The Difference Between Medicare and Medicaid

Understanding the difference between Medicare and Medicaid

The most common confusion people have when planning long-long term care funding is understanding the difference Medicare and Medicaid.


U.S. Citizens are typically eligible for Medicare coverage at the age of 65. People can become covered earlier based on disability status. It is important to understand that Medicare is federally funded. Because it is funded by the federal government, coverage criteria is the same from state to state.

Most assume when they become eligible they are covered long-term care services. This misunderstanding causes people to underestimate the money they will need to cover future long-term care expenses.

In truth Medicare only covers part of short-term or acute medical care and often requires a co-payment.

Medicare covered services include doctor visits, dental care, hospital stays, short-term home care services, and short-term nursing home stays. These services are also referred to as skilled services. Skilled services require the direct supervision by a physician or licensed health care professional. Long-term care services are typically considered non-skilled therefore not covered by Medicare.

Read Related Post: The Difference Between Long-term care and Short-term Care


Medicaid eligibility is awarded based on financial need. It is primarily funded by the state so criteria for eligibility varies based on the state you live in.

Medicaid covers long-term care services while covering co-payments resulting. Depending on the type of service and financial status, Medicaid may require a monthly payment in order to main coverage .

Medicaid offers dependable healthcare coverage for those eligible. To determine eligibility contact your states department of health and human services to get a list of criteria. A worker from health can human services can walk you through the process for free. If you are not quite Medicaid eligible but may be soon, contact an elder law attorney. Medicaid planning can be done as part of an advanced estate plan. For more information about advanced estate plans contact The Elder Care Firm or an attorney from the National Academy of Elder Law Attorneys.

A word about HMO and Advantage Plans

Every year around open enrollment time seniors receive an offer from a third-party insurer to become part of a Medicare-HMO or Advantage plan. Although there are some benefits to becoming a member of one of these plans it does restrict use of your Medicare coverage. Before deciding to join a Medicare HMO be sure to check the providers and facilities that accept that type in insurance. You should also check how the third party insurance affects eligibility for services like home care and sub-acute services.


About Tony Fischer

As an advocate for elders and their families, Tony has experience in the entire healthcare continuum. He has worked in hospitals, nursing homes, home care, hospice, and non-profits. His vast and unique experience led him to become a consultant that helps clients navigate the senior healthcare system. Tony also works hand and hand with healthcare providers to improve and streamline customer service. The company he founded with his wife Lori, Elder Advocacy Group Inc, advocates for seniors and senior health issues. They do this through the innovative concepts of Life Care Planning and Elder Care Coordination. Through these concepts Tony is able to help elders and their families plan to age successfully on their terms by protecting their right to choose the healthcare services they want provided in the place they want it. Tony shares his talents with other senior advocacy groups like the Area Agency on Aging Advisory Council where he advises a non-profit serving seniors in Wayne County, Michigan. He also produces FREE online content for seniors and their families