In the confusing world of medical and insurance benefits, it can be difficult to navigate among all the different benefit programs. Medicare and Medicaid are two benefit programs that are available that are often confused with one another. Understanding the difference between these two programs is critical in being able to navigate the realm of benefit programs available.
Medicare is the federal governmentās insurance program for people over the age of 65 and has many facets: Part A, B, C, and D. Medicare Part A is an insurance program that covers hospital, skilled nursing facility, Hospice, and Home Health services. Most people automatically qualify for Medicare Part A as long as they paid Medicare taxes when they were younger; otherwise, Medicare A can be obtained by enrolling as you would any other insurance program. Under Medicare A, a beneficiary is eligible for inpatient hospital services, and while in a nursing home, Medicare will cover up to 100 days of skilled services, which includes therapies and other skilled nursing services.
Medicare Part B is a medical insurance program in which beneficiaries pay a premium. Most Medicaid beneficiaries are automatically enrolled into the Medicare Part B program.
Medicare Part B covers medically necessary medical services and devices that are needed to treat an individualās condition.
Medicare Part C is also called the Medicare Advantage Program. Medicare Part C combines the Part A and Part B programs and most often the Part D program as well. The difficulty with a Medicare Part C program is finding providers who participate in the program, as well as each Medicare Advantage program has different fees and payment schedules, so participants need to understand their plan carefully.
Medicare Part D is the prescription drug benefit provided to accompany the other Medicare programs. There are many different Medicare Part D plans typically offered by conventional insurance carriers. It is critical to enroll in the appropriate time frames to avoid being charged late enrollment fees.
Medicaid, on the other hand, is a program that is provided by the states. Medicaid is typically referred to as Public Aid. In Illinois, Medicaid is administered by the Department of Health and Family Services. In order to qualify for Medicaid assistance, a person must need financial assistance and be at defined asset levels. For example, to qualify for Medicaid assistance in a skilled nursing facility, an individual must have less than $2,000 in assets. Medicaid also has provisions, called the Spousal Impoverishment Standard, which allows for a spouse to keep assets including the house, stocks, and other personal assets while the other spouse qualifies for assistance in a skilled nursing facility or supportive living facility.
It is important to note, in Illinois, Medicare and Medicaid currently do not cover Assisted Living services. The Medicare and Medicaid programs are complex and participants should research the programs and options available to them. For further information on Medicare services, you can visit www.medicare.gov and for Medicaid you can visit www.hfs.illinois.gov.
