A lot of people don’t realize that Medicare offers only limited coverage when it comes to nursing home stays, and in most cases there is no coverage at all unless the patient was admitted to the hospital for at least three days prior to being admitted to a nursing facility. What this means is that a number of seniors must pay out of pocket if they must enter a nursing home in order to receive rehab services.
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Parman & Easterday are members of the American Academy of Estate Planning Attorneys.

There is a lot of confusion between Medicare and Medicaid, and though they are both government sponsored healthcare plans, there are some major differences between the two.

Medicaid – This plan is sponsored by the federal government and is intended to provide assistance to those with a low-income. If you have a financial need, Medicaid will cover you, even if you are over the age of 65. Many seniors that are low income will have Medicaid in conjunction with Medicare, simply because it covers many expenses that Medicare will not, such as eye glasses, preventative care, and prescriptions. Medicaid will also cover Medicare premiums and the 20% co-pay that Medicare doesn’t cover.

Medicare – Unlike Medicaid, there are no income restrictions to qualify for Medicare; each person has already paid for this program through their employment taxes, or self-employment taxes. There are age restrictions due to the fact that the purpose of this program is to address the increased need for medical care for seniors, as well as their decrease in income.

To qualify for Medicare you must be at least 65 years old or have a qualifying disability. Unlike Medicaid, which is overseen by individual states, the federal government administers this medical coverage program. To obtain information about Medicare you need to contact the Social Security Administration.

Medicare is administered in three parts: Part A for hospital insurance; part B for routine doctor appointments and lab tests, plus in some cases it will pay for medical equipment; and with part C you get some coverage for prescription medications. The premiums and out of pocket cost for this coverage can be high, though not what you would pay with a private healthcare insurance.

If you are having problems covering the cost of your medical expenses, despite qualifying for Medicare, you might want to find out if you will also qualify for Medicaid. Those that qualify for both programs can save a great deal of money on the cost of their healthcare.

Larry Parman
Attorney at Law

Parman & Easterday are members of the American Academy of Estate Planning Attorneys.

In an earlier blog, I addressed some changes to Medicare brought about by the Healthcare Reform Act. In addition to those changes, the law establishes an Independent Payment Advisory Board to make recommendations on Medicare cost savings. These recommendations will automatically become effective if Congress does not enact an alternative proposal that achieves the same cost savings. Also, the Act ties Medicare Part D premiums to income, meaning more Part B and Part D beneficiaries will be moved into higher income categories and pay higher premiums.

This Act affects the insurance market. Starting late September or early October of this year, insurance companies will no longer be able to deny children coverage based on preexisting conditions. Companies offering individual and group plans also will have to extend dependant coverage to adult children up to age 26 and will not be able to rescind coverage or establish a waiting list for coverage of more than 90 days.

Finally, starting in 2014, insurance companies will not be able to deny coverage to anyone with preexisting conditions.

Next time I’ll review the affects the new law has had on the Medicaid program.

Jerry Shiles
Attorney at Law

Parman & Easterday are members of the American Academy of Estate Planning Attorneys.