• Troyer & Good, PC

Medicaid and Medicare: Which Pays for What?

Updated: Mar 18, 2019


Medicaid and Medicare are both health care programs that give financial aid to those in need. It’s important to know what each program covers so that you can use the programs to your advantage.


Medicaid


What is it?


Medicaid is a federal and state program that aims to provide medical coverage to those in financial need. In Indiana, the Family and Social Services Administration (FSSA) has primary responsibility over this program. Each state has its own qualifications for eligibility, but eligibility usually depends on the person’s income and assets. The program is available to individuals of all ages – including the blind, disabled, elderly, individuals under the age of 19, women who are pregnant, and families with children.


What will it pay for?


Medicaid pays for long-term care costs for the elderly, blind, and disabled in a Medicaid-approved facility. This coverage lasts as long as the individual remains eligible. Waiver services are also available for an individual to receive Medicaid benefits while residing in an assisted-living facility or an at-home care program.



Medicare


What is it?


Medicare is a federally run health insurance program for the elderly and disabled. It is meant for individuals over the age of 65, or for individuals with certain disabilities under the age of 65.  A person’s eligibility for Medicare does not depend on his/her financial status. In Indiana, an individual can apply for Medicare at the local Social Security office.


What will it pay for?


Medicare has four parts to its services. Part A assists with expenses related to hospital stays; and Part B assists medical needs like doctor’s services and out-patient hospital expenses for a monthly premium of $104.90. Medicare Part A will cover up to 100 days of coverage in a nursing facility if the patient was admitted to a hospital for at least three days and entered the nursing facility within 30 days.


Although Medicare covers up to 100 days of stay, it does not cover all expenses associated with the stay. Medicare will fully cover the first 20 days of a patient’s stay and partially cover the remaining 80 days. A Medicare recipient can also purchase additional coverage in the forms of Part C, which includes health plans like HMOs and PPOs, and Part D, which includes prescription drug coverage.

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