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Choosing the right insurance and benefits for your parent can become confusing. As your parent ages, they may be eligible for Medicare, Medicaid, or both. Find the right coverage for your care recipient's healthcare needs and discover what government assistance may help with their overall costs and medical needs.
Medicare is the national insurance program that helps people who are 65 and older, as well as those who have severe disabilities or kidney diseases, pay for health care services. Medicare is run by the Centers for Medicare & Medicaid Services (a federal agency) and is available throughout the United States. As a family caregiver, it is essential to understand the basics of Medicare assistance for your loved one.
Medicare covers more than just medical costs. The program also helps people with prescription drugs, dialysis, durable medical equipment like wheelchairs and walkers, home health care services, and even some vision and dental work. If your parent is eligible for Social Security disability benefits before turning 65, they may receive Medicare coverage. Not all Medicare programs cover family caregiver assistance or a visiting nurse. Understanding which options work best for your loved one will ensure they receive the care they need.
Because so many people pay into the program their whole lives through payroll taxes, it's not means-tested. Regardless of how much is in their bank account right now, if your parent is 65 or older—or has a qualifying condition—they qualify for Medicare coverage. Helping your family member gain assistance involves a quick call to the Medicare Helpline or a visit to their website.
Medicaid is a government assistance program that helps low-income people pay for medical expenses. Coverage includes doctor's visits, prescriptions, and hospital stays. Medicaid is available to people of all ages and income levels as long as they meet the program's requirements.
Medicaid provides coverage through both federal and state-run programs. Federal Medicaid is available in all 50 states and Washington D.C., while state-run Medicaid is only available in states that choose to participate in the program. The eligibility requirements for each type of Medicaid vary by state.
If you're looking for assistance with health care costs, Medicaid can help. It's a government program that helps low-income people and their families receive proper medical care. In most states, anyone can apply for Medicaid regardless of age. However, your parent's state may require they have a certain level of income or disability to qualify.
If you are a family caregiver, realize that each state differs in benefits and requirements. Not all programs will cover direct family caregiver assistance, prescriptions, and other forms of necessary medical care. Many programs require individuals to add dental and vision benefits. The difference between benefits changes significantly from state to state and is based on income and disability requirements.
To qualify for coverage under the federal government's Medicare program, your parent must have an income below 133 percent of the federal poverty level (FPL) for their family size (you can find this information on the website).
If your family member qualifies, Medicaid will pay for your medical expenses except for small copays or coinsurance. The amount paid depends on income level; the lower the income, the less paid out of pocket. Your family member may also be required to pay a small copayment when they visit doctors or other health care providers. Although this copayment varies by state, it will never be more than 5% of their monthly income.
Medicaid has strict eligibility requirements. Most people who qualify for Medicaid have low incomes. Still, they also often have other factors that make them eligible—such as being disabled or pregnant. Typically, Medicaid covers children and pregnant women. It also covers elderly adults and people with disabilities who make too much money to qualify for Medicare but not enough to pay for private health insurance.
People who usually receive Medicaid include:
Elderly adults qualify even if they don't meet the income requirements if they require long-term care services like family caregiver assistance that aren't covered by Medicare alone.
Depending on the state your parent resides in, your parent can have both Medicaid and Medicare. Depending on their income level, they may even be eligible for more than one type of Medicaid.
When someone is over age 65 and has a disability, they may qualify for both Medicaid and Medicare if they meet specific criteria. This is called "dual eligibility" because they are eligible for two programs simultaneously. The main benefit of dual eligibility is that it reduces the cost of healthcare services for families because they don't have to pay out-of-pocket costs like deductibles or copayments.
If your loved one has Medicare coverage through you or another source—like the Veterans Administration or military service— they don't necessarily need to apply for both Medicare and Medicaid at once to gain benefits. If your parent is a veteran, have them contact the VA, call the Medicare helpline, or talk with their social worker about eligibility.
Dual health plans are for people who have Medicare and private health insurance. They combine the best of both worlds: Medicare covers hospital care and prescriptions. In contrast, private insurance covers cost not covered by Medicare. Your parents keep current benefits from Medicare.
With a dual plan, your parent can receive better coverage than just one. This is because a Dual Health Plan combines two policies into one that's more than the sum of its parts. It's like having two insurance policies at once—one that covers prescriptions and one that covers hospital stays—but your parent doesn't need to pay two separate bills!
Your loved one can keep existing benefits under Medicare. Those benefits would be available if your loved one took advantage of free annual checkups through Medicare Part B when they set up a dual plan.
Anyone with Medicare and another type of insurance should consider getting dual plans instead of just one. The combination is a better deal than either option alone in most cases.
The most significant difference between Medicare and Medicaid for an elderly adult is that Medicare provides health insurance for those over 65. At the same time, Medicaid is a government program that provides health insurance to individuals with specific qualifications.
Medicare will cover health care expenses but only 80% of prescription drug costs. Other out-of-pocket expenses, like family caregiver assistance, may have to come from private funding. Medicaid will cover most out-of-pocket expenses, including prescription drugs. Medicaid does not cover nursing homes or long-term care expenses. Still, Medicare does cover these services for seniors who meet specific requirements.
When you need to find the right program for your parent, visit the online government website or contact the Medicare Helpline at 1-800-MEDICARE (1-800-633-4227) to find the right program for your parent.
