Medicare and Medicaid both help people to get access to medical care, but there are important differences between the programs. Medicaid is a program for people with lower incomes and it can cover people of all ages, provided that you meet eligibility criteria. Medicare is a program that only provides coverage to seniors. Medicare is not a means-tested program. You pay into the Medicare program with your taxes as you work and you become eligible for benefits as a senior. It does not matter how much money you have, you can still get Medicare. Medicaid, however, covers some things that Medicare does not cover and Medicare has higher co-insurance costs for many kinds of medical services that you receive.
It is important to find out if you can get Medicaid if you expect to need nursing home care or if you have other medical bills that you are worried about being able to cover. There are different Medicaid programs in New York, so you will need to explore the eligibility requirements for the relevant program that will provide the coverage that you need.
In general, the key criteria that can impact whether or not you will be eligible for benefits include your income level, the amount of resources that you have available to you, and your residency and citizenship status. An attorney can help you to understand the specific rules for determining if you are eligible for Medicaid and can assist you in making plans to try to become eligible if you could be disqualified from coverage as a result of having too many resources.
There is a limit in New York for the amount of assets that you are allowed to own when qualifying for certain types of Medicaid benefits, including the benefits for seniors 65 and over which provide coverage for the costs of nursing home care. If you have assets that exceed the limit, you will not be able to get Medicaid to pay for nursing home services or to cover any of your other costs until you have spent down your wealth. There are certain exceptions, such as some home equity being protected when certain criteria are met. Your other option is to create a Medicaid plan that will protect your assets.
Disability benefits provided through the Social Security Administration provide you with monthly income. There are different disability benefits programs, and you will need to understand the rules for trying to get medical coverage when you are on each type of program.
If you are receiving Social Security Disability Insurance, your income may still be too high to qualify for Medicaid and your levels of resources may also still be too high, as SSDI is not a needs-based program but is instead a disability insurance program that you buy into through payroll tax deductions. After 24 months of being on SSDI, you should become eligible for Medicare.
If you are receiving Supplemental Security Income due to a disability, you usually can obtain Medicaid benefits. You should talk with an attorney to find out how your disability will impact medical coverage and whether or not applying for benefits is going to be an option for you.
Many seniors need a Medicaid planning attorney to try to protect their assets in case they require nursing home care. When you need to go into a nursing home, Medicaid likely won’t pay unless you require skilled medical services. You probably will also be unable to get any Medicare Advantage plans or private insurers to pay, since there is very little coverage for nursing home care and the coverage that is available is generally only for skilled medical services.
This means you’ll have to pay out of pocket for nursing home care unless you can qualify for Medicaid coverage. This can result in the quick spend down of assets that you have worked to acquire over your life. Although some assets are protected, much of your money and property may have to be spent or sold to pay for nursing home bills before Medicaid begins to cover the costs of care.