principal is unable to give instructions, then the agent must act in the principal’s best interest.
  2. Health Care Proxy
    • This document allows the Client to appoint someone to make health care decisions on their behalf should the Client lose the ability to make those decisions himself or herself.
  3. HIPAA Authorization
    • Pursuant to Federal law, only you, your physician, and an authorized agent can access your medical records. This document permits the Client to authorize an agent to access his or her medical records.
  4. Living Will
    • This document permits the Client to express their wishes in regard to end-of-life medical treatment.
  5. Appointment of Agent to Control Disposition of Remains
    • This document permits the Client to appoint an agent to control his or her disposition of remains upon his or her passing. This is a written authorization that permits your agent to control your funeral arrangements or any other arrangements in regard to your remains after your demise.

In addition to the advance directives, the elderly Client should also have a Last Will and Testament and, in many cases, a Medicaid Asset Protection Trust.

What documents do you need for yourself?

Again, every client is unique. One size does not fit all and the Client’s individual needs, goals and circumstances must be considered before preparing an estate and advance plan.

It is beneficial for everyone to have comprehensive advance directives. These include:

  1. Durable Power of Attorney;
  2. Health Care Proxy;
  3. HIPAA Authorization;
  4. Living Will; and
  5. Appointment of Agent to Control Disposition of Remains.

In addition to the Advance Directives, the Client should have a Last Will and Testament.

Testamentary substitutes, such as a Revocable or Irrevocable Trust, are also important estate planning tools depending on the specific needs and goals of the Client.

Katie Ann Trotta

Russo Law Group, P.C.
100 Quentin Roosevelt Blvd., Suite 102
Garden City, NY 11530
516-683-1717 Ext. 2142

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