The differences between Medicare and Medicaid can be a common area of confusion.

The simpler program, in practice, is Medicare. Medicare is a medical insurance program that covers health care costs for individuals sixty-five and older. The program covers all individuals sixty-five and over regardless of income. Individuals may want to delay enrollment in certain aspects of Medicare if they are still working and still covered by private health insurance, but in general, Medicare covers services covered by traditional health insurance for everyone sixty-five and older.

Medicaid, on the other hand, is a program with need-based eligibility requirements. Medicaid covers health care costs for people below certain income and asset levels. However, Medicaid eligibility requirements for health care cost coverage can vary significantly by state. Missouri’s implementation of Medicaid is know as MO HealthNet. In Missouri, Medicaid coverage for health care is only available to individuals with special needs, or other disabilities, and are also below very restrictive asset and income limits. Families without a disability may be eligible for Medicaid coverage of health care costs in Missouri, but these families must still be below very restrictive asset and income levels that vary with family size. Other states, such as Illinois, that expanded Medicaid coverage after the passage of the Affordable Care Act, also known as Obamacare, have much broader eligibility standards for individuals and families.

The biggest difference between Medicare and Medicaid for older individuals is in how each program covers nursing home costs. Medicare only covers very limited nursing home stays immediately following discharge from a hospital.

Medicaid, however, does cover nursing home costs, but since Medicaid is a need-based program, individuals must be below certain income and asset levels to be eligible for coverage.

The good news about Medicaid nursing home coverage is that individuals and families can work with an experienced, elder law attorney to develop a plan that will allow individuals to become eligible for Medicaid nursing home coverage, if necessary, while still protecting an individual’s assets, residence, and life savings for their family. The further in advance that this planning occurs, the more effective the planning options will be in protecting an individual’s assets. Individuals and families should work with a local, elder law attorney to develop a plan that meets their specific needs.

To discuss, Medicare, Medicaid, and your planning options, please call Martha C. Brown & Associates at (314) 962-0186.