Austin Medicaid/Medicare Assistance Attorney

Medicare and Medicaid are both Federal government programs, but many people confuse the two. Each program serves a different purpose. Medicare is a health insurance program that serves primarily the elderly (over 65), younger disabled patients, and those on dialysis, regardless of income. In contrast, Medicaid is a broad-ranging program to assist people without the income and resources to pay for the costs of health care.

In this article, we will discuss the basics of each program, particularly as they affect the elderly. Sometimes elderly clients need assistance with planning for situations such as nursing home care. In these cases, it is wise to contact an elder law attorney such as Austin probate lawyer Farren Sheehan for help drafting estate planning documents and assisting with an elder law care plan.

Medicare

Basically, Medicare is a Federal health insurance program for certain groups of people. The primary group covered by Medicare are those who are 65 years and older. Healthcare bills are paid from a trust fund, though the patient is still responsible for co-pays and deductibles.

Medicare helps pay for the costs of many services, but there are limitations on what is covered. Typically, nursing home care is only covered up to the first 100 days. To be covered, a person must receive the services from a Medicare certified skilled nursing home after a qualifying hospital stay of at least three days just prior to entering the nursing home.

Nursing home residents should enroll in or keep their Medicare coverage when entering a nursing home. While Medicare may not cover the cost of nursing home care, Medicare may provide health coverage for hospital care, physician services, rehabilitation services, and medical supplies that are needed for nursing home residents.

Medicaid

Medicaid is a broad-ranging program to assist people without the income and resources to pay for the costs of health care. There are a number of categories of people the program assists, including the elderly, families with dependent children, and people with disabilities. Since 70% of Americans need nursing home care at some time in their lives, Medicaid is the eventual payer – and the source of greatest reimbursement – for long-term care costs for the majority of residents. Essentially, the Medicaid program is a safety net health care payer for people who have exhausted their life savings.

Medicaid Nursing Home Care for the Elderly

Many seniors reach the point where they need long term care in a nursing facility. Some have long term care insurance or can privately pay, but often the cost of care exceeds their personal savings.

There are several ways that people can pay for nursing home care. The primary sources of payment include:

  • Private Pay – savings and personal resources.
  • Medicare – under limited conditions.
  • Veteran’s Administration – under limited conditions.
  • Long Term Care Insurance – policies vary widely, and may include nursing home care as well as other long term care services.
  • Medicaid – for those with limited resources and income who qualify. However, not all nursing homes accept Medicaid patients.

What Determines Medicaid Eligibility?

Medicaid is a means-tested, federal-state, individual entitlement program, with extensive financial and non-financial rules for determining eligibility. The Medicaid program’s emphasis is on helping certain categories of low-income individuals. Therefore, the eligibility tests tend to focus on income and resource (asset) levels.

Medicaid nursing home eligibility is a complicated area of the law. There is a wide range of statutes, rules, and regulations that govern the Medicaid program. There are substantial variations in eligibility policy from state to state. Also, the federal laws are combined with each state’s laws, resulting in rules that are different in each state, and these laws and rules change over time.

Elder law attorneys, such as Farren Sheehan in the Austin area, are experienced in the maze of federal and state laws and regulations, giving them the ability to help their clients become eligible for Medicaid assistance to pay for long-term care costs.

Questions? Contact Sheehan Law, PLLC

If you have any questions about Medicare, Medicaid, estate planning and nursing home planning for the elderly, or anything else regarding probate law in Texas, please do not hesitate to contact us by phone at (512) 251-4553 for an initial consultation. Other contact information is listed in the upper right-hand area of this page, and a contact form is also available on our contact page.